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17 Şubat 2017 Cuma

The death of Karen Batts: the homelessness case that shocked Portland

The maintenance worker found the woman just before 2pm. She had made her way inside the parking garage in downtown Portland, Oregon, and now stood in the corner of the second floor, mumbling something the worker could not understand. The temperature was about 18F (-7C) with a wind chill. The woman started to remove her pants, a common reaction to severe hypothermia.


He ran to get help from a parking attendant, but by the time they returned, Karen Batts was lying on her back, naked from the waist down and unconscious.


Outside in America

At 2.16pm, medics called Portland police to notify them that Batts, 52, was dead. Within days it would emerge that, months earlier, she had been evicted from her apartment, in part because she had been unable to pay $ 338 in rent.


The death of Batts on 7 January has shaken Portland like few other events in recent memory.


The city’s image of itself as a bastion of liberal values and affable quirkiness is increasingly undermined by the plight of its homeless residents. Amid unusually brutal weather, Batts was among four homeless Portlanders who died of exposure in the first 10 days of 2017.


In the same period, a homeless woman was found holding a dead infant at a bus shelter; the medical examiner ruled it a stillbirth.


The toll on the city streets is rising with each passing year, up from 47 in 2011 to 88 in 2015. Of the recent deaths, Batts’s appears to have resonated the most. And while her death made headlines, a deeper investigation of her story raises difficult questions about whether Portland is failing its neediest citizens.



The SmartPark garage in downtown Portland, where Karen Batts died.


The SmartPark garage in downtown Portland, where Karen Batts died. Photograph: Jason Wilson for the Guardian

About five miles from where Batts was found, there is a white craftsman cottage in the middle-class, rapidly gentrifying Hollywood neighborhood. The mantelpiece in the living room is laden with family photos, including one of Batts, a studio portrait taken almost a decade ago at JC Penney. Her smile is broad and unforced. Her hair, in long ringlets, is just beginning to gray at the temples.


The cottage is home to Batts’s mother, Elizabeth, 77, and her brother, Alan, 53. The family knew that Batts’s health was declining. The last time Alan saw her, “she had her fingers in her ears to keep out the voices in her head”, he said. “I asked her if she wanted me to hug her and she said she didn’t want me to touch her.”


But it seemed impossible to do anything. “I was trying to help her,” he said, “but I just kept getting resistance.”




I was trying to help her, but I just kept getting resistance


Alan Batts, brother



Batts was born in 1964 in the German town of Heidelberg, while their father was serving in the US army. They returned to Portland when she was six years old, a mixed-race child in a town where African Americans were just 6% of the population.


At Grant high school she was a vivacious, outgoing cheerleader. She loved to dance. Even then, there were signs of what lay ahead. Her mother would find “little jars of spit-up” around the house. Later the family realized that she had an eating disorder, but at the time “I didn’t know what that was,” Elizabeth recalled.


Batts graduated with honors in 1982 and enrolled at Fisk University, a historically black college in Nashville, for a pre-dentistry course. Although she received several small scholarships, it became unaffordable and she dropped out after her first year. She came back to Portland and took intermittent classes at Portland State but was unable to finish the degree.


From then on, Batts drifted between short-term jobs and unstable housing arrangements. The family found it hard to keep track. “She lived in maybe 20 places” from the early 1990s onwards, her brother said. A comment that Batts once made to her mother revealed her mental disarray: “Don’t say too much in the apartment, they can hear me over the sprinkler system.”



Elizabeth and Alan Batts at the family home.


Elizabeth and Alan Batts at the family home. Photograph: Jason Wilson for the Guardian

In 1995, she went missing altogether, leaving her brother to put up flyers all over the city. When she returned after a few months, she telephoned and acted as though nothing had happened. The family suspects that she was homeless between 2000 and 2002.


Batts’s illness came to a head in December 2003, when she was found unconscious on a Portland street with alcohol poisoning. She was committed to Oregon State Hospital for a year.In 2004, having recovered sufficiently, she moved into a suburban halfway house.


She would never hold down another paying job and survived on disability benefits. At some point she was diagnosed with schizophrenia.Still, taking her medication and attending addiction meetings, it seemed like Batts had regained a measure of control over her life.



Batts spent most of her last decade in a downtown building for seniors and people with disabilities, owned by a nonprofit called Northwest Housing Alternatives, or NHA. For most of her time there she was stable – well enough, even, to join a family vacation to Hawaii in 2009.


Yet years later something tipped her off balance. Her brother theorizes it was when she stopped taking her medication.


Martha McLennan, the executive director of NHA, said that Batts started displaying serious behavioral problems in early 2016. She caused “damage, disruptions and hazards of different types”, such as entertaining rowdy guests, and was apparently consuming wood alcohol. Police records indicate that Batts was the victim of an assault.


As she racked up lease violations, on-site staff tried to connect her with mental health services, but Batts declined to engage with them. McLennan said there was nothing else they could do. “We’re a housing organization, not a mental-health organization,” she said.


Alan also pushed to get help for his sister, but she often refused visitors, including him. He called various county authorities and services, but each time found himself stymied. Police spoke to her through the door and did not consider her a danger to herself.



333 Southwest Oak, in downtown Portland, from which Karen Batts was evicted last year.


333 Southwest Oak, in downtown Portland, from which Karen Batts was evicted last year. Photograph: Jason Wilson for the Guardian

In September of last year, Batts received an eviction notice over her erratic behavior and failure on two consecutive months to pay rent.


Batts did not attend her eviction hearing, and on her last day, 27 October, the sheriff’s department was called to provide an escort off the property.


McLennan said that such evictions on NHA properties are rare and usually prevented. “She was evaluated for a mental health hold a number of times,” McLennan said, but “the standard required is a really high bar.”


Batts fell into an impossible middle ground, according to McLennan: healthy enough to refuse help, but perhaps too sick to recognize that she needed it.


“She didn’t really have the capacity to make positive choices, but the system says she has the right to make bad choices.”


It is not entirely clear how Batts spent her final months. But it appears she drifted into Portland’s homeless population, only occasionally attracting attention from law enforcement.


In early November, police found Batts in the middle of the street in a run-down part of downtown. She wasn’t wearing a jacket, shoes or pants.


As they got closer, they realized that she had been consuming hand sanitizer. “She was drinking it to keep her mouth clean,” according to a police report of the incident. “She had several bottles on her person.”


The police took Batts to the hospital, where she was placed on psychiatric hold. But soon, for reasons that are not fully clear, she was let back out onto the streets.


The following month, she received a ticket for sleeping on the train. The month after that, she would find her way to the parking garage where she died.



A Multnomah County investigation is under way into Batts’s death, involving what it calls a “full system analysis”.


McLennan said her organization has done some “soul-searching” since Batts’s death. “If things fall apart again, what systems are there to provide resilience? If someone doesn’t have strong systems, what is going to catch them?”


She also said she regrets the eviction. “But given the same set of circumstances, would it have the same result? You know, there’s a point at which we have to look after the interests of the neighbors and the property.”


Instead of laying individual blame, onlookers condemn a fragmented web of social services that prevents even the most well-intentioned from averting tragedy. “I am angry all the time, justifiably so,” said Benji Bao Vuong, a Portland activist. “There is no holistic, integrated treatment for the houseless person.”


A spokesperson for Portland’s new mayor, Ted Wheeler, defended his record, noting that the city opened 750 additional beds during the severe weather and that nobody who sought shelter was turned away.


Housing and homelessness were already hot-button topics in the city, but since the deaths there is a sense of greater urgency. Wheeler has co-sponsored an ordinance that will compel landlords to assist with relocation costs for tenants subject to no-cause evictions.


Back at the Batts family home in the Hollywood district, Alan, who spent 11 years in the air force and is a calm and steady man, struggled to control his emotions as he remembered his inability to help his sister. He recalled the last time he saw her alive, about a year before she died. They were walking together to a local train station.


“She asked me for a cup of hot water,” he said. “She didn’t drink tea or coffee, she just wanted to warm her hands.”


He watched as his sister walked into a bank where there was a counter offering drinks. She got what she needed. Then she walked away.



The death of Karen Batts: the homelessness case that shocked Portland

26 Haziran 2014 Perşembe

Karen Middleton: "Let"s add existence to many years, not just many years to life"

Working on a rehabilitation consultation project in Tower Hamlets was “a complete life changer,” say

Operating on a rehabilitation consultation undertaking in Tower Hamlets was ‘a total life changer’, says Karen Middleton. Photograph: David Harrison




For some former large-ranking public servants, leaving the NHS means consultancy, a directorship, or a rewarding position at some transatlantic arriviste.


But following 28 years, Karen Middleton has left NHS England’s offices as chief allied wellness professions officer for what her colleagues contact the “other side”. Getting trained initially as a physiotherapist at St Mary’s hospital in Paddington, London, just before practising in Essex and east London, she has headed property.


In February Middleton became chief executive of the Chartered Society of Physiotherapists (CSP) – a entire body that represents 52,000 physiotherapists in the Uk. It really is not quite as outdated as its Georgian headquarters in London, but since 1894 the CSP has been the key association, and much more recently trade union as well, for physiotherapists.


Despite their crucial care for individuals with cancer, heart failure, persistent obstructive pulmonary illness, stroke and sports activities injuries, physiotherapists have a minimal profile in contrast with several other healthcare professionals. Perhaps this is why Middleton insists that her most considerable achievement at NHS England was in obtaining greater recognition for physiotherapists and the other allied health specialists (AHPs), such as podiatrists, occupational therapists, radiographers and speech and language therapists. “Even though we’re nowhere close to where I’d like to be in terms of visibility, now there’s considerably greater recognition of the role of AHPs in each and every care pathway,” she says, “and which is been as a result of some important pieces of operate.”


Amid these, she contends, are the introduction of independent prescribing for physiotherapists and podiatrists and self-referral pilots. These showed that individuals who self-refer to physiotherapy get fewer days off function and are half as probably to be off work for more than a month, compared with these referred via standard routes. This implies the NHS is ready to conduct fewer x-rays, give out fewer medication and make fewer referrals to orthopaedic experts.


Then there have been the NHS support improvement programmes. In excess of twelve months, AHP services regarded as to be carrying out poorly by the former strategic health authorities had been redesigned. Waiting occasions were cut, even though clinical outcomes and patient knowledge had been improved at no extra price.


Middleton says: “The key to all thirty of these services redesigns was that the clinicians foremost the redesign commenced with the patient view of what essential to occur.” She believes that service planners are now considerably more aware of the value of patient view, but have concerns about acquiring a genuinely representative picture – like, for example, the voices of men and women with finding out disabilities.


Almost 20 many years ago Middleton worked on a rehabilitation consultation undertaking in Tower Hamlets, east London. “It was a full lifestyle changer,” she says. “I believed that I knew and understood what men and women who necessary rehab desired, but [investing] a month just listening to people’s stories fully transformed my perception.”


There was the physically disabled lady in a ground floor flat who asked for her windows to be cleaned so she could see the planet outside – not the electric wheelchair Middleton had expected. And individuals were considerably much more concerned about improving the co-ordination and administration of solutions than the clinical interventions.


Her experiences in Tower Hamlets enthused her about the potential of digital technologies to streamline patient solutions and empower clinicians. A single of the most effective resources for Middleton has been the NHS Atlas of Variation, which compares companies and outcomes. She wants to include an NHS Atlas of Variation for rehabilitation, so physiotherapy solutions across the country can be compared.


Asked why rehabilitation is still not integral to NHS acute care, Middleton murmurs: “How extended have you received?” She goes on to say that in terms of policy, targets or outcomes measures, the NHS is too targeted on mortality costs as an alternative of on what transpires when lives have been saved.


“Even though AHPs – and specifically physios – have a huge contribution to make in terms of saving lives, by way of avoiding falls and respiratory care, the true vital additional value of AHPs is not merely in including years to life, but life to many years.” She is alarmed by statistics displaying that by 2035 46% of males and 40% of females in the Uk will be obese and needs to see physiotherapists major the march for physical exercise.


As the CSP chief, Middleton programs to devote a day each week with physiotherapists, many of whom encounter uncertainty simply because of monetary pressures and down-banding of expert posts. Then there is the fantastic privatisation of NHS solutions. Must NHS physiotherapists be anxious? “Properly I do not feel there is a ‘great’ privatisation,” she says. “The final time I saw the figures it was four% of services. But there is no doubt that the plurality of provision is there.”


For Middleton, plurality could indicate unnecessary expenses – for tendering and contract management for illustration – and she is concerned that it could compromise much-necessary integration and co-ordination of companies. She is not confident, even so, that privatisation threatens NHS physiotherapists: “If they are providing excellent high quality care that is expense effective, secure, a fantastic encounter for sufferers, why would a commissioner go elsewhere?”


Speaking on the shift to 7-day operating in the NHS, Middleton says she believes it’s what the public needs and that it really is backed up by the findings of NHS England’s national health care director Sir Bruce Keogh (published in December 2013) about improved mortality rates, and lowered length of hospital stays and readmission costs. She cites the instance of Birmingham Heartlands hospital, which has launched 7 day working within present sources.


Her departure from the NHS has been an emotional affair and Middleton realises how significantly the service has been component of her recognize. At her leaving get together she told colleagues that her work will constantly be foremost about sufferers – regardless of whether she’s with the NHS or on the “other side”.


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Karen Middleton: "Let"s add existence to many years, not just many years to life"