I thought I knew the story inside and out, and then Joan Kloh relapsed.
She is the subject of the final installment of our five-part series on frequent users of emergency medical services: Health Care 911.
It took eight months to complete this work with U-T San Diego photojournalist James Gregg. In that time, I’d compiled a tree stump of research papers and notes that I toted from our offices near L.A. to the San Diego area where the story was reported.
I’d seen paramedics ply their demanding, sometimes dangerous, trade behind darkened trolley stations. I’d watched doctors tussle for control of their ER, and sometimes tussle with each other, when the work of treating frequent users got tough.
But in many ways, whatever authority I had to write came down to an institutional and human understanding of Joan, a recovering addict whose dependence on 911 accounted for more than $50,000 annually in public expenses. She had managed to stay sober — and out of the ER — up until the final weeks before publication.
By letting us into her tenuous recovery, she became our journalistic case study on the needs of frequent users, and the difficulty in reducing their 911 calls.
When I first met her she was a new enrollee in Project 25, a San Diego United Way effort to get frequent users off the street — essentially off 911 reliance — and into far-less costly housing and coordinated medical care.
She was still homeless at that point. And I huddled with her and her longtime boyfriend, Chip Bloemendaal, on the corner of 5th Ave. and Ash St., in downtown San Diego. A sidewalk rail protected their shopping cart encampment from any runaway cars and the awning of an antique store offered some protection from the elements.
Joan was in her first days of sobriety then, after years of drinking and use of other drugs, including methamphetamine. She said I earned her trust when I stretched out on their dirty blanket during the conversation. I noticed the phrase, “When God closes a door, He always opens a window,” machine-stitched into its wool. I chatted with them for nearly an hour without pulling out my notebook. I returned to my nice hotel room that summer night guilty, and grateful, for everything I had.
James and I went on to check up on Joan for over half a year, as we reported out the four other installments of the series. Her program-provided apartment in the City Heights section of San Diego had its temptations: a drug raid took place next door at one point. But the blanket was now laundered and draped over a sofa in Joan’s living room. Joan’s candor, clarity and intelligence during interviews become more startling, and moving, with each day of her sobriety.
She and Chip, who was housed with her as a package deal, were doing so well that we considered a companion profile of a more active and troubled frequent user, a flip side to Joan’s apparent success story.
A woman with frontal lobe damage, who was perhaps the most expensive and vexing frequent user in the city, became the possible subject of this piece. James and I met her at a local ER. Nobody could tell us where she lived or where she went after being discharged, day in and day out, sometimes several times in one day.
The chronically alcoholic woman was in no shape that night, or perhaps any other because of her cerebral damage, to grant us willful consent to write her story. But too stubborn to give up, we trailed the bus that Joan’s potential counterpoint boarded outside the ER — after she had been given a meal, a gurney and hours of safety at the facility. James drove, but the bus driver was eyeing us in the rear-view mirror with much suspicion, so we gave up the chase before we generated our own 911 call.
Later that night, I found the woman by retracing the bus route on foot. With eventual help from Officer John Liening of the San Diego Police Department’s Serial Inebriate Program, who knew the woman and had tried to help her previously, we were able to contact her parents. We met them at Rudford’s restaurant in nearby North Park to pitch participation in the story. Her mother showed us a lovingly-kept scrapbook of photos and keepsakes from the woman’s childhood. We desperately wanted to tell the story.
Because her cerebral damage had been caused by trauma incidents and was not technically mental illness, the woman did not qualify for ongoing psychiatric care, the family explained. They wanted her in a locked facility for her own safety, but a system that had endured decades of cuts would not accommodate.
After discussions with their extended family that went on for weeks, with some apparent disagreement on the issue, we were asked not to write about the woman. It was just too painful for loved ones to have her history documented in print, her mother explained, apologetic in a final voice message that she asked me not to return.
So we were left with Joan. But, it turned out, with a Joan who illustrated just how tentative success was for all Project 25 clients and, by extension, all frequent users. A month before her story was to appear, Joan and Chip decided they had come far enough for a beer to do no damage, she said later.
It did immense damage. The pair, already on shifting ground because of their transition from the streets, had a falling out with alcohol re-introduced. Liening said it resulted in the trashing of Joan’s apartment and both returning to the streets.
He arrested her eventually on a disorderly conduct charge, in consultation with Project 25. James and I waited outside the Las Colinas Detention Facility in nearby Santee in the early hours of the morning. She was released, after a two-week jail stay, back into the custody of Project 25.
We were as startled by her demeanor, post-relapse, as we had been dazzled by her clarity when sober. It might have been the rush of free air after weeks in jail, but her previous eloquence was gone. She admitted with a whisper in my ear that she had used meth while back on the street.
As for the taxpayer savings, Project 25 had not compiled what her relapse costs taxpayers by the time we went to press. But if it held true to previous behavior, it would be reduced from a more than 90 percent taxpayer savings to around 50 percent. Still impressive, by any measure.
But if Joan relapses again, the savings is slashed further. There is a distinct possibility that she could become a break-even proposition in terms of public dollar savings.
And I think that is where we are left in the story, headed toward break even. The success of frequent user programs is bound, without question, to needy men and women like Joan Kloh. And Joan Kloh’s future, for now, is bound to a program like Project 25.
