By Richard Halstead, Marin Independent Journal -
County health officials should consider creating a "sobering center," a safe place where public inebriates could be taken to sober up instead of being sent to a hospital emergency room or the county jail, the Marin Civil Grand Jury concluded in a report issued Thursday.
"A sobering center for Marin County can provide a more humane alternative," the grand jury said, and would likely "generate cost savings and improved efficiency for both county law enforcement agencies as well as for local hospital emergency departments."
Larry Meredith, director of the Marin County Department of Health and Human Services, said, "I think it's a thoughtful perspective, and one we want to take a little more time to reflect on."
Meredith agreed a sobering center would be a more humane approach to dealing with inebriates; but he questioned whether such a center would provide any cost savings to the county.
Marin County Sheriff Robert Doyle said he hadn't yet read the report, but he also expressed skepticism regarding cost savings for his department.
"The booking of public inebriates is just part of what we do in the county jail," Doyle said, "so I really doubt there would be significant cost savings."
Jon Friedenberg, the Marin Healthcare District's chief fund and business development officer, was more enthusiastic about the grand jury's recommendation.
Friedenberg said, "These are people who have no reason to be in the emergency department. To have somebody occupy a bed for four to 10 hours for no medical reasons whatsoever but just to sober up so we can discharge them is a grotesquely inappropriate use of emergency services and health care resources."
According to the grand jury's survey of Marin law-enforcement jurisdictions, police picked up 1,198 people for public inebriation in 2011. San Rafael accounted for 406 of the bookings; Novato handled 205.
The grand jury noted that law enforcement officers are often required to take public inebriates with possible injuries, or who are so drunk they can't walk, to a hospital emergency department for screening and possible treatment.
Friedenberg said, "Federal law doesn't allow us to refuse them, nor can we discharge them as long as they remain intoxicated."
The grand jury stated that on average, public inebriates occupy four to five beds every day in county hosptials' emergency departments for up to six hours at a time, and more than 20 public inebriates are incarcerated in the county jail every week.
As recently as fiscal years 2006-08, 295 inebriates, an average of six a week, were sent to the Helen Vine Detox Center in San Rafael for sobering, according to the report. Starting in 2008, however, budget cuts curtailed use of the detox center for that purpose. In 2011, only 97 of the county's public inebriates, about 8 percent, were transported to sobering beds at the detox center.
By comparison, that same year the city of Santa Barbara, a city serving a population a third the size of Marin's, admitted 734 inebriates into its sobering center. The grand jury said a study of a Shelter for Public Inebriates in Grand Rapids, Mich., found that the shelter saved the local emergency facilities and Grand Rapids taxpayers more than $280,000 a year.
In its report, the grand jury applauded the efforts of Marin County's Chronic Alcohol Use with Justice Involvement Project for exploring interventions to engage Marin's chronic inebriates in more long-term behavioral changes. The task force consists of the San Rafael Economic Development Department, the San Rafael Police Department and Marin County's Office of the Public Guardian, district attorney, public defender and Department of Health and Human Services.
The grand jury concluded its report by recommending that Meredith and the Alcohol Use with Justice Involvement Project, with input from local law enforcement, prepare a cost-benefit analysis of a stand-alone sobering center in Marin County and secure funding for a center from the primary beneficiaries.
Some initial steps have already been taken in this direction. In July 2012, the county of Marin started providing funding for two sobering beds at the Helen Vine Detox Center, and Meredith said perhaps as early as next month another two beds will be made available at the detox center for sobering. Meredith said Marin General Hospital has donated $100,000 and Kaiser Permanente has provided $50,000 to help cover the cost of the additional two beds.
Friedenberg said that until recently, the parties interested in this issue — the county, San Rafael, law enforcement agencies, and local hospitals — have acted on their own.
"We really haven't been working together," he said, "and as a result collectively we end up spending a huge amount of money providing a less than optimal response."
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