Homeless Portlanders Report Challenges Accessing Healthcare

In interviews with The Lund Report, homeless people said they were poorly treated by local healthcare providers, although several said they had positive experiences, and accessing care is a low priority until health concerns reach emergency status.

Homelessness both causes and results from serious health issues, according to the National Alliance to End Homelessness. But homeless people on the streets of Portland say the treatment they’ve received from local healthcare providers has not just helped their health problems—it’s contributed to them.

Emma Christensen, 27, walking with her pit bull, Prince, near the east end of the Steel Bridge, where she’s lived the last three years, said she had a miscarriage four months ago. Yet she said she spent less than eight hours at a local emergency room before leaving because staff were disrespectful towards her.

Christensen said she has “anxiety, PTSD and bipolar manic depression” and a history of drug use. She said she stopped using, though, when she found out she was pregnant.

“I did know I was pregnant and I ceased my drug use,” she said. One day, she said, she experienced vaginal bleeding that was “very painful and emotionally disorienting.”

“I willingly went to Legacy Emmanuel because I was in so much pain,” she said. But “because of the way that the staff were, I didn’t stay.”

The way staff were? Christensen said they were “short,” “judgmental” and showed a “lack of recognition for [my] being a human species.”

Now, Christensen said, if she had another health concern, she’d probably ignore it.

“I probably just wouldn’t go, because the way that they treat the homeless is just not okay,” she said. 

A Legacy Health official declined comment.

Coverage of Portland’s unsheltered homeless population often focuses on housing, reflecting the city’s housing/homeless “state of emergency,” renewed last October. Rarely if ever do local media report on the health needs and experiences of local homeless, even though study after study has shown homeless people use a disproportionate amount of public health dollars.

Oregon has 13,238 homeless, according to HUD’s Annual Homeless Assessment Report to Congress, released last November. The state’s 61% rate of unsheltered homeless is third-highest in the nation. (Results of a new Point-in-Time homeless count in Portland performed in January—likely to be higher than the last—are due in May.)

Interviews with six homeless individuals on the streets of Portland revealed three patterns:

  • Healthcare is not top priority for many living on the streets; it often takes a back seat to other basic concerns like food, shelter or work.
  • Houseless people often have a lack of trust in the healthcare system, or say they’ve been treated poorly by emergency room and hospital staff.
  • Unsheltered homeless have immediate, ongoing healthcare needs and describe frequent, recent interactions with emergency rooms and local clinics that serve the homeless.

Not all homeless have had bad experiences with local healthcare.

Raul Martinez, 48, said he was referred by Transition Projects to a Multnomah County clinic for help with an infected molar, and felt good about how he was treated.

“They checked blood pressure, everything.”

Some have even received alternative natural medicine, for free.

Linda Russell, 57, lives at Bud Clark Commons, a Home Forward building that provides housing and services for chronically homeless. She said she received acupuncture treatment courtesy of JOIN, a local nonprofit.

Russell, who was carrying an Easter meal courtesy of Union Gospel Mission, said she has severe depression and Affordable Care Act coverage, but prefers natural medicine.

“I don’t worry about all that [healthcare],” she said. “If it’s my time to keel over, it’s my time.”

Russell has three teeth left, and used to have dentures when she was in Vancouver, Washington. “I want to [get new dentures], but I don’t know what kind of insurance you need. You’re only allowed one every few years.”

One Side of the Coin

There are two sides to every coin, but HIPAA rules make it illegal for healthcare or social services agencies to discuss allegations like those made by Christensen without signed releases. What’s more, media have traditionally tended to treat homeless people as unreliable—it can be hard to believe someone who is using drugs or experiencing mental illness.

Yet we ignore the experiences of the “human species” living on our streets at our peril. And many unsheltered people are not only lucid, but highly intelligent.

Sean B, 41, is a certified pressman and college graduate who used to print the Boston Herald, he said. For the last year and a half he’s been on the street, most recently under Interstate 5 in a tent next to a posted “Illegal Campsite” notice. He said he has a Bipolar 1 diagnosis and regularly self-medicates, drinking “four liters” of wine a day. He has gone to Hooper Detoxification Stabilization Center—a Central City Concern facility located a couple blocks up the street from Sean’s NE Lloyd Blvd. tent site—three times in the last year and a half when he started getting the shakes.

Does Sean feel the system that helps him sober up takes good care of him?

“Not so much,” he said. “I was kept in a lit hallway for six days” on a gurney at Oregon Health Science University, he said. “They tried to get me into Unity [Center for Behavioral Health], but I guess I wasn’t f**ked up enough mentally, which is crazy after two life-support incidents.”

OHSU is committed to caring for patients in a way that “preserve[s] their dignity and independence while promoting their recovery,” Associate Director of Strategic Communications Tamara Hargens-Bradley wrote via email, noting that confidentiality laws prohibit discussing specific patients. “Patients in need of non-urgent care may experience delays in treatment when the hospital is experiencing high patient volumes.”

Charles Blackmon, 56, a veteran who said he was honorably discharged after service in the Marines and Army, suffers from neuropathy, problems with his left arm and knee pain. He lives in a tent on Airport Way and gets care at the Good News Clinic on SE 180th and Stark, he said.

Blackmon smiled and nodded as he accepted gifts of Easter eggs, warm chili and rice, water bottles and candy from Easter Sunday well-wishers in Old Town Chinatown. But his countenance darkened when he spoke about how the Veterans Administration has denied him benefits for 35 years.

“It’s always some formality,” he said. Blackmon, who was released from Multnomah County’s Inverness Jail in January, said he’s never been able to get straight answers from the VA system. “They told me I didn’t qualify because I didn’t finish my training,” he said. “That was a straight lie.”

Blackmon said local hospitals “keep kicking you out; they don’t do nothing for you. They just let you lay there for a few hours, then discharge you.”

A Veterans Administration Medical Center spokesman noted that the VA system has worked with community partners and “housed hundreds of Veterans in our region and provided countless services.” Daniel Herrigstad noted that veterans can be eligible for both medical and housing-related benefits, but the VA can’t confirm whether or not a specific individual has applied for benefits. “Hopefully we can help him as well.”

Blackmon isn’t giving up on himself, despite his frustrations, and recently met a well-connected VA official on the MAX train and plans to make another appointment with the Good News Clinic soon. “Failure is not an option,” the Oakland, Calif. transplant said.

Salvador Macias’ health situation is secondary to other needs, like finding work to help his father get emergency surgery in Jalisco, Mexico after he was gored by a steer. A 14-day solo trip on foot across the Sonoran desert took its toll on Macias’ feet, he said, and sometimes the pain is so bad he can’t work.

In ten days here, Macias has been able to work as a day laborer just once, he said in Spanish.

Macias, 29, had his shoes off, and was tending to his feet with a knife and scissors while talking to a friend, Raul Martinez, and Christensen, who was trying to find out if the Mexican men would clean her campsite for five bucks. “I brought a pain in my stomach when I came,” he said. He used to use “cristal” [methamphetamine] seven or eight years ago, but now “I don’t fall into temptation because I am always thinking about my dad,” he said.

As the youngest of seven children, Macias feels responsible for doing what he can to help his father. He said he’s never been homeless before and survived the Sonoran desert by virtue of “faith in God.” His goal? To save up enough money to get a bus to Pasco, Wash. where he would work 15-hour days picking onions.

“It’s tough,” he said.

Thacher Schmid is a freelancer based in Portland. His website is ThacherSchmid.com, his blog about poverty is Medium.com/@PoorForAMinute, email thachmid@gmail.com