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About Mental Health

He couldn’t escape the easy access to drugs in San Francisco’s Tenderloin. He couldn’t escape prison when he crossed the border into San Mateo County.

By Heather Knight | May 24, 2019

The first time I met Jeffrey Choate, he looked close to death.

He was passed out on a Larkin Street sidewalk, needles and other drug paraphernalia scattered around him. His dirt-smeared arms and hands puffed up like balloons, a sign of heroin addiction.

It was last September. A San Francisco police officer, a Chronicle photographer and I walked the Tenderloin for a column on the city’s all but officially sanctioned open-air drug market. Need a fix? This is the place to come.

Police Officer Brian Donohue checks on Jeffrey Choate after seeing him on the sidewalk in the Tenderloin in September. When Choate’s mother saw photos of him, she asked for help. | Lea Suzuki / The Chronicle 2018

The officer rousted him to make sure he was alive. He came to and told us his name. That he was 33. That he was from the East Bay, but was homeless and sleeping on San Francisco sidewalks. That he’d used heroin and crystal meth every day for years.

“I hate it, doing this,” he said. “As bad as it is, it’s kind of addicting out here.”

Underneath the grime, he appeared tall, young and handsome. Well-spoken. The encounter prompted so many questions: How did Jeffrey come to normalize shooting up on a Monday afternoon on a filthy sidewalk? Where was his family? We all ask these questions every day and rarely get answers.

This time I got one — one that indicts both the overly accepting progressive policies of San Francisco and the harsh law-and-order stance of bordering San Mateo County. Two counties that fail in their own ways to deal with the overwhelming drug problems on our streets and two counties that won’t admit those failures.

San Francisco, in the false name of compassion, let Jeffrey sink into misery on its streets. San Mateo, in the false name of justice, sent him to prison.

We met again five months later. Jeffrey’s grubby clothes had been replaced by a clean orange jumpsuit. His puffy arms were back to the brawniness of his high school baseball days, his straggly hair clean and short. We talked in a Redwood City jail visiting room. He’d been arrested and was being held there awaiting transfer to his next stop: state prison.

He’s been in jail for eight months now, convicted of shoplifting clothes from a Marshalls store in Colma and giving a false name to police. He was high on heroin and meth when he stole the clothes. He gave the name and birth date of a friend of his, an identity he’d used in previous run-ins with the police to avoid being picked up on parole violations. He said he felt badly about getting his friend in trouble and confessed his real name within an hour.

Prosecutors held out for a tough sentence, and a county judge agreed: State prison for five years.

“Should I be punished? Yeah,” Jeffrey said. “But find a happy medium. A happy medium means understanding why people use drugs.”

And there are a lot of those people. The National Institute on Drug Abuse says 1.7 million people in the United States suffer from substance abuse, and 652,000 are addicted to heroin. In 2017, 47,000 Americans died of opioid overdoses.

The crisis is rampant on the streets of San Francisco. In the city’s 2017 homeless count, the most recent for which detailed information is available, 41% of homeless people said they have a substance abuse problem.

That’s more than 3,000 homeless people grappling every day with the devastating pull of drugs or alcohol. Like Jeffrey, many of them battle their demons on our sidewalks for all to see.

“There are bad people,” Jeffrey said. “But we’re not all bad.”

Many of them have families that care about them. I was talking to Jeffrey again because of his mother.

It’s not unusual for families to write when they see their homeless relative in a news story. Sometimes they’re mad about the publicity; other times, they want help finding them.

The email from Susan Choate-Brye was different:

The young man, Jeffrey, that you interviewed for this article 10/6/18 is my son Jeffrey Choate. He told me that he was in the newspaper, and my heart broke when I saw the pictures of him on the streets. I have not seen him for over six months — had no idea if he was alive or dead.

She wanted to tell me her only child’s story because she knows there are many families like hers. Speaking up, she thought, might help someone else.

“I’m going to be as honest as the day is long with you, because that’s what this is all about,” she said when we talked at her sprawling home in Clayton, where she raised Jeffrey and lives with his stepfather.

Susan, 67, wears a cross around her neck, serves visitors ice water with lemon slices and loves “Dr. Phil.” She has a welcome mat and rosebushes out front and a swimming pool out back.

She worked at a flooring company until her back gave out and now is retired. She spends a lot of time in her home office, contacting doctors, lawyers, politicians — anybody she thinks might be able to help Jeffrey and people like him.

The people she asks for help almost never write back.

Steve Brye, 70, a former major-league baseball player who works in operations at the Port of Oakland, remembers the time he met the 4-year-old who would become his stepson. He’d answered a dating ad and showed up at Susan’s house. Her little boy answered the front door, demanding to know who he was.

“He was a cute little kid,” Brye said, chuckling at the memory.

Susan has albums filled with photos showing a happy childhood. Jeffrey wearing big, goofy sunglasses. Jeffrey in the bath, next to a Christmas tree, blowing out candles on his birthday cake.

“He loved sports. He loved going to school,” Susan recalled. “He was easy in the early years.”

Jeffrey liked playing Nintendo and watching World Wrestling Federation matches on TV — Randy “Macho Man” Savage was his favorite. He liked having friends over and making forts out of couch cushions. By middle school he was popular with girls, taking four of them to his seventh-grade dance.

At Clayton Valley High, he got decent grades and was a pitcher with a mean curveball. But sometime in his late teens, the happy and easy Jeffrey disappeared. Susan thinks wisdom tooth surgery when he was 17 was the turning point. Doctors prescribed OxyContin.

“When he turned 18, all heck broke loose,” Susan said. “He really changed as a person, became very angry. He stole from us. Nobody wanted to be around him.”

He enrolled at Diablo Valley College but dropped out. He lived with roommates, and Susan couldn’t keep a close eye on him.

But in 2007, when he was 22, Jeffrey asked for help. He was in trouble, he told Susan, addicted to pills.

He signed paperwork allowing her to view his Kaiser medical records. Susan and Steve had been paying for Jeffrey’s health insurance and were horrified to see what they had unwittingly funded.

From 2003 to 2007, Kaiser doctors had prescribed Jeffrey more than 1,700 pills, including OxyContin and Hydrocodone. Multiple doctors. Multiple prescriptions. The list goes on for pages. Seventeen hundred opioid pills for a young man just out of high school.

Jeffrey had complained to doctors about neck, back and foot pain. Doctors noted in his file he had a substance abuse problem but kept prescribing him opioids.

The National Institute on Drug Abuse reports that up to 29% of patients prescribed opioids misuse them, and as many as 12% will become addicted. About 6% of those who misuse opioids transition to heroin, while 80% of heroin users had misused prescription opioids. Americans consume 80% of the world’s opioid supply.

Kaiser officials declined to comment on Jeffrey’s health history, citing privacy laws.

In an email, Dr. Sameer Awsare, associate executive director of the Permanente Medical Group, said the company’s “heart goes out to Mr. Choate and his family.” Awsare went on to say Kaiser cut its opioid prescriptions by 40% from 2011 to 2017, and now prescribes lower doses and shorter courses when opioids are medically necessary.

That policy change came too late for Jeffrey.

His story gets murky after that 2007 talk with his mom. After years of daily drug use, he is unable to tell exactly what happened next. Instead, he bounces among anecdotes, injecting political beliefs and monologues about the science of opioid addiction.

But seven attempts at rehab failed. He grew estranged from his parents. By 2013, Jeffrey was so desperate to feed his pill addiction that he robbed three Bay Area banks. The unarmed robberies netted $4,770 — and 19 months in state prison.

When he got out, he started using cheaper, easier-to-score heroin and meth, buying it in the Tenderloin, where it’s about as easy to purchase as a pack of gum. Five parole violations kept him cycling in and out of jail.

Susan heard from Jeffrey only when he was locked up. Those were the nights she could sleep. At least she knew where he was, that he had a bed and food.

She sometimes thought about driving around to look for Jeffrey when he was out of jail.

“Had I seen him,” she says now, “I would have sat down on the street next to him and never left him. That’s what a mother does.”

Jeffrey admits to shoplifting food and other items to sell for drug money. Friends living in single-room occupancy hotels let him shower and use the bathroom, but he would sleep wherever he passed out, often near the corner of Ellis and Hyde streets. He said he got free syringes from the city’s needle exchange, usually 50 at a time. San Francisco handed out 5.8 million syringes last year with no requirement to return the dirty ones.

Over the years, he said, he’s been threatened with knives, hit on the head with a pistol and lost his belongings to theft. One night he found his best street friend, Bob, dead of pneumonia in a Tenderloin alley.

Jeffrey was arrested on Sept. 25, just a few weeks after our Tenderloin encounter, for the theft from Marshalls and using a false name. He had meth and heroin on him and was charged with two felonies and three misdemeanors. He’s been behind bars ever since.

Francoise Espinoza, a private defense attorney, took his case. San Mateo County has no public defender’s office and pays private attorneys to represent indigent defendants. Espinoza said she has about 70 clients at any time, most of them addicted to drugs.

Treatment, she said, is clearly the right answer for Jeffrey.

“I think he needs to do a lengthy drug treatment program,” she said. “I don’t think sending him to prison is going to make anything better. There’s always someone willing to supply and feed that need in prison.”

San Mateo County prosecutors offered Jeffrey a plea deal — 32 months in prison — but he opted to go to trial instead. In December, a jury found him guilty.

Susan provided emails showing Jeffrey’s parole officer had discussed a stay at Delancey Street, the famed San Francisco treatment center where former prisoners learn life skills and regularly turn their lives around. But Susan was concerned the facility doesn’t take people with dual diagnoses, such as drug addiction and mental illness, or who require psychiatric medication. Jeffrey has struggled with depression.

Instead, Susan secured him a bed at Henry Ohlhoff House, a San Francisco facility that accepts rehab patients who have a variety of other issues. Ohlhoff House Executive Director Arlene Stanich-Prince said clients who are mandated by judges to participate in the program often do the best because they know if they don’t succeed, it’s back to jail.

In court, Susan pleaded with San Mateo Superior Court Judge Gerald Buchwald to send Jeffrey there instead of state prison. To give him one more chance.

Instead, Buchwald sentenced Jeffrey to five years in state prison. Weeks later, he was transferred to San Quentin.

It’s hard to imagine Jeffrey would have gone to prison if he’d been caught shoplifting in San Francisco.

In the city, people stick needles in their necks or between their toes in the middle of the day on busy sidewalks with little fear of police.

Even drug dealers face few repercussions. In fiscal year 2017-18, police arrested or cited 883 people for selling drugs citywide, 56% of them in the Tenderloin. Police presented 747 drug sale arrests to the district attorney’s office, which charged almost 80% of them. Nearly half of those are still pending.

So far, 173 people have been convicted, with 32 sentenced to some jail time. Others received probation. The problem: Those out on probation and those awaiting action in their cases often return to the Tenderloin to deal.

San Francisco’s approach to the opioid crisis focuses on “harm reduction,” making the use of illicit drugs a little safer, such as nudging a heroin user to shoot up four times a day rather than five. The city has trained many of its employees to administer Narcan to reverse drug overdoses. Last year, they helped reverse 1,266 overdoses.

Jeffrey said San Francisco paramedics saved him from overdosing “like 12 times,” including once in a park restroom.

The city runs a street medicine team, but Jeffrey doesn’t remember ever being offered help. Perhaps that’s because there’s so little help to offer. For those who need residential drug treatment, the city has just 267 spaces available, with an additional 68 for those who also struggle with mental illness.

That’s in a city with 24,500 injection drug users, more than double the number from 2005. Some addiction experts say the city’s leniency — unlimited free needles, easy access to cheap drugs and tacit permission to use them in public — draws users here.

That leniency, though, stops at Geneva Avenue, the boundary between San Francisco and San Mateo County. The street is a dividing line in criminals’ minds, too. If you break the law, you definitely want to get picked up on the north side of Geneva.

San Mateo County District Attorney Steve Wagstaffe is proud of that.

“If there’s an act, there’s a consequence,” he said. “That’s the way we work down here in quiet little San Mateo County.”

Wagstaffe said defendants don’t get to choose a treatment center. He said Jeffrey’s insistence on what Wagstaffe deemed an “easier” option at Ohlhoff House indicated he wasn’t committed to getting off drugs.

San Mateo County’s approach helps keep its sidewalks safe for everybody, he said.

“I’m just grateful you can come here to our civic center, and there aren’t a bunch of people with needles in their arms laying around,” Wagstaffe said. “I think my community, at least, prefers that.”

When I last talked with Jeffrey at the Redwood City jail, he looked markedly healthier. But his first several days in jail were grim. Forced to go cold turkey, he’d suffered fevers, sleeplessness, diarrhea and mood swings.

“You’re not going to die from opiate withdrawal, but it feels like you want to,” he said.

He said taking opiates numbed him, made him less angry. When he’d fight with his mother or a girlfriend, opiates would make him feel better. He said his mom described him as “like a robot.”

He thinks drugs should be decriminalized and that treatment should be available to whoever wants it. He thinks cities should open safe injection sites so users can consume drugs out of sight of children and cops.

“When you’re willing to rob banks because you’re that sick off of opiates, then come talk to me,” he said. “When you basically have a death wish because it’s that bad, then I’ll listen. … Nobody tries to understand anything.”

It seems clear that Jeffrey would have been better off applying to Delancey Street than where he’s headed now. Five years in state prison seems like a waste — for Jeffrey and the taxpayers who will foot the bill.

It could also be hard to stay clean, considering there were nearly 1,000 overdoses in California’s prisons last year, a spike of 113% in three years that officials say is part of a shocking rise in opioid use among prisoners.

It’s also clear that neither San Francisco nor San Mateo County has the right answer for dealing with the Jeffreys on their streets.

Declaring success if addicts don’t overdose or contract HIV, but offering far too few treatment beds, seems like too low a bar, especially for a city with a health department budget of $2.3 billion. Allowing the Tenderloin to remain a public injection site where drug dealers have easy access to users is immoral.

But declaring success by shipping addicts who need help to state prison, where drugs are readily available, also seems cruel and shortsighted.

There are other answers out there.

In Portugal, for instance, possession of any type of drug that would last one person 10 days is decriminalized. If someone is caught with that small an amount, he or she must report to a special commission within three days and will be connected to drug treatment. Unlike in San Francisco, treatment slots are always available. If the person refuses treatment, police may get involved.

Drug dealers, meanwhile, face years in prison. As a result of the policy changes in the late 1990s, the use of heroin, cocaine and crack in Portugal has dropped, and dirty needles on sidewalks and open-air drug use are rare.

If there’s any upside to prison, it’s that Jeffrey and his mother have reconnected. She’s visited him regularly in Redwood City and San Quentin. In the mail, there are often long letters from Jeffrey. One was a letter of apology. When the phone rings, it’s often him calling.

“He does care about himself now,” Susan said.

These days, her overwhelming feeling is sadness, for all the years lost to addiction and estrangement. “It’s missing him — vacations we never took, movies we never saw together, holidays we never spent together,” she said.

On one of their last visits to the Redwood City jail, Susan and Steve spoke to Jeffrey through thick glass smeared with the fingerprints of relatives and inmates unable to touch each other.

Mostly they joked and told stories, but then the conversation turned serious.

“I look at you, and I just, I get angry. This is your life. Sixteen years of your life,” Susan told Jeffrey. “I just want you where you’re going to be safe and get help.”

On May 13, Jeffrey was back in a Redwood City courtroom. His attorney made a last-gasp plea to Judge Buchwald to suspend the five-year sentence and send Jeffrey to treatment instead.

Susan and Steve were sitting in the front row. They drove their “good car” — the one, Susan joked, that doesn’t have 200,000 miles on it — and brought Jeffrey a change of clothes. Just in case, by some miracle, the judge released him.

Buchwald, who declined to comment for this column, said in the hearing that he could have given him even more time in prison and refused to alter his sentence. So it was back to San Quentin, the first stop for those on their way to prisons around the state. Jeffrey will serve out his sentence at a prison in Susanville (Lassen County), a nearly 10-hour round-trip drive for Susan and Steve.

Susan said she was disgusted. She and Steve drove back to Clayton. A bedroom will be waiting there for Jeffrey, she said, whenever he comes home.

San Francisco Chronicle columnist Heather Knight appears Sundays and Tuesdays. Email: Twitter: @hknightsf