Despite the evening hour, the sun beats down on our group as we gather to orient new participants to the street run. It’s a typical Spring day in Florida, with temperatures already in the upper 80s. We stand in a circle on a downtown sidewalk in our green t-shirts. In the center of our circle are bags filled with socks, toiletries, and naloxone, an opioid reversal medication. We’ll distribute these supplies to those experiencing homelessness during our 90-minute street medicine run.
Street medicine is a movement that provides medical care to the unsheltered homeless. Its fundamental principle is meeting people where they are, whether under an overpass, in an urban encampment, or in a park.
Our street medicine team comprises 8-10 medical students and a supervising physician. Every other Friday, we walk a loop through our city’s downtown, tracing sidewalks and parks where those experiencing homelessness tend to gather. Many people on the street have come to know our group and the services we provide. Others we meet are new to homelessness or the area, and for them, we have printed menus with the supplies we carry for them to choose from.
On the outskirts of a public parking lot, one of the few areas downtown with trees to provide shade, we see Mike. I’ve been seeing him on street runs for years. He’s still sporting a hospital ID band today, and his face is noticeably bruised. He tells us he was in a fight and went to the Emergency Room. He was diagnosed with a facial fracture but told he didn’t need surgery. We give him acetaminophen and ibuprofen for the pain and a pair of clean socks. Over the coming weeks, we’ll watch his swelling resolve and bruising fade. He doesn’t have transportation to the follow-up clinic on his discharge paperwork.
As we reach the corner across from the park, we see Jasmine in her usual spot. She has long-standing swelling in her legs. On each street run, we provide her with two clean ACE wraps. She’s been in the hospital for skin infections multiple times because her leg swelling is often so severe that it causes her skin to split open, so we also check her skin for signs of new infection.
As we walk our route, I wonder where Mike, Jasmine, and the other 17 patients we see that night will go come Fall. In March 2024, Governor DeSantis signed the Unauthorized Public Camping and Public Sleeping Bill, HB1365, which prohibits people from sleeping in public places, including the sidewalks, streets, and parks where we make street runs.
After the law takes effect on October 1, counties in Florida will need to set up designated areas for those experiencing homelessness to camp once homeless shelters are at maximum capacity. Florida is the state with the third highest population of individuals experiencing homelessness at 30,809. In 2023, the Department of Housing and Urban Development counted 18,815 shelter beds in the state. With homelessness increasing, primarily driven by rising housing costs and the end of COVID pandemic aid programs, we can assume the number of Floridians experiencing homelessness will continue to surpass shelter bed availability.
Details of how the law will be enforced remain vague. Counties held off on announcing plans for designated camping areas awaiting the Supreme Court’s decision regarding a similar law in Johnson vs. Grants Pass. The court ruled in favor of the city of Grants Pass, Oregon, finding that ticketing individuals for sleeping in public places does not constitute cruel and unusual punishment in violation of the Eighth Amendment. The decision paves the way for the Florida law to go into effect.
However, questions remain about implementation. The law requires the designated encampments to provide mental health and substance use treatment. At the same time, millions of dollars for nonprofit organizations that help the homeless were cut from the state budget this year.
Our team has additional concerns. Although the law details provisions for mental health treatment, substance use treatment, sanitation, and security, broader medical care is not addressed. Furthermore, the law stipulates that designated property for encampments cannot be adjacent to residential property and cannot “adversely and materially affect the property value or safety and security of other existing residential or commercial property in the county.” Meaning that the law will force the unsheltered homeless away from health care facilities.
Those experiencing homelessness already face multiple barriers to accessing health care, including lack of transportation, limited access to phones or computers for scheduling appointments, and concerns about leaving behind personal possessions while seeking medical attention.
Street medicine has evolved to fill a need to bring health care to the unsheltered homeless, decreasing these barriers by bringing medical care to where people are.
How will this need be filled going forward when it’s no longer legal to be unsheltered on the street?
Jennifer Caputo-Seidler is an internal medicine physician.
