James K. “Bubba” Carter had been living outside for a decade. He didn’t like the rules at homeless shelters and worried that people there would steal his possessions. A life outdoors also meant he was free to drink the way he wanted.

His younger brother, Percell, checked on him several times a week and made sure he had something to eat. A few years ago, Percell invited James to join him back home in Virginia for Christmas. James declined. Days later, on New Year’s Day 2021, James was found lying dead in woods beside a bridge in Atlanta’s westside.

The 58-year-old was one of at least 32 people believed to have died from hypothermia while homeless in metro Atlanta since the start of 2021.

“I can’t describe it — it was unbelievable, but believable,” said Percell Carter, who wonders if he could have done more for his brother. Percell described James as an alcoholic who was kind and generous when sober. “It’s hard to help someone who doesn’t want it.”

James K. Carter, who had been without a home for a decade, was found dead from hypothermia in the city of Atlanta on Jan. 1, 2021.

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This winter, as public discussions swirled about how to address homelessness, The Atlanta Journal-Constitution began researching how many people are dying from exposure to cold temperatures in metro Atlanta. The AJC spoke with officials from medical examiner’s offices and reviewed dozens of autopsy reports and investigative summaries obtained through open records requests.

Nineteen of the 32 people were found in the city of Atlanta. Others were discovered in College Park and East Point in Fulton County, and in Marietta in Cobb County. Eleven people were found in DeKalb County, including in Chamblee, Doraville, Stonecrest, Brookhaven and in unincorporated areas.

In each case, hypothermia was the sole cause of death or one of multiple causes. Twenty-four of the 32 people were Black, seven were white, and one was Hispanic. Six of the 32 were women. The average age was 59.

Officials in Clayton and Gwinnett counties said no hypothermia deaths have occurred there since the start of 2021 among people confirmed to have been homeless.

But the total of 32 deaths likely is a conservative number.

It does not include, for example, at least three people who died of hypothermia in Fulton County over the same period, because officials couldn’t determine if they were homeless. Similarly, officials in Cobb County could not conclude for certain whether a 60-year-old man found in January in a wooded area, his clothes soaked from overnight rains, had been homeless.

The family of another man, Timothy William Crowley, believes he died from cold exposure while homeless, but the autopsy is not yet finished. Crowley, 48, was found Jan. 22 at a MARTA bus stop near Riverdale and Poplar Springs roads in Clayton County. Overnight temperatures dipped into the high 20s on the day he was found.

Among the 32, one was a 69-year-old man who was so cold he went to Emory University Hospital Midtown and stayed for 12 hours. After being treated for hypothermia, he left late at night and refused a shelter voucher. Hours later, on Jan. 22, 2023, he was brought back to the hospital, where he died.

This past December a Mercy Care employee, Michelle Keith, was visiting a homeless encampment near Interstate 75 beside Georgia Tech’s campus to help a client, when a man she knew sat up suddenly from underneath a downed tent. He seemed to have trouble focusing on her, tried to say something, and then collapsed. Keith performed CPR on him, but he died later at Grady Memorial Hospital from hypothermia. He was 74.

Exie Evans, left, and Marilyn Walton visit a MARTA bus stop in Clayton County on Friday, Feb. 9, 2024, where Timothy Crowley, Evans' nephew and Walton’s brother, was found dead. Crowley's family believes he was homeless at the time and they had been searching for him. (Ben Gray / Ben@BenGray.com)

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Ben Gray

Keith, a case manager on Mercy Care’s “street medicine” team, said in an interview that she had met the man at the encampment last summer and had been helping him for months, bringing him food and taking him to medical appointments. The man appreciated the help so much that he told staff at the nonprofit that he had adopted them as his family. He even listed Keith as his emergency contact.

Keith had filed a request for a permanent home for him in mid-November and he was excited by the prospect, according to representatives of Mercy Care. It was too late when Keith received a call in January informing her that housing was available for him.

The challenge of trying to stop people from dying in the cold is as complex as the situations are heartbreaking. In the city of Atlanta, the homeless population was 2,679 in January 2023, an increase from 2,017 the previous year, according to the annual Point in Time Count.

Atlanta Mayor Andre Dickens, when asked in an interview last month what more could be done to prevent such deaths, noted that in January the city opened 40 units of housing made from shipping containers in downtown Atlanta. He said a motel also was being fixed up to shelter people in 50 suites there, among other efforts. A key goal is to move 1,500 people into residences by the end of this year.

Last month, the city began removing encampments under some bridges because of the danger posed by fires that burn out of control after people start them to cook or stay warm.

The city of Atlanta has started a major new effort to clear out people living under bridges and encampments. A man watches from his tent as cleanup efforts begin on Monday, Feb. 26, 2024. (John Spink / John.Spink@ajc.com)

John Spink

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John Spink

In cold weather, several of the metro area’s cities and counties open warming centers, though some advocates believe they should open at higher temperatures.

The city of Atlanta’s policy is to activate special warming centers when overnight temperatures are expected to fall to 35 degrees or below for at least five hours; when temperatures reach 32 degrees or less along with an 80 percent or greater chance of precipitation; or if there is expected to be snow accumulation of an inch or more sticking to the ground in most locations.

DeKalb County opens warming centers when wind-chill temperatures drop to 32 degrees or below and are expected to remain that low for at least four hours. Gwinnett County opens its warming stations when temperatures reach 35 degrees and lower.

Cobb County provides some funding to MUST Ministries, which uses its MUST Hope House shelter in Marietta as the county’s warming center when temperatures are predicted to dip to 35 degrees and below.

Stephanie Ramage, who authored a report about hypothermia among Atlanta’s homeless, said the city of Atlanta should consider opening warming centers when it’s above 35 degrees.

“I would love to see the city take another look at the temperature that triggers the warming centers,” said Ramage, a former spokesperson for the city whose research found that 19 people died of hypothermia while homeless in the city in 2017 and 2018.

Although hypothermia usually happens at very cold temperatures, it can occur even at cool temperatures above 40 degrees if a person is chilled from rain, sweat or submersion in cold water, according to the Centers for Disease Control and Prevention.

Gordon Giesbrecht, a retired professor of thermal physiology at the University of Manitoba in Canada, said factors affecting whether someone becomes hypothermic include the clothes being worn, body mass, whether or not they are wet, the length of time exposed to the weather, and age.

“Your temperature regulation isn’t as good when you’re older,” said Giesbrecht, whose main area of research was hypothermia. He also noted that older people are more likely to have heart disease, and that the cold puts more strain on that organ. People who drink alcohol are also at greater risk.

Hypothermia leads to a lower body temperature, which can affect the brain and make someone unable to think clearly or move well, according to the CDC. Warning signs include shivering, slurred speech, confusion and memory loss.

Some people who are without a home said in interviews that they worry about hypothermia.

Gregory Moore, who was lying under a sleeping bag on a sidewalk in downtown Atlanta on a recent afternoon, said he is diabetic and has arthritis and high blood pressure. “That’s what I’m going to get, hypothermia,” the 61-year-old said. “I’m worried about myself.”

Later that day, Moore said he was heading to a homeless shelter and planned to enter a program.

Gregory Moore, who had been sleeping on the street in downtown Atlanta, said he was going to a shelter to enter a program that helps people who are homeless.

Reed Williams

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Reed Williams

Joel Caudell, 36, said his house in Macon was condemned by code enforcement officials and that he has been homeless for about three years. He said he worries about hypothermia because he and his wife both have health problems.

“Thank goodness the city of Atlanta provides warming centers,” he said, “but you’ve got to be willing to get on the bus and go.”

Percell Carter, whose brother James died in 2021, said there’s a need for more shelters and more beds for people living outdoors.

“The main goal is to get them off the street when it’s cold outside,” said Carter, who agreed to tell his brother’s story in hopes that it will inspire others to help people experiencing homelessness.

“This story’s not just James’s story,” Percell Carter said. “It’s a lot of people’s stories who are still out there.”

Reporter Matt Kempner contributed to this article.