I love data and the stories it can tell us. But one data point that saddens me is that two weeks ago in San Francisco a drunken 23-year-old woman hit three Chinese tourists with her car and killed one of them. The driver, who had three passengers in various states of inebriation with her, left the scene (hit and run) but was later apprehended by the police. At the very least, this is a terrible way for the city to treat its tourists. But it made me consider just how prevalent a problem drunk driving is in San Francisco and how well or ineptly we are dealing with it.
Let’s look at the data. First off, overall crime has been decreasing in San Francisco the last ten years. This has been true in big cities nationwide, but murders, assaults, rapes and robberies are all down in San Francisco, so let’s give our police department and judicial system some credit.
However, one statistic isn’t down in San Francisco—fatalities and injuries due to alcohol-related collisions. The number of alcohol-related fatalities have held steady the last five years and alcohol-related injuries are actually up. In 2010, there were 50 murders in San Francisco and 32 traffic deaths. 41% of those traffic deaths involved alcohol. (Statewide the number is 39%.) In 2010 there were 2386 assaults and 4788 traffic injuries. (Traffic injuries tend not to be reported unless they warrant a trip to the hospital where a report is filed.) 10% of those traffic injuries involved alcohol. (Statewide the number is 10.6%.) So you can see as violent crime rates come down and alcohol-related traffic fatalities and injuries don’t, alcohol-related traffic issues grow in significance.
So then we might wonder, just how tough is San Francisco on alcohol-impaired driving? It turns out that while California has some of the stricter DUI laws in the US, San Francisco is one of the laxest counties in the state when it comes to enforcement. In a 2011 DMV report, “An Evaluation of Factors Associated with Variation in DUI Conviction Rates Among California Counties,” that evaluates data from 2000 – 2006, it turns out that the county of San Francisco is the fifth worst of all 58 California counties in DUI conviction rates. Our conviction rate is 58.2% while Marin County’s is 85.8 and San Mateo County’s is 76.7. (It turns out that Marin has a remarkably low alcohol-related fatality rate—only one death in all of 2010.)
And San Francisco has the lowest, let me repeat, lowest DUI arrest rate of any county in the state. In 2006 it was .3 per 100 licensed drivers. In 2010, it was still .3. The statewide average is .9. In 2010 fewer DUI arrests were made in San Francisco than the previous two years (2008—1483, 2009—1534, 2010--1480.) And we have the highest rate in the state (10.4%) of letting DUI-arrested people plea bargain down to “dry reckless,” meaning a reckless driving charge with no alcohol-related penalties, points or priors involved. And we have a very high rate (13.6%) of letting DUI arrested people plea bargain down to a “wet reckless” charge, meaning an alcohol-related reckless driving charge. Neither “wet reckless” or “dry reckless” plea bargains involve license suspension at all. (For a troubling look at how San Francisco lawyers help DUI-arrested people plea bargain down, see here.) Drivers for whom San Francisco allowed “wet reckless” plea bargains had a mean blood alcohol content (BAC) of .112, well over the legal limit of .08! The people actually convicted of DUIs in San Francisco had a mean BAC of .169, more than double the legal limit! (The San Francisco archbishop who was arrested this last October for a DUI with a BAC of .11 plea bargained down to a “wet reckless” which meant a fine, probation and no license suspension. Because, you know, a license suspension would be inconvenient.)
|Stricter blood alcohol levels|
Note than in Sweden and Norway the legal limit for blood alcohol content is .02. Over .02 and you get your license suspended for three months. In San Francisco we don’t give DUIs unless the person is so drunk he/she basically can hardly put their keys in the ignition.
|Calibrate the darn thing|
And then we have the issue last spring of probable faulty calibration of the breathalizers used to determine blood alcohol content levels. This sloppiness by SFPD may result in over a thousand DUI cases since 2006 being overturned. Honestly, it’s pathetic.
The study mentioned before found that counties with low DUI conviction rates (of which San Francisco was one) had a 45% higher rate of alcohol-related crashes and injuries than in counties with high DUI conviction rates. The 2012 Annual Report of the California DUI Management Information System shows that statewide 3.1% of DUI first offenders had crashes within a year after their conviction, while only 1.9% of second offenders (who routinely receive much harsher penalties) had crashes within a year of their second conviction. Of course, this may be due to the fact that second offenders get their licenses suspended for a much longer period of time. (No license = fewer crashes.)
The 2012 Annual Report mentioned above shows the findings of a 1994 study which determined that 24% of first-time DUI offenders will incur another DUI incident within the next 8 years. It also shows that at the end of 13 years, 30% of male DUI offenders had reoffended as compared to 21% of women DUI offenders. (87% of all DUI offenders in 1994 were male. In 2009 close to a fourth were female.) DUI recidivism did use to be much higher before 1980. The drop is largely attributable to the implementation in 1982 of tougher sanctions on DUI offenders and implementation a lower legal blood alcohol limit. The report also offered up findings that show that assigning alcohol-reckless drivers to a either a 3 month or 9 month DUI intervention program has very limited effect on 1-year crash rates or further DUI incident rates.
So who is causing the fatal crashes, first timers or chronic drink and drivers? In 2009, 69% of drivers arrested in alcohol-involved fatal crashes had no prior DUI or alcohol-related reckless driving convictions. (Though in San Francisco they might have effectively plea-bargained down to “dry reckless” which wouldn’t have shown up in the data.) Another 24% involved drivers with one prior. When you throw into the mix the fatal crashes of drivers who had been drinking (according to the crash report) but were not even arrested, 74% of all alcohol-related fatal accidents involve no prior DUI, and 19% involve a driver with one prior. The chronic recidivists account for only 7% of fatal accidents.
It is interesting to look at alcohol-related injury and crashes—who is responsible and when they happen. In 2010 in California, alcohol-impaired men between the ages of 18 and 32 killed at a rate 5 – 8 times that of alcohol-impaired women. However, after age 32, men killed at rate only 3 times that of women. Peak age for alcohol-impaired driver to kill someone: 24. Peak age to injure someone: 21. Peak age for driver to be killed: 24. Peak age for driver to be injured: 21. Peak age for passenger to be killed in a collision involving alcohol: 21. Peak age for passenger to be injured: 18. Peak ages for pedestrians to be killed in a collision involving alcohol: 29, 46, and 58. (Not sure why there should be three mini peaks?) Peak age for a pedestrian to be injured: 22. Peak age for a bicyclist to be killed in a collision involving alcohol: three peaks at 21, 46 and 52. (Obviously people who are 46 years old should watch the heck out.) Peak age for bicyclist to be injured: 24.
|When the fatal accidents occur|
Alcohol-related fatal collisions in California are most likely to happen at 2am Saturday morning, but actually all Saturday evening and the wee hours of Sunday morning are pretty darn bad, as is Friday evening/ early Saturday morning. What’s surprising to me is how bad Sunday evening is from 5pm to 10 pm—worse than Friday from 5 pm to midnight.
Now let’s look at San Francisco public health in general. First the good news—San Franciscans are a healthy bunch, much healthier than the US average! Our men on average live 77.7 years, 2.3 years more than the US average, and our women live to 83.6 years, 3.2 years more than the national average. We have a much lower cancer rate than the national average, lower rates of chronic liver disease, coronary heart disease, diabetes (half the national rate!), Alzheimers, breast cancer, prostate cancer, and lung cancer. However, we have more drug-related deaths than average and more homicide deaths than the national average. We are equal to the nation’s average for firearm-related deaths and suicides. Children don’t tend to die at high rates in general, but for children in San Francisco ages 1 – 4, motor vehicle accidents are tied for the second leading cause of death. For children ages 5 – 14, motor vehicle accidents are tied for fourth. For persons aged 15 – 24, violence/assault is the leading cause of death, self-inflicted injuries come in second, and motor vehicle accidents are the third. For ages 25 – 34, violence/assault and self inflicted injuries are again one and two, and motor vehicle accidents are down at number 5. By age 35 people really start dying of enough different causes that motor vehicle accidents don’t make the top ten.
|Your liver should not look like this.|
(Just as an aside, I have to say from the data, if you’re 35 – 44 and can manage not to unintentionally overdose yourself with drugs, not commit suicide, not abuse drugs, not abuse alcohol, and not get hit by a car, you stand a very good chance of living to see 45. And if from 45 – 54 you can take it easy on the drugs and alcohol, not get hit by a car, and not commit suicide, you will very likely make it to 55. After 55, heart disease kicks in, but if you’ve been walking and biking the preceding years you’ll be protected from that, so again taking it easy on the drugs and alcohol will really increase your odds of making it to 65. I am just amazed how many San Franciscans die of cirrhosis of the liver, though it's true some could be due to hepatitis. But it’s pretty much all men. Very few women die of cirrhosis or alcohol abuse.)
So why am I putting so much effort into research and writing this? Do I hate alcohol? Do I just want no one to have any fun? Actually I’m very fond of a nice glass of wine, and philosophically I am against prohibitions of all kinds. When it comes to substances/items/behaviors that create public health risks, I favor policies of regulation, taxation and concerted education campaigns rather than making the substance/item/activity illegal. Yes, I have friends and family members who have died or suffered tragedy due to traffic accidents and drunk driving. I would be extremely surprised if anyone reading this has not.
But to go even further, the more I look at the data surrounding DUIs in San Francisco, the more appalled I am. Since my family does not drive much, my family members and I are often out on the streets of San Francisco walking, biking or waiting to take transit. This makes us vulnerable to irresponsible vehicle drivers. In fact, because members of my family walk and bike so much we are generally fit and healthy enough that a traffic accident will be the most likely cause of our early death! This is especially true for my children. And since 40% of all traffic fatalities in San Francisco involve alcohol, you bet this concerns me. Though we’d rather not face it, cars kill more people than guns do in the United States. In 2010, firearms killed 31,513 people, 19,308 of which were suicides. Traffic accidents killed 32,788. If you are not suicidal, you are far, far more likely to be killed by a car than a gun.
|Some countries drink and don't kill|
Now guns kill almost nobody in Europe, but cars also kill way less people there. (Yes, it's people who shoot the guns, and people who drive the cars.) The traffic fatality rate in Sweden is one fourth of ours. Yes, they drive less, but even their fatality rate per vehicle mile traveled is 40% of ours. And they consume more alcohol per capita than we do! The traffic fatality rates of the Netherlands, Finland, Denmark, Switzerland and Norway are 34%, 48%, 43%, 41%, and 41% of ours respectively, and all but Norway consume more alcohol per capita than we do. (The Finns and the Danes drink 30-40% more!) Traffic accidents cost the US $300 billion dollars a year, of which less than half is paid for through drivers’ insurance premiums. The rest is shouldered by all of us through increased health care premiums, increased Medicare costs, increased emergency personnel costs, clean up costs, and lives lost. If licensed drivers in the US were to pay the full cost of all the accidents motor vehicles incur, each would pay an additional $1500 per year. When you think about it, that is a pretty hefty subsidy.
Cars are powerful, dangerous and heavy. Their mass combined with potential for extremely fast acceleration is not to be taken lightly. Monetary penalties and points on a license are not sufficient deterrents to irresponsible driving, especially when it is so easy to reduce these penalties on the first offense. Besides, we don’t need reckless drivers to be poorer—we need them off the road until they truly commit to driving more responsibly. The penalty for irresponsible, reckless driving should be significant license suspension (90 to 180 days) rather than monetary penalties, alcohol programs (which don’t work) or even jail time. And the suspension needs to happen the very first offense. (In addition, driving with a suspended license or without a license should result in the car involved being permanently impounded.) License suspension is the one penalty that drivers fear enough to actually change their behavior. But because we’ve by and large designed our way of life around car driving, because we consider driving a necessity rather than a privilege granted only to responsible people, it is tragic that the one penalty that might reduce reckless driving and save lives is the penalty our court system is most loath to hand out.