Miami’s government plans to clear out several places where dozens of homeless people sleep under the Dolphin Expressway that has become the site of a public health investigation into the spread of HIV and hepatitis C.
Multiple officials have described the area as an “opioid and open sex den” that needs to be vacated while ensuring homeless people with drug addictions get treatment.
By Friday, whether a state health department investigation is complete or not, the city wants people living on sidewalks lining four streets between Northwest Second Avenue and Northwest First Avenue in Overtown to move out of the area so crews can sweep up discarded needles, clean up trash and remove any contaminated furniture and other items left on the sidewalk. The city has posted signs on the chain-link fences around the area warning of the clean-up and advising people to collect their belongings.
Administrators say they want to get people into shelter and get addicts into treatment. But for those who decline to get help, the city might invoke a Florida law to force individuals into drug treatment against their will.
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The details of the cleanup plan came to light at a meeting of the Miami City Commission on Thursday when Ron Book, chairman of the Homeless Trust, addressed commissioners. While thanking the commission for authorizing the closure of multiple streets to cars, Book described the area as an “opioid and open sex den” the likes of which he has not seen before. He described seeing a woman passed out with food hanging out of her mouth as a rat crawled on her face to nibble at the food.
“No community should ever have that,” he said.
The situation has garnered increased public attention because some parents walk their children to school around this area. After Book spoke to the Miami-Dade County School Board last week, Superintendent Alberto Carvalho warned parents to be on alert for suspicious activity and loitering around schools. Custodians recently picked up two discarded needles on school grounds.
Book and Milton Vickers, who directs Miami’s department of human services, said city workers have already moved about 30 people out of the area and into some form of shelter. Municipal workers and health professionals from the IDEA Exchange, a University of Miami-run needle exchange and outreach program, have helped at least 10 of them get into a drug rehabilitation treatment program since Oct. 1.
For those who refuse to leave or seek help, the city’s strategy includes involuntarily committing people to drug treatment, a step that some homeless advocates argue violates the civil rights of people who live on the street. The city might use the Marchman Act, a 1993 Florida law that allows the courts to involuntarily commit someone who is allegedly abusing drugs or alcohol so they can be assessed, stabilized and entered into treatment.
“That’s definitely on the table,” Vickers told the Miami Herald.
While some advocates for the homeless oppose it, other see the Marchman Act as a common-sense tool to avoid the criminal justice system and prevent someone with a serious drug addiction from harming themselves, a legal intervention that can save the life of someone who cannot stop putting a needle in their arm.
On the other hand, critics have said this method does little to solve the problem of homelessness. Civil rights activists disapproved when in 2016 Miami Beach police decided to use the Marchman Act to force homeless alcohol addicts into treatment.
The question of how to help people with addictions while cleaning a public space littered with needles and trash has put the complexity of Miami’s homeless issues into focus, forcing government bureaucrats, law enforcement, the courts, homeless advocates and public health officials to coordinate a response.
Health workers are still working to determine the magnitude of the problem. Lillian Rivera, director of the Miami-Dade health department, said the agency is working to wrap up its investigation by Oct. 19 in anticipation of the sweep and planned water and sewer construction in the area.
“We’re doing an inventory of all these folks’ names and the demographics of them. We’ll try to see where they go off to,” Rivera said. “But that’s going to be very difficult.”
Health officials earlier collected blood samples from many of the people living under the overpass.
“HIV definitely is being found, and we are looking for hepatitis C,” Rivera said. “But we don’t know yet the epidemiology of all of it.” Rivera said the agency is trying to assess how the individuals living under the overpass may have contracted HIV and hepatitis C infections and to assess the risk of those diseases spreading further. The dispersal of people being monitored by health authorities could make follow-up more difficult.
However, she said, Hurricane Michael’s destructive path through the Florida Panhandle has slowed the department’s investigation because some of the agency’s lead investigators are based in Tallahassee, where the storm left many homes and offices without power.
“This storm is going to put us behind,” she said.
The ultimate goal, Rivera said, is to get those individuals living under the overpass and who are addicted to heroin and other drugs into residential treatment. But the tools available for compelling an individual into a drug rehabilitation program are few.
One is the Marchman Act, which allows persons to be held for up to 5 days for initial assessment and up to 60 days for treatment.
Judges, police, doctors and psychiatrists can also involuntarily commit certain individuals under a 1971 law known as the Baker Act, which provides for emergency psychiatric care of a person with a mental illness who is deemed to be a danger to themselves or others. Adults can be held for up to 72 hours under the Baker Act, and minors can be held for up to 12 hours.
But Rivera said Florida officials may need more tools if intravenous drug use continues to rise because it poses a public health risk. She noted that California recently enacted a law that would allow county and city officials to appoint a conservator for a person who is incapable of caring for their own health due to a serious mental illness and substance abuse.
“This is something that maybe the state of Florida needs,” she said, “if this is as severe as what we’re seeing in places like California, Philadelphia, Ohio — all these hubs where they’re seeing IV drug use spike.”
If rehabilitation is the goal, then there’s the question of how to meet the increased need for beds in treatment programs.
Stephen Zuckerman, executive vice president of the South Florida Behavioral Health Network, a nonprofit that coordinates and funds treatment for people with mental illness and drug addiction, said the agency has redirected more than $2 million to pay for residential treatment beds and outpatient care along with medication to help control the addiction.
Many of the residential treatment beds are located at nonprofit drug rehabilitation centers such as The Village South on Flagler Street and Agape Network in South Miami-Dade. Medication-assisted outpatient programs are also run through the Banyan Health Network, Zuckerman said.
Zuckerman’s network also identified about $325,000 to fund outreach and help those living on the streets into a more stable environment, “whether it be an emergency housing situation or shelter housing so that we could then get them into treatment,” Zuckerman said.
An alliance of public health, law enforcement and government agencies is working on a plan to address the problem long term.
“The plan that we’re putting together is pretty much looking at just that one area,” Zuckerman said. “But the opioid issue is much greater than one street in Miami-Dade County. We didn’t start putting together a plan for purchasing residential placement beds just this past week. We started around two, three years ago when we started seeing a spike in opioid use in our county.”
For Miami’s government, the matter is even more nuanced as the city seeks to redefine the rules for how the government interacts with the homeless. A federal consent degree known as the Pottinger Agreement protects the rights of homeless individuals and bars police from arresting homeless people for loitering. The agreement, reached in 1998, resulted from a class-action lawsuit filed in 1988 by 5,000 homeless people with the American Civil Liberties Union to stop Miami police from making excessive loitering arrests.
Earlier this year, the city asked a federal judge to dissolve or modify the agreement, arguing the police should be trusted to be humane with people living on the street and that because of recent gentrification in downtown, police should be free from Pottinger’s restrictions. Federal court hearings began in September. A final hearing is expected later this month.
The ACLU attorneys contend that in cleanups done earlier this year, the city violated homeless people’s rights by harassing them, kicking them out of certain public spaces and destroying their property. The city has admitted to “outlier” situations where city workers have violated the agreement, but insists the city has shown “good-faith compliance.”
Against this backdrop, the city is calling the situation under the expressway a public health problem that City Hall needs to act on.
“This is a significant public health issue, and this is a problem that the city has to own,” Vickers said.
But the severity of the issue, according to health officials, is so far unclear. Earlier this week, Miami Herald news partner WLRN reported that professionals from the IDEA Exchange noted that 11 people have been infected with HIV in a six-month period, but it is unclear if this signals a higher incidence of the virus.
Dr. Hansel Tookes, head of the exchange, told WLRN that Miami has the highest rate of new HIV infections nationwide. He said one in 85 adults in Miami have HIV. The full picture of what’s happening in the homeless encampment, though, is still unknown.
“I won’t say that it’s a cluster because we don’t know that yet,” he said.