2003-10-16 -- Physicians for Effective Homeless Policies

Drs. Zevin, Quick and Wlodarozyk are doctors in the public clinics in
the Tenderloin and Bayview, but of course here are speaking as private
individuals.


From: barryzevin@comcast.net Date: Thu, 16 Oct 2003 05:05:08 +0000



Subject: Physicians for Effective Homeless Policies

Dear Physician colleagues,

The politicization of homelessness and health has taken a new turn for
the ugly. The supporters of Proposition M are manipulating information
about homeless deaths and citing support of San Francisco's physicians
as the main selling point of Proposition M. Proposition M is not good
for the health of homeless people. The Proposition mandates coercive
treatment of people caught panhandling without creating any new
resources. In these times of limited and diminishing resources that
means that treatment for the patients we identify as needing it and
best able to benefit from it will not be available.

Please review the attached editorial written by Bob Prentice, Dan
Wlodarczyk, Paul Quick and myself. Please email me a yes if you
support it and feel that you can publicly say so.  You will be added
to "Physicians for Effective Homeless Policies." If you need more
information please email me or call me. Please pass this on to other
physicians who live and work in San Francisco. Thank you very much.

Barry Zevin  415-205-0913



Taking Away Money Does Not Help Homeless People

As three physicians with two decades of experience working with and
treating homeless people, we are distressed by the continuous
politicization of homelessness, particularly recent initiatives that
propose punitive measures while claiming to be in the best interests
of homeless people.

Ballot initiatives that would take away cash assistance and outlaw
panhandling assert that denying sources of income will motivate
homeless people with addictions to enter treatment, and will reduce
the number of homeless deaths.  We realize that many people have grown
weary of the seeming intractability of homelessness, and of being
asked for money when they walk down the street, or pull their car up
to an intersection, especially when they fear the money will be used
to buy alcohol or drugs. We also understand the conflict between the
desire to be compassionate and the urge to just make it all go away.
However, there is little reason to take comfort in the notion that
measures conceived to be rid of the nuisance of homelessness will also
benefit homeless people.

A review of data on homeless deaths indeed portrays a troubling
picture. In the most recent, complete review conducted in 1999, about
half of all deaths of homeless people were attributed to drugs, and
just under 8% to alcohol.  Substance abuse accounted for a combined
60% of all deaths among homeless people.  When including the presence
of drugs or alcohol, although not necessarily the cause of death, the
figure for substance abuse has been more commonly in the two-thirds to
three-quarters range.

The claim that taking money away from people with addictions will
force them into treatment and reduce the number of preventable deaths,
however, contradicts our clinical experience. First, it denies the
reality that cash assistance does not always cover even the most basic
costs of living, and that people who panhandle often do need extra
money to make ends meet. In a list of Tenderloin residential hotel
prices compiled by the San Francisco AIDS Foundation, for example,
rooms range from $440 to $900 per month. On a General Assistance grant
of $395, it is impossible to live in a hotel for an entire month
unless it is in one of the limited programs with subsidized rents. Our
experience indicates clearly that homeless people's health improves
and their lives are more stable when they have adequate income.
Second, the argument understates the power of addiction. We have been
struck by how resourceful and desperate people can be when they have
to support an addiction. Denying one source of income will only result
in pressure to rely more on other means, such as commercial sex and
crime, which are worse alternatives for all of us. Third, the argument
reduces the motivation to enter treatment to the point of absurd
caricature. We have never heard any patient say that he or she wants
to enter treatment because they ran out of money. The life experiences
that lead to addiction are much more deeply rooted than a
simple-minded glass of cold water in the face can fix. Fourth, the
argument does not acknowledge the complexity of recovery, which is a
lifetime process that can include setbacks and failures. Making life
more difficult for people trying to recover is hardly a contribution
to their success. Fifth, the superficial notion that a motivational
quick fix is the key fails to take into account the inadequacy of
treatment systems for people who sincerely do want to overcome their
addictions. A large percentage of people who are addicted to heroin,
for example, would readily enter a methadone maintenance program if it
were available and free. Finally, the long-term solutions to addiction
and homelessness require a range of options and support from
detoxification and residential treatment programs to affordable
housing, accompanied in certain circumstances with support services
and money management.

As physicians providing health care to homeless people, we are acutely
aware of the limits of treating people one at a time. Our clinical
practice reminds us daily that what we see in our exam rooms is the
result of larger social policies that have worsened the conditions of
poverty. We often agonize over the contradictions of doing our best to
help people in a clinical setting, only to send them back into an
environment that does little to encourage stability or nurture their
best efforts to take care of themselves.

The ballot initiatives create mandated treatment without funding. This
diverts resources from those who our best clinical judgement says need
them most and would benefit most from them. We know that the people we
see in our clinical practice need decent housing, adequate incomes and
appropriate health care if they are to survive. Since commitments to
these principles do not characterize our current political climate,
the people we serve are left to fend for themselves under difficult
circumstances, and we often wind up practicing Third World medicine.

While we understand the impatience that leads to support for
initiatives like Proposition M, we persist in the hope that voters in
San Francisco will not yield to the deceit that it will improve the
lives of homeless people. That is the disingenuous invention of
political spin doctors, who do not represent a recognized branch of
medicine. We maintain faith that San Francisco can hold forth against
the cynicism that has taken over much of the state and nation, and
define the humane paths to ending homelessness and helping people
overcome their addictions. Please do not support initiatives that
disguise cynical and discriminatory policy as compassion.

Paul Quick, M.D.  Dan Wlodarczyk, M.D.  Barry Zevin, M.D.

This letter was signed by:


Josh Bamberger, M.D., Thomas Bodenheimer, M.D.,  Deborah Brown, M.D.,  William Cahill, M.D., 
Dan Ciccarone, M.D.,  Kimberly S.G. Chang, M.D.,  Janice Cohen, M.D.,  Joe Elson, M.D., 
Milton Estes, M.D.,  Richard Fine, M.D.,  Annalise Goldberg, M.D.,  Frederick Hecht, M.D.,  Sharad Jain, M.D.,  Leigh Kimberg, M.D.,  Jeff Kohlwes, M.D.,  Margot Kushel, M.D.,  Paula Lum, M.D.,  Meg Newman, M.D.,  Adam Nelson, M.D.,  Katie Olson, M.D.,  Terry Palmer, M.D.,  Michael Potter, M.D.,  Joe Roll, M.D.,  Dean Schillinger, M.D.,  Robin Serrahn, M.D.,  Ann Simons, M.D.,  Jacek Skarbinsky, M.D., Ahimsa Sumchai, M.D.,  Pamela Swedlow, M.D.,  Stephanie Tache, M.D., 
Alex Walley, M.D., Norma Jo Waxman, M.D.,  Barbara Wismer, M.D.,  Kay Yatabe, M.D.