Part II: Our Frozen Dead: Hypothermic ‘Domicile Unknown’ Deaths

A third of recent homeless hypothermia deaths happened when severe weather shelters were not open. Homeless advocates are looking for ways to prevent these tragedies.

Editor’s note: This is the second in a two-part series on hypothermic homeless deaths. Click here to read part one.

Ted Wheeler officially became mayor of Portland on January 1, 2017 — the same day as the first of six hypothermia deaths in Multnomah County in 17 days.

That spate of tragedies, among nine homeless hypothermia deaths in the county in 2016 and 2017, galvanized the region.

Portland and Multnomah County officials since steered millions of dollars into affordable housing units. The city-county Joint Office of Homeless Services added 100 additional winter shelter beds, bringing the total seasonal capacity up to 285 in winter 2017-2018, says spokesman Denis Theriault. That was on top of 1,300 year-round shelter beds.

But important questions raised by those tragic deaths still linger.

The six deaths happened during a deep freeze between January 1 and 17, 2017, when the local winter shelter system was open. But dates provided by county officials reveal that the other three hypothermia deaths were “outliers,” occurring on days when the temperatures didn’t dip below 40 degrees: September 25, 2016, March 25, 2017, and April 7, 2017.

Under current protocols, the severe weather shelter system doesn’t open unless temperatures fall below 25 degrees, or 32 degrees overnight “with at least an inch of driving rain.”

In other words, fully one-third of those who froze to death died when severe weather shelters weren’t open.

And the city-county joint office only contracts with Transitions Projects from Nov. 1-March 31 each year. Two of the nine deaths from last fell outside that period.

“Wow,” said Israel Bayer, the former executive director of Street Roots, mulling over the news that one-third of the hypothermia deaths occurred when severe weather shelters were closed.

“And it calls into question, are all of the first responders trained to do welfare checks on people experiencing homelessness during cold weather spells — to really understand the depth and severity of what we’ve got going on?”

He paused, reflecting.

“It’s hard.”

Can anything can be done to prevent such deaths from occurring in the future?

Weather is just one of several crucial factors.

“You wouldn’t expect to see a hypothermia death four days after summer,” Theriault said.

Multnomah County Commissioner Sharon Meieran notes that the tragedy of homeless people freezing to death is unfortunately “a challenge all major cities have been struggling with.”

“To my knowledge, there has not been any region where people are ‘doing this right,’” Commissioner Meieran wrote via email.

Nonetheless, Oregonians are working on several solutions, officials say.

“Government and nonprofits’ response [to severe weather] this year was more refined and coordinated than last year,” Theriault wrote in a statement. This winter, the county launched a pilot “to have a licensed medical professional available, from when the shelter opens until midnight, to assess if a guest needs immediate or next day medical attention.”

Under the pilot, 15 medical professionals worked in shelters for eight days in December and February. One of the 15 was Multnomah County Health Officer Dr. Paul Lewis.

Dr. Lewis wrote that he’s concerned primarily about three groups:

  • People who “aren’t functioning well and able to make good decisions about whether to access shelter, whether that’s because of hypothermia, because they’re intoxicated or experiencing a mental health crisis.”
  • People living outside “because they aren’t comfortable in large shelters, who are sometimes not prepared for the most extreme cold weather.”
  • People “we don’t even know are out there, because they’re so isolated and off the grid.”

“We weren’t seeing people with tents,” Dr. Lewis said. “It was a knapsack or less. It was horrible. I wouldn’t survive.”

The deaths raise other questions that stretch the boundaries of what could be considered health and housing. The legal strictures governing involuntary commitment, for example.

“Having seen what I see in the ER, I challenge the current status quo that people’s individual rights extend to the right to freeze to death when they clearly do not have the capacity to make rational decisions,” Commissioner Meieran wrote. “I’ve heard the saying ‘dying with your rights on,’ and for some I think this is a dark, accurate description.”

Sen. Floyd Prozanski, a Democrat who represents Lane and Douglas counties, is working on legislation to adjust the rules around involuntary commitments, Theriault wrote, “to help first responders and medical professionals better serve people who aren’t functioning well and who might be putting their lives at risk during severe weather by moving them to a safe place.”

But that option could lead to another potential pitfall: Oregon’s mental health system, ranked 49th in the nation last year:

“As long as involuntary commitment = Oregon State Hospital in our state (which is the current status quo), additional civil commitments alone will not solve the problem, even when people are truly at risk,” Meieran wrote in an email.

It can be hard to know where isolated houseless people are staying as temperatures dip or severe weather systems approach.

The Multnomah County Sheriff’s Office has stepped up efforts to use its HOPE team to reach isolated individuals who might be in danger.

One outreach worker at the Clackamas Service Center, Tiffany Grigg, often works long hours alone or with deputies from the HOPE team, serving hundreds of people living in the homeless camps of Multnomah and Clackamas counties.

Unfortunately, outreach workers are vastly outnumbered by the 3,052 unsheltered homeless people 2017 point-in-time counts identified in the combined four-county Portland metro area.

Oregon counted 13,953 homeless persons last year and is one of just four states in which more than half of those people live out of doors.

Advocates say people living on the street — or those who help them — are often reluctant to call law enforcement for what could be a life-saving welfare check.

Bayer, who is working on a book that includes a chapter about domicile unknown deaths, says distrust for police is a continuing challenge.

“This gets into weird, crazy dynamics,” Bayer said. “Some advocates are like, ‘Hey, don’t call the police,’ but if you need a welfare check, you need a welfare check.”

Key health barriers are also often part of the picture when someone dies of the cold. Bayer says more support for those struggling with addiction could make a difference.

“I continue to think we need to move forward to more harm reduction,” he said. “That could mean safe injection sites.”

But booze, combined with cold weather and unsheltered homelessness, can kill.

“Alcohol is particularly a problem [with hypothermia] because it can cause blood vessel dilation on the surface of the body,” State Medical Examiner Dr. Karen Gunson said.

“In the old days, they always said ‘Oh, let’s give them some brandy because they’re cold.’ [But] you’re dissipating heat at a more rapid pace.”

While solutions are not entirely focused on housing and providing warmth, shelters remain the first line of defense in preventing homeless deaths – and extra shelter is only available when conditions are harsh.

Currently, the Joint Office of Homeless Services declares a severe weather event when any of the following conditions are met:

  • Temperatures forecast at 25 degrees F or below
  • Forecasts predict at least an inch of snow in most areas
  • Overnight temperatures forecast at 32 degrees F or below, with at least an inch of driving rain
  • Other conditions, including severe wind chills or extreme temperature fluctuations

Dr. Gunson says maybe those lines should be redrawn.

“I think certainly if you’re dropping to freezing, and maybe if it’s just dropping below 40, you would begin to worry about the mentally ill, or those who don’t have tents,” Dr. Gunson said. “When the wind begins to blow at that temperature, if there’s rain or sleet, any time there’s precipitation, that’s a really bad combination.”

“Should it be a different one, like say, the temperature is below 40 and raining heavily? Or below 38 and raining heavily?”

Dr. Gunson points out, however, there’s only so much money to go around. Her office struggles to keep up with the rigorous procedures required for the total of approximately 1,000 annual autopsies and investigations her office does using an “antiquated” system, she said.

“I don’t want to sound heartless or anything, but if we look at [changes], would we have to take money from some other program that might also help [homeless people]?” Dr. Gunson asked.

The fight to reduce hypothermia deaths is unfolding on many fronts – which is necessary when tackling a problem that does not have a single solution, officials and advocates say. Supportive housing programs that offer not just shelter, but also services, can be expensive but studies have consistently shown they work.

Meieran, for one, is excited about a new recuperative transitional housing program in a former hotel on Southwest Barbur Blvd. in Portland. The program will provide wrap-around services to residents who are homeless and recently stabilized following a mental health crisis, a county webpage says.

Bayer believes if we could fund a broader range of affordable housing options “you’re going to have a lot less die.” But it’s a “pie in the sky” right now, he said.

Megan Hustings of the National Homeless Coalition lays the issue at the feet of President Donald Trump and Director of Housing and Urban Development Ben Carson.

“We don’t have public housing,” Hustings said. “The federal government’s spending very little on housing right now, and that just needs to change.”

Federal budget could yank the proverbial rug out from under the most thoughtfully-designed statewide, county and city programs. The White House budget cuts HUD funding 14 percent or $8.8 billion — despite the fact that the U.S. is seeing its first rise in homelessness since the Great Recession.

Vahid Brown, a housing director in Clackamas County, says hypothermia deaths are a reminder that homelessness isn’t just about housing: it’s a critical determinant of health.

“We just have to come to terms with the fact that houselessness is a threat to the life and safety of people who are houseless all year round,” Brown said.

Brown’s Village Coalition and others such as Square One Villages in Eugene advocate for homeless villages as low-cost, effective transitional approaches to homelessness that bring unique benefits like the “social infrastructure” of peer-based, self-governance.

Like shelters, they’re an example of a place where no one freezes to death.

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