Championing our down and out

Dr. Jeff Turnbull gives drunks booze. He also gives them shelter, meds, meals and 24-hour access to doctors and nurses. The president of the Canadian Medical Association was in the Yukon this month to talk about health-care transformation.

Dr. Jeff Turnbull gives drunks booze.

He also gives them shelter, meds, meals and 24-hour access to doctors and nurses.

The president of the Canadian Medical Association was in the Yukon this month to talk about health-care transformation.

But two hours before his speech, the plans changed.

“I asked him if he would tell his personal life story instead,” said Yukon Medical Association president Rao Tadepalli.

“Health-care transformation is important, but his story is more relevant.”

At Whitehorse General Hospital’s emergency department, Tadepalli has about 20 regulars.

He sees them a couple times a week.

Most of these people struggle with serious addictions and suffer from pneumonia, seizures and a host of other problems caused by hard living on the street.

Some of them have even had multiple blood transfusions.

Every year, two or three of them die.

But they shouldn’t.

These deaths are “absolutely preventable,” said Tadepalli.

At Ottawa General, Turnbull had the same problem.

He saw a steady flow of regulars.

“On average we were spending between $170,000 and $225,000 per person, per year,” said Turnbull.

“We were seeing these people on a daily basis.”

One of Ottawa General’s homeless regulars showed up with pneumonia.

Turnbull prescribed antibiotics.

“But they have no money, no drug plan, they don’t even have an address,” he said.

The prescription wasn’t filled.

The next day, the patient came back sicker.

Turnbull wrote another prescription he knew wouldn’t be filled.

Kicked out of the homeless shelter, along with everyone else, from 7 a.m. until 4 p.m., the patient spent all day in the cold.

He found a Tim Hortons to sit in, but was moved along.

It was the same story at the local mall.

The next day, the patient came back so sick he had to be hospitalized.

“An intensive-care hospital bed costs $2,800 a night,” said Turnbull.

After a week in the hospital, that patient has drained $20,000.

Then, haunted by addictions, the patient checked himself out before he was better.

And the cycle began again.

After watching the same patients come through the hospital’s revolving door for years, Turnbull took a giant leap outside the box.

The high-ranking doctor started visiting Ottawa’s homeless shelters, where his regulars hung out.

Turnbull found shelters that were bursting at the seams, filled to capacity every night with overflow mattresses strewn in local churches when the temperature plummeted.

He wasn’t surprised to learn Whitehorse’s Salvation Army shelter is in the same boat.

Its 10 beds are full all winter, with spillover clients sleeping on hard plastic chairs in the dining room.

The Salvation Army is a dry shelter, with no drinking allowed on the premises.

Ottawa’s shelters also used to be dry.

“So you’d get people binge drinking in the afternoon, basically rendering themselves unconscious, before coming to the shelters,” said Turnbull.

“They’d be up again at 4 a.m. when they’d start to detox.

“So they’d go out to the all-night grocery store and get Listerine.”

From a health perspective, it didn’t make a lot of sense to Turnbull.

That’s when he came up with an idea that sent shudders through the city’s police force and business community.

Turnbull wanted shelters to offer the city’s hard-core alcoholics five ounces of wine an hour.

Every day, he’d watched alcoholics panhandle until they made enough to buy sherry, then get blotto in time to get back in the shelter.

“That was their whole life,” he said.

“By giving them alcohol every hour it helps to stabilize that – all the craziness stops.

“And they’re drinking a quarter of what they were on the street.”

At first, the police were apprehensive, said Turnbull.

But after watching public drunkeness decline in the downtown core, the police force quickly changed its tune.

Police joined Turnbull’s board. And now, instead of picking up the intoxicated and hauling them to the drunk tank, police bring them to Turnbull’s medical detox.

The detox in Whitehorse is “homeopathic,” said Tadepalli.

“It’s not a real detox.

“It doesn’t have any tools, people just sleep it off.”

Whitehorse needs a medical detox with medical supervision, nurses and protocols, said Turnbull.

“These are people that are very, very sick.”

Everybody shies away from the drunks, he said.

“The police don’t want them in their cars, neither does the ambulance or the emergency department.”

So Turnbull offers them a medical detox, or wine, if they want it.

And he didn’t stop there.

Turnbull also set up clinics in some of the shelters staffed 24 hours by nurses and doctors.

“You can’t treat medical conditions until you treat people’s physical conditions, and you can’t treat those until people are in out of the cold,” he said.

The clinics have beds where sick clients can spend the day away from the cold, monitored by doctors and nurses.

And Turnbull even hired street nurses who wander back alleys and under bridges hunting down patients to make sure they’ve taken their meds.

Many street people are struggling with mental health issues as well as addictions.

“We see a lot of people with schizophrenia,” said Turnbull.

And it can take a long time to build up trust with these people.

“We start by saying, come in out of the cold, we’ll give you food and you can bring your pet.”

Turnbull’s clinics have a veterinarian on staff.

Once they feel more comfortable, Turnbull starts working on their physical problems.

“For instance, we might get their foot looked after,” he said.

As trust continues to build, “we’d say, ‘You’d probably feel better if you took this one medication.’”

It’s a process that takes months, he said.

“It takes a long time to build trust with people who are paranoid and suspicious of authority.”

Recently out for dinner with colleagues, Turnbull ran into one of this shelter clients.

“He was so excited to see me; he began talking about this problem he was having and then started to pull down his pants to show me, right at the table,” said Turnbull with a laugh.

Building on his hugely successful inner-city health program, Turnbull is now setting up apartments for some of his hard-to-house alcoholics.

The first building opened a year ago, and the new tenants shuffled into the rooms with their clothes in plastic bags.

When they saw their chests of drawers, they turned to Turnbull. “Can we put our clothes in here?”

They also wanted to know if they were allowed to stay in their apartments all day long.

And they asked, “Can we put our names on our doors?”

The surrounding community, which was apprehensive of its new neighbours, is now their greatest ally.

The guys volunteer in the neighbourhood, helping out the seniors and, in turn, the community helps out the guys.

What Turnbull has done in Ottawa is “incredible,” said Tadepalli, just back from visiting the inner-city health program.

“And so far, Dr. Turnbull has not had one single complication.”

In fact, he was given the Order of Canada for his work with Ottawa’s homeless.

Tadepalli would like to see the same thing happen in Whitehorse.

“Take one of (the regulars) that comes to emergency 15 to 20 times a month,” he said.

“And look at the cost involved.

“And then look at the cost involved with assisted living, where we bring in social workers, nurses and doctors.”

Turnbull’s cutting-edge shelter system saves Ottawa General Hospital more than $3.5 million a year.

Now, Tadepalli has a dream.

It involves the old Canadian Tire building downtown Whitehorse.

“We could convert it into a homeless centre with a community kitchen, nursing services, social workers, counsellors and physicians,” he said.

Tadepalli would even consider handing out free wine.

“Harm reduction strategies have tested a lot of my own views,” he said.

Watching his regulars die year after year – deaths that were completely preventable – his views changed.

“Services are most needed by the people who are downtrodden and ruining themselves by drinking,” said Tadepalli.

“And they need more than one champion.”

After his meetings with Turnbull, Tadepalli has realized the most important thing.

“It can be done.”

See other stories on Yukon’s alcoholism crisis.

Contact Genesee Keevil at

gkeevil@yukon-news.com