Medical providers say their clients are missing medications and appointments — and are even losing limbs.
When Mayor Nadine Woodward’s administration sought an additional shelter location in the winter of 2021/2022, one of the criteria was that it be located “away from the downtown core and include wrap-around support services.” The administration said they reviewed scores of properties before settling on the Trent shelter in an industrial area on the outskirts of the city.
The location of the shelter may mean there’s less visible homelessness downtown, but it has created a slew of problems for people living at the facility and its neighbors. Guests at the shelter are isolated and lack ready access to healthcare, stores, jobs or job-training activities. The area immediately surrounding TRAC has seen a crime spike and the nearby Chief Garry Park neighborhood has seen an uptick in encampments.
TRAC is the largest shelter in Spokane’s shelter system, with a regular capacity of 350 and an emergency “flex” capacity of up to 688 people during extreme weather. TRAC’s population has recently hovered around 300 people.
People staying at TRAC lack access to sufficient and timely medical care, according to doctors who work at the shelter on a regular basis. The city’s decision to site the shelter in an industrial area without easy access to grocery stores, pharmacies and doctors offices has created four interrelated health challenges:
- People who are at the site have trouble making medical appointments and getting prescriptions filled.
- Infectious diseases are especially hard to manage because of the difficulties isolating sick people in an open warehouse.
- The continued lack of plumbed restroom facilities exacerbates hygiene problems and disease transmission.
- People who can’t find their way to the city’s only emergency warming shelter often fall victim to cold exposure and frostbite, which has led to an increase in tissue damage, amputations and related injuries this winter.
Isolated
In the contract for TRAC, the Salvation Army is required to provide transportation to and from the shelter, including bus passes and individual rides. Nonprofit provided bus passes are generally either good for two hours or a day and are purchased by nonprofits at a discounted rate. In addition to bus passes and ride services, Salvation Army was requested to develop a budget for a special initiative between the city and Spokane Transit Authority in order to create a shuttle route between shelters, service providers, medical providers and the downtown STA Plaza.
During a public safety committee meeting on March 6, Ken Perine, the head of Salvation Army in Spokane, said that the organization had just purchased two vans for outreach and transportation for shelter guests. This purchase may signal the expansion of ride services offered at TRAC, but thus far medical providers say their patients haven’t had access to transportation other than bus passes. In some cases, this has forced doctors at the shelter to call ambulances in cases where a van service would have been just as effective and far cheaper.
On March 6, Bob Lutz, who works on the CHAS street medical team and previously served as the public health officer for the Spokane Regional Health District, said he had to call emergency services for a woman with high blood sugar — a condition which needed treatment, but could have been taken care of without an ambulance. “Unfortunately the only way to [get her treatment] was to call 9-1-1 because there was no transport for her to get to an urgent care or to get to an emergency room,” Lutz said. “That was a waste of resources.”
Lutz said he’s also had patients who need medical care refuse to take an ambulance because of fears they’d be saddled with the costs of the ambulance ride.
Luis Manriquez, a doctor who also works with the CHAS street medical team, shared similar concerns and experiences with RANGE. “Salvation Army said they don’t have capacity [to give people rides or pick up prescriptions], but they could give bus passes to the medical team to distribute,” said Manriquez.
Manriquez said the Salvation Army told him they have limited staff to drive their vans but were in discussions with the city to add more capacity. Salvation Army did not respond to RANGE’s inquiries for this article and they have yet to respond to any of the months of TRAC-related inquiries from RANGE.
The city administration has not responded to questions about health and transportation related issues at TRAC. This story will be updated if they do.
The CHAS street medicine team is currently able to give out bus passes, but Lutz said the passes are limited, and when they run out, shelter staff don’t give them freely. Lutz said he’s been frustrated by shelter staff who say that they don’t trust that the residents will actually use the passes to get to appointments and therefore don’t hand them out to people at the shelter — effectively confining people, especially those with limited mobility, to the shelter and surrounding neighborhood.
Layne Pavey with Revive, which provides peer support and housing services at TRAC, told the city council’s public safety committee on Monday that Revive has provided rides and picked up prescriptions for TRAC residents but has limited capacity as they take on more clients at the shelter. “I want our staff driving people to their appointments and engaging with them and helping them feel hope and building them up,” Pavey said. “But, now we’ve gotten to a point where our caseloads are so full that if a person needs a bus pass, and we can’t give them a ride, we want to be able to just dole those [passes] out. The more the better.”
Council member Zack Zappone, who is also on the STA board of directors, said he would like to see STA address their low income fare programs and offer additional ways for people who cannot afford transportation access outside of the nonprofit bus pass program. “There are clear gaps and needs in our community,” Zappone said. “Buses connect people to opportunity and freedom of movement. When we limit that we make it harder for people to get back on their feet and be a contributing part of the community.”
Zappone said he’s hoping to address increased access to public transportation at the next STA meeting on Thursday, March 16. (Be sure to keep an eye on RANGE’s civics newsletter for details.)
Regardless of changes to transportation access at Trent, it will never be as easy a place to access services as downtown shelters. “If you compare Hope House to TRAC, people can walk to three or four pharmacies from Hope House and they can’t really from TRAC,” said Manriquez.
Communicable diseases
While the location of TRAC itself is isolated, within the warehouse it is difficult for individuals to stay isolated from each other or practice good hygiene. There are some areas for people to isolate, but in general, there isn’t sufficient separation between guests, access to sanitary restrooms and handwashing facilities, or access to masks for people with respiratory diseases.
As RANGE has previously reported, the shelter has struggled to provide adequate handwashing facilities or clean portable bathrooms. Those struggles continue, according to testimony from Perine. “We’re still working with Spokane Regional Health District to mitigate communicable diseases. We still have issues… most of it’s based off port-a-potties and cold weather.” Portable handwashing stations also continue to malfunction at the shelter, according to Perine and council president Beggs, who recently visited the shelter and observed malfunctioning sinks.
Perine said that the addition of indoor bathrooms would go a long way toward improving conditions at the shelter. “Internal individual restrooms for the population is going to help with — oh, gosh — internal disease control, and also just be better for everybody.” The city has previously hired an architect to design facilities for the warehouse, but no plans to begin construction have been announced. The city is currently leasing the building and has exercised a contract clause that could allow the city to purchase the building from developer Larry Stone.
Lutz said that, especially earlier this winter, communicable disease spread was rampant. “It was just abysmal out there earlier on. It was a constant: respiratory symptoms, be it a cold, be it COVID, be it influenza — it was out there. And we also had bouts of what was never documented, but definitely acted as if it was norovirus.”
Part of the disease spread is the setting itself, but there also weren’t sufficient measures taken to encourage good hygiene, Lutz said. “[There was] no signage, no enforcement, no recommendations about wearing masks in the midst of cold, flu and COVID season,” Lutz said. “I had two patients who were both discharged from the hospital, diagnosed with COVID and went back to the facility and they weren’t wearing a mask, and they weren’t in isolation. They just went back in with the general public, and that was not uncommon.”
“The conditions in which people found themselves — crowded environments without requirements for masking, and certainly hygienic practices around bathrooms around sinks didn’t exist to the degree it needed to exist,” Lutz said. “And that’s why, again, I think you had as many illnesses out there as you did.”
An emergency shelter difficult to access in emergencies
This winter, the city has relied on TRAC as the sole official warming center to meet city laws requiring additional shelter space during extreme weather. During the frigid cold in December, Compassionate Addiction Treatment (CAT) offered emergency warming services at their downtown office, but did so without financial support from the city.
During that time, CAT’s executive director Hallie Burchinal said they served multiple people who were experiencing frostbite. She said outreach teams helped get people into their warming center, to the hospital and into beds in shelters or supportive housing after hospital stays. People that they helped get out of the cold included an elderly woman who had blankets and clothing frozen to her body and a man who only had socks on his feet, who Burchinal heard would likely lose his toes.
Burchinal said cases of frostbite have been worse this year than in previous years. “We have more shelter beds, but the location and other factors” have meant that those beds aren’t necessarily serving the population that needs them. Burchinal expects that the distance to TRAC will continue to be an issue this summer during extreme heat. “It’s really challenging to get there by foot or by public transportation,” she said. “It’s just created increased hardship.”
Getting people to and from TRAC has also been a financial hardship on their organization because they’ve had to buy more bus passes to get people access to shelter, Burchinal said.
Manriquez has also seen an increase in frostbite cases that have led to amputations this winter. He attributes that increase to the extreme cold as well as the city’s response. “I don’t know that TRAC is to blame, but the unwillingness to give people anything besides TRAC is certainly different from last year,” Manriquez said.
Last winter, the city opened a warming center at the convention center downtown and paid for hotel rooms to get people out of the cold. This year, the city has relied on capacity at TRAC as the solution and insisted that there has always been capacity there, despite reports from staff and pictures from guests that show the shelter turned people away earlier this winter. “There are definitely people, especially when it was the coldest in December, [who] had frostbite and needed a place to stay to try to minimize the amount of damage they got from that frostbite and TRAC didn’t have any beds,” Manriquez said.
The bottom line, Manriquez said, is that the Trent facility isn’t located in a place where it’s helpful to people who need it most, nor is it designed in a way that’s conducive to supporting people’s health.
“There’s no reason for (TRAC) to exist as a shelter except that the city wanted it to. Its location, its design … none of those things fit with the care of people, unless you’re just trying to literally warehouse them. As a warehouse, it’s a great solution.”
