Tag: health care

New Report Finds Serious Shortfalls in Mental Health Care for Washington Prisoners

A cell (left) and recreation area (right) in the Intensive Management Unit at the Monroe Correctional Complex in Snohomish County (Photo: Office of the Corrections Ombuds)

By Paul Kiefer

A new report from Washington’s Office of the Corrections Ombuds (OCO) raises concerns with the consequences of a shortage of mental health staff and treatment options in the state’s prison system, including the increased risk of suicide, self-harm, or placement in solitary confinement for inmates with unmet mental health needs.

The report, which the OCO released on Wednesday, is based on a review of roughly 335 complaints about alleged shortcomings in the state Department of Corrections’ (DOC) handling of mental health care, as well as interviews with incarcerated people and DOC staff and administrators.

In its review of mental health care options at state prisons, the OCO found that many problems hinged on the dearth of treatment providers available to the roughly 15,000 people in DOC custody. Facing overwhelming demand for mental health treatment and screenings, the DOC’s current providers handle overwhelming daily caseloads, sometimes without a designated work space to offer privacy to their patients. For people in custody, the shortage of treatment providers translates into long wait times for therapy appointments. Residents of the state’s 12 work release facilities, as well as inmates in some smaller prisons, have even fewer options for mental health care—in fact, the DOC doesn’t offer mental health treatment to work-release inmates at all.

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But the report also outlined other problems in the DOC’s response to the mental health needs of incarcerated people, including multiple instances in which prison staff did not properly document inmates’ risk of self-harm or suicide. The OCO has highlighted the same problems in earlier reports, including an April 2021 review of two deaths by suicide in DOC facilities last year that connected mishandled mental health screenings as a to both deaths.

The OCO’s review also raised concerns that prison staff rarely consider inmates’ mental health when punishing them for breaking rules. The investigators were particularly concerned about the use of so-called Intensive Management Units—solitary confinement—as a punishment for inmates with diagnosed mental health conditions, pointing out that placing those people in isolation can lead to “destructive or self-harming behaviors, often resulting in infractions and sanctions, causing time in solitary confinement to be repeatedly extended or increasingly harsh.” Continue reading “New Report Finds Serious Shortfalls in Mental Health Care for Washington Prisoners”

Sterling Harders: Proposed State Funding Cuts Would Harm Patients, Essential Health Care Workers

The 45,000 in-home and nursing home caregivers of SEIU 775 have always been on the front lines of health care. We’re the first ones to know if our clients are coughing or running a fever. We know when the person we care for seems dizzy, or when their appetite is off. We know first because we’re inside of their homes providing health care, preparing food, and cleaning surfaces, giving invaluable care to the most vulnerable people in our communities. We keep those who want to stay in their homes out of costly institutions, and care for those who require nursing home care to stay healthy.

Caregivers didn’t stop providing care during the coronavirus pandemic, despite a glaring lack of PPE in the first few months. Nelly, a caregiver in Yakima, lives with her client. When everyone in Nelly’s home, including Nelly, tested positive for COVID-19, she continued providing care and kept her vulnerable client out of the hospital.

The proposed Washington State Department of Social and Health Services (DSHS) cuts would kick 10,000 seniors and people with disabilities off home care, and put more than 10,000 caregivers out of work when we can least afford to lose more jobs.

Caregiving is essential. Yet it has been consistently devalued because of systemic racism and sexism. Like farm workers and domestic workers, caregivers were deliberately excluded from the worker protection laws created after the Great Depression. We were excluded because of who we are and what we look like—predominantly women, including black women, women of color and immigrants. Caregivers had to fight to win basic standards like minimum wage, the right to a union, and even the right to protection from harassment and discrimination long after other workers won those rights.

When the coronavirus hit, the caregivers of our union immediately started negotiating with the state for COVID protections. We were the first caregivers in the country to win hazard pay. But everything we’ve won—not just hazard pay but our health care, our wages, and our jobs themselves—are at risk due to the economic crisis brought on by the pandemic.

There are about 30 million people unemployed in this country, including half a million people in Washington State. Millions more are risking their lives going to work every day—not just caregivers but grocery workers and farmworkers and delivery drivers—and these folks are often working for near poverty wages. Yet with looming budget shortfalls facing our state, what’s on the table for caregivers? Cuts. The state is trying to find revenue by proposing massive, devastating, offensive cuts.

The proposed Washington State Department of Social and Health Services (DSHS) cuts would kick 10,000 seniors and people with disabilities off home care, and put more than 10,000 caregivers out of work when we can least afford to lose more jobs. The cuts to wages and benefits could result in a loss of $1,300 a year for a full-time caregiver. In nursing homes, perhaps the most dangerous place to be during a global pandemic, DSHS has proposed cutting funding by $240 million dollars per year. Continue reading “Sterling Harders: Proposed State Funding Cuts Would Harm Patients, Essential Health Care Workers”

As Labor Loses Clout Nationwide, This Seattle Health Care Workers’ Union Keeps Thriving

This story originally ran in the December 2017 issue of Seattle Magazine.

It’s 10:30 on a Friday morning in September, and the crowd at the Washington State Convention Center in Seattle is on its feet, cheering uproariously as the keynote speaker bounds out onto the stage, “I Am the Fire” by Halestorm blaring over the loudspeakers. Many of the people in the darkened ballroom are sleep-deprived, having arrived by bus late last night or in the early morning hours. But you wouldn’t know it to watch them now—hundreds of them, mostly women of color, wearing Service Employees International Union (SEIU) purple and clapping noisemakers as SEIU 775 president David Rolf emerges to deliver a characteristic barn-burning speech.

“When we were born, 15 years ago, if you worked full-time as a caregiver, you were under the federal poverty line. By the end of this new contract, if you work full-time as a caregiver, you will not be under the federal poverty line!” Rolf thunders. “It doesn’t mean we’ve reached the promised land. It doesn’t mean we’re living in the lap of luxury, checking in to the Four Seasons, flying around in our jets. But what a difference the union can make!”

What a difference 15 years can make. Since SEIU 775 was chartered in 2002—after a bruising legislative battle that culminated in a ballot measure, Initiative 775, giving home care workers the right to unionize, and for the union to negotiate with the state on its members’ behalf—it’s grown from a scrappy, unconventional union representing 1,600 long-term caregivers to arguably the most influential labor organization in state and local politics with 45,000 members, including home care providers, nursing home employees and adult day health care workers. (The group also represents about 1,000 workers in Montana.) That growth has happened during a time when unions’ memberships and influence have been declining precipitously nationwide; currently, just 7 percent of private sector workers belong to a union. Today, SEIU’s members contribute 3.2 percent of their paychecks to the union, which uses the money to negotiate for a contract on their behalf and lobby for other pro-worker policies.

In that time, SEIU’s political agenda has also expanded, from an advocate for low-wage, often isolated workers caring for elderly and disabled clients in their homes to a force to be reckoned with on issues ranging from fast-food workers’ wages to Seattle zoning laws.

Rolf has been there through it all. When the 775 chapter was started, Rolf says, home care aides made minimum wage—$7.18 an hour—with no benefits. Although these workers are hired by individuals, they’re paid by Medicaid through a contract with the state, which sets their wages. As individual employees who worked inside private homes, they lacked the ability to organize for better working conditions—until the union came along.

Over time, using tactics such as flooding lawmakers’ fax machines with messages and blocking the door to the governor’s office, that changed, as SEIU 775 won higher wages from the state Legislature, passed an initiative requiring paid training for home care workers and fought back efforts by what Rolf calls “radical extreme groups” to interfere with union organizing.

Sitting in his office in Pioneer Square, the youthful, 48-year-old Rolf recounts war stories from the union’s early years. Like in 2003, when then state Senate majority leader Jim West of Spokane denounced home care workers as “perpetual pathetics,” prompting the union to stage a prayer vigil in front of his house. The following year, when West was running for mayor of Spokane, SEIU 775 sent workers door to door to get out the vote in low-turnout Republican districts helping West win and clearing the way for a more union-friendly Republican, Bill Finkbeiner, to take his place in the Legislature.

“We weren’t necessarily polite, but neither were they,” Rolf says of legislators. “The state had made a set of policy decisions to keep these women in a state of life-threatening poverty as a condition of them being caregivers. Now we had a union. We had some hope. Expectations were raised, and people wanted the Legislature to do the right thing.”

Sherry Byrum, a home care worker whose goddaughter has spina bifida and needs round-the-clock care, has been a member of SEIU 775 since its early days. She says the work that home health workers do is important, but that isn’t reflected in their wages and benefits. “I’ve seen people lose their homes because they couldn’t pay their medical bills when they got hurt on the job,” Byrum says. “A lot of people do [these jobs] pretty much 24/7, 365 days a year.”

SEIU’s tactics—including confronting legislators directly—have been so effective that they’re now mimicked by other unions and community groups. They’ve also been willing to support union-friendly legislators across traditional party lines, endorsing Republicans like former state Sen. Steve Litzow, former state Sen. Don Benton and the late Sen. Andy Hill.

Teresa Mosqueda, a lobbyist for the Washington State Labor Council and a candidate for Position 8 on the Seattle City Council (election results were not available at press time), says these tactics have served a larger purpose: forcing legislators to recognize that marginalized workers are professionals and a force to be reckoned with. “I think when those in power can kind of close their doors, we have to figure out a way for our voices to be heard through those doors or through the walls, and I think they have done a really good job of that,” Mosqueda says.

Over the past 15 years, SEIU 775 has expanded its portfolio significantly beyond its original mission, throwing its considerable weight around on issues ranging from public subsidies for sports arenas (2006’s Initiative 91, which the union supported) to former Seattle Mayor Ed Murray’s Housing Affordability and Livability Agenda (in a Seattle Times op-ed, Rolf described opponents’ position as “selfishness raised to an art form”).

Perhaps no battle has so defined SEIU 775 to the public as the fight for a $15-an-hour minimum wage, which began with contract baggage handlers at Seattle-Tacoma International Airport and expanded to fast-food workers in Seattle. It culminated in a joint business-labor agreement to bring a phased-in $15/hour minimum wage to Seattle. (Rolf even wrote a book about it, called The Fight for $15.) After victory at Sea-Tac, where an SEIU-backed minimum-wage initiative passed by a mere 77 votes in 2013, the battle moved to Seattle, where fast-food worker strikes and mass demonstrations led then Mayor Murray to put together a joint business-labor task force that crafted a compromise bill that would phase in a $15/hour minimum wage over several years. Rolf served on that task force.

“The fight for $15 originated in an industry outside our own, but we joyfully embraced it and took it up as our cause,” Rolf says. “And whether it’s housing policy or tax policy or immigration policy or Black Lives Matter or subsidies to basketball teams, we’ve always tried to be a civically conscious organization and to not only be on the cutting edges of the industry and issues in our direct line of sight, but also income inequality as a whole.”

SEIU 775’s rise, of course, has not been without controversy. Other progressive groups have grumbled that the union—and Rolf in particular—gets more than its share of credit for battles that were won by coalitions, not individual unions or their charismatic leaders. Former Seattle City Council member Nick Licata, who had a front-row seat for the $15 wage debate at city hall, says SEIU’s work on the minimum wage was “necessary, but not sufficient” to pass the compromise. “[United Food and Commercial Workers] and the Economic Opportunity Institute [a progressive think tank] also played major roles, and I don’t think it would have happened without all of them,” Licata says.

Conservative groups have also taken aim at the union. The Freedom Foundation, a think tank that describes its mission as “advanc[ing] individual liberty, free enterprise, and limited, accountable government,” has spent years waging legal war against SEIU 775, seeking to tame its influence by convincing its members to stop paying their dues, which would cripple the group’s influence in Olympia and Seattle. For years, the Freedom Foundation has been Wile E. Coyote to SEIU’s Roadrunner, almost forcing the union into a corner, only to be outsmarted at the last moment with an unexpected roadblock.

In 2014, the U.S. Supreme Court ruled that mandatory union fees violated the free speech rights of home health care workers in Illinois, dealing a blow to unions like SEIU 775 that represent “quasi-public” employees. SEIU has since made union dues voluntary, but the Freedom Foundation and other conservative groups argue that they haven’t done enough to let their members know they can opt out. In 2014, the Freedom Foundation began canvassing SEIU’s members to urge them to stop paying dues, and SEIU lost a lawsuit seeking to keep its membership list private.

The twist? In 2016, the union struck back with Initiative 1501. While it was billed on the ballot as an initiative to protect seniors from abuse and privacy violations, what it actually does is exempt SEIU’s membership list from state public disclosure law. It was approved by 71 percent of voters.  “Initiative 1501 was one of the most effective ballot measures that any of us have ever seen,” says Maxford Nelsen, director of labor policy for the Freedom Foundation. “I’m not surprised that it passed by the margin it did, but it’s probably fair to say that the vast majority of voters were not cued in to the details of the measure.”

Rolf says the tactics of groups like the Freedom Foundation give SEIU no choice but to get, as Nelsen puts it, “clever.” “When people knock on your door and say you should drop out of the union, is it because someone’s paying them to help you save $30 a month on union dues,” Rolf asks rhetorically, “or is it because they have an agenda that’s about undermining the only democratic voice that workers in our country still have?”

That voice, as anyone who has observed the U.S. economy in the past 50 years knows, is shrinking, and SEIU is not exempt from the larger forces that are making that happen, including an increasingly fractured workforce, the rise of involuntary part-time and contract work, and the growing divide between information-sector millionaires and the workforce that serves them lattes and picks up their trash. The U.S. labor movement formed at a time when most people worked for large companies and most industries were unionized; today, in a globalized economy that places shareholder value above all else, that system no longer functions the way it did.

Rolf argues that like all unions, SEIU will have to adapt and figure out new ways to organize if it hopes to survive in the 21st-century economy. Going back, he insists, is not an option. “Every time unions get smaller, the middle class gets smaller,” he told the crowd at the convention center. “For 40 years, American workers have been getting screwed because they don’t have the collective power to stand up for ourselves, and our failed system of industrial relations, built for the factory economy of 1935, is just not going to cut it in the 21st century. We have to invent something new.”

Rolf doesn’t know exactly what that will look like, but his work organizing a disenfranchised group of independent contractors into a statewide powerhouse has convinced him that even in an increasingly fractured 21st-century economy, unions will be part of that solution.

In the Trump Era, a Seattle-Only Health Care Option?

This story originally ran at Seattle Magazine.

As the Trump Administration cracks down on undocumented immigrants and threatens to overturn the Affordable Care Act, pushing more than 20 million people off their health care plans, some Seattle leaders are looking for ways to ensure that people living in the city can access health care regardless of their income or immigration status.

To figure out how to accomplish this, they’re looking to the south—specifically, to San Francisco, another high-cost West Coast “sanctuary city” that just happens to have the only truly universal health care coverage system in the country.

The plan, known as Healthy San Francisco, isn’t technically health insurance—only San Francisco residents are covered, and only inside San Francisco’s borders. But it does provide comprehensive health care—everything from annual exams to mental health care to lab tests to addiction treatment—to people making up to 500 percent of the federal poverty line, or about $60,000 for an individual. This group includes independent contractors, lower-middle-class people without employer-provided insurance, and, increasingly, undocumented immigrants, who do not qualify for benefits under the Affordable Care Act.

The idea, according to San Francisco Health Department spokeswoman Rachel Kagan, is to “reduce the dependence of uninsured people on emergency rooms health care,” by getting them “plugged into the health care system earlier, where they can get preventative care.” At its peak, Healthy San Francisco had about 65,000 members; once Obamacare was up and running, enrollment declined to about 14,000.

People who qualify for Medicaid are ineligible for Healthy San Francisco, as are people who already have insurance. (Uninsured people who qualify for the Affordable Care Act can decide to pay the federal penalty and join Healthy San Francisco instead). “It’s supposed to be a program of last resort,” says Alice Kurniadi, a senior program planner at SFDPH, which oversees the program. Healthy San Francisco is funded by the city’s general fund, fees from participants, which max out at $1,800 a year, and a payroll tax on businesses—$2.64 per employee, per hour for businesses with more than 100 employees, and $1.76 an hour for businesses with 20 to 100 workers.

Seattle had a similar tax—derisively referred to as the “head tax” by opponents—for a brief period in the mid-2000s, when the city council passed a $25-per-employee tax to pay for transportation projects. That tax was repealed in 2009, and efforts to reinstate it for other purposes (most recently, to fund the city’s Office of Labor Standards) have failed. (Restaurants challenged the law in San Francisco, but lost; a subsequent court case concluded that the “Healthy San Francisco fees” many had instituted in protested went straight into restaurant owners’ pockets.)

City council Position 8 candidate Teresa Mosqueda, who says she will propose a “Healthy Seattle” plan here if she’s elected in November, acknowledges that there are significant differences between the fiscal and political climates in San Francisco and Seattle that will need to be addressed for the plan to have a shot here.

“The biggest difference is that [San Francisco] already has so much more revenue that they’re able to play with,” including a statewide income tax, Mosqueda says. “Because we have a different revenue system here, we need to have a larger conversation with businesses and employees” about the best way to fund a citywide health-care plan.

One thing Seattle does have in common with San Francisco, Mosqueda notes, is a large system of community health-care providers that could form the backbone of a public provider network. San Francisco’s “medical homes” are mostly community clinics, along with a few private providers. “They had three dozen health care centers and hospitals in their city,” Mosqueda says. “I’ve counted—we have almost four dozen community health centers in our city, and even more hospitals and a VA.”

No one I spoke to in either city was placing bets on whether Trump will manage to overturn the Affordable Care Act this year, but both San Francisco health officials and Mosqueda said it’s a good idea for cities to prepare for the worst.

“If we can actually create a pool that will allow people to get the comprehensive services that they need, then we should,” Mosqueda says. “I think it’s definitely possible in a post-ACA world” to deliver health-care services at the city level. “And also in a post-whatever-Trump-does world,” she adds.


The C Is for Crank Interviews: City Attorney Pete Holmes

Image result for pete holmes city attorneyCity attorney Pete Holmes was first elected in 2009 as a reformer. A bankruptcy attorney who advocated for marijuana legalization and was one of the original members of the Office of Professional Accountability Review Board (OPARB), the body that reviewed disciplinary decisions in police misconduct cases, he challenged then-incumbent Tom Carr from the left, assailing Carr for cracking down on minor crimes like pot possession and waging war against bars and clubs while letting DUI and domestic violence cases molder. Now, Holmes’ challenger, Scott Lindsay, is ripping some pages from the city attorney’s own playbook, accusing him of allowing domestic violence cases to founder, ignoring crimes committed by homeless people and people with substance use disorders, and failing to implement criminal justice reform.

I sat down with Holmes last month to discuss his record, Lindsay’s accusations, and issues ranging from health care to homeless RV residents to downtown disorder.

The C Is for Crank [ECB]: Your opponent, Scott Lindsay, has accused you of deprioritizing domestic violence cases in your eight years in office, pointing to stats that show a steady decline in the number of cases filed. How do you respond to this allegation?

Pete Holmes [PH]: That is simply, unequivocally wrong. And it’s unfortunate because, without getting defensive, it is quite easy for someone smart like Scott to take the stats out of context and give them a spin that is at best misleading and at worst, intentionally creates a completely false impression that is, in fact, diametrically opposed to what my policies are and what the performance has been. In truth, domestic violence referrals from SPD, as well as [case] filings, have been cyclical. They have gone up and down over the last 10 years.

What happens immediately in every case is that advocates reach out to the victim and assess whether or not a case needs to be filed. Sometimes the victim doesn’t want it to happen. What’s best for the victim is always assessed early in a case. Frankly, we’re making better decisions [on which cases to file.] A referral to the county for prosecution as a felony case, instead of  filing as a misdemeanor, will show up as a decline. That’s really what a really good  domestic violence section does, is to do triage. We don’t have the resources to file every case, nor would you want to.

If there is a follow-up investigation required for a misdemeanor, there are next to no resources available for that. In fact, for years, SPD had no detective support whatsoever for any misdemeanor  domestic violence referrals. So, in other words, whatever the patrol officer got that evening on response is all we have. Today, as we speak, we have one [full-time] detective at SPD that’s handing an average of about 1,500 cases. And this is not a criticism of SPD. They’re managing resource problems in the same way that we are. They do have a team that’s dedicated to felony domestic violence investigations. If it’s a felony, they get full backup support, and we have to get in line and wait. So that’s why our triage is even more important. This is something that I have talked about with every police chief since chief [John] Diaz: ‘Please make sure that this stays on your radar. We need misdemeanor support.’

“I know that the one thing even council members with whom I have had strong disagreements over the years, and there have been many will, tell you is that even when they’ve disagreed with Pete, they have never feared that Pete is going to somehow rat them out or put them in a false light.”

ECB: And nothing has improved since Diaz?

PH: Well, it comes and goes. The domestic violence unit under Captain Deanna Nollette is hugely supportive. It’s not a criticism. I recognize that we’re all struggling to get the job done, and we’re always using triage. That’s true with SPD as well as our office.

That’s the other thing that’s so disappointing when Scott pulls these stats and does not give the full story. This shouldn’t be a finger-pointing exercise. When you go public with stats like this, it’s not unlike if you leak an early draft of an ordinance. [Lindsay released an early version of city council member Mike O’Brien’s legislation creating protections for people living in their vehicles.] That’s not a good way to encourage collaboration.

ECB: Since you brought it up, what do you think was the impact of Scott leaking the RV legislation?

PH: That’s a great question for you to ask the council members. I know that the one thing even council members with whom I have had strong disagreements over the years, and there have been many will, tell you is that even when they’ve disagreed with Pete, they have never feared that Pete is going to somehow rat them out or put them in a false light. Because all these things have a lengthy, deliberative fact-gathering process, and arriving at the best policy is not waking up one morning and saying, ‘We should have an ordinance that says this.’ It’s going, ‘This is a problem. How should we address this?’ And you go through a lot of iterations. I don’t want to get in [O’Brien’s] head and say whether he felt pressured to get it out, but I don’t see how it was avoidable, frankly. And that’s why you shouldn’t do attention-grabbing stunts like that, especially if you’re going to be an ethical lawyer. That is precisely the wrong way to have a mature debate about a lightning-rod issue. If you want to throw red meat, if you want play on people’s fears and prejudices and anger, that’s Page 1 in Donald Trump’s playbook, and it only lends itself to poor, poor policy making.

ECB: What do you think of the legislation itself, which proposes opening dozens of small lots for people living in their vehicles and granting amnesty from parking tickets and fines for people living in their vehicles who agree to participate in a program?

PH: I’m not going to comment on that, except to say that under Scott’s tenure, the executive tried the approach of having these car camps, these designated parking spots, and I think the results speak for themselves on that. [The city abandoned the “safe lot” and “safe zone” program after concluding that the “safe lots” cost too much and the unmonitored “safe zones” resulted in too many public safety risks]. It doesn’t mean the problem went away. There are litter and human waste issues. The allegations of criminality at least have to be investigated. But when you ask people, ‘What would you like to do?’ that’s when usually people start to be quiet and say, ‘Well, seriously—is the tow truck driver going to tow away the camper that’s got a family in it?’ Perhaps there are some really hardened tow truck drivers who will do that, but are you comfortable with that if you’re in the position of authority and authorizing that?

“If you want to throw red meat, if you want play on people’s fears and prejudices and anger, that’s Page 1 in Donald Trump’s playbook, and it only lends itself to poor, poor policy making.”

So, a, the problem hasn’t gone away. B, the only thing you can do is to attempt to address it. And c, when you criticize early efforts in that way, especially in this office, it is so wrong-headed. It should be self-evident, but if you are simply walking into a room of people who are angry about homelessness for whatever reason—maybe they feel genuine distress about the plight of the homeless, maybe they just don’t like the blight of their city, whatever their reason, they’re angry about it—having a shouting match is just not going to lend itself to really good decision-making.

ECB: Your opponent talks a lot about how he came up with the idea for Navigation Teams [groups of police and social service providers who offer services before sweeping homeless encampments] when he worked at the mayor’s office. Do you think the teams are an improvement on the way the city used to do encampment sweeps?

PH: To an extent. I certainly have been impressed by the officers and the teams that include social service providers. That has been a much better response than the status quo, which was: Send out a cop to make an arrest. They are now actually engaged in bona fide problem-solving. I think it’s the right approach. But the big question is, are there sufficient resources for the Navigation Team to refer people to, and that’s always going to be the question.

There is also an issue about how the resources of the executive compare to the resources of the city attorney. If you’re running for this office, you need to make sure that you correct any misimpressions about just what it is you can do. You can promise that you’ll cure rain in Seattle. It does beg the question, how are you going to do that? It seems like [Lindsay] really got ahead of himself and doubled down when he said [to the Seattle Times editorial board] that he was the only person in the mayor’s office working on homelessness. That’s not true on its face, and it ignores that the mayor is the executive who appoints all the department heads—like human services, like SDOT, like the chief of police. All of those are subject to mayoral direction and that includes spending of resources the actual general fund. So the city attorney, in that case, is very much in a supportive role.

I think the city attorney’s role is also to say, ‘I’m sorry, Mr. Point Person for the Mayor [Lindsay], if you’re going to use prison labor to clean up an unauthorized encampment, that is a nonstarter from a liability perspective. I would like to think that you have enough just social justice chops in your body to understand that that’s a stupid thing to do—a heartless thing to do—but if you don’t, here’s the legal analysis. If one of these guys gets pricked by a used needle without the proper equipment by a used needle we are on the hook. So if you don’t understand common sense, here’s a legal analysis for you.’ That’s what the city attorney does.

ECB: What do you think of the merits of the lawsuit against Initiative 27, which would ban supervised consumption sites throughout King County?

PH: I can’t get into [the merits] because I’m looking at a response right now to the initiative. But it’s completely wrongheaded policy, and it’s an example of what I’m talking about. What’s disappointing about my race is that Scott is effectively playing into that same angry narrative. He is going after the people who want to just call a cop and ‘clean up these people, clean that tent, send these people packing on their way. What do you mean you’re going to allow people to shoot up? Are you crazy?’ And these are people that have done zero research, have probably next to no public health qualifications, and it is emblematic of how we backslide.

We do, at best, an ineffective job of trying to get policy headed in the right direction—that is, a public health approach to a public health problem. I think Scott is playing into that, and that is so disingenuous. It’s so cynical. That approach is simply going to mean that, well, the pendulum may just swing back the other way, which is, call the cops. Maybe we’ll renew the debate over whether we should have a  municipal jail, because there are consequences to every policy decision you make. So if we decide we’re going to go back to a law enforcement approach, a  criminal justice approach, to a public health problem, then you’re going to overtax the criminal justice system. You may find us having a difficult time maintaining the reforms under the federal consent decree when you start asking cops to go deal with addicts. That approach has failed. We can’t have backsliding right now, and the thing that’s going to make us most susceptible to backsliding right now is pandering.

“I think the city attorney’s role is also to say, ‘I’m sorry, Mr. Point Person for the Mayor [Lindsay], if you’re going to use prison labor to clean up an unauthorized encampment, that is a nonstarter from a liability perspective.”

ECB: Are the existing therapeutic courts sufficient to deal with all the people coming into the criminal justice system needing help with mental illness and addiction?

PH: Anything that is resource-oriented is insufficient. I can tell you, we simply don’t have enough resources. The criminal justice system is a bad place to deliver public health services. That said, there aren’t enough resources that we actually can refer people to and say instead of going to jail, I’m going to refer you to counseling or inpatient treatment or whatever. We can only do that now if we invoke the involuntary commitment act, where you’ve actually got someone who is not competent to stand trial and is a danger to themselves or others.

The preference would be that we upstream all these things and avoid the criminality in the first place. That’s the problem. Say you’ve got someone who’s not a criminal, who’s an addict, or you’ve got someone who’s mentally ill, and then we try to say, ‘Well, we’re going to force you to get that treatment.’ We obviously need to do that when that’s the only option we have, and we need more resources to do that, but where I struggle and where the policy debate needs more calm discussion is, how are we going to allocate more policy resources upstream? Every time you say, ‘We’re going to call the cops and make an arrest,’ that’s some money that can’t go upstream. The pie ain’t getting any bigger.

“We can’t have backsliding right now, and the thing that’s going to make us most susceptible to backsliding right now is pandering.”

ECB: What would you consider to be upstream of even programs like [Law Enforcement Assisted Diversion, the pre-filing diversion program for low-level offenders] or arrest?

PH: It would be wonderful if we had universal health care, but if we were able to do as much as we can to compensate for the lack of universal health care, that alone would be a huge  public safety advance.

ECB: Would you support a program along the lines of Healthy San Francisco, which provides health care to people who don’t qualify for Medicaid but also can’t afford or access insurance?

PH: Again, it begs the resources question. It’s going to cost money. Obviously, it makes sense to me, because it’s going to get you the better solution, but I can just sit here and hear the counter-arguments—that, ‘Oh, it’s Freeattle all over again. You’re going to offer these services and attract more people.’ That’s going to be the debate, and it’s going to be so unhelpful. The role of the city attorney  is to make it more likely that that debate is going to happen and happen in a productive way, and I would support having that debate.

Read my pre-primary interview with Holmes, where we discussed even more issues, including encampment cleanups and the role of the Community Police Commission in police reform, here.

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