The topic is devastation. As in, if you pass this piece of legislation, you could decimate the state's mental health crisis centers.
So say the experts standing before this Florida Senate committee. So says one senator who wonders what the motivation is for the bill. So says the senator, and former county sheriff, who worries about the impact on law enforcement. So says the senator who fears other unintended consequences.
Even the lawmakers in favor of the bill acknowledge it is far from perfect and it may not fix the problems it is supposed to solve.
So, after a healthy amount of consternation and concern, they postpone further discussion of SPB 7122 to a later date.
Twenty-eight minutes later, once the experts and some senators have left the room, the legislation is reintroduced for an immediate vote.
It passes the committee 6-4.
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Which is worse?
Is it the possibility that the state's Crisis Stabilization Units — centers dedicated to the immediate care of those being held under the Baker Act as a possible threat to themselves or others — might be forced to dramatically cut back on services in the coming months?
Or the idea that a committee of senators would conspire surreptitiously to send an obviously flawed — and quite possibly dangerous — piece of legislation down the line?
It's a toss-up. One is frightening, the other infuriating.
The gist of SPB 7122 is the state should no longer pay nonprofit crisis units a flat fee based on the number of beds they provide. This is called capacity funding.
Instead, this legislation suggests paying 25 percent based on capacity funding and the rest as beds are filled. The four Democrats on the committee voted for the bill, the Republicans voted 4-2 against it.
To be sure, there is a certain appeal to this proposal. Pay-as-you-go seems like a more prudent way to do business. It would also benefit hospitals — including the for-profits who are in favor of the bill — who sometimes take overflow cases without compensation.
But the reality is more complicated than the theory.
Think of crisis units the same way you think of a fire department. Even if there was no fire today, you still need resources available in an emergency. The same is true for crisis units.
If this legislation passes, however, the centers will no longer have the same guarantee of capacity funding. And that means they will likely cut services to ensure solvency.
Gracepoint, one of the largest crisis units in the state with 60 beds in Hillsborough County, would probably cut its capacity in half, said CEO Joseph Rutherford. Gracepoint might also eliminate its intake center, which works as a type of psychiatric ER.
"The way the bill is worded now, and this is not an overstatement, it would completely destabilize our system of care in this state,'' Rutherford said. "It will create a huge backlash on the jail system as well as hospital emergency rooms.''
If there are fewer crisis units, that means a larger burden on hospitals, which could create many issues. Hospitals don't have the same specialized mental health resources as crisis units. They have fewer crisis beds. And hospitals will almost certainly want more money than current rates.
When a unit closed in the Panhandle, a for-profit HCA hospital took over as the area's crisis center. Within a year, HCA requested legislators increase annual funding from $1.4 million to $2.4 million, according to testimony. That was one center in one less-populated area. Imagine the state's rising costs if more hospitals get involved in Tampa Bay, Miami and Orlando.
The sad part is these are just the operational issues.
In other words, what about the actual patients?
"We respond every single day for people in crisis in mental health situations,'' said Pinellas Sheriff Bob Gualtieri. "If the Crisis Stabilization Units shut down, what do we do? We can't use the jail. Are we supposed to keep them in the backseat of the cruiser until a hospital bed comes available?''
Most players agree that the current system is flawed. And the Department of Children and Families, which oversees crisis units, failed to act on requested reforms a couple of years ago.
The answer, however, is not to proceed recklessly with a financing plan that puts the entire mental health crisis system at risk.
It is neither funny, nor ironic, to say that is insane.