"The driver just looked at me and said, 'Get a wheelchair,'" says Adams, shaking his head in disbelief. After speaking with the man, Adams discovered an area hospital had discharged this patient, put him in a cab, and then instructed the driver to bring him to Ozanam, a local homeless shelter.
On other days, Ozanam has taken in patients who arrive with their incisions still bleeding. Staff at other shelters even recall a homeless man who arrived with a tube still sticking out of his chest -- he was recovering from open-heart surgery.
It's a practice known as "dumping," and people who work with the homeless say they see examples of it every day. "It's so commonplace that organizations that serve the homeless don't even notice it. It's just the norm," says attorney Martha Kegel, who represents homeless people through her position at the New Orleans Legal Assistance Corp.
It shouldn't be this way, says Kegel. "We need to become shocked again," she says. "Because it's shocking that hospitals have no respite (recovery) beds for homeless patients. It's shocking that jails dump mentally ill people onto the street at 12:01 a.m. without making sure that they have their medication and an ability to get along in the community. It's shocking that young people who have been in foster care are dumped when they turn 18 and end up homeless."
Dumping is common across the nation -- one study in Massachusetts found that 60 percent of the homeless people in that state's shelters had been released from some sort of institution within the past year. The alternative is called "discharge planning." If it's done properly, patients and inmates are eased into the community with appropriate housing, medication and care. That lessens the chances of homelessness, says Kegel, who chairs the advocacy committee for Unity for the Homeless, the agency that coordinates the local response to homelessness.
In January, Kegel's committee identified discharge planning as one of their three main priorities for the year. And now, the federal government is forcing cities like New Orleans to prioritize discharge planning. As of this year, municipalities must certify that they have discharge-planning policies and protocols in place before they can apply for funds to combat homelessness from the U.S. Dept. of Housing and Urban Development. It's part of a broader Bush administration effort to end chronic homelessness within 10 years.
Discharge-planning is essential to that effort, says Philip Mangano, who last month was named executive director of the U.S. Interagency Council on Homelessness, which coordinates the activities of the 18 cabinet-level federal agencies that deal with homelessness. Mangano spent 22 years as an advocate for the homeless in Massachusetts. He's placed people in permanent homes only to turn around and see more people come in the front door to re-fill those same emergency-shelter beds. So it's clear to him that chronic homelessness can't end until discharge planning begins. "Until then," he says, "you're bailing a leaky boat."
Clearly, Orleans Parish has some holes to patch, says Kegel. "As a rule," she says, "discharge planning in New Orleans tends to be very poor if not nonexistent."
Gary Greenich remembers sitting nervously in the back of the cab as it idled in front of the Ozanam Inn. "I was wondering," Greenich says, "if I can't go here, where am I going to go -- the street, the sewer, what?"
He had been under the impression that arrangements had been made for him. "The (local private) hospital had stuck me in a cab and said 'goodbye,'" says Greenich, who is just now regaining his balance after a surgery that amputated his left big toe -- "dry rot," he says. Foot problems are extremely common for homeless people, especially diabetics like Greenich.
Once Adams heard of Greenich's situation, he began scrambling to find the man a bed. Yet that scramble could have been avoided with one simple phone call, says Adams, because Greenich is the sort of patient that Ozanam can accommodate within its small group of medical beds, designated for people discharged from hospitals.
Ozanam provides no medical care -- patients have to be ambulatory and hospitals must make arrangements even for small things like changing bandages. But the medical beds provide a chance for patients to rest and recuperate. Typically, overnight guests are required to leave after the shelter's 6 a.m. breakfast. Those in medical beds are allowed to stay all day.
Greenich's toe was removed at a veterans' hospital in California, where he'd traveled to attend his mother's funeral. He'd spent a few weeks there recovering and then had returned to New Orleans via Greyhound bus, only to find that he'd become homeless while he was gone. "My roommate hadn't paid his share of the rent," he says. "So we'd been evicted."
One of his first local stops had been at the hospital. His regular New Orleans doctor had inspected the amputation and admitted him for a few days, says Greenich, tapping the yellow hospital bracelet on his arm for emphasis. After that, the hospital had sent him here.
He's anxious to return to work -- to the television industry, where he's done technical work for years, fixing satellite dishes and wiring, adjusting signals. But until he's more mobile, he says, he'll continue to rest his head in bed 61 at "the Oz."
By mid-August, Greenich says, he had become accustomed to the shelter's rhythms. Quiet time arrives each night at 8 p.m., except for during late Saints broadcasts, when the staff bends that rule a little. Morning comes at 4:30 a.m., when Greenich rises, has breakfast, and then heads over to the property room, where everything is marked according to bed number. It's Greenich's job to return the bags and coats to the overnight clients as they head out the door.
Then last week, Greenich went to the hospital to have his surgical staples checked. They re-admitted him, reports Adams. Ozanam Inn may not know anything further unless Greenich calls -- or until another cab pulls up in front.
This is Anthony's third stay at Covenant House. Initially, he says, he took off. "I was like, 'I don't need to be here,''' he says, "So I left."
That was a year and a half ago, when his foster parents first brought Anthony, now a tall 19 year old, to Covenant House. "I had messed up," he says -- he'd blown his 9 p.m. curfew one too many times. His foster parents had warned him, he says, but he'd been going downtown to visit his friends and it always took him longer to get back to New Orleans East than he'd planned.
Until he was 16, Anthony had been a downtown kid, living in the St. Bernard housing project. He, his mother and his younger brother stayed first with his grandfather and then with his great-aunt.
He was 12 when he ran away for the first time. "I was looking for my mother," he says. "Now I know where she is -- she's in St. Gabriel (Correctional Facility for Women). She got in there last year."
But when Anthony was 12, all he knew is that some days she would be around and some days she wouldn't. Half the time, if he ran away, he would find her at a friend's house. He'd say, "Where you been at, mama?" She'd say, "Out."
She went through rehab for a crack addition when Anthony was 14 and was around him, straight, for about a year. But then old habits kicked in and soon the foster-care people showed up. "They just said, 'You gotta come with us,'" says Anthony.
Covenant House sees lots of kids who have been through the foster-care system. Many of them have been through 15 or 20 different foster homes by the time they arrive here, say Stacy Horn Koch, executive director, and Joseph Bodenmiller, director of clinical programs. And far too many land in Covenant House right before their 18th birthday, says Koch.
"Many OCS (Office of Children's Services) workers dump them here 10 days before they turn 18," Koch says. "They bring them into our crisis center. But then when we try to get in touch with the workers, we won't hear from them until their 18th birthday." Once the kid turns 18, she notes, OCS is no longer responsible.
OCS spokesperson Marcia Daniel says that OCS starts discharge planning for foster kids at age 16, but could not specify by presstime why so many kids would end up at Covenant House. For her part, Koch does understand that OCS has a tight budget and enormous workloads. And she stresses that she does not mind taking the kids -- "That's what we're here for," she says. But she does mind that Covenant House is not part of the process -- they're not paid by OCS and they're not consulted as part of long-term planning for these kids.
About 80 percent of the kids at Covenant House have significant mental-health problems or substance abuse issues. And almost everyone in the substance-abuse program is dually diagnosed, which typically means that mental illness is fueling the substance abuse. That profile is startlingly similar to that of homeless people in general.
In fact, research has shown that many homeless adults spent time in the foster-care system. This means there's a lot of overlap between the people Covenant House deals with now and those the Ozanam Inn sees a few years later.
Covenant House tries to stay in touch with the homeless kids in the street. They have a dog cage in their yard, because homeless kids often have pets, says Koch, and pets aren't allowed inside. And they have special overnight programs especially for homeless kids, Bodenmiller says. "If a kid comes to us and says, 'I want a sandwich and a shower and a night off the street,' that's what he gets."
Koch and Bodenmiller say they try their hardest to keep Covenant House kids from drifting into the streets. But the dumping by OCS doesn't help matters. "Their discharge planning seems to be, 'Where do we put you next?'" says Bodenmiller. That's the wrong question, he says. If there isn't any progress, there shouldn't be any discharge.
"It's hard to get discharged from Covenant House," Bodenmiller explains, because they take kids step by step through GEDs, jobs, budgeting and apartments where their "rent" goes into a savings account.
It's this progression -- called Rites of Passage -- that Anthony is now in. Other programs might have "discharged" him after his first two false starts, but Covenant House took him back six months ago and he now seems to be a superstar. He has a job busing tables at a French Quarter restaurant and he routinely deposits his entire check into savings. "I'm gonna let it build up," he says.
He says he even quit smoking weed for good, not because Covenant House does random drug testing but because some of the other kids there took him to the library and showed him a book about how marijuana kills brain cells. "The cells do regenerate, but it takes a long time and I don't want to go through all that," he says.
Now, Anthony spends his days, before work, studying for the GED so that he can become a firefighter. It's something he's always wanted to do, ever since he was little and would stop by the station near the St. Bernard project. "And then," he says, "I want to learn how to manage my own apartment and the dos and don'ts. That's the next step."
Bruce Lange's son, Brän, was starting to act delusional on his last trip home to Ohio. For instance, he would talk about their family's trip to Paris. They had never had traveled there and in fact, says Bruce Lange, his son didn't even have a passport. Brän also seemed to worry that his father would take him somewhere and have someone mess with his mind.
In March, Brän called to tell his parents that he'd been arrested and was being held at Orleans Parish Prison (OPP). Something about a knife in his backpack, as far as his father could tell. Lange knew that, in Ohio, prisons provided mental-health services. So he began calling the psych unit at OPP and asking that they evaluate his son.
Lange says he called the OPP psych unit at least twice a week for the next two months -- so much that he developed a phone relationship with one woman in that unit. When he called, she would even recognize his voice, he says. She would tell him that they were going to do an evaluation, he says, but OPP never seemed to get around to it.
They had a bus ticket and money ready for their son upon his release, but somehow that date changed, says Lange. He now knows that his son was released on May 2, 2002. The day after his release, Brän climbed up the scaffolding around St. Louis Cathedral and plunged to his death. According to police reports, he had a suicide note in his backpack. The Lange family says they weren't notified until mid-May.
Lange's story is a dire example of the importance of discharge planning for mentally ill people. But, if the general state of medical care is poor, mental-health care is worse.
Mental illness is harder to diagnose and it's trickier to treat, especially since funding for mental health is constantly being cut. Hospitals can hold mentally ill patients only for a few weeks without filing commitment paperwork in court. Many patients are released to substandard and unlicensed mental-health housing, says Kegel. "Housing is the most acute need in mental health," she says.
Plus, homeless advocates point out, the public has much less sympathy for people with severe mental illness -- people with paranoia, schizophrenia or delusions. No one would call the police if someone was limping down the street. But they would call if someone was pacing around speaking in "word salad" -- words strung together in a meaningless string.
The behavior is especially intolerable to the public when the person is mentally ill and a substance abuser. Yet these dual diagnoses are almost the rule, not the exception, among the homeless population.
Dual diagnoses are also common outside the homeless community, in places like Orleans Parish drug court. Criminal Court Judge Calvin Johnson, who heads one of the drug courts at Tulane Avenue and Broad Street, has seen so many people with dual diagnoses that he's been spearheading an effort to launch a mental-health court that would address mental illness with treatment, much like a drug court treats addiction.
By all accounts, a significant portion of OPP inmates suffer from some form of mental illness. Yet from the outside, it's difficult to determine how OPP deals with this on a day-to-day basis. Calls to an OPP spokesperson about this topic -- or any other issues related to this story -- were not returned.
There are countless stories about mentally ill people not getting their medication during their stay at OPP. "That is a common complaint," says attorney Mary Howell, who has investigated OPP's practices on behalf of clients. "Or if they do get them, they're not getting them in the right dosage or at the right time period."
And extended jail stays often cause mentally ill people to lose disability payments. Attorney Martha Kegel knows this first-hand, since she files Social Security Income (SSI) claims for homeless people through her position at the New Orleans Legal Assistance Corp.
In federal facilities, Kegel says, prison staff will re-apply for SSI on behalf of the inmate as part of their discharge-planning process. That does not happen in state prisons or in local jails, she says.
In fact, Kegel just recently was able to secure SSI benefits for a client of hers who had lost his benefits during an extended jail stay. "I have long suspected that he was mentally retarded and mentally ill -- he seems to hear voices on a regular basis," says Kegel. The client had received SSI during 1999, probably for those reasons, says Kegel, but Social Security lost his file. So in April 2001, she began putting together the case from scratch. In the meantime, her client -- penniless and unable to work -- was living on the street. With proper discharge planning, this man's homelessness could have been avoided entirely.
Kegel says another client was severely derailed by a stay in OPP. "This man had never been arrested," she says. "But he had paranoid delusions that the police were hiring someone to shoot off firecrackers next to his bed at the shelter." Then, she says, one day, while he was leaning over to tie his shoelaces, police swooped in and picked him up for blocking a public passage. She knew he'd been brought to OPP, she says, so she called right away and asked the staff there to give him his medication. They agreed, but it evidently didn't happen, she says.
He came to see Kegel right after his release, she says, but he was obviously freaked out and ran away. "He was so afraid that the police would pick him up if he stayed in New Orleans that he ran to Arizona," she says. "It took me five or six months to find him."
Lately, shelter staff will tell you, dozens of homeless people have been released from OPP without their IDs or their possessions. As a result, homeless men and women are finding themselves outside of the prison at 12:01 a.m., a standard OPP release time. They have nothing -- no bus tokens, no medication, no shoes, wallet, purse or personal belongings. "Apparently there is some sort of black hole at Central Lockup," says Clarence Adams.
On days like these, he admits, effective discharge planning can seem light years away.