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Finding a safe place: Searching for a solution to handling public inebriates in protective custody

Taking incapacitated inebriates off the streets and putting them into protective custody might seem like a simple act of compassion, a lifesaver in Alaska’s cold climate enshrined in state law, but it comes with some problems.

Among the issues that the state’s behavioral health advocates and public officials are wrestling with in 2016: How do we provide appropriate, safe places for people to “sleep it off” if jails or hospitals aren’t the right place? And can we afford sleep-off centers?

Part of Title 47 in state law directs police and other patrollers to take custody of public inebriates and deliver them to an approved facility if the person is unable to care for him or herself and has nowhere else to go. In communities without a designated sleep-off center — including Fairbanks, the largest city in Alaska without one — there are often only a couple options left under the law: a hospital bed or a jail cell.

Officials across Alaska, including Fairbanks Mayor John Eberhart, have good reason to be concerned that those options could become more limited or unavailable altogether. Sleep-off centers like the ones in Anchorage, Bethel and Ketchikan seem to be the preferred solution, but Alaska faces a challenge in funding such facilities, let alone building more of them, as legislators work to bridge a multi-billion-dollar budget shortfall.

Fairbanks is just one example of a community where the need is apparent.

The Fairbanks Community Service Patrol has grown to be able to take the majority of incapacitated people off city streets, freeing up city police. But without a sleep-off center, increasing numbers of people taken into that type of protective custody are ending up at Fairbanks Memorial Hospital and Fairbanks Correctional Center, creating an added burden for both.

At its worst, though, the protective custody process has put some of those at-risk Alaskans in further danger. That includes Gilbert Joseph, whose death in late August at age 57 while in non-criminal custody at the Fairbanks jail was noted in an independent review of the state Department of Corrections released by Gov. Bill Walker in November.

The report’s authors, one of whom, Dean Williams, was recently appointed commissioner of the Department of Corrections, said Gilbert never should have been taken into custody at the jail in the first place.

“Mr. Joseph was highly intoxicated and did not appear to be medically stable enough to be detained in a prison setting,” the report states. “He was unable to walk or stand.”

Joseph’s death is just one example in the report of how protective custody for inebriates — mandated by a law that is sketchy on the procedural details — can fail the people the law is designed to protect. Other stories of highly intoxicated Alaskans who died behind bars support the report’s recommendation to change state law to stop the practice of taking them to jail for protective custody holds.

“Placing responsibility on prisons for the safety and wellbeing of medically unstable individuals puts a significant burden on corrections staff, puts the affected individuals at risk, and elevates liability exposure for the prison system,” the report states. “Developing appropriate alternatives with current resources will be a challenge, but this change would improve prison safety and reduce risk to affected individuals, prison staff and the prison system.”

Health care providers say medical facilities are a better option for inebriates with medical issues that need treatment, like they are for anybody, but that using hospital beds for protective custody holds is more expensive than a sleep-off center and not always necessary.

Simply put, taking drunks without medical needs to a hospital, for example, means hospital staff and beds are occupied by those people and that there is less availability for actual patients.

In Fairbanks, the number of intoxicated people getting taken to the hospital with no need for immediate medical treatment is putting a strain on hospital staff, said Mark Simon, a doctor in the Emergency Department at Fairbanks Memorial Hospital.

According to Community Service Patrol data, patrollers made 1,505 deliveries to the hospital in 2015, more than a third of their program’s total number of transports for the year.

“You have a certain amount of resources, and that involves people and rooms,” Simon said. “If you’re dealing with an intoxicated person who has no medical issues, that’s an opportunity lost to be taking care of other people. And that goes for everyone, from the doctors to the nurses to the nurses aides. Everything.”

“In the ideal world, if you acknowledge there’s this population you’re going to take protective custody of, it would be good to have a designated final stopping point, where there is a place that’s prepared to deal with them,” Simon said. “It’s not difficult to imagine a system that is better for all of our community resources … as well as a benefit to the recipient.”

Success in Bethel:

The city of Bethel was abuzz recently for the start of the Kuskokwim 300 mid-distance sled dog race, with people flying or snowmachining in from other towns and surrounding villages. Hundreds crowded around the starting line on the bare ice of the frozen Kuskokwim River for a few hours after dusk that Friday night to cheer on the dogs and mushers in 30 to 40 mph wind and single-digit temperatures.

Though the Southwest Alaska city of about 6,300 people is on the cusp of allowing alcohol sales for the first time in 40 years and has issued two liquor licenses, stores had yet to begin selling alcohol as of late January.

Still, alcohol finds its way to Bethel and has for years. Chronic alcoholism, binge drinking and drinking in public are problems Bethel continues to experience as much as anywhere else in Alaska.

On patrol that night, Bethel police officer Clifton Quinn pointed out a man sitting on some outdoor stairs attached to the Alaska Commercial Company grocery store, his head down. It’s a common spot for people to get out of the wind and drink, Quinn said. Sometimes officers or the local Community Service Patrol find people passed out there.

That’s where the Bethel Sobering Center comes in.

The Sobering Center is run by Yukon-Kuskokwim Health Corp. and receives the majority of its funding from a state grant. According to the health corporation, the Sobering Center’s annual budget of a little more than $1 million is funded by a roughly $820,000 state grant and about $201,000 from the corporation.

There would be other costs to the Bethel community without the sleep-off center, though.

Quinn and his superiors at the Bethel Police Department said the Bethel Community Service patrol and the Sobering Center take a huge burden off the police officers in terms of dealing with non-criminal local inebriates, who would otherwise draw time away from more desperate calls for service. Hauling someone to jail for a protective custody hold, the officers said, requires having the person cleared by medical staff at the hospital and makes the process much longer than simply dropping them off at the Sobering Center, where staff are trained to do that screening.

The idea of a sleep-off center was new to Quinn, who worked as a police officer for 10 years in Georgia, where he’s from, and has only lived in Bethel since September.

“I’ve never seen people drink the way they drink in Bethel,” he said. “It is just amazing how many do it and how bad they do drink.”

Early in his overnight shift, a dispatcher sent Quinn to a house on Bethel’s east side where a drunken man was pounding on the front door. The residents did not want him there, the dispatcher told Quinn.

Quinn parked in the small driveway in front of the house, and the Community Service Patrol van pulled in behind Quinn’s police SUV.

After telling the man he needed to leave, Quinn asked how much he had had to drink. About half of a bottle, the man said.

“I’ll go. Can I go with CSP?” the man asked.

“Yes sir,” Quinn said, helping the man off the front steps and into the service patrol’s van.

Quinn had his hand on the man’s shoulder to steady him. At one point the man said, “Get off me,” but that was as testy as the encounter ever got.

Asked why the man seemed familiar with the process of getting picked up and taken to the sleep-off center, Quinn gave a simple answer: “One of our regulars.”

A couple hours later, at about 1 a.m., Quinn helped get some others away from a house where the residents no longer wanted them hanging out. Two went in the Community Service Patrol van, one went with another officer and all three ended up at the Sobering Center.

Handling the inebriates:

At the Sobering Center, the staff processed the clients one at a time while others slept on mats inside a mostly dark room with a dozen surveillance cameras and a wall of windows from which the staff kept watch.

The center’s technicians, as they are called, are all either trained as emergency medical technicians or emergency trauma technicians. As with all clients, they took the new arrivals’ vital signs, gave them breath-alcohol tests and did a general medical screening. They also made sure the incoming clients did not have anything dangerous in their pockets and put their personal belongings in a locked cabinet. Finally, the staff gave them blankets and directed them to the sleep-off room full of mats, one side for women, the other for men.

The situation with the trio brought to the center early that morning is typical for inebriates picked up in Bethel.

Often, the inebriates taken to the Sobering Center are not homeless but have come to town from somewhere else, gotten drunk and been kicked out of a home they’re visiting, Kevin Tressler, the center’s director, and Richard Robb, Yukon-Kuskokwim Health Corp.’s director of residential services, said in an earlier interview.

Police or the Community Service Patrol bring in the majority, but some people are delivered by taxi after passing out while getting a ride or they walk to the center looking for a place to stay, Tressler said.

Some stay for a night and are never seen again, and some are known as regulars.

“There’s a lot of individuals we know on a first-name basis,” Tressler said.

“First name, middle name, last name, shoe size,” Robb said, laughing.

Robb, who has spent most of his adult life living in Bethel, recalled what it was like before the Sobering Center began operations in 2011. Police were spending more time picking up drunks, many harmful only to themselves, and there was sometimes a long wait for others trying to get emergency medical care at the hospital.

The health corporation’s statistics show a shift, too: Before the Sobering Center, about 22 percent of emergency room visits were due solely to a patient’s alcohol intoxication. In 2015, those visits were down to 4 percent. Yukon-Kuskokwim Correctional Center had been averaging more than 100 protective custody holds per month, and by 2015 the jail staff were seeing averages closer to 20 per month.

Some critics of Bethel’s Community Service Patrol and Sobering Center say those services amount to babysitting drunks, Tressler and Robb said. They disagree with the view.

“I don’t think we’re enabling anybody,” Robb said. “I think we’re proactively dealing with the issue and helping folks, which helps everybody else.”

If there are other options, Robb added, let him know.

“Because this is the other option,” he said.

Also, aside from taking some of the burden off the local hospital and jail, technicians at the Sobering Center are better positioned to help chronic inebriates start to think about drinking less, Tressler and Robb said.

While the person is getting cleared to leave — when a breath test shows they are sober or after a maximum of 12 hours — a technician can offer a hot snack, like an instant Cup Noodles. Tressler said that is a good opportunity to ask the person questions from a standardized questionnaire called Screening, Brief Intervention, and Referral to Treatment, SBIRTS for short.

Along with streamlining how they refer people to more focused treatment for alcohol abuse, Robb said the Sobering Center has had progress just from conducting the SBIRTS. People are not necessarily giving up drinking completely, but they start to recognize the harm caused by excessive alcohol consumption, he said. That can be accomplished simply by asking questions about how much they drink and what they drink — in some of the most dire cases, rubbing alcohol or, like Gilbert in Fairbanks, hand sanitizer — but the process also helps identify what further treatment a person might need.

From 60 to 70 percent of the inebriates brought to the Sobering Center stay for the SBIRTS, Robb said. Tressler pointed out a chart where technicians keep track of how many they have conducted every month, and it’s a point of pride to have the most.

National data show that 40 percent of those who go through the SBIRTS process have reduced what is considered harmful drinking after six months. Tressler admitted that a similar statistic is difficult to compile for Sobering Center clients, because a person might go home to any one of the 58 villages in the region that the health corporation serves and most do not return for a follow up, so that rate could be higher or lower for Sobering Center clients.

Whether they seek further treatment or not, the center is at least keeping some of the community’s most at-risk residents alive, Robb said.

“Another measure of success, to me, is every time somebody wakes up and walks out that door,” Robb said. “They lived through the night. They didn’t freeze to death, and they weren’t victimized by a crime.”

It is especially enjoyable to see someone go from Sobering Center client to treatment and on to holding down a regular job, as they’ve seen in some cases, Tressler said.

“To really move them in the right direction, I mean, that’s rewarding,” he said. “That’s the best part, is being able to improve your community.”

Despite the Sobering Center’s value to the Bethel community, Robb and Tressler said they are a little worried that state funding will dry up as legislators seek to make cuts while grappling with a multi-billion-dollar budget deficit.

Raymond Daw, the health corporation’s behavioral services director, said he did not think the corporation would be able to fund the Sobering Center without the state grant.

“Behavioral health overall is going to get a cut,” Daw said. “How that cut is distributed over grant programs is something we’re watching.”

Nowhere to go in Fairbanks:

It is unclear how a sleep-off center would be funded in Fairbanks, but some see a need for one in the city.

According to figures from the Fairbanks Community Service Patrol, the total number of transports by the patrol has grown in recent years, as has the number of individuals transported.

Compared with the period from 2009 to 2013, the data show a huge spike — more than two times as many per year — in the number of transports in 2014, when the patrol increased the number of hours it operates and expanded its service area from downtown to citywide.

In the Community Service Patrol’s early years, city police officers still handled about half the calls for inebriates in public, and since their work is more spread out and reporting is different, it is difficult to say how much of the increase in the patrol’s transport numbers is attributable to the patrol’s expansion. According to the Fairbanks Police Department, the Community Service Patrol now handles about 90 percent of the calls.

But with the patrol’s staffing and service area more consistent from 2014 to 2015, there was still a jump from one year to the next: The patrol conducted 3,573 total transports in 2014 and 4,127 in 2015.

Of those, 36 percent went to Fairbanks Memorial Hospital in 2015, up from 33 percent in 2014. Fairbanks Correctional Center was the destination for 29 percent of the total transports both years. The data also show that the total number of unique individuals transported increased from 606 in 2014 to 639 in 2015.

n 2015, 20 percent of the transports resulted in inebriates taken home to the care of a consenting adult, and 14 percent went to the Gateway to Recovery Detoxification Program. The detox program is run by Fairbanks Native Association and has, at most, eight beds for alcohol patients, but it is designed for a roughly three-day detox, not the shorter protective custody holds.

David van den Berg, executive director of the Downtown Association of Fairbanks, which oversees the Community Service Patrol, said there appears to be more incapacitated public inebriates now in Fairbanks since the patrol’s beginning, even if the data before 2014 are somewhat unreliable.

“We would feel pretty safe in saying that it is going up,” van den Berg said. “There’s more people needing this type of care than there have been.”

Van den Berg said he was not optimistic that a sleep-off center would result in less drinking among the hardcore drinkers the patrol picks up, but he said Fairbanks would probably benefit from having a better place to take them.

Some people say it is a travesty to hold a person against their will at the jail for being drunk outside, van den Berg said.

“But that type of brass tacks, hands-off is going to result in people dying, because these guys are total babies out there on the street, and they need help, a lot of them, to not die,” he said. “There’s a view that says you’re just prolonging their ultimate demise and it’s very expensive, so go ahead and let them.

“And that’s the tension, I guess, is to respect their constitutional rights and if they die, they die, or don’t respect their constitutional rights and protect them in spite of themselves, and we have Title 47 that says, ‘Yeah, let’s protect them in spite of themselves’,” he said.

In the wake of the report issued in November, van den Berg said he has been in meetings where local stakeholders expressed concern that Fairbanks Correctional Center will need to resist taking in as many people for protective custody holds or will someday take none at all to limit the Department of Corrections’ potential liability. One person likened the problem of picking up street inebriates to flying an airplane.

“As soon as you touch ’em, it’s like a plane that’s in the air, and it has to have a place to land,” the man said.

For the Community Service Patrol, the possibility of more pushback from the jail or hospital would make the mission of getting incapacitated people out of the life-threatening cold nearly impossible, van den Berg said.

“You wouldn’t want to go looking for them. You wouldn’t have anywhere to take them,” he said. “I don’t know what a sleep-off costs, but it’s been discussed for years. All things considered, it seems like the way to go.”

Eberhart, the city of Fairbanks’ mayor, agreed and said he has been talking to behavioral health experts about how to go about getting funding.

“I think this is definitely something that we need to address and that might be a very important missing piece of this continuum of care,” Eberhart said.

Asked if he is concerned that the Fairbanks jail might no longer take inebriates into protective custody before the city has another place for them, Eberhart said yes.

“I have been concerned about that, and I’m assuming the worst, that that will happen,” he said. “We need to start moving forward and seeing what can be done about that. … We’ve been talking about it for a number of years, and especially now.”

Diane Casto, deputy commissioner for the Department of Corrections, said a sleep-off center would be beneficial for Fairbanks, as well as other communities in Alaska.

But so would detox centers and other forms of treatment, and funding from the state is going to be hard to come by, she said.

Corrections officials, including those at Fairbanks Correctional Center, are not necessarily resistant to the idea of carrying out protective custody holds in the wake of the report released in November that was critical of the practice, Casto said.

Sure, Casto said, any institution wants to limit its exposure to liability, and putting non-criminal inebriates in jails that are already operating at capacity, where staff are busy and not always trained to deal with their hard-to-detect health problems, creates a potential for liability.

But the Department of Corrections’ goal is not to push back against taking those people into custody, Casto said. Corrections officials want to be part of a more comprehensive approach to substance abuse, in general, and the notion of holding inebriates in jails needs to be part of a broad discussion in that regard, Casto said.

They’ve also been focused on retraining staff on how to deal with the inebriates they continue to take into custody and reviewing that training, she said.

“We want to make sure that whoever comes into our care and custody, that we have the right place, the right skills, the right people and the right process to meet their needs,” Casto said. “And if we don’t, then they shouldn’t be coming into our custody, because it’s unfair to everyone.”

Originally published January 30, 2016 by Casey Grove in Fairbanks Daily News-Miner.

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