Dying homeless: Life on the streets often leads to an early death

In the hours and days after the discovery of the eighth homeless person found dead outside in the city last year, Petaluma Police detectives were looking for answers to what killed 60-year-old Michael Lee Patton, who was found lying face down on a downtown sidewalk just before Christmas.

When he was discovered by a passerby, Patton appeared to have a head injury. That and other factors meant investigators were not able to rule out homicide, not until they finished piecing together as much as they could of the final days, hours and, if possible, minutes of his life.

Since Patton was well known to many officers as part of the local transient community, they concentrated on the areas of the city that homeless typically frequent, seeking places he might have been or people who might have known him or seen him in his last days. Petaluma detective Sgt. Ed Crosby, who heads the department’s violent crimes unit, and Officer Bill Baseman, went to one such well-known spot: the park bench next to the Foundry Wharf business park that overlooks the Petaluma River.

In this picturesque setting, they found another homeless man they knew sitting on the bench teetering over, in what officers determined was a state of severe intoxication. It was almost the exact spot where one month earlier, the body of Leonard Smith, the seventh homeless person who had been found dead outside in Petaluma last year, was discovered.

“I said to him, ‘Do you know where you’re sitting?’” Crosby recalls asking the man, who police later took into custody. “He said, ‘I know.’”

That the irony was not lost on either man is part of their shared experiences. Crosby, a veteran of the Petaluma police force, had spent the last several weeks poring over police reports, combing through data, medical charts, interviews and other information as part of a review of what seemed like a disturbingly high number of homeless deaths in Petaluma, particularly over the last 20 months.

Patton’s death made it the worst year anyone can remember for the number of homeless people who were found dead outside. There have been 21 of these so-called unattended deaths in Petaluma since 2010. And while there has been no evidence so far that any of the deaths were homicides ­- an autopsy on Patton ruled out foul play - and a good deal that suggests numerous other causes, speculation among some in the community has centered on more sinister causes.

Crosby, who was tasked with reviewing the cases by Petaluma Police Chief Patrick Williams, set out in part to see if there were any similarities that connected the deaths but also to see if police might help prevent more in the future. But Crosby said everything he found pointed to a distressingly tragic fact, confirmed by a number of studies on homelessness published here and abroad: People who live for long periods of time without shelter, food, medical care and other basic human needs tend to die at a higher rate and younger age than the rest of the population.

“I can say with a fair amount of certainty that there is no evidence that a serial killer is at work here,” said Crosby. “Unfortunately, what we’ve found is similar to what is found in many other places. Certainly, it is sad but it doesn’t appear to be that unusual based on all the figures I’ve seen out there. The vast majority are dying of conditions that are, again sadly, not surprising for people who are chronically homeless.”

There have been 255 death investigations by Petaluma police since 2010, he said, meaning that about 8.2 percent of all deaths were of homeless people found outside. And while the numbers were highest this year, there was also a rise in deaths overall in the city over the same period. Police investigated 43 deaths in 2010, three of which were unattended and homeless; four of 40 in 2011; none of 48 in 2012; and six of 62 in 2013 before eight of 62 last year.

Crosby said he could only speculate as to what caused the jump (from 48 to 62) between 2012 and 2013, noting that it was likely linked to a number of things, including that Petaluma, like the U.S. population in general, has been aging.

And, while the deaths of homeless people have increased, so has the homeless population here, says Mike Johnson of Petaluma’s Committee on the Shelterless (COTS). Since about 2011, there are nearly twice as many homeless in the city, more than 900 according to some estimates. It is a sad reality, he says, that most of them do not make it into old age.

“You see very few old homeless people,” said Johnson. “It’s a very hard way of life. Living outside is absolutely guaranteed to kill you, a lot sooner than the rest of us.”

In fact, life expectancy for the homeless is far shorter than the rest of the population, which averages 78.7 years in the U.S. according to an October report by the CDC.

One Canadian study published in 2009 found homeless people die younger, even when compared to some of the more disadvantaged communities, such as the chronically poor. In the study, average life expectancy for a homeless person was 39 years, a number that tracked with research conducted in other parts of the world, including Germany (48.5), the United Kingdom (47) and Turkey (49). In Los Angeles the number is 48, and recent studies conducted in Denver and Sacramento found a range of 42 to 52 years.

While many factors contributed to the early deaths, the studies cited a number of commonalities, notably the difficulties posed from living outside and without shelter, including exposure to the elements, lack of good hygiene, decent food and clean water, regular access to medical care and, in urban areas, violence.

And while many suffered from the same medical conditions that affect the general public, such as heart disease, diabetes, smoking-related respiratory problems, cancer and mental illness, the homeless are far less likely to seek treatment.

Finally, many were chronic and acute abusers of alcohol and drugs, which can spark a whole host of problems effecting the heart, liver, lungs and brain.

All of these trends are reflected in what Crosby found in his research.

Citing a number of factors, including federal privacy laws that protect individuals’ heath care records, Crosby said he could not, without permission from their families, reveal certain information about the people who died, including if they suffered from specific medical conditions.

But he was able to provide a general breakdown of the 21 deaths here since 2010, of which three remain under investigation and three were pending lab results.

The average age of those found was 51 years, and nearly half were between the ages of 50 and 59. One person died of an apparently accidental overdose of medication, one by drowning that was also ruled accidental, four committed suicide, and nine were broadly classified as “natural” causes - a definition that includes diseases such as alcoholism, heart failure, aneurysms and cancer, to name a few.

Alcohol abuse appears to have had a significant impact on the health of many victims, even if it was not classified as the primary cause of death. In five of the nine deaths considered to have been the result of natural causes, Crosby said, the concentration of alcohol in their bloodstream - known as the BAC level - ranged from .25 to .50 percent. (The legal limit to drive is a BAC of less than .08 percent.)

Crosby said that while he couldn’t yet give specifics on the three deaths the cause of which was not yet undetermined, he did say that alcohol, depression or a combination of the two were likely contributing factors.

“So far, the totality of circumstances don’t speak to homicide, but we are still actively investigating two of the three cases,” he said. “We’ll go where the investigation takes us.”

Crosby said the most difficult part of reviewing the cases was finding out how little his department could have done to prevent them. He contemplates the conversation he had with the man who was practically passed out drunk on the same park bench where his friend had died.

“I told him if he didn’t stop what he was doing, he might end up just like Leonard Smith did. He told me he knew I was right,” said Crosby, adding that because the man had a BAC level of more than .20 he was transported to the county jail, where Crosby said he hoped he might seek help for his addiction.

“The vast majority are dying of conditions that the police department has no control over, it’s nothing we have the ability to affect. Unless people seek help and utilize the services available to them, there’s not much we can do.”

It is a reality that Johnson and the staff and clients of COTS face every day, particularly as they pass by the Japanese garden at the Mary Isaak Center where 143 stones mark the deaths of homeless people known to the center or its staff - including those of Michael Patton, Leonard Smith and the 19 other deaths investigated by Petaluma police over the last four years.

With the spike in recent deaths, the memorial has been a topic of conversation at the shelter, according to Johnson. But sadly, he said, few see it as a mystery.

“No, it’s not that unusual at all,” Johnson said of the deaths, adding that a large part of the homeless problem is tied to the lack of affordable housing and better-wage jobs that would help those people get back on their feet and have the means to succeed.

“It’s something we talk about, that changing your circumstances, that yes, doing the really hard work to move out of homelessness and make it stick is impossibly difficult. Believe me, it is very, very hard, but it’s better than the alternative. Because if you do not make a change, you are going to die out there.”

(Contact Elizabeth M. Cosin at elizabeth.cosin@arguscourier.com)