A garbage truck rumbled onto the street under the Dolphin Expressway in Overtown early Friday, flanked by cleaning crews in hazmat suits, government bureaucrats in surgical masks and police.
The scene played out on Northwest First Court, First Place and Second Avenue under the highway, where dozens of homeless people, many with opioid addictions, were living before several government agencies began a concerted effort to move the people into shelter or drug treatment a few weeks ago. With increased complaints from Overtown residents in neighboring apartment buildings, the city planned to clean up the sidewalks after health officials investigated new cases of HIV in the area — an inquiry that sparked fears of a serious public health problem.
Health officials determined there was no significant public health threat, though they declared the area a “sanitary nuisance” that required a major cleanup.
Working between road closure signs on Friday, Miami sanitation workers guided a large mechanical claw to a pile of dirty bedding, clothes, shoes and trash, which was scooped up and dumped into the back of the truck. Several municipal employees wearing green shirts talked to homeless people who live on the sidewalks, offering them shelter or a place in drug treatment if they suffer from addiction. Once debris and furniture were out of the way, street sweepers and water trucks loaded with disinfectant passed through. The city’s public relations staffers documented the work.
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Some people packed what they could of their personal belongings into shopping carts or plastic bins and walked away quietly. Others pushed their garbage, mattresses and shelves into the street to be disposed of later as they waited for direction to head to a shelter.
Standing nearby on Northwest First Court, David Peery, an advocate for the homeless, questioned the city’s stance that the area truly posed a health threat.
“It’s political,” Peery said. “It’s got nothing to do with public health.”
Peery is also a plaintiff in the legal case against the city of Miami that yielded the Pottinger agreement, a federal consent decree that prevents the police from arresting homeless people for loitering. He was skeptical as city crews carried out a scheduled cleanup, a sweep supported by the City Commission and high-level administrators who cited public health concerns.
Florida Department of Health officials were investigating a potential health threat on the street among the homeless residents, many of whom are addicted to heroin or other drugs. On Friday, health officials suggested that there was no outbreak of infectious diseases. Though the department confirmed 11 cases among the individuals living in the area, they cannot say with certainty if those infections were spread by or among injection drug users living under the overpass.
“We have reviewed the genetic information from samples where the HIV virus was recovered and compared these to the large number of sequences that we have accumulated as part of our routine surveillance efforts,” Nick Van Der Linden, press secretary for the Florida Department of Health, said in an email on Friday. “To date, these analyses have not identified direct transmission links between these cases and other known HIV cases in the community for whom we have sequence data.”
Van Der Linden said the agency will keep track of HIV-positive individuals dispersed from the area through the agency’s testing and treatment services.
A health department report issued to the city makes no mention of disease and focuses on a “sanitary nuisance” because of the discarded needles, heaps of garbage, smears of human waste and pools of standing water where mosquitoes could breed.
“Note that due to the varying locations and nature of biomedical waste around the sites, hazardous waste pickup should occur by certified professionals trained in biomedical waste pick-up,” reads the letter.
City Manager Emilio Gonzalez said the city wanted to do the cleanup more than a month ago, but the health department asked for more time to investigate the HIV cases. He disputed Peery’s skepticism, saying the biggest pressure came from nearby residents who have to navigate these streets as they walk their children to school.
“If this was political, it would’ve happened a long time ago,” Gonzalez said. “We’ve tried to be very deliberate, very careful.”
Regardless, Overtown residents who live nearby have clamored for some kind of cleanup for a while. They aired their frustrations at a town hall meeting Thursday night, complaining of drug use and open sex in the area.
“Our children are being affected by this,” said Willie Williams, pastor at the Greater Mercy Missionary Baptist Church in Overtown.
During the town hall, a homeless man sitting in the front row walked out, leaving behind a syringe on his seat. The chairman of the group hosting the town hall, the Overtown Community Oversight Board, used a piece of paper to grab the needle and hold it up to the audience as he passionately demanded public officials clean out the streets under the overpass.
“Overtown deserves better than this,” said Keon Williams, the chairman.
Friday morning, Williams confronted Peery in front of a reporter. Williams raised his voice as he demanded answers about the Pottinger agreement, which Williams and other residents have criticized as archaic restrictions that allowed the city to ignore Overtown’s growing homeless population and let the streets under the overpass fall into poor condition.
Peery, who could barely get a word in, eventually said that Pottinger simply existed to protect homeless people from being needlessly harassed and having their personal belongings destroyed by authorities. He added that the effort to get drug addicts into treatment was laudable and it was appropriate for the city to trash soiled bedding and other refuse.
“No one wants to live out here in this squalor,” Peery said later, adding that he sympathized with Williams’ view, but he worried about city workers discarding important documents, such as IDs and Social Security cards, that people left behind.
The heated exchange highlighted the complex problem lying at the intersection of many interests. There’s the need to care for the homeless population and those ensnared in a nationwide opioid epidemic, people who are often stigmatized for suffering from addiction. There are also the desires of residents who want to walk their children to school without having to see people shooting up, and the public health officials who want to make sure a vulnerable population gets medical attention and appropriate treatment.
City officials said they would not bother any people who choose to live on the sidewalks after the cleanup, as long as they don’t completely obstruct the sidewalk with furniture and they are not doing drugs.
As police and public officials moved homeless residents out from under the overpass on Friday, they faced a shortage of residential treatment centers and public funding for opioid abuse treatment.
“We have more need than capacity in our community,” said Laura Naredo, chief operating officer for the South Florida Behavioral Health Network, which has partnered with police, the health department, Jackson Health System and other agencies to move people into rehabilitation.
Naredo said that as of Oct. 10, 19 individuals from the area had been referred for residential opioid addiction treatment in Miami-Dade. “But every day we keep getting more,” she said on Thursday. “Yesterday I was copied on three or four different referrals.”
On Thursday and Friday, several more people accepted help from city homeless outreach workers and medical professionals working for the IDEA Exchange, a syringe-exchange and community outreach program run by the University of Miami. City officials estimated more than 30 people had been helped in the days leading up to the cleanup, including placement in detox and rehabilitation.
The Behavioral Health Network, which manages taxpayer-funded mental health and drug abuse treatment in the region, has earmarked about $5.5 million for opioid addiction treatment through next year, said Steve Zuckerman, the agency’s vice president.
But as opioid use in the region has risen, the Behavioral Health Network has been unable to keep up with demand. The agency estimates it was able to fund about 28 percent of the need for mental health and substance abuse treatment during the year that ended June 30. Opioid use includes injected heroin, as well as methadone and pills, such as Oxycodone.
“Any given month,” Naredo said, “we have in excess of 105 people on waiting lists trying to get into community resources” for residential treatment.
With priority given to opioid addiction treatment, though, those with dependency on alcohol, cocaine and marijuana — the three most commonly abused substances in Miami-Dade — have to wait, she said.
“You can imagine other people in the community who need services,” Naredo said. “It exacerbates an already difficult situation.”
Naredo noted that there are more private resources available to help insured Miami-Dade residents seek treatment for opioid addiction. But the Behavioral Network serves mostly the indigent, the working poor and those whose private insurance does not cover their care.
Zuckerman estimated Miami-Dade has 80 to 100 beds for publicly funded residential treatment. He said the Behavioral Networks’ cost for a bed at a facility such as The Village, Banyan Health System or Citrus Health Network ranges from $170 to $260 a day, depending on the services offered.
Not all of the people living under the 836 overpass enter residential treatment. Some need detox and require several days of hospitalization before they can begin residential treatment. Others may choose medication-assisted treatment and a shelter bed through the Homeless Trust, Zuckerman said.
With Friday’s deadline for people to leave the area, Naredo said the network was concerned about keeping track of individuals who needed treatment. She said the team of public agencies working to solve the problem made a final push this week to get people into residential treatment or shelters.
“We might lose them,” she said. “We might not be able to engage them. ... So there is that concern as the city starts to clean that up, we’re going to lose some of these people. It doesn’t resolve the problem. Those people are still going to be around. They’ll just be in a different location.”
The situation under the overpass has brought renewed attention to Miami’s reputation for having the highest rate of new HIV infections in the country, as well as the local impact of the nationwide opioid epidemic. Earlier in the week, Miami’s police department announced a new pre-arrest diversion program where people found with small amounts of opioids could avoid jail by entering into a 12-month drug treatment program. Health professionals applauded the concept, which is supported by federal grants and is supposed to be implemented in 2019.