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The cost of a single gunshot

No one can put a price on a human life or a family’s suffering, but policy experts can calculate the price society pays

Susan Turner, her grandson A.J. Towers, 4, and Pastor William E. Dickerson, at Greater Love Tabernacle in Dorchester, on Aug. 2. Susan Turner, her grandson A.J. Towers, 4, and Pastor William E. Dickerson, at Greater Love Tabernacle in Dorchester, on Aug. 2. (David L. Ryan/Globe Staff)
By James H. Burnett III
Globe Staff / August 23, 2011

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On Aug. 2, two men were shot at a home on Hansborough Street in Dorchester. In late July, a man was shot and killed in Chelsea. And earlier that month, a woman was fatally shot in Rockland on the South Shore.

It’s been a violent summer, and not just in Boston. And it has come amid a growing push nationally to focus attention on one often ignored effect of violence: the cost to society of every new gunshot victim.

Public health experts say that the physical and psychiatric care a victim requires, the loss of income they suffer while out of work, the cost of a crime scene cleanup, and even the long-term impact a shooting can have on a neighborhood’s property values, while difficult to quantify precisely, all combine to have an impact potentially as broad as a virulent flu strain.

“It has always been the simple things that we don’t consider with these costs,’’ says Massachusetts Attorney General Martha Coakley, who has focused on victim services and compensation during her 5-year tenure. “Take cleanup costs of crime scenes, where someone has been shot. Once that investigation ends and the police have left the scene and the emergency workers are gone, the residents are often left with a mess on their hands. Costs can run into the thousands - changing locks, replacing windows or doors, hazardous cleanup of blood and bodily fluids.’’

And those are just the smaller bills.

Alan Sager, public health and policy professor at Boston University, says that’s in addition to at least $200 a day for physical therapy that can last for weeks, months, or even years. If a shooting victim goes twice a week for a year, that’s $20,000. The same figures apply for mental health care, Sager said, assuming a victim is willing to undergo psychiatric therapy.

The average victim of a serious gun injury suffers physical and mental aftereffects for 20 years or more, according to Sager. That means the treatment for a single bullet wound can approach or exceed $1 million over the remainder of a victim’s life, depending on his or her age.

But there’s more, according to Sager’s Health Reform Program at BU: the cost to homeowners near a shooting scene, when their property loses value; the cost to schools that lose funding from their districts when fearful residents flee the neighborhood encompassing a shooting scene.

Coakley, in trying to determine just how much crime costs her office, persuaded the Legislature to beef up funding for the division in her office that oversees crime-scene cleanup. Among the many values they calculated were $1,500 for the average cleanup, and $500 for lock replacement, door and window repair, and other security (many homes involved in shootings are often rental properties with no insurance).

According to the Centers for Disease Control and Prevention, all nonfatal shooting victims in the United States, who were not shot during a sexual assault or attempted sexual assault, lose an average of $61,290 in pay in the following two years.

“These are real problems that no one can deny have costs in the thousands and hundreds of thousands,’’ says Dr. Stephen Hargarten, director of emergency medicine at the Medical College of Wisconsin, in Milwaukee, and cofounder of its Firearm Injury Center, the nation’s first trauma research facility to approach injuries suffered during the commission of violent crimes as public health problems and therefore worthy of price tags.

“There was a mentality that it was only quantifiable if it was a service or something else we are accustomed to paying for,’’ Hargarten says. “But it was about the time that people began making a case for viewing gunshot injuries through a broader lens in the 1990s that it became acceptable to valuate life after a traumatic injury. We do it for insurance purposes. Why not for educational purposes? Our society has said for decades that everything has a price. If that’s so, then this type of before-and-after is expensive.’’

Sharelle Turner, 32, is learning just how expensive.

Turner admits now that it was strange of her to ask an emergency room doctor, “How much?’’ moments after the doctor had told her that her son A.J. Towers, 4, would survive and fully recover from being shot in the back.

On the evening of June 27, Turner and A.J. and several dozen more sets of children, parents, and grandparents gathered at Harambee Park in their Dorchester neighborhood for an informal nighttime playdate and block party. The gatherings have become common in the summer, neighbors say. They’re loud, but they’re friendly.

On this night, several young men who police say were probably gang members, approached the park as though looking for rivals. At 9:20 p.m., one of the young men opened fire into the crowd, then another did the same. The entire incident lasted less than 30 seconds. When the smoke cleared, several adults had suffered minor injuries, including a man shot in the foot. A.J. lay motionless and bleeding, with a bullet in his lower back.

For the better part of a week, he slept in something akin to an induced coma at Boston Medical Center. Finally on the evening of July 3, A.J. awoke, groggy and fussy. The next morning, one of the rotating physicians entered his room and shared the good news: The boy was going to pull through.

That’s when his mother asked how much it was going to cost her. Turner felt awkward, but experts such as Hargarten insist she shouldn’t have.

As recently as the mid-1990s, Hargarten’s argument that things like lost family recreational time, an enveloping air of heightened fear on a residential block, depression, and even spousal tensions, all have a net worth might have been rejected by skeptics who insisted that only tangible things had dollar values.

Hargarten’s theories are rooted in the blast of kinetic energy released when a gun is fired, equivalent to a flu patient sneezing so hard his entire neighborhood is “struck’’ and potentially infected.

Old-school approaches to criminal firearm injuries say that burst is felt only by the person struck by the bullet. But when he launched the Firearm Injury Center in 1999, Hargarten was adamant that a gun fired during a crime distributed that energy across a much broader area than a victim’s body.

“His neighbors’ homes, for example,’’ Hargarten says. “Their property values will drop, following a shooting. And what about the city government that spent a half million dollars refurbishing a playground, and now no one wants to frequent it, because they associate it with getting shot? Wasted money.’’

Rev. Eugene Rivers, executive director of the Ella J. Baker House in Dorchester, says he has seen at first hand the impact violence can have on a single home.

“I’m certainly no medical expert, but I think I can argue that I’m something of a social scientist, and I can tell you that I’ve seen a terrible joke related to this issue come true,’’ says Rivers. “I know a man who survived a shooting only to die not too much later of a heart attack. He was not an old man. He was not an unhealthy man. And he was not experiencing complications from his injury, which had been healed for some time. He died, his family tells me - and they say his doctors told them - from the weight of the crippling stress that comes into your life when you survive something like this. I have seen entire families deal with this in ways ‘normal’ families can’t fathom.’’

Rivers is a longtime advocate of federal gun crime laws that promise strict prison sentences for felonies committed with firearms. He says he has seen married couples divorce because the partner who was a shooting victim stopped talking and became emotionally mute.

“I call this sort of thing exposure to secondhand gunsmoke,’’ Hargarten says. “You measure these things by where they stand on our own social scales. A child’s laughter? His parents might say it’s worth a million dollars. But let’s look at the domino effect: He stops laughing now. He grows depressed. His depression prevents him from developing social skills as he grows. When - if - he finishes high school he may not have the emotional capacity to get through college or train for and land good work. Then where does he find himself: being cared for by aging parents, maybe on some form of public disability? Now you’ve added hundreds of thousands of dollars to the potential millions in medical and psychiatric care.’’

On a recent afternoon, A.J. Towers sat up in bed, propped by pillows, alternately fiddling with a remote control, apparently trying to will something better onto Cartoon Network than the Scooby-Doo movie that was playing, and fiddling with a pile of children’s books - an old, dog-eared copy of “Yertle the Turtle’’ on top, a thrift-store find, his mother says.

“I didn’t ask that question ’cause I was just thinking about money,’’ Turner says of why she asked the doctor, “How much?’’ “Everybody knows any kind of hospital treatment costs a lot. This kind, especially. My child was shot. That’s not cheap. But I guess at the time I was just thinking about his life too, like how much of his life is going to be affected by this.’’

So far, A.J. has been visited by clergy who have soothed and prayed with him at no charge to his family. In a matter of weeks, he’ll begin seeing a psychiatric therapist, Turner says, adding that insurance will cover those counseling sessions for a time, “but they still cost somebody!’’

But Turner isn’t worried about A.J.’s body or mind, beyond what would be expected of any doting mother, because “he’s been well taken care of. And I know they, the doctors, will continue to take care of him. But there’s the other stuff.’’

On one hand, Turner is defensive and describes her son as the same boy he’s always been. But then she describes the “other stuff,’’ which includes A.J.’s sudden shyness. He was bubbly to the point of being silly. He was a prankster, who loved sneaking up on people and yelling “Boo!’’ Now he takes no pleasure in loud noises, even funny ones.

When Turner took A.J. to a news conference on Aug. 2, to give the media a glimpse at his progress, the sight of the television cameras set the boy screaming.

A.J. loves television, Turner says. He did, anyway, even joking about being a TV or movie star some day. Later, Turner explained her son’s reaction to the cameras as a fear of black, mechanical looking devices that are aimed at people, things that might be guns.

Turner says A.J. always asked “why’’ about every possible element of life, from the weather, to the causes behind traffic jams, to her choice off the menu at their favorite restaurant.

“He’s quiet now. That’s not fair,’’ Turner says. “He has lost his personality. That’s valuable.’’

James H. Burnett III can be reached at james.burnett@globe.com and followed on Twitter:@jamesburnett.