Caesar put a hurting on himself last night. He remembers boarding a bus bound for downtown Denver yesterday afternoon, then nothing until he came to this morning in a shopworn hospital bed. He was in a crowded dormitory inside the Denver Health detox center Denver C.A.R.E.S. For breakfast he was served a plate of eggs and a pink paper titled "Application for Emergency Commitment." It said he had been admitted to Denver C.A.R.E.S. for the 592nd time.
"When you've got nowhere else to go, you can always come here," Caesar says. "You just have to be drunk."
Caesar was stumbling down Wazee Street last night around 8 p.m. when the police stopped him, then called a Denver C.A.R.E.S. van to come pick him up. His blood alcohol level when he arrived at the detox center was an impressive .357 (most people are clearly drunk at .15; most lose consciousness at .3; most die at .5). "Client has strong odor of alcohol, has staggering gait and slurred speech," reads Caesar's intake report. "He is making inappropriate comments to staff." Specifically, Caesar was howling, "I am Spartacus!" and "Attica! Attica!"
"Sometimes I get a little mad when they come to get me because I don't want to go to detox that night," he says.
Denver C.A.R.E.S. isn't a hospital, nor is it a shelter or a jail. It is a hybrid of all three. It's where the police send intoxicated citizens when they don't want to put them in jail. It's also a place to put homeless alcoholics who might otherwise disturb commerce in LoDo or bed down near the steps of City Hall, where last year Mayor Webb specifically forbade them from sleeping. Denver Health Medical Center classifies the $5 million-a-year, publicly funded center as "a non-medical detoxification facility for public inebriates." It is the biggest and busiest of its kind in the country.
Every night, dozens of drunks are picked up off the streets, packed into cages in the back of city vans and hauled to Denver C.A.R.E.S. like wayward mongrels being taken to the pound. This is done in the name of their best interests and of providing a public service. Last summer, Mayor Webb's Downtown Safety Task Force -- a joint effort with the Downtown Denver Partnership -- recommended the city increase its funding of Denver C.A.R.E.S. by $240,000 a year to increase van pick-up service to 24 hours a day.
"I think it shows a good degree of enlightenment for the city to provide such a facility," says Dr. Stephen Cantrill, associate director of emergency medicine at Denver Health. "The presence of Denver C.A.R.E.S. depressurizes the emergency department. [Public inebriates] would be here if they weren't there, and this isn't the appropriate place for them."
Prior to the 1970s, public inebriation was viewed in Denver and throughout the country as a crime. In most cities, the police were responsible for managing homeless alcoholics by throwing them in jail. Many street drunks accumulated hundreds of misdemeanor convictions as they became mired in a cycle of arrest, short-term incarceration, release and re-arrest. Gradually, as alcoholism came to be viewed as a disease, this approach came to be viewed as inhumane, as well as an unwarranted burden on the court system. States began to decriminalize public inebriation.
Colorado did so in 1973, with the state legislature declaring, "Public intoxication is a health problem which should be handled by public health rather than criminal procedures."
Denver C.A.R.E.S. opened shop one year later. "The community in general realized we had to do something with public inebriates since we were no longer putting them in jail," says Dr. Edmund Casper, director of behavioral health services for Denver Health.
Casper helped establish Denver C.A.R.E.S. along with prominent local businessmen George Rock and Rex Morgan, who lobbied for state and city start-up funds to create the nonprofit service operating within the Denver Health system. A portrait of Rock and Morgan now hangs in the lobby of the Denver C.A.R.E.S. building at 11th Avenue and Cherokee Street, its third location. The detox center has been there nine years, long enough for the crack houses across the street to be replaced with stacks of $450,000 lofts. (Detox clients are now instructed to remove the white bands bearing their names and birth dates from around their wrists before they are released in the morning, and are dispersed in small groups rather than en masse, so as not to upset the loft owners.)
Most of them will be back soon. Denver C.A.R.E.S. has a revolving-door admissions policy; 85 percent of the detox center's clients are regulars like Caesar. "Frequent fliers," the staff calls them. Many have been to Denver C.A.R.E.S. hundreds of times since the center started keeping track of individual visits in 1993. (Last year, Denver C.A.R.E.S. logged 31,000 "days of stay.") Some have more than 1,000 admissions.
Caesar holds the record for the shortest time between stays. It happened two years ago in the fall. He was dropped off drunk one night, then released the next afternoon, stone sober. Two hours later he was in the back of a C.A.R.E.S. van with a blood alcohol level of .410. "He practically had to sprint to the nearest liquor store, buy a bottle of whiskey and chug it," says Denver C.AR.E.S. supervising nurse Steve Collins. As Caesar was shown to his bed that night, the other frequent fliers in the dorm honored him with a standing ovation.
Most homeless shelters in Denver turn away anyone who's been drinking. At Denver C.A.R.E.S., being drunk is the price of admission. The frequent fliers exploit this. "If you're really drunk but you've still got a little snap, you should call 911 and give them your location, tell them you're about to pass out, but you want to go to detox," Caesar says. "Then drink up whatever you've got left."
When the weather is bad and they can't go to a shelter because they have alcohol on their breath, some frequent fliers finish off a bottle to make sure they're legally intoxicated, then show up at the door of Denver C.A.R.E.S., where they know a bed and a meal await. "A lot of guys think this is home," says Collins. "Especially in the winter."
The frequent fliers refer to the other 15 percent of Denver C.A.R.E.S clients as amateurs.
"They don't drink like us," says Caesar. "They're just weekend warriors." Unlike the frequent fliers, almost all amateurs are detox clients for the first and last time. Some are DUI offenders. The rest are mostly a wide and wild variety of individuals who have three things in common: They were inebriated in public; they came into contact with the police; the police decided they should spend the night in detox, whether they wanted to or not. One time an entire wedding party was brought in, complete with the groom still in his tuxedo and the bride in her gown.
You don't have to be charged with a crime to be detained and confined to Denver C.A.R.E.S. State law empowers the police -- as well as C.A.R.E.S. van crews -- to place into protective custody anyone they judge to be incapacitated and a danger to themselves or others. "If it's for your own good, we can take you in," says Emergency Service Patrol supervisor Alison Givens, who has driven a van for Denver C.A.R.E.S. for twenty years.
Your own good, however, is a matter of interpretation. Last December, local real estate agent Diana Baird, a native of London, elected to take a cab home to Littleton at the end of a Thursday night spent drinking with friends. She called her husband from the cab a little before midnight to say she was on her way. Seconds later, the cab was pulled over for speeding by two Denver police officers, with whom Baird had a verbal exchange. "She said, 'Don't you have anything better to do?'" says her attorney, Walter Gerash. "That was all it took." Baird was placed in protective custody, searched, handcuffed and taken to Denver C.A.R.E.S. for the night. "There was no way they had probable cause to take her into custody when she was sitting in the back of a taxi," says Gerash, who is preparing a federal lawsuit against the City of Denver. "They plucked her from the car and took her to this toxic holding center," he says. "Her First, Fourth, Fifth, Ninth and Fourteenth Amendment rights were violated."
"If the police bring you here and you're legally intoxicated, we have to take you, and we have to hold you until you blow zeros," Collins says. But he also acknowledges that the police sometimes bring in pedestrians who were walking home in their own neighborhoods rather than driving drunk. "That's not cool," he says. "We don't like to see people brought here for trying to do the right thing."
But most amateurs wind up in Denver C.A.R.E.S. for doing the stupid thing. They got drunk and raised hell in public, just not enough hell to go to jail. Certain sports fans are a good example. "Super Bowl Sunday is a mess. Hockey playoffs are a mess," says Collins. "We have to increase our staff any night there's a big game. I may have been the only man in Denver who was praying the Avalanche didn't win the Stanley Cup." Police in LoDo took 117 hockey fans into custody in the hours after the Avalanche won the Stanley Cup and sent 54 -- nearly half -- to Denver C.A.R.E.S. This more than quadrupled the usual number of amateurs for a weekend. "It was like 'Night of the Avs Fans' in here," says Collins. "Guys in jerseys just kept coming. We discharged all night long, and we still had a full house in the morning." Broncos fans painted orange and blue "tend to freak out the regulars a little," he adds.
Like cheap Scotch and crème de menthe, the frequent fliers and the amateurs do not mix well. Last summer, Denver C.A.R.E.S. began to segregate the populations in different dorms. The result was a nearly 50 percent drop in violent incidents, virtually overnight.
On the Sunday morning after the Saturday night Caesar came in proclaiming himself to be Spartacus, Denver C.A.R.E.S. has 86 clients in the house: 63 frequent fliers, a dozen amateurs, and eleven women in a third dormitory. One of the amateurs is 33-year-old drywall contractor Felix Juarez. Juarez is dressed sharply, but he doesn't look well. With one hand on his stomach and the other under his chin, he resembles a hung-over version of "The Thinker." It's 8 a.m.
Juarez stares down at his snakeskin boots and releases an extended moan. "Not so good" is how he's feeling. He says he went out dancing the night before and had "three, four, five, maybe six beers." Then he walked to his girlfriend's house a few blocks away and rang the doorbell. When she didn't answer, he started whistling outside her bedroom window. The next thing he knew, he was surrounded by "two, three, maybe four" police officers. "They asked if I was drunk, and I said, 'Well, I don't think so,' and they brought me here." Juarez shrugs. "I still don't know what I did."
Juarez's cell phone rings. It's his girlfriend. She says that wasn't her house he was whistling outside of. He asks her to come get him, then hangs up and contemplates his boots some more. "Okay," he says after a pause. "I was drunk."
The door to the back of the van opens, and the stench billows out like a belch in the face. The puke potpourri inside is the buildup of fifteen years of transporting inebriates in the back, which is divided squarely into four caged compartments with sliding locks. The smell is so bad that crew members have sprayed ceiling foam in the cracks in the frame between the cab of the van and the chamber of cages in an attempt to seal out the reek.
At least one C.A.R.E.S. van (officially called an Emergency Service Patrol vehicle) is on the streets of Denver around the clock. There are two vans out most nights and three on holidays. They are curious vehicles, custom-designed for transporting drunken captives a short distance.
This design has been vastly improved in three spanking-new vans that entered service just this month. The compartments are four parallel rectangles instead of squares, making it easier for their inhabitants to lie down. The walls are shatterproof sheets of transparent polycarbonate instead of heavy wire mesh. Each compartment has individually controlled heating and lighting. There is an intercom system so that the driver and riders can communicate, as in a limousine.
"This should be much nicer for the guys we pick up," says driver Givens. "This offers them a lot more comfort and a little more dignity."
Givens started driving C.A.R.E.S. vans when the facility was still located in the old Army Finance Center at 38th Avenue and York Street. In two decades, she has cultivated a profound empathy for her charges. "Nobody at fourteen years old says to themselves, 'When I grow up, I want to be drunk in the streets, peeing on myself and eating out of garbage cans.' None of these guys want to live this way. They have a disease. And because most people don't understand that, these guys don't get a lot of respect. Most people aren't very nice to them. So I'm nice to them, and I treat them with respect."
Givens knows most of the frequent fliers by name. Some of them she has known for fifteen years. "Most of these guys, they never stop drinking. We stop getting calls to pick them up only when they're dead."
C.A.R.E.S. vans have two-member crews who handle twenty to thirty requests for pickup a night. The calls come from police, paramedics and private citizens reporting a man down on the sidewalk or in the alley behind their house.
The Friday of Memorial Day weekend, radio traffic on the emergency dispatch channel picks up about 4 p.m. Volleys of calls go out for C.A.R.E.S. van pickups: "Alameda and Federal," "Colfax and Colorado," "Vassar and Bannock," "Colfax and Grant/Logan alley," "man passed out in wheelchair, 14th and Broadway." Though the vans serve all of Denver, most of the calls are in and around downtown.
Denver Health paramedics Michael Morris and Greg Sawyer answer a code-nine (emergency) call for an unconscious person outside the Broadway Plaza hotel at 11th and Broadway. They arrive in their ambulance to find a disheveled man slumped against a brick wall, whispering to himself, with a bottle of malt liquor in one hand and a cardboard sign in the other. The sign reads "Disabled and Homeless. Any help good. Happy Mother's Day."
The paramedics check the man's vital signs. He appears uninjured except for a large scrape on the knuckles of his left hand. Morris asks him if he's been drinking. He nods, slowly and emphatically.
"We're sending you to detox," Morris informs him, before calling a C.A.R.E.S. van.
"Just let me get myself organized," the man says. He carefully nestles his Pittsburgh Steelers cap atop his tangled gray locks and then conducts a quick inventory of his jacket pockets. Cigarettes, check. Digital alarm clock, check. He settles back against the wall and closes his eyes. He's good to go.
"It would be a lot easier if we didn't have to burn lights and sirens through downtown Denver just to find out it's time to call the C.A.R.E.S. van," Sawyer says. "The problem is ...no one wants to talk to this guy, let alone touch him. They're not going to stop and see if he's just intoxicated or having a heart attack or what. They just call 911 and report a man unconscious on the sidewalk, and we have to treat it as an emergency."
Four minutes later, a white C.A.R.E.S. van cruises up to the curb, yellow emergency lights flashing. Two young men in blue uniforms disembark, snapping on latex gloves. They grab the man under each arm, lift him to his feet, escort him to the back of the van -- one of the old smelly ones -- and put him into a cage. He curls into a fetal position and appears to go to sleep.
Just as van crews can take a public inebriate into protective custody, Denver C.A.R.E.S. can hold a client against his will for up to five days without a court order. Under state law, the detox center is allowed to enact involuntary emergency commitments if a person is "clearly dangerous to the health and safety of themselves and others."
Five-day holds for frequent fliers are customary. "We have to do something to break up the pattern, even if it's for only five days a time," says Collins. Since most of the frequent fliers will take to the air again soon after they're let out, the five-day holds effectively force them to quit cold turkey, over and over again.
"It's legal kidnapping," complains Caesar.
In late March, he and 51 other Denver C.A.R.E.S. regulars signed a petition attached to a letter of complaint to Denver Health patient representative Bennette Rowlette.
"We are writing you concerning Denver Cares. About the treatment clients receive here," the letter begins. "Things like being held on holds just for showing our faces. A lot of people could do better if they wouldn't put us on holds, every admitting, for 5 days...The staff cry about people are just using this place for a shelter, so they give us the holding punishment...We would like you to realize that the eight amendment states that all citizens of the U.S. are entitled to be treated not with cruel and unusual punishment. Just because we are of that minority of the population who happen to have a sickness -- and alcoholism has been defined as a sickness -- we deserve this also." The letter also decried the eight "time out" rooms in Denver C.A.R.E.S., tiny concrete cells where the staff houses disruptive clients. "The staff treats people like animals. If we say anything that they don't agree to, they have you thrown in a 4' by 6' cell from 2 to 10 hours, and the cell has no relieving facilities in them, just a stainless steel bench."
On April 19, Dr. Michael Earnest, Denver Health's Medical Director of Quality Review and Improvement, responded via his own letter. "We are always evaluating the care we provide and appreciate all suggestions to improve our care," he wrote. "We hope you can understand the necessity of our applying holds so that we can protect individuals from the danger posed by their alcohol addiction.
"We also want to care for everyone in a humane, personally attentive way. Toward this end, we have made your letter known to the staff at Denver C.A.R.E.S. However, we have not identified the individuals who signed the letter.
"We hope this is of some assistance and reassurance to you about our commitment to provide you safety as well as humane and compassionate care," he concluded.
The Black Leprechaun is feeling somewhat less than assisted and reassured. "That letter is a bunch of bullshit," says the Leprechaun, a 49-year-old frequent flier legally known as Eric Coleman. The Leprechaun is on Broadway, squatting over a metal hole in the sidewalk to pantomime how difficult it is to relieve oneself inside a time-out room. "All they have for a toilet is a little thing in the ground like this," he says. "Imagine trying to take a shit like this when you've taken a few drinks."
Coleman fingers the beads on the glow-in-the-dark crucifix around his neck. He says there is one bead for every damn thing wrong with Denver C.A.R.E.S. "They feed us Rice Krispies every damn morning," he says. "There's no library. Guys come in messing in their pants and they don't clean them up. They don't spray us for lice. We got bugs going zippy-do-da up and down our arms. The Gatorade there is bullshit. It's watery with just a little taste. I mean, come on now. You know, when you come off drinking, you're dehydrated. They should give us cool water and some different juices to choose from, with flavor. We would deeply appreciate that."
It is early on a Sunday morning, and the man in the Denver C.A.R.E.S. dorm for amateurs is sobbing in a corner. He just woke up to the news that he was driving drunk last night and struck a pedestrian, whose leg is broken.
"That must suck," says first-timer Justin Thaber. "I'm glad I'm not him."
Thaber, 23, is a second-year senior at Colorado State University, down from Fort Collins for the weekend for a fraternity brother's wedding. The bachelor party was last night. "We started drinking at the Avalanche game, then we went to the Hard Rock and then a bunch of other bars. We were on our way back to the hotel for the strippers when it happened."
One of Thaber's buddies tackled him on the 16th Street Mall. They wrestled. The police were called. They interviewed Thaber, then called the C.A.R.E.S. van. Thaber's blood alcohol level was .167.
"I've had many more many times," he says. "I zonked right out when I got here. No spins, no problem." Thaber's green silk shirt is barely wrinkled. "I feel pretty good."
Except for the bill he was just handed. Denver Health is charging him $275 for his ten-hour stay.
"Dude," he protests. "I didn't even get a pillow."
Denver C.A.R.E.S. clients are charged $275 for every night spent in detox. Few of them pay. The center billed more than $4 million dollars last year and has collected just $90,420, nearly all of it from amateurs, the frequent fliers not generally being concerned with credit ratings.
Every bill includes a charge for counseling, as every client has to meet with a counselor before he's released. "With the first-timers, it's basically just a conversation where we say something like, 'Look, you're one of 23 guys in a city of a million-plus who were brought here last night for some reason,'" explains Collins. "We try to get them to question if they have a problem with drinking or if they were just in the wrong place at the wrong time. And a lot of them were just in the wrong place at the wrong time. We know that. We just think it's a healthy question for them to ask themselves."
Frequent fliers are asked in every counseling session if they wish to be referred to a treatment center. Only 8 percent agree, and most of them relapse. "I know of very few success stories in twenty years," says Givens. "It's a lot easier for me to count up all the guys who drank themselves to death than it is all the guys who got sober."
One year ago, less than 1 percent of Denver C.A.R.E.S clients sought treatment. The eight-fold rise in treatment referrals followed two significant funding increases. In addition to the money for the extra van service, the City of Denver allocated $154,000 last July to hire two clinical social workers and one addiction counselor assigned to "properly identify and refer Denver C.A.R.E.S. patients who are appropriate candidates for more extensive treatment." The City also gave $282,000 to Central Shelter, a residential treatment facility for homeless alcoholics, to set aside thirty additional beds for Denver C.A.R.E.S. regulars.
"They are caught in a self-destructive and expensive cycle," Mayor Webb proclaimed in a prepared statement. "Time and time again, they are back on the streets, drinking excessively. So the challenge is clear: We need to provide a place where this population can receive the treatment they need after being discharged from Denver C.A.R.E.S.
"Ultimately, we will be measured as a community by how we treat 'the least among us,' and we are, in a very real and productive way, reaffirming our commitment to those who have not yet shared in our city's prosperity."
Caesar wants to share in Denver's prosperity by getting out of his five-day hold early so he can make the last day the of the Capitol Hill People's Fair and maybe make a few bucks under the table taking down tents. "If you want out early, going to the AA meetings they have here is a good start," he says. Caesar mimics the nightly announcement: "The AA meeting is beginning. The AA meeting is beginning. All sober clients are invited to attend."
Also, if you have the DTs, hide from your counselor. "If they see you have the shakes or you're pacing, they'll know you're going through withdrawals, and they'll keep you on a hold. They sneak into the lunchroom to see who's eating, too, so you can't refuse to eat, even if you're really sick...Try not to let them take your vitals, because your vitals can give you away. The thing to do is, if you're in bad shape and you really want to get out, you have to save up all your strength and just fool the counselor for a few minutes.
"When you're going told turkey, this place isn't Denver C.A.R.E.S., man, it's Denver scares."
