FORT LAUDERDALE, Fla. – When homeless advocate Sean Cononie visited Kathleen Nolan in a group home he runs, he couldn't believe what he saw.
"She was covered from head to toe and was bleeding, major wounds," Cononie said.
Cononie, who founded the Homeless Voice and has been working with homeless people for decades, said he had never seen anything like it, and making it worse was the fact that the 59-year-old woman had been discharged from Broward Health Medical Center just five days earlier while suffering from the same condition.
"She should have had wound care at least," he said.
Cononie snapped disturbing photographs of Nolan, who is on disability and has been chronically homeless for roughly 20 years, before taking her to Cleveland Clinic, which immediately admitted her into the hospital. It was there, a few days later, where Nolan, who was still in horrible condition, agreed to speak with Local 10 News, saying she constantly felt a "stinging pain" across her body.
"I am covered from head to toe in sores. My feet, my hands, blisters," she said. "I can't walk."
She said Broward Health, which is subsidized with more than $130 million a year in tax money to care for indigent people, admitted her with the condition on April 8 and discharged her on April 11.
"They gave me a bus pass and told me to find my way home," she said.
She was residing in the group home at the time, where Cononie learned of her dire condition. She remained at Cleveland Clinic for five days and is now at Memorial Regional Hospital, where her symptoms are still present but finally show marked improvement.
Nolan, who gave Local 10 News permission to view her hospital records, was diagnosed with a rare autoimmune disease called pemphigus vulgaris. When Broward Health discharged her, it ordered her to see a doctor in a week.
Veteran health care attorney Jay Cohen questioned that recommendation, especially after seeing the photo of what Nolan looked like just five days after the discharge.
"That's a woman that this layperson believes needed continuous care in a hospital setting," Cohen said.
Nolan said she was grateful that Broward Health treated her for the time it did. She said Memorial Regional, which is part of another taxpayer-subsidized hospital system aimed at helping indigent patients, didn't even admit her after an emergency room visit on March 28 when, according to hospital records, she was covered with sores,
"(Nolan) presents with sores present all over her face and abdomen … she states the sores are red and painful," the hospital noted at the time.
But during the same visit, a physician, while re-evaluating Nolan, wrote in his notes she "reported significant improvement in symptoms and was requesting discharge home." The hospital then discharged her with prescriptions for a pair of antibiotics. The diagnosis during that visit was simply an infection, not the autoimmune disease she was later found to have. And she was instructed to set up an appointment with a dermatologist for a visit two days later.
It's not believed she saw the dermatologist, which didn't surprise Cohen, who said chronically homeless patients often have problems caring for themselves, adhering to medical regimens and making it to doctors' appointments. That's why they need more support services from the hospital system, such as a social worker to check up on them to make sure they are OK.
None of the hospital records viewed by Local 10 mention a social worker being assigned to Nolan.
"When a patient presents and is homeless and has no insurance and has no means or availability of others to help take care of that patient, that's all part of the factors that have got to go in to whether or not a patient can be safely discharged to the outside world," Cohen said, calling it "a breakdown across the board."
Memorial Regional spokeswoman Kerting Baldwin refused to comment on the specifics of the case, citing the federal law restricting release of medical information.
"As a public healthcare system, our mission is to care for our patients regardless of their ability to pay," she wrote in a statement. "We help them heal and recover, and, when it is medically appropriate, discharge them with a plan of care and resources that continue beyond their hospitalization. Discharge plans are tailored to the needs of the individual patient."
