It took the volunteer efforts of Reed V. Tuckson, the city's public health commissioner, and other volunteer doctors to keep the city's detoxification center open on New Year's Eve and over the holiday weekend earlier this month. Yet would hiring more doctors really solve the shortage that Tuckson says threatens the center?
The District's detox facility admits "patients" only when a doctor is present to examine them. It relies on a "medical model" for responding to the needs of publicly intoxicated people. Yet people are allowed to remain at the detox unit under the care of nurses when no doctor is there.
But many such programs elsewhere do not require a formal medical evaluation by a doctor as a condition for admittance. Instead, detox centers in other cities use less expensive, specially trained nurses to admit patients.In cases of clear medical emergencies, the police direct patients to general hospitals, which have better treatment facilities than detox centers.
Given the apparent shortage of doctors to do the work required in the District's detox center and similar facilities, and given their high cost, is there really a need for doctors to admit people? The purpose of a detox center, after all, is to provide a more humane alternative to the "drunk tank" or jail for publicly intoxicated people. These people -- who are not necessarily alcoholics, contrary to popular belief -- have many needs, nutritional and medical. But most of all they need shelter and a safe, warm, clean, dry place to sober up.
Police officers, who generally encounter publicly intoxicated people first, exercise broad discretion in deciding what kind of action to take, if any -- whether to ask the person to "move on," or to call him a taxi, or to arrest him for disorderly conduct or another minor charge, or to take him to a detox center. Physicians and nurses aren't on the scene when officers must make their crucial decisionson how to handle specific cases. (In fact, pub-lic health officials rarely advise police even in their training programs.) So there is no reason they must control admittance to the detox center.
The reasons police officers take intoxicated people to detox facilities have little to do with an immediate need for medical attention. The reasons, according to our research, are more likely to be these: 1) to deal with a person who is causing a "public nuisance" (e.g., an intoxicated person panhandling in a commercial district, interfering with pedestrian traffic or urinating in public); 2) to deal with sleeping or unconscious people on public streets; 3) to prevent fights, petty robberies and other usually minor crimes by and against intoxicated persons; 4) as a first step in aiding people who may need longer term rehabilitation; and 5) generally to avoid entering the criminal justice system and to save scarce criminal justice resources for more serious criminal behavior.
Some jurisdictions have implemented innovative programs to assist the police, relieving them of some of their duties involving inebriates. Some have used teams of recovering alcoholics and public health workers to pick up intoxicated individuals. In San Francisco, for example, the "boozer cruisers" would get to know the drunks and pick up those who needed to be taken to detox centers; if they needed help in their task, they would call on the police. Other cities have instituted taxicab vouchers, which permit taxicab drivers to get reimbursed for their fare if they drive intoxicated people to detox centers.
Ironically, detox facilities that use the "medical model," such as the one in the District, with their strict or cumbersome admittance procedures, may cost more lives than they save by discouraging police officers from picking up and delivering publicly intoxicated people. The results, of which we obtained evidence in some northern cities, include more deaths in cold weather, as more publicly intoxicated persons are left on the streets.
The District could save money by using, as other cities do, specially trained nurses or other persons, instead of doctors, to admit public inebriates to the detox center. Training and outreach programs to assist the police in identifying and transporting the needy, as well as simplified admittance procedures overall, would be a far greater benefit. -- David E. Aaronson is a professor of law at American University.