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Home My WebLink AboutMINUTES - 09131988 - 1.92 TO BOARD OF SUPERVISORS FROM: Mark Fi nucane, Contra Health Services Director Va3ta DATE: August 22, 1988 couqy SUBJECT: Compensation for Loss or Damage to Hospital and Clinic Patient/Visitor Property SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: Approve policy No. 155a dated July, 1988 setting the circumstances/procedures and thresholds of authority for compensating Hospital and Clinic patient's/visitor's property loss or damage. FINANCIAL IMPACT: None. Losses would be reimbursed regardless of this policy. REASONS FOR RECOMMENDATION AND BACKGROUND: No policy presently exists for property damage/loss by patients or visitors. This policy sets procedures in place as well as authority for various levels of compensation as a means to control losses/damages suffered and reduce the level of board involvement when immaterial amounts are involved. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON UP I q INS APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES. AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. cc: County Administrator ATTESTED SEP 13 1988_ _ County Auditor PHIL BATCHELOR, CLERK OF THE BOARD OF Health Services Director Health Services Controller SUPERVISORS AND COUNTY ADMINISTRATOR BY v/el�� M382/7-83 DEPUTY • -Merrithew Memorial Ho,' :a al and Clinics Policy No. 155a July, 1988 G� ,. Il COMPENSATION FOR LOSS OR DAMAGE TO HOSP AL AND CLINIC PATIENT/VISITOR PROPERTY I. PURPOSE To outline the procedure to be followed when patient/visitor property is lost or damaged. Note:. This policy does not apply to lost or..damaged personal property of employees. ounty Administrative Bulletin 313.1 outlines procedure to be followed when an employee requests compensation for lost or damaged property. Form AK-130 is used for employee requests. II. REFERENCES ° County Administrative Bulletin 313.1. ° Merrithew Memorial Hospital and Clinic Policies, "Securing Patient Valuables" and "Missing Personal Property of Patients." III. POLICY The loss of or damage to personal property of hospital and clinic patients/visitors is subject to reimbursement under certain conditions. To qualify for reimbursement, the loss or damage must result from a sud- den, unexpected event which is not related to normal wear and tear. Reimbursement will be considered under the following conditions: 1. The loss or damage of personal property must have occurred on or in hospital or clinic premises; 2. Negligence or lack of proper care by the patient/visitor was not a contributory cause-for the damage or loss. The exercise of good judgment under the prevailing circumstances at the time of loss or damage is an important consideration in the evaluation of this condition. Any loss or damage to personal property of an inpatient which is not depo- sited in the hospital safe is not reimbursable. When patients sign the "Condition of Admission" form (ADMTOI), they: ". . ..understand that this hospital maintains a safe for the safekeeping of money and valuables and that the hospital shall _ not be liable for the loss or damage to any money, jewelry, documents, furs, or other articles of unusual value or any other personal property unless deposited in the safe." The loss or damage to personal property of hospital and clinic patients/visitors may be reimbursed via hospital and clinic petty cash fund if reimbursement request is under $25. Requests valued between $25 and $200 will be processed by the HSD Accounting Department. Requests valued over. $200 and under $2,000 must be submitted to the County Administrator's Risk Management Division. Requests valued over $2,000 must be submitted to the Board of Supervisors. POLICY155 (9) . `Merrithew Memorial Hc, ital and Clinics Policy No. 155a COMPENSATION FOR LOSS A DAMAGE TO HOSPITAL July, 1988 AND CLINIC PATIENT/VISITOR PROPERTY -2- _ IV. AUTHORITY/RESPONSIBILITY It is the responsibility of: ° any employee who receives a report of lost or damaged patient/visitor property to complete an "Unusual Occurrence Report" (Form A-257) and to ini-tiate procedures outlined in this policy if compensation is requested. ° The responsible administrator to review all cases where compensation is r-e.quested :and make a_-recommendation to Executive Director:-- The Executive irector:-The-Executive Director to authorize or deny reimbursement to patient/ visitors for lost or damaged property when the reimbursement request is $200, or less. The Finance Department to process requests for payment which are authorized by the Executive Director. V. PROCEDURE A. Completion of Unusual Occurrence Report Anytime patient/visitor personal property is lost or damaged, an Unusual -Occurrence Report (Form A-257) should be completed. - See - Merrithew Memorial Hospital and Clinic Policy "Unusual Occurrence _ Notification Policy" for instructions on completing form. B. Request For Reimbur-sement Valued at $2,000 or Greater Any request forreimbursement for lost or damaged property valued at $2,000 or greater must be submitted to the Board of Supervisors through the Clerk of the Board. _.C.-- Requests for Reimbursement Greater Than $200 But Under $2,000 Any request for reimbursement for lost or damaged property valued at greater than $200, but under $2,000, must be submitted to the County Administrator's Risk Management Division, 651 Pine Street, Martinez. D. Requests For Reimbursement Valued at $200 or Less 1. Amount of Reimbursement The amount of compensation allowed for damaged property will be the actual cost to repair the damage. Reimbursement for items dams ed beyond repair will be limited to the actual value oT the item at the time of loss or damage, but no more than the ori ina cost. A lateprec1at�on rate of 10iwill be used on all art cies over one year old except contact lenses and eyeglasses. Some specific reimbursement examples are as follows: POLICY155a (9) Aerrithew Memorial Hc' ital and Clinics Policy No. 155a COMPENSATION- FOR LOSS jR DAMAGE TO HOSPITAL July, 1988 N AND CLINIC PATIENT/VISITOR PROPERTY -3- ° Eyeglasses - Only the repairs to frames and replacement of bro- ken eyeglasses is allowable. The cost of re-examination and the new prescription of glasses is not allowable. Reimbursement will be for the total cost of loss or damage, but no more than the original cost. ° Contact Lenses - When claims are being submitted for contact len- ses, the visitor/patient must: (a) provide a statement by their medical doctor or optician of the total cost of the lens repla- cement; and (b) provide a statement that new lenses were the same as. lenses lost or damaged- (ie. if lenses were hard lenses, cost to replace will be for hard lenses). Lens reimbursement will not cover eye examination or precription change. ° Clothing - Damaged clothing should be repaired when possible. For clothing damaged beyond repair, the actual value at the time of loss will be estimated and agreed upon by the patient/visitor and responsible administrator. 2. Reimbursement Procedure Any request for reimbursement for lost or damaged property valued at $200 or less may be processed within the Health Services Department. The "Patient/Visitor Request For Personal property Reimbursement" (Form A-408) should be used for this purpose and completed as follows: a. Patient/visitor should complete top portion of form, speci- fying the manner in which the loss or damage occurred. In the case of personal property loss which meets all of the criteria outlined in this policy, proof of loss must also be submitted. The burden of proof of loss shall rest with the patient/visitor. The damage property should accompany the request, 1T practical, for responsible administrator examina- tion. b. A witness, if available, should confirm the statement by patient/visitor. c. Patient/visitor should complete and sign a Demand Form (D-15), with the amount of reimbursement request specified. d. The responsible Hospital or Clinic Administrator shall either recommend or not recommend approval of the request based on criteria established in this policy. e. The Executive Director authorizes (with amount specified) or denies authorization of request. If reimbursement request 'is under $25.00, payment may be made with petty cash account. If request is between $25.00 and $200.00, Executive Director will POLICY155b (9) .._',ierrithew Memorial Ho- ?tal and Clinics Policy No. 155a COMPENSATION FOR LOSS k DAMAGE TO HOSPITAL July, 1988 ► " AND CLINIC PATIENT/VISITOR PROPERTY -4- forward completed request form to HSD Accounting Department for payment. f. If a payment request is between $25 and $200, the HSD Accounting Department will clearly mark the demand, "HOLD FOR PICKUP by (name and telephone number)." The demand will be sent to the Auditor's Office, Tor processing. g. The Auditor's Office will hold the check for pick-up by HSD Accounting staff, who will forward check to hospital admi- nistration for distribution to patient/visitor. 3. Property Damage Release When Hospital Administration receives the check, patient/visitor should be contacted to pick up payment. When check is released, patient/visitor should be asked to sign a "Property Damage Release" Form (Form A-407). A witness should also sign this form and copies should be distributed as indicated. This Hospital Administration copy will be maintained in Administration. VI. FORMS USED °Patient/Visitor Request For Personal Property Reimbursement (Form A-408). *Property Damage Release (Form A-407). VII. RESPONSIBLE STAFF PERSON Executive Director, Hospital and Clinics Frank ug isi , Jr., Executive Director Merrithew Memorial Hospital & Clinics Review Date: July, 1989 POLICY155c (9) r CONTRA COSTA COUNTY HEALTH SERVICES MERRITHEW MEMORIAL HOSPITAL & CLINICS PROPERTY DAMAGE RELEASE a i In consideration of the payment to me in the sum of I, do hereby release Contra Costa County (print name) and Merrithew Memorial Hospital and Clinics from any claims resulting from the loss or damage to my property occuring on ate It is further acknowledged that in the event I disagree with any dispute, disagreement or denial of reimbursement of loss or damaged property, I may for- mally present a claim for damages to the Clerk of the Board ofSupervisors. Signature Date Witness Signature Date 0 i, Distribution: Original-Hosp. Admin. Yellow-Patient/Visitor A-407 (1/88) CONTRA COSTA CONTY HEALTH SERVICE' MERRITHEW MEMORIAL HOSPITAL h CLIN. �• PATIENT/VISITOR REQUEST FOR PERSONAL PROPERTY REIMBURSEMENT ------------ This Section To Be Completed By Patient/Visitor Name: Patient u Visitor( Address: City Zip. Telephone: (Home) (Work) Describe the manner in which the loss or damage occurred: Y Amount of Loss Claim $ Where purchased: Amount to repair damaged property $ Date purchased: (attach invoice & actual repair) Original purchase price of article(s) $ (attach sales slip on same) r; Signature Date ---------- ------------- This Section To Be Completed By Witness Confirming statement by witness to incident: - j Witness Name (print) Witness Signature Date This Section To Be Completed By Responsible Administrator I recommend approval of this request because it meets the criteria for reimbursement as outlined in MMH & C Policy "Compensation For Loss Or Damage To Hospital and Clinic Patient/Visitor Property, " as follows: I do not recommend approval of this request because it does not meet the criteria for reimbursement for the following reasons: y a - --------------- This Section To Be Completed By Hospital and Clinic Executive Director I do not authorize payment. I authorize payment to patient/visitor in the amount of $ Signature Date Distribution: Original- Hosp. Administrator A-40B (1/88) Yellow - Patient/Visitor • �M • L V 0 ENDOR N A DEMAND F4 4761 on the Treasury of the COUNTY OF CONTRA COSTA Mode By STATE OF CALIFORNIA DATE NAME (LAST) ISIRST) IMPORTANT See Instructions on Reverse Side ADDRESS CITY. STATE 21►CODE 1 I For the sum of Dollars $ As itemized below: DATE DESCRIPTION k AMOUNT p N° The undersigned under.the penalty of perjury states: That the above claim and the items as'^'therein set out are true and correct; that no part thereof has been heretofore paid. and that the amount therein is justly due. and thatp the same is presented within one year after the last item thereof has accrued. Signed � • i VENDOR NO. Received, Accepted, and Expenditure Authorized DEPARTMENT HEAD OR CHIEF DEPUTY { SUN NO J INVOICE DATE 890CRIPTIONYNTI t Mcultenhigg NO]II/Cif PAYNEfty AMOUNT$ 1 1 :..':. . . N 1. ) r u YN T Y EC 1699. I 1 SYN.N0. IIIYOICE GATE 999CRIPTION FYIIO/ONe. ACCOUNT [NCYrONANC[ N0. ►/C PAYM[IIT AMOUNT 1 .. '. AXAAL[ A�0 Ae TN) TIrITt 0 NCOYNT YNT f R OPTION Ar 1 1 NYM 40. INVOICE DATE 0996MIPTION FUND/00W ACCOUNT [IICYIISNANC[ N0. P/C PAYMENT AMOUNT TANAeI[ AMOUNT TANN OPTION pACTIYI IDISCOUNT► C PlA! 1 Es 1 t015 ReY.lq/TT1 1