Steve Lopez: 'Very aggressive treatment' on the streets of Skid Row from a renegade M.D.

Steve Lopez, Los Angeles Times on

Published in Lifestyles

LOS ANGELES -- The team gathered at 4th and Crocker streets and headed south, into the blue-tented netherworld of social collapse, armed with life-saving drug-overdose kits and injectable, long-acting anti-psychotic medication.

"We're trying very aggressive treatment on the streets," said Dr. Susan Partovi. "Housing definitely saves your life, but there's a small sub-group of people who won't accept housing because of their mental illness."

She figures that if she administers medication that lasts a month and can help stabilize patients — with their consent — they've got a chance.

"They don't think there's anything wrong, and they think they don't need housing," Partovi said. "They don't think rationally, and so once you treat their delusions and their irrationality, they start to realize, 'Oh, I do need resources.' "

Partovi, who began practicing street medicine in 2007 in Santa Monica, has never been shy about her lack of patience with the official response to the entrenched humanitarian crisis. In 2017, I shadowed her as she walked through Skid Row with County Supervisor Kathryn Barger, advocating for broader authority to assist those in obvious acute mental and physical distress, even if they refused help, and despite opposition from civil rights attorneys and others.

By administering long-acting meds, Partovi—author of the just-published "Renegade M.D.: A Doctor's Stories From the Streets"—is once again pushing boundaries. She's acting out of a belief that her approach is medically sound, and with frustration sharpened by her street-level view of the countless bureaucratic cracks and canyons in the system. She's driven, too, by an uncompromising compassion for homeless people who are so sick, she can sometimes predict who will die next.


Critics might say a person in the throes of impairment isn't competent to give consent for a month-long dose of medication, and that such meds are neither a panacea nor a substitute for intensive ongoing case management. But to Partovi, the slow pace of intervention — along with multiple daily deaths on the streets — add up to a human rights violation and a moral failure, so she's stepping into the breach.

But she's not a psychiatrist, and her street medicine team's approach is not fully embraced by the L.A. County Department of Mental Health. DMH has psychiatric street medicine teams operating in several parts of the county. The Skid Row unit —which is led by Dr. Shayan Rab and injcludes psychiatric nurses, social workers and addiction counselors, and sometimes conducts sidewalk court hearings for those who resist treatment — was featured in a September 2022 article by my colleague Doug Smith.

Dr. Curley Bonds, chief medical officer of the department, says DMH psychiatrists first establish a working relationship with the client and invest time in determining a clinical history, including prescribed medications and dosage. It can be difficult, he said, to distinguish between psychosis and the effects of street drugs like methamphetamine, but trained psychiatrists have an advantage over doctors with other specialties. Treatment would ordinarily begin with short-term oral medication, Bonds said, to establish the "efficacy and tolerability of the agent."

Only then would long-acting injectables be an option, he continued, but even then, the civil rights of the patient would have to be a consideration.


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