No x-ray, no bed.
For the homeless in LA, that simple decree can mean the difference between getting a warm bed with a hot meal and a night out on the mean streets of Skid Row. It all depends on the results of their tuberculosis skin test. With a positive test, rescue missions require a chest x-ray showing the absence of active TB. In the past, that requirement kept a lot of homeless on the streets. Today, thanks to the efforts of Kaiser Permanente radiologists led by Dr. Keith Terasaki and Dr. Ronald Saul, chest x-rays from the Weingart Clinic on Skid Row are read daily, without charge, at Kaiser Permanente Sunset Los Angeles Medical Center.
In Los Angeles, Skid Row is home to approximately 7,000 homeless. These aren't the typical winos of yore, according to Dr. Saul. Increasingly they are families, immigrants, younger people with substance abuse problems, and women who are victims of domestic violence. "It's all kinds of people," he says.
Dr. Saul should know. In the last two years, in a program underwritten by Kaiser Permanente's community safety net, he has read thousands of chest x-rays for the homeless, ensuring they get a bed for the night—that night—in one of Skid Row's shelters.
Two years ago, Dr. Terasaki and Dr. Saul read x-rays after hours, on a no-fee basis, for the Hollywood Free Clinic and Melrose Free clinic. News of their volunteer efforts reached Dr. Paul Gregerson, the Chief Medical Officer of the Weingart Center, a mission in Skid Row that provides beds to more than 600 people nightly. He approached Dr. Terasaki and Dr. Saul, asking if they could help. When they toured the center, Dr. Saul was impressed with the level of care. "They were superb physicians. It was a privilege to help them out."
Terasaki and Saul set up a program at Kaiser Sunset to help the Weingart clinic see more patients, read more films, and use the money previously spent reading x-rays for urgent health care needs. Each day a courier from the Weingart Center delivers 15 to 20 chest x-rays. The radiologists at Kaiser read them during normal working hours, then dictate their reports and deliver the results back to the Weingart clinic.
"It's been incredible that Kaiser Radiologists have volunteered their own personal time to review x-rays," Dr. Gregerson says." It's saved us money we don't have for this service. Thanks to the radiologists at Kaiser we've been able to decrease the wait time for x-ray results from 3 to 4 weeks down to 2 to 3 days."
In two years the program has grown to include eight doctors, plus all 17 radiology residents at Kaiser Sunset. As part of their training, the residents perform an initial read of the x-rays and the Kaiser radiologists perform a final over-read.
"It seems like such a small thing," Dr. Saul says. "But do it consistently and it adds up. We're getting people into the shelters sooner, and we're contributing to keeping a great clinic open.
"I got to know a lot of these people when I worked in the ER substance abuse treatment clinic as a radiology resident in LA County Hospital," Dr. Saul remembers. "You realize they aren't that different than you or me. They had a hard time in their lives, which they couldn't handle, and they ended up on the street. But I've also seen them turn their lives around."
Thanks to Dr. Saul, more homeless on Skid Row have a chance to do just that. The first step: walking through the doors of a shelter with a clear chest x-ray in hand.
"The radiology department really helps me a lot. I don't need to spend two or three weeks to get a chest x-ray to get a bed in a mission. I can almost get it in same day. I'm glad the clinic is here to help me so I can get back on my feet."
Weingart Clinic patient