Small group of vagrants costs San Francisco $20M 

click to enlarge Helpful data: The Homeless Outreach Team has been seeking out San Francisco’s most-frequent users of emergency health services in hopes of setting their lives straight. (Mike Koozmin/The Examiner) - HELPFUL DATA: THE HOMELESS OUTREACH TEAM HAS BEEN SEEKING OUT SAN FRANCISCO’S MOST-FREQUENT USERS OF EMERGENCY HEALTH SERVICES IN HOPES OF SETTING THEIR LIVES STRAIGHT. (MIKE KOOZMIN/THE EXAMINER)
  • Helpful data: The Homeless Outreach Team has been seeking out San Francisco’s most-frequent users of emergency health services in hopes of setting their lives straight. (Mike Koozmin/The Examiner)
  • Helpful data: The Homeless Outreach Team has been seeking out San Francisco’s most-frequent users of emergency health services in hopes of setting their lives straight. (Mike Koozmin/The Examiner)

A group of 477 individuals costs The City more than $20 million in emergency medical services in one year — 10 of whom racked up ambulance, emergency, detox and crisis psychiatric services to the tune of $2.3 million.  

Those figures have been compiled as part of a new Department of Public Health initiative to get a better handle on San Francisco’s most hardcore homeless population — individuals dubbed “high users of multiple systems” who in many cases suffer from debilitating psychiatric or medical diseases, and typically have severe dependence on alcohol or drugs.

The information about this population was unavailable until the past few years, when Public Health began gathering all the data it collects on clients into a single database, said Maria X. Martinez, assistant to the director of health.

To be counted among this group of high users of multiple systems, an individual must repeatedly need at least two of The City’s four emergency services: ambulances, hospitalization, detox or sobering centers, or emergency mental health services, she said.

In an analysis of data from July 2009 through June 2010, Martinez identified 477 individuals who used at least two of the services regularly; 62 used all four services regularly. Over the course of the year, 34 of them died. All had recently been homeless.

Martinez says understanding the chaos these individuals face in their lives will help Public Health better handle their treatment and contain costs.

“No matter how you cut it, these are expensive patients,” she said. “It’s one of those things where 20 percent of your patients take up 80 percent of your time.”

The City’s Homeless Outreach Team has begun seeking out these high service users, said Dr. Rajesh Parekh, director of the team.

“There’s literally times we find them close to death on the streets, and the first order of business is to get them to the emergency room because we need to save their lives,” he said.

Once they are medically stabilized, the team tries to help them find services. Sometimes, this means simply helping these patients find a primary-care doctor, fill out Social Security income forms, and get the right medication, Parekh said.

“For some people, if you take care of the medical or mental health problems, other things start to get better.”

Parekh acknowledged there are many failures as well. Many in this population are extremely resistant to services. But with patience and perseverance, even they can slowly be won over.

He pointed to paranoid schizophrenics they sometimes run into who believe that everyone they speak to is a government agent out to get them. Outreach workers keep showing up and talking to these people, slowly building trust until they begin to accept some help.

“After a while they say, ‘I still think you’re with the FBI, but maybe you’re not a bad FBI agent, you’re one of the nice ones,’” he said.


‘Wet housing’ is a potential solution

Rather than constantly rescuing The City’s most-severely disabled alcohol abusers from the street, some have questioned whether it would be better to provide them a stable source of housing — and a stable source of booze.

This concept, dubbed “wet housing,” has already become reality in Seattle and New York. The idea is to take the folks who are the largest drain on the emergency response system and put them in housing, where at minimum they can live in a safe place off the streets, receive three meals a day, and receive medical treatment. Tenants are allowed to continue their alcohol and drug intake, and in some cases staff even provides alcohol to the tenants like medicine. In Seattle, this program saved a few million dollars a year, and had some success in eventually rehabilitating the tenants — or at least helping them drink less.

Last year, then-Supervisor and now mayoral candidate Bevan Dufty floated a similar project in San Francisco; he said he proposed it to then-Mayor Gavin Newsom, who was interested in the idea but “a little wary of what the public reaction would be.”

Now Dufty has proposed a wet housing project as part of his platform for mayor. He sees the project serving about 200 clients, perhaps in a renovated building.

Dufty said it could vastly improve the experience of both the clients and the average San Francisco resident or tourist, who he said would see a notable decrease of gravely disabled inebriates in the streets.

“This could be an amazing success in the sense that these people are not injuring themselves, not dragging down a business district, not tying up the sobering center and emergency room and jail,” he said.


Revolving door

A Department of Public Health study of individuals who frequently use at least two of The City’s four emergency services — ambulances, emergency treatment at a hospital, mental health crisis services, or detox/sobering services. This study took place between July 2009 and June 2010.

47.8: Average age of the 477 frequent users

75: Percentage who were men

257: Homeless for more than 10 years

477: Frequent users of at least two of the four emergency services

65: People who overlapped in all four systems

332: People who overlapped in at least three systems

0: No documented history of homelessness

34: Died during the course of the year

Source: San Francisco Department of Public Health


Hit to the system

Here is the cost breakdown of the 477 highest users of emergency services.

5 More than $200,000
29 $100,001-$200,000
83 $50,001-$100,000
171 $25,001-$50,000
126 $15,00 -$25,000
63 $5,001-$15,000
0 Less than $5,000


Source: San Francisco Department of Public Health

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