More homeless people are dying on Oahu. Can the crisis be reversed?
(ASSOCIATED PRESS) – According to Associated Press, Darlene Mayo, 52, died on a sidewalk near a Koa Pancake House in Wahiawa of severe anemia likely due to a chronic lice infestation.
Aris Garcia died of methamphetamine intoxication on a canal embankment behind a public transit hub in Kalihi. He was 79.
Nichole Seymour, 40, died of pneumonia and a lung infection on the south lawn of the federal office building and courthouse on Ala Moana Drive.
They lived homeless on Oahu. They died homeless on Oahu — in parks, at bus stops, in public bathrooms, on sidewalks, in hospitals. About half were under a doctor’s care in their final days. Hundreds more died outside. Many were alone. Some were hidden. Others were in plain sight.
Medical examiner’s data requested by Civil Beat shows that homeless people are dying in growing numbers. Methamphetamine is a culprit in hundreds of deaths, and the homicide and suicide rates for homeless people far outstrip those for the population at large.
From 2014 until the end of this November, at least 1,466 people died homeless on Oahu, according to the medical examiner’s records — 47 of them killed by someone else, 94 by suicide.
In the first 11 months of this year, 167 people died homeless. That was more than the island’s annual average of homeless deaths over the previous five years, and more than double those of 2014.
“It is a crisis,” said David Fong, a private case manager in Honolulu whose clients include people who are homeless and have mental health and or substance addiction issues.
As the numbers rise, a multipronged effort to curb the deaths is underway, primarily centered on Oahu, the population center.
It features two Honolulu programs that provide medical care and shelter to ill homeless people to slow the cycle of them being discharged from emergency rooms to the streets, only to return after falling sick or being injured again. It also involves a street outreach program whose staff includes EMTs, though that program is being audited at the request of council members who have questioned whether it is really addressing mental health crises and steering people into services.
Starting in January, Medicaid funding is to be used to care for people with issues that can be addressed outside a hospital, with a major focus on treating substance abuse and mental health, said Scott Miscovich, a doctor charged with leading the overall effort. A plan to divert homeless people into drug treatment instead of jail is also being developed, he said.
This week, Miscovich said, authorities started making use of a new law that makes it easier to hospitalize people involuntarily for psychiatric assessment and treatment if they are deemed a danger to themselves or others. He called it a “very important” piece of the new approach, although critics say the law threatens to violate people’s civil rights and reduce oversight of the hospitalization process.
In an example of systemic changes being sought, the state’s Medicaid program and other health plans are being urged to comb through their data so case managers can be assigned sooner to patients who show signs of substance use or mental health issues that can foreshadow or precipitate homelessness, such as not taking psychiatric medications and visiting emergency rooms frequently.
“This has been my focus for the past 18 months,” said Miscovich, whose Premier Medical Group manages the Honolulu facilities where people either found ill on the streets or being discharged from medical care are sent to live and get ongoing care.
Miscovich said the number of homeless deaths is almost certainly higher than records show.
The medical examiner has long noted homeless status, but capturing that information in a timely fashion can be challenging. The data isn’t regularly analyzed and people’s names are often missing. In a sign of the problems gathering accurate information, a series of requests for homeless death records from Civil Beat produced different results each time.
Miscovich credits Gov. Josh Green and Honolulu Mayor Rick Blangiardi with jumpstarting the initiative to reduce deaths in mid-2024. In the 18 months since, the medical examiner’s records show that at least 247 people have died homeless on Oahu.
Positive results — in the form of fewer deaths — should start to show in late 2026 or 2027, Miscovich said.
‘Overwhelm At Every Level’
Fong sees the issue through a close-up lens. Families hire him to advocate for and help loved ones to get services and benefits they’re entitled to. Despite the extensive support provided to people in his care, four of his clients have died homeless since 2014.
One was Linda Johnson. A Mid-Pacific Institute graduate who loved to dance hula, mental illness and methamphetamine addiction brought her low and forced her into homelessness.
Fong helped get her into treatment and housing in 2007, where he said she thrived. But in early 2022, as the COVID-19 pandemic interrupted her in-person mental health care and disrupted her routines, she went off her medications and left her group home to return to the streets.
The 48-year-old woman was beaten to death a few weeks later outside the Kapolei police substation, from which she had been released two days earlier. The man charged with killing her had a history of mental illness and had just been released from jail after allegedly assaulting a police officer; he was also on conditional release from the state hospital.
In Johnson’s case, police had removed her from familiar surroundings when they jailed her in Kapolei after arresting her in Waikiki for sleeping at Kuhio Beach Park. A police officer, who was later fired, reportedly ignored a passerby’s report shortly before the attack that Johnson was outside the substation and needed help. And Fong, who was listed as Johnson’s caregiver, was not notified when she was arrested or when she was about to be released.
“The system really failed her,” Fong said.
Like those of Fong’s other clients, one of whom died outside an Iwilei homeless services center, Johnson’s death exposes a complex web of interconnected problems. They include an overstretched system of care for people with mental health and substance abuse issues as well as the strain those challenges place on families and the threats vulnerable people confront daily when they live outside.
“It speaks to the degree to which our community is just experiencing overwhelm really at every level,” Fong said.
‘A Significant Undercount’
The official process of capturing data about people who die homeless is imperfect and it can take months before they are officially classified as homeless, if they ever are.
Agencies are often prohibited by law from sharing an individual’s personal information with each other, making tracking their housing status difficult. The medical examiner doesn’t have unfettered access to homeless service providers’ records. News of a person’s death on the streets doesn’t always reach outreach workers and other service providers who may have known them. Homeless people’s deaths in hospitals are not always reported to the medical examiner.
In 2019 and 2020, at the city’s request, the Department of the Medical Examiner produced reports on homeless deaths on Oahu but that practice didn’t continue. In an example of how unreliable the data can be, the 2020 report revised significantly upward the number of deaths announced the previous year, attributing the change to “new and corrected data” that had become available since the first numbers were released.
Those are among the reasons Miscovich said he believes the department’s list of deaths is a “significant undercount.”
“I wouldn’t doubt whether it’s double that,” he said.
Homeless deaths are also tracked in the Homeless Management Information System, or HMIS, a confidential, federally required database managed on Oahu by Partners in Care, a coalition of local nonprofits, government representatives and community members that coordinates homeless services and funding.
However, only people who at some point enrolled in homeless services and whose deaths database managers hear of — often from the medical examiner — are recorded in the database. Compared to the 167 people the medical examiner’s office said have died homeless so far this year, just 32 people have been recorded so far in HMIS.
Civil Beat’s requests to the medical examiner for records on homeless deaths resulted in several sets of data that changed with each request, sometimes because each new inquiry triggered a new review, which then turned up more deaths, Chief Medical Examiner Masahiko Kobayashi said.
For example, a first batch of records showed that 1,309 people died homeless from 2014 through Sept. 30, 2025. In a later response that included homeless homicides and other cases not previously counted, the medical examiner’s office provided a higher number, 1,466 from 2014 through the end of November 2025.
Each release of records showed a higher number of deaths than the last. And each showed that homeless deaths have increased through the years since 2014.
Kobayashi said that while the department’s reporting protocols have not changed, the number of reported deaths has steadily risen. He attributed that partly to an increased awareness among medical facilities of the criteria under which deaths are reported to the department.
But not every homeless person who dies on Oahu is reported to the department. For example, a homeless person who dies after a hospital stay longer than 24 hours and whose death certificate is signed by a doctor may not be reported.
Meth A Dominant Factor In Deaths
Improving how data about homeless deaths is captured and analyzed could have significant impacts, said Anna Pruitt, director of the Office for Poverty Research and Action at the University of Hawaii.
“If we have better data, we can better understand the problem and we can better figure out how to fix it,” Pruitt said.
Miscovich, who has met with Kobayashi and reviewed the death records, said that while the department’s data “is not a perfect science,” it supports the trends he has concluded are driving the high death rate.
“Out there in the streets and in the facilities I run, it’s basically severe mental illness, but even more so, substance use disorder,” Miscovich said. “And meth is dominating our homeless population right now.”
In nearly a third of the homeless deaths since 2014, methamphetamine use was listed by the medical examiner as either a primary or contributing cause, or as a condition of the person who died.
Miscovich said he believes the toll the drug takes as its users age, especially in heart disease, is behind several spikes in deaths over the last decade.
As the number of homeless deaths rose dramatically during that decade, the median age at death rose, too, to 58. Although the medical examiner’s records do not show a direct correlation between that rise and increases in methamphetamine-related deaths, they do show methamphetamine use was noted in 43% percent of the deaths last year, up from 30% a decade earlier.
To Miscovich, the numbers combined suggest that older homeless people who have used methamphetamine for longer are now dying.
“The meth and then heart disease and the multi-organ failure is just going through the ceiling,” Miscovich said, adding that the drug also contributes to violence as homeless drug users and dealers prey on others on the street, particularly women and older people.
Care Not Always Sought
Kevin Lynch was among those whose deaths were not counted, even though he lived on the edge of Kapiolani Park for many years and died at 62 after a battle with cancer.
Lynch had worked as a bookkeeper and later as a banquet waiter in Waikiki but drinking, difficulty following rules and financial troubles led him to the street more than a decade ago, said his brother, Darrel Lynch of Pearl City.
“He said, ‘This is going to be strictly temporary,’” Darrel Lynch said.
His brother loved crosswords, was a friendly, well-liked man not given to asking for help, and disdained homeless shelters, he said. His attempts to provide his brother with housing didn’t work because of Kevin’s drinking habits, and also because living outside appealed to him. Darrel visited him regularly at the park.
“I guess he had decided some time ago that, you know, his freedom and his ability to make his own calls was much more important to him,” Darrel said. Kevin was a smoker and didn’t seek out healthcare often. By the time he was diagnosed with throat cancer it was too late. He died on March 23 at Kuakini Hospital in Honolulu.
His brother would likely still be alive had he not been homeless, Darrel Lynch said.
“He only went to the hospital in the end because he was passing out, because he couldn’t breathe, because the tumor in his throat had grown so large it was obstructing his airway,” he said. “It never rose to the level of urgent in his mind.”
Kevin Lynch’s health care deficit is typical for most in his shoes, Miscovich said. Cancer screenings. Regular medication. Blood tests. They don’t happen.
“This group isn’t getting any kind of preventative health care,” he said. “And that’s why when you look at the cause of death, you’re seeing things that will be preventable with the general population.”
Yet a hospital stay is the most likely reason Lynch’s name never made it into the medical examiner’s records.
On The Front Line
On Monday, in a former First Hawaiian Bank building on North King Street, beds were lined up beneath what had been teller windows and across the high-ceilinged lobby. Some were still occupied but breakfast had been served, so many of the formerly homeless people who now live at Aala Respite were outside eating egg sandwiches.
Honolulu bought the former bank building for $8.4 million in 2023. There are 40 beds inside and another 22 in tiny home units outside. The residential care center opened late last year. Miscovich’s medical group runs it, receiving about $400,000 from the city a month.
Aala Respite is a front line in the doctor’s mission to reduce homeless deaths. He greeted residents warmly as he walked through the former lobby, shaking hands and sharing an embrace, and proudly pointed out a team of nurses.
The street outreach team brings many residents into the shelter. Others are discharged from emergency rooms via ambulance straight to the facility.
“We’re going to stop the people on that medical examiner’s list, that’s what this is all about,” Miscovich said. “We are specifically looking for the people in wheelchairs, the people lying in the streets.”
On a bench outside, underneath a shade tent, Aaron Lapham smoked a cigarette before breakfast. He has lived at Aala Respite for about a year.
Lapham was homeless for about 10 years, mostly on the North Shore, before being sent to Aala Respite from Adventist Health Castle hospital in Kailua, where he was being treated for alcoholism and mental health issues. He said at least five of his friends died on the streets, and methamphetamine or mental illness played a part in every death.
As for how much longer he would have stayed alive on the streets, the 56-year-old, who had been contemplating suicide a year ago, said “not much longer. It was just getting worse.”
Drugs played a role in his descent into homelessness, he said.
That and mental illness — which is often related — is common among Aala Respite patients, Miscovich said, and for those still living homeless.
Twenty years of working with people who are homeless has led Miscovich to a perhaps controversial view: that the high cost of living and a lack of affordable housing often blamed for homelessness actually are minor contributors.
“That’s what we see when you’re talking to these people in the streets,” he said. “They did have a home, but their drug use broke them. Their families just couldn’t deal with it. And they’re then going out to the streets.”
