On Nov. 10, Dean Allen Littrell, 57, froze to death in his sleeping bag in his makeshift camp in the woods behind Walmart.
Despite recent local attention to the homeless population and a health center in town with a designation to attend to homeless residents, some hurdles remain in place for people like Littrell, who slipped through the cracks.
Months earlier, in the warmth of the summer, Littrell made his usual stop into W.J. Doyle, a liquor store owned by Chris and Molly Hamilton. Littrell made frequent stops at the Hamiltons’ liquor store and had struck up a friendship with the family. Littrell loved to sing, and on numerous occasions, stopped on his way out of the shop to sing with the Hamiltons’ daughter.
On one occasion, in August, Littrell looked in especially rough shape, Chris Hamilton said. His skin was gray, and he looked feeble. Hamilton was worried and asked Littrell if he was OK.
Littrell called Hamilton over and lifted his pant leg, revealing blood streaming down his legs. Littrell told him he had been diagnosed with hairy cell leukemia on a recent emergency room visit and was experiencing severe gastrointestinal bleeds. Littrell was bleeding out of his rectum.
Hairy cell leukemia is a treatable form of cancer, and Hamilton urged Littrell to seek treatment. Despite initial hesitation, Littrell eventually agreed to make an appointment at Axis Health System.
Axis is designated as a Community Health Center and receives funding from the Health Resources and Services Administration, housed under the U.S. Department of Health and Human Services, to provide care to underserved populations. The federal funding helps support Axis’ Healthcare for the Homeless program.
As was typical of Littrell, and many other homeless people Hamilton interacts with, Littrell disappeared for a period of time, and with no cellphone, could not be reached. Subsequently, he missed the first two appointments Hamilton had helped him make.
As a result, in line with Axis’ policy, Littrell was placed on the list for same-day appointments only. But that posed two significant issues: First, Littrell didn’t have a cellphone, so he could not be reached when an appointment opened. To see if there was an available appointment, he would go to Hamilton’s store to use a phone. Second, and more significant for Littrell, he was told he must be sober during his appointment.
Littrell was rarely sober, Hamilton said, which was part of the reason he was homeless. The expectation that Littrell be sober on the same day he was informed of an appointment amounted to a death sentence, Hamilton said. Littrell never attempted to go to Axis because he knew he would not meet Axis’ sobriety requirement. Health insurance was not the issue either, as Hamilton said Littrell had Medicaid.
After continuing to watch Littrell deteriorate, Hamilton sent a text to the number he had for the Healthcare for the Homeless outreach specialist at Axis.
“Dean is headed far downhill. He has been in the ER multiple times lately. He says they diagnosed him with hairy cell leukemia. He has had gastrointestinal bleeds badly enough to run down his legs and soak through his pants. His skin is grey, he has lost weight and strength and his belly is distended. The last times I tried to get him in I was told that he has to blow below .08 to be seen and he can only make an appointment for that same day, which means call in the morning and stay sober during the day. He has a severe alcohol problem and is never sober during the day. Axxis (sic) is his primary care. Is there anything we can do? If we do nothing I’m afraid he will not live much longer,” Hamilton wrote in the first text.
Someone responded, confirming the text message had been received by an Axis employee, but expressing uncertainty about who the text was intended for.
“If I can refer you to the right person, I would love to be of help,” the person wrote back.
Hamilton identified himself and said he was trying to reach Robin with homeless outreach. When asked if he knew Robin’s last name, he wrote, “I don’t. She took Victoria’s position as supervisor for homeless outreach from what I understand. We see some homeless folks that don’t go to Manna with some regularity. We try to help where we can, collecting sleeping bags, tents, and the like, giving them vitamins, helping make phone calls and trying to gently push them to get healthy. Victoria chose to engage through our store and Robin didn’t so we haven’t had much contact lately.”
Hamilton never received a response. A couple of months later, Hamilton’s fear became reality: Littrell died.
It isn’t the first time a homeless person who the Hamiltons had tried to help had been deterred from or denied care at Axis for lack of sobriety.
Matthew Marinsek suffered a seizure in early 2020. After years of being homeless, largely because of his alcoholism, his seizure served as a wakeup call. He went to the Hamiltons, who he called mom and dad despite being in his 60s, and asked for help getting sober. The Hamiltons facilitated a couple of meetings between Marinsek and his stepchildren and decided the best course of action would be to set up an appointment at Axis to understand his options.
“He was looking for some way to get sober and to see where the seizures were coming from,” Molly Hamilton said.
Marinsek was interested in getting sober for health reasons, but also so he could spend more time with his family. Despite his interest in getting sober, Chris Hamilton said he was terrified to get help because he had centered his life around drinking. It took a lot of convincing and coaxing to make an appointment at Axis.
“The thing about the boys, is that they get nervous, the whole idea of not drinking makes them scared, and they want to drink to calm them down. Matthew was scared,” Molly Hamilton said.
On Feb. 28, Hamilton went with Marinsek to his first appointment at the Axis branch, La Plata Integrated Health.
“We just realized that the only way he (Marinsek) was going to get there, was if I took him,” Hamilton said.
When Marinsek showed up for his preliminary appointment, to assess his needs and create a plan for himself, he was Breathalyzed and was denied access because his blood-alcohol content was over 0.08. Hamilton couldn’t recall exactly what his BAC was, but it was alarmingly high, even though she was unable to tell he was drunk. Without explanation or creating a plan for Marinsek to seek alternative help, Hamilton and Marinsek were asked to leave. Distraught, knowing how much work it had taken to get Marinsek to the appointment, Hamilton sent a text to the Axis employee they had seen.
“Thank you for seeing us today. I apologize for Matthew being drunk. I want you to know that my husband and I do not push people into doing things that they don’t want to do. Matthew came to us and wanted help and he is terrified. We had meetings with he and his kids and he wants to get sober. We are trying to help them the best way we know how. I really expected more compassion from you about his situation,” Hamilton wrote.
Hamilton said she never received a response to her text. A couple of weeks later, Marinsek disappeared. His family remains unsure of his whereabouts, which is uncommon for Marinsek.
“He’s the type of person if he didn’t call once a day, he’d call once a week,” Marinsek’s stepson, Clarence Radcliff said. “When Axis denied him, he just sort of gave up.”
Sarada Leavenworth, senior director of Strategy and Development at Axis Health System, said she cannot speak about individual cases because of privacy laws, but confirmed patients are required to be sober at the time of their treatment. To help support patients who struggle to maintain sobriety, Axis has a detox center, Crossroads, that people can check themselves into to sober up before an appointment.
“We don’t require patients to be long-term sober at any of our facilities ... but outside of detox, if you were under the influence right at this moment, we wouldn’t be able to have an appointment with you, for example with a doctor, until you were sober currently, like on that day. The reason for that is pretty simple: It’s that there’s a lot of safety issues that come up if someone’s under the influence while they’re in an appointment,” Leavenworth said.
Chris Hamilton said Littrell and Marinsek were aware of the Crossroads option but had no interest in subjecting themselves to the pain associated with detoxing.
“Detoxing is horrendously uncomfortable; that’s a non-starter. No one in their right mind is gonna go detox out of hardcore alcoholism just to have a conversation,” Chris Hamilton said.
Leavenworth also pointed to problems that arise around consent to treat when someone is under the influence of drugs or alcohol. She emphasized the sobriety requirement is not unique to Axis.
“In terms of medical or dental care, or meeting with those therapeutic providers, it’s not an Axis policy that someone would need to be sober during that appointment, that’s a pretty standard industry expectation. ... Any other doctor, unless you were specifically a detox oriented provider, would be expecting someone to make good decisions for themselves, and we can’t guarantee that would happen if someone is under the influence. What I mean is under the influence enough that we can tell,” Leavenworth said.
Gary Meisner, who supervises Healthcare for the Homeless, said a patient would be asked to take a breath analysis test only if it seemed obvious he or she were under the influence.
Littrell’s and Marinsek’s stories, and the text messages between the Hamiltons and Axis employees, seem to support a common criticism among the homeless community and its advocates: The staff turnover rate at Axis makes it difficult to establish trust and to know who is responsible for reaching out to the homeless community. Regardless of the sobriety requirement, Littrell and Marinsek were never followed up with and it was left to friends, family and random community members to check up with them.
A community homeless advocate, who requested to remain anonymous, said the homeless outreach program misses a significant portion of the homeless population because Axis does not do outreach at Purple Cliffs and does not meet people under bridges or at liquor stores.
As a result, there is a lack of trust between the homeless community and their health provider, according to the advocate and some homeless people who asked to remain anonymous for fear of repercussions if they needed Axis services in the future.
Leavenworth said Axis was preparing to do outreach at Purple Cliffs before COVID-19, but has been forced to stay away since the beginning of the pandemic. However, she emphasized the agency’s outreach efforts at Manna soup kitchen, Volunteers of America and other institutions that serve the homeless population. She also said Axis works to connect with the homeless community at Purple Cliffs through the Neighbors in Need Alliance.
Leavenworth also said Axis is building trust within the homeless community. For example, Leavenworth said Axis saw more than 350 patients experiencing homelessness in 2020. In 2019, Axis saw 401 homeless patients, for a total of 1,800 visits, which averages four or five repeat visits per patient.
There is no way to compare the homeless population in La Plata County between 2019 and 2020 because the total homeless population is only counted every other year. However, in the point-in-time survey required by the Department of Housing and Urban Development, in 2017, there were 91 people in La Plata County experiencing homelessness compared with 192 in 2019. While the trend shows an increase in homelessness, it is far from perfect, as the count occurs in late January, which is when the homeless population is lowest in La Plata County.
“There are a lot of people we have been able to reach, which makes us really happy,” Leavenworth said. “We want that number to go up.”
The frustration the Hamiltons and some members of the homeless community feel toward Axis might be explained by the overall challenges institutions face when working with homeless populations.
Jenn Lopez, who was former Gov. John Hickenlooper’s director of homeless initiatives, said medical centers like Axis often receive only enough money to scratch the surface of the problem. Rural communities face gaps in their efforts to care for the homeless community, as evidenced by Marinsek’s disappearance and Littrell’s death, she said.
It might not be Axis’ responsibility to provide care to intoxicated people, but there needs to be a local facility that does, she said.
Donna Mae Baukat, executive director of Community Compassionate Outreach, also said she was concerned about the lack of options for homeless people battling substance abuse. Right now, the only options in the community are either detox or a treatment center in Fort Lyon. Baukat said she is part of a commission with Mercy Regional Medical Center that is working to bring a treatment center to Southwest Colorado.
However, for Lopez, to focus so specifically on treating alcoholic people is to somewhat miss the point.
“Dean died because he didn’t have housing,” Lopez said.
smarvin@durangoherald.com
