An emergency medicine doctor is arguing that housing is the underlying cure for many of his patients' health problems — and Toronto's overloaded healthcare system — after he helped treat a man who lost his foot to frostbite while living in a tent this past month.
On top of the “extraordinary injustice” of a man losing his foot due to lack of housing, Dr. Raghu Venugopal warned that medical issues related to homelessness are putting excess pressure on an emergency room (ER) system already at the brink.
As a result, the entire patient population is suffering, he said.
As it stands now, precious medical resources and taxpayer dollars are being diverted to treat “entirely preventable” injuries related to homelessness, Venugopal argued.
The ER doctor claimed it would be cheaper to provide permanent housing to unhoused Torontonians, than treat injuries sustained from life on the street. Research from the auditor general of Ontario supports this idea.
Venugopal, who works out of three Toronto hospitals, said he was given written permission by his patient to share his story, though the patient’s name and the hospital where he was treated have been withheld for privacy reasons.
He said the incident occurred this January.
‘One of the worst things you can ever see’
Venugopal’s patient had been living in a tent downtown near multiple major hospitals when he began experiencing issues with his foot, the ER doctor told TorontoToday.
The cause of the issue was a constant “freeze and thaw cycle,” Venugopal said, in which the patient’s foot underwent numerous rounds of freezing and warming as the man battled the elements in Toronto.
The man had visited multiple ERs in the past, but when the underlying cause of injury and illness is related to homelessness, there’s only so much hospitals can do, Venugopal said.
By the time Venugopal met the man, his foot had undergone necrosis, an irreversible death of body tissue that often causes the affected area to turn black.
“It was one of the worst things you can ever see,” Venugopal said of the moment he examined the patient. “It was essentially a dead, infected foot.”
Along with the necrosis, the man’s foot was badly infected and had minimal blood flow.
“He was in a lot of pain,” Venugopal said. “This patient required broad spectrum antibiotics, painkillers, fluids, blood work, a CAT scan, and consultation with multiple surgical specialists.”
Doctors determined the foot could not be saved and the patient was admitted to an operating room for amputation.
“It’s the absolute worst outcome,” Venugopal said. The life-altering amputation will have a significant impact on the patient’s quality of life, the doctor added, making an already difficult life on the street even harder.
Venugopal’s patient has since been discharged from the hospital, and the ER doctor has not been able to contact him since.
Beyond the risk of infection to his stump, Venugopal said he’s concerned the patient will require a wheel-chair for the rest of his life. In Ontario, only 75 per cent of the cost of medical prosthetics is covered under the province’s Assistive Devices Program.
Maggie Helwig, rector of St. Stephen-in-the-Fields church, said she’s met numerous unhoused people who have lost limbs. The church runs weekly drop-in programs that provide warm meals to Torontonians in need.
“We get a number of people who come to our drop-ins in wheelchairs, who are unhoused and who have lost feet or legs, sometimes to frostbite, sometimes to circulatory problems or infections,” Helwig said. “Being homeless without the ability to walk … it’s obviously even more difficult than just being homeless.”
Unhoused people with mobility issues face significant barriers to accessing services, such as having to transit across the city, according to Lorraine Lam, an organizer with the Shelter & Housing Justice Network.
“Imagine you’re unhoused and you just lost a foot. You need to recover from the trauma of that and you’re still expected to somehow mission across the city to warming centres,” Lam explained.
“How many people have to lose limbs and die before we take this seriously?” she asked.
Toronto ERs "destroyed"
For Venugopal, the principle of caring for one's neighbour should be reason enough to provide immediate housing to those without a roof over their heads. But he said there are also economic and healthcare-based arguments for why Toronto should explore a housing-first solution to homelessness.
One reason is that “avoidable” injuries and illnesses caused by homelessness divert time and resources away from other patients, increasing wait times and potentially putting other patients’ lives at risk, Venugopal said.
“Sometimes we have patients brought in with no vital signs who are found in the snow,” Venugopal explained.
Cases of this magnitude require “the highest level of physician and nurse support,” Venugopal said. It’s an all-hands-on-deck situation, meaning other patients likely won’t receive timely care.
“You may come with [an injury], pneumonia, a heart attack, or a diabetic crisis, but all those things can wait when someone has no vital signs,” Venugopal said. “The general population wants this to never happen, because it will grind their ER to a halt.”
“Right now, ERs in Toronto are destroyed,” Venugopal told TorontoToday. “We’re constantly in a crunch for beds.”
In Ontario, the latest provincial data shows the average ER wait time is over 20 hours for a hospital bed — almost three times longer than the target eight hours. In Toronto’s busiest ERs, the wait can be up to 25 hours, according to data obtained by the Globe & Mail.
While homelessness didn’t create this problem — Ontario had nearly 50,000 hospital beds in 1990 but currently has about 35,000, the Trillium reports — Venugopal said providing housing can stop some medical issues before they happen, notably cold-related injuries.
In cases like that of Venugopal’s patient, in which an unhoused person comes in with a cold-related injury that requires operation, significant resources are drawn away from the rest of the patient population.
These patients require multiple doctors, specialists and nurses to attend to the individual, Venugopal said, displacing other patients whose medical needs “have nothing to do with homelessness.”
But the situation that occurs the most, Venugopal said, are examples in which unhoused people come to the ER with minor wounds or medical problems. While these issues can be resolved quickly, they do take time and resources.
These kinds of non-urgent ER visits tend to spike when the temperature drops. In Toronto, non-urgent ER visits among unhoused patients rose by 70 per cent during cold weather months, a 2024 study found.
Some unhoused people also resort to visiting ERs in the winter to stay warm, according to Helwig.
“Obviously this is increasing the burden on emergency services, but people are desperate for some way to get out of the cold,” she explained.
Housing as preventative medicine
Apart from the diversion of ER resources, people that require medical care due to homelessness do so on the taxpayer’s dime.
“It is extremely expensive to the taxpayer, to employ me and to employ ER nurses and to have the ER run,” Venugopal said. “In comparison, it's extraordinarily cheap just to provide people housing.”
A 2024 study estimates homelessness in Toronto accounts for excess healthcare costs to the tune of $70 million to $100 million annually. On top of that, Toronto’s shelter system runs a bill of about $780 million each year, said Gordon Tanner, general manager of shelter and support services, during an October press conference.
Social housing, government-assisted housing that provides lower-cost rental units geared to a person’s income, could provide a much cheaper alternative.
A 2017 report from the Office of the Auditor General of Ontario found the cost of providing social housing to one household was just $613 per month. Meanwhile, a shelter bed cost three times that amount, at $2,100 per month, while a hospital bed was 22 times more expensive, costing $13,500 per month.
Venugopal said he once had a patient knowingly commit a crime so he could go to prison and be off the street.
The same auditor general report found that the cost of one bed in a correctional facility was $4,300 per month, seven times more expensive than social housing.
For Venugopal, the importance of housing cannot be overstated as a form of preventative medicine.
“I recall one patient who for years would come to the ER with a lot of psychological distress,” Venugopal said. “The ER visits 100 per cent stopped when the patient got housing. It wasn't the doctors, it wasn't the nurses, and it wasn't the medicines. It was the housing that stopped the ER visits."
While Venugopal is calling on the provincial government and Ontario premier Doug Ford to fund more hospital beds, he believes housing could be just as, or even more, important to overall health than medical care.
“I can't be more appreciative of the incredible impact of housing on people's mental health, physical health and their use of recreational substances. It is just a silver bullet,” he said.