City Attorney Halts Conservatorship Filings – and Looks to the County to Step Up | Voice of San Diego
San Diego Stops Taking County to Court Over Homeless People Who Keep Dying
City attorney ends legal war over who pays to help the most broken people cycling through jails, hospitals and streets
San Diego has backed down from a bitter legal fight with the county over who should pay to care for homeless people so mentally ill and drug-addicted that they're literally dying on the streets.
For years, the city sued the county in a desperate attempt to force it to take responsibility for people who cost taxpayers millions in emergency room visits, police calls, and jail stays while getting no real help. Now the city is throwing in the towel, gambling that county politicians will finally step up without being dragged to court.
The stakes are life and death. The city's Lifesaving Intervention For Treatment (LIFT) program was created for people like a schizophrenic man who was detained by police more than 50 times, or a woman who hit the emergency room 220 times in two years while terrorizing her neighbors and slowly killing herself.
The Death Spiral
These aren't your typical homeless people. They're the ones who make news when they die under freeway overpasses or attack strangers downtown. They have severe mental illness, often combined with drug addiction, and they cannot take care of themselves. Many don't even know they're sick.
Without intervention, they cycle endlessly through the most expensive parts of government: emergency rooms that can't turn them away, jails that can't hold them long, and police who get called to the same locations over and over. Each crisis costs thousands of dollars. Many die within a few years.
Since 2021, San Diego identified 81 such people through its LIFT program. The city's solution was radical: when all else failed, take the county to court and force a judge to appoint someone to make medical and housing decisions for them.
It worked. The city won 26 out of 28 court cases, forcing the county to provide care it had refused to give voluntarily. But county officials hated the strategy, fighting every case even when they usually lost.
The Legal War
The fight started when then-City Attorney Mara Elliott grew fed up with the county's refusal to help. When the county rejected requests for mental health conservatorships—the traditional way to force treatment—the city found a workaround.
Former assistant city attorney John Hemmerling discovered he could file probate conservatorships instead, essentially suing the county to make a judge force them to provide care. "I found legal authority to be able to file those, and we did, and it pissed them off," Hemmerling said.
The strategy created courtroom showdowns where city lawyers would document someone's horrific decline while county lawyers argued they didn't qualify for forced treatment. As Elliott put it bluntly in 2023: "The county has opposed every petition we have filed."
But the city kept winning, and each victory meant the county had to pay for intensive care, housing, and supervision for someone they'd previously ignored.
Why the City Gave Up
New City Attorney Heather Ferbert, who took office in December, has now ended this legal warfare. Her office cites budget pressures and hopes that a newly Democratic county government might cooperate without being sued.
The timing isn't coincidental. Democrats took control of the county Board of Supervisors for the first time in decades, promising more focus on homelessness and mental health. The county also has a new acting counsel after the previous one abruptly retired.
"We look forward to finding ways to work with the county to do this work without the city needing to expend substantial and limited resources on conservatorship petitions," Ferbert's office said.
Translation: Maybe you'll help us voluntarily now instead of forcing us to drag you to court every time.
The Human Cost
Police and fire officials are alarmed by the change. They know what happens to severely mentally ill people without intervention—they deteriorate rapidly and often die.
"This was a great tool for holding the county accountable for dealing with the worst cases out there," said Jared Wilson, president of the San Diego Police Officers Association.
Deputy Fire Chief Becky Newell emphasized that conservatorships were truly a last resort: "Nobody here wants to take anybody's rights to make their own decisions away. In the case of filing for conservatorship, it is because they've done multiple assessments to show that the person is not able to make decisions on their own."
Without the threat of lawsuits, there's no mechanism to force the county to act when someone is dying but refuses help.
New Programs, Old Problems
The city is betting that new state programs might fill the gap. California's CARE Court was supposed to create a pathway to force treatment for people with psychotic disorders, but San Diego's version has become entirely voluntary.
Even more telling: instead of funneling people into forced treatment, San Diego's CARE Court is mostly helping people get out of conservatorships. Twenty-one percent of participants are stepping down from the strictest level of care, not stepping up to it.
The county has also prepared for new state laws that expand who can be forced into treatment, particularly people with severe drug addictions. But without pressure from the city, it's unclear whether county officials will use these tools aggressively.
The Blame Game
At its core, this is a fight about money and responsibility. The city deals with the immediate chaos—police calls, emergency responses, public complaints about people living and dying on sidewalks. The county controls most mental health and addiction services but has historically been reluctant to use its most intensive (and expensive) interventions.
The city's lawsuits forced the county to pay for care it preferred to avoid. Without that pressure, advocates worry the county will return to its old pattern of letting people cycle through crisis after crisis until they die.
County officials say they remain committed to helping people with mental health and addiction problems, but they were "unaware" of the city's decision to stop filing conservatorship cases.
City council members who championed the LIFT program are cautiously optimistic that the county's new Democratic leadership will step up voluntarily. "The county should step up," said Councilwoman Jennifer Campbell. "I think we're waiting to hear from them now: Are you going to step up and take this on?"
What Happens Next
For now, San Diego's most vulnerable people are caught in the middle of this political gamble. The city is betting that cooperation will work better than confrontation. The county says it's committed to helping but hasn't explained how it will identify and treat people who refuse help.
Meanwhile, people like the man with 50 police detentions or the woman with 220 emergency room visits continue cycling through the most expensive parts of government, costing taxpayers millions while getting no real help.
The question isn't whether the city and county can work together—it's whether severely mentally ill and addicted people will live or die while politicians figure it out.
The Staggering Cost of Doing Nothing
Each severely mentally ill person in San Diego's death spiral costs taxpayers $350,000 to $700,000 annually in emergency services—more than a luxury car every year.
Conservative breakdown per person:
- Emergency room visits: $297,000 (110 visits × $2,700 each)
- Ambulance transport: $33,000 (15 trips × $2,200 each)
- Police response: $16,250 (25 calls × $650 each)
- Jail costs: $4,140 (12 short stays)
The math is brutal: San Diego's 81 most vulnerable people cost the city $28-57 million annually in crisis services. By comparison, the 26 conservatorships the city won cost just $1.3 million per year—a potential savings of $27+ million annually.
For the worst cases like those with 220 ER visits and 50+ police calls, costs can reach $700,000 per person per year.
These figures don't include: Fire department calls, court proceedings, property damage, lost productivity, or the devastating impact on families and communities.
The financial argument for intervention is overwhelming—even expensive conservatorship care costs a fraction of letting people cycle through crisis services until they die.
Sources
- Halverstadt, Lisa. "City Attorney Halts Conservatorship Filings – and Looks to the County to Step Up." Voice of San Diego, September 11, 2025. https://voiceofsandiego.org/2025/09/11/city-attorney-halts-conservatorship-filings-and-looks-to-the-county-to-step-up/
- San Diego Superior Court. "CARE Act." Superior Court of California - County of San Diego. https://www.sdcourt.ca.gov/careact
- San Diego County Health and Human Services Agency. "CARE Act Program." https://www.sandiegocounty.gov/content/sdc/hhsa/programs/bhs/CARE_act_program.html
- Halverstadt, Lisa. "San Diego's CARE Court Is Serving Those Formerly in Conservatorships." Voice of San Diego, March 10, 2025. https://voiceofsandiego.org/2025/03/10/san-diegos-care-court-is-serving-those-formerly-in-conservatorships/
- KPBS. "City of San Diego urging CARE Court reforms." April 4, 2025. https://www.kpbs.org/news/politics/2025/04/02/city-of-san-diego-urging-care-court-reforms
- San Diego County Health and Human Services Agency. "Senate Bill 43." https://www.sandiegocounty.gov/content/sdc/hhsa/programs/bhs/senate_bill_43.html
- Wikipedia. "2025 San Diego County Board of Supervisors special election." July 5, 2025. https://en.wikipedia.org/wiki/2025_San_Diego_County_Board_of_Supervisors_special_election
- Robinson, Lucas. "Democrats will again control San Diego County's Board of Supervisors. Here's what they want to accomplish." San Diego Union-Tribune, July 5, 2025. https://www.sandiegouniontribune.com/2025/07/05/democrats-will-again-control-san-diego-countys-board-of-supervisors-heres-what-they-want-to-accomplish/
- City of San Diego. "Heather Ferbert." City of San Diego Official Website. https://www.sandiego.gov/cityattorney/hferbert
- Ballotpedia. "Heather Ferbert." https://ballotpedia.org/Heather_Ferbert
- City Attorney Halts Conservatorship Filings – and Looks to the County to Step Up | Voice of San Diego
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