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Department of Health Services

Public Health Disease Control

SB 1152/ HSC 1262.5 Hospital Patient Discharge Process: Homeless Patients

Published: July 03, 2019

Input from Local Health Jurisdictions (Section 2)

 To:Hospital and Emergency Department Directors in Sonoma County
 From:Karen Holbrook, MD MPH, Interim Health Officer,
Sonoma County

Mary Miller, PHN MSN, Public Health Nursing Services Director, Department of Health Services

 Questions:Disease Control Unit - Public Health (707) 565-4566
 cc:Please Share with all Medical Staff

Effective January 1, 2019, California Health & Safety Code Section 1262.5 establishes requirements of general acute care hospitals, acute psychiatric hospitals and special hospitals serving homeless patients. Local Health Departments (LHDs) are required to provide guidance on implementation of one section of the new legislation within the jurisdiction of the LHD. Sonoma County inclusive of nine incorporated cities comprises the jurisdiction of the Sonoma County Department of Health Services and Health Officer.

The section requiring LHD guidance states: “the homeless patient has been offered or referred to screening for infectious disease common to the region, as determined by the local health department.”

After review of local prevalence and incidence rates of infectious diseases amongst homeless individuals within Sonoma County, and because we are experiencing significant outbreaks, upticks in cases and/or exposures of select infectious diseases within our homeless population, we recommend using care opportunities in the Emergency Department (ED) or Hospital to enhance screening for syphilis, gonorrhea, chlamydia, HIV, HCV and active TB. Specific recommendations are included in the attached Health Advisory: Discharge Guidelines for Patients Experiencing Homelessness.

Rates of early syphilis among Sonoma County residents have significantly increased in recent years (up 315% from 2016 to 2018). The rate of early syphilis is approximately 125 times higher among people experiencing homelessness compared to the general population. In certain homeless networks, the estimated incidence of early syphilis is 30%. Although less dramatic, the rates of other sexually transmitted diseases are significantly higher among people experiencing homelessness relative to the general population. Also, recent active TB cases exposed many individuals within the homeless population prior to diagnosis and treatment. As many homeless individuals have co-morbidities putting them at higher risk for TB infection progressing to active TB disease, a more robust, systematic effort of early identification of active TB cases would benefit those individuals and the general public.

Another article within the same section of law states: “The homeless patient has been offered vaccinations appropriate to the homeless patient’s presenting medical condition.”

Although this article does not require LHD input, we encourage hospitals and EDs to develop protocols to ensure vaccination for influenza, hepatitis A and hepatitis B in homeless populations as these vaccinations are critical to reduce disease burden in homeless populations and the larger community. Hepatitis A outbreaks have affected homeless populations in California and nationwide despite the availability of an effective vaccine. Outbreaks can spread rapidly within and beyond encampments and can last months. All vaccinations provided should be entered into the California Immunization Registry (CAIR).

We will update recommendations in the future upon reviewing new epidemiologic data as well as guidance from the California Department of Public Health. We look forward to partnering with your organization to optimize the care of homeless patients within Sonoma County. Please let us know if you have questions or concerns.