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Thursday, April 29, 1993 - Page updated at 12:00 AM

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Harborview Doubles As Shelter For Drunks - At Quite A Cost

Most inebriates cost Harborview about $350 a day - roughly five times what it would cost to put that same person in a sobering unit overnight. Some of these patients have returned to Harborview so often their bills reach $50,000. A few exceed $100,000 in unpaid care.

It's not even dark yet and the man is down, drunk. His head bends sharply against the curb, his body spills out into the street. He can't walk. He can't talk. He can't fend off the assault that most certainly awaits him - he's got money in his pocket and other street people know it.

Two Seattle police officers peer down at the man in Pioneer Square. It's a familiar scene - and so is the outcome.

Rather than send him to the King County Detoxification Center to sleep it off, the officers call for an ambulance. Detox is full.

The man is sent to Harborview Medical Center, even though he does not have a medical emergency, and even though it will cost taxpayers about five times more than a night at Detox.

This scene is repeated 17 to 20 times a day, sometimes more, and at costs that have made elected officials cringe and take notice.

Next week, King County Councilman Ron Sims will hold a committee meeting to review a comprehensive plan that includes everything from creating a flop house for drunks who have passed out on the streets, to establishing a network of housing and rehabilitation services for those who want to stay sober.

The proposal is expensive: $9 million a year. But supporters say that is half what the haphazard system now costs for ambulances, Fire Department aid cars, Harborview, jail, Detox and costs in public assistance for Social Security and Medicaid payments.

Harborview alone absorbs about $1 million a year in costs from inebriates who fill hospital beds when Detox is full.

That's because Detox has only 45 beds and most of those are for drug abusers or drunks who stay at the center between three and 21 days. Comparatively, there are about 1,000 street inebriates in King County, most in Seattle.

With so few beds and so many drunks, the spillover flows mostly to Harborview.

In the hospital's emergency room, two gray doors swing open to an urgent world of gunshot wounds, broken bodies, lost limbs and failing hearts. This is the region's trauma center, and the most critical cases end up here.

In the midst of it all, on gurneys that line the walls, drunken men and women moan or scream or curse or sleep.

"I want my pants!" howled one man as attendants tried to removed his soiled clothing.

"Your pants have got to be destroyed," responded a nurse. "They're foul."

The man reared up from his gurney: "Well, why don't you take me out and shoot me and get it over with."

His voice roared through the ward as the nurse tried to calm him. "No, no. I just want to get you some sweat pants."

The nurse walked away from him, shaking her head. "Von" was a regular. She knew his many moods and knew he'd be back another day.

That kind of intensive attention must be given while caring for the nearby emergency cases, which often involve life-threatening injuries.

Nurses and doctors must check on drunk patients every 15 minutes if they're restrained in leather straps, which most of them are, to prevent them from falling onto the floor.

"Some of them are so vile," said nurse Abbi Spilker. "For eight hours a shift, you listen to people who are just crazy drunk and it can get on your nerves."

Other patients are affected, too. Just outside the doors of their hospital rooms, the gurneys hold people too drunk to comprehend the severity of what's going on around them. Their howling cuts into the night.

Law requires that all emergency-room patients when admitted receive a thorough medical evaluation, even if it's somebody who's been brought in every night for a week.

"It becomes very labor-intensive," said Dr. James LoGerfo, Harborview medical director.

And very expensive. LoGerfo said most inebriates cost the hospital about $350 a day - roughly five times what it would cost to put that same person in a sobering unit overnight.

Some of these patients have returned to Harborview so often their bills reach $50,000. A few exceed $100,000 in unpaid care.

These expenses are passed on to other patients through higher fees for services, or to taxpayers, who pay for Medicaid. Harborview is a public hospital that relies mostly on funding from Medicaid and Medicare.

"Certain people know there are certain symptoms that will get them admitted," said LoGerfo. "But, where else will they go?"

Unlike other cities such as Portland, which has a no-frills overnight sobering unit for 75 people, Seattle doesn't have a place where inebriates can simply go and sleep it off.

Detox is oriented toward longer stays and rehabilitation. And, since 1971, when it became legal to be drunk in public, the jail's drunk tank has been closed.

In Seattle, the shadows are filled with street alcoholics. They beg, they drink, they pass out and many end up at Harborview.

"These patients have no advocacy," says LoGerfo. "We shove them somewhere and try not to deal with the problem. It's unconscionable."

That sentiment is shared in the Harborview emergency ward. Yes, these patients are frustrating and time-consuming. But they are in need, too, and that is not lost on the doctors and nurses who care for them.

Last week, under a totem pole in Victor Steinbrueck Park north of the Pike Place Market, nine Harborview nurses attended a memorial service for a patient they had known for years.

Clarence Winterhawk was a Harborview regular and although the nurses couldn't stop him from drinking, they could provide him friendship in an unfriendly world.

The nurses and others stood in a circle around Clarence's brother, Wayne. His eyes were rheumy with hard living and grief, tears spilling over his cheeks. He knelt to the ground and touched it with huge, worn hands. He stood and beckoned the sky.

Members of the Arapaho Tribe, Wayne and Clarence grew up in Wyoming. Together, they moved to Seattle. Life was a struggle for both, and Harborview became a secondary home.

"Wayne, we just want to tell you that Clarence was happy the night he died," said nurse Spilker, reaching out and taking his hand.

Wayne threw his head back and moaned. "God Bless you," he said, crying.

"He (Clarence) came in most every day," she added. "We cut his hair on the night shift, got him meals. He was great. He was funny. He loved Harborview.

"And we loved him."

Copyright (c) 1993 Seattle Times Company, All Rights Reserved.

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