Agenda Item # 9.1 - An Vo | Received 06/05/2023June 2nd, 2023
Dear City Council,
Thank you for your public service and for trying to make Gilroy a better place for everyone.
The purpose of this letter is to voice our perspective on the matter at hand: “Ordinance Banning
the Use of Certain Public Right-of-way as Sleeping or Living Accommodations.”
We acknowledge some of the issues the residents of Gilroy face, such as trash and contaminants
that are associated with the homeless encampments; the limitation of enjoying a public space
such as a park if there are unhoused people sleeping there; parents’ fear for their children’s
safety when the homeless individuals are by their schools, acting erratic due to their mental
health.
However, we ask that the passing of this ordinance be modified to consider the potential physical
and mental harm this ordinance would impose. We ask that more time and thought be dedicated
to find meaningful solutions, to better integrate this vulnerable population into our society where
they become responsible and friendly neighbors, so families feel safe and comfortable enjoying a
day at the park.
As doctors, nurses, social workers, and outreach workers providing healthcare to the unhoused,
we work closely with unhoused folks and have a closer perspective on their lives. These folks
have painful stories and trauma related to the lack of social support, everyday struggles due to
poverty, medical illnesses and difficulties managing social limitations.
With six years of experience providing health care for the homeless population, I have heard
repeatedly the trauma that these patients go through. From childhood, they have experienced
physical and sexual abuse, family members being in prison or have addictions. This trauma
follows them through adulthood and cause some major health consequences, such as post
traumatic disorder, anxiety, addiction. ACE (Adverse Childhood Experiences) is a questionnaire
that correlates negative health outcomes based on the numbers of traumas experienced in
childhood. A study published by Bymaster and colleagues in 2017 which surveyed 125 homeless
patients showed more than 66% of the study participants had ACE scores of 5 or more compared
to 8.7% of 29,000 people in five states (1). While the issues around homelessness must be
addressed, to push them out of their “homes,” to make it more difficult for them to find a place to
rest, without providing alternatives, is creating more trauma and worsening their mental health.
The sweeps, the abatements, and the unstable community add to their trauma, worsening and
exacerbating their post-traumatic stress disorder, depression, schizophrenia, addiction, and other
illnesses. We genuinely believe that untreated mental health is a major cause of addiction, and
the ongoing trauma and displacement perpetuate their addiction. In the last two years, fentanyl
has poured into the U.S. and illicit drug makers decided to put fentanyl in methamphetamine as
well, resulting in more overdoses. There were 42,000 deaths in 2016. In 2022, there were
105,452 deaths.
When we see unhoused patients, we address their physical health, mental health, and addiction
all at the same time. We have seen people get better with treatments. However, there are
challenges in providing care for the unhoused when we cannot find them for continuity of care.
When the folks are constantly on the move looking for a place to sleep, they do not have the
mental capacity to take medicines or go see a therapist for addiction counseling.
Recently, we cared for a patient with heart failure and methamphetamine use. When we first met
this individual, she was out of breath, couldn’t walk for more than 100 feet without huffing and
puffing. Her legs were swollen. She had water in her lungs. Our nurse got blood work in the field.
We diagnosed her with heart failure and kidney injury. The next week we came back and gave her
medicines. Because her medicines could cause electrolyte disturbances, we had to come back
again to get blood tests and to adjust her medicines. A month or two later, the patient made her
way to our medical mobile bus parked by the social service office on Fridays. Before she was too
out of breath to come, now she could walk better after taking her medicines. We worked on her
addiction as well, and she was able to stop using methamphetamine. She is now 4 months clean
and sober. For this patient, if she was being moved constantly, I would not have been able to
provide the continuity of care and she would not have gotten better. She would have either died
or got to the hospital that would cost the county a lot more money. Thus, we make great effort to
provide care and prevent ER visits. We can’t do this if we can’t see them regularly. A study by
Chang and colleagues in 2023 showed that the average lifespan of unhoused folks in Santa Clara
County is 53 years old compared to 83 years in the general population (2). There are many
causes of early death; many are related to untreated mental and physical health.
Another challenge we encountered in delivering care due to abatement was the inability to
address time sensitive curable diseases. We recently met two patients needing weekly treatment
of a curable disease. They got the first one, but due to sweeps, they moved, and we could not
find them for the subsequent treatments. These interruptions to the treatment plan are something
we encounter frequently. Interruptions in the treatment plan require us to start over thus
increasing medical cost. Without out appropriate treatment, the disease will worsen and spread.
As you can see, it is difficult to control something when the folks are moving a lot. If the city has
a plan to provide alternative places for the displaced folks, we could follow up with them more
easily and on the public health perspective, get rid of these illnesses more effectively.
As you continue to work towards ending homelessness, we ask you to take these stories and
facts into account. The trauma, the mental health, the curable illnesses, and the addiction, they all
need consistent follow up. If we could establish other temporary housing or shelter, then that
would be very meaningful for both the unhoused folks and the residents of Gilroy. We could
consider small parking spaces for about 20 cars or trailers, camping grounds that limit the
number the tents, and tiny homes that have been proven effective in San Jose. These are some
ways to create a safer and more stable community for the unhoused and the residents of Gilroy.
Sincerely,
An Vo, MD
Diane Morales, Nurse
Chris Baker, Nurse
Barbara West, Nurse
Tara OHiggins, Nurse
Amber Frymier, Nurse Practioner
Sergio Salazar, Community Outreach Specialist
Citation:
1. Bymaster A, et al, A Pediatric Profile of a Homeless Patient in San Jose, California , J
Health Care Poor Underserved, 2017;28(1):582-595. doi: 10.1353/hpu.2017.0041
2. Chang JS, Saxton K, Bright G, Jorden MA, Gutierrez A, Xia K (2023) Deaths of profound
despair: A retrospective cohort study of mortality among people experiencing
homelessness. PLoS ONE 18(2): e0281912. https://doi.org/10.1371/ journal.pone.0281912
3. Chang JS, et al., Harms of encampment abatements on the health of unhoused people.
https://doi.org/10.1016/j.ssmqr.2022.100064