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HomeMy WebLinkAboutMinutes 01-19-2012sT. LucIE couNTY PUBLIC sAFETY COORDINATING COUNCIL unwary 19, ZO1Z 3x30 p.nf. fT. LUCIE COUNTY ADMINIfTRATiON ANNEX BOARD OF COUNTY COMMIff10NERf CONFERENCE ROOM 3 1. Call to Order -Chairman Tod Mowery Z. Roll Call 3. Approval of Minwtef- Oetober Z7, Z011 Meeting 4. fheriff': Office Update - fheriff Mafeara/Mayor Tighe s. Update by Criminal ~w:ti~e Coordinator- Marh Godwin 6. ~wdieial Update- Chief ~wdge Levin 7. Old Bw=ine:f 8. New Bw:ine:f: 9. Ad~owrnment Members: Suzanne Caudell Janet Collins State Attorney Bruce Colton Commissioner Tod Mowery Public Defender Diamond Litty Justine Patterson Sheriff Ken Mascara Chief Judge Lein John Romano Major Pat Tighe Judge Philip Yacucci PUBLIC =AF+ETY COORDINATING COUNCIL Minutes of Meeting January 19, 2012 Convened: 3:33,p.m. Ad~owrnede 4:23 p.m. CALL TO ORDER Commissioner Mowery called the meeting to order at 3:33 p.m. in Conference Room # 3, 2300 Virginia Avenue, Fort Pierce, Florida. ROLL CALL Roll call was taken. Member: Prefente Member: Ab=enib: Other: Pre:enib: Bruce Colton, State Attorney Commissioner Tod Mowery Chief Judge Steve Levin,l9t" Circuit Judge Philip J. Yacucci,l9t" Circuit Justine Patterson, Department of Corrections Scott Harloff for Suzanne Caudell, CORE Program Ken Mascara, Sheriff of SLC Major Pat Tighe, SL SO Janet Collins, Bail Association John Romano, New Horizons Diamond Litty, Public Defender Mark Godwin, SLC Criminal Justice Coordinator Broderick Underwood, C11S Analyst Allison Duffy, SLC Drug Lab Lisa Savage, SLC Pre-Trial Program Lt. William McMahon, SL SO Adam Fetterman, SL SO Lt. Dan O'Brien, SL SO Faye Outlaw, County Administrator Trevor Morganti, SL SO Susie Caron, BOCC APPROVAL OF MINUTE=: The minutes from October 28, 2011 were unanimously approved. Pabiie faiefy Coordinating Coaneil ~anyary 19, ZO1Z Page Z UPDATE by fLC fherriff's Office- Maior ?ighe behalf of fheriff Ma=earns Major Tighe gave an overview from two articles he referenced: Reuters, December 24, 2011, "Mentally III Flood ER as States Cut Services" and Healthcare Cost and Utilization Project,luly 2010 (Statistical Brief #92). Articles are attached. In 2007 the St. Lucie County Jail had approximately 17 percent of the population diagnosed with a mental illness, in 2011 the number climbed to 23 percent. It was predicted that number will continue to increase. Major Tighe explained the dilemma with lacks of space in the jail for extremely psychotic individuals and the issue of where to release or transfer them to. Members discussed the cuts in funding they have experienced over the past decade for Mental Health Programs from Washington and Tallahassee. Mr. Godwin mentioned the Mental Health and Substance Abuse grant the County had recently came to an end. The County did apply for new grants but, it was awarded to another County. Mental Health Court has helped keep misdemeanor offenders out of the jail. The participants are assisted with benefits and there is a low recidivism rate for those who graduate from the program. Chief Judge Levin advised that there are 150 - 180 participants at any given time in the Mental Health Court. John Romano, CEO of New Horizons explained there is about 1.2 million plugged into the system and without that the Sheriffs jail would be more crowded because the programs help to keep the individuals (for the most part) stable and in the community where it is more cost effective to Izeep them. He advised that housing is a problem and there is lack: of residential treatment programs. The group collaborated about ways to find solutions for the issues faced. Mr. Romano stated he would speak: with his contacts and kteep lookting into grants, federal, state or private. Judge Yacucci askted since Adam Fetterman (General Counsel for SLC Sheriffs Office) was in attendance if he could suggest anything we can do or contact in Tallahassee. Mr. Fetterman gave some insight and suggested showing support for some reform Bills that may alleviate some pressure for the DOC. Also possibly show innovation for how we approach problems. We may then be able to approach someone likte Senator toe Negron and say this is a financially effective. system. Commissioner Mowery inquired about more suggestions from Mr. Romano. Mr. Romano explained Adam hit it on the head with Senator Negron and that he has his own feelings on Substance Abuse and Mental Health types of services. Mr. Romano and Senator Negron have made progress through the years. He is putting together a program for Senator Negron and some others to show that Mental Illness is a disease of the brain, just likte cancer is a disease of the body. He offered to also reach out to the National Mental Health Counsel in Washington. The group spokte of lookting into Bills that they can support. Commissioner Mowery commented if it was agreed, it can be put on as a New Business item. Major Tighe continued his report .with highlights from the SLC Sheriffs Office Department of Detention 2011 Annual Report. Please see attached. Sheriff Mascara mentioned a change to a trend he monitors, specifically the breakdown of felony and misdemeanors population of males and females. The male felony ratio has gone down in the past eight weekts. About a year to eighteen months ago it was 78 - 80% and today the male felony side was 66% and the female felony side was 77%. He was not sure if there was a little lag on the county court side or if the Felony Judges were running them through quicker. Pablie faiety Coordinating Coaneil ~anaary f9, ZOtZ Page 3 UPDATE by Criminal ~a=ties Coordinator- Marh Godwin: Mr. Godwin went over and discussed the Average Monthly Population Report (See Attached). He mentioned in regards to felony cases they have seen a change in the sentencing process which can result in the lowering number of cases. He informed the group of the latest feature on the Civil Court side that Broderick Underwood, CJIS Analyst, has done. Attorneys now have the ability to file electronically for the Civil Judges, there are one thousand Attorneys registered Circuit wide and State wide. Also announced was a Circuit wide hotline system implemented this week. The hotline has sixteen lines and receives 400 to Soo calls a night, it is a randomized system and informs individuals when to report for a drug test. Mr. Godwin reported that the programs are doing well. He also introduced Ms. Justine Patterson who is the new Circuit Administrator for the Department of Corrections Nineteenth Circuit. Ms. Patterson said she was happy to be here and ready to help out in any way she can. JUDICIAL UPDATE -Chief badge Levin Chief Judge Levin gave a rundown of the shifting of Judge's assignments. He gave an update on the Seventh Street Juvenile Facility and indicated it may close down as of March first. That was his hope because by then they should be fully into the expansion of the first floor of the courthouse and fourth floor of the "other" courthouse. He thanked Miss Outlaw for her part in helping out with major hiccups and seeing that the project got done. He also thanked the Sheriff s office for their assistance as well. He mentioned a few more shifts for some judges after the move takes place and said if there were issues or questions on who is where or what is happening to please ask him. He complimented the Drug Screening Lab and the new automated hotline that was done very professionally and working out well. OLD BUfINEff -None NEW BUfINEff -None Pablie fafety Coordinating Coaneil ~anaary 19, ZOfZ Page 4 Commenit=e Commissioner Mowery asked if there were any comments from the members or public. Mr. Romano announced that New Horizons was holding a 2012 Children's Behavioral Health Summit at the Indian River State College on January 27, 2012. Breakfast and Lunch provided with the registration cost of $50.00 and 5.0 CEU's. Major Tighe announced the SLC Sheriff Office along with Indian River, Okeechobee and Martin County Sheriffs Offices will hold a Drug Summit in April at the Indian River State College. There is no cost to attend. Lisa Savage, SLC Pretrial Manager advised that the Department of Juvenile Justice (DlJ) had training for their staff on the new GPS monitoring program for juvenile defendants. They will be starting use of the GPS units on Monday, January 23`d. The circuit will receive around 15 units, with SLC probably receiving six units. Law enforcement will be called by the GPS company call center to respond to specific problems that might occur at night or on the weekends (most likely an alert of tampering with the unit or cutting off the unit). Justine Patterson mentioned that her agency (Department of Corrections) will be closing 4 work camps and 7 prisons, one of them being Indian River which affects local individuals. If they can't place them, they will be without jobs. She asked to please keep them in mind if anyone knows of any open positions. Sheriff Mascara asked Mr. Godwin how much it costs to house a juvenile per day. Mr. Godwin stated it was $20o per day and elaborated on the benefits of the Juvenile Assessment Center and Detention Center. AD~011RNMENI': Commissioner Mowery adjourned the meeting at 4:23 p.m. Submitted by, Carlene Busse THE NEXT MEETING WILL BE HELD February 23, 2012 St. Lucie County Criminal Justice System Average Monthly Inmate Population Excluding Federal Inmates -~ ~~~~ 2009 Avg Population ~--2010 Avg Population ~--- u2011 Avg Population 1600 ; 1400 ' 1.32. ~, <,:~1295~. ,.~30ti ,,.,,,1349 ,...,-1323 1307 1~~.~~:.1333 ~r 1399 ,.~~ 3~.1...,.,,~~~~~:u,».~..,,~ 1200 -~ 11g~-~3~86--~9--°' 11 172 1 ~vn9 11~ ,0 ~ 1000 _ _~ 1068 1101 1093 1086 ~ 1098 1160 1164 ~~705G S00 - 600 i aoo 200 0 - _ _-,___-~ ~ ~ ~_-_ T-~-----_-, Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Y~riyAtiara~eilailyPopalation 5ummary~ Excluding Faderallna~~ Avg Daly R4pulation~ aaet '. X007 240$ 2000 2090 2899 Mentally ill flood ER as states cut services -Yahoo! News Page 1 of 6 YAHC,~t~! NEV1/~ Mentally ili flood ER as states cut services REiJ7~RS ry' Julic Sieenhuyscn mid.7itian Mincer ~ Reutc~s -Sat, Dec a4, ao u CHICAGO/NEW YORK (Reuters) - On a recent shiftat a Chicago E:mergenc~r ciep~~rtment, Dr. Willism Sullivan treated a ................................ newly homeless patient who was threatening to kill himself. "He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the'(Tnivetsity,.pf illi~~is Medical Center at Chicago and a past president of the Illinois College of .................. ................................ Emergency Physicians. Sullivan said the man kept repeating that he wanted to kill himself. "iY seemed almost as if he was interested in being admitted." Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies -attempted suicide, severe depression, psychosis - as states slash .mental health sen=ices and the country's worst economic crisis since the Great Depression takes its toll. This trend is taxing emergency rooms akeady overburdened by uninsured patients who wait until ailments become acute before seeking treatment. "These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston. Increased demand in mental health services http://link.reuters.com/sud75s State mental health budget cuts .......................... http://link.reutcrs.com/tud~gs Visits to the hospital's psychiatric emergency depargnent have climbed 20 percent in the past three years. "We've seen actually more very serious suicide attempts in that population than we had in the pastas well;' she said. Compounding the problem are patients with chronic mental illness who have been hurt by a squeeze on mental health services and Find themselves with nowhere to go. On top of that, doctors are seeing some cases where the patient's most critical need is a warm bed. "The more I see these patients, the more I realize that if it's sleeting and raining outside, the emergency room is the only place they have," said Dr. R Corey Waller, director of the Spectrum Health Medical Group Center for Integrative Medicine in Grand Rapids, Michigan. . Government agencies such as the National Institutes of. Mental Health, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration could not provide fresh data on use of psychiatric services in recent years. But doctors from more than a dozen hospitals nationwide, mental health advocacy groups and state-funded agencies told Reuters they are all seeing a marked increase in psychiatric emergencies. A WORSENING PROBLEM http://news.yahoo.com/mentally-ill-flood-er-states-cut-services-131133880.htm1;_y1c=X3o... 1 /2/2012 Mentally ill flood ER as states cut services -Yahoo! News Page 2 of 6 The National Association of State Mental Health Program Directors (NASMHPD), an organization of state mental health directors, estimates that in the last three years states have cut $3.4 billion in mental health services, while an additional 400,000 people sought help at,public mental health facilities. In that same time frame, demand forcommunity-based services climbed 56 percent, and demand for emergency room, state hospital and. emergency psychiatric care climbed i8 percent, the organization said. '"This wasn't one round of cuts;' says Ted Luiterman, director of research analysis at NASMHPD Research Institute. "It was three or four for many states, and multiple cuts during the year." If the economy doesn't improve, next year could be worse because many community mental health agencies are cutting programs and using up reserve funds, says Linda Rosenberg, president of the National Council for Community Behavioral Healthcare. "It's been horrible;' she said. "7lrose that need it the most -the unemployed, those with tremendous family stress -have no insurance." In the emergency room, this increased demand has meant doctors and social workers are spending hours and sometimes days trying to arrange care for psychiatric patients languishing in the emergency, clepartn}~~?t, taking up beds that could be used for traditional types of trauma. More than ~o percent of emergency department administrators said they have kept patients waiting in the emergency department for 24 hours, according to a 2oio survey of 600 hospital emergency departrnent administrators by the Schumacher Group, which manages emergency departments across the country. Tea percent said they had "boarded" patients for a week or more. And many hospitals are not prepared for the increased caseload of psychiatric patients, says Randall Hagar, director of government affairs for the California Psychiatric Association. California cut $58~ million in state-funded mental health services in the past two years, the most of any state, according to the National Alliance on Mental Illness, a patient advocacy group. '"They don't have secure holding rooms. They don't have quiet spaces. They don't have a lot of things you need to help calm down a person in an acute psychiatric crisis," Hagar said. "Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed," he said. FROM CITIES TO SMALL TOWNS In North Carolina, the state has cut its inpatient psychiatric capacity by half since 2005, says Dr. Bret Nicks, an emergency physician at Wake Forest Baptist Medical Center in Winston-Salem and a spokesman for the American College of Emergency Physicians. Nicks points to a report from the Institute of Medicine released in 2006 that found U.S. emergency departments were already overtaxed and overcrowded. "Now you are adding in patients who are unsafe to leave but yet have nowhere to go," he said. "I consider patients with acute psychiatric needs as really the forgotten patient population in the U.S. right now." Dr. Stephen Anderson is an emergency department doctor at Auburn Regional Medical Center, a mid-size suburban hospital outside of Seattle. "When the economy is hurt they are some of the first to drop off the healthcare rolls," he said of local residents in the largely blue-collar community. http://news.yahoo.com/mentally-ill-flood-er=states-cut-services-131133880.htm1;~+1c=X30... 1 /2!2012 Mentally ill flood ER as states cut services -Yahoo! News Page 3 ofd j Anderson, who heads the Washington Chapter of the American College of Emergency Physicians, said the state has lost a third of its inpatient psychiatric beds in the past decade. Lately he is seeing a marked escalation in patients with psychiatric problems turning up in the emergency department. In early December, a third of its beds were occupied with people in a psychiatric crisis who were not safe to return to the community. The problem extends out to small towns. Sullivan splits his time between the big emergency department at the University of Illinois Medical Center at Chicago and St. Margaret's Hospital, a tiny facility in Spring Valley, Illinois, about ioo miles southwest. of the city. On a recent shift, a young woman with schizophrenia arrived at the hospital. She had just lost her job and apartment and was living with relatives. She could not afford the medications that were keeping her illness in check. The woman asked Sullivan to switch her prescriptions to drugs that could be found on the $4 discount list at Wal-Mart and other discount stores. "I didn't feel comfortable doing that;' Sullivan said, noting that emergency physicians are being asked ko deliver specialized care that should be handled by a psychiatrist. He found a healthcare facility about 25 miles away with a psychiatrist who could help, but even that presented a problem for the woman., who had no way of getting to the appointment "It's almost akin to having a cardiac patient Dome in and say,'I need someone to adjust my defibrillator.' In the emergency department, we can do a lot, but there are some things we have to leave with the specialists; ' he said. (Editing by Michele t,'ershberg and Eric Beech) (~•~ Cupyrgh!'I'hnmsorr keuters 201 t. Check for res'i'ricticmn :ri: ht tir//about.nluh7(S.cun;/nrlllega!.asp C'rrp~•righi tF 201~~ Yaha,! in;:. all right., reserved. 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Z ~ d ~ c ~ V '+r 41 O! LL' t% ~ v m .u,.. -~ p ~-1 ~ .W... .W.r M (~ _ ~a U O QQ 7 y $ ~ ~ '~ ,k C O G O .c G I O O O ti _O 4 O ,~ ~ O '!~ 'e0 d ~ .ta .C y o ~ •~ •~ a °' ~ •y •~ •~ O •~ •~ • n a .c c i~,'' ~ ~ ~ aaC m m ~ i i v~ vai ~ ~ .N-i vai vi rii :•i vi cn rii op r~i d LA O Q M N r4 O ~ ~ N ~ C d ~ i I ~ 1 1 1 N 1 N m eh ~ 1 I N ~ I 1 1 o° ~ $ O M . -~ ~ N N m 00 00 O1 e •1 ai t -1 N N M L!~ M N C~ ca hl C'•~ E'er ,~~.~ '.~~ a~~. t. .. _. ~ - i_~:. € Ii: AF3c G~'~' l~.tii kger~cE fi;:~r ~ealtnce~ro H.~ .-a _ i"-'~t~r~,'I~~hi PR~:.i=.-,- %esea<wt~ artc~ ~~:alit~~ . _;~ ter" I( Mental Health and Substance Hit~i,iigr~ts Abuse-Related Emergency In 2007, 12.0 million emergency artment Visits among Adults De de gartment (ED) vis'Its involved a p ~ dia nosis related to a mental health 2007 and/or substance abuse condition (MHSA), accounting for 12.5 Pamela L. Owens, Ph.D., Ryan Mutter, Ph.D., and Carol Stocks, percent of all ED visits in the U.S., R.N., M.H. S.A. or one out of every eight ED visits. introducticsn ^ MHSA-related ED visits were two and a half times more likely to result An estimated one in three individuals has suffered from a in hospital admission than ED visits related to non-MHSA conditions- mental health or substance abuse condition within the last 12 nearly 41 percent of MHSA-related months,' yet the community treatment system to support 2 ED visits resulted in hospitalization. services for these individuals is regarded as ineffective, This is particularly evident in emergency department (ED) ^ Medicare was billed most frequently utilization. The number of patients with mental health and for MHSA-related ED visits (30.1 substance abuse {MHSA) conditions treated in EDs has been percent), followed by private on the rise far more than a decade.3 Not only is this of insurance (25.7 percent), uninsured concern to members of the mental health community, but also (20.6 percent), and Medicaid (19.8 to the members of the emergency medicine community who percent). are concerned that ED overcrowding results in decreased ^ visits related to mental health quality of care and increased likelihood of medical error." Asa conditions accounted for 63.7 specific example, a 2008 American College of Emergency percent of all MHSA-related ED Physicians' ED directors' survey reported that patients with visits. Substance abuse conditions MHSA conditions not only have had increased ED boarding accounted for 24.4 percent of all but also that the resource-intensive care required for times MHSA-related ED visits, and co- , these patients has an impact on the quality of care for all other occurring MHSA conditions accounted for 11.9 percent. patients in the ED.S ^ ED visits billed as uninsured were This Statistical Brief presents data from the Healthcare Cost two to four times less likely to result and Utilization Project (HCUP) Nationwide Emergency in hospital admission, depending on Department Sample (NEDS) on MHSA-related ED visits the type of MHSA condition. among adults in 2007. Specifically, patient and utilization ^ Mood disorder was the most characteristics of ED visits for MHSA are discussed and common MHSA reason for an ED compared with all other types of ED visits. The distribution of visit (42.7 percent), followed by MHSA-related ED visits are presented by age and primary anxiety disorders (26.1 percent), expected payer. The MHSA conditions described here and alcohol-related conditions (22.9 percent). The remaining common 'National Comorbidity Survey and National Comorbidity Survey Replication conditions included drug-related (NCS-R). Available at: www.hco.med.harvard.edu/ncs, NCS-R Twelve-month conditions, schizophrenia and other Prevalence Estimates. Table 2. Available at: psychoses, and intentional self- htto://www.hcn.med.harvard.edu/ncs/ftodir/NCS-R 12- harm. month Prevalence Estimates.odf Institute of Medicine. Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, D.C.: National Academies Press. 2006. 3Larkin, G.L., Claassen, C.A., Edmond, J.A., Pelletier, A. J., and Camargo, C.A. Trends in U.S. Emergency Department Visits for Mental Health Conditions, 1992 to 2001. Psychiatric Services. 2005;56:67177. `Institute of Medicine. Hospital-based Emergency Care of the Breaking Point. Washington, b.C.: Institute of Medicine. 2004. SAmerican College of Emergency Physicians (ACEP) Psychiatric and Substance Abuse Survey 2008: Fact Sheet. Available at: include those conditions found in the Diagnostic and Statistics Manual of Menta! Disorders, Fourth Edition, excluding dementia and intellectual disabilities. The Brief also provides information about the types of MHSA conditions by age and primary expected payer. In addition to prevalence estimates, data on the likelihood of hospital admission are. presented. Estimates are based on all-listed diagnoses. All differences between estimates noted in the text are statistically significant at the 0.05 level or better. 1--isid'sr+os General findings In 2007, of the 95 million visits made to the emergency department (ED) by adults in the U.S., 12.0 million (12.5 percent) were related to MHSA (table 1 X4.1 million of which had mental health or substance abuse conditions listed as a primary diagnosis. Nearly 41 percent (4.8 million visits) of these MHSA- related ED visits resulted in hospital admission-an admission rate that is over two and a half times that for ED visits related to other conditions (figure 1). Table 1 shows that the majority of MHSA-related ED visits were for women (53.9 percent). The largest percentage ofMHSA-related ED visits (46.6 percent) were for younger adults ages 18 to 44 years, followed by 45 to 64 year olds (34.5 percent). Adults 65 years and older accounted for nearly one in five (18.9 percent) MHSA-related ED visits. Compared with ED visits for other conditions, those related to MHSA were more likely to be for 45 to 64 year olds (34.5 percent versus 25.8 percent) and less likely to be for adults 18 to 44 years (46.6 percent versus 52.4 percent) and 65 years and older (18.9 percent versus 21.8 percent). Medicare, healthcare insurance for those 65 years and older or those on Social Security Disability Insurance, was billed more frequently for MHSA-related ED visits (30.1 percent), followed by private insurance (25.7 percent), uninsured (20.6 percent), and Medicaid (19.8 percent). In contrast, private insurance was billed more frequently for most other types of ED visits (34.5 percent), followed by Medicare (24.7 percent), uninsured (20.6 percent), and Medicaid (14.9 percent). Types of MHSA-related ED visits Table 1 shows the distribution of MHSA-related ED visits, including those related to only mental health conditions (i.e., not substance abuse condition), those related to only substance abuse conditions (i.e., not mental health conditions), and those related to co-occurring MHSA conditions. Over 7.6 million ED visits related to mental health conditions only, accounting for 63.7 percent of all MHSA-related ED visits. Nearly 3.0 million ED visits related to substance abuse conditions only, accounting for 24.4 percent of all MHSA-related ED visits. Over 1.4 million visits related to co-occurring MHSA conditions, accounting for 11.9 percent of MHSA-related ED visits. Patient and payer characteristics of types of MHSA-related ED visits Table 1 shows that ED visits related to mental health conditions were more likely to be for women (65.4 percent), while ED visits related to substance abuse conditions (29.3 percent) and co-occurring MHSA conditions (43.0 percent) were less likely to be for women and more likely to be for men. Regardless of the type of condition, MHSA-related ED visits were more likely to be for younger adults 18 to 44 years. ED visits related to co-occurring MHSA conditions were disproportionately more likely to be for 18-44 year olds-58.8 percent of ED visits for co-occurring MHSA conditions were for 184 year olds (versus 42.7 percent for mental conditions only and 50.7 percent for substance abuse conditions only). ED visits related to mental health conditions were disproportionately more likely to be for the oldest adults 65 years and older (25.3 versus 9.1 and 5.2 percent related to substance abuse conditions and co-occurring MHSA conditions, respectively). Medicare was billed more frequently for mental health-related ED visits (37.2 percent), followed by private insurance (27.5 percent) and Medicaid (18.3 percent). Fewer mental health-related ED visits were billed as uninsured (13.8 percent). In contrast, the largest percentage of substance abuse-related ED visits was billed as uninsured (35.6 percent). Private insurance accounted for 22.2 percent of substance abuse- related ED visits, followed by Medicaid (20.7 percent) and Medicare (16.3 percent). Nearly one-fourth of ED visits for co-occurring MHSA conditions were billed as uninsured (26.3 percent) or to Medicaid (25.7 percent) or private insurance (23.4 percent). Medicare accounted for 20.3 percent of ED visits related to co-occurring MHSA conditions. 2 Admission status for MHSA-related ED visits, by age and expected payer Figure 1 highlights that ED visits related to co-occurring MHSA conditions were the most likely to result in hospital admission (57.1 percent), followed by visits related to mental health conditions (39.3 percent), and substance abuse conditions (36.6 percent). Figures 2 and 3 show that visits related to co-occurring MHSA conditions were more likely to result in hospital admission than either visits related to mental health only or substance abuse only within age and payer groups. Admission rates increased with age, regardless of the type of MHSA-related ED visits (figure 2). ED visits for adults 18 to 44 years with mental health conditions were the least likely to result in hospital admission (20.3 percent), while ED visits for adults 65 years and older with co-occurring MHSA conditions were the most likely to result in admission (82.0 percent). Hospital admission rates varied by expected payer (figure 3). ED visits billed to Medicare were more likely to result in admission, regardless of the type of MHSA condition (58.9, 58.0, and 70.8 percent, related to mental health only, substance abuse only, and co-occurring MHSA, respectively). ED visits billed as uninsured were the least likely to result in hospital admission, regardless of the type of MHSA condition (15.1, 23.8, and 41.3 percent related to mental health only, substance abuse only and co- occurring MHSA, respectively). Number and distribution of ED visits for the most frequenf all-listed MHSA conditions, by age and expected payer As shown in table 2, the most common all-listed reason for aMHSA-related ED visit was mood disorder (42.7 percent of MHSA-related ED visits), followed by anxiety disorders (26.1 percent), alcohol disorders (22.9 percent), drug disorders (17.6 percent), schizophrenia and other psychoses (9.9 percent), and intentional self-harm (6.6 percent). The top five conditions accounted for 96.0 percent of all MHSA- related cases in the ED, taking into account that there may be multiple diagnoses on an ED record. Some variation was noted by age and expected payer. For example, among adults 65 years and older, mood disorders accounted for over half of the ED visits (52.0 percent) followed by anxiety disorders (28.8 percent), and schizophrenia and other psychoses (11.4 percent). Although mood disorders were the most frequent condition for all age groups and most payers, alcohol-related conditions were the most frequent condition among the uninsured. Figure 4 shows the age distribution for specific MHSA-related ED visits by condition. ED visits for intentional self-harm (69.0 percent) and drug abuse conditions (63.1 percent) were disproportionately more likely to be for young adults 18-44 years old-accounting for almost 500,000 ED visits and over 1.3 million ED visits in 2007, respectively. Figure 5 shows that the payer distribution for each of the MHSA condition specific ED visits varied considerably. For example, ED visits related to mood disorders and those related to schizophrenia and other psychoses were disproportionately more likely to be billed to Medicare (36.6 and 47.4 percent, respectively). ED visits related to drug abuse, alcohol abuse, and intentional self-harm were more frequently billed as uninsured than any other payer (33.3, 31.9, and 29.3 percent, respectively). €~a.a ~?c~urc:;~ The estimates in this Statistical Brief are based upon data from the HCUP 2007 Nationwide Emergency Department Sample (NEDS). The statistics can also be generated from HCUPnet, a free, online query system that provides users with immediate access to the largest set of publicly available, all-payer national, regional, and State-level hospital care databases from HCUP. t:),~ir+i~i~:r~~ Diagnoses, ICD-9-CM, and Clinical Classifications Software (CCS) The principal diagnosis is that condition established after study to be chiefly responsible for the patient's admission to the hospital. Secondary diagnoses are concomitant conditions that coexist at the time of admission or that develop during the stay. All-listed diagnoses include the principal diagnosis plus these additional secondary conditions. ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are about 13,600 ICD-9-CM diagnosis codes. CCS categorizes ICD-9-CM diagnoses and procedures into clinically meaningful categories.s This "clinical grouper" makes it easier to quickly understand patterns of diagnoses and procedures. Mental health conditions include CCS 650-659, 662, and 670. Substance abuse conditions include CCS 661 and 662. Case definition All-listed CCS diagnosis and external cause of injury codes used to identify mental health and substance abuse cases included: 650 Adjustment disorders 651 Anxiety disorders 652 Attention-deficit, conduct, and disruptive behavior disorders 655 Disorders usually diagnosed in infancy, childhood, or adolescence including pervasive development disorders, tic disorders, and elimination disorders 656 Impulse control disorders, not elsewhere classified 657 Mood disorders 658 Personality disorders 659 Schizophrenia and other psychotic disorders 660 Alcohol-related disorders 661 Drug-related disorders 662 Intentional self-harm/suicide and intentional self-inflicted injury 670 Miscellaneous disorders, including eating disorders, mental disorders in pregnancy, dissociative disorders, factitious disorders, sleep disorders, and somatoform disorders Although dementia (CCS=653) and intellectual disabilityldevelopmental disorders (CCS=654) are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, these diagnoses, which are frequently characterized by the development of multiple cognitive impairments related to medical conditions, frequently require more medical than psychiatric treatment and thus are excluded from the analysis. Treat-and-release ED visits Treat-and-release ED visits were those ED visits in which patients are treated and released from that ED (i.e., they are not admitted to that specific hospital). While the majority oftreat-an-release patients (92.2%) were discharged home, some were transferred to another acute care facility (1.5%), left against medical advice (1.7%), went to another type of long-term or intermediate care facility (nursing home or psychiatric treatment facility) (1.6%), referred to home health care (0.5%) or died (0.2%); or discharged alive but the destination is unknown (2.2%). ED visits resulting in hospital admission ED visits resulting in a hospital stay included those patients initially seen in the ED and then admitted to the same hospital. Types of hospitals included in HCUP HCUP is based on data from community hospitals, defined as short-term, non-Federal, general and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. They exclude long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals, but these types of ED visits are included if they are from community hospitals. Unit of analysis The unit of analysis is the ED visit, not a person or patient. This means that a person who visits the ED multiple times in one year will be counted each time as a separate ED visit. e HCUP CCS. Healthcare Cost and Utilization Project (HCUP). June 2009. U.S. Agency for Healthcare Research and Quality, Rockville, MD. www.hcuo-us.ahra.aovltoolssoftwarelccs/ecs.iso 4 Payer Payer is the primary expected payer for the ED visit. To make coding uniform across all HCUP data sources, payer combines detailed categories into more general groups: - Medicare includes fee-for-service and managed care. Medicare is a Health Insurance Program for people age 65 or older, some disabled people under age 65 (social security disability insurance), and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). - Medicaid includes fee-for-service and managed care Medicaid patients. - Private insurance includes Blue Cross, commercial carriers, and private HMOs and PPOs. - Other includes Workers' Compensation, TRICARE/CHAMPUS, CHAMPVA, Title V, and other government programs. - Uninsured includes an insurance status of "self-pay" and "no charge." `When more than one payer is listed for a hospital discharge, the first-listed payer is used. HCUP is a family of powerful health care databases, software tools, and products for advancing research. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP includes the largest all- payer encounter-level collection of longitudinal health care data (inpatient, ambulatory surgery, and emergency department) in the United States, beginning in 1988. HCUP is aFederal-State-Industry Partnership that brings together the data collection efforts of many organizations-such as State data organizations, hospital associations, private data organizations, and the Federal government-to create a national information resource. HCUP would not be possible without the contributions of the following data collection Partners from across the United States: Arizona Department of Health Services Arkansas Department of Health California Office of Statewide Health Planning and Development Colorado Hospital Association Connecticut Hospital Association Florida Agency for Health Care Administration Georgia Hospital Association Hawaii Health Information Corporation Illinois Department of Public Health Indiana Hospital Association Iowa Hospital Association Kansas Hospital Association Kentucky Cabinet for Health and Family Services Louisiana Department of Health and Hospitals Maine Health Data Organization Maryland Health Services Cost Review Commission Massachusetts Division of Health Care Finance and Policy Michigan Health & Hospital Association Minnesota Hospital Association Missouri Hospital Industry Data Institute Nebraska Hospital Association Nevada Department of Health and Human Services New Hampshire Department of Health & Human Services New Jersey Department of Health and Senior Services New Mexico Health Policy Commission New York State Department of Health North Carolina Department of Health and Human Services Ohio Hospital Association Oklahoma State Department of Health Oregon Association of Hospitals and Health Systems Pennsylvania Health Care Cost Containment Council 5 Rhode Island Department of Health South Carolina State Budget & Control Board South Dakota Association of Healthcare Organizations Tennessee Hospital Association Texas Department of State Health Services Utah Department of Health Vermont Association of Hospitals and Health Systems Virginia Health Information Washington State Department of Health West Virginia Health Care Authority Wisconsin Department of Health and Family Services Wyoming Hospital Association J'4~.p:Ptdi ~.u'4^ ~'~~~-.~':: The HCUP Nationwide Emergency Department Sample (NEDS) is a nationwide database of hospital- based ED visits. The NEDS is nationally representative of all community hospital-based emergency departments (i.e., short-term, non-Federal, non-rehabilitation hospital-based emergency departments). The NEDS is a 20% stratified sample of hospital-based EDs and includes records on all patients, regardless of payer. The NEDS contains information on 26 million records (unweighted) on ED visits at over 950 hospitals in 27 states. The vast size of the NEDS allows the study of topics at both the national and regional levels for specific subgroups of patients. The NEDS is produced annually, beginning with the 2006 data year. HCUPnet is an online query system that offers instant access to the largest set of all-payer health care databases that are publicly available. HCUPnet has an easy step-by-step query system, allowing for tables and graphs to be generated on national and regional statistics, as well as trends for community hospitals in the U.S. HCUPnet generates statistics using data from HCUP's Nationwide Inpatient Sample (NIS), the Kids' Inpatient Database (KID), the Nationwide Emergency Department Sample (NEDS), the State Inpatient Databases (SID) and the State Emergency Department Databases (SEDD). For more information about HCUP, visit www.hcug-us.ahro.4ov. For additional HCUP statistics, visit HCUPnet, our interactive query system, at www.hcua.ahrq.gov. For information on hospitalizations in the U.S., download HCUP Facts and Figures: Statistics on Hospital- Based Care in the United States in 2007, located at htto://www.hcup-us.ahrc{.gov/regorts.Lsp. For a detailed description of HCUP, more information on the design of the NEDS, and methods to calculate estimates, please refer to the following publications: Steiner, C., Elixhauser, A., Schnaier, J. The Healthcare Cost and Utilization Project: An Overview. Effective Clinical Practice 2002;5(3):143-51. Introduction to the HCUP Nationwide Emergency Department Sample, 2007. Online. January, 2010. U.S. Agency for Healthcare Research and Quality. htto~//www hcup-us ahrq aovJdb/nationlneds/NEDS 2007 Introduction v5.pdf Houchens, R., Elixhauser, A. Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2009. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June 6, 2005). U.S. Agency for Healthcare Research and Quality. httg~/Iwww hcup-us ahrq qov/reports/CalculatinoNlSVariances200106092005 pdf 6 Owens P.L., Mutter R., Stocks C. Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007. HCUP Statistical Brief #92. July 2010. Agency for Healthcare Research and Quality, Rockville, MD. htto://www.hcup-us.ahra.gov/reports/statbriefs/sb92.pdf *** AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. We also invite you to tell us how you are using this Statistical Brief and other HCUP data and tools, and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please a-mail us at hcuaCc~ahra.gov or send a letter to the address below: Irene Fraser, Ph.D., Director Center for Delivery, Organization, and Markets Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 7 O O N 7 '~ Q C O R N C :C+ :d C O V d N 7 a m V C 7 N C R .L m A c m w d W w O v L w V A t V M o 0 0 ~ 0 0 0 »~ ~ O 00 O N M r~ M M i W M (>J ~ 1~ M~ N N N~ N o 7 dl = ~? o V ~ N ~- ti ~ N ~ ~-- W <D Cp O to ~ M M O O Q Oi N ~ r r d: r (O X 0 0 N O R N 00 N N E r M~ r r ~~ r O O M d~ OrD ~ M O~ ~ CD OO Ln N M M M f/1 O o 0 0 0~ o 0 0~ o ~ ~ M M 1~ N ~°,,. 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MHSA-related ED visits were three to four times more i.d~ancen. likely to result in hospitalization than other types of ED visits, 2007 ex:ela•r,:, e; lien., (ri ,','arc 100'/° • ~. ...... 42.9'/. ~~ ~ , -._ ...._.._.._ tid125L~~`. 6G ~ . - 'd3A6 w N 60% ... __ 11.6K W O rn a e m 40°i° v `m a 20% _ e o% MHSA{elated ED 4isits Manta) health conditions Substance abuse conditions Coooeurring MHSA All otlter ED visits only only condiMons ^Admined to Fbspital ~:. Treated and Rebasetl Source:PgenrytorHeaHhcareResearchendQueiry.HeallhcaroCOStandUllitaEOnProjea,NedonwideEmergeng0aparenentSampk,2007 ~HRt~ Figure 2. Admission rates for MHSA-related kdvaace,r~; ED visits increased with age, 2007 tl:!Jlr!: ~:Ie% 100% ,- ,. -. ._ „_. le.~ ~z~ :~r,z qD 9 'Sa,O 9b:? N_ ~ 60! _78.7 Tfr~3 O W - O ee a 40 V d Q 2U% fiin 1644 Yr 4564 Yr fi5+ Yr 16.44 Yr 4564 Yr 65+ Yr 18-04 Yr 45.04 Yr 65+ Yr Mental health condition only Substance abuse disorder only Co-occurrlny MHSA conditions iAdmhtedtotheHosphat ~~ Treated and Released Source: ggencybrHealdtcare Research and Cuallry, Healthcare Costand UOlization Project Nationwide EmergencyDapartrnenf Sample.2007 10 ~HA,a; Figure 3. Uninsured MHSA-related ED visits were two ;,d,.irt.-ins to four times less likely to result in hospitalization than rxre4?lice r:~ hr„rtr ~,,,. visits billed to other payers, 2007 10091 .. .:<.. ,:.: .. ~ .. ,:,:: 90% .. r~ ~~. 202 80°'0 4ti 1.. 42.0 39se 42.0 70% ! bsa 68.] .~ ~~ 67.7 86A ' , ~ n 7G:0 60"~ Ib2 Q 84;0 W m 5090 to R m 4D9o a 30! . . ~ t . 2090 10% e r g9b ..... ......__.. - __ ' ....._... .... ... __ ... ...... _.._._ -' .___. ._..._. ... . Medicare Medicaid Privato Uninsured Medicare Medicaid Private Uninsured Medicare Medicaid Private Uninsurod Mental trea8h condhion only Substance abuse catdition Co-occurring MHSA only conditions M Atlmhted to Hospdal ~ Treated and Released Source: Agency br Healthcare Research end Quality, Healthcare Cost end Utllizefion Project, Nationwide Emergency Department Sample. 2007 ~H,R~ Figure 4. The youngest adults disproportionately Anv:.nC,,,r~ accounted for ED visits related to intentional self-harm t:~tCC1iL':iCC t' H-°~rl~t ~~r~ and drug abuse conditions, 2007 ^1B-44 Yaars ~~46~6 Yaars ae+Yaars Intentional salt harm (792.939 visits) x27.6 ~ 3.4 Schlzaphrenia 8 other psychotic ,~ - ~ 371 ~ ~~ 21.6 disordere (1,180.445 visits) Drug-relates conditions (2.108,081 visits) - 1¢T 4:8 Alcohobrelatetl conditions (2.738,638 visits) ~ ~47.i. 8.0 Anxiety disortlera 13.124,412 visha) ^-®-~ 31.R 20.9 Mood tlisordere (5.101,384 vleda),- 34,2 .,Y 25.1 0% 20"t b0•:. 00'/: 80% 100°~° Percentage of ED visits Source: Ageney for Healthcare Researoh end Duality, Healthcare Cost and U911maon Project. Nationwide Emergency Department Sample, 2007; based on ail-liatetl diagnoses, Percentages represenlthe percentage of wntli6on speci6e MHSAreleted ED Wsits for pellenis witltin an age rategory. Percenrages total 700 percent 11 ~HRt~ Figure 5. Expected payer was associated with ::d.arurc specific MHSA-related ED visits, 2007 Exrtliarrci- rn Ftru!fr ~;rr~r ^Medirare ""Mediwitl PdvatY ^Unimwed Other Intentional aefl harm (788,033 visits) ® . 2,~;n 26.5 ~43 Sehizopl9ronro 8 othor psychotic disordefs (7,776,676 visits) 263 : 10.8 3.2 Drug-rotated conddions (2.089,719 ® '. visits) aax 18.9 -x4.7 Alcohol-rotated conditions (2,729,409 - ~ -- VIa1t5) IAG 24.6 ~.- .. Anxiety tlrsortlars (3,712,528 visits) 1i.: ' .32.1 ~ $:4 Mood disordefs (5,092,408 visits) _®~ 19.6 26.3 ':.,:® 3.3 095 2095 40Yo 60% 809E ]OlMS Percentage of ®Visits eaurw: ABerroY for Fba3heare Pesesreh and Curiry, Heatheara Cwt and Uufzatlon Rgset, aiiiomvitls Fimrganey papsrtment Sarrpk. 2007: based on aFfated diagnoses. Mssirp expeoted payer Inforrrr4on on 43.778 MHSA-raMad ®raeorw. Poreenspee reprasMtihe psrosrdags of eorWilion •pac3ic tA9SA-rapted ®vhi~ bgW to • WYn category. lir<ardagsa lota1100 psrcmt. 12 St. Lucie County Sheriff's Office De artment of Detention p Sheriff Ken J. Mascara 2011 Annual Report • ' i 1 s. f -- }' .. ~ <. i:. .:. ~ ... .. .~ Ms i ~. F. ;..l li .. '~ :: . ;._. ~. a ~. Year 2011 Review from Maior F. Patrick Tighe, Director of Detention In these uncertain economic times, one of the greatest challenges that we have faced in 2011 is maintaining a workplace culture that keeps staff motivated, engaged and performing their best in the corrections environment where they silently serve the public and an inmate population which is ever changing. This past year we have lost staff that moved closer to their families or onto other jobs within and outside of the agency. We did not replace any staff, in an effort to further reduce expenditures, until November 2011. Staff members who remain continue to perform their best under these conditions. Their perseverance to these challenges is reflected in our statistics; a decrease in inmate violence and assaults, a decrease in workers compensation claims, meeting compliance with the Florida Model Jail Standards Inspection and the Liability and Insurance Inspection which took place the latter part of 2011, and their excellence in keeping a safe and secure place for those who reside, visit, and work at the St. Lucie County Jail. In addition to the dedicated staff members, the community partnerships we have formed with the Public Defender's Office, State Attorney's Office, Indian River State College, Aramark and numerous clergy and volunteers from our Faith Community assist with the inmate programs, contributing to the positive impact on the lives of many individuals who are making positive changes for the first time in their lives. We are begimiing to see the impact of these programs. The recidivism rate of persons who participated in a program during their incarceration is 15%, compared to 33% for those who were not in any program. Persons who participated in the culinary program show a 5% rate of recidivism. The Department of Detention looked at ways to cut costs and increase cost savings in 2011. We partnered with Indian River, Martin and Okeechobee County Jails and implemented cost savings with bulk purchases in consumables as well as sharing in the inmate transports. In just the first two bulk purchases St. Lucie County alone saved approximately $8,665.00. In Fiscal Year 2010-2011 the cost savings from our transportation partnership was $21,743.70. Other areas that were discussed and/or researched but have not been implemented included bulk purchases for copier paper, sheets and towels, gloves, trash bag liners, and dental services. History of the St. Lucie County Jail The existing St. Lucie County Jail became operational in September 1987, housing 508 maximum, medium and minimum security inmates. Since then, more bed space has been constructed throughout t$e years to meet the ever increasing inmate population; increased space in 1990, 1993 and 2004. In 2004 with a rated capacity of 794, the average daily inmate population was 1184, exceeding the rated capacity by 390 inmates. With overcrowding a big issue, as with most jails, construction for 2 additional pods began and was completed in 2005, which increased the total bed space to today's rated capacity of 1370. The St. Lucie County Jail implemented the Objective Jail Classification System (OJCS) in the year 2005. This managing tool has proven to be successful in assessing the security, identification of special segregation, program needs and housing assignments in addition to the care of inmates and safety and security for all those who reside, work and visit in their facility. Contracted Service Providers * CORIZON Health, Inc. -Inmate Medical, Mental Health and Dental * Aramark Correctional Services -Food Service, Laundry, Commissary and Inmate Banking Facility Descriution The St. Lucie County jail is comprised of twelve (12) housing units with a total jail capacity of 1,370 authorized beds. The building also has administrative offices, a laundry facility, kitchen, chapel/multi-purpose room and processing unit. The facility is a singular continuous building that encumbers 284,000 square feet. 2 Carrent Department of Detention Personnel: 1 -Director of Detention (Major) 1 -Captain of Administration/Operations 6 -Lieutenants - Operations = 4 -Booking/Intake= 1 -Administration Support = 1 18 -Sergeants - Operation Sergeants = 10 -Booking/Intake Sergeants = 4 -Transportation Sergeant = 1 -Inmate Work Unit Sergeant = 1 -Training Unit Sergeant = 1 -Administration Sergeant = 1 198 -Certified Detention Deputies 31 -Civilians St. Lucie County Sheriffs Office Department of Detention Organizational Chart PRISONER . . ~RELIOIWB ~~ `PROGRAMS'..:. SHERIFF CNIEf '- DEPUTY MAJOR/.: ' EMERGE . :DIRECTOR CHAPIJIR! " RESPO OF DEiTENTION ~ ': TfiAI 4 _. . __ .- _.~ PRISONER ~ TRANSPORT i ~. M ~ ... INMATE '~ • • RECREATfON : '. _~~__ LR2UTENANT~'~ ~ DAY1 » 12 HOUR SNIFT ~ LIEUTENANT ~ DAY2 12 HOURSHIFr ' _ . j ADMIN19lRAtiYE i ~ NnAKEi ~ BOOKING LJEUJENAN7::~ ! ~~~ . ~ i FOOO SERNOE I: ~ INtARE/ BOONWD ~~ ~ . ~ I 'RELEA6E j r CIASSIFIGtTfON' •MANACFR ~ - ..7, ' INMATE .. CLA881FICATgN ADMINISTRATION INVE9TIi SERGEANT (FRONT-DEfM) _ t ~ce~ i ACCAEDITATN7N . ._. ._. INMATE YYORK '. ~~ PROGRAM ~ IEUTENANT 12 NOUR'SNIFT~ ~ .. MEDICAL6 ~ MENTAl HGA4TN'~ I EX OFFENDER - ~REOIStMT10N ~ t CONFMEMENf BTAlU6- i • TRAkIWO.UNIT• 4-j I .. .... .... LIEUTENANT ~:; 12 H TOUR 6NIF.T. .. . . • ... ~ FACILITY MAINTENANCE ~ ~ ~ .. F PRISONER PROQRAMS .,..: .: .. ...._ FIRE SAFETY.,. i 6 NIMATE .. '~ 'DISC IP.LN7E'~~:. Accreditations Florida Model Jail Standards (FMJS); The St. Lucie County Sheriff's Office requests annual FMJS inspections of the jail. The last inspection occurred in October 2011 in which staff received accolades for their professionalism and job knowledge. Florida Corrections Accreditation Commission (FCAC); The St. Lucie County Jail first received accreditation in February 2000, and has maintained its accreditation status with the Florida Correctional Accreditation Commission since then with inspections every three years. The most recent inspection was in January 2012, meeting 100% compliance with the standards. National Commission on Correctional Health Care (NCCHC); Accredited was initially awarded to the St. Lucie County jail in 1998 and having maintained the .National Commission on Correctional Health Care Standards for Health Services in Jails since then with the most recent reaccreditation in November 2010. Classification The average daily inmate population in year 2011 was 1,217. The St. Lucie County Jail houses federal inmates for the U.S. Marshals Service under contract, offsetting some of the shortfall in the county budget. The average daily federal inmate population in the year 2011 was 62. Classification has used the Objective Jail Classification System (OJCS) since year 2005 as a managing tool which has proven to be successful in assessing the security, identification of special segregation, program needs and housing assignments as well as the care of inmates and the safety and security for all who reside, work and visit the jail. The Classification Unit processed a total of 10,071 initial assessments in 2011. These assessments along with a Classification interview prove to be paramount in proper inmate housing placements and to identify the special needs of each inmate to receive treatment based upon the assessment. This process meets the guidelines established by the National Institute of Corrections. The Classification Unit continues to monitor the increasing female population, special needs, mental health and physically ill population. These populations can stress the jail management system by demanding limited space in housing, straining the medical provider and services and by the changes in management strategies to ensure a safe incarnation. The pain killer epidemic continues to be the driving force behind the increase in the female population which averages about 17% of the jail population in the St. Lucie County Jail. Additionally, they have found that the amount of mentally ill inmates with chronic illness and inmates who are physically ill has increased because of the limited resources available to them in the local community. These populations can stress the jail management system by demanding limited space in housing, straining the medical provider and services and by the changes in management strategies to ensure a safe incarceration. Despite this, they have been successful in diverting some of those inmates from their facility through clever cooperation with the Public Defender's Office, the Pre-Trial Program, their medical provider Corizon Health, and the judiciary to release them under their own recognizance, thereby relieving the county tax payers. Recidivism Rates - 5% for those who previously participated in the inmate culinary program during a previous incarceration. - 15% for those who participated in an inmate program during a previous incarceration. - 33% for those who did not participate in any inmate programs. 4 St Lucie County Sheriff's Office, Department of Detention Average Daily Inmate Population Years 2000 - 2011 1700 •- -- ---- ----- --- - -- . - - --- -- - ----- , tr . .. ,. ... : ,_ _ 1600 .9553 1500 1 438 - ~~ 1400 1383 ,I ~ ~ ~ 1300 _ ' ,z~r i a lyea 19 s2 i , i • 1200 . - -- - 4'108 1 ,rA 2 - ,~ C 1100 t : ti ~ ~ ~ ~ 1000 ' ' 97 a k . ~ 1 ~i 4 - f 900 ~ Q .815 : i! 7 788 ' y_i '' !^ 800 - . ~ ' ~ - ~ - ~. .'' ` !!: 4 700 - 600 ~ .. ~, ._-- ~;. ~ r -. . ~ `,. r r , ;. -. 2000 2001 2002 2003 2004 2005 2008 2007 2008 2009 2010 2011 Year Inmate Assaults The St. Lucie County Sheriff s Office, Department of Detention, indicates their inmate assaults on both officers and other inmates continues to decrease. They contribute this partly to the many inmate programs and staff training. St. Lucie County Jail Inmate Assaults -Inmate on Inmate Assaults --Inmate on Officer Assaults ~ Inmate Programs A wide spectrum of services, activities, and programs for inmates are provided. The St. Lucie County Sheriff's Office, partnered with other local agencies and volunteers, is successful in creating inmate control in their facility as well as aiding in the recovery of many individuals through their inmate programs. Inmate Programs Include: - Substance Abuse Program -Spiritual Learning Program - Adult Education/GED Program -Culinary Program Other programs and activities for inmates include horticulture, carpentry and physical fitness. Descriution of Inmate Programs The Journey Forward, Substance Abuse Program, a partnership with the Public Defender's Office, Department of Children and Families, Corizon Health Services and several local faith-based community leaders is a 90-day therapeutic program designed to promote long-term recovery and successful re-entry into the community. This program is structure to help participants identify the root causes of their addiction, enhances motivation to change, and assists with new ways of thinking/coping to navigate the challenges of life in recovery. These individuals receive continued assistance after release with after-care programs through the Public Defender's Office and housing through 23 faith-based halfway houses. The Adult Education/GED Program in the St. Lucie County Jail was created by the St. Lucie County Sheriff partnered with Indian River State College (I.R.S.C.) as a way to assist inmates who lacked proper education and training, many who were considered unemployable, which in many cases may have been contributing to their repeated offenses. This comprehensive Adult Education Program is designed to address these issues. Individualized for each student, the program helps with reading, mathematics, language skills and GED exam preparation. The Spiritual Learning Program, created in the St. Lucie County Jail in 2009, is providing positive growth through spirituality. This is a 90-day program which includes scripture study, group meetings, meditation and worship. The St. Lucie County Sheriff's Office Chaplain and over 200 local faith community volunteers provide a structured environment on a daily basis. The Culinary Program "In2Work"; is a program in which the St. Lucie County Sheriff's Office partnered with Aramark Correctional Food Services and Indian River State College to offer candidates culinary training from a certified instructor. The participants who successfully complete this cumculum receive a State of Florida Food Service certification. Those who participate and complete the college portion of the program receive college credits to be used at Indian River State College upon release. In fiscal year 2010-2011, inmates urepared 1.298,484 inmate meals and 32.716 staff meals. Inmates in this program also prepare and/or serve various meals for special meetings and events at the jail and for the St. Lucie County Sheriff's Office including Sheriff Mascara's annual clergy appreciation luncheon. Meals. on Wheals are prepared at the jail by inmates in the culinary program who experience the rewards of community service and learn proper nutrition and food preparation. In fiscal year 2010-2011. 96,613 meals were prepared by inmates in St. Lucie County Jail's Culinary Program for Meals on Wheels. 6 Inmate Pro>rram Statistics Years 2010 & 2011 (As of November 2011) Program Statistics Years 2010 - 2011 Public Defender Re-entry ' Cuiina~P~nuq "Ct7linarjr,'P-1~tanr~ SplrkuaLLeaminp IRSC -GED - ~~{Saie6tatT _- ~` The Journey Forward t:etl~led- SYarled ` '1RSC Colbge COUrxet: ~ Starledln2009/Lagan YEAR 2U07 ' S[nrted Jan ~1 Gackln In 2010 Limited to 15 Ie r month to take the test MPaAlel tad flCom eted ! htM s w MP abd '7lCom NPenid eted Com tad Tested Test 2010 670 99 =fu8` '182` ~ 'r ~ +239 57 731 185 140 78 2011 558 84 "Itf9 '110 446 30 228 i4 465 135 130 81 TOtelB 1226 193 #47 '' ZA2 .148 ;r76 487 131 1198 300 Z70 137 Inmate Work Unit Prosram The St. Lucie County has an Inmate Work Unit Program currently consisting of three work crews with 4-10 inmate workers who initiate and complete a myriad of projects daily throughout the community including roadside clean-up, small furniture repair, construction, landscaping, small engine repair, and the installation of irrigation systems. In partnership with a local radio station, inmates in this work program have repair and recondition hundreds of abandoned bicycles that are utilized in the annual "Christmas Kids" program. Bicycles are also given to inmates being released who need transportation. The following cost savings are reported by the St. Lucie County Sheriff's Office Inmate Work Unit Program for projects and work performed: Inmate Work Unit Cost Savings Years 2010 & 2011 Number of Inmate Wort: Labor Savings .Hours cr.•: $12/hour ~ .. 2010 41,740 $500,880.00 2011 67,943 $815,316.00 TOTAL $109,683 $1316196.00 Transportation Statistics Fiscal Year 2008 - 2009 Number of Transports to Court = 17,125 Total Number of Miles Driven = 129,689 Fiscal Year Fiscal Year 2009 - 2010 2010 - 2011 15,961 14,395 133,395 129,137 2011 Medical Transports = 287 2011 Baker Act Transports = 71 2011 Total Inmates Transported = 19,693 The St. Lucie County Sheriff s Office, Department of Detention initiated a collaborative with several other Treasure Coast Jails to share in transporting inmates. In the year 2011, this collaborative resulted in the utilization of staff more efficiently and an estimated $21,743.70 cost savings for St. Lucie County Sheriff s Office. 7 Boolan~ Unit Statistics for Fiscal Year 2010-2011 BoaKin /;Releases Total Bookies 11,463 Total Char es Booked 24,386 Total Number Released 11,444 Juvenile Bookies 96 ICE Faxes Sent 884 Ice Picku s 164 Boiatis Suret Bonds -Number 7,660 Suret Bonds -Monies $35,935,447.75 Cash Bonds -Number 954 Cash Bonds -Monies $780,419.00 Us~e'of Force.. Ph sical 9 Chemical 4 Restraint hair C 26 ~.( n Cflr~at~r~d i, Mari'uana 28 Crack/Cocaine 9 Prescri tion Medication 27 Wea ons 2 Other 23 ,. Merital~-t~ealth Suicide Attem t 2 Suicidal Threats 341 Diversion to Mental Health 10 S'.'.. ' . ...~.,.. Medical) Refused 113 Medical Emergency 15 Lobby/Switchboard The lobby clerical staff has efficiently scheduled over 1700 professional appointments for inmates and their legal counsel in 2011. In addition they assist visitors and issue facility passes, answer numerous telephone requests and redirect them accordingly, and write cash and surety bonds. Law Library/Indigent Inmate & Legal Requests The library is responsible for supplying inmates with reading material, books and also legal requests which are researched through the Westlaw services on the Internet. The library issues 300-500 books and magazines to inmates weekly and between 150-2001egal requests weekly. Each inmate is allowed three legal requests a week. Over 2000 legal requests have been processed in 2011. Every request is answered with a copy returned to the inmate and the original forwarded to the Classification Unit for placement in the inmate's classification file. Americans with Disabilities Act (ADA To comply with the 2010 ADA revisions, handicap grab bars have been installed in the Medical and Booking Units to assist inmates who are handicapped or disabled. Training Unit The St. Lucie County Sheriff s Office, Department of Detention maximizes their department's operational readiness by training their personnel in all aspects of employee, inmate and civilian safety, health, security, and legal issues. Much of this is done through Essential Learning which provides on-line training courses which employees can do at their discretion while meeting the training deadline dates. The following is a list of completed training and other tasks by St. Lucie County Department of Detention Training Unit during year 2011: • 904 hours of firearms training • 148 hours of remedial firearms training • 24 hours of auto transition training • 141 completed inmate phone work orders • Facility phone audit • 4462 hours of Essential Learning on-line training for detention deputies • 912.5 hours of Essential Learning on-line training for detention supervisors • 144 hours of detention deputy orientation • 80 hours of detention clerk orientation • 188 hours of detention civilian orientation Crisis Intervention Team Training has been a positive program for the St. Lucie County Sheriff's Office including the Department of Detention staff by providing them with knowledge and skills to improve their responses to individuals with mental illness, developmental disabilities and substance abuse challenges. This positive and progressive program provides training in de-escalation techniques and crisis intervention. Since inception, we have witnessed a steep decline of inmate/officer assaults, use of force incidents and staff/prisoner injuries. We continue to send staff to this vital training. Emergency Response Team The Emergency Response Team (ERT} was established in July 2001 to respond to specialized emergency situations occurring in the correctional facility beyond the normal response capabilities of shift personnel. In addition to numerous hours of training and performing cell checks/shakedowns, 136 hours of high risk court escorts were performed by the ERT team in 2011. Chaplain Services Calendar Year 2011 Total Inmate Participation in Chapel Services = 38,733 Total Individual Inmate Counseling Services = 3.686 Total Number of Inmate Contacts = 42,419 Community Contacts = 6,097 The St. Lucie County Sheriffs Office Chaplain serves the employees as well as individuals who are incarcerated. The Chaplain makes numerous community contacts from social and school events, retreats, community clergy and ministerial meetings, staff visits and other civic and church community contacts on behalf of the Sheriffs Office. The Chaplain also assists with the community 911 Memorial Service and the Sheriff s Annual Clergy Luncheon. 9 Central Services County Maintenance / Energy Conservation for the Jail Information provided by Roger Shinn, St. Lucie County Central Services During year 2011 the St. Lucie County's Jail Maintenance and Facilities staff along with contractors have completed various special projects including but not limited to the following: -Medical -Removed part of cell walls, reinforced ceiling in group cells and added electrical wiring for dialysis machine. - Kitchen -Replaced flooring, rewired island, replaced three floor drains. - Delta 1 & 2 -Removed all day sinks, installed 288 air vent hatches and reinforced 13 shower plates. - ADA -Front door, parking lot access and grab bars in Booking and Medical. - Lobby -Replaced sewer line. - Windows -over $60,000.00 spent on replacing cracked windows throughout the facility. - A/C Vents -Cleaned by outside contractor. - Lighting -Outside lighting was replaced. - Sally Port -Door replacement. - Cameras -Added cameras in transport, room #120 and #122. Central Service Maintenance Work Orders for the Jail in Year 2011: Submitted Work Orders: 3973 Completed Work Orders: 3822 Offender Registration Offender Registration is handled at the St. Lucie County jail in the lobby. The following registration statistics were reported in 2011: Sexual Offender/Predators Registered = 48 Career Offenders Registered = 7 Department of Detention Investigations Unit The St. Lucie County Sheriff s Office, Department of Detention Investigation Unit in 2011 implemented and performed several security, safety and investigative measures, including Operation Gatekeeper and Turning in Potential Suspects (T.I.P.S.) which have been successful. Operation Gatekeeper resulted in the following: License Plate Reader (LPR) Vehicle 720 tags captured Warrant Checks 235 Drivers License Validation 235 Arrests 12 Felony Arrests 2 Misdemeanor Arrests 10 Traffic Citations 8 Warnings (FR suspensions) 5 Vehicles Towed 2 Confiscated 64 Grams of Marijuana 2 Tablets of Hydrocodone 1 Hypodermic Needle 10 T.I.P.S. T.I:P.S. is a broad scoped initiative which presents "wanted suspect", "need to identify" suspects and crime bulletins to staff and inmates in efforts to solve ongoing, future, past and cold criminal cases. Additionally, inmate population is accessed which has resulted in the following: * 1 Firearm recovered * 1 Stolen auto recovered * 11 Morphine tables and 51 grams of cannabis found * 5 Wanted Suspects * 2 Wanted Suspects Identified in connection of three armed robberies Criminal Investigation (Jail) Results: * 43 Felony Arrests * 4 Misdemeanor Arrests * 62 Grams of Cannabis Medical / Corizon Health, Inc. Inmate Care Fiscal Year Oct 2010 to Sept .2011_ Medical Intake Assessments = 10,995 Sick Calls = 12,441 Ambulance Trips = 58 Hospital Admissions = 49 Other Out-Patient Visits = 316 Inmates on Prescription Medication = 5859 HIV Cases Treated = 423 HIV Tested = 1493 Psychiatric Evaluations = 1823 Inmates on Psychiatric Medication = 3430 Corizon Health, Inc. staff includes: Clarence Cryer, Health Service Administrator Dr. Jaime Jorge Patrick Kane, Director of Nursing Misty Gaddis, Nurse Practitioner Food Service / Aramark Inmate Meals Served: 1,298,484 Staff Meals Served: 32,716 Meals prepared for the Meals on Wheels Program: 96,613 2011 Purchases & Improvements * Transportation collaboration with other treasure coast jails saving on staffing and costs. * Cost savings on bulk purchases for consumables in collaboration with other treasure coast jails. * Video Visitation proposal for a new system was put out to bid in 2011 and a vendor was selected. This system should be installed and operational in 2012. 11 Budget Due to budget restraints and a decreasing budget, staff has worked at the St. Lucie County Sheriff's Office Department of Detention without raises for five years. As positions became vacant they were not replaced until recently, in November/December 2011. The St. Lucie County Sheriff s Office Department of Detention's budget has been decreasing: Year 2008/2009 2009/2010 2010/2011 2011/2012 Budget $28,742,883 $28,835,837 $28,165,118 $26,124,888 The St. Lucie County Jail has seen a change in the inmate population with the increase in females, and people with special needs/mental health issues and those who are physically ill. These populations can stress the jail management system by demanding limited space in housing, straining the medical provider and services and by the changes in the management strategies to ensure a safe incarceration as well as the budget for caring for these individuals. The jail's medical service provider, Corizon, along with the auditor for medical, Alliance Medical, and St. Lucie County work together on case management for cost efficiency and the best care for these individuals. The pill epidemic continues to be the driving force behind the increase in the female population which averages 17% of their jail population. The amount of mentally ill inmates with chronic illness and inmates who are physically ill has increased because of the limited resources available to them in the local community. The St. Lucie County Jail has been successful in diverting some of those inmates by cooperation between the Public Defender's Office, Pre-Trial Program staff, Corizon Health, Inc, and the judiciary to release them under their own recognizance, thereby relieving the county tax payer. Various agencies throughout the county have also sent their staff to be training in Crisis Intervention Training (CTT) which has been helpful in jail diversion as well as deescalating situations when individuals who have mental illness are incarcerated. On January 4, 2012, 43% of the inmate population in the St. Lucie County Jail is considered indigent. Current and Future Challenges As the St. Lucie County Jail expanded from approximately 508 inmates with additions built increasing their rated capacity to 1370, the kitchen and medical unit remained the same which continues to be a challenge for their contracted service providers as well as classification for inmates requiring housing in their medical unit. Despite these challenges, the St. Lucie County Sheriff's Office, Department of Detention, has been creative in looking at their procedures and processes for efficiency and cost savings. One way they have accomplished this is through their Inmate Work Unit, saving the tax payers of St. Lucie County an estimated $815,316.00 in year 2011. In addition, they have not only cut costs for their agency but for several other Treasure Coast Jails that they share in transporting inmates and make bulk purchases for consumables. Through their transportation collaborative, St. Lucie County Sheriffs Office alone, had an estimated cost savings of $21,743.70. Since 2010, the Department of Detention has lost staff due to relocating closer to their families or onto other jobs within and outside of the agency. In an effort to further reduce expenditures, they did not replace any staff until November 2011. Both the operational characteristics of the jail and the associated staff-to-inmate ratio pose challenges which the staff members of the St. Lucie County Sheriff's Office, Department of Detention have managed to overcome through training, dedication and management oversight, to run their facility safely, securely, and efficiently. .:. , . 12