Dr. James O’Connell, president of the Boston Health Care for the Homeless Program and a faculty member of the Boston University School of Medicine, has built an inspiring career as a “street doctor,” caring for homeless people on the sidewalks, benches, and bridges where they live.
A native of Newport, R.I., O’Connell was educated by the Sisters of St. Joseph of Springfield at St. Joseph's Parish Grammar School. He graduated summa cum laude from the University of Notre Dame in 1970 and received his master’s degree in theology from Cambridge University in 1972. After graduating from Harvard Medical School in 1982, he completed a residency in internal medicine at Massachusetts General Hospital (MGH).
In 1985, he began full-time clinical work with homeless individuals as the founding physician of the Boston Health Care for the Homeless Program (BHCHP), which aims to provide or ensure access to the highest-quality healthcare for all homeless men, women and children in the greater Boston area.
“After four years of medical school and three years of residency, I had thought my training was finally over,” O’Connell wrote in his recent memoir, Stories from the Shadows: Reflections of a Street Doctor (2015). “My education in homelessness and poverty was just beginning.”
The nonprofit program now serves over 13,000 people each year in two hospital-based clinics (Boston Medical Center and MGH), and in more than 60 shelters and outreach sites in Boston.
O’Connell and his colleagues established the nation’s first medical respite program for homeless persons in 1985, with 25 beds nested within the Lemuel Shattuck Shelter. This innovative program now provides acute and subacute, pre- and postoperative, and palliative and end-of-life care in BHCHP’s 104-bed Barbara McInnis House.
In 1987, O’Connell began the first multidisciplinary team to care for homeless AIDS patients; in 1991, he started the nation’s first racetrack clinic to serve migrant and homeless workers in the backstretch areas of Suffolk Downs Racetrack. Four years later, working with the MGH Laboratory of Computer Science, O’Connell designed and implemented the nation’s first computerized medical records system for a homeless program.
From 1989 to 1996, he served as the national program director of the Homeless Families Program of the Robert Wood Johnson Foundation and the U.S. Department of Housing and Urban Development. In 2000, he began an MGH-based “street team” that integrates and co-locates medical and psychiatric care for rough sleepers. MGH is the only private academic center to host such a team, O’Connell said.
Today, BHCHP is the largest and most comprehensive healthcare program for the homeless of the 240 programs around the country that are currently funded by the U.S. Health Resources and Services Administration. With a budget of $50 million (75% from Medicaid/Medicare, 25% from grants and philanthropy), the program has over 400 employees and has finished in “the black” each of the past 30 years.
O’Connell’s weekly routine includes 25-30 hours of clinical work caring for homeless persons at MGH and on the streets, 15 hours of administrative duties overseeing BHCHP, five hours teaching residents and students, and five hours in research.
An assistant professor of medicine at Harvard Medical School, O’Connell is also the editor of The Health Care of Homeless Persons: A Manual of Communicable Diseases and Common Problems in Shelters and on the Streets. His articles have appeared in the New England Journal of Medicine, the Journal of the American Medical Association, Circulation, the American Journal of Public Health, the Journal of Clinical Ethics and several other medical journals. He has been featured on ABC’s Nightline and NPR’s Fresh Air with Terry Gross, and in a feature-length documentary titled Give Me a Shot of Anything.
O’Connell has collaborated with homeless programs in many cities in the U.S. and around the world, including Los Angeles, London and Sydney. He has received numerous awards, including the Albert Schweitzer Humanitarian Award in 2012 and The Trustees’ Medal at MGH’s bicentennial celebration in 2011. He also advocates at local, state, national and international levels, and was invited to the Obama White House to represent the issues of homelessness during the debate on healthcare reform.
His research is devoted to addressing the marked health disparities borne by homeless persons, publishing papers on various dimensions of healthcare for homeless persons including mortality, risk factors for death, tuberculosis and AIDS, elder homelessness, addictions and street homelessness. His team’s current research is focused on the care of rough sleepers on the streets of Boston, and the financial and health outcomes of placing chronically homeless persons in low-threshold supportive housing, including utilization of emergency departments and inpatient services.
“Despite heartache and hardship, the work has never disappointed me. The medicine has been challenging and complex, and our patients have shown more courage and resilience than I ever expected,” O’Connell wrote in the president’s message on the BHCHP website. “The gratitude we receive moves us every day.”
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