February 20, 2003

The Board of County Commissioners of Brevard County, Florida, met in special session on February 20, 2003, at 9:07 a.m. in the Government Center Florida Room, Building C, 2725 Judge Fran Jamieson Way, Viera, Florida. Present were: Chairperson Jackie Colon, Commissioners Truman Scarborough, Ron Pritchard, Nancy Higgs, and Susan Carlson, Assistant County Manager Don Lusk, and Assistant County Attorney Shannon Wilson.

INTRODUCTION, RE: MENTAL HEALTH AND COMMUNITY SOLUTIONS

Chairperson Colon advised the subject of this morning’s workshop is the Commission on Mental Health and Community Solutions; and the Board is excited to be able to discuss this issue and see where the community is going to move forward. She advised a second workshop will be held at 1:00 p.m. on the Commission on Aging.

Housing and Human Services Director Gay Williams stated in August 2001, the mother of Robert Marshall Ferris II gave a moving account of her son’s life and unfortunate death in the jail. She stated Ms. Wimmer related that her son Rob was an exemplary child who excelled in school, graduated from Cornell University, and served in the U.S. Military; in Rob’s early 20’s he was diagnosed with chronic schizophrenia; but with the help of medication he was able to live a productive life. She stated in late 2000, Rob was taken off his medication because it was suspected to be bad for his heart; the new medication he was placed on was not effective or he chose not to take it because of its effects; and the result was decompensation with a three and a half week stay in Circles of Care. She stated again in May 2001, Rob began to decline, resulting in his mother’s seeking and receiving an ex parte Baker Act Order; however, Ms. Wimmer was informed without a break order from the judge, the Sheriff’s office would be unable to enter Rob’s apartment. She stated Ms. Wimmer’s initial request was denied, but was later granted with the help of NAMI advocate Freda Schildroth; before it could be executed, with Rob completely decompensated at this point, he was arrested at his residence by SWAT, was taken to the jail, and charged with 21 counts of assaulting the police and resisting arrest. She stated while in jail, Rob remained violent, refusing food, water, and medication; and two days later he died of asphyxiation by a two-inch piece of blanket found in his throat. She stated Rob’s story was the impetus for this meeting; and the Board’s interest in the mental health needs of its citizens has given opportunity to bring health care, law enforcement, mental health providers, and advocates for the mentally ill together to research and address specific areas where there are gaps in services and systemic changes need to occur.

OVERVIEW OF PLANNING PROCESS, RE: COMMISSION ON MENTAL HEALTH AND
COMMUNITY SOLUTIONS

Lead Planner for Housing and Human Services Ian Golden thanked the members of the Commission on Mental Health and Community Solutions, the technical advisors, and the citizens who have dedicated their time and energy to the process; and stated their enthusiasm and hard work have resulted in a set of recommendations. He stated it is estimated the number of those diagnosed with serious and persistent mental illness ranges from 7,200 to 14,400 in Brevard County; 13% of the jail’s inmates are diagnosed with mental illness and are housed in the forensic areas; and this has tremendous impacts on jail operations. He advised inmates with mental illness are up to six times more expensive to care for and their average length of incarceration is longer; a recent study found that 92% of the Sheriffs and 85% of jail administrators in Florida feel that local jails are ill equipped to provide appropriate mental health and substance abuse services; and 100% of public defenders and 94% of responding circuit and county judges, 89% of jail administrators, and 85% of sheriffs and police chiefs feel that access to mental health and substance abuse services avoids unnecessary hospitalization and incarceration. He stated this underscores the importance of these services as the key to decreasing the growing numbers of mentally ill in the criminal justice system. He advised Brevard’s juveniles are probably the most under-diagnosed in the population; one in ten under the age of 19 has a diagnosable mental illness; there are 763 emotionally handicapped and 226 seriously emotionally disturbed students in Brevard’s schools; and the 989 students in the program are serviced by eight social workers, which equates to one social worker for every 124 students. He stated of those involved with the Department of Juvenile Justice, it is estimated as many as 80% have some type of substance abuse problems; an average of 10% of juveniles on probation have a diagnosable mental illness; and one of every five deaths between the ages of 10 and 24 were as a result of suicide, over half of which were inflicted by gunshot. He stated suicide ranks third in the nation as a cause of death in this age group; it is the second leading cause of death in Brevard County, next to accidents; and it is estimated that a juvenile seriously contemplates or attempts suicide an average of eight times before being successful, which are eight opportunities to make a difference in a child’s life. He stated growing numbers of children are suffering needlessly because their developmental needs are not being met; and the absence of self worth and presence of depression leads them into substance abuse, delinquency, and other self-destructive behaviors. He stated Brevard’s elderly population faces its own silent crisis with an estimated 18,900 persons over the age of 65 suffering from mental illness. He stated the symptoms of Alzheimer’s, dementia, and substance abuse are often mistaken for mental illness, and cause individuals to be placed inappropriately in a mental health treatment facility for stabilization when they are medically ill and in need of medical evaluation and treatment, follow-up care, and case management. He stated this misdirection has a significant impact on individuals who wish to voluntarily admit themselves for treatment and find no beds available; often the greatest opportunities for success are when treatment is started as soon as the individual accepts that they need help; but these delays increase the chances for relapse and decompensation. He stated as the Mental Health Commission began to study the issues and scope of its task, it became obvious it was facing an enormous endeavor; and displayed a slide showing the diagnostic sampling of Circles of Care Inpatient Psychiatric Unit, showing approximately 42% of patients with depression, 7% with schizophrenia, 16% with substance-related disorders, 2% with disorders due to a general medical condition, 8% with psychotic disorders that could be a focus of clinical attention, and 25% other. He stated the Commission was created due to the tragic death of Mr. Robert Ferris and the testimony of his mother Trish Wimmer before the Board in August 2001. He stated the primary focus in the first four months became the jail, its capacity, facility, staffing, and services as a whole; and following the intensive exploration of the jail, the Commission began delving into the point of crisis and options for diversion and stabilization in lieu of incarceration. He stated the various subcommittees have produced a total of 32 recommendations; the subcommittees became a driving force in addressing the needs of health care facilities, law enforcement, transportation, mental health providers, and the entire system of care for mentally ill persons in crisis; and the recommendations were gathered and placed in four categories, legislative, appropriations, research and analysis, and support and endorsement. He stated during the prioritization process, the commission was asked to rank the recommendations in each category; and the top recommendation from each category with the exception of support and endorsement then became the ten priority recommendations that will be presented to the Board today.

PRESENTATION, RE: PRIORITY ISSUES

Pam Hasselbring, Special Projects Coordinator with Housing and Human Services, stated during the first meeting of the Commission on Mental Health and Community Solutions, there was consensus to initially focus on the issues of the Detention Facility, its capacity, staffing, and services; and the Facility and Capacity Subcommittee addressed two of these areas. She stated the Brevard County Detention Center was built in 1987; it was projected that the new facility would be able to house and program a number of classifications of inmates while observing all required separations for a number of years; the residential portion consists of four buildings or pods, conjoined; each pod is divided into six cellblocks and a recreation area, all of which surround a central control center; and each pod was to house 96 inmates for a total of 384. She advised the population numbers exceeded that capacity before the County took occupancy; as a result, the County sought and received authorization from the State to double-bunk the pods; and with the additional beds in the annex, the total jail beds are now 1,041. She stated the facility houses pre-trail and convicted inmates as well as those sentenced for up to one year; inmates are separated by age and gender; and those who are charged or convicted of severe crimes are separated from those with lesser charges. She stated the jail attends to inmates’ special needs including acute and chronic medical and mental health conditions; average daily inmate population in 2002 was 1,208; the number yesterday was 1,282; and there is currently a 1.52 average monthly growth in inmate populations or ten per month, which means the population could reach 1,400 by the end of September 2003. She stated the original projections did not reach this average until 2005; the highest population in 2002 was 1,433 on October 1, 2002; and the chart shows an accurate, if not underestimated, projection of inmate population growth. She stated throughout the 14 years the facility has been in existence, steps have been taken to provide the best housing and treatment to all special needs inmates using the resources at hand; however, with the steady increase in jail population and the subsequent growth of the number of inmates with special needs, the need for expansion is more important than ever before. She stated three priority recommendations and one secondary recommendation are being presented to the Board by the Facility and Capacity Subcommittee; and they are a short-term residential treatment facility (SRT), renovation of forensic pod 100, and renovation of all forensic cells to safety glass fronts and doors. She stated the SRT is the most glaring gap in the County’s treatment system; and it is the top priority recommended today. She stated an SRT is a 90-day intensive locked facility where individuals can receive continued treatment in a secure environment, surrounded by staff trained to intervene with the mentally ill, such as nursing staff, psychiatrists, social workers, case managers, etc.; an SRT would allow for diversion of Baker Act patients in lieu of jail and diversion of mentally-ill inmates; and it would provide the County with a local treatment option to stabilize the seriously mentally ill, eliminating the need for treatment at the State psychiatric hospitals. She stated as the Commission on Mental Health researched the issues related to diverting individuals out of jail, it became apparent that the successful diversion would require more community-based options for treatment; Brevard County has short-term crisis treatment and long-term residential beds; and the gap falls between the two options. She stated traditionally the costs associated with operations of an SRT are funded through legislative appropriations; it is estimated that construction costs would be $1.3 million with staffing costs of $1.4 million; and Circles of Care has offered to cover the cost of construction if funding for staffing is made available. She stated there are currently two cellblocks utilized to observe suicidal and extremely disturbed inmates; they are located on the first level of their respective cellblocks; in front of the cells on that level are enclosures with glazed fronts, known as bubbles; and they are modifications made to facilitate intermittent and remote observation. She stated the door to the cell behind each enclosure is kept locked, preventing the inmate access to the toilet unless he or she requests to use it; and when their request is made, one or two officers, depending on the inmate’s risk level, enters the enclosure and opens the door to the cell, waiting to bring the inmate back into the enclosure, locking the cell door behind them. She stated officers report they frequently have trouble getting the inmate to come back into the enclosures and that inmates continuously call to use the toilet, reducing the time the officers can be available for other essential duties in the pods; so even though the bubble area is equipped to allow better visibility of the inmates, they are staff intensive and promote behavior problems. She stated in terms of a long-term solution to the higher visibility and safety of these inmates and the officers assigned to them, the original cell could be modified to include a glazed front so that observation would be effortless and staff would not have to lock and unlock the cell for bathroom use; sufficient glazing could be mounted in front of the cell to allow clear visibility and a semblance of privacy without demolishing the entire front and compromising the structure; and this would warrant further research, but could be a practical and efficient solution. She stated the construction of three new forensic bubble areas in pod 100 would enable jail officials to better segregate female inmates of different classifications in one area; this is an immediate fix; but a more preferred option would be the renovation of the original cells. She stated the most cost efficient long-term solution would be the construction of two additional pods, specifically designated for forensic patients; the proposed construction would take into account the projected inmate growth over the next decade; and expert architects and programmers in jail design would best determine the configuration of its space, staffing, and programs. She stated the reality is such an expansion would only be possible by tax referendum, although the need for expansion is real and inevitable. She introduced Chief Paul Rumbley of the Palm Bay Policy Department, who has 22 years of experience with the Orlando Police Department from 1970 to 1992, was chief of Police and City Manager for the City of Lake Wales from 1992 to 1994, and has served as Chief of Police for Palm Bay from 1994 to present. She stated he is First Vice President of the Florida Police Chiefs Association, Chairman of Covenant Christian School, and Chair of the Commissions on Mental Health and Community Solutions, as well as chairing the Services and Staffing Subcommittee and the Point of Crisis Task Force.

Chief Paul Rumbley stated this was a huge undertaking; and it was clear that they not only needed to look at the detention facility but the staffing side of the house as well. He stated they formed a task force, listened to testimony by experts who deal with staffing issues in the forensic and corrections areas, and came to the Board in February 2002; the Board agreed to enhance the current forensic program at the jail; and the Board included two additional screeners and two half-days of psychiatric coverage. He stated the previous staffing was not adequate to give the proper attention to those afflicted with severe mental disorder; and presented a bar graph showing that since services were enhanced more people with mental illness are being screened more effectively and being diverted properly. He stated what the Board has done is an indication of something that works without having to spend a lot of money. He stated the second aspect is the staffing analysis; that would be the corrections officers that staff the facility, which was a large undertaking; and the staffing analysis is currently being addressed by a consulting organization. He stated the report and recommendations will be forthcoming to the Mental Health and Community Solutions Commission and the Board. He introduced Dr. Mary Beth Kenkel, Dean and Professor of the School of Psychology at FIT; stated she has been a clinical community psychologist for over twenty years; before coming to FIT in July 2001, she was Chancellor of the Fresno campus of the California School of Professional Psychology and then Dean for the University School of Social and Policy Studies; and Dr. Kenkel has served as the Chair of the Prevention and Aftercare Subcommittee.

Dr. Mary Beth Kenkel stated the Task Force looked at the area of prevention; the whole commission focused on preventing tragedies such as happened to Mr. Ferris in the jail; but the subcommittee wanted to look at some of the more specific prevention strategies. She stated they started looking at three different age groups, youth, adults, and the elderly; and they also looked at three different levels of prevention. She stated primary prevention tries to address mental health problems before they occur, usually through mental health education and skills training, often directed toward youth and the general population. She stated secondary prevention tries to find out who is at risk for mental health problems and get them into treatment early; and a lot of the recommendations will focus on the secondary prevention area. She stated they concentrated on tertiary prevention even more; some very serious mental health problems have a genetic component and psycho-social strategies will not prevent their occurrence; but there is a lot that can be done to minimize the impact of mental health problems, to prevent the worsening of psychiatric problems, and to prevent re-hospitalization; so some of their recommendations deal with tertiary prevention. She stated the Task Force had two major recommendations; one was a drop-in center for mental health consumers; and the second was an increase in substance abuse or Marchman Act beds. She stated the drop-in center is a place for mental health consumers, run by consumers, and that is an important philosophical idea; it is a place where mental health consumers can have some refuge and get some support; and safety is a big issue. She stated the mentally ill, particularly those on the streets, are often victimized; the center would provide a safe haven for them; and it would allow them to have an opportunity to get a couple of meals a day, do their laundry, access things through the computer, get some job training, and socialize with others. Dr. Kenkel stated the critical aspect of this is that it is run by the consumers themselves with support from the County in getting started; it is based on the recovery notion of mental illness; the self-help notion gives the mentally-ill patient a feeling of empowerment and self esteem; so this is a very important recommendation. She stated the second issue is Marchman Act beds; currently Circles of Care has 20 adult detox beds; last year over 1,800 adult patients were admitted; they may have been referred by the courts, probation, parole, or emergency personnel; and on any given day another 10 to 15 people wanted treatment, but were unable to get in. She stated substance abuse is one of the most significant problems in society; it is highly associated with criminal activity; and it often co-occurs with mental health problems; but there are not enough beds for people who want to seek treatment. She stated when a person is identified with a primary substance abuse problem, and there are no Marchman Act beds available, they are Baker acted, which uses up the previous few Baker Act beds, so there is a problem there. She stated Circles of Care has three juvenile addiction receiving beds, with the third being a recent addition due to discussions within the Task Force; and advised of the impact of the third bed in reducing the number of juveniles who had to be transported out of the County for treatment. She noted with the extra bed and the solutions devised by the Task Force, there have been no transports of juveniles out of the County in the past four months; and that is a real achievement. She stated the two major recommendations are the drop-in incentive and the Marchman Act beds; the estimated cost of each new bed is approximately $70,000 a year; and there are 15 secondary recommendations. She stated they recommend the adoption of a medical security program similar to the one in Seminole County that uses a database on the mentally ill who voluntarily offer to join the program to reduce the risk to law enforcement personnel and to the mentally ill associated with on-scene interventions; and recommended changing the rule that defines an institute for mental disease so that residential centers for the mentally ill will have more than the current limit of 16 beds, and still have the residents retain their Medicaid funding. She stated they strongly recommend a State parity law such that health insurers would be required to provide coverage for mental illness at the same levels as physical illness; and this would increase the access to mental health treatment and shift some of the cost now incurred by government to private insurers. She stated the current Florida Assertive Community Treatment (FACT) team of twelve providers will provide very intensive case management for the most seriously mentally ill within the County; they have a capacity of 100 clients; and currently they are at 60 clients. She stated based upon both current and future need, another FACT team is needed; access to mental health counseling when problems first appear is an effective prevention measure; the funds are available for that through temporary assistance for the needy families program; however, the application for funds is cumbersome and takes a long time; and they recommend streamlining the application process so clients can get treatment when they first need it. She stated care of the mentally ill puts a strain on the entire family; and recommended respite care, which provides a short-term treatment to the mentally ill so the families can get some relief from the daily strains of providing care. She stated they estimate 16,000 Floridians with serious and persistent mental illness need the newer psychotropic drugs but are not eligible for Medicaid; the State’s psychiatric drug program is funded below need; and they need to find the means to have better access to these drugs. She stated the commission also supports the juvenile assessment center concept, which is very much within the secondary prevention idea; it immediately identifies those youth that need treatment and refers them; so the commission likes that idea. She stated they heard from many officials working in the schools that there are two groups of children they are dealing with, the serious and emotionally disturbed (SED) and the emotionally handicapped (EH); and those children are not graduating at the same rate as others within the school. He stated the graduation rate is dropping; in 1999, 87% of the SED and EH schools graduated with a standard diploma; in 2001 that was only 64%; so that is a very big decrease. She stated they also found out even though the SED children get counseling and treatment, there are no resources to pay for that type of service for the emotionally handicapped children; so they see programs of counseling and mentoring for these children in the schools. She stated in prevention for youth, there is a need to build strong families; and the Together in Partnership Family Management Program currently in operation is a good program, but needs to be expanded in terms of its reach. She stated another primary prevention effort is mental health education; the Sunshine State Standards mandate instruction in mental and emotional health; and they would like to see a program in all schools on mental health education. She stated drug abuse by all ages is a problem in the County; they were particularly concerned about the youth; and they support continuation of the drug court. She stated the Board will also be hearing about mental health court, which is a very effective means; and they need to find ways to increase the access to drug treatment and the funding of it. She stated they would like to determine the feasibility of implementing a call program to contact mentally-ill individuals similar to the Sunshine Call Program that is now in place for the elderly; that is a way to check in to see how people are doing; and if there seems to be a problem, it is a way of getting them the needed treatment right away instead of waiting for a crisis to happen. She stated they looked at some of the concerns with the elderly population; law enforcement sometimes gets involved with elderly patients with Alzheimer’s or dementia when there is a domestic disturbance at the home; the response of law enforcement in that situation can either escalate or deescalate it; so one of the things they are proposing is the training of law enforcement in the identification of problems of the elderly associated with Alzheimer’s or dementia and strategies they can use. She stated some caregivers of elderly individuals with dementia or Alzheimer’s need a break; it can be either a family member or nursing home staff; and they may Baker Act the individuals because they do not know what to do with them. She stated they may be sent to mental health receiving facilities that are not well equipped to deal with the medical problems some elderly may have; and suggested looking into a facility, such as a special wing in a nursing home to accommodate these individuals who are beginning to show mental health problems. She stated there are a wide array of recommendations; many will help prevent the incidence of new mental problems by quickly identifying those at risk and getting them treatment; and others will help reduce the negative impact of mental illness on the individuals, their caregivers, and the community at large.

Ms. Hasselbring stated the Central Intake Task Force reviewed processes and procedures in the booking area of the detention center to identify potential improvements to the current system of intake; and they looked at the screening tools utilized to identify potential mental health diagnosis, which result in an individual being referred to the forensic cellblock or a suicide risk area to be monitored. She stated they also reviewed standard operating procedures of intake screeners, the use of restraints and de-escalation techniques used for more combative inmates; their priority recommendation dealt with the forced use of psychotropic medication; and the basis of the recommendation is the protection of the individual from harm from themselves or a correction officer, and potentially further decompensation due to stress of medication withdrawal. She stated the administrative correction personnel at the jail favor forced medication; the criteria for administering such medication would be a coordinated effort of the mental health and medical physicians; a standard operating procedure would need to direct the protocol and administration of the psychotropic medication; and the policy and procedure for the forced use would be based on the currently applicable regulations, Statutes, and standards to protect the individual’s rights in its implementation. She stated a secondary recommendation dealt with the need to hire and train additional corrections officers at the jail; during 2002 there were 77 inmate-on-officer fights with 41 officer injuries; there were 20 attempted suicides, 4 suicides, and two attempted escapes; and there were 213 inmate-on-inmate fights with 216 inmate injuries and 1,318 disciplinary confinements for infraction of rules. She stated the secondary recommendation is to encourage the efforts of the Sheriff’s Office to hire and train additional corrections officers and require such training to include crisis intervention team training (CIT) with the goal of at least one CIT-trained officer being available per shift. She stated since the jail opened in 1987 the inmate population has increased by 90%; in that same period the number of security officers has grown by only 6%; with incremental growth in population comes incremental growth in security responsibility; and the more inmates and officer workload, the more risk of mistakes, escapes, assaults, injuries, attempted suicides, and deaths.

Chief Rumbley introduced Major John Blackledge; stated he is a Patrol Commander with over 20 years of police experience; and he became the key liaison person for the Point of Crisis Task Force. He stated Major Blackledge will explain the issues surrounding point of crisis; the reality is the law enforcement community does engage those with severe mental disorders, which they are calling point of crisis; and Major Blackledge will explain alternative options for police officers and Sheriff’s deputies. He stated they will also address the Baker Act, emergency rooms, and medical care.

Major John Blackledge advised of his background in the City of Palm Bay, role as a teacher at the Police Academy, and work with officers in the field who are experiencing the types of things he will describe. He stated he will illustrate the types of things they encounter that lead to point of crisis; and advised the revolving door for law enforcement is not so much the criminal justice system but incidents with the mentally ill. He advised of a squad of officers that interact with Riverdale School, which is exclusively working with emotionally-disturbed children. He stated on regular occasions, they get repetitive calls requiring them to go to the same residence where a family is having trouble interacting with a family member; yesterday he commanded a SWAT call that ended up being a suicide case; and that is part of the frustration law enforcement experiences. He stated the law enforcement community is interested in a team full-service approach; and they need it badly. He stated an incident may come to the attention of law enforcement through a 911 call from a family member indicating there is a serious crisis going on with potential for loss of life or some other problem; it may be a call on a non-emergency basis where a family member calls in and indicates they are having trouble and need help; and the reality is at 3:00 a.m., there is nobody else with the authority under the law and the ability to manage this other than firefighters, who in terms of authority lack some ability to make action occur. He stated often there will be an onsite notification flagged by a citizen indicating something is a little odd, such a man lying in the roadway or someone in a spot where there is a problem that the police need to take care of; and it could be an alcoholic problem or a mental illness problem. He stated in many cases there are calls from residents who have not seen their neighbor in some time; and they conduct well-being checks. He stated the Sheriff’s Office Civil unit goes out with a small number of deputies and tries to deal with requests where families have gone before the court indicating their family member needs treatment; there may not be an absolute crisis at the moment; but they convince the court that the family member needs treatment under the Marchman Act, Baker Act, or some type of commitment. He stated law enforcement is engaged to knock on the door and ask the person to come out; and one of those situations resulted in gunfire, which becomes a greater issue. He commented on community policing; and stated one of their major focuses is interactions, disturbances, and conflicts between neighbors; and in many cases there is not a crime problem, but a mental illness problem. He stated field contact is how they become engaged with people; they either discover or are told there is a mental illness crisis; and there are three or four results of those interactions. He stated the first is to refer the person to secondary services, such as a homeless shelter or some other process; the next option is to do a courtesy transport to take them home, if they are not mentally ill, but have had to much too drink; however, in many cases the only option is to place them in holding cells. He stated the question is whether the individual is mentally ill or should be arrested; the officer on the street becomes frustrated with some of the processes; and sometimes through ignorance, laziness, or being hamstrung by the law, no action is taken. He stated the officer who encounters the person and makes a decision is required by law to ask the person if they want help, and whether they will voluntarily go; the purpose of the Baker Act was so that government does not detain a person against his or her will unless there is a very strong basis, much like probable cause for an arrest; and there are criteria for Baker and March Acts. He stated the first thing the law tries to do is see if the person will go on their own with help through family in some cases, using ambulance transport or transport in the back of a police car; and there is concern that at times that becomes an issue because the person has nothing other than mental illness, yet has to be transported in a law enforcement vehicle. He stated the first option is voluntary admission, trying to get them to services on his or her own; and in some cases, if those persons have created a criminal offense such as threatening neighbors with a firearm and things like that, and part of the root cause is mental illness, the appropriate response by the officer is to make an arrest, then to Baker Act them, for which they will be transported to the jail, where they will receive the appropriate treatment through the jail process. He stated in some cases because of lack of recognition, ignorance, need for more education, laziness, or inability to act under the law, those persons are arrested because they have committed a crime, but they do not get detained under the Baker Act and the flags do not go up. He stated they may go to jail, get processed, and be out of jail on bond or be released in the morning, and they do not receive the required treatment. He stated the next option is the Marchman Act; the officer may believe the person is on drugs, has an alcohol problem or is using inhalants; and that person is processed through the Marchman Act. He stated they can take the person to family members or friends if they can manage the individual; they can lock him in a holding cell to detox, either at the County jail or a local department’s holding facility; and the other and best option is treatment with resolution in a treatment program. He stated there are frustrations because of lack of services and facilities; and commented on Baker Act and transport. He stated the next option would be available onsite services, such as CIT-trained officers, mobile assessment, and involvement of the FACT team; and the last one is the potential for a tactical response due to the critical nature and safety issues involved, not only to the officers, but to the community. Major Blackledge stated what happens at the point of crisis is they move them into some system; on one part of the County, there is the Wuesthoff receiving facility where they are licensed to do mental illness treatment; and the other is Circles of Care. He stated in other cases they go to health care that is a non-receiving facility; one example would be a person who overdosed on drugs; they would need medical treatment before being brought to the mental illness arena; and they would have ambulance transport to the emergency room, where they would be treated, cleared, and processed onward. He stated Coastal Health Systems is the transport for Baker and Marchman Act in the County; but what is not reflected in the numbers is the number of Baker Act individuals who are transported by officers. He stated for officers in South Brevard, it is often easier to transport rather than wait for Coastal; and that was a concern to all members of the subcommittee who were members of law enforcement, Coastal, and fire service. He stated the first recommendation is for Baker Act reform; and advised of the tool provided for in Chapter 901 that allows an officer to stop, detain, and figure out what is happening; and then once that has been done, the officer has the opportunity to develop probable cause to decide if the person needs to be arrested or not. He noted Baker Act does not provide that option; it is an all or nothing situation; and reform to the Baker Act is needed to allow law enforcement officers some increased discretion and the opportunity to do a temporary detention to do on-scene investigation to determine what is happening. He stated if the individual does not say one of the magic words, I want to hurt myself, kill myself, or kill someone else, there is a problem. He stated they need to provide for civil liability protection and immunity from prosecution when an officer has done the best job he or she can in good faith, but has not been able to come to a resolution; and there are a lot of times they walk away, with the feeling something is wrong, but the criteria was just not there. He advised of one of his officers and an incident where the law did not allow him to take the individual into custody, but later the individual killed his mother and shot at his stepfather. He stated law enforcement officers are caring human beings; and it comes with great angst that the officers have to walk away unless there is some change in the law to make things happen. He stated the application of the Baker Act in Brevard County, primarily due to the increase in population and the needs of the consumers, has become a difficult process to navigate through; there were over 3,000 Baker Acts in the County in 2000 alone; and if officers are not allowed to assess previous history and look at the total picture, then many times, they will be required to walk away. He stated right now as long as the individual says the magic words, they can have that individual placed so that they are assessed, although not beyond the 72-hour limit. He stated the causes for the demand for mental health treatment can be traced to the population growth and more public awareness; people are realizing that more needs to be done; there are an increasing number of individuals admitted who are elderly; officers need to be better trained to recognize things like Azheimer’s, as Baker Act is not the answer to a person with Alzheimer’s; but at the same time a place is needed for those people to go. He stated the Florida Sheriff’s Association along with the Chiefs of Police in the State are seeking to improve not only officer safety and a better quality of life for the public, but importantly, protection and care for the people who suffer from severe mental illness by making reforms to the Baker Act, including a need for a treatment standard that is better than what is existing today and assisting in outpatient treatment. He advised the subcommittee recommends there be some provision for State-funded Statewide assistance to facilitate the changes in the Baker Act Law.

Ms. Hasselbring stated during the meetings of the Point of Crisis Task Force, it became apparent that there was a need to form an alignment to research the impact of the Baker Act and Marchman Act on the County’s emergency departments; a first step was to bring prospective partners to the table to define the problem and establish a core group of stakeholders to implement recommendations; and a Task Force was formed to include all of the County’s hospital emergency and security directors, Coastal Health Systems, law enforcement, mental health inpatient receiving facilities, and Public Safety. She stated the collaborative effort of these individuals to address the issue, which had the potential for disagreement or criticism, was commendable; they were passionate about the need to be comprehensive and address the full range of concerns presented by an individual with mental illness; and some members are present today. She stated Major Blackledge was instrumental in providing the law enforcement perspective and helped facilitate the coordinated effort.

Major Blackledge stated law enforcement has to be the jack of all trades, but can be master of none; they go to calls never knowing if they will have to be a lawyer, paramedic, family counselor, child psychologist, social services worker, martial artist, pastor/preacher/rabbi, or terrorist experts; and they also have to fix cars on the side of the road. He stated they cannot be the specialist who handles everything; so once they receive persons, they need to move them along to the ones who can address the needs they have; and that means the addition of more Baker Act beds. He stated a common frustration is to end up with a person in the back of the patrol car going from place to place to find some place to take the person; Circles of Care and Wuesthoff Behavioral Health are the two Baker Act receiving facilities in the County; Circles of Care has 28 Baker Act beds and 24 private beds; it can admit 10% over the bed capacity or a total of 57; and this past calendar year, it had 60 to 70 at any one time. He stated Wuesthoff has a 16-bed receiving facility; this past year, it averaged 16 patients per day, going from 2,920 to 4,330 patient days. He stated a factor in bed availability is the receiving center’s ability to release a Baker Act patient without psychological or psychiatric evaluation and signature; and that involves more staff and more process. He stated the number of beds has not changed in 20 years; there is a backup in the system; and often law enforcement is on the first step of that backup. He stated it is not unusual for patrol officers to get called to the emergency room at Palm Bay Community Hospital; and they end up having to stand by and help because the staff is trying to take care of people with medical issues. He stated the second recommendation is a proposed receiving facility; the purpose would be to provide a location where law enforcement, Coastal Health Services, and others, including family members can pull someone in and process that person where there is not a medical problem; and that idea needs further study. He stated it would reduce law enforcement time spent in non-criminal activity and would significantly reduce the number of Baker and Marchman Acts being held in the hospital; it would prevent law enforcement from being recalled for an individual who did not meet the old Baker criteria; and again Baker Act reform is needed. He stated the key focus function is to serve as a triage, medical, and mental health central distribution facility, similar to what the County has with the Juvenile Assessment Center. He stated this is less of a criminal justice problem, and more a medical health care problem that involves mental illness; outlined what happens when someone has a heart attack in terms of response; and advised law enforcement does not transport those people in the back of their patrol cars to a hospital emergency room, but it does do that with mental illness. He stated sometimes it is necessary because of the physical aspect of what happens to someone in mental health crisis; but there are better alternatives and certainly people who are better trained. He stated they would infuse a proposed central receiving center where they would pull out this subject from the criminal justice process and put it where it would be more appropriately placed and assess where they should be placed in longer-term care.

Chief Rumbley stated that is a clear explanation of the point of crisis issue; but now they want to transition into a program that has created much excitement for the commission and the County; and it comes from hard work and initiative and some visits to Broward County. He introduced Judge Cathleen Clarke, Chairperson of the commission, who will address the issue of the mental health court; and advised of her educational background and experience as a judge.

COMMISSION ON MENTAL HEALTH AND COMMUNITY SOLUTIONS SUCCESSES

Judge Cathleen Clarke expressed appreciation to all the individuals who were part of the issue of mental health court; stated on December 16, 2002, Chief Judge Bruce Jacobus signed Administrative Order 236B creating the Mental Health Court of Brevard County; and it is based on a model in Broward County as well as other models throughout the State. She stated on January 6, 2003, the Mental Health Court began, keeping in mind the unique characteristics of the County and recognizing its limited resources; and the goal is to identify non-violent defendants in the jail with a current diagnosis of schizophrenia, bipolar disorder, recurrent major depressive disorder, post traumatic stress disorder, other psychotic disorders of unspecified nature, or developmental disability; the goals insure that the mentally-ill defendant in the County jail will receive proper treatment and not remain in the jail for extended periods of time because of the mental illness; and the first step is identification. She stated individuals are to be identified at the jail at booking following the arrest; they are screened by the forensics at the jail with the assistance of Florida Tech Psychology Department; and once identified as a possible candidate for Mental Health Court, the individual is referred to the State Attorney’s office so that the prosecutors can further screen the individual by doing a background check of any prior criminal history or any pending criminal cases to see if the person meets the criteria. She stated if the individual is presently on probation, the Mental Health Court judge will obtain the consent of the judge who placed the individual on probation before his or her case can be transferred to Mental Health Court. She noted under the present Administrative Order, defendants charged with felonies, driving under the influence, sexual offenses, and certain domestic violence cases do not meet the criteria for admission; and referrals to the Mental Health Court may be made by any judge, the forensic program at the jail, by Florida Tech Psychology Department, the State Attorney’s office, the defense attorneys, law enforcement, mental health providers, or any interested person. She stated the defendant must be screened at the jail; the State must be given an opportunity to research the background and all pending charges; and if the State consents to the individual’s participation in the Mental Health Court, the prosecution of the charges will be deferred and ultimately will be dropped upon successful completion of treatment or if the individual is on probation, the violation of probation charges will be dismissed by the court. She stated if the individual agrees to participate in treatment, the person will be released from the jail; the individual waives his right to a speedy trial to participate in Mental Health Court, and signs a release for medical and psychological information; it is a voluntary program; and the defendant does have a right to an attorney. She advised after the individual has been identified, screened, and agrees to participate, he or she is brought before the Mental Health Court judge; there are reviews at 8:30 a.m. Monday through Friday; at the review hearing the judge will inquire as to the voluntary nature and willingness to participate in treatment; and then the defendant will meet with a case manager who will provide assistance in obtaining proper treatment, housing, and other services. She stated the individual is released conditioned on agreeing to participate in the program and receive treatment; the Mental Health Court case manager is responsible for monitoring compliance with medication and any other court orders; presently the manager is under the supervision of Circles of Care; and every week there is time set aside for status hearings. She stated the frequency of an individual’s status hearing will depend on the person’s specific needs; some may require a status hearing every week and some every month; but the system is set up so that as soon as individuals are identified, they can be brought before the court to see if they are going to participate. She stated the rapidly increasing number of misdemeanor cases involving mentally-ill or developmentally-disabled defendants has contributed to a congested and overburdened court docket and jail overcrowding; under the old system, there was a revolving door for those who were arrested for non-violent offenses involving psychiatric acting out, such as trespass charges; and advised of an individual who came before her on trespass charges because he had allegedly gone to homes and watched television although he had been warned not to go there. She stated there are a lot of individuals who do not have proper housing or funds, who have mental illness issues; they will go back to a convenience store where they have been warned not to go; and their only charge will be trespassing. She stated particularly in cold weather, there is a lot of that because individuals realize they will have a place to live and food to eat; so a lot of people come in with mental illness issues on trespass charges. She stated individuals come in on simple things like Ordinance violations; they start acting out; this can escalate into disorderly conduct, assault on a law enforcement officer, or resisting arrest; these individuals are placed in the jail; and with no money to bond out, they can be there for a long period of time. She stated if they are released for time served, they are often released without having any type of treatment; and then there is a revolving door. She stated the new strategy and aim of the Mental Health Court is to isolate and focus upon individuals arrested for misdemeanor offenses who are mentally ill or developmentally disabled to recognize the need for appropriate treatment and insure they get treatment while protecting the public. She stated with more intervention these misdemeanants can receive the proper treatment.

Chief Rumbley stated in the law enforcement community, the minor misdemeanor charges are tremendous in number; he experienced this in Orlando as a young police officer with lots of homeless and mentally-ill persons on the streets; and it is indeed a revolving door, so there is great hope in the Mental Health Court. He stated Mental Health Court is potentially diverting people from the jails; the congestion and backup exacerbates the issue of proper management; and advised of Judge Clarke’s passion for this issue and acceptance of additional responsibility. He stated one of their successes has to do with housing for the mentally ill; funding has been appropriated for addition of 28 units in the County that will be designated specifically for housing the mentally ill; and that is in the process now. He stated another success is the improved screening intake form at the jail; better screening removes subjectivity; and it is more of an objective analysis and evaluation of those coming in with mental disorder to the jail to insure they get proper medication and are diverted into the right programs for them. He stated another success is crisis intervention team training; and advised of the participation of the Palm Bay Police Department in implementing a crisis intervention team based on the Memphis model to bridge the gap between law enforcement and mental health and health services systems. He stated by January 2004 there will be 18 trained officers with the Palm Bay Police Department; and recommended resolving to have the entire County do that so there will be a systematic approach. He stated crisis intervention training is critical; the Board has already approved an enhanced level of forensic services; but the commission is asking the Board to continue this as a line item budget as the Board has seen the improvements through the enhancements that have been funded already. He stated they recommend mandatory officer training in managing encounters with the mentally-ill; the Chairman of the Police Standards and Training Commission has written advising all recruits in the State who are trained to be police officers will be receiving 14 hours divided into two modules on mental illness recognition and how to deal with the mentally ill and elderly population. He stated that should begin by the summer as a mandatory component of training recruits; the Florida Police Chiefs and Sheriffs have talked about training for those in service; and trust fund dollars will be used to fund that specialized training. He stated the next issue is break orders; at the beginning of the workshop Ms. Williams talked about the tragedy that occurred in the jail and that there was an ex parte order to pick up Mr. Ferris but without a break order, the civil processors could not go in, even though they knew he was decompensating; and the commission approached Sheriff Williams to talk about the problem. He stated the Sheriff researched the issue and changed the procedure and policy relative to the Baker Act, so now civil process servers who have an ex parte order can go to a home, and if the person is clearly decompensating based on what they know, what they see, and the testimony of family members, they can go in and take the individual into custody and protective care and transport the person to a receiving facility. He stated that is a small thing, but it is awesome; and it will impact what they are trying to do by not having to go back to a judge to get a break order because time is everything in the lives of the mentally ill who are decompensating moment to moment. He stated Coastal has been transporting juveniles to Orlando under ex parte orders, sometimes getting there and finding out the bed is already full; but Circles of Care added a bed in the County; and in the last four months there have been zero transports of juveniles to Orlando. He stated they applaud the collaborative effort to make that a reality; and there have been a lot of successes, but those are the key ones.

DISCUSSION, RE: RECOMMENDATIONS AND NEXT STEPS

Chief Rumbley stated the first recommendation is to implement and complete construction of additional forensic areas in pod 100 creating a pod dedicated to female inmates; and the Board may see that in this year’s budget. J. B. Kenna advised it is a March 4, 2003 Agenda item coming out of Planning and Zoning that talks about usage of correctional impact fees to fund the project. Chief Rumbley stated the second recommendation is research the refurbishment of the forensic areas to have doors replaced with safety glass; Ms. Hasselbring spoke about that; and the idea is to have the bubble areas designed to maximize staff efficiency and protection. He stated the third recommendation is to continue funding the enhanced level of services within the forensic program at the jail; and that is approximately $126,880. He stated the other recommendation is to authorize staff to research and study the concept of the central receiving center for misdemeanor and non-offending Baker Act and Marchman Act patients; that is what Major Blackledge was talking about; and that would be a place where officers and family members could take individuals to be processed, similar to the Juvenile Assessment Center. He stated the next recommendation is for the Brevard County Jail Oversight Committee to explore and develop a policy/procedure for the forced use of psychotropic medication. He stated the next recommendation is to support the concept of the drop-in center, which Dr. Kenkel talked about, where consumers assist consumers through the engendering of a supportive environment that is conveniently located to assisted living facilities, transportation, etc. Chief Rumbley stated the commission is suggesting a few next steps for the Board to consider; the first is to recommend the Board continue the Commission on Mental Health and Community Solutions in order to implement recommendations and identify recommendations regarding prevention and aftercare. He stated it was a lot of hard work, but it is so needed; and the commission wants to stay the course as there is more to do. He stated the members of the Commission on Mental Health and Community Solutions are honored to have served the Board and the community, to deal with this challenge; and commented on the meetings of the commission. He stated he has been a policeman for over 30 years, and to see all the players come to the table with a common purpose is an awesome experience; this is a major issue that takes a collaborative effort; and much has been accomplished through that collaborative effort and common vision to improve the system of care for the mentally ill. He stated they remain focused and committed to the mission that the Board gave them; the recommendations, initiatives, and successes will make a new beginning for improving and creating a system of management and care for the severely mentally ill and those afflicted by substance abuse; and the proposed initiatives will prevent future tragedies such as what occurred on July 1, 2001 with Mr. Ferris.

Chairperson Colon stated the Board would like to give an opportunity to the mother of Rob Ferris; and expressed appreciation to Judge Clarke and the Commission Mental Health and Community Solutions. She stated she has known Chief Rumbley for eight years; this is not part of his job description; and she is thankful that law enforcement has been able to embrace this issue because it is critical for the community. She stated when they went to Broward County to witness the mental health court and the jail, it was incredible; all of these people are helping to make it possible; and she is proud of what they have accomplished in such a short time.

Trish Wimmer, mother of Rob Ferris, stated she appeared before the Board in August 2001 to relate the story of her son’s death in jail; the Board’s responsiveness to her plea to fix the
system has been stunning; the creation of the Commission on Mental Health and Community Solutions was a stroke of genius; and members of the CMHCS are to be congratulated for their dedication and professionalism. She stated there have been many positive changes made; but there is much yet to do, especially Countywide crisis intervention training. She stated people in jail are innocent until proven guilty; many mentally-ill people are there because there is no place else for them to go; and they should receive treatment in jail for the mental health and substance abuse problems and be treated humanely. She stated there is a need for expansion of the jail because of overcrowding; and expressed appreciation for what has been done. She stated she hopes the Board will determine that the CMHCS should be continued.

The meeting recessed at 10:38 a.m. and reconvened at 10:55 a.m.

Chairperson Colon stated the Board is going to be discussing some of the recommendations and the next steps it may take.

Mr. Golden stated they broke down the recommendations by category; and the first page deals with legislative recommendations from the Commission on Mental Health and Community Solutions. He stated the first recommendation is to fund and staff a 16-bed short-term residential treatment facility according to State model costs; and they are not asking for any Board action as the Board approved this in November 2002 as part of the legislative package, which has gone to the delegation. He stated the impact, if it passes, would be funding for the operational piece of the SRT.

Commissioner Carlson inquired which legislator has that; with Mr. Golden responding he believes it was given to Representative Needelman. Assistant County Manager Don Lusk advised Representative Needelman and Senator Posey have sponsored it. Commissioner Higgs inquired if staff will be following this closely so the Board is kept up to date; with Mr. Golden responding affirmatively. Commissioner Carlson advised the Board can call on Legislative Coordinator Carol Laymance as well.

Mr. Golden stated the second legislative recommendation is to legislate for an increase in the number of Baker Act beds in the County; this was also part of the legislative recommendations that came to the Board in November 2002; so at this time no action is required.

Commissioner Carlson inquired if under each legislative request Mr. Golden can tell which legislator has it. Mr. Golden stated if he knows, he can do that; and if not, he can get that information back to the Board.

Mr. Golden stated the third legislative recommendation has to do with increasing the number of Marchman Act beds in the County, strategically locating them, and designating a number as additional receiving facility beds; and he will get back to the Board on who is sponsoring the issue. He stated no Board action is required at this time as the Board took action in November 2002. He stated the last legislative recommendation was also before the Board in November; it has to do with the legislative amendments to the Baker Act law, to allow law enforcement increased discretion and temporary detention, provide for civil liability immunity, allow previous history to be utilized, and to provide for a State-funded Statewide assisted treatment program. Mr. Lusk noted this is Statewide, and he is not sure who is doing it; but he is sure something is happening because there have been some editorials.

Chief Rumbley stated the Florida Sheriffs’ Association appeared before the Executive Board and Board of Directors of the Florida Police Chiefs in St. Augustine in January 2003, and presented a resolution asking them to join in the effort; and they agreed. He stated the Chiefs and the Sheriffs of the State are on board with the legislative changes; they have sponsors, although he does not know who they are; and there is a very strong lobby in Tallahassee including Sheriff Don Eslinger of Seminole County, who is a key player. He stated he will be championing this as well in Tallahassee.

Chairperson Colon inquired if Chief Rumbley becomes President of the Florida Chiefs this summer; with Chief Rumbley responding affirmatively. Chairperson Colon stated that will help; with Chief Rumbley responding they will be bringing the message to the legislators strongly.

Mr. Golden stated the next set of recommendations has to do with appropriations; and the first one is to implement and complete additional forensic areas in pod 100, creating a pod dedicated to female inmates. He stated the Board heard the approximate cost of this is $80,000 to $100,000; and hopefully on March 4, 2003, the Board will see an Agenda item to use correctional impact fees to take care of this and some other items at the jail. Mr. Lusk advised it is a separate Agenda item, because there is a whole list of improvements they want to do at the jail, and this is just one of them.

Mr. Golden stated the second recommendation is further research into the refurbishment of all existing forensic cells to have existing fronts and doors replaced with Lexan or safety glass fronts and doors as part of a long-range model jail plan; and the commission is asking the Board to authorize staff to investigate and report back on the cost associated with that refurbishment.

Motion by Commissioner Higgs, seconded by Commissioner Carlson, to authorize staff to investigate and report back to the Board on the costs associated with cell refurbishment. Motion carried and ordered unanimously.

Mr. Golden stated the third recommendation is to continue funding the enhanced level of services within the forensic program at the County jail; the price tag associated with that was original $122,000; but there is a 4% annual increase. He stated the commission is asking the Board to authorize the Public Safety Department to include this increase in its annual budget.

Motion by Commissioner Higgs, seconded by Commissioner Carlson, to authorize the Public Safety Department to include in its budget the increased funding for the enhanced level of services within the forensic program at the County jail.

Commissioner Pritchard inquired what Mr. Golden means by enhancing services. Mike Harley, Circles of Care, stated the forensic services provided at the jail up to this point were all funded by the State; after the tragedy, it became evident there was a need for more services; and the Board on a one-time basis allocated $122,000 to bring in a psychiatrist for two extra half-days each week and to fund two full-time forensic specialists, which increased the ability to screen inmates, make sure they get on medication and expand coverage to the weekends. He stated they want to make sure the mentally ill are screened as soon as they are admitted; and one of the slides shown earlier illustrated the resulting increase in services to the mentally ill after the program was initiated.

Commissioner Higgs stated this is a great long-range investment to help the population, which is difficult to deal with; it is an investment that has given a return; and the Board needs to keep it up.

Commissioner Scarborough stated one cost to law enforcement, the court system, and the jail is recidivism; and the better they are able to deal with the cause, particularly if the cause is not criminal intent, but by the person failing to medicate, it is money well spent. Commissioner Higgs noted it has a great cost/benefit ratio. Commissioner Pritchard stated he is aware of that, but was wondering what the enhancement of services was; and if anything, it costs less to treat than to incarcerate; with Commissioner Scarborough advising particularly if it is necessary to keep re-incarcerating.

Chairperson Colon called for a vote on the motion. Motion carried and ordered unanimously.

Mr. Golden stated the next set of recommendations has to do with research and analysis; the first recommendation is to authorize staff to research and study the concept of a central receiving center for misdemeanor and non-offending Baker Act and Marchman Act patients to receive medical clearance, integrated assessments, and appropriate referrals; and the CMHCS is requesting the Board authorize staff to investigate and report back on the costs and logistics involved in a central receiving center.

Motion by Commissioner Pritchard, seconded by Commissioner Higgs, to authorize staff to investigate and report back on the costs and logistics involved in a central receiving center.

Commissioner Carlson inquired if the central receiving center is modeled after Broward County; with Mr. Golden responding he is not sure if Broward County has one, but they had discussions with Orange County, which does have one in place. Commissioner Carlson inquired if staff will bring back information on cost benefit; with Mr. Golden responding yes.

Chairperson Colon called for a vote on the motion. Motion carried and ordered unanimously.

Mr. Golden stated the second recommendation is for the Brevard County Jail Oversight Committee to explore and develop a policy/procedure for the forced use of psychotropic medications based upon currently applicable regulations, Statutes, and standards to protect individual rights and implement such policy/procedure.

Motion by Commissioner Pritchard, seconded by Commissioner Scarborough, to authorize the Brevard County Jail Oversight Committee to explore and develop a policy/procedure for the forced use of psychotropic medications based upon currently applicable regulations, Statutes, and standards to protect individual rights and implement such policy/procedure.

Commissioner Carlson inquired with forced medication, what are the percentages of injury for the inmate; with Commander Terry Altman responding that would be one of the things that would be looked at. Commander Altman stated they want to be sure that anything they do is in accordance with State law, regulations, and guidance; they would never intentionally inflict pain on someone to administer the medication; but it may be better to force the medication on someone rather than let them injure themselves or use some other alternative such as the restrain chair.

Commissioner Higgs inquired which Commissioner is on the Oversight Committee this year; with Assistant County Attorney Shannon Wilson responding she is a liaison for that Committee, which is headed up by one of the Circuit Court judges, but there is no Commissioner appointed to it. Commissioner Higgs inquired who will insure the group hears the issue; with Ms. Wilson responding Ms. Heffernan, Mr. Parker, and she can insure that.

Chairperson Colon called for a vote on the motion. Motion carried and ordered unanimously.

Mr. Golden stated the next recommendation has to do with the concept of supporting a drop-in center where consumers assist consumers through the engendering of a supportive environment that is convenient to assisted living facilities, transportation, and is financially supported through various avenues; and the request for the Board is to meet with stakeholders and develop a realistic implementation plan for a County drop-in center.

Motion by Commissioner Carlson, seconded by Commissioner Pritchard, to authorize staff to meet with stakeholders and develop a realistic implementation plan for a County drop-in center.

Commissioner Pritchard inquired if this would be similar to the fire stations’ Safe Place program, would there be multiple facilities, would it be a new or existing facility, and would people have to travel far to get to it. Mr. Golden stated all that needs to be researched; there have been discussions with consumers from Orange County about how the center is run there; and they would like to look at those models and bring back a plan. He stated they need to look at funding sources; but the concept of the Safe Place is similar.

Chairperson Colon called for a vote on the motion. Motion carried and ordered unanimously.

Mr. Golden stated the last recommendation is to continue the Commission on Mental Health and Community Solutions in order to implement recommendations, identify recommendations in regard to prevention and aftercare, serve as advocates to the County on issues from State and national organizations on prevention and aftercare, and move the system of care for the mentally ill into a system reflective of the health care the commission desires for the County. He stated the request is to authorize the Chairperson to sign a resolution extending the sunset date of the Commission on Mental Health and Community Solutions.

Motion by Commissioner Pritchard, seconded by Commissioner Carlson, to authorize adoption of a resolution extending the sunset date of the Commission on Mental Health and Community Solutions. Motion carried and ordered unanimously.

Commissioner Pritchard inquired how long are they requesting to extend; with Mr. Golden responding one year. Mr. Kenna stated the Commission will be extended to February 28, 2004. Commissioner Scarborough suggested extending it farther; with Commissioner Higgs advising next year the Board can get a report and decide what it wants to do.

Motion by Commissioner Carlson, seconded by Commissioner Higgs, to adopt Resolution amending Resolution 2001-295 and extending the sunset date of the Brevard Commission on Mental Health and Community Solutions. Motion carried and ordered unanimously.

Commissioner Scarborough stated this has been one of the best workshops he has ever experienced in his years in local government; and he is impressed that there is a holistic approach.

Commissioner Carlson inquired when can the Board expect feedback on the studies; with Mr. Golden stated the CMHCS will look at the studies in the same way it looked at the first year and all the issues it addressed, taking it a piece at a time. Mr. Golden stated over the course of the next year, the Board will have those studies coming back to it; and the first one will probably come back in the first quarter. He advised the CMHCS will be meeting quarterly; and the subcommittees will take the brunt of the ongoing work. Commissioner Carlson expressed appreciation for all the hard work.

Commissioner Pritchard stated doing this is not a cost because there are actually savings; and recommended staff come back with a savings amount of implementing all the recommendations. He stated if someone is incarcerated, it costs “x” amount of money; if someone is treated, it costs “x” amount of money; but the overall cost would be substantially less because the person who is properly medicated would not be out committing crimes and tying up police resources and jail space; and the whole idea is to treat people better and more effectively with programs such as have been recommended. He expressed appreciation for the group’s efforts.

Commissioner Scarborough stated Judge Clarke heard in St. Petersburg they had a very large gentleman, and when there was trouble, they had to send ten police officers; one small lady with some training went in and using intelligence rather than brawn was able to handle him; and rather than putting police officers at risk, it is possible to use one well-trained person to handle the situation. He stated that is smart government, using people’s wits and intelligence rather than just charging ahead.

Chief Rumbley complimented Pam Hassebring and Ian Golden on their work.

Chairperson Colon stated Mr. Golden sits on many committees; it is critical to have a holistic approach; and because he is able to bring information to every group, Together in Partnership is sensitive to what is happening with the mentally ill.

The meeting recessed at 11:20 a.m. for lunch and reconvened at 1:05 p.m.

INTRODUCTION, RE: BREVARD COMMISSION ON AGING

Housing and Human Services Director Gay Williams stated three years ago the Brevard Commission on Aging was created by Resolution of the Board to serve as a facilitator for community planning and an advisory board on aging issues; the presentation this afternoon will highlight the activities and accomplishments on the Commission on Aging and its community partners during 2002 as they work to engage active older adults in community activism, address the needs of frail elders, and to protect those who are most vulnerable from abuse, neglect, and exploitation. She stated the Department of Housing and Human Services and the Brevard Commission on Aging are thankful for the ongoing support of the Board.

PRESENTATION, RE: 2002 OVERVIEW OF BREVARD COMMISSION ON AGING

Paula Preston, Planner with Housing and Human Services, repeated Ms. Williams’ expression of appreciation for the support the Board has provided to the Commission on Aging. She stated since the first organizational meeting two and one-half years ago, the Commission on Aging has worked to identify issues of importance to Brevard’s senior population, and has developed strategies to address areas that need improvement. She stated census data indicates the County is headed for great change in the next few years as the population grows older; twenty percent of the County’s population is age 65 or older right now; twenty-five percent is age 60 and older; and that number is expected to climb dramatically over the next fifteen years as the baby boomers begin to reach retirement age. She stated the County currently ranks seventh out of 67 counties in the State in the number of older adult residents; this is already having an impact on health care and social services systems; and it is requiring the County to rethink how it delivers services and to whom it delivers them. She stated the good news is that although the residents are older and living longer, they are also healthier and actively engaged in the community as voters and volunteers. Ms. Preston stated a third of the elder residents are homeowners and contribute to the community through the payment of property taxes; and they also contribute financially to the County through Social Security payments, VA benefits, Medicare payments, and their own personal savings, investments, and pension funds. She stated at the same time there are those that need basic support services to maintain their independence; there are 2,000 people on the waiting list for federal and State-subsidized services in the region, 500 of those in Brevard County; and as of the third quarter of 2002, nursing home beds were at 94% occupancy with a moratorium on creation of any new beds until July 2005. She stated the Commission on Aging developed three goals centered around the need to maintain independence; and they are (1) productivity and personal fulfillment, (2) the need for education on aging issues, and information on available resources and services, and (3) the need to better coordinate the provision of services and resources that are currently available. She stated in 2002, the Commission on Aging worked collaboratively with many community partners to begin implementing actions to create substantive improvements in quality of life for seniors and the community; they addressed long-term care issues for frail older adults; they looked at expanding recreation and leisure services for active adults; and they encouraged better coordination in the service delivery system. She stated with the help and financial support of the Board, they were able to issue a request for proposal to implement a shared cost program to provide basic assistance with eating, dressing, personal hygiene, light housekeeping, and other activities of daily living to low-income frail seniors who are not Medicaid eligible. She stated it will allow them to remain in their homes and avoid going into a nursing home; it is modeled after a pilot project of the Florida Department of Elder Affairs; and it is being considered at the State level as a means to leverage service dollars by asking clients to pay a portion of the cost of services based on their income. She stated the Commission on Aging will be working with the Community Services Council and other local service providers on this project; and they expect to begin delivery services within the next two weeks. She stated a second priority is the building of partnerships to advance understanding of aging issues and advocate for the resources to meet identified needs; in February 2002, the Senior Advocacy Coalition was formed as a partnership between the Commission on Aging, the Senior Resources Alliance, and the Orange County Commission on Aging; and through that coalition, more than 100 volunteers have been actively engaged in educating elected officials on aging issues. She stated the coalition members have put together position papers and delivered information packets to their delegate members; and in November 2002 they held a regional luncheon where elected officials were invited and provided more information on the need for home and community-based services. She stated the group continues to be active; and she is sure some elected officials will hear from them as they will be making a trip to Tallahassee on March 6 to represent the County at Ambassadors on Aging Day at the Capitol. She stated the Commission on Aging also convened an informal networking group of service providers this year, the Brevard Senior Provider Network; it is made up of both for-profit and not-for-profit providers of services to older adults; and it was brought together to increase communication and share information among the development; and it is planning a cooperative training session for front-line staff for later this year. She stated recognizing the area senior centers offer older adults the opportunity to continue a lifestyle of positive aging, the Commission on Aging became an active partner of the Board of the South Brevard Senior Center, the District 5 Commission office, Parks and Recreation Department, and Facilities Management to outline a plan to revitalize the senior center and expand the program offerings. She stated building renovation plans are being finalized now; and construction should start on that in the next few months. She stated in Central Brevard, a group made up of representatives of Cape Canaveral Hospital, the Cities of Cocoa Beach and Cape Canaveral, the Merritt Island Executive Council, the Cocoa Beach Citizens Action Committee, local service providers, and AARP has come together to look at the need for a senior center/community center in that area; the group developed a survey that is currently in distribution in the community to determine what the citizens want; and the concept they are currently looking at goes beyond the traditional senior center or community center concept, and is a blending of the two. She stated hopefully at the end, they will have a center that will provide adult and child day care services, health and wellness programs, recreational and community activities, and community information at one location; and the Commission on Aging staff is serving as facilitator for that group. She stated while there have been many successes this year, there is still a lot to be done; and one of the top priorities is the protection of vulnerable older adults from abuse, neglect, and exploitation. She stated to address this concern, the Board asked the Commission on Aging to explore the feasibility of developing a public guardianship program in the County; and they are prepared to report back to the Board on that issue and offer recommendations and options for the Board’s consideration and action. She introduced Melissa Otto, who is the Chair of the Public Guardianship Work Group, and will provide a general overview of guardianship services.

PRESENTATION, RE: GUARDIANSHIP REPORT

Melissa Otto, Investigator, State Attorney’s Office, Elder Services Unit, stated every day in the County, social service workers, medical personnel, and law enforcement encounter individuals who are not able to make appropriate decisions for themselves concerning their own well-being and care; some of them are suffering from mental illness, brain injuries, or developmental disabilities; others have dementia; and many have been abused, neglected, or exploited by their present caregivers. She stated some are in long-term care facilities; others live alone in squalid conditions with no food; and this has gone unchecked. She stated in January 2002, the Commission on Aging brought to the Board’s attention that the County had no formal system to safeguard adults who lacked capacity to care for themselves and had no one willing or able to step in to make critical decisions for them; and based on that finding, the Board directed staff to form a work group to examine the need for public guardianship services in the County, and to explore options for funding and developing a public guardianship program. She stated in February 2002, the Public Guardianship Work Group was formed, consisting of representatives from Brevard County Legal Aid, Circles of Care, the County Clerk’s Office, the Department of Children and Families, Adult Protective Services, Spacecoast Chapter of the Florida Guardianship Association, and the State Attorney’s Office, with consultation by the Statewide Public Guardianship Office; the first activity of the group was to examine the current system of guardianship services in the County; next they talked with others throughout the State who have public guardianship programs about the types of services provided, how they funded their programs, and how and by whom the programs were administered; and finally the group consulted with the Statewide Public Guardianship Office on the process for appointment of a public guardian, training requirements for guardians, and policies and procedures for operating a program in compliance with current Statutes on guardianship. Ms. Otto stated the adult guardianship programs oversee the personal and/or financial affairs of people over the age of 18 who have either developmental disability, mental illness, brain injury or dementia, and who are deemed unable to make decisions regarding their own care; there are currently more than 88,000 non-institutionalized adults in the County who suffer from a disability that limits one or more of their life’s activities; more than 36,000 of them live at or below the poverty level; and last year there were more than 600 cases of confirmed abuse, neglect, or exploitation, in which intervention was needed to protect the person or property of the vulnerable adult. She displayed slides showing the home of an 82-year old gentleman who retired from a high-level administration position at Kennedy Space Center; advised after his retirement, he began experiencing the signs and effects of dementia, he had been divorced for some years and had no caretaker in the home, and although he had four children, he had been estranged from them for some many years. She stated neighbors, knowing he was unable to cook, would bring him food, but because he was suffering from the early stages of dementia, he would often forget to eat, and the food would stay on the kitchen counter; and by the time the neighbors intervened, the house was infested with rats and roaches and was completely unlivable. She stated this is not an isolated case; there are many adults in Brevard County who lack the ability to manage their own affairs; and without intervention they become victims of scam artists, end up in hospital emergency rooms and in mental health facilities that are not equipped to deal with them. She stated Florida law does make provisions to insure that these people are protected and their rights maintained; and this is accomplished through the appointment of a guardian. She stated the process of appointing a guardian involves a series of legal steps that remove specific decision-making authority from the individual and place it with the guardian; any adult can petition the court to determine the incapacity of another adult; once a petition for incapacity has been filed, the court enters an order appointing an attorney to represent the ward; a three-member examining committee is appointed consisting of a psychiatrist or other physician and two or more members who may be psychologist, gerontologist, registered nurse, nurse-practitioner, licensed social worker, and anyone else the court deems competent to handle the task of rendering an expert opinion; and the examining committee provides a written report to the court and the attorney for the ward within 15 days. She stated if there is no finding of incapacity, the case is dismissed; if there is a finding of incapacity, a guardian is appointed; Florida Statute mandates any court order appointing a guardian must state specifically the rights that have been removed from the person and assigned to the guardian; and it is not a process that is taken lightly by the courts. She stated guardians may serve in a limited capacity when persons are able to do some things for themselves or in a plenary capacity when the person needs help with all aspects of care; fortunately most people have family or friends who are willing and able to step in and help; but for those who do not have family in the area, the services of a professional guardian can be retained for a fee. She stated they are concerned about those who need services, but lack the financial resources to compensate a professional guardian; the County currently has no public guardianship program; and for years, the courts have depended on a small number of professional guardians who provide services for indigent clients. She stated as the State mental institutions have closed and the adult population has gotten older, the need for guardianship services has grown; however, the number of professional guardians able to take on pro bono cases has not; and that leaves the courts and other service professionals dependent on a very informal system with limited capacity and oversight. She stated the Florida Legislature made provisions in the late 1980’s to add a category for public guardians to the Florida guardianship law specifically with the intent of providing services for indigent clients; however, only a few judicial circuits were able to establish and fund programs; so in 1999, the Statewide Public Guardianship Office was established by the Legislature to provide for centralized State supervision of existing public guardian programs and to explore funding options for the development of additional programs. She introduced Jerry Woefel, Deputy Director of Administrative Services and Governmental Relations for the Statewide Public Guardianship office; and stated Ms. Woefel will advise of the oversight responsibilities of the office and how the State office would work with the County to select a public guardian and implement a program, if funding is secured.

Jerry Woefel, Deputy Director of Administrative Services for the Statewide Public Guardianship office, stated the office was created by the Legislature in October 1999; and the office was staffed in June 2000 with the mandate to identify need for services, provide a structure for provision of services, and define a funding source. She stated no one had a grasp on the need; these people are the forgotten faces of Florida; and no one has ever counted them. She stated they surveyed every county, institution, and court; and the estimate Statewide is 27,000 individuals who need guardianship services. She stated to find a funding source to provide for 27,000 people, the State allowed the office to create a direct support organization, which is basically a foundation, because State revenue cannot support services; and they are trying to raise dollars locally for local programs because there is a capability of drawing down federal dollars. She stated the State has qualified for administrative claiming for reimbursement for certain services the guardians provide; and if the County creates a public guardianship program, it will sign an agreement with her office to allow the County to draw down the federal dollars, which has been determined to be fifty cents on the dollar. She stated the reimbursement from the federal government is estimated to be about a quarter of the State program; they have asked that any individual county or circuit that would like to create a public guardianship program be willing to fund almost half of the program; initially the County will be looking at providing three-quarters of the budget for the creation of the public guardianship program; once the program is created, the State office can help fund a quarter of the program; and the other quarter will come from the federal government. She stated when the Legislature created the office, it gave it a monumental task although they only have two employees, an elder law attorney and an administrative officer; and their mandate was to identify the need, come up with a service provision model, find a funding source, and report to the Legislature by October 1, 2000. She stated they had no office, phones, computer, or staff; but by October 1, 2000, they reported the number of individuals in the State that were identified who would need the process and a possible funding source from the federal government. She stated they were then told they had oversight of three pilot projects that had been set up 14 years prior to determine the best service modality for public guardianship services; the State funded three programs; one was a 501C3 private entity, one was through the School of Social Work at a university, and one was State employees funded by the State; and the office was asked to evaluate the three programs and determine which model was best suited for Statewide development. Ms. Woefel stated the determination was made that all three were appropriate for the individual communities they were serving; the most expensive services were being provided by State employees, although they were not any better than those provided by the 501C3 or the University School of Social Work; and two of the three, the 501C3 and the University School of Social Work have become contract services to the State, funded through State dollars in conjunction with local dollars and grant funds. She stated the State program that was funded directly using State employees will be privatized as of July 1, 2003, and will become contract services like the other two programs. She stated they have realized that professional guardians have been providing most of the public guardianship work pro bono; but Florida is now at a stage where they can no longer shoulder that financial responsibility, which is why the office was created. She advised the State cannot fund it; the average cost for provision of public guardianship services in the State is $2,250 per year per individual; in order to reach that, the office has asked for an additional two million service dollars to be provided for start-up programs Statewide; and that is what the office has to offer to counties that are willing to create public guardianship programs. She stated every year they ask for additional service dollars; last year they were given $50,000 and created two new public guardianship programs for the State; and this year they are asking for an additional $2 million. She stated with the tight budget, it does not look like they will be getting any additional service dollars; next month all other public guardianship programs will be drawing down federal funds, which will be funneled into the creation of new public guardianship programs; so if the County determines it can fund a public guardianship program, those dollars will be matched fifty cents on the dollar for approved services, which will be approximately a quarter of the funding source. She stated the process is relatively simple; the County would send a letter of intent; and they would work with the County to provide the personnel, funding, equipment, and whatever else is deemed necessary to create a viable program. She stated the County may work with the university or with a 501C3 entity as other counties have; but it will not work with the State employees because that will not be allowed after July 1. She stated it will be a locally-funded program enhanced by State and federal dollars; her office will provide training, equipment, and a software package for award management; and advised of costs for development of the software program and curriculum for professional and public guardians. She stated the Director of Administrative Services for the Statewide Public Guardianship must make the appointment; in 1999, the Legislature removed the judicial appointment; so the County would apply to the Office of Administrative Services for the Statewide Public Guardianship for whatever appointment would best suit the County’s situation. She stated two entities have sent letters of intent to seek appointment for the County; her office will hold those letters of intent and application until it hears the desires of the Board; and they will not move forward with an appointment until they know the Board’s desires. She advised the Director has to be in communication with the local judge in order to select the entity that is appointed; the process has been initiated by two entities on behalf of the County; so the County is in the process. She stated as soon as an appointment is made, the County becomes eligible for training, equipment, software, and federal and State funds.

Chairperson Colon stated Ms. Woefel said dollars are available at about twenty-five percent; and inquired if there is training and equipment above that; with Ms. Woefel responding yes.

Ms. Woefel advised anytime the State office receives State dollars, it uses as much of that funding that is not already allocated to contract services to buy necessary equipment and training for start-up programs; and it is not included in whatever grant monies are available.

Commissioner Carlson inquired if there has ever been an instance where two entities were appointed to work together to provide the service. Ms. Woefel advised they have not because the occasion has not arisen; two years ago the Legislature gave the authority to appoint more than one entity; so the legislative intent was that would be a viable option. She stated it has been done in other circuits, which encompass multiple counties.

Commissioner Pritchard inquired if the guardianship program is a one-on-one program where one person would be guardian for one person; with Ms. Woefel responding an entity or individual is appointed; in the case of a public guardianship program, if it is a corporation, one person would be appointed by the courts; it would be necessary to have a ward management person; and by Statute, that individual can only provide services to a maximum of forty individuals. Commissioner Pritchard inquired if each individual is $2,250; with Ms. Woefel responding yes. Commissioner Pritchard inquired how many individuals in the County could qualify for this program; with Ms. Woefel advising she does not know. Ms. Woefel stated in order to qualify for a public guardianship program, the individual must meet Medicaid eligibility; and commented on average costs. Commissioner Pritchard stated Ms. Woefel said between State and federal reimbursements, it would equal approximately fifty cents on the dollar for approved services, which would be approximately one-fourth of the total cost; with Ms. Woefel advising that is correct.

Carol Waters, Director of the East Central Florida Memory Disorder Clinic, stated she is the Chair of the Brevard Commission on Aging; and a tremendous amount of homework has been done on this issue. She stated the different organizations that made up the Task Force did the work, research, and study that needed to be done; Florida law provides for the assessment of a reasonable fee for services rendered by a guardian; client eligibility for public guardianship services is limited to individuals whose asset and income levels do not exceed State Medicaid eligibility limits; and recognizing that compensation could not be expected from the assets of indigent wards, Chapter 28, Florida Statutes, authorizes counties to impose by ordinance or special law a fee of up to $15 for each civil action filed for the establishment, maintenance, or supplementation of a public guardianship program. She stated to determine if this would be a feasible option for funding a program in the County, the Guardianship Committee worked with staff from the Clerk of Courts office and County Attorney’s office to estimate potential revenue; based on the number of civil cases filed in 2001, estimates range from $66,500 if a fee of $7.50 were imposed, to approximately $95,000 if the maximum fee were imposed; with estimated operating expenses of $2,500 per ward per year, this would allow services to be provided to 27 to 38 clients; and that is a good start. She stated while this is not enough to meet the estimated need for services, it would qualify the County for the supplemental assistance from the Statewide office as the federal funds become available. She stated they also looked at what other counties are doing; Dade County’s program is operated by a private not-for-profit agency with an annual caseload in excess of 900 wards and a budget of $2.2 million; it is the largest public guardianship program in Florida; and to fund the program, Dade County assesses a $10 surcharge on civil court filing fees, which generates approximately $420,000, with an additional $1.5 million provide from County General Revenue funds. She advised Lee County provides limited services through a private attorney; a $5 fee is imposed on each civil action, which is currently matched with $5 from General Revenue funds; an estimated $93,000 in revenue will be generated in 2003; and proposed revisions to the current structure are to raise the surcharge on filing fees to $10 with no match from County funds, and to implement a standard flat fee payment of $150 per ward per month. She stated in Osceola County, the public guardianship program was initiated in 1995 with a $3 charge on civil filing fees, matched by County general revenue dollars; funds were held in abeyance for 18 months to generate sufficient revenue to start the program; in September 2001, the filing fee surcharge was increased to the maximum of $15 allowed by Statute; and estimated revenue is $73,000 annually that will serve approximately 29 clients. She stated Volusia County’s guardianship program has been operated as a private pay program for 11 years, prior to the appointment as public guardian; but the Volusia County Council on Aging took over the program in October 2001 and applied to become public guardian at that time. She stated in October 2002 the Council on Aging appeared before the Board of County Commissioners of Volusia County to request a surcharge on civil court filing fees to fund the programs; a $10 fee was approved to be matched with $35,000 from the County General Revenue Fund; and the program is budgeted to serve 50 wards at an estimated cost of $2,760 per ward. She stated in order to provide services in Brevard County, the Commission on Aging and the Guardianship Work Group are asking the Board to authorize drafting an ordinance to add $10 to fees imposed on civil cases as allowed by Statute to establish the program; they are asking that the fees collected be deposited in a separate account for public guardianship services to be administered through the Brevard County Housing and Human Services Department; and they further recommend that Housing and Human Services be allowed to retain 10% of the funds collected to cover the cost of administering the program. She stated in order to generate sufficient revenue to start the program, they are asking that funds collected be held in abeyance for one year; and after a period of one year, they recommend the funds be distributed to the State-appointed public guardian or guardians on a quarterly basis, reimbursed at the rate of $208 per month per ward, after an adjudication of incapacity by the court. She stated the Brevard Commission on Aging and Guardianship Work Group recognize the potential impact on the future ability of agencies and organizations to access filing fees to expand services or to develop new programs; however, the need for guardianship services is so great that it cannot be ignored. She commented on a quote from Abraham Lincoln, “You cannot escape the responsibility of tomorrow by evading it today”; and recommended the Board take action.

Commissioner Pritchard inquired what is the difference in level of service between $600 per client and $2,700 per client; with Ms. Waters responding the difference would be the required services that the individual needs as some people need more in-depth services than others. Commissioner Pritchard requested an example of services provided; with Ms. Waters responding guardians Katherine Rollins, Barbara Whitley, and Mike Wilson will respond.

Barbara Whitley stated taking someone on as a guardian is like taking on a 40-year old child; so the crisis may run from someone losing his or her teeth to having being called in the middle of the night to take care of someone having a schizophrenic outbreak; it depends on the depth of need for the person; everyone has different needs; and the guardian is totally responsible for the ward’s care. Ms. Preston advised programs that can operate on an economy of scale have lower administrative costs; so Dade County, which has a $2.2 million budget and serves over 900 wards, is able to provide some services at lower cost because it can lower its administrative costs. Commissioner Pritchard inquired when they are talking about services, are they talking about Meals on Wheels or assistance with cleaning the house; with Ms. Whitley responding no, it is a decision making, such as whether or not to turn on a respirator. Ms. Whitley stated the guardian makes the total decisions for the person; the guardian would be called to make a decision on whether or not to amputate a leg for instance; and the guardians have to make some pretty heavy decisions and cannot just walk away. Commissioner Pritchard inquired where is the cost associated with those decisions. Ms. Woefel advised the reason the span is such is because there are different categories of guardianship; someone may take on a guardianship of a person in total or just for property or mental health; and it depends on what activities are appointed to the guardian by the judge. She stated the $600 level in Lee County is for property management only. Commissioner Pritchard inquired if the $600 or $2,700 is paid to the guardian; with Ms. Woefel responding yes. Commissioner Pritchard inquired if the client requires something to be done to their property, who pays for that; with Ms. Woefel responding the guardian decides what must be fixed, chooses the appropriate individual to have it fixed, and secures the needed funding. Commissioner Pritchard inquired if the person was close to indigent, would it be up to the guardian to locate the funds to have something repaired; with Ms. Woefel responding exactly. Ms. Preston advised it is a high level of responsibility. Commissioner Pritchard stated he understood the responsibility, but not where the money was going; and the $2,496 per client would go to the guardian for providing services for the ward and being on call twenty-four hours a day, seven days a week.

Chairperson Colon stated it is x amount for a certain number of wards; when it meets capacity, that is it; and inquired how realistic is that per person. Ms. Waters stated the recommendations made are extremely realistic as a first step; right now there are zero dollars for zero wards; but there are people who are indigent who need a guardian. She advised of calls from people requesting guardian services; and stated this is a solution that has to start.

Commissioner Pritchard inquired how is the amount of money the guardian receives determined. Ms. Preston stated they have not based a fee on the amount of services; that will average out over the course of caring for clients; and what they propose is a per month fee to manage all affairs of the client. Ms. Waters stated at $208, it is not exorbitant; and so far there are individuals who are signing up to help. Commissioner Pritchard inquired if for $208 per month a guardian would take total charge of a person; with Ms. Waters responding yes.

Chairperson Colon inquired if they would stay with the guardians who cannot drop a person; and what happens when they reach a certain age. Ms. Waters stated they stay with the guardian as long as the guardian is in good standing and able to do the services.

Commissioner Carlson stated Volusia County instituted a $10 filing fee and it is estimated to provide $138,000; and inquired if that is the 25% that Ms. Woefel was talking about. Ms. Preston responded no, that money is the money that would be generated from the filing fees plus the County’s contribution of $35,000 in General Revenue funds. Commissioner Carlson inquired if that would be added on top of the federal and State dollars; with Ms. Preston responding that is correct. Commissioner Carlson stated Volusia County’s pot of money is more than $138,000, and that is just a small percentage of the funds; and inquired how many are served in Volusia County; with Ms. Preston responding Volusia County is funded for 50 wards right now. Commissioner Carlson inquired if they have a model similar to what is being proposed, which is the per month basis; with Ms. Preston responding she does not believe so; the money is administered through Court Administration; and it goes directly to them on a quarterly basis to provide services to as many clients as they can serve.

Commissioner Scarborough stated there are two responsibilities, the person and the property; the discussion has been about responsibility for the person; he has a bit of familiarity with what banks charge when they pick up a trust just to handle the property side; and it would be multiples of the numbers being discussed. He stated for the level of service that is being provided, it is almost like volunteer work because the guardian is taking over all affairs of a person, which is a dynamic situation. Ms. Otto stated at this time, not having a public guardianship program, the guardians are giving that time; $208 is not going to cover the whole thing; but the guardians are willing to assume the responsibility. She stated forty clients is not really enough to do everything needed; but it is a start.

Chairperson Colon stated it is a wonderful program; but inquired how does the community protect itself; and is this under the State Attorney’s office. Ms. Otto stated those are things that were discussed; in her position she sees abuses of this process, usually by family members; and that is why there is the Office of Statewide Public Guardianship. She stated it is their job to screen and make sure the people who are applying for the privilege of being a public guardian are qualified, bonded, insured, and trained; and the State Attorney’s office would not have to assume that responsibility.

Commissioner Carlson inquired would it be better to have one entity or multiple entities for multiple potential resources; and stated with everything under one umbrella, oversight is much easier. Ms. Waters stated her personal bias is if there are two, it would be wonderful because if there is a huge workload and not enough money going with it, it is wiser to spread it out; with Ms. Otto agreeing.

Chairperson Colon inquired how would that work, and would they share the 25% that is allocated from the State; with Commissioner Carlson responding yes. Chairperson Colon stated those dollars would be stretched however the community would want; and they are given that flexibility. Ms. Otto stated all that funding would come into Housing and Human Services for administration of the program; as clients are identified as indigent, placed into the program, and assigned to a guardian, then those fees would go out per ward. Ms. Preston stated there is not another county in the State that has more than one currently. Ms. Woefel stated one recently appointed two guardians in Dade County; one is the one that was discussed, and the other is a 501C3; the second guardian was appointed to address a specific problem with the developmentally-disabled community; so as there are two completely different sets of individuals that the programs address, there are two programs. Chairperson Colon stated there is no way one person could oversee 900 individuals.

Commissioner Carlson stated the point she is trying to make is the administrative side of that equation and what dollars go to the administration versus to the wards and care of those wards; and dilution of that by having multiple entities is not something she would like to see if it is not best for the individuals to be helped. Ms. Woefel stated the appointments that come from her office and the funding from the State or federal government are tied to a particular ward, not to a particular program. Commissioner Carlson stated the entity that applies is potentially an entity that does other things besides public guardianship, so they must get administrative dollars from somewhere else, and it is understood the State dollars go strictly to the wards; with Commissioner Higgs disagreeing. Ms. Otto stated they allocate the quarter percent funding based on per ward rather than per program. Assistant County Attorney Shannon Wilson inquired if the State’s dollars are reimbursement dollars; with Ms. Woefel responding they are. Ms. Woefel stated there are general revenue dollars that become available to any public guardian; this year there is $120,000 that is going to be available for the public guardians; so they will apply for what they are calling grant dollars, which is over and above whatever else is available. Ms. Otto advised as more programs are created throughout the State, there will be less dollars to access. Ms. Woefel advised the more programs there are, the more federal dollars will be drawn in.

Commissioner Pritchard stated one of the recommended actions is for Housing and Human Services to be allowed 10% of the collected funds for program administration; with Ms. Otto advising that is out of filing fees. Commissioner Pritchard inquired for administration of the ward program, are they looking at two entities; with Ms. Otto responding they are looking at the $10 from civil court filing fees they can draw and place into Housing and Human Services; and of those dollars, 10% would be taken out by Housing and Human Services to fund the administration of the program. Commissioner Pritchard inquired what was Commissioner Carlson talking about having two entities and two overheads. Commissioner Carlson stated Ms. Woefel mentioned that two entities had petitioned for the public guardianship program, and potentially one would be picked; and that is why she asked if two could be picked. Ms. Otto advised those are the actual service providers. Commissioner Carlson stated it is based on per person, so there is no real competition because the judge identifies the guardian. Commissioner Pritchard inquired who are the two entities applying; with Ms. Woefel responding it is not a matter of public record at this point; they both submitted applications with all materials required; and they are in the process of making sure both are completed. Commissioner Pritchard stated he just wanted to clarify that the entities that are applying are not going to dilute the money available to the clients. Commissioner Carlson stated what has come to light is the administrative side; and ten percent off the top of the filing fees that will come in will be for administration. Commissioner Pritchard stated the entities will not dilute the money available to the client, and 10% will be used for administrative fees; and stated forty clients at $2,500 would require generating approximately $100,000 in fees with a $10 fee per civil action filed. Attorney Wilson advised the figures were based on the 2001 filing fee figures; the Clerk of Courts did not track how many of the filings were indigency filings with no filing fees collected; and that is why there is a range of projection. She stated they do not have accurate figures for 2002, although they anticipate there will be more filings; so it is a projection that is not exact. Commissioner Pritchard inquired what is the average fee for a civil action; with Ms. Wilson responding there are different categories of civil actions. Ms. Preston advised of a fold-out chart included in the package. Commissioner Pritchard stated when someone is already paying a $267 fee, another $10 is not that significant; the cheapest fee is the Notice of Trust at $79; so it is not like going from $10 to $20.

Commissioner Carlson inquired if the $210 cap applies to each individual and if there was a $267 fee currently, they would not have to pay the $10. Attorney Wilson advised that is not the case because there is an exemption; one part of the Statute says if they are at their cap, the maximum they can go is $10; they looked at each of the filing fees to determine the maximum they could impose; there are some categories of cases where $15 could be imposed; but they are waiting for the 2002 statistics to get better figures.

Chairperson Colon inquired if anyone has identified who in Housing and Human Services will be handling the administrative part, and will it be necessary to hire someone to do this. Ms. Williams advised there is already a contract administration team; and this will just be an additional contract to draft and monitor. Chairperson Colon stated there are some people who wish to speak.

Attorney Lynne Thompson stated she has been practicing in the area of guardianship law since 1989, which was when the massive change in the guardianship Statutes came down from the Legislature, dramatically changing the process of appointing guardians. She stated the community is identifying people who are in need of assistance; they get referrals from health care providers, Circles of Care, law enforcement, the adult protective services agency, and vigilant financial institutions; the numbers are huge; private guardians have taken on a tremendous part of this load; and it is simply not fair. She stated they have done it because there was no one else to do it; they continue to carry large numbers of people for whom they are paid nothing; but they have them in appropriate living facilities, properly medicated and supervised, and their finances under control and free from exploitation; and for this they are receiving nothing. She stated it cannot go on; and advised of pro bono work being done by attorneys. She stated frequently once help is instituted, families may come forward; and requested the Board help fill this void to take control of these people so they are no longer at risk; and if families come forward at that point, that is great, but at least the individuals are out of danger.

Marcia Mario, Mental Health Counselor with Circles of Care and Executive Director with the Sunflower Coalition of Caregivers, stated they have a resource center in Merritt Island called Sunflower House. She stated in the 20 years, she has been involved with caregiving and elder issues, she has seen and heard some heartbreaking stories; and it is almost as if they were approaching an age where there would be a bunch of two and three year olds running loose, with no one claiming responsibility. She stated if it is nobody’s responsibility, it is everyone’s responsibility.

Michael Wilson stated he is a gerontologist in Brevard County; he runs a care management consulting and guardianship firm; and if a decision is not made today to deal with this, the age wave is only going to build to a point that it is going to be a decision that will be twice as difficult in the future. He stated his consulting firm estimates there are 320 people in the County who need this service now; across the State, there are between 32,000 and 35,000 individuals who would be eligible for this kind of program; so it is definitely something that he hopes the Board will consider and adopt.

Commissioner Scarborough stated he heard that when a person gets to be over 80 or 85, there is a 50-50 chance of the person’s suffering from dementia, although not all of those would be indigent; and if Mr. Wilson could put together some numbers for the Board, it would give the Board some idea of the problem in terms of public guardianship. He noted there is also the issue of abuse of persons with money, which is the other side of the coin. Mr. Wilson stated people are being exploited; he can definitely figure that in; and he will happily present that information to the Board.

James White, Executive Director-Administrator for the Trinity Towers Housing Facilities in Melbourne, stated he is also a board member of the Florida Association of Homes for the Aging, which is an advocacy group in Tallahassee supporting the concerns of senior citizens. He stated the majority of the residents at Trinity Towers and other housing facilities in the area are low to extremely low-income persons; over the years he and his social workers have had the need to refer residents to guardians in the community; they have asked Barbara Whitley of Brevard Guardianship Services to intercede on behalf of the residents; and she has responded to champion the cause time and time again. He stated in 1988 they started a Task Force in Melbourne for elder concerns in the community; and it evolved into the South Salt Council, which is part of the Triad Organization that State Attorney Norm Wolfinger supports in the County. He stated Ms. Whitley has worked with law enforcement officers who have turned to her and her organization to help seniors in need and crisis; the need is real in the communities; when people are no longer in charge of their affairs, they are referred to people in the community; and it is a crisis at this time.

Joyce Tesdall stated she works for the Department of Elder Affairs, State Agency, the Cares Unit; they are the medical component for the Medicaid nursing home benefits and other Medicaid waiver programs; and their job is to assist frail elders to live out their lives in the least restrictive environment. She stated they see people who are too ill and confused to access medical care or available services; they need guardianship in the County to assist these people; and she is present to encourage the Board to help these clients.

Barbara Whitley stated Brevard Guardianship Services has been in existence since 1989; and introduced the Board, consisting of Lynne Thompson, Joe Miniclier, Jim White, Ken Whitaker, Dr. Keller, and Linda Wilson. She stated they started off with ten to fifteen guardians in 1989; now they consistently have 72 guardians; and they are always working with at least five people who are in need of guardianship. She advised of working with an 82-year old man who moves plants from neighbors’ yards in the middle of the night and steals mail from mailboxes; he is perhaps a danger to himself; and he does not need to be left in the community, but needs to be safe some place; and that is one of their jobs. She stated they located his brother who lives in Connecticut and cannot come down as he has a broken pelvis; he worked all his life as a janitor at a local church; he has no money; and this is an appropriate case for the guardianship program. She advised of a referral of an older person who is living in a crack house because dealers have moved in on him and are using his income to supply their habits; and this is an appropriate case for guardianship. She stated they have dealt with these things for 14 years; there are a number of cases they feel good about because they have found family members; but the workload is continuing. She stated she has a staff of 15; they visit wards every two weeks on a regular basis; they are available 24 hours a day, seven days week; and with gas at $1.65 a gallon, the workers are having a tough time. She stated every caseworker has approximately 30 clients and tries to see that they are visited, and their medical, health, and physical needs taken care of. She distributed brochures concerning Brevard Guardianship Services.

Chairperson Colon inquired if the workers are volunteers; with Ms. Whitley responding no, they are paid staff, and most have their Bachelor of Social Work or Master of Social Work degrees. She stated they tried to use some volunteers to begin with; but the educational level needs to be there as well. She stated they need the responsibility and ethics that the degree brings them. She advised there is a nurse on staff who is a big help in explaining when they run into difficult problems; but they try and work with mainly a higher education level. She noted there are some students working with them; this semester there are two interns from the UCF School of Social Work; they are master level interns who have been with them for two semesters; but they will be losing them soon as they will be graduating. Chairperson Colon stated the guardians are a blessing to the County.

Joe Miniclier stated he is an attorney with the firm of Stromire, Bistline, and Miniclier; and he had the honor to work with Barbara Whitley and Brevard Guardianships. He stated the need for a public guardian program for the County is obvious; the Board heard the stories; and someone who is professional is needed to do this. He commented on having his wife volunteer, and her being forced to quit because she was overwhelmed by the human drama that went on and depressed by the lack of care from families and friends. He stated they really cannot have a volunteer force because it is an incredibly difficult job; any guardian, day in and day out, makes decisions that affect a ward’s life; there are massive decisions to be made; and it is time for the County to fund the program, make it function, and make it operate. He stated over the past 15 years, they have averaged doing 20 to 50 guardianships per year pro bono; he and Ms. Whitley are getting long in the tooth, so somebody is going to have to be there to take care of this; and it would be a shame if the County did not take this opportunity to put together a program to help the vision that Franklin Roosevelt described as, “cradle to grave.” He stated he also handles the guardian advocates for Washington Square in Titusville; the residents there are profoundly disabled; they are people who never had a chance to live life; and they also need guardianship services. He stated once they become adults, their parents cannot make their decisions any longer; so that has to be factored in as well. He stated it is not just the elderly, but there are others with disabilities who need assistance; and the recommended program is something that needs to be done properly now.

RECOMMENDATIONS AND BOARD ACTION, RE: GUARDIANSHIP

Ms. Preston stated the recommendation is that a public guardian program be started in the County; in order to do that, they would need authorization from the Board to draft and advertise an ordinance; and if the Board plans to use a surcharge on civil court filing fees to help fund this program, it would need to authorize drafting and advertising an ordinance to amend Chapter 38 to allow that.

Motion by Commissioner Scarborough, seconded by Commissioner Pritchard, to direct staff to draft and advertise an ordinance amending Chapter 38 of the Code of Ordinances authorizing an additional fee of $10 on any civil action filed in circuit court to establish, maintain, or supplement a “Public Guardian Program.” Motion carried and ordered unanimously.

Commissioner Pritchard stated he has had personal experience with this issue; and it is everyone’s responsibility as there are people who cannot take care of themselves.

Attorney Wilson inquired if the Board is talking about a $10 surcharge across the board; with Commissioner Scarborough responding that was his motion. Attorney Wilson advised there are categories that are available for $15. Commissioner Pritchard stated he would prefer $10 across the board.

Commissioner Carlson stated that is where the Board can start; and after it gets a better assessment of the filing fee revenues, it can always come back.

Ms. Preston stated the second recommendation is for the Board to approve Housing and Human Services to administer the Public Guardian Program at the local level and authorize utilization of 10% of the funds collected for that administration.

Motion by Commissioner Higgs, seconded by Commissioner Carlson, to authorize the Housing and Human Services Department to administer the Public Guardianship Program and authorize the utilization of up to 10% of the funds collected from filing fees for administration. Motion carried and ordered unanimously.

Ms. Preston stated the third recommendation is to ask the Clerk of Court, who collects the funds, to divert the funds to Housing and Human Services in an account restricted for Public Guardianship Program.

Motion by Commissioner Pritchard, seconded by Commissioner Carlson, to authorize the Clerk of the Circuit Court to collect the funds and divert them to a Housing and Human Service Department account designated for Public Guardianship Program. Motion carried and ordered unanimously.

Ms. Preston stated they are requesting Housing and Human Services to hold any funds collected in abeyance for one year, and then allocate the funds based on a set fee per ward, per month. She stated they wish to allow an opportunity to set the program up appropriately to consider all applicants for public guardianship and to set up the administration.

Commissioner Higgs inquired if it would be possible to consider other ways to do it so that it can be implemented sooner than a year; and stated between agencies and staff, it may be possible to come up with a methodology that would allow them to move forward. She inquired if they can find a way to implement sooner, can they do that. She requested the Board hold on this recommendation.

Chairperson Colon stated the Board will not take any action until it is able to get some feedback to see if it can be implemented sooner. She thanked all participants; stated the Board is looking for quality of life for everyone in the community; and this is a tremendous step, which she is proud to be part of.

ANNOUNCEMENT

Assistant County Manager Don Lusk stated tomorrow is the City/County Manager’s Summit; County Manager Tom Jenkins has done a report for the Board laying out the already existing cooperative agreements with the cities and counties; and he wanted to share that with the Board in advance of the meeting.

Upon motion and vote, the meeting was adjourned at 4:30 p.m.

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JACKIE COLON, CHAIRPERSON
BOARD OF COUNTY COMMISSIONERS
ATTEST: BREVARD COUNTY, FLORIDA

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SCOTT ELLIS, CLERK

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