Dr. Jim O’Connell Speaks on Healthcare for the Homeless

By Nicolette Overton
BU News Service

Some of the best bedside manner in the country is being provided to those without beds, in and around Boston, Massachusetts. Dr. Jim O’Connell, 65, was not always going to be a doctor. He received his bachelor’s degree in philosophy from Notre Dame and then his master’s degree in philosophy and theology from the University of Cambridge. He spent some years wandering; it was not until he reached the age of 30 that he enrolled in Harvard University Medical School.

On a Wednesday evening in early February, he spoke at the Beacon Hill Friends House at 6 Chestnut St. about Boston Health Care for the Homeless Program. BHCHP began in 1984 when the Robert Wood Johnson Foundation and the Pew Charitable Trusts provided funds for 19 homeless health care programs across the United States.

Dr. O’Connell was chosen to run the Boston program in 1985 and now serves as the President. He still practices medicine on the streets of Boston and in many clinics, while also lecturing around the globe about homeless health care.

Holly Baldwin, director of the Beacon Hill Friends House, organizes discussions and lectures each month for the house.

“We wanted to have a series of events to bring people here and to share stories or experiences about things that are related to the Quaker values of peace and justice and equality,” said Baldwin.

At the Friends House, Dr. O’Connell began his speech with a slide show of photographs of homeless Bostonians he has met and befriended over the years.

“Sometimes they would blow your mind. Often they blow your mind,” Dr. O’Connell said of the stories he’s collected after spending nearly 30 years caring for Boston’s homeless.

However, Dr. O’Connell has also seen the worst hand that poverty and homelessness can deal.

“Our kind of poverty is the kind of spirit, as well. Most people die completely alone. Most people suffer completely alone. And if they have friends, they’re often friends they’ve picked up on the streets who don’t show up when they’re really sick.”

This is why one of the most important aspects in treating the homeless is not the medicine dispensed, but the quality of care.

Kip Tiernan, who passed on July 2, 2011, was a “fierce advocate” for the homeless and the underprivileged in Boston.

She founded Rosie’s Place, the first shelter solely for women and children in the country. She also helped to found numerous other establishments, as well as Boston Food Bank and Boston Health Care for the Homeless Program.

“She insisted it had to be looked at as an issue of social justice, and not charity,” Dr. O’Connell said of Tiernan’s influence in the kind of care BHCHP provides. Originially, they were not allowed to use volunteers. Only medical professionals were allowed to work for the program.

“They wouldn’t let us use students because they thought students would come to experiment on homeless people. They wouldn’t let us do any research because that got in the way of the advocacy community,” said Dr. O’Connell.

They insisted on these rules when accepting the grant money so that the medical professionals and caregivers would be completely dedicated to the job. People would have to stick around.

“Their whole point was that for good things to happen you have to have continuity of care, consistency of the provider, and a real chance to get to know the people,” said Dr. O’Connell.

Dr. O’Connell thought he would do this for a year, like an “urban peace corps.” Thirty years later, he is regarded as the foremost authority on homeless health care. There are now more than 220 homeless health care programs around the country.

Most of these programs are federally funded, with almost 80 percent of funding coming from Medicare and Medicaid. Federal funding is better than grant money because most grant money disappears in a couple years.

However, BHCHP has often been ahead of federal requirements and national trends. In 1994, Massachusetts General Hospital created electronic medical records for BHCHP.

“You can actually do much better care because you know what’s been done,” said Dr. O’Connell.

Electronic medical records help produce that “continuity of care” for the homeless, even if consistency of medical provider cannot be given.

“Almost all of the time is spent by people in front of computers instead of talking to people. And I worry about that a lot,” said Dr. O’Connell.

The downfall of electronic medical records is that the possibility of getting to know your patient, by asking questions and fully engaging with them, drops dramatically when their information is provided to medical providers on a screen.

“You’re a very good listener and you’ve been listening to the homeless people for thirty years or so. What have you learned about why people end up on the street?” asked Bill Mitchell.

Mitchell, a resident of the Friends House for the past six months and college friend of Dr. O’Connell’s, helped organize this month’s discussion.

“Boston is an interesting town because mayors had promised any person who wanted a bed at night time could have one,” replied Dr. O’Connell.

For the homeless of Boston, this meant that they did not have to be sober, they did not have to be clean, they did not have to even give their real names. Most cities require that homeless seeking shelter be clean and sober.

“They hate it when you say they’re choosing to live on the streets. That’s the first mistake I made,” said Dr. O’Connell. “They’ll shoot right back at you, I’m choosing not to go to one of those shelters.”

“I have one guy who is very clear on why he stays on the Common, although he’s not allowed to sleep there anymore. When he goes into Pine Street, he cannot tell his own voices from the voices of other people,” continued Dr. O’Connell.

The problem with not being able to get the homeless into shelters or, even better, affordable housing, is that many become chronically sick and have a much higher mortality rate.This occurs even though the street population’s demographics are about equal to that of the overall population’s.

Combating homelessnes can also cost the government a lot of money. Boston Health Care for the Homeless found that over 10 years, 119 homeless people have had 18,000 emergency room visits. The Centers for Disease Control and Prevention reported that in 2012, Americans made 136.1 million visits to one of the country’s 3,900 emergency rooms. The average expenses for Americans who had one or more visits to an ER in 2009 were $1,318, as reported by the Agency for Healthcare Research and Quality.

“There’s a standard of imminent danger to themselves or others. That means that’s when you really have to act or bring someone in,” said Dr. O’Connell.

This standard kept Dr. O’Connell and his team from bringing in a homeless woman. One day, she was brought in against her will by the police and Dr. O’Connell lost track of her. He ran into her at a shelter a couple years later. She was on medication and a member of the board of the shelter, a consumer board member.

“She said, ‘You effin bastard. You left me out there.’ She was serious. She was like, why didn’t you help me?” said Dr. O’Connell.