Category: Health

Health, homelessness, housing, human services

Marquee Plan to End Unsheltered Homelessness Depends on Federal Funding Source Some Call Risky
Image via We Are In.

By Erica C. Barnett

Last week, the King County Regional Homelessness Authority’s implementation and governing boards approved a 2024 budget proposal that assumes the agency will receive significant future funding from Medicaid to keep the Partnership for Zero program, which aims to end unsheltered homelessness in downtown Seattle, going. Currently, the program is funded by corporate and philanthropic donations through a public-private partnership called We Are In.

The federal funding would come through a statewide program for Medicaid clients called Foundational Community Supports that funds “pre-tenancy” services for chronically homeless people—everything from getting an ID to negotiating an apartment lease.

“Based on current research, we estimate that Medicaid will reimburse 85% of Partnership for Zero (PfZ) costs,” or about $5.2 million, the KCRHA’s 2024 budget says. In 2022, a group of corporate and philanthropic donors pledged $10 million to fund the initial downtown Seattle “demonstration project,” which pays case managers known as system advocates to connect people living downtown to services, shelter and housing. Over the next five years, KCRHA plans to expand Partnership for Zero countywide.

Several members of both boards, including Auburn Mayor Nancy Backus, expressed reservations about relying on a federal program that the KCRHA has never used before to fund one of the agency’s marquee initiatives. “I’m just concerned about approving [a budget] where you don’t have the money,” Backus said. “As someone who provides our budget to the council every two years, we never put anything in the budget … that’s aspirational.”

“I think that there were some estimates that were like, ‘this will make it rain money,’ and then there were other estimates that were like, ‘this will get you two nickels.’ We feel confident that this is a capturable amount of revenue.”—KCRHA CEO Marc Dones

“I would love not to spend more money than we have,” KCRHA CEO Marc Dones responded. “So what we’re doing is a number of dry runs with Medicaid billing while we’re still entirely grant- funded”—essentially, submitting invoices for real services to see what gets rejected and approved.

“Our current conservative estimate [is] an 85 percent reimbursement,” Dones added. “I think that there were some estimates that were like, ‘this will make it rain money,’ and then there were other estimates that were like, ‘this will get you two nickels.’ We feel confident that this is a capturable amount of revenue.”

But providers and advocates familiar with Foundational Community Supports, speaking to PubliCola on background, said that although the concept behind FCS is extremely forward-thinking—the six-year-old program treats housing as a form of health care, which is new for Medicaid—relying so heavily on FCS to fund a costly, high-profile effort like Partnership for Zero is a significant risk.

To understand why, it’s helpful to understand a bit about how nonprofits use the program to fund services for unsheltered people in King County.

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Foundational Community Supports is a fee-for-service program; it pays $112 for every documented “encounter” between a service provider and a client, up to a maximum of six encounters a month. (In the case of KCRHA, the government itself, rather than a nonprofit, will be the service provider). If a case manager has a dozen clients and manages to document six encounters with each of them every month for a year, that adds up to about $95,000. The starting salary for KCRHA’s system advocates—formerly homeless peers who serve as case managers and outreach specialists for Partnership for Zero—is $75,000, so a $95,000 reimbursement would more than pay for both’ salaries and benefits, with some to spare for administration and other costs.

So far so good. Except, service providers say, that it’s almost impossible to “max out” on providing services to unsheltered people this way. Case managers must document each encounter with an unsheltered person in detail, with case notes that demonstrate what service they provided and how that encounter got the person closer to their housing goal.

Opportunities for “wasted” time abound. If a case worker goes out looking for a client and doesn’t find them—a common situation when trying to find unsheltered people, especially in a city that sweeps encampments—that time doesn’t count. If a case manager is new and still in training, or in the process of convincing someone to sign up for the program, that time doesn’t count. And if everything goes perfectly but the case notes are too short, or too long, or don’t include the right kind of details to convince the third-party administrator reviewing a person’s forms, that time doesn’t count either.

Because Foundational Community Supports isn’t a reliable source of funding, service providers don’t typically rely on it to fund entire programs; instead, they “braid” FCS with other funding sources to create a stable foundation for ongoing programs. The constant documentation and pressure to monetize every interaction with unsheltered clients can make it harder to build relationships with unsheltered people. According to one experienced homeless service provider, FCS is “just not really how rapport-based type outreach services relationships work, or how they’re usually delivered.”

Multiple people with Medicaid billing experience mentioned the concept of the “golden thread”–  a consistent narrative through every piece of documentation that explains why the person needs specific services and how each of those services are helping them achieve their self-determined goals. Failure to convincingly document that “thread” is “why a lot of claims get denied,” one former service provider said.

“We are comfortable that that’s a good number, but we’re not going to know until we start doing it and we’ll build a better and better understanding of what a successful reimbursement package is.”—KCRHA Chief Administrative Officer Meg Barclay

Facing pushback from board members last week, Dones pointed that the agency still has money left over from We Are In’s original $10 million commitment to pay for the program through 2023 and potentially beyond, if getting funds through Medicaid proves more challenging than the agency anticipates. And, KCRHA Chief Administrative Officer Meg Barclay noted, the KCRHA is consulting with the Corporation for Supportive Housing, which trains service providers to do Medicaid billing, to learn how to maximize their reimbursements.

Even so, Barclay added, Medicaid is “kind of a black box—sort of strange. So we are comfortable that that’s a good number, but we’re not going to know until we start doing it and we’ll build a better and better understanding of what a successful reimbursement package is.”

Debbie Thiele, CSH’s managing director for the western United States, told PubliCola last year that FCS is “designed to be as user-friendly as possible to a group of providers who are not health care providers.”

One implementation board member, Simha Reddy, said he saw the KCRHA’s effort to fund Partnership for Zero through Medicaid as an experiment that could be helpful to other nonprofit providers who could “jump on the bandwagon” and “learn alongside us.”

And Dones pointed out that the KCRHA won’t be the only government entity to rely on Medicaid funding to run a homelessness program—Spokane, they said, “funds a huge portion of their system” with Foundational Community Supports.

“I do think that the discussion around the difficulty of these dollars is not actually borne out by even our neighbors in Washington,” Dones told the implementation board last week. However, service providers who spoke with PubliCola said Spokane is both smaller (with a homeless population of around 1,800) and more affordable than King County, making it easier to house people in private-market housing and help them stay there.

The budget both boards approved last week isn’t a final spending plan. The KCRHA will send it to its two primary funders, King County and the city of Seattle, later this year, and adopt a finalized budget in December. What the votes represent is a bet on Dones’ plan to fund Partnership for Zero, which will otherwise run out of funding next year.

Editor’s note: Due to a transcription error by the author, the original version of this story incorrectly attributed Backus’ quote to Seattle Deputy Mayor Tiffany Washington.

Drugs, Health, Police, public safety

More Cops Are Training as Emergency Responders. Is That a Good Thing?

By Erica C. Barnett

The death of pedestrian Jaahnavi Kandula, killed by a police officer driving to respond to a suspected overdose, has revived a longstanding dispute between Seattle’s fire and police departments about who should respond to medical emergencies, particularly overdoses.

Last month, after SPD announced that officer Kevin Dave was rushing to respond to an overdose in his capacity as an emergency medical technician (EMT), SFD union leader Kenny Stuart wrote a letter to Mayor Bruce Harrell objecting to the “troubling trend” of SPD officers “being trained and certified as Emergency Medical Technicians (EMTs) and … deployed to medical emergencies in our city.”

The issue with this, Stuart continued, is that the fire department—not SPD—is responsible for emergency medical response as part of the county’s Medic One system; “randomly allowing additional EMTs from other city departments to self-dispatch or to perform EMS functions” has “led to delayed scene security, delayed medical care, decreased continuity and coordination of care, and general confusion in life-threatening emergencies.”

Mayor Bruce Harrell’s office did not immediately respond to an email seeking his response to Stuart’s letter, if any, on Friday.

SPD’s EMS trainings are not funded by the city; instead, the Seattle Police Foundation solicits donations to pay for trainings and equipment. The police foundation website says the police need trained EMTs to respond to life-threatening situations at active crime scenes before it’s safe for fire department medics to enter. The head of the EMS program, SPD officer Tyler Verhaar, did not immediately respond to a request for an interview; we’ll update this post with his comments if we hear back.

“If police continue to respond to [medical calls] unchecked, you will end up with officers who are EMTs jumping calls so they can get some good publicity, and that’s not what it’s about.”—Retired assistant fire chief A.D. Vickery

Stuart, from the firefighters’ union, declined to talk on the record about the union’s opposition to SPD officers responding to medical emergencies. But former SFD assistant chief A.D. Vickery, who started at the department in 1968 and retired in 2020, said he’s heard alarming reports about police officers “racing to the scene, putting everybody at risk, so they can be the first one to the patient.”

“The Fire Department responds to hundreds of thousands of alarms. We are very cautious. There’s lots of people on the rig all working to make sure we get to the scene in a  appropriate period of time without creating a hazard,” Vickery said. “If police continue to respond to [medical calls] unchecked, you will end up with officers who are EMTs jumping calls so they can get some good publicity, and that’s not what it’s about.”

SPD has declined to comment on the circumstances that led to Dave striking and killing Kandula in a crosswalk the night of January 23. Initially, an SPD blog post said the then-unidentified officer was responding to a nearby emergency call “at the request of” the fire department; later, a department spokeswoman updated the post to say SPD was responding “with” Fire. Subsequently, police chief Adrian Diaz said Dave was “responding as an EMT” to the initial 911 call itself.

Many police department officers are equipped with Narcan (naloxone) nasal spray, which can restore breathing by rapidly reversing the effects of opioids like fentanyl, sending a person who is overdosing into abrupt withdrawal. Although fire department EMTs have carried nasal naloxone since July 2022, the department prefers to deliver oxygen first to restore an overdose victim’s breathing.

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“With the increase in people using both methamphetamine and fentanyl at the same time, our teams then work to stabilize the patient’s breathing with small doses of naloxone ([which]also avoids a painful opiate withdrawal from excessive naloxone) and reverse the overdose,” SFD medical director Dr. Michael Sayre said.

According to one theory, bringing people back slowly also makes it more likely they’ll agree—in their groggy state—to go to the hospital, where they can access opiate withdrawal meds and learn about treatment options. “Some patients, once recovered from the drug’s effects, may refuse transport. That is a concern because it is a lost opportunity to connect patients with support services… that could be offered through the emergency department,” Sayre said.

Although the fire department doesn’t want SPD responding to medical emergencies themselves, they do want police on site when they respond to overdoses. One reason, which Fire Chief Harold Scoggins cited in a recent letter to the city’s Community Police Commission, is that overdose patients can purportedly “become violent” after they’re revived. A spokeswoman for the fire department said patients who overdose on fentanyl while also using meth, in particular, can “become quite agitated… risking harm to themselves and others around them,” because “when both substances are present, the sedative effects of fentanyl are reversed by naloxone, and the stimulant effects of methamphetamine then predominate.”

Curious how often first responders actually encounter hostile situations from bystanders, I requested the fire department’s database of assault reports from EMS calls. In 2022, first responders logged 135 such incidents, which ranged from verbal abuse and threats to punches, “donkey kicks,” and a “wrestling match”; one person threw a hamburger at a fire truck.

But the main reason fire EMS wants police at the scene of overdoses, according to Vickery, is to “control the scene to allow the EMTs or the medical personnel to do their jobs” without having to worry about bystanders or opportunistic thieves. “The environment that the overdoses take place in now is a much more hostile environment,” Vickery said. “In 1968, you might have an overdose in a particular area and it really was isolated to the room and the people that knew them, but there was not this the hostility that exists today.” Overdoses often occur on streets or in encampments, including many that first responders won’t enter without SPD backup.

Curious how often first responders actually encounter hostile situations from bystanders, I requested the fire department’s database of assault reports from EMS calls, which only includes incidents that involved formal reports (in other words, it isn’t comprehensive). In 2022, first responders logged 135 such incidents, which ranged from verbal abuse and threats (“Stated that he was going to kill us and that we were ‘motherf***ers””) to punches, “donkey kicks,” and a “wrestling match”; one person threw a hamburger at a fire truck.

Only a few of the reported incidents involved people brought back from an overdose with naloxone who were “combative” afterward and had to be restrained.

Overall, the reports unsurprisingly include many people in obvious crisis—like the person who was “slamming his head against the sidewalk several times before being restrained by SFD crews for his own safety as well as ours,” or the “well-known [patient]” who threw water on fire fighters before “barricading himself” inside a bathroom.

The tension between police and fire about their roles as first responders isn’t going away, as the police foundation continues to solicit donations for “training, certification, and medical supplies” for cops to respond to emergency calls. Vickery says he has no problem with police officers getting EMT certification on their own time, but says “there needs to be clear delineation” between the role of police providing backup at medical emergencies and fire personnel responding to those emergencies as EMTs. “The fire department doesn’t arrest people—stay within the realm of what your responsibilities are and support each other,” he said.

Drugs, Health, legislature, public disclosure

Bill Would Expand Access to Fentanyl Testing, PubliCola Updates Seattle Employee Directory
Image source

1. As King County hit a demoralizing new record of 1,019 overdose deaths in 2022—a jump of nearly 30 percent over the previous year—a Republican state senator has introduced a bill that would make it easier to access test strips that can indicate the presence of fentanyl in drugs.

As PubliCola has reported, fentanyl is now the default opioid for drug users in King County, a trend that has driven the huge spike in overdoses. Even people who don’t seek out opioids can be at risk, because drugs like cocaine and methamphetamine can be contaminated with fentanyl. Test strips, which can detect the presence of fentanyl in a small amount of a drug, are an essential part of harm reduction efforts, but state law still classifies them as prohibited “drug paraphernalia,” limiting their availability.

Last year, GOP state senator Jim Honeyford, R-Sunnyside, filed a bill that would have changed that designation, but it died in committee. This session, Sen Ron Muzzall, R-Oak Harbor, reintroduced the legislation.

Muzzall told PubliCola that while substance abuse has always been an area of concern for him, it’s also a personal issue. Muzzall is friends with Skagit County Commissioner Lisa Janicki, whose son Patrick died of a fentanyl overdose in 2017 after becoming addicted to pain pills. Muzzall says he knew Janicki’s son and that his death made a deep impression. 

“When a mistake like that leads to having to bury your child.. . well, that emptiness never goes away,” Muzzall said. “And that was a tragedy that was brought about by a prescription of Oxycontin. The liability lies with the pharmaceutical industry that led up to that. And it’s just invading our communities.”

Janicki has been a vocal advocate for Attorney General Bob Ferguson’s successful lawsuit against opioid manufacturers, which will add $476 million to the state’s harm reduction and treatment efforts over the next 17 years. 

The fentanyl test strip bill is an essential part of those efforts, Muzzall said. “It’s just silly that we don’t make these as easily accessible as possible,” he said. “This bill will take the criminality out of providing them.”

Muzzall, who says fatal overdose is a behavioral and mental health crisis that will likely cost the state a billion dollars to address, is working alongside Democratic Sen. Annette Cleveland of Vancouver on a number of bills to address the issue, and hopes to successfully move the test strip bill through committee this time around.

“If an individual is compassionate, bipartisanship comes easily,” he said.

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2. In 2021, then-mayor Jenny Durkan’s information technology department took the public-facing directory of city employees offline, removing a vital resource that allowed members of the public and journalists (as well as city of Seattle employees themselves) to contact people who work at the city. Public employees’ contact information is a matter of public record, and keeping this information secret violates a long tradition of transparency that persists in other government entities across the state, from King County to the entire State of Washington.

Durkan, who falsely claimed the directory would be online again in a matter of months, is no longer in office, but her successor, Bruce Harrell, has made no moves to restore this resource. The former city employee directory website is now a static page with links to a list of the city’s official media relations officers, the websites of various city departments, and the city’s data portal (which does not contain the directory).

Because we believe the city directory is a valuable public resource, PubliCola has taken it upon ourselves to maintain an updated database of city employees and their contact information ourselves. Here’s the latest searchable and downloadable version, with information current as of January 5, 2023. We will continue maintaining and updating this database until and unless the city of Seattle decides to put theirs back online.

—Andrew Engelson, Erica C. Barnett

Addiction, Drugs, Health

King County is on Pace for a Record Year of Overdose Deaths
Overdoses in King County, 2012 (L) and 2021 (R)
Overdoses in King County, 2012 (L) and 2021 (R)

By Andrew Engelson

Tricia Howe, who directs an outreach program for drug users at REACH, Evergreen Treatment Services’ homeless outreach program, had firsthand experience of King County’s overdose crisis earlier this summer. In a matter of weeks, there were two overdoses outside REACH’s Belltown office.

“One of our case managers came into my office and said, “I think there’s somebody outside who doesn’t look like they’re breathing,” Howe said. “I grabbed a whole bunch of Narcan out of my drawer and ran outside.”

The man’s lips were blue, Howe said, and he wasn’t breathing, though he did have a pulse. She gave him a standard dose of naloxone nasal spray (Narcan), which can reverse the effect of opioids and restore a person’s breathing, but he failed to revive. So Howe gave him a second dose. “He took one deep breath, but was still not responsive,” she said. As Howe was preparing to administer a third dose, first responders arrived, put the man on oxygen, and he finally started breathing.

Based on the man’s response, fentanyl was almost certainly involved. The drug, which is up to 50 times more potent than heroin, can cause overdoses even among frequent opioid users. According to Howe, because fentanyl is cheaper to manufacture, it is quickly replacing heroin and oxycontin as the primary drug available to people who use opioids.

Data from the Washington State Patrol shows that the share of fentanyl in King County drug seizures has climbed dramatically, from around 10 instances in 2018 to more than 100 in 2021. Howe said that all of the counterfeit oxycodone (OxyContin) pills her staff have recently tested have been positive for fentanyl.

“It’s so available now and people are actually seeking it out at this point, where that was not the case before.” According to Howe, because fentanyl is cheaper to manufacture, it is quickly replacing heroin and oxy, and is making overdoses more common and more difficult to reverse. 

Though former mayor Ed Murray expressed early support for what would have been the first such sanctioned site in the US, Jenny Durkan’s administration showed little enthusiasm for supervised consumption. Durkan downgraded the plan in 2019 to a single site in a mobile van, citing concerns about the Trump administration’s legal action against a proposed consumption site in Philadelphia. 

A 2017 study showed that 83 percent of fentanyl overdoses in Massachusetts required a second dose of naloxone. Howe notes that overdoses of heroin or oxy were easier to reverse than fentanyl. “In the past, you could definitely expect the person to wake up and almost walk away,” says Howe.

Seattle and King County are in the midst of a severe overdose death crisis that began to spike during the pandemic and shows no sign of abating. People without shelter are particularly at risk. A ten-year study published in September by the King County Medical Examiner’s Office and Public Health Seattle-King County found that that accidental deaths nearly quadrupled  between 2012 and 2021 among people living unsheltered, and that overdoses now account for 71 percent of such deaths. 

As of last week, according to King County Public Health, there had been at least 710 fatal overdoses in the county this year. Of those, at least 473 involved fentanyl. That number has already eclipsed last year’s 708 overdose deaths, including 385 caused by fentanyl.

“When we first started our heroin and opioid task force in 2015, there were three fentanyl overdose deaths,” said Brad Finegood, a strategic advisor at the public health department. “The numbers have grown exponentially.”

Drug users tried to avoid fentanyl when it first arrived on the West Coast, Finegood said, but that attitude has dramatically shifted, and now people are actively seeking out fentanyl. According to a Pew study published in 2019 on drug use in San Francisco, more than half of opioid drug users now actively seek it, despite the dangers. Complicating matters, fentanyl is either smoked or vaporized and then inhaled, so traditional initiation barriers have fallen away.

“For younger people who are experimenting with drugs,” Finegood said, “that makes it much more feasible because they don’t have to use a needle.” Public Health and REACH have had to counter the misinformed belief that fentanyl is safer because it’s smoked rather than injected.

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According to the US Department of Justice, most fentanyl originates in China and is made into pills or powders by cartels based in Mexico. Batches of fentanyl that are poorly blended can result in what Finegood calls the “chocolate chip cookie effect,” in which pockets of higher concentrations cause accidental overdose.

A young man named Ian who was living in an encampment near the Home Depot in the Bitter Lake neighborhood said in August that he had no choice but to start using fentanyl. Originally from Wasilla, Alaska, Ian said he first became addicted to opioids while taking Oxycontin for pain. “Then oxy disappeared,” he said. In 2016, the CDC advised doctors to lower prescription levels of oxycodone and this, combined with the Drug Enforcement Agency’s recent crackdown on illegal and fraudulent prescriptions, has made medical-grade pills rare.

Ian said that in the absence of oxy, he did heroin for a while. “Then that disappeared. Now it’s all fetty.”

Half a dozen people at the encampment told me they use fentanyl and know many others who do. Nearly everyone had witnessed overdoses and several said they knew people who’d died.

“Everyone’s doing fetty,” said Jessie, who’s 26 and has been using drugs, including meth, since she was 11 years old. She didn’t live in the Bitter Lake camp, but was helping a friend pack up their belongings before the city came to sweep the site. “I’ve been sober, but it didn’t last,” she said. When asked if she’d seen friends overdose, Jessie said, “Yeah, of course.”

The transformation of fentanyl from risky outlier to the opioid of choice in King County mirrors national trends. In 2021, fentanyl accounted for the majority of overdose deaths in the U.S, though methamphetamine continues to be a close second, both nationally and locally. 

Although Seattle, King County, and the cities of Renton and Auburn formed an opiate overdose task force in 2015, local leaders have shelved a key recommendation from the task force’s report: establishing two supervised consumption sites in King County. 

Seattle could have been home to the first such sanctioned site in the U.S., following the lead of Vancouver, B.C. and 200 other sites currently operating elsewhere in Canada, Europe and Australia.

Though former mayor Ed Murray expressed early support for what would have been the first such sanctioned site in the US, Jenny Durkan’s administration showed little enthusiasm for supervised consumption. Durkan downgraded the plan in 2019 to a single site in a mobile van, citing concerns about the Trump administration’s legal action against a proposed consumption site in Philadelphia. 

“It’s a no-brainer. If you don’t want people to use right in front of you and you don’t want needles all over your parks, then you’ve got to give people a place where they can go.”—Tricia Howe, REACH

Even as the Biden administration changed course and said it would consider allowing sites, neither Durkan nor Mayor Bruce Harrell followed through on the scaled-back plan. Earlier this year, New York City moved past Seattle and opened two safe consumption sites that have already succeeded in preventing 500 deaths.

Kris Nyrop, who spent two decades working on HIV prevention among drug users in Seattle and helped design Seattle’s Law Enforcement Assisted Diversion (LEAD) program, says the window for action in King County is quickly closing.

“We have two years,” Nyrop said. “Biden is not going to prosecute if Seattle moves forward. So how do we get Mayor Harrell and a majority of the council behind this?”

In fact, Councilmember Lisa Herbold added $1.1 million to the 2021 Human Services Department budget to create safe consumption spaces in existing social services facilities. The city did not move forward on that approach and Harrell’s proposed 2023-2024 budget does not fund it. 

Instead, Mayor Harrell has vowed to crack down on people who sell and use drugs, in a highly publicized effort to target “hot spots” such as the intersection of 12th and Jackson in Little Saigon. Anyone walking through the area today can see that this short-term strategy was ineffective at reducing public drug use and sales in the area.

Howe said that the only effective way to reduce visible drug use on the street isn’t more policing, but sanctioned consumption sites. “It’s a no-brainer. … If you don’t want people to use right in front of you and you don’t want needles all over your parks, then you’ve got to give people a place where they can go.”

In the absence of sanctioned sites, Public Health has been quietly moving forward on other, lower-profile strategies aimed at empowering drug users to consume drugs as safely as possible. 

In addition to social media campaigns to educate young people about the extremely high risks of fentanyl pills (“blues”), Finegood says Public Health is doing more targeted educational outreach to users about safer consumption practices. 

This includes training drug users to recognize the symptoms of overdose, encouraging people not to use alone, and making the overdose reversal medication naloxone widely available. Finegood said Public Health has set up the first mail-order naloxone program in the country, and is working extensively with local pharmacies to offer the drug free, without a doctor’s prescription. “We’ve also set up a couple naloxone and fentanyl tester vending machines,” Finegood said. Continue reading “King County is on Pace for a Record Year of Overdose Deaths” →

criminal justice, Health, Mental Health

In a Sign of Worsening Conditions, Understaffed King County Jail Has Lacked Water for a Week

By Erica C. Barnett

The King County Jail in downtown Seattle has lacked potable water since Thursday, September 29, and people incarcerated at the jail have been relying on bottled water for the past week, PubliCola has confirmed.

According to a spokesman for the county’s Department of Adult and Juvenile Detention (DAJD), the county “has had the tap water in the jail tested multiple times in multiple locations, and all tests have indicated that the water meets EPA standards for drinking water. However, since the water is still cloudy, we are providing bottled water for drinking and cooking purposes.” The jail has “ample supplies of bottled water,” the spokesman said.

According to the president of the King County Corrections Guild, Dennis Folk, inmates are allowed one bottle of water at a time and can trade in empties for new bottles. This restriction, Folk said, makes it less likely that people will melt the plastic bottles to turn them into weapons or fill them with urine or feces to fling at guards or other inmates.

However, it’s unclear how frequently people inside the jail are actually getting access to water.

“What we are hearing is that there is rationing of water and people are having to choose between hydration or hygiene, and there just isn’t enough water available,” the president of the public defense union (SEIU 925), Molly Gilbert, said.

A spokesman for the jail said there is no rationing and that DADJ offers water “at every meal, periodically throughout the day, during medication delivery, and per request of jail residents.”

PubliCola reported the news exclusively on Twitter Thursday morning.

According to an email from King County Department of Adult and Juvenile Detention (DAJD) director Allen Nance to the King County Department of Public Defense, the department became aware of “complaints related to water quality” last week (according to Folk, the water coming out of the taps was brown). “We immediately implemented bottled water for all persons in custody and staff out of an abundance of caution,” Nance wrote.

“We have women in the jail who are having their period and they’re unable to get a change of underwear for the week,” Gilbert said. “It’s inhumane, it’s unconstitutional, and it’s a clear liability for the county.”—Molly Gilbert, SEIU 925, King County Public Defense Chapter

Water testing found high “turbidity,” or cloudiness—basically, foreign particles in water that can indicate the presence of disease-causing microbes—and the water has remained off since then while the county has tried to figure out the source of the problem. In his email, Nance said the brown water may have resulted from faulty screens on the water heaters at the jail. According to the DAJD spokesman, the county has sent samples of the water for testing and expects to get the results back tomorrow.

The ongoing water shutoff is just the most recent example of ongoing problems at the jail that have severely limited residents’ access to medical care, attorneys, and time outside their cells. In a survey conducted by the ACLU of Washington in late September, public defenders reported that their clients often lacked access to basic medical care, such as treatment for injuries and dental care, and medication, including everything from insulin to psychiatric meds. When there aren’t enough guards on duty, Gilbert said, escorts for the jail nurses who hand out medication are often the first thing to go. Responding to Gilbert’s statements, the jail spokesman said there are “few if any instances when medication passes would be affected by corrections officer staffing” and that the jail delivers medication even during staffing shortages.

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Most of the ongoing issues at the jail stem directly from a worsening staffing shortage, combined with a growing population as the county books more people on misdemeanor charges and transfers inmates from the Regional Justice Center in Kent, whose setup requires more guards per incarcerated person. In recent months, staffing shortages at the jail have led to frequent lockdowns, in which people are locked in their cells 23 hours a day, and defense attorneys report waiting hours to meet with clients, who have to be escorted to meeting areas by guards who are in short supply.

In January, the unions for the public defenders and jail guards joined forces to ask county officials to reduce the population at the downtown jail. Although that request was in response to COVID outbreaks, the staffing shortages that were at issue back then have only worsened in the intervening months.

“We have women in the jail who are having their period and they’re unable to get a change of underwear for the week,” Gilbert said. “It’s inhumane, it’s unconstitutional, and it’s a clear liability for the county.” The jail spokesman disputes this and says jail inmates regularly receive fresh clothes regularly, and can get clean underwear whenever they want.

King County offers hiring bonuses for guards at both the adult and youth detention centers, but hiring hasn’t kept up with attrition as guards burn out and leave. Booking fewer people into the jail would be one solution—about half the people in the downtown jail are booked for three days or less—but that idea is politically unpopular at a time when perceptions of crime have increased. One candidate for King County Prosecutor, Federal Way mayor Jim Ferrell, recently signed on to an “open letter”  from eight South King County mayors calling for more felony bookings and “incarceration to ensure… public safety.”

Drugs, Health

In Reversal, Library Will Allow Staff to Use Narcan on a Voluntary Basis

Diagram showing how to administer Narcan to an overdosing personBy Erica C. Barnett

In a sudden reversal of longstanding policy (and after three years of dogged coverage by PubliCola), the Seattle Public Library announced Wednesday that it will stock its 26 library branches with Narcan (naloxone), a nasal spray that can reverse opiate overdoses. Each branch will get one two-dose kit of Narcan, and the downtown branch will get one for each floor, with a few left over for later distribution, a library spokeswoman told PubliCola.

Library staff who want to administer Narcan if someone overdoses will be able to go through voluntary training in how to administer the drug. Untrained staffers won’t be allowed to give the drug, according to the library’s announcement, meaning that if someone overdoses at a library with no trained staff, “there is no guarantee that a patron who overdoses on Library grounds will receive naloxone.”

This policy contrasts with other Seattle departments. Frontline Seattle parks workers, such as lifeguards, parks concierges, and park rangers, all carry Narcan and can use it without special training. Other library systems also supply Narcan to workers and the public. In Chicago, for example, all library staff are trained to use Narcan and the library distributes kits for free to anyone who wants one.

The library spokeswoman said she could not provide any details about why the department changed its policy. A blog post announcing the change said only that “over the last few months,” the library went through “a careful review process, which included updated guidance on liability from the City Attorney’s Office and an examination of other City departments’ practices.” We have reached out to City Attorney Ann Davison’s office for more information on the change.

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In July, as we exclusively reported, a staffer asked if it would be okay for him to carry Narcan at work. At the time, the library said it had been advised by the city attorney’s office that employees who administered the drug would be unprotected by the both state’s Good Samaritan law, which protects people who voluntarily render emergency care, and a separate law protecting Washington residents from liability specifically for administering Narcan. Any library employee who used Narcan to try to reverse an overdose, a union representative told staffers in an email, could be subject to discipline.

A spokeswoman for the library said that the library is “requesting that staff not use their own supply of Narcan while at work during this interim period” before staffers have gone through training. “After staff volunteers are trained, we may revisit that.” The spokeswoman said the library is “in conversations about training with several organizations.”

Previously, the library had varying reasons for not stocking Narcan, which works by restoring breathing in an overdosing person. Back in 2020, a library spokeswoman told PubliCola that putting Narcan in libraries would require bargaining with the library union, for example.

People die of opiate overdoses when they stop breathing, and emergency responders often prefer to perform rescue breathing or provide oxygen to an overdosing person because naloxone can send people into rapid withdrawal, an extremely unpleasant side effect that, in practice, sometimes leads people to refuse additional care. Narcan, however, is extremely simple to administer—you squirt it into one nostril—and can save a person’s life during the period after they stop breathing but before medics arrive.

According to the King County Department of Public Health, there have been at least 42 likely overdoses in or outside public libraries in King County since 2019, including 16 inside library branches. Since 2017, at least eight people have died of drug-related causes at libraries in King County, half of them in Seattle.