The Politics of Freezing To Death

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Atlanta released a report that appears to show a major increase in hypothermia deaths over the last year. Everyone has an opinion about what is happening here. Some of those opinions are even informed.

The short answer is that I think the report may simply be wrong. It’s also entirely possible that I am wrong.

In January, the Fulton County Medical Examiner’s office told me that there had been 10 hypothermia deaths for 2018, not 15. It’s possible that they reclassified some since, or that they didn’t provide data outside of the city.

But I’m looking through the names here and one leaped out at me: Lillie Hillman. She is classified as a hypothermia death in the report. Hillman died of sepsis.

I know this because an advocate speaking before the city council claimed — against all existing evidence — to have tried to get her into a shelter the night she died. I tracked down the circumstances of her death to determine what had actually happened. Hypothermia can complicate sepsis, but she would have died on a clear day in June without treatment. Service-refusal born of schizophrenia killed Lillie Hillman. The cold made her death ignominious.

Atlanta absolutely needs low-barrier shelters. Peachtree and Pine was, at the end, not a shelter. It was a hazard people took shelter from.

I looked closely at hypothermia deaths following the closure of Peachtree and Pine, since I helped lead the effort to get it closed. I pulled data regularly out of the Medical Examiner’s office.

My count of hypothermia deaths from 2006 to 2018 showed an average of 9.4 deaths, not 4.3 as the city’s report says today. Only about half of those deaths were of people who were homeless. This leads me to wonder if the M.E. — or the author of the report — concluded that all of the deaths in 2018 were of people who were homeless, and is comparing it to the lower figure from previous years.

My conclusion before leaving Central Atlanta Progress earlier this year was that the number of homeless deaths relative to the number of cold weather days had actually fallen relative to the long run average, which is why I am scratching my head at this report.

It isn’t enough to simply count years: you have to look at how many days of deadly cold had occurred. As few as six people have died during a winter in the last 10 years — that’s the relatively mild winter of 2011-2012. In the winter of 2014-2015, which appears to have been fairly brutal, 16 people died. Of those, 13 were homeless. 

For the last 20 years or so, the United States averages about 1,300 hypothermia deaths in a year, a bit more than four out of every million people. Atlanta has been running way high, about five times what would be expected of a city of half a million.

Let none of my concerns about this report mask things. We have a problem.

But I believe Peachtree and Pine contributed to additional deaths, because those who would seek shelter would be directed there … and decide that the street itself was safer. Peachtree and Pine was a privately-run organization, and resisted external efforts to reform its deadly practices. It could not be “fixed.”

The city took extraordinary steps to make shelters open during cold weather days after we closed P&P. Teams fanned out on the coldest days, imploring people to take shelter. On such a day, more than 100 contacts were made with people sleeping on the street. Only seven came in.

Does the city need to ensure we have low-barrier shelter open in cold weather? Absolutely. Has the city done all it could to keep cold weather shelters open. No, it has not. I pushed for one during the Super Bowl and was largely rebuffed, for example.

But laying these results on the closure of Peachtree and Pine while both ignoring how the shelter contributed to deaths and ignoring the other things happening in this city makes it harder to get this policy right.

The long-term solution to housing insecurity is permanently supportive housing, and innovation with new ideas. I left Central Atlanta Progress to join Padsplit, where we offer people affordable co-living space, renting by the room. We need more housing options, at prices working people can pay.

I’ve spoken to the author of the AJC story, and I’ll be providing him — and the city — with the data I have in service to the problem at hand.