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Free Clinic Brings Street Medicine To Homeless

Helping Hand | Dr. Coley King performs a quick physical exam during a respite care house call.
Section 8 | This apartment is one of many used by the Venice Family Clinic as part of their "housing first" approach to caring for the homeless.
Street Scar | LEFT: Daniel Cullum shows the stab wound he suffered before he joined the VFC program four months ago.
By The Chimney With Care | Daniel Cullum's old orthopedic boot sits beneath the fireplace in their new Section 8 apartment.
Paperwork | RIGHT: Mobile clinics don't have online databases. Patient records are kept the old-fashioned way.

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By Jeremy Fuster

There was a time when Thomas Rogers, a homeless former electrician who lost his job after an accident, could be found struggling to get around Santa Monica Beach with a walker. Now, the walker sits unused next to the front door of his Section 8 apartment. He still walks around with a noticeable limp, but sure enough, he can now move under his own power.

In the corner of the room stands another man who watches Rogers with an approving smile beneath his handlebar mustache.

“You’re really looking good, Tommy!” he says, “If you just keep it up and continue to hold off on the drinking, it’s definitely going to get better.”

This is Dr. Coley King, a physician at the Venice Family Clinic (VFC), the largest free clinic in the United States. His visit to Rogers’ apartment is one of several house calls he makes every week to former homeless enrolled in the clinic’s respite care program.

Most homeless housing programs require their clients to consent to psychiatric exams and substance abuse rehab before they can become eligible for supportive housing. The Venice Family Clinic’s program turns the homeless aid process on its head, using a “housing first” philosophy designed to get the most vulnerable of the homeless population into housing before beginning treatment.

The “housing first” approach, pioneered in New York by the social services group Common Ground, particularly targets homeless who suffer from multiple disabilities, diseases, or addictions, even if they aren’t willing to go to rehab sessions. The idea is that by making supportive housing the top priority, chronically homeless people can be placed in an environment where they are much more likely to make both physical and socioeconomic improvements.

Before making these house calls, Dr. King worked for several years at the L.A. County/USC Medical Center, where he provided urgent care to the homeless on Skid Row. While he still considers his old job to be an important service, he finds his current line of work much more meaningful to both his patients and himself.

“Since I’ve come to Venice Clinic, I’ve been working with a similar homeless population, but with a much more satisfying way of providing medicine with long-term continuity. We can regularly visit the same people, like Tommy, and can see the progress as they rehabilitate,” he said.

In addition to the house calls, King and other VFC doctors head out to visit the homeless on the streets of Culver City and Santa Monica once a week. This practice of taking clinics to major homeless hangouts is known as street medicine, and has become a common method of collaboration between local clinics and homeless aid groups throughout the United States since it was created in the 1980s.

As one might expect, street medicine isn’t for the faint of heart. Dr. King has been involved with it for six years now, and he’s met his fair share of people who refuse to let a doctor look at them. Some react with outright hostility. For Dr. King, this is where his cool demeanor and his patient but insistent tone towards his patients comes in.

“We won’t push anything on them. We make it very clear what it is we’re offering them, usually some kind of medicine that can help with whatever they’ve got, and then we’ll come back another day,” he said. “It’s definitely hard sometimes. They don’t want to be taken advantage of. But with time and trust we can very much develop a good relationship.”

Take, for instance, Daniel and Nancy Cullum, a married couple who joined the respite care program four months ago. At today’s house call, they are all smiles, joking around with Dr. King and exchanging questions with him about their medication.

But when Dr. King first met them, it was a much different story. The Cullums had a tough life on the streets, with Daniel even getting stabbed in the shoulder. Consequently, they did not take King’s news of their poor health very kindly.

"They were actually angry with me for several months and didn't want to talk to me," King said. "Fortunately we were able to get them off the streets and into a good apartment, and now they're looking forward to their first Christmas indoors."

The Cullums even have stockings around their new fireplace. Two are bright red and have their names on them. A third one made of hard black plastic and velcro straps sits beneath them. It's an orthopedic boot that Daniel got from the VFC for his foot fracture.

"It was a great early Christmas present," he said with a big grin.