At least 18 homeless people died from hypothermia since Atlanta’s infamous homeless shelter known as Peachtree-Pine officially closed in August 2017, according to an internal city report.

Fourteen of those deaths occurred in the 2018 calendar year.

The number of fatalities is particularly striking when compared to data from the Fulton County Medical Examiner’s office, which shows the entire county had an annual average of 4.3 homeless deaths that “involved cold exposure” or hypothermia over the 10-year period from 2007-16.

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The Atlanta City Council has grown increasingly concerned about the problem and last month held a committee work session to discuss outreach and providing services to the chronically homeless population as winter weather takes hold.

The city's report doesn't specifically mention Peachtree-Pine, a massive brick building in south Midtown that for years was the center of tuberculosis outbreaks, bitter legal battles and a social debate about how to serve one of most challenging segments of the homeless population.

Peachtree-Pine was often referred to as a "low-barrier" shelter, meaning it accepted virtually anyone who needed a roof over their heads, including chronic alcoholics typically rejected by other shelters.

The Peachtree-Pine homeless shelter.

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“This is what we were worried about,” said Steven G. Hall, a Baker Donelson lawyer who helped represent the shelter in legal disputes. “We were worried that there would not be a backstop.”

The report, which was authored by city ombudsman Stephanie Ramage, examined two years of homeless hypothermia deaths in 2017 and 2018. Ramage found that 19 homeless people died from hypothermia during that period.

According to the report, alcohol was the most common denominator in the deaths.

In sixty five percent of the fatalities, autopsy reports indicate that alcohol intoxication or withdrawal from alcohol was a significant factor.

“Alcoholics are likely to choose drinking over surviving,” Ramage wrote. “If told they can’t drink in a shelter, alcoholics are likely to stay out of doors in the freezing cold where they can drink.”

City Council President Felicia Moore cast the lone vote against legislation that effectively closed Peachtree-Pine. She said the city didn’t have a sufficient plan to compensate for the loss of 800 beds on cold nights.

She also cited another possible contributing factor: In 2018, the city eliminated the municipal court's cash bond requirement for some low-level offenders who otherwise would sit in jail because they couldn't afford bail.

Moore supported the measure, but said it might have had fatal, unintended consequences.

“People don’t realize that our jail was a de facto homeless shelter,” Moore said.

Micheal Russ gets up after spending the night under the drive-thru of a West End bank Wednesday, November 27, 2019. STEVE SCHAEFER / SPECIAL TO THE AJC

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The report found the timing of outreach efforts and age of the victims were the other two most significant factors.

“Outreach to homeless individuals regarding the likelihood of freezing to death in November is crucial, as is a media campaign that informs the public how to spot someone who may be suffering the final stages of hypothermia and how to help them,” the report says.

Six of the 19 deaths occurred in November, but none took place in February.

A Bottoms’ spokesman said the mayor last year raised the activation temperature for winter warming shelters from 25 degrees to 32 degrees.

Atlanta’s average daily cold temperature in February is 35 degrees, while it is 41 in November. The report attributes the lack of February deaths to outreach efforts that increase awareness of the risks of freezing to death, and cause the homeless to seek shelter in greater numbers.

The average age of the 19 fatalities was 59, “which is reflective of a national trend toward an older homeless population, one that has been predicted to triple in the next decade as homeless Baby Boomers age,” the report says.

At the end of this month's work session, council members clashed with Cathryn Marchman, executive director of Partners for Home, the primary non-profit that works with the city to address homelessness.

Council member Antonio Brown, who has been homeless himself, said there needs to be more outreach to the chronically homeless and more facilities to provide services.

Marchman said “low barrier” shelters are almost non-existent in the city.

“Outreach on the night and on the weekend is only as good as a bed that we have to connect someone with,” Marchman said.

She added that the majority of people reached by advocates refuse to spend the night in an emergency shelter.

Brown disagreed, saying he has done outreach work and Marchman found beds for people he contacted her about. Brown also said he seldom encountered homeless people who turned down shelters.

“The reality is everyone I’ve touched has expressed interest in moving into an emergency shelter,” Brown said.