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PSCC Minutes 09/16/2022 DraftSeptember 16, 2022 1 MINUTES OF THE COLLIER COUNTY PUBLIC SAFETY COORDINATING COUNCIL MEETING Naples, Florida, September 16, 2022 LET IT BE REMEMBERED the Public Safety Coordinating Council in and for the County of Collier, having conducted business herein, met on this date at 9:00 AM at the Collier County Jail Muster Room, 3347 Tamiami Trail E., Naples, FL 34112, with the following members present: Chairman: Rick LoCastro, Chair, Board of County Commissioners Vice Chair: Kevin Rambosk, Sheriff, CCSO Michael McHugh, Chief Circuit Judge (excused) Rob Crown, County Judge (excused) Amira Fox, State Attorney’s Office (excused) James Stewart, Asst. State Attorney, State Attorney’s Office (designee) Kathy Smith, Public Defender’s Office (excused) Rex Darrow, Supervising Assistant Public Defender (designee) Brad Rouskey, State Probation Circuit Administrator (excused) Robin Kelly, State Probation, Senior Supervisor (excused) Jay Freshwater, Correctional Probation Supervisor (designee) Jeff Nichols, Director, County Probation Scott Burgess, CEO, David Lawrence Center Bev Bell, David Lawrence Center (designee) Peg Elmore, Exec. Dir., Southwest Florida Workforce Development Board Also Present: Lee Willer-Spector, PSCC Liaison, County Communications, Government & Public Affairs Janeice Judge Martin, Collier County Judge, Drug Court Michael Smykowski, County Clerk of Courts (designee) Katina Bouza, Corrections Support Division Director, CCSO Mark Middlebrook, Chief of Corrections, CCSO Keith Harmon, Corrections Operations Captain, CCSO Monique Nagy, CCSO Elizabeth Sampedro, CCSO September 16, 2022 2 Any persons in need of the verbatim record of the meeting may request the minutes from the Collier County Communications, Government & Public Affairs division. I. Introduction A. Call to Order Chairman LoCastro called the meeting to order at 9 a.m. B. Approve New Statutory Member – CareerSource Southwest Florida Chairman LoCastro noted that Peg Elmore will be replacing PSCC member Joe Paterno, who retired as the CEO of the Workforce Development Board of Southwest Florida/CareerSource Southwest Florida. II. Approval of Agenda and Minutes A. Approval of Agenda Mr. Burgess made a motion to approve the agenda. Second by Vice Chair Rambosk. The motion to approve the agenda passed unanimously, 8-0. B. Review and Approval of Minutes from April 22, 2022 Mr. Burgess moved to approve the April 22, 2022, meeting minutes. Second by Vice Chair Rambosk. The motion passed unanimously, 8-0. III. Old Business [Ms. Elmore joined the meeting at 9:04 a.m.] A. Results of Review of FGCU Evaluation Report for DLMHCDCG from the April 22, 2022, PSCC Meeting – David Lawrence Center A discussion ensued over the report’s criticism and the following points were made:  It appears more collaboration is needed.  It was never David Lawrence Center’s intention to attack. There’s a problem getting into the jail due to COVID and it involves jumping through many hoops. There are inherent delays we have no control over. All the collaborators have responsibilities.  30 days is a hard number to meet.  55 days is the standard now.  It’s not the judges’ intent to criticize the State Attorney’s Office.  This version has slightly more merit, but still gives the impression that excessive work delays could be easily fixed, that it’s more laziness and several offices should do a better job.  The report classified these as excessive delays. It’s not a delay, it’s a process.  If we don’t respond or dispute this report, it becomes fact.  PSCC members can contact the report writers directly or submit their responses to dispute criticism. Responses can be made into a letter/addendum attached to the report.  PSCC members should cite the paragraphs and pages they are disputing.  The prior version focused on the State Attorney’s Office, which was unfair. Ms. Elmore apologized for arriving late, saying this office was hard to find. This is new to her September 16, 2022 3 because her experience is in employees and training, but she’s willing to learn. Mr. Burgess made a motion to accept the report, with a pending addendum. Second by Vice Chair Rambosk. The motion passed unanimously, 8-0; Ms. Elmore abstained. B. Update on MAT for all inmates requesting treatment for SUD — Katina Bouza, Corrections Support Division Director, CCSO Ms. Bouza presented a report on the Collier Criminal Justice Medication-Assisted Treatment Program (MAT) and noted that:  For months, we’ve been talking about doing induction in the jail, which means any inmate who comes in and is identified as having a substance-use disorder and may not be on MAT and wants to start it, we would contemplate starting it at the jail.  There are many issues involved.  This grant-funded program involves a $1.2 million three-year shared contract with the David Lawrence Center.  The contract covers medication, medical staffing, peer specialists and re-entry staff.  There are many factors to consider, such as how many participants, what type of medications and whether more medical staff are needed.  Armor Correctional Health Service, our medical contractor, will again provide two more medical providers on nursing staff.  MAT takes about 20-25 minutes for deputies handling a group of 10-12 inmates and a nurse to dispense MAT because it’s a prolonged process.  Deputies must ensure inmates are seated 1-3 feet apart, remain seated with their hands on their laps, they can’t touch their faces, and a nurse must check their mouths.  We need two deputies to watch them and one nurse to dispense MAT and check out inmates.  If we were to expand to 40 more people, that would involve two more hours of deputies’ time.  All those factors must be considered, so she’s been working on getting the data together to present to the sheriff through her chief to see if the sheriff wants to consider expanding MAT.  Her next presentation will show where we are with the grant.  We have grant goals to meet. One that we’re not meeting and probably won’t meet by the end of the first year is the number of program participants.  Another goal is MAT participants have to see their community provider five days post- release. We’re doing pretty well on that, but still not meeting it. But that’s people who are already in treatment before they came in. If they weren’t in treatment when they came in, are they going to follow up? A lot of questions are unknown.  The sheriff will ultimately make the decision whether it’s something the jail wants to do based on the information we provide him. A discussion ensued and the following points were made:  A good MAT program subpopulation would be veterans, Mental-Health Court and Drug Court participants.  It can take 55 days for an inmate to detox and we don’t want them to go through detox.  The biggest concern is allowing an inmate to walk out of the jail without a followup.  A good estimate of potential participants would be those going into treatment courts; historical numbers could be looked at.  DLC also works with Drug Court and Mental-Health Court. It would help to get them to follow up with the provider five days later because participants are being heavily supervised and in Treatment Court; that would help meet the grant goals. September 16, 2022 4  A lot of people are lost after they leave jail because it’s not convenient for them. IV. New Business A. Presentation/Discussion – CJMHSA grant award Jail MAT — Katina Bouza, Corrections Support Division Director, CCSO Ms. Bouza provided an update and reported that:  The grant requires a MAT-status presentation at each PSCC meeting that includes statistics, community overdoses prior to MAT implementation, participant recidivism rates, community overdose fatalities, Narcan deployments, and implementation of PSCC recommendations.  The three-year grant began on Oct. 1, 2021, totals $1.2 million and is a partnership between the Sheriff’s Office and the David Lawrence Center.  The program serves any arrestee or anyone actively participating in MAT in the community; they will be offered MAT in the jail.  MAT medications include Suboxone, Subutex and Methadone, all delivered to the jail by New Seasons Treatment Center under an agreement.  Three to four years ago, Vivitrol was used in the jail and was targeted to Drug Court entrance, which made a seamless transition.  Transitioning out of the jail system is where many inmates are lost because the process isn’t convenient for them.  We’re working on a cost analysis for expanding the program to other inmates who opt to begin MAT in custody and analyzing how opening MAT to new inmates will affect success.  If we expand and include just Treatment Court, we won’t need two more nurse practitioners and could use just one more.  Current staffing includes an Advanced Registered Nurse Practitioner provided by Armor; a Registered Nurse provided by Armor; a CCSO Discharge Planner; a MAT-Care Coordinator provided by DLC; and a MAT Peer Specialist provided by DLC.  Grant Goals are that MAT reduces detoxes in the jail, overdoses in the community and provides a continuum of care and treatment.  She tried to obtain numbers for overdoses in the community pre-MAT, but it takes a year or more to get that data from the medical examiner.  In 2020, 14% of inmates were on MAT at the time of arrest.  In 2021, that number also was 14%, so it’s fairly steady.  In the first quarter of 2022, 2.4% were on MAT and 2.3% were on MAT in the third quarter. Judge Martin provided statistics for recidivism among MAT participants:  55 inmates participated and seven of those were readmissions. The grant does not allow us to count them again, such as when they violate probation in Drug Court, which hurts us when we try to reach that goal.  Four of the 55 were rearrested post-release, one for driving on a suspended license and three for Treatment Court violations.  Thirteen of the 48 failed to follow up with a community partner within five days of release.  One was removed from the program. She said she was pregnant when she got here, but she wasn’t after repeated tests confirmed that and she was taken off the program.  Five inmates were sent to a facility that didn’t offer MAT, so that’s considered unsuccessful under the grant, which isn’t our fault. Chairman LoCastro asked if there were repercussions for the 13 of the 48 inmates who failed to September 16, 2022 5 follow up. Ms. Bouza said there were no repercussions. We hook them up with our re-entry specialist, our MAT care coordinators from DLC, who set up appointments with their private providers. Unidentified Woman said if they are past five days, they are considered unsuccessful. Ms. Bouza said some had appointments within two weeks and didn’t come in five days after release. If I have a private doctor or I’m very committed to MAT and I already have my appointment set up within two weeks and get out of jail and I’m told you have to follow up within five days, it’s kind of silly because I already have an appointment. We have a call with the contractor and others because they know that we’re not going to meet the number. They may not change it, but we’re going to talk about it. If you already have an appointment, why is that unsuccessful? Vice Chairman Rambosk said they do need to talk about that because it’s bureaucratic red tape. A discussion ensued and the following points were made:  They may keep the appointment but won’t give us information. They have scripts and meds at home.  TeleMed would be considered a successful appointment, if it’s within five days.  Five days post-release is the measure.  If they go home with a script, why do they need to see a doctor?  Some leave jail and go to a facility that doesn’t offer MAT. The majority of sober houses don’t accept MAT and want to advance their own treatment.  Ms. Bouza was fairly certain the DOC offers MAT, but when she called, the person who answered the phone wasn’t certain.  The positive point is that 55 inmates didn’t undergo withdrawal symptoms.  In 2020, 24% were on a withdrawal protocol and in 2021, 26% were on that protocol. Ms. Bouza continued her presentation:  Last quarter, the county was notified that it didn’t have a subcommittee, a criminal justice, mental health, social-work and drug-abuse planning council. We said we had the PSCC, but they said that wasn’t a subcommittee, so we quickly came up with a subcommittee to comply with Florida Statute 394.657.  Subcommittee members include the CCSO, DLC, SAO, PD’s office, judges, NCH and others. About 75 invitations were sent out and about 10 participated in the call.  Minutes from that subcommittee are included with the PSCC agenda packets; the next subcommittee meeting is in October.  We asked the subcommittee for recommendations to bring to the PSCC.  40% or fewer arrests after release is a good measure, so we’re good with that number.  50% or fewer within six months, so we’re good with that number.  Reduction in jail detox is one of our goals.  25% or more program participants on Social Security, so that number is good.  50% or more were referred from a state mental hospital, so that doesn’t meet the goal.  40% or more program participants will be successfully discharged on bond release and we’re at 68%, so we’re doing great.  The bottom one is 50% or more receiving in jail. We’re at 68% of clients served in the community. That’s where we’re failing the annual target.  This grant cycle ends on October 5, so we’re not going to meet this, but that’s OK. We won’t September 16, 2022 6 lose the entire grant. We will have some money taken away and they won’t award as much. Chairman LoCastro said if she needs more people on the subcommittee to please keep them posted so they can attend. Judge Martin said she served on it for more than a decade and judges were not notified about joining the subcommittee. Ms. Bouza said she’d add them to the list. Ms. Bell said David Lawrence Center probably could make the numbers for people coming in on MAT. The problem is that many are using other drugs and the provider then says they won’t dose them because they’re abusing other drugs. The providers aren’t comfortable dosing them. Ms. Bouza said we don’t do induction. You must first sign a release of information so we can find out what medication you’re on and obtain your medical records, so if you’re on a certain medication, then we can continue it. We need to know if it’s been reduced or increased. We get females who are using Fentanyl who are on MAT. If it’s New Seasons Treatment Center or David Lawrence Center, we can continue MAT. But some doctors won’t continue treatment if you’re on opioids. MAT covers opioids. Judge Martin called that naïve. Ms. Bouza said we have to make sure we connect inmates to a new community provider if they’re dropped by their community provider for taking Fentanyl. When we start induction for treatment court, we might be able to continue that. It’s just one more barrier. Judge Martin noted that historically the jail has done nothing for 30 days if an inmate comes in on cocaine or psychotropic meds. Has that changed? Ms. Bouza didn’t believe that was correct, but it does take a while to determine what prescriptions they’re on. That can take months. Sometimes an inmate will say they got a prescription at Publix or CVS. If we can’t figure out where they get their medication, it could take 30 days by the time they sign the release of information and we get to that pharmacy and get the records released. If they have a doctor, it’s quicker. Chairman LoCastro noted that if someone is on psychotic meds, it’s not great for them to go off cold turkey. Is that the norm? Ms. Bouza said you’re talking about sometimes homeless people. Typically, they can track it for most inmates. Vice Chairman Rambosk said if information is provided properly, they include that in their evaluation. Middlebrook said the information must be confined. Ms. Bouza concluded her PowerPoint presentation, noting:  We have quarterly Subcommittee meetings that we’re going to schedule in advance of the PSCC meetings. The purpose is to evaluate the project by reading data, making a formal program, recommendations or corrections. September 16, 2022 7  We’re doing the annual progress report, participating in a three-year strategic plan, and involvement with a data-collaboration practice.  The dates for the PSCC Subcommittee are October 19th, January 18th and April 19th.  We have not yet set a date for our strategic plan update meeting. B. Review of the Latest Jail Occupancy Snapshot — Katina Bouza, Corrections Support Division Director, CCSO Chairman LoCastro said he thought she was going to create a more robust report, not a one-day snapshot. One day doesn’t tell us anything. It could have been a light day and doesn’t tell us trends and issues. Ms. Bouza said we’ve been emailing the reports quarterly, which it takes that into account, and it’s a monthly report that shows a month of who is in custody. If you want us to stop this, we could stop. Vice Chairman Rambosk said the numbers are trending up and were in the 600s, but increased to more than 700 inmates daily. Chairman LoCastro said he didn’t want to create a ton of work, but it sounds like those reports already exist. Maybe they could put a monthly summary on top of the report. There are a lot of rumors, including those about illegal aliens, whether they’re sent back. He noted this report said there were 132 illegal aliens in the jail. Vice Chairman Rambosk said the statistics with our programs are good and most illegal aliens commit crimes against residents, many of them family members. Capt. Harmon outlined the process for inmates who report they were born outside the U.S.:  Anyone arrested who states they were born outside the U.S. or U.S. territories are referred to a deputy in jail who has undergone training to get certified and classified as a designated immigration officer.  Under section 287(g), the U.S. Department of Homeland Security Immigration and Customs Enforcement’s program for immigration nationality, you state where you were born and they’re asked if they’re a U.S. citizen.  If you state you were foreign born, we determine the current status, if you’re lawfully here and we have access to federal databases to determine that.  If you’re amenable to removal, ICE will put a hold on that inmate and notify ICE in Miami that we placed a hold on someone and here’s the information.  That person will go through the criminal justice system, do their criminal charges or they’ll post bond once they’re ready to be released from the jail if they’ve had a hold placed.  ICE will then make a determination about whether they will be taken into custody.  We do two runs a week to Miami and 99% are taken into custody.  Once at Krome (immigrant processing center), we’re done and ICE makes a determination whether they will keep them incarcerated pending removal proceedings or release them on recognizance for a court date and they’d have to post an immigration bond.  If they’re Cuban, they will release them on an order of supervision and they have reporting requirements, depending on where they live.  If they’re on OREC (order of release on recognizance) or OSUP (order of supervision), they report here if they live here. It depends where they live.  Under certain circumstances, they may be released from here, but those are usually females September 16, 2022 8 with several children she has to take care of. ICE will allow her to be released on her own recognizance so she can care for them, but she still must go through the removal process.  An immigration judge will ultimately rule whether they get removed or grant them a stay. Vice Chairman Rambosk said everyone gets due process under the constitution. We don’t make the determination to release someone. If there is no detainer, we don’t have the authority. Chairman LoCastro asked how many of the inmates who go to Miami and are then released show up for their court dates. Capt. Harmon said 19%. That’s a nationwide DOJ statistic, which he thought would be much lower. Vice Chairman Rambosk noted that they do investigate all the reported rumors about illegal aliens and most are unfounded. Chairman LoCastro said the last one he received was that there was a bus full of immigrants at the mall and it turned out to be a bus full of Immokalee residents shopping for school supplies. Vice Chairman Rambosk said they investigated a rumor about a busload of immigrants and it turned out to be a bus carrying a Hispanic musical troupe that was giving concerts throughout the country and it made two stops in Collier County. He noted that only 75-78 sheriff’s offices of the roughly 3,000 nationwide do the work Collier County does. Capt. Harmon noted that they were on their fourth administration and have to follow the rules. A discussion ensued over the “Collier County Sheriff’s Office Daily Jail Population Sheet” and other topics:  The increase in the jail population was due to overall county population growth and COVID, along with out-of-county arrests.  The SWFL Workforce Development Board saw 60 refugees in Lee County who were receiving food stamps and illegally here, a number that’s increased to 500 people and it’s a problem that’s going to escalate into jails and the corrections system.  Refugees are flying to Jacksonville and coming here, mostly Ukrainians and Afghans.  If you’re not legally allowed to work in the U.S., you’re going to be desperate.  Vice Chairman Rambosk cited concern about that problem in Collier and has started to research whether the Department of Children & Families has changed its process.  Rambosk, who is on the National Sheriff’s Association Border Security Committee, said border counties have seen this problem for a long time and can’t keep up anymore.  It takes 12-15 months for a refugee to get a work permit. Ms. Bell said Rachel Brand, their grant coordinator, asked her to read a report:  The September 8 report was revised to reflect the correct name of the State Attorney’s Office 20th Judicial Circuit and accurately reflect the time it takes to admit clients into the Drug Court program.  A data-driven analysis was provided for the events and time frames between arrest and admitting clients into Drug Court.  The language in the report was revised by State Attorney Amira Fox, who submitted it to the report writers and they revised the report. September 16, 2022 9 Judge Martin called all the information beautiful, despite whatever quarrels they have with it. We didn’t have an employee years ago or the ability to pull a grant like that, let alone comply with it and enjoy the transparency and evaluation we have now. In 2017, we started a yearly Mental-Health Workshop with the Board of County Commissioners and as a result, the BCC approved three FTEs. This is what you’re all doing to support us. It was a sea change for us. We quickly obtained a significant grant, which we discussed, but she wants to credit the PSCC for helping. This is how much money we could potentially pull down if we had the manpower to capture good data and record it. You all responded immediately and this is happening. C. Presentation/Discussion Drug Court Quarterly Report (Grant Award 2020-2023) — Bev Bell, David Lawrence Center Ms. Bell presented a report, “Bureau of Justice Assistance JustGrants Report Drug Court Joint/Enhancement” and noted:  For the last quarter, April 1-June 30th, we had 10 new admissions into Drug Court and our after-care program and moved about 50 participants.  22 of the active participants had at least one dose of MAT.  We had one successful completion this quarter; others were unsuccessful – one had a criminal complaint, one absconded.  Our case manager, a peer specialist, offers them client therapy, focus journaling, nutrition services, education, and services from the Shelter for Abused Women and the Department of Health. Judge Martin said she had one anecdote from those numbers. We had a young mother who was one of the highest risk/highest needs clients we’ve ever served. She was also in drug dependency court. His team and mine collaborated. We got her through. She was a MAT participant and was doing brilliantly and blowing us away. About three months before she was to move on from Drug Court, she was set to move into a sober home. She and her provider decided the sober home was more important than MAT, a fair call on her part. She went through detox to safely get off the MAT and did everything right. She finished our program successfully and moved on. Fortunately, we still have treatment and probation post-moving on. But pretty quickly, she went back to using and it turned into a criminal arrest and she’s back in jail now. We resolved her case last week. She showed a lot of insight when she said, “Judge, I should have never gotten off that. Everything changed.” After 45 days in jail, she assessed the situation and said she had to get back on MAT. She’s finishing Project Recovery and we’re trying to make sure she has an immediate handoff. We’re working to convince sober living to consider the MAT program and she’s extremely optimistic she’ll be successful. D. PSCC Subcommittee — Katina Bouza, Corrections Support Division Director, CCSO (Covered by a prior discussion above) V. Member Comments Mr. Burgess said they have a central receiving facility, a project we’re working on with the county. It’s going before the BCC’s October 6 PSCC Subcommittee Workshop and the October 8 Planning Commission meeting as a critical No. 1 priority. It will go before the BCC on November 8 if it’s successful before the Planning Commission. Then they can begin construction and it’s going to offer more than double the capacity. With the need for sober living and housing, we’re moving forward with building a second home. We built Hope September 16, 2022 10 Home, our first sober home and six people live there. It accepts people on MAT. The outcomes are fantastic and people are getting employed and transitioning into housing. We hope to build a second home for 24 people on 2½ acres next to our original home. We offer peer support and have a senior peer support resident who lives in the home and two will be living in the hew home. Judge Martin noted that it’s the biggest barrier they face. Mr. Burgess said we’re trying to gather the data to ensure we’re moving forward with evidence-based treatment. Chairman LoCastro said emails are pouring in to commissioners about the new David Lawrence Center facility, saying they didn’t know about it. He asked “How could you not know?” This is zero-hour and it’s not in his district or it would be in his newsletter. A tidal wave of complaints came from a small group. We’ve done a lot of work to get the site. He doesn’t want it to come to a screeching halt due to NIMBYs. It’s in District 3, which is Commissioner Saunders’ district, so he needs to continue to be a champion for this. He doesn’t want it to come back for reconsideration. Mr. Burgess said maybe they could send out a notice about the meeting coming up. The more people we have in support of that is important. Chairman LoCastro said we want to make sure voices are going to be heard. Construction costs are increasing. This could be even smaller, delayed or both. He still gets emails about pan-handling and whether trespassing is illegal. Being homeless isn’t illegal and asking for money isn’t illegal. He noted that pan-handlers have to stay on the median. He said he called the non-emergency number about pan-handling to report that as soon as the light turned red, the woman walked into traffic and when it turned green, ran back to the median. It’s a big safety issue. If they stay on the grass and take money from the closest lane, is it legal? Vice Chairman Rambosk said you can’t be out in traffic. The ordinance intended by all of us was unconstitutional. A discussion ensued about pan-handling and the following points were made:  Panhandlers can stand within a four-foot area of the median.  They cannot walk into traffic.  Dispatchers handling the non-emergency number weren’t aware of the new ordinance.  The Sheriff’s Office is getting more calls about pan-handlers walking into the streets.  Unless the CCSO gets authorization from a private property owner, they can’t remove pan-handlers.  Deputies give pan-handlers a card listing numbers that provide help and resources. Nearly all pan-handlers have cellphones. Judge Martin noted that the man arrested for the recent stabbing was high on spice. Chairman LoCastro said the Planning Commission unanimously voted not to allow medical marijuana dispensaries and the vote by the BCC will require a supermajority. He’s a retired colonel and knows a lot of vets have cancer, leukemia and PTSD who use it and some September 16, 2022 11 customers are buying it to stop seizures in their kids. He asked members to please reply to Lee (Willer-Spector) when she sends out the agenda so they know if there will be a quorum. Reply to Lee only, not “reply all.” If you can’t attend, you can call in, but it’s more valuable if you’re here in person or send a representative. This is a very important committee. Ms. Willer-Spector said she’s amazed at this group of people and what they’re able to accomplish. Chairman LoCastro said it’s amazing how many commissioners don’t know what we do. VI. Public Comments None VII. Adjournment-Next Meeting Date (Meetings will be called as needed) There being no further business for the good of the County, the meeting was adjourned by order of the Chairman at 10:34 a.m. COLLIER COUNTY PUBLIC SAFETY COORDINATING COUNCIL Commissioner Rick LoCastro, Chairman These minutes were approved by the Council on , (check one) as presented, _______, or as amended _______.