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Society bears the cost when homeless people refuse shelter

I was sipping on some chocolate milk while reading the front-page News article on Jan. 18 and it got me thinking about the pros and cons of government mandates in general, whether it’s the order to place homeless people in shelters “taken there by force if needed” when the temperature drops to 32 degrees or lower, or restricting the size of a soft drink, or the effective bans on smoking in many places.

While one can argue that it’s a free country and people should be allowed to enjoy the great outdoors in subzero temperatures if they so please, one has to keep in mind the social burden and cost to the consequences thereof. Usually the individuals who complain about the loss of liberties and government restrictions are the same ones who favor either lower taxes or don’t pay them at all. Like politics, usually the truth is somewhere in between.

I have never written to a newspaper but, figuring this was the best way to spread the message, I am also using this as a word of caution for our current cold weather. While this year has been much kinder thus far, the regional hospitals are already gearing up for the yearly battle against frostbite.

As was mentioned in the article, Gov. Andrew M. Cuomo’s new rule will protect lives but also save countless limbs. Out of curiosity, I looked at the volume of frostbite and amputations at Erie County Medical Center last winter and the numbers were staggering. Mind you, this is data from only one of the larger hospitals in the region, but multiply this by all the hospitals in cold weather climates and you can imagine the extent of the problem.

Mental health problems and drug or alcohol abuse are very common in this cohort of individuals, making the “involuntary placement” to a warmer place somewhat misleading. One assumes the individual is competently making that decision to stay out in the cold. However, one can’t really refuse or accept something if he or she has no capacity to do so in the first place.

Anyway, ethics aside, the following numbers represent an overview from Nov. 1, 2014, to April 24, 2015, at ECMC. There were approximately 142 patient encounters with a diagnosis of frostbite, 98 of which were to the hand. Nine patients ended up with an amputation of some sort, ranging from a single finger or toe, to one case of bilateral above-knee amputations, to a case of all 10 fingers amputated.

Frostbite is basically the local complication of hypothermia to the external organs, usually the digits and appendages such as the ears and nose. At the tissue level, the smaller vessels carrying blood and cells literally freeze, leading to cell death. The degree of injury depends on multiple factors, such as time exposed, degree temperature and co-morbidities. The extent of injury can vary from blisters and swelling to necrosis or gangrene.

Since it is extremely difficult to determine what is viable and what will die off, unless there is infection, the plan is usually to allow demarcation, which will clearly delineate the border of nonviable tissue, and plan on future amputation of the dead tissue.

As part of the department of surgery at UBMD, I am committed to encouraging preventative measures by getting the word out to the community. As much as I love the art and practice of surgery, I don’t enjoy taking off limbs and digits. The physical and mental cost burden to the patient can be quite extreme, and rehabilitation is often long and arduous, leading to potentially lifelong disability.

That is where the cost to society comes into play as well, since the taxpayer is often the one picking up the tab, just like the care for lung cancer in the smoker, heart attack in the morbidly obese, head injury in the helmetless motorcycle driver (a dig at Florida since it has better weather right now), etc.

While social factors certainly play a role, we have seen this across the whole spectrum of individuals – everything from the homeless obtunded alcoholic, to the friendly neighbor shoveling snow, to the young female walking home with inappropriate footwear. It doesn’t take much with the famous Buffalo weather, especially if there is also poor circulation and diabetes present as a co-morbidity.

Raphael Blochle, M.D., is a general and vascular surgeon with UBMD at Erie County Medical Center.