What do we learn from a year-long intervention on behalf of an unhoused neighbor who lost limbs to Winter Storm Uri? That it takes dozens of interveners to make up for San Antonio’s broken safety net and lack of climate preparation.
Part Two: The Murphy Method
Words by Marisol Cortez / Media by Greg Harman
I’d taken my son’s scooter down to meet them—faster than on foot.
But I was early, so as I waited I rode around the small triangular island of overgrown flora off the access road of 35-S, across from Albert’s camp. I felt self-conscious, aware the abuela across the street was eyeing me as she loaded her nietos into the truck. Feigning unconcern, I fiddled with my phone. Soon Daniel Groven appeared–a big blonde bear of a man about my age, early 40s–in his white City of San Antonio van, parking it against the oddly-platted triangle of grass. I can park anywhere in this, he joked in greeting. Perk of the job.
Maria Turvin arrived shortly after, dressed in a Wonder Woman shirt and long skirt, Indigenous beadwork around her neck. Amid the summer’s rising season of Delta, we were all masked outdoors again.
It was early August of 2021 when the three of us met in person for the first time. Deeply disturbed to see a neighbor sleeping rough after losing limbs to Winter Storm Uri (See Part One: ‘Lessons From a Polar Vortex‘), I had reached out first to Turvin, Yanawana Herbolarios’s operations director, and then to Groven, a social worker employed as homeless outreach specialist with the City’s Department of Human Services.
We decided to meet up in the neighborhood. By then I’d become attuned to the streetscape rhythms of Albert’s day: usually he parked his wheelchair on the corner of Pendleton until it got too hot; then around noon he moved up the street to the shade of the Nogalitos Street off-ramp, where he’d established a one-person camp. Though the day was overcast and gray, I’d banked on finding him there by early afternoon, resting in the narrow median between the highway’s roaring four lanes and the access road that served our neighborhood. I wasn’t wrong. As we gathered at 1pm, we could see Albert there at the camp, lying beside his wheelchair.
So what’s the plan? I asked, taking nervous glances across the street to see if Albert was watching.
My goal today is to get him to accept housing, Groven said. He thought he’d found an alternative to Haven for Hope that Albert might be willing to tolerate, a shelter that took in people with more intensive medical needs. As we would soon find out, as Turvin had already learned in the case of another multiply disabled client named Murphy, no shelter in town was equipped to meet those needs.
But what about his friend, I asked, the one Albert doesn’t want to be separated from? Jake, the tall white guy with the white hair: I’d talked to him the other day for the first time, asking how Albert was doing. Not so good, he’d told me. He refuses to see the doctor.
Maybe if we work on the friend, Turvin said, get him on our side. Maybe the friend is the key.
We crossed the access road and approached Albert where he lay on a dirty blanket. Groven tried first, crouching down to introduce himself and ask if he’d go with him to the shelter, doctor, anything. I can take you today, he said. But Albert shook his head no.
Then it was Turvin’s turn. She’d brought a vintage leather doctor’s bag filled with first aid supplies, plus an emergency rations kit with snacks and toiletries. She sat down beside Albert and pulled his arm onto her lap, opening the bag to retrieve sterilizing wipes and bandages, laying them out in preparation. I stood just behind her, to the side, catching a glimpse of her face in profile as she smiled down at Albert, radiating the tenderness of a parent talking to a baby. I thought about Albert as a baby somebody had loved once, a new and soft and precious being; I thought about my own children–but that was too much, and I had to look away. I stepped back to allow Albert and Turvin the privacy of her ministry, and for the first time really took in the detritus scattered on the ground. Soda bottles, fast food wrappers, dirty clothing.
There are a bunch of needles here, Groven said, shaking his head. I looked down slowly, seeing them for the first time. So Greg was right. I’d mentioned to him that I’d recently seen Albert in his wheelchair parked outside a house up the block, talking to the guys there for hours. I’d thought it weird: in all my years of seeing Albert on the streets, I’d never seen him interacting with anyone there. Greg had seen in it a sign that Albert was being sold to, exploited.
In fact the Westside is “the heart of the opioid epidemic in San Antonio,” according to D5 Homelessness Outreach Specialist Nikketa Burges. She comes to her work from personal experience, both as someone who was unhoused multiple times in her youth and as someone whose sister has struggled with heroin for 20 years. In her observation, rates of heroin use on the Westside have historically been higher than other parts of town, but this is complicated by the fact that the opioid epidemic here is both visibilized and invisibilized in particular ways.
On the one hand, economic disparities and criminalization based on race make opioid use more visible on the predominantly Latinx Westside.
“The data shows that white people use drugs at the same rate as people of color, it’s just not as heavily policed,” she said. “And also you see more resources in middle class white areas than in these areas.”
At the same time, the opioid epidemic in San Antonio is invisibilized because—unlike mainstream perceptions of the opioid crisis as white and rural— here it hits hardest in communities no one cares about, even as Texas’s increase in the number of fatal overdoses (33% in the last 12 months) slightly exceeds the nationwide increase (30%).
I had registered this on some level, sensed something worsening upstream and trickling down to the scale of our neighborhood. There had always been a couple drug houses on our block, but it’d been enough to give them a wide berth: we left them alone, they returned the favor. But whether it was COVID or something farther up the food chain of the opioid trade, something had shifted in the last year. People seemed more destitute, sicker, desperate. They riffled through mail boxes as they passed between houses on foot, looking for things of value. They took bikes off the front porch in moments of sloppy security, requiring us to have to start locking ourselves in fastidiously.
As Turvin finished bandaging Albert’s arm, his friend Jake returned from up the street. To Albert’s previous suggestion that he and Albert made up an inseparable unit, Jake flapped his lips.
Ppssshhht! I’d get off the streets in a heartbeat, he said. I’m 63 years old. Can you help me get my social security?
In the months after our initial meeting, Groven and Turvin would in fact be able to assist Jake in recovering ID and applying for benefits, in the process moving him from the streets to low-barrier shelter to permanent housing. But with Albert we ran into barrier after barrier, paradoxically unable to access any real option because of his extreme vulnerability.
We saw this firsthand when, a few days after our neighborhood meeting, Albert was hospitalized for heat exhaustion–his third hospitalization of four that year. That stay would prove to be a microcosm of the sorts of binds we found ourselves in over the next few months. While we hoped we might coordinate with the hospital to finally get Adult Protective Services to act, the social workers there told us APS would be unlikely to do anything while he was in the hospital, viewing it as a safe place. Yet after his discharge, APS closed the new case Daniel had filed. Months later, when asked to explain why APS would take seven months to act on Albert’s behalf after our first report, Mary Walker, APS media specialist for San Antonio, wrote that “[i]n some instances, particularly in cases involving adults, assistance is not always accepted and cannot be forced.”
The hospital had taken a similar position: they could help only those who wanted it, one social worker told us, and even then offer only resources–“then it’s up to them,” she said. And yet when Albert did later agree to enter a shelter voluntarily, that shelter discharged him to the streets not long after, unable to handle the medical realities of the detox process they’d mandated to admit him.
In a system already famous for its failures and fragmentation, Albert would expose every gaping crack.
HOW DID YOU FARE IN THE WINTER STORM? WHO IS TO BLAME? WHAT SHOULD BE DONE?
Fill out Deceleration‘s survey before we submit to San Antonio City leaders next month: SURVEY: How Did San Antonio’s Winter Storm-Related Utility Outages Impact You? | ENCUESTA: ¿Cómo le afectaron los cortes de servicios públicos relacionados con la tormenta invernal de San Antonio?
As summer peaked, we began to consider an approach the Herbolarios had used to break through bureaucratic inertia in the case of Murphy, a client with quadriplegia who also struggled with substance issues. It was a tactic of last resort when all other institutional options had been exhausted, its urgency only underscored by the experience of losing another client earlier that year to the sorts of bureaucratic impasses Murphy–and now Albert–faced.
In Murphy’s case, Turvin had landed on a novel approach. She and her medics had met Murphy in the summer of 2020 at the “cage camps down at Commerce,” which the City would sweep just a few months later. At the time, Turvin later recalled in an interview, her medic collective was “super green, in terms of [knowing] what the system actually had to offer in San Antonio. We were like, ‘oh, this is ridiculous; surely we can get this man off the street!’” When she learned that, in fact, “there are zero shelters in San Antonio capable of caring for the medically disabled”–those, in other words, who need live-in assistance with basic activities like toileting, bathing, and eating–she’d filed a case report with the state’s Adult Protective Services, “the first [APS] report any organization had made on Murphy.” She had the good fortune of being assigned a young, idealistic caseworker who “just wanted to do a good job.” He had worked alongside the Herbolarios for months, first to persuade Murphy to accept nursing home care and then to find temporary housing until Murphy could be transferred to a nursing home. Along the way, his higher ups at APS would close Murphy’s case three times.
At that point Turvin decided to take it up the chain. “I don’t really know why I decided it would be a good idea to just do the email, but I did,” Turvin remembered. She’d emailed Council people, the Mayor and City Manager, APS and DHS bosses, Haven staff, “everybody I felt had been accountable at dropping the ball, essentially, at getting this man help.’’ She’d gone so far as to include local media watchdogs, telling them privately to hold off unless the city and agencies failed to respond.
But things moved quickly after that, APS finally agreeing to pay for a hotel and caregiver until Murphy could be transferred to a nursing home. Once there, APS also completed a medical examination that determined Murphy was unable to make his own medical decisions, effectively keeping him from returning to the streets. It had worked—“but,” Turvin said, “to make [it] happen was…insane.” The Murphy Method, she later dubbed it with a rueful laugh.
We decided to try it again with Albert. And so Turvin and I emailed District 5 Councilwoman Teri Castillo, CC’ing Groven and his DHS bosses, the Mayor and City Manager, the heads of the city’s major homelessness service agencies, several housing justice activists, and Albert’s last APS caseworker.
“It doesn’t matter that [Albert] refuses help,” we wrote. “It’s not a dead end so much as an indication that the existing system is inadequate for meeting the needs of the most vulnerable, and it doesn’t excuse our responsibility as his neighbors to find a more individualized solution. We don’t know what that solution might be, but we do feel that in putting our heads together and thinking creatively we can come up with something that helps Albert get the care he needs and deserves.”
In our Zoom meeting on August 26, 2021, Turvin had stronger words for the twelve attendees. “There’s no such thing as no solution,” she said. “I always tell my medics that. If we say, ‘oh well,’ he will die. He will certainly not survive another winter storm event. And we will have another winter storm event.”
At the conclusion of the meeting—less a satisfying consensus than a chaotic scatter at the too-soon hour mark—a strategy along two parallel tracks seemed to take shape. On the longest-term horizon was the Murphy Method, which would circumvent Albert’s ability to decline services by bringing him under county guardianship, making possible his admission to a nursing home equipped to care for him medically.
The prospect of using the state to take someone’s right to make their own medical decisions raises a disturbing question: to what extent do people have the right to choose to live and die on the streets? On the other hand, to what extent can we consider someone’s refusal of services a real choice, if that person is effectively unable to choose otherwise—because of trauma or serious mental illness, because of substance use as self-medication, or becuase the state refuses to fund the kinds of shelter and service options that meet people’s real needs? As has been well documented, the astronomical rise of urban homelessness began during an era of Reaganite austerity, which slashed federal funding for public housing and deinstitutionalized state hospitals but then refused to fund community-based alternatives.
Viewed in this historical context, the insistence that services be made available only those who “want” or “choose” them effectively functions as institutionalized neglect, protecting the state’s desire to withhold investment in care for all more than the freedom and dignity of the most vulnerable.
Under the logic of austerity, those on the streets have a civil right to be free from care, but no human right to be housed and healthy. More than restricting autonomy, the Murphy Method insists that the state spend the time and money and effort required to care for its poorest and sickest.
In the last decade, states like California and Hawaii have tested conservatorship programs as a matter of policy, making it easier for cities, states or advocates, as an intervention of last resort, to compel those gravely impaired by serious mental illness or substance use to receive care. It’s controversial, no doubt, raising vital questions about the rights of bodily autonomy and self-determination for people with disabilities who are often also disproportionately unhoused, impoverished, and racialized.
In Bexar County, conservatorship of unhoused people with life-threatening disability is less policy than program, applied on a case-by-case basis. Established in 2014 as a “guardianship program of last resort”, the Bexar County Guardianship program is used primarily to care for “adults who are unable to make basic life decisions and lack family or friends who could assist them.” Asked how many people the program currently serves and what percentage of those are unhoused, Bexar County Guardianship Program director Heather Summers did not respond by deadline. In 2018, however, the program was funded to serve a total of 65 people; at that time, 45 were enrolled with an additional 147 applicants on the waitlist.
Trying to assess how often guardianship is used to house people for whom there are few other options, I asked outreach worker Nikketa Burges whether it was a common strategy among her D5 clients. “I thought it would be more common than it really is,” she said, “just based on my ideas about the way the state has behaved. [But] it’s really not, and it’s something that takes some time to deploy as well. It’s not something that any of us take lightly as outreach workers. [I]n Albert’s case, there was no other option for him. And ultimately I think he [was] kind of okay with it, because this had to happen in order for him to get access to the things that he needs.”
In our first meeting with D5 Councilwoman Teri Castillo’s office, Turvin likewise acknowledged that although respecting Albert’s autonomy was important, “I also recognize when we’re at a point when someone can’t make decisions. He may not need a guardian for the rest of his life. But in a crisis moment, he does. Then we get him to a point where he can be [in control] again.”
The more urgent, immediate challenge was getting Albert off the streets as quickly as possible as the legal process unwound. Toward the end of the meeting, housing justice activist Molly Wright, formerly unhoused herself, cried as she raised a chilling question:
What would we do if Albert died while we were waiting for guardianship and permanent housing? Had we thought of that? Did we have a plan?
As we would soon discover, it was no abstract question. One morning in early September I got a voicemail from Groven. “I wanted to tell you in person,” he said haltingly, “but I received word this morning that Albert passed sometime last night or this morning.”
For 45 panicked minutes, he, Turvin and I texted as we rushed to Albert’s camp, before learning it was all a mixup: Albert had been confused for another man with a similar name and struggle. A false alarm. It brought a wash of relief with guilt fast on its heels: maybe it wasn’t Albert that time, but some other unhoused man with mental illness was dead on the street outside his parents’ house as the cops looked on with contempt.
It lit a fire under Groven, who’d been especially shaken. Just a day later, he texted to say that Albert had miraculously agreed to enter a county detox facility for the weekend if he and Jake could be housed together in a new hotel shelter program operated by SAMMinistries, raised as a temporary housing option in our meeting with District 5. It was low-barrier, meaning it didn’t require residents to get clean, though they couldn’t use on-site. It wasn’t a perfect option: the hotel was old and not ADA compliant. Moreover, SAMM would only admit Albert if he detoxed first, which meant he’d need a pain plan in place in a shelter without medical staff. Finally, his friend Jake would have to agree to go. But it was worth a shot.
Unfortunately, it would be a short-lived solution, for the distinction between low-barrier and no-barrier is vast for those with multiple disabilities and, in particular, substance-use issues. At first the reportbacks from SAMM were glowing: Albert was talkative, relieved, committed to sobriety and staying off the streets. But after a couple days, Jake began appearing in the neighborhood again, ostensibly to use, and Groven and Turvin’s reports grew more mixed. Albert was still committed to recovery and staying off the streets, but he was bored, not sleeping well, and dealing with some pain. He was calling Groven multiple times a day, lonely and anxious after Jake left. By that weekend, Albert had rejoined Jake at their old camp—at first for just a day, but by the next weekend he was back on his regular corner.
When I’d stopped by to check on him and bring him his favorite sweet tea, Albert had been quick to reassure me that he wasn’t “doing that bad thing anymore,” as he put it. Indeed, he looked much better—hydrated and nourished, his skin and face filled out—and he patted his panza, laughing about how fat he’d gotten in the shelter. But the following Monday Groven texted to say that Albert had relapsed, though he’d agreed to go back to the hotel that day. He was back in the neighborhood a week later, followed by word from Groven that SAMM had “exited” him from the shelter. Two more APS reports had been filed while he was there, one by Groven and another by SAMM staff. APS closed both of them shortly thereafter, claiming that (per Groven) Albert did not qualify as a client due to his lack of income and age–puzzlingly, since APS’s mission explicitly states that they serve any adult with a disability. Asked to share SAMM’s perspective on the decision to remove Albert, Vice President of Programs Rex Brien said only that he was “unable to comment on any specific case outcomes regarding any of the clients in our programs.”
I would learn why Albert was discharged from the hotel shelter only afterwards. Not only was he bored, lonely, and anxious at SAMM, which disallowed visitors and social gatherings due to COVID, he also struggled with the physical effects of detoxing, soiling himself “to the point,” Groven wrote, “where linen was being tossed out regularly along with the mattress after he was exited from the program. All of these issues, it is my understanding, go along with the detoxing.”
Burges placed the incident in even wider context. Especially in states that invest in criminal rather than medical approaches to substance misuse, she said. “What we have here is this disconnect. We have everybody saying [addiction] is a disease … But here in Texas and San Antonio specifically, our institutions haven’t caught up to that. So there isn’t an understanding of what happens when one does detox off drugs, which can be really hard on the [gastrointestinal] system and cause incontinence for a time. According to the way shelters view things, [Albert]’s too much of a liability, because they don’t have nursing staff and things like that.”
Turvin put it more candidly.
While “it [would] be easy to place the blame on Albert,” she wrote, “this failure is not his. The support systems he needed weren’t in place. Cases like these are why we NEED a harm reduction medical shelter for the houseless. Without it, long term success without us having to resort to guardianship was not realistic.”
The alternative model Turvin is referring to here involves three elements. First is medical respite care, which the National Health Care for the Homeless Coalition defines as “acute and post-acute care for persons experiencing homelessness who are too ill or frail to recover from a physical illness or injury on the streets but are not ill enough to be in a hospital.” Texas has four such facilities—two in Austin, one in Houston, and one in North Texas—but none in San Antonio.
Further upstream from medical respite care, both Turvin and Burges also alluded to the need for no-barrier shelters, or shelters that take a harm-reduction approach to substance use. As a public health paradigm, Turvin said, harm reduction is about reframing addiction as intentional coping strategy or self-medication so that people can begin to have a different, less destructive relationship to it—even if they never quit altogether. Harm reduction is teaching safer-sex methods instead of preaching abstinence-only; where drugs are concerned, it’s a form of “radical pragmatism” that in practice looks like needle exchange programs (Bexar County’s pilot program is Texas’s first), wet shelters, and safe injection sites.
Farthest upstream, these approaches more fundamentally require an ethic of care that is “improvisational and adaptable” enough to attend to people’s often very complex and individualized needs: a “no-man-left-behind, we-will-do-whatever-it-takes kinda attitude,” Turvin said. “Everybody’s different. There’s no one-size-fits-all solution for houselessness. It’s really easy to place the blame on our clients, but if you look at [how] so many programs are set up, it’s just this basic formula. Client doesn’t do xyz, client gets exited. She bad, they good.”
The result is a system of supportive services that paradoxically excludes those who most need them. Now a DHS outreach worker, Eric Morris previously assisted the South Alamo Regional Alliance for the Homeless (SARAH) in analyzing recent city and county data on homelessness service provision, particularly the demographics of what HUD calls “system performance,” or who is able to successfully access permanent housing. In the process, he saw that San Antonio fit a troubling national pattern originally uncovered by HUD.
“Basically,” he said, “if you’re a single white male that is middle-aged, young, not elderly, you’re gonna get housed. And why that was taking place was, the housing providers help the ones that are easy, essentially cherrypicking.”
“That right there tells you all you need to know about how our supportive services for the houseless are set up,” Turvin said, recalling Morris’s analysis of local and national data. “There’s systemic racism right there, in a graph for you to see.” (Note: While HUD makes publicly available data on the racial/ethnic breakdown of unhoused populations in a given region—which shows the overrepresentation of people of color, in particular Black people, among those experiencing homelessness—this is not the case for local data on housing outcomes. While we requested this data from SARAH as HUD’s local data collection arm, they did not respond by publication deadline.)
Morris agreed with Turvin’s assessment. Though many claim that substance use and mental health are root causes of homelessness, he said, “it’s not the true cause. As we dig deeper, the reason we have this problem is because we have not addressed white supremacy in the way we need to. And the negative effects of capitalism create these problems where people are seen as trash.
“There’s a quote I use often, [from] a social worker in California,” Morris continued. “‘Social workers are the janitors of capitalism.’ The system we have in place economically creates a viewpoint that people [who] are not able to be self-sufficient are not human.”
While SARAH formed in 2015 as part of HUD’s push to address precisely these systemic biases in access to services, Morris states it’s hard to assess whether programmatic changes have led to different outcomes. But “from being on the ground now” as an outreach worker, he said, “my viewpoint is that this [pattern] is still taking place. Maybe not as extreme as before. But anecdotally from what I see, housing providers are still wanting to house people who are easy rather than chronically homeless, people living with not only co-morbidities but tri-morbidities or even multimorbidities: physical health failing, mental health problems, probably also struggling with substances to try to self-medicate, and social disconnection.”
People like Albert, in other words.
Expelled from the shelter and back on the streets by early October, Albert relapsed hard. One morning, driving past his camp on my way to drop off my son at school, I saw him openly shooting up at the camp, something I’d never seen him do before. It wasn’t hard to read it as a gesture of futility and despair, the shrug-off of saying, fuck it.
A week later, Turvin sent photos her medics had taken of his arm. The soft crook of his elbow was pocked with a deep, circular wound the color of yellow pus; inflamed and infected track marks stretched like lightning from there up to his shoulder. “It’s a shooters’ wound,” Turvin explained, “an intramuscular injury caused by needle use.” Without treatment, she said, it could become a life threatening emergency; even with antibiotics, shooters’ wounds were hard to treat on the streets because of inconsistent access to hygiene and poor nutrition.
As we waited on guardianship to make nursing home care possible, our only option was to try to fill in the gaps ourselves, as best we could. As the temperatures dropped, we worked with local mutual aid groups to make sure Albert always had tent, blankets, and food. D5 talked to SAPD, newly empowered by Texas’s anti-homeless camping ban, to persuade them not to confiscate donated items. Turvin and her medics dropped off safe supplies for shooting up, reminding Albert where (and where not to) inject, and started training additional street medics in wound care so that they could visit more than twice a week. D5 and I worked to organize community trash pick up at the camp.
Finally, in early December, some good news came: Albert’s attorney had filed a motion that day for temporary and permanent custody. “Now we wait for the motion to be granted,” wrote Groven.
It couldn’t come quickly enough.
Just 30 minutes later, Turvin emailed with a more urgent update: on a visit to change Albert’s bandage, she had discovered him actively suicidal, threatening to jump off a bridge after she left. “This is an emergency situation,” she wrote. “We could lose him today.”
When I arrived at the camp that day I found Groven and Turvin there already, plus Rachell Tucker and Taylor Bazajou from the District 5 office, an SAPD squad car, and a young black dog limping in and out of the chaos. Groven had already called 911, and soon another police vehicle pulled up, a kind of van I’d never seen before that resembled a paddywagon. I was terrified: Were they taking him to jail? Turvin reassured me they weren’t; he’d admitted to the cops what he’d told her, so by law they had to take him to the hospital for a 72-hour psychiatric hold. But it was still disturbing, watching armed officers taking a sick and disabled man to the hospital in a police van. Didn’t they make some HBO documentary about San Antonio’s model Crisis Intervention Team?
They have one, Groven shrugged, but I’ve never seen ’em show up.
Albert, for his part, looked calm enough as SAPD wheeled him into the back of the van. But according to Groven and Turvin he’d cussed both of them out something fierce. He’d been mad, mad at Jake for getting housing and leaving him behind, mad he was still on the streets ten months after Uri took his limbs.
Next week, come back for our third and final installment of “‘His Name is Albert.'” In “The Longest Night of the Year,” we visit Albert in the hospital that would finally get him off the streets and spend the last weeks of 2021—a time of year that also sees the National Homeless Person’s Memorial Day—scrambling to make sure he stays housed for good.