An AnMed patient couldn't walk and had nowhere to go. The hospital called her an Uber.

It had been a long day, but Chris Wilson decided to take on one more fare before heading home to Greenwood.

He'd been making the rounds driving Uber in Anderson all afternoon on Oct. 26, and his last ride request came from AnMed Health Medical Center, a fairly common pickup location for patients looking for a ride home after an appointment, he said.

Wilson accepted the ride, but what he found when he arrived at the hospital left him shaken.

As he waited out front, a nurse rolled his passenger out in a wheelchair – an elderly woman, clad in nothing but a hospital gown, moaning in pain. 

'This lady needs help'

It appeared the woman, 59-year-old Tambralyn Hill, was too weak to walk, and hospital staff had to lift her into the backseat of his car, Wilson said.

The listed destination was a nearby pharmacy, but when Wilson asked where to take Hill after that, the nurse was unable to offer much guidance. The Salvation Army might take her, the nurse told him, and she had a sister who lived nearby, but ultimately it would be up to him to make those arrangements.

“They couldn't tell me anything about where this woman was going,” Wilson said. "I was a little bit shell shocked about it, I was a little bit surprised, but at the same time, I kept thinking to myself, this lady needs help, I need to help this woman get somewhere safe."

Hill moaned and cried as Wilson drove, he said. From the driver's seat, he agonized over what to do with the sobbing woman in the back of his car.

Hill told The Greenville News on Nov. 12 that she’s been homeless on and off for some time, and has been admitted to the hospital on multiple occasions since she was diagnosed with a heart condition last year. She said she also suffers from respiratory and digestive conditions.

Days after her Oct. 26 discharge, she was admitted to AnMed again.

A 'long-running problem'

In an emailed statement, AnMed spokeswoman Lizz Walker said the hospital is reviewing Hill's Oct. 26 discharge after Wilson wrote a post about his concerns on social media.

"It is our policy to provide assistance and support for patients upon discharge based on their need and request," Walker wrote. "While we stand ready to connect patients with many types of assistance, including transportation, prescription access, food, and housing, we also respect the patient's right to choose when and how they access these services."

National Health Care for the Homeless Council CEO Bobby Watts, whose organization advocates for ethical medical treatment for the homeless on a national level, said the nature of Hill's discharge is troubling, but not uncommon across the country.

"This has been a long-running problem," he said. "... Certainly, it is not good care and it's self-defeating care. By getting someone out of the hospital but not in a good place, it's entirely predictable that they would get sick again and come back to the hospital."

Safely discharging homeless patients in recovery can be a complicated process that often forces hospitals to keep them past the point of medical necessity, Watts said. The patients are almost always uninsured and unable to pay their medical bills, so extended stays can put additional stress on the hospital's staff and resources — especially if they're regularly re-admitted.

Shelters not equipped

And most shelters are not equipped to care for someone recovering from a serious illness or injury.

Brandon Cook, the coordinator for a recently opened medical respite center in Greenville that gives homeless patients a place to recover after leaving the hospital, said he's not aware of any similar facility in the Upstate. 

That can lead to situations like the one Wilson encountered, Watts said.

In recent years, a handful of states have passed legislation making it illegal to discharge homeless patients before finding them safe and suitable lodging. But South Carolina has no such law. 

When Wilson left the hospital that evening, the sun was waning over Anderson. As he drove, he periodically asked Hill questions and she answered, but mostly, she kept her eyes tightly shut and wept.

"She was wailing in discomfort and all she kept saying was 'God help me, God help me, I can't believe they're doing this to me,'" Wilson said.

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When he arrived at the pharmacy, it had just closed, and he set about trying to find a place for Hill to stay.

She gave him a phone number for her sister, Sonja Hurt, but when no one answered, he decided to drive to Hurt's Anderson home.

When Hurt came out of the house, which sits about 10 minutes away from the hospital, Wilson saw she used a wheelchair and worried she’d be unable to care for her ailing sister. But there was nowhere else he could take her.

After Wilson explained the situation, Hurt told him to bring her sister inside. Hill couldn't make it from the car to the front door on her own, Wilson said, so he had to pick her up and carry her into the house. Inside, he placed her in one of Hurt’s spare wheelchairs before he left for home.

"She was hugging her sister and crying on her shoulder," Wilson said. "And her sister was pretty angry. She said she was going to call the hospital and basically curse them out for booting her out that way with nowhere to go."

For the next several days, Hurt said, Hill seemed confused and in constant pain. She couldn't walk and was barely able to talk to her sister.

“She was hollering and crying the whole time she was here,” Hurt said. 

A few days after she was discharged, Hill fell and hurt herself, and her sister was unable to pick her up. Hurt called 911, and an ambulance came and took Hill back to AnMed.

On Nov. 12 — 17 days after Wilson picked her up — Hill sat in her bed at Anmed with two paper-clipped packets she said hospital staff gave her earlier that day — a list of homeless shelters and phone numbers printed on each one.

Hill, who said her mounting health issues often leave her disoriented, spent part of that afternoon parsing through the list, trying to find somewhere she could stay when she was discharged again.

But by the time she started making calls that afternoon, she said, no one was answering the phone. She planned to start making calls again first thing in the morning.

"I just don't know what I'm going to do," she said through tears. "I'm hoping by tomorrow I'll find somewhere to go and I won't have to worry about it anymore."

Walker said patient privacy laws prevent her from speaking to Hill's case specifically, but AnMed refers homeless patients to local shelters such as The Salvation Army and Haven of Rest as needed.

Lyndsey Hall, homeless and housing support director for The Salvation Army's Anderson branch, said while AnMed often sends patients to the nonprofit's shelter, if a person is recovering from a serious illness or injury, its facilities and staff aren't equipped to care for them.

When the hospital sends someone beyond her location's ability to help her way, Hall said, she tries to connect them with other agencies better suited to meet their needs. But such agencies are virtually nonexistent in the area. 

"In Anderson County, we're at a loss for that," she said. "It is a very, very big need." 

Millions spent on charity care

In another emailed statement, Walker said the hospital — which spent an annual average of $16.7 million on charity care between 2016 and 2018 — sometimes delays a patient's discharge for nonclinical safety concerns, such as housing arrangements. She did not answer a question regarding how frequently that happens.

According to Watts, developing comprehensive discharge plans for homeless patients on the front end can dramatically cut down on costs to the hospital in the long run.

A 2006 study published in the American Journal of Public Health found in a survey of 225 hospitalized homeless adults that those with access to respite centers like Cook's are less likely to be re-admitted after discharge. The study also found that homeless patients had significantly shorter hospital stays overall if they had access to respite care.

It is difficult for a patient to recover from an acute medical problem or serious injury while living on the street or in a homeless shelter that lacks the resources to properly care for them, Watts said.

"If you don't have a place to live, you have to deal with that illness, but without any comforts or even necessities," he said. "In the richest country in the world, it's just a tragedy, a human tragedy of colossal proportions."

Respite care allows homeless patients to recuperate fully, potentially avoiding future hospital visits, as well as connecting them to a continuum of other services. 

Cook's respite center, Greenville County's first such facility, opened its doors in January. 

New Horizon Family Health Services operates the all-male, six-bed center out of Miracle Hill's Greenville Rescue Mission.

The respite care facility came about after roughly six years of coordination among homeless service providers in the area who recognized the county's dearth of a transitional medical facility as a serious issue.

Shelters in the area were regularly serving people with medical conditions they weren't equipped to handle, and watching as their health deteriorated over time.

Since January, the center has served just more than a dozen patients, including a man who stayed at the facility for more than 200 days after he was struck by a semi truck.

Cook said the program, which is funded entirely through federal grants, is growing steadily, but more is needed to meet the Upstate's need.

"I'd like to get to the point where we don't have any more stories like this," he said, referring to Hill's case.

After Hill was re-admitted to AnMed, Hurt said one way or another, she hopes her sister gets the assistance she needs.

"Tammy needs help," she said.

Conor Hughes is a public safety reporter with The Greenville News. Contact him via email at chughes@gannett.com or on Twitter @ConorJHughes.