Imagine leaving a cell after two years - with only $200 to your name. From that $200 you must first buy a bus pass and some clothes. Imagine that you also happen to have diabetes, severe mental illness, or profound intellectual impairment. You stand there, looking at the bills in your hand. If you had no home, no friends, and no social support of any kind - where would you go? How will you afford your pills? Or get a doctor's appointment? Should you go to San Francisco? Los Angeles? If you tried one city before your last prison term, would you now try the other?
This story will investigate the ways in which homelessness, healthcare and incarceration come together to create a type of "homeless churn." It will explore, through real people's stories and aggregate data, the ways in which our current systems and their failures may be inadvertently concentrating and proliferating homelessness in our largest urban areas.
Moreover, this story will define simple, proven measures that can improve outcomes and assist in the coordination of the care of migratory patients. It will assess whether these effective measures have been implemented in California, and if not, why not. It will also explore the moral and ethical conflicts that collide within the competing priorities of post-release healthcare delivery, individual privacy and incarceration.
Finally, it will look at the costs - both monetary and in terms of human suffering - to the individual and to local communities when patients, who happen to have been prisoners, fall between the cracks.
With tens of thousands of prisoners released each year to Los Angeles and San Francisco, system failures can have a profound impact on the lives and health of individuals and local communities. But simple system changes can also result in widespread improvements to these same lives. The ways in which San Francisco, Los Angeles and the prison system interact are ripe for examination, particularly in these times of increasing homelessness, fewer resources, and widespread incarceration.
I am a practicing internist physician who sees patients in a homeless clinic for the San Francisco Department of Public Health. I am also a writer for San Francisco Chronicle's SFGate's City Brights.
My writing has appeared in, among others, Slate, the Los Angeles Times, the San Francisco Chronicle's Sunday magazine and the New England Journal of Medicine.
Post-residency, I spent two years as a Robert Wood Johnson Fellow in epidemiology and public policy and have published health services and cost-effectiveness research. I developed this project idea for USC Annenberg's California Endowment Health Journalism Fellowships.
First person interviews from affected individuals, on location, will be presented in both text and video formats.
The project will include data analysis of prisoner release patterns, a comprehensive review of prison and healthcare policies and costs/budgets, and video interviews with experts both in San Francisco and Los Angeles.
In addition, I will blog occasional pieces titled "Diary of A Homeless Doc," with appropriately confidential first-person accounts of patient stories as lead-in posts to the main pieces.
In 1994, while a fellow, I was paid an hourly wage to read and summarize individual prison health records by Wilson, Sonsini, Goodrich and Rosati, as part of the class action Pelican Bay Prison lawsuit, Madrid v. Gomez.
