As Romona Stevenson's Greyhound bus rolled into Phoenix one drizzly night in January, her lungs were struggling for air.

The Delaware native was homeless, penniless and fleeing an abusive boyfriend. She had been hoping for a fresh start in a new city.

Now, a persistent cold had worsened into a serious respiratory infection. The bus driver called 911. An ambulance rushed her to the county hospital.

"I felt like a ton of bricks was on my chest and on my head, and there was no way of shaking it," Stevenson, 55, said. "I was so sick."

Over more than a week at Maricopa Medical Center, she begged hospital staffers to help her find shelter, interviews with Stevenson and nearly 700 pages of medical records show. Employees gave her phone number after phone number, but none of the places she called had open beds.

"I was to the point, you know what? If you don't have any regular shelter beds or hospital beds, how about a drug bed? Just so I wouldn't be out there. I was desperate at that point," Stevenson recalled.

Doctors approved her discharge eight days later knowing she didn't have any housing lined up. Hospital staffers gave her a walker, a bag of medications and a taxi ride to the Human Services Campus.

There were no available beds there. Hospital staff knew Stevenson didn't have one reserved.

"My heart just dropped," Stevenson said.

That night and the following night, she lay on a bus-stop bench outside McDonald's at Seventh Avenue and Van Buren Street, clutching a thin blanket too short for her toes as temperatures dropped near freezing.

Afraid of being attacked, Stevenson set out a lighter and hairspray as a weapon. She said she didn't sleep a wink.

"I know the county hospital can't keep me… But sometimes we do need a helping hand," she said. "They should have never put me out there. They should have waited until I had a shelter bed."

When Stevenson got into a shelter two nights later, she woke up suddenly unable to breathe and called the paramedics. She had to be screened by a new doctor for infection.

Maricopa Medical Center officials who reviewed Stevenson's case at The Arizona Republic's request concluded the hospital discharged Stevenson properly and safely, a spokesman said. It's up to patients to nail down a place to go, he said.

"Ms. Stevenson's story illustrates a larger problem regarding housing instability in our community," hospital spokesman Michael Murphy said. "Homelessness is a national and state crisis with rising numbers in the Valley."

Hospitals discharge to the streets

Medical facilities across the Phoenix area regularly discharge sick or injured people experiencing homelessness to the street or shelters, where they do not receive proper medical care, social-service providers said. Some are dropped off wearing nothing but hospital gowns.

People's conditions can deteriorate in those settings, sending them back to the hospital, racking up costs to taxpayers and delaying their paths out of homelessness.

"A lot of times people are released back into the streets (and) they're back out there again vulnerable to the elements and violence and the lack of follow-up care and the risk of infection," Dana Martinez, shelter services director for A New Leaf, said. "If they can't get healthy, they can't get back on their feet."

A few months ago, a mentally impaired man in a wheelchair was found at a bus stop filthy and hungry with an amputated foot. He had recently sought help at Abrazo Central’s emergency room.

Documents and interviews showed the hospital, along with Camelback Post-Acute Care and Rehabilitation and a county agency that was supposed to care for him, failed to ensure his safe housing.

The man ended up with an infection that required a new amputation to the knee.

After The Republic started asking questions, the Maricopa County Public Fiduciary placed the man in a long-term care home. The Arizona Department of Health Services and medical and nursing boards are investigating his treatment.

Few shelters offer medical services

Maricopa County has seen a nearly 150 percent spike in people living on the street in the past five years.

Homeless advocates blame the shortage of affordable housing and skyrocketing evictions, among other factors.

Emergency homeless shelters, as well as the 100 medical-respite beds the non-profit Circle the City provides to people who are sick, are filled to capacity, sometimes limiting safe locations hospitals can send patients who need housing.

As many as 350 people are turned away each month from Central Arizona Shelter Services, the 470-bed shelter where Stevenson was denied the first night, CEO Lisa Glow said.

On a recent tour, she pointed to a handwritten note next to a blue, vinyl mattress on the floor, deployed to expand accommodations during bad weather. The note to staff about that night's occupant said "seizures."

Although the campus has paramedics on call for emergencies, it isn't a medical facility, Glow said. People have died in the shelter from epileptic episodes.

"We have clients who come here who have paralysis, who have lost limbs, open wounds, back surgery, knee surgery, hip surgery that they're recovering from," Glow said. "This isn't really the most comfortable place to recover, but there aren't enough places in the community for them to go, including enough shelter beds. So they end up here."

Preparing for a 'silver tsunami'

CASS is working with partners such as Circle the City, to better coordinate care for medically vulnerable people amid the shortage of space, Glow said.

The surge in medical challenges she said they are seeing at emergency homeless shelters will only increase in the wake of a "silver tsunami," Glow predicted.

Seniors over age 55 are the fastest-growing segment of CASS's population, she said. About half come in with disabling conditions.

To deal with the demand, the shelter is launching a $1 million campaign, called Operation Restoring Dignity, to renovate sleeping areas, update bathrooms and increase handicap accessibility.

Eventually, Glow wants to roughly double the capacity of the building.

If it weren't for city zoning restrictions and funding, CASS could serve all the people it now turns away. The shelter already has an occupancy certificate for 700. Zoning attorney Paul Gilbert said he is working with the campus to raise the limit to 1,000.

"We're very serious about making this happen," Glow said. "It's a community issue that we want to raise awareness about and then do something about it."

One doctor wouldn't let her go

By all accounts, staffers at Maricopa Medical Center provided Stevenson with extensive medical care.

Physicians hooked her up to an oxygen tank and administered breathing treatments, records showed. They prescribed antibiotics. They treated her heart conditions and refilled medications for schizophrenia and bipolar disorder. Stevenson received diet and smoking counseling. When she left, she received $73 worth of medications for free.

But when it came to housing Stevenson, few at the hospital seemed to take it seriously, according to medical notes.

As many as 20 physicians, nurses, social workers, psychiatrists and members of a domestic-violence team called Mariposa Wings to Safety knew Stevenson was homeless but did not ensure she secured stable housing prior to discharge.

She requested help finding housing almost every day during her admission, according to medical records.

"I'm worried, wondering, 'When I leave the hospital, where I'm gonna go? Where I'm gonna go?' That's constantly nagging at me," she recalled.

Employees repeatedly gave Stevenson lists of shelters to call from a hospital phone, according to records.

But the shelters either didn't have room or didn't answer, Stevenson told hospital staffers, and she didn't have a personal phone for shelters to call her back.

"What I didn't understand was … why is it that (hospital employees) didn't call?" Stevenson said. "You're a social worker. You should have more pulls and strings to be able to do something."

One medical professional raised an alarm, according to medical records.

A psychiatrist forced the hospital to cancel Stevenson’s discharge on the seventh day.

"Given the patient's circumstances: lack of food, shelter, transportation, and medications, it would not be appropriate to discharge her at this time," he wrote. "These fundamental issues would need to be resolved prior to discharge."

But on the eighth day, a new rotation of employees didn't follow that advice.

A different doctor approved Stevenson to leave without housing lined up.

Maricopa Medical Center frequently cares for people who are poor and homeless. A hospital spokesman said employees followed protocol by providing Stevenson with "resources" to find housing.

"It is the patient's decision if they want to notify (the shelter) or attempt to secure a bed," Murphy said.

She asked for help nearly every day

Stevenson's medical records detail how many hospital staffers knew she was homeless and did little about it, despite her requests for assistance. Here are just a few of those notes, which have been edited for clarity, including spelling out abbreviations.

Day 1:

"Patient expressed the following concerns: homeless," wrote a nurse.

"Patient … is needing assistance with a place to live," another nurse reported.

"Assisted patient in contacting domestic violence central screening hotline," a social worker wrote. "Per hotline, patient should call when she is closer to discharge."

Day 2:

"Maricopa Wings to Safety advocate saw patient, gave community resources and will continue to follow up as needed," an employee with the domestic-violence team wrote. "Patient states she wants to go to shelter once discharged. … Patient can call Central Screening Hotline once patient is discharged."

"Anticipated discharge needs: Patient homeless. Patient has no support in AZ," a nurse wrote. "Patient stated that she was provided community resources, behavioral health and shelter resources."

Day 3:

"Maricopa Wings to Safety advocate saw patient, gave support and will continue to follow up as needed," an employee reported.

Day 4:

"Better but not well enough for safe discharge to shelter," said a doctor.

Day 5:

"She reports continuing to have anxiety because she does not know where she is going to live after discharge," a psychiatrist noted. "She has gotten numbers from social work but has not had success finding a place to stay. … Recommend: social work follow up to help patient find housing/shelter."

Day 6:

"She reports she needs to speak with someone about housing for a place to stay when she leaves here," a doctor noted.

"Patient reports needing additional resources as she has contacted contact numbers for shelter list that was provided but has not been successful in finding shelter that has availability," a second doctor wrote. "She requested to speak to advocate again to ensure she has all the information resources available to her. … Provided patient with contact information to additional shelters. … Patient to contact shelters to find safe place to go to upon discharge."

Day 7:

Stevenson's anxiety escalated as she faced imminent discharge.

"Patient… became emotional and said she was stressed due to her homelessness situation and not having anywhere to sleep tonight," a dietitian noted.

"Patient in hallway, angry about not having a place to discharge to," a nurse wrote. "Patient explained she was going downstairs to find a phone to call shelters listed on packet given to her by care management. Patient then seen in bed, calling shelters to find placement. Patient unable to find somewhere to accept her, stating shelters were either full or needed phone number to return call (patient does not have a personal phone)."

Finally, a psychiatrist cancelled Stevenson's discharge.

"She was extremely upset," he wrote. "She denies suicidal ideation, but states that she does not know how she will feel once it is nighttime with nowhere to sleep. Given the patient's circumstances: lack of food, shelter, transportation, and medications, it would not be appropriate to discharge her at this time. These fundamental issues would need to be resolved prior to discharge. … Care manager notes she will assist patient in establishing the above services."

"Social worker tomorrow to help placement (likely a shelter)," another doctor wrote.

Day 8:

Despite promises by hospital staffers, the next day Stevenson still did not have a bed in place. A doctor signed off on her discharge anyway.

"Have all plan of care problems been resolved or marked as appropriate for discharge?" a questionnaire asked. "Yes," a nurse wrote.

Hard to get healthy on the streets

Hospitals in Arizona and around the country are increasingly coming to the conclusion that people can't get healthy without a safe place to sleep.

Research shows people are less likely to receive preventative care, fill prescriptions and follow treatment plans if they are experiencing homelessness, said Murphy, the Maricopa Medical Center spokesman. They also are more likely to visit the emergency room.

By contrast, homeless patients who recuperated at Circle the City visited hospitals roughly 60 percent less afterward than they did before, a three-year study by Brandeis University and National Healthcare for the Homeless Council found.

In response, medical centers and insurers are launching programs to combat homelessness and build affordable housing.

Maricopa Integrated Health System, which operates Maricopa Medical Center, is exploring partnerships to develop transitional housing for homeless patients, Murphy said.

"We know that stable housing is key to patients' health outcomes," he said. "We are eager to work with other health systems in the Valley and community partners to improve patients' housing options."

On that goal, the hospital and Stevenson agree.

"It should not be right that the hospital be allowed to dump people off at any shelter (where) there's no resources that night or the next night," Stevenson said. "Just don't throw them to the curb."

Now that she has a temporary bed, Stevenson is working to find permanent housing and a job, she said.

"My goal is … I say three months I'll be in my own place," she said. "Long as I ain't outside, my feet don't get cold, I'll be all right."

How to help

Readers, medical staff, business leaders and politicians can all work together to reduce homelessness and patient dumping. Here are a few options.

1. Donate to expand emergency shelter.

Central Arizona Shelter Services is raising $1 million to renovate its 470-bed facility through a campaign called Operation Restoring Dignity. The project will refurbish sleeping areas, update bathrooms, increase handicap accessibility and more. Ford Motor Company, Thunderbirds Charities and True North Studios have already pledged their services. The shelter is looking for more businesses and individuals to pitch in. Gifts up to $400 per person qualify for an Arizona charitable tax credit.

Email development@cassaz.org or call 602-417-9800.

2. Fund medical respite beds.

Circle the City, which cares for homeless patients after a hospital stay, eventually hopes to operate 200 beds to fully meet demand, costing $4 million per year. Gifts up to $400 per person qualify for an Arizona charitable tax credit.

Give online at circlethecity.org/donate, by phone 623-900-7671 or by mail at 300 W. Clarendon Ave., Suite 200, Phoenix, AZ 85013.

3. Support other charities that help the homeless.

To volunteer or donate to other organizations, go to https://azhousingcoalition.org/needhelp.

4. Contact your elected representatives.

Contact Gov. Doug Ducey at azgovernor.gov/engage/form/contact-governor-ducey or 602-542-4331.

Find your state senator and representatives at azleg.gov/findmylegislator. Or call the Arizona Senate at 1-800-352-8404 and the Arizona House at 1-800-352-8404.

5. Learn about other solutions.

Read about 17 ways to prevent homeless patient dumping in Arizona.

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Fill out this online form, text HereToHelpAZ to 51555, or call 602-444-2255 from 11 a.m. to 1 p.m. Tuesday through Friday to talk to a Call for Action volunteer.

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Editor's note: CASS, Circle the City and the domestic-violence team at Maricopa Medical Center, Mariposa Wings to Safety, are funded in part by The Republic's Season for Sharing campaign.

Consumer reporter Rebekah L. Sanders investigates issues of fraud and abuse involving businesses, health-care entities and government agencies. Contact her at rsanders@azcentral.com. Follow her on Twitter at @RebekahLSanders.