Released from the hospital, dead hours later

Shortly before Homer Lee Rhoades’ death in 2014, the 56-year-old homeless man walked out of the St. David’s North Austin Medical Center against medical advice. It is unclear why Rhoades was taken to the hospital, but death records show that he had become aggressive with medical staff.

A few hours after leaving the hospital, Rhoades was struck by three cars while trying to walk across MoPac, leaving his corpse dismembered.

Rhoades’ death highlights the difficult role hospitals and jails play in trying to prevent homeless deaths in the area.

Nine of the deaths analyzed by the Statesman involved people who had left or been discharged from a local hospital or jail hours or days before their deaths. Most involved fatal traffic accidents or a return to substance abuse after being released.

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N P Samuel Castilleja, who is living on the streets in East Austin, says he prefers to stay away from downtown because of the threat of violence and prevalence of drugs and alcohol there. Ricardo B. Brazziell / American-Statesman Castilleja shows bug bites on his body from sleeping on the ground. He’s been living on the streets for nearly four months. Ricardo B. Brazziell / American-Statesman Castilleja, wearing a medical ID bracelet, says he needs his health to get well so that he can get off the street and get a job. Ricardo B. Brazziell / American-Statesman Castilleja, who has been sleeping on the ground outside a restaurant on East Riverside Drive, pulls up his pant leg to show bruises on his legs. Ricardo B. Brazziell / American-Statesman Castilleja says that in addition to bug bites from sleeping on the ground, he has stomach issues that need medical attention. Ricardo B. Brazziell / American-Statesman

Several homeless advocates said they would like to see hospitals and jails provide homeless people struggling with substance abuse or mental health conditions with a list of places where they can seek help upon discharge.

“At no point in time do we know more about that individual … than when they’re in one of our institutions,” Troxell said. “We know they’re going to leave our institutions. We need to put together a game plan to know they’re safe, so they know how to get their medications, know how to pay for those medications and know a point of contact that can help them.”

Some local hospitals already provide aid at discharge. St. David’s North Austin Medical Center, for example, gives homeless patients vouchers if they cannot pay for their medication and often connects them with resource centers like the Salvation Army, the Austin Resource Center for the Homeless and Austin Travis County Integral Care.

Staff members at Seton Healthcare Family hospitals, including University Medical Center Brackenridge, tell homeless patients about shelters and food pantries. Their medical staff also tries to adjust the prescriptions it gives so as to not give homeless people medication with high street values that could make patients prey to attacks on the street.

Officials at the Travis County Jail assess each arrested person before discharging them to determine whether they are still a danger to themselves or others. That assessment takes into account whether the person needs to be referred to a crisis intervention team or to a facility for voluntary commitment.

“But as far as telling them, ‘Once you leave jail you can go to the Salvation Army,’ we don’t do that,” said Roger Wade, spokesman for the Travis County sheriff’s office.

A coalition of Central Health Travis County, the University of Texas Dell Medical School, the Ending Community Homelessness Coalition and other groups is currently working on improving discharge policies across local systems.

Of those who died after recent discharges, two were suicides, including a 27-year-old man who jumped to his death from a downtown building hours after being released from UMC Brackenridge.

At Seton Healthcare Family hospitals, medical staffs draw up a safety plan for potentially suicidal patients, detailing what steps to take if they start feeling suicidal again, said Kari Wolf, the group’s vice president of medical affairs for psychiatry.

But at some point, officials said, even people with suicidal histories have to be released.

“The law is very clear,” said Wade. “You can only be forcibly detained if you’re a danger to yourself or others.”

From left, Shanda Taylor, Eugene Espinoza, Denzil Wooten, Greg Covey and Charles Robert Caple are seen at U.S. 183 in October. Taylor, who also battles drug addiction and bipolar disorder, says she wishes there were more resources out there to help people like her. Ricardo B. Brazziell / American-Statesman

Shanda Taylor, who has been homeless on and off since 2003, said her battle with homelessness, drug addiction and bipolar disorder has led her to attempt suicide several times. Taylor, who frequently panhandles at an intersection near U.S. 183, said she has darted in front of cars to try to take her own life.

She said she wishes more resources were available to help people like her.

“I pray every day for my addiction, my mental health and my situation,” Taylor said.

But without increasing services, Wolf said, the unfortunate truth is that many homeless people will continue losing their battles against mental health conditions.

“For some people, their mental illness is a terminal disease,” she said. “It’s not satisfying as a physician who’s taken an oath to save lives, but we have patients we have given care to for years and years and years and they’re still going to die from suicide.”