Board of County Commissioners - Regular Meeting

And in there, we are signaling to this board, here's what we're going to come back to you with in the 25-26 mid-year item.

So in other words, this is going into reserves for now until we can make a decision at the mid-year.

Yes ma'am. 4.7, which is a large sum, is from 24-25. Absolutely.

Thank you. Thank you. Bye.

Good morning, Commissioner Bastian, Commissioner Bermudez, Commissioner Cohen-Higgins.

Good afternoon, President.

Senator Garcia, Commissioner Gilbert, Commissioner Gonzalez, Commissioner Hardiman, Commissioner Lopez. Here. Commissioner Millian-Orbis. Present. Commissioner Regalado.

Present.

Commissioner Steinberg? Vice Chairman McGee? Chairman Rodriguez? Present. Eight members present, you have a quorum?

We don't need a quorum, but yes, eight members present. All right, please stand, rise for the invocation this morning. A few words by Commissioner Vicky Lopez, followed by the Pledge of Allegiance.

Thank you, Mr. Chairman. If everyone would bow their heads. Heavenly Father, thank you for the opportunity to serve this incredible county in today's discussion. May we feel your presence and your spirit as we attempt to move forward something that is incredibly important to all of us. We ask this in your holy name, amen. I pledge allegiance to the flag of the United States of America and to the Republic for which it stands, one nation under God, indivisible, with liberty and justice for all.

You may be seated. All right, Madam Attorney, can we proceed into the only item on today's agenda?

Yes, Mr. Chair, you have one discussion item regarding the proposed mental health facility, and it would be appropriate to do that now.

Let's take out of it to a which is my discussion item on the mental office in and I'm going to start with the administration if they're if they're ready. But look I'll say this I call this committee of the whole in response to committee chairwoman Vicky Lopez's risk request to my office to discuss the proposed mental health facility and and so I think you commissioner for for taking that initiative. on just getting some of the, and I know there was more than you, but you sent me the memo, because ultimately what I've said time and time again, I just did a couple of interviews before this meeting on this very topic, is we just need, there's a lot of just unanswered questions that we've asked time and time again and have not received the response. And I, for one, could separate not receiving the response I want from just not receiving a response at all. And a lot of the questions we've just not received any response. And that's what worries me. And as I outlined in my memorandum, My response in calling this committee the whole, the purpose is for us to discuss the proposed funding plan for the facility, including the projected cost, funding sources, long-term financial impacts, and the demonstrated need for the project. The goal is to ensure there is a clear and sustainable path forward that addresses both the current and long-term demands of this facility. I will first allow the administration to give What I understand, they have a presentation. Who will be doing that, Chief?

Yes, thank you. Through the chair, I wanted to make a small comment. Under Mayor Levine's cover leadership, this project, which has long been stalled, was given new life and administration has worked hard to honor the county's commitment to the court and the community. As you will hear from our staff, we're going to have a brief presentation. We are able to fully fund the center operations without any reliance on the general fund or additional general funds for the first three years. In our effort to make sure every dollar goes as far as possible, we took another hard look at operating costs. I'll take this moment to thank some of the commissioners that were very I guess put us to put us to make us sharpen our pencil and we looked at it and we came back and we reduced some costs. And I think you'll be happy with the presentation. We were able to reevaluate the cost of maintenance and shift those savings into programming. So we anticipate operations will be covered for three years rather than the two years based on the available funding. It is also important to point out that we are not using any projected savings. We are not using any savings to offset our costs. The first three years of operations are covered with available funding streams. We have those streams currently here. We will develop alternate plans if needed. Again, if the commission decides to change the plan, alter the plan, or request a change, we will provide an alternate plan if needed for the future. But we have worked hard to develop this program. on GOB, our lease, with the state and the board's discretion or direction. Under the mayor's direction, our team assembled the funds and partners to make it happen and make this project a reality at last. So if you will entertain us for a few minutes, Mr. Commission Chair, I will call for Kathy Burgos, the Community Services Director, and she will present our presentation. Thank you.

Good morning or afternoon chair and commissioners. Thank you for giving us the opportunity to present a mental health model that focuses on evidence approaches to recovery and resilience. As the chief mentioned, I'm Kathy Burgos and it is our department that will oversee the mental health facility. The mission of this project is to divert individuals who are severely mentally ill through a continuum of care which includes case management and wrap around services. As contracted through the board resolution, you directed us to negotiate contracts with two providers. The first one is WestCare, who will be in charge of clinical services for crisis, short term, and long term beds. The second provider that you directed us to negotiate with is the advocate for ancillary services. We understand that this model is in need of wraparound services as well, such as primary care, podiatry, so on and so forth. We wanted to also share that we have two complementary programs that will be involved or being proposed for this project, which includes New Direction, which is a program that's currently under our community services department, focused on those who struggle with mental illness. As well as substance use and dependency. We're also including in this project another program that truly complements these services, which is the homeless trust with behavioral health care and transitional housing. I want to express that this complements the programming. It is not a duplication of services. We also wanted to share with this board the center structure. It is important for us to really present a model that's comprehensive. We've included on the first floor, we would have intake and triage. The second floor, we will have crisis stabilization, which are the ten beds. The services will be provided by WestCare as well as short term beds on the fourth floor. And on the fourth and the fifth floor, we will have long term residential services. On the fifth floor is the model that I just mentioned, which complements these services, clinical services provided by WestCare, which are 24 beds with new direction. And then on the sixth floor, we have WestCare and the Homeless Trust providing behavioral care and transitional housing. On the seventh floor, which we plan to build out, we will have an opportunity for future expansion. We're excited to report that it includes a research and evaluation. The advocate program will contract with an accredited academic institution to independently evaluate the effectiveness of this model. Ensuring outcomes are measured, reported, and that we continuously improve this continuum of care. Transitioning to outpatient. This is a model that focuses on clinical services, as I mentioned, as well as wraparound services. The current clinical provider, which is WestCare, brought in-kind services to this model, and the in-kind services includes outpatient. It's important to point out that as we serve the population, when they re-enter their communities, there will be support in order to sustain the changes that the clients have experienced. If the pilot ends, we will really focus on transitioning appropriate care through a network of already established behavioral health providers across the county. We will have an extremely close relationship with our managing entity to ensure that we have access to the network of providers. No client will be left without a care pathway. We wanted to share, and it's in line with what our chief, Chief Palmer, shared with the group. We do have the two year outlook. So the fiscal impact to the county, the cost for WestCare, which includes crisis beds, short term beds, and long term beds. For the two year period, it costs $25 million, $25.5 million. For the advocate program, when we look at the two year outlook, the cost is $3.6 million. The last cost is our building expenses, and within our building expenses is $9.25 million. This gives us approximately $38 million in total. The revenue sources, and this also includes the two-year outlook, Within the plan, we have 34.5, almost $35 million in opiates funding, 5.6 in Miami rescue plan funds, 3.85 in the new direction treatment program, and 2.24 which the homeless trust will be contributing to the programming. Non-county funds will include 7.6 million, and this is for federal and state funds secured by WestCare, and $774,000 non-county funding obtained by the advocate. This is a total of $46.3 million. The county will continue to pursue additional funding opportunities and the advocate program is contractually obligated to engage in continuous advocacy as well as funding efforts. Thank you.

Thank you, Chief. All right, thank you for this. All right, so before I open it up to my colleagues, I would like to share a few comments and questions of my own. I may bounce back and forth between. Commissioner speaking, but so I recently visited. Our tgk 1 of our corrections facility. Which chief Palmer was there and some others from corrections leadership team. I know some, some from that I see here today. Thank you for coming out and for being so thorough and. During my visit, and I toured all of the mental health. Floors both male and female. And I was, I mean, look, it's a site that nobody wants to see. I don't think I was functional the rest of that day, and perhaps the week. But I was pleasantly surprised as to the work that both our corrections department and CHS, the Jackson team placed there, are doing. It surprised me, and it shouldn't have, right? What, over a decade? We were in a consent decree, or two decades? We were in a consent decree, and the fact that we were released from that consent decree last year, I think speaks volumes as to the work that both our corrections department and CHS is doing over in our corrections system. But from how patients are assessed and treated, they walk me through that. where progress is being made, where it lacks, where gaps challenge exist. And in my conversations with them, mostly with CHS, Some of the insights highlighted were, of course, the ongoing challenges of providing consistent mental health care within the correctional system. There was a few, not as many as I thought or anticipated, but there was a few. But the one that stood out the most to me, and it's important and I encourage my colleagues to really do a deep dive into this and even go out there and tour our corrections facilities if you haven't yet, at least if you haven't done the mental health floors. But what CHS really pointed out, and it almost took them two or three times to say this before I caught on to it, is that we have a select amount of inmates, I believe the number they told me a week and a half ago was about 65 or so, that are awaiting to be transferred out to a competency restoration treatment facility. And I said, wow, so this could really help. I mean, this is a no-brainer, despite any cost. This would be no-brainer to open up this mental health facility and transfer these folks over. To my surprise, none of these inmates would qualify to go to this facility. These inmates need to go to a state hospital. This facility is not a state hospital. This is an information that I'm making up. This is an information said to me by someone on the street. These are the leadership team of the administration and of CHS. Side note, I'm surprised that no one has done this, that none of my colleagues has done this. I'm surprised this hasn't been done before, and I'm surprised the administration hasn't done this. But I've gone ahead and put a hold and started legislation on directing the administration to make our facilities certified to be a competency restoration treatment center because one thing i learned during my visit and chief palmer was there is that we're equipped we've got the know-how we've got the tools we've got the experience the chs team is experienced and qualified they have the credentials we just need to get accredited by the state And we would solve a huge gap that we currently have and have had for years in our corrections department. A four to six month wait is the average wait that I was told. Some could go more, that's just an average. Could be eight months, nine months waiting for a state hospital. It's honestly unconscionable to see these humans, these people, they're people just like you and I. Having to sit in a cell because there's no space in state hospitals and we have not taken any action prior is beyond me. I just learned about it. The minute I learned about it, I looked to my team, I said, we have to fix this. Especially if the corrections is telling me it could be fixed. But going back to what we're here to discuss, the mental health facility. As we move forward, there are several questions, very important questions, I believe, that I've asked, I've not received clear answers to. And so I will ask a few here today, and hopefully we can get to the bottom of it. So first, Chief Palmer or Kathy, Chief in your opening remarks, you talked about a 3 year plan. I mean, to me, it's a year of 12 months here, 12 months, but. You talked about 3 year, but the entire presentation is based on 2 years is 1 hand not talking to the next. I'm confused as to why you're opening remarks. Talk about. 3 year funding, but the entire presentation is based on 2 year funding. So, is the presentation not updated? Was it not communicated to Kathy? that you have allocated an additional year?

No, it was done intentionally, sir. The presentation is based on the item in front of the board, which is the two-year pilot project, which is the instructions we were given by the commissions. The three years is we went back at the request of the board, sharpened our pencil, argued, fought about it in layman's terms, and we discovered that we, in fact, do have three years of funding. So I wanted to put that out there. We have three years of funding. Our budget management can attest to that. Kathy presented two years as instructed by myself because that goes and speaks directly to the item in front of us. It was not a miscommunication. It was not intended that way.

So for the record, and I just got a call yesterday at 7 p.m. from the mayor of the county to explain this to me. Something that I understand was explained to other commissioners well over a week ago. But the chair of the board did not matter to be explained this what was requested at committee, which was not an official. Directed because it did not go to the board, but what was requested at committee. To come back with a 10 year plan was not. Contemplated was not thought to be. A good idea to bring back to this committee of the whole, I just find out at 07 PM last night. That it was a 2 year or 3 year plan that was being brought. Not the 10 year that was requested. I'm sure you're very prepared for that question because you knew that that was coming and you're going to have a very clean answer for it. But take a stab at it just because I wonder how. I'd like to see your clean answer on that chief. And I'm being very honest.

I'm not being, I'm going to give you an honest answer, sir. Uh, we know the money that we have currently, we know we can project two years. We know after sharpening the pencil, we have three years. I could not in good conscience tell you what projects we're going to fund or defund in seven, eight, nine, or ten years from now. So I verbalized that to the commissioner that made the request. I said, I'm being honest with you, I don't know how to do that. I don't know how to give you ten year projections. I can give you ten years of what grants we have now, but some of them will expire and some of them will be gained. So to give you a ten year budget will be difficult. And at best it will be a guest for me and I don't want I didn't want to do that. So that's why I don't have the answer for that.

So chief and I appreciate that and I trust that you're you're obviously being very forthcoming and I appreciate that and I respect you immensely. My question then maybe to Carla Denise is when it comes to our budget doesn't government isn't our budget a five year and there's even a 10 year forecast.

Through the chair, yes. Most organizations will forecast or create plans that go anywhere from one, three, five, or ten years. Those are the normal typical cycles of trying to project what is needed.

The answer is yes. So yes. And I know the state does it too, because I was in the legislature, as we've all discussed plenty of times. So we can, in essence, in this county, which is a massive county, We can forecast at least the next five years of our budget across the county departments. But we cannot forecast a single mental health facility of what it's going to cost, whether it's expenses alone or income, but we cannot forecast anything beyond Now I'm hearing three years, even though the presentation is only alluding to two. So that's not doable for this mental health facility, but it's doable for every other massive department and system that runs through our county.

No, sir. I'm sorry. I'm sorry. Did you want to? No. OK, go. No, I just wanted to clarify through the chair. We can tell you what the anticipated expenses are. The original item had five years of those anticipated expenses. So yes, the budget that we even produced for the county Shows what our anticipated expenses are based on the current run rate. Revenues we do on an annual basis. So revenue is done on an annual basis, but we can project expenses based on our current run rate. If we were kept everything the same revenue is annual.

Okay, so do we have at least the expenses moving forward?

Yes, Sir.

Is this 2 year plan here for the existing beds which I have a question on whether it's I keep hearing 75 now here there's an additional 24 so it might be 99. I'm unclear as to how many beds world we would open up if this move forward is is are these numbers based on those beds or is it based on full capacity of this facility.

No, those numbers are based on the programming that we have in the existing facility. So 75 will be critical beds for significant mental illness, 24 are new direction, 48 are homeless transitional housing. And it's not a capacity. We still have another floor available that we can do for future expansion. But this budget covers all the programming that we currently have inside the facility as a wraparound total answer for what we believe is needed. That's what we have.

So this budget is for the building of full capacity with the exception of the last floor that's not built out which we still need to spend millions of dollars to build out but this this budget is for full capacity not for the 75 beds today this is for the 200 beds capacity that the building will hold.

Through the Chair, I see why it may not be crystal clear. The reason why you have heard the 75 number is that because we were directed to negotiate contracts, the providers, when it comes to our clinical provider, WestCare, they will be serving the 75 beds. But we went back and did our homework, and we saw services that would complement the model of 75. So that's why, to the chief's point, you're seeing 24 beds for a new direction, which is a population in need, as well as the 48 beds with the homeless trust. So that gives you, and I did the math really quick for you, that gives you, according to the model that we're presenting today, that gives you, Chair, 147 beds. When we checked in with our P I O D department, they shared with us that in full capacity, the facility would be around early two hundreds. It was something like 206, 209 to answer your question specifically.

Chief tell me what what what is the criteria for determining which patients will be sent to this facility instead of. Current facilities within our corrections department. I'm not stuck by the way that question I've asked and this times with no answer not an answer I don't like not A partial, just crickets. So what is the criteria? No one's been able to tell me what is the criteria. If I have a friend, how do I get there? How do I get someone? I may need to check myself in there after this. And that's no laughing matter. Because it is beyond me how basic questions have not been answered and the ones that have been answered have been answered with different, you know, answered one way from one person answered a different way from advocates for the some that are here today. But I just continue to get different answers or no answer. This is one that I've got a no answer. What is the criteria to answer that one?

So A Baker Act, a routine Baker Act can be taken to the facility and it will receive a Baker Act. And the amount of Baker Acts we can take is innumerable and it will be difficult to give you a number on that. However, this is a diversion program. Someone is arrested. When they're arrested, they get introduced into corrections. If they have a mental illness, we'll put them into our mental health center. At that time, public defenders, private attorneys, the judges request CMS, and CMS is here and they can speak to this, to do an evaluation. There's an evaluation done of that offender. Depending on the crime they committed, if it's a misdemeanor, there's a certain criteria. If it's a felony, there's a certain criteria. But depending on the crime they committed and the ability for the state attorney to gain compliance or acknowledgement from the victim, we can divert them. There are, right now,

Hold on, Chief, because it's different than what I learned. We can divert them or a judge can divert them?

We meaning public safety. We meaning the judges, the public defenders, the private attorneys.

We would physically transfer them, of course.

Directions would transfer them, but the system would identify them for diversion and the system will transfer them to diversion. We would do the physical transport to the facility.

A judge will determine that?

Yes.

Okay, so continue with the criteria.

Nonviolent misdemeanors? Most misdemeanors and nonviolent felonies qualify. There's a number, and again, a criteria is difficult to hit because there's a lot of variables. Depending on the crime they committed and depending on the criminal past, it depends on whether or not we can divert them. If they committed a crime of significance or a personal crime, the victim may not want to wish the state attorney to divert the mentally ill patient, so we won't be able to do it. But in general, all misdemeanor crimes and nonviolent felonies can be diverted through the request of the court and the court diversion program.

So what you're saying is accurate. That's what I learned a week and a half ago. But to the naked ear, it's not entirely forthcoming. What you're saying is true. What's coming out verbally is true. But to the naked ear, it's saying we can divert all these people. It's not that simple. It's not that simple.

We cannot divert all of them. I never said that.

No, no, no.

We can divert a significant amount. It is our hope that we can divert 60-something individuals because we need to, to make space at the jail and to help them with their medical condition. But I never guaranteed any diversion because it is not up to me. As you clearly stated, it's up to the court to divert them.

What partnerships have been made with local providers and agencies to ensure continuity of care after individuals leave the facility? So now you get in, you're there for X amount of time, I understand it's going to be temporary. You're only there temporary, several weeks, maybe a couple months, two, three months, but it's not a long term facility. The idea is to get you better and get you on your way. What's in place afterwards?

Through the chair. What a wonderful question.

Kathy, do me a favor. Let's get to the question. Absolutely. I will go there. I just got excited. All my questions are going to be wonderful. Mostly because I'm the chair of the board. So like everybody's going to say that they're like, let's just get to the answers. I'm sorry, but let's get to the answers.

So to answer your question specifically and directly, we will work closely with the current partners. And the chief alluded to this. We will set up a criminal justice partnerships with everyone from public defenders, state attorneys, and we will also link with the already existing network of providers. Because it's an important piece to link to the client once they re-enter the community.

So, by the way, I love the presentation. I mean, it was short and sweet. It was. It was. The headline of the very, the cover page really gets me. The headline is an evidence-based approach to recovery. An evidence-based. Yeah, we have no evidence. Because a lot of times you guys, I've asked questions, you guys say, well, this is the first of its kind. There's no data. There's no evidence. So an evidence-based approach to recovery and resiliency. I'll leave that at that, but it's a great, great model for this.

The chair, are you okay with me answering that?

Yeah, absolutely. This is not a one, one sided thing. This is supposed to be to resolve this. So hopefully this moves forward, which by the way is my intent, but not without the proper questions being answered and the taxpayers of Miami Dade County knowing what we're getting into the voters, the residents and the taxpayers of Miami Dade County knowing the truth because there's been a lot of misinformation. That we're I'm sure we'll get to today and hopefully everything is is replied to adequately with the right answers. Not the right ones that I feel is right or that I want to hear, but just the right answers. And hopefully this could move forward. That is my intent at least. And that's why I acquiesce to the Madam chair Lopez's request of having a workshop. So, and I should have said that at the beginning, I. And we, I think I speak for everyone, even though I shouldn't do that, I think I speak for everyone when I say that we all want this to come to fruition. It needs to be done responsibly. So absolutely, whatever you want to address throughout this workshop, I have the floor, my colleagues could recognize others, but you will have the opportunity to respond to it. Because I want this to be fruitful and informative and get what we need to move forward. With that, another question that I've asked and my team has asked, and again, we haven't gotten any response, Kathy, is what data exists, if any, and maybe it doesn't exist, and then that's the response that I need, but silence is not the response that I need, is what data, whether it's WestCare that provides it or an aggregate of entities that, Folks and this question came about after my visit to. Right, because 1 of the professionals at actually. Thought differently than what I've heard in the past. What evidence exists? What data is there to show me that. Continuity of care will I don't want to use the word guarantee because nothing in life is guaranteed. But where's the data that shows that folks that go through this process won't end up back in the system in some sort of system, whether it's our correctional system into another mental health facility into. What what data is there? I mean, West care has to have some data. The state account like, we need to have data because we, we spend. Government spends millions and millions and millions of dollars on data and analytics. So how do we know that after we do this very feel good and important facility that it's working, that the folks aren't going to go and commit another crime and end up in our corrections facility? And I'll put the horse before the carriage here. Your professionals, Chief Palmer was there, said, No, we can't. There's no way to do that. If they're going to commit a crime, they're going to be back here in our corrections facility. But what data exists that if folks get the proper care at the right time and continuity of care, that's why continuity of care is important, is that they will not end up back in the system. Is there any data to that?

Through the chair. This is the reason why we're bringing the two-year plan. It includes a partnership with University of Miami to collect the data that you're speaking of. You're speaking of recidivism data, right? If what we're doing is successful. And if those who have been in the criminal justice system do not re-enter the criminal justice system. It's important to point out that this would be, according to the data, and we can send some journals to you, some articles, that those who are severely mentally ill, this is the way to appropriately treat them. It takes a comprehensive approach to addressing those who are severely mentally ill. So we've looked at the different components that make it successful. When you speak of the continuity of care, that continuum of care, when we have the local university at the table, we will also be looking at those numbers. That's an important piece. Because you want to make sure that the change is sustainable.

Director, that doesn't answer my question. My question is, let's take WestCare, for example. I don't know if they're here today. WestCare has several outpatient facilities throughout South Florida, right? So what I'm asking is, they have to have data, they're seeing people already. They're seeing patients today, they have been for years. So there's got to be, I'm sure that as a company, unless they're a startup or something, or mom and pop and they don't do this stuff, but any company that, especially if they receive government funds, they track this stuff. So they have a history. So I don't want to see a journal. I don't want to read a journal published by some editor from New York or California. I don't want to see a journal. I want to see data. I want to see real numbers. Like, hey, us putting in this facility is going to save these many lives.

Commissioner Wesker is here. If you'd like them to come up.

I asked.

I mean, again, I said from the beginning, this will be a very ebb and flowing conversation.

Hi, Commissioners, Mr. Chairman, Frank Rubito, Senior Advisor for WestCare, 5200 Blue Lagoon Drive, Miami. Recidivism, the way I think I understand, Mr. Chairman, is re-arrest. That's what you're more interested in?

It could be re-arrest or it could just be ending up in another mental health facility or a WestCare, a Citrus, a CHS.

Sure, our data shows 11%. the clients that we serve drop out and come back to us. We can't track, for example, if I drop out today, if I'm going to show up at Citrus. There's no way that we can look at that or grasp that kind of data.

Fair enough, that's fair enough for you to say, and thank you. So that's a very direct answer, which I appreciate.

On the re-arrest rates, the civilian organizations don't have access to the criminal justice database. We did set up many years ago with drug court through the clerk's office a way to track these cases. So it did take some programming, it did take some expense. But it can be done, and the clerk, interestingly enough, is a major player in the data. So there is a way to track, but we would have to sit down with the clerk, sit down with whoever else we need to sit down with in the justice system, and figure out whether or not we can get that started again, or have to reprogram it, and someone can cover the cost. We did that years ago through a federal grant.

So it exists in the universe.

It does. It did.

That's what I thought because, I mean, I suspect and I see Carlos Magoia from Jackson sitting here with us today. I mean, just like there is like for those that are addicted to opioids, you know, you could try to cheat the system, go to a different hospital. But I imagine that the state has a system where hospitals, you know, kind of communicate. red flag someone that's addicted and don't give this patient opioids or narcotics. I imagine the same thing exists, maybe it doesn't. The state should have the same system for all patients, including those in the mental health.

I'll use a term that I don't like, but it's used. The state does look at what they refer to as frequent flyers. People who just utilize a lot of the system and it costs the system a lot to provide interventions to them. If you're so inclined to want to open up this facility and provide the services, we're looking at a continuum within the same facility. So I can take you by the hand and bring you from the crisis stabilization unit over to the short term residential treatment. You're not just being discharged from one level of care and hoping through care coordination or some other means that you show up somewhere else in the system that's going to provide you with the next level of care. So this is a continuum within the same facility, which is extremely efficient when you want to move someone from the deepest end to the non-deep end and get ready for discharge.

And thank you for that, which raises a whole ton of other concern for me how a project like this that has been in the making for 20 plus years, that no one, none of its or advocates has thought, let's reinvest in that data so that we can show the community, not just the commissioners, but the community that this is going to be effective. Because this is the data that shows it exists, it just needs to be reactivated and invested into it. I don't understand. I mean, this is the expert, Chief. I mean, the expert, this guy represents WestCare, who will be running this facility. He's saying the data exists in the universe. It just needs to, we need to pay for it.

He's entirely correct, and I agree with him, but he doesn't have the data of the rearrest rate from corrections. This is what's the beauty of this facility, because all of the data will be in one location, and we can all talk the same information, and we can share it with you.

So right now, corrections- So right now, wait, hold on, Chief. So you're saying that without the existence of a physical building, this data would not, we don't have the capabilities to have this data today. We need to open up a- You know what I'm saying, sir?

Okay, go ahead. What I'm saying is if we have an organization or a group that's talking to each other like that, we can collect the data. Currently, there is no group that way. He has data for all the facilities in his area of expertise. Absolutely, I'm not going to argue with him. But he can't tell you how many offenders get re-arrested because he doesn't have access to that.

Absolutely. He just admitted that he doesn't have access to that. Absolutely. But I want to know all of it. I want to know the aggregate of it. And it exists somewhere, right? It's just compiling it. And I just don't understand why 20 plus years of something in the making, way beyond the mayor's administration, by the way. Obviously, I know that she has an eight-year term and she's only in her second term. So this is not... Definitely not towards the mayor at all. It's just, and I just said this in an interview, I just feel it is an insult, not just to myself, and not just to this body, but to the taxpayers of Miami-Dade County to bring them a half-baked program, situation, item, especially something that's not been rushed, that has been in the making for 20 plus years. Something that we all know has been in the making for 20 plus years. You all have said it to me way before my time here. Judge Leifman has said it on the news several times that it's been 20 plus years that he's been working on this. So why is this being brought to us in what I would call a half-baked fashion with just a two-year pilot? Which, by the way, Just to correct the rhetoric, I mean, this whole two-year pilot narrative just started. This is something that the administration just shifted to recently. This was never in the last two or three years discussed to me as a pilot program. It was just discussed as we just have the funding for two years or three years or up to five. But it was never said it was a pilot program. It was just now it's a more attractive sales pitch to say pilot program. Because when you say pilot program, what do you have to lose? It doesn't work. But guess what? Pilot programs are free. The average pilot program with Miami-Dade County don't cost Miami-Dade County anything. The average pilot program don't cost anything. We have the funding for the first two years, but it's costing us. We have the funding, but it's costing us. So it's not free. So I don't know that I would call this a pilot program, but I understand the reason behind it. What happens, Chief, what is the plan And the mayor will be out by then, because like I said earlier, she's in her second term and should be terming out at that point. But what happens if this so-called pilot program ends up not working? What's the plan? What's the plan for this facility?

So I'm going to call Kathy back up for an answer to that. Thank you, sir. We had a five year plan and we're directed to readjust our plan to a two year. And I don't like the word pilot because it kind of makes it sound off, but. And you're correct, it's going to cost funds. We do have those existing funds, but it will not cost any additional general funds, and that's what our position is. But I'll let Cathy speak to the point of if the program is defunded in the future, what we will do with the patients.

Chair, we would seamlessly transition them into the network of providers. What that means is the population that we'll be serving, they will all have treatment plans. We will have multidisciplinary staffings where different professionals will know the case intimately. therefore if the pilot doesn't work then we would link to one of our community providers according to the service needs of the individual so so director and i appreciate that answer and and obviously it's probably the best answer you could give i get it if that's the case

Why not do that today? Why not assist these folks today and not drop 30, 40, 50 million dollars a year on a facility? Why don't we assist those patients? Why haven't we been assisting them for years past? What you just said is true, that there is processes in place. There is facilities available. There is care out there. Why don't we assist them today? Why are we allowing our mental health community to grow without assisting them?

through the chair because we don't have a comprehensive system in place.

But that's my question, directors. If this doesn't work in two years or three, right now we found another 12 month of funding. If this doesn't work in three years, We also won't have what you just said, the comprehensive network won't exist because it didn't work. So why, does it make sense what I'm asking, Director? I mean, I don't think I'm shooting in the dark here. What's different in three years than today? What's different? And I realize, Director, that the line of questioning that I'm doing, it comes off as if I'm not wanting to do this. That couldn't be further from the truth. But we need to do it with transparency. That's what I'm asking. If it's transparent, I'm all for it. But we can't do it misleading the public. So what's, you know, when this came about, and I won't, you know, there's so many, maybe even on this dais that may have more history on this than I do because they've just been around longer and they've been on this longer than I have. But from what I have looked into, read, and been briefed on, is when this came about, there was a real, and we spoke about this when I toured TGK a week and a half ago, there was a real issue happening in our corrections facility. That's why this was born, this idea. We got into the consent decree. I mean, there was bad things happening in our corrections facility all the time. Let's not get into what those bad things were, but everybody could imagine the worst of the worst. Today, we've come out of that consent decree by a judge. I toured it, and again, it's a devastating scene, but it's being operated very, very healthy. We're not in the same need that we were 20 years ago. So we started with an issue, trying to solve an issue. In the making of this 20 plus year facility, we have since solved the core issue. We have solved the core issue. But now we're too far along on the facility and we've spent upwards of $40, $50 million in renovating it. So it's like we need to open up a building that's empty right now and we've spent so much money on. So let's just spend another $30, $40, $50 million a year to open it, even though there's no longer the same need that we had 20 years ago. So that in itself is concerning to me. I still recognize that it is good for the community, but I'm very realistic per what I learned, not my words, from what I learned touring the facility is that this will not solve issues for our corrections department. And this was said to me by the leadership team, CHS. I mean, the folks in the meeting that the chief knows. And these are the people on the ground. I mean, it doesn't matter what, it doesn't even matter what us as upper management says. I mean, this is the people on the ground saying, like, this isn't going to solve anything. Look, not the last question I have, but for now, and then I'll move on to my colleagues. And I'll probably come back to myself. But the last question, and I know the answer to it, I want to put it on the record because it's my one thing to just be forthcoming with the people. We've heard from some of the advocates do press after press after interview after interview after articles talking about how this will save a great amount of money for Miami-Dade County. In fact, I've heard numbers thrown around of $300 million, $400 million. I mean, real impactful figures. To whoever would like to answer, Chief, will this save any funding, any money for Miami-Dade County taxpayers?

Would this save money? No, sir. You toured the facility. The problem is so significant that if we opened up the center at full capacity, we will still need a mental health center at corrections. So, no, the clear answer is no, it will not save us millions of dollars. It will save us some money as we reduce the population in corrections if the system and the program works.

Chief, chief, chief, chief.

But I'm not going to get into that right now. No, but chief. No. But chief.

You made one little mistake just now is when we discussed this a week and a half ago, it wasn't that it'll save a little bit of money. It was from you, from your mouth, from the entire leadership team of the mayor that was there and from the corrections facility itself. It was it will save zero dollars, not a little bit of dollars, zero dollars, which it's OK to Commissioner Gilbert has been very open on the record saying that That's his issue, is that has been misled about the savings, and we just need to get comfortable with the fact that this will cost the county money. But it's going to save zero. I mean, and that's what you all said to me a week and a half ago, unless you all lied to me.

No, I'm telling you right now, it's not going to save us any money. Okay, all right.

That's what I wanted to just put on the record.

And just for the record, the hundreds of millions of dollars are not our numbers. Our numbers were articulated by Kathy. We stick by our numbers, and OMB can back those numbers. Anything else or other numbers, those are not our positions, and those are not our numbers.

I understand, Chief, and thank you for clarifying that. But I have, and I won't play it, I won't do a theater here, but I have a compilation of... press interviews after press interviews talking about the 2 to $300 million savings that that will bring to this county and it's not happening. You know with that I will I will open it to my colleagues, but Guys, I think we took commissioner Gilbert's past points is we need to if this is going to move forward at some point. We need to get comfortable with the fact that this will in a time. In a time when with uncertainty. That the governor in this legislature is talking about reducing or eliminating property taxes. We need to get comfortable with adding another 20 to 50Million dollars a year expense. To this facility. If that's the will of this board, then that will be the will of this body. But we need to be comfortable that the decisions that we make today will impact us tomorrow. With no data. Because if there was data showing that it was going to save a single life, I would be comfortable with that. Because just one life is enough for me. I said that back when we talked about the school zone cameras. If it saves one child's life, that's enough for me. But there's no data. Real data being provided. There's, to the director's point, there's journals. With that, I guess, and I wanted to, I'll recognize you in a minute, Commissioner Gilbert, but who really requested this was Commissioner Lopez. So Commissioner Lopez, I'm happy to have you lead the conversation as the first commissioner after myself to speak, because you did request this, and then I'll go around the dais.

I did. I would like to. I know that Commissioner Gilbert may have to leave, so I will waive my time.

Commissioner Gilbert, you're recognized.

Thank you, Mr. Chairman. Thank you, Commissioner Lopez. Thank you all for being here today. So, and I won't necessarily be that long, but I think it's important to understand philosophically how I see things when I'm presented with the idea. Because everybody wants government to do something. I ask myself the question, is it something that we should be doing? Is there a problem that we can actually help with? When I answer that question, that drives everything else. And I think that partially, and this isn't to be critical of specific folks, but I think partially we're on this path right now because of prior actions of prior commissions and prior mayors, but also because how the conversation's been framed. Why are we thinking that people who are in need of mental health in this community, why are we thinking that that needs to automatically have the ability to pay for itself? Why are we there with that? How do we get down on that road? We got on that road because people told us that it would save us $300 million, and we all know that's not true. Some people said we might make money. That's not true. I take as true the chairman's supposition that this might not save us any money. And it may cost us but but what I do know is this I've had a family member who went through the criminal justice system who was mentally ill and I know that proper treatment shouldn't be in a jail I Know that I Know that we can't treat everybody in this building, but for those that we can we should I I know that for all the other things we do, I take a slight exception to what I guess the initial response from the administration. We might do projections and forecasts for our funding. We have an annual budget. Every year we sit here, sometimes until three and four in the morning, and we decide what's the values of this community? What do we have to spend money on? I am prepared to tell the administration Work this formula, work with everybody, come up with the best plan, mitigate the cost as much as you can. The backstop for every service provided for this county is the general fund, period. If we'd said that two years ago, if you all had said that two years ago, we'd have voted. We've gotten to this conversation of whether it's true or not that it will pay for itself. I don't think that's true, but I pay taxes because I want to actually help. I pay taxes for services that I don't use all the time. Federal taxes, local taxes. I pay taxes because the strong shall bear the infirmities of the weak. I start from the proposition of, is this something we should do? Will it help someone? I answered that question. Yes, we got sidetracked on what I think is the I call it the the sprinkles on a cupcake. We got sidetracked with this idea that it had to pay for nothing else. We don't we don't ask police to pay for themselves. They give you all more tickets. We don't we don't ask fire. You don't pay because you got an actual fire at your house or because you were experiencing a medical distress and you were having a heart attack and they showed up and they didn't charge you for the defibrillator. We supplement, what is it, 89% of transportation. We ain't asking everybody to pay for that full bus ride. We're not asking everyone to pay for the full functioning of the parks. This is not a proprietary system. It was not envisioned as a proprietary system. We are analyzing it through the prism of a proprietary system right now, but we're doing that because of the conversations that folks have been having telling us. And I remember when I got briefed by this for the judge, it sounded great. And I thought to myself, this is something I want to do. And I didn't believe then that the numbers were right. I didn't believe it then judge, but, but, The numbers weren't right, but the mission was so righteous. The numbers don't have to be right if the mission is righteous. It's something that we should do as a collective, as a community, because it's the right thing to do. We backstop everything else. We don't make people pay for services any other time. And so what we're saying now is, People who are experiencing the fragility of mental illness and that interaction with the criminal justice system, it should pay for itself. I don't subscribe to that. I think that the conversation on the finances sidetracked us from our core mission of providing services. And so now we go down this road of questioning And because in court, what they tell us is false in one false in all. So now when I don't believe your numbers, folks, it's actually fair to question whether the efficacy of the treatment is actually the same. And that's, I see how we're getting, we're going down this road. So I just like us to go back to, and really that's why I came to this committee to hold, which I believe just probably, you know, should be a kind of commission meeting because I love the ability to vote on this one way or another, but it, Just go back to the beginning. Is it something that we should do? Will it help somebody? If it does, then our instructions to the administration should be, hey, Madam Mayor, Chief, you all work with everybody. I want you to get as close to making this thing pay for itself as possible. And then when you bring back our budget, you bring us back to Delta. You bring us back the difference. This is the difference. We said it's something we wanted to do. This is going to be the shortfall. You either supplement it or you won't. And I know that because you all have done an extraordinary job of generating press around this, the press doesn't affect me. I know how to ignore Doug. I do. He's laughing because he knows I do. I mean, that's not going to affect me. Because from my perspective, we make these decisions all the time. Every time we pass a budget, we're doing value decisions. I find value in this proposition. And so independent of Mr. Chairman, I think that you're questioning, though, you know, it was exhaustingly long, but I think it was right on point on the numbers. The numbers... There's far too much confusion, double talk, changing of positions. There's far too many things in the numbers that actually make us forget everything we've seen in government. I want you to find one time in government where a social service actually paid for itself. Y'all just find one. Mr. Chairman, through the chair, I'd open it up to anybody. One time where social service actually paid for itself. It's not going to. So you're asking him and us to believe that this one will. It's not. It's just not. It's like saying gravity don't exist. I dropped something that's going to fall. We ain't in outer space. Maybe an outer space is space for itself. Here in Miami-Dade County, we pay for it. And I'm comfortable paying for it, Mr. Chairman. Thank you.

Thank you, Commissioner.

Mr. Chairman.

Commissioner Lopez.

Thank you. Thank you. Thank you, Commissioner Gilbert, because I could not agree more. So I have been a huge champion of mental health services. And I agree with you, Commissioner Gilbert, that this isn't something we should be questioning whether we do or we don't. I had the pleasure of having an extensive briefing with Judge Leifman and then again with the mayor and her leadership team about this. And honestly, as a budget chair in the Florida legislature, we appropriated hundreds of millions of dollars. To mental health services, all of which go through our managing entity and then out into our community based organizations. There's not a 1 of them that would exist. without that funding. In addition, I told Judge Leifman that I hated hearing the word pilot because the word pilot appears to almost reflect that we're not sure it would work. It will work like every single mental health CBO today that is funded through the state. They work. We just don't have enough money to expand them because the need is so great. Not only in forensic beds but in these types of crisis stabilization beds. I got a lot of comfort after my briefing with the mayor and her leadership team because I learned that people would be transitioned within the same facility just as Mr. Rubino said because I have experience knowing that the state only funds 60 days of treatment for substance abuse and 90 days for mental health. If you know anyone suffering from either one of those diagnoses, that is ridiculous. It's too short of a time and that is why we have to transition people from residential beds to another type of residential or transitional bed with services because oftentimes people need up to a year just to stabilize and get ready to move into the real community that we want them to flourish in. So I recognize that this may cost us money, but first of all, I don't want to call it a pilot. And I want to make that very clear to everyone who's listening. This isn't a pilot for me. This is yet another facility that will be able to address the needs of our community. And in this case, specific members who have found themselves in the criminal justice system when they are seriously and persistently mentally ill and could receive the best kind of services in a different setting. So, first, I'm not calling it a pilot. I think no one should repeat that word ever again. It is just another mental health facility. One. Two. The thought that I think that it should be self-sustainable is also ridiculous. There is not one community-based organization in Miami-Dade County today that doesn't experience the, not minimal funding by the government, but I would say almost anywhere between 85 to 95% of their revenue stream is of some sort of government fund, whether it's federal, state, or local. So for us to think for a moment that this facility should be self-sustaining is also a fallacy. And it leads people to believe that somehow only this facility has to be self-sustaining. It's ridiculous. No other CBO that is operating currently and providing behavioral health, both substance abuse and mental health, is self-sustaining. And thirdly, we have not yet explored The state's responsibility. This particular facility, there's no other facility like this across the state. Had a long discussion with an appropriations chairman in the state who wants to see this facility opened. And he said, we've yet to even explore how we can be helpful. I think that it could be a model. We have just explored a different type of continuum of care model right now with a CBO in Miami-Dade County that is testing a new type of continuum of care that may be expanded throughout the state. I think that's what we should be looking at. If this facility can open and open as quickly as possible. Look, and you know, I hate when I hear that there's going to be an evaluation done after two years. That's also ridiculous. That presumes that somehow an evaluation is going to come out that this didn't work. You know what the evaluation should show? That we should have opened the facility and put every single bed to use. That's the fourth item I want to talk about. When we talk about just the 75 beds, excluding those residential transitional beds, I'm asking myself why we're not filling every bed. I don't understand that. Because once again, we have to continue to say that it has to be self-sustaining. So now that I know what the seven floors look like, now that I have a better understanding of how people will be transitioned. And let me just tell you this, because I've talked about the 100 Lindas in my community, in my district who are perpetually homeless and have intersected with not only the criminal justice system, but with the homeless trust. It strikes me that no one has talked about what police officers have to do on the ground. My police officers in downtown Miami will have a choice now. If we open this facility and we open it tomorrow, they will not have to make an arrest. They will be able to look at Linda and say, Linda, we love you. You need crisis stabilization today. And Linda will go into the facility, she will have crisis stabilization services, and she will soon move through a continuum of care that will treat Linda for exactly what we haven't been able to do for the 20 years that Linda has been on the street. Linda deserves to live. in a safe and sustainable life, not on the streets or in the jail. So I am just going to encourage my colleagues. Look, I know all that I need to know now.

Guys, I let it slide the first time. We're not in an official BCC meeting, but we don't do the clapping thing. You guys did it on your own? You know what you do? Why are you clapping?

Mr. Chairman, I do want to say this. I still think we have to drill down on the costs. There may be some discrepancy in WestCare's operating costs for the first two years. Chief, I think it was shown to be $25 million in the slide. I understand from Westcarrot it might be $17 million. I'm not going to debate the numbers here. I think you ought to get with them and make sure that we have the right numbers. And the same goes for the criteria. Let me tell you something. If there was ever somebody who was the re-entry expert besides Judge Leifman, it's Commissioner Lopez, who for 20 years has devoted her career to helping people who are leaving both the jail and the prison system and leading them to a better life. The court system knows exactly how many people recidivate. They know exactly, we know, the state also knows how many people leave the prison system. What I will tell you, too, is the encumbrance of this particular situation on the state prison system. I do a lot of work with the director, with the secretary of the Department of Corrections at the state. When we don't fix it, here at the jail. You are just forcing those people to now be committed to a state prison system for when their sentence is 366 days and guess what happens then? That person moves into a much more severe criminal justice situation where there is not enough programming for them there. So we would be saving the state some money, which hopefully will come back down here for the facility. So I encourage my colleagues to look carefully at, and I would say philosophically. I think you were correct, Commissioner Gilbert. This is a philosophical situation we find ourselves in. We either understand our responsibility. Listen, we understood our responsibility for the homeless. And so now we make sure that the homeless get the services that they need. Now we have to make sure that those who are severely, persistently mentally ill, and I'm going to add this because if anyone's ever been to a jail or been in jail or have had anyone in the criminal justice system, you know that if you entered with any kind of mental health situation, And some are not severe. Some are just, wow, I had a moment and I find myself in this system, or I've always had these moments and now I'm back in the system. The system exasperates any mental health condition. It does by its very nature. And you have to know that to understand why we need this facility. And so I will not belabor this any longer except to say that I hope that this facility opens tomorrow. And we don't talk about pilots and we don't talk about sustainability. Here's what we're going to do. We're going to prioritize the very small money. Listen, we have a decreasing pot of money in the general revenue. And unfortunately, we will have to make the hard choices. And for me, it will always be people over buildings and then those people vulnerable over not so vulnerable. This is for vulnerable people. Thank you.

Thank you, Commissioner. I mean, there's no children in the audience, right? Like you guys understand English or? Come on, guys. Commissioner Cohen-Higgins.

Thank you. Thank you, Mr. Chair, and thank you to my colleagues for their remarks. I know all of us are paying very close attention, and thank you to the residents that are here, knowing that you're not able to speak. You're sitting here and paying close attention. You don't have the opportunity for public comment, so I thank you greatly for taking the time out of your busy schedules to be here with us on this important issue. And I thank our administration for the work that you've done up until this point to get us to where we are today. And I appreciate you finding an additional year of funding for this facility. And I think the points raised by my colleagues so far, and I certainly look forward to hearing from all of my colleagues that are here participating in this workshop. I think I can't agree more with what everybody Has said, and I have been the 1. Who has been extremely concerned about the finances of this project because I think it's important. I don't know that I need to repeat that regarding the philosophical part of this discussion, whether or not I agree with it. I think everybody agrees. with this project philosophically. But I think that's only half of the conversation. I think the other half of the conversation needs to be addressed as well, which is the financial part of this project, which is why I asked for the funding going into the future. And while I appreciate the three years, I understand that we have never done a ten year financial projection to the chief and to the director. But it's also my understanding that we've never been in this situation either, meaning that there has been a building constructed That was supposed to be funded by somebody else that has sat around for the duration of 20 years where we are now asked many, many years later to carry the bill in a time of extreme and extraordinary financial uncertainty. So yes, I asked for ten years of funding because we do five years every single year and I authentically want to see the success of this building. And so I will spend a lot of time at least regarding my remarks on the finances of this because here's the reality and I appreciate those that are in the audience. And I have a philosophical question to ask all of you. Everybody is in agreement on the philosophical should we and will it help people? Everybody agrees yes. My concern is where's the money coming from to pay it? And the question that I have for all that are here in support of this item and frankly to all of the residents of Miami-Dade County and to our colleagues is, are we willing to raise taxes? And I ask that not because I'm trying to engage in scare tactics, not because I'm trying to be the bearer of bad news, but because if you look at our own financial projections within the next five years in Miami-Dade County, every single year we are projecting a financial deficit. a financial deficit, meaning we don't have the money currently on hand to fund the next five years based on our already existing line items on our budget. This will be an entirely new line item on our budget, Chief. Is that correct? This is an entirely new line item on our budget at a time where we currently don't have the money to pay for what we currently have on our line items and on our budgets. And keep in mind This time last year, we were presented with a financial projection that ended up being far bigger in actuality than what was projected. So when I see a five year projection and it shows up to $177 million in year five that we will be short. Yes, an additional 20, 30, $40 million in addition to that is something that we need to take in very serious consideration because I authentically wonder. In two years, or now three years, and thank you for that, when the money runs out, whether the same people that are philosophically so much in support of this item are going to also champion and ask our taxpayers to raise their taxes to support it. Because that is the ultimate decision that we will have to make. And if we're not going to be willing to raise taxes to support this, then what are we going to remove? What are we going to defund? And so those are the questions that I have always had and why I have said, let's do that work now. Let's do the difficult task now, because if we're able to identify projects now and say this is a priority, We are not going to raise taxes because we've identified different pockets of money to insure. Because I've said it many times, I will say it until I am no longer in office, I will not raise taxes on the residents of Miami-Dade County. So in two years, are you all going to be here and say, please raise taxes on the residents so we can continue funding this? That's the question that I have that I'm not sure that we're willing to take that next step. And to our chief, I really do appreciate you clarifying the record as you did today. I think it's important to note that had we received that clarity many, many months ago, I think we would be in a different position, quite frankly, right? Because this question came up back in December, and the answer wasn't as clear as the answer that you provided today. So I really appreciate you providing us with that level of candor. And I also appreciate you clarifying the record to say, listen, We as an administration that are going to be responsible with funding this and operating it, we have never said that this would save us hundreds of millions of dollars. And I appreciate that level of candor as well because we as commissioners, we're out in the community, we're speaking with residents, we get presented with questions. And the question that would always come to us, well, it saves us hundreds of millions of dollars. Why don't you green light this? Why are you concerned with the financials of this project, Commissioner? Because clearly it will save us hundreds of millions of dollars. I am eternally grateful for you course correcting that narrative and I appreciate you taking the bull by the horns on that. I also think it's important to know and understand historically how we have gotten here. Because a lot of the feedback that I've received from residents as well includes this idea that this has taken 20 years. My goodness, how dare you allow a project of this import that everybody feels philosophically needs to open and needs to happen. How dare you all allow it to be 20 years and this project not open? I couldn't agree more. And so I started looking into why is it that 20 years later, 22 years to be actual, why hasn't this building opened? And so I'm going to ask a series of questions because I do think it's important, especially with term limits, especially considering the fact that none of the commissioners that are here before us today and that will be asked to make this very difficult decision had anything to do nothing at all to do with the 20 year history that brings us here today. I think it's important for us to go through that history. And so to the attorneys, this effort and I think our chairman for bringing up the impetus of this, the impetus of this was a correction system that was in horrible state. consent decrees the forgotten floor this is going back to early 2000s and as a result there was a ballot referendum where our voters were asked what what was the question that our voters was asked back in 2004 as it pertains to mental health and this facility

Commissioner, in 2004, the voters were asked to approve the development of a mental health facility to free up jail space and provide effective and cost-sufficient alternative facility to house the mentally ill as they await a trial date.

Okay, that was the ballot language referendum back in 2004. Was there an addendum to that referendum that spoke to the cost of the facility? What is the dollar amount that the voters approved back in 2004 for this mental health facility?

The cost was $22.1 million.

Okay, and I think that's important because we are here speaking to the spirit of honoring what our residents asked us to do. Yes, it was 20 years ago and none of us were here at that time. But that is what our charge was from our residents back then. And subsequent to that, for whatever the reason, there was a number of increases to that 21, excuse me 22.1 million dollars and and to the attorneys in the efficiency of time you can just please stop me and keep me honest and correct me if i'm if i'm wrong as i go through this in 2016 there was an increase of 12 million dollars by the board of county commissioners via gob bonds bringing the project total to 34 million in 2017 there was an 8 million dollar contribution from the public health trust bringing the project total to 42 million dollars and in 2020 there was a nine million dollar contribution by the board of county commissioners via gob bonds bringing the project total to 51.1 million dollars is that accurate is that reflective of what your numbers and your records say to the attorneys Okay, the reason I say that is because again, a lot of the narrative has been, you all need to get this done, it's been 20 years. But I don't understand why from 2004 to 2020, there was 16 years of just straight additional money, additional money, additional money, 16 years. Of just putting more money into the pot, and this is not the construction of a brand new building. This is simply the renovation of 2200 Northwest 7th Street, correct? This wasn't the construction of a new building. This was the renovation of an existing building, and the seventh floor isn't even finished yet, correct?

Correct.

Okay. So 16 years of escalated funding, but the building still wasn't done in 2020. As far as I know, the certificate of occupancy wasn't issued on this property until January of 2024. Is that what your records indicate? January of 2024, I have the certificate of occupancy. That's when the building was and the renovations were complete. We would have to confirm that with staff. Okay, I have it here. Thank you. Senator Garcia is saying, this is the certificate of occupancy. It's dated January 24th, 2024. So from 2004, when the voters of Miami-Dade County originally gave us their charge, 20 years later, the building is just now open and ready for occupation. I have no idea why it took 20 years, but that's how long it took just to renovate the building. I also think it's important when talking about what brought us here to understand the expectations because I talked about the intention of the voters. But I also think it's very important to talk about what the intention of even the advocates that are here were for the vast majority of this entire project. And so to the attorneys or to the administration in 2017, there was a sub lessee agreement that was issued to a company at that time. and they are often referred to as thriving minds. Is that accurate? Correct. And then the sub lessee was then asked to handle the renovations of the building. There was some back and forth. The costs were escalating and Thriving Minds said, hey, we'll take it over. We'll handle the renovations because for whatever the reason, the administration at that time was taking too long and things were not moving. So Thriving Minds takes over and they're the ones now charged with handling the renovation of this center. Is that accurate?

That's correct.

Okay. And then in March of 2021, thriving minds terminates with the county. Is that your recollection? They send a letter to the county saying, Hey, listen, we're not, we're not doing this anymore. We're not up for this. Is that accurate? Yes, that's correct. Okay. Why did thriving minds terminate in March of 2021 with Miami state county before the certificate of occupancy was ever issued?

They exercise their right to terminate for convenience, Commissioner.

But there was no understanding of why it is that they terminated, no understanding of why all of a sudden now, so many years later, they've been given a contract, why it is that they terminated?

I defer to staff.

Yeah. So the termination letter doesn't speak to it. It just says we're terminating for convenience pursuant to and consistent with the agreement. But there was negotiations at that time. The administration said, hey, wait a minute. Whoa, whoa, whoa. Work with us because we really need this building to be completed and we really need it to be open. So can you at least carry the construction and the renovation of this until we get the certificate of occupancy? Is that accurate? Yeah.

Yes, that's accurate.

And so then they didn't officially terminate until after we received the certificate of occupancy in January of 2024, correct?

That's correct.

Okay, so from January 24 until September of 2024, right, we are looking for different alternate operators of this facility because now we don't have an operator. We don't have an operator. And the reason I talk about that is important because under the sub lessee agreement that was entered into in Miami-Dade County back in 2017, that agreement said multiple, multiple times that the sub lessee would be the The only entity that would bear the cost of operating this facility in subsection F under operations time and time again. It says, the acknowledges and agrees that upon completion of improvements to the premises, the i.e. thriving mines shall immediately at its sole cost and expense commence with the operations of the premises. And it just goes on and on further. The sublease hereby acknowledges and agrees at its sole cost and expense to acquire any and all permits and licenses. It even goes into maintenance, lawns, landscaping. Our responsibility as a county was never to pay tax dollars to operate and maintain this facility, at least under this contract from 2017 to 2024 or 2021 when they terminated. Is that accurate?

That's correct, Commissioner. I think there was a specified amount not to exceed $100,000 worth of utilities that the county was going to pay for along with the capital improvements to the facility. But you're correct that the other expenses and the operating expenses were to be the sole cost of the sub lessee.

Right, and so the section that you're referring to is section M, and it talks about utilities. And it says that the county, which is the sub-lessor, is not to expend essentially more than $100,000 for maintaining the sublease premises. That's in section M. And Judge Leifman, I know that you're here, but I hope that you will agree because I think it's within the history and everybody that I've spoken to about this completely agrees. It was never the intention that Miami-Dade County taxpayers would carry the financial burden of operating and maintaining this facility. And if so, it was maxed out at $100,000 a year. We're now looking at a 20 year, 20 million, excuse me, $20 million operational cost coming out of our general fund for this facility. I think it's important because again, if we're going to speak so vocally and advocate for this, I think it's important to talk about the historical perspective that brings us here. And so at some point, after Thriving Minds terminated with Miami-Dade County, Miami-Dade County said, wait a minute, we need another operator. And they put out a solicitation to have bids to say, someone help us. We need this building operated. We can't do it. We're not going to do it. We need help with the operations. And I believe Jackson Hospital was one of those proposers or one of those entities that was considering operating this facility. And I would love for Jackson to approach, because if they're here, I'm very particularly interested in their perspective.

All right, Mr. McGaughy, I see you standing up. You're welcome to approach the well and engage in an ebb and flow in Q&A with Commissioner Cohen-Higgins.

Welcome. Welcome, Mr. McGuire. Thank you very, very much for being here. And again, as I kind of go through the timeline and kind of laying the groundwork of what brings us here, in addition to take 16 years of escalating costs that the board supported and literally 20 years of renovation, I think it's important to note that from 2024 to 2021, it was never the expectation of this county to pay anything more than $100,000 a year to operate this building. And so thank you for being here. Did you all submit a proposed budget for the mental health facility a few years ago when the administration said, hey, we need proposals, we need people to look at this and give us some numbers?

Not exactly at the time, but approximately two years ago. The mayor approached us and said we had gone through an RFP and we wanted to see what you guys could do. And by the way, with me, I have to my right, Vicky Severwalls, the CEO of Jackson Behavioral Health Hospital. To my left, I have Susan Payton-Martinez, who is the Director of Corrections Health in the county jail. So the team got together and also understanding the inmate population. and how and how we deal with there as well as what we do in behavioral health especially right now with the current diversion uh court directive diversions that we do we put we put a pro a proposal together based on a partnership with the county of which what we would do would be the clinical side and the county would do the maintenance of the building, the feeding of the people, the environmental, all the other pieces. And it was a combined operating budget that we would do at that point in time.

And what was the annual operating budget that you and your professionals and experienced staff came up with to operate the same? It's the same building, right? 2200 Northwest Seventh Avenue?

It was the same building. For the first time as I listened to this, it's slightly different. At the time, the budget was to put 16 critical crisis stabilization units instead of 10. And we were doing 48 short term beds. No long-term beds, so at that point it was approximately, what's that, 16 plus 48, 64 beds, I guess it was, for those patients. And then the top two floors, the homeless trust would deal with some longer-term environments. But to that point, our share of the budget was around $18.5 million, and the remaining approximately another Another $20 million or so was coming from the county as far as dealing with security, environmental, and meals, and everything else that was going for a total budget of around $39 million a year.

Okay, and that's why, and again, I appreciate you approaching because, again, for me the philosophical is that box is checked. The financial is where we're going to have to make very difficult decisions. And so when we have a presentation as early as this morning showing $38.2 million for two years, which totals about $19 million of funding for this facility, help me understand how your number's at 39 million. and the administration is at $19 million. That's a huge delta.

I cannot compare what we did versus this. All I can tell you is that our share of that number would have been $18 million. Expenses. We did identify, based on our experience with the population, that about 27% of the population would qualify for Medicaid, and there was an offset of around $4.5 million. $4.3 to $4.5 million that would qualify for Medicaid. That would have reduced the cost to us, the cost to the county, or the cost to whoever, down to $14.2 million a year. So what I said to you about the 18 million was the operating expenses. The net of the $14 million approximately would have been after the Medicaid reimbursements.

Okay, and thank you for bringing that up to our chief in your financial budgets and analysis. What is the percentage of Medicaid reimbursements that you all are factoring in? Because it's millions of dollars difference. So Jackson did 27% Medicaid reimbursement. What is the percentage Medicaid reimbursement that you all factored into your budget?

Through the chair, if it's okay, I'd actually like WestCare, who's the equivalent provider, to answer the question on what they've projected in terms of percentage of Medicaid reimbursement.

I mean, and I'll allow it because, again, the idea of this is to get to the bottom. But this is not I mean, you guys were very clear at the start of this meeting that this is the administration's thing. This is something you all are putting together. And these are your numbers. And this is the mayor's project to move forward. And obviously, there's a lot of moving parts here. So we want to get the same way you could approach. You will be able to answer. Trust me. I'm just I'm saying is. The number has to be the same across the board. It's not. It has to be. I mean, because the same reimbursement you get from Medicaid, I mean, Medicaid's not going to be preferential to you than to Jackson. And I trust you have a great, no, I don't know. But I don't know you, sir. I trust Mr. Magoya and his team with, let me not say what I trust him with. but he turned around our county hospital like we could not have imagined. So I trust him blindly. I think everyone on this dais feels the same. It's unarguable. I mean, Senator Garcia, I think, has other issues with him. Maybe it's hair-related or something, but go ahead, answer the question, because it should be the same. I mean, you're off a little bit, but it should be the same.

30%.

Okay, that's not too off.

Okay, and so the budget that we are preparing now anticipates a 30% Medicaid reimbursement. Yes. Okay, and to Mr. McGoya, ultimately Jackson chose not to operate this facility. Why is that?

We didn't make a choice either way. The only thing we said was, at the time, we do operate the largest behavioral health hospital in the state. We have 220 inpatient beds. We already have a commitment to that facility, which at the time, our net losses, behavioral health is one of the most underfunded, or the probably the most underfunded of any cares in the country. I mean, this initiative has been going on nationally for a long period of time. We lose in excess of $20 million a year in doing behavioral health. I'm not here to complain about it or anything else. I'm just stating a fact of what we lose. In addition to that, we spend another $85 million in corrections health, which we don't get any reimbursements for. The only hospital in the state that doesn't get reimbursed. I'm not complaining about that either. I'm just stating facts. So for those reasons, I said that we could not operate this without getting full reimbursement for whatever cost it would be. over and above any reimbursement that we would get. It was the administration's choice to continue to look for things and it was not any other choice except, and it was all just constructive conversation.

And thank you for explaining that. Does Jackson currently have a jail diversion program?

So we don't have a diversion program, and there's a court directed diversion program. There's over 100 patients a year that go through that program. Based on the court directed, there's some of those patients or inmates that are either in misdemeanors or felonies. And we, Jackson Behavioral Health, along with Corrections Health, works with that. And we're not the only ones, it's us plus another four facilities or so, that some of those patients end up going through same thing, CSU crisis, stabilization, then later short term. To our facts, over the last several years, similar to the numbers that was quoted earlier, readmission rate runs around less than 13%. So now what we don't know, and the data is there by the way, how many of those patients could eventually end up back in the jail. But we do know for years how many of those patients went into a diversion strategy. And based on those names, we should be able to go back and figure out how many of those could have ended up back in jail.

And I understand, and I said, does Jackson have a jail diversion program? It's not Jackson's, but you treat the patients that are assigned to your CSU from that diversion program, correct?

That's correct.

Okay, and are all of the patients assigned that you receive from that diversion program? Meaning, is there a backlog? Do you all have patients that need beds in this diversion program? Or are all of the patients that you all receive in this diversion program placed successfully?

Well, that's really not Vicki, sorry. So Susan did go back and check not only ours, but any of those court-directed inmates that go to a diversion facility. If they happen to be misdemeanors, most of them are placed within days. And if they happen to be in felonies because of complexities in dealing with the state attorney, and if I'm wrong with anything Susan speak up, they get placed within weeks. But bottom line, there's no backlog whatsoever. They've all been placed.

They've all been placed. Okay, so to the administration, help me understand with an existing diversion program in place where Jackson is treating patients and misdemeanors are placed immediately, felonies take a little bit longer, but 100% of those diversion cases are currently being assigned. Help me understand the need for this diversion program. And the cost, which I'm going to ask you separately afterwards, help me understand the need for this diversion program. All of the diversion cases that Jackson has received have been assigned and are currently being signed. There's no backlog. And again, we have to compare apples to apples. We're talking about inmates sitting in a cell that need a state hospital that is not the population that will be treated by this facility. Help me understand the data and the metrics that you just received from our public health provider. All cases are being assigned. What is the need for this facility? And I'll leave it there.

Okay, so we're not suggesting replacing or supplanting existing services in the community. Understood. There are robust. We're looking to treat the most acutely ill individuals that are not being serviced right now. That's what we're trying to do with this facility. And increase of beds, which beds are necessary in general, and do a wraparound service around those individuals.

Okay, and thank you for that. And if you could help me understand the disconnect between Jackson's budget, and actually to Mr. Magoya, was there a large discrepancy in your budget projection or your budget analysis and preparation regarding security, police presence at this facility, and what you thought was the need and the financial output for that?

Well, two years ago when we were discussing this, the security budget was actually put together between our Jackson security team as well as corrections and Miami-Dade police at the time. I'm not sure because obviously it was Miami-Dade police. Everybody worked together in understanding what kind of security levels were necessary. Based on the joint planning that was done by both institutions, we felt that the kind of security that was needed was higher level than just a normal security guard level because of the complexities of the patients that were coming in the door. And that was a difference of opinion from the others. And obviously, our costs that we have provided in this budget was higher for that reason.

Okay, to the chief. There seems to be a large number of discrepancy between public health trust and the budget that they proposed and the budget that we are proposing. Or am I mistaken on that? The numbers seem very, very different.

I can't speak to the budget that they proposed. I wasn't here. I am not aware of it. So I can't debate. I'll take him at his word.

Yeah, no, I'm not in any way trying to create a debate. What I am trying to establish is when we have professionals that are seasoned in this area, they deal with mentally acute ill patients every single day. They have prepared a budget for this exact location and estimated an annual operating cost of $39 million when you deduct grants, when you deduct fundraising, an average of about $35 million per year to operate this facility. Our budget is substantially lower than that, by half. So I'm just trying to understand, they're not even close. So you all are proposing a budget that is completely not based on what Jackson proposed. Why not take their budget and use that as a framework? Because the numbers are so way off. Help me understand the disconnect between those two numbers, if you will. Yeah, it's our own county hospital. It's not Mount Sinai or Baptist or private. These are our own hospitals. Why the discrepancy between the two numbers? Is it possible that we are going to pay substantially more per year for this facility than what we are currently estimating. That's my underlying question.

Through the chair, you asked several questions. I'm going to answer the first one. The numbers that we've used are based on the proposals that came from the vendor that we have decided to contract with, based on the amount of funds that they believe are needed to operate the programs and the services that will be in that building. There's also another number, which is the amount of money it costs just to make sure that the building that we own or we have is well maintained. It is a priority of the administration and the board that we protect the investments that we have. So WestCare gave us numbers for operating the programs that will be running in that building. That's the number that we used in order to identify or annual expenses.

Okay, thank you for that explanation, and thank you Carlos and team for being here. I don't have any other questions, and again, I really appreciate you all being here and sharing your perspective on this. I at least find it very valuable.

Thank you, and we have no problems with Senator Garcia, just for the- Thank you for clarifying that.

Yeah. Yeah, no, I don't have any further questions. I pretty much outlaid everything that I needed to on this. And again, I am extremely cautious about kicking the can down the road on this. I think it's far too delicate of an issue. I think that we are potentially creating a crisis for ourselves and for our county when just engaging patch work temporary funding for a facility that is so far from being a pilot. It is ridiculous to suggest that it is with $50 million invested and a mandate from our voters. There is no world that exists that this opens and closes. There's just no world. I mean, the idea that this closes after two or three years is all of us being completely intellectually dishonest. Once patients are treated, Once beds are filled, this facility becomes a budgetary entitlement for the taxpayers of Miami-Dade County. And we are currently straining our... And again, if we're going to do this, let's do this. But my ask was, let's find the money now and identify what we're going to pull from. I'm happy to yield back money. The money that we just received from FIFA legacy funding, let's put it to the Leifman Building, right? We had... People talking about rodeos and parades. I'll do it. Let's put it to the Lifeman building. Let's put walkways for the wealthy to the Lifeman building. Let's do the hard work now because it's inevitable. 24 months is right around the corner. And those of us that will still be sitting on this dais, I really do not want us to have a facility full of our acutely vulnerable, mentally ill population. And I appreciate the director, Burke Joves, making clear in your presentation that the majority of these beds are long-term beds, long-term. The majority, look at the slide. I mean, I'll put it up for you. This is not patients coming in for two and three and 30 days. The majority of the beds are long-term patients. So the idea of phasing out when somebody is in the middle of a six-month treatment plan, long-term care in this facility, who is going to tell them? That it is time to pack up and to go home. This facility is not closing. I think we should do the hard work now of identifying funding so that we're able to ensure the success of this building. Thank you so much, Mr. Chair.

Thank you, Commissioner. And you're right, that's exactly what I've been saying is just how are we going to pay for it. And you're right, let's put some of the money of our pet projects. And take it and put it towards it. I'll give mine as well.

Will you accept the fund so that we can patchwork some additional temporary funding into year four? Because that's what I asked you to do. And I get that you didn't want to do it. I can't is very different from I don't want to. I appreciate year three, but I think on a subject that is so sensitive. And I'm not going to talk about my personal experience because I'm not going to try to muddy the waters with an emotional weight, which I know we all have. this needs to open this needs to be successful i do not want the day to come where we are faced with the question of having to close the doors of this or raise taxes i will not do either one so i will yield projects i will give back funding i will give whatever i need to make this successful i would hope that my colleagues would be willing to do the same thank you mr chair and look there's an easy funding source

We're about to have a ton of free cash right now as a result of what was discussed in the prior committee, given the DEI bill that just passed the legislature. All these organizations right now are not going to be able to get funded. There's millions of dollars there. Put them towards this. But it's easy to throw it on us or to say, we'll figure it out after the pilot program, which, by the way, the mayor won't be the mayor at that point. should be turned out. So it'll be the next person's issue. It's easy to kick the can down the road, and that is what we're saying. Now it's being portrayed as certain commissioners don't agree and don't want mental health. No, no, no, no. Let's not say that because that's couldn't be further from the truth. But we're responsible and we're not caving to political pressure. Commissioner Steinberg, then Gonzalez.

Okay, thank you. And thank you for the history. And I think it puts it in this posture. We now have, as I heard, three year funding source. I say we move forward. roll up our sleeves over the next 18 months, figure out what the future funding sources are going to look like, create a plan, but we need to do this. I want to remind us just briefly, ROI sometimes isn't always just monetary. It can be just as a matter of community impact as well, that return on investment. And I'll just also say that We're not getting a vote today, obviously. I think everybody knows where my vote would be. But I've said it before and I'll say it again. What's the cost of doing nothing? And I'm glad to hear that we're finally moving in a trajectory to do something.

Thank you, Commissioner. Commissioner Gonzalez, you're recognized.

Thank you, Mr. Chair. And first of all, I want to thank the Chair for putting this conversation together, because I think it's important that we have this conversation. I think that we've all been asking to sit down, have a conversation, and figure out how we're going to do this. Because I do agree with a lot of the sentiment up here that this needs to be done. I want to start off with some positive stuff. It is clear, and the numbers don't lie, Miami-Dade County has been leading, leading in initiatives to solve our unsheltered individuals in Miami-Dade for a very long time. I see Miss Millette here, and the Homeless Trust has been doing a phenomenal job. I said this before, but I think it warrants repeating that we currently have 800 to 1,000 a year of individuals that are not sheltered. Now, Miami-Dade County reported 1,068 unsheltered out of 3,570 total homeless, one of the nation's lowest. numbers of hardened populations. In comparison, we look at a county like Los Angeles, 46,000 out of 72,000. We've had this conversation before, but there is a demographic of folks that are unsheltered, that need something different, that is not housing first. And for that, I want to thank Judge Leifman, whether this moves forward or not, the fact that Miami-Dade County is having this conversation. And folks, I want everybody at home and here to know every single commission, I don't want to speak for my colleagues, but I think I can in saying that every single commissioner up here wants nothing more than to solve this issue not only solve this issue but to give folks the treatment and what they need in order to really solve homelessness and sometimes it's not just housing it's treatment and that treatment will then pay dividends in the future i think the frustration that that that has been had for for a while now is just fiscal And I have been trying, along with many of my colleagues, have been trying to figure out where we're going to find the funds to do this. So to my colleagues, I've been in communications with, for example, Florida International University. There are grants. that are attributed, not specifically for the homeless population, but they're attributed to any university, whether it be University of Miami or Florida International University. They're state grants that could go to these universities for workforce. Which has led to conversations with particularly FIU to see if they can help with some of the maintenance and required medical treatment that's going to be had at this facility. In the past, I've suggested taking certain dollars that have been attributed to the homeless trust. I mean, Commissioner Cohen-Higgins, along with the chairman, have also proposed various places where we can derive funds. So I'm glad that we're having this conversation, because I think that hopefully, very soon, God willing, we're going to be able to land this plane. I need to ask just a couple of questions regarding the financials. So I don't know if perhaps I can have Judge Leifman come up, but Judge Leifman, my first question goes to pledges from other cities, municipalities, and or just Institutions are like, for example, I know for a fact that the homeless trust has tried to go above and beyond with what they're going to be kicking in. Right and I think we've heard from many of our colleagues and I share this sentiment that to open this to close it. Is it responsible and would be catastrophic? So we're not going to do that. We need to keep this facility open. So let's talk about how we're going to be able to not only open this, but make sure that it thrives moving forward, right? And Judge, you're recognized for an I've been following Q&A with the commissioner. Thank you, Mr. Chair. So specifically, I remember that there was a mention that there was cities, municipalities, and other organizations that were going to kick in funds. Have you gotten or have you received any... memorandum, affidavit, or anything concrete that says, hey, here's a list of these folks. This is how much money they're going to be putting in every year.

Do you have that, Judge? I don't have a list, Mr. Chairman, thank you. The city of Miami had an agenda item about three weeks ago. By a 5-0 vote, they directed the city manager to come up with a funding plan for the facility. and they're waiting for that proposal to come back to them. I have a meeting with the city manager in the next couple days to further discuss it, and I will be able to come back to you with an idea when they will have a plan. I will tell you, all five commissioners were exceedingly supportive of the project, and there is money, and they're figuring out how they can do it. I do not have any other municipalities at this time but candidly i think this issue affects the city of miami most because of the high number of homes people in the city and they're very motivated We have also had a meeting with the city of Miami Beach mayor. We do not have a commitment yet, but we are continuously having that conversation. There are other funds as well that we are looking at. And you may, if you'd like, I'll be happy to talk about.

Yeah, well, one, I'd love for you to go through what those funding sources look like. And then I'd love to help in any way that I can, and I'm sure my colleagues would love to help in any way that they can in suggesting with other municipalities. This is, you're right, okay? City of Miami would probably be the most effective. But this is a countywide issue. 100%. And I think that if we were to perhaps together or with commissioners from the districts that have these municipalities go and speak to these cities. I think that there could be a compelling argument that, and I think a lot of those councilmen and commissioners would be more than willing to kick in. There needs to be something concrete. Yes. And you have my commitment that I'll work with you, like I've been working with FIU, like I've been working with UM. You have my commitment that I'll work with you, but we can't go off hypotheticals. And I think you agree with that, Judge. 100%.

It will help to have the building open. that's what we hear from a lot of the municipalities and the other potential resources that they're more willing to do this once there is a commitment from the county to open the facility and so i'm in this chicken and egg kind of situation for instance one of the things that we can do is we can apply for what's called a CCBHC. It's a Certified Community Behavioral Health Center. They are federally funded. What they basically are, are, you know, an FQAC is a federally qualified healthcare facility. About three years ago, the federal government started to do that for behavioral health. They're wonderful. They do about 200 a year. And there's absolutely no reason that WestCare, and I know that they're interested in doing this, can apply to be a CCBHC. If they do that, they will then receive federal funding And it pays a higher Medicaid rate. So while they're projecting 30% at this point, that number could be increased, bringing more and more dollars and less of a burden to the county. It is a substantial opportunity. Again, can't do it until we get open. FIU, both of us have had wonderful conversations with President Nunez. There is serious interest to do this. Again, I'm taking their medical school staff on a tour of the facility in a few weeks. We've begun that conversation, but nothing will happen until the facility is open. We have already raised substantial philanthropy dollars. Many of our funders are asking for the money back.

Can you give me numbers, Judge?

A couple million dollars already.

But what's a couple million, sir? Two. Got it.

Okay. All right, I'm not trying to be sarcastic or fresh. But is this- Money is sitting in a bank right now, untouched, but we get constant calls from our Donators telling us if we don't get this started soon, they're going to need the money back. We had $750,000. Actually, we had $1.5 million from the City of Miami and ARPA money to help fund this. They've already taken $750,000 back because we didn't get the project open. We lost three-quarters of a million dollars by the delays. The other $750,000 is gone. We lost the other $750,000. So we lost $1.5 million from the City of Miami ARPA dollars because of the delays. We as commissioner said we've had a certificate of completion since January 2024. We'd expected to have been open before then and we could have used those dollars so we're losing money plus. There are costs to keep it closed. You're losing $1,000,000 a year. JUST BY KEEPING THE FACILITY CLOSED BECAUSE IT HAS TO BE MAINTAINED. SO WE HAVE PHILANTHROPY, WE HAVE CORPORATE, THE PRESIDENT OF BRISTOL MEIER SQUIBB FOUNDATION, NOT OF THE FOUNDATION BUT OF THE ENTIRE CORPORATION THAT IS A MULTIBILLION DOLLAR COMPANY IS COMING DOWN TO VISIT THE FACILITY IN THREE WEEKS. Okay, they think this is the answer to the most acutely ill that consistently cycle again and again. Now they have provided advocate a grant for both continuity of care and for peer support, substantial. But they believe that this center is the way for this issue.

And is there a dollar amount for that grant and is it recurring?

1.2?

One point five million dollars. One point five million. Is it recurring or is it just a one time?

It's a one time at this point. But if it's successful, we can reapply and we can apply for other grants as well. There are Bureau of Justice Assistance. There are sample.

And I'm sorry to cut you off, Judge, but I'm just thinking now the ARPA money is the ARPA money something that can be applied for in the future?

No, it's gone. It had to be spent this year.

Is that so that's a grant?

No, that was part of the Americans for Recovery Act that came out of the COVID crisis.

Got it. And that would have been a one-time as well?

It would have, but we were going to use that to pay for one-time cost. For instance, in the facility, we need to build out a medical office. We were going to do that. We need to use it for that. It's a one-time cost. We need to build out a dental, excuse me, an ophthalmology facility. because Baskin Palmer has agreed to provide those services in the facility. And they will bill Medicaid directly, just like Camillus Health will bill Medicaid directly. So there's no long term cost for us, but we have the short term cost of building out. Those dollars would have been used for that. We had all of this planned out, but all of these delays have made it impossible for us to spend the money. So every day that goes by, it's costing and we're losing money and we're losing credibility. It's getting very hard. We're not asking right now for any money from anybody because it's unethical until we can tell them 100% that this facility is going to open.

Got it. As far as the folks that would be able to be treated here, YOU KNOW, THERE IS A CONCERN THAT PERHAPS THE BEDS COULDN'T BE FILLED.

CAN YOU? THEY WILL BE FILLED, I ASSURE YOU. UNDERSTOOD. BUT HERE'S WHAT I NEED FROM YOU. I SHOULDN'T EVEN SMILE AND I APOLOGIZE.

BUT HERE'S WHAT I NEED FROM YOU. YES. Can you clarify? Yes. Right? Because that's not the discussion that was made here, right? The discussion that was had here was a limitation as to who can even go to these facilities.

Yeah, there was some confusion, and that's why I'm thrilled to have this opportunity. Commissioner Lopez, I cannot thank you enough for arranging this, because these are really complicated issues, and you just touched on one of them. The court has been running a very sophisticated diversion program for 25 years. And it attacks different problems within the system. The chairman was referring to the population that is incompetent to proceed. We tackled that 20 years ago and created a program at Jackson. And we already divert a good amount of people who otherwise would be sitting in jail. Going to a state facility for restoration. That number is pretty small compared to what it used to be. We're not taking that population, nor did we ever think we would. The chairman asked, and I wish he was here. Oh, here he is. Thank you. Because I want to answer your questions.

By the way, your questions were- Judge, I think that that's a misconception if you're right. Because what I've understood is that, and I don't know if this was a miscommunication with you know, conversations with the administration. But what I understood is that this was specifically to help folks that are incarcerated, that are not incompetent, that have been adjudicated incompetent and need to go to the state hospital for restoration.

Okay. Explain the very, very small group of people.

Explain the difference.

Yeah. So, um, When someone gets arrested, we change the screening tool at the jail. They weren't even using a validated tool back in the day. They now, through Jackson, who does a wonderful job identifying people who have a mental health disorder. Let me back up a little because I think this will be helpful. Think about mental illness like we think about cancer. There are many different types of mental illnesses and there are many different levels of acuity, almost like stage one through stage four. So when someone comes in, they may be suffering from depression, okay, but they're not psychotic, they don't need crisis care right away. They can be treated in the jail and they're generally put in general population. Then there is another population that is much more acute. They go into separate special cells and they try to treat them. What happens though for the diversion program is once they are identified, if they are identified on a misdemeanor and say they meet criteria for the Baker Act, which is very different than criteria for competency or not necessarily having a mental illness. So you can have a very serious mental illness and not meet the criteria for the Baker Act. So the people Mr. Magoya was talking about that we send is a smaller subset as well that goes over to Jackson if they meet that criteria, either for assisted outpatient commitment or the Baker Act. We send them to Jackson mostly. We hold them for a couple weeks. We get them stabilized. For misdemeanors, it's done within three days. We then send a member of our team from the court. They're all trained on how to talk to this population. And we encourage them to go into the program. And we have leverage. And that's why we believe this system works. And we never talked about this earlier. They're on a hold from the court. So if they say yes, they'll take the program. They don't get rebooked. They go back to court. They're met by a peer specialist, someone with lived experiences. Many of them are graduates of our program. They're given food, something to drink. They have to take medication. Transportation and housing is all set up for them. It's an amazing program.

That's happening right now?

Happening for 25 years, okay?

How is this different?

Well, that's what I'm going to tell you. Recidivism for that population went from 75% to 20%. we've done an amazing job we expanded to felony cases the recidivism among the felony population mr chairman went from seventy five percent to six percent we have all the recidivism data for you it's all kept we have a research hub within the court that manages all this and i will give it all to you it's fascinating data we also have a list of those that meet the criteria unfortunately that was not discussed earlier We get a we I shouldn't say me anymore. I'm retired from the court. The court every single day gets a printout from the county of who's eligible for diversion. it's based on charge because we're not taking violent people that would be a danger to the community it's based on their diagnosis which is really based on where they're located in the jail so we know they have a serious mental illness because there's several different mental illnesses but we have a very tight criteria and it's also based on their prior offenses we don't want anybody with more than four felony convictions BECAUSE WE WANT TO MAKE SURE WE PROTECT PUBLIC SAFETY. ON THAT LIST FOR THE LAST FIVE YEARS WERE 16,400 PEOPLE. OKAY? WE NEED CAPACITY. BUT WE ONLY DIVERT ABOUT 500 PEOPLE A YEAR RIGHT NOW, BUT THE ELIGIBILITY LIST IS HUGE. SO TO ANSWER YOUR QUESTION, THE PEOPLE WE WANT FOR THE BUILDING ARE THE PEOPLE WE FAILED. Okay? Because they're kind of the stage four mental health population. When community mental health was designed in America, the most acutely ill were still in state hospitals. So community mental health is for moderately ill people. You can't go to a crisis unit with psychosis and be cured in three days. It doesn't work that way. That population needs longer-term care. So the people that will go into the building are the people that have failed the existing system. So Jackson's done a great job with psychosis. the diversion program we have, but the recidivism is 20 to 30 percent to get rearrested. They may only 12 percent go back to Jackson later, which is great, but a lot of them are getting rearrested quickly or they're going back to the street. Our computer data is really good, Mr. Chairman. We merge what's called the HMSI, that's the Homeless Management Information, with our CJIS information, that's the criminal justice information system. So we know their criminal record and their homeless record. And the people we're planning to target for the building are the most acutely ill. We've narrowed it down to about 1,049 people. Those 1,049 people over the last five years made up 21% of all the mental health beds in the jail, 1,000 people basically. They spent 317,000 days in the Dade County Jail, those 1,000 people. The numbers you heard today will be able to take, for those 75 beds or so, about 300 people a year. We will start with that very acute population that's killing the entire jail population.

Got it, but Judge, and I don't know if the Chief can chime in, because that's not the information, and I mean, correct me if I'm wrong, but that's not the information I was getting from the Chief.

All right, Commissioner and and I'll I'll jump in. So judge and thank you for saying that you have the the numbers that they're happy to share it with you. But here's here's the challenge that I have and and to Commissioner Gonzalez is pointing. He still has the floor, but just to chime in for a second is. I was just I mean they said on the record, so I'm repeating what they just said. Few minutes ago is the administration has given at least me, but he said here. Clear instructions that that that. YOURSELF INCLUDED, JUDGE, ARE AN ADVOCATE FOR THE BUILDING, THAT WE'RE ONLY TO LISTEN TO WHAT THEY'RE TELLING US. SO I NEED TO HAVE CLARITY. WE TALK REGULARLY. THAT'S NOT WHAT THEY'VE INDICATED. THEY'VE NOT SAID YOU DO OR DON'T.

THESE ARE COMPLICATED.

I'VE ASKED FOR THESE NUMBERS REPEATEDLY AND NOW YOU'RE SAYING THEY EXIST. But you guys have not provided that to us. I mean, in fact, you said they don't exist. You just actually, literally, it's on camera.

I don't think he was saying that doesn't exist.

No, no, no. I don't mean to contradict him at all. No, no, no. I do think he was saying that because we could roll back the tapes. We have a great TV production.

I did not hear that from him, so I don't want to contradict him, and I'll let him speak.

But you were sitting right there. This was today, not last week.

I understand. I've heard a lot of stuff today, and so- There's a lot of statements that are being made.

We stand by our numbers as an administration. The judge has numbers. We appreciate his consult. He's an advocate. He's very passionate.

But I'm still not sure what number you're saying you disagree on.

The community services department will be operating the structure through our vendors. If you have a specific question about numbers, I can answer, but I'm not really sure what number we're talking about.

Yeah, I'm not either.

I don't know where you think we can- He said some numbers, but I'm not really sure what number we're talking about.

Well, this is very simple. I mean, very simple. I've been asking, what is the- How many patients, how many inmates will be transferred here? What are the numbers? Who will this serve? What is the criteria?

I think we all agree it's about 300 people a year.

That has not come from the administration though. The administration has not said that number ever. I've asked a dozen times off the record, on the record. They've not said that. At the same time, they're saying that the only numbers that count, judge, are the ones that come from them, not from you.

I appreciate that and I stand by that too, but I don't think they've said otherwise. Mr.

Chair, just to clarify, and just to clarify, because Chief, I don't know if it was you or Mr. Magoya that came up and said that this wasn't going to, the folks that were going to go to this program were not going to be the same folks that are in the jail system. So maybe can you clarify that?

Okay, the folks that we're trying to treat are the most acutely ill.

Okay.

That's what the judge is referring to. At capacity, at capacity, that center will not save us a lot of money at the jail, because I still have to run a mental health center at the jail. So the judge is referring to- I'm not talking about savings.

I didn't mention savings.

What the judge is referring to- Regardless of those 300 people, we're not saving money because we still have to run the program.

Yes, what the judge is referring to is we have 75 beds, 90 day terms. So if you do simple math, 75 times four is 300 a year. He believes that we as an organization can serve 300 a year and maybe 1,000 a little bit over three years. As an estimate? That's an estimate. Those are not our numbers because I can't guarantee you capacity 75, 300 a year. I'm only giving you the numbers that I can guarantee.

So what numbers can't we guarantee?

That's up in the air. That's depending on what the courts, like the commission chair said, agrees to defer or divert into the system. At maximum, it's 75.

Well, there's 75 beds. But trust me, when I say this, we divert a lot more than 75 a year. It's not an issue for us. And the court will have no problem keeping those beds full. Now, I will say this because it's complicated. the first group that may come in may stay longer because they may be the most acutely ill. We know who all these folks are. We know them by name. And so as we get the most acutely ill stabilized and back into the community, the criteria may widen and we'll be able to take people that are less ill that don't need to stay as long. Just like if you go to Sylvester with serious cancer, right? Depending on your diagnosis when you get there is how long you're going to be there. But the projections that we have made for this building and I believe that WestCare is looking at in terms of their planning is about 300 people a year.

300 people a year. Yes. That's the estimate. Yes. Chief, I think, did you want to say something?

Well, through the Chair, Commissioner, I really want to make sure we understand your question. Because I would agree, we're not arguing or we're not in disagreement. I just want to make sure I understand your question because words do matter and specificity matters. So would you mind repeating your question?

Absolutely. I think the issue here is we're operating as the chief properly addressed. We're operating off hypotheticals, and operating off hypotheticals I think what the chief clarified is we can't give concrete numbers. So where I think the judge is giving a concrete number, so I don't think anybody's lying here. I think where the judge is giving a concrete number according to his estimate, I understand why the chief would say, hey, that estimate is merely an estimate. And in order to justify spending the funds, I can't give you a specific number of people that would be going into the facility. Because although 75 beds exist, we are not in control of what a judge would decide and how many folks a judge would decide would go into the facility. Now the clarification from the judge- I think the bigger issue is- Judge, give me a second, sir. I'm sorry. The clarification from the judge was that at this point in time, There are, did you say 16,000, 1,600?

There were 16,000 over the last five years, but we were focused on the top 1,000 that have the highest recidivism, that get arrested the most, that cost the most. There are studies that show about 15 to 20% of this population account for 40 to 60% of the cost. So you want to focus. You want to use a population health model and focus on the people that are the most expensive, that are cycling the most, the greatest risk for public safety issues, their quality of life, but there's still public safety issues. And that's who we want to focus. I think the issue isn't that the court's not going to have enough people. What we don't know yet is the acuity of the person. And so the chief is right. He doesn't want to lock in and come back in a year. And you say, hey, you said 300 people. We did 75. Well, those 75 may end up staying longer. But if you average this probably over a few years, what you're going to find is probably about 300 people a year should be served in this facility.

And I think that that analysis was necessary. I think that that analysis was necessary in order to be able to justify that if we're saying that theoretically but realistically the beds could be filled.

Now also understand the facility has a crisis stabilization unit. Jackson sees I think about 25 people a day. You do the math, the building also is going to see you know, thousands of people a year coming through the crisis stabilization unit. Since 2018,

What is the crisis stabilization unit?

The Baker Act facility, okay? Since 2018, Dade County, I don't mean the county government, but in Dade County has lost 259 beds. There's a shortage right now. We do not have enough beds in Dade County.

259 beds for what?

Baker Act facilities have closed since 2018, okay? So you have more people going to fewer facilities and having less access to treatment. meaning they get sick longer they stay out on the street and they end up getting arrested so this is part of expanding capacity so we will see also thousands of people come through the facility through the baker act they may not meet criteria for short-term residential because they may not be that high user population this is why this is so appreciated to have this hearing because this is really complicated stuff and when we get up for two minutes and try to answer something this complicated we can't do it and it creates a lot of misinformation and so Yes, we have data on what's happened in the past. We have a pretty good idea how many people will come in there. But we have about 75 beds for the acutely ill population that we think over time in a year will stretch out hopefully to about 300 people.

And Chief, because I remember that you mentioned Baker Act specifically. Has the administration taken the folks that are to be Baker Acted into consideration in putting forward this analysis?

Yes, absolutely.

And what conclusion did you come to?

Based on my experience, if you give law enforcement an option of taking a crisis patient, To a hospital or to a facility like this, they're going to use this facility. It's a lot easier, it's easier to clean in and out. There's no line, no waiting. It's not a hospital.

That is it.

They can go right to care. Is it necessary? So we considered it, but I like to work in concrete numbers, and I can't tell you how many Baker Rocks are going to be there. No, and I understand. The judge has experience, and he believes it'll be thousands. I don't know that.

Not from the jail, though. Judge, you gotta stop that.

So I'm telling you that concrete, I don't know how many- It's hard being a judge, man.

We're used to that, I apologize. I know it comes from passion.

I know, my apologies. And judge, remember when you were a judge. I'm trying, yeah, but I interrupt it all the time. That's why I'm doing it, so I'm trying not to be a judge. Well, you wouldn't let the lawyers interrupt all the time.

Right, so Chief, if you can continue, because I think that this has been a valuable exercise.

So, Commissioner, you always ask the most intriguing questions, and I think they were really important questions, and so I'm kind of doing a little Cathy here. But I think the point that you're trying to make and the judge is trying to make is that there is a community need. There is absolutely community need. There are more people who need help than we currently have services, beds to provide. So this will be a value add to the community. The question that the board is contemplating and struggling with is whether or not the cost of doing this is worth whatever your personal values dictate.

No, I don't think it's, I don't think that's really the thing, but chief questions are great to be fair, to be fair chief. I don't think any of the commissioners, cause that's not fair to say, I don't think any of the commissioners up here, whether they're for it or against it, I don't think any of them have a personal value, have a personal opinion that the value is not there. And I did want to get to the crux of the fact that this is something that's necessary. This is something that would be, you know, Life changing for not only for individuals, but it would be it would be a substantial change to the county and a great example. I think that what we've all been. What everybody has been debating is. Is this fiscally something that we can afford? It's not about personal, I don't think anybody up here has at any time said that personally they don't want to see this happen. I think personally everybody has a heart and sees the necessity. And I don't want to speak for my colleagues, but they can reiterate if they disagree. I think the issue here is fiscally, can this be afforded? And that's why I wanted to really establish, hey, is this necessary? And I think that the chief very astutely and responsibly is not giving hypotheticals. He's giving what concretely he can actually say is a possibility. But I think that once the judge was able to explain the need, we can see that, hey, there is a potential necessity here. It goes back to the beginning of the conversation. How do we afford this? And I think that that's what we're here for.

And I respect that. I'm a taxpayer. I live in the county. I agree.

We've just identified, for example, thinking outside the box with FIU like we've done. I think that there's grants there.

Miami, CCBHCs, philanthropy, we'll do it all.

Do you see a world? And don't give me a hypothetical, sir, right? I need you to answer me because I'm starting to see this vision, right? Do you see a world where this facility is not going to need eventually because we're talking about philanthropy, we're talking about grants, we're talking about being able to be operated by universities. Do you see a world where this facility doesn't need county funds to operate? given that it is successful?

I think there will be some county funds needed. I do.

Forever?

I don't know if forever. I hope not. There are avenues and pathways through Medicaid, through other things that will help. But I don't think it's nearly the numbers you all think it might be. I don't think it's going to be anything more than 10 to 15 million at the outside.

A year?

A year, at the very most.

So 10 to 15 million from the county?

But not for years, because remember, there's two buckets here. There's a bucket for operations of the actual clinical services, and if you talked i don't speak for anyone here but if you speak to west care they will tell you that based on the opioid money that goes for eighteen years they are revenue neutral for five years the county did a great job bringing back you can ask them don't ask me THE COST OF THE BUILDINGS FIXED, THEY DID A GREAT JOB BRINGING THE COST DOWN. I DON'T KNOW WHAT THE ACTUAL NUMBER WAS, I'LL LET YOU SPEAK ON THAT, BUT THEY DID BRING THE ACTUAL COST DOWN. SO I DON'T THINK YOU'RE TALKING ABOUT SOME MASSIVE AMOUNT. It'll probably incrementally go up and you'll be able to follow it. At the same time, we will do everything on our power to bring in other. Look, if the city of Miami gives us a few million dollars a year, that's going to extend this probably, A lot.

And honestly, Judge, that's really my point, right? If we can get a real concrete plan for the fiscal economic impact, then we're cooking with gas. Because I think everybody up here wants this.

But we can't do it unless we get a commitment that you're going to open it. No one's going to give us any more money right now. And so you're all going to have to make that decision. And I can't make it for you. I think Commissioner Gilbert was incredibly thoughtful in his comments. We wouldn't ask that question though if someone had cancer or heart disease. We spend hundreds of millions of dollars. we've got more than that's and we're spending a lot of our money in corrections which works me as a taxpayer you know fifty seven million in year in overtime for the last five years for corrections for corrections actually thirds of your budget deficit last year for five years i mean come on but different so they can i think and i don't want to be disrespected not a lot but i think we have to reverse the question judge judge judge i think you've been doing a great job initiative repassionate mission

Can you reel it in because the difficulty to the commissioner, the difficulty I'm having is your line of questioning and I thank you for it is very informative, but it's, it's, it's falling back into what the administration is trying to get away from, which is what the rhetoric that judge lifeman has put out. He's very passionate. He's very proficient in this, but his numbers are not the numbers that the administration is using. And I think, and Commissioner Cohen-Higgins was the one that did the line of questioning, so you're welcome to chime in, but I think the question that you're asking of the dollar amount, I think Megoya answered it, at a minimum, answered it for you, right? Because the $20 million deficit that he runs at a year, $20 million that he runs at, and I'd venture to say Jackson runs pretty efficient, pretty lean in the way that they operate. And Judge Leifman is standing up here saying that they anticipate to see more people than what Jackson does. Therefore, that deficit is going to be greater than the $20 million deficit. I mean, I don't know if you could argue that these are apples to apples, but for a world where no one could give us a real number, because we've not done this before, I think that's the best comparison we have is that the leanest, operation that we can look to today operates at a $20 million deficit for a comparable facility. But respectfully, it's not comparable. Correct, because it doesn't exist, which is my issue with the headline. They have high labor costs, they have 10 million for security. Judge, judge, do me a favor, judge, please take a seat. And we'll get back to the factual numbers that the administration is. So commissioner, you still have the floor. But again, I see that the administration is having heartburn with this line of question because they've continued to try to move away from the advocates into the factual numbers to the extent that they have factual numbers, which we don't have many.

I think the conversation is important, and that's why I wanted to go through this line of questioning, because I think all things should be considered. I do see the passion and I see the point in a lot of what Judge Leifman is saying, but I also understand the responsibility in not wanting to operate in hypotheticals. I wanted to get both of those worlds in order to really consider what the possibility is and Weigh that against what factually the numbers are that we can talk about. And also. I wanted to get a commitment from the judge, which I think the judge has said today. To be able to go out there and try to see if try to see and I think everybody's been asking that from the beginning. How can we get concrete dollars for this to happen? So with that, I don't have any other questions. The only one clarification that I did want is to understand the Medicaid process as far as the monies are concerned. But I think we can do that in private. Thank you, Mr. Chair.

Thank you, Commissioner. All right, I have, Bastian's been waving at me, and then I have Regalado, and then, okay, Bastian, can I, do you need to go now? Can I recognize Regalado for a second, and then? Yeah, and then for the record, right after this, the infrastructure committee will take place.

Mr. Chair, I don't have a problem waiting to the end. I was just saying Carlos Martinez wanted to say something, and he has to go because he has a flight. That was my only point. I'm happy to wait to the end.

Come up. And then Commissioner Bastien will be recognized thereafter.

Carlos Martinez, Miami-Dade public defender. Thank you so much for having the conversation. It is really clear that you all care. So let me bring it down to not a hypothetical. And I want to make sure we all remember his name. The guy's name is Henry Diaz. Henry Diaz is a man who, were this place open, he would not be in a coma right now. Why do I say that, and why am I so certain that that's the case? This man was put in a cell. The cells that we have at the jail for the mentally ill have two people in it. The cells that they have, the rooms that they have, At the center is one person. This man that's in a coma, he was beat up by another inmate who was severely mentally ill as well. But he was put in a coma. So I wanted to make sure that you all know that there are real life people that can be impacted by your important decision. uh... in opening up the center i did want to mention a couple more things and then i'll go away uh... we currently have in terms of filling uh... filling the center that is not going to be a problem uh... that we have so many people right now i have eighteen hundred clients in the jail that have serious mental illness that's through our identification process looking at all the mental health records prior baker acts all sorts of issues the courts that they do the interviews and they actually are able to do the interviews earlier and look at a lot of data their numbers show 2400 of my clients so right now trying to reconcile what's the difference between my 1800 and 2400 to try to figure out what i missed those two numbers tell you that there's a tremendous need and that it's going to be partially filled By this place opening up, I know that there was a mention about incompetent to proceed. And those individuals are being housed at the jail. Unfortunately, the state of Florida has not adequately funded all the forensic beds that they need to be funding. Therefore, the people are waiting in our jail. And the jail is not the right place for these mentally ill individuals. But right now, As of today, I have 46 clients who have been found to be incompetent to proceed on felony cases. And it's been more than 15 days since that finding of incompetent to proceed. The law is that they have to be transferred. Unfortunately, we cannot litigate that issue. It's a long story, but we cannot litigate that issue going against the state of Florida. The average for men that are currently in the jail awaiting for a forensic bed is 88 days, three months. For women, it's 147 days. That's more than five months. So there is a serious need and what this will do once it opens, it will really have a valve so that we can better treat the individuals who are in custody, uh, and also the individuals who go, uh, to the center. Thank you so much for, uh, for, and I see a question.

Thank you, Carlos. Of course. Yes, you're right. Yeah, of course. And I have, I just have thoughts too. I mean, I agree with everything you said and you're right. It's, you know, and I don't, I don't, this is, you know, I didn't even know you were speaking today. Right. And of course I'm going to recognize you. You're one of my colleagues is like, but do you have funds that you could put towards this? Like, does the, does the judicial system have funds? How do we pay for this? It's what we're saying. You know, it's easy to, you know, put your hand on your forehead and, and, and, and go and shake your head. Like, what are these commissioners not understanding? Like, don't they understand we need this? It's how will it be paid for? Like how are we, we're going to open this for two to three years, and then how do we continue it? This is real, I mean, money, despite what people think, money doesn't grow on trees for government.

So in terms of my budget, I don't have a separate budget that I can tap into. All I have is the state funding to be able to do the work, hiring attorneys, hiring support staff, so no. But I can tell you that part of the issue is the state has a responsibility here too. So I think the state should be pitching in so that if Miami-Dade County decides to open this and it creates an opportunity for them, I think the state should be definitely pitching in for what they do, particularly Miami-Dade County. This is a national model. And I know you didn't ask me this, but I'm getting old. So I've been around a long time. Miami-Dade County, and you mentioned something before about the trust. Miami-Dade County was the first one in the world to create a drug court. When nobody thought, there was no money for it. Guess what? The commission decided we're going to fund treatment. They funded outpatient treatment, not inpatient. But it worked. They also did that with the juvenile assessment center. They decided we are going to focus on our children and their future. And guess what? When that was created, there were 13,000 children arrested in Dade County. This past year, it was less than 1,000, so around 1,000 kids. No, no, I understand. There are a lot of impacts, and there are a lot of unknowns. At the time, we had no idea how well it was going to work. We knew it was going to work, but not how well. And we've gotten here. So whatever I can do at the state level to lobby for funds or figure out other ways, and if I hear anything about mental health dollars, That are available, I'll bring it to you and I'll bring it to the center to make sure that it happens. This is so critical and you all agree. You know, it's the money is the issue.

I agree with you and to your point and to correct. So not correct. But, like, just emphasize on it. Commissioner Lopez mentioned. She had a conversation with a legislator who said, you know, we really haven't looked into it. Like. I think that legislator was misleading commissioner. I think they've not only looked into it, they've gone in the opposite direction. They've actually cut mental health funding. So not only did they look into it, but they went in the opposite direction. And they're content. And that's, and that's the trend that we're seeing both at an, at a federal and at a state level is they're cutting mental health funding. So here's what they're doing. They're saying we're going to cut mental health funding. which they did already. This isn't like a conversation. They've already done this. And so this body can say, you know what? We're going to pick up the slack because it's that important. So we're going to pick up the slack and we're going to come in and put realistically the 20, $30 million a year after a couple of years. And then the state is saying, well, on top of us cutting the funding for mental health and you guys, thankfully, thank you for picking up the slack County. We're also saying, putting on the ballot to eliminate property taxes. The money you were going to fund them, we're also going to take that away from you as well. Are we going to start printing money in somebody's backyard in Hialeah? Are we going to start taking pots of money from all of the constitutional officers, from the sheriff, from the clerk, from the property appraiser, from the tax collector? We're going to have to start at some point Services are services. Whether it's social service, infrastructure, how do we... It's not a question that you actually have to answer. I understand that you're on the same boat as us. You go and argue in Tallahassee for dollars. I remember you sitting in my office when I was a legislator and you asking for additional funding or just to keep the same funding. So I understand that it's not a real question for you to respond to. It's just... It's not the question is not the rhetoric is that some commissioners don't want mental. That's the rhetoric. That's not the real question. It's how do we pay for it? And it's easy to say, how can you put a dollar amount on lives? It's easy to put at the heartstrings and make this an emotional thing. You know, such and such a person would not be in a coma. Of course, of course not. When you say that to me, what type of cruel human being would not approve a center like this? How do we make it successful? How do we make sure it's successful for decades, not for three years? Commissioner Koenigans.

Thank you, Mr. Chair, and thank you, Mr. Martinez, for being here and being so patient. And moreover, thank you for opening with saying that you recognize that we all care. It's a workshop. Nobody's taking a vote, right? No action items are before us. We're all investing the time because we recognize the import. But you said a couple of things that I find very interesting, if you don't mind me asking you just a couple of questions. So when you say that you have 1,800 clients that are deemed mentally ill, and there's another number that says 2,400 – Help me understand what that actually means, because that obviously exemplifies a need that is great. But this particular facility is only going to be taking in diverted, misdemeanor, mentally ill, nonviolent patients. So instead of the 1,800 and the 2,400, what's the number of... Misdemeanor mentally ill non violence, because that's the real number right? Felony felony felony charges are not going here. Violent charges are not going here. What's that number?

So, at the end, I'm glad did you ask? I heard the conversation. I texted my folks, you know, give me the numbers and. The numbers is about 300. Right now that I have, that if you're looking just at charges, not all the other things, it's about 300. So that's a big number. Okay. And the most challenging thing with those 300, because I asked them, also tell me which ones are homeless, are unhoused. Because the issue, I heard the comment, we have about 1,000 people unhoused. Guess what? You got a ton of them in the jail. So we're paying for their housing. In the jail, so it's about 300.

Okay, and thank you for that because I think it's important for us to focus on the population that's actually going to be receiving the benefits of this facility. And so when you say 300, help me understand when Jackson comes to the podium and says that every mentally ill patient that they received through our existing and current jail diversion program, i.e. a judge says young man or young woman. I'm going to divert you to receive mentally mental health treatment and that they are all being assigned and all being placed. And Jackson does not have a backlog of that. Help me understand that to what you just said. Why are those 300 not being entered into the diversion program that Jackson's just spoke about?

We only try to enter them in that program when there's an open bed. For us, they meet Baker Act criteria, and there's an open bed. So unlike the state incompetent to proceed, that we got to do it when it happens, with these, we actually wait to see when there's an opening, and then we're keeping track of that every week. And we try to fill it in as soon as we can to try to divert it.

But see, that's where there's a disconnect. Because presumably, if they're with you and they've been diverted by court order, they're sent to Jackson currently, right? Or some other participating- Just Jackson.

Just Jackson. The one that we're talking about is MDFAC.

Okay.

And don't ask me what that means, but- Okay. What the letters mean.

I won't ask you.

We abbreviate everything here.

But so of that population of 300, if they're being sent to Jackson- Why isn't Jackson saying that they have a backlog of 300? I mean, everything's connected. Why isn't Jackson saying they have a backlog of 300?

Because we're not telling them. So it's different criteria for the different, there's incompetent to proceed, there's MDFAC, which is different criteria. And then you throw it all in and you have to get state attorney approval before you even go to the court. So for MDFAC, it is very discrete criteria, and we're tracking to see what's open before we even say, hey, we need to place somebody. We have never done, my office, we have never done an assessment of all the clients who qualify. To tell them, hey, go ahead and we need to place all these people. Because we know the way the process works, the state attorney has to look at it, everybody has to agree, and there are lots of issues with that.

Interesting. Okay, thank you, Mr. Chair. Thank you, Mr. Martinez.

Thank you so much for the opportunity, appreciate it.

Always. All right, Commissioner Bastien, and we'll come back around.

Thank you, Mr. Chair. Discussions have been very long, but I think we will need it. And I'd like to start by thanking you, Commissioner Lopez, for requesting and advising this conversation today. And then I'd like to thank each and every one of you. for your line of questioning. And I agree with the general sentiment that there is no one on this dais who doesn't care about mental health. However, I agree with the sentiment shared by Commissioner Lopez and Commissioner Gilbert. And then I'd like to end by chipping in the line of communication that you started, and I believe that you are on the right track. The fact is, we are already paying for the treatment of these people. We are paying because Miami-Dade County has been functioning as the largest psychiatric care treatment. The jail system, our jail system, has been used as the largest psychiatric care treatment. We may think that we haven't been paid, but we are indeed paid. But we are paying to house these people but not to give them the treatment they need in a space that is dignified. And that's where the chance needs to be. I visited the center and as I probably shared before, And I was very impressed. I was impressed because as a mental health professional, it is not enough to treat one symptom and then you let go. If you do that, then there is a chance for recidivism. However, what the center offers is, and I think someone mentioned it earlier, I don't recall who, it's the continuum of care. That is extremely important. So this stabilization strategy, in my mind, is realistic, it is measurable, and it is achievable. But what we need to do, and I've been hearing the chair, and he's right in asking some of the questions about funding. But what we need to do here is open the center. Open it. Why should we open it? We need to open it because it's been proven that the need is there. These people, they are incarcerated over and over again because they have not received the treatment and continuum of care that they need. Now, to go back to the line of questioning of Commissioner Gonzalez, The question has been, where will we find the money? It is a valid question. But like Commissioner Oliver Gilbert and then Commissioner Lopez indicated, this center is needed. When people are sick, and I think the judge, unfortunately, he had to sit down because he's so passionate about this work. He's been doing it for years, and he needs to be commended. He needs to be commended for investing years, years to make sure that people with mental health are treated with the respect and dignity that any human being deserves. And to his defense, I mean, these funds have been raised since 2004. I mean, this center has remained open for so long. I guarantee you, if the center was open right after there was alignment in our thoughts, in our plans, and it was open, a lot of the questions that my colleagues are asking today would have been answered. Do you agree? They would have been answered. So that's why I say it is time to open it. How can we pay for it? And then you started with your line of questioning. And then Judge Leifman has submitted, has shared with you that there are institutions, private institutions that are interested. City of Miami has already committed to finding resources. And I would advise you, Judge Leifman, to also reach out to other cities. Because this issue is a countywide issue like you so clearly indicated. What about the city of Miami? What about the other cities? They should also be contacted, and then they should also be encouraged to contribute. But there are also other sources that can be looked at. And Commissioner Lopez, you also alluded to the state. And we can always go back to them, right? Medicaid reimbursement is already considered, can generate money, and I know the percentage has already been revealed, and more can be done with that. Targeted case management, billing, and fluid as existing behavioral health waiver structures can also be looked at. Federal grants through the Substance Abuse and Mental Health Service Administration should also be reached out to. The Resource and Service Administration should be reached out to. Other hospitals can also partake in this because a lot of times they do accept these patients even though they cannot pay. Other private institutions, public health center, can also be contacted. There are ways where that funds can be raised to support the center. And I agree with Commissioner Gilbert who said that we shouldn't be expecting for the center to generate income. This is not the intent of such a center to generate income. So we know exactly what happens when treatment is unavoidable. We know what happens. Mentally ill people end up in jails, and sometimes they are hurt. Sometimes they lose their lives. People self-medicate. They decompensate. They enter into crisis. Law enforcement becomes the first responder, and this is not acceptable. The jail becomes a treatment center. It is not acceptable. The taxpayer absorbs the cost repeatedly on the back end. This is not acceptable. Every study tells us the same thing. Diversion and treatment costs less than incarceration and crisis response. I repeat, diversion and treatment costs less than incarceration and crisis response. It is well, it's been well, well researched. This center that we visited and that we believe should be open today, not yesterday, will allow Miami-Dade County to transition out of the role of de facto state psychiatric provider and into the role of a coordinator of a behavioral health system that is humane, that is fiscally responsible, evidence-based, and built for recovery. The plan exists. The partnership, some exist, but more can be done. And Judge, I hope you're paying attention. The funding opportunities exist. You are on the right track, Commissioner Gonzalez. Now what we must do is to have the courage and the discipline to go and get them. The discipline to go and secure them. We must have the courage and the discipline to get them because it's about human lives. It's about human lives. Instead of continuing to recycle people with serious mental illness to jails and homelessness, Miami-Dade can become the first community in the nation to build a fully integrated system specifically designed for this high need population. And the need exists, it does. It does. So it is about deciding whether, ma'am, the country will continue paying enormous costs for failed status quo, providing services at the wrong place, or finally invest in a smarter, more humane, more fiscally responsible system that improves public safety while restoring dignity, recovery, and opportunity. I believe that This can be done. I understand the funding issue, and I think that the opportunities are there. They are there to get this center open and then to provide the services to mentally ill patients. When people are ill, if they are physically ill, they go to the hospital. Human beings with mental illness should not be incarcerated. They should not be in jail. They should be in a place where they can be treated with the dignity that they deserve. Open the center. And then you and I, Commissioner Gonzalez, and I know probably more of you on the dais, Commissioner Lopez, And there are things we can do. And lastly, I believe it is time that Judge Leifman, there is an overdue meeting with the administration. There is a meeting. You need to meet with Judge Leifman. And his passion should be commended. It should be commended. We need this passion to build a center of that magnitude, which would put us, not only nationally but globally, in a very positive light. So please meet with the judge, get your facts together, and let us help and support my colleagues who want this, but their concerns are valid. They want to make sure that once it opens, that this center will become a success that we can all be proud of. I believe we can do it. I believe it is time. It is time. Thank you

Thank you.

Thank you. I will be brief. Thank you, Mr. Chair.

I'm not going to repeat what all of our colleagues have said already. And of course, I agree with everybody here. And I know that we are all on the same page about opening up this center. We as the Board of County Commissioners were asked to approve an annual budget. And we have a duty to look out for the financial health and stability of our county. But most importantly, to look out for our taxpayer dollars. And I think it's time that we get creative. Have we sought out private dollars? I would ask the administration, have we, and to Judge Leifman if the chair permits, have we sought out private dollars? Is there anything that prohibits us from partnering with private entities? to sustain this center, to strike up a partnership. I know that we're working with UM on consulting or research services, but they are charging us for that. Are we working with other universities, educational facilities, hospitals, medical centers to create a partnership where they can run some services in the facility and generate revenues to sustain the center long term?

Ma'am, through the chair, we're open to all those suggestions. And University of Miami was identified by one of our providers, but we're not reluctant to work with Florida International if need be, or anyone else, or any other private partner.

But University of Miami, as I read it, they're providing research, right, at a cost.

Through one of our providers, yes.

But they're charging us. What I'm asking is are we looking for ways to partner with them or with other entities whereby they can establish services at the center so that they can provide long term revenues for us or that we can charge them for rent or other services that might provide revenue back so that we can create, generate money for the center.

We're looking at other ways of generating money for the center, including seven floor, parts of the first floor, the kitchen that we have. But as to the contract or the agreement between the University of Miami, I would refer to the advocate program if they want to answer that, because I'm not sure if they're paying or how much they're paying.

Okay, can I ask? Sure. Okay, thank you.

Good afternoon, Isabel Perez Marina from the advocate program. Um, our agreement with the university of Miami is for startup funds, um, to do the research and evaluation it's for one year. And then they are tasked with getting research grants to continue the work for future years. So the budget only accounts for one year with the university of Miami, with the understanding that they continue to bring in funds through research, but we are paying them $120,000 to do that.

Right.

We are. It is part of our budget. We have been trying to get that money paid through other means and not part of what the county request is going to be.

Are you having conversations with them about a long-term relationship in some other way? Not that we continue paying them for research, but that... We have a relationship with them right now.

So they are currently our research partner on the Bristol-Myers Squibb Foundation grant, and that pays for a portion of their work there. And so we've already started those conversations and that work.

Yeah, I would encourage that we seek out to establish these relationships that we can establish a financial relationship, right? Like a P3, a partnership with an entity that can afford to help us so that we're not trying to self sustain. And I know that Commissioner Bastien said this, I know that Commissioner Gonzalez alluded to this, but actually seeking actively seeking ways that we can, I don't know if it's, they establish a clinic there or a private hospital establishes services there. They have the patients, they can provide the service. Maybe they can, they can receive more funds from Medicaid or Medicaid, right? Because, uh,

So those conversations are being had not just with the University of Miami, but other providers that offer primary care, other federally qualified health clinics, and as was mentioned earlier with FIU Medical, who could also come in and provide a lot of services at no cost to the existing budget.

Okay, thank you. And I know that Commissioner Gonzalez already alluded to the municipalities, but this impacts all our municipalities. I personally have six in my district, and I know TGK is right next to Miami Springs, for example. And I know that short term stays at TGK, some of these folks end up on the streets in Miami Springs, in Hialeah. I think I'm committed to asking, we need to hold our municipalities to helping us because they are all impacted. by the folks that are going in to the jails and coming out of the jails. And they all have a responsibility, not just City of Miami. All municipalities have a responsibility to help us. It shouldn't just be on us to hold this afloat because all of the voters of Miami-Dade voted for this. So I would encourage that we do seek out those dollars from City of Miami and other municipalities that can help us annually for this. And I wanted to ask, because we've been mentioning the Baker Act a lot, how many people are Baker Acted in Miami-Dade County on an annual basis? Do we have that number? I imagine it's a lot.

You can answer that. Do you have an answer? Through the Chair, Commissioner Orbis, I don't have the number of people or Baker Act. But what we did in the performer that helped us understand how much funding is needed for programming, is we identified the number of people who would use each bed. But also those who would be part of our ongoing treatment program. And so our proforma has in the mobile response about 1,200 people a year. And in the new direction, central intake assessment, 1,500 people per year who we could potentially service. Crisis stabilization has 1,216 people a year, which who we could potentially service in this facility.

And these are already? Are these people that are already in the jail or in another facility?

No, so I think there has been an over emphasis of the jail. The purpose of the center, and it's intentionally called a diversion center, is to make sure that we get the most needy people. Some of them will end up in jail because we haven't facilitated the process of preventing them from getting there in the first place. But folks will come from various places based on the incredible work that Advocate does, WestCare does, and our New Directions does to identify the right people who are eligible.

Right, that's what I'm getting at because it's a diversion program. Not necessarily everybody who's Baker acted falls into the same category, right, or qualifies to go into this. So there is a distinction, right?

Correct. Commissioner, there are probably six different categories of people who will qualify for this facility, whether they're an inpatient, three days, or whether they're just a pass through, right, and get unique services that need to be provided.

Thank you. Commissioner, to your question, 32,000 Baker Acts.

That's a great number.

Yeah.

Yeah. Thank you. Thank you for your question. No further questions. I'll conclude by saying we need to figure this out, no doubt. But we also have a responsibility to our taxpayers to not make an irresponsible financial decision, not only for the taxpayers, but also for the folks that would be in this facility. We don't want to let them down. Thank you.

Thank you, Commissioner. Senator Garcia?

Thank you, Mr. Chairman. And considering that this is Mental Health Awareness Month, you know how excited I am that we're having such a robust conversation on mental wellness and mental health in our community. I've always said this. Every single one of us is one crisis away from having to need resources and help. Every single one of us. It doesn't matter who you are. how healthy you think you are, we can all fall into a situation where we need some help. The fact that we're having such a great conversation on the finances is extremely important. It really is, because I think now finally I think for the first time I think we've been able to get some of these concrete numbers and understand where the finances are as it relates to this building. Let me take a step back. The reason that Thriving Minds gave up the building in big part is because of the cost of running this building. They could not afford it. So then by them not being able to afford it, it came over to the county, right? That doesn't mean that we don't do anything. The reality is that our jails right now are the number of warehouse people in our jails. People with acute mental illness. And we can do better for them. What do we think, what value do we put on people's lives? That's what we have to start asking ourselves. At the same time, trying to balance what the future budget is going to look like. What the county is using, what the administration is using, they're using the opioid dollars in big part as a big base funding for the maintenance of this building. Tell you this, those opioid dollars could have gone back into our community for the different providers. A lot of providers that we have, that we have in our community, we could have used those dollars. Thriving minds could have managed those dollars and it could have gone back into the community, but we're not. We have this building before us, and we're going to use those dollars as the base. I think that money runs for about 18 years. It runs for a significant amount of years. I think it's about $4 million a year. We have other funding sources that we can try to tap into this. This commission created the Behavioral Health Committee or Task Force Board that I chair. We gave that board the authority to oversee the administration of this building. While I think that. We can do better. The state must do better. We must do better by mental health. Judge, you have to understand that the issues that you're seeing here right now, it is a funding issue for a lot of us. I'm a fiscal conservative. I believe in social justice and social health for our people, especially when we talk about mental health services. However, I can't criticize any of our commissioners for asking the questions on the financial aspect of this. Because the reality is that there is going to be, I think this is the first time that I hear that there is going to be some county investment that has to be done moving forward as it relates to this building. However, we could also look at the fact that until we don't open this building, we have the finances for the next three to five years, roughly. If we don't open this building, then we'll never know. So that is where you see the advocates that are here. This is where we as policymakers are struggling with what is the right thing to do. How do we move forward? You know, we keep on hearing in the press that it's been 20 years. I've been involved with this building since 2014, intimately, since 2014. I even made some comments to folks. I was like, wait, are we sure we want to go down this path? But when we hear 20 years, think about it, it really got the certification, the CU or CO in 2024. So it's been a couple of years. And Commissioner Regalado, I applaud you for taking on this mission and making sure that we try to have a building that does provide services. So then here we are, what is the value that we put? on the most acute in our community. You know, unfortunately, the federal government, when they deregulated or they closed down the mental health hospitals, they left these individuals on the streets and now they became our, I don't want to say our problem because, yeah, they are a problem, but they became our obligation. I didn't want to say problem, thank you. They became our obligation to deal with and without the funding. So yes, we can lead the charge, but we have to lead the charge responsibly. And Judge, thank you for the work that you've done because, and you've heard me say this before, everything that I've done in mental health services, in rewriting the mental health laws, no wrong door policy, unique identifying number. A lot of the things that I did while in the legislature, you know very well that I attribute them to you. your help and the services that you provide to our community. Now, this building is a jail diversion program. This is what it is. We can do better than just that. I've talked about this in the past, but this is what we have before us right now. And as we have these conversations, we've got to remember who's in those prison cells. Got to remember that there are people, they're your brothers, sisters, uncles, family members, who unfortunately have had fallen in hard time and never had access. To the right mental health services, and this is why it's expensive. I think that a public-private partnership, I think we do have to proceed, move forward with better public-private partnerships. Chairman, I don't think there's no way that this building is going to fund itself. There's just no way. There is going to have to be county investments, state investments, or federal investments. We're going to have to find that out. But the fact that we're having this robust conversation and talking about the actual real numbers and what's going to cost and what's not going to cost, it's important and it's been long overdue. So as it relates to me, in my position, while I do have reservations, I do still have questions and the long range planning of it. I think we do have to put a value on people's lives and those people that are in the jails right now. And we have to proceed with caution. This is why we did offer an amendment to this proposal. to make sure that we you know put a time frame look at the future funding and make sure that we do have something that's long lasting and that is not going to put not only a burden on the taxpayers maybe they can't but actually help people so i'll tell you that thank you all for for this amazing conversation that we're having I appreciate the fiscal analysis that we finally are diving into it because a lot of times when we were having these conversations, a lot of it gets lost in the press. You know, we talk about 20 years. It hasn't been 20 years. It's been a couple of years. It's been 20 years for Judge Leifman and Sally Heyman. Thanks, Sally Heyman, by the way. Anyway, she... This is where we are. And we need to, I think it's, I feel comfortable if we can get some of these numbers up to date, or get the numbers that Carla Denise was talking about. I think we have a projected path that we can have the funding for the first couple of years, and then we gotta figure something out. I do disagree with one of the things that was said, that once we open it, it will never close down. No, I've seen a lot of programs that start. And then we can transfer, we can move patients out into the community, into different parts of the system itself. But I think we have to give it a shot. And you all know where I was at the beginning, and I'm at the point now where I think we do have to give it a shot and give the system an ability to see if we can take care of the most acute individuals and at the same time start developing a robust program that will not only help the most acute, Because the reality is this is a family problem, but to help those individuals that are really struggling, that never have access with a criminal justice system. And those are our neighbors. So, Mr. Chairman, thank you very much for allowing this conversation, because sometimes I'm uncomfortable because of the funding and the social aspect of it. But the fact that you allowed this conversation says a lot about you and about your leadership on this board. So I thank you very much. And for all of you for really getting involved in the issue that really affects so many of us. So with that, Mr. Chairman, I'm going to close. And just always remind... all of us in this community that it's our job as human beings as people to take care of one another and with that i close mr chairman thank you senator commissioner regalado

Thank you. First, I'm not going to rehash. I'm just going to clear up a few things that have come up. And I want to thank you, Mr. Chairman, and Commissioner Lopez for the opportunity to have everyone speak at length about something that is so important to all of us. I want to speak to a few things that Carlos Martinez said, and that's why I was glad that he got to speak. I know he had to take a plane and couldn't stay with us. But he spoke specifically to how we house the mentally ill in our jail system. And I wanted him to say that because it's not an opinion, it's a reality. In 2010, I worked with Carlos Martinez on civil citations. When we brought civil citations to the school district and we made the argument that we shouldn't be arresting children, that we should be giving them civil citations, it was not well received. It was not well received. We were very criticized, and it took five years for us to show that the proof was in the pudding. Similarly, when we worked on changing the truancy rules at Miami-Dade County Public School, it was not well received, and I received a lot of criticism, and it took eight years to show that the proof was in the pudding. And when we worked on training our police officers at the school district to speak and treat children differently and not to move to arrest or to be correct, it was not well received and it took several years. I referred to this as a pilot because I was asked at committee that why did I bring an item that had two years of funding with a five year plan and I was asked to reduce it and I did. So a lot of what is in this item that is currently being criticized is my response to requests that were specifically made to me at committee. I was specifically asked to give the county a way out if this did not work. And I was very open to doing that because I just want us to open the doors. I just want us to open the doors and I have faith in this government and in our ability to come back and course correct if that is the need. We come back and we course correct all the time. And I don't think that this will be different. And I want to thank Commissioner Garcia for his patience and his belief in that once we get this going, we can fix whatever isn't perfect. But I do want to say that there have been some misrepresentations in the sense that not all of the things that have been presented here today are the same. I'll give you an example. When we talk about Jackson and what Jackson does, we need to clarify the different things. Mr. Chair, you asked why the title of this presentation was an evidence-based approach. And the answer to that, I mean, everyone has their opinion. The reason that we talked about that was when you Baker Act someone, you give them 72 hours. The current, and that's clearly not enough, when for people who are bipolar and schizophrenic, the current program that Jackson Health System has for diversion, which was Judge Leifman actually was involved in finding the funding for that, that current program is a 30-day all-in program. And we know that 30 days is not enough for someone who is bipolar and schizophrenic, which is why the diversion program that we are talking about is a 90-day program because there is evidence to support. That 90 days is the number where someone who is bipolar or schizophrenic has received enough medication so that they can continue that medication at their own volition as opposed to in a mental health facility. And that's important. And when we look at the intake for what's currently happening at Jackson Health, it is not the same intake that we're talking about in this program. It's different intakes. And they have different comorbidities. I looked at the Jackson Health proposal. And the reason that it was 30 million is because it's based on their experience at the jails, which, by the way, speaking of thriving minds, thriving minds donates 1.5 million to that. They pay for 10 beds. And the people who are being treated by Jackson right now in our jails are people that have multiple comorbidities, have mental health issues, but are also aggressive felons, which is why the security number in that proposal was different from the security proposal that we got from this proposal and Leifman. And there is a third proposal. So some of you mentioned public-private. It depends on how you use that term. We cannot put a for-profit entity in this building because of the way that the building was built and the money from which it was built. But we had an unsolicited proposal. And that unsolicited proposal had 58 beds for $14 million. So we can't say that the Jackson number is the number. And we have mentioned they have labor costs, they have labor agreements, they're talking about a different population, they're serving a different population. That's why that number was different. When we went to the providers that were a part of the RFI, they said, look, this is the population, this is our experience with this population, and this is what we believe it will cost based on their experience, which was different from the experience that Jackson had, which was very different from a for-profit proposal that we got that is $14 million making a profit. So it's different humans given a different amount of time with different mental illnesses because what you do with someone that is bipolar or schizophrenic is very different from someone that may have a lesser. And we could go two more hours on the different phases. Judge Leifman tried to compare it to cancer. A lot of people do. They say you have a phase one, a phase two, a phase three, a phase four. depending on their needs in terms of mental health. And that also determines the time that they need. One thing that none of these has that this proposal has that I think is so important is the wraparound and the work with the homeless trust, which is why we brought the homeless trust into this, because a lot of these folks are also homeless. And that's why we needed to ensure that there was, beyond the 90 days, an investment in giving them the wraparound services so that they could reenter society and break the cycle. And that's really what we're trying to prove. We're trying to prove that if you give people a space that is not a jail... and you give them services, and you give them 90 days, and you give them medication, and you give them the ability to reenter, you don't just throw them out, you know, in TGK, you don't just throw them out in the street. If you give them that ability and you connect them to the social services that can help them, then they're not going to come back in the jails. That's really all we're trying to prove, and we just want the opportunity to prove that. And finally, Carlos Martinez mentioned Henry Diaz. It's important for everyone to understand that there are certain things that happen in these systems. Once you ring the bell, you can't unring it. In the case of Henry Diaz, who was brutally beaten by another inmate, In a mental health, you know, jail, you know, cell in our jail system, they dropped the charges. But he was still there. And that's just the reality of the jail system. And we could go on, and I'm a fiscal conservative, and I'm the first one to talk about it, but I also believe in this board and in this government and in our ability to find partnerships and to apply for grants and to look at the costs and to do the right thing. We do that all the time. We do that all the time. But you can't apply for a grant for a building that's not open. You just can't. I mean, it's a very difficult thing to do. It's very difficult for Judge Leifman to go and ask people to give him money to do a thing that we're not doing right now. Because until you open the doors, it is just an idea. Until we are allowed to do the work. So I think that, and that's why I put the reporting requirements. I said we'll come back to the board as often and as necessary. If you want to do monthly reports, we'll do monthly reports. As much information as you want so we can open the doors. Because at the end of the day, we can all care about the mental health of the residents of Miami-Dade County. But we know that we have a problem here. And we can sit here and rattle off the names of all the people that unfortunately have suffered as a result of this problem. But until we take the step forward, until we actually do the thing that other people have been talking about doing for a long time, you know, it's not going to happen. And as someone who has done these things before, it's not always popular, it's not always clean and easy, and it's never perfect. And you do go changing the thing as time goes because you learn from it. And then other people learn from it as they take these pilots and as they take these concepts and they reapply them. I can tell you today in 2026, I would have been so happy if somebody would have told me in 2010 that the backlash that I got for civil citations would actually create a national model that would help thousands of children not being arrested. And when you look back on this 10 years from now, I don't think we're going to be worrying about the money. I think we're going to be proud that we created a national model. And Mr. Chair, I don't know what the outcome of this is, but my request is that we please move this out of committee and take it to the BCC.

Vice Chairman. Mr chairman, are you going to answer her question or that you want me to tell me? Okay. Oh, thank you. That's what I was asking. Um, 1st of all, let me just say to my colleagues, thank you so much. It's been a great discussion. Dialogue has been excellent. Um, and just life men into your team, you know, you know how I feel about you. Um, I have the. in the honor of serving in front of you while I was a prosecutor here, especially dealing with drug court. And I had an opportunity to watch how you interacted with those individuals who, some were dual diagnosed, some just needed a place to rehab. But more than anything, you gave every last one of them the one word that matters, and I've heard that come across pretty much Commissioner Bastien's. um statements on the record and that's a place of dignity you you you you provided dignity um you know my remarks are very brief and i think the questions i'm hearing um they are premised on the question of fiscal i like to see it a little differently right The fiscal question is not whether the county can afford the center, right? I think the question is whether the county can afford to keep it closed. I think the question of whether or not we can afford to keep it open will keep us here day in and day out. But if we get to the heart of the matter, the heart of the matter is can the county afford to keep it closed? And from the arguments I've heard earlier and the statements I've heard earlier from my colleagues, we are all in agreement that the county cannot afford to keep it closed. So I'll wrap it up by simply saying this. We've found ways to address issues as they come to us, one by one, every time. Never any hesitation. When there are dogs out there that need dogs and cats that need to be handled with care and respect and love, we find ways to fund those. We never hear about operation and maintenance costs when we're dealing with those furry friends. When we would need to create opportunities for vendors and others to have a shot at providing services to miami-dade county we never debate that cost when we issuing out those millions and millions of dollars in those contracts but i'm just a little bit baffled at the idea that we would have a discussion on the fiscal side about saving the lives of individuals who are found to have experience mental health issues and the reason why that is so in my humble opinion so baffling is that there is no roi in the financial side that can support any one position or all the positions here on this board but if we take off the roi in the form of a cash payment and we look at it in the sense of how these individuals are going to be able to contribute to society afterwards, and how the recidivism rate will actually drop. And we've seen that happen over time when individuals receive the appropriate care. You then begin to see this as not as a real fiscal question, but it really goes back to what we stated earlier. It's really a question of dignity. And I wanted to ask this question to the well care folk who are actually going to operate this thing for us. One of the things I've heard from Commissioner Bassian's way of explaining in her statement is Is there going to be a cap for the county's portion of this? And if that is not clear enough for me to ask, is there a way where the county can cap its contributions while you and your team be held responsible for raising any other funds in excess of that?

You want me to answer that question? Be shooting myself in the foot, but the short answer is yes.

Okay. Now, has this cap amount been discussed and have you guys fallen on a percentage that this board can feel comfortable with?

No, sir.

Okay. But the conversation has happened? No, sir. Okay. Okay. I'm done. I'm done. Okay. Thank you. So, Mr chairman, I'll close by simply saying this. I didn't have a day. Look, um, I'm, you know, I'm in full support of opening this facility. Um, I do believe the operating and maintenance costs here. Um, it's not. 1 that should drive the discussion. I think the question should be how soon can we give the keys to this door to all of the partners to open this building so that we can put our ambassador, Judge Leifman, on a plane with all the connections that he has to go out and showcase this as a national opportunity for people to buy into. And it's not as if we don't have any sort of looking for precedent on his ability to move the needle forward to benefit a society overall. Look, I believe it's the 1989 judge, the drug court. Opened its doors, folk laughed, folks said it could never work. Why? Because who wants to put, in their words, who want to put resources into helping folk with crack cocaine issues? Because let's be honest, in those years, there was this taboo that certain people, certain cultures, certain races were the ones who were eating away at the public funds and creating a black eye for particular communities and particular neighborhoods and particular counties. But it wasn't until, you know, the great people like Judge Leifman and many others who came to the rescue of those individuals who have been left on the streets for so long and said, I honestly believe that redemption should be the driving force to get these individuals to become again, once they were, you know, to become, you know, Citizens not only capable of carrying out great deeds, but also fallen within what our Lord and saviors always tell us all the time. That is to give a second chance and show redemption. So, you know. I just hope we can move this thing forward really soon. I believe this is also one of those things that fits right into the format of what we've heard that Janet Reno and Herbert Klein and Bennett Berman and Gerald Webberton, when they founded that drug court, those were the same principles that they used then that we're asking that we do now. And I do not believe, in my humble opinion, that the advocacy group and the partnership with the county behind them will find themselves in an economic situation where they cannot find the funding. You open it, they will come because the need is there. And I don't I'm not just speaking from someone who just read an article or just read journals about these things. Oh, they're these same people who we drink beers with. They sit on our corners. They're a part of families that we know. Some of them are outside of this building, standing out there, sitting on a creek and talking with us. And we're having conversations with them. And it's only a matter of time before they found themselves not in prison, but in jail. And let's be honest, those individuals who have been deemed to have these mental health issues and are sitting in our jails, they still have a constitutional right to have a fair trial. Many of them haven't been tried yet because they haven't received the actual due process and the care that's needed to get them competent enough to stand trial. So this is not like we're talking about prisoners. We're not. We're talking about arrestees who have yet to have gone through the process of the full criminal justice system to determine whether or not they're innocent or guilty. But our Constitution reminds us and every in statute reminds us that these people are actually innocent until proven guilty. So while we know that they're innocent until proven guilty, let's get them to put them in a situation where we know that we can save, number one, money from housing them inside of a warehouse. That's Senator Garcia talked about, which is our jail, and number two, get them the care that they need so that they can become productive citizens, in turn, saving us more money and not having to house them at a ridiculous cost. So those are my comments on the record, Mr. Chairman, and thank you so much for this opportunity.

Thank you, Mr. Vice Chair. Commissioner Conehiggins, I knew you wanted, and then I'm going to wrap this up.

Thank you. Thank you, Mr. Chair. I just have a couple of quick follow-up questions. And this is to the sponsor, and I can have Judge Leifman or the sponsor ask. But I think, and again, correct me if I'm wrong, but you said we can't apply for grants until the building opens, correct?

I mean, he has, but it makes it very difficult. We've lost some of the money, so we lost some of the ARPA money, and there's a lot of folks that we've talked to that want it to be opened, and we can then apply for a lot more grant. I don't know, Judge, if you want to speak more to that, but that's pretty much the gist of it, yes.

Yeah, I get that it makes it more difficult. I think that's pretty intuitive, but I'm asking the follow-up question because if my memory serves me correctly, in December when this was first introduced, there was a level of urgency attached to the item, i.e., we are going to lose a substantial amount of grant funding if this is not advanced. And we did. We did. But how did you get the grant funding when the building wasn't opened already? I guess that's what I'm trying to understand.

It was through the city of Miami ARPA.

Okay. Understood. So that was the grant federal grant understood proposal. Okay. That makes sense. Okay. Understood. You're able to qualify for additional and far more grant funding once the facility is open. Yes. Understood.

Yes, ma'am. And our foundation doesn't feel ethically responsible to go ask for more money. If I can't commit to them that I, it's going to open.

Sure, I think that makes a lot of sense. Final question, and thank you, actually, if you don't mind staying, Judge Leif, and I think it's- If the chairman allows me. I think he will. I think I said thank you to everyone, but I want to say thank you to you. 20 years is not a short amount of time, right? we lost some of our colleagues already here and that's not to criticize but i'm just saying it's to represent that to dedicate so much time to one particular issue is no easy feat so i do thank you for being so steadfast and 20 years later you're still so passionate about this um i find that remarkable and extraordinary um and so my follow-up question is and and i think the chairman alluded to this if not specifically referenced it during his remarks Once this facility opens, because I think it's clear from the committee of the whole today that you have the votes and I believe that this will open. Once it opens, it will be run, operated, and funded by the county and by our department run by the brilliant and amazing Director Burgos. What is your involvement going to be, Judge Leifman, once the facility opens?

I don't have any direct responsibility, but I am more than happy to raise money for it. We have a 501 foundation. The chairman of our foundation is here, Mr. Paul Singerman. He's one of the managing partners of a big law firm here in Miami-Dade County. They are committed to working on this, and I'm a member of the board, and I'll continue to do that. In any way else, I could help.

Thank you. So your role will be that of fundraising and philanthropic. You're not serving in an advisory role in any kind of employment status with the facility once it's opened?

If I'm asked, I would consider it, but I have not been asked, and I'm not doing anything at this point.

Understood. Thank you so much. Thank you, Mr. Chair.

Thank you, Commissioner. Commissioner Orbison. Quick question.

Another follow up question on something that the sponsor said. Commissioner Regalado said that there can't be any for profit entity at this building because of the way the building was funded. I just want to clarify that because in the questions that I asked and so many other colleagues asked, The answers were we are actively seeking these partnerships. So what are we actively seeking if no entity can be in there and generate funds?

Would you like me to address that? Sorry.

Through the chair, I think that's an important question for the county attorney to answer.

Yeah, so I can jump in if you guys want to jump in, but the idea is we got an unsolicited that was going to run it and make a profit. So the, there are limitations, how the, like who is in the facility, you know, they can't monetize the facility. So you can have an entity that can partner with the county and they can be a for-profit. They just can't make profit from this situation. Right. So, but we can sell sponsorships, right. We can partner with, you know, different entities, you know, that that's fine because they're getting PR out of it. So that's normally how these things work. Like, you know, you can, you know, sell a piece of it and, you know, you know, have a sponsor here or a sponsor there. That's how a lot of these organizations work, but you can't have someone generating dollars, operating dollars from the operating and maintenance of it.

Okay. So a. hospital or an entity that's providing health services to maybe the persons that are in the facility, is that considered for profit to them? And that would make them ineligible to work in the facility?

through the chair i mean yeah i really i'll help clarify because it's a really really good question we look at this for all of our buildings so we can do a contract as we have with the advocate in west care for entities that are not for profit to provide services so they'll be providing services in the building any money that they make that's above and beyond expense because they're not for profit they have to reinvest back in the company if a for-profit like a fortune 500 company wanted to come and use this facility to generate profit for shareholders. That would be questionable given the percentage because of the way we finance the building. We use public financing in order to do this, so it has to be for public good. Okay.

And if I may, through the chair, and council may be able to answer this better, but the contract with the state of Florida has prohibitions as well. And you have to, oh, I'm sorry. I didn't, I thought, my bad.

You got the floor.

I'm so sorry. I really didn't mean, I thought.

You are in control of this chamber.

I know I'm not. I wish I was. We'd have this done.

Whatever you want. Finish your statement.

I'm sorry. I'M JUST THE OLDEST ONE HERE WHO'S BEEN AROUND SINCE THE VERY BEGINNING WHEN WE GOT THE BUILDING. THE STATE OF FLORIDA OWNS THE BUILDING. THEY LEASED IT TO DADE COUNTY FOR 99 YEARS FOR A DOLLAR A YEAR. THANK YOU, RON BOOK AND MARCO RUBIO. in that contract there are prohibitions for for-profit companies operating in the building in order to do it they have to go through an entire process through Tallahassee not the county to get permission to do it it's not easy plus and this is the real wrinkle they cannot receive any state dollars like for mental health services, if they're for-profit. Only the not-for-profits, like WestCare, can receive those dollars. So you limit yourself if you put a for-profit in the building. Now, as Commissioner Regalado was saying, she's absolutely correct. Now, we can work with for-profit companies and find ways to generate revenue to help support the building, but they cannot be operators in the building.

Well, it's possible. They just have to go through a state process.

And then they...

I understand. I understand. Yes. But it is possible.

Yes.

Okay. Thank you.

Thank you, Commissioner. All right. So with that, first and foremost, thank you all for coming out today and sticking around for this very important but lengthy conversation. It was, in fact, as some of my colleagues said, insightful and robust, and I have listened very carefully. There is still a set of Unanswered questions that I personally have, and I will work with with you all the administration. To to try to ease those, those last little questions and concerns. But I have been listening carefully and I will take everything I heard under advisement and see how we move forward. So, thank you guys so much. Appreciate it. Now, the next committee could start.

Thank you.