Deaths of homeless people go uncounted in Oakland — and most places

Wilma Lozada (left), and outreach team member and Dr. Colin Buzza visit a homeless encampment near Lake Merritt in Oakland. Alameda County Health Services recently started a new street medicine program in which psychiatrists go into encampments specifically to provide treatment for opioid addiction and mental illness. less Wilma Lozada (left), and outreach team member and Dr. Colin Buzza visit a homeless encampment near Lake Merritt in Oakland. Alameda County Health Services recently started a new street medicine program in which ... more Photo: Michael Macor, The Chronicle Buy photo Photo: Michael Macor, The Chronicle Image 1 of / 5 Caption Close Deaths of homeless people go uncounted in Oakland — and most places 1 / 5 Back to Gallery

It had been weeks since Larry Joseph Botelho was spotted outside the box truck he lived in and kept parked near the Oakland airport. By the time someone asked police to check on him, the 63-year-old homeless man’s body was decomposing on a makeshift bed in the truck.

The Alameda County coroner’s office determined he died of natural causes. An investigator tracked down doctors, social workers and former employers, ran fingerprints, reviewed government records and an ancestry website, but found no relatives.

Botelho was cremated as an indigent — his ashes sent to Holy Cross Cemetery in Antioch, and his truck towed. Coroner’s case No. 01378 was closed.

Nothing in the official record shows he died homeless. His death certificate lists a home address: the spot on 98th Avenue where his truck was parked.

Like many local governments, Alameda County does not collect data on how many homeless people die each year or their causes of death. Even if it did, neither the state nor federal government tracks such data — or requires that it be collected.

Photo: Michael Macor, The Chronicle Dr. Colin Buzza talks with a resident of the camp during a visit a...

The Chronicle checked with coroners’ and medical examiners’ offices, county public health departments, the California Department of Public Health, U.S. Health and Human Services, and the Centers for Disease Control and Prevention and found that none had records on how many homeless people die — or mandates to collect the information.

The California Electronic Death Registration System, a database run by the state Department of Public Health, occasionally gets a death certificate where “homeless” or “encampment” is listed in place of a person’s residence, said spokeswoman Theresa Mier. But there aren’t any guidelines for doctors or medical examiners on when to use the designation.

Likewise, the U.S. Health and Human Services Department doesn’t have information or know of any national estimates on deaths of homeless individuals, said spokeswoman Carla Daniels.

Agencies that do attempt to keep track of how many homeless people die in their jurisdictions have no standardized guidelines or rules to follow. They rely on their own definition of who counts as homeless. And even if a person is clearly homeless, as in Botelho’s case, that information may never appear on the death record.

Once a homeless person dies — usually decades earlier than the U.S. life expectancy — investigators proceed with the same steps they do for any deceased person, said Lt. David Vandagriff, who runs the Alameda County coroner’s bureau.

First, they identify the dead. Next, they track down the family. Autopsies are conducted and reports are made. But a person’s housing status often does not make it into the official record.

If investigators can track down an address associated with the dead — where an estranged spouse lives or the place they would pick up mail — they often won’t be marked as homeless in the paperwork that documents how they died and who they were. If they find no address, they may write “homeless” or “transient” in that section of a death record.

“We are duty bound to show them respect and dignity,” Vandagriff said. “Quite often when we’re interacting with next of kin, we want to show them that this is not something that we’re judging your departed on. We’re not classifying them as anything other than a departed member of your family.”

At a homeless encampment beneath a highway overpass in West Oakland on a recent day, Danielle Golden ticked off the names of friends from the camp who died. She sat in a discarded recliner chair, not far from a tattered “homeless lives matter too” sign.

“Tamoo, Kilo, Chocolate, Spicey Mike, Ebo,” she said, just counting those she said died in the past year. Two were hit by cars, one was stabbed, another shot in the head. The latest perished in a fire. Their names were memorialized with sidewalk chalk until the rain came. It’s unclear whether they were marked as homeless in county death records.

Photo: Michael Macor, The Chronicle Danielle Golden, who is homeless, has seen several of her friends...

In San Francisco, a woman named Alice, who for years lived on the sidewalk outside a Burger King, likely will not be included in the city’s 2018 count because she moved into a single-room-occupancy hotel in the Mission before she died last month, said Rachael Kagan, spokeswoman for the city’s Department of Public Health.

Unlike Oakland, San Francisco compiles the number of homeless people who die each year. But officials caution that their count is probably a significant underestimation because homeless people who spend their last days in housing or a hospital may not make the tally.

In Contra Costa County, Capt. Steve Simpkins of the coroner’s office provided numbers but emphasized they aren’t perfectly accurate. They showed that an average of 33 homeless people died each year over the past decade, but last year the figure jumped to 64. He said nothing was readily apparent to explain the increase.

The lack of systematic data — or any data at all — when it comes to people dying on the streets is in sharp contrast to the concerted effort to count how many people are living on the streets.

Every two years, to qualify for federal dollars, local governments send scores of volunteers fanning out to shelters and tent cities and parks to methodically count every homeless person they can find. Last year in Alameda County, the so-called point-in-time census revealed a 25 percent jump in the homeless population in Oakland and a nearly 40 percent increase countywide.

Bobby Watts, CEO of the National Health Care for the Homeless Council, said it’s vital to know the mortality rate of the homeless population.

“It’s the first and most basic measure of health or public health: Is someone alive or dead?” he said. “It’s an extremely important measure. It’s something we need to know. Some localities do a better job than others.”

Cities that do make efforts to collect data noted an increase in homeless deaths last year, Watts said.

The collection of uniform and reliable homeless death data could help create policies to prevent deaths, say some health and homeless services providers. It could also help spur action to tackle the crisis.

“This is information that can be used to create interventions and just to underscore the long-term solution of housing,” Watts said. “It doesn’t have to be 100 percent accurate, but it’s better to have some good information than none at all.”

Maria Foscarinis, executive director of the National Law Center on Homelessness and Poverty, said if more people knew how dire homelessness is — by way of mortality statistics, for instance — there might be a heightened sense of urgency.

“A lot of people don’t understand how serious a problem this is and who is affected and why,” she said. “When people are dying — that’s just another piece of evidence that it’s a public health emergency.”

Lucy Kasdin, deputy director of Alameda County’s Health Care for the Homeless unit, said statistics on homeless deaths would be “incredibly valuable” in developing interventions and figuring out how to best allocate resources.

Not everyone agrees.

Photo: Michael Macor, The Chronicle Wilma Lozada (left), an outreach team member, and Dr. Aislinn Bird...

Josh Bamberger, a UCSF physician who has been treating homeless patients for the past two decades, said there’s already sufficient data on the perils of homelessness.

“We have mountains of data to tell us why homelessness is bad,” he said. “It’s bad for your health, it’s expensive, and it kills you at a younger age.”

He pointed to a 2009 research paper he co-authored that examined the impact of housing on the survival of homeless people with AIDS. Only two out of 71 placed in housing died after five years. In the same period, three-quarters of the 610 people without housing had died. Some studies have indicated that homelessness is correlated with a 25-year decrease in one’s life expectancy.

“If the health care system embraced housing as the one and true treatment to improve the health of homeless people, that money would be well spent,” Bamberger said. “I used to believe I should put my energies in providing the best care. … But there’s an absurdity in having a patient with perfect blood pressure, perfect control of their sugar and treatment of their cancers and then rolling them out in their wheelchair into the rain.”

Barbara DiPietro, senior director of policy for the National Health Care for the Homeless Council, said the data would be beneficial if it led to more housing. She wasn’t convinced it would.

“When people die, they’re even more invisible than when they were alive,” she said. “Collecting data at death almost feels too late.”

While experts disagree on how useful the data would be, it’s proved to be helpful for some who collect it. When San Francisco, for instance, found that one of the top three causes of death in the homeless population was related to alcohol consumption, that information became the impetus for opening a sobering center a decade ago, Kagan said. The center provides meals, showers and beds for people to sleep off inebriation while their vital signs are monitored.

“When you know what is going on with this population,” Kagan said, “you can develop responses to those needs before they become a cause of death.”