The ambulance driver, Adam Lipinski, was a longtime veteran of similar scenes. Although the nearest emergency room was at Portola Hospital, twenty blocks away in the inner Richmond District, he knew both from rumor and personal experience that Portola was in an embattled financial state right now. Because it was forbidden by law to do otherwise, any hospital would have to take this victim into the ER and try to stabilize him somewhat. But if he was in fact homeless and uninsured, as Lipinski suspected, there was no way that Portola would then admit him into the hospital proper.

Lipinski wasn't a doctor, but he'd seen a lot of death and knew what the approach of it could look like, and he was thinking that this was one of those cases. After whatever treatment he got in the ER, this guy was going to need a stretch in intensive care, but if he didn't have insurance, Lipinski was all but certain that Portola would find a way to declare him fit to move and turf him out to County.

Last month, the hospital had rather notoriously transferred a day-old baby-a baby!-to County General after she'd been delivered by emergency C-section in the ER at Portola in the middle of the night, six weeks premature and addicted to crack cocaine. The mother, of course, had no insurance at all. Though some saint of a doctor, taking advantage of the administration's beauty sleep, had simply ordered the baby admitted to Portola's ICU, by the next day someone had decided that the mother and child couldn't pay and therefore had to go to County.

Some Portola doctors made a stink, arguing that they couldn't transfer the mother so soon after the difficult surgery and birth-she was still in grave condition and transporting her might kill her, and the administration had backed down. But it countered that the baby, Emily, crack addiction and all, would clearly survive the trip across town. She would be transferred out. Separated from her mother within a day of her birth.