A growing number of deaths the Multnomah County Medical Examiner’s Office investigates are among people experiencing homelessness.
When Michael Jensen was found dead in his tent, his feet were sticking out of the tent, and he was lying on his right side “with his hands up under his chin like he was cold,” a homeless outreach worker said.
Temperatures for the day when Jensen was reportedly found deceased, either November 10 or 11, hovered between 50 and 44 degrees, with significant rain and gusty winds.
In the tent next door, Matthew “Little Bear” Gardipee drew a simple, horrifying conclusion.
“I think he froze to death,” Gardipee said.
It’s not clear whether or not that’s true. Jensen’s death would likely have been classified as “domicile unknown,” but there could have been other factors involved. Multnomah County Health Department and county medical examiners don’t typically release any information about, or comment on, specific domicile unknown deaths.
What is clear is that amidst a continuing, perhaps worsening, housing crisis, some people do freeze to death on Oregon streets. During a frigid, snowy cold snap in Portland during the first 17 days of 2017, six unsheltered homeless people died of hypothermia on city streets.
This winter was milder in Oregon, but not in Atlanta, Georgia. In a similarly deadly three week cold snap there, 11 died on the streets of Atlanta in January this year.
The deaths are a fraction of an estimated 700 unsheltered homeless deaths from hypothermia in the U.S. each year, according to the National Homeless Coalition. The coalition estimates the total “indigent disposition” or “domicile unknown” deaths from all causes is between 3,000 to 13,000, said Megan Hustings, interim director.
Some cities and counties, like Multnomah County, do the grim tally. Others, like Atlanta, don’t.
Since 2011, the annual “Domicile Unknown” report, a collaboration between Multnomah County and advocacy nonprofit Street Roots, provides a baseline analysis of such deaths for the Portland area — unlike most jurisdictions nationally.
Hustings at the National Coalition of Homeless said she was aware of a similar report in Sacramento, but few others.
“We are sort of the only ones who pay attention to this [nationally], to folks passing away on the street,” Hustings said. In 2010, the coalition studied hypothermia deaths nationally and found 700. It hasn’t replicated it since, so it’s not clear if anyone does such a study now.
Amongst those who died of cold in 2017, one woman’s death in particular touched Oregonians: that of Karen Batts, a 52-year-old African American woman struggling with mental illness who froze in a downtown Portland SmartPark garage, three months after her eviction from affordable housing for $338 in unpaid rent.
More than a year later Batts’ tragic death was trending on Facebook, presented as if it were breaking news in early 2018 by a website called Bloomsmag.com, a now defunct site linked on GoDaddy.com to a man named Muhammed Naeem.
“RIP Karen Batts, 52,” a Massachusetts man named Ed Shoemaker commented on Facebook January 30, apparently not realizing the news was a year old. Google trends showed a spike in interest in Batts’ death in early 2018.
How often do local domicile unknown hypothermia deaths occur?
In the wake of its 2016 Domicile Unknown report, released in December, the Multnomah County Health Department shared information with the Lund Report showing a total of nine hypothermia-caused domicile unknown deaths in Multnomah County in 2016 and 2017. Of those, six occured during the historic snowy deep freeze that killed Batts — but three were outliers, on days when temperatures didn’t come close to freezing, with low temperatures of 41, 45 and 50 degrees, according to the National Weather Service.
The first of those three outlier hypothermia deaths happened on September 25, 2016 — a few days after summer ended. The other two were March 25, 2017, and April 7, 2017.
Some of those who live amongst the more than 3,000 unsheltered houseless people in the four-county Portland metro area believe more people freeze to death than authorities say. Jensen may be an example, Gardipee says.
Oregon State Medical Examiner Karen Gunson says apparent signs of hypothermia, such as hands located near one’s neck, may not actually matter, scientifically speaking.
“That doesn’t really mean anything to us,” Dr. Gunson. Dr. Gunson said her team of death investigators carefully studies the scene of a domicile unknown death in addition to performing an autopsy.
Three possible indicators of a hypothermia death Dr. Gunson does rely on:
- Paradoxical undressing, which happened in Batts’ case. The dying person’s “thermostat is uncoupled,” Dr. Gunson says, leading them to feel overheated and to remove clothing.
- Wischnewski ulcers, a series of gastric mucosal erosions or ulcers. “If we see those, that gives us a huge clue,” Dr. Gunson said.
- Livor, or blood settling, which is bright pink. “After death, your heart isn’t beating any more, so your blood just settled by gravity,” Dr. Gunson explained. “Normally it’s a deep purple color after about eight hours or so. But from people who die from the cold it’s a bright pink, almost like carbon monoxide. That’s another clue.”
“You can die of hypothermia even if the weather is about 45 degrees or even 50 degrees, but you get wet,” Dr. Gunson said. “Many times the problem with homeless is they don’t stay dry.”
Alcohol is “particularly” a problem, Dr. Gunson said, because it can cause blood vessel dilation, on the surface of the body. The old trope about warming up with a stiff shot of brandy can be a killer.
Obtaining any information, even just dates, on these extremely sensitive cases can be tough. Dr. Gunson and other health officials work hard to protect such information.
“This isn’t really HIPAA,” said Multnomah County Health Officer Dr. Paul Lewis, referring to the Health Insurance Portability and Accountability Act of 1996. “The vital records data, if you’re not the next of kin, details about the death are generally considered private.”
“It’s called privacy, but it’s really respect,” Dr. Lewis said.
A whole sequence of events happens when a body is found outside: police and emergency medical technicians are called, death investigators often follow up, medical examiners do autopsy, notification of next of kin, cremation. The Oregon State Medical Examiner and Multnomah County Medical Examiner’s Office investigate “all suspicious or unattended deaths, including accidental or violent deaths or overdoses,” the 2016 Domicile Unknown report says.
Dr. Gunson said the scene investigation and finding family members are of paramount importance. “Those are the important steps we have to take,” she said. “We do not stint on them. We don’t cut corners.”
Yet Dr. Gunson’s offices operate on a finite budget while ruling on the official cause of death for about a thousand deaths each year on what she called “an antiquated system.”
“I would love to give everybody all the data they want,” Dr. Gunson said. “The thing is, that may or may not be important. It may be one of those things that it may help somebody’s research, but it will put me behind by two days.”
A growing number of deaths the Medical Examiner’s Office investigates are among people experiencing homelessness, the 2016 Domicile Unknown report states. In 2016, 32 people died in a public space, the report says.
In Portland, there’s a list of funeral homes who take the body, cremate and hold on to the remains, even if no one can be found to take them.
“It’s sort of remarkable how many [family members] will step up and take responsibility for their dead loved one,” said Dr. Gunson. “[But] there are other times when people say, ‘Well, we don’t have enough money, we don’t want to have anything to do with it.’ Then we have a system where we can contact one of the local funeral homes and they take what they call a ‘turn case.’”
Or there may be no family member to find. Jensen may have been in that category, Gardipee said — his mom had died not long before he did. “I think that was the only people he had,” Gardipee said.
While her job is to make clear-eyed, unsentimental conclusions based in the evidence, Dr. Gunson is not insulated from the emotional impact of her work.
“You always feel sad for somebody that dies alone in the cold,” Dr. Gunson says. “How could somebody not feel bad about that? You wonder, what could we have done differently to not make this happen?”
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.
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.
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.
This two-part series was first published in the Lund Report.