Item V02
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: November 20, 2002
Bulk Item: Yes 0 No [8]
Division: Administrative Services
Department: Grants Administration
AGENDA ITEM WORDING: Review and discussion of the Health Profile Report for
Monroe County. prepared by the Health Council of South Florida. and approval of
invoice from Health Council in the amount of $15.000.00.
ITEM BACKGROUND: This is the third deliverable in the contract with Health Council to
perform a study of the health care needs of Monroe County.
PREVIOUS RELEVANT BOCC ACTION: Approval of orioinal contract at Dec. 2001
meetino; approval of amendment to contract to include payment schedule at Jan 2002
meetino; approval of fundino at July 31, 2001 budoet hearino; approval of task force
appointments af March 2002 meetino; approval of invoice for second deliverable at
Auoust 2002 meetino.
CONTRACT/AGREEMENT CHANGES: n/a
STAFF RECOMMENDATION: Approval
TOTAL COST: $15,000.00
COST TO COUNTY: $15.000.00
REVENUE PRODUCING: Yes 0 No [8]
BUDGETED: Yes [8] No 0
AMOUNT PER MONTH
YEAR
APPROVED BY: COUNTY A TTY [8] OMB/PURCHASING [8] RISK MANAGEMENT [8]
DIVISION DIRECTORAPPROVA~~-(J -'1 -
James L. Roberts --.......
DOCUMENTATION: INCLUDED: 0 TO FOllOW: [8] NOT REQUIRED: 0
DISPOSITION:
AGENDA ITEM #:
VL
11/12/02 10:11 FAX 3055920589
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AIncu1t requeiled
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REQUEST FOR PAYIISIT INVOICE
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An EtpIIII ~ Emp/Dyf!f
Monroe County
Community Health Profile
A Report of the Co",,,,unity
Task Force for the
Nlonl'Oe County Community
Health Initiative
October 3, 2002
Prepared by:
The Health Council of South Florida, Inc.
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TABLE OF CONTENTS
Map of Monroe County Regions by Zip Code
Acknowledgements
Executive Summary
Introduction
Data Limitations
History and Purpose of the Health Council of South Florida
I.
Socio-Demographic Overview of Monroe County
A. Population
1. Geography
2. Population Size
3. Population Growth
4. Gender
5. Race and Ethnicity
6. Age Cohorts
B. Socio-Economic Factors
1. Income
2. Propensity to Purchase Health Insurance
3. Uninsured
4. Household Size
5. Homelessness
6. Public Assistance Programs
7. Child Abuse
8. Juvenile Arrests
C. School Indicators
1. Stability
2. Limited English Proficiency
3. FreeIReduced Price Lunch
D. Findings
Attachments
Maps
II.
Health Status
A. Leading Causes of Death
1. Cancer
2. Heart Disease
3. Unintentional Injuries
4. Stroke (Cerebrovascular Disease)
5. Chronic Obstructive Pulmonary Disease (COPD)
6. Chronic Liver Disease and Cirrhosis
7. Diabetes
Page Number
11
IV
I
3
5
I-I
I-I
I-I
1-4
1-5
1-6
1-8
1-13
1-13
1-15
1-16
1-17
1-18
1-20
1-25
1-27
1-28
1-28
1-28
1-29
1-30
1-33
1-48
II-I
II-2
II-3
II-4
II-4
II-4
II-5
II-5
III.
8. Pneumonia/Influenza 11-6
9. Suicide 11-7
10. Human Immunodeficiency Virus/Acquired Immuno-
Deficiency Syndrome (HIV/AIDS) 11-7
B. Communicable Diseases 11-10
1. Human Immunodeficiency Virus/Acquired Immuno-
Deficiency Syndrome (HIV/AIDS) 11-10
2. Tuberculosis (TB) 11-13
3. Sexually Transmitted Diseases (STDs) II-IS
C. Maternal and Child Health 11-19
1. Live Births 11-20
2. Prenatal Care and Low Birth Weight 11-20
3. Infant Mortality 11-22
4. Live Births to Mothers 10 to 17 Years Old 11-23
5. Births to Unwed Mothers 11-23
D. Findings 11-24
Attachments 11-26
Health Care Providers and Support Services
Primary Care
1. Rural Health Network Health Services Clinics
2. Monroe County Health Department Service Sites
Physicians
1. Primary Care Physicians
2. Specialty Care Physicians
3. Evening Hours
4. Insurance
Hospitals
1. Acute Care Services
2. Specialty (Tertiary Care) Services
3. Emergency and Trauma Services
III -14
Mental Health and Substance Abuse Services
1. Community Mental Health and Substance Abuse Services
2. Inpatient Mental Health Services
3. Inpatient Substance Abuse Services
School-Based Health Programs
Florida Keys Healthy Start Coalition
Nursing Homes
Assisted Living Facilities
Home Health Agencies
In-Home Services for the Elderly
Hospice
Child Care Facilities
Transportation Services
Findings
111-1
III - 2
III - 3
111-6
111-8
III - 9
III - 9
111-10
111-12
III-13
III -14
III -15
III -16
III - 21
111-22
111-22
111-23
111-26
111-27
III-28
III-29
111-29
111-30
III-31
111-34
IV.
Attachments
Maps
Health Care Utilization and Financing
A. Average Length of Stay and Hospital Discharges
B. Discharges from Hospitals by Patient's Race and Gender
C. Discharges from Hospitals by Patient's Age
D. Reasons for Hospitalization
1. Hospital Discharges from Monroe County Hospitals
2. Hospital Discharges from Non-Monroe County Hospitals
E. Inpatient Charges
F. Principal Payers for Inpatient Hospital Stays
G. Emergency Room Utilization
H. Emergency Room Admissions by Principal Payer
1. Source of Admission and Hospital Discharge Status
J. Findings
Attachments
III-37
III -48
IV-l
IV-2
IV-3
IV-3
IV-4
IV-4
IV-6
IV-12
IV-14
IV-16
IV-17
IV-20
IV -21
IV-23
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ACKNOWLEDGEMENTS
The Monroe County Community Health Profile was made possible through a grant from
the Monroe County Board of County Commissioners. It was completed with the support
and participation of local agencies and the active contributions of members from the
Monroe County Community Health Initiative Task Force.
Task Force Chair and Co-Chair
R.C. Jake Rutherford, M.D., Chair
Keith Douglass, Co-Chair
Monroe County Department of Health
Rural Health Network of Monroe County
Members of the Task Force
Julio A vael
Al Brotons
Cheryll Cottrell, R.N.
Tracey Greene
Reverend Jim Gustafon
Liz Kern, R.N.
Meylan Lowe-Watler
Julia Pranschke
Debra Premaza, R.N.
David Rice, Ph.D.
Rick Rice
Charla Rodriguez
Mayor Pro-Tern Dixie Spehar
Louis La T OITe
Debra S. Walker, Ph.D.
Robert Walker
Jane Mannix Lachner
City of Key West
EMS of Monroe County
Mariner's Hospital
Plantation Key Convalescent Center
Mariner's Hospital
Hospice of the Florida Keys, Inc.
Lower Keys Medical Center
Senior Advocate
Lifeline Home Health Care
Guidance Clinic of the Middle Keys
Fisherman's Hospital
Monroe County Department of Children
and Families
Monroe County Board of County
Commissioners
Monroe County Social Services
Monroe County School Board
AIDS Help, Inc.
Monroe County Prison Health Services
Special thanks are extended to Bill Kwalick of the Key Largo Chamber of Commerce and
Michael Cunningham, Director of the Florida Keys Area Health Education Center
(AHEC) for their participation during the Task Force meetings.
11
_w-...
Special Acknowledgements
We wish to give special acknowledgement to those organizations that provided data and
related information for this report. The development of the Health Profile would not
have been possible without their participation and contribution of relevant health
information.
Technical Support and Assistance
Florida Department of Health
Office of Health Planning, Evaluation and Data Analysis
Office of Vital Statistics
Bureau ofHIV/AIDS
Bureau of Tuberculosis
Bureau of Sexually Transmitted Diseases
Monroe County Health Department
Medicaid Area 11 Field Office
Rural Health Network
Department of Children and Families, District 11
Community Services Planning Center
Mental Health and Substance Abuse Program Offices
Florida Department of Juvenile Justice, Bureau of Data and Research
Staff Acknowledgements
Health Council of South Florida, Inc.
Sonya R. Albury
Vianca H. Stubbs
Rob Harris
Shale en R. Hamilton
Executive Director
Senior Health Planner
Data Manager
Research Associate
III
EXECUTIVE SUMMARY
The Monroe County Community Health Profile describes Monroe County and its regions,
Upper, Middle and Lower Keys, at the zip code level, and focuses on elements
concerning the health of the residents throughout the area. This Monroe County
Community Health Profile is the fifth in a series of efforts implemented by the Health
Council of South Florida, Inc. to encompass District XI (Miami-Dade and Monroe
Counties). The document profiles the community utilizing zip code boundaries as the
geographical level of presentation, and provides an important framework to
understanding the health issues within this diverse South Florida community. As such, it
accompanies previous efforts completed for the southern, western, central and northern
portions of Miami-Dade County (please see the South Miami-Dade Health Profile, the
West Dade Health Profile, the Central Miami-Dade Health Profile and the North Miami-
Dade Health Profile reports).
As in its companion documents, the Monroe County Community Health Profile seeks to
take a quantitative - yet comprehensive and holistic - approach toward depicting various
factors which comprise the health of this area. Thus, this publication presents a snapshot
of the general level of health and health care resources available in Monroe County.
Between 1980 and 1990, Monroe County's population grew by nearly a quarter, adding
14,836 new residents. Since 1990, however, the population for Monroe County has
remained relatively stable, growing by only 1.1 % and was estimated at 78,907 for 2001.
Between 2001 and 2006, Monroe County's population is projected to decrease by 2.8%.
While the vast majority of the County's population were White, Hispanics were the
largest minority group. The Hispanic population substantially increased by 31.8% in the
last decade; these new residents were more likely to settle in the Middle and Lower Keys,
where they representented 18.0% and 16.5% of the populations respectively.
Uninsured population estimates for Monroe County indicated that more than one-fifth
(21.2%) of residents were uninsured in 1999 representing an estimated 14,533 persons in
IV
1999. As of December 2001, 1,680 children were enrolled in Florida's KidCare program
in Monroe County. Based on monthly enrollment reports, Healhty Kids, MediKids and
CMS have each experienced steady increases in enrollment throughout 2001.
The health of a population can be measured by reviewing the leading causes of death and
analyzing whether these deaths could have been prevented through early diagnoses and
intervention. In 2000, six of the twelve causes of death in the US, Florida, and Monroe
County were chronic diseases. These included heart disease, cancer, stroke, chronic
obstructive pulmonary disease (COPD), diabetes mellitus and chronic liver
disease/cirrhosis.
In 2000, Monroe County's AIDS cases rate was twice the state's rate, 62.82 per 100,000
versus 31.35 per 100,000. In relation to age, the 30-39 age group had the highest
percentage of persons with HIV as well as the highest percentage of persons living with
AIDS, at 51.0% and 47.1%, respectively. The number of pediatric (under age 12) cases
of HI V was too small to be reported.s
Infant mortality rates have long been considered a primary indicator for reflecting the
quality of a population's health care. In Monroe County, throughout Florida, and the
nation, infant mortality rates were the lowest in recorded history. Early entry into
prenatal care ranked well in Monroe County. Of the 3,904 resident live births from 1996
to 2000, only 382 (or 9.8%) of mothers in Monroe County received late prenatal care or
none at all. The highest percentage in the Monroe County area for late or no prenatal
care was in the Middle Keys.
Of the 10,322 hospital discharges by Monroe County residents in 2001, slightly more
than one-quarter (26.7% or 2,751) were by County residents utilizing 18 hospitals located
in Miami-Dade County. Baptist Hospital of Miami showed considerable utilization at
7.8%, followed by Mt. Sinai Medical Center & Miami Heart Institute, and South Miami
Hospital at 3.8% and 3.4%, respectively. Monroe County residents were primarily
hospitalized at non-Monroe County hospitals for other permanent cardiac pacemaker
v
implant or Percutaneous Transluminal Coronary Angioplasty with coronary artery stent
implant at 6.7% (or 207 of all non-Monroe County hospital discharges by Monroe
County residents). A number of specialized health services, such as cardiac and
neurosurgery, and all tertiary care services are not available in Monroe County. Access
to these services continues to be a barrier for Monroe County residents. Some outpatient
services such as cardiac catheterization are also not available in Monroe County because
they must be co-located at a facility with a companion inpatient cardiac catheterization
program. Cardiac catheterization programs which include the provision of coronary
angioplasty, valvuloplasty, or ablation of intracardiac bybass tracts must be located
within a hospital which also provides open heart surgery.!
In addition to providing a socio-demographic overview of the area and an analysis of
health status indicators, the Profile contains an inventory of the primary health care
delivery services available throughout Monroe County and quantifies the utilization of
these services by area residents. Also included is a review of social and support services,
as well as some of the other factors that have a direct impact on the community's health
care.
1 Certificate of Need Rule 59C-l.032 - Cardiac Catheterization and Angioplasty Institutional Health
Services, Agency for Health Care Administration. Effective August 23, 1995.
VI
INTRODUCTION
As part of an ongoing effort to assess the health care needs in Miami-Dade County, the
Health Council of South Florida, Inc. with the financial support of the Monroe County
Board of County Commissioners is pleased to announce the Monroe County Community
Health Initiative. The goal of this Initiative is to outline the current health care delivery
system and the health care needs of residents in the Upper, Middle and Lower Keys. This
Initiative includes an inventory of the health resources in Monroe County, a quantitative
summary of the health care providers in the region as well as a Community Health
Perspectives Report: A Dialogue with Providers and Consumers that encompasses results
from Personal Interviews/Community Surveys, Physician Focus Groups, and Town Hall
Meetings performed throughout Monroe County.
The Council has produced Health Profiles in the areas of South, West, and Central
Miami-Dade County, and recently completed an assessment for North Miami-Dade
County. These profiles have served to effectively identify some of the most relevant and
critical health care needs of the population within each of those population centers.
Similarly, the Monroe County Community Health Profile articulates some of the most
critical conditions and areas of health risk and need among local residents. To further
buttress this effort, coupled with the Perspectives Report, the Council will be developing
an Action Plan that details strategies advanced by the Task Force to address the
accessibility, availability, quality and cost efficiency of health care services to the
populations residing in the Upper, Middle and Lower Keys.
The Monroe County Board of County Commissioners met in March, 2002, at which time
they reviewed and unanimously approved the slate of members to serve on the Monroe
County Community Health Initiative Task Force. The Task Force serves as an advisory
body to the Monroe County Community Health Initiative in order to assure that the
information presented in this report provides an accurate description of the Monroe
County community and that it is also portrayed in a culturally sensitive manner. The role
of the Task Force has been to provide guidance within a local community driven
approach to coordinate and enhance the health care delivery system in Monroe County.
Task Force members include public and private health care providers, community
advocates, religious leaders, and government representatives.
This profile may be useful to service providers and funding entities as they plan for the
development and expansion of services in Monroe County.
2
DATA LIMITATIONS
1. The 2000 and 2001 demographic data for the 13 zip codes in the Monroe County
Community Health Initiative were prepared by ESRI Business Information Solutions,
Arlington, Virginia, using generally accepted statistical techniques. Changes in
population since the 2000 Census were captured from a variety of data sources and
applied to provide the most accurate update for 2001. Forecasting population change
in the size and distribution at the county level is based on a 1991 through 1999 trend
line, adjusted for error of closure to reflect an intercensal time series. "Selection of
an appropriate trend line for a county depends upon population size, past change, and
the projection data, one, five or ten years in the future." ESRI Business Information
Solutions applies the generally accepted linear model to calculate 2001 and 2006
county forecasts from the intercensal estimate series derived from the Bureau of the
Census' county population estimates, 1991-1999.
2. Not every address can be placed on a map at its exact latitude and longitude. Streets
change frequently. New streets are added with new development; streets disappear as
areas change; and street names change, making it difficult to match every address to
an existing Geographic Information System (GIS) address base.
3. Statistical health data in the Health Status Section is non age-adjusted due to the
collection format of the sources. Health data are also collected by zip code and do
not necessarily reflect each corresponding neighborhood equally. Each zip code cited
refers to the geographic area as designated on the Map of Monroe County by Region
prepared by the Health Council of South Florida.
4. According to the data provided by the local District 11 Mental Health and Substance
Abuse Program Office of the Florida Department of Children and Families, many of
the clients listed as receiving services may be listed twice or more if they sought help
at other centers or had more than one visit, thus counting as a new patient each time.
3
5. Some increases or decreases in death rates may be due to a change III the
methodology used to classify causes of death from the ninth version of the
International Classification of Diseases (ICD9) to the tenth revision (ICDI0) in 1999.
6. Statistical rates for Monroe County are likely to fluctuate between years due to the
effects of small numbers in rate calculations. Therefore, trends are best viewed over
multiple years for Monroe County.
4
HISTORY AND PURPOSE OF THE
HEALTH COUNCIL OF SOUTH FLORIDA
The Health Council of South Florida is the State designated local health planning agency
for Miami-Dade and Monroe Counties (District XI). It is part of a statewide network of
local health councils, serving as a private, not-for-profit option for local and state
governments for service contracts. The Council offers objectivity by representing all
segments of the health care industry, and most importantly, the public's perspective and
needs of the individuals being served. The Council performs needs assessments;
conducts special studies; forms local and statewide community boards; develops position
papers; researches health needs and engages in health education program planning and
evaluation.
The Health Councils' governing board is comprised of representatives appointed by the
Board of County Commissioners for Miami-Dade and Monroe Counties. In keeping with
its mission to improve health care in Miami-Dade and Monroe Counties, the Council
effectively promotes the development of health services, personnel, and facilities which
meet the identified health needs for the district's 2.3 million residents in an efficient and
cost-effective manner. Access to high quality health care that is cost-effective is the
cornerstone of its mandate.
For over 34 years, the Council has been engaged in forecasting health care needs and
access to health care delivery systems; providing data analysis and insight; increasing
public awareness; and providing advice and assistance to Miami-Dade and Monroe
County officials in the development and implementation of health care policy. The
Council's services include: health planning and data analysis; community-based
research; health policy development; consumer education; and program administration.
One of the many reasons for the continued success of the Council is the ongoing
coordination and collaboration with other community partners who have contributed and
participated on many initiatives together. These partnerships have been formed with both
5
public and private entities, as well as consumer groups for whom they ultimately serve.
Among its many partners, some notables are the Monroe County Board of County
Commissioners, the Rural Health Network of Monroe County, Florida Keys Area Health
Education Center, the Local Coordinating Board for the Transportation Disadvantaged
and the Community Transportation Coordinator, the Florida Department of Health, the
Agency for Health Care Administration and Monroe County Social Services.
6
I. SOCIO-DEMOGRAPHIC OVERVIEW OF
MONROE COUNTY
An assessment of Monroe County's demographic and socioeconomic characteristics is
essential to prepare for the fundamental premises behind reliable health planning. The
demographic and socioeconomic make-up of a community is a direct factor which
impacts community health status. It is important to understand the relationship between
the two in order to implement an effective health planning process.
A. POPULATION
1. Geography
Monroe County is located in the southernmost point of the continental United States at
the tip of the Florida Peninsula. Monroe County's geography is composed of 822 islands
over 120 miles in length, which extend from the southeastern tip of Florida to the Dry
Tortugas and lies between the Gulf of Mexico and the Atlantic Ocean. Of these 822
islands, only about 30 of them are actually inhabited. The Keys are' separated from the
mainland by Biscayne Bay in Miami-Dade County, Barnes Sound, Blackwater Sound and
Florida Bay. The northern end of the Keys start in Key Largo and the southern tip ends
in the 2,200 acre (3 miles by 4 miles) island of Key West, which is the County's main
population center. The highest point in the Keys, only 18 feet above sea level, lies on
Windley Key. The mainland portion of the County is via US-I. Air service is available
at Key West or Miami International Airports.
2. Population Size
For the purposes of the Monroe County Community Health Initiative, Monroe County is
divided into three regions; Upper, Middle and Lower Keys. The Initiative encompasses a
thirteen zip code area with varying levels of economic and socio-demographic indicators.
Zip code and region distribution is as follows. The Upper Keys are comprised of
Islamorada (33036), Key Largo (33037) and Tavernier (33070), the Middle Keys include
1-1
Long Key (33001), Marathon (33050) and Key Colony Beach and Marathon Shores
(33051 and 33052 respectively). The Lower Keys encompasses Key West (33040, 33041
and 33045), Summerland Key (33042), Big Pine Key (33043) and Sugarloaf Shores
(33044).
According to Sourcebook America, CAC1 Marketing System for 2001, the Lower Keys
region has the largest population among the three regions with 45,212 residents or 57.3%
of the total County population. The largest concentration was located in Key West
(33040) with 33,890 residents, followed by Summerland Key (33042) with 6,029 and Big
Pine (33043) with 5,211. The region with the second largest population size was the
Upper Keys with 21,858 or 27.7% of the Monroe County population. Key Largo was the
largest population center in the region with 12,970 residents, more than twice the size of
Tavernier (33070) or 1slamorada (33036). The Middle Keys follows with just over half
that size. It had 11,837 residents or 15.0% of the County's total, with Marathon (33050)
having the dominant share. The remaining zip codes demonstrated an aggregate
population ofless than 620 people. (See Table I-A).
1-2
Table I-A
Monroc County 2001 Population by Zip Codc
Zip Code 2001 Population Average 1997-2001
Upper Keys
33036 3,438 3,875
33037 12,970 14,100
33070 5,450 5,804
Subtotal 21,858 23,779
Middle Keys
33001 535 N/A
33050 11,302 12,426
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 11,837 12,426
Lower Keys
33040 33,890 32,985
33041 included in Zip Code 33040
33042 6,029 5,779
33043 5,211 4.925
33044 82 N/A
33045 included in Zip Code 33040
Subtotal 45,212 43,690
Monroe County 78,907 79,895
Source: Sourcebook America, 1998-2001 Editions, ESRI Business Information Solutions.
Note: These numbers may vary slightly from the 2000 Census Bureau due to the data being based on
historical trends and estimates for 2001. Please see the Data Limitations section for further detail.
Monroe County's population SIze was 78,907 for 2001. When contrasted with the
average population between the years 1997 and 2001, the five-year average was slightly
(1.3%) higher overall for the County; this reflects a downward, albeit slight, trend in
population size. The only region which displayed a larger 2001 population size was in
the Lower Keys, namely Key West (33040), Big Pine Key (33043), and Summerland Key
(33042). (See Graph 1-1).
1-3
Graph 1-1
Monroe County Population,
2001 and 1997-2001 Average Population
33043
3,874,8
I 13.438
14.099.6
1 112.970
5,804.4
1 5,450
]535
12.426.0
I ,'.: '<;; ;,..'-'".'.'111.302
32.985.4
1 J.,.;-' ", ,.'; 133.890
5.779.0
I . ." 16.029
4.925.4
15.211
02001 .5 Yr. Average
82
33036
33037
33070
33001
33050
33040
33042
33044
o
5.000
10,000
15.000
20,000
25.000
30.000
35.000
40.000
200112006 Data Source: Sourcebook America. 2001 Edition. ESRl Business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRl Business Information Solution.
1980 Data Source: Sourcebook America, 1998, Edition. ESRl Business Information Solutions.
3. Population Growth
Over the decade between 1980 and 1990, Monroe County's population grew by nearly a
quarter (23.5%), adding 14,836 new residents, compared to an increase by nearly a third
(32.7%) for the State of Florida. Since 1990, however, the population for Monroe County
has remained relatively stable, growing by only 1.1 %, and is estimated at 78,907 for
2001. The slow downturn in growth has resulted in a modest decline in population size; a
decrease has been projected for the year 2006, with the County resident population
expected to be lower by 2,171 (-2.8%) over a five-year period. In contrast, the State is
expected to increase by 9.5% in total population size over the same period. (See Table I-
E and Attachment 1-1).
1-4
Table I-B
Monroe County
Population Change by Zip Code and Florida Keys Region
1980 to 1990 Census and 2001 Census to 2006 Pro,jection
1980 1990 Percent 2001 2006 Percent
Zip Code Census Census Change Estimate Projection Change
Upper Keys
33036 2,507 3,762 50.1% 3,438 3,243 -5.7%
33037 8,579 12,842 49.7% 12,970 12,718 -1.9%
33070 3,627 5,442 50.0% 5,450 5,175 -5.0%
Subtotal 14, 713 22.046 49,8% 21.858 21./36 -3.3%
Middle Keys
33001 N/A N/A N/A 535 507 -5.2%
33050 10,221 12,790 25.1% 11,302 10,629 -6,0%
33051 N/A N/A N/A N/A N/A N/A
33052 N/A N/A N/A N/A N/A N/A
Subtotal 10.221 12. 790 25.1% 11.837 11.136 -5.9%
Lower Keys
33040 30,901 32,976 6.7% 33.890 32,875 -3.0%
33041 N/A N/A N/A N/A N/A N/A
33042 3,940 5,226 32.6% 6,029 6.146 1.9%
33043 3.233 4,675 44.6% 5,211 5,363 2.9%
33044 N/A N/A N/A 82 81 -1.2%
33045 N/A N/A N/A N/A N/A N/A
Subtotal 38.074 42.877 12.6% 45.212 44.465 -1.7%
Monroe County 63,188 78,024 23.5% 78,907 76,736 -2.8%
Florida 9,746,961 12,937,926 32.7% 16,349,220 17,895,689 9.5%
200112006 Data Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRI Business Information Solution.
1980 Data Source: Sourcebook America, 1998, Edition, ESRI Business Information Solutions.
4. Gender
In 2001, Monroe's population was slightly weighted by a larger male population. There
were 42,057 (53.3%) males and 36,850 (46.7%) females. These percentage rates were
consistent between each of the three regions, with little variation. The percentage of
males ranged from 52.1 % in the Upper Keys to 54.2% in the Lower Keys, although the
greatest percentage was in Islamorada (33036) where 54.9% of the population was male.
In SugarIoaf Shores (33044) the male/female population was equally divided. (See
Attachment 1-2).
1-5
5. Race and Ethnicity
~ White
According to Sourcebook America, 2001 Edition, 90.7% of the population in Monroe
County was White (or 72,187). The percentage of White individuals living in Monroe
County ranged from 85.4% to 97.4% within zip codes. The zip codes with the highest
concentrations of White individuals were Islamorada (33036), Long Key (33001),
Tavernier (33070), Sugarloaf Shores (33044), and Summerland Key (33042), ranging
from 97.4% to 95.8% in descending order. Over the decade between 1990 and 2000,
Monroe County's White population increased by 1.0%, while the State's White
population increased by 15.9%. (See Table /-C and Attachment /-3).
~ Black
Monroe's Black population was much smaller at 3,820 residents representing only 4.8%
of the County population overall, and a substantially lower proportion than that of
Florida's Black population (14.6%). The highest concentration of Blacks resided in the
Lower Keys, specifically within Key West (33040) at 8.4% of the population. The
Middle Keys followed, with Marathon (33050) having the second highest concentration
(4.2%). In the Upper Keys, Key Largo had a somewhat higher concentration than the rest
of the region (1.9% vs. 1.3% overall). Over the decade between 1990 and 2000, Monroe
County's Black population decreased by 10.2%, while the State's Black population
increased by 32.6%. (See Table /-C and Attachment 1-4).
~ Hispanics
The Hispanic population in Monroe County was the largest minority group at 15.8%
(12,575) and closely mirrored the statewide rate at 16.8%. Hispanics were more likely to
settle in the Middle and Lower Keys, where they represented 18.0% and 16.5% of the
populations respectively. The most notable concentrations were in Key West (33040) at
19.8%, Marathon (33050) at 18.7%, and Key Largo (33037) at 15.4%. Conversely, very
few Hispanic residents have settled on Long Key (33001) at 2.4% or 13 persons, or
1-6
SugarloafKey (33044) at 9.6% or 8 persons. Over the decade between 1990 and 2000,
Monroe County's Hispanic population increased by 31.8%, while the State's Hispanic
population increased by 70.1 %. (See Table /-C and Attachment /-5).
~ Asians
Asians accounted for less than 1 % (716) of the population in Monroe County. The largest
share, 519, resided in the Lower Keys. Over the decade between 1990 and 2000, Monroe
County's Asian population increased by 8.5%, while the State's Asian population
increased by 75.0%. (See Table /-C and Attachment /-6).
1-7
Table I-C
Monroe County
20011 Population by Race, and Hispanic or Asian Origin
White Black Hispanic Asian
Zip Code Population Number Percent Number Percent Number Percent Number Percent
Upper Keys
33036 3.493 3,402 97.4 7 0.2 241 6.9 10 0.3
33037 13.052 12.360 94.7 248 1.9 2,010 15.4 52 0.4
33070 5.529 5.335 96.5 39 0.7 647 11.7 44 0.8
Sublolal 22,074 21,098 95.6 294 1.3 2,898 13, I /07 0.5
IMlddle Keys
33001 543 526 96.9 3 0,6 13 2.4 6 1.1
33050 11.486 10.556 91.9 482 4.2 2.148 18.7 57 0.5
33051' N/A N/A N/A N/A N/A N/A N/A N/A N/A
33052' N/A N/A N/A N/A N/A N/A N/A N/A N/A
Sublolal 12,029 II,082 92,1 486 4.0 2,161 18.0 63 0,5
Lower Kevs
33040 34.230 29.232 85.4 2,875 8.4 6,778 19.8 445 1.3
33041" N/A N/A N/A N/A N/A N/A N/A N/A N/A
33042 . 6.005 5.753 95,8 66 1.1 366 6.1 42 0.7
33043 5.168 4.904 94.9 57 1.1 346 6.7 31 0.6
33044 83 80 96.4 0 0 8 9.6 I 1.2
33045" N/A N/A N/A N/A N/A N/A N/A N/A N/A
Sublolal 45,486 39,970 87.9 2,998 6.6 7,498 16,5 519 I.l
Monroe County 79,589 72,187 90.7 3,820 4.8 12,575 15.8 716 0.9
Florida 15,982,378 12,466,255 78 2,333,427 14.6 2,685,040 16.8 27/,700 1.7
'Dolo for Zip Codes 33 I 51 and 33 I 52 are included in Zip Code 33050,
"Dalafor Zip Codes 33041 and 33045 are included in Zip Code 33040.
Source: Sourcebook America, 2001 Edition. ESRl Business Informalion Soiutions.
6. Age Cohorts
The age breakdowns for the residents of Monroe County are in eight major categories:
1. o to 4 years old;
2. 5 to 14 years old;
3. 15 to 19 years old;
4. 20 to 24 years old;
5. 25 to 44 years old;
6. 45 to 64 years old;
7. 65 to 84 years old; and,
8. 85 years and over.
1-8
~ Zero to Four Years Old
There were 3,393 children ages 0 to 4 years residing Monroe County in 2001. The Lower
Keys region (33040-33045) showed a slightly higher percentage of infants and toddlers at
4.5%, when compared to the County (4.3%). The highest concentrations were located in
Key West (33040) representing 4.9% (1,661) of this zip codes' population. The Upper
Keys (33036, 33037 and 33070) followed at 4.1 %, and the highest concentrations were
located within Tavernier (33070) and Key Largo (33037) at 4.8% (262) and 4.3% (558)
respectively. The Middle Keys had a smaller portion at 3.8% or 449 children 0 to 4 years
old.
~ Five tiJ Fourteen Years Old
Approximately 9.7% (7,654) of Monroe County's population were between the ages of 5
to 14 years, which was lower than the State's percent at 12.9%. Nonetheless, this group
represented the largest percentage and aggregate number among the under twenty-five
age groups. The largest concentration of these children (between 11.4 to 6.5% per zip
code) was located in the Upper Keys, averaging 10.2% overall for the region and
included 2,220 children. However, the highest number of children corresponded to Key
West (33040) in the Lower Keys, with 3,287 (9.7%) of the zip code's 5 to 14 year old
population and 9.6% for the Lower Keys region or 4,321 children in this age bracket.
~ Fifteen to Nineteen Years Old
Teens, ages 15 to 19 years, accounted for 3,630 people countywide or 4.6% of its resident
population. The State had a higher percent at 6.3%. The Upper Keys had the highest
concentration of teens on a regional level at 4.8% (1,057), followed by the Lower Keys at
4.5% (2,054). Only Tavernier (33070) broke the 5% barrier with 5.1 % of its population
in this age category representing 278 youth. However, several zip codes had larger teen
populations due to their larger overall population sizes.
1-9
~ Twenty to Twenty-Four Years Old
In Monroe County, 4.6% of the residents were between the ages of20 to 24, compared to
5.9% for the State. The highest proportion was concentrated in the Lower Keys (5.3%)
and Key West (33040) in particular, with 6.2% (2,101). This was followed by the Middle
Keys (4.1%) with Marathon (33050) at 4.2% (475). The Upper Keys had the lowest rate
(3.4%) while Key Largo (33037) had the highest concentration for the area at 3.6% (467).
The lowest numbers and proportions of young adults were located in Sugarloaf Shores
(33044) and Long Key (33001). (See Table I-D).
Table I-D
Monroe County
,\ge Groups 0 to;l through 20 to 24,
b~ Zip Code and Florida Keys Region, 2001
A..e 0-4 Al!e 5-14 Al!e 15-19 Al!e 20-24
Zip Code Population Number Percent Number Percent Number Percent Number Percent
Upper Keys
33036 3,438 83 2.4 223 6.5 131 3,8 113 3.3
33037 12.970 558 4.3 1.375 10.6 649 5 467 3.6
33070 5,450 262 4.8 621 11.4 278 5,1 169 3,1
Subtotal 21.858 902 4.1 2,220 10,2 1.057 4.8 749 3.4
Middle Keys
33001 535 19 3,6 37 6.9 23 4.3 14 2.6
33050 11.302 429 3.8 1.085 9.6 486 4.3 475 4,2
33051" N/A N/A N/A N/A N/A N/A N/A N/A N/A
33052" N/A N/A N/A N/A N/A N/A N/A N/A N/A
Sub/otal 11.837 449 3.8 1.122 9.5 509 4.3 489 4.1
Lower Kevs
33040 33,890 1,661 4.9 3.287 9,7 1,559 4.6 2,101 6.2
33041.. N/A N/A N/A N/A N/A N/A N/A N/A N/A
33042 6,029 205 3.4 531 8.8 241 4.0 163 2.7
33043 5,211 177 3.4 495 9.5 250 4.8 151 2.9
33044 82 2 2.4 8 9.8 4 4.9 2 2.4
33045.. N/A N/A N/A N/A N/A N/A N/A N/A N/A
Subtotal 45,212 2,045 4.5 4,321 9.6 2,054 4.5 2.417 5.3
Monroe County 78,907 3,393 4.3 7,654 9.7 3,630 4.6 3,630 4.6
Florida 16,349,110 964,604 5.9 2,109,049 11.9 1,030,001 6.3 964,604 5.9
.Data for Zip Codes 33151 and 33152 are included In ZIp Code 33050.
"Data for Zip Codes 3304\ and 33045 are included in Zip Code 33040.
Source: Sourcebook America, 200\ Edition. ESRI Business Information Solutions.
~ Twenty-Five to Forty-Four Years Old
Approximately 31 % of Monroe's residents fell within the 25 to 44 year old age group,
which was slightly higher than the State (28.1 %). The highest areas of concentration
1-10
were in the Lower Keys region at 33.2% (15,032); a very high rate was evidenced in Key
West (33040) in particular at 35%, followed by Big Pine Key (33043) at 29.9%. The
Upper Keys had the second highest concentration with 27.2% (5,938). The Middle Keys
ranked last for this younger, working age population, at 26.8% (3,172).
~ Forty-Five to Sixty-Four Years Old
Just under a third (31.6%) of the total population in Monroe County fell within the 45 to
64 year old age category. This was the highest percentage of any age group in Monroe
County, even higher than the State's percentage at 23.2%. The highest area of
concentration for this age group was in the Middle Keys (33.4%), with Long Key (33001)
having the highest concentration (35.5%). The Upper Keys closely followed at 32.8%,
and even more residents; Islamorada in particular, had a large representation at 39.7%.
The Lower Keys, weighed in at 30.5% overall for the region, and the highest proportions
resided in Sugarloaf Shores (33044) and Summerland Key (33042) at 41.5% and 39.7%
respectively.
~ Sixty-Five to Eighty-Four Years Old
The population in Monroe County between the ages of 65 and 84 years old represented
13.3% of the population, which was lower than the State at 15.5%. The highest
proportions of individuals between the ages of 65 and 84 generally concentrated in the
Middle and Upper Keys, with 16.6% and 15.8% of the population respectively in this age
bracket. The Lower Keys had, on balance, a younger population, and only 11.3% of the
population fell in this category. Long Key (33001) had the highest concentration in this
age bracket countywide with 20.6% of their population in the young elderly group.
~ Eighty-Five Years Old and Over
Elders in their advanced years, eighty-five and above, represented a very small proportion
of the overall population in Monroe County at 1.3% (1,026), which was lower than the
State's 2.2%. For this age group, the percentages ranged from 0% in Sugarloaf Shores
1-11
(33044) to 1.9% on Long Key (33001), albeit the number was quite small at 10 residents.
As a region, the Upper Keys had the highest concentration at 1.7% and the Lower Keys,
with the lowest at 1.1 %; however, the aggregate numbers were highest in the Key West
area due to the population size. (See Map I and Table I-E).
It should be noted that the age distribution for Monroe County was somewhat older than
that generally found in the State as a whole, reflecting a higher percentage of the age
group comprised of persons between 25 and 64 years. This working age population will
be important to consider when reviewing the health status of the County in the following
Section.
Table I-E
Monroe County
,\ge Groups 25 to 44 through 85 and Over,
b~ Zip Code and Florida Ke~s Region, 2UUI
Al!e2S44 A..e 45-64 A..e 65-84 Al!e 85 and Over
Zip Code Population Number Percent Number Percent Number Percent Number Percent
Upper Keys
33036 3,438 870 25.3 1.365 39,7 602 17.5 48 1.4
33037 12.970 3,515 27,1 4,060 31.3 2.127 16.4 220 1.7
33070 5,450 1,553 28,5 1.739 3\.9 736 13.5 93 1.7
Subtotal 21.858 5,938 27.2 7.163 32,8 3,464 15.8 361 1.7
Middle Keys
33001 535 132 24.7 190 35.5 110 20.6 10 1.9
33050 11,302 3,040 26,9 3,764 33,3 1,854 16.4 170 1.5
33051- N/A N/A N/A N/A N/A N/A N/A N/A N/A
33052- N/A N/A N/A N/A N/A N/A N/A N/A N/A
Subtotal 11,837 3.172 26.8 3.953 33.4 1,964 16.6 180 1,5
Lower Keys
33040 33,890 11,862 35 9.557 28.2 3,525 10.4 373 l.l
33041-- N/A N/A N/A N/A N/A N/A N/A N/A N/A
33042 6,029 1,592 26.4 2,394 39.7 844 14 48 0.8
33043 5,211 1.558 29.9 1,803 34,6 719 13,8 57 l.l
33044 82 21 25,6 34 41.5 11 13.4 0 0
33045-- N/A N/A N/A N/A N/A N/A N/A N/A N/A
Subtotal 45.212 15,032 33.2 13,788 30.5 5.099 JJ.3 478 J./
Monroe County 78,907 24,146 30.6 24,935 31.6 10,495 13.3 1,026 1.3
Florida 16,349,110 4,594,131 18.1 3,793,019 13.1 1,534,119 15.5 359,683 2.1
-Data for Zip Codes 33151 and 33152 are IOcluded 10 ZIp Code 33050,
"Data for Zip Codes 33041 and 33045 are included in Zip Code 33040,
Source: Sourcebook America, 200 I Edition. ESRI Business Information Solutions.
1-12
B. SOCIO-ECONOMIC FACTORS
1. Income
This section reviews three income level indicators for the Monroe County area and the
three regions; Upper, Middle and Lower Keys. They are: median household income, per
capita income, and households with incomes less than $15,000 Gust under the federal
poverty threshold for a family of four).
~ Median Household Income
The CACI Marketing Systems defines median household income as "the value that
divides the distribution of household income into two equal parts".! In 2001, Monroe
County's median household income was $44,283, about 18.7% higher than Florida
overall ($37,307). Within the three regions; Upper, Middle and Lower Keys, 6 out of the
9 reporting zip codes (zip codes 33036, 33037, 33070, 33001, 33050, 33040, 33042-
33044) indicated median incomes higher than that of the County's. The areas with the
highest reported median household incomes were Sugarloaf Shores (33044) at $57,372
and Summerland Key (33042) at $52,541, both in the Lower Keys. In the Upper Keys,
Islamorada (33036) had the highest income at $50,000, followed by Tavernier (33070) at
$47,966. The remaining zip codes reviewed reported median household incomes
between $40,278 and $45,673 (zip codes 33037, 33001, 33050, 33040, and 33043).
~ Per Capita Income
The per capita income provides a more accurate description of the actual living
conditions in the Monroe County area. According to the 2001 CACI data, the per capita
income in Monroe County was $26,639. The highest per capita income was found in
Islamorada (33036) reporting at $34,671; the next highest per capita income by area
corresponded to the Lower Keys region, on Summerland Key (33042) with a per capita
income of$31,446; in the Middle Keys region, Marathon reported a per capita income of
I The Sourcebook of Zip Code Demographics, Tenth Edition, CACI Marketing Systems, 1999.
1-13
$28,016, the highest for the area; however, this was still lower than Big Pine (33043) at
$28,892 and Sugarloaf Shores (33044) at $28,613 in the Lower Keys. The lowest per
capita incomes by region were as follows for the Upper Keys: Tavernier (33070) reported
at $26,439; Middle Keys: Long Key (33001) with $21,972; and lastly for the Lower Keys
region, Key West (33040) came in with an income of $24,255.
~ Households with Incomes less than $15,000
The average 2001 percentage of households with incomes of less than $15,000 for
Monroe County was 12.0%, as compared to 17.6% for the State as a whole. This reflects
a relatively low percentage (46.7% lower) of very low-income households than was
found throughout the State. The areas with the highest concentrations of very low-
income households were most dominant in the Lower Keys, with a 13.1 % rate overall;
Key West had the highest percentage at 14.8%; the Middle Keys region reported
percentages ranging from 8.9% to 11.0% for an overall rate of 10.9%; lastly, the Upper
Keys had a rate of 10.4%, with Key Largo reporting 11.8%. An important consideration
regarding the percentage of low-income households in the Upper Keys is the Ocean Reef
community, located on the northern portion of Key Largo. Ocean Reef is a private
community and country club whose residents tend to have higher incomes; therefore,
there can be great disparities within particular zip codes. The largest variations among
zip codes occurred in the Lower Keys, with only one reported household in the lowest
income bracket, in Sugarloaf Shores (33044), at 2.9%; other rates ranged from 7.2 to
14.8%. (See Table I-F).
1-14
Table I-F
:\IOnrfll' COllnt~ 2001 Income
h~ Zip Codl" and Florida Ke~s Region
Households with
Median Income
Household Per Capita Less Than 515,000
Zip Code Income Income Number I Percent
UDper Kevs
33036 $50,000 $34,671 166 9.6
33037 $43,931 $26,891 687 11.8
33070 $47,966 $26,439 176 7.6
Subtotal Not Reported Not Reported 1,029 10.4
Middle Keys
33001 $40,278 $21,972 22 8.9
33050 $44,906 $28,016 568 11.0
33051* N/A N/A N/A N/A
33052* N/A N/A N/A N/A
Subtotal Not Reported Not Reported 590 10.9
Lower Kevs
33040 $41,296 $24,255 2,129 14.8
33041** N/A N/A N/A N/A
33042 $52,541 $31,446 195 7.2
33043 $45,673 $28,892 226 9.7
33044 $57,372 $28,613 1 2.9
33045** N/A N/A N/A N/A
Subtotal Not Reported Not Reported 2,551 13.1
Monroe County $44,283 $26,639 4,170 12.0
Florida $37,307 $20,199 1,140,106 17.6
"Data for Zip Codes 33151 and 33152 are Included In Zip Code 33050.
""Data for Zip Codes 33041 and 33045 are included in Zip Code 33040.
Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
2. Propensity to Purchase Health Insurance
Another indicator utilized to review economic status is the propensity to purchase health
insurance, which according to CACI Marketing Systems is the percent of the local rate of
insurance vs. the U.S. Consumption rate. A score of 100 equals the Average Demand
Nationally. An index of 86 implies that demand was 14% lower than the U.S. average.
In Monroe County, the index of 108 suggests that the demand was 8% higher than the
U.S. average. In fact, 7 out of the 9 zip codes reported indexes higher than that of the
County's. In the Upper Keys, Islamorada (33036) had the highest index at 135.
Following closely behind, in the Lower Keys, both Summerland Key (33042) and Big
Pine Key (33043) had the next highest demand with index rates of 133 each. In the
1-15
Middle Keys, only Marathon (33050) in the Middle Keys had a rate above the County
mean at 115. The remaining areas of Monroe County showed a lower propensity to
acquire insurance, between 93 and 113, Key West (33040) having the only index rate
below the national average. (See Attachment 1-7).
3. Uninsured
Data provided by the Agency for Health Care Administration in its Florida Health
Insurance Study 2000 indicate that 21.2% (or 14,533) of Monroe County's population
were uninsured in 1999. The greatest concentrations of uninsured are in the Lower Keys
with Key West (33040) at 25.7% and Big Pine Key (33043) with 19.0%. In the Middle
Keys, Marathon (33050) had the second highest percentage of uninsured with 21.7%.
Statewide, an estimated 16.8% of the population was uninsured in 1999. (See Table 1-G
and Map 1-2).
1-16
Table I-G
\lllnroe ('ounty Uninsured Population
by Zip ('ode, 1999
Zip Code Number Percent
Upper Keys
33036 392 13.5%
33037 1,882 17.3%
33070 909 18.4%
Subtotal 3.183 N/A
!Middle Keys
33001 included in Zip Code 33050
33050 2,400 21.7%
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 2,400 N/A
Lower Keys
33040 7,497 25.7%
33041 included in Zip Code 33040
33042 782 12.3%
33043 580 19.0%
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 8,859 N/A
Monroe County /4,533 21,2%
Florida 12,375,034 16.8%
Source: Flonda Health Insurance Study, 2000, Summary of the SmaIl Area
Analysis Estimates, Agency for Health Care Administration.
4. Household Size
ESRl Marketing Systems as well as the U.S. Census Bureau define a household as a
person or group of persons who live in a housing unit.2 A housing unit may be occupied
or vacant, but to be considered a household, it must have persons residing in it. These
persons do not have to be related, as a family is defined as a group of two or more people
(one of whom is the householder, the person in whose name the housing unit is owned or
rented) living together and related by birth, marriage or adoption. 3 ESRl Marketing
Systems 2001 estimated average household size for Monroe County was 2.23, which was
9.3% lower than that for the State at 2.46. One area, Islamorada (33036) in the Upper
Keys, reported a household size of 1.96. Two areas in the Lower Keys, Sugarloaf Shores
2 Sourcebook America, 200 I Edition, ESRI Business Information Solutions.
3 Ibid.
1-17
(33044) and Key West (33040) reported household sizes above the County's 2.23 at 2.41
and 2.29 respectively. In the Upper Keys, only Tavernier (33070) reported a higher than
average household size at 2.28. In the Middle Keys, both areas were below the County
average. (See Map 1-1 and Attachment 1-8).
These data may be reflective of larger households with children at home as well as lower
to middle Income areas. Earnings oftentimes go toward maintaining the family
household with a modest amount of discretionary income available for additional
expenses. However, Sugarloaf Shores (33044) seems to be an exception.
5. Homelessness
The availability of affordable housing is a major concern in the Keys due to its resort
economy, unique geography and fragile ecosystem. The economy is driven by
seasonable employment in the service industry and incomes are frequently exceeded by
the cost of living, especially when the environmentally sensitive areas have led to
restricted land use, and with housing costs that are above the norm for the State as a
whole. Added to this is the challenge of assisting the homeless population, given their
overall low economic status, mental health and social service needs. It is always difficult
to obtain an estimate of the number of homeless persons within a given community.
Commonly the best estimates may be obtained through organizations which provide
services to the homeless. According to the Southernmost Homeless Assistance League,
Inc. (SHAL) the number of homeless in Monroe County is 2,151, including those who
reside on derelict boats. A large share (71.1 %) is comprised of males (1,529). Over 100
represent families, and 268 or 12.5% are children. (See Table I-H). High concentrations
of homeless can be found in the Lower Keys with 861 (Zones 1 and 2); near Boca Chica
Bridge to Cudjoe Key and up to the West side of the 7-Mile Bridge with 391 (Zones 3
and 4); and a large share on the East side of the 7-Mile Bridge up to MM 74 with 467
(Zone 5); and a small portion north to Key Largo with 139 (Zone 6). (See Table I-I).
1-18
Table I-H
\Ionroe Count)' Homeless Population
Male 1,529 71.1%
Female 330 15.3%
Unknown 292 13.6%
Total 2,151 100.0%
Homeless Families 110 5.1%
Children 268 12.5%
Teenager 46 2.1%
Source: Southernmost Homeless Assistance
League, 2002.
Table I-I
Conccntration of Uomelcss Population
Within ;\Ionroc Count~'
Zone 1: Near Shore Water & Islands off Key West
Zone 2: Lower Keys Land Mass up to the Boca Chica Bridge
Zone 3: East Side of Boca Chica Bridge to Cudjoe Key + Derelict Boats
Zone 4: Cudjoe Key to West Side Bridge to MM 74 + Derelict Boats
Zone 5: East Side of7-Mile Bridge to MM 74 + Derelict Boats
Zone 6: MM 74 to Ke Lar 0 + Derelict Boats
Source: Southermost Homeless Assistance League, 2002.
211
650
279
112
467
139
The Rural Health Network in Monroe County has also collected statistics on the
homeless population. Of the total patients seen through its health services programs in
2001 (4,161), 568 reported themselves to be homeless (13.7%). The largest share was
located in the Lower Keys with 264 (46.5%). The next highest number of homeless
served was in the Upper Keys with 186 (32.7%), followed by the Middle Keys with 118
(20.8%). These numbers did not include those individuals who temporarily lived with
friends and claimed that address as their residence, which could increase the numbers to a
figure approximating 15% or higher.
1-19
6. Public Assistance Programs
A review of public assistance indicators can assist in broadening knowledge about the
financial levels as well as some of the cultural differences of some of the residents of
Monroe County. These factors may have a direct impact on the health care access
patterns by area residents. An example of the cultural influence in terms of health care
access is the high utilization of emergency room services to treat non-life-threatening
illnesses. Another observable pattern is the Fire Department being contacted when a
perceived medical emergency occurs.
~ Temporary Assistance to Needy Families (T.A.N.F.)
Temporary Assistance to Needy Families (T.A.N.F.) is the primary government program
designed to improve the nutrition of low-income individuals and families and is
administered by the Department of Children and Families, Office of Economic Self
Sufficiency. In general, a household must have total gross monthly income4 less than or
equal to 130% of the federal poverty level and total net monthly income5 less than or
equal to 100% of the federal poverty level to be eligible for food stamps; however,
elderly and disabled households only have to meet the net monthly income standard.6
T .A.N.F. ,has experienced a significant decline in cash assistance caseloads since its
beginning. Florida's caseload decline has been the highest among the eight largest states
in the nation. There was a 68% decline between August 1996 and December 1999.
Since 1998, the decline in cash assistance has continued, but the Medicaid trend has
reversed and the number of children eligible for Medicaid is on the rise.
The financial status of some of the families living in Monroe County is partly
demonstrated through the rate of food stamp beneficiaries in the area. A snapshot of the
eligible families for this type of assistance conducted by the Department of Children and
4 Gross income means a household's total, non-excludable income, before any deductions have been made.
5 Net income means gross income minus allowable deductions.
6 Florida Department of Children & Families, Food Stamp Program Fact Sheet, October 2000.
1-20
Families for 2001 indicated that 261 of the families in the area received food stamps.
The highest concentrations of recipient families were located in Key West (33040) of the
Lower Keys with a percentage rate of 1.8% (138 families); in Key Largo (33037) of the
Upper Keys at 1.4% (51 families); followed by Marathon (33050) of the Middle Keys at
1.3% (40 families). Other areas in Monroe County showed T.A.N.F. rates substantially
lower, varying from 0 to 1.0 %. (See Table I-J).
Table I-J
"unroe County
Telllporar~ \ssistance to Need~ Families CL\.N.F.),
and "edicaid Eligible Reeipients by Zip Code and Florida Keys Region, 2001
TANF Recipients
(March 2001) Medicaid Recipients
Number of I % of Total I % of Total
Zip Code Population Families Number FamiUes Number Population
Upper Keys
33036 3.438 974 0 0,0% 212 6.2%
33037 12.970 3,681 51 1.4% 1.490 11.5%
33070 5.450 1.483 11 0.7% 599 11.0%
Subtotal 21.858 6.138 62 Not Reported 2.301 10.5%
Middle Keys
33001 535 158 0 0,0% 18 3.4%
33050 11,302 3,130 40 1.3% 1,523 13.5%
33051 N/A included in Zip Code 33050 0 0.0% N/A
33052 N/A included in Zip Code 33050 0 0.0% N/A
Subtotal 11,837 3,288 40 Not Reported 1,541 /3. 0%
Lower Keys
33040 33.890 7,692 138 1.8% 4,205 12.4%
33041 N/A included in Zip Code 33040 0 0.0% N/A
33042 6.029 1,789 7 0.4% 313 5.2%
33043 5,211 1,451 14 1.0% 463 8.9%
33044 82 29 0 0.0% 4 4.9%
33045 N/A included in Zip Code 33040 0 0.0% N/A
Subtotal 45.212 10,961 159 Not Reported 4.985 11.0%
i\.fonroe County 78,907 20,387 261 1.3% 8,827 11.2%
Florida 16,349,220 4,210,760 Not Reported 2,597,870 15.9%
. .
Source: Sourcebook Amenca, 2001 EdItion. ESRI Busmess Infonnanon SolutIOns.
Miami-Dade County Department of Children and Families. 2002.
District XI, Medicaid Office, 2002.
~ Eligible Medicaid Recipients
The Medicaid Program provides health care servIces to indigent people, and IS
administered by the Agency for Health Care Administration. The Department of
1-21
Children and Families, Office of Economic Self-Sufficiency and the Social Security
Administration determine recipient eligibility.?
A snapshot of the eligible individuals for Medicaid conducted by the Department of
Children and Families and the District XI Medicaid Office indicated that 11.2% (or
8,827) of the population in Monroe County were Medicaid recipients. The region with
the highest percentage of Medicaid recipients was the Middle Keys at 13.0%, and
specifically Marathon (33050) with the highest rate at 13.5%. In the Lower Keys, Key
West (33040) had the highest proportion of Medicaid recipients (12.4%) and in the Upper
Keys, Key Largo (33037) reported the largest concentration at 11.5%. The remaining
areas rep<?rted percentages ranging from 3.4% to 11.0%. (See Table I-J). In Monroe
County, the greatest percentage of Medicaid recipients (based on total resident
population) are between the ages of 21 and 44 (2.7%) followed by the 0 to 5 age group
(2.4%). (See Attachment 1-9).
~ KidCare
The 1998 Florida legislature created the Florida KidCare Program through the federal
Title XXI block grant formally known as the Children's Health Insurance Program
(CHIP). KidCare is Florida's own version of this national matching grant program. The
legislation governing KidCare expands eligibility and health care coverage for low-
income Florida children who do not have health insurance. The program's targeted
populations include families transitioning from welfare to work, African Americans,
Hispanics, rural families, and Native Americans. The program has three main goals:8
7 The Social Security Administration determines the eligibility for first time applicants for Social Security
benefits. They also determine the eligibility for Supplemental Security Income (SSI). When a person is
determined eligible for SSI by the Social Security Administration, they are automatically eligible for
Medicaid and need not go to the Department of Children and Families unless they also want to apply for
food stamps. Social Security also has programs for disabled and dependent children and children who
receive SSI are also automatically eligible for Medicaid.
8 Florida KidCare: A Partnership for Children's Health Insurance, January 2000.
1-22
I. To enroll eligible children in health insurance;
2. To help families understand how to use their children's health insurance
appropriately; and
3. To ensure that Florida uses its full share of federal funds.
KidCare is for uninsured children under age 19 who meet income and eligibility
requirements. The KidCare law took effect on July I, 1998 and enrollment started on
October I, 1998. The program includes four parts:
I. MediKids for children from ages I to 5 whose family incomes are above
current Medicaid eligibility criteria but less than 200% of the federal
poverty guidelines;
2. Florida Healthy Kids for children ages 6 to 19;
3. The Children's Medical Services (CMS) Network for children with special
health care needs from birth to age 19; and
4. Medicaid for children ages 0 to 19.
Florida adopted a unique administrative structure for its children's health insurance
program. Three state agencies (the Agency for Health Care Administration, Florida
Department of Health and the Department of Children and Families) and the non-profit
Florida Healthy Kids Corporation form the core of the KidCare partnership. The entire
effort is supported by a network of regional outreach staffs that work with the families in
their communities.
Although many children qualify for these KidCare programs, perhaps half of eligible
children in the state are enrolled. Many parents who have never tried to enroll their
children in Medicaid do not know that their children qualify for the programs. Others
lack basic information on how or where to enroll.9 Fluctuations in family income can
result in children moving on and off a program, either Medicaid or one of the other
KidCare programs.
9 Ibid.
1-23
The Healthy Kids program, a school enrollment-based insurance program that provides
comprehensive health insurance coverage to school-aged children and their younger
siblings, relies on financing from the state and federal government (about 49%),
participating families (about 35%), and local governments (about 16%). In order to
qualify for the Florida Healthy Kids program, recipients must be at or below 200% of the
poverty level within the State. If income exceeds this level, recipients may qualify for
reduced premiums based on a sliding-scale fee schedule. Other eligibility requirements
include:
1. residing in a county with the program,
2. being between 6 and 19 years of age or a young sibling of a recipient,
3. - not being eligible for Medicaid benefits or CMS, and
4. not being enrolled in any other health insurance program.
As of December 2001, 1,680 children were enrolled in Florida's KidCare program in
Monroe County.lO Based on monthly enrollment reports, Healthy Kids, MediKids and
CMS have each experienced steady increases in enrollment throughout 2001. Between
January and December 2001, CMS enrollments increased 10% and MediKids
enrollments increased 41.4%. In 2001, there was an average of 1,275 children enrolled in
Healthy Kids in Monroe County. CMS enrollment averaged 43 children per month. The
MediKids program, which experienced the greatest increase in enrollment, had an
average of 181 children enrolled. Summerland Key (33042) had the greatest percentage
increase in enrollment for CMS and MediKids, each with a 100.0% increase. Key West
(33045) and Marathon Shores (33052) experienced the largest gains in Healthy Kids
enrollment at 100.0% and 66.7%, respectively. It should be noted that the address
provided is that which families gave as their residence address. However, in some cases
the address may correspond to the parent who pays the premium, and not necessarily
where the child resides. (See Attachment 1-10).
10 Statewide KidCare Enrollment for 2001, Florida KidCare. Available at: www.floridakidcare.org.
1-24
As stated in the 1999 report entitled KidCare: The Impact of Medicaid Eligibles in the
Healthy Kids Program, prepared by the Institute for Child Health Policy, the success of
this program may be attributed to several factors. The fIrst one is tliat parents like the
fact that they are able to contribute towards their children's health insurance. Second, the
application process is easy and understandable. Third, parents like the choice of doctors
in the Healthy Kids Program. Finally, the enrollees report that they enjoy working with a
non-governmental health insurance program.
Nonetheless, according to the Florida Health Insurance Study conducted in 1999,
approximately 22.8% (3,824) of children between the ages of 0 and 18 in Monroe County
were uninsured, ranking the county the fourth highest in the state for percent of uninsured
children. 'It should be noted that this fIgure included children of all incomes, including
children who do not qualify for the KidCare program due to family income levels
exceeding 200% FPL. Recent estimates (February 2002) by the KidCare Collaboration
Project of The Lawton and Rhea Chiles Center at the University of Florida excluded
uninsured children who do not meet income eligibility criteria for the KidCare program
and estimated that 1,132 Monroe County children under 200% FPL are not covered by
the KidCare program. Family coverage for the parents also remains an unmet need.
7. Child Abuse
During fIscal year 2001/2002, the Department of Children and Families' Florida Abuse
Hotline Information System received a total of 211,034 reports of child abuse. In
Monroe County, there were 1,155 reports of child abuse during the same time period.11
With so many cases of child abuse reported, and subsequently investigated, it is no
wonder that child protection systems may be stretched beyond their capacity to fully
respond to the complex needs of troubled families. Many families may not receive the
help that they desperately need to rebuild their lives. Extended support from the
community is especially needed for families in crisis in order to come to the aid of the
most vulnerable family members, the children.
11 Florida Department of Children and Families, Florida Abuse Hotline Information System, Child Abuse
Protective Investigations Report Type for Reports Received, July 2002. Reports available at
www.myflorida.com.
1-25
During calendar year 2001, the Department of Children and Families in Monroe County
investigated 613 reports of child abuse. Nearly half (297 or 48.5%) of all investigations
were conducted in the Lower Keys, particularly in Key West (33040) at 229
investigations. While Key West possessed the greatest number of investigations, it held
the third highest rate of investigations at 38.42 per 1,000 children under age 18 and was
surpassed by Big Pine Key (33043) at 44.44 (or 38 investigations) and Marathon (33050)
at 41.73 (or 78 investigations).
Of the 613 child abuse investigations in Monroe County, just over half (or 323) were
verified cases of child abuse. The Lower Keys had the highest rate of verified child
abuse at 14.35 per 1,000 children under age 18. Within that region, Big Pine Key
(33043) and Key West (33040) had the highest rates for individual zip codes, at 19.88
and 14.26, respectively. (See Table I-L).
1-26
Table I-K
Child Abuse Protecti\C Investigations and Verified Cases of Child Abuse per 1.000 Children
by Zip Code in 'Iunroe Count~. 2001 (Children Under 18 Years of Age)
2001 Rate Number of Rate
Population Number of Per Verified Per
Zip Code Under 18 Investigations 1,000 Cases 1.000
Upper Keys
33036 387 8 20.67 2 5.17
33037 2,418 44 18.20 19 7.86
33070 1,120 28 25.00 6 5.36
Subtotal 3,925 80 20.38 27 6.88
Middle Keys
33001 71 0 0.00 0 0.00
33050 1,869 78 41.73 20 10.70
33051 0.00 0 0.00 0 0.00
33052 0 0 0.00 0 0.00
Subtotal 1,940 78 40.21 20 10.31
Lower Keys
33040 5,961 229 38.42 85 14.26
33041 0 0 0.00 0 0.00
33042 921 30 32.57 9 9.77
33043 855 38 44.44 17 19.88
33044 0 0 0.00 0 0.00
33045 0 0 0.00 0 0.00
Subtotal 7,737 297 38.39 III 14.35
Unknown Zip Code 0 0 0.00 7 N/A
Monroe County 19,467 613 31.49 323 16.59
Florida Not Reported
Source: Florida Department of Children & Families, District 11,
Community Services Planning Center, 2002.
8. Juvenile Arrests
The number of juveniles charged in Monroe County in 2000-2001 totaled 1,176. These
charges include the sum of all the violations recorded for a specific area by the Florida
Department of Juvenile Justice. A large share of these charges was for misdemeanors
(46.1 %); however, a full 36% were for felony charges. Actual arrests were made to 795
youth offenders and again, 36.1 % were for felonies.
At the regional level, the Middle Keys experienced a higher rate of juvenile charges and
arrests, at 6.9% and 5.0% respectively. Most of these occurred in Marathon (33050).
Yet, many of the charges were for misdemeanor offenses. The Lower Keys experienced
lower rates of charges than the Upper Keys, but for arrests they were nearly equal. On an
1-27
individual community level, Big Pine Key (33043) had the highest overall charge and
arrest rates at 10.5% and 6.4% respectively, many of which were for felonies. (See
Attachments 1-11 and 1-12).
C. SCHOOL INDICATORS
The Florida Department of Education compiles data by elementary, middle and high
school levels. The school year 2000-2001 indicators reviewed in this section are the
crime and violence incidents, the percentage of absenteeism for 21 days and over, the
percentage of students with limited English proficiency, and the percentage of
free/reduced price lunch for elementary and middle school students. (See Attachment 1-
13).
1. Stability
The stability of a school and district is calculated based on the percentage of students in
the October membership count who are still present in the second semester's February
count. This indicator can be utilized to present a picture of movement within a given
school or district. Monroe County elementary schools experienced the greatest stability
with 94.8% of students present in the second semester count. Monroe County middle
schools had a comparable rate of 94.4% whereas area high schools reported 90.1 % of
students present in the second semester. Key West High School's stability rate, 88.4%,
was the lowest individual percentage within the district. Montessori Charter School
experienced the greatest stability at 98.0%. (See Attachment 1-13).
2. Limited English Proficiency
The percentage of limited English proficiency (LEP) among students at the elementary
level in Monroe County was reported between a low of 0.0% at Island Montessori
Charter School (Tavernier - 33070) to a high of 14.0% at Gerald Adams Elementary (Key
1-28
West - 33040). The percentage of students with limited English proficiency in the
remaining eight elementary schools ranged from 2.0 to 13.5%.
The middle schools with the highest percentage of students with limited English
proficiency were Horace O'Bryant Middle School (Key West - 33040) at 7.6% and
Marathon High School (Marathon - 33050) at 6.1 %. The remaining three middle schools
ranged from 1.3 to 4.9%.
The high school with the highest level of limited English proficiency was Marathon High
School (Marathon - 33050) at 8.3%. The remaining two senior high facilities, Key West
High School (Key West - 33040) and Coral Shores High School (Tavernier - 33070) had
limited English proficiency percentages of7.5 and 4.5% respectively.
3. FreeIReduced Price Lunch
The number of students eligible for free or reduced price lunch is the key determinant on
the level of assistance a school may receive from the Federal Title IIMigrant Program.
The Title 1 program administers Federal funds to school districts for high quality
supplemental instruction and support services for educationally disadvantaged children
and youth. There are two Title 1 programs, the Schoolwide Program and the Targeted
Assistance Program. Schools may be eligible for the Schoolwide program if 50% or
more of the student body is eligible for free or reduced price lunch and the administration
opts for the program. Targeted Assistance Programs are available to schools that do not
qualify for the Schoolwide Program or opt out of the program, and only those students
who are eligible for free or reduced lunch are served under Title I. 12
At the elementary school level, three of the ten elementary schools reported that over
50% of their students received free or reduced-price lunches. According to Title 1 in
Florida Schools, the three Monroe County schools are served under the Targeted
Assistance Program. The three elementary schools which ranked highest in this category
12 Florida Department of Education, Equity, Safety and School Support, Title VMigrant Programs, 2002.
1-29
were Glynn Archer Elementary (33040) at 60.6%, Gerald Adams Elementary (33040) at
59.9% and Stanley Switlik Elementary (33050) at 54.9%. The percentage for the seven
remaining schools ranged from 3.8 to 44.3%.
Among the middle schools, Marathon High School (33050) had the highest percentage of
students on free/reduced price lunch at 44.0%, followed by Horace O'Bryant Middle
School (33040) at 42.1 %. The remaining three schools reported percentages between
21.9 and 37.4%.
D. FINDINGS
Based on-- the most widely accepted data as compiled by CACI Marketing System for
2001, the 13 zip code area comprising the Monroe County Community Health Initiative
has an estimated 78,907 residents. The population within the 3 regions is comprised of
the Upper Keys (zip codes 33036, 33037 and 33070) with a population of2l,858 (27.7%
of the County's population); the Middle Keys (zip codes, 33001, 33050-33052) with a
population of 11,837 (15.0% of the County's population); and the Lower Keys (zip codes
33040-33045) with a population of 45,212 (57.3% of the County's population). This
section describes the socio-demographics of the area and some of the major findings as
follows:
~ Highest population concentrations are in: Key West (33040) at 33,890 and Key Largo
(33037) at 12,970 residents.
~ It is estimated that by year 2006, the area's population will decrease by 2.8%.
~ Monroe County's population is divided nearly equally with regard to gender, 53.3%
of the population was male in 2001.
~ Approximately 90.7% of all residents in Monroe County are White and 15.8% are of
Hispanic origin. Only 4.8% of the population in Monroe County is Black and 0.9% is
of Asian descent.
~ In terms of the age breakdown of area residents, the largest percentage was comprised
of individuals between 45 to 64 years old (31.6%), closely followed by people
1-30
between the ages of 25 to 44 years old (30.6%). These percentages were higher than
the State as a whole.
~ The highest median household income in Monroe County ($57,372) was reported in
Sugarloaf Shores (33044); the highest per capita income was found in Islamorada
(33036) reporting at $34,671.
~ The lowest income areas were in the Lower Keys. For households with an average
income ofless than $15,000 in 2001, the highest rates were experienced in Key West
(33040) at 14.8% and Key Largo (33037) at 11.8%. The percentage of low income
households for the County as whole, however, was substantially lower than the
State's rate (12.0% vs. 17.6%, a 46.7% difference).
~ The average household size for Monroe County was 2.23; 10.3% lower than the
State's average household size at 2.46.
~ The homeless population has been estimated at 2,151 countywide; 71.1 % are male,
and 268 are children. A large portion of the homeless reside in the Lower Keys.
~ Based on the data provided by government assistance programs, there are several
geographic areas within Monroe County with high numbers and rates of T ANF and
Medicaid recipients. Some of these areas are Marathon (33050), Key West (33040)
and Key Largo (33037).
~ As of December 2001, 1,680 children were enrolled in Florida's KidCare program in
Monroe County. Based on monthly enrollment reports, Healthy Kids, MediKids and
CMS have each experienced steady increases in enrollment throughout 2001.
~ More than half (52.7%) of all child abuse cases investigated in Monroe County in
2001 resulted in verified child abuse cases. The Middle Keys had the highest rate for
reports of child abuse at 40.21 per 1,000 children under age 18. The highest rates of
verified child abuse occurred in Big Pine Key (33043) and Key West (33040).
~ Juvenile arrest data indicate that the Middle Keys had the highest incidence of
juvenile charges and arrests than any Florida Keys region; however, the offenses
tended to be dominated by misdemeanor crimes. The single community with the
highest rates was Big Pine Key (33043) with a 10.5% charge rate and a 6.4% arrest
rate, the largest share of which were for felonies.
1-31
~ According to the Florida Department of Education 2001-2002 School Indicators
Report, there are several elementary, middle and senior high schools that show high
rates of need, based on the review of various indicators. Some of the schools with the
highest rates are often located in relatively low-income areas, including schools
located in Key West and Marathon. The 33040 zip code in Key West has five of the
ten elementary schools, one of the five middle schools and one of the three high
schools. Glynn Archer Elementary (Key West - 33040) ranks first among all Monroe
County schools for students receiving free or reduced price lunches at 60.6%. Coral
Shores High School (Tavernier - 33070) had the lowest rate of limited English
proficiency among all County high schools. Districtwide, Monroe County elementary
and middle schools each experienced a greater stability rate within the student
population than Florida schools overalL Countywide, Monroe County high schools
had slightly lower stability rates than Florida schools overall (90.1 % vs. 91.8%).
1-32
ATTACHMENTS
1-1: Monroe County Population Change by Zip Code
1-2: Monroe County Population by Gender
1-3: Monroe County White Population Change by Zip Code
1-4: Monroe County Black Population Change by Zip Code
1-5: Monroe County Hispanic Population Change by Zip Code
1-6: Monroe County Asian Population Change by Zip Code
1-7: Monroe County Health Insurance Purchase Potential Index
1-8: Monroe County Average Household Size by Zip Code
1-9: Monroe County Medicaid Recipients by Age, Zip Code
1-10: Monroe County KidCare Enrollment by Program, Month, and Zip Code, 2001
1-11 Monroe County 2001 Juvenile Charges by Zip Code
1-12: Monroe County 2001 Juvenile Arrests by Zip Code
1-13: Monroe County 2000-2001 School Indicators Report
Maps:
1-1 : Monroe County 2001 Population by Zip Code
1-2: Monroe County 1999 Percent Non-Elderly (under 65 years of age)
Uninsured by Zip Code
1-33
Attachment 1-1
Monroe County
Population Change by Zip Code and Florida Keys Region
1980 to 1990 Census and 2001 Census to 2006 Projection
1980 1990 Percent 2001 2006 Percent
Zip Code Census Census Change Estimate Projection Change
Upper Keys
33036 2,507 3,762 50.1% 3,438 3,243 -5.7%
33037 8,579 12,842 49.7% 12,970 12,718 -1.9%
33070 3,627 5,442 50.0% 5,450 5,175 -5.0%
Subtotal 14.7/3 22,046 49.8% 21,858 21,136 -3.3%
Middle Keys
33001 N/A N/A N/A 535 507 -5.2%
33050 10,221 12,790 25.1% 11,302 10,629 -6.0%
33051 N/A N/A N/A N/A N/A N/A
33052 N/A N/A N/A N/A N/A N/A
Subtotal .. 10,221 12.790 25.1% 1l.837 ll,136 -5.9%
Lower Keys
33040 30,901 32,976 6.7% 33,890 32,875 -3,0%
33041 N/A N/A N/A N/A N/A N/A
33042 3,940 5,226 32.6% 6,029 6,146 1.9%
33043 3,233 4,675 44.6% 5,211 5,363 2.9%
33044 N/A N/A N/A 82 81 -1.2%
33045 N/A N/A N/A N/A N/A N/A
Subtotal 38,074 42,877 12.6% 45,212 44,465 -1.7%
Monroe County 63,188 78,024 23.5% 78,907 76,736 -2.8%
Florida 9,746,961 12,937,926 32.7% 16,349,220 17,895,689 9.5%
200112006 Data Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRI Business Information Solutions.
1980 Data Source: Sourcebook America, 1998, Edition, ESRI Business Information Solutions.
1-34
Attachment 1-2
Monroe County Population by Gender and Zip Code, 20{H
2001
Population Percent Male Male Percent Female Female
Upper Keys
33036 3,438 54.9 1,887 45.1 1,551
33037 12,970 51.9 6,731 48.1 6,239
33070 5,450 51.0 2,780 49.0 2,671
Subtotal 21.858 52.1 11.398 47.9 10,460
Middle Keys
33001 535 52.5 281 47,5 254
33050 11,302 52.2 5,900 47.8 5,402
33051 included in zip code 33050
33052 included in zip code 33050
Subtotal 11,837 52.2 6.181 47,8 5.656
Lower Keys
33040 33,890 54.7 18,538 45.3 15,352
33041 included in zip code 33040
33042 6,029 52.6 3,171 47.4 2,858
33043 5,211 52.5 2,736 47.5 2,475
33044 82 50.0 41 50.0 41
33045 included in zip code 33040
Subtotal 45,212 54.2 24,486 45.8 20,726
Monroe County 78,907 53.3 42,057 46.7 36,850
Florida 16,349,220 48.8 7,978,419 51.2 8,370,801
Source: Sourcebook America, 2001 Edition, ESRl Business Information Solutions.
1-35
Attachment 1-3
Monroe County
\Vhite Population Change by Zip Code and Florida Keys Region
t 990 and t 997 to 2000 Census
1990 2000 Percent 1997 Percent
Zip Code 2000
Change Change
Upper Keys
33036 3,738 3,402 -9.0% 4,222 3.402 -19.4%
33037 12,346 12,360 0.1% 13,575 12,360 -9.0%
33070 5,315 5,335 0.4% 5,704 5,335 -6.5%
Subtotal 21.399 21.097 -1.4% 23.501 21.097 -10.2%
Middle Keys
33001 N/A NA N/A NA NA NA
33050 11,897 11,082 -6.9% 10.870 11,082 2.0%
33051 N/A N/A N/A N/A N/A N/A
33052 N/A N/A N/A N/A N/A N/A
Subtotal 11.897 11.082 -6.9% 10.870 11.082 2.0%
Lower Keys
33040 28,431 29,312 3.1% 27,342 29,312 7.2%
33041 N/A N/A N/A N/A N/A N/A
33042 5,153 5,753 11.6% 6,240 5,753 -7.8%
33043 4,588 4,904 6.9% 4,561 4,904 7.5%
33044 N/A NA N/A NA NA NA
33045 N/A N/A N/A N/A N/A N/A
Subtotal 38.172 39.969 4,7% 38.143 39.969 4.8%
Monroe County 71,468 72,148 1.0% 72,514 72,148 -0.5%
Florida 10,751,417 12,466,255 15.9% 11,824,703 12,466,255 5.4%
2000 Data Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRI Business Information Solutions.
1997 Data Source: Sourcebook America, 1998, Edition, ESRI Business Information Solutions.
Data for Zip Codes 33151, 33152 and 3300 I are included in Zip Code 33050
Data for Zip Codes 33041, 33044 and 33045 are included in Zip Code 33040
1-36
Attachment 1-4
"()Uroe County
Black Population Change hy Zip Code and Florida Ke~s Region
1990 and 1997 to ZOOO Census
1990 2000 Percent 1997 2000 Percent
Zip Code Change Change
Upper Keys
33036 30 7 -76.7% 43 7 -83.7%
33037 307 248 -19.2% 412 248 -39.8%
33070 44 39 -11.4% 53 39 -26.4%
Subtotal 381 294 -22.8% 508 294 -42.1%
Middle Keys
33001 N/A NA N/A NA NA NA
33050 640 485 -24.2% 652 485 -25.6%
33051 N/A N/A N/A N/A N/A N/A
33052 N/A N/A N/A N/A N/A N/A
Subtotal 640 485 -24.2% 652 485 -25.6%
Lower Keys
33040 3,122 2,875 -7.9% 3,817 2,875 -24.7%
33041 N/A N/A N/A N/A N/A N/A
33042 26 66 153.8% 38 66 73.7%
33043 37 57 54.1% 47 57 21.3%
33044 N/A NA N/A NA NA NA
33045 N/A N/A N/A N/A N/A N/A
Subtotal 3,185 2,998 -5.9% 3.902 2.998 -23.2%
Monroe County 4,206 3,777 -10.2% 5,062 3,777 -25.4%
Florida 1,759,558 2,333,427 32.6% 2,165,911 2,333,427 7.7%
2000 Data Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRI Business Information Solutions.
1997 Data Source: Sourcebook America, 1998, Edition, ESRI Business Information Solutions.
Data for Zip Codes 33151, 33152 and 33001 are included in Zip Code 33050
Data for Zip Codes 33041, 33044 and 33045 are included in Zip Code 33040
1-37
Attachment 1-5
Monroe County
Hispanic Population Change by Zip Code and Florida Keys Region
1990 and 1997 to 2000 Census
1990 2000 Percent 1997 Percent
Zip Code 2000
Change Change
Upper Keys
33036 229 241 5.2% 377 241 -36.1%
33037 1,126 2,010 78.5% 1,777 2,010 13.1%
33070 561 647 15.3% 848 647 -23.7%
Subtotal 1,916 2,898 51.3% 3,002 2.898 -3.5%
Middle Keys
33001 N/A NA N/A NA NA NA
33050 1,202 2,161 79.8% 1,553 2,161 39.2%
33051 N/A N/A N/A N/A N/A N/A
33052 N/A N/A N/A N/A N/A N/A
Subtotal 1,202 2,1 61 79.8% 1,553 2,161 39.2%
Lower Keys
33040 5,949 6,786 14.1% 7,864 6,786 -13.7%
33041 N/A N/A N/A N/A N/A N/A
33042 251 366 45.8% 458 366 -20.1%
33043 210 346 64.8% 309 346 12.0%
33044 N/A NA N/A NA NA NA
33045 N/A N/A N/A N/A N/A N/A
Subtotal 6,410 7,498 17.0% 8,631 7,498 -13.1%
Monroe County 9,528 12,557 31.8% 13,186 12,557 -4.8%
Florida 1,578,427 2,685,040 70.1% 2,136,642 2,685,040 25.7%
2000 Data Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRI Business Information Solutions.
1997 Data Source: Sourcebook America, 1998, Edition, ESRI Business Information Solutions.
Data for Zip Codes 33151,33152 and 33001 are included in Zip Code33050
Data for Zip Codes 33041, 33044 and 33045 are included in Zip Code 33040
1-38
Attachment 1-6
Monroe County
Asian Population Change hy Zip Code and Florida Keys Region
1990 and 1997 to 2000 Census
1990 2000 Percent 1997 2000 Percent
Zip Code Change Change
Upper Keys
33036 11 10 -9.1% 22 10 -54.5%
33037 38 52 36.8% 57 52 -8.8%
33070 22 44 100.0% 35 44 25.7%
Subtotal 7/ 106 49.3% /14 106 -7.0%
Middle Keys
33001 N/A NA N/A NA NA NA
33050 64 63 -1.6% 107 63 -41.1%
33051 N/A N/A N/A N/A N/A N/A
33052 N/A N/A N/A N/A N/A N/A
Subtotal 64 63 -1.6% 107 63 -41.1%
Lower Keys
33040 460 446 -3.0% 658 446 -32.2%
33041 N/A N/A N/A N/A N/A N/A
33042 16 42 162.5% 32 42 31.3%
33043 23 31 34.8% 37 31 -16.2%
33044 N/A NA N/A NA NA NA
33045 N/A N/A N/A N/A N/A N/A
Subtotal 499 519 4.0% 727 519 -28.6%
Monroe County 634 688 8.5% 948 688 -27.4%
Florida 155,255 271,700 75.0% 248,787 271,700 9.2%
2000 Data Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRI Business Information Solutions.
1997 Data Source: Sourcebook America, 1998, Edition, ESRI Business Information Solutions.
Data for Zip Codes 33151,33152 and 33001 are included in Zip Code 33050
Data for Zip Codes 33041,33044 and 33045 are included in Zip Code 33040
1-39
Attachment 1-7
,
\Ionroe County
Uealth Insurance Purchase Potentiallndex*
Healtb Insurance
Zip Code Purchase Potential Index
Upper Keys
33036 135
33037 112
33070 113
Subtotal Not Reported
Middle Keys
33001 108
33050 115
33051 included in Zip Code 33050
33052 included in Zi/J Code 33050
Subtotal Not Reported
Lower Keys
33040 93
33041 included in Ziv Code 33040
33042 133
33043 133
33044 113
33045 included in Zip Code 33040
Subtotal Not Reported
Monroe County 108
Florida 93
*IOO=Average Demand Nationally. An index of86 implies that demand is 14% lower
than the U.S. average; an index of 110 implies that demand is 10% higher. Calculated
by combining CACl's ACORN Consumer Classification System. based on population
and housing characteristics of an area, and the Survey of American Consumers,
conducted by Mediamark Research, Inc., a syndicated research firm specializing in
media and marketing information.
Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
1-40
Attachment 1-8
33036
33037
33070
Subtotal
Middle Keys
33001
33050
33051
33052
Subtotal
Lower Keys
33040
33041
33042
33043
33044
33045
Subtotal
Monroe County
Florida
Source: Sourcebook America, 2001 Edition,
ESRI Business Information Solutions,
1-41
1.96
2.23
2.28
Not Reported
2.17
2.15
included in Zi Code 33050
included in Zi Code 33050
Not Reported
2.29
included in Zi Code 33040
2.22
2.21
2.41
included in Zi Code 33040
Not Reported
2.23
2.46
Attachment 1-9
:\Ionroe County
Medicaid Recipients by Age,
Zip Code and Florida Keys Region, 2001
Aee 0-5 Al'e 6-11 Aee 12-14 Aee 15-17
Zip Code Population Number Percent Number Percent Number Percent Number Percent
Upper Keys
33036 3,438 53 1.5% 26 0,8% \5 0.4% 10 0,3%
33037 \2,970 352 2.7% 2\7 1.7% \0\ 0.8% 93 0.7%
33070 5,450 107 2.0% 96 1,8% 4\ 0.8% 6\ 1.1%
Subtotal 21.858 512 2.3% 339 1.6% 157 0.7% 164 0.8%
Middle Keys
3300\ 535 2 0.4% 3 0,6% 0 0.0% \ 0.2%
33050 \\,302 326 2.9% 210 1.9% 76 0,7% 67 0.6%
3305\- NtA NtA NtA NtA NtA NtA NtA NtA NtA
33052- NtA NtA NtA NtA NtA NtA NtA NtA NtA
Subtotal 11.837 328 2.8% 213 1,8% 76 0.6% 68 0.6%
Lower Keys .
33040 33,890 87\ 2,6% 553 1.6% 207 0.6% 163 0,5%
33041-- NtA NtA NtA NtA NtA NtA NtA NtA NtA
33042 6,029 80 \,3% 44 0.7% \0 0,2% \8 0.3%
33043 5,211 99 1.9% 56 1.1% 33 0,6% 29 0,6%
33044 82 \ 1.2% 0 0.0% 0 0,0% 0 0.0%
33045-- NtA NtA NtA NtA NtA NtA NtA NtA NtA
Subtotal 45,212 1.051 2,3% 653 1.4% 250 0,6% 2/0 0,5%
Monroe County 78.907 1.891 2.4% 1,205 1.5% 483 0.6% 442 0.6%
Florida 16,349,220 567,714 3.5% 425,731 2.6% 183,519 1.1% 152,358 0.9%
-Data for Zip Codes 3315\ and 33\52 are included in Zip Code 33050.
--Data for Zip Codes 3304\ and 33045 are included in Zip Code 33040,
Sources: Sourcebook America, 200\ Edition, ESRI Business Infonnation Solutions; and District XI Medicaid Office, 2002.
1-42
Attachment 1-9 (continued)
Monroe Count~
\Iedicaid Recipients by Age, Zip Code
and Florida Ke~ s Region, 200 I (continued)
ARe t8-20 Al!e 21-44 Age 45-(;4 Al!e 65+ Total
Zip Code Population Number Percent Number Percent Number Percent Number Percent Number Percent
Upper Keys
33036 3,438 4 0.1% 47 1.4% 25 0,7% 32 0.9"10 212 6.2%
33037 12.970 67 0.5% 345 2.7% 142 1.1% 173 1.3% 1,490 11.5%
33070 5,450 20 0.4% 119 2.2% 71 1.3% 84 1.5% 599 11.0%
Subtotal 21.858 91 0.4% 511 2.3% 238 1,1% 289 1.3% 2,301 10.5%
lfiddle Keys
33001 535 0 0,0% 5 0.9% 2 0.4% 5 0.9"10 18 3.4%
33050 11,302 61 0.5% 376 3.3% 209 1.8% 198 1.8% 1,523 13.5%
33051" N/A N1A N/A N/A N/A N/A N/A N/A N/A N/A N/A
33052" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
Subtotal 11,837 61 0,5% 381 3,2% 211 1.8% 203 1.7% 1.541 13.0%
Lower Keys
33040 33.890 166 0.5% 1,051 3.1% 583 1.7% 611 1.8% 4.205 12.4%
33041" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
33042 6.029 8 0.1% 76 1.3% 40 0.7% 37 0.6% 313 5.2%
33043 5.211 26 0,5% 105 2.0% 70 1.3% 45 0,9% 463 8.9%
33044 82 0 0,0% I 1.2% 0 0.0% 2 2.4% 4 4.9%
33045" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
Subtotal 45,212 200 0.4% 1.233 2.7% 693 1.5% 695 1.5% 4,985 11,0%
Jfonroe County 78.907 352 0.4% 2,125 2,7% 1,142 1.4% 1.187 /.5% 8,827 1l.2%
Florida 16.349,220 124,463 0.8% 601,098 3.7% 215,430 1.3% 327,557 2.0% 2.597,870 15.9%
'Data for Zip Codes 33151 and 33152 are Included In Zip Code 33050,
"Data for Zip Codes 33041 and 33045 an: included in Zip Code 33040.
Sources: Sourcebook America, 200 I Edition, ESRI Business lnfonnation Solutions; and District XI Medicaid Office. 2002.
1-43
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Attachment 1-11
ZIP Code
Upper Keys
33036 387 24 6.2% 5 1.3% 9 2.3% 10 2.6%
33037 2,418 120 5.0% 43 1.8% 57 2.4% 20 0.8%
33070 1,120 100 8.9% 47 4.2% 36 3.2% 17 1.5%
Subtotal 3.925 244 6.2% 95 2.4% 102 2.6iJ1J 47 1.2%
Middle Keys
33001 71 2 2.8% 0 0.0% 0 0.0% 2 2.8%
33050 1,869 124 6.6% 31 1.7% 67 3.6% 26 1.4%
33051 . 7 5 2 0
33052 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 1,940 133 6.9% 36 1.9% 69 3.6% 28 1.4%
Lower Keys
33040 5,961 279 4.7% 106 1.8% 133 2.2% 40 0.7%
33041 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33042 921 45 4.9% 13 1.4% 28 3.0% 4 0.4%
33043 855 90 10.5% 42 4.9% 36 4.2% 12 1.4%
33044 0 8 0.0% I 0.0% 3 0.0% 4 0.0%
33045 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 7.737 422 5.5% 162 2.1% 200 2.6% 60 0.8%
Monroe County 19,467 1176 6.0% 424 2.2% 542 2.8% 210 1.1%
.Population was not reported by Department of Juvenile Justice.
Source: Bureau of Data and Research, Florida Department of Juvenile Justice, 200 I.
"The data in "Charges" is the sum ofal! violations of the law recorded on JJIS in a specitic zipcode.
1-45
Attachment 1-12
ZIP Code
Upper Keys
33036 387 18 4.7% 5 1.3% 5 1.3% 8 2.1%
33037 2,418 80 3.3% 26 1.1% 39 1.6% 15 0.6%
33070 1,120 52 4.6% 19 1.7% 17 1.5% 16 1.4%
Subtotal 3.925 150 3.8% 50 1.3% 61 1.6% 39 1.0%
Middle Keys
33001 71 2 2.8% 0 0.0% 0 0.0% 2 2.8%
33050 1,869 92 4.9% 29 1.6% 46 2.5% 17 0.9%
33051 . 3 2 I . 0
33052 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 1,940 97 5.0% 31 1.6% 47 2.4% 19 1.0%
Lower Keys
33040 5,961 206 3.5~/O 86 1.4% 85 1.4% 35 0.6%
33041 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33042 921 34 3.7% II 1.2% 19 2.1% 4 0.4%
33043 855 55 6.4% 27 3.2% 16 1.9% 12 1.4%
33044 0 6 0.0% I 0.0% 2 0.0% 3 0.0%
33045 0 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 7,737 301 3.9% 125 1.6% 122 1.6% 54 0.7%
Monroe County 19,467 795 4.1% 287 1.5% 338 1.7% 170 0.9%
.Population was not reported by Department of Juvenile Justice.
Source: Bureau of Data and Research, Florida Department of Juvenile Justice, 200 I.
1-46
33037
33070
33070
Middle Keys
33050
Lower Keys
33040 549
33040 429
33040 50
33040 593
33040 368
33042 589
4,579
State Level Data 1,176,938
Source: Department of Education, Florida Schools Indicators Report, 2000-2001.
Attachment 1-13
Ke Lar 0 School
Island Montessori Charter School
Plantation Key School
95.5
92.2
98.0
97.5
91.8
93.3
94.8
93.7
14.0
13.5
2.0
7.1
4.4
2.5
7.4
9.9
Lunch
44.3
3.8
22.0
54.9
59.9
60.6
4.0
28.5
30.4
33.6
41.6
53.3
Lunch
37.4
21.9
44.0
94.3 7.6 42.1
95.6 1.3 28.0
94.4 5.2 36.6
93.6 5.2 45.7
Lower Keys
33040 Horace O'B ant Middle School 843
33042 Sugarloaf School 364
District Level Data 2,113
State Level Data 554,265
Source: Department of Education, Florida Schools Indicators Report, 2000-200 I.
Zip
Code
Upper Keys
33070
Middle Keys
33050
Lower Keys
33040
Coral Shores High School
Marathon High School
Key West High School
District Level Data
Slate Level Data
1,339
2,580
643,998
88.4
90.1
91.8
1-47
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8.3
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6.7
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II. HEALTH STATUS
A. LEADING CAUSES OF DEATH
The health of a population can be measured by reviewing the leading causes of death and
analyzing whether these deaths could have been prevented through early diagnosis and
intervention. In 2000, six of the top twelve causes of death in the United States, Florida
and Monroe County were chronic diseases, that is, diseases that persist for a long time
and that require long-term management. These include heart disease, cancer, stroke,
chronic obstructive pulmonary disease (COPD), diabetes mellitus and cirrhosis/chronic
liver disease.
Heart disease has been the leading cause of death since 1921 in the United States,
Florida, and Monroe County. The death rates for chronic obstructive pulmonary disease
and diabetes have risen, making them important conditions to track. The remaining
leading causes of death are generally divided into infectious diseases
(pneumonia/influenza and HIV / AIDS among others) and "social" diseases such as
unintentional injuries, motor vehicle crashes, suicide and homicide.
In 2000, the five-year averages (1996-2000) of Monroe County resident deaths, In
ranking order were attributed to the following:
1. Cancer
2. Heart disease
3. Unintentional Injuries
4. Stroke (Cerebrovascular Disease)
5. Chronic Obstructive Pulmonary Disease (COPD)
6. Chronic Liver Disease/Cirrhosis
7. Diabetes
8. Pneumonia/Influenza
9. Suicide
10. HIV/AIDS
II-I
Based on deaths and death rates per 100,000 populations by zip code for calendar years
1996-2000, the top 10 leading causes of death for Monroe County varied from the State's
ranking order. The order for the State was:
1. Heart Disease
2. Cancer
3. Stroke (Cerebrovascular Disease)
4. COPD
5. Unintentional Injuries
6. Diabetes
7. Influenza and Pneumonia
8. Suicide
9. HIV/AIDS
10. Chronic Liver Disease/Cirrhosis
There are some data limitations which need to be considered when evaluating the leading
causes of death. Statistical health data are non-age-adjusted due to the collection format
of the sources. Health data are also collected by zip code and do not necessarily reflect
each corresponding neighborhood equally. Each zip code cited refers to the geographic
area as designated on the Monroe County Map prepared by the Health Council of South
Florida, Inc. Additionally, rates for Monroe County are likely to fluctuate between years
due to the effects of small numbers in rate calculations. Therefore, trends are best viewed
over multiple years for Monroe County.
1. Cancer
The leading cause of death in Monroe County is cancer. This is not consistent with other
regions, as heart disease is the leading cause of death in Florida and the United States.
Cancer was the second leading cause of death in Monroe County in 1999. The seven
most prevalent types of cancer, nationally, are breast, colorectal, endometrial, lung, oral
and esophageal, prostate and stomach. It is estimated that 50% or more of cancer
incidences can be prevented through smoking cessation and changing dietary habits.
II-2
In Monroe County, cancer was the leading cause of death in the area with a five-year
death rate of 228.83 per 100,000 population. This death rate was lower than that for
Florida during that period. Florida's cancer death rate was 251.16. The highest rate
occurred in the Middle Keys, where Marathon's (33050) death rate was 262.68. The
Upper Keys had the next highest rate, 233.99. Located within the Upper Keys region,
Tavernier (33070) had the second highest death rate in the county at 250.12. The Lower
Keys' death rate for cancer (215.90) was the lowest of the three regions. (See Attachment
II-I).
2. Heart Disease
Heart Disease was the second leading cause of death in Monroe County as opposed to
Florida as a whole, where heart disease was the leading cause of death. Incidence of
heart disease in Monroe County may be directly related to lifestyle choices. High blood
pressure, elevated cholesterol levels, smoking, physical inactivity and obesity are all
preventable factors associated with premature death due to heart disease. During 1996-
2000, the Monroe County five-year death rate per 100,000 population for heart disease
was 199.61 per 100,000 population compared to a rate of 331.40 for Florida. The Middle
Keys had the highest death rate due to heart disease at 208.60, followed by the rate for
the Upper Keys which was only slightly 10wer, at 205.15. The rate of 193.85 for the
Lower Keys was lower than that of the county. The highest rates for individual zip codes
were in Tavernier (33070), Marathon (33050), Key Largo (33037) and Key West (33040)
with rates of213.91, 208.60, 203.51, and 201.13, respectively. (See Attachment II-2).
Although heart disease mostly affects individuals over 65 years old, it is noteworthy that
a few of the highest death rates were cited in areas which do not have the highest
concentration of residents over 65.
11-3
3. Unintentional Injuries
The overall five-year death rate per 100,000 due to unintentional injuries in Monroe
County was considerably higher than the State as a whole (55.72 versus 38.42). In fact,
all zip codes in Monroe County reported five-year death rates greater than the statewide
five-year death rate.. The highest rate corresponded to Marathon (33050) followed by
Summerland Key (33042) and Tavernier (33070) at 69.53, 68.93 and 65.82 respectively.
The remainder of the County reported five-year death rates ranging from 45.63 to 64.26.
There were a total of 225 unintentional injury deaths in Monroe County between 1996
and 2000 (see Attachment 11-3).
_.
4. Stroke (Cerebrovascular Disease)
Stroke, or cerebrovascular disease, was the fourth leading cause of death in both Monroe
County and the State. Monroe County's five-year rate for stroke related deaths was 45.82
per 100,000 population. The Middle Keys had the highest rate of deaths due to stroke.
The rate in that region, 71.08, was higher than those for Monroe County and Florida. The
Lower Keys had the next highest rate, 44.10, which is slightly 10wer than the rate for the
county, although the rate for Key West (33040) which is 10cated in the Lower Keys was
slightly higher than the county's at 46.79. Prevention strategies can include adoption of
healthy life styles associated with the prevention of heart disease. (See Attachment II-4).
5. Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COP D) is a condition comprised of two
separate but related diseases, chronic bronchitis and pulmonary emphysema. With
COPD, a person's airflow in and out of the lungs becomes progressively limited. Risk
factors include smoking, air pollution, and family history. Lung disease encompasses
several conditions specific to this organ, including cancer, chronic bronchitis,
emphysema, and asthma. Like heart disease and cancer, lifestyle factors such as cigarette
II-4
smoking and occupational hazards, such as working with asbestos, can increase the risk
of lung disease that, in turn, causes the majority of lung disease deaths.
Monroe County reported a 40.86 five-year death rate due to COPD which was lower than
the rate for the State as a whole at 55.01. The highest rate, 58.72, was reported in the
Middle Keys. The remaining regions had rates below that of the county as a whole;
although the areas of Marathon, Tavernier, Summerland Key and Big Pine Key (33050,
33070, 33042, and 33043) had rates above that of the county, ranging from 48.25 to
58.72. (See Attachment /1-5).
6. Chronic Liver Disease and Cirrhosis
Both chronic liver disease and cirrhosis are associated with excessIve alcohol
consumption. It is a frequent cause of death among heavy alcohol users. Chronic
hepatitis C infections are a major cause of chronic liver failure. Poisoning, hepatitis B
and pancreatitis can also cause chronic liver disease. Cirrhosis results in gradual loss of
liver function over many years.
Chronic liver disease and cirrhosis was ranked sixth as a leading cause of death in the
County and eleventh for Florida. In Monroe County, there were 94 deaths between 1996
and 2000 that resulted from chronic liver disease and cirrhosis. The overall death rate
due to Chronic Liver Disease/Cirrhosis in Monroe County for the same period was 23.28,
nearly twice that of the State at 12.79. The region with the highest death rate was the
Middle Keys, with a rate of27.81. The highest death rate occurred in Islamorada (33036)
with a rate of39.55, which is considerably higher than the rate for Monroe and over three
times the rate for Florida. (See Attachment 11-6).
7. Diabetes
Diabetes is the seventh leading cause of death in Florida and also ranks seventh in
Monroe County. It is a chronic metabolic disease in which the body does not produce or
properly use insulin, a hormone that is needed to convert sugar, starches, and other foods
11-5
into energy. Diabetes can lead to senous complications such as blindness, kidney
disease, nerve disease, amputations and/or heart disease, stroke and impotence. Patient
education is critical to reduce the risk for complications in order to gain knowledge about
the disease, learn and practice the skills necessary to better control glucose levels, and
obtain regular checkups from the patient's health care team.
For the period of 1996-2000, the five-year death rate due to diabetes in Monroe County
was 20.80 per 100,000 population compared to the State rate of27.l0, Death rates due to
diabetes were relatively consistent across the three regions, with rates ranging from 19.77
to 21.63. The lowest rate occurred in the Upper Keys and the highest rate in the Middle
Keys. The highest rate overall, 26.33 was in Tavernier (33070), and is higher compared
to all other zip codes, the County, and the State. (See Attachment 11-7).
8. Pneumonia/Influenza
Flu outbreaks typically occur during the winter months from late December through
March, leading to increased numbers of people with respiratory illness. The start, peak
period, duration and total health impact, such as hospitalizations and deaths, of the flu
season can vary considerably from year to year. Although influenza is not a reportable
condition in Florida, influenza activity is monitored throughout the state, with assistance
from the Centers for Disease Control, through a system of sentinel medical providers.
The network of Florida providers who have participated in flu surveillance include
pediatric and adult primary care, university health centers, and county health
departments.
The single most important preventive measure for individuals, especially those at high
risk for serious complications is vaccination. Pneumoccoccal pneumonia and influenza
are the most detrimental infectious diseases for the elderly population. Aggressive
immunization programs against both conditions can contribute to lower death rates,
particularly in the young elderly (ages 65-75).
II-6
The five-year (1996-2000) death rate per 100,000 population due to pneumonia/influenza
in Monroe County was 20.56, somewhat lower than that of the state at 24.30. The
highest rate among all three regions was 21.59 in the Lower Keys, followed by the Upper
Keys and the Middle Keys with rates of 19.77 and 18.54, respectively. At the zip code
level, the highest individual death rate due to pneumonia/influenza occurred in Big Pine
Key (33043). This area's death rate at 58.07 was over twice that of the State.
Tavernier's (33070) rate at 29.62 was also considerably higher than that of the County
and State. (See Attachment 11-8).
9. Suicide
The overall suicide death rate in Monroe County was higher than that of the State as a
whole with five-year rates of 19.81 and 14.00 per 100,000 population. The highest rate
among all three regions was 21.63 in the Middle Keys, followed by the Lower Keys and
the Upper Keys with rates of 19.75 and 18.95, respectively. The only zip code with a rate
that exceeded that of the Middle Keys was Tavernier (33070), with a suicide rate of
26.33. (See Attachment 11-9).
10. Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
(HIV / AIDS)
Though there is no cure for HIV/AIDS, it is now considered a chronic disease, influenced
by comprehensive care, disease management and new treatment alternatives. These
advances also place increasing demands on available treatment alternatives. Positive
outcomes in the different HIV/AIDS stages depend on the quality of primary care
provided by physicians with vast knowledge of HIV/AIDS and related conditions.
Primary care services offer continued monitoring of health status and essential drug
therapies. Lack of these services can result in HIV/AIDS related illnesses, reduced
quality care and premature death.
II-7
HIV / AIDS was the tenth leading cause of death for Monroe County residents at a rate of
16.84 deaths per 100,000 population. The rate of deaths due to HIV/AIDS for the State is
slightly lower at 13.18. The Lower Keys had the highest rate of deaths due to HIV / AIDS
with a rate of 27.56. The highest overall rate was in Key West (33040) with a rate of
34.64 deaths per 100,000 population. This rate is more than twice than of the County.
Death rates for the Upper and Middle Keys were very comparable ranging from 4.12 to
4.64, respectively. These rates are considerably lower than the rates for the Lower Keys,
the County and the State. (See Attachment II-I 0).
In summary, in the Middle Keys, Marathon (33050) exceeded the death rates of the State
in six of the ten leading causes of death. In the Upper Keys, Tavernier exceeded the State
in five ofthe ten causes of death. In the Lower Keys, Big Pine Key (33043) exceeded the
State in four of the ten leading causes of death. There were no zip codes in Monroe
County which exceeded the State's death rates for heart disease or diabetes. (See Table
II-A).
II-8
Table II-A
i\lonroe County
Analysis of the 10 Leading Causes of Death, 1996-2000
Five-Year Death Rate Per 100,000 Ponuladon
Monroe State of Monroe County Zip Codes and Regions
Cause of Death County Florida With Rates Exceedln~ Total State Rate
Cancer 228.8 251.2 33050
Middle Keys
Heart Disease 199.6 331.4 None
UnintentionaIlnjuries 55.7 38.4 33036.33037,33040.33043
33050, 33070
Upper, Middle and Lower Keys
Stroke (Cerebrovascular Disease) 45.8 67.0 33050
Middle Keys
Chronic Obstructive Pulmonary Disease 40.9 55.0 33050.33070
Middle Keys
Chronic Liver Disease/Cirrhosis 23.3 12.8 33036,33037.33040,33042.33043
33050, 33070
Upper, Middle and Lower Keys
Diabetes 20.8 27.1 None
Influenza and Pneumonia 20.6 24.3 33043,33070
Suicide 19.8 14.0 33037,33040.33042,33043
33050, 33070
Upper Middle and Lower Keys
HlV/AlDS 16.84 13.18 33040
Lower Keys
Soun:e: Flonda Department of Health, Ollice of VItal StatIStiCS, 2002.
II-9
B. COMMUNICABLE DISEASES
1. Human Immunodeficiency Virusl Acquired Immunodeficiency Syndrome
(HIV I AIDS)
Acquired Immunodeficiency Syndrome (AIDS) is rapidly becoming the most devastating
infectious disease occurring in modem times. On the basis of current data and since the
initial reporting of the disease in 1981, over half a million Americans have been
diagnosed with AIDS and more than a third of a million have died from the disease.
AIDS occurs when the HIV virus has damaged an individual's immune system, leaving
the person vulnerable to opportunistic infections caused by bacteria, protozoa, fungi and a
number of other serious and life-threatening viruses and malignancies. The toll in human
lives and the financial burden of AIDS makes health planning and policy imperative for
preventing the continued spread of this epidemic.
HN/AIDS disproportionately affects District XI (Miami-Dade and Monroe Counties)
compared to the State of Florida. Monroe County, in particular, has been hit hard by the
epidemic. In 2000, Monroe County's AIDS cases rate was 62.82 per 100,000 population,
while the state's rate was 31.35 per 100,000. The rates in 2000, for both Monroe and
Florida have decreased overall since 1996, although it should be noted that Monroe
County experienced a significant decrease in the rate of AIDS cases from 1996 to 1997.
(See Graph II-I). Based on HN/AIDS data from the Florida Department of Health's
Bureau of HI VI AIDS, there were 151 total reported cases of HI V between 1997 and 2001
and 242 reported cases of AIDS in Monroe County during the same period. (See
Attachment 11-11).
II-I0
Graph II-I:
AIDS Cases per 100,000 Population for
Monroe County and Florida, 1996-2000
__ Monroe __ Florida
180
150
=
=
=. 120
=
~ 85.88
.. 90 71.74 71.04
.. 62.82
co.
~ 60
..
.. 49.86
30 39.84 35.99 31.35
34.93
0
1996 1997 1998 1999 2000
Year
Between 1997-2001, a total of 134 (89%) HIV cases were reported among males in
Monroe County. The total number of AIDS cases reported between 1981 and 2001
amongst males were 1,146 which accounted for 95.1% of the total (1,205) reported AIDS
cases for the County. In general, homosexual males comprise the majority of the
HIV/AIDS cases in Monroe County (see Tables II-B and II-C), although cases in
heterosexual women are rising.
The number ofb6th HIV and AIDS is significantly lower for females; during 1997-2001,
the number of reported cases of HIV and AIDS among females was 17 (11.2%) and 59
(4.9%) of the cumulative totals respectively. (See Tables II-B and II-C).
Table I1-B
Repol.ted ('ases of UI\' h~ Exposure ('ate:.:or~, 191)7-21101
~ XPHSUI'l' Call'~Hr~ 'Jail's " " rl'III.lks " " I Hlal U~l
Men who have sex with men 95 70.9 0 0 95 63.0
Injecting drug use 5 3.7 4 23.5 9 6.0
Men who have sex with men and injecl drugs 6 4.5 0 0.0 6 4.0
Hemophelialcoagulation disorder 0 0.0 0 0.0 0 0.0
Helerosexual contact 4 3.0 3 17.6 7 4.6
Receipt of blood, components or tissue 0 0.0 0 0.0 0 0.0
Risk not reported or identified 24 17.9 10 58.8 34 22.5
Total 134 100.0 17 100.0 151 100.0
Source: Florida Department of Health. Bureau ofHIV/AIDS. 2002.
11-11
Table II-C
Reported Cases of ,\IDS by Exposure Category, 1981-2001
Exposure ('ale::or~ 'I a les l~ll Females 0;;, Tolal 'y"
Men who have sex with men 942 82.2 0 0 942 78.2
Injecting drug use 52 4.5 16 27.1 68 5.6
Men who have sex with men and inject drugs 72 6.3 0 0.0 72 6.0
Hemophelia/coagulation disorder 0 0.0 0 0.0 0 0.0
Heterosexual contacl 16 1.4 20 33.9 36 3.0
Receipt of blood, components or tissue 0 0.0 0 0.0 0 0.0
Risk not reported or identified 64 5.6 23 39.0 87 7.2
Total 1,146 100 59 100.0 1,205 100.0
Source: Florida Department of Health. Bureau ofHIV/AIDS. 2002,
In relation to age, the 30-39 age group had the highest percentage of persons with HIV as
well as the highest percentage of persons living with AIDS, at 51.0% and 47.1 %,
respectively. The number of pediatric (under age 12) cases of HI V was too small to be
reported. Although, it should be noted that there may be existing pediatric HIV cases in
Monroe County that may not have been reported to the Bureau ofHIV/AIDS. Cases of
HIV have been reported since 1997; if a child tested positive for HIV prior to 1997 and
has not been tested since, then that child's case of HIV would not have been reported.
Those cases may be captured by the Bureau when one of three things occurs: the
reporting requirements change; the child receives another HIV test; or the child develops
AIDS. The non-Hispanic White population had the greatest percentage rate of HIV and
AIDS compared to other racial and ethnic groups, with 84.1 % and 85.5%, respectively.
Hispanics ranked second in number and percentage of AIDS cases, while the non-
Hispanic Black population had the second highest incidence of HIV infection. (See
Tables II-D and II-E).
II-12
Table II-D
Rl'!>orled Cases of 111\ h~ \:,:e. l{aee/Hhllil:it~. 1997-211(11
\~l' Ca,cs " Raccl Ethnkit\ ( a'c' 0
," '"
<12 . N/A Non-Hispanic White 127 84.1
13-29 24 15.9 Non-Hispanic Black 14 9.3
20-29 0 0.0 Hispanic 10 6.6
30-39 77 51.0 Total 151 100.0
40-49 34 22.5
50-59 13 8.6
60+ 3 2.0
Total 151 100.0
'Florida Department of Health policy suppresses aggregate data
wherein there are less than three cases.
Table II-E
Reported Cases of AIDS h~ \gr. RaCl'/Hhllicit~ . 19SI-ZIIOI
\gl' C a,c' " " Racl'/~ thnicil\ ( aws ."
,"
<12 4 0.3 Non-Hispanic White 1029 85.5
13-19 3 0.2 Non-Hispanic Black 78 6.5
20-29 147 12.2 Hispanic 91 7.6
30-39 568 47.1 AsianlPacific Islander 5 0.4
40-49 348 28.9 Unknown . N/A
50-59 103 8.5 Total 1203 100.0
60-64 23 1.9
65+ 9 0.7
Total 1205 100.0
Source: Florida Department of Health, Bureau of H1V/AIDS. 2002,
2. Tuberculosis (TB)
Tuberculosis (TB) is an infectious air-borne disease that primarily affects the lungs but
can also affect almost any organ in the body. Among the many public health concerns of
the state and District XI, (Miami-Dade and Monroe Counties) the prevention and
treatment of tuberculosis still proves to be of specific interest because, although overall
rates are down, there are increased cases of drug-resistant TB. Concomitantly, there is an
underutilization of Directly Observed Therapy (DOT), a treatment modality based on
intensive case management that assures patient compliance with treatment protocols by
the direct observation of the ingestion of medication. Although this sounds simple, it
becomes labor-intensive, particularly in homeless shelters, correctional facilities, and
other sites where there are higher incidence rates of TB. In spite of the overall reduction
of the number of new cases, those that exist also often involve psychosocial problems
such as mental illness, homelessness, substance abuse and unemployment. Treatment for
II-13
TB often takes a year or more, making tracking difficult among transient populations.
Also, TB patients co-infected with HIV require complex medical management activities
that involve intensive monitoring and care coordination among multiple providers.
In Florida, and South Florida in particular, there are many predisposing conditions for
TB, including a high number of immigrants and residents from Third Wodd countries
where TB is endemic. Cultural and language barriers (as well as immigration status) may
prevent foreign-born persons from seeking care or following the advice of medical
providers. However, the number of reported cases was not high for Monroe County,
which only cited 27 cases in comparison to 6,301 for the State as a who Ie during 1997-
2001. The highest number of cases was reported in Key West (33040) which accounted
for 59.3% of the total number of cases. Within the Upper Keys, five TB cases were
reported. However, as stated in the Data Limitations section, Florida Department of
Health policy states that data for zip codes wherein there are less than 3 cases, the
aggregate number must always be suppressed. (See Table II-F).
II-14
Table II-F
'(onroe Count~
Reported Cases of Tuherculosis
h~ Zip Code. 1997-2001
Upper Keys
33036 *
33037 *
33070 *
Subtotal 5
Middle Keys
33001 0
33050 6
33051 0
33052 0
Subtotal 6
Lower Keys
33040 16
33041 0
33042 0
33043 0
33044 0
33045 0
Subtotal 16
Monroe County Total 27
Florida 6301
*Florida Department of Health policy states that data for zip
codes with <3 cases must always be suppressed.
Source: Florida Department of Health, Bureau of Tuberculosis,
2001.
3. Sexually Transmitted Diseases (STDs)
Sexually transmitted diseases (STDs) are infectious diseases spread almost exclusively
from one person to another by sexual contact, either heterosexual or homosexual. The
five classic venereal diseases include syphilis, gonorrhea, chancroid, lymphogranuloma
venereum and granuloma inguinale, but there are others, including HIV/AIDS, genital
herpes infection, chlamydia, trichomoniasis, candidiadis, genital or venereal warts, and
Gardnerella vaginalis. STDs may result in complications that can cause or contribute to
a person's death. STDs may also have serious multiple health problems, including pelvic
inflammatory disease, sterility, cancer, birth defects, miscarriages and general systemic
complications.
II-IS
~ Chlamydia
Chlamydia infection, simply referred to as chlamydia, is a STD that often presents no
symptoms until irreversible damage has occurred. Often referred to as the "other silent
epidemic," chlamydia is now the most common STD among all groups of heterosexual
Americans. Chlamydia is one of the main causes of pelvic inflammatory disease and
infertility, and it may be difficult to detect and control because it is frequently
asymptomatic. In 1999, a total of 659,441 chlamydia cases were detected in the United
States (254.1 per 100,000 population). I
In 2001, Monroe County reported a total of 59 cases of Chlamydia. The highest rate in
Monroe County was located in zip code 33040 (Key West) followed by zip code 33050
(Marathon) with 40 and 10 reported cases, respectively. (See Table II-G).
Table II-G
Ih'porll'd Cases of ( hlam~ dia. \Iollrue COUllt~. 1995-2on I
1l)l)X 1'IlJ') 2111111 211111 10t.lI
UDon K_
33036 0 0 . 0 .
33037 9 6 5 22
33070 5 * 5 3 15
Sublolal 14 8 II 5 38
MU/d1e Keys
33050 I 51 91 51 1011 29
Sublolal I 51 91 51 1011 29
Lower Kt!1!s
33040 32 25 10 40 107
33042 . . . 3 8
33043 0 * * 4
33045 . 0 0 C 2
Sublolal 35 29 13 44 121
Monroe County Total 54 46 29 S9 188
*Florida Department of Health policy states that data for zip
codes with <3 cases must always be suppressed.
Source: Florida Department of Health, Bureau of Sexually Transmitted Diseases,
2001.
I Sexually Transmitted Disease Surveillance 1999, Division of STD Prevention, Centers for Disease
Control and Prevention, September 2000.
II-16
~ Gonorrhea
Gonorrhea is a curable STD caused by the bacterium Neisseria gonorrhoeae. These
bacteria can infect the genital tract, the mouth, and the rectum. In women, the opening to
the uterus, the cervix, is the first place of infection. The disease however can spread into
the uterus and fallopian tubes, resulting in pelvic inflammatory disease (PID). PID
affects more than 1 million women in this country every year and can cause infertility in
as many as 10 percent of infected women and tubal (ectopic) pregnancy.
In 2000, 358,995 cases of gonorrhea were reported to the U.S. Centers for Disease
Control and Prevention (CDC). In the United States, approximately 75% of all reported
cases of gonorrhea are found in younger persons aged 15 to 29 years. The highest rates of
infection are usually found in 15- to 19-year old women and 20- to 24-year-old men.
Health economists estimate that the annual cost of gonorrhea and its complications is
close to $1.1 billion.
Gonorrhea is spread during sexual intercourse. Infected women can also pass gonorrhea
to their newborn infants during delivery, causing eye infections in their babies. This
complication is rare because newborn babies receive eye medicine to prevent infection.
When the infection occurs in the genital tract, mouth, or rectum of a child, it is due most
commonly to sexual abuse. In 2001, the total number of cases in Monroe County for
gonorrhea was 27, with 25 of these cases occurring in Key West (33040). (See Table 11-
H).
II-17
Table II-H
Reported Cases of Gonorrhea, Monroe County, 1998-2001
199X 1999 2000 2001 Total
Upper Keys
33037 0 * 0 0 .
33070 * 0 * 0 4
Subtotal * . . 0 6
Middle Keys
33050 0 61 01 *11 8
Subtotal 0 6 01 *11 8
Lower Keys
33040 9 12 8 25 54
Subotal 9 12 8 25 54
Monroe County Total 11 20 10 27 68
*Florida Department of Health policy states that data for zip
codes with <3 cases must always be suppressed.
Source: Florida Department of Health, Bureau of Sexually Transmitted Diseases,
2001.
~ Syphilis
Syphilis is a complex STn caused by the bacterium Treponema pallidum. It has often
been called the great imitator because so many of the signs and symptoms are
indistinguishable from those of other diseases. The time between contracting the
bacterium and the start of the first symptom can range from 10 to 90 days (average 21
days). Primary stage syphilis is marked by the appearance of a single sore (called a
chancre). The second stage starts when one or more areas of the skin break into a rash.
The latent (hidden) stage of syphilis begins when the secondary symptoms disappear. If
the infected person has not received treatment, he/she still has syphilis even though there
are no signs or symptoms. According to the CDC, in the United States, 35,628 cases of
syphilis were detected in 1999, including 6,657 cases of primary and secondary syphilis,
11,677 cases of early latent syphilis, and 556 cases of congenital syphilis in newborns.
The CDC also report that national primary and secondary syphilis rates for 1990 through
1999 declined by 88% (20.3 to 2.5 per 100,000 population), bringing the national rate to
II-18
its lowest level since reporting began in 1941.2 The total number of early latent syphilis
and infectious syphilis cases in Monroe County were five and four, respectively. (See
Table /I-I).
Table II-I
Lower Ke s
U erKes .
To~l 5
*Florida Department of Health policy s~tes that da~ for zip
codes with <3 cases must always be suppressed.
Source: Florida Department of Health, Bureau of Sexually
Transmitted Diseases 2001.
C. MATERNAL AND CHILD HEALTH
Adequate prenatal care, coupled with prevention and early intervention services during
the prenatal, infant and early childhood periods, results in healthier, more capable and
more productive residents. Good prenatal, infant and early childhood care yields
tremendous savings to society due to the reduced need to access costly medical and social
services. Prenatal and perinatal care improve birth outcomes and reduce the number of
children who die prematurely or suffer from conditions such as developmental delay,
cerebral palsy, chronic respiratory disjunction, meningitis and other problems. To invest
in mothers and children today is to reap gains in medical, educational and social service
costs, to increase the community's overall quality of life, and to ultimately yield higher
resident productivity in the future.
2 Ibid.
II-19
1. Live Births
In 2000, there were 779 resident live births to women ages 15-44 in Monroe County. The
birth rate of women of childbearing age has fluctuated moderately in Monroe County
over the past five years. The birth rate was highest in 1996, at 50.93 live births per 1,000
women (age 15-44). The 10west birth rate (39.84) occurred in 1998, when there were
only 688 live births. (See Graph 11-2).
During the period of 1996 to 2000, there were 3,904 resident live births in Monroe
County; nearly half of alllive births (46.6%) occurred in Key West (33040). The next
highest percentage of resident live births was in Key Largo (33037) followed by
Marathon (33050) with 16.1 % and 12.5%, respectively. Also during this period, the
highest percentage (67.7%) of all live births was to Non-Hispanic White mothers;
followed by births to Hispanic mothers at 22.1 %. (See Attachments II-I2 and 11-13).
Graph II-2
Birth Rate per 1,000 Women Ages 15-44,
Monroe County and Florida. 1996-2000
-+- Monroe .....a-.-- Floridl
80
6S.41 6S.S4 6S.17 6S.12 67.01
60
a 4~84 39.84 4S.71 45.09
~ 'u."
~. 40
:i
10
0
1996 1997 1998 1999 1000
Year
Source: Florida Department of Health, Office of Vital
Statistics, 2002.
2. Prenatal Care and Low Birth Weight
Low birth weight babies are those infants weighing less than 2,500 grams. According to
the cnc, expectant mothers with no prenatal care are three times as likely to have a low
birth weight baby. Low birth weight is often classified as a contributing factor to infant
mortality. Furthermore, it is estimated that 20-30% of all low birth weight births are
II-20
attributable to smoking, underscoring the importance of prenatal care counseling on how
to avoid unhealthy practices during pregnancy.
In Monroe County, only a small number of women do not begin prenatal care during the
first trimester. Of the 3,904 resident live births from 1996 to 2000, only 382 (or 9.8%) of
mothers in Monroe County received late prenatal care or none at all. Prenatal care is
considered 'late' when begun during the second or third trimester. The highest
percentage (13.6%) of mothers receiving late or no prenatal care was in the Middle Keys.
The Lower Keys had the same percentage as the County for late or no prenatal care. The
Upper Keys had a 10wer percentage (7.8%) than the County, although there are no
obstetric services available in that region. (See Attachment //-14).
There were 223 low birth weight births from 1996 to 2000; representing 5.7% of alllive
births during this period. Births to Non-Hispanic White mothers had the highest
percentage of low birth weight births with 136 (or 3.5%) of all babies being less than
2,500 grams. The Middle Keys had the highest percentage of low birth weight births at
6.3%. The Upper Keys had the second highest percentage, of 10w birth weight babies at
5.9%. Big Pine Key (33043) reported the highest percentage of 10w birth weight births
compared to any other Monroe County zip code at 9.4%. (See Table //-J and Attachment
//-15).
II-21
Table II-J
Resident Lh e Births Less than 2,500 grams by Zip Code
and \Ialernal Race/Ethnicil~, \Iunrue Cuunt~, 1996-2000*
Total Non-Hispanic White Non-Hispanic Black Hispanic
Live Births Low Birth Wehtht Low Birth Weil!ht Low Birth Weil,ht Low Birth Weil!ht
1996-2000 1996 - 2000 I % LBW 1996 - 2000 I % LBW 1996 - 2000 I % LBW 1996 - 2000 %LBW
UDDer Kevs
33036 126 3 2.4% 3 2.4% 0 0.0% 0 0.0%
33037 629 41 6.5% 28 4.5% 8 1.3% 5 0.8%
33070 260 16 6.2% 9 3.5% I 0.4% 5 1.9%
Subtotal 1,015 60 5.9% 40 3.9% 9 0.9% 10 /.0%
Middk Kevs
33001 16 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33050 489 32 6.5% 17 3.5% 6 1.2% 8 1.6%
33051 18 I 5.6% 1 5.6% 0 0.0% 0 0.0%
33052 15 I 6.7% I 6.7% 0 0.0% 0 0.0%
Subtotal 538 34 6.3% 19 3.5% 6 /./% 8 /.5%
Lowe, Keys
33040 1.821 90 4.9% 42 2.3% 14 0.8% 25 1.4%
33041 70 4 5.7% 2 2.9% 2 2.9% 0 0.0%
33042 228 17 7.5% 16 7.0% I 0.4% 0 0.0%
33043 181 17 9.4% 16 8.8% 0 0.0% I 0.6%
33044 3 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33045 48 I 2.1% I 2.1% 0 0.0% 0 0.0%
Subtotal 2,351 129 5.5% 77 3.3% 17 0.7% 26 /./%
Total 3,904 223 5.7% 136 3.5% 32 0.8% 44 1.1%
*Table does not show low bIrth weight bIrths to mothers categonzed as 'OtherlUnknowo' race/ethnicity, of which there were two
county wide during the five year period. Aggregate numbers under 'Total Low Birth Weight Births' do include those births.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Infant mortality rates have long been considered a primary
indicator for reflecting the quality of a population's health
care. In Monroe County, throughout Florida, and the nation, infant mortality rates are the
lowest in recorded history. The infant mortality rates in Monroe County had been
decreasing from 5.9 infant deaths per 1,000 live births in 1996 to 1.5 in 1998. Since that
time, the infant mortality rate has risen, reaching 9.0 infant deaths per 1,000 live births in
2000 (7 infant deaths). Comparatively, the infant mortality rate has remained relatively
constant for the State, at 7.4 in 1996 and decreasing slightly to 7.0 in 2000. (See Graph
11-3.)
Rates calculatedfor Monroe
County may fluctuate considerably
between years due to the effects of
small numbers in rate calculations.
Therefore, trends are best viewed
over multiple years.
3. Infant Mortality
When the infant mortality rate is evaluated for all infant deaths per 1,000 live births from
1996 through 2000, the trend rate for Monroe County (4.9 infant deaths per 1,000 live
II-22
births) is considerably lower than that of single year. The infant mortality rates for each
region of the Florida Keys are very similar to that of the County. The Middle Keys had
the highest rate (5.6) followed by the Upper Keys and the Lower Keys with infant
mortality rates of 4.9 and 4.7, respectively. (See Attachment 11-16).
Graph 11-3
Infant Mortality Rate per 1,000 Live Births:
Monroe County and Florida 1996-2000
-+- Monroe -- Florida
';;' 10.0
...
t:
;Q 8.0 7.4
"
~
9.0
6.0
~ 5.9
..: 4.0
...
"
.e 2.0
=:
~
0.0
1996
.1
7.2
1997
1998
1999
2000
Year
4. Live Births to Mothers 10 to 17 Years Old
Approximately, 3.2% of live births in Monroe County between 1996 and 2000 were to
females 10 to 17 years old. That percentage is notably higher than the State's percentage
at 2.5%. The area with the highest percentage (5.4%) was the Middle Keys, with
percentages for individual zip codes ranging from 5.5% in Marathon (33050) to 6.7% in
Marathon Shores (33052). The remaining regions for Monroe County each had
percentages lower than that of the County as a whole. (See Attachment 11-17).
5. Births to Unwed Mothers
The percentage of live births to unwed mothers from 1996 to 2000 for Monroe County
residents was 32.7%, slightly lower than the State's percentage at 36.9%. The highest
percentage was in the Middle Keys (39.2%), followed by the Lower Keys (32.5%) and
11-23
then the Upper Keys (29.9%). From 1996 to 2000, the lowest number of live births to
unwed mothers occurred in 1998. Since then, the number has increased but has not
exceeded the County's number of live births to unwed mother (282) in 1997. (See
Attachment 11-18).
D. FINDINGS
The major findings concerning the health status of Monroe County residents are as
follows:
~ The top t\.vO leading causes of death among Monroe County residents are the same as
those that affect the State as a whole (cancer and heart disease).
~ Non-Hispanic Whites were reported to have the highest number, 127 (84%) of the
to13l HIV / AIDS cases in Monroe County;
~ The reported cases of Chlamydia in Monroe County nearly doubled from 2000 at 29
to 2001 at 59.
~ The reported cases of Gonorrhea nearly tripled from 10 in 2000 to 27 in 2001.
~ The birth rate of women of childbearing age has fluctuated moderately in Monroe
County over the past five years. The birth rate was highest in 1996 at 50.93 live
births per 1,000 women and lowest in 1998 at 39.84.
~ The percentage of births to unwed mothers was slightly 10wer in Monroe County than
the State as a whole. The highest percentage was in the Middle Keys. The highest
number of births, comparing 1996-2000, occurred in 1997 when there were 282
births.
~ The highest concentration of births to mothers between 10 and 17 years old was
within the Middle Keys, with percentages ranging from 5.5% in Marathon (33050) to
6.7% in Marathon Shores (33052). The remaining regions of Monroe County each
had percentages 10wer than that of the County as a whole.
~ Infant mortality rates in Monroe County decreased between 1996 (5.9) and 1998
(1.5). Since 1998 the infant mortality rate has risen to 9.0 infant deaths per 1,000 live
births in 2000 (7 infant deaths).
II-24
~ Early entry into prenatal care ranked well in Monroe County. Only 9.8% of mothers
received late prenatal care or none at all.
~ The highest percentage in the Monroe County area for late or no prenatal care was in
the Middle Keys.
~ Nearly half of alllive births occurred in Key West (46.6%). The highest percentage
(67.7%) of live births was to Non-Hispanic White mothers, followed by Hispanic
mothers at 22.1 % of live births in Monroe County.
II-25
Attachments
II-I: Monroe County Resident Cancer Related Deaths 1996-2000, and Death Rate per
100,000 Population
11-2: Monroe County Resident Heart Disease Related Deaths 1996-2000, and Death
Rate per 100,000 Population
II-3: Monroe County Resident Unintentional Injury Related Deaths 1996-2000, and
Death Rate per 100,000 Population
II-4: Monroe County Resident Cerebrovascular Related Deaths 1996-2000, and Death
Rate per 100,000 Population
II-5: Monroe County Resident COPD Related Deaths 1996-2000, and Death Rate per
100,000 Population
II-6: Monroe County Resident Chronic Liver Disease and Cirrhosis Related Deaths
1996-2000, and Death Rate per 100,000 Population
II-7: Monroe County Resident Diabetes Related Deaths 1996-2000, and Death Rate per
100,000 Population
11-8: Monroe County Resident Influenza and Pneumonia Related Deaths 1996-2000,
and Death Rate per 100,000 Population
11-9: Monroe County Resident Suicide Related Deaths 1996-2000, and Death Rate per
100,000 Population
11-10: Monroe County Resident HIV/AIDS Related Deaths 1996-2000, and Death Rate
per 100,000 Population
II-II: Reported Cases ofHIV/AIDS by Zip Code, Monroe County, 1997-2001.
11-12: Resident Live Births by Zip Code, 1996-2000, Monroe County
11-13: Live Births by Zip Code and Matemal Race/Ethnicity, 1996-2000, Monroe
County
II-14: Late or No Prenatal Care by Zip Code, 1996-2000, Monroe County
II-15: Low Birth Weight Live Births (<2,500 grams) by Zip Code, 1996-2000, Monroe
County
11-16: Monroe County Infant Mortality Rate (per 1,000 live births), 1996-2000 and 5
Year IMR
II-17: Live Births to Mothers Age 10-17 by Zip Code, 1996-2000, Monroe County,
11-18: Live Births to Unwed Mothers by Zip Code, 1996-2000, Monroe County.
II-26
Attachment II-I
\Junruc (uun" Rcsillcnt ('anccr Rdatl'lI Dcaths
1996-2111111. and Dcath Ratc pl'r 101I,lIl1(1 pupulatiulI
Number of Deaths
Five Year
Five Year Death Rate per
Population 100,000
(1996-2000) 1996 1997 1998 1999 2000 1996-2000 Population
Upper KeyS
33036 20,230 11 14 6 8 8 47 232.33
33031 70,759 40 30 31 ~8 32 161 227.53
33010 30,386 14 15 15 16 16 76 250.12
Subtotal 121.375 65 59 52 52 56 284 233.99
Middle Keys
33001 included in Zip Code 33050
33050 64,718 40 40 29 31 30 170 262.68
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 64.718 40 40 29 31 30 170 262.68
Lower Keys
33040 164,570 81 n 69 68 60 350 212.68
33041 included in Zip Code 33040
33042 29.015 18 6 18 9 13 64 220.58
33043 24,107 10 4 18 12 12 56 232.30
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 217.692 109 82 105 89 85 470 215.90
Total 403,785 214 181 186 In 171 924 228.83
Florida 75,706,875 37,746 37,813 37,783 38,182 38,622 190,146 251.16
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-27
Attachment 11-2
"onrOl' ('ount~ R~,id~nt lI~art Oiwaw Rdal~d O~aths
19lJ/l-21Itlll. and ()~ath Rat~ pn IIlIl.lItHl population
Number of Deaths
Five Year
Five Year Death Rate per
Population 1996 1997 1998 1999 2000 1996-2000 100,000
(1996-2000) Population
Upoer Keys
33036 20,230 10 6 11 7 6 40 197.73
33037 70,759 29 16 31 36 32 144 203.51
33070 30,386 18 12 13 12 10 65 213.91
Subtotal 121.375 57 34 55 55 48 249 205.15
Middle Keys
33001 included in Zio Code 33050
33050 64,718 38 27 26 18 26 135 208.60
33051 included in Zio Code 33050
33052 included in ZiD Code 33050
Subtotal 64,718 38 27 26 18 26 135 208.60
Lower Keys
33040 164,570 53 61 85 79 53 331 20\.13
33041 included in ZiD Code 33040
33042 29,015 11 12 6 11 6 46 158.54
33043 24,107 9 11 5 7 13 45 186.67
33044 included in Zio Code 33042
33045 included in ZiD Code 33040
Subtotal 217.692 73 84 96 97 72 422 193.85
Total 403,785 168 145 177 170 146 806 199.61
Florida 75,706,875 49,480 49,539 50,734 51,124 50,016 250,893 331.40
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-28
Attachment 11-3
'l(lIJru~ ("uunl, R~,i(knllninl~ntiunallnjur~ l{l'Iall'd Ikalh,
1l)l)(,-2IHIlI. MId Ih',llh Ral~ pl'r IlIn.nnn PllJlulatiun
Number of Deaths
Five Year
Five Year Death Rate per
Population 100,000
(1996-2000) 1996 1997 1998 1999 2000 1996-2000 PopulatIon
Upper Keys
33036 20,230 * 4 * 3 4 13 64.26
33037 70,759 10 7 4 4 9 34 48.05
33070 30,386 . 5 7 5 2 20 65.82
Subtotal 121,375 10 16 /1 /2 15 67 55.20
Middle Keys
33001 included in Zip Code 33050
33050 64,718 7 12 8 14 4 45 69.53
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 64,718 7 /2 8 /4 4 45 69.53
Lower Keys
33040 164,570 17 12 14 26 13 82 49.83
33041 included in Zip Code 33040
33042 29,015 . 7 5 4 . 20 68.93
33043 24,107 3 . * 3 * II 45.63
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 217.692 20 /9 19 33 /3 /13 51.9/
T olal 403,785 41 49 40 59 36 225 55.72
Florida 75,706,875 5,373 5,509 5,823 5,994 6,388 29,087 38.42
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-29
Attachment 11-4
"onroe Count~ I{esident Cerehro\asular Disease Related Dl'aths
1l)l)/i-2111111. .lOd [le.111I Rate per 100.000 Population
Number of Deaths
Five Year
Five Year Death Rate per
Population 100,000
(1996-2000) 1996 1997 1998 1999 2000 1996-2000 Population
UDDer K/!IIs
33036 20,230 3 0 . . 0 7 34.60
33037 70,759 * 7 7 8 4 27 38.16
33070 30,386 0 5 * . . 9 29.62
Subtotal 121.375 3 12 7 8 4 43 35.43
Middle Keys
33001 included in Ziv Code 33050
33050 64,718 9 10 15 4 8 46 71.08
33051 included in ZiD Code 33050
33052 included in ZiD Code 33050
Subtotal 64.718 9 10 15 4 8 46 71.08
Lower Keys
33040 164,570 17 23 13 10 14 77 46.79
33041 included in Ziv Code 33040
33042 29,015 * * * 3 . \0 34.46
33043 24,107 3 * . . * 9 37.33
33044 included in ZiD Code 33042
33045 included in ZiD Code 33040
Subtotal 217.692 20 23 13 13 14 96 44.10
Total 403,785 35 48 42 30 30 185 45.82
Florida 75,706,875 9,828 9,986 10,035 10,512 10,381 50,742 67.02
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-30
Attachment 11-5
'IOllnt~ (oulll~ Ih',id~lll ( 01'1> I{dal~d D~ath,
1I)'I6-2(IOU, and Ih'alll Ral~ pl'r IlIU,lllHll'opulal;oll
Number of Deaths
Five Year
Five Year Death Rate per
Population 100,000
(1996-2000) 1996 1997 1998 1999 2000 1996-2000 Population
Upper Keys
33036 20,230 0 0 . * 0 * 9.89
33037 70,759 3 4 4 5 6 22 31.09
33070 30,386 3 4 4 4 2 17 55.95
Subtotal 121.375 6 8 8 9 8 41 33.78
Middle Kt!J1s
33001 included in Zip Code 33050
33050 64,718 6 10 7 8 7 38 58.72
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 64. 7J 8 6 10 7 8 7 38 58.72
Lower Kt!J1s
33040 164,570 8 8 13 15 16 60 36.46
33041 included in Zip Code 33040
33042 29,015 * 3 4 4 14 48.25
33043 24,107 * 6 * * * 12 49.78
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 217,692 8 17 17 19 16 86 39.51
Total 403,785 23 35 35 39 33 165 40.86
Florida 75,706,875 7,679 8,067 8,lSl 9,146 8,605 41,648 55.01
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-31
Attachment 11-6
\lonrOl' ('ounl\ R~,id~nl Chroni~ li\~r Di'~a,~/(,irrho,is Related Dl'alhs
1')1)(,-21)(111, and Ikalh Ral~ p~r HIII.OOO Populalion
Number of Deaths
Five Year
Five Year Deatb Rate per
Population 100,000
(1996-2000) 1996 1997 1998 1999 2000 t996-2000 Population
Upper Keys
33036 20,230 * * * * * 8 39.55
33037 70,759 * 3 * 3 4 14 19.79
33070 30,386 0 . . 3 . 7 23.04
Subtotal 121,375 4 6 4 8 7 29 23.89
Middle Keys
33001 included in Zip Code 33050
33050 64,718 * 4 * 6 5 18 27.81
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 64,718 * 4 * 6 5 18 27.81
Lower Keys
33040 164,570 7 7 6 8 35 21.27
33041 included in Zip Code 33040
33042 29,015 0 0 . . . 5 17.23
33043 24,107 0 * * 3 . 7 29.04
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 217.692 7 8 9 13 10 47 21.59
Total 403,785 12 18 15 27 22 94 23.28
Florida 75,706,875 1,821 1,937 1,872 1.991 2,060 9,681 12.79
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-32
Attachment 11-7
'Iunroe ('uunt~ Resilknt Diabetes Related ()l'aths
I 1)1)6-20IHl, and Dl'ath Rate per IOO,OHO Population
Five Year Death
Five Year Population Number of Deaths Rate per 100,000
(1996-2000) 1996-2000 Population
Upper Keys
33036 20,230 * 9.89
33037 70,759 14 19,79
33070 30,386 8 26.33
Subtotal 121,375 24 19.77
Middle Keys
33001 included in Zip Code 33050
33050 64,718 14 21.63
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 64,718 14 21.63
Lower Keys
33040 164,570 41 24.91
33041 included in Zip Code 33040
33042 29,015 3 10.34
33043 24,107 * 8.30
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 217.692 46 21.13
Total 403,785 84 20.80
Florida 75,706,875 20,520 27.10
Note: Due to the very low occurrence of Diabetes related death in individual years, the
data can only be shown as combined five year death rates.
*Florida Department of Health policy restricts the release of aggregate, zip code level
data, wherein there are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-33
Attachment 11-8
'Ionrnl' ('ount~ Rl'..illl'nt rnl'umonia and Inllul'nza Rl'Iatl'd Dl'aths.
19%-2(1110. and Dl'ath Rail' pl'r 1110,(1(10 ropulation
Number of Deaths
Five Year
Five Year Death Rate per
Population 100,000
(1996-2000) 1996 1997 1998 1999 2000 1996-2000 Population
Upper Kevs
33036 20,230 0 * 0 . C 3 14.83
33037 70,759 5 * * 3 * 12 16.96
33070 30,386 * 3 3 . 9 29.62
Subtotal 121.375 5 3 3 3 0 24 19.77
Middle Keys
33001 included in ZiTJ Code 33050
33050 64,718 3 3 4 * 0 12 18.54
33051 included in ZiTJ Code 33050
33052 included in ZiTJ Code 33050
Subtotal 64.718 3 3 4 . 0 12 18.54
Lower Keys
33040 164,570 11 8 3 4 6 32 19.44
33041 included in ZiTJ Code 33040
33042 29,015 * 0 0 0 0 . 3.45
33043 24,107 4 5 * 0 3 14 58.07
33044 included in ZiTJ Code 33042
33045 included in ZiTJ Code 33040
Subtotal 217.692 15 13 3 4 9 47 21.59
T olal 403,785 25 22 13 11 12 83 20.56
Florida 75,706,875 3,785 3,869 4,080 3,323 3,336 18,393 24.30
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002,
II-34
Attachment 11-9
\Ionroe Count~ Ht'sident Suidde Deaths
I 996-2IHHl. and Ikath Rate per 101l,IHIU Population
Five Year Death
Five Year Population Number of Deaths Rate per 100,000
(1996-2000) 1996-2000 Population
Upper Keys
33036 20,230 * 9.89
33037 70,759 13 18.37
33070 30,386 8 26.33
Sublotal 121,375 23 18.95
Middle Keys
33001 included in Zip Code 33050
33050 64,718 14 21.63
33051 included in Zip Code 33050
33052 - included in Zip Code 33050
Subtolal 64, 718 14 21.63
Lower Keys
33040 164,570 32 19.44
33041 included in Zip Code 33040
33042 29,015 6 20,68
33043 24,107 5 20.74
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 217,692 43 19,75
Total 403,785 80 19.81
Florida 75,706,875 10,601 14.00
Note: Due to the very low occurrence of Suicide related death in individual years, the
data can only be shown as combined five year death rates.
*Florida Department of Health policy restricts the release of aggregate, zip code level
data, wherein there are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
11-35
Attachment 11-10
.\)onroc C(}t1nt~ Rcsidcnt HI\'/.\IDS Relatcd Dcaths
1996-2IHHI, and Dcath Ratc pcr 100,11110 Population
Five Year Death
Five Year Population Number of Deaths Rate per 100,000
(1996-2000) 1996-2000 Population
Upper Keys
33036 20,230 0 0.00
33037 70,759 4 5.65
33070 30,386 ... 3.29
Subtotal 121,375 5 4.12
Middle Keys
33001 included in Zip Code 33050
33050 64,718 3 4.64
33051 included in Zip Code 33050
33052 included in Zip Code 33050
Subtotal 64,7/8 3 4.64
Lower Kevs
33040 164,570 57 34.64
33041 included in Zip Code 33040
33042 29,015 0 0.00
33043 24,107 3 12.44
33044 included in Zip Code 33042
33045 included in Zip Code 33040
Subtotal 217,692 60 27.56
Total 403,785 68 16.84
Florida 75,706,875 9,979 13.18
Note: Due to the very low occurrence ofHIV/ AIDS related deaths in individual years,
the data can only be shown as combined five year death rates.
"'Florida Department of Health policy restricts the release of aggregate, zip code level
data, wherein there are fewer than three cases,
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-36
Attachment 11-11
Reported IIIV/,\IDS Cases by Zip Code
Monroe County 1997-200 I
opu a Ion
1997-2001 r Cases Rate (per 100,000) I Cases Rate (per 100,000)
Upper Keys
33036 19,374 * -- * --
33037 70,498 5 7.092 4 5.674
33070 29,022 * -- * --
Subtotal 118,894 N/A N/A N/A N/A
Middle Keys
33001 included in zip code 33050 0 -- 0 --
33050 63,208 10 15.821 17 26.895
33051 included in zip code 33050 0 -- 0 --
33052 included in zip code 33050 0 -- 0 --
Subtotal 63,208 10 15.821 17 26.895
Lower Keys
33040 164,927 118 71.547 212 128.542
33041 included in zip code 33040 -- -- -- --
33042 29,060 6 20.647 5 17.206
33043 24,627 8 32.485 8 32.485
33044 included in zip code 33042 0 -- 0 --
33045 included in zip code 33040 * -- 0 --
Subtotal 218,614 N/A N/A 225 102.92
Total 400,716 151 37.683 242 60.392
'Rorida Department of Health policy suppresses zip code level aggregate data wherein there are less than three cases.
Source: Rorida Department of Health, Bureau ofHN/AIDS, March, 2002.
11-37
Attachment 11-12
~
1996 1997 1998 1999 2000 1996 - 2000 births
Upper Keys
33036 30 23 20 23 30 126 3.2%
33037 141 119 114 128 127 629 16.1%
33070 58 57 46 58 41 260 6.7%
Subtotal 229 199 180 209 198 1015 26.0%
Middle Keys
33001 5 3 * 4 * 16 0.4%
33050 104 87 95 103 100 489 12.5%
33051 7 * * 3 4 18 0.5%
33052 6 3 * * * 15 0.4%
Subtotal 122 95 101 112 108 538 13.8%
Lower Kevs
33040 384 388 304 369 376 1821 46.6%
33041 15 14 11 18 12 70 1.8%
33042 46 49 57 32 44 228 5.8%
33043 41 39 30 41 30 181 4.6%
33044 * * 0 0 0 3 0.1%
33045 10 11 5 11 11 48 1.2%
Subtotal 498 502 407 471 473 2351 60,2%
Total 849 796 688 792 779 3904 100.0%
Florida 189,338 192,304 195,564 196,963 204,030 978,199 -
Source: Florida Department of Health, Office of Vital Statistics, 2002,
II-38
Attachment 11-13
R~,idl'lIt Li\C Birth, h~ Zip (od~ and :\Jat~rnallb~c/f.thnicit~_ IlJlJ6-21IlJll, \/onrol' (ount~
. Total Births I Non-Hisnanic White Non-Hispanic Black HislJ anic
'Y. of all live % of all live % of all live % or all live
1996 - 2000 births 1996 - 2000 births 1996 - 2000 births 1996 - 2000 births
Upper Keys
33036 126 3.2% 113 2.9% 0 0.0% 12 0.3%
33037 629 16.1% 458 11.7% 25 0.6% 138 3.5%
33070 260 6.7% 212 5.4% * 0.0% 40 1.0%
Subtotal 1015 26.0% 783 20.1% 26 0.7% 190 4.9%
Middle Keys
33001 16 0.4% 15 0.4% * 0.0% 0 0.0%
33050 489 12.5% 268 6.9% 44 1.1% 166 4.3%
33051 18 0.5% 13 0.3% * 0.1% 3 0.1%
33052 15 0.4% 12 0.3% * 0.0% * 0.1%
Subtotal 538 13.8% 308 7.9% 48 1.2% 171 4.4%
Lower Keys
33040 1821 46.6% 1106 28.3% 175 4.5% 441 11.3%
33041 70 1.8% 57 1.5% 7 0.2% 5 0.1%
33042 228 5.8% 194 5.0% 3 0.1% 25 0.6%
33043 181 4.6% 163 4.2% 0 0.0% 15 0.4%
33044 3 0.1% 3 0.1% 0 0.0% 0 0.0%
33045 48 1.2% 29 0.7% * 0.0% 15 0.4%
Subtotal 2351 60,2% 1552 39.8% 186 4.8% 501 12.8%
Total 3904 100.0% 2643 67.7% 260 6.7% 862 22.1%
Florida 978,199 100.0% 728,684 74.5% 222,327 22.7% 198,538 20.3%
Note: Live Births for 'Other' Race/Ethnicity is not included in table.
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-39
Attachment II-14
1996 - 2000 1996 I 1997 I 1998 I 1999 2000 1996 - 2000 Percent
Upper Keys
33036 126 0 3 * * 4 9 7.1%
33037 629 13 11 11 6 12 53 8.4%
33070 260 * 5 5 * 3 17 6.5%
Subtotal 1015 15 19 17 9 19 79 7.8%
Middle Keys
33001 16 * 0 0 0 0 * 12.5%
33050 489 10 6 10 16 25 67 13.7%
33051 18 0 0 * 0 0 * 5.6%
33052 15 * 0 * 0 0 3 20.0%
Subtotal 538 13 6 13 16 25 73 13.6%
Lower Keys
33040 1821 21 23 23 51 62 180 9.9%
33041 70 0 0 * 3 * 5 7.1%
33042 228 * * 7 5 6 21 9.2%
33043 181 * * 5 7 5 20 11.0%
33044 3 * 0 0 0 0 * 33.3%
33045 48 0 * 0 * * 3 6.3%
Subtotal 2351 24 28 36 67 75 230 9.8%
Total 3904 52 53 66 92 119 382 9.8%
Florida 978,199 6,244 5,974 6,773 6,678 7,089 32,758 3.3%
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002,
II -40
Attachment 11-15
-~~
Live Births LBW Births % LBW
1996-2000 1996 1997 1998 1999 2000 1996 _ 2000 1996-2000
Upper Keys
33036 126 0 * 0 * * 3 2.4%
33037 629 10 7 7 8 9 41 6.5%
33070 260 4 3 I 4 4 16 6.2%
Subtotal 1015 14 1J 8 13 /4 60 5.9%
Middle Keys
33001 16 0 0 0 0 0 0 0.0%
33050 489 8 5 6 8 5 32 6.5%
33051 18 * 0 0 0 0 * 5.6%
33052 15 * 0 0 0 0 * 6.7%
Subtotal 538 10 5 6 8 5 34 6.3%
Lower Keys
33040 1821 30 19 II 16 14 90 4.9%
33041 70 0 * * * * 4 5.7%
33042 228 * 3 8 * * 17 7.5%
33043 181 6 3 4 * 3 17 9.4%
33044 3 0 0 0 0 0 0 0.0%
33045 48 0 0 * 0 0 * 2.1%
Subtotal 2351 38 26 25 20 20 129 5.5%
Total 3904 62 42 39 41 39 223 5.7%
Florida 978,199 14,866 15,461 15,797 16,126 16,284 78,534 8.0%
*Florida Department of Health policy restricts the release of aggregate, zip code level data, wherein there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II -41
Attachment 11-16
\Ionrol' CotJnt~ Infant \Iortalit~ Rate (pa 1,000 Lhl' Births)
I 996-2tHlO and 5 Year nlR
It)l)h 1'l1J7 (11'lM
II'" Bllth, Death, 1\11{ I he Birth, De.llh, 1\11{ Il\l' Birth, De,.th, I\IR
Upper Kews
33036 30 0 0 23 0 0 20 0 0
33037 141 . 14.2 119 * 8.4 114 0 0.0
33070 58 0 0.0 57 0 0.0 46 0 0.0
Subtotal 229 . 8.7 199 . 5.0 180 0 0.0
Middle Kt!lIs
33001 5 0 0 3 0 0 2 0 0
33050 104 * 9.6 87 0 0.0 95 * 10.5
33051 7 0 0.0 2 0 0.0 2 0 0.0
33052 6 0 0.0 3 0 0.0 2 0.0
Subtotal 122 * 8.2 95 0 0.0 101 * 9.9
Lower Kt!lIs
33040 384 * 5.2 388 . 2.6 304 0 0.0
33041 15 0 0.0 14 0 0.0 II 0 0.0
33042 46 0 0.0 49 * 20.4 57 0 0.0
33043 41 0 0.0 39 * 25.6 30 0 0.0
33044 2 0 0.0 I 0 0.0 0 0 0.0
33045 10 0 0.0 II 0 0.0 5 0 0.0
Subtotal 498 . 4.0 502 3 6.0 407 0 0.0
Monroe 849 5 5.9 796 4 5,0 688 * 1.5
Florida - - 7.4 - - 7.1 - - 7.2
It)99 2111111 \1)1)(,_2111111
I "e BII th, Ill'"th, 1\1 I{ I IH' B,rth, Dl',lth, 1\1 I{ I I'" B,rth, Dl'ath, I\IR
UDDer Kt!lIs
33036 23 0 0 30 0 0 126 0 0
33037 128 0 0.0 127 * 7.9 629 4 6.4
33070 58 0 0.0 41 . 24.4 260 I 3.8
Subtotal 209 0 0.0 198 * 10.1 1015 5 4.9
Middle Ki!1JS
33001 4 0 0 2 0 0 16 0 0
33050 103 0 0.0 100 * 10.0 489 3 6.1
33051 3 0 0.0 4 0 0.0 18 0 0.0
33052 2 0 0.0 2 0 0.0 15 0 0.0
Subtotal 112 0 0.0 108 * 9.3 538 3 5.6
ower Kt!lIs
33040 369 * 5.4 376 4 10.6 1821 9 4.9
33041 18 0 0.0 12 0 0.0 70 0 0.0
33042 32 0 0.0 44 0 0.0 228 * 4.4
33043 41 0 0.0 30 0 0.0 181 . 5.5
33044 0 0 0.0 0 0 0.0 3 0 0.0
33045 II 0 0.0 II 0 0.0 48 0 0.0
Subtotal 471 * 4.2 473 4 8.5 2351 II 4.7
Monroe 792 4 5.1 779 7 9.0 3904 19 4.9
Florida - - 7.3 - - 7.0 - - --
*Florida Department of Health policy restricts the release of aggregate, zip code
level data, wherein there are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
II-42
Attachment 11-17
LiH Births to 'Ioth~rs .\g~ 111-17, h~ Zip Cod~, Il)96-21l1l1l, 'Ionro~ Count~
Total Live
Births Number of Live Births to Teens Births to Teens Percent
1996-2000 1996 1997 1998 1999 2000 1996 - 2000 1996-2000
Upper Keys
33036 126 '" 0 0 0 * 2 1.6%
33037 629 3 2 5 4 5 19 3.0%
33070 260 * '" '" 0 5 8 3.1%
Subtotal 1015 5 3 6 4 II 29 2.9%
Middle Keys
33001 16 0 0 0 '" 0 * 6.3%
33050 489 6 5 7 3 6 27 5.5%
33051 18 0 0 0 0 0 0 0.0%
33052 15 '" 0 0 0 0 '" 6.7%
Subtotal 538 7 5 7 4 6 29 5.4%
Lower Keys
33040 1821 II 9 10 8 10 48 2.6%
33041 70 0 0 0 0 0 0 0.0%
33042 228 0 3 3 0 3 9 3.9%
33043 181 0 2 '" 3 '" 7 3.9%
33044 3 0 0 0 0 0 0 0.0%
33045 48 '" 0 0 0 0 '" 2.1%
Subtotal 2351 12 14 14 II 14 65 2.8%
Total 3904 24 22 27 19 31 123 3.2%
Florida 978,199 5,356 5,043 4,943 4,605 4,446 24,393 2.5%
"'Florida Department of Health policy restricts the release of aggregate, zip code level data,
wherein there are fewer than three cases,
Source: Florida Department of Health, Office of Vital Statistics, 2002.
I1-43
Attachment 11-18
1996-2000 1996 1997 1998 1999 2000 1996 - 2000 1996-2000
Upper Keys
33036 126 9 8 4 8 11 40 31. 7%
33037 629 45 34 31 37 41 188 29.9%
33070 260 18 16 15 15 II 75 28.8%
Subtotal 1015 72 58 50 60 63 303 29.9%
Middle Keys
33001 16 * 0 0 * * 3 18.8%
33050 489 42 37 37 41 43 200 40.9%
33051 18 * 0 0 0 0 * 5.6%
33052 15 * * * * 0 7 46.7%
Subtotal 538 46 39 39 43 44 211 39.2%
Lower Keys
33040 1821 118 152 84 117 127 598 32.8%
33041 70 7 6 * 8 4 27 38.6%
33042 228 11 11 21 5 11 59 25.9%
33043 181 14 14 11 13 12 64 35.4%
33044 3 * * 0 0 0 * 66.7%
33045 48 5 * * 4 * 13 27.1 %
Subtotal 2351 156 185 120 147 155 763 32.5%
Total 3904 274 282 209 250 262 1277 32.7%
Florida 978,199 68,082 69,226 71,602 73,785 78,026 360,721 36.9%
*Florida Department of Health policy restricts the release of aggregate, zip code level data,
wherein there are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002,
II -44
III. HEALTH CARE PROVIDERS AND
SUPPORT SERVICES
An important factor for gauging the health of a community is the availability of health
care providers and support services. Can members of a community obtain the appropriate
level of care when it becomes necessary? Health care and support services encompass a
wide array of services which either provides direct care or enables members of a
community to seek out the care that they need. Direct care services include: primary care
obtainable through community based clinics or hospitals, primary care and specialty
physicians, substance abuse and mental health services, nursing homes, hospice care,
home-health agencies, and companion services for the elderly. Support services such as
child care, and public transportation may enable the community to obtain the necessary
health care services.
A. PRIMARY CARE
Primary care, which is considered the least costly level of care, focuses on prevention,
early detection and treatment. Primary care is important in the treatment of simple and
common illnesses and in the maintenance of chronic conditions. Because primary care is
integral to a healthy community, access for the entire population is imperative. Primary
care is also important in 10wering overall health care costs because it helps prevent more
costly use ofhospital emergency rooms.
Although Monroe County was designated a Medically Underserved Area by the U.S.
Department of Health and Human Services in 1995, there are no federally qualified
health centers, or more commonly referred to as community health centers, in Monroe
County. However, local residents may obtain primary care on a private basis through
local physician providers. Low income residents may obtain care for their primary health
needs by visiting either of two mobile clinics. The MediVans travel along highway US-I
in the Upper, Middle and Lower Keys. Other available options include low-cost clinics
which are operated by the Monroe County Health Department, the Rural Health Network
III-I
of Monroe County, Inc. (RHN), as well as an indigent care clinic at Lower Keys Medical
Center on Stock Island.
1. Rural Health Network Health Services Clinics
In Monroe County, the MediVans are mobile services which offer primary care services
for the County's residents. The two MediVans are operated by the RHN and supported
by Monroe County Government, Florida Keys Area Health Education Centers (AHEC)
and the US Department of Housing and Urban Development (HUD). The second
MediVan began operating in March 2002. The purpose of the MediVans is to enhance
access to primary care in Monroe County. An objective of the program is to avoid
inappropriate hospitalization by providing prevention and early intervention services
throughout Monroe County. The vans offer preventive screening, diagnostics and limited
laboratory services to all persons regardless of their ability to pay.
The RHN provides services to Monroe County through the two mobile health units as
well as through the Ruth Ivins Clinic in Marathon and the St. Clare Clinic in Key West.
The St. Clare Clinic opened in June 2002. In 2001, the Ruth Ivins Clinic and one mobile
health unit combined served 3,460 clients, representing a total of 4,161 visits for health
services, or 1.2 visits per person. In 2001, services were rendered to 2,657 adults
(76.8%) and 803 children (23.2%). Of the 3,460 clients, 2,064 (59.6%) were female and
1,396 (40.3%) were male. There was a fairly even geographic distribution in the number
of clients served. A slightly greater number of clients (1,209) came from the Lower
Keys, followed by the Upper Keys and the Middle Keys, with 1,165 and 1,114 clients,
respectively.
To make an appointment to receive health services through the Rural Health Network
contact the desired site location:
Upper Keys:
Middle Keys:
Lower Keys:
Monday - Wednesday call (305) 797-4104 (Key Largo to Islamorada),
Thursday and Friday call (305) 289-3748 (Ruth Ivins Center).
Wednesday - Thursday call (305) 797-1156 (Big Pine Key).
Tuesday and Friday call (305) 292-6825 (St.Francis/St. Clare Center).
III - 2
In the last quarter of 2001 (October through December), the RHN provided a total of
5,652 health care services in Monroe County. The five most common services provided
were: pharmaceutical assistance (848), hypertension treatment (836), counseling (722),
blood work (412), and general physicals (335). Four of those five, general physicals
(1,175), hypertension treatment (830), pharmaceutical assistance (769), and counseling
(497) were the most common services provided during the first quarter of 2002. In that
quarter, wound care (337) was the fifth most common service request at RHN clinics. I
2. Monroe County Health Department Service Sites
The Florida Department of Health's mission is "to promote and protect the health and
safety of all Floridians". The Department accomplishes this by identifying health risks in
the community; detecting, investigating, and preventing the spread of disease; providing
primary care for individuals with limited access to such care in the private sector; and
ensuring that health care practitioners meet set requirements for providing adequate care.2
County health departments provide most of the public health services in Florida. In
Monroe County there are four county health department sites that provide health services
to County residents. These health clinics are located at the Lower Keys Medical Center
and the Roosevelt Sands Center in Key West, the Ruth Ivins Center for Public Health in
Marathon, and the Tavernier Public Health Unit in Tavernier. (See Table III-A and Map
III-I). The Monroe County Public Service Building, the Roosevelt Sands Center, the
Ruth Ivins Center for Public Health and the Tavernier Public Health Unit also provide
WIC services. Healthy Start services are offered at the Monroe County Public Service
Building, the Ruth Ivins Center for Public Health and the Tavernier Public Health Unit.
In 2001, a total of 5,548 Monroe County residents received primary care services from
Monroe County Health Department clinics. Those clients accounted for 14,729 visits, for
an average of 2.7 visits per person. The greatest number of clients and visits occurred in
the Lower Keys, where there were 3,825 clients and 11,225 visits or 2.9 visits per person.
I Rural Health Network, Health Services Clinics Statistical Summary, August, 2002.
2 Florida Department of Health Website. Available at www.myflorida.com. August 2002.
111-3
The Upper Keys had the second highest number of visits and clients, 1,108 and 2,111
respectively, yet had the lowest average number of visits per person at 1.9. At the zip
code level, clients from Key West (33041 and 33040) had the highest average number of
visits per person within the County at 4.3 and 3.0, respectively. There were 9,396 visits
to primary care centers by residents in Key West (33040), accounting for 63.8% of all
visits countywide. The lowest number of visits per person occurred in Sugarloaf Shores
(33044) with 1.3 visits per person. (See Attachment 111-1).
It should be noted that the infrastructure costs for providing public health services in
Monroe County is oftentimes higher than that of other local health departments in the
State due to the County's geographic expansiveness and transportation constraints.
III-4
Table III-A
Monroe County Public Service 5100 College Road Monday through . Administrative and
Building Key West, FL 33041 Friday: Business/Operation Offices
8:00 a.m. - 5:00 p.m. . Vital Statistics Office
Tel: 305/292-6894 . Lower Keys Environmenlal
Health Office
. Healthy Start and WIC
Services
. TB and School Health
Coordinators
. WIC Director's Office
Lower Keys Medical Center 1200 Kennedy Drive Monday through . Early Intervenlion HIV
Key West, FL 33040 Friday: Clinic / STDs
8:00 a.m. - 5:00 p.m. . Primary Care Clinic and MD
Tel: 305/294-5535 Services
Roosevelt Sands Center 105 Olivia Street Monday - Thursday: . Primary Care Clinic and ;"-10
Key Wesl, FL 33040 8:00 a.m. - 5:00 p.m. Services
. WIC Services
Tel: 305/293-1741 Fridays: . Immunizations/STDs/F amily
8:00 a.m. - 12:00 p.m. Planning
Ruth Ivins Center for Public 3333 Overseas Highway Monday lhrough . Primary Care Clinic and MD
Heallh Marathon, FL 33050 Friday: Services
8:00 a.m. - 5:00 p.m. . HIV/AIDS Services
Tel: 305/289-2450 . Healthy SIan and WIC
Services
. Environmental Health
Services
Tavernier Public Health Unit 148 Georgia Avenue Monday through . Primary Care Clinic and MD
Tavernier, FL 33070 Friday: Services
8:00 a.m. - 5:00 p.m. . Heallhy Slart and WIC
Tel: 305/853-3240 Services
. STD and HIV Services
Upper Keys Environmental 85960 Overseas Highway Monday through . All Upper Keys
Health Unil Venelian Plaza Friday: Environmental Health
Shopping Center, Unil #5 8:00 a.m. - 5:00 p.m. Services
Islamorada, FL 33036
Tel: 305/853-1900
Source: Monroe County Health Department, August 2002.
III-5
B. PHYSICIANS
Much of the medical care obtained within 10cal communities is provided by private
physicians at their offices. The information on the number of physicians serving Monroe
County was obtained from the District XI Medicaid Office and the Monroe County
Yellow and White Pages. This information was verified by the Council through a
telephone survey of doctors registered within Monroe County; however, there may be
other doctors associated with some private offices whose names were not identified nor
disclosed during the telephone interviews. Additionally, all information, including
insurance policies and office hours, was self-reported either by physicians or their staff,
and is subject to change at any time.
According to data gathered and verified by the Council, there are 103 practicing
physicians In Monroe County. Of this group, there are 41 (39.8%) primary care
physicians composed of family and general practitioners, obstetricians/gynecologists,
pediatricians, and internists. Specialists represent the majority of physicians practicing in
Monroe County at 60.2% (or 62 physicians). Specialties include cardiology, orthopedic
surgery, psychiatry, podiatry, ophthalmology, and general surgery, among others. (See
Tables III-B through III-D).
III -6
Table III-B
I
8
I
1
3
3
I
I
2
1
I
13
10
23
Table III-C
\Ion rill' COllnt~ I'h~ sicians
h~ SJll'cialt~ for \Iilidk "c~ s Rc~ion" 2002
Middle Kevs
Cardiology 2
Familv Practice* 2
GastroenterololrV I
General Sumerv 2
Internal Medicine- I
OohthalmololrV 2
Orthopedic Surgery I
Otorenolarvnl!ololrV I
Pediatrics* I
PediatricslInternal Medicine* I
Psvchiatrv I
RadiololrV 5
Rheumatology 1
UrololrV I
-PRIMARY CARE TOTAL 5
SPECIALISTS TOTAL 17
TOTAL PHYSICIANS 22
Source: Health Council of South Florida Telephone Survey, 2002.
III - 7
Table III-D
"unrue ('UUtlt~ Ph~ sicians
h~ Spt'cialt~ fur Lu\\er Kl'~s Rl':,:iun, 21102
Lower Kevs
Cardiology I
Chirooractor 4
Dermatology I
Family Practice* 10
General SUrl!:ery I
Gvnecology I
Hematology I
Internal Medicine* 5
Neurolol!V 2
OB/GYN* 5
Oohthalmolol!V 2
Otorenolaryngology I
Orthopedic 4
OtorenolarvOIzology I
Pain ManalZement I
Pediatrics* 3
Plastic Surgerv I
Podiatry 2
Psychiatry 3
PulmonoIolN 2
Radiation Oncology I
Radiology I
Urolol!V 2
Vascular SurlZerv 3
*PRIMARY CARE TOTAL 23
SPECIALISTS TOTAL 35
TOTAL PHYSICIANS 58
Source: Health Council of South Florida Telephone Survey, 2002.
1. Primary Care Physicians
Access to primary care physicians is an essential component to establishing a regular
source of care, a concept often referred to as "a medical home". Preventive care and
early treatment in a primary care setting can help promote the health of the individual and
his/her family. By preventing conditions and treating them early when diagnosed, the
threat of developing a more acute, life threatening condition is lessened. The health of
the patient is enhanced and more costly treatment is avoided.
III-8
There are 41 primary care physicians practicing in Monroe County; over half of those (23
or 56.1 %) are 10cated in the Lower Keys, and predominantly within Key West (33040).
There are only five primary care physicians in the Middle Keys all of which are located
in Marathon (33050). Also, there are no physicians offering obstetrical or gynecological
care in the Middle Keys. Moreover, there are no designated obstetric beds at Fishermen's
Hospital, which is 10cated in the Middle Keys. (See Attachment III-2 and Map 111-2).
2. Specialty Care Physicians
There are 62 specialty care physicians providing care throughout Monroe County. While
specialists make up the majority (60.2%) of physicians in the County, the perceived need
for additional specialty care services may be due to the fact that there are few physicians
to choose from within a given specialty. For example, based on the Council's telephone
survey there are four general surgeons, four psychiatrists, three podiatrists, three
cardiologists, and two orthopedic surgeons located throughout Monroe County.
Conversely, the specialties with the greatest number of physicians in a given region are
opthamology (Upper Keys), radiology (Middle Keys), and orthopedic and chiropractic
(Lower Keys). (Refer back to Tables 111-B through 111-D). The Lower Keys possesses 35
of the 62 specialists (56.5%) in the Keys, 34 of those are located in Key West (33040);
and the remaining specialist is located in Big Pine Key (33043). (See Attachment 111-3
and Map 111-3).
3. Evening Hours
Of the County's 103 physicians, less than one-fifth (15.5% or 16) reported offering
evening hours. Three times as many specialists as primary care physicians reported
having evening hours at their primary office - only 11 of the 103 physicians (10.7%)
reported having more than one office. Twelve of the 62 specialists (19.4%) compared to
four of the 41 primary care physicians (9.8%) have evening hours at least once a week.
(See Table III-E).
III-9
Table III-E
('1"'ll'oln' ~'l'lIll1j! UHlir' \ll'du,.',lId 'h'dll:an K,d( .1Il' I'rn.IIt'ln\llr.H1H'
Pln\,n.11I I 'pl' \lImltl'f IJol'rll'lIr '\ulIlhl'r Plnl'nt \umhn Pl'fl'l'nt \ulIlhl'f Pl'rl'cnt \urnlH.'f PI fu'n. :\ urnhl'r Pl'fl"t.'n'
Prim Care
Upper Keys 13 31.7% 2 4.9% 8 19.5% 1\ 26.8% 6 14.6% II 26.8%
Middle Keys 5 12.2% 0 0.0% I 2.4% 2 4.9% 2 4.9% 4 9.8%
Lower Keys 23 56.1% 2 4.9% 14 34.1% 17 41.5% 7 17.1% 23 56.1%
Monroe County 41 100.0% 4 9.8% 23 56./% 30 73.2% /5 36.6% 38 92.7%
SPecialists
Upper Keys 10 16.1% 3 4.8% 5 8.1% 9 14.5% 2 3.2% 9 14.5%
Middle Keys 17 27.4% 1 1.6% 1\ 17.7% 17 27.4% 1\ 17.7% 17 27.4%
Lower Keys 35 56.5% 8 12.9% 23 37.1% 34 54.8% 23 37.1% 34 54.8%
Monroe County 62 100.0% /2 19.4% 39 62.9% 60 96.8% 36 58.1% 60 96.8%
All Phvsicians 103 100.0% /6 /5.5% 62 60.2% 90 87.4% 5/ 49.5% 98 95./%
Source: Health Council OfSOUlh Florida Telephone Survey, 2002.
4. Insurance
According to the same telephone survey, the vast majority (95.1 %) of physicians accept
some form of private insurance. A smaller percentage (87.4%) of physicians accepts
Medicare, followed by 60.2% who accept Medicaid, and 49.5% who accept payment
from Florida's KidCare. In the Upper Keys, the leading, specified form of insurance
accepted by physicians was Beech Street, which was accepted by 7 physicians; followed
by Blue Cross Blue Shield, United Healthcare, and Acordia, which were accepted by 6
physicians each. The leading insurance provider in the Middle Keys was Acordia, which
was accepted by 5 physicians. Six physicians in the Middle Keys stated that they accept
"all major medical" health plans. Blue Cross Blue Shield was also the leading insurance
accepted by physicians in the Lower Keys, followed by Acordia, Beech Street and United
Healthcare. (See Tables III-E and III-F).
III -10
Table III-F
er Ke s
Beech Street 7
Blue Cross Blue Shield 6
United Healthcare 6
Acordia 6
Tricare U.S. Dept. of Defense 2
Cigna 1
All major medical 1
Millenium 1
Foundation Health 1
Uns ecified 7
Middle Ke s
All major medical 6
Acordia 5
Blue Cross Blue Shield 4
Tricare U,S. Dept. of Defense 2
Beech Street 2
United Healthcare I
First Health 1
Cigna 1
Un ecified 2
Lower Ke s
Blue Cross Blue Shield 24
Acordia 18
Beech Street 15
All major medical 10
United Healthcare 8
Florida League of Cities 7
Pacific Life 3
Tricare U.S. Dept. of Defense 2
Gp 2
Millenium 2
Humana 1
AARP 1
Un ecified 5
Source: Health Council of South Florida Telephone Survey, 2002
III -11
c. HOSPITALS
There are four hospitals 10cated within Monroe County; three of these facilities provide
general acute care. In Monroe County, each individual resident is within 45 minutes of a
general hospital. (See Table III-G and Map III-4). Historically, public transportation in
Monroe County has been limited to Key West, which contains 42.9% of the county's
population. The planning and delivery of transportation services are complicated by the
limitations of the single road used to travel through the Keys. These transportation
barriers are currently being addressed by the Community Transportation Coordinator
(CTC) in Monroe County. The Florida Keys CTC system, started in 1997, currently has
subcontracts with. other providers to coordinate transportation services throughout the
Keys.
A number of specialized health servIces, such as cardiac and neurosurgery, and all
tertiary care services are not available in Monroe County. Access to these services
continues to be a barrier for Monroe County residents. Patients requiring specialty
procedures are routinely referred to facilities in Miami-Dade County. Additionally, some
outpatient services such as cardiac catheterization are also not available because they
must be co-located at a facility with a companion inpatient cardiac catheterization
program.
Table III-G
Dircctor~ of \Ionroc Count~ Hospitals
Hospital ;\amc ,\ddrcss Phonc "umhcr
Lower Keys Medical Center - Kennedy Drive 1200 Kennedy Drive (305) 292-7959
Key West, FL 33040
Lower Keys Medical Center - College Road 5900 College Road (305) 294-5531
Stock Island, FL 33040
Fishermen's Hospital 3301 Overseas Highway (305) 743-5533
Marathon, FL 33050
Mariner's Hospital 91500 Overseas Highway (305) 852-4418
Tavernier, FL 33070
III -12
1. Acute Care Services
Acute care beds are licensed to provide treatment for episodic injuries or illness with an
average length of stay of less than 30 days, although patient recovery periods may be
longer. Patients admitted to acute care beds typically remain a minimum of24 hours.
Acute care includes both secondary (hospital inpatient) and tertiary care (high level
hospital-based care such as trauma care, bum units, neonatal intensive care and other
forms of regionalized services), with beds that can be categorized as adult
medical/surgical, pediatric, obstetric/gynecology and intensive care. These beds can be
designated for certain conditions such as cancer, diabetes or others without further
regulation requirements. In Monroe County, Lower Keys Medical Center - Kennedy
Drive facility is licensed to operate four acute care beds, but the facility only utilizes its
in-patient substance abuse beds.
Table III-H
\culc Carc, i\lonroc Count~, 211111
Lic. Avail. Admissions Patient Occup. ALOS
Name of Facility Beds Beds Days Rate
Fishermen's Hospital - Marathon 58 58 1,809 6,670 31.5% 3.7
Lower Keys Medical Center - College Road 103 103 4,132 16,645 44.3% 4.0
Lower Keys Medical Center - Kennedy Drive 4 4 0 0 0.0% 0.0
Mariners Hospital 42 42 1,441 6,135 40.0% 4.3
Monroe County Total 207 207 7,382 29,450 39.0% 4.0
District XI Total 7,814 7,825 304,714 1,627,111 57.0% 5.3
ALos: Average Length of Stay
Source: Health Council of South Florida, Hospital Utilization Report, Calendar Year 2001.
In 2001, there were only 4 acute care hospitals with 207 licensed beds in Monroe County,
while District XI as a whole had 32 facilities. Monroe County has experienced a 15.8%
increase in admissions since 1997 (from 6,376 to 7,382 admissions). The total number of
licensed beds is used to calculate the occupancy (utilization) rate ofhospital beds within a
given service area. The occupancy rates in Monroe hospitals averaged 39.0% in calendar
year 2001. The Average Length of Stay (ALOS) in a Monroe County acute care
hospitals in 2001 was 4.0 days; the District average was 5.3 days. (See Table III-H).
III-13
2. Specialty (Tertiary Care) Services
As defined by Florida Statute 408.032(19), a "tertiary health service" means a health
service, which due to its high level of intensity, complexity, specialized or limited
applicability, and cost, should be limited to and concentrated in a limited number of
hospitals to ensure the quality, availability, and cost-effectiveness of such service.3
Tertiary care services are those services which require sophisticated training and
expertise to provide; are generally more costly than other health care services; and are
needed only by a small percentage of health care seekers, usually following emergency or
secondary care. The tertiary health care services which are included in the Florida
Statutes and the Florida Administrative Code (FAC) for Certificate of Need (C.O.N.)
review include: open heart surgery, neonatal intensive care, comprehensive rehabilitation,
organ transplant surgery, and specialized bum treatment. Services that are considered
experimental and/or developmental are also considered as tertiary care.
The Council has designated the entire confines of District XI, encompassing both Monroe
and Miami-Dade Counties, as a single region for the planning and allocation of tertiary
care services. Currently, there are no tertiary health services available in Monroe
County; however, patients may access this higher level of care from providers in Miami-
Dade County as part of the district-level services offered.
3. Emergency and Trauma Services
Florida's Access to Care Law requires access to emergency services regardless of a
patient's ability to pay. As defined by Florida Statute 395.002(10), "emergency services
and care" means medical screening, examination, and evaluation by a physician, or to the
extent permitted by applicable law, by other appropriate personnel under the supervision
of a physician, to determine if an emergency medical condition exists and, if it does, the
care, treatment, or surgery by a physician necessary to relieve or eliminate the emergency
3 Florida Statues online, Florida Sunshine online Website, June 2000.
III-I 4
medical condition within the service capability of the facility, During calendar year
1999, there were 3 hospitals in Monroe County providing emergency room services.
Lower Keys Medical Center - College Road provided 48.5% of the County's emergency
room services, or 51 visits per day. (See Table III-I).
Table III-I
Emergency Room Visits & Admissions,
:\Ionroe C()unt~, 2001
Visits Per Admissions
Name of Facility Visits Day
Fishermen's Hospital - Marathon 7,760 21 1,292
Lower Keys Medical Center - College Road 18,491 51 2,834
Mariners Hospital 11,872 33 1,443
Monroe County Total 38,123 104 5,569
District XI Total 945,391 2,590 183,756
Source: Health Council of South Florida, Hospital Utilization Report, Calendar Year 2001.
D. MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
Access to mental health services has been a difficult area to analyze, since there are few
quantifiable indicators regarding the incidence and prevalence of mental illness among
populations. There are estimates, including the National Institute of Mental Health's
1997 survey of 10,000 households; this survey found that between 15 and 23% of the
general adult population reported symptomatology of some type of mental illness at some
time during the previous six months.4
A milestone in mental health planning was the
publication of the U.S. Surgeon General Dr. David
Satcher's report on mental health in early 2000.5 The
report helps to put behavioral health on an equal footing
with physical health in the public policy arena and attempts to move mental health into
For additional information on
services provided by the
Department of Children and
Families, contact them at
(305) 377-5029.
4 National Institutes of Mental Health, 1998.
5 The Surgeon General's Report on Mental Health, National Institutes of Health website, March
2000.
III-I 5
the mainstream of public health issues. The Surgeon General's report estimates 44
million American adults and 13.7 million American children experience mental disorders
each year. Major depression, alcohol use, bipolar disorder, schizophrenia and obsessive-
compulsive disorder were identified among the 10 leading causes of disability
nationwide.6 In Florida, the Department of Children and Families has oversight
responsibilities to assure access to mental health services.
1. Community Mental Health and Substance Abuse Services
There are nrne providers of mental health and/or substance abuse services in Monroe
County. Collectively, these programs provide an array of adult mental health and
substance abuse services. (See Table 111-J and Map 111-5).
Table III-J
Site
Address
Cunnin m Counselin
Guidance Clinic oftbe U er Ke s
92330 Overseas Hi bwa 305-852-922
92140 US Hi bwa 1 305-852-328
x
X
X
Guidance Clinic oftbe Middle Ke
300041 Street Ocean
305-289-6150 X
X
33045 He1 Line, Inc. P.O. Box 2168 305-292-8445 X
33045 K West Honsin Autbori . Safe Port 1000 Kenned Dr. 305-292-150 X
33040 Mental Health Care Center Lower K 12054 Street 305-292-6843 X
33040 Mental Health Care Center Lower K - Overla Services 12054 Street 305-292-6843
33040 Monroe Coon Pretrial Services 323 F1emin Street 305-292-34 X
33040 Monroe Coon IGerald Adams Elem. - Al ba Pro am 5955 Colle e Road 305-293-16 X
33040 P.A.C.E. Center for Girls. Inc. 3130 Fla ler Avenue 305-522-611 X
Total Pro ams Available 9
Note: Mental Health and Substance Abuse Programs are also available within the Monroe County Prison System.
Source: Agency for Health Care Administration, Florida HealtbStat, August 2002.
X
X
4
o
The Guidance Center of the Middle Keys provides both outpatient and inpatient
behavioral healthcare. Outpatient services provide assessment as well as short-and long-
term counseling and psychiatric services. Inpatient services provide help for adults in
acute psychiatric crisis and adults in need of alcohol or drug detoxification. Case
management is provided for clients with persistent and severe mental illness; the case
manager refers clients to services and agencies that will help meet long-range needs, and
6 Ibid.
III -16
monitors client progress. The Guidance Clinic also offers a variety of transportation
services, including Medicaid transportation coordination; the Guidance Clinic is the
designated CTC for Monroe County. The CTC is responsible for administering a
countywide system of transportation for all Monroe County citizens who are
transportation disadvantaged7. In the Lower Keys, the Care Center for Mental Health
offers community mental health including psychiatric diagnosis, substance abuse
treatment and 24-hour emergency services for those in imminent danger from self or
others. In the Upper Keys, the Counseling Center in Key Largo staffs two clinical social
workers, a psychiatrist and a school psychologist.
According to the Department ofChildren and Families, during calendar year 2001, a total
of 645 adults residing in Monroe County received mental health services throughout the
different centers in Monroe County, The 645 adults who have been served by
Department of Children and Families mental health programs have had a total of 1,245
visits for services. Additionally, 60.2% of the clients served were females (or 388) and
the remaining 39.8% were males (257). Residents in the Lower Keys were the most
likely to seek out mental health services; 383 persons in that region received care, during
a total of827 visits (or 2.2 visits per person). (See Table IIl-K).
7 Florida's transportation disadvantaged are defined in Chapter 427.011(1) as "those persons who because
of physical or mental disability, income status, or age, are unable to transport themselves or to purchase
transportation and are, therefore, dependent upon others to obtain access to health care, employment,
education, shopping, social activities, or other life-sustaining activities, or children who are handicapped or
high-risk as defined in s. 411.202, F.S."
III-17
Table III-K
Adults Receivin~ l\Ientalllealth Services
Calendar Year 2001
Total Male Female
Persons Served Visits Persons Served Visits Persons Served Visits
0/. of 'Yeof 0/. of %of 0/. of
ZIP CODE Number Region Number Region Number Total :'<umber Total Number Percent Number Total
Upper Keys
33036 25 17.4% 37 17.4% 9 36.0% 12 32.4% 16 64.0% 25 67.6%
33037 74 51.4% 117 54.9% 26 35.1% 34 29.1% 48 64.9% 83 70.9%
33070 45 31.3% 59 27.7% 15 33.3% 17 28.8% 30 66.7% 42 71.2%
Subtotal 144 22.3% 213 17.1% 50 34.7% 63 29.6% 94 65.3% 150 70.4%
Middle Keys
33001 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33050 113 95.8% 200 97.6% 46 40.7% 79 39.5% 72 63.7% 123 61.5%
33051 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33052 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 118 18.3% 205 16.5% 46 39.0% 79 38.5% 72 61.0% 123 60.0%
ILower Keys
33040 256 39.7% 670 53.8% 112 43.8% 328 49.0% 144 56.3% 342 51.0%
33041 24 3.7% 26 2.1% 13 54.2% 14 53.8% II 45.8% 12 46.2%
33042 46 7.1% 58 4.7% 16 34.8% 19 32.8% 30 65.2% 39 67.2%
33043 45 7.0% 60 4.8% 18 40.0% 24 40.0% 27 60.0% 36 60.0%
33044 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33045 12 1.9% 13 1.0% 2 16.7% 2 15.4% 10 83.3% II 84.6%
Subtotal 383 59.4% 827 66.4% 16/ 42.0% 387 46.8% 222 58.0% 440 53.2%
Monroe 645 100.0% 1,245 100.0% ,,57 39.8% 529 42.5% 388 60.,,% 716 57.5%
Source: Department of Children and Families, 2002.
In 2001, a total of 330 children received mental health servIces through programs
available through the Department of Children and Families. Of those 330, 71.8% (or
237) were males and 28.2% (or 93) were females. Children in Monroe County made a
total of 665 visits for mental health services. Nearly the same percentage of children in
the Upper and Middle Keys received mental health services in 2001 with 22.7% and
21.2%, respectively. Children in the Lower Keys represented 56.1 % of children served
countywide. (See Table III-L).
III-I 8
Table III-L
Children Reecivin~ Mental Health Services
Calendar \ ear 20lll
Total Male Female
Persons Served Visits Persons Served Visits Persons Served Visits
%of 0/. of 0/. of 0/0 of 'Yo of
ZIP CODE Number Region Number Region Number Total Number Total Number Percent Number Total
Upper Keys
33036 3 4.0% 3 2.1% 2 66.7% 2 66.7% 1 33.3% 1 33.3%
33037 35 46.7% 65 44.5% 27 77.1% 54 83.1% 8 22.9% 11 16.9%
33070 37 49.3% 78 53.4% 27 73.0% 59 75.6% 10 27.0% 19 24.4%
Subtotal 75 22.7% 146 22.0% 56 74.7% 115 78.8% 19 25.3% 31 21.2%
Middle Keys
33001 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33050 70 100.0% 137 100.0% 51 72.9% 96 70.1% 19 27.1% 41 29.9%
33051 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33052 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 70 21.2% 137 20.6% 51 72.9% 96 70.1% 19 27.1% 41 29.9%
Lower Keys
33040 136 41.2% 326 49.0% 92 67.6% 244 74.8% 44 32.4% 82 25.2%
33041 4 1.2% 4 0.6% 4 100.0% 4 100.0% 0 0.0% 0 0.0%
33042 I 0.3% I 0.2% 0 0.0% 0 0.0% I 100.0% I 100.0%
33043 40 12.1% 47 7.1% 31 77.5% 37 78.7% 9 22.5% 10 21.3%
33044 I 0.3% 1 0.2% 1 0.0% 1 0.0% 0 0.0% 0 0.0%
33045 3 0.9% 3 0.5% 2 66.7% 2 66.7% 1 33.3% I 33.3%
Subtotal 185 56.1% 382 57.4% 130 70.3% 288 75.4% 55 29.7% 94 24.6%
MODroe ",,0 100.0% 665 100.0% 237 71.11% 499 75.0% 93 211.2% 166 25.0%
. .
Source: Department of ChIldren and Famlhes, 2002.
According to the Department of Children and Families, during calendar year 2001, a total
of 472 adults residing in Monroe County received substanc~ abuse services throughout
the different centers in Monroe County. The 472 adults who have been served by
Department of Children and Families Substance Abuse programs have had a total of
1,058 visits for services. Additionally, 58.7% of the clients served were male (or 277)
and the remaining 41.3% were females (or 195). The vast majority of adult substance
abuse services in Monroe County were rendered to persons living in the Lower Keys,
with 59.5% of the client base for 2001. Of the 472 Monroe County adults who received
substance abuse services, the majority 58.7% were male. Males represented the greater
portion of persons seeking substance abuse services countywide and in every zip code
and Florida Keys region, except in Key West (33041) where an equal percentage of
males and females (50.0% or 1 adult) received substance abuse services, (See Table 111-
M).
III-19
Table III-M
Adults Receiving Substance Abuse Services
Calendar Year 2001
Total Male Female
Persons Served Visits Persons Served Visits Persons Served Visits
"/0 of %of %of 0/0 of 0/0 of
ZIP CODE Number Region Number Region Number Total Number Total Number Percent Number Total
Upper Keys
33036 30 30.6% 38 31.1% 16 53.3% 19 50.0% 14 46.7% 19 50.0%
33037 39 39.8% 49 40.2% 22 56.4% 29 59.2% 17 43.6% 20 40.8%
33070 29 29.6% 35 28.7% 17 58.6% 18 51.4% 12 41.4% 17 48.6%
Subtotal 98 20.8% 122 11.5% 55 56.1% 66 54.1% 43 43.9% 56 45.9%
Middle Keys
33001 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33050 94 100.0% 149 100.0% 52 55.3% 91 61.1% 42 44.7% 58 38.9%
33051 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33052 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 94 19.9% 149 14.1% 52 55.3% 91 61.1% 42 44.7% 58 38.9%
ower Keys
33040 219 46.4% 714 67.5% 133 60.7% 497 69.6% 86 39.3% 217 30.4%
33041 2 0.4% 2 0.2% 1 50.0% I 50.0% I 50.0% I 50.0%
33042 26 5.5% 32 3.0~{' 16 61.5% 21 65.6% 10 38.5% II 34.4%
33043 28 5.9% 34 3.2% 15 53.6% 17 50.0% 13 46.4% 17 50.0%
33044 2 0.4% 2 0.2% 2 0.0% 2 0.0% 0 0.0% 0 0.0%
33045 4 0.8% 4 0.4% 4 100.0% 4 100.0% 0 0.0% 0 0.0%
Subtotal 281 59.5% 788 74.5% 17l 60.9% 542 68.8% 110 39.1% 246 31.2%
Monroe 472 100.0% 1,058 100.0% 277 58.7% 698 66.0% 195 41.3% 360 34,0%
Source: Department of Children and Families, 2002.
In 2001, a total of 89 children received substance abuse servIces through programs
available through the Department of Children and Families. Of those 89, 59.6% (or 53)
were males and 40.4% (or 36) were females. Children in Monroe County made a total of
135 visits for substance abuse services in 2001. Children in the Lower Keys represented
70.8% of all children receiving substance abuse services countywide. In the Upper and
Lower Keys, more male children than female children received services; whereas in the
Middle Keys, female children were slightly more likely to be served albeit, the numbers
were low. (See Table III-N).
III-20
Table III-N
Children Recci\in~ Substance Abuse Senices
Calendar Year 2001
Total Male Female
Persons Served Visits Persons Served Visits Persons Served Visits
0/. of 0/0 of 0/0 of 0/. of 0/. of
ZIP CODE Number Region Number Region Number Total Number Total Number Percent Number Total
Upper Keys
33036 1 5.9% I 4.0% 1 100.0% I 100.0% 0 0.0% 0 0.0%
33037 8 47.1% 15 60.0% 5 62.5% 7 46.7% 3 37.5% 8 53.3%
33070 8 47.1% 9 36.0% 3 37.5% 3 33.3% 5 62.5% 6 66.7%
Subtotal 17 19.1% 25 18.5% 9 52.9% 11 44.0% 8 47.1% 14 56.0%
Middle Keys
33001 1 11.1% 1 10.0% 1 lOO.O% I 100.0% 0 0.0% 0 0.0%
33050 8 88.9% 9 90.0% 3 37.5% 3 33.3% 5 62.5% 6 66.7%
33051 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33052 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 9 10.1% 10 7.4% 4 44.4% 4 40.0% 5 55.6% 6 60.0%
Lower Keys
33040 49 55.1% 68 50.4% 29 59.2% 44 64.7% 20 40.8% 24 35.3%
33041 6 6.7% 12 8.9% 6 lOO.O% 12 100.0% 0 0.0% 0 0.0%
33042 2 2.2% 8 5.9% 0 0.0% 0 0.0% 2 100.0% 8 lOO.O%
33043 6 6.7% 12 8.9% 5 83.3% 9 75.0% I 16.7% 3 25.0%
33044 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
33045 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%
Subtotal 63 70.8% 100 74.1% 40 63.5% 65 65.0% 23 36.5% 35 35.0%
Monroe 89 100.0% 135 100.0% 53 59.6% 80 59.3% 36 40.4% 55 40.7%
. .
Source: Department of ChIldren and Famlhes, 2002.
2. Inpatient Mental Health Services
During calendar year 2001, there was one hospital offering inpatient psychiatric services
in Monroe County -- Lower Keys Medical Center - Kennedy Drive with 15 adult
psychiatric beds and 10 child/adolescent psychiatric beds, The utilization rate for adult
psychiatric beds was 77.4%, with an ALOS of 7.5 days. In 2000, the facility ceased
admitting children and adolescents. All of District XI had 701 Adult Psychiatric beds in
2001, a decrease of 114 beds since 1999. The current number of inpatient psychiatric
beds for children and adolescents districtwide is 90, a decrease of 36 beds since 1999.
(See Table III-O).
III-21
Table III-O
Inpalit-nt Ps~chiatric Utilization, Monroe County, 2001
Lic. Avail. Admissions Patient Occup,
Name of Facility Beds Beds Days Rate ALOS
Lower Keys Medical Center - Kennedy Drive
Adults 15 15 568 ~,240 77.4% 7.5
Children 10 NA 0 0 0.0% 0.0
Monroe County Total 25 15 568 4.240 77.4% 7.5
District XI Total 791 769 20.293 219,996 76.2% 10.8
ALOS: Average Length of Stay
Source: Health Council of South Florida, Hospital Utilization Report, Calendar Year 200 I.
3. Inpatient Substance Abuse Services
During calendar year 2001, Monroe County had 20 adult substance abuse beds, and zero
child/adolescent substance abuse beds. Occupancy rates for these adult substance abuse
beds averaged 6.5%, with an ALOS of 4.9 days. (See Table III-P). All of District XI had
an inventory of 131 Adult Substance Abuse beds during this same time period with an
average occupancy rate of 16,5% and an ALOS of 6.1 days. The 1994 closure of the
licensed substance abuse program for children and adolescents at Glenbeigh Hospital left
the district with few services for this population group.
Inpatient Substance Abuse Ulilization, ;\Ionl'ol' County, 2001
Lic. Avail. Admissions Patient Occup. ALOS
Name of Facility Beds Beds Days Rate
Lower Keys Medical Center - Kennedy Drive
Adults 20 NA 96 ~75 6.5% 4.9
Children 0 NA 0 0 0.0% 0.0
Monroe CounlY Total 20 NA 96 ~75 6.5% 4.9
District XI Total 131 NA 1,282 7.879 16.5% 6.1
Table III-P
ALos: Average Length of Stay
Source: Health Council of South Florida, Hospital Utilization Report, Calendar Year 200 I.
E. SCHOOL-BASED HEALTH PROGRAMS
The goals of a comprehensive school health program are to I) promote health, 2) prevent
injury and disease, 3) prevent risky behavior, 4) intervene to help children in need or at
risk, 5) help students with special needs, and 6) promote positive health and safety
behaviors. School health services may vary from the minimum required by law (such as
dental, hearing, vision, and spinal screenings and sports physicals) to the delivery of
hands-on personal health services on school grounds, Sites may utilize different school-
III-22
based and school-linked health center models. They may be staffed by school district
employees, local Department of Health employees or other public or private sources. In
Monroe County, school-based health programs are staffed by either full or part-time
nurses or full or part-time health technicians. There are twelve school-based health
programs operating in Monroe County schools. (See Table III-Q).
Table III-Q
33037
33070
33070
Middte Kevs
33050
330S0
Lower Kevs
33040
33040
33040
33040
33040
33040
350 Sombrero Road
3400 Overseas Highway
S8SS West Jr. College Road
1302 White Strcet
1105 Leon Strect
2100 Fla ler Avenue
121214 Strect
Sig,bee Park
225 Crane Boulevard
x
X
X
X
X
X
X
X
X
X
X
X
X
X
X
F. FLORIDA KEYS HEALTHY START COALITION
The Florida Keys Healthy Start Coalition is a community-based, prenatal and infant care
coalition of private and public agencies, community-based providers, and private
providers in Monroe County. The Coalition is organized under the authority of the
Department of Health to implement the provision of Florida's Healthy Start legislation in
Monroe County. It is the intent of the Healthy Start legislation to establish a system that
guarantees that all women have access to prenatal care and that all infants have access to
services that promote normal growth and development.
The local Coalition was organized in 1992 and is funded through a $150,000 annual
contract with the Florida Department of Health. The Coalition, which spans Monroe
County, is composed of 30 voting members from community-based providers, interest
groups, and concerned citizens. Healthy Start Care Coordinators provide childbirth
III-23
education, stress management, home visitation, parenting skills, nutritional information,
breast feeding education, baby spacing information, and counseling regarding financial
assistance programs for pregnancy and infant care costs.
The Florida Keys Healthy Start Coalition has a Healthy Babies fund to assist pregnant
women, including undocumented aliens, with their prenatal care costs. As of September
2002, the Coalition has assisted 16 Healthy Start clients, for the 2002-2003 program year,
with support totaling over $4,359.57. The Coalition increased the Healthy Babies
allocation from $3,500 per year to $7,500. However, it appears that the Healthy Babies
allocation this upcoming year may not be enough to assist residents with prenatal care
expenses due to an increase in assistance requests.
The percentage of women in Monroe County receiving Healthy Start Prenatal Risk
screenings in 2001 (30.3%) declined to 38.2%. The Monroe County percentage
decreased less significantly than the State's percentage. The State percentage in 2001
was 48.0% compared to the Monroe County percentage of30.3% during the same year.
The percentage of pregnant women entering prenatal care within the first trimester has
declined from 90.0% in 1998 to 83.6% in 2000. Based on local surveys, the number one
reason for pregnant women not receiving prenatal care is financial. Insurance premiums
continue to rise; and in Monroe County many small businesses are unable to offer
affordable insurance to their employees or have reduced coverage for maternity care. In
addition, many families in Monroe County exceed the income eligibility criteria for State
subsidized insurance programs. Economically disadvantaged women, whether illegal or
legal residents, struggle to find doctors or midwives who can provide them with prenatal
care.
The Florida Keys Healthy Start Coalition maintains a detailed inventory of the resources
available for pregnant and parenting women in Monroe County. The inventory provides
information and includes, but is not limited to, the number of pediatricians, obstetricians,
gynecologists, and other health care facilities located in the County. The Coalition has
III-24
observed significant changes in medical resources over the past three years. The
Coalition counts only eight pediatricians in all areas of the Keys, which is two fewer than
practiced within the County three years ago. The Naval base provides a pediatric clinic
for military dependents but they have decreased their hours of operation to Monday
through Friday. One of the most critical setbacks for Monroe County has been the 10ss of
several OB/GYN physicians in the Middle and Upper Keys. According to the Coalition
there are five obstetricians in Key West, as opposed to eight in 1999. As of January
2002, the only obstetrician in the Middle Keys that accepted Medicaid discontinued his
practice due to the high cost of malpractice insurance. There are no local OB/GYN
providers in the Upper Keys, although there are OB/GYNs who visit from Miami-Dade
County and provide services one day per week in either the Upper or Middle Keys.
The Healthy Start Coalition developed an excellent communication and referral system
with two hospitals in Miami-Dade County, Baptist Hospital and Miami Children's
Hospital. A strong relationship with hospitals in Miami-Dade County is very important
because women in the County must deliver either in Key West, at Lower Keys Medical
Center, or at a hospital in Miami-Dade County. Live births average slightly more than
700 per year. Of Monroe County women surveyed by Healthy Start, 41.0% stated that
they sought care and delivery services in Miami-Dade County. The vast majority of out-
of-county births were uncomplicated deliveries, but the Lower Keys Medical Center in
Key West has been able to provide initial care, treatment and stabilization to high risk
mothers, and arrange for transportation to tertiary care facilities located on the mainland.
Infants requiring neonatal intensive care have also been transported to the mainland. The
closest NICU facilities are located at Baptist Hospital, South Miami Hospital and Miami
Children's Hospital, all of which are 10cated in Miami-Dade County.
III-25
G. NURSING HOMES
The swell in the numbers of baby-boomers places an even greater emphasis on services
for the elderly than in previous years. In 2000, 14.6% of Monroe's population or 11,521
residents were 65 or older; 3.1% lower than the state's percentage of elderly residents
(17.7%). With Monroe County's high numbers of elderly -- and even more projected by
the year 2020 -- the need for a comprehensive array of long-term care services is
paramount. Formallong-term care services in Monroe County are limited as they are
primarily offered within nursing home facilities. A variety of social support services are
offered through Older Americans Act services provided by Monroe County Social
Services. These services include congregate meals, in-home assistance and
transportation. Moreover, many residents provide informal support services to older
persons. Nonetheless, the isolation of many older residents impacts their health and well-
being, underscoring the importance of formal residential services for those in need.
Though nursing homes are generally associated with the needs of the frail and sick
elderly, illness and injury, which can require long-term care, can occur throughout life.
More restrictive than Assisted Living Facilities (ALFs), nursing homes are a less costly
alternative to inpatient hospital care and are in increased demand due to longer lifespans
and diseases such as Alzheimer's disease. All nursing homes have SNF (Skilled Nursing
Facility) beds, with skilled care provided by an array of RNs and LPNs providing 24
hour, 7 day per week daily living and medical care_
The demographics of those who reside in nursing homes in District XI differ slightly
from the state as a whole. District Xl's nursing homes have a higher percentage of the
younger population. The state's proportion of those residents in nursing homes that are
under 70 years of age is 11.8, while District Xl's is 15.6. Within the District, Monroe
County has a higher proportion of residents between ages 50 and 79 than Miami-Dade
County and a lower proportion of residents older than 89 years, The nursing homes of
District XI are culturally diverse, with 21 different language capabilities.
III-26
During calendar year 2001, there were 3 licensed nursing homes in Monroe County -
Key West Convalescent Center, Marathon Manor, and Plantation Key Convalescent
Center. Together, these three nursing homes had a total of 360 nursing home beds in
2001, comprising 4.2% of all nursing home beds in District XI. The nursing home
occupancy rate for Monroe County in 2001 was 68.6%. Occupancy rates have decreased
since 1997 (81.0%) to 2001 (68.6%). (See Table 1II-R and Map 111-6).
Table III-R
"ursin:: Hnme Utili'.linn, \Innrnc ('nunt~. 2001
Total Total Total Medicaid Medicare
Lic. Avail. Patient Occup. Patient Percent Patient Percent
Name of Facility Beds Beds Days Rate Days Medicaid Days Medicare
Key West Convalescent Center 120 120 34.716 79.3% 26,068 75.1% 6,425 18.5%
Marathon Manor 120 120 27,166 62.0% 19.984 73.6% 3,430 12.6%
Plantation Kev Convalescent Centcr 120 120 28,228 64.4% 21.344 75.6% 4,169 14.8%
Total Nursin~ Home Facilities 360 360 90,110 68.6% 67,396 74.8% 14024 15.6%
District XI Total 8,627 8.587 2,660,266 89.2% 1.920.159 72.2% 313,556 11.8%
Source: Health CouncIl of South Flonda, Nursmg Home and Skillcd Nursmg Urnt Uuhzatlon Report, Calcndar Y car 200 I.
H. ASSISTED LIVING FACILITIES
Assisted Living Facilities (ALFs) offer a combination of long term, low level health care
such as supervision or assistance with daily living or higher levels of care, such as for
those affected by Alzheimer's disease. These services include meals, housing, personal
care and recreation. Many ALFs provide limited medical and support services, and as
such serve as diversion programs to avoid more-costly and restrictive institutionalization
in nursing homes. There are a total of 3 ALFs in Monroe County; each with a capacity of
less than 40 beds. However, it should be noted that Peacock House and The Heron
primarily serve as group homes for adults with mental illness. The Peacock House and
The Heron are licensed by the Agency for Health Care Administration to provide limited
menta 1 health services. (See Table 1II-S and Map II1-7).
III-27
Table III-S
Monroe County ALF by Zip Code
Zip Code Facility Address City Beds
33040 Bayshore Manor 5200 Jr. College Road Kev West II
33040 The Peacock House 2221 Patterson A venue Key West 8
33050 The Heron 1320 Coco Plum Drive Maralhon 16
. .
Source: Agency for Heallh Care AdmmtstratlOn, FacIlity Locator, July, 2002. AvaIlable at: www.floridahealthstat.com.
I. HOME HEALTH AGENCIES
In Florida, the Agency for Health Care Administration licenses home heath agencies to
send both skilled (RN's, therapists, social workers) and unskilled (home health aides,
certified Ilursing assistants, homemaker/companions) staff into a patient's home. They
may also provide staffing to health care facilities on a temporary basis. The three home
health agencies in Monroe County employ approximately 32.6 registered nurses, 19.6
home health aides, 9.5 physical therapists, as well as speech therapists, occupational
therapists, medical social workers, and a registered dietician. In 2001, home health
agencies in Monroe County served 1,336 patients, and made approximately 32,462 home
visits. (See Tables III-T and III-V).
Table III- T
Monroe County Home Health Agencies by Zip Code
Zip Code Facility Address City Phone
33070 Lifeline Home Health Care 92300 Overseas Highway Tavernier (305) 853-0363
33040 Lifeline Private Duty Services, Inc. 2027 Flagler Avenue Kev Wesl (305) 295-8189
33040 Visiting Nurse Assoc. of the Florida Keys 1319 William Street Key West (305) 294-8812
Source: Agency for Health Care Administration, Facility Locator, July, 2002. Available at: www.flondahealthstat.com.
Table III-V
\Ionroe (ounty Home Health Agenc~ Statistics
'ullIher oj Patients Sened. 'umber of Visits. and ~ull- lime E'lui\alent Slatl
Patients Physical Regbtered Health Speech Occupational Social Rrglstered
Facility Served Visits Therapists ~urses Aides Thenpists Therapists Worker Dledclan
Lifeline Home Health Care 348 8.887 3.5 6 4
Lifeline Private DUtY Services, Inc. 106 N/A 3 4.5 2 0.25 0.25
Visitina Nurse Assoc. of the Florida Kevs 882 23.575 3 22.1 13.6 0.5 0.25 2 0.25
Total 1.336 32.462 9.5 32.6 19.6 0.75 0.5 2 0.25
Source: Self-reported by home health agenclcs, 2002.
III-28
J. IN-HOME SERVICES FOR THE ELDERLY
There is a limited scope of services available for elderly persons residing in Monroe
County. Four agencies offer a combination of either health or social services for the
elderly, Many services are available for all older persons; others are available to 10w-
income or disabled elderly persons. (See Attachment 1II-4),
The Monroe County Social Services Department offers seven programs for the elderly
including: senior centers, family caregiver support, a special needs registry, a senior
employment program, nutrition program, welfare/medical assistance program, and a
transportation program. Lifeline Health Care of South Florida, Inc. and the Visiting
Nurse Association of the Florida Keys have offices in the Upper and Lower Keys and
offer a variety of in-home medical services through their designation as home health
agencies. Additionally, the agency offers other in-home services including homemaker
assistance, Griswold Special Care's home care program provides companionship,
escorts, home health aides, live-in companions, meal preparation, among other services to
assist the elderly or home-bound with daily activities. For more information on services
available for the elderly, contact the Alliance for Aging's Elder Helpline at (305) 670-
4357.
K. HOSPICE
Hospice care provides services for persons with any type of end-stage illness, such as
cancer, heart disease, AIDS, and Alzheimer's disease. The type of care provided by
hospice is comfort oriented and focuses on quality of life by addressing the physical,
emotional and spiritual needs of both the patient and the family. Personal care is
provided in the patient's place of residence, whether at home, in a long-term care facility,
or at a nearby hospital.
There are two licensed hospices providing inpatient services in Monroe County, Hospice
Care of Southeast Florida and Hospice of the Florida Keys. According to data provided
III-29
by the Agency for Health Care Administration, Hospice Care of Southeast Florida
reported a total of 431 admissions in District XI (Miami-Dade and Monroe Counties)
during calendar year 2001. Hospice of the Florida Keys, which operates solely in
Monroe County, reported a total of 106 admissions during the same time period. All of
District XI has five licensed hospices providing inpatient services. In 2001, all of District
XI had 6,566 patients that were admitted to hospice, representing 9.6% of the State's total
admissions (68,264). (See Table III-V).
Table III-V
Hospice Admissions, Monroe County, District XI, and Florida, 2001
First Second Third Fourth
Quarter Quarter Quarter Quarter Total
HospiCe 2001 2001 2001 2001 2001
Hospice Care of Southeast Florida* 99 87 105 140 431
Hospice of the Florida Keys 21 37 23 25 106
Monroe County 120 124 128 165 537
District XI Total 1,736 1,534 1,622 1,664 6,566
Florida Total 17,868 16,781 16,407 17,208 68,264
Source: Agency for Health Care Administration, Certificate of Need Policy Planning, 2002.
Note: * Data reflects hospice admissions in both Miami-Dade and Monroe Counties.
L. CIDLD CARE FACILITIES
Increasing numbers of preschool age children are being cared for outside of the home.
This is partly a consequence of a greater number of women with young children entering
the workforce. In 2001, there were 3,393 children under the age of five in Monroe
County. There are a total of 31 child care facilities, which are licensed by the Florida
Department ofChildren and Families, in Monroe County. The capacity of these facilities
ranges from 15 to 235. The Lower Keys has the greatest number of child care facilities
with 15 providers, followed by the Upper Keys with 12 providers, and the Middle Keys
with 4 providers. (See Table III-Wand Map 111-8). In addition to these 31 child care
facilities, there are 7 licensed and 53 registered family home day care providers located
throughout the Keys that serve small numbers of children; capacity sizes range from 5 to
10.
III-30
Table III-W
Zip Code Name Capacity Address Phone
Upper Kevs
I 33036 Paradise Play School 25 86450 Overseas H\W 305-852-0899
2 33036 St. James Children's Center 50 87500 Overseas H\W 305-852-2161
3 33037 First Baotist Church Jack Hill Child Care Center 55 99001 Overseas H\W 305-451-2125
4 33037 Island Preschool 78 5 Transvlvania A venue 305-451-1181
5 33037 Key Largo School 15 10480 I Overseas H\W 305-451-1511
6 33037 Little Sea Horse Academv 40 104960 Overseas H\W. 305-451-6045
7 33037 Montessori in Kev Largo, Inc. 35 99341 Overseas H\W. 305-451-0146
8 33037 Precious Lambs Christian Child Care 23 100390 Overseas H\W 305-451-2109
9 33070 Burton Memorial Child Develooment Center 34 93000 Overseas H\W 305-852-0250
10 33070 Creative Plavschool Cooo 25 93000 Overseas H\vv 305-852-2581
II 33070 Montessori Island School 150' 92295 Old Slate Road 305-852-3438
12 33070 Under the Sea Preschool and Day Care 52 90001 Overseas Hwy 305-853-9797
Middle Kevs
13 33050 ABC Dav School 100* 6530 65 Street, Ocean 305-743-3521
14 33050 Community Coonerative Preschool 34 550 122 Street, Ocean
15 33050 Grace Jones Dav Care Center 36 23041 Street, Gulf 305-743-6064
16 33050 Happy Apple Preschool, Inc. 46 12350 Overseas Hwy. 305-743-9020
Lower Kevs
17 33040 Easter Seals- Teachinl! Little Children 30 5520 Collel!e Road 305-294-1089
18 33040 Frederick Doul!lass Child Care 49 103 Olivia Street 305-294-3934
19 33040 Frederick Doul!lass Gvm 25 111 Olivia Street 305-292-8190
20 33040 Grace Lutheran School 235 2713 Flal!ler Avenue 305-296-8262
21 33040 Grouper Lane Preschool 66 735 Grouper Lane 305-852-9520
22 33040 Inez Martin Child Care Center 102 1100 Varela Street 305-296-5231
23 33040 Kev West Preschool Cooo, Inc. 30 2610 Flagler A venue 305-296-4749
24 33040 Little Conch Academv, Inc. 76 1501 7 Street 305-294-4653
25 33040 Montessori Children's School 75 1221 Varela Street 305-294-5302
26 33040 Safe Port Child Care 76 1400 Kennedy Drive 305-295-1505
27 33040 Sunbeam Christian School 115* 1311 5 Street 305-294-6018
28 33040 Temple Christian Preschool 100 5727 Second A venue 305-294-2775
29 33042 Banana Cabana Academv 55 22673 Pieces of Eight Road 305-745-1400
30 33043 Bil! Pine Kev Co-Operative Preschool 27 255 Crane Blvd. 305-872-0088
31 33043 Sunshine Nursery School 45 30050 Pond Lane 305-872-2432
Source: Florida Department of Children and Families licensed child care facilities, 2002. Available at www.myflorida.com
*Montessori Island School total capacity = 150; Pre-K capacity = 60.
ABC Day School total capacity = 100; Pre-K capacity = 25.
Sunbeam Christian School total capacity = 115; Pre-K capacity = 15.
M. TRANSPORTATION SERVICES
Transportation is a uniquely difficult issue for residents of Monroe County due to the
narrow 112 mile geography of the County. There are two transportation services which
are available to all residents of Monroe County. The Dade-Monroe Express operates
III-31
between Marathon (approximately Mile Marker 50) in Monroe County and Florida City
in Miami-Dade County. The Dade-Monroe Express is funded through a grant by the
South Florida Workforce Development Board in Miami and the Welfare to Work
program. The cost of this bus service is only $1.50 one-way and was developed to
provide transportation for workers in either Monroe or Miami-Dade to and from work.
The route runs between Publix in Marathon (mile marker 50) and Wal-Mart in Florida
City (33501 South Dixie Highway). The. bus makes three designated stops (at mile
markers 98, 90, and 74) but it will stop upon hail within the Keys.
The Florida Coordinated Transportation System provides trips for transportation
disadvantaged (TD) persons in two population groups. The first group includes all
persons who are elderly, disabled, and/or low-income. These persons are the potential
TD population (formerly referred to as TD Category I), whom are eligible for trips
purchased by social service agencies. The second population group is the TD population,
which includes persons who are transportation disadvantaged according to the eligibility
guidelines in Chapter 427, Florida Statutes (i.e., persons who are unable to transport
themselves or to purchase transportation, and children who are "high risk" or "at-risk").
These individuals, formerly referred to as TD Category II are eligible for trips purchased
through the state TD Trust Fund as well as for trips purchased by social service agencies.
The Guidance Clinic of the Middle Keys, Inc. (OCMK) provides a variety of
transportation services in the course of accomplishing its primary mission of delivering
mental health and substance abuse treatment and care. It is also the Community
Transportation Coordinator (CTC) for Monroe County, and is responsible for
administering the annual Transportation Disadvantaged (TD) appropriation, as well as the
development and administration of a countywide system of transportation for all Monroe
County residents who are transportation disadvantaged. OCMK is also the Medicaid
Transportation Coordinator, responsible for arranging transportation for individuals on
Medicaid.
III - 32
In 2001, a total of 1,891 passengers utilized the Transportation Disadvantaged program,
38.3% fewer passengers than served in 2000, According to the CTC, this decrease may
be partially due to changes in reporting patterns. In 2001, there was a 1,107.4% increase
in passenger no-shows compared to 2000. (See Table III-X). Those 1,891 passengers
made a total of 94,567 trips. The most common type of service provided by the TD was
for ambulatory trip services, followed by fixed-route services. (See Table III-Y). Children
utilized TD more than any other passenger type, making more than 52,000 trips.
Disabled persons also utilized the TD at a high frequency, Other (Disabled) and the
Elderly (Disabled) made 18,913 and 4,728 trips, respectively. Overall, elderly persons
made 9,457 trips. (See Table 111-2).
Table III-X
Table III- Y
Commendations
o
2
NA
B Ty e of Service
Fixed Route
Deviated Route
Ambulatory
Non-Ambulatory
StreIcher
School Board Services
Total Trips
Source: The Commission for the Transportation Disadvantaged.
200/ Annual Performance Report. 2002.
39.1%
Complaints
-50.0%
Passenger No-Shows
54
652
1107.4%
Unmel Tri Re uest 12 12
Source: The Commission for the Transportation Disadvantaged.
2001 Annual Performance Report, 2002.
0.0%
Table III-Z
Monroe County Transportation Disadvantaged Operating Data,
Passenger Trip Information 2UIl!
By Passenger Type
Elderly 9,457
Elderly (Disabled) 4,728
Elderly (Low Income) 0
Elderly (Disabled & Low Income) 0
Children 52,012
Children (Disabled) 0
Children (Low Income) 0
Children (Disabled & Low Income) 0
Other 9,457
Other (Disabled) 18,913
Other (Low Income) 0
Other (Disabled & Low Income) 0
Total Trips 94,567
Source: The Commission for the Transportation Disadvantaged,
2001 Annual Peiformance Report, 2002.
III - 33
Forty percent of all trips made using Transportation Disadvantaged had a life-sustaining
purpose. The second leading trip purposes were to obtain educational, training, or day
care. (See Table III-AA). The majority of funding for TD trips is through the
Commission for Transportation Disadvantaged, through other unspecified 10cal agency
funding, and through the Agency for Health Care Administration. (See Table III-AB).
Table III-AA
Table III-AB
B Tri Purpose
Medical
Employment
EducationlTraininglDaycare
Nutritional
Life Sustainin
Total Trips
Source: The Commission for the Transportation Disadvantaged.
2001 Annual Performance Report. 2002.
# Trips % of Total
42,009 44.4%
12,155 12.9%
o 0.0%
2.0% 0 0.0%
40.0<!/(l 0 0.0%
100% Other 40.403 42.7%
Total Trips 94,567 100%
Source: The Commission for the Transportation Disadvantaged,
2001 Annual Perfonnance Report, 2002.
N. FINDINGS
Access to health care is an important determinant of a community's health status. In
Monroe County, the following findings and conclusions are illustrated regarding
availability and access to health care services.
~ Primary care, which is considered the least costly level of care, focuses on
prevention, early detection and diagnosis. Rural Health Network operates two
primary care clinics and Lower Keys Medical Center (College) has a walk-in clinic
for those who do not have health care insurance. Low-income residents can obtain
primary care services at two MediVans which travel along highway US I in the
Upper, Middle and Lower Keys. The MediVans offer a variety of primary care
services, including women's health, immunizations, disease control and management,
physical exams and wound care.
~ There are six Monroe County Health Department sites throughout the county; four of
which provide direct patient care services, including primary care, immunization,
early intervention, epilepsy care, family planning, and STD/HIV services.
III-34
% There are four hospitals in Monroe County, three of which provide general care. A
number of surgical services, such as cardiac and neurosurgery, and all tertiary care
services are unavailable in Monroe County. Residents requiring such services are
generally referred to facilities in Miami-Dade County.
% Monroe County hospitals experienced a 15.8% increase in acute care admissions
since 1997.
% There are ten programs which provide mental health and/or substance abuse services
within Monroe County, seven of which are located in the Lower Keys. According to
the Department of Children and Families, adult females and male children made up
the majority of the client base receiving mental health services in 2001. Adult males
and male children made up the majority of clients receiving substance abuse services
in 2001.
% During calendar year 2001, Monroe County had 20 adult substance abuse beds;
occupancy rates for these beds averaged 6.5% with an Average Length of Stay of 4.9
days.
% There were twelve school-based health programs operating in Monroe County
Schools during the 2001/2002 school year. These were staffed by a nurse and/or a
health technician. School health services must provide dental, hearing, vision and
spinal screenings and sports physicals under the minimum requirements by law.
% The Florida Keys Healthy Start Coalition provides prenatal and infant care
coordination to mothers in Monroe County. The Healthy Babies fund assists all
pregnant women, including those who are undocumented with their prenatal care
costs. The Coalition maintains a resource inventory of health care providers as well
as maintains working relationships with hospitals in Miami-Dade County in order for
Monroe residents who need special tertiary care or who choose to deliver outside of
the County.
% During calendar year 2001, there were three licensed nursing homes in Monroe
County, which were licensed for 360 nursing home beds. The nursing home
occupancy rate for Monroe County in 2001 was 68.6%; a substantial decrease from
1997 when the occupancy rate was 81.0%.
III - 35
~ There are three assisted living facilities in Monroe County (Bayshore Manor, The
Peacock House, and The Heron), each with a capacity of less than 40 beds. However,
it should be noted that Peacock House and The Heron primarily serve as group homes
for adults with mental illness.
~ There are three home health agencies in Monroe County, all of which are licensed to
send both skilled and unskilled staff into a patient's home to provide care.
~ There are two licensed hospices providing inpatient services in Monroe County,
Hospice Care of Southeast Florida and Hospice of the Florida Keys. According to
data provided by the Agency for Health Care Administration, Hospice Care of
Southeast Florida reported a total of 431 admissions in District XI (Miami-Dade and
Monroe Counties) during calendar year 2001. Hospice of the Florida Keys, which
operates solely in Monroe County, reported a total of 106 admissions during the same
time period.
~ In 2001, there were 3,393 children under age five living in Monroe County and a total
of 31 child care facilities. In addition to child care facilities, there are 7 licensed and
53 registered family home day care providers which provide child care out of their
homes.
~ Countywide public transportation is a unique difficulty for Monroe County due to its
geography. The Dade-Monroe Express provides affordable transportation, at $1.50
one-way, and is funded by the Welfare to Work program. The bus travels from
Marathon to Florida City. The Transportation Disadvantaged (TD) provides
transportation for the elderly, disabled and low-income as well as for the
transportation disadvantaged.
III-36
Attachments
111-1: Utilization of Monroe County Health Department Clinics by Monroe County
Residents, Calendar Year 2001.
111-2: Monroe County Primary Care Physicians
111-3: Monroe County Specialists
111-4 Monroe County In-Home Programs for the Elderly
Maps:
III -1: Monroe County Public Health Centers
111-2: Monroe County Primary Care Physicians
111-3: Monroe County Specialists
111-4: Monroe County Hospitals
111-5: Monroe County Mental Health and Substance Abuse Programs
111-6: Monroe County Nursing Homes
111-7 Monroe County Assisted Living Facilities
111-8: Monroe County Child Care Facilities
III - 3 7
Attachment 111-1
Clients
Upper Keys
33036
33037
33070
Subtotal
Middle Keys
33001
33050
33051
33052
Subtotal
Lower Keys
33040 3,125 9,396 3.0
33041 86 371 4.3
33042 312 723 2.3
33043 238 567 2.4
33044 8 10 1.3
33045 56 158 2.8
Subtotal 3,825 11,225 2.9
Total 5,548 14,729 2.7
Source: Monroe County Health Department, Operations Office, 2002.
165
651
292
1,108
292
1,261
558
2,111
1.8
1.9
1.9
1.9
19
576
9
11
615
39
1,322
15
17
1,393
2.1
2.3
1.7
1.5
2.3
III-38
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Attachment 111-4
Monroe County, 2002
In-Home Programs for the Elderly
Source: Alliance for Aging, Elder Helpline, September, 2002.
Lower Kevs
33040 - Monroe County Social Services Department
1100 Simonton S1., Room 1-204
Key West, FL
Community/In-Home Services
Program: Senior Centers
Available Services: Senior Centers
Program: Family Caregiver Support Program Title III-E
Available Services:
Adult In-Home Respite Care
Case Management
Home Delivered Meals
Home/Community Based Care Financing
Homemaker Assistance
Personal Care
Respite Care
State Medi-CalIMedicaid Waiver Programs
Emergency/Disaster Services/Crime Related
Program: Special Needs Registry
Available Services:
Special Needs Shelter Care
Transportation (Disaster Victims, Disabilities, Older Adults)
Electric Bill Assistance (Older Adults)
Evacuation Transportation (Disaster Victims)
Mass Shelter Care (Disaster Victims)
Burial Services
Cremation
Rent Assistance
Utility Assistance
Employment and Financial Services Assistance
Program: Senior Employment Program
Available Services:
Job Training
Senior Community Service Employment Programs
Food and Personal Goods
Program: Nutrition Program
Available Services:
Congregate Meals
Home Delivered Meals
Nutrition Education
Clothing
Emergency Food
III -44
Attachment 111-4 (continued)
Health Care Services
Program: Welfare Program/Medical Assistance Program
Available Services:
Community Clinics (Low Income)
Health Care (Low Income)
Presciption Expense Assistance (Low Income)
Transportation
Program: Transportation Program
Available Services:
Disabled Transportation
Transportation (Older Adults)
33040 - Lifeline Health Care of South Florida - Lower Keys
2027 Flagler A venue
Key West, FL
Health Care Agencies
Program: In-Home Services
Available Services:
Case Management
Chemotherapy/Radiation Therapy
Enterostomal Therapy
Home Health Aides
Home Health Care
Home Nursing
Homemaker Assistance
IV Therapy
Medical Equipment/Supplies
Medical Social Work
Occupational Therapy
Personal Care
Physical Therapy
Speech Therapy
Ventilator Care
III -4 5
Attachment 111-4 (continued)
33040 - Griswold Special Care - Monroe County
3434 Riviera Drive
Key West, FL
Community/In-Home Services
Program: Home Care Services
Available Services:
Companionship
Escort
Home Health Aides
Homemaker Assistance
In-Home Meal Preparation
Live-In Companions
Live-In Housekeeping Assistance
Personal Care
Transportation
33040 - Visiting Nurse Association of the Florida Keys
1319 William Street
Key West, FL
Home Care Agency
Program: In-Home Services
Available Services:
Case Management
Chemotherapy
Companionship
Enterostomal Therapy
Escort
Home Health Aides
Home Health Care
Home Nursing
Homemaker Assistance
IV Therapy
Medical Supplies
Medical Response System
Medical Social Work
Occupational Therapy
Pain/Symptom Management
Personal Care
Physical Therapy
Respite Care
Speech Therapy
Wound Care
111-46
Attachment 111-4 (continued)
Upper Kevs
33070 - Lifeline Health Care of South Florida - Upper Keys
92300 Overseas Highway
Tavernier, FL
Health Care Agencies
Program: In-Home Services
Available Services:
Case Management
Chemotherapy/Radiation Therapy
Enterostomal Therapy
Home Health Aides
Home Health Care
Home Nursing
Homemaker Assistance
IV Therapy
Medical Equipment/Supplies
Medical Social Work
Occupational Therapy
Personal Care
Physical Therapy
Speech Therapy
Ventilator Care
33070 - Visiting Nurse Association of the Florida Keys
92001 US 1
Tavernier, FL
Home Care Agency
Program: In-Home Services
Available Services:
Case Management
Chemotherapy
Companionship
Enterostomal Therapy
Escort
Home Health Aides
Home Health Care
Home Nursing
Homemaker Assistance
IV Therapy
Medical Supplies
Medical Response System
Medical Social Work
Occupational Therapy
Pain/Symptom Management
Personal Care
Physical Therapy
Respite Care
Speech Therapy
Wound Care
III -47
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IV. HEALTH CARE UTILIZATION AND FINANCING
This section provides a review of inpatient utilization of health care within and outside
Monroe County. It also explores the financing of that care by various payer sources, at
both the regional and County level, compared to the State as a whole.
There are four hospitals available to Monroe County residents within the three regions of
the Florida Keys; each individual resident is within 45 minutes of a general hospital. In
2001, the residents of Monroe County accessed primarily Lower Keys Medical Center
(College) for inpatient care at 38.9%. Fishermen's Hospital, Mariners Hospital, and
Lower Keys Medical Center (Kennedy) followed with 13.9%, 11.1%, and 6.0%,
respectively, of total discharges for the area.
Of the 10,322 hospital discharges by Monroe County residents in 2001, slightly more
than one-quarter (26.7% or 2,751) were by County residents utilizing 18 hospitals located
in Miami-Dade County. Baptist Hospital of Miami showed considerable utilization at
7.8%, followed by Mt. Sinai Medical Center & Miami Heart Institute, and South Miami
Hospital at 3.8% and 3.4%, respectively. An additional 1.4% of hospital discharges by
Monroe County residents were from four Broward County hospitals; however, the
percentage for each hospital was 0.2% for each of these inpatient facilities. (See Figure
IV-A and Attachment IV-i).
IV-I
Figure IV-A
Monroe County Residents
2001 Hospital Inpatient Discharges
All Other Hospitals
2.1%
\ Broward County
Lower Keys Medical \, / Hospitals
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Hospitals
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Source: 2001 Hospital Inpatient Data File, Bureau for Health Statistics, Agency for Health Care Administration,
A. AVERAGE LENGTH OF STAY AND HOSPITAL DISCHARGES
Based on 2001 data, the average length of a hospital stay by Monroe County residents
was 4.9 days, comparable to the State's 4.8 days. The average length of stay at the
regional level was 5.2 in the Upper Keys, followed by 4.9 and 4,6 in the Lower and
Middle Keys, respectively. The average by zip code varied from a low of 4.2 in
Sugarloaf Shores (33044) to a high of 5.4 in Key Colony Beach (33051) and Tavernier
(33070). The total number of hospital discharges countywide was 10,322 with more than
half (5,830) corresponding to residents from the Lower Keys. Hospital discharges for the
remaining two regions equaled 2,740 for Upper Keys residents followed by 1,752 for
Middle Keys residents. The number of hospital discharges for Monroe County at the zip
code level ranged from 31 to 4,502. The highest frequency of discharges corresponded to
residents from Key West (33040), Key Largo (33037), Marathon (33050), Tavernier
IV-2
(33070), Summerland Key (33042), Big Pine Key (33043), and Islamorada (33036). (See
Table IV-A).
B. DISCHARGES FROM HOSPITALS BY PATIENT'S RACE AND
GENDER
Countywide, more than three-quarters (79.2%) of hospital discharges in 2001 were
among White residents. White Hispanic and Black residents followed with 9.7% and
6.3% of hospital discharges, respectively. At the regional level, the largest percentage of
hospital discharges in the Lower, Middle and Upper Keys was among White residents.
The second largest percentage in the Lower Keys was among individuals of the Black
race at 8.7% followed by White Hispanics at 8.5%. In the Middle and Upper Keys, the
second largest percentage was among White Hispanic residents at 13.4% and 10.0%,
respectively.
In 2001, a slightly higher percentage of Monroe County males (50.6% or 5,218) than
females (49.4% or 5,104) were discharged from hospitals. A higher percentage of
hospital discharges among males was also reflected among Lower (51.5% vs. 48.5%) and
Upper Keys (50.1% vs. 49.9%) residents. Only in the Middle Keys were more females
(51.8%) than males (48.2%) discharged from hospitals. (See Table IV-B).
C. DISCHARGES FROM HOSPITALS BY PATIENT'S AGE
In 2001, there were a total of 10,322 Monroe County resident hospital discharges. The
largest percentage of hospital discharges for Monroe County residents was among infants
under age one at 8.8% (or 906) and individuals between the ages of 70 and 79 years old,
ranging from 8.0 to 8.1 %. The next highest hospital discharge percentage among Monroe
County residents was for individuals between the ages of 45 and 54 years old, ranging
from 7.5 to 7.7% and for people between the ages of 65 to 69 years old at 6.6%. The
percentage for other age categories varied from 6.4% to a low of 0.9%. The lowest
IV-3
percentages were found among children between 10 and 14 years of age (0.9%) and
children between 5 to 9 years old (1.1 %).
Regional data indicate that the largest percentage of hospital discharges for Lower Keys
residents was among infants under age one at 10.3% (or 598) and individuals between the
ages of 45 and 54 years old, ranging from 7.9 to 8.5%. Comparable to countywide age
distributions, the lowest percentages were found among children between 10 and 14 years
of age (0.9%) and children between 5 to 9 years old (1.3%). For the Middle and Upper
Keys, the largest percentage of hospital discharges was among older individuals between
the ages of65 and 79 years. For example, the largest percentage of hospital discharges in
the Middle Keys was among persons between the ages of 75 and 79 years old at 11.2%,
followed by individuals between 65 and 74 years of age, ranging from 8.4 to 9.9%, The
lowest percentages of hospital discharges in the Middle Keys were also found among
children between 10 and 14 years of age (0.7%) and children between 5 to 9 years old
(1.1%). The percentage for other age categories varied from 7.5% to a low of 1.5%. Age
distributions for hospital discharges in the Upper Keys showed that the largest percentage
of hospital discharges was among individuals 70 to 74 years old (10.6%) followed by
persons between 75 and 79 years of age (9.1 %) and individuals 65 to 69 years of age
(7.5%). The lowest percentages in the Upper Keys were found among children between
5 to 9 years old (0.8%) and children between 10 and 14 years of age (0.9%). (See Table
IV-C).
D. REASONS FOR HOSPITALIZATION
1. Hospital Discharges from Monroe County Hospitals
~ Monroe County Residents
According to the 503 diagnosis related groups (DRGs) in 2001, the leading reasons for
hospitalization by Monroe County residents were psychoses (372) and vaginal delivery
without complicating diagnoses (370), each accounting for 3.6% of the County's hospital
IV-4
discharges. (See Table IV-D). Other frequently utilized DRGs include neonate with
other significant problems at 353 (or 3.4% of the County's total discharges), heart failure
and shock with 262 (or 2.5% of the County's total discharges), other permanent cardiac
pacemaker implant or Percutaneous Transluminal Coronary Angioplasty (PTCA) with
coronary artery stent implant at 245 (or 2.4% of the County's total discharges) and
normal newborn deliveries at 233 (or 2.3% of the County's total discharges).
Statewide, the leading reasons for hospitalization were normal newborn deliveries (5.6%
or 126,771) and vaginal delivery without complicating diagnoses (5.1 % or 116,493).
Other frequently utilized DRGs include psychoses at 3.6% (or 82,711 of the State's total
discharges), heart failure and shock at 3.0% (66,999 of the State's total discharges) and
chest pain at 2.7% (or 62,124 of the State's total discharges).
Regional data show that the leading reasons for hospitalization among Lower Keys
residents in 2001 were psychoses at 316 (or 5.4% of the region's total discharges),
neonate with other significant problems at 259 (or 4.4% of the region's total discharges),
and vaginal delivery without complicating diagnoses at 236 (or 4.0% of the region's total
discharges). Of Monroe County's 372 psychoses DRGs, more than four fifths (316 or
84.9%) were by Lower Keys residents. Unlike other Florida Keys regions, the leading
reason for hospitalization aJJ.long Middle Keys residents was chest pain at 52 (or 3.0% of
the region's total for this DRG). Other frequently utilized DRGs in the Middle Keys
include neonate with other significant problems (49) and heart failure and shock (49),
each accounting for 2.8% of the region's total discharges. In the Upper Keys, heart
failure and shock was the leading reason for hospitalization at 106 (or 3.9% of the
region's total for this DRG) followed by vaginal delivery without complicating diagnoses
at 3.4% (or 93 of the region's total discharges) and normal newborn deliveries at 86 (or
3.1 % of the County's total discharges). Table IV-D lists the top 20 diagnoses for
hospitalizations of Monroe County residents and provides the percentage for each of
these compared to the State.
IV-5
"Psychoses" was the number one reason for hospital discharges among the residents of
Monroe County, but caution should be expressed in order to interpret this finding
correctly. To have psychoses as the number one discharge simply refers to a "hospital
coding pattern and is not necessarily a medical issue," according to the Florida Hospital
Association and the planning departments at several local hospitals. Included in the
International Classification of Diseases, 9th Revision (ICD-9) code, "Psychoses"
comprises nine subcategories, and within each subcategory there are additional divisions.
According to the consultations with local hospitals' planning departments, the ICD-9
code for a discharge may not coincide with that of admission for the same patient; that is,
a patient may be admitted to the hospital with one condition but be discharged with
another. In the ICD-9 Chapter V, there is a glossary which defines the contents of each
category." The introduction to Chapter V in ICD-9 indicates that the glossary is intended
so that physicians can make the diagnosis based on the descriptions provided rather than
from the category titles. Lay coders are instructed to code whatever diagnosis the
physician records.
~ Non-Monroe County Residents
Non-Monroe County residents discharged from Monroe County hospitals in 2001 were
primarily hospitalized for chest pain at 4.3% (or 50 of the County's 1,169 hospital
discharges by Non-Monroe County residents), followed by heart failure and shock (3,8%
or 44), atherosclerosis with comorbid condition (3.4% or 40), and psychoses (3.2% or
37). (See Table IV-E).
2. Hospital Discharges from Non-Monroe County Hospitals
~ Monroe County Residents
In 2001, 3,109 Monroe County residents sought inpatient treatment outside of the
County, or 30.1 % of the total. They were primarily hospitalized at non-Monroe County
hospitals for other permanent cardiac pacemaker implant or PTCA with coronary artery
IV-6
stent implant at 6.7% (or 207 of all non-Monroe County hospital discharges by Monroe
County residents). Other frequently utilized DRGs include vaginal delivery without
complicating diagnoses (3.4% or 105), normal newborn deliveries (3.2% or 100),
psychoses (3.2% or 98) and circulatory disorders except acute myocardial infarction with
cardiac catheterization and complex diagnosis (3.0% or 93). (See Table IV-F).
IV-7
Table IV-A
Monroe County Residents
Average Length of Hospital Stay, 2001
Average
Hospital Length
Zip Code Discharges Patient Days of Stay
Lower Keys
33040 4,502 22,729 5.0
33041 60 277 4,6
33042 619 2,650 4,3
33043 550 2,561 4.7
33044 31 130 4.2
33045 68 347 5.1
Total 5,830 28,694 4.9
... Middle Keys
33001 64 331 5.2
33050 1,495 6,711 4.5
33051 141 758 5.4
33052 52 241 4.6
Total 1,752 8,041 4.6
Upper Keys
33036 507 2,468 4.9
33037 1,514 7,741 5.1
33070 719 3,916 5.4
Total 2,740 14,125 5.2
Total Monroe County 10,322 50,860 4.9
State of Florida (Resident) 2,267,331 10,899,592 4,8
Source: 2001 Hospital Inpatient Data File, State of Florida,
Agency for Health Care Administration, July 2002,
IV-8
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Table IV-E
l'on-Monroe County Residents
2001 Discharges from Monroe Count) Hospitals
Top 10 Diagnosis-Related Groups
Chest pain
Heart failure and shock
Atherosclerosis with CC
Psychoses
Simple pneumonia and pleurisy, Age> 17 with complication or comorbid condition (CC)
Circulatory disorders with acute myocardial infarction and major complications, discharged alive
Cardiac arrhythmia and conduction disorders with CC
Specific cerebrovascular disorders except transient ischemic attack
Angina Pectoris
Esophagitis, gastroenteritis and miscellaneous digestive disorders, Age> 17 without CC
All DRGs (Non-Monroe County residents discharged from Monroe County Hospitals)
Discharges
Number Percent
50 4.3(%
44 3.8%
40 3.4IYo
37 3.2%
35 3.0%
35 3.0%
35 3.0%
26 2.2%
26 2.2%
26 2.2%
1,169 100,0%
Source: 2001 Hospital Inpatient Data File, State of Florida, Agency for Health Care Administration, July 2002.
Table IV-F
Monroe County Residents
200 1 Dischar~es from :\on-Monroe Count) Hospitals
Top 10 Diagnosis-Related Groups
Discharges
Other permanent cardiac paccmaker implant or PTCA with coronary artcry stent implant
Vaginal delivery without complicating diagnoses
Normal newborn
Psychoses
Circulatory disorders except acute myocardial infarction with cardiac catheterization and complex diagnosis
Circulatory disorders except acute myocardial infarction with cardiac catheterization without complex diagnosis
Rehabilitation
Coronary bypass with cardiac catheterization
Cesarean section without CC
Major joint and limb reattachment procedures oflower cxtremi ty
All DRGs (Monroe County residents discharged from non.Monroe County hospitals)
Number Percent
207 6.7%
105 3.4'%
100 3.2~'O
98 3.2~'O
93 3.0%
75 2.4%1
63 2.0%
58 1.9%
57 t .Sl~~~
54 1.7%
3,109 100.0%
Source: 200 I Hospital Inpatient Data File, State of Florida, Agency for Health Care Administration, July 2002.
E. INPATIENT CHARGES
Inpatient charges refer to charges for those hospital services incurred by a patient who is
officially admitted and occupies a hospital room while receiving hospital care including
room, board and general nursing care, 1 The total inpatient charges for Monroe County
residents were $198,670,579 during 2001. Among Monroe County hospitals, Lower
Keys Medical Center reported the highest inpatient hospital charges for 2001, accounting
for 29.3% ($58,175,687) of all charges among Monroe County residents; in comparison,
IV-12
Lower Keys Medical Center's inpatient discharges was 44.8% during the same year. It
should be noted, that Lower Keys Medical Center (College) accounted for 92.0% of the
total inpatient hospital charges at Lower Keys Medical Center, and 86.7% of the
hospital's total inpatient discharges. Fishermen's Hospital had the second highest
inpatient charges at 13.6%, followed by Mariners Hospital at 12.2%. Among Miami-
Dade County hospitals utilized by Monroe County residents, Baptist Hospital of Miami
reported the highest inpatient hospital charges at 12.0%, followed by Mount Sinai
Medical Center & Miami Heart Institute at 6.9%, and South Miami Hospital at 5,3%. In
Broward County, Broward General Medical Center reported the highest inpatient hospital
charges by Monroe County residents at 0.4%, followed by Cleveland Clinic Hospital,
Holy Cross Hospital, and Memorial Regional Hospital at 0.2% each. (See Table IV-G
and Attachment IV-2).
Table IV-G
Monroe County Residents
200t Inpatient Charges h~ lIospital
Charl!es
Hosoital Total Percent
Monroe County Hospitals
Lower Keys Medical Center - ColIege $53,526,036 26.9%
Fishermen's Hospital $26,972,974 13.6%
Mariners Hospital $24,296,375 12,2%
Lower Keys Medical Center - Kennedy $4,649,651 2.3%
All Monroe County hospitals (4 hospitals) $109,445,036 55.10/0
Miami-Dade County Hospitals (29 hospitals) $81,261,068 40.9%
Broward County Hospitals (20 hospitals) $3,522,317 1.8%
All other hospitals (81 hospitals) $4,442,158 2.2%
All hospitals (134 hospitals) $198,670,579 100.0%
Note: Charges - Total do lIars charged to the patient (before any discounts). Rounded to the nearest dolIar,
Source: 2001 Hospital Inpatient Data File, State of Florida, Agency for Health Care Administration, July 2002.
I Getting the Most for Your Medicaid Dollar, Charles B. Inlander, People's Medical Society, (1991) p. 107.
IV-13
F. PRINCIPAL PAYERS FOR INPATIENT HOSPITAL STAYS
The two major payers for hospitalizations in Monroe County in 2001 were Medicare (a
federal health insurance program for the elderly and disabled) and Commercial insurance
at 37.6% and 30.9% respectively. Medicaid, a state and federal health insurance program
for the poor, paid for 14.4% of the County's hospitalizations followed by Self
Pay/CharitylUninsured with 11.1 %, Champus at 4.0%, Workers' Compensation at 1.5%,
Other State/Local Government at 0.3%, and Other and Veterans Affairs at 0.1 % each,
(See Figure IV-B and Attachment IV-5).
Figure IV-B
Principal Payers for Inpatient Hospital Stays, 2001
Other
Medicare
Commercial Insurance
Medicaid
Self Pay ICharity IUnderinsured
Champus
Workers' Compensation
Other State/Local Government
Veterans Affairs
0.0% 5.0"10 10.0% 15.0% 20.0% 25.0% 30,0% 35.0% 40.0% 45.0%
Source: 2001 Hospital Inpatient Data File, Bureau for Health Statistics, Agency for Health Care Administration.
Similarly, the two mam sources of payment for hospital inpatient stays for Lower,
Middle, and Upper Keys residents were Medicare and Commercial insurance. Medicare
accounted for nearly half (45.8%) of the payments in the Middle Keys and 43.1 % and
32.6% of payments in the Upper and Lower Keys, respectively. Commercial insurance
coverage for inpatient hospital stays accounted for more than one-third (35.3%) of
payments in the Upper Keys, 30.3% of payments in the Lower Keys, and 26,2% of
payments in the Middle Keys. Medicaid payments for inpatient hospital stays were 1.5
IV-14
times higher in the Lower Keys (16,2%) than in the Upper Keys (10,3%). The vast
majority of Champus and Self Pay/CharitylUnderinsured payments for inpatient hospital
stays, countywide, were from the Lower Keys (at 88.1% [362/411] and 65.0%
[746/1147], respectively), (See Figure IV-C and Attachment IV-5).
Figure IV-C
Principal Payers for Inpatient Hospital Stays
Countywide and by Region, 2001
50.0%
Monroe COWlty
Lo\Wr Keys
Middle Keys
Upper Keys
45.0%
40,(}%
35.0%
30.0%
25.0%
20.0%
I- Medicaid Gl Commercial Insurance 0 Medicare I
For calendar year 2001, Medicaid paid $30,332,297 in claims for a total of 8,827 Monroe
County recipients. The average payment countywide was $3,436 per person. The
leading provider type was pharmaceutical claims at 29.5%, followed by general hospital
and nursing home claims at 24.8% and 21.7%, respectively. Statewide, Medicaid paid
$8.9 billion in claims for a total of 2,597,870 Florida residents. The average Medicaid
payment statewide at $3,428 per person was slightly lower than the County's average
Medicaid payment. The leading provider type statewide is general hospital at 22.8%,
followed by nursing home and pharmaceuticals at 19.7% and 17.5%, respectively. (See
Attachment IV-6).
IV-IS
G. EMERGENCY ROOM UTILIZATION
In 2001, Lower Keys Medical Center rendered more emergency room services (42.7%) to
Momoe County residents who were admitted to the hospital than any other Momoe
County inpatient facility. However, this was not disproportionate to the hospital's overall
admissions at 44.8%. Another 20.4% of the area's admissions through the emergency
room occurred at Fishermen's Hospital which was disproportionately high compared to
13.9% of admissions; followed by Mariners Hospital (20.0%) also high compared to
11.1 % of overall admissions. It should be noted that Lower Keys Medical Center
(College) rendered 89.6% of all emergency room services at Lower Keys Medical Center.
An additional 29 Miami-Dade County hospital emergency rooms (or 14.3% of all
discharges) were utilized by Monroe County residents. Baptist Hospital of Miami
accounted for 5.6% of emergency room admissions by Monroe County residents,
followed by Jackson Memorial Hospital (2.2%), South Miami Hospital (1.1%) and
Miami Children's Hospital (1.1%). An additional 7 Miami-Dade County hospitals
represented less than 1.0% each of emergency room admissions by Monroe County
residents. (See Figure IV-D and Attachment IV-3).
Figure IV-D
Monroe County Residents
2001 Emergency Room Admissions by Hospital
45.0%
40.0%
35.0%
30,0%
25,0%
20.0%
15,0%
10.0%
0.0%
Lower Keys Fishermen's Mariners Miami-Dade All Other
Medical Center Hospital Hospital County Hospitals
Hosp itals
Source: 2001 Hospital Inpatient Data File, Bureau for Health Statistics, Agency for Health Care Administration.
IV-16
H. EMERGENCY ROOM ADMISSIONS BY PRINCIPAL PAYER
Countywide, Medicare and Commercial Insurance were the prImary payers for
emergency room admissions at 44.2% and 20.5%, respectively. Other leading payers
countywide were Self Pay/Charity/Underinsured (15.8%) and Medicaid (10.4%).
Emergency room admissions data by hospital and principal payer show that Medicare and
Commercial Insurance were the primary payers for emergency room admissions at Lower
Keys Medical Center (College) and Mariners Hospital; taken together, these payers
comprised from 60.1 to 78.2% of the emergency room admissions. Quite differently,
Lower Keys Medical Center's (Kennedy) major emergency room payers were Self
Pay/Charity/Underinsured (35.4%) and Commercial Insurance (30.7%); whereas,
Medicare represented only 15,6%, At Fishermen's Hospital, Medicare was the primary
payer for emergency room admissions at 50.3%, followed by Self
Pay/Charity/Underinsured (15,9%) and Commercial Insurance (13.7%). Table IV-H
provides emergency room utilization and payer information for all hospitals, within and
outside Monroe County, used by Monroe County residents.
IV-17
Table IV-H
Monroe County Residents
2001 Emergency Room Admissions
b~ Hospital and Principal Pa~cr
Hospital and Principal Payer
Admissions
Number Percent
Lower Keys Medical Center - College
Medicare
Commercial Insurance
Self Pay/Charity/Underinsured
Medicaid
Champus
Medicare HMO
Commercial PPO
Workers' Compensation
Commercial HMO
Medicaid HMO
Veterans Affairs
Other StateILocal Govemment
Other
All payers
710
384
276
257
78
47
43
24
1
o
o
o
o
1,820
Fishermen's Hospital
Medicare
Self Pay/Charity/U nderinsured
Commercial Insurance
Commercial PPO
Medicaid
Workers' Compensation
Champus
Veterans Affairs
Commercial HMO
Medicaid HMO
Medicare HMO
Other State/Local Government
Other
All Payers
487
154
133
92
77
14
6
3
2
1
o
o
o
969
Mariners Hospital
Medicare
Commercial Insurance
Self Pay/Charity/Underinsured
Medicaid
Medicare HMO
Workers' Compensation
Champus
Commercial HMO
Commercial PPO
Medicaid HMO
Other State/Local Govemment
Veterans Affairs
Other
All Payers
516
230
119
51
16
12
9
o
o
o
o
o
o
953
39.0%
21.1%
15.2%
14.1%
4.3%
2.6%
2.4%
1.3%
0,1%
0.0%
0.0%
0.0%
0.0%
100.0%
50.3%
15.9%
13.7%
9.5%
7.9%
1.4%
0.6%
0.3%
0,2%
0,1%
0,0%
0.0%
0.0%
100.0%
54.1%
24.1%
12.5%
5.4%
1.7%
1.3%
0.9%
0,0%
0.0%
0.0%
0.0%
0.0%
0.0%
100,0%
IV-I8
Table IV-H (continued)
~Ionroc COUllt~ 1{I',idl'lIl,
Zlllll EIIlI'r:':I'nc~ Room \dmj"joll'
h~ !Io'pilal and I'rincipall'a~ l'r
Hospital and Principal Paver
Lower Keys Medical Center. Kennedy
Self Pay/CharitylUnderinsured
Commercial Insurance
Medicare
Medicaid
Champus
Medicare HMO
Commercial PPO
Workers' Compensation
Commercial HMO
Medicaid HMO
Other State/local Government
Vetcrans Affairs
Other
All Payers
All Monroe County hospitals
Medicare
Commercial Insurance
Self Pay/CharitylUnderinsured
Medicaid
Commercial PPO
Champus
Medicare HMO
Workers' Compensation
Commercial HMO
Veterans Affairs
Medicaid HMO
Other State/Local Government
Other
All Payers
All otber bospltals (134 bospitals)
Medicare
Commercial Insurance
Medicaid
Commercial PPO
Self Pay/CharitylUnderinsured
Commercial HMO
Medicare HMO
Medicaid HMO
Other StatelLocal Government
Champus
Workers' Compensation
Other
V cterans Affairs
All Payers
All bospltals
Medicare
Commercial Insurance
Self Pay/CharitylUnderinsured
Medicaid
Commercial PPO
Champus
Medicare HMO
Workers' Compensation
Commercial HMO
Medicaid HMO
Other StatelLocal Government
Veterans Affairs
Other
All Payers
Admissions
Number Percent
75 35.4%
65 30.7%
33 15.6%
27 12.7%
9 4.2%
1 0.5%
1 0.5%
I 0.5%
0 0.00/0
0 0.0%
0 0.0%
0 0.0%
0 0.0%
212 100.0%
1,746 44.2%
812 20.5%
624 15.8%
412 10.4%
136 3.4%
102 2.6%
64 1.6%
51 1.3%
3 0.1%
3 0.1%
1 0.0%
0 0.0"1.
0 0.0%
3,954 100.0"1.
264 32.9%
113 14,1%
109 13.6%
109 13.6%
101 12.6%
47 5.9%
19 2.4%
17 2.1%
9 1.1%
6 0.7%
5 0.6%
3 0.4%
0 0.0%
802 100.0%
2,010
925
725
521
245
108
83
56
50
18
9
3
3
4,756
42.3%
19.4%
15.2%
11.0%
5.20/D
2.3%
1.1%
1.2%
1.1%
0.4%
0.2%
0.1%
0.1%
100.0%
Source: 2001 Hospital Inpatient Data File, State ofFlonda,
Agency for Health Care Administration, July 2002.
IV-19
J. SOURCE OF ADMISSION AND HOSPITAL DISCHARGE
STATUS
In 2001, the two major sources for hospital admissions by residents of Monroe County
were through the emergency room, which accounted for 46.1 % of all hospital admissions,
and through physician referrals at 41. 7%, To a lesser extent, other sources of admissions
included normal deliveries, hospital transfers, among others. (See Attachment IV-4) ,
Florida residents are somewhat more likely to be admitted to the hospital through the ER
than residents of the County at 48,5%. Monroe County residents, however, are more
likely to be admitted to the hospital through physician referrals than State residents at
36.5%.
After being discharged from the hospital, 78.2% of individuals residing in Monroe
County returned to their home. Other patients entered a short-term general hospital
(totaling 7.1%) and about 4.6% were discharged to a skilled nursing facility. Residents
of Monroe County were more likely to return home after an inpatient stay than Florida
residents overall (78.2% versus 74.4%), nearly three times as likely to be placed in a
short-term general hospital (7.1% versus 2.2%) than residents statewide, and half as
likely to be discharged to a nursing home. (See Attachment IV-4).
IV-20
J. FINDINGS
The following are some of the major findings for this section on health care financing and
utilization:
~ Among Monroe County hospitals, Lower Keys Medical Center reports the highest
volume of inpatient discharges for residents of Monroe County.
~ The average length of stay in the hospital for Monroe County residents was 4.9 days,
comparable to the State's 4.8 days. The average length of stay at the regional level
was slightly higher in the Upper Keys at 5.2 days.
~ The largest percentage of hospital discharges, countywide, corresponded to infants
under age one (8.8%) and individuals between the ages of 70 and 79 years old
(ranging from 8.0 to 8.1 %).
~ For the Middle and Upper Keys, the largest percentage of hospital discharges IS
among older individuals between the ages of 65 and 79 years. The largest percentage
for Lower Keys residents is among infants under age one.
~ Notably, the leading DRGs, countywide and by Monroe County residents, were
psychoses, vaginal deliveries without complications, neonate with other significant
problems, heart failure and shock, and other permanent cardiac pacemaker implant or
PTCA with coronary artery stent implant, and normal newborn deliveries. Outside of
Monroe County, the leading DRG by Monroe County residents was permanent
cardiac pacemaker implant or PTCA with coronary artery stent implant, followed by
vaginal delivery without complicating diagnoses, normal newborn deliveries,
psychoses, and circulatory disorders except acute myocardial infarction with cardiac
catheterization and complex diagnosis.
~ The leading DRG in the Middle Keys was chest pain followed by neonate with other
significant problems, and heart failure and shock.
~ Non-Monroe County residents discharged from Monroe County hospitals in 2001
were hospitalized for chest pain, followed by heart failure and shock, atherosclerosis
with comorbid condition, and psychoses.
IV-2l
~ Lower Keys Medical Center reported the highest inpatient charges in 2001 of all
charges among Monroe County residents.
~ Medicare and Commercial insurance were the principal payers in 2001 for
hospitalizations in Monroe County overall and within all Florida Keys regions. They
were also the main payers for emergency room admission at three of the four
hospitals available in Monroe County (Lower Keys Medical Center - College,
Fishermen's Hospital, and Mariners Hospital).
~ The average Medicaid claims payment for Monroe County residents was $3,436 per
person, slightly higher than the average Medicaid claims payment for Floridians
statewide at $3,428.
~ The vast majority of Champus and Self Pay/Charity/Underinsured payments for
inpatient hospital stays, countywide, were from the Lower Keys.
~ Lower Keys Medical Center admitted the most Monroe County patients through the
emergency room at 42.7%, followed by Fisherman's Hospital and Mariners Hospital
at 20.4% and 20.0%, respectively.
~ Emergency room admissions accounted for nearly half (46.1%) of all hospital
admissions in Monroe County.
~ Based on inpatient discharge data, Monroe County residents are more likely to return
home after an inpatient stay than Florida residents overall and nearly three times as
likely to be placed in a short-term general hospital than residents statewide; but half
as likely to go to a nursing home post discharge.
IV-22
ATTACHMENTS
IV-I: Monroe County Residents, 2001 Inpatient Discharges by Hospital
IV-2: Monroe County Residents, 2001 Inpatient Charges by Hospital
IV-3: Monroe County Residents, 2001 Emergency Room Admissions by Hospital
IV-4: Monroe County Residents, 2001 Hospital Discharges by Source of
Admission and Discharge Status
IV -5: Monroe County Residents, 2001 Principal Payers for Inpatient Hospital Stays
IV-6: Monroe County Residents, 2001 Medicaid Claims Paid by Provider Type
IV-23
ATTACHMENT IV-1
Monroe County Residents
2001 Inpatient Discharges by Hospital
Dischar2es
Hospital Number Percent
Monroe County Hospitals
Lower Keys Medical Center. College 4,014 38.9%
Fishermen's Hospital 1,434 13.9%
Mariners Hospital 1,150 11.1%
Lower Keys Medical Center - Kennedy 615 6.0%
All Monroe County hospitals (4 hospitals) 7,213 69.9%
Miami-Dade County Hosuitals
Baptist Hospital of Miami 807 7.8%
Mt. Sinai Medical Center & Miami Heart Institute (S) 390 3.8%
South Miami Hospital 347 3.4%
Jackson Memorial Hospital 278 2.7%
Mt. Sinai Medical Center 153 1.5%
Miami Childrens Hospital 146 1.4%
Homestead Hospital 106 1.0%
Kendall Medical Center 99 1.0%
Hea]thSouth Doctors' Hospital 95 0.9%
Mercy Hospital 58 0.6%
Cedars Medical Center 54 0.5%
Jackson South Community Hospital 47 0.5%
Parkway Regional Medical Center 32 0.3%
Palmetto General Hospital ]8 0.2%
University of Miami Hospital & Clinics 15 0.1%
Palm Springs General Hospital 14 0.1%
Pan American Hospital 13 0.1%
Coral Gables Hospital 12 0.1%
All Miami-Dade County hospitals (29 hospitals) 2,751 26.7%
Broward County Hospitals
Broward General Medica] Center 24 0.2%
Cleveland Clinic Hospital 17 0.2%
Holy Cross Hospital, Inc. 20 0.2%
Memorial Regional Hospital 21 0.2%
All Broward County hospitals (20 hospitals) 141 1.4%
All other hospitals (81 hospitals) 217 2.1%
All hospitals (134 hospitals) 10,322 100.0%
Note: Charges. Total dollars charged to the patient (before any dIscounts). Rounded to the nearest dollar.
Source: 2001 Hospital Inpatient Data File, State of Florida, Agency for Health Care Administration, July 2002.
IV-24
ATTACHMENT IV-2
Monroe COllnt~ Residents
2lHlt I npatient Charges h~ Hospital
Char es
HosDital Total Percent
Monroe County HosDitals
Lower Keys Medical Center. College $53,526,036 26.9%
Fishermen's Hospital $26,972,974 13.6%
Mariners Hospital $24,296,375 12.2%
Lower Keys Medica] Center - Kennedy $4,649,651 2.3%
All Monroe County hospitals (4 hospitals) $109,445,036 55.1%
Miami-Dade County HosDitals
Baptist Hospital of Miami $23,748,072 ]2.0%
Mt Sinai Medica] Center & Miami Heart Institute (S) $13,750,218 6.9%
South Miami Hospital $10,599,533 5.3%
Jackson Memorial Hospital $10,740,063 5.4%
Mt Sinai Medical Center $7,478,683 3.8%
Miami Childrens Hospital $2,900,252 1.5%
Homestead Hospital $1,211,441 0.6%
Kendall Medical Center $809,157 0.4%
HealthSouth Doctors' Hospital $2,137,453 1.1%
Mercy Hospital $1,002,822 0.5%
Cedars Medical Center $1,828,469 0.9%
Jackson South Conununity Hospital $570,784 0.3%
Parkway Regional Medical Center $605,783 0.3%
Palmetto General Hospital $1,091,518 0.5%
University of Miami Hospital & Clinics $415,534 0.2%
Palm Springs General Hospital $131,479 0.1%
Pan American Hospital $190,552 0.1%
Coral Gables Hospital $500,598 0.3%
All Miami-Dade County hospitals (29 hospitals) $81,261,068 40.9%
Broward County HosDitals
Broward General Medical Center $892,743 0.4%
Cleveland Clinic Hospital $420,180 0,2%
Holy Cross Hospital, Inc. $430,595 0.2%
Memorial Regional Hospital $398,947 0.2%
All Broward County hospitals (20 hospitals) $3,522,317 1.8%
All other hospitals (81 hospitals) $4,442,158 2.2%
All hospitals (134 hospitals) $198,670,579 100.0%
Note: Charges - Total dollars charged to the patient (before any discounts). Rounded to the nearest dollar.
Source: 2001 Hospital Inpatient Data File, State of Florida, Agency for Health Care Administration, July 2002.
IV -25
ATTACHMENT IV-3
Monroe County Residents
200 I Emcrgenc) Room Admissions by Hospital
Hosnital
Admission Source:
Emergency Room
Number Percent
Percent
Total Discharges Admitted
Number Percent throuph ER
4,014 38.9% 45.3%
1,434 13.9% 67.6%
1,150 11.1% 82.9%
615 6.0% 34.5%
7,213 69,9% 54.8%
807 7.8% 33.0%
278 2.7% 37.4%
347 3.4% 14.7%
146 1.4% 34.2%
106 1.0% 41.5%
390 3.8% 5.9%
95 0.9% 22.1%
58 0.6% 25.9%
47 0.5% 29.8%
99 1.0% 14.1%
26 0.3% 53.8%
2,751 26,7% 24,7%
358 3.5% 34,1%
to,322 100,0% 46,1%
2,267,331 48.5%
8,382 59,0%
2,343,970 48,9%
Monroe County Hospitals
Lower Keys Medical Center - College
Fishermen's Hospital
Mariners Hospital
Lower Keys Medical Center - Kennedy
All Monroe County hospitals (4 hospitals)
Miami-Dade County Hospitals
Baptist Hospital of Miami
Jackson Memorial Hospital
South Miami Hospital
Miami Childrens Hospital
Homestead Hospital
Mt. Sinai Medical Center & Miami Heart Institute (S)
HealthSoutli Doctors' Hospital
Mercy Hospital
Jackson South Community Hospital
Kendall Medical Center
North Shore Medical Center
All Miami-Dade County hospitals (29 hospitals)
All other hospitals (101 hospitals)
All hospitals (134 hospitals)
State of Florida (Residents)
Monroe County Hospitals (All discharges)
Florida Hospitals (All discharges)
1,820 38.3%
969 20.4%
953 20.0%
212 4.5%
3,954 83.1%
266 5.6%
104 2.2%
51 1.1%
50 1.1%
44 0.9%
23 0.5%
21 0.4%
15 0.3%
14 0.3%
14 0.3%
14 0.3%
680 14.3%
122 2,6%
4,756 100.0%
1,098,680
4,948
1,145,415
Source: 2001 Hospital Inpatient Data File, State of Florida, Agency for Health Care Administration. July 2002.
IV -26
ATTACHMENT IV-4
Monroe Count) Residents
2UIlI Hospital Inpatient I>ischarges
B) Source of .\dmission and I>ischarge Status
State of Florida
Resident
Discharges
Number Percent
Monroe County
Resident
Discharges
Number Percent
Source
Emergency room 1,098,680 48.5% 4,756 46.1%
Physician referral 827,762 36.5% 4,302 41.7%
:>Iormal delivery 154,943 6.8% 594 5.8%
Hospital transfer 53,998 2.4% 355 3.4%
Transfer 13,143 0.6% 76 O.7~~
Skilled nursing home 6,776 0.3% 59 0.6%
Clinic referral 28,243 1.2% 55 0.5%
Sick baby 34,313 1.5% 38 0.4%
HMO referral 30,701 1.4% 35 O.3~~
Premature delivery 7,959 0.4% 29 0.3%
CounlLawenforcement 5,420 0.2% 16 0.20/0
Extramural.birth 792 0.0% 0 O.O~~
:>lot availablelUnknown 4,601 0.2% 7 0.1%
Total Discharges 2,267,331 100,0% 10,322 100.0%
Discharge Status
Discharged home 1,687,193 74.4% 8,068 78.2%
Discharged to a short.term general hospital 48,801 2.2% 731 7.1%
Discharged to a skilled nursing faciliry 187,605 8.3% 470 4.6%
Discharged to home care under supervision of a homecare organization 163,497 7.2% 416 4.0%
Expired 55,473 2.4% 232 2.2%
Discharged to another type of institution 82,331 3.6% 203 2.0%
Left facility against medical advice 20,218 0.9% 130 1.3%
Discharged to an intermediate care facility 19,737 0.9% 70 0.7%
Discharged home on IV medications 2,476 0.1% 2 0.0%
Total Discharges 2,267,331 100.0% 10,322 100.0%
Source: 2001 Hospital Inpatient Data File, State of Florida, Agency for Health Care Administration, July 2002.
IV-27
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