A 63-year-old homeless woman tested for coronavirus at Scripps Green Hospital on Thursday afternoon spent the night in her car, despite county protocols ordering that people awaiting test results who do not have a safe place to stay move into one of hundreds of motel rooms amassed by the county.
Her experience highlights the challenges officials and residents in need face as the county scrambles to open up motel rooms for people who have tested positive or are showing symptoms of coronavirus who do not have a safe place to stay and to coordinate with dozens of health care and service providers to move people into them.
Nancy Miller said she got tested Thursday, after staying in an El Cajon motel room for two nights with the help of a voucher through McAlister Institute’s inclement weather program. A nonprofit official recommended the test after she said she had been sick for days.
After taking the test, Miller said, she left Scripps Green Thursday afternoon without direction on where she could self-isolate.
“They said, ‘We don’t know where you should quarantine. We only take a swab,’” Miller recalled.
Miller, who has been short of breath, dizzy and vomiting the past several days, returned to her car feeling dejected. She said she spent the night parked outside a La Jolla grocery store with Cuddles, her toy poodle.
“I can’t quarantine because I have no home,” Miller said. “I’ve been trying.”
A spokesman for Scripps Health suggested in a statement that Miller’s homelessness may not have been apparent to hospital staff.
“When a patient calls into the dedicated Scripps nurse line, their home address is requested and recorded in their record,” spokesman Keith Darcé wrote. “Every patient who has been tested at our COVID cabanas has provided a home address during registration.”
But Miller said she told Scripps Green nurses that she was homeless.
Miller’s experience contradicts guidelines shared with hospitals, health care providers and homeless service agencies in a Tuesday memo from Public Health Officer Wilma Wooten.
The memo, obtained by Voice of San Diego, notes that the county has secured motel rooms across the region for “pre-screened individuals requiring isolation.”
“To reduce transmission of COVID-19, the individual must be transported DIRECTLY to the hotel,” Wooten wrote in the memo. “It is important to communicate to the individual that they are required by (the) county public officer to remain in their room until further notice.”
At a Wednesday press conference, Wooten and County Supervisor Nathan Fletcher said the county is deploying 16 homeless outreach teams with public health nurses to link unsheltered homeless San Diegans with coronavirus symptoms with care and motel rooms.
Yet Miller fell through the cracks as she sought and received a coronavirus test.
She said she got a call from county officials Thursday night after an advocate and VOSD separately contacted the county. When Miller spoke with VOSD at about 12:30 p.m. Friday, she was on her way to a Mission Valley hotel she was told she’d remain in until she receives test results.
Miller said she had previously made multiple calls to the 2-1-1 referral line and Fletcher’s office.
“I’ve left repeated messages for the last five days saying I need to be quarantined,” Miller said.
Fletcher publicly laid out the procedures for obtaining a motel room earlier this week.
According to that procedure, homeless people who show symptoms of coronavirus should be screened by a health care provider and then moved into one of the more than 1,400 rooms the county is using to temporarily shelter people. One hundred of those rooms are specifically for homeless San Diegans considered particularly at risk, while the 1,327 others are for any person who has tested positive for coronavirus, shows symptoms or is awaiting a test result and who does not have a safe place to stay. The county began placing people into those rooms earlier this week, though officials have declined to say how many people have been placed in them.
Fletcher acknowledged in an interview Friday that staff at Scripps Green should have connected Miller to a motel room on Thursday. He said both the county and health care providers are rushing to ramp up a complex process.
“In a time of crisis when folks are moving very rapidly to stand up tremendous capacity to meet a great need, there will be isolated instances where one doctor at one hospital may not have gotten the full briefing on exactly how it works but every day we are communicating to our health care providers, we are communicating with homeless service providers, we are communicating with hospitals, the resources that are available,” Fletcher said. “We will continue to do that every single day.”
Spokespeople for the county’s Health and Human Services Agency, 2-1-1 San Diego and nonprofit McAlister Institute, an agency focused on substance abuse programs that provides some motel vouchers for homeless San Diegans during inclement weather, all had similar assessments.
“The COVID-19 pandemic is a rapidly evolving situation, and we are working diligently with health care and social services providers to ensure that we can best respond to the needs of all members of our community,” county spokesman Craig Sturak wrote in an email to VOSD. “We are continually reviewing policies and direction with our provider partners as the situation changes and will continue to do so during this public health emergency.”
Meg Storer, a vice president at 2-1-1 San Diego, said 2-1-1 has directed homeless callers who fear they may have coronavirus to contact their health care providers and connected those who do not have them directly to the county’s public health nurse triage line since only healthcare providers can direct people to the county’s motel rooms.
Dr. Jim Dunford, McAlister’s medical director, said the agency tried to accommodate Miller and that her experience spotlights the need to address the unique problems facing homeless San Diegans.
“This whole situation underscores the complexity of managing complex health care issues when you’re dealing with a very vulnerable population who lack the normal connections to the health care system,” Dunford said. “That, I think, is the particular lesson.”
County officials have said they are working to provide more shelter and coronavirus screening options for homeless San Diegans and that those who fear they may have coronavirus should contact their health care providers. Gov. Gavin Newsom has also said the state has identified 950 hotels statewide that could at least temporarily house homeless Californians.
Many homeless San Diegans who live on the streets, however, do not have health care providers and often struggle to keep their cell phones charged, a challenge that has grown following closures of local libraries, where they often check email and charge their phones. Without those resources, they can struggle to seek appointments and information, and to stay in touch with those who may be trying to help them.
Homeless San Diegans and advocates expressed confusion about how to access the motel room and other resources local government officials are pledging to provide.
Marie, a 60-year-old homeless woman with congestive heart failure and other health issues, told VOSD earlier this week that she had repeatedly called 2-1-1 hoping to access to a motel room to no avail.
Lynn M. Schmidt, who managed to secure a cot in Father Joe’s inclement weather shelter multiple days this week, said she had also been calling 2-1-1 for days in hopes of securing a motel voucher as her fears about coronavirus escalated and she struggled to keep her phone charged.
“I don’t know what to think,” Schmidt said.
Keely Kiczenski, who works at Think Dignity’s East Village storage facility, said she called the county Thursday to better understand how homeless San Diegans could be referred to the motels.
That morning, a homeless man wearing a mask showed up at the storage facility and asked who he could contact to get a motel room. The man told Kiczenski he was experiencing symptoms of coronavirus.
Knowing that only health care providers can refer patients to those rooms, Kiczenski said she encouraged the man to flag down the Police Department’s homeless outreach team.
“I need a better answer,” Kiczenski said.
Several homeless San Diegans who stay in the Mission Bay area said Thursday they had yet to encounter outreach teams spreading the word about coronavirus. Some said they had learned much of what they knew about the virus from a flyer handed out at a recent feeding event. Others were skeptical of local officials’ promises to be proactive about protecting homeless San Diegans.
“Nobody comes and talks to us about it,” said Kenneth Mannott, who also noted that the soap dispensers in his nook of city-run Mission Bay Park rarely work and could put those who stay in the area more at risk contracting the virus.
Lekeita Smith, 36, said she feared local leaders had largely forgotten homeless San Diegans despite their promises of increased aid. The city’s decision to close libraries was particularly jarring to Smith and others – as was the recognition that following directives to remain at home or practice social distancing are infeasible for people living on the streets.
“If we had the money, we could isolate like everyone else,” Smith said. “We don’t have anywhere to go.”