Protecting Unhoused Patients from the Harms of Encampment Sweeps

Editor’s note: Unsheltered patients mentioned in this story are identified only by their first names to protect their privacy.

The Kern River Parkway Trail spans the east-west length of Bakersfield for some 30 miles. The waterway drains the Sierra Nevada range but is often dry or nearly so by the time it reaches the city, which is known for its triple-digit temperatures in summer. A bike path that runs along the riverbed is popular, and most of the lands on both sides of the river are preserved to protect wildlife, like coyotes, roadrunners, and bobcats, from development.

Except there is development of sorts. The eastern section of the trail, in an area known as Oildale (named because it’s adjacent to two large oilfields), is at times home to as many as 100 people living in makeshift accommodations just off the path, camouflaged by bushes and shrubbery.

On a recent Thursday, around 6:30am, a four-wheel drive truck from Clinica Sierra Vista, a local Federally Qualified Health Center, cruises through the service gate. Later, a van carrying clinic caseworkers and another from an animal welfare nonprofit will shadow close behind.

Matthew Beare, MD, inches the truck forward, windows down. When he spots a patient, he brakes abruptly, shouts a greeting, and jumps out, followed by Diana Michel, a medical scribe, and Ana Valenzuela, a medical assistant. Today, Mike, wearing shorts and a blue t-shirt, is their first patient. He has already been waiting a good hour. A heart failure patient, Mike needs a refill on his blood pressure medication.

“[Bakersfield] Code Enforcement is already here,” Mike said. The city has sent a crew to “sweep” — or remove — shelters belonging to unhoused people in areas along the dry waterway.

Mike has ventured out to get his medication, along with personal hygiene kits, bagged lunches, and dog food donated by the crew. But his wife Bonnie, also a regular patient, is hidden away with their dogs, Miley and Angel, hoping not to be targeted by Code Enforcement.

Mike and Bonnie have been swept multiple times, which has had a significant impact on the couple.

During one sweep, Mike had just been released from the hospital after suffering from a stroke. Everything was taken, including his medications. “Sometimes they tell you that you can come down and claim your stuff. But where? Nobody even knows,” he said.

Mike went on to explain that officials sometimes claim they’ve warned unsheltered people about an imminent sweep, but the warnings — large yellow tags — are posted football fields away.

Farther along the parkway, at a spot where regulars know to find Beare’s team, city trucks are bulldozing tents and personal belongings. Purple sequins from someone’s half-buried bedazzled t-shirt catch the sunlight.

Nationwide, Black, Latino/x, and Indigenous people are far more likely to experience homelessness in the US than White and Asian people. But the Oildale encampment mirrors the community, which is majority White with 29% living in poverty, and 20% living in high levels of poverty, according to the US government’s official poverty guidelines.

At the regular meeting place, about 20 patients show up for Beare — an alarmingly low turnout. “They must be hiding out because of Code Enforcement,” Beare said.

His patients need medical attention. Injuries can quickly turn dangerous when people live outdoors. One patient in the camp recently succumbed to necrotizing fasciitis, a deadly bacterial infection that started as a small cut on his hand. This week, someone else seems to have a bone infection.

Encampment Sweeps Increase Morbidity and Mortality

Living unsheltered also means being susceptible to violence. For Beare, who has practiced street medicine outreach for about five years, it’s routine to treat the aftermath. But he says the actions of crews working on behalf of the city, county, or state clearing away encampments of unsheltered people should be seen for what they are: another form of violence threatening his patients.

“The people here are not being offered a place to live,” Beare said. “They’re just having their possessions, the only shelter they have, and sometimes their medications and identification documents taken from them. It’s horrific.”

Encampment sweeps are indeed counterproductive, said Kaitlin Schwan, PhD, director of the California Street Medicine Collaborative and clinical associate professor of family medicine at the University of Southern California. “We know from the evidence-based research that sweeps or displacement of people lead to increased morbidity and mortality. People can die,” she said.

And yet, sweeps are escalating in intensity and severity across California. In June, the US Supreme Court ruled in the case of City of Grants Pass v. Johnson, enabling local governments to enact and enforce criminal penalties for camping or sleeping in public spaces, even if those localities can’t provide alternative shelter.

California’s Executive Order

Following that decision, California Governor Gavin Newsom issued an executive order directing state agencies “to move urgently to address dangerous encampments while supporting and assisting the individuals living in them.” The order offered guidance for cities and counties to do the same, but did not legally require them to do so. Recently, Newsom threatened to withhold funding from local governments that do not take swift action to remove encampments.

“We’re seeing patients lose critical medications, lose identity documents, lose personal belongings, and even have durable medical equipment like expensive electric wheelchairs swept up,” said Michelle Schneidermann, MD, director of the California Health Care Foundation’s People-Centered Care team. “These losses harm people’s health, take an enormous emotional toll, and waste valuable health care resources.”

Chiyann, who was recently hospitalized for an infected abscess, rides her bicycle up to the group surrounding Beare’s team. She finds her partner Richard with their two dogs on a leash. He carries a small backpack and delivers bad news: Code Enforcement just paid them a visit. Chiyann, clearly agitated, hugs her dogs. “Our blankets, my clothes, are all gone,” she said. “We had a mattress and everything,” Richard added with tears in his eyes.

The antibiotics the hospital sent Chiyann home with are also gone.

Beare consults with Chiyann on a course of action. On the truck, he has some basics — non-controlled substances and antibiotics like doxycycline and amoxicillin. What he doesn’t have, he prescribes. His teammates Michel and Valenzuela dispense what they can.

Another patient suffering from a foot injury is having a tough time walking. Sesli Watson, a case worker, promises a cane; she’ll drive back later to deliver it. Another regular patient is presented with a pair of size 14 tennis shoes that Beare’s friend in San Diego recently donated. “Nobody ever has shoes big enough to fit this patient,” the doctor said. “He’ll be stoked.”

But the team can’t magically replace vital documents, nor can they offer immediate housing. Caseworkers can help patients go through the process of replacing their birth certificates or other government-issued identification, but that can take a while. Back at the clinic office, lead case manager Victoria Worthy works on getting as many people as possible on a wait list for housing. “But if we get them IDs and those get taken, that’s a problem,” she said. Without identification, people can lose their chance at housing.

Street Medicine Teams Offer Lifesaving Services

Street medicine teams like the Clinica Sierra Vista crew have never been more important, said Marc Dones, policy director at UCSF’s Benioff Homelessness and Housing Initiative. They provide lifesaving services by resupplying vital medication or medical supplies, hospitalizing patients with severe mental or physical health conditions, and finding medical respite care facilities.

Dones, who formerly directed a countywide program to end homelessness, says they’ve seen cities spend more than $30 million on so-called “clean ups” that Dones calls displacement. “It is very straightforwardly the case that displacement costs more than a lot of other strategies that we could use,” they said. “And if you converted that displacement-based budgeting into short-term rental assistance, for example, that would do a lot more for a lot of people.”

As for Beare, he recently embarked on a new strategy. Historically, he has treated city officials and law enforcement coolly, as if an invisible wall existed between them and him. “I never wanted my patients to think I was working with law enforcement. I want my patients to trust me,” he said.

But because the sweeps have become so prevalent and destabilizing for his patients, Beare reached out to the city manager’s office and requested a meeting. He acknowledges that city officials are under a lot of pressure from everyone — including nearby homeowners — to remove the encampments. His initial conversation with city officials a few days prior gave him hope. “They seemed to be interested in doing the right thing,” he said, his eyes drifting toward the city trucks at work.

“Street medicine programs are uniquely situated to reach out to cities in exactly the way Dr. Beare did,” said Schneidermann. “Health care can’t solve the homelessness crisis alone, but street medicine teams are a crucial link to help connect people to services, including housing.”

Encampment Resolution Tools

New resources offer help to cities struggling to balance the needs of people experiencing homelessness and people who live near encampments. The UCSF Benioff initiative published encampment resolution tools that focus on connecting unsheltered people to stable housing instead of displacing them through sweeps.

In Los Angeles, local agencies have been working collaboratively on resolution techniques. For example, Inside Safe in Los Angeles has moved nearly 3,100 people from encampments into interim housing since December 2022. Nearly 700 of their clients are now permanently housed.

Back in Bakersfield, John, an unhoused man wearing a Betty Boop t-shirt waiting patiently to see the doctor, doesn’t expect the city to try anything new. He figures sweeps will continue.

“[The city workers] actually seem to enjoy doing this to us,” John said. “And a lot of people out here already have mental health issues. To me, it’s just the definition of torture to take what little we have — especially like this.”