Jeff’s Story
Produced for New Directions
A Program of the Hospital Council of Northern & Central California
Funded by the Frequent Users of Health Services Initiative
and The Health Trust, San Jose, California
June 2007
This is Jeff,
a 48-year-old
client of the New
Directions project
in Santa Clara County
Jeff was born and raised in the San Jose area,
where he also has spent most of his adult life.
After finishing
high school, Jeff
held a variety of jobs,
most involving light
manual labor.
Eventually he went
into business for
himself, washing
windows and
providing building
maintenance services.
Over time, however, alcohol abuse
and a lack of routine medical care
took a toll on Jeff’s health.
In his late thirties, he was diagnosed
with Type 2 diabetes, a condition that
went largely untreated.
Although he continued to work
off and on, Jeff frequently had no
place to live, and his unmanaged
diabetes spawned a variety of
serious complications – including
chronic foot infections.
Self-employed and
uninsured, Jeff relied
on the emergency
department at Santa
Clara Valley Medical
Center whenever he
needed to see a doctor.
During one
two-year
period, he
logged a total
of 35 costly
ED visits.
In May 2005,
Jeff was arrested
and charged with
fraudulently cashing
a $45 check.
He accepted a plea bargain and was sentenced
to eleven days in a county correctional facility.
While he was serving his sentence,
the sandals Jeff wore in place
of his own medically prescribed
footwear aggravated a pre-existing
abscess on his right foot.
By the time he was released from jail,
the wound had become seriously infected.
A few weeks later, surgeons at Valley Medical
Center amputated the big and second toes
of Jeff’s gangrenous right foot.
Now homeless, disabled and clinically depressed,
Jeff was placed in a convalescent home until
later that summer, when further
complications with his foot
again landed him in
the hospital.
This time, a New Directions
social worker contacted Jeff and offered to
enroll him in a program of case management services.
Over the next year,
Jeff’s complex health
problems persisted, and
his cumulative health
care charges increased
to more than $300,000.
But with the help of his case manager, he was
reconnected to a primary care physician, approved
for SSI and Medi-Cal, and approved for housing
assistance from the federal Shelter Plus Care Program.
By the summer of 2006,
he was living in his
own apartment
thanks to his
monthly rent
subsidy.
With a roof over his head and ongoing access
to outpatient medical care, Jeff’s health
has stabilized dramatically.
After years with no family contact, Jeff is back
in touch with his two sisters. He is attending
a community college, and he’s learning how
to use his new computer, which he hopes one day
will lead to an alternate means of employment.
And he hasn’t been back
to the emergency room or
the hospital in over a year.
Since the Frequent Users of Health Services
Initiative awarded its first round of grants in 2004,
New Directions and other programs like it have
provided intensive case management to some
650 frequent user patients in California,
preventing thousands of avoidable
emergency department visits.
With further expansion of case management
services – including systematic changes
in the way health and social service programs
are financed and administered – cost-effective
outpatient services could be provided
for thousands more.
Freeing up space in the state’s crowded
emergency departments for patients who are
truly in need of critical care…
…and improving the lives
of the people these programs serve.
People like Jeff.