Jim O’Connell and the Boston Health Care for the Homeless Program (BHCHP)

At the core of O’Connell’s treatment philosophy is the belief that medical professionals should strive to forge human connections with their patients. “We spend an awful lot of time getting to know our patients because we learned – mostly from nurses many years ago – that earning the confidence and trust of folks who have been scarred by being out on the streets, or in the shelters for a long time is bedrock for doing any kind of health care,” he told WBUR in 2024. “You have to try to be present in their lives in a really supportive way.”

Found His Calling by Chance

O’Connell gave up a promising (and lucrative) career in oncology to devote his life to treating people living with homelessness. Born into a working class family, O’Connell graduated salutatorian of his class at the University of Notre Dame, and later studied theology and philosophy at the University of Cambridge, where he was a teaching assistant to the historian and political theorist Hannah Arendt (1906-1975). After completing his residency in internal medicine at Massachusetts General Hospital (Mass General) in 1985, O’Connell received a fellowship from the Sloan Kettering Cancer Center in New York City. 

O’Connell agreed to defer the offer from Sloan Kettering when Dr. John Potts, chief of medicine at Mass General, asked him to spearhead a pilot program designed to integrate individuals living in material poverty into the healthcare system. Funded by the Robert Wood Johnson Foundation, the initiative became the foundation for the BHCHP.

O’Connell’s first assignment brought him to the Pine Street Inn, a shelter and healthcare services clinic in Boston’s South End. From the outset, O’Connell discovered that his extensive medical training had provided little preparation for treating people who lived in the streets. On the advice of Barbara McInnes (1935-2003), a public health nurse working with unhoused patients, O’Connell put away his stethoscope and focused on getting to know his patients. 

O’Connell spent his first two months at Pine street helping people soak their feet. While administering treatment, he asked them questions and listened to their stories. From time to time he recognized a patient he’d once seen at the Intensive Care Unit (ICU) at Mass General. Whereas these individuals had been resistant to care in the hospital, however, they proved open to treatment in the shelter. As he continued his work at Pine Street, O’Connell developed bonds with his patients unlike anything he’d experienced during his training. 

Devising an Unorthodox Treatment Program

After requesting a second deferral from Sloan Kettering, O’Connell eventually decided to become BHCMP’s full-time president. When the foundation grants expired in 1989, O’Connell received support from the state legislature, which approved Medicaid funding to continue the program. O’Connell used a portion of the new funds to acquire a van, enabling BHCMP to launch a mobile healthcare service.

Along with his Street Team, O’Connell spent his nights driving around Boston, visiting patients in alleys, under bridges and in other corners of the city. In addition to his doctor’s knapsack – which contained a stethoscope, blood pressure pump, ear thermometer and other diagnostic equipment – O’Connell also stocked the van with warm drinks, sandwiches and soup for his patients. 

By 1996, BHCMP was treating over 6,000 unhoused patients a year. In 2002, Mass General provided the organization with a facility where it could conduct a Thursday Night Street Clinic. Meanwhile, the program continued to expand rapidly. By 2019, BHCMP operated clinics at all 30 of the city’s homeless shelters, as well as two hospital clinics, on an annual budget of USD 60 million. In 2024, Mass General created a permanent facility for BHCHP personnel to treat individuals living in the streets – becoming the nation’s first major medical center to sponsor a designated clinic for unhoused patients. 

While O’Connell and his team provide an invaluable service, however, they can do little to solve the broader problems confronting their unhoused patients. Mortality rates among individuals living in the street remain far higher than the general population, while issues such as mental illness, material poverty and rising housing costs pose serious barriers to overhauling a healthcare system that falls far short for many marginalized groups. 

In the face of these harsh realities, O’Connell remains focused on his program’s core purpose: to deliver care that acknowledges the essential dignity of the patient. “Why did I feel comfortable with these people? I have no idea,” O’Connell told Barbara Moran in 2015. “But there was something about getting close to people and understanding how courageous they were, given their brokenness, that made you recognize lots of things in yourself. It meant that the distance between me and them seemed less and less as time went on.” For patients living in the street, the compassion and generosity of O’Connell’s mission is embodied in his determination to close this distance. 

Contributor: Stephen Meyer