The beds lie in neat rows in the dim light, elongated shallow bowls of heavy plastic, each cradling a waterproof mattress.
They’re built to contain the urine and vomit of drunkenness, then to be ready for service again after a quick wash and treatment with disinfectant.
In its first month of operation, Los Angeles’ Dr. David L. Murphy Sobering Center saw just 30 people through the crisis of alcohol intoxication severe enough to draw the attention of police or paramedics.
But the Center is located in Skid Row just east of Los Angeles City Hall, heart of a downtown homeless population that at last count approached 10,000. An estimated one third of that population is believed to be alcoholic.
“Once we have somebody in here, we can say, ‘Are you willing to take that next step? Are you willing to go to a residential facility where you can stay for 30 days. We’ll take care of that for you,’” said Lezlie Murch, senior vice president for programs at Exodus Recovery, which runs the center.
“Imagine if you’re living on Skid Row, and you’re homeless. If you are detoxing, maybe you’re doing it in your tent, or on the street, or in jail. How are you going to move toward long-term sobriety for yourself, even if you’re willing? It’s overwhelming. That’s the advantage of this kind of controlled environment.”
Advocates say this center is much more than a 21st-century drunk tank. It is run by medical professionals, not cops, and there are no criminal charges associated with a stay there. The center can help up to 50 people at a time and eventually expects up to 8,000 visits a year. In separate recovery rooms for men and women, the lights are kept low to promote a restful environment, and there are private accommodations for people who can’t bear to be in a group. There are showers, washing machines and driers to help people get cleaned up, and round-the-clock staffing by nurses, mental health professionals and addiction specialists.
The approach has its roots in US Supreme Court rulings and federal laws dating from the late 1960s and early 1970s that established alcoholism as a disease and that sought to emphasize treatment, said Shannon Smith-Bernardin, deputy director of the San Francisco Sobering Center and a co-founder of the National Sobering Collaborative, which sets standards for centers nationwide. Still, she said such centers are rare. California has just six, Smith-Bernardin said: in San Diego, San Francisco, Santa Barbara, Santa Cruz, Alameda County and Los Angeles. She said efforts to establish new centers are underway in San Mateo, Contra Costa and Napa counties.
In opening their $4 million Center in January, Los Angeles County Board of Supervisors members said they hope its addiction-centered programs will achieve what other such facilities have done – save government money and steer the people it serves toward a decent life.
Murch said public safety personnel are just learning of the new facility as she and her colleagues brief them at fire and police stations.
One advantage for law enforcement is that referring someone to the center frees officers from the time-consuming task of citing people for a public intoxication, Murch said.
Similarly, being able to drop people off at the sobering center could save Los Angeles paramedics a lot of time. When an ambulance crew brings a severely intoxicated person to an emergency room, the hand-off can take as long as six hours, county documents show. There are about 8,000 such visits a year, but county officials hope the sobering center will help them cut that by more than half, saving $9.6 million dollars annually.
Figures that Smith-Bernardin prepared for Los Angeles County show further cost savings. A stay at the San Francisco center costs less than half the expense of an emergency room visit, Smith-Bernardin’s findings show.
“It just makes sense,” said Yolanda Vera, an aide to County Supervisor Mark Ridley-Thomas, who sponsored the Los Angeles plan.
“The emergency room isn’t designed to give these individuals even references to services they might need to treat a chronic problem.”
Vera said Mitchell Katz, director of the county’s Department of Health Services, strongly supports the plan. So do downtown commercial organizations whose members see their businesses harmed by throngs of intoxicated people in their neighborhood.
Clement Yeh, medical director at the San Francisco Fire Department, said his city’s sobering center saves paramedics 1,400 to 1,500 emergency room visits a year. He noted that the savings far surpass avoiding that initial visit.
“We have people that we may see in the 911 system for acute intoxication multiple times,” he said. “We may bring that one person to the emergency department dozens of times for the same type of issue. We find that when we bring them to the sobering center, they get great care and they get their sobriety needs met in a way that improves the chance that they’re going to break that cycle.”
Smith-Bernardin believes that a sobering center can help people best when there’s no legal penalty associated with a referral. That’s the model Los Angeles has adopted as well.
But Deni McLagan, program director of San Diego’s serial inebriate program, said frequently, California Penal Code 647 F, which makes public drunkenness a misdemeanor, can make the difference between life and death.
San Diego’s sobering center, which opened in January 2000, is the state’s oldest. Under its program, anyone police or paramedics take to the center five times in a 30-day period is deemed an abuser of public services and faces jail time. McLagan says just as with drug courts that give people a choice between rehabilitation and incarceration, “coerced treatment” is often necessary.
“If I left my dog out in the rain, and I didn’t feed it, and I didn’t care for it, and I didn’t take care of its health, and I knew that it was eating poison, a police officer could take my dog and arrest me,” she said. “But we can treat human beings like that. I can’t tell you how many people who have come through my program who say, ‘This is the first time anybody has cared about me.’”
“The problem is that alcoholism is a problem that you will deny having and refuse treatment for. I agree that just arresting people doesn’t do any good and even adds to public costs. That’s why we don’t just arrest people. We arrest people and offer them an opportunity to solve their problems.”
Vera said Los Angeles officials may change their approach as they track data regarding how the Skid Row center affects demand for police and emergency medical service. They’ll take note of whether a stay at the center makes demonstrable changes in people’s lives.
Drinking a beer outside his tent a couple blocks from the center one recent morning, Joe Pavlovic, 56, said he does expect it to help.
“I’ve seen people lying in the street drunk, and sometimes they die there before the cops or an ambulance can get to them,” he said.
“If this takes the load off of them some, so they can get to the really serious cases in time, that will be great.”
Ronald McCray, the Skid Row center’s recovery supervisor, said his own experience shows that there’s no substitute for a calm setting and conversation with somebody committed to freedom from addiction. McCray says that’s what saved him from crack cocaine 15 years ago.
“I’ll let them know, ‘I‘ve cried those same tears, I felt exactly the way they’re feeling now,’” he said. “I tell them, ‘You don’t have to feel that way any longer, if you don’t want to. But there are some things that you must do to get better.”