Make government work better

Season 1 Episode 3: Valuable lessons from a landslide

SOLUTION:

Get government to work more effectively. Use a disaster response playbook to organize county government around the opioid epidemic. Approach addicted people with compassion, as you’d approach a person with any other medical condition.

STORY:

Addiction hits home for the top dog of a disaster-prone county. An old-school cop gets a wake-up call and learns “handcuffs and a trip to jail” just won’t cut it anymore. Also, we learn what a landslide can teach us about tackling the opioid epidemic.

This season we’re in Snohomish County, Washington which has an oversized share of overdose deaths in the state and is now treating the opioid epidemic like a natural disaster.

LINKS TO MORE INFORMATION AND RESOURCES:

Snohomish County overdose and addiction treatment resource guide.  

Here’s what we refer to as FEMA’s emergency response playbook (the National Incident Management System (NIMS), which outlines the structure of a Multi-Agency Coordination, or MAC, group)

LINK: Excel doc of Multi-Agency Coordination Group’s goals and objectives (with status of completion as of August 8, 2018)

TRANSCRIPT

TRANSCRIPT OF FINDING FIXES: EPISODE 3

(Click the play button at the top of this page to listen)

Anna Boiko-Weyrauch: From the top of the Snohomish County government headquarters you can see one volcano and two mountain ranges—the Olympics and the Cascades.

You can see the waters of Puget Sound and in the distance, thick forest.

Anna Boiko-Weyrauch: In this part of the world, we live and die by our wilderness. We’ve got earthquakes, mudslides, and wildfires. Our landscape is prone to disaster.

Now Snohomish County is treating the opioid epidemic like a natural disaster. It’s one of very few counties that’s treating it this way.  

Kyle Norris: That’s why we’re here. In this episode, we’re going to meet the county top dog and and old school cop to understand the county’s response to the opioid epidemic. We’re going to learn what they’re doing that’s different and how it’s working.

So first, we start at the top. Dave Somers is the county executive, it’s like a CEO, but he’s elected. He sits in a scenic office at the top of county government.

Boiko-Weyrauch: Before he got here, Dave used to be a fish biologist. And before that, he was a marching band nerd.

Dave Somers: I was a sousaphone player—tuba—for two years. I did that for two years and then I was drum major for three.

Boiko-Weyrauch: Nowadays, everyone is looking to him for direction, a lot like when he was drum major—but harder.

Somers: The drum major you just went out there looked good, put on a big hat, and blew the whistle and, you know, marched around. But it’s a little bit tougher when you’re dealing with things like the whole opioid addiction problem and homelessness. Those don’t have quite as clear a path.

Boiko-Weyrauch: Somer’s past prepared him in another way too. He grew up scarred by his mother’s struggle with alcohol.

Somers: Growing up with alcoholism, you’re pins and needles all the time. And you really are afraid to say the wrong thing, do the wrong thing. And they'll often go off for really for no reason, but you don't know that when you're—especially when you’re a young person—you know, you think, “What am I doing wrong?”

Boiko-Weyrauch: It was especially hard on his younger brother.

Somers: He struggled with drugs for many years. And he lived in tent cities for a while, really was on the edge, and there were people there to help him, and he was strong enough to say he wanted to help and change and he's doing well now.

Boiko-Weyrauch: Dave’s brother got the help he needed and made it out of a tent. But so many people in this county are still out there, living in the woods. So now when Dave confronts the same issues of addiction and homelessness as the leader of the county, he knows the problem isn’t bad people.

Somers: There’s many paths for people to fall into addiction and homelessness and they’re good people. They are just folks that are broken for some reason, whether it’s loss of a job, mental health issues, or health issues.

Boiko-Weyrauch: During the interview, again and again, Dave says people with addiction are good people.

Somers: So to me it's humanized it. I know the folks in my life that have struggled with this are really great people and I'm very grateful when there's somebody there to help them and I just want to be the same.

Boiko-Weyrauch: At the top of county government, literally, the top of this building, this perspective on addiction is making a difference in how local government approaches the opioid epidemic.

In Snohomish County, the policy from the top is to treat people as people, not the problem. To treat the disease, addiction, as a disease. And to treat rampant opioid addiction as an epidemic, like they would with any other disease.

We’re going to introduce you to a few other people who have helped shape this approach. And in this episode, we’re talking about what a landslide can teach us about tackling the opioid epidemic.

Norris: But first, this is Finding Fixes, a podcast about solutions to the opioid epidemic around the US. This season we’re gonna focus on Snohomish County, Washington. Population: about 760,000 people.

Boiko-Weyrauch: I’m Anna Boiko-Weyrauch.

Norris: I’m Kyle Norris. Anna is going to be your guide through this approach to solving the opioid epidemic.

This episode is about how to get one of the clunkiest, most inefficient systems there is—government—to work in a life or death situation.

Ty Trenary: Yep! Oh, yeah.

Boiko-Weyrauch: Our next stop is with the Sheriff. Sheriff Ty Trenary is a presence. He’s dressed in uniform, and gives a big, firm handshake. He talks loud, shoots straight.

Norris: I wanna know how do you unwind.

Trenary: Bourbon! Teasing. (chuckles)

Boiko-Weyrauch: You can hear a woman in the background telling him he needs to drink more of it. We’ll introduce her in a second.

When the Sheriff talks, he hits the table with a finger and leans in for emphasis.

Ty tells us the story of how he experienced a dramatic turnaround. You see, before he was elected sheriff, Ty was the police chief of the town of Stanwood. A place with about 6,000 people.

Trenary: I had a mom walk in the front door of the police department and basically said, “Chief, you have a heroin problem in your community.” And I—I remember thinking, “Well that’s not possible. This is Stanwood and heroin is in big cities with, you know, with homeless populations. It's not in rural America.”

Boiko-Weyrauch: For decades, heroin WAS a big city problem. That changed in the past 10-20 years. Prescription pain pills and heroin became a rural, suburban AND urban problem. If you want the whole story, read the book Dreamland by Sam Quinones, it’s really really good.

Back to the sheriff, though. Ty had no idea how vast the problem was—from pharmaceutical companies pushing drugs; to people being over-prescribed pain pills, getting addicted and becoming homeless; to teens experimenting with smoking heroin; to senior citizens accidentally overdosing on opioids. Ty would learn all that much later. Back then, he was more old school.

Trenary: Every problem that I’d had could be solved with a pair of handcuffs and a trip to jail. Right? That’s just what we do. Go into a neighborhood where there’s a problem house or a problem individual, work with the community, ultimately every solution ended with a pair of handcuffs and a trip to jail. And so I had to really understand what was causing the heroin problem to understand that a pair of handcuffs and a trip to jail weren’t going to solve the issue.

Boiko-Weyrauch: Let’s talk about that jail for a second. It was key to Ty’s dramatic turnaround that I mentioned.

Trenary: So now as the elected sheriff, I have a jail that I have not worked in.

As a deputy, as a patrol deputy, I never went beyond basically that booking area. Fill out the paperwork, get my handcuffs back, go back out the door. So now as the sheriff, I want to see it all. I want to see, how do handle laundry? How do we handle food?

I don’t know what I’d envisioned but I certainly hadn’t prepared myself for what I saw when I got to medical.

Boiko-Weyrauch: He toured his county jail—beyond the booking area. When he saw the medical ward, he was shocked.

Trenary: As I’m being led into medical, I’m thinking what an Everett clinic looks like, right? A room of people that have varying issues going on, not a room overflowing with one problem, and that problem being people detoxing from heroin.

Norris: Paint me just a quick visual, I mean, what did you see?

Trenary: Very, very sick, very, very sick people. Because detoxing from heroin is like having the worst possible stomach virus you can have. People are proned out, just suffering. I just remember being overwhelmed by the fact that everybody in this area had one common problem.

Boiko-Weyrauch: It’s a problem his go-to solution—a pair of handcuffs and a trip to jail—wasn’t going to solve.

The county jail—his jail—was a defacto detox center and it was overwhelmed. At any given time, around half the inmates were withdrawing from heroin. Some of them were so sick and weren’t getting proper medical care, they were dying in jail. From 2010 to 2014, over a dozen inmates died.

Trenary: It took becoming the sheriff to see the impacts inside the jail with the heroin abuse, to see the impacts in the community across the entire county for me to realize that we had to change a lot about what we were doing.

Boiko-Weyrauch: They have changed what they’re doing. In the next few episodes we’re going to look at how law enforcement and the jail are running differently.

But right now, we’re staying with county leadership. Leadership that very recently faced a tremendous disaster. A local disaster that killed dozens of neighbors and friends. And it happened in minutes.

(Sound of voices on an emergency-response scanner)

Boiko-Weyrauch: One of the deadliest landslides in American history.

First Responder: I’m carrying out one victim, appears to be about a six-month-old baby.

Boiko-Weyrauch: 43 people died. It happened March 22nd, 2014 in Oso, Washington—about 30 miles from the county seat towards the mountains

Voice on scanner: The road is flooded. Lines are down.

Boiko-Weyrauch: It would also carry some valuable lessons for the sheriff and the whole county.

Voice on scanner: The barn and a roof has also washed into the roadway.

Boiko-Weyrauch: On that day, first responders heard the highway was washed out. Houses were in the road.

Trenary: When I was when I was alerted Saturday morning that there was a mudslide, I thought, “Boy, that's a weird place for mudslide.”

Voice on scanner: We’ve got Highway 530, 100 percent blocked.

Voice on scanner: This is a major slide here.

Boiko-Weyrauch: Mud traveled more than half a mile and swallowed an entire neighborhood.

Trenary: We were getting video from our helicopter that was up above. It still wasn’t fathomable.

Boiko-Weyrauch: Oso is a tiny town in northwest Washington State. It’s nestled next to the Cascade Mountains with thick, lush forests. When the disaster hit, the job of getting information out fell to Shari Ireton. She’s the director of communications for the Sheriff’s Department. When the Sheriff joked earlier about drinking bourbon to relax, Shari was in the background teasing him that he needs to drink more.

When we started researching this podcast everyone said you have to talk to Shari. When we met her for the first time, we noticed Shari carries three cell phones.

Shari Ireton: One is obviously my work-issued cell phone. One is the media line for the Sheriff's Office, that the reporters and news outlets can reach us twenty-four seven. And the other one is my mom twenty-four seven line—my personal cell phone.

Boiko-Weyrauch: This whole idea that we’re talking about this episode—treating the opioid epidemic like a natural disaster—this whole approach originally started with her. She's done some national training in emergency response. And her idea was what if the county used the system they used during the landslide to respond to the opioid epidemic. In a nutshell, get everyone working together on the same page. Which is what she saw happen with the landslide.

Back then, one of her responsibilities was taking reporters to see the mudslide.  She ended up learning something too during those trips.

(Helicopter noise)

Ireton: We came down the hill and I looked up and I—it was amazing basically to see Black Hawk helicopters flying with our helicopter and a fixed wing over the top of that and all in coordination with each other all with the same objective which is life safety. We need to get folks off that pile and save them.

Boiko-Weyrauch: What if they used that system of tight coordination and communication—of everyone working together across government agencies—what if they used that system to tackle the opioid epidemic?

County leaders took the idea and ran with it.

Somers: Good afternoon, I want to thank you all for being here today.

Boiko-Weyrauch: On November 20, 2017, Snohomish County Executive Dave Somers held a press conference and handed down an executive order. This was an emergency.

Norris: Hello hello. And who are you?

Jason Biermann: Jason Biermann, I'm the director of Emergency Management for Snohomish County.

Norris: OK, and where are we standing?

Biermann: So right now you're standing on the edge of the Snohomish County Emergency Coordination Center floor. This is the coordination center for the county.

Boiko-Weyrauch: It’s a big room with maps and monitors, and lots of desks all in clusters. There’s a big sign that says, “What do you know and who needs to know it?”

Kyle and I paid them a visit to see what this emergency response looks like on the ground. The county is using this room—and an emergency coordination approach to respond to the opioid crisis.

And we talked to Jason Biermann. He’s the guy in charge of the county’s response to any number of things that might go wrong here.

Biermann: Earthquakes, we have a volcano here. We have flooding, wind storms. We are susceptible a bit to tsunami and seiche, what’s called an inland tsunami.

Boiko-Weyrauch: The volcano, are you talking about Baker or Rainier?

Biermann: Glacier peak. But we do have a volcano just...just east of here.

Boiko-Weyrauch: I didn’t even know I should be afraid of that volcano.

Boiko-Weyrauch: Yeah, Glacier Peak, turns out it’s a big volcano. So say Glacier Peak were to blow, county workers would flock to this building where we’re standing and this room would come to life.

Biermann: This technology sits here, it's ready to go. It literally is flicking the mouse and turning on the monitors.

Boiko-Weyrauch: And in an emergency like an eruption or an earthquake, all the different agencies responding to the crisis would come together. Their representatives would have a meeting every six to twelve hours and debrief. Remember the opioid epidemic is a slow moving emergency.

So as they prepare to respond to this crisis like a natural disaster, they have meetings every two weeks.

People from all over city and county government show up: from the fire department, waste management, human services, public health, the sheriff’s office and local cities. The technical name for this group is the Multi-Agency Coordination group, or MAC group. It comes from FEMA’s emergency response playbook.

Everyone sits around a few tables. They talk through PowerPoint slides

MAC Group Participant 1: Six-ten is completed.

MAC Group Participant 2: It is?

MAC Group Participant 1: Yeah.

MAC Group Participant 2: Great.

Boiko-Weyrauch: It’s like they’re speaking a secret language.

MAC Group Participant 3: I think 7.5 is kind of…

Boiko-Weyrauch: They throw out numbers like six-ten and seven-point-five. The numbers refer to items on their to do. There are seven big goals. Like Goal One: Reduce opioid misuse and abuse. Or Goal Five: Reduce collateral damage to the communities.

I’m not going to go through every single one. But, broad strokes here: each goal is broken down into a ton of smaller pieces, smaller objectives, like: training schools to prevent addiction, reaching out to homeless people and giving them services, training senior citizens to dispose of prescription pain pills. They span across segments of society.

When you print all these goals and objectives out on paper, they stretch six pages in teeny tiny font.

Ireton: Some of these goals are really long-term. I mean they're going to take years, decades.

Boiko-Weyrauch: That’s Shari Ireton again, the sheriff’s director of communications. She is the also spokesperson for this group that represents so many branches of local government. Shari has lots of cell phones and wears lots of hats.

Shari says, the key to this approach is that you have to be realistic.

Ireton: So if you set an objective for yourself to just end the opioid epidemic you're probably never going to be successful. By breaking it down, it's like eating an elephant. You just can eat one piece at a time. Breaking it down into a piece that you can actually digest.

Boiko-Weyrauch: This is actually one of the principles of the emergency management approach—not eating elephants. But breaking goals down into smaller pieces. These bite-sized pieces have to be achievable, they have to have a deadline, and you have to be able to measure the success.

So a good objective isn’t end the opioid epidemic. But for example, connect 288 inmates to drug treatment when they’re released from jail. Or distribute 500 bags that you can lock shut with a key, for people to secure their prescription pills.

Some things that sound really simple on paper are much harder to pull off

Ireton: You know like, like the needle clean-up I think that was a really interesting objective to accomplish.

Boiko-Weyrauch: Say you find a needle—a syringe for injecting drugs, in your flower bed. How do you get rid of it?

Ireton: Before we tackled this objective, it was really against county code to just drop even a pop bottle with a needle in it at a disposal. You couldn’t just toss it in your garbage. We have places now across the county that people can take and dispose of—sharps disposal containers. That was a collaboration with the health district, public works and solid waste division and partnering with some law enforcement community agencies across the county to make that available.

Boiko-Weyrauch: That’s why you need all these agencies in a room together—to help undo some of their own red tape.

Ireton: Yeah, yeah it's kind of getting out of our own way I guess sometimes.

Boiko-Weyrauch: Let’s get down to brass tacks (I love that expression). How is this approach working for the county—is it more efficient? More effective? Here are a few numbers.

Snohomish County laid out the plan in November 2017. By Memorial Day 2018, they completed 36 objectives. A few months later, they were up to 58. These objectives include things like training schools to prevent addiction, figuring out how to refer people who overdosed to treatment, and help people in treatment get subsidized bus cards so they can move on with life more quickly.

In the process, the county has hit a few snags, though. A big one is funding. Another is bureaucracy.

As much as they want to get rid of their own red tape—at the county level—not everything is up to them. There’s also state government, the federal government. There are so many more layers of government.

Even if you forget those other layers for a second, they have enough on their plate that they can do. Their to-do list just keeps getting longer.

Over nine months it almost tripled in size. They keep adding new objectives all the time, including getting pharmacists and state legislators more involved. They can hardly update their website to keep up with the changes.

So I gotta point out this: This is one way the opioid epidemic is totally different from a landslide. The opioid epidemic keeps going.

Snohomish County Executive Dave Somers again.

Somers: The Oso Mudslide was horrific and was extremely intense in a small area, it affected several communities and obviously a number of folks lost their lives and lives were disrupted. But there was a beginning and there's kind of an end. The opioid crisis is just keeps rolling on, it's so pervasive. It's in our urban areas it's in a rural areas. Every walk of life and every family can be touched by this, so nobody's immune.

Boiko-Weyrauch: We’re going to pivot now.

So all that stuff we just heard about the county and it's response, well let's remember that at the heart of everything they're doing is people.

For the next few minutes we’re going to focus on just two people.

The same day those government officials met, figuring out big plans for the county, Hallie and Monty were figuring out much smaller plans.

Monty McGary: 7:30.

Hallie Martin: It’s in Marysville, it starts at 7.

Boiko-Weyrauch: Which NA meeting were they going to go to.

Martin: No, it’s 7:00 p.m. Monday by the Books. 7 p.m.

McGary: No, we’re going to the one at 7:30, the California Street one.

Boiko-Weyrauch: We’re following Hallie Martin and Monty McGary throughout this series. They’re a couple in their early 20’s who decided to stop using heroin on Valentine’s Day 2018. Today is day 33 of no drugs.

McGary: Monday through Friday I work, I’m a carpenter. So I go to work, then come home, take a shower, we usually get coffee, then go to a meeting.

Boiko-Weyrauch: Narcotics Anonymous and Starbucks are daily stops in equal measure.

Martin: I kind of like the blackberry. It tastes like real blackberry, though, taste it.

Boiko-Weyrauch: Hallie buys them blackberry and raspberry red bull Italian sodas, banana bread and poppy seed cake.

Monty’s got dirty blonde hair and a short, scruffy beard. He usually wears a baseball cap and a hoodie.

The word love is tattooed on his knuckles—he says to remind him how to act.

McGary: You know, if I’m feel like, not loving, then I can look in my hand. And I was thinking of putting life over here too. Because life is, I don’t know, life is very meaningful to me right now. And tattoos hurt really bad.

Boiko-Weyrauch: Monty started on opiates at age 12.

McGary: I always felt like I was missing something in my life and then the reason why I think I became an addict is because once I tried drugs it made me feel whole.

Boiko-Weyrauch: Like a lot of people, the roots of his addiction stem back to being abused as a child, he says.

Monty says he’s been saved from overdoses on different occasions by his dad and two girlfriends, including Hallie.

Now, he is working hard to stay away from drugs. Monty’s daily struggle looks like this:

McGary: In my head I talk terrible to myself. Like in my addiction I’ve told myself I'm not good enough and like, it's been my thought. So, like, throughout the day, the times that I want to use, it's, like, when I self-talk in negative way. And so I have to be mindful and, like, watch what I'm saying to myself because it's not true.

Boiko-Weyrauch: Sitting across from him at the table, Hallie is also struggling.

Martin: I think that everybody when they get clean, they feel kind of like lost, they're like blah! What do I do now? I just get overwhelmed.

Boiko-Weyrauch: Hallie and Monty have other struggles. Court cases and housing. Hallie and Monty can tell you which local jails have better food and nicer people, from personal experience as inmates.

When we first meet them, they’ve been living at a hotel looking for a room to rent.

Still, Monty is driven. Sipping an italian soda, he says his goals push him forward.

McGary: I don’t know, I just want to live today. I want things out of life. Like my goal in life is to have a family and, I don't know, the white picket fence. Like maybe buy a piece of property to build a house and have kids, dogs, you know all that just like, a normal—even though I don't know how normal life really is. I just want a boring normal life. I don’t want all that chaos in my life anymore.

Boiko-Weyrauch: These two people are really trying. The county is really trying. And for all of them—it's a long road ahead.

But, we’ve reached the end of this episode.

To recap, we explored how using natural disaster response as a playbook can help a county deal with opioids. We also heard how the leaders of Snohomish county are approaching the epidemic from a standpoint of compassion, instead of punishment. Changing the way you think about people with addiction can change your approach in big ways.

County Executive Dave Somers again:

Somers: A lot of people just think the only way to solve this is to arrest people, you know. Drug use is illegal, just arrest them. Well, we know that doesn't work, so we're changing the game.

Boiko-Weyrauch: Just how are they changing the game? From here, we’ll break down what they’re doing differently. Over the next few episodes we’ll look at how cops and jails are being reworked to help people with addiction.

Dillon: They open doors for people and it just matters if you want to walk through it. Once they opened that door for me, I ran through it, didn’t walk through it. I was tired of living that kind of life.

Norris: Thanks so much for listening.

Finding Fixes is a project of Investigate West, a nonprofit journalism organization working in the public interest.

Our team includes Anna Boiko-Weyrauch, me—Kyle Norris, and Julia Drachman with help from Paul Kiefer. Alisa Barba is our editor. Joan Caine is our fairy godmother. Music by Jake Weholt and Josh Woodward. Photos by Leah Nash.

You can find us on social media and online at Findingfixes.com

Leave us a review on iTunes. Send us a message at fixes@findingfixes.com.