Preventable Amputations, Part 1: Why Are Young Homeless People in Kensington Losing Limbs?
Trigger Warning: This article contains graphic images and descriptions of severed body parts as well as content dealing with substance use and addiction.
Doctors in Philadelphia are opting to amputate unsheltered homeless drug users when there are alternative options. This relatively new phenomenon has been made worse by the raging Opioid epidemic and the stigmas attached to its victims.
We sat with professionals witnessing the injustice firsthand in Kensington, Philadelphia, to bring our readers the most accurate and up-to-the-minute accounts. Learn why young people enduring homelessness and battling addiction are losing limbs through avoidable operations and how we can fight back.
Steph’s Story: Amputated at 23
It’s a brisk morning, and Sarah Laurel, the Executive Director of Savage Sisters Recovery, has taken a break from her rigorous routine of providing trauma-informed care to people recovering from substance use disorder to speak on an important topic – the amputation of her friend Steph, and the emotional wounds that left her reeling.
“She was 23 years old and from the Philadelphia suburbs, someplace in or near Bucks County,” Laurel recalls. “She had a very severe open wound on her wrist, and she had attempted to go to the hospital twice.”
“The first time, they gave her a prescription for antibiotics and sent her on her way. The second time, they refused to treat her for the pain and again gave her a prescription for antibiotics. The folks at the hospital told Steph that she needed to get into a buprenorphine program, MAT. Steph refused because she wasn’t ready to do that, and they sent her on her way. Now, she’s an amputee. She lost her hand at a very young age.”
Laurel paused as the finality of it started to set in. Then she continued:
“Part of the advocacy work that we are trying to do at Savage Sisters is to urge hospitals and emergency rooms to treat the urgent need of saving the limb. And after treating that and saving the limb, then they can address mental health and substance use.”
“But refusing to treat the infection and treat the pain that comes along with that infection causes our friends to leave because they feel uncomfortable, stigmatized, and discriminated against,” Laurel said. “Steph’s life is forever changed at the age of 23.”
Steph’s story is emblematic of a growing and disturbing trend of amputating unhoused young people. According to experts, there appear to be two reasons this keeps happening. They are as follows:
- Some doctors are misinformed about the wounds their patients incur, and they genuinely believe the only life-saving option is to amputate. This is due to a misunderstanding of a drug called Xylazine and the complex wounds it can cause, which, with proper care, can be treated without amputation.
- Some doctors are influenced by a negative view of unsheltered homeless people as irresponsible. These doctors know there are other options, but they don’t trust their patients to care for themselves properly, so they amputate instead.
Either way, unsheltered patients are undergoing life-altering surgeries, having precious body parts removed, and, according to harm reductionist and anthropologist Kelsey León, most of them leave the operating table “feeling like they did not fully consent.”
Understanding Xylazine: A New Poison in the Toxic Drug Supply
Kelsey León of the Community Action Relief Project, who studies harm reduction and barriers to treatment in the Penn and the School of Medicine hospital, also has a story to tell. It is one of the toxic substance traveling through the already deadly Kensington drug supply. That substance is notoriously known as Xylazine.
“In Kensington right now, amongst people who are using the street dope supply, people are being exposed to a substance called Xylazine, which has filtered into the drug supply. This is an unintentional exposure,” León emphasized. “Nobody’s seeking it out, but it is in the supply.”
People suffering from substance use disorder in Philadelphia are dealing with the repercussions of Xylazine, often dubbed the “zombie drug” or “sleep cut.” The sedative is intended for use in animals but is getting laced into the drugs they are addicted to. The combination of Xylazine and Fentanyl is a notorious factor in recent overdose deaths.
“People are chemically dependent on the supply, so they don’t have a choice about what’s going into it,” León continued. “Xylazine is a veterinary sedative. It’s been associated with causing grotesque wounds on the body in humans. There are several theories as to why that happens, but the operating hypothesis is that it decreases blood flow to the extremities because it is a central nervous system depressant. So, you need blood flow to any cut or wound in order for it to heal. And if there’s less blood circulation, you’re getting less blood flow to the wound.”
“The way that’s manifesting on people, they will either get small, coin-sized wounds that are far away from the site of injection or an opening of old wounds,” León said. “Other times, some folks have chronic long-term limb-length wounds typically on the extremities, either on forearms or on the shins that we have seen in other spots as well. These complex wounds can involve exposed bone, exposed tendon, and lots of prevalent drainage. They can be malodorous.”
“For anyone you can imagine, this is extremely upsetting to have to live with, and it’s extremely isolating psychologically, even beyond the physical. It’s a lot to have to manage on top of managing your withdrawal and everything else that unhoused patients already have on their plate. So, the harm reduction community has supported folks with a walk-in clinic called Prevention Point Wound Care Clinic, which is a low-barrier clinic I used to work in.”
“You walk in. You can get dressing changes. You can get antibiotic prescriptions,” León continued. “Other folks are doing more street-side wound care. Just that compassion is, in itself, a pathway to care. These services are what are keeping these wounds from becoming worse because wound care supplies are extremely expensive.”
“Having providers who are compassionate and harm reduction-oriented is sadly much less common in the hospital and other medical clinics, and that’s where we’re seeing these injustices.”
Complex Wounds Caused by Xylazine Can Heal Without Amputations
“What we do know about these wounds is that they do heal,” León affirmed. “They’re quite disturbing to see, but the wounds will heal with regular dressing changes and barring any infection that would require IV antibiotics in a hospital stay.”
“Unfortunately, having a clean and private place to properly wash your wounds and access supplies is a huge barrier if you’re unhoused,” León said. “It’s extremely difficult to do these dressing changes if you’re doing them on the street and it’s super painful.”
“For unhoused people, there are options for getting wound care supplies, but those are time-constraint limited. Sometimes that doesn’t always match up with people’s schedules,” León continued. “So, when it comes to amputations, when folks do come into the hospital, many surgical teams who have not been treating these wounds street-side or in the community look at a wound like that and immediately think that it’s necrotic.”
“If there’s osteomyelitis, infection of the bone, or inhibited blood supply, their knee-jerk reaction has been ‘we need to amputate it.’ And tragically, that has caused people to have amputations and sometimes to receive these operations with what I would describe as less than informed consent.”
Death Over Dismemberment: Advocates Describe Would-be Patients Crawling Back Out onto the Streets of Kensington in Fear
It’s common to see folks in Kensington in wheelchairs, missing limbs, but that isn’t everyone’s story. Some people never make it that far, as we soon learned.
“There’s no way to describe the feeling of being rushed through an amputation procedure or kind of pressured into it,” León said. “The perceived coercion has sometimes resulted in people just leaving the hospital because they don’t want to have their arm amputated, and they’re not being given another option.”
Of course, that departure from the hospital doesn’t save them from the misery of the gaping wounds. It only makes them that much more likely to die.
“If you’re not being treated properly for both the withdrawal and the pain that you’re feeling because of the issue with your limb, you’re just gonna leave,” said Laurel of Savage Sisters. “I’ve seen so many people just leave and crawl back to Kensington Avenue because they’ll just do Xylazine on the street, and they’ll just submit to it. I know that sounds very difficult for people to hear and understand. But I think it speaks volumes to how medical systems in Philadelphia treat unhoused patients – if they feel safer on Kensington Ave than they do in a hospital.”
Stigma and Stereotypes About Unhoused People Play a Serious Role in These Amputations
We’ve spoken at length about the complexity of these wounds and the need for medical professionals to understand that there are options outside of immediately making amputations. However, many advocates concur that doctors are exhibiting biased, discriminatory practices based on their personal views about homeless people and people with substance use disorder.
Some say they are opting to amputate because they believe the homeless person won’t exercise proper wound care. Still others, like abolitionist harm reductionist Billy Ray Boyer of the SOL Collective, say it doesn’t matter whether doctors are acting out of willful ignorance or actual ignorance. They should, by this point, know what to do.
“I’m open to understanding that it’s complex and that it is a newer phenomenon, people having wounds of this scale and type,” said Boyer. “But also, it’s been long enough now. It’s as though people want to act like there isn’t like such a stigma in the medical setting toward homeless people, and drug users, and especially toward homeless drug users.”
Boyer goes on: “From conversations that I’ve had with people and from the conditions that I have observed on the street in Kensington, and in some medical settings, the idea that doctors are unfamiliar with these wounds and don’t know what to do is quickly becoming an outdated and unacceptable excuse.”
“Because people have had these wounds for a while now, and the feeling of people that I’ve spoken to is often that it was the only option that they were presented with, and they were not given much detail or any sense of the possible alternatives to amputation,” Boyer said.
“I wouldn’t even characterize it as stigma anymore. This is active discrimination,” said Laurel. “I think that we need to call it what it is. People are being discriminated against across the board in the medical systems, in treatment facilities, through housing, and on social media, and through this new web-weaponized political agenda against public health.”
*Urgent Reminder: At least 20 homeless people die on the streets of the US each day. Many of those deaths are preventable and a byproduct of the lack of access to sufficient, non-discriminatory healthcare.
Housing Has Never Been More Important to Healthcare Than it is Right Now. Contact Your Representatives.
Nobody should lose their legs, arms, or other body parts simply because they are unhoused. There are other options, not only for wound treatment but also for ensuring that all people live in houses. Tell your legislators that housing is healthcare and that our fellow humans deserve the irrevocable right to both.
Learn more in Part II in our Preventable Amputations series.
