- Associated Press - Sunday, June 5, 2016

BISMARCK, N.D. (AP) - Though Bismarck Police Officer David Haswell hasn’t seen this intoxicated man before, the call is all too familiar.

It’s a Friday around 6 p.m. and Haswell, a 29-year-old rookie police officer, gets a call about a shirtless 31-year-old man with what appears to be a bottle inside his pocket outside of an apartment complex on Portland Drive in Bismarck. An anonymous person called it in and said the man was punching windows in the complex, the Bismarck Tribune (https://bit.ly/1XGzk5v ) reported.

Upon arrival, Haswell and another officer discover a bottle of Robitussin in the man’s pocket and he appears to be intoxicated. A quick inspection of the building and the officers find no broken windows or any residents willing to say anything.

The 31-year-old man is put in handcuffs and placed in the back of a police car. The call quickly turns to a “detox” call, which means it’s now the officers’ duty to find somewhere to take the man for detoxification.

In most cases, Bismarck police will attempt to contact a relative. In this case, the man is unresponsive to the officers’ questions so he has nowhere to go except jail.

Around 6:30 p.m., the officers are on their way to Sanford Health to get him cleared to go to jail. Within minutes, they arrive at the hospital’s emergency room and use a wheelchair to take him to the front lobby and check him in.

“He just needs to be cleared,” Haswell tells the emergency room receptionist.

Around 6:40 p.m., the man and Haswell are admitted to a room where a nurse checks his blood pressure, pulse and temperature.

“You been drinking today?” the nurse asks the man in the wheelchair.

No response. He tells the nurse he’s diabetic.

“Where do you live?” the nurse asks.

“Nowhere,” he says.

“Are you homeless?” No response. The man slumps in the wheelchair and eventually falls asleep. The nurse leaves the room and about 20 minutes later a doctor comes in, asking a series of similar questions. Haswell stands by in the room.

“We’ll just check his blood sugar and call it good,” the doctor tells Haswell.

About two hours after the call was made, the man is medically cleared by the doctor. Haswell gets a few papers and walks across the street to Burleigh County Detention Center to detox, a room, which smells of urine, at the jail with two mattresses on the floor. He’ll spend eight hours there until he sobers up.

“It’s sad, too,” Haswell says upon leaving the jail. “It sucks because they’re just in a bad spot.”


There’s a limited number of social or medical detox providers in Bismarck and the region, which mean law enforcement officers and jails are left responsible for a portion of the population that may be in need of treatment, rather than just a place to sober up.

Now, law enforcement, jails, hospitals, public health units, human services and treatment providers in the region are looking at alternatives to a hospital and jail, which, in Bismarck, are undeniably overwhelmed by the numbers of intoxicated people.

In Bismarck and the south central region of the state, referred to as Region 7, there are 35 licensed treatment substance use disorder providers, yet only two programs provide social detoxification services: West Central Human Service Center and Heartview Foundation.

There’s also no medical detox facility in Bismarck, and neither of the two hospitals in the city offer beds solely for medical detox.


“We see this everywhere,” said Theresa Lemus, a federal consultant with the U.S. Department of Humans Services’ Substance Abuse and Mental Health Services Administration, who added that North Dakota is not unique.

Lemus and another federal consultant Marmie Schuster-Walker spent six months in the Bismarck-area gathering information about withdrawal and intoxication management services, formerly called detox, from service providers, law enforcement, public health, human services and other community-based organizations.

The federal consultants provided a list of recommendations at a community withdrawal management meeting earlier this month, essentially stating the region needs to better think how to use its resources and create a facility where intoxicated people could go to detox and stay for treatment, if interested.

Pam Sagness, director of North Dakota Department of Human Service’s Behavioral Health Division, said the department identified a gap in the number of social or medical detox providers in the region more than a year ago and requested assistance from SAMHSA’s Center for Substance Abuse and Treatment last year.

After the meeting, several providers in the area, including Heartview, law enforcement and jail officials decided to look further at what can be done to avoid incarcerating intoxicated people who haven’t committed any crimes.

Burleigh County Detention Center has partnered with Heartview to create a voluntary Web-based portal inmates can use that directs them to services, including treatment programs.

The portal was created under a federal grant and is in its beginning stages. It will work in conjunction with an initial screening or mental health questionnaire the county jail has been using the past two years.

The initial screening will flag whether a person could use additional services, and then a second screening will identify the services needed, said Maj. Steve Hall.

“It’s a change of philosophy for county jails to do these kinds of things, because we’ve never had to do that in the past,” said Burleigh County Sheriff Pat Heinert. “But in order to help people in today’s world, we have to start looking at those kinds of things.”


Detox calls are costly and time-consuming for law enforcement, hospitals and jails. Last year, the Bismarck Police Department spent $52,149 on calls for service regarding detox, each call averaging 58 minutes. Typically, two officers are required to respond to a report of an intoxicated person.

In most cases, police officers are the first contact.

“Who else are they going to call? It’s our job basically to find them the services,” said Deputy Chief Randy Ziegler, adding that nothing is solved when intoxicated individuals are jailed.

“(Jail) is basically just a place for them to spend the night. They get kicked out in eight hours, and we haven’t accomplished anything,” he said. “It’s been a revolving door for years.”


Emergency rooms at the local hospitals in Bismarck and Burleigh County Detention also are reporting substantial numbers of patients and inmates in need of detox.

A spokeswoman from CHI St. Alexius Health said the highest occurrence the hospital’s ER is seeing continues to be alcohol-related diagnoses, with an annual average over five years at about 207 primary cases.

In addition, the hospital has seen meth abuse diagnoses raise seven times since 2011.

Justin Reisenauer, an emergency medicine physician at Sanford Health, said the “top three players” he and other emergency physicians have seen ER patients take or abuse are alcohol, narcotics and meth.

“Definitely we have a major epidemic of narcotic abuse here,” Reisenauer said.

Neither Sanford Health nor CHI St. Alexius Health have an inpatient detox program. At Sanford, when a patient comes in withdrawing and wants to get clean, “basically, we stabilize them and clear them from any emergent issues, and then they go home with family,” Reisenauer said.

Outpatient follow-up is done at one of three places, he said, either New Freedom Center, West Central Human Service Center or Heartview -all depending on the patient’s insurance.

“I definitely think an inpatient detox center … in collaboration with both (Bismarck) hospitals would be beneficial - long overdue, for sure,” said Reisenauer, who has been at Sanford for about five years.


At Burleigh County Detention Center, the number of inmates staying at the jail only for detox or intoxication management are high, but appear to be going down in recent years, which Maj. Steve Hall said could be reflective of officers on the street attempting to find alternative places to bring these people.

Last year, there were 432 inmates at the county jail for just intoxication management. On average, 36 withdrawing inmates a month, or about one a day.

Most jails including Burleigh County aren’t licensed to provide detoxification services. At Burleigh County, it’s referred to as intoxication management.

“The only thing we can do is watch them while they sober up,” said Burleigh County Sheriff Pat Heinert. “We have no recourse to help them, treatment options, referral options.”

Jail officials hope, with the new portal to connect inmates to services, as well as the upcoming hiring of a mental health professional, some help will be offered to inmates with mental health and addiction issues.


“It’s overwhelming for jails and hospitals,” said Kurt Snyder, executive director of Heartview, which has 12 residential beds and provides a social setting detox for residents.

The facility has a two- to three-week-long waiting list, and 50 percent of its calls are coming from people in Williston, Dickinson and Minot, where services may be scarce.

Bismarck is sometimes the closest place people can go for help, Snyder said. In some cases when beds are full, Heartview will transport patients to its facility in Cando, a couple hours away.

In many instances, Heartview’s facility in Bismarck is inaccessible to police officers.

“A police officer can’t access us for a social setting detox with someone at 9 at night,” he said. “I don’t have the staff or the ability to staff that way.”

“Part of the solution needs to be the addition of additional withdrawal management beds, without a doubt. Wherever that would be,” Snyder said.


In addition to a community detox center, some other potential solutions being looked at are a collaboration between state, local or private providers to develop more services.

Also, offering training for police officers and creating some sort of screening assessment tool so they know where to bring a person who’s intoxicated, whether that be a hospital or detox center.

“(Training) would be so helpful for them,” said Ziegler.

Snyder agrees: “There needs to be some way to assess or a decision tree so that not everybody’s going to jail,” he said. “But then we have to have those options available, and right now there is no access.”

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