Item C31BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: August 21, 2002
Bulk Item: Yes ® No ❑
Division: Administrative Services
Department: Grants Administration
AGENDA ITEM WORDING: Approval of the Community Perspectives Report Monroe
County, provided by the Health Council of South Florida Inc under contract and
payment of invoice in the amount of $15 000 00 to Health Council
ITEM BACKGROUND: This is the second deliverable in the study of the health care
needs of Monroe County, being conducted by the Health Council of South Florida Inc
PREVIOUS RELEVANT BOCC ACTION: Approval of funding for study at Julv 2001
budget meeting, approval of contract at December 2001 meeting approval of
amendment to include_ schedule of deliverables and payments at January 2002 BOCC
meeting, and approval of appointments to Community Health Task Force at the March
2002 meeting.
CONTRACT/AGREEMENT CHANGES: n/a
STAFF RECOMMENDATION: Approval
TOTAL COST: $15,000.00
COST TO COUNTY: JiL900.00
REVENUE PRODUCING: Yes ❑ No
BUDGETED: Yes ® No ❑
AMOUNT PER MONTH
YEAR
APPROVED BY: COUNTY ATTY ❑ OMB/PURCHASING ❑ RISK MANAGEMENT ❑
DIVISION DIRECTOR APPROVA
James L. o erts
DOCUMENTATION: INCLUDED: ® TO FOLLOW: ❑ NOT REQUIRED: ❑
DISPOSITION: AGENDA ITEM #: (` 2 /
MEMORANDUM
To: Task Force Members and Interested Parties of the
Monroe County Community Health Initiative
From: Robert C. "Jake" Rutherford, M.D., M.P.H., Chair
Date: August 8, 2002
Re: Monroe County Health Initiative Taskforce Meeting
Attached is the packet for the next Monroe County Community Health
Initiative Task Force meeting which will be held on:
Date: Monday, August 12, 2002
Time: 10:30 to 12:30 p.m.
Place: Marathon Government Center
2798 Overseas Highway
BOCC Room
Marathon, Florida 33042
At this meeting we will be discussing and approving the Monroe County
Community Health Perspectives Report and reviewing the status of the
Monroe County Health Profile. We look forward to an excellent
discussion on these topics..
If you have any questions, please feel free to contact Lourdes Gonzalez,
Project Director, at (305) 592-1452 ext. 107.
Thank you for your continued support and cooperation.
Attachments:
Agenda
Minutes of Meeting, July 29, 2002
Final Draft of the Monroe County Community Health Perspectives Report
First Draft of the Monroe County Community Health Profile Report
C:\WINNT\Profiles\Owens-David\Temporary Internet
Files\Content.IE5\194FMVEQ\meeting packet.doc
Community Task Force for the
Monroe County Community Health Initiative
AGENDA
Monday, August 12, 2002
10:30 a.m. — 12:30 p.m.
at the
Marathon Government Center
2798 Overseas Highway
BOCC Room
Marathon, Florida 33042
I.
Welcome and Introductions
10:30-10:40
Dr. Rutherford
II.
Minutes of Meeting
10:40-10:50
Dr. Rutherford
a) Review and Approval of Meeting Minutes:
July 29, 2002
III.
Community Health Perspectives Report
10:50-11:20
V. Stubbs /
S. Albury
a) Review and Final Approval of Monroe County
Community Health Initiative — Community Health
Perspectives Report
IV.
Community Health Profile
11:20-1140
S. Hamilton /
a) Socio-Demographic Overview
S. Albury
b) Health Status
c) Service Inventory
V.
Other Business
11:40-12:00
Dr. Rutherford/
a) Old Business
b) New Business
VI.
Adjournment
12:00
Dr. Rutherford
Next Meeting September 16, 2002
C:\WINNT\Profiles\Owens-David\Temporary Intemet
Files\Content.IE5\194FMVEQ\meeting packet.doc
Monroe County Community Health Initiative
Task Force Meeting
July 29, 2002
In Attendance:
Health Council of South Florida Inc.
Jake Rutherford, M.D., Chair
Son a R. Albury
Keith Douglas, Co -Chair
Lourdes Gonzalez
Cheryl Cottrell, R.N
Tracy Greene
Unable to Attend
Julia Pranschke
Julio Avael
Debra Premaza, R.N.
Liz Kern, R.N.
David Rice, Ph.D.
Charla Rodriguez
Rick Rice
Me Ian Lowe-Watler
Robert Walker
Jane Mannix-Lachner
Debra Walker, Ph.D.
Welcome and Introductions
Dr. Jake Rutherford, Chair of the Monroe County Community Health Initiative, called the
meeting to order at 10:45 a.m. Marathon Government Center, 2798 Overseas Highway,
BOCC Room. Dr. Rutherford welcomed everyone to the meeting of the Monroe County
Community Health Initiative and self introductions were conducted.
Review and Approval of Meeting Minutes
Dr. Rutherford asked if any of the members had any amendments to the minutes of the
June 17, 2002 meeting. There being none, Dr. Rutherford asked for a motion for
approval of the minutes.
Mayor Pro-Tem Dixie Spehar moved to approve the minutes from the Monroe County
Community Health Initiative Task Force meeting of June 17, 2002, as submitted.
Robert Walker seconded, the motion carried unanimously.
Community Health Perspectives report
Dr. Rutherford proceeded to brief the Task Force Members on the Community Health
Perspectives report as distributed to all members during the meeting. Dr. Rutherford
informed Task Force members that the version of the Community Health Perspectives
Report is not the final version and that most of the summary data analysis and cross
C:\WINNT\Profiles\Owens-David\Temporary Internet
Files\Content.IE5\194FMVEQ\meeting packet.doc
tabulations were currently being performed due to the high volume of surveys received
by the Health Council of South Florida. Dr. Rutherford commended the Health Council
for their work thus far.
Dr. Rutherford explained that a Final Draft of the Community Perspectives Report would
be available for the upcoming Task Force Meeting and that a 1 st Draft of the Community
Health Profile should be ready for Task Force review as well. Dr. Rutherford added that
during the August meeting the Task Force should approve the Final Draft of the
Community Perspectives and consider the Community Health Profile for preliminary
approval.
Dr. Rutherford asked that the August meeting be moved from August 19th to August 12th
due to the fact that he was scheduled to be out of town on the 19th. All Task Force
Members agreed to change the meeting date as suggested by Dr. Rutherford.
Ms. Gonzalez proceeded to discuss the Community Health Perspectives Report and its
findings. Mr. Rutherford asked about the pending "Part A" and "Summary Analysis"
sections of the Report and what they would contain. Ms. Albury responded that the
summary analysis section would include composite results from all the approaches
used; personal interviews/community surveys, physician focus groups and town hall
meetings. Ms. Gonzalez added that Part A would include cross tabulations by age,
location, gender, insured/uninsured, and employed/non-employed, contingent on
sufficiency of response levels. Ms. Albury referred the Task Force to Attachment II -A of
their Community Perspectives Report which reflected an initial summary of all the
composite results. Ms. Albury informed the Task Force that as they are guided through
this section and look at the findings for particular areas of indicators, there could be
some additional cross tabulations the group may want to be performed.
Ms. Gonzalez guided the Task Force through the composite results of the entire 1,132
surveys summarized by the Health Council and highlighted some of the responses such
as the fact that 76% of the respondents stated that they had health insurance coverage
and 24% were reported to be uninsured. Ms. Albury added that this figure was very
consistent with the Florida Health Insurance Study. Ms. Gonzalez added that
substance abuse was stated as an issue when looking at how participants perceived the
health of the Monroe County community. Additionally, dental services was viewed as a
major need, yet not an available service. Other results that were addressed included
respondents familiarity with programs such as Medicare and Medicaid, prescription drug
coverage, transportation, services, emergency room utilization and physician office
hours.
Ms. Gonzalez proceeded to discuss some of the responses gathered through the
physician focus groups. Ms. Gonzalez added that some of the findings from the
physician focus groups were similar to that of the personal interviews/community
surveys results; however, in some cases, their perceptions were different. Ms.
Gonzalez stated that some of the physicians noted that a portion of their colleagues
have opted not to accept any new or Medicaid patients and/or certain insurance
2
carriers. Ms. Gonzalez added that physicians were seeing a rising number of
emergency room visits which may be due to the limited number of primary care
physicians in the area. Additional concerns expressed by physicians were
reimbursement levels and access to specialists. A discussion ensued amongst Task
Force members with regard to dental practitioners in the Keys.
Mr. Walker asked if a recommendation section and an executive summary would be
included in the final version of the report. Dr. Rutherford stated that the Summary
Analysis will give the Task Force a composite of the various approaches and would
serve as an executive summary. Ms. Albury added that once the Health Council has
completed the quantitative data sets, all the information would be gathered in order to
make sound recommendations which will be incorporated into the Action Plan and Final
Recommendations document. Dr. Rutherford indicated that the Task Force would have
a month to review the Community Health Profile and send comments to the Health
Council for incorporation into the Report. Ms. Albury suggested that the September
meeting could be dedicated to developing an Action Plan and Final Recommendations.
Dr. Rutherford requested a motion for preliminary approval of the Monroe County
Community Health Perspectives Report.
Dr. David Rice moved to preliminarily approve the Monroe County Community
Health Perspectives Report, as submitted. Robert Walker seconded, the motion
carried unanimously.
Dr. Rutherford thanked the Health Council for their vigorous and hard work throughout
the survey gathering process.
Adjournment
The date for next meeting of the Monroe County Community Health Initiative Task
Force will be Monday, August 12, 2002 at 10:30 a.m.
There being no further business, the meeting adjourned at 12:20 p.m.
3
C:\WINNT\Profiles\Owens-David\Temporary Internet Fi1es\Content.1E5\FBWIJV58\81202 NItg Minutes.DOC
Monroe County Community Health Initiative
Task Force Meeting
August 12, 2002
In Attendance:
Unable to Attend
Jake Rutherford, M.D., Chair
Keith Douglas, Co -Chair
Tracy Greene
Julio Avael
Jim Gustafon
Cheryl Cottrell, R.N
Liz Kern, R.N.
Jane Mannix-Lachner
Me Ian Lowe-Watler
David Rice, Ph.D.
Julia Pranschke
Rick Rice
Debra Premaza, R.N.
Charla Rodriguez
Health Council of South Florida. Inc.
Mayor Pro Tern Dixie S ehar
Son a R. Albury
Debra Walker, Ph.D.
Lourdes Gonzalez
Robert Walker
Shaleen Hamilton
Vianca Stubbs
Interested Parties
Michael Hartne
Bill Kwalick
Welcome and Introductions
Dr. Jake Rutherford, Chair of the Monroe County Community Health Initiative, called the
meeting to order at 10:50 a.m. in the BOCC Room of the Marathon Government Center, 2798
Overseas Highway. Dr. Rutherford welcomed everyone to the meeting of the Monroe County
Community Health Initiative and self introductions were conducted.
Review and Approval of Meeting Minutes
Dr. Rutherford asked if any of the members had any amendments to the minutes of the July 29,
2002 meeting. There being none, Dr. Rutherford asked for a motion for approval of the
minutes.
Mayor Pro-Tem Dixie Spehar moved to approve the minutes from the Monroe County
Community Health Initiative Task Force meeting of July 29, 2002, as submitted. Liz Kern
seconded; the motion carried unanimously.
Ms. Stubbs proceeded to present the Monroe County Health Initiative's Community Health
Perspectives Report. Ms. Stubbs first explained the methodology used for the Report; she
added that the Health Council had conducted/administered Personal Interviews/Community
Surveys at ten sites throughout the Keys; held two physician focus groups, one in the Lower
Keys Medical Center and the other at Fishermen's Hospital; and also hosted a three -site Town
C:\WINNT\Profiles\Owens-David\Temporary Internet Files\Content.IE5\FBWIJV58\81202 Mtg Minutes.DOC
Hall Meeting. She added that the survey instrument utilized for the Personal
Interviews/Community Surveys was comprised of 26 questions and was available in both
English and Spanish.
Ms. Stubbs stated that at the previous Task Force meeting on July 29, 2002, Task Force
Members made a request that the Commission districts and number of registered voters be
added to the final version of the Community Health Perspectives Report. Ms. Stubbs explained
that this has been incorporated into the report and proceeded to relay the relevant information
for each commission district. Ms. Stubbs then guided the Task Force through some of the
results obtained from the Community Health Perspective Report responses. Among the survey
respondents, most resided in the Lower Keys; a higher percentage of females responded; and
interviews were primarily completed by individuals between the ages of 20 and 49.
Ms. Stubbs added that 75% of the respondents stated that they had health insurance coverage
and 24% were reported to be uninsured. In comparison, 63.2% of the employed survey
respondents reported to be uninsured. Other results that were addressed were health
insurance types by regions, familiarity with programs such as Medicare and KidCare, availability
of primary care providers, unmet health service needs, the ability to keep medical
appointments, prescription drug coverage, access to transportation services and emergency
room utilization.
Ms. Stubbs proceeded to discuss some of the findings gathered through the physician focus
groups. Barriers to care identified by physicians included: lack of primary care physicians; lack
of knowledge about available services and resources; and lack of public transportation to and
from the doctor's office. A health care service gap which was cited by the physicians was lack
of dental care services. Other issues raised by the participating physicians were problems
experienced by the working uninsured; increased emergency room utilization for primary care
services; residents who view health care as an entitlement and not a responsibility; and KidCare
Programs intent and reimbursement.
Ms. Stubbs reported some of the salient findings gathered through the Town Hall Meetings and
the perceived solutions. Findings include: the escalating cost of health insurance coverage;
the difficulties accessing pediatric, obstetric and dental care; lack of counseling and training on
in -home services and care; the need for improvements in nursing home facilities and 24 hour
in -home services; and the lack of community education. Ms. Stubbs followed with the possible
solutions stated by Town Hall Meeting attendees. Various suggestions were proffered such as
the provision of a nurse in every school; establishment of universal health care coverage
program; passage of a one cent sales tax; pursuit of legislative reform; impose a tax or charge
a fee for high risk events and several others.
Dr. Rutherford asked for a motion for approval of the Monroe County Community Health
Perspectives report.
Robert Walker moved to approve the Monroe County Community Health Perspectives
Report as submitted. Charla Rodriguez seconded; the motion carried unanimously.
Ms. Albury proceeded to lead the discussion on Section I of the Community Heath Profile
pertaining to socio-demographic data. Ms. Albury stated that the introductory portion, as well
as Sections I and 11 had been completed in draft form for the Task Force's review. She added
that data for Sections III and IV were incorporated into tables for initial review. Ms. Albury
proceeded to provide a detailed overview of the socio-demographic information on population
size, population growth, race and ethnicity, age cohorts, socio-economic factors and school
indicators.
Ms. Shaleen Hamilton then gave a summary of the health status information contained in
Section II. She noted key findings on health indicators such as leading causes of death,
communicable diseases, maternal and child health and substance abuse.
Dr. Rutherford commended the Health Council for their extraordinary achievements with the
Community Health Perspectives Report as well as the initial draft of the Community Health
Profile.
Adiournment
The date for next meeting of the Monroe County Community Health Initiative Task Force was
scheduled for Friday, September 20, 2002 at 1:00 p.m. to be held at the same location.
There being no further business, the meeting adjourned at 1:00 p.m.
3
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) Trachea, Bronchus Lung Cancer
4) Unintentional Injuries
5) Stroke (Cerebrovascular Disease)
6) Chronic Obstructive Pulmonary Disease (COPD)
7) Chronic Liver Disease, Cirrhosis
8) Diabetes
9) Pneumonia/influenza
10) Suicide
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. Trachea, Bronchus, Lung Cancer
4. Stroke (Cerebrovascular Disease)
5. COPD
6. Unintentional Injuries
7. Diabetes
8. Influenza and Pneumonia
9. Suicide
10. HIV/AIDS
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 populations. This death rate is 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; within that region Tavernier (33070) had
the second highest death rate in the county, 250.12. The Lower Keys' death rate for
cancer (215.90) was the lowest of the three regions. (See Attachment II-1).
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 is 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 for heart disease at 208.60, followed by the rate
for the Upper Keys which was only slightly lower, at 203.15. 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 of 213.91, 208.60, 203.51, and 201.13, respectively. (See Attachment H-2).
Although heart disease mostly affects individuals over 65 years old, it is noteworthy that
the highest death rates were cited in areas which do not have the highest concentration of
residents over 65.
11-3
3. Trachea, Bronchus, Lung Cancer
Of all cancers diagnosed in 1999 in the United States, lung cancer accounted for 14%.
Cigarette smoking is the most significant known risk factor for this disease. Additional
risk factors include exposure to industrial substances, radiation, air pollution and
environmental tobacco smoke (non-smokers). According to the Florida Annual Cancer
Report, trachea, bronchus and lung cancer is one of the five most common cancers
diagnosed in Florida, as well as being one of the five leading causes of cancer related
deaths in Florida. Trachea, bronchus, lung cancer was rated as the third leading cause of
death according to the five-year (1996-2000) death rate per 100,000 population in
Monroe County as well as the State. The Monroe County rate was 74.54, just under the
rate of 75.46 for Florida.
The highest rates of trachea, bronchus, and lung cancer related deaths were reported in
the Upper Keys, where the rate was 92.28. The rate in the Middle Keys (84.98) was also
above that of the county. Individual zip codes with rates above that of the county were:
Key Largo, Tavernier, and Marathon (33037, 33070, and 33050) with rates of 107.41,
85.57, and 84.98, respectively. (See Attachment H-3).
4. Unintentional Injuries
The overall five-year death rates per 100,000 due to unintentional injuries in Monroe
County were 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) with 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 H-4).
II-4
5. Stroke (Cerebrovascular Disease)
Stroke, or cerebrovascular disease, was the fifth leading cause of death in Monroe County
and the fourth for the State. The Monroe County 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 lower than
the rate for the county, although the rate for Key West (33040) which is located 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 H-5).
6. Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) 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
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 chronic obstructive
pulmonary disease (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 II-6).
II-5
7. 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 seventh 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 of 27.81. The highest death rate occurred in Islamorada (33036)
with a rate of 39.55, which is considerably higher than the rate for Monroe and over three
times the rate for Florida. (See Attachment H-7).
8. Diabetes
Diabetes is the seventh leading cause of death in Florida but it ranks eighth 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 into
energy. Diabetes can lead to serious 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 healthcare 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 of 27.10. The rate of death
due to diabetes was relatively consistent among the three regions, with their rates ranging
from 19.77 to 21.63. The lowest rate occurred in the Upper Keys and the highest rate in
II-6
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 H-8).
9. 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, with assistance from the CDC, influenza activity is monitored
throughout the state 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 is for individuals, especially those at high
risk for serious complication 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).
The five-year (1996-2000) death rate per 100,000 due to pneumonia/influenza in Monroe
County was 20.56, somewhat lower than that of the state at 24.30. The highest rate of the
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. The highest individual rate of death
due to pneumonia/influenza occurred in Big Pine Key (33043) where the rate, 58.07 was
over twice that of the State. Tavernier's (33070) rate of 29.62 was also considerably
greater than the county and State. (See Attachment H-9).
10. Suicide
The overall suicide 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 of the
II-7
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, with a suicide rate of 26.33. (See
Attachment II-10).
In summary, in the Middle Keys, Marathon (33050) exceeded the death rates of the State
in seven of ten causes of death; and Tavernier exceeded the State in six of ten causes of
death. In the Lower Keys, Big Pine Key (33043) exceeded the State in four of ten
leading causes of death In the Upper Keys, Key Largo exceeded the state's death rate in
four of the ten leading causes of death. There were no zip codes in Monroe which
exceeded the State's death rates for heart disease or diabetes. (See Table II -A).
II-8
Table II -A
Cancer
Mourne
State of
251.2
Monroe County Zip Codes
33050
228.8
Heart Disease
199.E
331.4
None
Trachea, Bronchus, Lung Cancer
74.5
75.5
33037,33050,33070
Unintentional injuries
55.7
38.4
33036,33037,33040,33043
33050,33070
Stroke (Cerebrovascular Disease)
45.8
67.0
33050
Chronic Obstructive Pulmonary Disease
40.9
55.0
33050,33070
Chronic Liver Disease/Cirrhosis
23.3
12.8
33036, 33037, 33040, 33042, 33043
33050,33070
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
II-9
B. COMMUNICABLE DISEASES
1. Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
(HIV/AIDS)
Acquired Immunodeficiency Syndrome (AIDS) is rapidly becoming the most devastating
infectious disease occurring in modern 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. Although there is
no cure for HIV/AIDS and it was once perceived as fatal, it is now considered a chronic
disease, directed by comprehensive health care, disease state management and new
treatment alternatives. 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.
HIV/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, while the
state's rate was 35.00 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
Attachment II-11 and Graph II-1). In general, homosexual males comprise the majority
of the HIV/AIDS cases in the District, although cases in heterosexual women are rising.
Based on HIV/AIDS data from the Florida Department of Health's Bureau of HIV/AIDS,
there were 151 total reported cases of HIV between 1997 and 2001 and 1,201 reported
cases of AIDS in Monroe County between 1981 and 2001.
II-10
Graph II-1:
AIDS Cases per 100,000 Population for
Monroe County and Florida
—$--Monroe —* -Florida
180
0 150
0
e 120
0
90
a
a
L
30
0
1996 1997 1998 1999 2000
Year
158.4
85.88
71.74
71.04
Between 1997-2001, a total of 134 (89%) HIV cases were reported among males in
Monroe County. The total number of AIDS cases reported within 1981 and 2001
amongst males were 1,142 which account for 95% of the total reported AIDS cases.
The number of both HIV and AIDS is significantly lower for females; during 1997-2001,
the number of reported cases of HIV and AIDS among females was 17 (110/o) and 59
(5%) of the totals respectively. (See Table II-B and Table II-Q.
Table II-B
Men who have sex with men
95
70.896
Injecting drug use
5
3.7
Men who have sex with men and inject drugs
6
4.5
Hemophelia/coagulation disorder
0
0.0
Heterosexual contact
4
3.0
Receipt of blood, components or tissue
0
0.0
Risk not reported or identified
24
17.9
Total
134
100
Source: Florida Department ofHealth, Bureau of HIV/AIDS, 2002
0 0
95
62.914
4 23.5
9
6.0
0 0.0
6
4.0
0 0.0
0
0.0
3 17.6
7
4.6
0 0.0
0
0.0
10 58.8
34
22.5
17 100
151
100
Table II-C
I
Men who have sex with men
938
82.1
0
0
938
78.102
Injecting drug use
52
4.6
16
27.1
68
5.7
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 contact
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
1142
100
59
100 _
1201
100
Source: Florida Department of Health, Bureau of HIV/AIDS, 2002.
In relation to age, the 30-39 age group has the highest percentage of persons with HIV as
well as the highest percentage of persons living with AIDS, 22.5% and 47.3%
respectively. 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 85.3%,
respectively. Hispanics ranked second in number and percentage of AIDS cases, while
non -Hispanic Black population had the second highest percentage of HIV. (See Table II-
D and Table H-E).
Table II-D
13-29
24
15.9
Non -Hispanic White
127
84.1
20-29
0
0.0
Non -Hispanic Black
14
9.3
30-39
77
51.0
Hispanic
10
6.6
40-49
34
22.5
Total
151
100
50-59
13
8.6
60+
3
2.0
Total
151
100
Table II-E
13-19
3
0.2
Non -Hispanic White
1025
85.3
20-29
147
12.2
Non -Hispanic Black
78
6.5
30-39
568
47.3
Hispanic
91
7.6
40-49
348
29.0
Asian/Pacific Islander
5
0.4
50-59
103
8.6
Unknown
2
0.2
60-64
23
1.9
Total
1201
100
65+
9
0.7
Total
1201
100
Source: Florida Department of Health, Bureau of HIV/AIDS, 2002
II-12
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, (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
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.
Florida, and in particular, District XI, has many predisposing conditions for TB,
including a high number of immigrants and residents from Third World 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 is not high for Monroe County, which
only cites 27 cases in comparison to 6,301 for the State as a whole during 1997-2001.
The highest number of cases was cited in Key West (33040) which amounts to 59% of
the total number of cases. As stated in the Data Limitations section, the 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-13
Table II-F
Monroe County
Reported Cases of Tuberculosis
I)NI 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
*Honda uepartment of tleanti policy states mat aata rot 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, pediculosis (crabs), scabies,
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
II-14
health problems, including pelvic inflammatory disease, sterility, cancer, birth defects,
miscarriages and general systemic complications.
'4:> Chlamydia
Chlamydia infection, simply referred to as chlamydia, is a sexually transmitted disease
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).1
In 2001, Monroe County reported a total of 59 cases of Chlamydia. The highest rate in
Monroe County is located in zip code 33040 (Key West) followed by zip code 33050
(Marathon) with 40 and 10 reported cases respectively. (See Table H-G).
Table II-G
Upper K
3036
0
0
+
r
r
3070
Subtotal
5
14
•
8
5
it
3
5
15
38
ldd/e Keys
Subtotal 5 9 5 I 29
ower %ys
3107
042
r
r
•
3
8
3043
0•
•
+
3045
Subtotal
•
35
0
29
0
13
2
12l
onroe County Total
*PI-M. rye..-......__. _c..__...
54
46
29
59
188
------•- -... . t,.,.,,.y OWLrb Lnac uaut ror 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.
11-15
Cb Gonorrhea
Gonorrhea is a curable sexually transmitted disease (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 I 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 percent 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 II-
H).
II-16
Table II-H
Reported Cases
Lower Keys
of*( , onorrhea,
Monroe
County.
1998-2001
33040
9
12
8
2511
54
Subotal
1 9
12
8
211
54
Middle Keys
33050
1 0
6
0
11
8
Subtotal
1 0
6
0
8
Lime—, Keys
33037
0
,
0
33070
.
0
,
4
Subtotal
•
•
'
6
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 sexually transmitted disease (STD) 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-
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 Centers for
Disease Control and Prevention, 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 Centers
for Disease Control and Prevention also report that national primary and secondary
11-17
syphilis rates for 1990 through 1999 declined by 88% (20.3 to 2.5 per 100,000
population), bringing the national rate to its lowest level since reporting began in 1941. Z
The total number of early latent syphilis and infectious syphilis cases in Monroe County
were five and four respectively. (See Table II -I).
2 Ibid.
Table II-1
Re 'on
Zip Code 1998-2001
Lower Keys
133040 41
Total
4
s
33040 4
PLowEerKe
Ke s
33037otal
5
'rlonda uepartment of Healtn policy states ttiat data tor zip
codes with <3 cases must always be suppressed.
Source: Florida Department of Health, Bureau of Sexually
Transmitted Diseases 2001.
11-18
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 four 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.
1. Live Births
In 2000, there were 779 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 lowest 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 live births in Monroe County. With
nearly half of all live births (46.6%) occurring in Key West (33040). The next highest
percentage of 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 Hispanic births at
22.1 %. (See Attachment 11-12 and 11-13).
II-19
Graph II-2
Birth Rate per 1,000 Women Ages 15-44,
Monroe County and Florida, 1996-2000
—4—Monroe —*—Florida
80
65.41 65.54 65.17 65. 12 67.01
60
46.84
45.71 45.09
Z
39.84
a
40
a
20
0
1996
1997 1998
1999 2000
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 National Centers for Disease Control and Prevention (CDC), 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 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 live births from 1996 to 2000, only 382 (or 9.8%) of mothers
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 care, and the Upper Keys had a lower percentage
than the County. (See Attachment 11-14).
II-20
There were 223 low birth weight births from 1996 to 2000; representing 5.7% of all live
births during this period. Births to Non -Hispanic White mothers had the highest
percentage of low birth weight births with 61.0% of all babies being less than 2,500
grams. The Lower Keys had the highest percentage of low birth weight births, with
57.8% of all low birth weight births for the County during that period. The Upper Keys
had the second highest percentage, with 26.9% of all babies having a low birth weight.
(See Table II-J and Attachment II-15).
Table II-J
Resident
Live Births
Less
than 2,500
grams by
Zip Code
1996-2000
Total Births
Non -His anic White
Non -His anic Black
His anic
F1996-20001
% LBµ'
1996 - 2000
% LBW
1996 - 2000
% LBW
1996 - 2000
°
/. LBW
EWE K s
33036
3
2.4%
3
2.7%
0
0.0%
0
0.0%
33037
41
6.5%
28
6.1%
8
32.0%
5
3.6%
33070
16
6.2%
9
4.2%
1
100.0%
5
12.5%
Subtotal
60
26.9%
40
1 17.9%
9
4.0%
10
4.5%
Middle X
33001
0
0.0%
0
F 0.0%
1 0W2.7%8
0.0%
33050
32
6.5%
17
6.3%
6q
g%
33051
1
5.6%
1
7.7%
00.0%
33052
1
6.7%
1
8.3%
00.0%
Subtotal
34
15.2%
19
8.5%
63.6%
Lower X s
33040
90
4.9%
42
3.8%
14
25
5.7%
33041
4
5:7%
2
3.5%
2
0
0.0%
33042
17
7.5%
16
8.2%
1
E3.3
0
0.0%
33043
17
9.4%
16
9.8%
0
6.7%
33044
0
00%
0
0.0%
0
0
0.0%
33045
1
2.1%
1
3.4%
0
0.0%
0
0.0%
Subtotal
129
57.8%
77
34.5%
17
7.6%
26
1.7%
P
Total
223
100.0%
136
61.0%
32
143%
44
9.7%
ouurce: riortaa Departmmt of -Health, Office of Vital Statistics, 2002
3. Infant Mortality
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
Rates calculated for 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.
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 of Florida, ranging from 7.4
in 1996 and decreasing slightly to 7.0 in 2000. (See Graph H-3.)
When the infant mortality rate is evaluated for all infant deaths per 1,000 live births from
1996 through 2000, the rate for Monroe County (4.9 infant deaths per 1,000 live births) is
considerably lower than for any 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 H-16).
Graph II-3
Infant Mortality Rate:
Monroe County and Florida 1996-2000
—4— Monroe Florida
9.0
a
e 9.0 7.2
> 7
6.0
5.9 0 5.1
4.0
2.0 l.5
0.0
19% 1997 1998 1999 2000
Year
4. Live Births to Mothers 10 to 17 Years Old
Monroe County reported a percentage of 3.2% for live births to females 10 to 17 years
old during a five year period (1996 to 2000). That percentage is notably higher than the
percentage for Florida, which is 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
II-22
(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 rate of births to unwed mothers from 1996 to 2000 for Monroe County is
32.7% which is slightly lower compared to that of Florida at 36.9%. The highest
percentage was in the Middle Keys, followed by the Lower Keys and then the Upper
Keys. X From 1996 to 2000, the lowest number of births to unwed mothers occurred in
1998. The number has been increasing in subsequent years, but has yet to exceed to
highest number of births (282) from 1997. (See Graph 11--2).
U-23
D. SUBSTANCE ABUSE
According to the Department of Children and Families, during calendar year 2001, a total
of 472 adults residing in Monroe County received substance 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, 41.3% of the clients served were females (or 195)
and the remaining 58.7% were males (277). (See Table II-K).
Table II-K
ZIP
Ad nits ReceiN
Male
Persons
Served
in-
Calendar
Visits
Substance Abuse
Year 2001
Female
Persons
Served
Services
Visits
Total
Persons
Served
-1
Visits
U er Keys
33036
16
19
14
19
30
38
33037
22
29
17
20
39
49
33070
17
18
12
17
29
35
Subtotal
55
66
43
56
98
122
Middle A eys
33001
33050
52
91
42
58
94
149
33051
0
0
0
0
0
0
33052
0
0
0
0
0
0
Subtotal
52
91
42
58
94
149
Lower Aeys
33040
133
497
86
217
219
714
33041
1
1
1
1
2
2
33042
33043
15
17
13
17
28
34
33044
2
2
0
0
2
2
33045
4
4
0
0
4
4
Subtotal
171
542
110
246
281
788
Monroe CFo-nnty
1 277
698
195
360
472
1058
Source: Department of Children and Families, 2.UU1.
II-24
In 2001, a total of 89 children received substance abuse services through programs
available by the Department of Children and Families. Of those 89, 59.6% (53) were
males and 40.4% (36) vere females. Children in Monroe County made a total of 135
visits for substance abuse services. (See Table H-L).
Table II-L
Children Receiving
Calendar
Male M
Persons
Substance Abuse
Year 2001
Female
Services
Total
Persons
Count
Persons
Count
ZIP
Served
Count WSS
Served
OfSSN
Served
OfSSN
Upper Keys
33036
1
1
0
0
1
33037
5
7
1 3
8
8
I
33070
3
3
5
6
15
Subtotal
9
11
8
14
8
9
MiddVe Keys
17
25
33001
1
1
0
0
1
33050
3
3
5
6
1
33051
0
0
0
0
8
9
33052
0
0
0
0
0
0
Subtotal
4
4
5
6
0
0
ower ACYN
9
10
33040
29
44
20
24
49
68
33041
6
12
0
0
6
12
33042
0
0
2
8
2
33043
5
9
8
33044
0
0
1
3
6
12
33045
0
0
0
0
0
0
0
0
63
0
100
Subtotal
40 65
0
23 35
Monroe County
80
36
SnnreP•
55
89
135
-- '"....... uuaaa�W, 4VV1.
II-25
E. FINDINGS
The major findings concerning the health status of Monroe County residents are as
follows:
1�> The top three leading causes of death among Monroe County residents are the same
as those that affect the State as a whole (heart disease, cancer, stroke and trachea,
bronchus, lung cancer.
1�o The suicide death rate in Tavernier (33070) is nearly double that for the State as a
whole; 26.33 per 100,000 population versus 14.00.
13�, Non -Hispanic Whites were reported to have the highest number, 127 (84%) of the
total HIV/AIDS cases in Monroe County;
14�, The reported cases of Chlamydia in Monroe County nearly doubled from 2000 at 29
to 2001 at 59.
14,-� The reported cases of Gonorrhea nearly tripled from 10 in 2000 to 27 in 2001.
14-�> 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.
1�> The percentage of births to unwed mothers was slightly lower 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.
u* 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 lower than that of the County as a whole.
W Infant Mortality rates in Monroe County had been decreasing 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).
1:4� Early entry into prenatal care ranked well in Monroe County. Only 9.8% of mothers
received late prenatal care or none at all.
1T-26
The highest percentage in the Monroe County area for late or no prenatal care was in
the Middle Keys.
Nearly half of all live births occurred in Key West (46.6%). The highest percentages,
(67.7%), of live births were to Non -Hispanic White mothers; followed by Hispanic
live births with 22.1 % of live births in Monroe County.
H-27
Attachments
II-1: Monroe County Resident Cancer Related Deaths 1996-2000, and Death Rate per
100,000 Population
II-2: Monroe County Resident Heart Disease Related Deaths 1996-2000, and Death
Rate per 100,000 Population
11-3: Monroe County Resident Trachea, Bronchus, Lung Cancer Related Deaths 1996-
2000, and Death Rate per 100,000 Population
II-4: Monroe County Resident Unintentional Injury Related Deaths 1996-2000, and
Death Rate per 100,000 Population
11-5: Monroe County Resident Cerebrovascular Related Deaths 1996-2000, and Death
Rate per 100,000 Population
II-6: Monroe County Resident COPD Related Deaths 1996-2000, and Death Rate per
100,000 Population
II-7: Monroe County Resident Chronic Liver Disease and Cirrhosis Related Deaths
1996-2000, and Death Rate per 100,000 Population
11-8: Monroe County Resident Diabetes Related Deaths 1996-2000, and Death Rate per
100,000 Population
II-9: Monroe County Resident Influenza and Pneumonia Related Deaths 1996-2000,
and Death Rate per 100,000 Population
II-10: Monroe County Resident Suicide Related Deaths 1996-2000, and Death Rate per
100,000 Population
II-11: Reported Cases of HIV/AIDS by Zip Code, Monroe County, 1997-2001.
11-12: Resident Live Births by Zip Code, 1996-2000, Monroe County
II-13: Live Births by Zip Code and Maternal Race/Ethnicity, 1996-2000, Monroe
County
II-14: Late or No Prenatal Care by Zip Code, 1996-2000, Monroe County
11-15: Low Birth Weight Live Births (<2,500 grams) by Zip Code, 1996-2000, Monroe
County
II-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.
II-18: Live Births to Unwed Mothers by Zip Code, 1996-2000, Monroe County.
Attachment II-1
Five Year
Monroe
1996-2000.
Count % Resident
and death
( ancer
rate per 100.000
Related Deaths
population.
Five Year
Population
Death Rate per
U perXeys
(1996 2000)
1996
1997
1998
1999
2000
1996-2000
100,000
Population
3036
20.23
1 1
14
6
8
8
3070
70 759
40
30
31
28
3
47
232.33
3070
30 386
14
15
15
16
l61
227.53
ubtotal
121,375
65
59
52
52
1
56
76
250.12
fiddle Keys
284
233.99
3001
included in Zi
Code 33050
3050
3051
64.7181
40
40
29
31
3
170
262.68
included in Zip
Code 33050
3052
included in ZipCode
33050
ubtotal
64,718
40
40
29
31
30
170
wer Keys
262.68
3040
3041
164 570
81
72
69
68
6
350
212.68
included in Zi
Code 33040
3042
29,01
l 8
6
18
9
13
64
3043
24,107
10
4
18
12
I
58
232.30
3044
included in Zi
Code 33042
56
232.30
3045
included in ZipCode
33040
Subtotal
217.692
109
81
105
89
85
470
215.90
Tota
Florida
403,785
75,706,875
214
37,746
181
37,813
186
172
171
924
228.83
37,783
38,18,
38,622
190,146
251.16
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Attachment II-2
Five Year
Population
(1996-2000)
Monroe CotintN
11996-20110.
1996
Resident
and death
1997
Ileart Disease
rate per 1100,000
1998
Related Deaths
population.
1999
2000
1996-2000
Five Year
Death Rate per
100,000
Population
Upper Keys
3036
3037
3070
30,386
18
12
13
12
t
65
213.91
ubtotal
121,375
57
34
55
55
48
249
205.15
iddle Keys
3001
included in Zip
Code 33050
3050
64,718
38
27
26
18
26
135
208.60
3051
included in Zip
Code 33050
3052
included in Zip
Code 33050
ubtotal
64,718
38
27
26
18
26
135
208.60
wer Keys
3040
3041
included in Ziv
Code 33040
3042
3043
3044
included in Zip
Code 33042
3045
included in Zip
Code 33040
ubtotal
2
73
84
96
97
72
422
193.85
TotalEE
5
168
145
177
170
146
806
199.61
Florida,706,875
49,480
49,539
50,734
51,124
50,016
150,893
331.40
Source: Florida Department of Health, ujjice of vital Yatistics, .11uu-1.
Attachment II-3
.,.- •-_..--- - aggregate, zip code level data, wherein there are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Attachment II4
Related
Five Year
Population
(1996-2000)
Monroe
Deaths,
1996
Count,� Resident
1996-2000, and
1997
Unintentional
Death Rate
1998
Injury
per 100,000
1999
Population.
2000
72000
Five Year
Death Rate per
100,000
Population
Up er Keys
3036
20110'
'
3037
3070
'
ubtotal
121,375
10
16
11
12
15
67
55.20
fiddle Keys
3001
included in Zip
Code 33050
3050
64.71
7
12
8
14
4
45
69.53
3051
included in Au
Code 33050
3052
included in Zi
Code 33050
ubtotal
64.718
7
12
8
14
4
45
69.53
wer Keys
3040
3041
included in Zip
Code I Ind()
3042
'
3043
3'
'
3044
included in
Code 33042
3045
included in Zip
Code 33040
ubtotal
217,692
20
19
19
33
13
113
51.91
Totall
40.1,785
41
49
40
59
36
225
55.72
Florida
1 75,7061875
5,373
,.1.. r:
5,509 5,823 5,994 6,388
., wont..«, .1,,, r 1-- nf avvrevate Tin code
19,087
level data,
38.42
wherein there
-rLU11 d Lvya.....�... w......... r -� -- - - -
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Attachment II-5
Upper Keys
Related
Five Year
Population
(1996 2000)
Deaths,
1996
("JuMN Resident
1996-211110, 1111(1
1997
Cerebrovasular
death rater
1998
Disease
per 1011.000
1999
population.
2000
1996-2000
Five Year
Death Rate per
100,000
Population
3036
20.230
3
0
'
'
0
71
34.60
3037
70,759
27
38
38.16
16
3070
30 386
0
5
'
'
«
9
.
ubtotal
fiddle Keys
121,375
3
12
7
8
4
462
3
35.43
3001
included in Zin
Code 33050
3050
64,718
9
10
15
4
8
46
71.08
3051
included in Zip
Code 33050
3052
included in Zip
Code 33050
ubtotal
64,718
9
10
15
4
8
46
71.08
wer Keys
3040
3041
1
-included in Zip
Chk-33040
3042
29,015«
.
«
In
34.46
3043
24,107«
«
3044
included in Zi
Code 33042
3043
ubtotal
217,692
10
23
13
13
14
96
44.10
Total
403,785
35
48
41
30
30
18S
45.82
Florida
75,706,875
9,828
9,986
10,035
10,512
10,381
50,7421
67.02
*Florida Department of Health
policy restricts the
release of aggregate, zh) code
level data_ wherein
th wr
are tewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Attachment II-6
Five Year
Population
(1996-2000)
Monroe
1996-2000,
1996
County Resident
and death
1997
O•D Related
rate per 100.1100
1998
Deaths
population.
1999
2000
1996-2000
Five Year
Death Rate per
100,000
Population
Upper Keys
3036
20.230
0
0
`
0
'
9.89
70.759
3
4
4
5
6
22
31.09
30,386
3
4
4
4
2
17
55.95
V037
tal
121,375
6
8
8
9
8
41
33.78
e Ke
inclu d in Zip
Code 33050
3050
64,719
6
10
7
8
7
38
58.72
3051
included in ZipCode
33050
3052
included in ZipCode
33050
Subtotal
64.718
6
10
7
8
7
38
58.72
Lower Keys
3040
164.570
8
8
13
15
16
60
36.46
3041
included in Zip
Code 33040
3042
13045
3043
3044
Subtotal
217,692
10
17
19
21
1
861
39.51
Tota
403,785
23
35
35
39
3311
1651
40.86
Florida
75,706,875
7,679
8,067
8,151
9,146
8,605
41,6481
55.01
*171—Mn T1Pnartm Pnt of Health
nnlicv restricts the release of noarevate. zin code
level data. wherein
there
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Attachment II-7
Upper Keys
Monroe
Five Year
Population
(1996-2000)
CountN Resident
1996-2000,
1996
Chronic
all(] death
1997
Lker Disease/Cirrhosis
rate per 100.000
1998
populalion.
logo
Related Dealh%
2000
1996 2000
ar
Fi:Rate
Deatper
10
Poon
3036
20,230
3037
3070
ubtotal
fiddle Keys
70 75
30 386
121.375
.
0
4
3
+
6
'
,
4
3
3
8
4
+
7
8
14
7
29
39.55
1979.
23.04
23.89
3001
included in Zi
Code 33050
3050
3051
64 718
•
included in ZipCode
4
33050
*
6
5
18
27.81
3052
included in ZipCode
33050
ubtotal
wer Keys
64,718
+
q
6
5
18
27.81
3040
3041
3042
+
+
3043
+
3044
ncluded in Zip
Code M42
7—
2904
3045
included in
(lode 3 304'0
ubtotal 217,692
Tota 403,7851
Florida 75,706,8751
*Florida Department of Health
7 8 9
12 18 15
1,821 1,937 1,872
policy restricts the release of
13 1
27 2
1,991 1,060
aggregate, zin code
47
94
9,681
level rlatn Whp-ii
21.59
23.28
1279
tl,o.s
._� I—L uiau Luicc I;AJCJ.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Attachment 11-8
Nlonroe CotintN Resident Diabetes
1996-2000, and death rate per 100.000
Five Year Population
(1996-2000)
Related Deaths
population.
Five Year Death
Rate per 100,000
1996-2000 Population
Upper Keys
33036
0 230
*
9.89
33037
70759
14
19.79
33070
30,386
8
26.33
Subtotal
121,375
24
19.77
Middle Kevs
33001
luded in ZipCode 33050
33050718
14
21.63
33051
364,718
luded in ZipCode 33050
33052
Subtotal
14
21.63
Lower K s
33040
164.570
41
24.91
33041
ncluded in Zip Code 33040
33042
9,015
3
10.34
33043
4107
*
8.30
33044
ncluded in Zip Code 33042
33045
ncluded in Zip Code 33040
Subtotal
17,692
46
21.13
Total
03,785
84
2080.
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.
Attachment II-9
Related
Five Year
Monroe
Deaths,
Count.% Resident
11996-2000, and
Influenza
death rater
and Pneumonia
per 100j)(10
popufafion.
Five Year
Population
Death Rate per
Upper Keys
(1"6-2000)
1996
1997
1998
1999
2000
1996-2000
100,000
Population
3036
20,230
0
.
0
,
3037
70,759
5
�
�
0
3
14.83
16.96
3070
30,38
■
3
3
»
12
29.62
ubtotal
121.375
5 3 3
9
fiddle Keys
3
0
24
19.77
3001
3050
64,71
3
3
4
'
3051
included in ZipCode
33050
0
12
18.54
3052
included in ZipCode
33050
ubtotal
64,718
3
3
4
ower Keys
0
12
18.54
3040
164 570
I1
8
3
4
6
3041
included in ZipCode
33040
32
19.44
3042
3043
'
3044
3 445
ubtotal
217,692
15
13
3
4
Total
403 785
25
22
13
11
9
1211
47
21.59
10.56
Florida
75,706,8751
3,785
3,869
4,080
3,323
3,336
83
18,393
24.30
*Florida Department
of Henith
nM; .,
are fewer than three cases.
Source: Florida Department of Health, Office of Vital Statistics, 2002.
Attachment II-10
Monroe County Resident Suicide Deaths
1996-2000, and death rate per 100,000 population.
Five Year Death
Five Year Population Rate per 100,000
(1996-2000) 1996-2000 Population
U er K s
33036
20.230
* 9.89
33037
70 759
13 18.37
33070
30,386
8 26.33
Subtotal
121,375
23 18.95
Middle EMS—
33001
luded in ZipCode 33050
33050
718
14 21.63
33051
luded in ZipCode 33050
33052
luded in ZipCode 33050
[64,
Subtotal
718
14 21.63
Lower X s
33040
164,570
32 19.44
33041
33042
29015
6 20.68
33043
24,107
5
20.74
33044
33045
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 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.
Attachment II-11
Reported
Nlonroe
11INVAIDS
cases by Zip Code
Population
County
I
HIV
AIDS
71
1997-2001
Cases
Rate per 100,000
Cases
Rate(per 100,000
U er K
33036
19.374
s
#
33037
70,498
5
7.092
4
33070
29,022
■
5.67
Subtotal
118,894
N/A
N/A
N/A
N/A
Middle Keys
33001
included in zip code 33050
0
33050
63,208
10
-
15.821
0
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
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
s
Subtotal
218,614
N/A
N/A
225
102.92
Total
400,716
151
37.6831
21
5.241
*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, Bureau of HIV/AIDS, 2002.
Attachment II-12
Rosident Live Births by Zip Code, 1996-2000,
Monroe County
1996 1997 1998 1999
°/. of all live
2000 1996 - 2000 births
Upper Ks
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 Kevs
0
33050
104
87
95
103
100
489
12.5%
33051
7
2
2
3
4
18
0.5%
33052
6
3
2
2
2
15
0.4%
Subtotal
122
i 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%
0
33044
2
1
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.
Attachment II-13
Total Births Non -His anic White Non -His anic Black His
anic
% of a8 live % of all live % of all live % of all live
1996 - 2000 births
1996 - 2000 births 1996 - 2 000 births 1996 - 2000 births
U er K s
33036
126
629
71 3.20/.
°
113
45Ro
1 2.9%
0
0.00
°
12
0.3 %
o
o ° • o
0
Subtotal 1015 26.0% 783 20.1% 26 0.7% 190
Middle Re s 4.9%
33001
16
0.4%
15
0.4%
■
33051
489
12.5%
268
6.9%
44
0.0%
33051
18
0.5%
13
0.3%
■
M-%/ol
4.3%
33052
°
0.1%
o
■
o
Subtotal 538 13.8% 308 7.9% 48
Lower R 4.4%
33040
1821
H06
28.3%
175
4.5%
441
11.3%
33041
70
57
1.5%
7
0.2%
5
0.1%
33042
228
E46
194
5.0%
3
0.1%
25
0.6%
33043
33044
181
163
4.2%
°
0
0.0%
°
15
0.4%
0
33045
Subtotal
2351
°
60.2%
1552
o
39.8%
■
186
o
4.8%
501
0
124%
Total
3904
100.0%
2643
67.7%
260
6.7% 1
862
22.1%
Florida
978199
100.0%
728 684
74.5%
222,327
22.7% 1
198,538
20.3%
Note: Live Births
for `Other' RarP/Fth".
:r., : _ ]__1__J_
J
*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.
Attachment II-14
Late or No Prenatal Care by Zia Code.1996-2000, Monroe County
Live Births
1996-2000
Number Receiving Late/No Care
Late/No Care
1996-2000
Percent
1996
1997
1998 1999 2000
Uover Ke s
33036
126
0
3
*
*
4
9
7.1%
0
33070
260
*
5
5
*
3
17
6.5%
Subtotal
1015
15
19
17
9
19
79
7.8%
Middle Keys
33050
489
6
10
16
25
67
13.7%
33051
18
11*3
0
*
0
0
*
5.6%
33052
15
0
*
0
0
3
20.0%
Subtotal
538
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%
*
*
o
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.
Attachment II-15
U er K s
Live Births
1996-2000
1996
I1997
1998
1999
2000
1996 B2000
1996-20 0
33037
33070
Subtotal
Middle Keys
629
260
1015
]p
q
14
7
3
11
7
1
8
8
4
13
9
4
14
41
l6
60
°
6.5%
6.2%
5.9%
33001
33050
33051
33052
Subtotal
LowerK s
16
489
18
15
538
0
$
*
*
10
0
5
0
0
5
0
6
0
0
6
0
8
0
0
8
p
5
0
0
5
0
32
*
*
34
0.0%
6.5%
5.6%
6.7%
0
6.3%
33040
33041
33042
33043
33044
1821
70
228
181
30 =F
p
+
6
19
*
3
3
11
*
8
4
16
*
*
+
14
*
+
3
90
4
17
17
4.9%
5.7%
7.5%
9.4%
33045
Subtotal
Total
Florida
48
2351
3904
978,199
0
38
62
14,866
0
26
42
15,461
+
25
39
15,79
0
20
41
116,126
20
39
16,2 84r
129
223
78,534
%
5.5%
5.7%
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.
Attachment II-16
Monroe Countv Infant Mortality Rate (per 1,000 Live Births)
Upper Keys
3036
30
0
0
23
0
0
20
0
0
3037T
+0.0
3070
58
0
0.0
57
0
0.0
46
0
0.0
ubtotal
229
+
8.7
199
*1
5.01
180 1
0
0.0
e Keys
3001
5
0
0
3
0
0
2
0
0
3050
104
+'10.5
3051
3052
6
0
0.0
3
0
0.0
2
0.0
ubtotal
122
*
8.2
95
01,
0.0
101
*
9.9
owerKeys
3040 384
* 5.21 388
*1 2.6 304
0
0.0
3041 15
0 0.0 14
0 0.0 11
0
0.0
3043
3044 2
0 0.0 1
0 0.0 0
0.0
3045 10
0 0.0 it
0 0.0 5
0
0.0
ubtotal 498
+ 4.0 502
3 6.0 407 1
01
0.0
Monroe
Florida
U Keys
7.4
7.1 -
-
7.2
3036
23
0
0
30
0
0
126
0
3037
3070
58
0
0.0
41
"
24.4
260
1
3.8
ubtotal
209
0
0.0
198
1
4.9
. eKeys
3001
4
0
01
2
0
01
16
01
0
3051
3052
2
0
0.0
2
0
0.0
15
ubtotal
112
0
0.0
108
9.3
538
over Keys
3040
369
*
5.41
376
41
10.61
1821
1
4.9
3041
18
0
0.01
12
01
0.01
70
0.0
3042
32
0
44
01
0.0
228
* 4.4
3043
--0.01
3044
3045
11
0
0.0
11
0 0.0
48
0 0.0
ubtotal
471
• 4.2
473
4 8.5
2351
111
4.7
Monroe
Florida
7.3
-
1 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.
Attachment II-17
7m---
1996
Number of Live Births to Teens
1997 1998 1999 2000
Births to Teens
1996-2000
Percent
1996-2000
33036
33037
33070
Subtotal
Middle Keys
126
629
260
1015
*
3
*
5
0
2
*
3
1 0
15
*
6
0
4
0
4
*
1 5
5
11
2
19
8
29
1.6%
3.0%
1
3.%
2
33001
33050
33051
33052
Subtotal
Lower K s
16
489
18
15
538
0
6
*
7
0
5
0
0
5
0
7
0
0
7
*
3
0
0
4
0
6
0
0
6
*
27
0
:
29
6.3%
5.5%
0.0%
6 7%
5.4%
33040
33041
1821
70
11
0
9
0
10
0
8
0
10
1 0
4$
0
2.6%
0.0%
33042
33043
228
181
0
0
3
2
3
*
0
3
3
*
9
7
3 9%
3.9%
33044
33045
3
48
0
*
0
0
0
0
0
0
0
0
0
0.0%
Subtotal
Total
Florida
2351
3904
978,199
12
24
5,356
14
22
5,043
14
27
4,943
11
19
4,605
14
31
4,446
65
123
24,393
2.8%
3.2%
2.g%
*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.
Attachment II-18
Lhe
Births to
Live Births
1996-2000
Unwed Mothers bv Zip Code, 1996-2000, INMonroe Countv
Unwed Births Unwed Births
1996 1997 1998 1999 2000 1996-2000
Percent
1996-2000
U er R s
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
11
75
28.8%
Subtotal
1015
72
58
50
60
63
303
29.9%
Middle K s
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%
*
o
33042
228
11
11
21
5
11
59
25.9%
33043
181
14
14
11
13
12
64
35.4%
33044
1 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.
M AM
wonroe County
Community
Health
A Report of the Community
Task Force for the
Monroe County Community
Health Initiative -
Prepared by: y
The Health Council of'South Florida} Inc.
TABLE OF CONTENTS
Page Number
Map of Monroe County by Regions i
Acknowledgements ii
Executive Summary iv
Introduction 1
Data Limitation 2
History and Purpose of the Health Council of South Florida 4
I. Socio-Demographic Overview of Monroe
A.
Population
I-1
1. Geography
2. Population Size
3. Population Growth
4. Race and Ethnicity
5. Age Cohorts
B.
Socio-Economic Factors
I-11
1. Income
2. Propensity to Purchase Health Insurance
3. Household Size
4. Homelessness
5. Public Assistance Programs
6. Juvenile Arrests
C.
School Indicators
I-19
1. Incidents of School Crime and Violence
2. Percentage of Absence 21+ Days
3. Limited English Proficiency
4. Free/Reduced Price Lunch
5. Dropout Rate
D.
Findings
1-22
Attachments
1-24
Maps
1-36
II. Health Status
A.
Leading Causes of Death
II-1
1. Cancer
2. Heart Disease
3. Trachea, Bronchus, Lung Cancer
4. Unintentional Injuries
5. Stroke
6. Chronic Obstructive Pulmonary Disease (COPD)
7. Chronic Liver Disease and Cirrhosis
8. Diabetes
9. Pneumonia/Influenza
10. Suicide
B. Communicable Diseases
II-10
1. Human Immunodeficiency Virus/Acquired Immuno-
Deficiency Syndrome (HIV/AIDS)
2. Tuberculosis (TB)
3. Sexually Transmitted Diseases (STDs)
C. Maternal and Child Health
II-19
1. Live Births
2. Prenatal Care and Low Birth Weight
3. Infant Mortality
4. Live Births to Mothers 10 to 17 Years Old
5. Births to Unwed Mothers
D. Substance Abuse
II-24
E. Findings
II-26
Attachments
II-28
III. Health Care Providers and Support Services
A.
Primary Care Centers
B.
Mobile Health Services
C.
Physicians
I. Primary Care Physicians
2. Specialty Care Physicians
3. Medicaid Acceptance
4. Evening and Weekend Hours
D.
Hospitals
E.
Mental Health and Substance Abuse Programs
F.
School -Based Health Programs
G.
Nursing Homes
H.
Assisted Living Facilities
I.
Children's Day Care Facilities
J.
Transportation Services
K.
Findings
Attachments
IV. Health Care Utilization and Financing
A.
Average Length of Stay and Hospital Discharges
B.
Discharges from Hospitals by Patient's Age
C.
Reasons for Hospitalization
D.
Inpatient Charges
E.
Principal Payers for Inpatient Hospital Stays
F.
Emergency Room Utilization
G.
Emergency Room Admissions by Principal Payer
H.
Source of Admissions and Hospital Discharge Status
1.
Findings
Attachments
V. Findings and Implications
VI. Recommendations
A. Community Education and Outreach
B. Health Care Services
Map 1
m
O co M �O
M M M
N
2
1
m
a
O O L U
Ci 0 00 0
cn M M M
M cM M M
N
ll
Y N
I
4) CD a) omEa mYYcomcoY
m
N co � to
U O O O O O O
M M Cl) M cr) co
N
LL
Z`
co
C
O
m
(D
ui -a
U O
� U
U) N
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 Avael
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 Torre
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.
Ifl
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 of HIV/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
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 Executive Director
Lourdes Gonzalez Health Planner
Rob Harris Data Manager
Shaleen Hamilton Research Associate
Executive Summary
(Pending)
IV
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 Health Council of South Florida, Inc. 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 will be articulating some of the most
critical conditions and areas of health risk and need among local residents. To further buttress
the this effort, coupled with the Perspectives Report, the Health 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 served 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 is 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.
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 does 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.
2
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.
5. Some increases or decreases in death rates may be due to a change in the methodology used
to classify causes of death from the ninth version of the International Classification of
Diseases (ICD9) to the tenth revision (ICD10) in 1999.
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 Health 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 33 years, the Health 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 Health 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 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
4
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.
I. SOCIO-DEMOGRAPHIC OVERVIEW OF
MONROE COUNTY
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-1. 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
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), Summerla.nd Key (33042), Big Pine Key (33043) and Sugarloaf Shores
(33044).
According to Sourcebook America, CACI Marketing System for 2001, the Lower Keys
region has the largest population among the three regions with 45,212 residents or 57.3%
I-1
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 Islamorada (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 of less than 620 people. (See Table I -A).
TABLE I -A
ouurce: wurcebook America, 2001 Edition, ESRI Business Information Solutions.
Please 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.
I-2
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 I-1).
GRAPH I-1
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.
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.
I-3
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. Comparably, the state is
expected to increase by 9.5% in total population size over the same period. (See Table I-B
and Attachment I-]).
TABLE I-B
- - -��• ��_•_�__, ���.. Dusmess 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. Race and Ethnicity
W 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
I-4
concentrations of White individuals are 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 1980 and 1990, Monroe County's
White population increased by 1.0%, while the State's White population increased by
15.9%. (See TableI--C and Attachment 1-2).
W Black
Monroe's Black population is 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 (15.1%). The highest concentration of Blacks resides in the Lower Keys,
specifically within Key West (33040) at 8.4% of the population. The Middle Keys
follows, with Marathon (33050) having the second highest concentration (4.2%). In the
Upper Keys, Key Largo has a somewhat higher concentration than the rest of the region
(1.9% versus 1.3% overall). Over the decade between 1980 and 1990, Monroe County's
Black population decreased by 10.2%, while the State's Black population increased by
32.6%. (See Table I-C and Attachment 1-3)
W Hispanics
The Hispanic population in Monroe County is the largest minority group at 15.8%
(12,575) and closely mirrors the statewide rate at 15.8%. Hispanics are more likely to
settle in the Middle and Lower Keys, where they represent 18.0% and 16.5% of the
populations respectively. The most notable concentrations are 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
Sugarloaf Key (33044) at 9.6% or 8 persons. Over the decade between 1980 and 1990,
Monroe County's Hispanic population increased by 31.8%, while the State's Hispanic
population increased by 70.1%. (See Table I-C and Attachment 1-4)
q:> Asians
Asians account for less than 1% (716) of the population in Monroe County. The largest
share, 519, reside in the Lower Keys. Over the decade between 1980 and 1990, Monroe
I-5
County's Asian population increased by 8.5%, while the State's Asian population
increased by 75.0%. (See Table I-C and Attachment 1-5)
TABLE I-C
Zip Code
UPercent
er Keys
Population
Monroe
2000 Population
White
Number Percent
County
by Race, and Hispanic
Black
Number Percent
Origin
Asian
Number Percent
Number an ic
33036
33037
33070
Subtotal
Middle Keys
3,493
13,052
5,529
22,074
3,402
12,360
5,335
21,098
97.4
94.7
96.5
95.6
7
248
39
194
0.2
1.9
0.7
1
10
52
44
07
0.3
0.4
0.5 05
241
.
2,010
15.4
647
111
2,898.3
!3,
33001
33050
33051*
33052*
Subtotal
Lower Keys
543
11486
,
N/A
N/A
12,029
526
10,556
N/A
N/A
11,082
96.9
91.9
N/A
N/A
92.1
3
q82
N/A
N/A
486
0.6
4 2
N/A
N/A
4.0
6 1.1
57 0.5
N/A N/A
N/A N/A
63 0.5
13
2.4
2,148
18,7
N/A
N/A
N/A
N/A
2,161
18.0
33040
33041**
33042
33043
33044
33045**
Monroe
Monroe County
Florida
34,230
N/A
6,005
5,168
83
N/A
45,486
79,589
15,982,378
29,232
N/A
5,753
4,904
80
N/A
39,970
72,187
71,466,255
85.4
N/A
95.8
94.9
96.4
N/A
87.9
90.7
78
2,875
N/A
66
57
0
N/A
2,998
3,820
2,333,427
8.4
N/A
1.1
1.1
0
N/A
6.6
4.8
14.6
445
N/A
42
31
I
N/A
519
716
271,700
1.3
N/A
0.7
0.6
1.2
N/A
1.1
0.9
1.7
6,778
19.8
N/A
N/A
366
6.1
346
6.7
8
9.6
N/A
N/A
7,498
16.5
11,575
15.8
2,685,040
16.8
*Data far zip codes 33131 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.
5. Age Cohorts
The age breakdowns for the residents of Monroe County are in eight major categories:
1. 0 to 4 years old;
2. 5 to 14 years old;
1 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.
I-6
W Zero to Four Years Old
There were 3,393 children ages 0 to 4 years residing Monroe County in 20011. 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.
q�, Five to 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
represents 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
14�, 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.
I-7
tl:> Twenty to Twenty -Four Years Old
In Monroe County, 4.6% of the residents were between the ages of 20 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
Zip Code
U er Keys
Population
Monroe
by Zip Code and
-Age 0.4
Number Percent
County
Florida Keys Region,
A e 5-14
Number Percent
2001
A e 15-19
Number Percent
A e 20.24
Number Percent
33036
33037
33070
Subtotal
Middle Keys
3.438
12,970
5,450
21,8581
83
558
262
901
2.4
4.3
4.8
4.1
223
1,375
621
2,210
6.5
10.6
11.4
10.1
131
649
278
1,057
3.8
g
5.1
4.8
113
3.3
469
3.1
l69
749
3 4
3,q
33001
33050
33051*
33052*
Subtotal
Lower Keys
535
11,302
N/A
N/A
11.837
19
429
N/A
N/A
449
3.6
3.8
N/A
N/A
3.8
37
1,085
N/A
N/A
1,/22
6.9
9.6
N/A
N/A
9.5
23
486
N/A
N/A
509
4.3
4.3
N/A
N/A
4.3
14
2.6
475
4.2
N/A
N/A
N/A
489
N/A
4. /
33040
33041**
33042
33043
33044
33045**
Subtotal
Monroe County
*Data for Zio Codes 33151
33,890
N/A
6,029
5.211
82
N/A
45,212
78,907
16,349,120
and it iv) ,..:....i..a_a
1,661
N/A
205
177
2
N/A
2,045
3,393
964,6045.9
:_ �:_ ,.
4.9
N/A
3.4
3.4
2.4
N/A
4.5
4,3
_ -
3,287
N/A
531
495
8
N/A2.4
4,321
7,654
1,109,04
9.771,559
N/A
8.8
9.5
9.8
N/A
9.6
�9,7
12.
3,630
1,030,001 6.3
6
4=N/AN/A
4.6
2,101
6.2
N/A
N/A
163
2.7
151
2.9
2
N/A
2,417
3,630
N/A
5.3
4.6Florida
964,604
5.9
**Data for Zip Codes 33041 and 33045 are included in Zip Code 33040.
Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
t�> Twenty -Five to FortyFour 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 were
I-8
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 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 (33044) and Big Pine Key at 41.5% and 39.7% respectively.
4* SixtyFive to EightyFour 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.
'I:> 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 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 (33044) to
1.9% on Long Key (33001), albeit the number was quite small at 10 residents. As a
I-9
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).
TABLE I-E
Monroe
Countv
by Zip
Code and
Florida
Keys Region,
2001
Code
!UpperXeys
Population
A e 25-t4
Number Percent
A e 45 64
NumberPercent
Age 65-84
Number Percent
Age 85 and Over
Number Percent
33036
33037
33070
Subtotal
Middle X s
3,438
12,970
5,450
21,8581
870
3.515
1,553
5.938
25.3
27.1
28.5
27.2
1,365
4,060
1,739
1 7,163
39.7
31.3
31.9
32.8
602
2,127
736
3,464
17.5
164
13.5
15.8
48
1.7
220
1.7
93
361
1.7
1.7
33001
33050
33051"
33052"
Subtotal
Lower Krys
535
11,302
N/A
N/A
11,837
132
3,040
N/A
N/A
3,172
24.7
26.9
N/A
N/A
26.8
190
3,764
N/A
N/A
3,953
35.5
33.3
N/A
N/A
33.4
110
1,854
N/A
N/A
1,964
20.6
16.4
N/A
N/A
16.6
1p
1 9
170
1.5
N/A
N/A
N/A
N/A
180
1.5
33040
33041""
33042
33043
33044
33045""
Subtotal
Monroe County1.1
Florida
-Data for Zip Codes 33151
33,890
N/A
6,029
5,211
82
N/A
45,212
78,907
16,349,220
and 33152 are
11,862 35
N/A N/A
1,592 26.4
1,558 29.9
21 25.6
N/A N/A
15,032 33.2
24,146 30.6
4,594,131 28.1
included in Zi Code 33050
9,557
N/A
2,394
1,803
34
N/A
13,788
24,935
3,793,019
28.2
N/A
39.7
34.6
41.5
N/A
30.5
3L61
23.2
3,525
N/A
844
719
11
N/A
5,099
10,495
2,534,129
10.4
N/A
14
13.8
13.4
N/A
11.3
13.31
15.5
373
1.1
N/A
N/A
48
0 8
57
I.I
0
0
N/A
478
1,026
.159,683
N/A
--
2.2
P
""Data for Zip Codes 33041 and 33045 are included in Zip Code 33040.
Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
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.
I-10
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 (just under the federal
poverty threshold for a family of four).
q> 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).
q� 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 $28,016, the highest
1 The Sourcebook of Zip Code Demo agr nhics, Tenth Edition, CACI Marketing Systems, 1999.
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.
4� Households with Incomes less than $15,000
The average 2001 percentage of households with incomes 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 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%; and lastly, the Upper Keys had a rate of 10.4% with Key Largo reported at
11.8%. The largest variations occurred in the Lower Keys, with only one reported
household in this income bracket in Sugarloaf Shores (33044) or 2.9%; and other rates
ranged between 7.2 to 14.8%. (See Table IF).
I-12
TABLE I-F
Monroe County 2001 Income
b Zip Code, and Florida Kevs Region
Households with
Median Income
Household Per Capita Less Than $15,000
Zip Code Income Income Number I Percent
11 er Keys
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 Keys
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 forZip Codes 33151 and 33 i52 are mcluma in Lip L.oae »u:)u.
**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 versus 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 Monroe County 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. Only Marathon
I-13
(33070) 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
1-2).
3. Household Size
The CACI 2001 estimated average household size for Monroe County was 2.23, which
was 10.3% 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 (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
countyaverage. (See Map I-1 and Attachment 1-3).
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.
4. 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. According to the Southernmost Homeless
I-14
Assistance League, Inc. (SHAL) the number of homeless in Monroe County is 2,151. 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-G). 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-H).
Table I-G
Population
Male 1,529
Female
330
Unknown
292
Total
2,151
Homeless Families
110
Children
268
��E]
Teenager
46
Source: Southernmost Homeless Assistance
League, 2002.
Table I-H
Zone 1: Near Shore Water & Islands off Key West 211
Zone 2: Lower Keys Land Mass up to the Boca Chica Bridge 650
Zone 3: East Side of Boca Chica Bridge to Cudjoe Key + Derelict Boats 279
Zone 4: Cudjoe Key to West Side Bridge to MM 74 + Derelict Boats 467
Zone 6: MM 74 to Key Largo + Derelict Boats 139
Source: Southermost Homeless Assistance League, 2002.
The Rural Health Network on Monroe County has also collected statistics on the homeless
population. Of the total patients seen through its health services programs since
September 1999, 1,500 reported themselves to be homeless, or about 17% overall
(1,500/8,950). The largest share were residents of the Lower Keys with 3,200 (35.8%); the
I-15
next largest share was from Upper Keys with 3,000 patients (33.5%); followed by the
Middle Keys with 2,500 (27.9%). This 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 20% or higher.
5. 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 observed pattern is the Fire Department being contacted when a perceived
medical emergency occurs.
q> 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 income less than or
equal to 130% of the federal poverty level and total net monthly income 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.4 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.
Z Gross income means a household's total, non -excludable income, before any deductions have been made.
s Net income means gross income minus allowable deductions.
4 Florida Department of Children & Families, Food Stamp Program Fact Sheet, October 2000.
I-16
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
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 Lower Keys at
1.3% (138 families). Other areas in Monroe County showed T.A.N.F. rates substantially
lower, varying from 0 to .96%. (See Table I -I).
tl�> 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 Children
and Families, Office of Economic Self -Sufficiency and the Social Security Administration
determine recipient eligibility.5
A snapshot of the eligible individuals for Medicaid conducted by the Department of
Children and Families and the District XI Medicaid Office indicated that 10.0% (or 7,922)
of the population in Monroe County were Medicaid recipients. The region with the
highest percentage of Medicaid recipients was the Middle Keys at 11.7%, and specifically
Marathon (33050) had the highest rate at 12.1%. In the Lower Keys, Key West (33040)
S 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.
I-17
had the highest proportion of Medicaid recipients (11.1 %) and in the Upper Keys, Key
Largo (33037) reported the largest concentration (10.3%). The remaining areas reported
percentages ranging from 2.0% to 9.6%. (See Table I -I).
TABLE I -I
Medicaid
Zip Code
Tentporar�
Eligible Recipients, and
2000 Number of
Population Families 2000
Monroe Couritv
Assistance to Needy Families
Medicaid Reiinhurs enjen(s by
TANF Recipients
arch 2001)
% of Total
Number I Families
(T.A.N.F.),
Zip Code and Florida Ke�s Re,,ion
Medicaid Recipients 2000
Number
% of Total
Population
Reimbursements
Upper Krys
33036
3,493 974
0
0.0%
160
4.6%
$499,019
33037
13,052 3,681
51
1.39%
1,343
10.3%
$3,493,247
33070
5,529 1,483
11
0.74%
533
9.6%
$2,460,918
Subtotal
22.074 6.138
62
Not Reported
2,036
9.2%
$6,453,184
Middle Keys
33001
543 158
0
0.0%
ll
2.0%
$38,527
33050
11,486 3,130
40
1.28%
1.394
12.1%
$5,157,432
33051
included in Zip Code 33050
0
0.0%
included in Zip Code 33050
33052
included in Zip Code 33050
0
0.0%
included in Zip Code 33050
Subtotal
12,029 3,288
40
Not Reported
1,405
11.7%
$5,195,959
Lower Keys
33040
34.230 7,692
138
1.79%
3,783
11.1%
$15,086,585
33041
included in Zip Code 33040
0
0.0%
included in Zip Code 33040
33042
6,005 1,789
7
0.39%
273
4.5%
$700,711
33043
5,168 1,451
14
0.96%
418
8.1%
$1,507,777
33044
83 29
0
0.0%
7
8.4%
$333
33045
included in Zip Code 33040
0
0.0%
included in Zip Code 33040
ublotal
45,486 10,961
159
Not Reported
4,481
9.9%
$17,295,406
[llfonroeCounty
79,589 20,3871
261
L3%1
7,922
10.0%
$28,944,548
Source: Sourcebook America, 2001 Edition, ESRI Business Information Solutions.
Miami -Dade County Department of Children and Families, 2002.
District XI, Medicaid Office, 2002.
6. 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,
I- 18
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
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
Attachment 1-9).
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, the percentage of free/reduced price lunch for
elementary and middle school students and the dropout rate for high school students. See
Attachment 1-10).
1. Incidents of School Crime and Violence
Eight of the ten public elementary schools in Monroe County reported incidents of crime
and violence. Gerald Adams Elementary (Key West - 33040) reported the highest number
of incidents (130), followed by Plantation Key School (33070) and Key Largo School
(Key Largo-33037) with 51 and 49 incidents respectively. The remaining five elementary
schools reported between 2 to 27 incidents. Two schools reported having no incidents of
crime and violence during the reporting period; these were Island Montessori Charter
School (Tavernier - 33070) and Montessori Charter School (Key West - 33040). Only one
school was an "A" rated facility, Glynn Archer Elementary (Key West — 33040). (See
Attachment 1-6).
The number of crime and violence incidents in the five public middle schools located in
Monroe County ranged from 27 to 259 reported occurrences. The two schools with the
highest number of reported incidents were Horace O'Bryant Middle School (Key West -
33040) with 259 and Marathon Middle School (Marathon - 33050) at 158 incidents. The
I- I9
remaining schools reported between 27 and 51 incidents of crime and violence.
Nonetheless, 4 of the 5 middle schools had an "A" rating.
At the high school level, the number of reported incidents in the three schools in Monroe
County ranged from 70 to 158. The high school with the highest number of incidents was
Marathon High School (Marathon - 33050) with 158. The lowest number of incidents
occurred at Coral Shores High School (Tavernier - 33070). Only Marathon High was an
"A" rated facility.
2. Percentage of Absences 21+ Days
At the elementary school level, the percentage of students absent 21 days and over varied
from 0.5% at Sigsbee Elementary (Key West - 33040) to 13.7% at Montesorri Charter
School (Key West - 33040). Other elementary schools with a comparatively high
absenteeism percentage were Gerald Adams Elementary (Key West - 33040) at 9.4% and
Island Montessori Charter School (Tavernier - 33070) at 8.3%. The remaining elementary
schools reported percentages between 5.3 and 8.2. (See Attachment I-7).
At the middle school level, two schools reported rates above 10%, Sugarloaf School
(Summerland Key-33042) and Plantation Key School (Tavernier - 33070), at 13.5% and
10.5% students absent for 21 days and over, respectively. The remaining middle schools
in Monroe County reported percentages between 6.5% and 9.6%.
At the senior high school level, Coral Shores High School (Tavernier - 33070) reported the
highest percentage of absenteeism of 21 days and over at 11.1 %, followed by Marathon
High School (Marathon - 33050) at 9.9% and lastly Key West High School (Key West -
33040) at 8.7%.
3. 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% at Island Montessori Charter
I-20
School (Tavernier - 33070) to a high 14.0% at Gerald Adams Elementary (Key West -
33040). The percentages of students with limited English proficiency in the remaining
eight elementary schools ranged from 2.0 to 13.5%. (See Attachment 1-7).
The middle schools with the highest percentages 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%. (See Attachment 1-7)
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 of 7.5% and 4.5% respectively. (See Attachment I-
9).
4. Free/Reduced Price Lunch
At the elementary school level, three of the ten elementary schools reported that over 50%
of their students received free or reduced -price lunches. The three elementary schools
which ranked highest in this category were Glynn Archer Elementary (Key West-33040)
at 60.6%, Gerald Adams Elementary (Key West - 33040) at 59.9% and Stanley Switlik
Elementary (Marathon - 33050) at 54.9%. The percentage for the seven remaining schools
ranged from 3.8% to 44.3%. (See Attachment I-10).
Among the middle schools, Marathon School (Marathon - 33050) had the highest
percentage of students on free/reduced price lunch at 44.0%, followed by Horace O'Bryant
Middle School (Key West - 33040) at 42.1%. The remaining three schools reported
percentages between 21.9% and 37.4%. (See Attachment I-10).
5. Dropout Rate
Coral Shores High School (Tavernier - 33070) reported the highest dropout rate in Monroe
County at 5.1%, compared to the overall county rate of 3.0%. The second highest rate was
I-21
reported for Marathon High School (Marathon - 33050) at 2.8%, followed by Key West
High School (Key West - 33040) at 1.7%. (See Attachment I-10).
E. 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 of 21,858 (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:
'1.�> Highest population concentrations are in: Key West (33040) at 33,890 and Key Largo
(33037) at 12,970 residents.
q:> It is estimated that by year 2006, the area's population will decrease by 2.8%.
qb 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 the area residents, the largest percentage is
comprised of individuals between 45 to 64 years old (31.6%) closely followed by
people between the ages of 25 to 44 years old (30.6%). These percentages are higher
than the state as a whole.
'1�> The high median household income in Monroe County is $57,372 as reported for
Sugarloaf Shores (33044); the highest per capita income was in Islamorada (33036) at
$34,671.
q> The lowest income areas were in the Lower Keys. For households with an average
2001 income of less than $15,000, the highest rates were experienced in Key West
33040) at 14.8% and in Key Largo (33037) at 11.8%. The percentage of low income
I-22
households for the county as whole, however, was substantially lower than the state
rate (12.0% versus 17.6%, a 46.7% difference).
0* The average household size for Monroe County is 2.23, which is 10.3% lower than the
State as a whole at 2.46.
The homeless population has been counted at 2,151 countywide; 71.1 % are male, and
268 are school age children. A large portion of the homeless reside in the Lower Keys.
Based on the snapshots provided by government assistance programs, there are several
geographic areas within Monroe County with high numbers and rates of TANF and
Medicaid recipients. Some of these areas are Marathon (33050), Key West (33040)
and Key Largo (33037).
W Juvenile arrest data indicate that Middle Keys has the highest incidence of any region
but the offenses tend to be dominated by misdemeanor crimes. The single community
with the highest rates is Big Pine Key (33043) with a 10.5% charge rate and a 6.4%
arrest rate, the largest share of which were for felonies.
W 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 the 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. Among the schools in this zip code, one elementary school, one middle
school and one high school rank either first or second in incidents of crime and
violence. Elementary schools in zip code 33040 also rank high in the percentage of
students absent for 21 days or more. Glynn Archer Elementary (Key West — 33040)
ranks first among all Monroe County schools for students receiving a free or reduced
lunch at 60.6%. Coral Shores High School (Tavernier — 33070), while having a very
low number of criminal incidents, and the lowest rate of limited English proficiency
among other high schools, conversely showed the highest rates of absenteeism and
students dropping out.
I-23
ATTACHMENTS
I-1: Monroe County Population Change by Zip Code
I-2: Monroe County White Population Change by Zip Code
I-3: Monroe County Black Population Change by Zip Code
I-4: Monroe County Hispanic Population Change by Zip Code
I-5: Monroe County Asian Population Change by Zip Code
I-6: Monroe County Health Insurance Purchase Potential Index
I-7: Monroe County Average Household Size by Zip Code
1-8: Monroe County Number of Homeless Persons by Zip Code
1-9: Monroe County 2001 Juvenile Charges and Arrests by Zip Code
I-10: Monroe County 2000-2001 School Indicators Report
Maps:
I-1. Monroe County 2000 Population by Zip Code
I-24
ATTACHMENT I-1
Zip Code
Population Change
''I to 19901
1980
Census
Monroe
by Zip
1990
Census
County
Code
Percent
Change
I6 Projection
2001
Census
2006
Projection
Percent
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
21,136
-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%
11,837
11,136
-5.9%
Lower K s
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
3Z7%
16,349,220
17,895,689
9.5%
2001/2006 Data Source: Sourcebook Amenca, 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.
I-25
ATTACHMENT I-2
White
Zip Code
Population
1990
Monroe
Change by
1990 and 1997
2000
County
Zip Code
to 2000
Percent
Change
and Florida
Census
1997
Kevs Reoion
2000
Percent
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
71,148
-0.5%
Florida
,-..
10,751,417
12,466,255
15.9%
11,824,703
12,466,255
S.4%
-- - ovuicc: avurce000k Amenca, 2-Out Edition, EJKl business Information Solutions.
1990 Data Source: Sourcebook America 2000 Edition, ESRI Business Information Solution.
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
I-26
Attachment I-3
Black
Zip Code
Population
1990
Monroe
Change by
1990 and 1997
2000
County
Zip CodeFlorida
to 2000
Percent
Change
Census
1997
2000
Percent
Change
g
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
Z998
-23.2%
Monroe County
4,206
3,777
-10.2%
5,062
3,777
-25.4%
Florida
1,759,558
2,333,427
3Z.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 Solution.
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
I-27
Attachment I4
Hispanic
Zip Code
Upper Keys
Population
1990
Monroe
1990 and 1997
2000
County
to 2000
Percent
Change
Census
1997
2000
Percent
Change
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
2,161
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
innn n — a
1,578,427
2,685,040
70.1%
2,136,642
2,685,040
25.71.
..
I-28
Attachment I-5
Asian
Zip Code
Population
1990
Monroe
Change by
1990 and 1997
2000
County
Zip Code
to 2000
Percent
Change
and Florida
Census
1997
Keys Region
2000
Percent
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
71
106
49.3%
114
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 Solution.
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
I-29
Attachment I-6
i Monroe County
Health Insurance Purchase
Zip Code
Potential Index*
Health Insurance
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 Zip Code 33050
Subtotal
Not Reported
Lower Keys
33040
93
33041
included in Zip Code 33040
33042
133
33043
133
33044
113
33045
included in Zip Code 33040
Subtotal
Not Reported
Monroe County
108
Florida
93
*100=Average Demand Nationally. An index of 86 implies that demand is 14% lower
than the U.S. average; an index of 1 10 implies that demand is 10% higher. Calculated
by combining CACI'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.
I-30
ATTACHMENT I-7
Nlonroe County
A%erage Household Size
bN Zip Code and Florida Keys Region, 2001
Average
Zip Code Household Size
Upper K s
33036
1.96
33037
2.23
33070
2.28
Subtotal
Not Reported
Middle Keys
33001
2.17
33050
2.15
33051
included in Zip Code 33050
33052
included in Zip Code 33050
Subtotal
Not Reported
Lower Ke
ys
33040
2.29
33041
included in Zip Code 33040
33042
2.22
33043
2.21
33044
2.41
33045
included in Zip Code 33040
Subtotal
Not Reported
Monroe County
2.23
Florida
2.46
Source: Sourcebook America, 2001 Edition,
ESRI Business Information Solutions.
I-31
ATTACHMENT I-8
Homeless
PENDING
I-32
ATTACHMENT I-9
ZIP Code
Monroe
Population i
Under 18
Charges,Juvenile
Total
Percent
Felony
111 I
Juvenile Charges
Percent Misdem.
Percent
Other
Percent
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
2.6%
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%
1
0.0%
3
0.0%
4
0.0%
33045
0
0
0.0%
0
0.0%
0
0.0%
0
0.0%
Subtotal
1 7,737
422
5.5%
1 162
2.1%
200
2.6%
60
0.8%
Monroe County
19,467
1 1176
6.0%
1 424
2.2%
1 542
2.8%
1 210
1.1%
*Population was not reported by Department of Juvenile Justice.
Source: Bureau of Data and Research, Florida Department of Juvenile Justice, 2001.
"The data in "Charges" is the sum of all violations of the law recorded on JJIS in a specific zipcode.
I-33
Attachment 9 (continued)
NtIonroe
Juvenile
CountyIndicators
Arrests,
Population
i
Fiscal
Vear 2000-2001
Juvenile Arrests
ZIP Code
Under 18
1 Total
Percent
I Felony
Percent
Misdem.
Percent
Other
Percent
Upper Keys
33036
387
T 18
4.7%
5
1.3%
5
1.30/.
1 8
2.1%
33037
2,418
80
3.3%
26
1.1%
39
1.6%
15
0.6%
33070
1,120
1 52
4.6%
19
1.7%
17
1.5%
16
1.4%
Subtotal
3,925
1 150
3.8%
50
1.3%
61
1.6%
1 39
1.0%
Middle Keys
33001
71
2
2.8%
1 0
0.0%
0
0.0%
2
2.8%
33050
1,869
92
4.9%
29
1.6%
46
2.5%
1 17
0.9%
33051
"
3
2
*
"
33052
0
0
0.0%
0
0.00/.
1
0
0.0%
0
1 0
0.0%
Subtotal
1,940
97
5.0%
31
1.6%
47
2.4%
/9
1.0%
Lower Keys
33040
5,961
206
3.5%
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%
11
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
0.01!%
1
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%
1 54
0.7%
Monroe County
*pn "I'r;..
19,467
795
4.1%
287
1.5%
338
1.7%
1 170
0.9%
Source: Bureau of Data and Research, Florida Department of Juvenile Justice, 2001.
1-34
ATTACHMENT I-10
Monroe Count 2000-2001 School Indicators Report
ELEMENTARY SCHOOLS
Zip
Code
School
School
Grade
# of
Students
Incidents of
Crime&Violence
% Absent
21+Days
% Limited
En.Prof.
% Free/Redueed
Lunch
33037
Key Largo School
B
802
49
8.2
6.3
44.3
33040
Gerald Adams Elementary
B
549
130
9.4
14.0
59.9
33040
Glynn Archer Elementary
A
429
6
7.4
13.5
60.6
33040
Montessori Charter School
B
50
0
13.7
2.0
4.0
33040
Poinciana Elementary School
B
593
6
5.9
7.1
28.5
33040
Si sbee Elementary School
B
368
2
0.5
4.4
30.4
33042
Sugarloaf School
C
589
27
8.2
2.5
33.6
33050
Stanley Switlik Elementary
B
709
16
6.5
7.2
54.9
33070
Island Montessori Charter School
Not Reponed
80
0
8.3
0.0
3.8
33070
Plantation Key School
B
410
51
5.3
6.3
22.0
District Level Data
N/A
4,579
287
6.9
7.4
41.6
source: Department of haucation, r iortaa Scnoois inmcators Report, muu-200 i.
Monroe Count 2000-2001 School Indicators Report
MIDDLE SCHOOLS
Zip
Code
School
School
Grade
# of
Students
Incidents of
Crime& Violence
% Absent
21+ Days
% Limited
% Free/Reduced
Lunch
33037
Key Largo School
A
398
49
7.7
4.9
37.4
33040
Horace O'Bryant Middle School
A
843
259
9.6
7.6
42.1
33042
Sugarloaf School
A
364
27
13.5
1.3
28.0
33050
Marathon High School
A
257
158
6.5
6.1
44.0
33070
Plantation Key School
B
251
51
10.5
3.1
21.9
District Level Data
N/A
1 2,113
544
9.7
5.2
36.6
Source: Department of Education, Florida Schools Indicators Report, 2000-200 L
Monroe Count 2000-2001 School Indicators Report
SENIOR HIGH SCHOOLS
Zip
Code
School
School
Grade
# of
Students
Incidents of
Crime & Violence
% Absent
21+Das
% Limited
Eng. Prof.
Dropout
Rate
33070
Coral Shores High School
C
809
70
11.1
4.5
5.1
33050
Marathon High School
A
432
158
9.9
8.3
2.8
33040
Key West High School
C
1,339
103
8.7
7.5
1.7
District Level Data
N/A
2,580
331
9.6
6.7
3.0
Source: Department of Education, Florida Schools Indicators Report, 2000-2001.
1-3 5
MapI1
k
� .
|
�
i
k
�
§
2q/S°q�2°G222o
LOmco q �R°°*C,
nw �oLd Q aR<�
§o
5
� | n ill-1-1 w� �
a
a \ 2 ) 3 ■
k
u 2
o % p § \
20_ o 2«�
0 m @
oRoj/§ƒM;kQ0
E 3Ea%#23a
o t cucu
n@a)Il§
V-or-0'Ncoto �o�
oonn #�Lo040
Q000�33�000roo
�RRgARQAGaRRRRo
N 7
� �
k
& k � § ■ { § \ §
■ ƒ
§
I3
C _n , ty
Community Health
Perspectives Rep. art
F ,4' 01810gue with Providers
and Consumers
Prepared ky.-
The Health Council of Sout .h Florida, Ine.
Table of Contents
Acknowledgments
Page Number
i
Map 1: Monroe County Regions by Zip Code iii
Map 2: Monroe County Community Health Initiative Personal Interviews/
Community Surveys, Physician Focus Groups and Town Hall Meetings iv
Monroe County Commission Districts, Corresponding Precincts
and Registered Voters v
Prologue 1
Introduction and Purpose 2
Data Limitations 3
Methodology 4
Results 5
Part A: Personal Interviews/Community Surveys 6
1. Composite Results
2. Cross Tabulations
Part B: Physician Focus Groups 17
Part C: Town Hall Meetings 19
Summary Analysis 22
Attachments
I. Questionnaires
A. Personal Interview and Community Surveys Instrument— English
B. Personal Interview and Community Surveys Instrument - Spanish
C. Physician Focus Group Discussion Questions
D. Town Hall Meeting Discussion Questions
II. Personal Interviews/Community Surveys
A. Cumulative Responses to Close -Ended Questions
B. Cumulative Responses to Open -Ended Questions
C. Cross -Tabulated Responses
III. Physician Focus Groups
IV. Town Hall Meetings
A. Meeting Packet
B. Discussion Notes
Acknowledgements
The Monroe County Community Health Perspectives Report 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.
Chair and Co -Chair
R.C. Jake Rutherford, M.D., Chair Monroe County Department of Health
Keith Douglass, Co -Chair Rural Health Network of Monroe County
Members
Julio Avael City of Key West
Al Brotons EMS of Monroe County
Cheryll Cottrell, R.N.
Mariner's Hospital
Tracey Greene
Plantation Key Convalescent Center
Reverend Jim Gustafon
Mariner's Hospital
Liz Kern, R.N.
Hospice of the Florida Keys, Inc.
Meylan Lowe-Watler
Lower Keys Medical Center
Julia Pranschke
Senior Advocate
Debra Premaza, R.N.
Lifeline Home Health Care
David Rice, Ph.D.
Guidance Clinic of the Middle Keys
Rick Rice
Fishermen's Hospital
Charla Rodriguez
Monroe County Department of Children &
Families
Mayor Pro -Tern Dixie Spehar
Monroe County Board of County
Commissioners
Louis La Torre
Monroe County Social Services
Debra S. Walker, Ph.D.
Monroe County School Board
Robert Walker
AIDS Help, Inc.
Jane Mannix Lachner
Monroe County Prison Health Services
Special thanks to Bill Kwalick of the Key Largo Chamber of Commerce and Michael Cunningham,
Director of the Monroe County AHEC for their
participation during the Task Force meetings.
0
Special Acknowledgments
The Personal Interviews/Community Surveys, Physician Focus Groups and Town Hall Meetings
were made possible with the support of the following organizations:
Monroe County Community Health Initiative Task Force
Rural Health Network of Monroe County
Lifelines Medi-Van
Ruth Ivins Health Care Center for Public Health
Lower Keys Medical Center
Fishermen's Hospital
Mariners Hospital
AARP of Monroe County
Monroe County Health Department
Monroe County Social Services
Monroe County Public Works
Staff Acknowledgements
Health Council of South Florida, Inc.
Sonya R. Albury Executive Director
Vianca H. Stubbs Senior Health Planner
Lourdes Gonzalez Project Director
Rob Harris Data Manager
Shaleen Hamilton Research Associate
Map 1
m
-0o
r- cc a,
O `p f0 `
J
cu
ao Y �C-u
d
co
m M CD
V M M M
IV
fn
a�
Y
co
.0
0
LL
CD
2
L
cc
N
m o
a
r0 c p c
O Y L L
; o, m V cc
c m >+
d
tN
(� O O O Cl
P') M co f7
Cl) C7 Cl) Cl)
N
N
CD
Y
co
.o
.o
LL
3
O
d
O N M T LO
V 0 0 0 0 0
M M cn M M M
cn Cl) c`9 M Cl) co
N
111
e
ll0A
N
C)
C)
N
f4
7
c
c0
U
C
T
m
O
O
c
C
U
a)
(U
U
L
a
T
rn
0
CD
c�
U
a)
LL
(O
0
m
Map 2
4�:;7
LO
z�
1
� Lty
tD �
c0
0
cn04
jC
in m 0
O c
C O > L •0 (D
U
F= a) i --
O fl.a)LL OU .i
U a a) U U U :a c a) a y 1
U)= oU�U o ac) a> a) 0 0C�
c co aNi 0 L c y LL Y 2 U rn o y
O L a) > a) ca y N L L e — >1 as w
m E �•ctn"U�� co a) a) m a)�
c a ca CO CO 7 CC U n p = coo N N C4 \i
cOLn Q NY���cncncnfn T ii� 3 =Y� 000
= d �NM'-�tcl)CDI-- CC) mC� C14 mI- LO M
't� r
y
J Q 0 M
1V
N
O
O
CV
m
7
c
m
0
c
T
CT
O
c
L
U
a)
H
cu
U
:c
0.
rn
0
a)
C�
cn
a)
LL
m
c
O
m
a)
m 0
U O
�U
0 .o
(n N
Map 3
o�
o �w!
LOWa C.m oN o 0at-
M M f- O) N 00 O v� v� Lo O
�-,:r O co O N � C O O A T
C C �M mLO Lo M�- 2 MVI OD
o a t a
Lip U U U U
Q g O O
fl. N N N N
p E e 4; .e
dm
a
O U J U U
N c c
d >+.
C C T
O m a) Cn m O
N N
w y N C Co O c CLD
a°YE-'�3�a.m3��r� �
CY
0 �YYAe
Yfnmtn Y� Y �F�-
m �
C O c0 cf � O N L7 O p_ N O p
U a a a 0� 0 a � a to
CO M M CM O O O O O O
=MMMM LMMM CO � Co O
N c
9
3 N
V
3.
Monroe County Commission Districts, Corresponding Precincts and Registered Voters
Commissioner
Commission
Corresponding
Registered
District
Precincts
Voters
Mayor Pro-Tem Dixie Spehar
1
Precinct 1
984
500 Whitehead Street, Suite 102
Precinct 2
1461
Key West, FL 33040
Precinct 3
1214
Phone: (305) 292-3440
Precinct 4
821
FAX: (305) 292-3466
Precinct 10
1424
boccdis1(cDmail.state.fl.us
Precinct 11
2083
Precinct 12
1560
Total for District 1 9,547
Commissioner George Neugent
2
Precinct 13
1326
25 Ships Way
Precinct 14
1487
Big Pine Key, FL 33043
Precinct 15
2131
Phone: (305) 872-1678, 292-4512
Precinct 16
1836
Fax: (305) 872-9195
Precinct 17
1446
gneugenKaDmail.state.fl.us
Precinct 18
1218
Precinct 19
1756
Total for District 2 11,200
Mayor Charles "Sonny" McCoy
3
Precinct 5
2369
530 Whitehead Street
Precinct 6
1328
Key West, FL 33040
Precinct 7
804
Phone: (305) 292-3430
Precinct 8
1468
Fax: (305) 292-3577
Precinct 9
1422
boccdis3Cc�mail. state.fl.us
Total for District 3 7,391
Commissioner Bert Gimenez
4
Precinct 20
1233
490 63rd Street, Ocean #110
Precinct 21
1065
Marathon, FL 33050
Precinct 22
735
Phone: (305) 289-6000
Precinct 23
1362
Fax: (305) 289-6306
Precinct 24
1775
boccdis4(&mail.state.fl.us
Precinct 25
1630
Precinct 26
1909
Total for District 4 9,709
Commissioner Murray Nelson
5
Precinct 27
1249
Damaro Building, Suite II
Precinct 28
1619
99198 Overseas Highway
Precinct 29
2186
Key Largo, FL 33037
Precinct 30
1241
Phone: (305) 852-7175
Precinct 31
1126
Fax: (305) 852-7162
Precinct 32
1734
boccdis5a-mail state.fl.us
Precinct 33
1105
Total for District 5
10,260
Total for all Districts 48,107
Prologue
The development of the Community Health Perspectives: A Dialogue with Providers and
Consumers report is designed to complement the Monroe County Community Health Profile. It
is one of several research components of a larger overall Initiative. The findings, observations
and opinions expressed in this document are those of the participants, and not that of the Monroe
County Community Health Initiative Task Force or the Health Council of South Florida, Inc.
Rather, they reflect independent perspectives provided by individuals participating in the
Personal Interviews/Community Surveys, Physician Focus Groups, and Town Hall Meetings
performed throughout Monroe County.
It is important to note that this is a qualitative analysis of the opinions of several providers and
community members residing and/or working in Monroe County. A quantifiable, statistical
sample of the population's opinions in Monroe County is beyond the scope and resource
limitations of this project. Therefore, individual opinions expressed within this report should not
be considered as representative of a statistically valid sample. However, the results are useful for
directional purposes. This report is to be utilized as a complementary document to the Monroe
County Community Health Profile, which is based on an analysis of documented statistical
information concerning the population's demographics, health status and health care utilization
patterns.
Monroe County Community Health Initiative
Community Health Perspectives of
Providers and Consumers
Introduction and Purpose
The Health Council of South Florida, with the financial support of the Monroe County Board of
County Commissioners and in collaboration with the Monroe County Community Health
Initiative Task Force (MCCHI), conducted a series of community -based discussions throughout
the Monroe County area. For the purposes of this Initiative the Monroe County area was divided
into three regions: Upper, Middle and Lower Keys. The community centered projects (Personal
Interviews/Community Surveys, Physician Focus Groups, and Town Hall Meetings) provided a
wide array of qualitative data. Taken together, these datasets form the basis for the Community
Health Perspectives report. The following information describes these assessment activities with
the intent of providing a better understanding of the myriad of factors affecting the health of the
uninsured and underinsured population in Monroe County.
As such, the following report outlines the results of the Personal Interviews/Community Surveys
conducted or collected between March through June 2002, the Physician Focus Group sessions
held on May 7`h and June 19`h; and the three -site Town Hall Meeting conducted in Key Largo,
Marathon and Key West on May 23`d, 2002. Collectively, these personal interviews, surveys,
focus groups and community meetings succeeded in obtaining valuable community participation
and information on access to health insurance and the availability of affordable health care as
addressed by the MCCHI Task Force. The Task Force was exceedingly helpful in reaching out
to the community and encouraging participation from a large cross-section of the community.
Constructive feedback and recommendations from these results will be incorporated into the
MCCHI Action Plan and Recommendations/Strategies report.
A general description of the Monroe County Community Health Initiative was presented to
participants of the Personal Interviews/Community Surveys, Physicians Focus Groups and Town
Hall Meetings. The Initiative was described as a multi -phased project that seeks to enhance the
delivery of primary and preventative health care services to the uninsured and underinsured
population in Monroe County.
Data Limitations
The groups surveyed in this report were a sample of convenience and were not planned to be a
statistically valid sample due to time and resource constraints. Nonetheless, this report provides
insight concerning the perspectives of community residents and providers in Monroe County
with regard to their health care. As such, it emphasizes qualitative findings over quantitative
findings. Quantitative findings on demographic data, health status indicators and health
resources, will be compiled in the companion Monroe County Community Health Profile. This
report should be reviewed in conjunction with the Monroe County Community Health Profile to
gain a fuller perspective of the dynamics of the health indicators in Monroe County.
Methodology
Three approaches were used to elicit the perspectives of the community in the 13 zip codes of
Monroe County (Please refer to Maps I & 2):
Personal Interviews/Community Surveys
Physician Focus Groups
Town Hall Meetings
For the Personal Interviews/Community Surveys, HCSF staff visited multiple locations and
attended events/meetings throughout Monroe County such as a health fair, a seafood festival,
several public health clinics, local neighborhood churches and associations, as well as a center
for the elderly. The personal interview/community survey instrument was administered and
available in both English and Spanish. (Please refer to Attachments I -A and I-B).
The survey instrument was composed of 26 questions and divided in two sections: health care
insurance coverage and health care access. Additionally, Nbnroe County Community Health
Initiative Task Force members were invited to distribute the surveys via e-mail to local health
departments, county government offices, local chambers of commerce, churches, banks and
other community groups. The survey instrument was also made available for publication in a
local newspaper for residents. Readers were encouraged to complete the survey and fax or drop-
off the completed questionnaire at a local health department site. The purpose was to identify
some of the most relevant and critical health care needs of the local resident population.
A general description of the project was created for presentation to the participants at the
interview sites for administration of the questionnaire. No personal information, such as names,
addresses or phone numbers, were requested in order to maintain anonymity and cooperation.
Two Physician Focus Groups were held at the Lower Keys Medical Center in Key West on May
7, 2002 and at Fishermen's Hospital in Marathon on June 19, 2002. Focus group participation
was sought among both primary care/family practice physicians and specialists. The focus group
questionnaire contained 15 questions pertaining to health care access and support services and
needs; health care practices; and health care finances. (Please refer to Attachment I-Q. These
small, focused discussions were designed to obtain information from the physicians' perspective
on health care access issues in Monroe County.
To further strengthen the qualitative results of the community data gathering, the Health Council
of South Florida, in collaboration with the Task Force membership, scheduled the first of its kind
event - a three -site televised Town Hall Meeting. The Town Hall Meeting sites were publicly
noticed so that all Monroe County residents could participate and express their views. (Please
refer to Attachment I-D for a copy of the discussion questions and Attachment IV -A for the full
meeting packet).
The results of this three -pronged approach to garnering the perspectives of the community are
detailed by each activity. Collectively, they offer valuable insights on consumer and health care
provider opinions concerning health care access within Monroe County.
Results
The findings and results, presented in this report, are based upon a total of 1,202 participants
from all data collection activities (Personal Interviews/Community Surveys, Physician Focus
Groups and Town Hall Meetings). All findings are presented in narrative and with
corresponding attachments that display results for individual questions.
Part I: Personal Interviews/Community Surveys
In an effort to capture the opinions of Monroe County residents regarding health insurance
coverage and health care access, a series of Personal Interviews/Community Surveys were
administered throughout the Upper, Middle, and Lower Keys between March and June 2002.
Surveys were also distributed throughout the county by Monroe County Community Health
Initiative Task Force members and the local media.
The personal interview/community survey consisted of 26 questions, including open-ended
questions, and took approximately 10 minutes for respondents to complete. Personal
interviews/community surveys were administered at the Mariners Hospital's Health Fair, the
Marathon Seafood Festival, several clinic sites of the Rural Health Network of Monroe County,
at neighborhood public health clinics, and at two locations frequented by senior citizens.
Between the months of May and June 2002, 974 surveys were collected by Task Force members
and forwarded to the Health Council of South Florida for analysis. Another 158 were collected
through personal interviews/community surveys. Every effort was made to conduct the surveys
in surroundings familiar to the respondents and during non -working hours. The following table
presents a breakdown of the number of personal interviews/community surveys completed by
survey site:
Table I: Personal Interview/Community Survey Sites
l
Site
Mariner's Hospital Health Fair
Location
Tavernier
Number
Received
51
2
Marathon Seafood Festival
Marathon
13
3
Ruth Ivins Center for Public Health
Marathon
7
4
St. Justin Martyr Catholic Church
Key Largo - Medi-Van
5
5
San Pedro Catholic Church
Tavernier - Medi-Van
8
6
Islamorada Fire Dept.
Islamorada - Medi-Van
5
7
St. Peter's Church
Big Pine Ke -Medi Van
16
8
Hams School
Key West-Medi Van
21
9
AARP Membership Meeting
Key West
20
10
Senior Center
Key West
12
Total Received from Sites
158
Total Received from Task Force Members
974
Personal Interviews/Community Surveys -Total
1,132
Regional Breakdown
A total of 1,132 personal interviews/community surveys were gathered and analyzed by the
Health Council of South Florida. The majority of the surveys (731 or 64.6%) were completed by
respondents from the Lower Keys. Upper Keys respondents followed with 251 completed
surveys (22.2%) and Middle Keys respondents completed the remaining 131 surveys (11.6%). A
total of 19 surveys did not include the respondent's zip code. Therefore, these surveys could not
be broken down at the regional level.
Gender
More females (710) than males (401) completed the personal interviews/community surveys.
The largest majority of female respondents were from the Upper Keys (73.7%), while the largest
portion of male respondents were from the Lower Keys (39.1%). Please refer to Table II below.
Male
Female
No Answer
Total
Table II: Survey Respondents, by Gender and Region
Total Lower Middle U er
Number
Percent
Number
Percent
Number
Percent
I Number
Percent
401
286
39.1 %
42
32.1 %
65
25.9%
710
436
59.6%
84
64.1 %
185
73.7%
21
9
1.2%
5
3.8%
1
0.4%
1132
731
100.0%
131
100.0%
251
100.0%
Age
Personal interviews/community surveys were primarily completed by individuals between 20
and 49 years of age (639 respondents). An additional 449 surveys were completed by county
residents 50 years of age and older. The opinions of youth (0-19 years old) were not adequately
captured through this survey instrument as only 5 youths participated countywide.
Employment Status
More than three-quarters (76.2%) of survey respondents indicated their employment status as
employed. However, nearly one -quarter (23.0%) of survey respondents indicated that they were
currently unemployed. While the county's unemployment rate may be a factor, this finding is
more likely due to the large number of older survey participants who may be retired. In fact, of
the 260 unemployed survey respondents, 80 were unemployed individuals 65 years of age and
older. By utilizing these depreciated figures, the unemployment percentage among all survey
respondents decreases to 15.9%.
1) Perceptions of a healthy community
Overall, 44.8% of the survey respondents described their community as "healthy". Respondents
cited Monroe County's lifestyle, climate, and availability of outdoor activities (16.2%, 82
respondents) as the main reason for perceiving their community as "healthy". Other reasons
cited were that people living in the Keys are healthy (7.7%, 39 respondents), health care services
are accessible (6.3%, 32 respondents) and health care services are available (4.1%, 21
respondents). It should be noted that respondents from the Middle Keys were more likely to
describe their community as "unhealthy" (49.6%) than respondents from the Lower and Upper
Keys, 40.9% and 37.5%, respectively.
Two -fifths (40.6%) of survey respondents described their community as "unhealthy". While a
myriad of reasons were offered, the leading causes were: alcohol use (17.8%, 82 respondents),
the large number of uninsured (15.7%, 72 respondents), drug use (13.9%, 64 respondents), and
lack of affordable health insurance coverage (13.0%, 60 respondents). Please refer to Table III
below.
Yes
No
No Answer
Total
Table III: Perception of a Healthy Community, by Region
Total Lower Middle Unner
Number
Percent
Number
Percent
Number
Percent
Number
Percent
507
44.8%
324
44.3%
47
35.9%
125
49.8%
460
40.6%
299
40.9%
65
49.6%
94
37.5%
165
14.6%
108
14.8%
19
14.5%
32
12.7%
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
Cross tabulations between survey respondents' perception of a healthy community and health
insurance status were performed. Data revealed that one -fifth (21 or 20.4%) of uninsured survey
respondents perceived their community as "unhealthy" due to the lack of affordable health
insurance coverage compared to 11.0% of insured survey respondents (39).
2) Health insurance coverage
When asked about their health insurance status, 854 of 1,132 respondents (75.4%) reported
having some form of health insurance coverage. Countywide, the major insurance types reported
by survey respondents were Blue Cross Blue Shield (18.3%, 156 respondents), Acordia (12.0%,
102 respondents), Medicare (11.7%, 100 respondents), and Medicaid (8.1%, 69 respondents).
Blue Cross Blue Shield was the leading insurance type cited among Lower, Middle, and Upper
Keys respondents, 17.2%, 23.8% and 18.5%, respectively. Other sources of health insurance
include coverage through the Florida League of Cities, employer -based coverage, and
TRICARE. Please refer to Table IV below.
Table IV: Leading Health Insurance Types, by Region
Cumulative Responses Lower Keys
Number
IPercent
Blue Cross Blue Shield
156
18.3%
Acordia
102
12.0%
Medicare
100
11.7%
Medicaid
69
8.10%
Florida League of Cities
35
4.1 %
Middle Keys
Number
IPercent
Blue Cross Blue Shield
24
23.8%
Acordia
16
15.8%
First Health
9
8.9%
Employer -based
(company not specified)
4.0%
Humana
177i
4.0%
Number
Percent
Blue Cross Blue Shield
97
17.2%
Medicare
64
11.4%
Florida League of Cities
35
6.2%
Medicaid
1 281
5.0%
TRICARE
1 221
3.9%
Upper Keys
Number IPercent
Blue Cross Blue Shield
33
18.5%
Medicare
31
17.4%
Acordia
18
10.1 %
CIGNA
8
4.5%
Employer -based
(company not specified)
7
3.9%
AARP
7
1
3.9%
Humana
7
3.9%
Nearly a quarter (24.0%) of respondents stated that they do not have health insurance coverage.
The most common reasons cited by uninsured respondents were inability to pay premium
(52.6%), employer does not offer coverage (5.1%), currently unemployed (4.8%), undergoing
probationary period at new job (2.6%) and having a pre-existing condition (2.2%).
Cross tabulations between survey respondents' health insurance status, gender, and employment
status were performed. Data revealed that male survey respondents were 1.8 times more likely
to be uninsured than female survey respondents, 33.7% versus 18.7%, respectively. Nearly two-
thirds (63.2%, [172/272]) of the uninsured are currently employed. Please refer to Table V
below.
Yes
No
No Answer
Total
Table V: Insurance Coverage, by Gender and Employment Status
Total Em to ed Unem Dloyed Male FemalE
Number
Percent
Number
I Percent
Number
Percent
Number
Percent
I Number
Percent
1,132
100.0%
863
100.0%
260
1007/6
401
100.0%
710
100.0%
854
75.4%
687
79.6%
161
61.9%
263
65.6%
575
81.0%
272
24.0%
172
19.9%
98
37.7%
135
33.7%
133
18.7%
6
0.5%
4
0.5%
1
0.4%
3
0.7%
2
0.3%
1,132
100.0%1
863
100.0%1
2601
100.0%1
401
100.0%
7101
100.0%
3) Needed services not covered through health insurance
Over two -fifths (43.4%) of survey respondents indicated that they were in need of services that
are not covered through their health insurance. Leading unmet service needs include: dental
services (13.6%), vision services (11.5%), prescription services (5.3%), prevention/wellness
visits (4.2%), and more physicians who accept health insurance coverage (2.2%).
Regional data show that Upper Keys respondents indicated a greater need for dental and
prescription services than respondents from the Lower and Middle Keys. Respondents from the
Middle Keys indicated a greater need for vision services (15.8%), women's services (4.0%) and
birth control (3.0%) than Lower and Upper Keys respondents. Please refer to Table VI below.
Table VI: Needed Services, by Region
[None/All needed services are covered 1 3701 43.3%1 2411 42.8% -5-0/.-T-781 43.8%
Dental services
116
13.6%
74
13.1%
11
10.9%
29
16.3%
Vision services
Prescription services
98
45
11.5%
5.3%
58
31
10.3%
5.5%
16
2
15.8%
2.0%
23
11
12.9%
6.2%
Prevention/Wellness visits
36
4.2%
29
5.2%
5
5.0%
2
1.1°%
More physicians who accept insurance
Women's services
19
16
2.2%
1.9%
8
9
1.4%
1.6%
4
4
4.0%
4.0%
7
3
3.9%
1.7%
Birth control
1 14
1.6%
9
1.6°%
'Al
3.0%
2
1.1%AII
services are needed
Al0.9%
Al1.1°%
0
0.0%
2
1.1%
Physician visits
7
0.8%
5
0.9%
0
0.0%
2
1.1%
Other
42
4.9%1
221
3.9%
71
i-IL_
6.9%
13
7.37
No answer
_211
8.3%1
53
9.4%
7.9%
9
5.1 °%
4) Knowledge of Medicaid and KidCare/Healthy Kids Programs
As a whole, almost all survey respondents (1,071 or 94.6%) indicated that they had heard of the
Medicaid Program. However, nearly one-third (348 or 30.7%) of respondents had not heard of
the KidCare/Healthy Kids Program. These findings are also valid for each of the three regions,
Lower, Middle, and Upper Keys. Survey respondents aware of the KidCare/Healthy Kids
Program cited the following as leading sources for the KidCare/Healthy Kids Program
awareness: schools (12.8%), newspaper (10.3%), friends, acquaintances, and family members
(8.6%), work (8.2%), Department of Children and Families (6.4%), and word of mouth (6.1 %).
Cross tabulations between survey respondents' awareness of the KidCare/Healthy Kids Program,
insurance status and gender were performed. Data revealed that two -fifths (109 or 40.1 %) of
uninsured survey respondents were not aware of the KidCare/Healthy Kids Program.
Furthermore, female survey respondents were 1.5 times more likely to have heard about the
KidCare/Healthy Kids Program than male survey respondents (76.5% versus 52.4%,
respectively). Please refer to Table VII below.
Table VII: KidCare/Healthy Kids Program Awareness, by Insurance Status and Gender
Yes
No
No Answer
Total
Total Insured Uninsured Male Female
Number
I Percent
Number
I Percent
Number
Percent
Number
Percent
Number
Percent
1,132
100.0%
854
100.0%
272
100.0%
401
100.0%
710
100.0%
765
67.6%
605
70.8%
156
57.4%
210
52.4%
543
76.5%
348
30.7%
239
28.0%
109
40.1 %
184
45.9%
156
22.0%
19
1.7%
10
1.2%
7
2.6%
7
1.7%
11
1.5%
1,132
100.0%1
854
100.0%1
272
100.0%
401
100.0%
710
100.0%
5) Medical home
Nearly half (537 or 47.4%) of survey respondents stated that they go to a doctor's office for
health care services. Other leading sources for health care included: clinics (10.2%), the
LifeLines MediVan (6.3%), health services located in Miami (5.1%), and hospitals (4.8%).
Regional data shows that survey respondents from all three regions primarily utilize a doctor's
office for healthcare. Survey results additionally revealed that 5.1% of survey respondents from
the Lower Keys utilize the Lower Keys Medical Center. Meanwhile, 16.0% of Middle Keys
survey respondents utilize Fisherman's Hospital and 5.3% south health care services at the Ruth
Ivins Center for Public Health, and approximately 8.0% of survey respondents from the Upper
Keys utilize Mariner's Hospital for health care services.
Cross tabulations between survey respondents' usual source of health care and insurance status
revealed that uninsured survey respondents are 14 times more likely to utilize the LifeLines
MediVan for health care services than insured survey respondents, 21.3% versus 1.5%,
respectively. Furthermore, a higher percentage of uninsured survey respondents (6.6%) than
insured survey respondents (0.7%) reported using the emergency room for health care services.
Meanwhile, insured survey respondents were 3 times more likely to go to the doctor's office for
health care services than uninsured survey respondents, 56.4% versus 18.4%, respectively.
Please refer to Table VIII on the following page.
10
Table VIII: Usual Source of Health Care, by Insurance Status
Total Insured Uninsured
Number
Percent
Number
Percent
Number
Percent
1,132
100.0%
854
100.0%
272
100.0%
Doctor's office
537
47.4%
482
56.4%
50
18.4%
Clinic
115
10.2%
81
9.5%
32
11.8%
Lifelines MediVan
71
6.3%
13
1.5%
58
21.3%
Miami
581
5.1 %
53
6.2%
5
1.8%
Hospital
54
4.8%
31
3.6%
22
8.1 %
Do notgo/have not needed to go
50
4.4%
13
1.5%
37
13.6%
Truman Medical Group/Clinic/Center
34
3.0%
29
3.4%
5
1.8%
Fishermen's Hospital
33
2.9%
29
3.4%
4
1.5%
Lower Keys Medical Center
37
3.3%
27
3.2%
10
3.7%
VA/VA Clinic
25
2.2%
21
2.5%
4
1.5%
Emergency room
24
2.1 %
6
0.7%
181
6.6%
Mariners Hospital
22
1.9%
20
2.3%
21
0.7%
Naval Air Station
19
1.7%
19
2.2%
01
0.0%
Locally
18
1.6%
16
1.9%
21
0.7%
Womankind
15
1.3%
11
1.3%
4
1.5%
Anywhere/everywhere
10
0.9%
9
1.1 %
1
0.4%
Homestead
9
0.8%
9
1.1 %
0
0.0%
Key West
9
0.8%
9
1.1 %
0
0.0%
Ruth Ivins Center for Public Health
8
0.7%
1
0.1 %
7
2.6%
County Health Department
8
0.7%
5
0.6%
3
1.1 %
Marathon
8
0.7%
8
0.9%
0
0.0%
Other
43
3.8%
28
3.3%
15
5.5%
No answer
127
11.2%1
931
10.9%
33
12.1 %
6) Accessibility of primary health care centers and/or physician's office
The majority (84.6%) of survey respondents countywide stated that primary health care centers
(clinics) and/or physicians' offices are accessible to them. However, regional data shows that
respondents from the Upper Keys have greater difficulty accessing these sources of care than
respondents from the remaining regions, 16.7% in the Upper Keys compared to 8.6% and 8.4%
in the Lower and Middle Keys, respectively.
Countywide, the five leading barriers to primary care expressed were inability to pay (16.1%),
lack of physicians accepting their health insurance plan (14.4%), required travel to Miami for
specialty care and medical tests (7.6%), lack of insurance coverage (7.6%), and difficulty getting
an appointment (3.4%).
7) Availability of primary care provider during evening and weekend hours
More than two-thirds (70.8%) of survey respondents stated that their primary care provider does
not offer evening hours. Nearly two-thirds (64.8%) of survey respondents also stated that their
primary health care provider does not offer weekend hours. Please refer to Tables IX and X on
the following page.
11
Yes
No
No Answer
Total
Yes
No
No Answer
Total
Table IX: Availability of Evening Hours, by Region
Total I nwar RMAAIe
Number
Percent
Number
Percent
Number yy
Percent
Number
C
Percent
177
15.6%
120
16.4%
17
13.0%
36
14.3%
801
70.8%
517
70.7%
99
75.6%
174
69.37/6
154
13.6%
94
12.9%
15
11.5%
41
16.3%
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Table X: Availability of Weekend Hours, by Region
Total Lnwar nniriruo
Number
Percent
--
Number
Percent
Number
Percent
UP
Number
pw
Percent
234
20.7%
189
25.9%
9
6.9%
31
12.4%
733
64.8%
438
59.9%
105
80.2%
191
76.1 %
165
14.6%
104
14.2%
17
13.0%
39
15.5%
1132
100.0%
731
100.0%
131
100.0%
261
104.0%
Survey findings indicate that Lower Keys respondents have greater access to their primary care
provider during weekend hours than respondents from the remaining regions. In fact, Lower
Keys respondents are 2 to 3.5 times more likely to have access to a primary care provider during
weekend hours (25.9%) than respondents from the Middle and Upper Keys, 6.9% and 12.4%,
respectively.
8) Unmet health service needs
Nearly one-third (30.3%) of survey respondents stated that they need health services that are not
available to them. Among the three Florida Keys regions, respondents from the Upper Keys
cited the highest unmet health service needs at 34.3%; compared to 31.3% and 29.1% for the
Middle and Lower Keys, respectively. Countywide, the five leading unmet health service needs
cited were dental services (14.7%), vision care (7.0%), specialty physicians (5.2%),
pharmaceutical services (3.9%), and mental health services (2.5%). Regional data show that
respondents from each of the three regions cited the same leading unmet health service needs.
Please refer to Table XI on the following page.
12
Table XI: Unmet Health Service Needs, by Region
i otal
tower
mloaie
up3er
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Total Interviewed
1,132
100.00%
731
100.0%
131
100.0%
251
100.0%
Yes
343
30.3%
213
29.1%
41
- 31.3%
86
34.3%
Dental Services
166
14.7%
102
14.0%
22
16.8%
41
16.3%
Vision care
79
7.0%
46
6.3%
10
7.6%
23
9.2%
Specialty h sicians
59
5.2%
38
5.2%
8
6.1%
13
5.2%
Pharmaceutical services
44
3.9%
321
4.4%
4
3.1%
8
3.2%
Mental health services
28
2.5%
16
2.2%
2
1.5%
9
3.6%
Support services
17
1.5%
10
1.4%
2
1.5%
4
1.6%
All services
15
1.3%
8
1.1%
2
1.5%
5
2.0%
Testing/diagnostic services
8
0.70/6
4
0.5%
1
0.8%
3
1.2%
Physicians and Dentists that accept insurance
8
0.7%
6
0.8%
1
0.8%
1
0.4%
More affordable health services
8
0.7%
6
0.8%
2
1.5%
0
0.0%
Prevention/wellness care
7
0.6%
5
0.7%
0
0.0%
21
0.8%
Other
37
3.3%1
25
3.4%
1
0.8%
1111
4.4%
No answer
52
4.6%1
301
4.1%
6
4.6%
14
5.6%
Cross tabulations between survey respondents' need for unavailable health services and health
insurance status were performed. Data indicated that uninsured survey respondents have greater
(43.8%) unmet health service needs than insured survey respondents (26.1%). For example,
uninsured survey respondents' need for dental services (26.5%) is 2.4 times greater than that of
insured survey respondents (10.9%). Uninsured survey respondents also indicated a greater need
for pharmaceutical services than insured survey respondents, 10.7% versus 1.8%, respectively.
Please refer to Table XII below.
Table XII: Unmet Health Service Needs, by Insurance Status
Dental Services
166
14.7%
931
10.9%
721
26.5%
Vision care
79
7.0%
471
5.5%
32
11.8%
Specialty h sicians
59
5.2%
47
5.5%
12
4.4%
Pharmaceutical services
44
3.9%
15
1.8%
29
10.7%
Mental health services
28
2.5�°
17
2.0%
11
4.0%
Support services
17
1.5%
10
1.2%
7
2.6%
All services
1.3%
3
0.4%
12
4.4%
Testing/diagnostic services
0.7%
7
0.8%
1
0.4%
Physicians and Dentists that accept insurance
0.7%
8
0.9%
0
0.0%
More affordable health services
037
0.7%
4
0.5%
4
1.5%
Prevention/wellness care
0.6%
5
0.6%
2
0.7%
Other
3.3%
25
2.9%
12
4.4%
No answer
4.6%
39
4.6%
13
4.81%.
9) Ability to keep medical appointments
For a variety of reasons, nearly one -quarter (23.1%) of survey respondents have been unable to
keep their medical appointments. A regional analysis of survey responses shows that Upper
Keys respondents had greater difficulty keeping their medical appointments (28.3%) than
respondents from the Middle (26.7%) and Lower Keys (20.5%). Please refer to Tables XIII and
XI V on the following page.
13
Yes
No
No Answer
Total
Table XIII: Able to Keep Medical Appointments, by Region
Total Lower M'ddl
Number
Percent
Number
Percent
Number
c
Percent
up
Number
oer
Percent
261
23.1 %
150
20.5%
35
26.7%
71
28.3%
843
74.5%
567
77.6%
94
71.8%
170
67.7%
28
2.5%
14
1.9%
2
1.5%
10
4.0%
1132
100.0%
731
100.0%
131
100.o%
251
100.0%
Table XIV: Reasons for Inability to Keep Medical Appointments
Work
Money45
89
34.1%
52
34.7%
14
40.0%
22
31.0%
Transportation
17.2%
22
14.7%
8
22.9%
15
21.1%
Unexpected Uemer en
43
19
16.5%
7.3%
22
10
14.7%
4
11.4%
16
22.5%
Too
Too sick or inured
injured
14
5.4%
7
6.7%
4.7%0
5
14.3%
4
5.6%
Forgot
5
1.9%
2
1
5.7%
2.9%
5
0
7.0%
0.0%
Other
No answer
21
8.0%
��22.0
3
8.6%
8
11.3%
49
18.8%
Countywide reasons cited for not being able to keep medical appointments include work
(34.1%), inability to pay (17.2%), lack of transportation (16.5%), and unexpected
conflicts/emergencies (7.3%). Less than 2% of survey respondents attributed forgetfulness as a
reason for not keeping their medical appointments.
Regional data show that Upper Keys respondents (22.5%) are two times more likely than Middle
Keys respondents (11.4%) to cite a lack of transportation as a reason for not keeping their
medical appointments.
10) Transportation to Doctor's Office
Survey respondents were asked if they use or do not use various transportation services when
traveling to a doctor's office. Transportation options included public transportation, county
social services, taxi, Transportation Disadvantaged System vehicles, driven by friend, and driven
by self. More than four -fifths of survey respondents (84.5% or 956) indicated that they drive
themselves to the doctor's office. Survey respondents also indicated that they rely on friends for
transportation (13.0%), as well as public transportation (10.1 %).
Regional data show that respondents from the Middle Keys were more likely to utilize
Transportation Disadvantaged System vehicles than respondents from the Lower and Upper
Keys; 7.6% compared to 4.0% and 3.2%, respectively. Higher utilization of the Transportation
Disadvantaged System vehicles by Middle Keys respondents may be partially attributed to the
Guidance Clinic of the Middle Keys serving as the Monroe County Community Transportation
Coordinator. However, it should also be noted that Transportation Disadvantaged providers are
14
available throughout the entire county. The Guidance Clinic of the Middle Keys contracts with
the following five transportation providers in the Keys: the United Fellowship of Florida; Wesley
House; Florida Keys Homeless Outreach Coalition; Monroe County Social Services; and The
Children's Shelter.I
11) Knowledge of free or low cost clinics
Overall, a majority of Monroe County survey respondents were aware of the availability of free
or low cost clinics throughout the Keys (60.9%, 689 respondents). However, over one-third
(37.2%) of survey respondents were unaware of the availability of these local clinics. Please
refer to Table XV below.
Yes
No
No Answer
Total
Table XV: Awareness of Free or Low Cost Clinics, by Region
Total Lower Middle Up3er
Number
Percent
Number
Percent
Number
Percent
Number
Percent
689
60.9%
442
60.5%
83
63.4%
151
60.2%
421
37.2%
276
37.8%
47
35.9%
94
37.5%
22
1.9%
13
1.8%
1
0.8%
6
2.4%
1,132
100.0%
7311
100.00%
131
100.0%
251
100.0%
12) Emergency room utilization
An overwhelming majority of survey respondents (921 or 81.4%) indicated that they have not
used the emergency room for non -emergencies in the past 12 months. However, 192
respondents (17.0%) have presented at the emergency room for a non -urgent condition in the
past 12 months. Regional data show that Upper Keys respondents (20.7%) were more likely to
have utilized the emergency room for non -emergencies than respondents from the Middle and
Lower Keys, 17.6% and 15.3%, respectively. Please refer to Table XVI below.
Table XVI: Emergency Room Use for Non -Emergencies, Past 12 Months, by Region
Yes
No
No Answer
Total
Tntnl Lower Middle Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
192
17.0%
112
15.3%
23
17.6%
52
20.7%
921
81.4%
605
82.8%
108
82.4%
196
78.1 %
19
1.7%
14
1.9%
0
0.0%
3
1.2%
1132
100.0%
7311
100.0%
131
100.0%
251
100.0%
Over one-third (36.0%) of survey respondents countywide stated that their physicians' or clinics'
hours of service and/or cost factors have been involved in their decision to visit the emergency
room; for half (50.1%) of the survey respondents, these concerns were not included in their
decision to present at the emergency room. It should be noted that 158 survey respondents
(14.0%) did not respond to this question.
1 The Monroe County Sourcebook The Health Council of South Florida, Inc., 2001.
15
Furthermore, nearly three-quarters (73.3%) of survey respondents indicated that their doctor or
nurse had not spoken to them about when to use the doctor's office versus the emergency room.
Regional data show that respondents from the Upper Keys received more information from their
physician or nurse concerning this issue than respondents from the remaining regions. Please
refer to Table XVII below.
Table XVII: Education on Appropriate Emergency Room Use, by Region
Yes
No
No Answer
Total
Total Lower Middle Upper
Number Parcant mllmho r.i.._
21.3%
153
20.9%
1U11JUci
23
rercent
17.6%
Number
67
Percent
830
73.%
541
74.0%
103
78.6%
175
26.7%
69.7%
54
4.8%
37
5.1 %
5
3.8%1
3.6%
1,1321
100.00/.
731
100.0%
131
100.0%
2511
100.0%
Survey respondents were given the opportunity to identify ways to "get the word out" regarding
proper use of emergency rooms. It should be noted that half (566) of all survey respondents did
not answer this question. However, among those who did respond, newspaper advertising
(16.0%), brochures/flyers (8.1%), television/commercials (7.6%), radio/radio spots (7.5%),
advertising (unspecified) (7.3%), and doctors/doctors' offices (7.2%) were sited as effective
communication methods. Regional data findings were consistent with countywide responses.
Additional Comments
A total of 283 survey respondents (25.0%) completed the additional comments section of the
personal interview/community survey. Countywide, the most noted remark by survey
respondents was that health insurance coverage is not affordable (6.5%). Other remarks cited
included the following: coverage is minimal and offers no preventive care (2.6%), health care is
unaffordable for most (1.9%), high deductibles prevent many from accessing services (1.9%),
and few doctors/dentists accept insurance (1.3%). For a complete listing of all remarks, please
refer to Attachment II-B.
I[l
Part II: Physician Focus Groups
Two Physician Focus Groups were held, one at the Lower Keys Medical Center on May 7, 2002,
and one at Fishermen's Hospital on June 19, 2002. A total of 23 physicians participated.
(Please refer to AttachmentffI).
The following are the salient findings from the two Physician Focus Groups:
1. When physicians were asked if they believe that Monroe County residents have
difficulty in accessing primary and/or emergency health care, some stated that
major barriers do not exist, but that there are some road blocks. For example,
some providers have opted to not accept new patients and Medicaid patients, as
well as not accept certain health insurance plans. Physicians noted that the
working uninsured do not seem to access health care services readily due to
financial constraints (e.g., office visit charges, prescription costs). There is also a
lack of primary care physicians, a lack of knowledge about available services and
resources, and a lack of public transportation, to and from the doctor's office.
Emergency room visits continue to increase, especially for non -urgent care
(primary care). In fact, physician respondents observed that emergency room
utilization continues to rise at the Lower Keys Medical Center even through there
is a primary care clinic located within the hospital.
2. Participating physicians stated that a lack of dental care services and open
heart/neurosurgeon services are major health care service gaps in Monroe County.
3. Excluding pediatricians, obstetricians and gynecologists, participants reported that
there are approximately 21 primary care physicians in Monroe County, including
both internal medicine and family practitioners.
4. Physicians stated that in the past four years many residents have been utilizing the
emergency room for primary care services. Patients also perceive that emergency
rooms have shorter waiting times than doctors' offices, and will therefore, be
treated sooner.
5. Physicians noted that many residents view health care as an entitlement rather
than an individual's responsibility. Oftentimes, residents forego preventive care
and present themselves at emergency rooms for urgent care. Physicians feel that
this belief is culturally influenced and that the emergency room has become a
"medical home" for many people.
6. When asked which communities, neighborhoods and/or population groups in
Monroe County have greater health care needs, physicians identified the working
uninsured. These individuals face financial barriers when accessing health care
services (e.g., office visit charges, high prescription costs). Another physician
17
stated that there are no underserved communities. Rather, individual communities
need to improve their relationship with the local health care system.
7. Physicians noted that the use of multi-lingual staff is sometimes challenging.
However, using multi-lingual staff can successfully reduce language barriers that
may hinder non-English speaking patients from accessing health care services.
8. Physicians perceive that insurance companies offering coverage in Monroe
County cannot make a profit without over -pricing. This is partially due to the
county's lack of a substantial low -risk pool (young and healthy families) who are
willing to purchase health insurance coverage.
9. Some physicians are opting out of KidCare because they feel that the original
intent of the program, which was to provide an affordable health insurance
alternative to people who cannot afford commercial insurance, has been lost.
These physicians believe that their revenue base has been eroded by the KidCare
program since it is reimbursed at Medicaid rates; this is viewed in contrast to
commercial plans, of which they feel many of their patients could otherwise
afford, but find the premiums for KidCare more affordable.
10. When asked if they believed that there are adequate crisis intervention, mental
health and substance abuse services available to area residents, physicians stated
that mental illnesses and substance abuse are serious problems in the area, but
considered the Lower Keys Medical Center — Kennedy Drive and sites in
Marathon, as well as the Upper Keys, to have adequate substance abuse services.
It was also noted that there is a move toward the provision of community -based
mental health services. Barriers to accessing these services were identified as
long waiting times for making appointments and a limited number of physicians
in the Upper and Middle Keys who accept Medicaid.
18
Part III: Town Hall Meetings
On May 23, 2002, the Health Council of South Florida with the support of the Monroe County
Board of County Commissioners, and in conjunction with members of the Monroe County
Health Initiative, joined the citizens of Monroe County in an effort speak out on the growing
health insurance crisis in Monroe County. Using a first of its kind format in Monroe County,
Health Council staff, Task Force members and County Commissioners came together for a
televised, simultaneous, three -site Town Hall Meeting. Residents, health-care providers,
insurance carriers, small business owners and reporters met at the County government centers in
Marathon and Key West, and at the library in Key Largo, to discuss health care coverage in
Monroe County. Individuals throughout the Keys joined together, in moderate numbers (47
participants), to discuss what is being termed by many in Monroe County, as an insurance crisis
of significant proportions.
Key West
Dr. Jake Rutherford, Director of the Monroe County Health Department, was the overall
moderator of the three town hall meetings held throughout the County. Together with Mayor
Pro-Tem Dixie Spehar, Dr. Rutherford kicked off the discussion at the Key West site. Twenty
individuals attended the town hall meeting in Key West. Present at the Key West site were
Chamber of Commerce representatives, local providers, physicians, small business owners and
concerned citizens.
Overall, residents and providers stated that co -payments and deductibles are extremely high and
simply unaffordable for the average citizen. As one participant stated, "we have assets, we don't
have a volume of income". According to one physician present, 18,000 deaths in the United
States are due to a lack of health insurance coverage. Individuals believe that government,
specifically the federal government, needs to step in and find possible solutions to this issue.
Another issue raised by local providers at this town hall meeting was that insurance rates are
negotiated far below cost. Some stated that Medicare is the best payer and requires less paper
work. However, Medicaid rates vary considerably. Insurance companies are leaving the Keys
due to the minimal profit margin. Additionally, attendees felt that they were being taken
advantage of by the insurance companies that still remain in the Keys. Some residents have tried
to enroll in a Miami -Dade County plan, but once the insurance companies realize that they live
in Monroe County, they are denied coverage. Several bcal residents were considering putting
their monies into preventive medicine rather than have health insurance. Others felt that this was
not a Monroe County problem, but rather a State of Florida issue. They added, "The County
needs some creative ideas/solutions and we need to move expeditiously. Monroe County has a
pool of talented professionals and a special community camaraderie that can help solve the
problem".
Marathon
Keith Douglass, Monroe County's KidCare Director at the Rural Health Network, facilitated the
meeting at Marathon's Government Center. Sonya Albury, Executive Director of the Health
19
Council of South Florida, co -facilitated. A total of 17 individuals attended this meeting,
including residents and local health care providers.
At this town hall meeting attendees were asked several questions and were given the opportunity
to answer individually. When asked where they went for health care, some attendees stated that
they went to the emergency room at times because there was no other alternative. Others stated
that they must travel to Miami -Dade County when needed services are not available locally.
There are also difficulties accessing pediatric, obstetric/gynecological, and dental care. Most
attendees at this site stated that their regular providers of care are physicians whom they
primarily see for annual check-up exams. However, three attendees stated that they cannot
afford even this basic level of care. Individuals with chronic conditions need to access health
care services more often. Therefore, the treatment of complex conditions requires greater
integration of care.
Concerning their ability to buy health insurance coverage, the majority of attendees expressed
grave concern regarding the escalating cost of health insurance coverage. Over the past years,
several attendees have experienced premium increases exceeding 175%, coupled with reduced
health coverage. Insurance premiums hikes have forced some to reprioritize their expenses and
reduce credit card bill payments to pay for health insurance premiums.
When asked how accessible public transportation is in Monroe County, respondents stated that
there is a lack of public transportation. Also, appointments for pick-up services usually have to
be made, and it can be difficult at times to navigate the answering system and speak to a person
who can provide assistance.
Several companies throughout the Keys have opted to use leasing companies, including the
Florida Keys Children's Shelter. Representatives from the small business sector presented the
advantages and disadvantages of utilizing leasing companies. One drawback was that leasing
companies can change a company's carrier. However, an advantage of using leasing companies
was that they offer Worker Compensation coverage.
Key Larp-o
Debbie Premaza, a registered nurse at Tavernier's Lifeline Home Services and Health Council of
South Florida Board Member, facilitated the town hall meeting held at the Key Largo Library.
The meeting was co -facilitated by Lourdes Gonzalez, the Initiative's Project Director from the
Health Council. A total of 10 individuals attended, including residents and local health care
providers.
Participants expressed several concerns during the meeting. These included the need for
counseling and training on in -home services and care, improvements in nursing home facilities,
the need for 24 hour in -home services, and the need for more acute care facility services. The
group also identified the importance of educating consumers on legal/medical documents such as
powers of attorney, advance directives, and health care surrogates.
20
County residents stated that they were given inflated rates when they inquired about health
insurance coverage. Applicants were required to pay in advance for their choice when acquiring
health insurance, and it could take over 2 months to get approved. Attendees further added that
pharmaceutical drugs were too expensive for the general public to afford.
Participants at the various town hall meeting sites offered very tangible solutions to the existing
health insurance crisis in Monroe County. They were as follows:
o Provide a nurse in every school.
o Provide universal health care as a long-term solution.
o Pass a one cent sales tax.
o Pursue a legislative reform to use part of the county's bed tax to allocate true coverage
for health care.
o Tax or charge a fee for high -risk events such as power boat racing.
o Impose a toll.
o Consider adding more surgical centers that offer reduced rates.
o Advocate for insurance reforms to compel insurance companies that serve profitable
areas to also cover underserved counties.
o Examine inpatient revenues of for -profits versus not -for -profits (hospitals) and look at the
most cost effective delivery of care.
o Examining the issue of offering generic drugs in order for the cost to be more affordable
to Monroe County residents.
Participants at all three town hall meeting sites testified that Monroe County's geography serves
as a barrier to specialists and specialized health care. Other parts of the state and country do not
have this unique problem. Nonetheless, many expressed that it is a reasonable request for all
residents of Monroe County to be able to access basic primary care.
21
Summary Analysis
The activities held within the community reveal qualitative information to compare with the
results in the companion Monroe County Community Health Profile document. The activities
include 158 personal interviews/surveys collected through local events, churches, public health
clinics and senior centers. Between the months of May and June 2002, an additional 974 surveys
were collected by Task Force members and forwarded to the Health Council of South Florida. A
total of 1,132 personal interviews/community surveys were analyzed by the Health Council.
Data analysis included responses to open and closed -ended questions, as well as cross tabulations
between survey questions and respondents' insurance status, employment status, gender and age.
The information gleaned from these activities and group discussions can be summarized as
follows:
Personal interviews/Community Surveys
➢ Over two -fifths of survey respondents (44.8%, [507/1132]) perceived their community
as "healthy".
➢ Nearly one -quarter of survey respondents (24.0%, [272/1132]) indicated that they do not
have some form of health insurance coverage. Nearly two-thirds (63.2%, [172/272]) of
the uninsured are currently employed.
➢ A large percentage of insured survey respondents countywide reported having health
insurance coverage through Blue Cross Blue Shield (18.3%, [156/854]), Acordia (12.0%,
[102/854]), Medicare (11.7%, [100/854]) and Medicaid (8.1%, [69/854]).
➢ Two -fifths of uninsured survey respondents (40.1%, [109/272]) were not aware of the
KidCare/Healthy Kids Program. Regardless of insurance status, almost all survey
respondents countywide (94.6%, [1071/1132]) were aware of the Medicaid Program.
Table XIX: Knowledge of Public Health Insurance Programs
Personal Interviews/Community Surveys
Question
Response
Have you heard of Medicaid?
Yes
No
94.6%
4.4%
(1071/1132)
(50/1132)
Have you heard of the KidCare/Healthy Kids Program?
Yes
No
67.6%
30.7%
(765/1132)
(348/1132)
➢ The LifeLines MediVan was cited as the leading source (21.3%, [58/272]) for health care
services among uninsured survey respondents.
➢ Survey respondents from the Upper Keys reported having greater difficulty accessing
primary health care centers and/or physician offices than survey respondents from the
remaining regions.
22
➢ Nearly two-thirds of survey respondents (64.8%, [733/1132]) have not been able to
access their primary care physician during weekend hours. Survey respondents from the
Middle and Upper Keys reported greater difficulty accessing their primary care provider
during weekend hours than respondents from the Lower Keys.
Table XVIII: Access to Primary Care Providers
Personal Interviews/Community Surveys
Question
Response
Does your primary health care provider offer evening
Yes
No
hours?
15.6%
70.8%
(177/1132)
(801/1132)
Does your primary health care provider offer weekend
Yes
No
hours?
20.7%
64.8%
(234/1132)
(733/1132)
➢ Leading unmet health care needs countywide were dental services (14.7%, [166/1132]),
vision care (7.0%, [79/1132]), specialty physicians (5.2%, [59/1132]), pharmaceutical
services (3.9%, [44/1132]), and mental health services (2.5%, [28/1132]).
➢ Uninsured survey respondents (10.7%, [29/272]) reported a greater need for
pharmaceutical services than insured survey respondents (1.8%, [15/854]).
➢ The majority of survey respondents (84.5%, [956/1132]) drive themselves to the doctor's
office. However, survey respondents from the Upper Keys were two times more likely
than Middle Keys respondents to cite a lack of transportation as a reason for not keeping
their medical appointments.
➢ Respondents from the Middle Keys rely more on Transportation Disadvantaged System
vehicles for transportation to the doctor's office than respondents from the remaining
regions.
➢ Survey respondents primarily attributed high insurance premiums, lack of employer -
based insurance, unemployment, probationary period at a new job, and pre-existing
conditions as contributing reasons for their inability to secure health care coverage.
➢ Some respondents expressed their concern regarding the health status of their community,
primarily citing alcohol use, the large number of uninsured, drug use, and lack of
affordable health insurance coverage as contributing factors.
➢ Survey respondents cited work schedules, inability to pay, lack of transportation, and
unexpected conflicts/emergencies as reasons for missing medical appointments.
➢ Most survey respondents (81.4%, [921/1132]) indicated that they had not used the
emergency room for nonurgent conditions in the past 12 months.
23
Physicians
(Physician Focus Groups)
Major concerns of the Physicians, pursuant to.the Physician Focus Groups, include:
➢ Several physicians expressed their concern regarding residents' perception of health care
as an entitlement rather than an individual's responsibility. Oftentimes, residents forego
preventive care and present themselves at emergency rooms for urgent care.
➢ Physicians perceived that insurance companies need to over -price in Monroe County due
to the area's lack of a substantial low -risk pool (young and healthy families) willing to
purchase health insurance coverage.
➢ A major concern of physicians interviewed was that the original intent of the KidCare
program has been eroded due to its use by families who can afford paying commercial
insurance premiums.
➢ Patient access to primary health care has been blocked due to some providers opting to
not accept new patients and Medicaid patients, as well as not accepting certain health
insurance plans.
➢ Barriers to care, as identified by participating physicians, include a lack of primary care
physicians, a lack of knowledge about available services and resources, and a lack of
public transportation to and from the doctor's office.
Lack of dental care services and open heart/neurosurgeon services are major health care
service gaps in Monroe County.
➢ Physicians stated that emergency room utilization has increased due to county residents
presenting at the emergency room for primary care services. Physicians added that
emergency utilization continues to increase at the Lower Keys Medical Center even
though there is a primary care clinic located within the hospital.
➢ When asked which communities, neighborhoods and/or population groups in Monroe
County have greater health care needs, physicians identified the working uninsured.
Physicians added that the working uninsured encounter financial barriers to accessing
health care due to their inability to pay office visit charges and prescription costs.
➢ Physicians perceive that there are adequate crisis intervention, mental health and
substance abuse services available to area residents. However, barriers to accessing these
services were identified as long waiting times for making appointments and a limited
number of physicians in the Upper and Middle Keys who accept Medicaid.
➢ Physicians also commented that there is a move toward the provision of community -
based mental health services.
Residents
Town Hall Meetings
➢ Residents expressed concern regarding the escalating cost of health insurance coverage and
prescription drugs.
➢ Individuals believe that government, specifically the federal government, needs to step in and
find possible solutions to this issue.
➢ Residents perceive that insurance rates are negotiated far below cost and that insurance
companies are leaving the Keys due to the minimal profit margin.
24
➢ Nearly two-thirds of survey respondents (64.8%, [733/11321) have not been able to
access their primary care physician during weekend hours. Survey respondents from the
Middle and Upper Keys reported greater difficulty accessing their primary care provider
during weekend hours than respondents from the Lower Keys.
Table XVIII: Access to Primary Care Providers
Personal Interviews/Community Surveys
Question
Response
Does your primary health care provider offer evening
Yes
No
hours?
15.6%
70.8%
(177/1132)
(801/1132)
Does your primary health care provider offer weekend
Yes
No
hours?
20.7%
64.8%
(234/1132)
(733/1132)
➢ Leading unmet health care needs countywide were dental services (14.7%, [166/1132]),
vision care (7.0%, [79/1132]), specialty physicians (5.2%, [59/1132]), pharmaceutical
services (3.9%, [44/1132]), and mental health services (2.5%, [28/1132]).
➢ Uninsured survey respondents (10.7%, [29/272]) reported a greater need for
pharmaceutical services than insured survey respondents (1.8%, [15/854]).
➢ The majority of survey respondents (84.5%, [956/1132]) drive themselves to the doctor's
office. However, survey respondents from the Upper Keys were two times more likely
than Middle Keys respondents to cite a lack of transportation as a reason for not keeping
their medical appointments.
➢ Respondents from the Middle Keys rely more on Transportation Disadvantaged System
vehicles for transportation to the doctor's office than respondents from the remaining
regions.
➢ Survey respondents primarily attributed high insurance premiums, lack of employer -
based insurance, unemployment, probationary period at a new job, and pre-existing
conditions as contributing reasons for their inability to secure health care coverage.
➢ Some respondents expressed their concern regarding the health status of their community,
primarily citing alcohol use, the large number of uninsured, drug use, and lack of
affordable health insurance coverage as contributing factors.
➢ Survey respondents cited work schedules, inability to pay, lack of transportation, and
unexpected conflicts/emergencies as reasons for missing medical appointments.
➢ Most survey respondents (81.4%, [921/1132]) indicated that they had not used the
emergency room for nonurgent conditions in the past 12 months.
23
Physicians
(Physician Focus Groups)
Major concerns of the Physicians, pursuant to the Physician Focus Groups, include:
➢ Several physicians expressed their concern regarding residents' perception of health care
as an entitlement rather than an individual's responsibility. Oftentimes, residents forego
preventive care and present themselves at emergency rooms for urgent care.
➢ Physicians perceived that insurance companies need to over -price in Monroe County due
to the area's lack of a substantial low -risk pool (young and healthy families) willing to
purchase health insurance coverage.
➢ A major concern of physicians interviewed was that the original intent of the KidCare
program has been eroded due to its use by families who can afford paying commercial
insurance premiums.
➢ Patient access to primary health care has been blocked due to some providers opting to
not accept new patients and Medicaid patients, as well as not accepting certain health
insurance plans.
➢ Barriers to care, as identified by participating physicians, include a lack of primary care
physicians, a lack of knowledge about available services and resources, and a lack of
public transportation to and from the doctor's office.
➢ Lack of dental care services and open heart/neurosurgeon services are major health care
service gaps in Monroe County.
➢ Physicians stated that emergency room utilization has increased due to county residents
presenting at the emergency room for primary care services. Physicians added that
emergency utilization continues to increase at the Lower Keys Medical Center even
though there is a primary care clinic located within the hospital.
➢ When asked which communities, neighborhoods and/or population groups in Monroe
County have greater health care needs, physicians identified the working uninsured.
Physicians added that the working uninsured encounter financial barriers to accessing
health care due to their inability to pay office visit charges and prescription costs.
➢ Physicians perceive that there are adequate crisis intervention, mental health and
substance abuse services available to area residents. However, barriers to accessing these
services were identified as long waiting times for making appointments and a limited
number of physicians in the Upper and Middle Keys who accept Medicaid.
➢ Physicians also commented that there is a move toward the provision of community -
based mental health services.
Residents
Town Hall Meetings
➢ Residents expressed concern regarding the escalating cost of health insurance coverage and
prescription drugs.
➢ Individuals believe that government, specifically the federal government, needs to step in and
find possible solutions to this issue.
➢ Residents perceive that insurance rates are negotiated far below cost and that insurance
companies are leaving the Keys due to the minimal profit margin.
24
➢ Local residents are considering putting their monies into preventive medicine rather than
purchasing health insurance coverage.
➢ Many residents are utilizing the emergency room for primary care services because they have
no alternative.
➢ Residents expressed difficulties accessing pediatric, obstetric/gynecological, and dental care.
➢ Small business owners are opting to use leasing companies. Residents stated that one
advantage of using leasing companies was that they offer Workers Compensation coverage.
➢ Residents cited a need for counseling and training on in -home services and care,
improvements in nursing home facilities, the need for 24 hour in -home services, and the need
for more acute care facility services.
➢ Residents expressed a greater need for community education on management of
legal/medical documents (i.e., powers of attorney, advance directives, and health care
surrogates).
Perceived solutions
Town Hall Meetings
Tangible solutions to the existing health insurance crisis in Monroe County were offered by
Town Hall Meeting participants. They were as follows:
➢ Provide a nurse in every school.
➢ Provide universal health care as a long-term solution.
➢ Pass a one cent sales tax.
➢ Pursue a legislative reform to use part of the county's bed tax to allocate true coverage for
health care.
➢ Tax or charge a fee for high -risk events such as power boat racing.
➢ Impose a toll.
➢ Consider adding more surgical centers that offer reduced rates.
➢ Advocate for insurance reforms to compel insurance companies that serve profitable areas to
also cover underserved counties.
➢ Examine inpatient revenues of for -profits versus not -for -profits (hospitals) and look at the
most cost effective delivery of care.
➢ Examine the issue of offering generic drugs in order for the cost to be more affordable to
Monroe County residents.
25
Attachment I A
Monroe County Community Health Initiative
Community Forums / Personal Interviews
Health Care Insurance Coverage
1. Would you describe your community as a "healthy community"? YES NO
Why or why not?
Fj
U
4.
5.
6.
7.
Do you have any kind of health care coverage or insurance? YES NO
If so, what insurance coverage do you have?
If not, why don't you have insurance coverage?
Are there any services you need that are not covered? YES NO
If so, what are they?
Do you have prescription drug coverage? YES NO
Have you ever had to use your insurance and have been denied reimbursement?
If so, why were you denied?
Have you heard of Medicaid? YES NO
Have you heard of the KidCare/Healthy Kids Program? YES NO
How did you learn about these programs?
Health Care Access
YES NO
9. Where do you go for health care?
a. Are primary health care centers (clinics) and/or physicians' offices accessible to you? YES NO
If not, why not?
b. Does your primary health care provider offer evening hours? YES NO
c. Does your primary health care provider offer weekend hours? YES NO
10. Are there health services you need that are not available to you? YES NO
If so, which ones? (For example, dental, optometrist, mental health, pharmaceutical, support services, etc.)
11. In the past 12 months, have you needed medical, dental or other health care, but did not seek care because
you could not afford it? YES NO
12. Do you have any special needs that you cannot get services for? YES NO
If so, what are they?
13. Have you ever been unable to keep your medical appointments YES NO
If so, for what reason?
- Continued on Reverse —
14.
How do you normally get to a doctor's office?
Do you use public transportation? YES NO
Do you drive? YES NO
County Social Services? YES NO
Taxi? YES NO
Transportation Disadvantaged System Vehicles? YES NO
Friend? YES NO
15.
When seeking health services, do you feel that health care workers...
a. Treat you well? YES NO
Why or why not?
b. Are they culturally sensitive? YES NO
Why or why not?
16.
Are you aware that there are free or low cost clinics available? YES NO
17.
Have you ever visited a free or low cost clinic? YES NO
18.
Have you or your family used the emergency room for non -emergencies in the last 12 months?
YES NO If yes, why?
19.
Are your physicians' or clinics' hours of services or cost factors involved in your decision to visit the
Emergency Room? YES NO
20.
Under what circumstances would you:
Call 91 P
Go to the Emergency Room?
21.
Has a doctor or nurse talked to you about when to use the doctor's office versus the emergency room?
YES NO
22.
What do you feel is the best way to get the word out regarding proper use of the emergency room?
23.
What is your zip code?
24.
Gender: Male Female
25.
How old are you?
26.
Are you employed? YES NO
Additional Comments (Optional):
Attachment I-B
Entrevistas con la Comunidad de Condado Monroe
Acceso a Servicios de Salud y Servicios de Apoyo
1 Describiria usted a su comunidad como "una comunidad saludable?"? SI NO
Por que si o por que no?
2. Tiene usted seguro medico? SI NO
Si su respuesta es SI, que tipo de seguro medico tiene?
Si su respuesta es NO por que no tiene usted seguro medico?
3. Hay algunos servicios medicos que usted necesite que no esten cubiertos por su seguro? SI
4. Tiene usted cobertura para medicamentos de receta? SI NO
5. Alguna vez a usado su seguro medico y le han negado pagos? SI NO
Si su respueste es SI, por que?
Informacion sobre el Cuidado de Salud
NOW►(S�
6. Ha oido usted sobre el programa Medicaid? SI NO
7. Ha oido usted sobre el programa KidCare/Healthy Kids? SI NO
8. Como obtuvo usted informacion sobre estos servicios? SI NO
9. A donde va usted cuando necesita servicios medicos?
a. Son accesibles para usted los principales centros de salud (clinicas) o consultorios medicos? _SI NO
b. Ofrece su centro de salud servicios en horas despues del trabajo? SI NO
c. Ofrece su centro de salud servicios en los fines de semana? SI NO
10. Hay algunos servicios medicos que usted necesite que no esten disponibles? SI NO
Si su espuesta es SI, cuales? (Por ejemplo, dental, optometrista, mental, farmaceutico, servicios de apoyo etc.)
11. En los ultimos 12 meses, ha necesitado usted algun servicio medico, dental u otro tipo de cuidado medico,
pero no se ha atendido por falta de recursos? SI NO
12. Usted necesita de algun cuidado medico especial que no pueda adquirir? SI NO
13. Alguna vez ha faltado a sus citas medicas? SI NO
14
Si su respuesta es SI, por que razones?
Usa usted transportacion publica para it a los consultorios medicos? SI
Si su respuesta es SI, es esto muy dificil para usted? SI NO
Si su respuesta es NO, que forma de transporte utiliza? Por que?
Usted maneja? SI NO
Toma un taxi? SI NO
NO
Usa Servicios del Condado? SI NO
15. Cuando busca servicios medicos, cree que los trabajadores de centros de salud...
a. to atienden bien? SI NO
Por que?
b. Entienden de sus costumbres? SI
Por que? Por que no?
Practicas del Cuidado de Salud
NO
16. Sabia usted que existen clinicas gratis or de bajo costo? YES NO
17. Ha visitado usted alguna clinica que ofrezca servicios gratis or de bajo costo? SI NO
18. En los pasado 12 meses, a usado usted o su familia la sala de emergencia para casos que no son emergentes?
YES NO
19. Son las limitaciones en las horas de servicios medico o el costo de los servicios medicos un factor decisivo
para usted it a una sala de emergencia? SI NO
20. Bajo que circumstancias:
a. Llamaria usted al 911?
b. Visitaria la sala de emergencia?
21. Le ha informado su doctor o enfermera cuando usar el consultorio medico en lugar de la sala de emergencia?
YES NO
22. Como podriamos lograr dar a conocer el use correcto de lost consultarios medicos en lugar de las salas de
emergencia?
23. Cual es su codigo postal (zip code)? _
24. Genero: M F
25. Que edad tiene?
26. Esta trabajando? SI NO
Comentarios Adicionales (opcional):
Attachment I-C
Monroe County Community Health Initiative
Physician Focus Group Discussion Questions
Health Care Access & Support Services
1. In general, do you believe that Monroe County residents have difficulty in accessing primary health
care? Why? (e.g. cultural barriers, limited numbers of nearby sites, lack of extended evening and/or
weekend office hours, difficulty in obtaining transportation to and from the doctor's office, paying for
treatment, knowledge of where to go, etc.).
What do you perceive to be the major health care service gaps in Monroe County (e.g., pharmacy,
dental care, mental health, specialists)? Why?
3. Which communities/neighborhoods/population groups in Monroe County do you believe have greater
health care needs? Why? What are some viable strategies that could mitigate health care needs?
4. Do you feel that women in Monroe County are receiving adequate and timely prenatal care services?
If not, where do you feel there are gaps in prenatal care services?
Do you feel that there are adequate crisis intervention, mental health and substance abuse services
available to the residents in these areas?
6. Are bilingual medical and/or clerical staff available to provide translation when necessary for
patients? If so, what percentage of your staff is bilingual and for what language(s)?
Health Insurance
7. Regarding health insurance:
• Do you believe that some of your patients may qualify for Medicaid or KidCare/Healthy Kids but
do not know these resources may be an option for them? If so, what percentage?
• How are your patients made aware of Medicaid or KidCare eligibility requirements?
8. What problems are your patients experiencing with health care insurers?
9. What problems are you experiencing with health care insurers?
Health Care Practices
10. Do you believe the some patients utilize the emergency room as a substitute for primary care? If so,
under what circumstances? How would you change this?
11. How do you address calls from patients after office hours; under what circumstances are they advised
to go to the emergency room?
Health Care Finances & Future Directions
12. How would you finance indigent health care (e.g., Tobacco settlement funds, Medicaid, additional
tax)?
13. Do you think it is better to increase access to health insurance or provide free care, e.g. through a
public clinic?
14. Should any health care program be modified or expanded (e.g., Medicaid, Healthy Kids)?
15. What do you think should be done to solve the health care crisis?
Attachment I-D
Town Hall Meeting Discussion Questions
Question # 1
Where do you go for health care?
Question # 2
How often do you go for health care?
Question # 3
Are there services you need that are not available to you?
Question # 4
Are the places for health care accessible to you?
Question # 5
Do you have or can you buy affordable health insurance?
Question # 6
Does your health insurance cover you fully?
Question # 7
Have you ever used the Emergency Room to obtain health services?
Question # 8
Do you use public transportation? How accessible is it?
Additional Comments:
Attachment II -A
Monroe County Personal Interview Surveys
Cumulative Responses to Closed -Ended Questions
Total Lower Middle Upper
[Number
Percent Number Percent Number Percent Number Percent
1. Would you describe our community
as a "health communit "?
Yes
507
44.8%
324
44.3%
47
35.9%
125
49.8%
No
460
40.6%
299
40.9%
65
49.6%
94
37.5%
No Answer
165
14.6%
108
14.8%
19
14.5%
32
12.7%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
2. Do you have an
kind of health care cove ra a or insurance
Yes
854
75.4%
563
77.0%
101
77.1 %
178
70.9%
No
272
24.0%
164
22.4%
29
22.1 %
73
29.1
No Answer
6
0.5%
4
0.5%
1
0.8%
0
0.0%
Total
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
3. Are there an
services you need that are not covered?
Yes
491
43.4%
317
43.4%
60
45.8%
107
42.6%
No
485
42.8%
324
44.3%
52
39.7%
101
40.2%
No Answer
156
13.8%
90
12.3%
19
14.5%
43
17.1
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
4. Do you have
rescri tion
dru covera e?
Yes
733 64.8%
480
65.7%
92
70.2%
151
60.2%
No
363 32.1 %
228
31.2%
37
28.2%
90
35.9%
No Answer
36 3.2%
23
3.1 %
2
1.5%
10
4.0%
Total
1,132 100.0%
731
100.0%
131
100.0%
251
100.0%
5. Have you ever had to use
our insurance and have been denied reimbursement?
Yes
220
19.4%
147
20.1 %
25
19.1 %
47
18.7%
No
687
60.7%
459
62.8%
74
56.5%
143
57.0%
No Answer
225
19.9%
125
17.1 %
32
24.4%
61
24.3%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
6. Have you heard of Medicaid
Yes
No
No Answer
Total
1,071
50
11
1132
94.6%
4.4%
1.0%
100.0%
690
33
8
731
94.4%
4.5%
1.1 %
100.0%
126
4
1
131
96.2%
3.1 %
0.8%
100.0%
239
11
1
251
95.2%
4.4%
0.4%
100.0%
7. Have
you heard of the Kid Care/Health Kids Pro ram?
Yes
765
67.6%
488
66.8%
91
69.5%
176
70.1
No
348
30.7%
232
31.7%
37
28.2%
71
28.3%
No Answer
19
1.7%
11
1.5%
3
2.3%
4
1.6%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Total Lower Middle Upper
Number Percent Number Percent Number Percent Number Percent
9a. Are primary health care centers clinics and/or physicians' office accessible to you?
Yes
958
84.6%
635
86.9%
112
85.5%
196
78.1
No
118
10.4%
63
8.6%
11
8.4%
42
16.7%
No Answer
56
4.9%
33
4.5%
8
6.1 %
13
5.2%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
9b. Does our primary health care
rovider offer evenin
hours
Yes
177
15.6%
120
16.4%
17
13.0%
36
14.3%
No
801
70.8%
517
70.7%
99
75.6%
174
69.3%
No Answer
154
13.6%
94
12.9%
15
11.5%
41
16.3%
Total
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
9c. Does our primary health
care
provider offer weekend hours?
Yes
234
20.7%
189
25.9%
9
6.9%
31
12.4%
No
733
64.8%
438
59.9%
105
80.2%
191
76.1
No Answer
165
14.6%
104
14.2%
17
13.0%
39
15.5%
Total
1132
100.0%
731
100.0%
131
100.0%
261
104.0%
10. Are there health services
you need that are not available to
ou?
Yes
343
30.3%
213
29.1 %
41
31.3%
86
34.3%
No
665
58.7%
448
61.3%
71
54.2%
132
52.6%
No Answer
124
11.0%
70
9.6%
19
14.5%
33
13.1
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
11. In the past 12 months, have you needed medical, dental or other health care, but did not seek
care because
you could not afford it?
Yes
507 44.8%
316
43.2%
56
42.7%
128
51.0%
NO
603 53.3%
404
55.3%
71
54.2%
118
47.0%
No Answer
22 1.9%
11
1.5%
4
3.1 %
5
2.0%
Total
1132 100.0%
731
100.0%
131
100.0%
251
100.0%
12. Do you have an
s ecial needs that you cannot et services for?
Yes
205
18.1 %
134
18.3%
20
15.3%
48
19.1
No
855
75.5%
559
76.5%
103
78.6%
180
71.7%
No Answer
72
6.4%
38
5.2%
8
6.1 %
23
9.2%
Total
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
13. Have
you ever been unable to kee our medical a
ointments?
Yes
261
23.1 %
150
20.5%
35
26.7%
71
28.3%
No
843
74.5%
567
77.6%
94
71.8%
170
67.7%
No Answer
28
2.5%
14
1.9%
2
1.5%
10
4.0%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Total
I
Lower
Middle
Upper
Number
Percent Number Percent i Number Percent Number
Percent
14. How do you normally get to a doctor's office?
Do you use public transportation?
Yes
114
10.1 %
97
13.3%
6
4.6%
8
3.2%
No
749
66.2%
484
66.2%
93
71.0%
162
64.5%
No Answer
269
23.8%
150
20.5%
32
24.4%
81
32.3%
Total
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
Do you drive?
Yes
956
84.5%
598
81.8%
114
87.0%
230
91.6%
No
112
9.9%
89
12.2%
11
8.4%
10
4.0%
No Answer
64
5.7%
44
6.0%
6
4.6%
11
4.4%
Total
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
Count Social Services?
Yes
32
2.8%
25
3.4%
1
0.8%
5
2.0%
No
588
51.9%
418
57.2%
63
48.1 %
102
40.6%
No Answer
512
45.2%
288
39.4%
67
51.1 %
144
57.4%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Taxi?
Yes
15
1.3%
11
1.5%
0
0.0%
4
1.6%
No
608
53.7%
434
59.4%
63
48.1 %
105
41.8%
No Answer
509
45.0%
286
39.1 %
68
51.9%
142
56.6%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Transportation Disadvanta ed System Vehicles
Yes
48
4.2%
29
4.0%
10
7.6%
8
3.2%
No
582
51.4%
420
57.5%
57
43.5%
100
39.8%
No Answer
502
44.3%
282
38.6%
64
48.9%
143
57.0%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Friend?
Yes
147
13.0%
93
12.7%
16
12.2%
37
14.7%
No
502
44.3%
361
49.4%
52
39.7%
84
33.5%
No Answer
483
42.7%
277
37.9%
63
48.1 %
130
51.8%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
15a. When seeking
health
services do you feel that health care workers treat you welly
Yes
963
85.1%
621
85.0%
105
80.2%
220
87.6%
No
85
7.5%
52
7.1 %
15
11.5%
17
6.8%
No Answer
84
7.4%
58
7.9%
11
8.4%
14
5.6%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
15b. Are the
cultural) sensitive?
Yes
735
64.9%
474
64.8%
90
68.7%
160
63.7%
No
141
12.5%
93
12.7%
11
8.4%
32
12.7%
No Answer
256
22.6%
164
22.4%
30
22.9%
59
23.5%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Total
Lower
Middle
Upper
Number
Percent Number Percent Number Percent Number
Percent
16. Are you
aware that there are free or low cost clinics available?
Yes
689
60.9%
442
60.5%
83
63.4%
151
60.2%
No
421
37.2%
276
37.8%
47
35.9%
94
37.5%
No Answer
22
1.9%
13
1.8%
1
0.8%
6
2.4%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
17. Have
you ever visited a free or low cost clinic
Yes
386
34.1 %
239
32.7%
46
35.1 %
97
38.6%
No
727
64.2%
479
65.5%
85
64.9%
150
59.8%
No Answer
19
1.7%
13
1.8%
0
0.0%
4
1.6%
Total
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
18. Have you or our Tamil used the emer enc
room for non -emergencies in the last 12 months?
Yes
192
17.0%
112
15.3%
23
17.60,6
52
20.7%
No
921
81.4%
605
82.8%
108
82.4%
196
78.1
No Answer
19
1.7%
14
1.9%
0
0.0%
3
1.2%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
19. Are your physicians' or clinics' hours of services or cost factors involved in your decision to visit
the Emergency
Room?
Yes
407
36.0%
245
33.5%
54
41.2%
103
41.0%
No
567
50.1 %
380
52.0%
58
44.3%
120
47.8%
No Answer
158
14.0%
106
14.5%
19
14.5%
28
11.2%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
21. Has a doctor or nurse talked to you about when to use the doctor's office versus the emergency
room?
Yes
248
21.9%
153
20.9%
23
17.6%
67
26.7%
No
830
73.3%
541
74.0%
103
78.6%
175
69.7%
No Answer
54
4.8%
37
5.1 %
5
3.8%
9
3.6%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Total
Lower
Middle
Upper
Number Percent
Number Percent
Number Percent
Number Percent
23. What is your zip code?
33040
569
50.3%
569
77.8%
33041
12
1.1 %
12
1.6%
33042
66
5.8%
66
9.0%
33043
77
6.8%
77
10.5%
33044
1
0.1 %
1
0.1 %
33045
6
0.5%
6
0.8%
Total Lower Keys
731
64.6%
731
100.0%
33001
1
0.1 %
1
0.8%
33050
123
10.9%
123
93.9%
33051
5
0.4%
5
3.8%
33052
2
0.2%
2
1.5%
Total Middle Keys
131
11.6%
131
100.0%
33036
42
3.7%
42
16.7%
33037
131
11.6%
131
52.2%
33070
78
6.9%
78
31.1 %
Total Upper Keys
251
22.2%
251
100.0%
No Answer or Incorrect
19
1.7%
Total
1,132
100.0%
24. Gender
Male
401
35.4%
286
39.1 %
42
32.1 %
65
25.9%
Female
710
62.7%
436
59.6%
84
64.1 %
185
73.7%
No Answer
21
1.9%
9
1.2%
5
3.8%
1
0.4%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
25. How old areyou?
0-19
5
0.4%
3
0.4%
0
0.0%
1
0.4%
20-49
639
56.4%
424
58.0%
74
56.5%
133
53.0%
50+
449
39.7%
283
38.7%
51
38.9%
111
44.2%
No Answer
39
3.4%
21
2.9%
6
4.6%
6
2.4%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
26. Are you employed?
Yes
863
76.2%
551
75.4%
116
88.5%
186
74.1 %
No
260
23.0%
179
24.5%
13
9.9%
63
25.1 %
No Answer
9
0.8%
1
0.1 %
2
1.5%
2
0.8%
Total
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Attachment II-B
Monroe County Personal Interview Surveys
Cumulative Responses to Open -Ended Questions
1. Why or why not would you describe your community as a "healthy community"?
Describe community as a "healthy community"
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Yes
507
100.0%
324
100.0%
47
100.0%
125
100.0%
The fife style/climate/outdoors activities
82
16.2%
45
13.9%
9
19.1 %
28
22.4%
People are healthy
Accessibility of health care services
39
32
7.7%
6.3%
26
20
8.0%
6.2%
2
3
4.3%
6.4%
11
9
8.8%
7.2%
Availability of health services
21
4.1 %
16
4.9%
2
4.3%
3
2.4%
People are drug and alcohol free
4
0.8%
4
1.2%
0
0.0%
0
0.0%
Other
51
10.1 %
27
8.3%
3
6.4%
16
12.8%
No answer
297
58.6%
1 197
60.8%
1 29
61.7% 1
61
48.8%
1. Why or why not would you describe your community as a "healthy community"?
Would not describe community as a "healthy community"
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
460
100.0%
299
100.0%
65
100.0%
94
100.0%
A lot of drinking/alcoholism
82
17.8%
48
16.1 %
15
23.1 %
19
20.2%
Large number of people without health insurance
72
15.7%
48
16.1 %
9
13.8%
15
16.0%
Drugs
64
13.9%
41
13.7%
7
10.8%
17
18.1 %
Lack of affordable health insurance
60
13.0%
38
12.7%
7
10.8%
15
16.0%
Health services are not affordable/expensive
46
10.0%
31
10.4%
11
16.9%
4
4.3%
AIDS
43
9.3%
36
12.0%
2
3.1%
5
5.3%
The lack of insurers
27
5.9%
17
5.7%
4
6.2%
6
6.4%
Large elderly population
22
4.8%
6
2.0%
9
13.8%
7
7.4%
Limited health services, lack of specialists
17
3.7%
11
3.7%
1
1.5%
6
6.4%
Lack of access to health services
13
2.8%
12
4.0%
1
1.5%
0
0.0%
Lack of adequate coverage
12
2.6%
10
3.3%
1
1.5%
1
1.1 %
The number of homeless persons
12
2.6%
6
2.0%
5
7.7%
1
1.1 %
Limited number of providers accepting insurance
11
2.4%
5
1.7%
5
7.7%
1
1.1 %
Hepatitis C
10
2.2%
4
1.3%
1
1.5%
5
5.3%
Smokers
10
2.2%
10
3.3%
1
1.5%
0
0.0%
Other
102
22.2%
73
24.4%
11
16.9%
19
20.2%
No answer
35
7.6%
24
8.0%
2
3.1%
8
8.5%
2. Do you have any kind of health care coverage or insurance?
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Yes
854
100.0%
563
100.0 %
101
100.0%
178
100.0%
What insurance coverage do you have?
Blue Cross Blue Shield
156
18.3%
97
17.2%
24
23.8%
33
18.5%
Acordia
102
12.0%
7
1.2%
16
15.8%
18
10.1%
Medicare
100
11.7%
64
11.4%
3
3.0%
31
17.4%
Medicaid
69
8.1 %
28
5.0%
3
3.0%
6
3.4%
Florida League of Cities
35
4.1 %
35
6.2%
0
0.0%
0
0.0%
Through Employer (Company not specified)
27
3.2%
15
2.7%
4
4.0%
7
3.9%
TRICARE U.S. Dept. of Defense Military Health System
27
3.2%
22
3.9%
1
1.0%
4
100% (Company not specked)
24
2.8%
15
2.7%
3
3.0%
6
2.2%
3.4%
Monroe County/Monroe County School Board
21
2.5%
15
2.7%
3
3.0%
2
1.1%
AARP
19
2.2%
12
2.1%
0
0.0%
7
3.9%
Cigna
First Health
18
2.1%
8
1.4%
2
2.0%
8
4.5%
Health (Company not specified)
17
17
2.0%
2.0%
3
14
0.5%
2.5%
9
3
8.9%
3.0%
3
0
1.7%
Foundation Health
16
1.9%
12
2.1%
1
1.0%
2
0.0%
1.1%
Millenium
16
1.9%
15
2.7%
0
0.0%
1
0.6%
Major Medical (Company not specified)
16
1.9%
11
2.0%
1
1.0%
4
2.2%
Pacific Life
15
1.8%
12
2.1%
2
2.0%
1
0.6%
VA
18
2.1%
15
2.7%
0.0%
3
1.7%
United Health Care
13
1.5%
7
1.2%
1
1.0%
4
2.2%
Humana
12
1.4%
1
0.2%
4
4.0%
7
3.9%
Health/Medical and Dental (Company not specified)
10
1.2%
8
1.4%
1
1.0%
1
0.6%
Principal
10
1.2%
8
1.4%
0
0.0%
2
1.1%
Other
154
18.1 %
82
14.6%
19
18.8%
41
23.0%
No Answer
65
7.60
48
8.5%
5
5.0%
11
6.2%
Total
Lower
Middle
Upper
Number
Percent
Number Percent
Number
Percent Number Percent
No
Why don't you have insurance coverage?
272 100.0%
164 100.0%1
29 100.0%
73 100.0%
Can not afford insurance coverage
143
52.6%
82
50.0%
14
48.3%
46
63.0%
Employer does not offer it
14
5.1 %
10
6.1 %
2
6.9%
2
2.7%
Unemployed
13
4.8%
12
7.3%
0
0.0%
1
1.4%
Waiting period required/New Job
7
2.6%
7
4.3%
0
0.0%
0
0.0%
Preexisting condition
6
2.2%
2
1.2%
1
3.4%
3
4.1%
Other
15
5.5%
9
5.5%
3
10.3%
3
4.1%
No answer
74
27.2%
42
25.6%
9
31.0%
18
24.7%
3. What services do you need that are not covered?
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Have health care coverage
854
100.0%
563
100.0%
101
100.0%
178
100.0%
None/All needed services are covered
370
43.33/.
241
42.8%
49
48.5%
78
43.8%
Dental services
116
13.6%
74
13.1 %
11
10.9%
29
16.3%
Vision services
98
11.5%
58
10.3%
16
15.8%
23
12.9%
Prescription services
45
5.3%
31
5.5%
2
2.0%
11
6.2%
Prevention/Wellnessvisits
36
4.2%
29
5.2%
5
5.0%
2
1.1%
More physicians who accept insurance
19
2.2%
8
1.4%
4
4.0%
7
3.9%
Women's services
16
1.9%
9
1.6%
4
4.0%
3
1.7%
Birth control
14
1.6%
9
1.6%
3
3.0%
2
1.1%
All services are needed
8
0.9%
6
1.1%
0
0.0%
2
1.1%
Physician visits
7
0.8%
5
0.9%
0
0.0%
2
1.1%
Other
42
4.9%
22
3.9%
7
6.9%
13
7.3%
No answer
71
8.3%
53
9.4%
8
7.9%
9
5.1%
5. Have you ever had to use your insurance and have been denied reimbursement?
Base: Have health care coverage or insurance and have been denied reimbursement.
Total
Lower
Middle
Upper
Number Percent
Number Percent
Number Percent
I Number Percent
189 100.0%
126 100.0%
23 100.0%
39 100.0%
Why were you denied?
Total
Lower
Middle
Upper
Number Percent
Number Percent
Number Percent
Number Percent
Service was not covered
38 20.1 %
25 19.8%
8 34.8%
5 12.8%
Physician fee exceeded usual/customary
15 7.9%
13 10.3%
1 4.3%
1 2.6%
Prescription not on formulary
9 4.8%
6 4.8%
0 0.0%
3 7.7%
Preexisting condition
8 4.2%
4 3.2%
2 8.7%
2 5.1 %
Birth control pills
6 3.2%
5 4.0%
0 0.0%
1 2.6%
Prior authorization was required
6 3.2%
2 1.6%
1 4.3%
3 7.7%
Billing errors
6 3.2%
2 1.6%
1 4.3%
3 7.7%
Out -of -network provider
5 2.6%
3 2.4%
1 4.3%
1 2.6%
Had not met deductible
4 2.1 %
1 0.8%
3 13.0%
0 0.0%
Not medically necessary
4 2.1 %
3 2.4%
0 0.0%
1 2.6%
Company went out of business
4 2.1 %
3 2.4%
0 0.0%
1 2.6%
Other
29 15.3%
20 15.9%
2 8.7%
7 17.9%
No answer
55 29.1%1
39 31.0%1
4 17.4%1
11 28.2%
7. Have you heard of the KidCare/Healthy Kids Program.
Total
Lower
I
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Yes
765
100.0%1
488
100.0%1
91
100.0%1
176
100.0%
8. How did you learn about these programs?
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Schools
98
12.8%
61
12.5%
11
12.1 %
25
14.2%
Newspaper
79
10.3%
50
10.2%
12
13.2%
17
9.7%
Friends/acquaintenances/family
66
8.6%
36
7.4%
3
3.3%
27
15.3%
At work
63
8.2%
41
8.4%
9
9.9%
12
6.8%
Department of Children and Families
49
6.4%
36
7.4%
2
2.2%
11
6.3%
Word of mouth
47
6.1 %
30
6.1 %
6
6.6%
11
6.3%
The media
35
4.6%
24
4.9%
1
1.1 %
10
5.7%
Advertising
33
4.3%
23
4.7%
3
3.3%
6
3.4%
Community/civic organizations
33
4.3%
22
4.5%
2
2.2%
9
5.1 %
Television
28
3.7%
17
3.5%
3
3.3%
8
4.5%
Employed in health care
26
3.4%
17
3.5%
6
6.6%
3
1.7%
News/news media
25
3.3%
20
4.1%
2
2.2%
3
1.7%
Flyers/brochures
22
2.9%
16
3.3%
4
4.4%
2
1.1 %
At health care provider
22
2.9%
14
2.9%
5
5.5%
3
1.7%
Radio
12
1.6%
10
2.0%
1
1.1 %
1
0.6%
Health Department
12
1.6%
6
1.2%
3
3.3%
3
1.7%
Keith Douglas
12
1.6%
3
0.6%
5
5.5%
4
2.3%
Other
56
7.3%
29
5.9%
4
4.4%
21
11.9%
No answer
1 164
21.4%1
100
20.5%1
23
25.3%1
36
20.5%
9. Where do you go for health care?
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Total Interviewed
1132
100.0%
731
100.0%
131
100.0%
251
100.0%
Doctor's office
537
47.4%
329
45.0%
73
55.7%
130
51.8%
Clinic
115
10.2%
106
14.5%
5
3.8%
2
0.8%
Medivan
71
6.3%
25
3.4%
3
2.3%
42
16.7%
Miami
58
5.1 %
27
3.7%
4
3.1 %
26
10.4%
Hospital
54
4.8%
40
5.5%
6
4.6%
7
2.8%
Do not go/have not needed to go
50
4.4%
38
5.2%
4
3.1 %
7
2.8%
Truman Medical Group/Clinic/Center
34
3.0%
34
4.7%
0
0.0%
0
0.0%
Fishermen's Hospital
33
2.9%
9
1.2%
21
16.0%
3
1.2%
Lower Keys Medical Center
37
3.3%
37
5.1 %
0
0.0%
0
0.0%
VA/VA Clinic
25
2.2%
19
2.6%
2
1.5%
3
1.2%
Emergency room
24
2.1 %
15
2.1 %
4
3.1 %
5
2.0%
Mariners Hospital
22
1.9%
0
0.0%
0
0.0%
20
8.0%
Naval Air Station
19
1.7%
18
2.5%
1
0.8%
0
0.0%
Locally
18
1.6%
13
1.8%
2
1.5%
3
1.2%
Womankind
15
1.3%
15
2.1 %
0
0.0%
0
0.0%
Anywhere/everywhere
10
0.9%
7
1.0%
2
1.5%
1
0.4%
Homestead
9
0.8%
3
0.4%
2
1.5%
3
1.2%
Key West
9
0.8%
8
1.1 %
0
0.0%
1
0.4%
Ruth Ivans
8
0.7%
1
0.1 %
7
5.3%
0
0.0%
County Health Department
8
0.7%
2
0.3%
2
1.5%
4
1.6%
Marathon
8
0.7%
4
0.5%
3
2.3%
1
0.4%
Other
43
3.8%
10
1.4%
4
3.1 %
27
10.8%
No answer
127
11.2%
91
12A%
10
7.6%
22
8.80.
9a. Are primary health care centers clinics and/or physicians' office accessible toyou?
Total
I Lower
Middle
Upper
I
Number
Percent
Number
Percent
Number
Percent
Number
Percent
No
1 118
10.0%1
63
100.0%
11
100.0%1
42
100.0%
Money
19
16.1 %
10
15.9%
1
9.1%
8
19.0%
No doctors/providers that accept my insurance
17
14.4%
9
14.3%
3
27.3%
5
11.9%
Have to travel to Miami (specialists, tests, VA hospital)
9
7.6%
2
3.2%
1
9.1%
6
14.3%
Uninsured
Difficult to get appointment
9
4
7.6%
3.4%
6
1
9.5%
1.6%
0
1
0.0%
9.1%
3
2
7.1%
4.8%
Transportation
No health care centers/doctors in the area
Work/No place to go after 5:00pm
Other
No answer
3
2
2
9
47
2.5%
1.7%
1.7%
7.6%
39.8%
1
0
1
6
29
1.6%
0.0%
1.6%
9.5%
46.0%
0
1
1
0
3
0.0%
9.1%
9.1%
0.0%
27.3%
2
1
0
1
14
4.8%
2.4%
0.0%
2.4%
33.3%
10. Are there health services you need that are not available toyou?
Total
Lower
Middle
I
Upper
Number Percent
Number Percent
Number
Percent
Number
Percent
Total Interviewed
1132
100.0%
731
100.0%
131
100.0%1
251
100.0%
Yes
343
30.3%
213
29.1%1
41
31.3%1
86
34.3%
Dental Services
166
14.7%
102
14.0%
22
16.8%
41
16.3%
Vision care
79
7.0%
46
6.3%
10
7.6%
23
9.2%
Specialty physicians
59
5.2%
38
5.2%
8
6.1%
13
5.2%
Pharmaceutical services
44
3.9%
32
4.4%
4
3.1 %
8
3.2%
Mental health services
28
2.5%
16
2.2%
2
1.5%
9
3.6%
Support services
17
1.5%
10
1.4%
2
1.5%
4
1.6%
All services
15
1.3%
8
1.1 %
2
1.5%
5
2.0%
Testing/diagnostic services
8
0.7%
4
0.5%
1
0.8%
3
1.2%
Physicians and Dentists that accept insurance
8
0.7%
6
0.8%
1
0.8%
1
0.4%
More affordable health services
8
0.7%
6
0.8%
2
1.5%
0
0.0%
Prevention/wellness care
7
0.6%
5
0.7%
0
0.0%
2
0.8%
Other
37
3.3%
25
3.4%
1
0.8%
11
4.4%
No answer
52
4.6%
30
4.1 %
6
4.6%
14
5.6%
12. Do you have any special needs that you
cannot qet services for?
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Total Interviewed
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
Yes
205
18.1%
134
18.3%
20
15.3%
48
19.1%
Dental services
57
5.0%
43
5.9%
4
3.1 %
10
4.0%
Orthopedic surgeon
11
1.0%
8
1.1 %
0
0.0%
3
1.2%
Mental health
9
0.8%
6
0.8%
1
0.8%
2
0.8%
Medications
9
0.8%
6
0.8%
1
0.8%
1
0.4%
Orthodontist (braces, retainers, dentures)
7
0.6%
6
0.8%
0
0.0%
1
0.4%
Other specialists
6
0.5%
4
0.5%
0
0.0%
2
0.8%
Opthalmologist
6
0.5%
3
0.4%
0
0.0%
3
1.2%
Diabetes
5
0.4%
2
0.3%
1
0.8%
2
0.8%
Neurologist
5
0.4%
3
0.4%
1
0.8%
1
0.4%
Obstetrician/Gynecologist
5
0.4%
4
0.5%
0
0.0%
1
0.4%
Podiatrist
5
0.4%
3
0.4%
0
0.0%
2
0.8%
Dermatologist
4
0.4%
3
0.4%
0
0.0%
1
0.4%
Endocrinologist
4
0.4%
3
0.4%
1
0.8%
0
0.0%
Cardiologist
4
0.4%
4
0.5%
0
0.0%
0
0.0%
Vision care/optometrist
4
0.4%
2
0.3%
0
0.0%
2
0.8%
Other
46
4.1 %
26
3.6%
5
3.8%
15
6.0%
No answer
41
3.6%
24
3.3%
7
5.3%
8
3.2%
13. Reason for being unable to keep medical appointments
Total
Lower
Middle
Upper
Number Percent
Number
Percent
Number
Percent
Number
Percent
Have been unable to keep appointment
261 100.0%
150
100.0%
35
100.0%
71
100.0%
Work
Money
89 34.1 %
45 17.2%
52
22
34.7%
14.7%
14
8
40.0%
22.9%
22
15
31.0%
21.1 %
Transportation
43 16.5%
22
14.7%
4
11.4%
16
22.5%
Unexpected conflictlemergency
19 7.3%
10
6.7%
5
14.3%
4
5.6%
Too sick or injured
14 5.4%
7
4.7%
2
5.7%
5
7.0%
Forgot
5 1.9%
3
2.0%
1
2.9%
0
0.0%
Other
21 8.0%
11
7.3%
3
8.6%
8
11.3%
No answer
49 18.8%
33
22.0%
3
8.6%
10
14.1%
15a. When seeking health services do
vou feel that health care workers treatyou
well?
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number Percent
Number
Percent
No
85
100.01
52
100.0%
15
100.0%
17
100.0%
Rude/not polite
14
16.5%
5
9.6%
3
20.0%
6
35.3%
Rushed/too busy
13
15.3%
5
9.6%
4
26.7%
4
23.5%
No money, no service/respect
11
12.9%
8
15.4%
2
13.3%
1
5.9%
Not caring/insensitive
8
9.4%
4
7.7%
2
13.3%
2
11.8%
Attitude
5
5.9%
4
7.7%
1
6.7%
0
0.0%
Other
4
4.7%
2
3.8%
1
6.7%
1
5.9%
No answer
37
43.5%1
26
50.0%1
4
26.7%1
6
35.3%
15b. Are they culturally sensitive?
Total
Lower
Middle
Upper
Number
1
Percent
Number
Percent
Number Percent
Number
Percent
No
141
100.0%
93
100.0%
11
100.0%
32
100.0%
Communications/only spoke English
10
7.1 %
7
7.5%
1
9.1 %
2
6.3%
Don't care for the homeless
2
1.4%
1
1.1 %
1
9.1 %
0
0.0%
Racial prejudice
2
1.4%
2
2.2%
0
0.0%
0
0.0%
No answer
127
90.1 %
83
89.2%
9
81.8%
30
93.8%
18. Have you or your family used the emergency room for non -emergencies
in the last
12 months?
Total
Lower
Middle
Upper
Number
Percent
Number
Percent
Number
Percent
Number
Percent
Yes
192 100.0 %
112 100.0%
23
100.0%
52
100.0%
Why?
Accident
Unable to see physician (evening/weekend/holiday/too busy/too far)
41
27
21.4 %
14.1
22
19.6%
2
8.7%
15
28.8 %
Medical emergency/emergency
%
18
16.1 %
4
17.4%
6
11.5%
Sick child (flu, croup, fever, strep)
13
6.8 %
7
6.3%
1
4.3%
4
7.7%
Referred by physician
8
4.2%
7
6.3%
0
0.0%
1
1.9%
No other place to go
5
2.6 %
2
1.8%
0
0.0%
3
5.8%
Heart (blood pressure, possible heart attackistroke
5
4
2.6 %
2.1%
0
0.0%
3
13.0%
2
3.8%
Ear infection
3
2.7 %
0
0.0%
1
1.9%
Illness/Fever
3
1.6%
3
2.7 %
0
0.0%
0
0.0%
Migraine/severe headaches
3
3
1.6%
2
1.8%
0
0.0%
1
1.9%
Allergic reaction
1.6%
3
2.7 %
0
0.0%
0
0.0%
Animal bite
2
1.0%
1
0.9 %
1
4.3%
0
0.0%
Asthma
2
1.0%
2
1.8%
0
0.0%
0
0.0%
Have no insurance/No money
2
2
1.0%
2
1.8%
0
0.0%
0
0.0%
Kidney stones
1.0%
1
0.9 %
1
4.3%
0
0.0%
Mental condition (Anxiety/Depression)
2
2
1.0%
0
0.0%
0
0.0%
2
3.8%
Pregnancy/Miscarriage
1.0%
2
1.8%
0
0.0%
0
0.0%
Other
2
1.0%
1
0.9%
1
4.3%
0
0.0%
No Answer
7
3.6%
6
5.4 %
0
0.0%
1
1.9%
63 2.8% 33 29.5 %
19. Are your physicians' or clinics' hours of services or cost factors involved in oTM
diito visit the Eme enc
10 43.5%
Room?
17
32.7
Yes
No
69
61.6 %
18
78.3 %
27
51.9%
No Answer
33
29.5%
4
17.4%
21
40.4%
Total
10
8.9%
1
4.3%
4
7.7%
.112 100.011
21. Has a doctor or nurse talked to you about when to use the doctors office versus the am ency room?
23 100.0%
52 100.0%
Yes
No
57
29.7%
36
32.1%
6
26.1 %
13
25.0%
No Answer
126
65.6%
69
61.6 %
17
73.9%
37
71.2%
Total
9
4.7%
7
6.3%
0
0.0%
2
3.8%
192 100.0%
112 100.0%
23 100.0%1
52 100.0%
20a. Under what circumstances would You call 911?
Total
wer
Middle
Upper
Number
Percent[Number
Percent
Number
Percent
Number
Percent
TotalInterviewed
1132
1000%
100.0%
131
100.0%
251
100.0%
Extreme/absolute/critical emergency/life threatening
734
64.8%
480
65.7%
87
66.4%
161
64.1%
Major/serious accidenttinjury
121
10.7%
83
11.4%
12
9.2%
24
9.6%
Chest pain/heart attack
103
9.1 %
60
8.2%
12
9.2%
29
11.6%
Unable to help self/unable to drive
43
3.8%
30
4.1%
3
2.3%
9
3.6%
Major/serious health problem
32
2.8%
23
3.1%
4
3.1%
5
2.0%
Death/dying
32
2.8%
21
2.9%
3
2.3%
7
2.8%
Large amount of bleeding
29
2.6%
13
1.8%
2
1.5%
14
5.6%
Crime (shooting, theft, attempted murder)
26
2.3%
18
2.5%
2
1.5%
5
2.0%
Fire
19
1.7%
11
1.5%
41.6%
Limited knowledge/Could not handle situation alone
8
0.7%
2
0.3%
2
1.5%
Felt threatened
6
0.5%
3
0.4%
1
0.8%
4
1
1.6%
0.4%
Other
18
1.6%
15
2.1%
1
0.8%
2
0.8%
No answer
148
13.1%1
91
12.4%
17
13.0%1
33
13.1 %
20b. Under what circumstances would you go to the Emer enc Room?
Total
Lower
Middle
Upper
Number Percent
Number Percent
Number Percent
Number
Percent
Total Interviewed
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
Extreme/absolute/critical emergency/life threatening
455
40.2%
301
41.2%
66
50.4%
82
Doctor not available/after office hours
189
16.7%
126
17.2%
27
20.6%
36
32.7%
14.3%
Major/serious accident/injury
177
15.6%
108
14.8%
16
12.2%
51
20.3%
Major/serious health problem
75
6.6%
45
6.2%
10
7.6%
19
7.6%
Chest pain/heart attack
60
5.3%
33
4.5%
7
5.3%
19
7.6%
Pain/severe pain/prolonged pain
36
3.2%
22
3.0%
8
6.1 %
6
Large amount of bleeding
31
2.7%
18
2.5%
3
2.3%
9
2.4%
3.6%
Death/dying
Need immediate care
24
2.1%
16
2.2%
2
1.5%
4
1.6%
Minor medical problems (sick, fever, minor cut, not well)
24
19
2.1%
1.7%
17
2.3%
3
2.3%
4
1.6%
On advise of physician
10
1.4%
2
1.5%
7
2.8%
Ambulatory emergency or accident
14
9
1 2%
12
1.6%
1
0.8%
1
0.4%
Illness (unspecified)
0.8%
4
0.5%
0
0.0%
5
2.0%
Limited knowledge/Could not handle situation alone
8
6
0.7%
0.5%
5
0.7%
2
1.5%
1
0.4%
No money
2
0.3%
1
0.8%
3
1.2%
Other
5
0.4%
2
0.3%
3
2.3%
0
0.0%
No answer
17
1.5%
12
1.6%
4
3.1%
1
0.4%
279
24.6%
184
25.2%
20
15.3%
66
26.3%
22. What do you feel is the best way to get the word out regarding
ro er use of the emer enc room?
Total
Lower
Middle
Upper
Number
Percent
Number Percent
Number Percent
Number
Percent
Total Interviewed
1,132
100.0%
731
100.0%
131
100.0%
251
100.0%
Newspaper/newspaper advertising
181
16.0%
100
13.7%
29
22.1%
51
20.3%
Brochures/flyers/supplements/posters
92
8.1 %
55
7.5%
9
6.9%
26
10.4%
Television/commercials
86
7.6%
44
6.0%
7
5.3%
34
13.5%
Radio/spots
85
7.5%
49
6.7%
2
1.5%
26
10.4%
Advertising (unspecified)
83
7.3%
61
8.3%
7
5.3%
15
6.0%
Doctors/doctor's offices
81
7.2%
46
6.3%
13
9.9%
20
8.0%
Word of mouth
52
4.6%
40
5.5%
2
1.5%
8
3.2%
Media/mass media
48
4.2%
35
4.8%
1
0.8%
10
4.0%
Education
41
3.6%
23
3.1%
6
4.6%
11
4.4%
Direct mail
34
3.0%
22
3.0%
5
3.8%
7
2.8%
Schools/educate the children
30
2.7%
18
2.5%
2
1.5%
9
3.6%
Emergency rooms
26
2.3%
19
2.6%
2
1.5%
4
1.6%
Presentations/meetings/forums
18
1.6%
13
1.8%
1
0.8%
3
1.2%
Employers
12
1.1 %
10
1.4%
0
0.0%
2
0.8%
Insurance companies
10
0.9%
7
1.0%
0
0.0%
2
0.8%
Health care providers
9
0.8%
6
0.8%
1
0.8%
2
0.8%
Billboards
8
0.7%
6
0.8%
1
0.8%
0
0.0%
Clinics
8
0.7%
4
0.5%
3
2.3%
0
0.0%
Social service and government agencies
8
0.7%
5
0.7%
0
0.0%
3
1.2%
Outreach/canvassing/health fairs
8
0.7%
4
0.5%
1
0.8%
3
1.2%
Hospitals
8
0.7%
5
0.7%
0
0.0%
3
1.2%
Other
40
3.5%
30
4.1 %
4
3.1 %
6
2.4%
No answer
566
50.0%
375
51.3%
68
51.9%
111
44.2%
Additional Comments (Optional)
Total
Lower
Middle
Upper
Number Percent
Number
Percent
Number
Percent
Number
Percent
Total Interviewed
1132
1W.0%
731
100.0%
131
100.0%
251
100.0%
Did not comment
849
75.0%
548
75.0%
94
71.8%
190
75.7%
Commented
283
25.0%
183
25.0%
37
28.2%
61
24.3%
Health insurance is not affordable
74
6.5%
48
6.6%
11
8.4%
15
6.0%
Coverage is minimal/a disgrace/no preventive care
29
2.6%
15
2.1 %
6
4.6%
8
3.2%
Health care is not affordable for most
22
1.9%
11
1.5%
10
7.6%
1
0.4%
Big deductible/prevents many from accessing services
21
1.9%
15
2.1 %
3
2.3%
3
1.2%
Few doctors/dentists accept insurance
15
1.3%
8
1.1 %
4
3.1 %
3
1.2%
Few medical specialists for those with serious problems
10
0.9%
4
0.5%
0
0.0%
6
2.4%
Very few insurance companies offering health coverage
9
0.8%
8
1.1 %
0
0.0%
1
0.4%
Would not have coverage if not for employer
7
0.6%
5
0.7%
1
0.8%
1
0.4%
Advocate national health care
6
0.5%
5
0.7%
0
0.0%
1
0.4%
No access for the uninsured and the poor
6
0.5%
4
0.5%
1
0.8%
1
0.4%
Grateful for the Medivan/does a wonderful job
6
0.5%
3
0.4%
0
0.0%
3
1.2%
Need for evening/weekend services when doctor not available
5
0.4%
5
0.7%
0
0.0%
0
0.0%
Other
123
10.9%
81
11.1%
13
9.9%
28
11.2%
-J
MW
0000 0000
r- N t` O
n N O O 7 m N O
0) O D Cl) O
cD O c7 O
m �- 7 000 C
V 7 N Q
0 0 0 0 0 0 0 0
D) -: O p N 0 0
04 a) p 0 cOo N O O
00 N m^ V � m to
R
co cD 7 �-- to
0000 0000
N p CO O u) O co O
D 1 0 0 n N 0
n NpO c� cD .-O
co n
0 0 0 0 0 0 0
a0 N O p t` p
M V) O N co 0
W O o O O
0000 0000
R to O In N M O
c°) co — O — <D N O
(n O co V O
N •f sr O V O co O
N N Cl)N (D
N
Dove 000a°
Cl! r- O V Nto rr O O
a)0 0 r- N O
00 to C.) co co N cn
N O co (04 DD N co
0a°0e 0e0 0
vr*aoo V:u?o
O N O
O O co V O
R N H ^ cD O) r` N N N O t`
N
0 0 0 0 0 0 0 0
O V cD O 10 O N O
DO) �O ap Ln O^ N �p
N N N O N p
W o0 cD N c0
Cl.
E
m
0000 0000
mgoo ocDr.�o
y O c`7 O_
V
O N = to co m N
r` V) mcD C c2
O t � (h
N
x
N
r• lC
� U
U 72
Y
m
O `p
C �
c0 c`q
N y
L L
J
O p
> N
c0 C C
._0 Ccy 0 10
rD Y 2 Z F- r` } z
O OI O
0 mO McoN
0a�
v
C W N a0 T
Co O N
O
N
z
�e eee
o 7 v m!
1. m
m
a v C14
j E m Cn cn
z
oe ee e
� O N Uq cn
O co h G N
m O
ma
yyo comet
LL r M CO
z
o e e e e
m O v N
26 c7 n
m m O v N
_a
m
m O -T N O
7 .- N
7
z
C e e e e
O co Go lh
m O LCl)O cV
ca o v in
a
E o vo 0
m to
C a N
z
.-
2 6
cv1:ry
c� C
m m 0
oa
m
7 A O
a
�
u°vGo
w E co$
m
z
N
�
o e
e e e e
C� O
m
N O CO O
m 0
N O
rCL
N
C N
r
m
O_ r N
n r
D � N
U
N N
7
Z
L
m
m
e e e e
o e
O
L
� c O
m O
D
�r7o
en
c`') co O
mar
o
m
m m
c cn
O l UN
N ao
Eco
z
.�
U_
e
e
o�O
mO
Go(i
m a
E
C N
F N M
V
r c h N N
ccN C7
a
� �
m
Z
c
o
o
�
m
m �
L m
N
t C
o V
E'
O
O
N
o
O
ca
m
w N
L
m
0
C �
—
Q R
N o o
> z z F
a�i 61
�a
a �
c E
z
Z
iaa�
E
z
O
O
- '- Cl! O
(O O O
co N p
O N w O)
co m
t2 t0 O
Lo
C o
N V O
am
O
v
c rn
m a
o E
N
z
co
ado
ao
Wy
d
c m v
= Eto
z
co
do
U
N N O
maw
Eoo
LL m
E
m
z
�o
do
20
mo
maw
m
� � o
E�
z
ce
v d o
d2o
odo
_ate
a
E `m o
dmo
E N
z
c o
do
U o
T
N O
oar
E o o'
m
w E co
z
0
v � c
Imo
way
N
C � N
C
D E N
E
7
z
C
O
O
a�
c a
E "D
3
z
c e
m o
U p
_ N O
md�
o
~ N M
E
z
7m
A
3
e eeeeeee
O M aD M N t0 �O m
00 ��ff my Om�
e ((aV°Vea°a'a'ee
o M M m o n m m
$ mai pcv o°i�
O mV N N � N fV 0
M
e eeeeeee
O M N M m O N n
8 n.. Oi tO? OmtC
N 7 N N m
e eeeeeee
o Nn mM^i°
$ ^2 ro vi o
N N' n M O m
N M N N
e assesses
O m m m n m N
.- t0
m
o° eeeeeee
O N 10 i O v m t 0 m
O aG °C tn<OaG n
C �
M m O m M m
m m M N no
O �Moommm
10
g v°iroc�ipm
N m'mOM�m
n
e eeeeeee
$ mf� tGV GO m
M m N N M N
O eeeeeee
8 N� M.-m^ m
O °NDM MN �10 0n1
O N
C
FaE a
O �
a
U U m
L N
y 5 Q E
f0 O L � 10
E��Brn
N N Val - m
N a m C
o 1�a ¢>aOz
M
S
e
eeeeeeeeeeeeeeeeo
O
mmmn m� mN mNf� mN N(O V O
a0
N M NlM�N� my n v10 nv vMtO
e
e eeeeeee e e e e e e e e e
op
O
Minmv,c�om 0u»rnq q.-ln4
N t7 m O n G O) M f7 t7 N O N (V t7 (O m
N
N
mm 11'OO�
10 t7�N mw Om Omm olowwmN
e
eases eeee e eee eee
O
n vmvmv n �O tO mN mtON 4
N
e
eeeeeeeeeeeeeeeee
o
$
n M m v M 7 v q m m n M o n m rn n
°�^<d °in <c v. c�i oio vocoin vi
� N
e
eee e2ee ee eee ee ee ee
0
8
on�n m°oM toI01
n
^ mN1�� m Mm0
N .-
n
n
� N
e
eeeeeo°ee eeee eeeee
O
m iO 1�m nn NCO min e-V: t0 t°.-O
N
N
NMmmn.- .-m00 ^mOON M
n m0v My NN m N
e
eeeeeeeegage eeeeee
o
8
w�<qv, ammo Omo orn qm"n
N
C
7 m 0 O O N N N m
e
eeeeeeeeeeeeeeeee
O
m mOOMOmN m 10� vN NEON n
N
m
M
n m O m M m N n m N m m m m v
m tO NM MM NN.--
e
e e e e e e e of e e e e e e e e e
Op
°on mOOM mmnmm f°v NNN�D
O
^ V n (V fV (V (V fV fV (V h
� � N
tom
nmmvv NN.--- — on
'c
E
C C
T
m
> > >
y
t
c q C
o m
m
L a
C� y yNy C
N N O O
.0
O j ,o O ._ L° m
a
C _ Ul
o o y
O
L O m m> F
g
_� � ((ay��i � mm° E
O
O N N ° m O a ci m
c
o °' m cYi v1 mm 'Z`S a o is
3
cy5 m f
ry=
QJO-j mJJ m2:3
(E OZ
ce eeeeeeeeee ee eeeewr, ee
mo Minrnm �pooNMrnvv vrn �vvann�n
j 0 <mo wo m NN Nm oN rNO o0) C O o o 4a0
O m O N
ar
C O 7 MO N cR M0 O N 7 r n r N N a 0N N M m
m E Q N7N N (+f r r r r N co
N
z
ce ee.eeeeeeIle -le eeeCC* ag ee
O a)In h0f M (Iq V:q q rcp O)r0 m (p GDT ap cp
gar
d
'O �p tt m NaO .e�}t tf1N Y� O 00 `nN ntn fit° w o O
C� Nn'tNN N1 NfV Nr N r Nco
E
z'
�e eee eeeeeeeeeeeeee eeee.e
mO N pOrm U9 N cq 0v v, aoO7 cO nmmn ONv
m N 00 m m n m M N m N N 0 r r N N N O o 0 0 o r v o
m a '
E m0 m m MOMn OMO� M O M n `u) O o co 70 n O a
LL E n M < N r N N r r r r M n
z
ce ae aR eeeeeeeee ee eeeeeee
m O < N O O n O h O n 1° u Y O g O O O n n O n N n N
fi O
N O M r
O N m N � N M N N 04
O N? O� M M R M r u) u)
E� r r r.t
z
Q)e e..eea'eee.eeeee.eeeeeee
� mo nrnvcpLpopvor rrninrnco'It inaapLnoNN
m 20 frou')mm000imm roo. oo�o<c�
p m 0 M r r
as r
E O m nu)N OrOaD aO a0 V7 V'NN rQrN 7Ofp 0)
mc p O M N r N r r N
c E N
z
�e eeeeeee eeeee eeeeeaeeeeee
�,o vnron qcocovmrnI':ngLq omgr-q q 7
O O O f o o M a C' I M M r r r- r r r O O O O O f V r
°ar
E t°a MN TMMO) tp tp �n loMM W �000 f07 m
E a f0 � CO � vM M M M N
W E r r r r r r N
aD
z
Ze eeeeeeeeeeee eee eee. eeee
mo am tll cor tp ao to n ip cp nOn u� v,00<pr OInr
m
V O o r r ap fh r r (7 r (p O O O r O O O N r 0 In N
m 0 r N r
gar
C N O N a p 1 o N n u 7 V r O v C O NON v r O O P. M O o M
' C N t o M N N M r r M
E
z
z
�. eeeeeeeeee.ee.e.e.eeeee
m O ? Nu� N (p Lq a V N N n M N O cl 7 r (q 81 M T
O ( p O r w M r M M M N O N N r r 0 0 O M O
m o u)
mar
rq M M M N N !p0 W mr OOQ�r to ap m
C m� aDN m r V 7 M r N N N N N cqO) r N
ECO C
z
Ze eeee.eeeeee.ee.a? ae ee
m0 7NM 7 cq 70mMN T ntpM TcO wn n p-wN
C O n O f p L n M N M N N r rrr O O O O O O M r
CD 0 O r r
ma
o N ntn m a O Mnu7 �N OIm in OO)O1 m a0 aDMn
2 N n to 1 A u� M M N N N r r r 'It N
Er
7
Z
m
mU
L o �
c_
m
c a U c m
m o m E
3 �
om- m
n cy cy o f7 'a - m
> m c -wo Etcc p
° m > m
i v o co
o i
D m N C O m Y o 3
u t g >•_r9 E Q �ma t ro3 ��$ c
gg°- E a c E m 2 m° E E T tr N N
OUii2 CI -IL J d> W 2z J3 �=Ya'GJ 2 z
Oi
Co
a eeeeeee ee
m0
>
� O t7 m°D NO m
Oar
cc
E
Z
e
NNo�? omoce•�
�e
o
M
O
voi m o
°m 7mN.-0N m Oi
D
v
a r
n
M w m w"- o N w n
M
E
z
c e
e e e e e e e e e e
�i0
'd• OOtn OO �� Via)
m NO
m a
tD NOin thM ��nN
ILLm
�mmNN�ru)N
E
z
Z
Co
e e eo° ee eee e
m o
26
0 0 0 0 0 0 0 0 0 0
m v m m? N (V N O
dam
m
m NMvN--r V)m
N
E
z
z
C g
e e e e e e e e e e
01 O
m C OI R r• O O m N
O a S
N O
c E
Z
e e e e e eee e e
c e
mmO
`o
O M Ot700 nt. l'70
O M Ot700 mm c70
o
[V m m O O N N 01
T a
O
N
Ean
d1 mmYMONN nN
w E
z
Z
e e e e e e e e e e
e
N
c m
noomo-M.-mm
� E
z'
�8
t7 cl 1p lh peppe�eape�
g fp g tp
mar
C
C N f0
E
O
y
7
Z
a
eeeeeeeeee
ce
41
U
mo
O O
o�c�cvin nn rom
m^f�f�MNrrn O1
V
m
a 0
7
U
O m
H
pl mm M m
RNN
o.
E
U
C
�
Z
U
.y
L
O
o
L
O
C Q
•�
c � m
E
d°
U
m
o N
m a c
m
12 m p5p, may; o
O
L
N
p a ) o
o
o 0
E
o o 3
NT a N J N m C
G
C L] C C L m
rn
z
o `0 O
2 Z m O O F Z O Z
Zee eeeeeeeeeeeee
�on ocn mmaoccccrnoo?v mm
OO Nm 49M---00 �-0 mU0
O N M
aO
l0 M IA N N
o E v
cn z
Zee eeeeeeeeeeeee
N O M 7 Un n O t N O Cf M m r N
�a�
C 0 0 M N O OI m V m N o O n
� E to
N N
z'
Zea" eeeeeeeeeeeee
N O O Q M
N O M
maw
y
O) In V N N N
LL � n N
z
Z
Zee eeeeeeeeeeeee
N O n O u0 n N O n O O O O N O w0
N O M n to Mtn M N 0 0— 0 V In
da
O O N m m n m 0 0 V m N
V m N N N
E
z
Z
Zee eee ee eeSee ee ee
4J0 m mm �nmmci V Omm cnm
O OO v ow. !'1 m—.N 0000 mo
o N O M N
astcp Wpp� pp
Et mRTNCO �ONN Tub
C N
� E
Zed e eeee eeeeeeee
�O O m cq V 01 mrnn(O N N
Gl O N M n l0 N N O O O O O M V
oar
E (MO N t0 N N Of ^ m n aD m ul
N C'1
A
w N
E
z
z
Ze a eee eee eee eeee
NO m oGo On0(O7 V cDo vm
N
�a�
N
C N 01 NN
C n n M N
�EN�
z'
Ze^ eee e e eeeeeeee
Q1 O m o uO m O N V w W uO m m u0
NS N Own to —cq OO N V
d a 0-
N V M M n n !.n2 n m V N In m
E ao C N O) O V N M
mN
z'
Zee eeeeee a e e e e ee
O N O M n O N W uO u0 M n n n (D M f0
m OO n
d 0 N M mCA O V mnln mmmn nN
E
z
g
a�
m
� c
a�j C
c n
O U
>. N
N � U
_u Qa Y Z
N imp
Y N t U a] Z a7 N
L N U y 2 N O Q L C
Zm o W 2 rn°va�
w c O U y N' m > m m
i o>v)ia2ci�a�a2a`Oz°
Ze eeeeeo of
`m 8+o 00 00000
> 00 w N N
O d
v
C t
m a N
SO E
z
Ze eeee eee
�o DLO.0MInMao
o ao�c+iKicG
EL O ci M
V n N O N n N M
D ELO
N
E
z
z
Zee e ee eeee
N O n f0 op Gp O O
m `m c 'n is m m vi
- N
m a
LE d O^ t0 N N N
N
E
z
c e e e e e e e e
�o ao•-OIM - Map
d a O N V
w
c 0— n N c M N V
a
E
Z
ce eeeee-
e
d 06 66 N 1f)
0a07
O.
E
D
c E
z
Ze eeeeeee
do V rnvv,cnom
maoo oin oo4ri4
O
G n M n n M N O
Egg M
w E
Z
Ze e eeeeee
�o nm n
O n n In M n n 10
m d 0 M M
�a
a1
C CN
C N
E
7
�e eeeeeee
N O N O)
� 0-
LO V
C m N^ n M N n
a " N
E
z
mo c°wi ^ofccivc6
m a
FO- ' v ^
Eco
z
r
LLL .8 O
E
z'
Ze
N O
O
E
z
c e
O 8
-da-
E
� N
c E
z
Z e
0
o�o
ra o
O
O. M
WEm
z
N O
mmo
5a-
C_ � N
C E N
E
z
E �I
E c°
z
��
E
a
E
z
eeeeeeeeeeeee
er- mrl% wu)wme ee
•-n rn �mmcn commrn o
�c rci �f7N(V .=c o� ni
rnrn coin.-M mccov� v� n
�m RN •-N m
eeeeeeeeeeea
cnv, Maonv cnwnm co
N� M<O1n Ins �m e-cn in
eeeeeeeeeeeee
M t n (n N N n O N 1 n t n O O
NO/ (G N �iCi C7 C C
�n
m
eeeeeeeeeeeee
�n N
m
eeeeeeeeeeeee
co
Mau ova rno mcnon Mrn v
O M N M N N N O o— m
�o `oicQic�i�i N�'m Mto m
eeeeeeeeee eee
�cncnaonoMcccnnn.-o
t�O N to N' Ql n O N N M Of
v
eeeeeeeeeeee,
M V N V to cn M N a0 n cn � 1n
���ppO Gawpp Pppj fV pp N.-O O�
tD a00 anOM MN N�.O-m OD)
ee eeeee ee a eee
mn.-mmmco a> nn v�cc.-
V
ttOO� � O V IN�I C N N Cn m m m a0
rn �
c
0 c
O
L
ID N
- a -
EE 'v
E' v °� r
m m m y e °c
c
a E
a
v O an d U
is 0 N m aE
mar `off+ dv
N Lal ; Cam. N
E a
ryry m
p U
m N
9a
y
c m
�a
E
z
mN
a
N
C
E
m
z
ma
0
~a
E
z
Z
a a a a o a a o a a g o a a a a o
�O QfD O1 W OD n .-c+f Of 0) t? O10 Ot7
N
��cmo �i��mc�inm QQ m Qornm
a a a a a a a a a a a a a a a a a
OHO ram- P-m 'It 000 wt0 0 M°D N10
�� vim P/C7 f7 t�f c7 fV �G G GO NN
Q� T QC�f NOf W C7OQ N NCO Qh
aooaaaaaaaaaaaa'as
nAn�mQmm'-co�m m ncn .-<o
O'm1017 f")� fV O G CG (V O
Q N N
mnmmOQ nth mt7 Nm m 10N �Om
aaaaaaaaao a100 rl as
n O N N 10 1� O O N� 10 N �O N n N Q
aoaaaoaaaaaaoaaaa'
N� mQ t�mNC� f�{01 mN O QN Of Yf
°0� °C tf7 fV f7 HIV �� G� O G� nth
N � Q
n�N^ m0 t7m t")l0 Nfn O �f71f1 C7
a o a a a a a a o a a a a a a a o
nN f�0 f+f0 N Qm Qn W mN Nn
Pfm �i: mri t7N N� �0000 Nm
Q�
n n m$ m m a m m m N rn
Im�
e a a a a a a a a a a a a a a a a
�rmoaom(cminQonn°o mm
n1� mr N V -N OOOO -N
f� M
r Olm� onQQ -ONNm nV)
oaaoaaaaaauaa
On P7m 00100 tym Q: .- r mq"
Q
�rn mm mfV tnfV (V O GO'-N
V pp� pp N
a aaaaaaaaaaaaaaa
Nr wm t'f4�Q u�tp
�m �m 1pogt+1NN N� �0000 �N
7 a00 ^r �D t'7 f")N NO � W mmin `N
m
c ; c
o 0
c m
m � o
m c �
t C_ ,dy (LG
E eoo m U C
ro
a f0��2ma°°m `�%o y30
`° o c •c c m E E .°� $ .cam. Y m.
nm m6 EEg m o a
�� �iayEEtm
r�
wo22Lc�a3�z 0E EZ Z
Z-, m o
LL ;:
E
z
C o
m 0
U 6
mao
m
� � o
EQ
z'
c e
� m O
o26
oa0
o.
E m
m � N
c E
z
c a
N O
UO N, N
o a
aim
E n 10
w E
z
C e
c� O
v
m 4) O
�L
y
C N
C A
D E E N
z
m
ma
y �
C E
3
z
a
E
z
a aaaaaaaaaaaaaaaaaaaaaa
Q m mn0 (")t7mapOm Qm � �4)r v nr'-n W
rnn mmmNlOOi� N � N� �� 00000 �Q Qi
Q
n m mrnn QQ nm W m �nmmQ f7 Nfh C7m
m O] t7 C7 N N N N N
N
aaaaaaaaaaaaoaaaaaaoaaa
Ln o m o n v cn r1l: m m m m m m m Q e
Q m n r m m a m m t7 M N O O O o 0 O O m m
Q
m wLn oN m N Q No r, QmQ mQN mN m
W 0 Q Q 10 N N N m N N N
07
a a a ao o o a o 0 0 o aI' a s oaaoo a
N n n M L m N O A O m n O m n m O
ao A°cn °o v v v of of of o oo-oo rA
Q
N N 47 m m 0 m O m Q m N n In n m uO n Q o N Q
m m
M
oaaoaaaaaooaaaaaaaoaaaaa
m O A m n A w� n 0 m r N m N N m t0 m N O r LO �
Q n A m m Q o N m N - - - -- p 0 0 0 o m Q
N
mm mnmN -N a owLoN NN N�Q C7Q n
m N f7 N N N e-
a aaaoaaaaaaoaooaaa000aa
(P O m IO m uO N n m m m O N O Q m p Q Q N N Q
Qm Q cn('7m01 N�00 0000 o0--mh
w)
m M N O) O n N
a a aooaaa000aaoaoaoaaao
OOmnmmN W NrNQ1-QOm0)nmmmm m Cf
m Of m mm n M e70 � f7 Nr-.-.-00 OOOOQ m
In
Q
v
aaaoaoaaoaaaaaaaooaaaaa
m � ��Qi(7 Of ��rf NOfAAOQO �Q�00 m
r m m m Q h N N 0 0 0 0 0 O O N Q
N O QQNNmcnN Of mmNNO�O cn� �Om Of
Cl) N
a o o a PI C) f'1 w A 0 o e a a o 0 o a o 0 o a o 0
N Q N Q Q a) m .- Q) N N m 01 0) tp m cp Q) f0 w Q
A m m m 00 n e v (7 N N N 0 0 o 0 o 0 7 m
Q
nN 7 mmmN04 mmOOmmmA �O mO) fh
n A A n m m mN N
Q
a o a o m a a a a o a c o a m a a o a a a o
o � (o m m ry m N m o r M co � rn m r r r n r u� o
. .
m m r r A r Q Q M C7 N N E � 0 0 O O O O O th O
10
N m N N N m O m m N 0 W m m m m m p m
mrnmmmaomQm Qm
N
m
y C
N y
� O N `
> C N O m L
C m V w C m
m E
>
m N m N V O) L
a n l0 Ol
O V y U 'a 'o C N
m a�i pEp o E o H E cc
n m
U U O y C V m
Z O y E v C m N C m t- N m y N U y N
° m E d
O T C U 9 .m..
mtm 'o- �pp0
coG 'Ei3'maSamigm�mGe 'D EEEym om�odtcwzca �a_wsx0m0xo0zc
co
c
0
a
0
c
c
E
0
O
Qv
ae�aeaeae��e aeaeaee
O� c0 ap mmt7vvm vv N
W t"1 �� 00.-000 00 N
tO eV-mm V V tONN V NNfO
S�e1 a ae ae ae a@ ae ae ae ae oe a de
A tn00 t0 mt0 a0 �O t� tON 10
hfV tV (V �00000 00m
M^'^ O fO N N th N V PI
�D
o e aE ae ae de ae ae aQ ae �^ ae e
fhA �A Ot7mA V f0 OD {O �D
A f+f (V fV fV �COGC OGO
NN"f vmf0 Nt77 t0 V N
A
ae e a ae ae ae ae 9 0e e ae eN A N O N N 10 i 0 A 10 O N A
a
ae a ae ae ae ae ae ae ae ae ae ae ae
W N GO N c0 0 V O N p V w
f+)O�G �GGCG� GCO
aDN t7N t7NN.�pf7O�
N
ae 2e 3e ae ae ae ae ae ae X ae ae ae
�ON�N V mODA Af+1 AY1O
�A l7N N �00000 00 �
fD NCDm'CD At0 t017 t0 V l0
m
ae ae ae ae ae ae ae ae ae ae
lo.-mv vp7pA7 r•pA
fO�tV C CGS -CCU ECG
ae eP ae P ae 9 0 ae 9ae ae ae
wow m fONAtON V V W W
��16p16 �-C4 �.=0000 OOC
O I N :! N' O t O A N C7 l h N N
aeaeaeae ae ae ae ae ae 01
iO tO m m mCf m W q t0 t0 of N V m
f D
n NNN ^OmAtO �D fD �O th
N
_m
mym m
U
W L O > c
O y a 8
O m L
C $
m .CCEL $
(yp,1 F G aka{
m OE0 ymo�
e 3•c�
m y m c g
v A m c m m� d
mE m v
g!o i� am
—'E_°E3 °mY��
g�v�E�C
>>.P��'c
=U=m LLLL>3$z 0 ZO
t/1
CC
rj
•,,
C
a
P.�
.0
a
v)
�30
++
00 N
�
C
�N►C�CIA-1
C�
t
�
� ►�
.t�
QI
ram,,
C
CC
a,
a
�x
�
O
1�
0
O
L
m
C O
Q1 O w
L to
ui co
c >
m E O
O U w .m C
O c°) E
'O m L C) O 0
c w U
U m c
a0i Q 2f0E 0
> °o
>,� c m
m =
3.>
o` a o
p U) m m cn
w m C
O N N N ui
O mL
N > '
v- .�+
m O c `•- O m
a C C "O U .V
O E m 3
G O O N
L L
3 ° •Nas... ° o
to
t/j
>,
a�
U
mom
Q
m o
c U p v°i a) a)
� C w. ." L 'O
Y
a)
�, U p.
C
w
a) m U) 0 7= .- C
.L..
a)
m 03 7 m
u a)'0
m mWEo 5 to
c
`EoaE
O N E t '6 > >, C
d
V L N cn
O
C m o° E to m= c'O N
EmN
`n
to m~
a)a)
ul -0OC
s c Q
0 0
O
Utn�Ecmi
cO m
c (n 0 M m
to m L, a) a a) to a�
" CDo°�EUmo��m
0)
.=
$ : .� w m
c0im
N
EmmnL
O C E 'a > O 0 ,O O) a) 3
� cm
O`
a)
o m L
N fit_
c me ° CL.c fIIi
`mr�LL"000m 3aCU
m
umiw E E c 3 c a>)
�° m°
c
°70 c Zs
o c 0
3 c._
a) c a)>.no 0 3
O r-
m to
m m rn
m U M -p •y L O U E a) N C
m C O 0` 0 """
(C C
E p
a) L N
>+ a O L Y
w(D 2 0 —w
p 3'E U O CY " o 0
oai
mQ.
o
C m >, m
�--cm
c o'C °
3a�immmyoof60��
°)c°�Ec'm
a)
�c
c
mm
n i c`a m H m 'cu � to cu �, to to
U `m
L
p C U m a)
.�+
a) (D
U O >
O
a) U
.L. > a) a) O 0 m p a) a) U a) a)
mLL () a)LL OLL
cL�-Hd 2� QF- f -�I-F-
C a)
aL
❑H
w`
7
to m C Q"
�.5 W !.E
U)
U
.m
cC -0
L >;
U
C a)
� — C,-
m-0
O
Ua)
m
sa
90 a) m 10
C
CU"20c
O X °
Co
a)
OLC
p Q.0 O� -
an d
Eo0—
> 0 m
a
rn
0)U E
m to �O O
a) ai�°
)
M m w
a) o
-
" - Co
-O-
L
N L 'y @
O 0 to
�o > w
m
(D �� `-0 - a)
� ma)oE
°goo
cc c
°j, U
-C.0
aa)):3 E
U a) M a)
09
p C
�0
U
�o
�03oL
'O 'O `` 0 O
m>a)°Oc�
o C p
>,•-E
E 0 a) U
Eco—
L
cL�E "•T
-,to�L
O O C
ooc
(D
m
� C C 0) r C L
� U
C m to
U U
� rn 0 .0 .c
m
0-- a)
.E
(D• a) m U
cn
N
it
Q m is
.= 2 0 O O
N t(n) '
M 0)L fn
c CD
O
o
w
U
3
O
V O
Q) L
a
L
O N
O O
C
O
Q
C
>
O
Q
O
>
ri
3
-
ED
m m
°
C
(n m
C
m
cn U
a)
0)
C
a) U
•Q
N N
O
° g
>
U)m
L
a�
m
w o.
ami
U
CL
y N
C U
m
m
�p U
°
C U
7 C
m
U U
O
C
U
L O
22
C
i3
U
Q� N
N L
>
-Q '°
a)
vi
a)
L
w
W
L
Z C
N a)
cu
to L c
C Qm O
0
O C
Ca
om ui
U
c)-c0)
w
a)
�m
co
O O U
� 7
Y C 7
7
C
�
0
'y
fn
>
C
m O m
o.�
C
U
w m
a)
O a)
rn
uZ)
m CU a))
C CL
°
m'�
t'>1
��
�
h
m aa) a
vmiL y y m
swJ� E
. co a).c
c/% a)
m a)
`L
mL
o.0
L
O
Q) � (D
a w L
a) a)
cU o i O-
m L
U m
Q
a)
Q
m
C�
a)
m 7 C a) w
Cn w N
Y Q)
E
N
L cco
IM
.
vEcnc ui
C >.
�0 y
mrn�m-0
C' O O
��
O
.0
EU)
U�iz
L O
m0c�o y
in U m Y
oU)oaa)
m C
'a
c
3c
a
C y >,�
m cot
L �,CD N L
o°
0) N
2
O
y"
m'o a
E� 3
��
O
m U
MG)
N
v e
CU o a� m�
m
o� o c `�
o o
o)E
`�
° Ecu
c°)
wa��� c
o.
>,cnc �
U w°
(D
m
0�
•§�
°o
c
vmi o- m
N E
NY
N L U L a)
E
W m
N
w
�
as
m
C m m Q 0-
2) N m Q. �
N_ D7
� cU 0°
O
cn cL cD
°� E > >L
°
m U"a
ac) CO
c
f >>m m.N
a
a) E O
o
co m m a
a)4) o
a 0 mr
c
�
0LL�>0
d:.Ua.
()LE
co
U
O
U
CD
a)
O
�
C
CDU)
in m
Cl'
ca c
O
ca 'a Cl.
E
o
U m y
c a)m
cc L + fl
CD
Y
Q
m
a)
c
7 y C
Q�
L m
O Q
o
a) cn
y
U y
o, O Oo
C
N
m
m 'Q a)
O U
p m
N.
mC'D
�p U
-°
C C
ma)
m L
c3o0
C
m
m L E
m C
E U T
) m
tam)
�_3
—YE
E�
L O
a C
m
m
w Q mEn
c
E m
> m
a) L
cp y
=3
(D U O
m Y
�E2
°c
��cn
a=
c
o.om
�a)�
ja
>, c rn
m
�
o`cn
>, o a�
°,'a)
m
CL
ca p
3 U
2 Y
0 °
0
o m a)
w
Q
CU L L
a) -0.� U O C
o Ql
(n C C O 0) .0 U)
m p m >, U E x
L
I—
CD
•- Co
L p n O C a)
a) E
O
0)ram EN o
m a)
U
-.00
O '0
C
— H a) " C 'p O
cu
O
O a) >,
cL°
m
O E co ui C
— O O a) T O
a) +' C
O
U
C m °)
a) m
N w
m CO - 0 N= y Y c
"OO
3 E
CL � � ° f°
E -° m
m
cn
C
.�
cn =3 (D O a)
m
a) c
N m
N C •C U
cE72
co ca)°
..
0 Em
cn
QaL a0 O O
N
Q0)
m
E 0° a)
L
O
m C >, 7
c0= 4) c >m0N n
CLY
U)
O
m
o
vi0))>,W -0 Co �E
LmCL
�'
0 Ems'
a)
.CU()0.
a)
U
OCD
°L. N. O
L
vice ScnE v c >,T
0 cn CD
°E
o
0
cu co
o a)
O
a) a) c a) c m CDcm
U °
`)
L 00
Q)
3
O
C
m
CL rn ui C° C m� Y w O
y
m T
C c
y
p
> " ° �0 a) � � v �
Cccp ° � m " a°i
Q
p aa)
to ° °
c
�c
m @Lo.L— aco
E)co�Ucu
a
Eo)m
0 Co
n co O . U) O
N
a) U cn cn m U) y .=C a) U CL V M
°
O
r
E
O °
m o y
L
c m m aci �s ° cn~�-0 `' o-
C
z
c0i ai
� U) >
'�
m
0. 7 U Y O U N m c N CL
E N m a) n� >+rn c O
p
'0
a) O C
E a)
rn C 3 a)
c c� 0 rn
O
°
C
�°
>
p C 0= O O Cc •C a m O 0 a)
CD
U U
y- (np
L c
.0 U w O
a
N
9
L C C "—'' O E a") +-' m
a) '—'' O .-. m 0 0-0 •— c 7 'N
j
- 0) a)
A
N
� •.U_+ to C C
j
m
C N � N -OO U O) U >. ° �.
m L x FE C -O a) C 3 'C a)
p
U
E .� =
O
a) to
CD N
U
a)
m m 3�' c U cam0—
w° U°
C m V
C
0 3 3
N
a a) a)
U o 3
co
O@ Z' 4c-- O
fA •C U a) C L_ > .� 0) ` 7 VE a) m
>+ >
C 'y w
c c`o
O` 0 U a)
cn
p
a)2LEo3co�o L).c
3
cm m
ccn n�0
3
m
vcoicN
U L U m-0 O O C >, c m
C a) .O .� y O O C O a) U .� —
C
O
a) n ...
E a) a)
c
m a) Co E n
3
,O
N
O E a) o) (n -° a) OU U O -O_ � V —
V E >
>, U—
=
p
a) >
CM C p
O O E
co
p
a)
c
7 a) a) O L >, 4)
0 0 '— L N _0 .0 O` L
°=Hw
p
U
O O 'T
L a) a)
O
w E m L °-
C'1
a)
J n ,�, �H nd= n�
I—a.m
0 w cF-v
o
(L d
Z) o
C'J z
.
L_
3
a)
U _
� °Lm.
rn
�'
O N c
�`.
O°
n
UCU
p
L
U
U�
O
�p
m
x
m
c
c
:3 E
io w c
t
a)
c
cn o.
�o
0.o a)
Em m
aci
m a)
�m
°)
a)'�
c
a) rn
O
w a)
°'
U U
c m
n
n
x
Q 7 U
=
U C "c
N
C
—
o m
w
`
°
a) c
E� �d
Ap o
U N� °
m
`
-
0
T
7
0 to
N N
u> E E
c
C
O
>'
7
N V Oi U
L
mc..
�
Lm-NE
U
�.�U ()
m
?
cnn
=
c`
a) m
m C
0
o
O O
o�
E
��
L O L
.0°3
O L
>'3CD m
o
C U
yC
i
n m
o
a)
i
7 >+ a)
O N E E
a) �=
0
3 0
O
L V
m C
T m C
° 3
O= m
O
O C
L
.0
o m
= U -L.
�- O
_
w U
m
> a)
?
y O
O E 0
y Cl-
0 0 m
N
en a) C
co C
O7 U
W
� L U
3
F /
f
. / n
a
7 n
E a)
.
t E
E R
e
2 (D
=
o ;
o
a
J D
2
k
$ 7
a
$
R
ƒ
\
°
�
t
co
k \
2 0
• m
k CL
T
0 $
=
/
o=
N-0
a
I� k
_ e «
° 0)
c :3
mac)
(D \
'a'%
/2/2
2 0
%2 §
' )' 20.
2
U o g
/ \ c LM
m (
CD' \
/ 2 \ 4)
o m
» $
o
E
-0c
0 M 0
3
7% ƒ
_> 2 £ @ n
2;
a) (n
o;
2 t
/ E 2
f
X
m e e
o
2«om�
c
°' m
>_-_-
° w u) E
®
_»
_ _
a M 0:
�kk��/
0 c
� a
/
k0 e
f° m
C
CCD
°
°* o §
/
-0 ° E
°E e
§%%2£�®§
c
o
E o
ƒ
/ k M2
/ 0 -
@ §
0
E 0
k m
C
0o>o=5c2
= u U) 2
��2§
2 0
O'a16
0=
%�
±£/0
� 2 c o m
omg£==2Q0.=-o
2 0 0
6 0 O C-0
> « o
� = m m £ _
o-moo3-0
± k t%
k ® E
�comCL
o
2<I/w
3
o
/
k
/
0
E
5
2
2
�
§
k
/
2
a-
2
§
k
/
/
c
/
5
2\
ƒ%
2
/�
q�
k�
ƒ /
§
Attachment IV -A
Monroe County Community Health Initiative
Town Hall Meeting
Key Largo, Marathon and Key West
May 23, 2002
5: 30 p.m. — 7:30 p.m.
UPPER KEYS
Time:
5:30 — 7:30 p.m. — Site Confirmed
Location:
Key Largo Library
Tradewinds Shopping Center
Mile Marker 101
Moderator:
Debra Premaza, R.N., Member,
Monroe County Community Health Initiative
HCSF Staff:
Lourdes Gonzalez
Technician:
Jose Estevez
MIDDLE KEYS
Time:
5:30 — 7:30 p.m. — Site Confirmed
Location:
Marathon Government Center
2798 Overseas Highway
Mile Marker 50
BOCC Room
Moderator:
Keith Douglass, Co -Chair
Monroe County Community Health Initiative
HCSF Staff:
Sonya Albury
Technician:
Jimmy Perry
LOWER KEYS
Time:
5:30 — 7:30 p.m. — Site Confirmed
Location:
Harvey Government Center
1200 Truman Avenue
Key West
BOCC Room
Moderator:
Jake Rutherford, M.D., Chair
Monroe County Community Health Initiative
HCSF Staff:
Vianca Stubbs
Technician:
Vicky Yaklevic h
Town Hall Meeting
Monroe County Community Health Initiative
Thursday, May 23, 2002
5:30 p.m. — 7:30 p.m.
at the
Key Largo Library
Marathon Government Center
Harvey Government Center
I.
Welcome and Introductions
5:30-5:45
Dr. Jake Rutherford
II.
Proiect Overview
5:45-6:00
HCSF Staff —
a) Background
Lourdes -Key Largo
b) Funding
Sonya -Marathon
c) Purpose of the Initiative
Vianca-Key West
What has been Accomplished thus far?
a) Community Forums/Personal Interviews
b) Physician Focus Groups
c)
III.
Facilitated Discussions
6:00-6:40
Facilitators
Debbie Premaza
Keith Douglass
Dr. Jake Rutherford
IV.
Summary of Comments
Key Largo
6:40-6:50
Debbie Premaza
Marathon
6:50-7:00
Keith Douglass
Key West
7:00-7:10
Dr. Jake Rutherford
V.
7:10-7:20
Dr. Jake Rutherford
Next Steps
VI.
7:20-7:30
Mayor Pro Tern Dixie
Closing Remarks
Spehar
Question # 1
Where do you go for health care?
Question # 2
How often do you go for health care?
Question # 3
Are there services you need that are not available to you?
Question # 4
Are the places for health care accessible to you?
Question # 5
Do you have or can you buy affordable health insurance?
Question # 6
Does your health insurance cover you fully?
Question # 7
Have you ever used the Emergency Room to obtain health services?
Question # 8
Do you use public transportation? How accessible is it?
Additional Comments:
"aah Omwil Nay
The Health Council of South Florida is the state designated local health planning agency for Miami -
Dade and Monroe Counties. 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 supporting health education programs.
In keeping with its mission to improve health care in Miami -Dade and Monroe Counties, the Health
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.
For over 33 years, the Health 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.
Through its wide array of services, the Health Council of South Florida is dedicated to setting the
standard for excellence in community health planning. The Council offers quality planning expertise
at an affordable cost to ensure that there is an objective source of health care information and an
opportunity for community dialogue on contemporary health issues. To capitalize on the expertise of
this dynamic organization, the Council engages the talents of individuals from diverse fields such as
health services administration, public health, social work, management information systems,
accounting, research, education and planning, and applies these talents utilizing a team approach.
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 Lower, Middle and Upper Keys. The project will include an inventory of the health
resources in Monroe County, a quantitative summary of the primary care providers in the region as
well as a Community Health Perspectives Report that encompasses results from focus group
discussions with local residents and health care providers.
The Health Council of South Florida, Inc. 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 those areas.
The Health 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 Lower, Middle and Upper Keys.
The Monroe County Board of County Commissioners met on March 20, 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 will serve as an advisory group for the Monroe County
Initiative. The role of the Task Force is to provide guidance within a local community driven
approach to coordinate and enhance the primary health care delivery system in Monroe County. A
Chair and Co -Chair have also been selected by the potential members and were unanimously approved
as follows: Chair, R.C. Jake Rutherford, M.D., Director, Monroe County Health Department; and Co -
Chair, Keith Douglass, Rural Health Network of Monroe County, KidCare Director.
117
1. Please turn off or silence you cell phones and/or beepers.
2. Please limit your comments to 3 minutes.
3. Please be courteous to others.
4. Please allow time for others to express their opinions.
5. Only one person shall speak at a time.
6. All concerns are valid.
"Health Insurance Crisis"
Town Hall Meeting
Please join your neighbors and friends to sound off
on health care in the Florida Keys:
Are doctors, dentists and other health care
providers available to you?
Can you get the health care you need when you
need it?
Can you afford to purchase Health Insurance?
If you answered NO to any of these questions, then you need to attend
the upcoming )Monroe County Community Health Initiative countywide
Town Hall Meeting!
The Health Council of South Florida with the 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 the
populations in the Lower, Middle and Upper Keys.
In order to do this we need you, the residents of Monroe County.
There will be Town Hall Meetings held on Thursday, May 23, 2002, one at
the Key Largo Library, one in the Marathon Government Center, and one in
the Key West Government Center. The Town Hall Meeting will be held
from 5:30 p.m. — 7:30 p.m. We invite all interested parties to attend.
We need your input!
If you wish to attend or have any questions please contact Lourdes
Gonzalez, Project Director at (305) 592-1452, Extension 107.
:o
Town Mall Meetings
S-Z�" ��., 74-P-6,-Ne $��.,
Please join your neighbors and friends to sound off on health care
in the Florida Keys
4- Are doctors, dentists, and other health care providers available to you?
4- Can you get the health care you need when you need it?
14- Are the places for healthcare accessible to you?
4- Do you have or can you buy health insurance?
Does your health insurance cover you fully?
If you can't come please watch your friends at the simultaneous meetings
in all three locations on Channel 16 —
a brand new use of our county's TV network!
Please see below for locations:
KEY LARGO
Key Largo Library
Tradewind Shopping Center
MARATHON
Marathon Government Center
2798 Overseas Highway
KEY WEST
Harvev Government Center
The Monroe County Community Health Initiative Task Force composed of representatives from the:
Monroe County Board of County Commissioners, Monroe County Health Department, Monroe County
Social Services, Monroe County School Board, AIDS Help, Inc., Rural Health Network of Monroe County,
Mariner's Hospital, Fishermen's Hospital, Lower Keys Medical Center, Monroe County Prison Health
Services, Bayshore Manor, Department of Children & Families, Guidance Clinic of the Middle Keys,
Hospice of the Florida Keys, EMS, City of Key West, Lifeline Home Health Care &
The Health Council of South Florida, Inc.
For additional information, please contact.
The Health Council of South Florida, Inc.
at (305) 592-1452, Extension 107
nonuis
o.
Attachment IV-B
Monroe County Community Health Initiative
Key West Town Hall Meeting
May 23, 2002
DISCUSSION NOTES
Question # 1
Where do you go for health care?
o Co -payments are too high at doctors' offices and insurance deductibles are very expensive.
Question # 2
How often do you go for health care?
No response.
Question # 3
Are there services you need that are not available to you?
o A cap on transplants is needed. Does the County have an agreement with Jackson for needs beside trauma?
Question # 4
Are the places for health care accessible to you?
No response.
Question # 5
Do you have or can you buy affordable health insurance?
o The average employee cannot afford health insurance.
o Several people (122) have applied to fund a group policy for themselves.
o Many people in the Keys cannot apply to group policies.
o Insurance companies are supposed to spread the risk, but they are not spreading the risk correctly.
o One person is uninsured for the first time in 40 years.
o How many businesses have insurance? When a business has only 40 members, it is difficult to obtain
insurance.
o The market is limited and the overhead costs are high. I can not afford paying $285 for a doctor's office visit.
o Insurance companies have stated that there are `not as many healthy lives' as a reason for not coming to the
Keys.
o I have tried to enroll in Miami -Dade County, but once they find out that I live in Monroe- forget it.
o I'm considering putting my money in preventive medicine rather than have insurance.
Question # 6
Does your health insurance cover you fully?
o I feel that Blue Cross Blue Shield is taking advantage of people because they know that they are the only
insurance company in the Keys.
o What do we have to do to get an insurer down here?
Question # 7
Have you ever used the Emergency Room to obtain health services?
No Response.
Question # 8
Do you use public transportation? How accessible is it?
No Response.
Other Comments
o State commissioners defend insurance companies. Where are our legislators? Our federal government needs to
step in and address this issue.
Provider Comments
o Insurance rates in the Keys are negotiated far below the cost of service.
o Medicare is the best payer; require less paperwork.
o Medicaid rates vary considerable within and outside of the state.
o Principal is pulling out of the area due to their profit margin.
o Lower Keys Medical Center's revenue would decrease 40% if Blue Cross Blue Shield were to leave.
o The average cost per employee for a small dentist pharmacy is $320 monthly.
o The average cost per employee for a leasing company is $285 monthly.
o Lower Keys Medical Center pays $120,000 in medical malpractice insurance for 4 physicians.
Potential Solutions
o Pass a one cent penny sales tax.
o Examine whether the county should tax high risk events (e.g., boat racing).
o Impose a toll for drivers.
o Consider adding more surgical care centers.
o Advocate for insurance reform.
Monroe County Community Health Initiative
Marathon Town Hall Meeting
May 23, 2002
DISCUSSION NOTES
Question # 1
Where do you go for health care?
o I will end up going to the emergency room if I need to get care.
Question # 2
How often do you go for health care?
o Most go once a year for an annual exam; three can't afford this basic level of care.
o Those with chronic conditions have greater health care needs.
o Complex conditions require much more integration of care and treatment varies by physician.
o Participants usually go no more than 3 times in 1 year to a particular physician (e.g. PCP).
Question # 3
Are there services you need that are not available to you?
o There is no OB/GYN and there are no birthing centers north of Key West.
o Malpractice issues are a concern.
o There are no pediatricians in the Middle Keys.
o There is a need for dental care.
Question # 4
Are the places for health care accessible to you?
No response.
Question # 5
Do you have or can you buy affordable health insurance?
o There is no place to go for coverage if an insurance company refuses to cover you.
o I am on my 4-5`h insurance company. One of my staff members has a pre-existing condition (Arthritis).
o Our insurance cost is up 15% caused by one person alone; next year we expect another 15% increase.
o We are looking for alternatives.
o Foundation Health is leaving Chamber plan.
o The School Board is self -insured.
o There have been big hits on hip replacement surgery.
o We had to raise the deductibles and premiums.
o We are not alone — every other school district is confronting this.
o The situation is hurting children and keeping them from learning.
o There are so many escalating costs — e.g. $5,000/per person deductible.
o The insurance crisis has a major impact on your family and your business' ability to offer benefits to
employees.
o "We're down here bleeding." A $640 premium increased to $1,041 and later increased to $1,747 per
month. "I just can not do $1,700 a month."
o Five years ago a 90/10 policy cost $209 per month with a $1,000 deductible for two people. Now it costs
$996.79 for a 70/30 policy with a $2,000 deductible. I would trade the deductible and co -payment. What
hurts are the ongoing prescription costs.
o I was about to cancel insurance but have now applied for Healthy Kids.
o I have resorted to making minimal payments on my credit cards so I can afford health insurance.
o My cost was $275 per month. I am now on my third insurance plan in a few years. We now pay $859 per
month and my husband's policy is $1,000+. Blue Cross Blue Shield only offers two plans and HIPPA
offers an individual policy at $850/month with a $2,500 deductible.
o A local air conditioning business pays $48,000 a year in premiums.
o Health Alliances: We've tried to band together, but they won't give us an insurance quote for 75 people.
o Addressing gaps in services will not solve the problem — we need insurance.
o We are not so much sicker and yet the cost of doing business is high.
Question # 6
Does your health insurance cover you fully?
o There are so few choices and many doctors do not accept the coverage we have. There is limited
prescription coverage.
o Pre-existing conditions are a major problem.
o Reimbursement issues between patients and the insurance company are another problem.
Question # 7
Have you ever used the Emergency Room to obtain health services?
o When I used the emergency room and ambulance there was a big bill!
o The emergency room was not really needed but I wanted them to pay for the treatment.
Question # 8
Do you use public transportation? How accessible is it?
o There is a lack of public transportation.
o A new bus will soon be in operation and will help a little.
o We usually have to make an appointment for transportation. It was noted that the MediVan will help you
get there with a car.
o It can be difficult to navigate the answering system and talk to a live person.
Other Comments
Small Business
o The "golden rule" is that insurance companies are extremely expensive and are therefore not an alternative.
o One drawback of employee leasing is that they can change your carrier.
o Employee leasing offers workers compensation too.
o The Florida Keys Children's Shelter had to go to a leasing company.
o When Rheumatoid Arthritis came up, the company stated, "We might have to exclude that person".
o Leasing companies will take on companies of 5 or more only.
o Monroe residents are often fishermen and independent contractors.
o Many policies have poor coverage and open enrollment periods.
Solutions
o Provide universal health care as a long-term solution.
o We can consider a one cent sales tax to cover 10% of population or approximately 8,200 people.
o Pursue a legislative fix to use part of bed tax.
o Use a fee or event tax for power boat races and other types of events.
o Impose a toll.
o Consider adding more surgical centers that offer reduced rates.
o Advocate for insurance reforms to compel companies that serve profitable areas to also cover underserved
counties.
o Examine inpatient revenues of for profits versus non profits (hospitals).
Miscellaneous
o Promote the use of generic drugs.
o Address the needs of the homeless population.
o Should Monroe County partner with Miami -Dade County?
o The Hawaii Plan offers near universal coverage.
o Review the 4.1 Million bed tax.
o All hospitals are running 7 digits for indigent care.
o Many fear a catastrophic illness.
o I contacted the Insurance Commissioner. We cannot compel carriers to do business anywhere under
current law.
Monroe County Community Health Initiative
Key Largo Town Hall Meeting
May 23, 2002
DISCUSSION NOTES
Question # 1
Where do you go for health care?
o Monroe County residents must travel to Miami for specialty care.
Question # 2
How often do you go for health care?
Question # 3
Are there services you need that are not available to you?
o Counseling and training are needed for in -home services and care.
o Twenty-four hour in -home services are needed.
o Nursing home facilities need improvement.
o There is a need for more acute care facilities.
Question # 4
Are the places for health care accessible to you?
No response.
Question # 5
Do you have or can you buy affordable health insurance?
o Monroe County residents are rated up at 25% when inquiring about health insurance.
o No HMOs want to stay in Monroe County.
o Premiums for special conditions can cost $2,000 per month.
o When inquiring about health insurance coverage you must apply and pay for your choice and it can take two
months to get approved.
o Insurance companies are making at least a 25% profit on health care and a 45% profit on mental health care.
Question # 6
Does your health insurance cover you fully?
o Pharmaceutical drugs are too expensive and should be regulated by the government.
Question # 7
Have you ever used the Emergency Room to obtain health services?
No response.
Question # 8
Do you use public transportation? How accessible is it?
o There is a need for specialty transportation.
Other Comments
o Education is needed regarding legal/medical documents such as: power of attorney, advance directives, health
care surrogates, etc.
o There should be a statewide health insurance plan for Monroe County adults, similar to the Florida KidCare
Program.
08/13/02 18:03 FAZ 005-262r9905 HEALTH COUNCIL
Z 02
- - F. .. . v-• 1— � . �._ w .S ►--Y,0 11 . WL&"j"q lit.aWWOr-M -
1�
s
August 13, 2002
David P. Owens
Grants Administrator, Monroe County
1100 Simonton Street, Room#2-210
-------
Dear Mr. Owens,
Per requirements of the contract agreement between Monroe County and
the Health Council of South Florida, Inc., attached is the Community
PMRggfives ReportReport, as approved by the Monroe Comity CananuniJy
Health Initiative Task ,Force and invoice #2 in the amount of $15,000.00_
If you have any comments or questions, please feel free to contact me at
(305) 592-1452 cxt 112.
Sincerely, 1) 1xi Jdajf
Miguel Mudafort
Financial Administrator
arm- - Is to'WWrM
Ba�Itl! C#n Jn 16ani-Ql�ir
a� Haw" COW1010L
8M L%V 12 SOW
Suft 300
Y*'k FL 22126
Tel 305.592.1452
fir 3X592 nSAS
wwwJrealhMWxrlmy
0-mall hCGfQhGaWWmdloM
o++llm
Phil GIUCK M.D.
o.k
Elena dd Vak J.D.. M.BA
ve. ow
LIZ Kern, kk
We B. %ftw, JJ3, L.Lx
Board Members
Owes Gray
Lack d Lannon
Debwa MasK Ph.D.
Or�bie Prmaoa. R.N.. R 9 N
Jinn RhW@
Steven D. Sonernich
Rev. John Whb
Bwc+AM Diecmr
sor"P.A"
MEwWQvr"Fi#Wff
VO/ LJ/ V- - V. a-nm )VJrLQ.; aUUUO nZAL111 (;UWNCIL t9jU3
REQUEST FOR PAYMENT INVOICE
Rem@ a8 Payments to:
HEALTH COUNCIL OF SOUTH FLORIDA, INC.
w" NW 12 30-961. Suite 300
YIAML FLORLDA33126
Anm Mr. Dard P. Owens
Monroe Carty Grants Adrnmtralor
1100 Skwft + Street, Room 2-210
Key West. Florida 33040
Delhisrables
Cm=Lnty Perspectives Report for Monroe County 515.0W.M
Amount n4Mled i15,000-M
PROVIDER AGGEENC,Y-OFFIC
PREPARED BY
' �
NAB: Miguel S. NW&fart
TfrLE Finance Aiaminlatetor
DATE: 011=12
Mm MYOCK I[381F:
a>EO000UMMWA
DATE GOODS NW-cZ D ANO AFFMAYM
�- , , I is trams
badrb r in Affami-Dares
ad Illf lroa Camelm
=5 NW 12 Sheet
Sldle 300
lfiati. R. 33126
Tel 305-W-1452
Fact 305.582 m
wawrheeNtOotulcl.efp
amen htsex"Wolwllrtq M
Deborah Mask PhD.
tar
Rev. jam We
wnow
Pad Gkic G M.D.
_-- 7 .71 , -
BOM Memtlm e
Goias Gniv
Lk Kem, ii.K
Mchlef Laraton
M&W Pkwm
ad" Pteewsta. R.N., B.S.N.
Am Rltada
WE 9. Raftywk I.D.. L.L.M.
Steen SorWwaich
Soup IL Attl q
ale j;" y Gifftw