Even from a distance, the man slumped over in his wheelchair at the edge of MacArthur Park looked discouraged, beaten down, ready to give up. Around him in the drug-ridden patch about two miles from downtown, other homeless people sat on the sidewalk on a blistering 95-degree March day, hoping for handouts of water and food. Inside the park, people are seen openly using fentanyl and injecting methamphetamine.

When a trio wearing “USC Street Medicine” T-shirts approached the man in the wheelchair, his face lit up and he greeted them enthusiastically. He knows they are lifesavers.

Three weeks before, someone had doused Gary (not his real name) with butane, then set him on fire. Gary spent 3 days in the ICU before being released from the hospital but was far from recovered.

Burns from the attack covered 5% of his body surface. The USC Street Medicine team — Katia Cnop, DO, the program’s associate medical director and a clinical assistant professor of family medicine at the USC Keck School of Medicine, Los Angeles; Miguel Nila, LVN, a nurse and caseworker; and Raymond Luna, a community health worker — got to work. After listening to Gary’s heart and lungs, Cnop applied new dressings to the burns that covered much of his back.

Gary has been in a wheelchair for about a year, Cnop said, due to heart failure with reduced ejection fraction and cardiac cachexia. He also has sarcopenia, weakness, and severe malnutrition. He has opioid use disorder, using fentanyl regularly. He’s over 6 ft tall but weighs around 100 lb. He told the team he hadn’t eaten in 2 days.

Gary sat patiently while Cnop worked. “I trust you to do what you are going to do,” he said softly. Gary appears to be in his fifties, but Cnop confided he is just 34, visible proof, she said, that addiction ages.

Sidewalk Salon

The team gave him food and water, but discovered a new, urgent issue. Lice had infested Gary’s hair. The team moved fast, rolling him over to the street medicine vehicle, parked across the street, where they quickly set up an impromptu hair salon.

With a protective gown on, Cnop cut his hair as Nila made sure the gown was keeping out the pests and Luna searched for hair supplies in the SUV. “I don’t want to be bald!” Gary cried.

Cnop reassured him he won’t be. Calming down, he told the team he used to have long black hair “past his butt” and a playlist of thousands of songs. Cnop didn’t fall for the entire youth rocker story. “What!” she teased. “You’re a strawberry blond.”

With no shampoo on hand, Cnop rubbed gauze over his hair to banish the lice, rinsed his hair the best she could, and applied permethrin cream. Not the best remedy to kill lice, she said, but the available one.

“Thank you so much for doing this,” Gary told the team. “You’ve saved a lot of people’s lives. You’ve saved mine.” Cnop shot back: “You’re not going to die on me, friend.”

The team spent nearly an hour with Gary, much longer than with most patients, Cnop said. But need dictates the time. Typically, these “office visits”’— usually conducted on the tailgate of the team’s Chevy Silverado — are much briefer. They have to be, to keep up with the numbers.

“People are usually happy to see us,” Cnop said. Often, they are happy not just for the vital sign check-ups but for the delivery of needed medications. Before this day’s run, the team had gathered multiple bags of medications hanging at the street medicine offices, each marked with the patient’s name. The hope was to find that person at the same place they were the last encounter, which is not always reality.

A Large and Mobile Patient Pool

Homelessness has declined in both Los Angeles County and the City of Los Angeles recently, but the numbers are still overwhelming. According to the Los Angeles Homeless Services Authority, 72,195 people in the region were homeless in 2025, including 43,695 in the city.

Deaths among the homeless have declined slightly, but the numbers — six a day — are still sobering. In 2024, the most recent year for which data are available, drug overdose was the leading cause of death on the streets, followed by coronary heart disease, transportation-related injuries, homicide, and suicide.

USC Street Medicine provides a major source of healthcare for the homeless in Los Angeles. Brett J. Feldman, MSPAS, PA-C, his wife Corinne Feldman, MMS, PA-C, and two others co-founded the program in 2018. Both Feldmans are also clinical associate professors of family medicine at USC Keck School of Medicine.

Feldman is in his 20th year of providing healthcare to the homeless. He started his career with Lehigh Valley Health Network in Allentown, Pennsylvania, and was director of street medicine there, before moving to California. His outlook on the homeless is both realistic and loving.

“There are always people trying to help them and always people trying to get rid of them,” Feldman said in a recent interview. “We all hate homelessness,” he added. The goal is to convince people “to love the person separate from their housing status.”

Model Program

The USC program has a staff of about 45 clinical and nonclinical staff who provide an average of 1300 visits a month. The clinical personnel include two primary care physicians, a psychiatrist, and an HIV specialist, along with physician assistants and a nurse practitioner.

The annual budget is about $6 million, Feldman said, with funding from the City of Los Angeles along with institutional funding, grants, and partnerships.

The program is held up as a model nationally and internationally. Jim Withers, MD, who coined the term “street medicine” in 2004, is founder and director of Operation Safety Net, a Pittsburgh street medicine program. He is also founder of the Street Medicine Institute, an international organization in which the Feldmans are also active.

“He’s like the kid who’s more talented than the parents,” Withers said of Feldman. “We just celebrate what he does and try to keep up with him.”

“The USC program is absolutely a model,” agreed David Munson, MD, medical director of the street team for the Boston Health Care for the Homeless Program. The initiative is exemplary “both in terms of how they provide care to such a large, complex population of people experiencing unsheltered homelessness [and] how they have been leaders in advancing the coordination and training of street medicine programs across the country,” Munson added.

Ready to Quit Fentanyl

Earlier that day, Cnop’s team went to another location within the five-mile radius they cover within the city’s Council District 1, which cuts through parts of northeast and northwest Los Angeles. Four other teams cover other areas. HIV and psychiatric specialist teams also offer care.

They had an appointment with a man who said he was ready to quit using fentanyl. They waited, hoping he would show. Within minutes, Gordon, 26, in a black LA Raiders hoodie, rounded the corner and smiled as he recognized them.

Taking his seat on the Chevy’s tailgate, he shared his past. A heroin habit, a bad driving record, prison time. “I crashed four cars and lost my driver’s license,” he said. Now, he smokes fentanyl daily and takes two alprazolam daily. “If I continue this, it’s not going to end well,” he said.

“We can deal with the Xanax after the fentanyl,” Cnop reassured him.

Gordon sat as Nila took multiple blood samples and Cnop asked more about his health history. She explained the details of a new program to get off fentanyl. He said he was ready. The team signed him up for his first injection on the detox program the next week.

Direct-to-Inject

The USC team has begun using a new method to get people off fentanyl, called direct-to-inject. Cnop called it “very fresh” and effective. Recent publications explain the concept. Unlike previous approaches, the injectable-only overlapping buprenorphine protocol does not require prior sublingual dosing.

Cnop offers her patients the 2-day San Francisco method or the 3-day Seattle method. The Seattle method allows patients to continue to use fentanyl on days 1 and 2. It replaces older methods, which patients find uncomfortable and difficult as they have to remember detailed instructions.

Cnop said she has had success with the patients who have gone through the treatment so far: 83% of the 48 people who began treatment completed the 3-day regimen, and 56% stayed clean through month 4, she said. With the older methods, fewer than 10% would complete the induction phase, she noted.

The Team: Smooth Riding

The team, riding for 6-plus hours together each shift, have an easy back-and-forth. On the street, they operate as a smooth team, helping and looking out for each other.

Cnop, who is board-certified in family medicine and addiction medicine, is perhaps the most health-conscious on the team, thinking twice when Luna offers her a curly fry. She clearly loves the pace, jumping in and out of the vehicle constantly. The position “allows me to be a full-scope family physician,” she said.

Luna connects with patients quickly as he freely shares his story: a family he called dysfunctional and his history of addiction and crime, including a 3-year prison term for conspiracy to distribute meth. But now, at 47, he has been clean for 10 years. “I found redemption in Christ,” he said.

His job, he said, is to keep people safe.

In the field, the teams use coded language to alert each other to danger. “Red pen” means there is imminent danger and a need to pack up and leave. Saying “yellow highlighter” signifies caution, best to leave soon.

But Luna’s bouncer persona has a softer side. He proudly shows off his cell phone photo of his 19-month-old baby girl, whom he also credits with keeping him sober.

At 29, Nila is the youngest on this team. Dedicated, warm, and focused, he works quickly and quietly, taking patients’ vital signs. He is also a caseworker and had recently helped a homeless woman gather needed documents so she could get a phone. Soon after, her encampment was swept, and all the documents were lost. They would have to start all over, he said, and not for the first time. He looked discouraged as he talked about it but not defeated.

A Day for Firsts

After lunch, the team headed to the Cecil Hotel. Sitting on the border of the city’s “Skid Row,” the Cecil has a dark past of death, mystery, and fears of hauntings and now provides housing for the homeless. They had an appointment with a couple who had moved in that day. Soon, Jane; 34, and Scott, 45, both tattooed and dressed for the heat wave, headed over to the Silverado with their pit-bull mix. Jane let him talk as they take turns holding the dog’s leash. “I’m super excited,” he said. “I’m ready for this new phase of life.”

The pair had passed the preliminary workup and were ready to get off fentanyl, getting their first injection. That workup includes a medical, psychiatric, and addiction history to assess risk during the induction process, and what each person’s withdrawal process typically looks like and what mental health concerns they may face.

Both listened closely as Cnop explained the procedure. Scott sat on the tailgate first for the injection, then Jane. Cnop gave them a handout detailing the process and a list of support medications, including trazodone, loperamide, clonidine, and hydroxyzine. She reminded them to call her with any questions. “In a week you will feel sober,” she tells them.

Hope for Homeless Healthcare

Some recent advances have made street medicine easier to provide, experts in street medicine said. A 2023 regulation from the Centers for Medicare & Medicaid Services established street medicine as a reimbursable model of care.

A new California law authorizes managed care plans under Medi-Cal to contract with field medicine providers, including street medicine teams, so homeless patients can receive care regardless of network assignment.

Despite the massive number of unhoused people in Los Angeles, the team sometimes struggles to find patients. Usually they can treat between seven and 13, Cnop said, but the roster this day is lower. Besides Gary, the Raiders’ fan and the hotel couple, the team found a 61-year-old man with chronic obstructive pulmonary disease. An earlier stop at a recycling center, where someone said they would be, came up empty. “Sometimes you strike out,” Cnop said.

Homeless patients without phones or computers have difficulty keeping track of appointments or even the date. Encampment sweeps by local police and other government agencies often result in people not being where they told their healthcare team they would be.

“Ever since the Grants Pass decision, sweeps have ramped up,” Feldman said, referring to the 2024 Supreme Court ruling that local ordinances that impose penalties for camping on public land do not constitute cruel and unusual punishment of homeless people. “When people are swept, we can’t find them,” he said. “Treatment gets interrupted. They lose their communities that are supportive. They lose the medication we are giving them. In addition to healthcare, whoever is helping them with housing also can’t find them.”

The paradox is frustrating. Cities and counties are investing hundreds of millions of dollars in solving homelessness, “while at the same time perpetuating it though sweeps,” Feldman said.

From a policy level, he said, “street medicine can be very bipartisan.” People who see the overwhelming mental health and substance abuse issues point to the need for treatment.

Then there’s the forced treatment camp, he said. “Whichever angle people come from, street medicine makes sense,” he said. “People are in favor of treatment.”

Addicts fall into that camp, too. “People typically don’t enjoy being addicted to substances,” Feldman said. “It’s very uncomfortable. After a while, they really don’t even get high. They are just trying to stop from getting sick.” He calls drug treatment “a fairly easy sell.”

Tenacity, Explained

Before wrapping up the shift for the day, the team went to a drive through to get a hamburger for Gary. As they circled back to the park to deliver the food, two men who had been sitting nearby stood up — not to help, but likely to steal. As Cnop had told him earlier: “You’re easy to be taken advantage of. It’s not fair.” Luna intervened, grabbing some supplies from the Silverado to hand to the men.

Before leaving, the team gave Gary a red bag for storing food and supplies and Cnop wrote her phone number on it. She told him, as always, to call her if he needed anything, no matter how late. She reminded him, as she did all the patients, that she always sleeps with her phone by her side.

Editor's Note: "Gary's" burns covered 5% of his body, not 15% as originally reported. The total budget for the USC Street Medicine Program is roughly $6 million. 

The sources in this article reported having no relevant financial conflicts of interest.

Kathleen Doheny is a freelance journalist in Los Angeles.