Homeless Death Review Team takes a close look at deaths

ANDREW SCHULTZ spoke with his brother for the last time 13 years ago.

Phil was in Philly, where he had wandered after leaving his home and job on Long Island. It was a brief conversation, a phone line connecting brothers 150 miles apart.

In the intervening years, on trips down to Philadelphia, Andrew often thought about walking the streets, trying to reconnect with his brother. He never did.

"Once he didn't want to go back with us, or do anything with us, I figured how am I going to force him to come home or to do anything for him?" he said. "I came to realize that this is the life he wanted to lead."

The next time Andrew saw Phil, it was at his funeral Oct. 28, after Phil died homeless in Rittenhouse Square.

In most cities, a death like Phil's would be forgotten. But in Philly, a group of about 50 people from various disciplines pore over reports of every homeless death.

The city's Homeless Death Review Team has been working in near-silence since 2009, and has been a trailblazer for similar programs across the country.

It took a senseless tragedy to start the conversation.

Joseph "Big Joe" Kelly was killed on the Vine Street Expressway in February 2008 while stopping to help Jeffrey Williams, a homeless, wheelchair-bound man who had veered into traffic.

The driver of a passing pickup truck didn't see Williams and his good Samaritan. Both died at the scene.

Outreach workers later discovered that Williams had landed on the highway after being turned away from a packed overnight shelter while looking for a place to bed down.

It was a wakeup call for the people who deal with homelessness, an opportunity to analyze what wasn't working - and what was.

In January 2009, staff from the city's Office of Supportive Housing and Department of Behavioral Health contacted the Medical Examiner's Office with a proposal: assemble a board of service providers to review each death.

There was a precedent for it: The Medical Examiner's Office was already convening "review teams" for infant deaths and women who die within a year of giving birth.

"When a person dies, one person has one piece of the pie," said Roy Hoffman, a pediatrician who coordinates review teams for the Medical Examiner's Office.

"But if you bring everyone together after the fact, all of a sudden we have 20-20 hindsight and get to see the whole picture."

The idea for the team was well-received in the city's Public Health Department and beyond. Its members ballooned to include emergency-room doctors from all major city hospitals; representatives from medical-insurance companies; outreach workers from Project HOME; and even police officials.

"People just signed on. There wasn't a lot of hand-holding," said Marcela Maguire, director of the Department of Behavioral Health's homeless services and one of the founding members.

"Everyone involved said, 'Yeah, people shouldn't die of homelessness, and we should do something about that.' "

The process is simple: Hoffman and his staff compile basic information on each death - name, age, location and cause of death, etc. - and share a list of about 13 names with the member organizations.

They turn inward, seeing if the individuals on the list appear in their own data. Then, about four times a year, the team's members get together and talk.

"Some of this record-keeping can be fragmented," said Laura Weinbaum, vice president for public affairs and strategic initiatives for Project HOME, whose active caseworkers are de facto experts on the city's changing homeless population.

"During these meetings, everyone goes around the table and says, 'I saw this guy on this date,' and we create a timeline of their system interactions."

Suddenly, information that previously existed in separate silos becomes unified, and clearer pictures of the people who've lost their lives emerge.

Connections appear across the system, like learning that a person who turned up with chest pains at Thomas Jefferson University Hospital was arrested for retail theft in 1992, and spent a few nights in a "winter bed" facility set up by the Office of Supportive Housing.

It's labor-intensive and time-consuming: Since it was formed in 2009, the team has released only one full report, a 2012 study that analyzed deaths from 2009-10.

But it's also cheap: The team's members are all volunteers. No additional money from the city is devoted toward the work.

Roberta Cancellier, deputy director of the Office of Supportive Housing, estimates that about 94 percent of homeless people who die in the city had some form of contact with "the system."

"It allows us to stitch together a picture of an individual's life at time of death," she said. "That's essential to making process changes, and understanding gaps in the system and what we can do to eliminate them."

Surprises inevitably emerge, like the revelation that virtually no homeless people die from hypo- or hyperthermia.

Instead, according to the team's 2012 report, most die naturally. Drug and alcohol overdoses and circulatory-system diseases are the top causes.

In response to those findings, the team developed 121 new slots for addiction treatment, and opened up new dialogues with ER staffs about the homeless people who seek hospital treatment for addiction instead of for a medical emergency.

"Our work can't always show an immediate effect," said Hoffman, "because no issue is cut-and-dried, even drug intoxication has layers: You get into conversations about poverty, crime and education.

"But that doesn't stop us."

The group's work has caught on: Similar teams have cropped up in New York, Denver, Portland, Ore., and Los Angeles.

Philly's team remains hard at work, and is putting the finishing touches on its second report, according to its members.

New areas of focus include Kensington, where previously hidden pockets of homeless drug addiction are slowly emerging.

The hope is that the combined voices of the team's members will lend more credence to policymakers, especially as a new mayoral administration takes shape.

"We're out there yelling about homelessness all the time, and it becomes part of the woodwork," Weinbaum said. "But when the [Medical Examiner's Office] and doctors come in, it lends a different perspective.

"One thing that unites us, no matter our politics or position, is that no one wants someone to die on the street. That seems like a pretty powerful motivator."

On Twitter: @Vellastrations