Instead of an exam table, the patient sat in a lawn chair. And instead of a private room, the health care team saw the patient in a riverbed near graffiti-covered concrete under a bridge.

However, the key mission was achieved — delivering medical care to some of the most vulnerable residents across Santa Barbara County in hopes of avoiding the need for emergency room visits or hospital stays.

Last week, representatives of Dignity Health, the Santa Barbara County Public Health Department, CenCal Health and agencies involved in helping homeless residents met in Santa Maria to talk about street medicine in a conference room at Marian Regional Medical Center.

“Today, we are adding to our outreach program and collaborating with other community organizations to go where the homeless population is,” said Dr. Mouhanad Hammami, director of the county Public Health Department.

“Part of this is to figure out what are people doing already, what are the gaps in care that we need to fill and how are we going to do that,” added Dr. Will Chung, leader of Marian’s Family Medicine Residency Program.

The pilot program, which comes as the state launched an effort to address the homeless population’s health needs, will include a doctor accompanying a nurse and other personnel  for the first time to provide needed care.

In addition to providing critical care, the teams will make referrals to clinics or other services to get homeless residents the needed help.

As a population, homeless residents can be hard to reach and track since they move around frequently, which can affect getting services to them. 

The hope is that the program will address non-urgent medical needs and refer patients for other care to ease the burden on emergency departments at local hospitals, Hammani said. 

The effort will include sending a doctor from Marian’s Family Medicine Residency Program to provide training for treating a different segment of the population. 

“One of the big aspects of residency training is population health and how do we care for certain populations,” Chung said, adding that the residents already get training in treating geriatric, underserved farmworker and other populations.

“The homeless is really an area that we have not been able to address directly just because of all the challenges, the most obvious being they do not have a home. With that comes all of the social, racial and economic barriers,” Chung said. 

Chung connected with longtime Dr. Noemi “Mimi” Doohan after she became medical director of the County Health Care Centers, knowing she had significant street medicine experiences. 

“With the funding now available we decided this is the perfect opportunity to collaborate and not duplicate resources and understand what is out there within our  county,” Chung said.

“We know there’s a lot of people out there doing things. This is the perfect time for us to get together to collaborate with all the other agencies, all the other organizations so we are performing comprehensive full-scope care to this population.”

People who wind up homeless don’t always have issues centered on mental health or substance abuse, Chung added. 

Chronic medical problems for them don’t necessarily differ from the rest of the population — high blood pressure, diabetes and more — and many ended up homeless because of extenuating circumstances.

“You have to meet them where they are,” Chung said, “and that’s where you build the trust on the street, in the riverbeds. That’s where you really get to know what their personal barriers are.”

For Sue Andersen, Marian’s president and chief executive officer, involvement goes back to the nuns who founded the hospital 82 years ago, the Sisters of St. Francis.

“What they’ve left us with is that we need to take care of this whole community, no matter what, not matter who,” Andersen said.  “This fits right along with that. How can we take care of this population, actually keep them out of the hospitals?

“How can we get them healthy enough, get roofs over their heads and food in their stomachs so maybe they don’t have the health problem that a lot of them do?

“We’re really excited about all collaborating together here and trying to figure out solutions for this population.”