HomeMy WebLinkAboutMINUTES - 09251990 - 2.2 TO: BOARD OF SUPERVISORS
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Phil Batchelor, County Administrator ;:="=' =-�``• Contra
FROM:
Costa
September 25, 1990 Count/
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DATE:
1990-91 Budget Report - Phase III
SUBJECT:
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
I. RECOMMENDATIONS:
1. Accept this report on the status of revenues and
expenditure changes to the 1990-91 budget brought about
actions on the state budget.
2. Direct the County Administrator to continue to monitor the
budget changes necessary as a result of state budget
problems.
3. Set a hearing date of October 23 , 1990 to adopt a booking
fee ordinance.
4. Continue meetings with cities and other taxing entities
affected by the booking fee to consider their concerns and
suggestions prior to the October 23 , 1990 hearing.
5. Direct staff to meet with schools, special districts and
cities to pursue mutually acceptable new revenue sources.
6. Accept findings required as a result of the September 11,
1990 hearings on Health Services reductions.
7. Request staff to report back to the Board in November
related to internal adjustments necessary within the
Health Services Department budget to maintain a balanced
fiscal plan.
8. Direct the County Administrator and Health Services
Director to return to the Board on November 6, 1990 with a
status report on the replacement of the county hospital.
CONTINUED ON ATTACHMENT: RYES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON— September 25, 1'990 APPROVED AS RECOMMENDED X OTHER
Supervisor Torlakson voted no on Recommendation No. 6.
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X 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 SPD .Pmb r 25, 1990
Director Of Health Services PHIL BATCHELOR,CLERK OF THE BOARD OF
County Counsel SUPERVISORS AND COUNTY ADMINISTRATOR
BY
M382 (10/88)
DEPUTY
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II . LATEST STATUS AND IMPLICATIONS OF 1990-91 BUDGET
The 1990-91 budget process has been one of the most difficult
challenges that the Board of Supervisors has had to face in
over a decade. The devastating reductions made by the State
Legislature and the Governor in programs that had already been
suffering from a significant lack of financing has resulted in
decisions being made to reduce or cut back . programs that
logically should be expanding to handle the increasing demand
for services. Although significant reductions have been made
in almost every area of the budget that is financed from the
General Fund or state revenues, the question still remains,
"What additional reductions will have to be made in programs,
projects and people in the future?"
Since the Phase II budget reductions were made on August 14,
1990, a great deal of time and effort has been spent by staff
in meeting rooms in Sacramento. Significant efforts were made
to work with the leadership in both Houses of the Legislature,
with CSAC, and the various county lobbyists to minimize any
additional damage to the County. In the previous two budget
reports the Board was asked to take those steps necessary to
make the reductions that could be most optimistically
anticipated as a result of the state budget process. However,
it was pointed out at that time that if the allocation formulas
that were required in order to distribute the reductions on a
county-by-county basis were not favorable to Contra Costa,
several million dollars more would have to be cut from the
budget.
Fortunately, the allocation formulas which were adopted for the
Medically Indigent Services Program, the Mental Health Program
and the Child Welfare Program were those that involved the
least additional damage to Contra Costa. Therefore, we do not
anticipate that any additional cuts will have to be made in
mental health, the Medically Indigent Services Program or
child welfare at this time.
Although this information is certainly positive, there is
little room for optimism as we consider the difficult budget
situations that are facing us in the immediate future.
The following are but a few of the items that will be
considered by the Board as they make policy decisions to
operate the County for the remainder of this fiscal year
and the 1991-92 fiscal year.
-- In order to mitigate a portion of the approximately $14
million in reductions that would have been required to
bring the 1990-91 budget into balance, the Board followed
the direction given by the State Legislature and budgeted
$6 . 8 million in revenues for new fees that would be
charged to the cities, school districts and special
districts. This included $5 .7 million in administrative
fees for property tax collection and $1. 1 million in fees
to be charged to agencies which book people into the
county jail.
However, the cities have indicated that they feel that the
State Legislature has been unfair to charge them for these
items after their budgets had been finalized. Some school
districts expressed concern that this would exacerbate
their budget problems which were not insignificant prior
to these fees being charged. Some representatives from
the school community have indicated that they do not
intend to pay these fees and instead would be taking the
County and the State to court to stop this process--which
they feel is not legal. Although the County will proceed
to collect these fees and withhold any monies due the
County from property taxes, there is still the uncertainty
which remains that all of these fees will be realized in
this fiscal year as the legal challenge proceeds.
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--. The cities, . school districts and special districts were
not only distressed at being required to absorb part of
the state budget problem, but in some cases expressed
serious concern about how this could be done without
substantially damaging some .of their programs.
Recognizing this reality, it seems apparent that there
will be a constant barrage leveled toward Sacramento to
undo the legislation which currently mandates or at least
makes possible the extraction of revenues from these
levels of local government. Therefore, in order recognize
their individual needs and to avoid endless confrontation
and. adversarial proceedings in the Legislature and the
courts, it would make sense to work with the involved
parties to seek a mutually acceptable solution.
The CAO State Budget Task Force has authorized me to talk
with the President of the City Managers Association about
exploring a mutually acceptable plan to fund county
programs that are currently financed through booking and
property tax fees. He expressed an interest in working
with us to vigorously explore this approach. Additional
contacts will be made with the League of Cities and the
appropriate representatives of the school districts and
special districts. If a delegation representing all of
these entities could approach the Legislature in December,
it would be a much more productive utilization of time and
will help avoid becoming embroiled ina very divisive dual
with other units of local government.
-- Although the County received a substantial cut in the
Mental Health Program of approximately $2..5 million, it
faces another substantial cut in the 1991-92 fiscal year
because it is a disproportionately high recipient of
mental ' health monies. There are six counties which
receive a disproportionately high per capita allocation of
mental health :funds. As a result, these counties face
$12.7 million in additional reductions in the next fiscal
year. Unless some action is taken by the Legislature to
mitigate this situation, Contra Costa faces a possible
reduction of an additional $2. 2 million in 1991-92.
The County currently receives $59 . 8 million_ to assist in
funding health care programs.. The passage of Prop 99 on
the November 1988 ballot was designed to funnel money into
the health care system, and the County has utilized those
funds to shore up some of the health programs that are
most in need. However, the . most recent report received
from CSAC this last week indicates that the Tobacco Tax
has been decreasing at the alarming rate of 14 percent per
year. Although this is positive from the standpoint of
having fewer people smoking, it is also a factor that must
betaken into . account in trying to maintain and balance
the health services budget in the future.
-- During the Phase II budget deliberations, the Board
diverted General Fund monies tentatively allocated for the
opening of the new West County Detention Facility so that
they could be utilized to balance the 1990-91 budget.
Nevertheless, the . cost of operating this new jail
facility, which is estimated to be $12 million on an
annual basis, will have to be allocated in the 1991-92
budget. When this facility opens, it will be competing
for General Fund financing with the rest of the criminal
justice, health services and social service programs
countywide.
-- The Board is well aware of the deteriorating conditions of
the existing hospital facilities. Several reports have
been presented describing the need in this area.
Licensing authorities have indicated that several steps
must be taken to improve the condition of. the facilities
unless the County .anticipates replacing the main hospital
buildings in the. .near future. The dilemma the County
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faces, of course, is that making the required changes as
required by the licensing authorities would take millions
of dollars. But, replacing the facility would require
even more money. However, one thing is clear; each year
that the existing facilities are utilized to serve an
ever-increasing population, the decision point when
something must be done moves closer.
It appears that some actions will have to be taken in the
near future to reduce other programs to free up funds to
provide for adequate hospital facilities to serve the
public. It is anticipated that this would cost somewhere
in the range of $2. 5 to $3 .5 million a year above current
levels of expenditure for the next twenty years. A report
dealing with this subject will be presented to the Board
in on November 6. We mention it now only to point out
that this challenge will also have to be considered in
budget planning for the future.
-- one of the most difficult tasks in balancing the county
budget is the lack of local control and the ability to
raise revenues to meet local needs. The State of
California has not given counties the discretion to manage
in this area. This increases the importance that must be
placed on every dollar that is generated from local
sources such as property taxes and property transfer
taxes. These two sources together with the motor vehicle
in-lieu tax and sales tax, which are collected at the
state level, are used to pay the county share of all
mandated programs as well as providing for all other local
needs.
These four sources of revenue are sensitive to economic
conditions in the community, and recent reports from our
financial departments and the State of California indicate
that there is a recessionary trend that may have the
effect of significantly reducing the amount of growth that
can be expected by the County during the next fiscal year.
This, of course, will come at a time when the local fee
revenues are being challenged legally, a new jail must be
opened, a new hospital facility is required, additional
mental health cuts are expected, as well as other state
budget reductions.
-- The November 1990 ballot has more fiscally related items
on it than any previous ballot in history. It contains 28
statewide propositions, ten of which deal with state
bonding issues. for a total of $3. 5 billion. In addition
to these measures, there are 18 local measures, six of.
which deal with additional public financing. It is
unknown what impact the ballot will have on the voters
since there seem to be such an overwhelming number of
issues to be decided.
If Proposition 134 (the nickel a drink initiative) were to
pass by a larger majority than Proposition 126 ( the penny
a drink measure) and if Proposition 136, which severely
restricts tax increase possibilities, were to be defeated,
some relief could be provided to counties. If Measure D
on the local ballot were to pass, this also would provide
some much needed .financial relief to the County. However,
it appears to be a tremendous uphill battle to achieve a
success in either one of these areas.
The most recent reports coming out of Sacramento at this
point indicate the state deficit to be in the $2-3 billion
range for 1991-92. This is based on several factors
including the fact that one time sources of revenue of
approximately $1 billion were used to balance the budget
for 1990-91, the general recessionary climate which is
reducing the amount of dollars that will be realized in
the State General Fund, and the fact that the state
mandated programs are growing at a faster rate than
. revenue is being generated. Unless the new Governor takes
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a more long-range view toward solving the budget crisis on
a permanent basis, the County may be facing substantial
additional cuts ' from the State of approximately the same
size as those received this fiscal year.
These are just a few of the issues that will be facing the
Board as you balance the County' s fiscal plan in the
coming year.
Gaining a perspective on the larger issues that have an effect
on the budget is an important part of this status report.
Receiving and understanding additional information requested in.
earlier budget reports is also part of this report. The
following portion of the report is divided into three sections:
update on newly approved revenue sources, status of remaining
program impacts and discussion of mandates waived, resulting in
funding loss, as a result of State budget actions.
III. Update on Newly Approved Revenue Sources
A number of new revenue sources were approved by the state
legislature in adopting the state budget. These revenues were
intended to reduce the impact of the massive cuts in health
services, social services, and criminal justice. The Board
decided to dedicate all property tax administrative fee
revenues to health, mental health and social service programs,
and to dedicate booking fee revenues to reduce the impact of
justice system funding losses.
Property Tax Administrative Fee
Our earlier report estimated that $5. 7 million could be raised
as a result of charging for property tax administrative costs.
A statewide task force has been formulated, made up of
representatives of the County Auditor 's Association, CSAC and
the State Controller' s Office. Once this group completes their
work, the League of Cities and School and Special District
representatives will be invited to review and comment upon the
recommended process. Their work is expected to be completed by
late September.
County staff has been in touch with cities, districts and
schools related to the potential fee. However, at this time,
since the state task force has not completed its work,
definitive numbers cannot be developed for each agency. Staff
met with city representatives on August 8th to discuss the fee
authority in general, and met with the entire Mayor' s
Conference on September 5th along with Supervisor Torlakson.
More meetings will take place based on the Board' s direction
today.
It must be emphasized that the County' s balanced budget is
dependent upon receiving these additional revenues. A survey
was taken of the Bay Area counties to determine which would be
implementing the fees and it was determined that all of the
counties surveyed are implementing the property tax
administrative fee pursuant to the guidelines developed by the
State committee.
Booking Fee
The booking fee is in much the same situation as the property
tax administrative fee, in that before firm numbers can be
developed for our county, the results of a statewide task
force' s work on this project are needed. Cities have also
formed a statewide task force to review any methodology
developed by the counties and state in order to try to minimize
the fees that they would be charged. The initial estimate for
Contra Costa County was $123 per booking, which is one of the
lower amounts estimated from among the larger counties surveyed
by staff. Amounts ranged from $50 in the smallest counties to
over $200 in the larger counties.
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At this time, it appears that the statewide committee work will
be completed by early October. Therefore it is appropriate to
set a hearing date in October to consider the amount of the
booking fee for Contra Costa County, and it is recommended that
the Board establish a hearing date of October 23 and direct
staff to issue appropriate notices, and meet with affected
entities regarding these fees.
Utility and Business License Tax
A number of counties are researching the possibility of
implementing these new revenue sources. Our County Counsel is
participating in both Regional and State Associations of County
Counsel groups to thoroughly investigate all the legal
ramifications of implementing either of these fees. When this
research is complete, and when more precise information is
developed related to the revenue potential of these new sources
for Contra Costa County, a recommendation will be forwarded for
the Board' s consideration.
IV. STATUS OF REMAINING PROGRAM IMPACTS
A number of budget reductions were made to programs in the
Criminal Justice, Social Service, Health and Mental Health
areas. At the time these budget cuts were made, specific
program impacts were not determined for all departments. The
following statements describe program impacts for each of these
reductions.
A. AB90 Cuts
Half of the amount allocated to the justice system
subvention program was eliminated through the state budget
process. The Board approved a similar reduction in each
program funded at the local level, with the exception of
the Byron Boy' s Ranch and the Home Supervision Program.
In lieu of 50% reductions in those two programs, it was
decided that the Girl' s Treatment Center be closed and
that savings freed up from that closure be used to
backfill AB90 reductions for the other two Probation
programs, , keeping both programs whole. In addition, some
booking fee revenue was used to backfill for two months of
funding reductions, so that 12 month of reductions would
not have to take place in 10 months worth of operations.
Program impacts as a result of these cuts in other
specific areas are:
Criminal Justice Agency
Planning, Coordination, Evaluation & Administration was
reduced by $17,771 by decreasing temporary planning &
research assistance and services and supplies. The
Agency is exploring other resources to handle
anticipated planning associated with State bond issues
on correctional facilities.
District Attorney
Performance of AB3121 (juvenile prosecution) functions was
reduced by $115,096 and the Adult Pre-Trial Diversion
function was reduced by $82,060. Use of Subvention
Program 1989-90 carryover funds and an addition of funds
from increased Municipal Court revenues will permit these
two programs to operate at the originally budgeted level.
Public Defender
Defense of Juveniles was reduced by $34, 508 by decreasing
the number of hours charged to this project from 2,080 to
1,329. The reduced amount will fund only a portion of the
attorney responsible for handling these activities. The
department will use existing County monies to fund the
difference between the amount requested and the amount
needed. Thus, the project activities will continue but
the savings needed to fund the program will be made up in
some other area of their budget, either through an
increased vacancy factor or a reduction in services and
supplies.
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City of Brentwood
Youth & Family Services was reduced by $37,415 by
decreasing the hours of the director, clinical consultant,
and program assistant, by eliminating the family counselor
position, and by reducing services and supplies. These
reductions will mean a decrease by approximately half of
the number of youths served by the program.
Health Services
Detention Facility Mental Health Services was reduced by
$67, 352 by decreasing staff by two Mental Health Treatment
Specialists. The project ' s goals and objectives will not
be reduced because of the AB-90 cuts in recognition of the
fact that the Detention Facility Mental Health Program is
an integrated effort with various funding sources.
Friends Outside (Sheriff)
Friends Outside was reduced by $16,166, which will be
covered by an Inmate Welfare Fund supplement. There will
be no reduction of services.
Battered Women's Alternatives
The Battering Abatement Training Program was reduced by
$11,041. This reduction was achieved by laying off a
staff member and the following:. one abatement group was
cut, intakes were reduced, follow-up studies, the Couples
Group, the Counter-violence Group, and Batterers Anonymous
services, were cancelled, individual treatment was
reduced, and client fees were increased.
B. Trial Court Funding Reduction
Trial Court Funding reductions totalling $477,000 were
necessary as a result of the Trial Court Funding cuts not
offset by. new booking fee revenues. The impacts of the
Trial Court Funding reductions in each department are as
follows:
Through increased revenues, the Municipal Court will cover
reductions of $60,470 in its own budget and $25 , 415 in the
District Attorney' s budget. The Public Defender will
cover its reduction through an increased vacancy factory
of $14,980 . The Probation Department, which was reduced
by $8,833 , will. cover their cut with savings from the
closure of the Girls ' Treatment Center. The County Clerk
was reduced by $35,256, which will be covered by
additional filing fee revenues. The Sheriff' s Court
Services were reduced by $11, 137 , which it will cover
through an increased vacancy factor in the Court Services
Division. The Superior Court was reduced by $61, 516; this
savings will be accomplished by increasing revenues in
State Aid Mandated Expenditures. The remainder of the
funds were reduced from the jail staffing account; this
loss will have to be addressed in Fiscal Year 1991-92.
C. Health Services v
As mentioned previously, no further reductions in Health
Services programs, beyond those already achieved, are
anticipated at this time. It needs to be pointed out,
however, that the department is still. trying to manage an
additional internal reduction of approximately $2.45
million in addition to all of the other reductions already
made, and that the outcome of these _efforts may not be
known for several more months. Therefore, it is
recommended that the Board direct staff to return to the
Board with a status report on the progress of achieving
these reductions in November.
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Additionally, the Board held a hearing on September 11
related to the reductions necessary in the Health Services
Department. At the hearing, it was noted that two
programs originally identified for reduction were to be
funded: the Teenage Program and removal of the Medically
Indigent Adults (called BACS in our County) from the
Contra Costa Health Plan. These were removed from the
reduction list by the Board. A number of other issues
were raised during the hearing. Responses are included in
Attachment "A" . Related to the remaining program
reductions, the following findings and determinations are
recommended as shown on Attachment "B" .
D. Social Services
Based upon the . latest State information, it appears that
Contra Costa County will receive the same number of
dollars in 1990-91 for Child Welfare Services as it did in
89-90. This allocation does not address caseload or COLA
growth. The State has indicated that funding levels would
be accompanied by a reduction in mandates which will help
address the caseload and COLA problem.
The Director of Social Services has begun working on a
Statewide Director' s group meeting with the State to
develop changes in child welfare services regulations to
accomplish the promised reduction in mandates. That
group' s work is to be completed by November 1. Until that
time, the County' s program as it exists at this time
should remain in place. If adjustments are needed once
the final state regulations are filed, a recommendation
will be brought to the Board at that time.
A more serious problem now facing the department appears
to be addressing the Counties ' homeless program. Last
year' s County costs were about $295, 000. This year
$700,000 in net County cost is budgeted and an additional
$1 .7 million in grant funding is expected. If County
costs exceed the amount budgeted, the department will
confront another budget balancing challenge.
E. Mandates
A number of mandates were eliminated with the adoption of
the state budget, as was funding. The initial look
indicated that the mandates would have no significant
impact on how the county conducts its operations, but
significant revenues would be lost. A closer look has
revealed that about $80 , 000 in revenues will be lost. A
description of the mandates that were defunded as a result
of the second round of legislative review and their impact
is as follows:
Lis Pendens. - Lis Pendens is public written notice of a
pending lawsuit. Reimbursable activities included
services copies of the lis pendens upon adverse parties
and owners of record, preparation and recording of the
required proof of service, research, responding to related
inquiries, maintaining pertinent files and records.
Since no reimbursement claim was filed under this chapter,
there will be no actual loss to the County associated with
the defunding of this mandate. The activities associated
with this mandate were being performed prior to the
mandate, and according to the County Clerk, cannot be
discontinued without adverse impact to case files. A fee
is being charged to recover costs.
Investigations of Guardianships. This mandate required
the County to make an investigation and to file with the
court a report and recommendation concerning each proposed
guardianship of person or estate. It also required that
some cases be referred to other County agencies for
investigation, if necessary.
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The Probation Department reports that discontinuation of
this activity would leave minors virtually unprotected.
The department is in the process of developing a user fee
for this service. According to the Department, no claims
have been submitted on this mandate because, prior to
trial court funding, staff who performed this function
were funded by the State.
Juvenile Felony Arrests. Reimbursable costs included the
increased costs to the district attorney incurred for the
review and evaluation of cases in which minors are
referred on 707 (b) charges (W&I ) , minors 16 years of age
who are referred for a second felony. Court-related costs
were not reimbursable.
The Probation Department has determined that it would not
be feasible to discontinue performing the mandated
activities. They are not currently charging a user fee
and are not confident that a user fee could be easily
implemented on an administrative level. No claims have
been filed under this mandate, therefore, there is no
actual loss of revenue to the County.
Victims ' Statements. Reimbursable activities included
contacting the victim to request a statement, adding the
statement to the probation report, and reviewing the
victim' s statement.
In FY 1989-90, ' the Probation Department recovered $16,580
for this mandate. The defunding of this mandate will
result in the loss of this revenue in FY 1991-92.
However, since obtaining victims ' statements is part of
Probation' s overall investigation function, these costs
could be charged to probationers as a user fee. The
Probation Department has reported that obtaining victims '
statements is required by the Judicial Council Rules as
well as the Penal Code, and cannot be discontinued.
Dental Records. This mandate required the coroner,. when
he/she is unable to identify a dead body, to order a
dental examination. If identification still could not be
made, the dental records were required to be sent to the
Department of Justice. Law enforcement agencies were
required to request written consent of the next of kin for
the missing persons ' dental records and report missing
persons to the Department of Justice.
The Sheriff ' s Department reports that it must identify
dead, bodies before they can be buried and they have a
limited capacity for storing unidentified bodies.
Therefore, it would not be feasible to discontinue
performing the mandated activities. No reimbursement has
been sought for this mandate; therefore, defunding of the'
mandate will result in no actual revenue loss.
Marijuana Records. This mandate required law enforcement
agencies to destroy or obliterate records of marijuana
convictions and arrests not followed by conviction for
cases that met certain criteria.
At the inception of this mandate, the procedure for
destroying marijuana records was automated on the
computer. It may cost more to change the current process
and discontinue the mandated activity than continue
performing it.
Disabled Motorists ' Assistance. Reimbursable activities
included development, adoption, publication and
distribution of a disabled motorist assistance policy,
officers ' time up to ten minutes while rendering
assistance to disabled motorists, and transporting
stranded motorists.
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The Sheriff ' s Department reports that it will continue to
render assistance to disabled motorists regardless of the
mandate being defunded. Disabled motorists assistance is
seen as part of the Sheriff ' s job. No actual revenue will
be lost due to the defunding because reimbursement has
never been claimed under this mandate.
Missing Persons ' Reports. This mandate added special time
constraints and other requirements to the dental records
mandate ( 462/78) for cases involving minors whose
disappearance was under suspicious circumstances.
The Sheriff ' s Department reports that it may or may not
continue to meet the timing constraints required by this
mandate. It will be decided on a case-by-case basis. The
Department believes that this and many other mandates
really reinforce many services that should be provided,
and that the services should be provided even if the
mandate is removed. No revenue loss is associated with
this mandate.
Candidate Filing Fees. This mandate required the County
to accept valid signatures in lieu of candidate filing
fees.
The County Clerk Elections Division recovered between
$2,000 and $5,000 every other year on this mandate. The
defunding of this mandate will have no revenue impact on
the County; however, since the fiscal burden will be
shifted to candidates filing for office.
Airport Land Use. This mandate required that counties
which have airports served by a scheduled airline and
operated for the benefit of the general public to
establish an airport land use commission, and that
counties provide, in certain instances, a copy of its
general plan to the commission.
The Community Development Department staffs the airport
land use commission. The Department will be submitting a
claim to recover prior year costs. The defunding of the
mandate, therefore, will begin to impact the Department
beginning with FY 1991-92 at approximately $15,000 per
year. The Department could not yet determine whether it
could discontinue this activity. However, they did
indicate that they would investigate whether a fee could
be charged to offset the cost of staff time.
Pre-Treatment Facilities. This mandate did not apply to
the County, but affected some of the special districts.
Short-Doyle Audits. This mandate required the County to
perform specified duties within prescribed time
constraints relative to auditing mental health programs.
The Health Services Department will continue to perform
the Short-Doyle audit without budget augmentation because
they believe the audit ensures proper operation of the
mental health program. No revenue impact is associated
with the defunding of this mandate. Although prior
Short-Doyle claims have been submitted in accordance with
SB90, no reimbursement has ever been received.
Detention of Minors. This mandate required special
services for minors under 18 years of age when they are
detained in a jail or other locked facility for more than
24 hours.
Because of other legal restrictions on detaining minors,
Contra Costa County does not detain minors in County jail.
Therefore, there are no cost or programmatic impacts
associated with the defunding of this mandate.
Employee Personnel Files. Reimbursable activities
included providing employees copies of their personnel
records upon request at their work location and permitting
employees to inspect their personnel files on County time.
The defunding of this mandate will have no significant
fiscal impact on the County. Costs for this mandate have
traditionally been so low that it was not cost effective
to track them or submit a reimbursement claim.
Involuntary Lien Notices. - Reimbursable activities
included recording involuntary liens and notifying the
judgment debtor - of the lien.
The Recorder currently charges $3 to record an involuntary
lien. About 12,000 cases of involuntary liens are
processed annually for governmental entities and in
1988-89, the Recorder received $36,000 in State
reimbursement. It is estimated that beginning with FY
1990-91, $50.,000 will be lost due to the defunding of the
mandate. It might be counter-productive to charge the
governmental entities a fee to recover the loss; however,
because the largest governmental entity recording
involuntary liens is the County.
Investment Reports. This mandate required the County
Treasurer to .report to the Board of Supervisors monthly on
the , status of County investments. Costs involved in
complying with the mandate are minor. . No loss of actual
revenue will occur as a result of the mandate being
defunded. It is not known whether the Treasurer will
continue performing the mandate.
Open Meetings Act. This mandate required local
legislative bodies and governing boards to post within
certain constraints an agenda containing brief
descriptions of items to be transacted or discussed at a
regular meeting. Additionally, it prohibited any action
being taken on, any item not appearing on the posted
agenda.
Real Property Subdivision Mergers. This mandate required'
counties to give notices informing property owners of
mergers, determine whether particular parcels meet
prescribed criteria forunmerger, and record a Notice of
Unmerger with respect to an unmerged .parcel.
The Community Development Department currently charges
fees for both merger and unmerger of contiguous parcels.
Since costs have been recovered through these fees,
reimbursement has never been requested from the State.
The Department ' intends to continue the activity and
charging an appropriate fee.
After further review of the costs and options available on
these former mandates, a recommendation on how to proceed will
be developed and brought back to the Board. It appears that a
number of these mandates have revenue generating potential:
The County' s consultant on fees will be asked to review these
items for possible inclusion in the fee schedule.
Attachment
ATTAC[ N=. A
CONTRA ; COSTA COUNTY
HEALTH SERVICES DEPARTMENT
DATE: September 20, 1990
TO: Board of Supervisors
c� ,�
FROM: Marrc' 'inucane, Hea�th Services Director
SUBJECT: Health Services Department Report Responding to Issues
Raised at the September 11, 1990 Hearing on
Heath Services Reductions
The Health Services Department submits this report to the Board of
Supervisors in response to issues raised at the September 11, 1990
hearing on Health Services reductions, and recommends that it be
accepted by the Board of Supervisors .
1 . Sexually Transmitted : Disease (STD) Program: Attached is a
copy of the September 17, 1990 report by Wendel Brunner and
Francie Wise on. the adjustments made by 'the Department to
accommodate the STD program reductions : Twelve hours per week
of clinic services have been replaced with 40 hours per week
of STD investigator .services, on site at the Richmond and
Pittsburg Health Centers; together with expanded staff and
expanded hours of operation at the remaining STD clinic in
Concord. The Concord STD clinic is available to all persons
in the County, and can be reached by public transportation.
Persons who are entitled to health care from the county, and
who appear at the County medical clinics for STD treatment
will be seen on that day.
Previous estimates by the Health Services Department of the
effect of the reductions in the STD program were inaccurate in
that they contemplated far more severe service reductions than
have occurred or they failed to take into account the
accommodations that have been accomplished by the Department.
Given the program elements described in Dr. Brunner' s report,
the STD reductions will not eliminate diagnosis and treatment
services for more than 4,500 clients . In the case of
indigents, the STD reductions may increase waiting times in
terms of hours, but will not have a detrimental impact on
their health care needs .
2 . Ambulatory Care Services : The Health Services Department will
manage the ambulatory care services reductions so that the
medical care services provided by Contra Costa County meet the
standards of care provided by the state Medi-Cal and federal
Medicaid .programs .
3 . Reduction in Alcohol Overmatch: The reduction in alcohol
overmatch funding will not reduce the level of health care
services provided to indigents insofar as clients in the Basic
Adult Care Program will continue as members of the Contra
Costa Health Plan, to be eligible for detoxification services .
4 . Reduction in Mental Health Adult Programs: The reduction in
mental health adult programs will not reduce the level of
health care services provided to indigents insofar as clients
in the Basic Adult Care Program will continue, as members of
the Contra Costa Health Plan, to be eligible for up to 20
outpatient mental health visits .
MF:LB:bgg
attachment
STDBS920 .MEM
ATTACHMENT A
s .. Contra Costa County
•:�"- Health Services Department
_ PUBLIC HEALTH DIVISION
S'
Administrative Offices
1111 Ward Street
Martinez,California 94553
Os�q COUIZ"�
September 20, 1990
To: Mark Finucane
Health Services Director A� j
From: Wendel .Brunner, M.D�, l /
Director of Public Health
Francie Wise, PHN, MPH
Director of Communic - le ae se Control
Re: Sexually Transmitted Disease Clinical and
Preventive Services
Following the budget reductions in the Sexually Transmitted Disease
(STD) Program, we have reorganized the program as outlined below
to continue to provide the best sexually transmitted disease
services possible.
STAFFING
Two STD positions were eliminated in the budget reductions, a
driver clerk and a communicable disease technician. The driver
clerk functioned as a courier for STD laboratory cultures, and was
used primarily to maintain our contract sexually transmitted
disease laboratory services with Planned Parenthood and other
community providers. Both the laboratory and the Communicable
Disease Program are considering ways to cover the workload of that
courier position, but we are not planning to eliminate our contract
with Planned Parenthood. The Planned Parenthood clinics play an
important role in STD control in this county through. their
relationship with our laboratory. In effect they function as
satellite STD clinics, treating sexually transmitted diseases
according. to Health Services Department . protocols. Since we
perform their laboratory services, all diagnosed cases of sexually
transmitted diseases are . automatically reported to the Health
Services Department through the Public Health Laboratory.
The communicable disease technician position which was eliminated
does contact investigation and field work for the STD program,
A372 (1/89)
ATTACHMENT A
following-up on contacts to sexually transmitted disease cases and
bringing them in for treatment. However, the individual affected
by the reduction has been picked up in a new CD tech position
created and funded under new State TB control money. That
individual will be working half-time in TB control, and will
continue to work half-time in the Sexually Transmitted Disease
Program. The position reductions, therefore, resulted in the net
loss of . 5 FTE CD technician and a driver clerk. There remains in
the Sexually Transmitted Disease Program 3 .5 FTE investigators:
2 FTE public health .epidemiologists and 1.5 FTE communicable
disease technicians. In addition the State Health Services
Department will be providing us with a staff person on an interim
basis three days a week to assist in case review.
PUBLIC HEALTH SEXUALLY TRANSMITTED DISEASE CLINICAL SERVICES
Three of the four weekly STD clinics were eliminated, including the
two weekly clinics in Richmond and one in Concord. The remaining
clinic is held Tuesday evenings in Concord. Although West County
has the largest number of sexually transmitted disease cases, the
Concord clinic was the most well attended and saw the most clients.
In addition, the Concord clinic provided services to ,many East
County residents, also an area with considerable sexually
transmitted disease.
In anticipation of an increasing number of clients coming to the
Concord clinic, we lengthened its time of operation by 1-1/2 hours
and increased its staffing. The clinic now accepts patients from
5: 30 to 9: 30 p.m. and remains open until all those registered
patients have been seen. The clinic is now staffed by two
physicians and three nurse practitioners. One of the nurse
practitioners provides family planning services under the Office
of Family Planning Program, thereby providing a more comprehensive
and integrated service at the clinic site. The clinic is also now
staffed by all four VD investigators who do extensive interviews
to identify the sexual contacts of the clients, so they can be
notified and brought in for treatment. In addition, three staff
from the AIDS Program are at the clinic to provide confidential HIV
testing and counseling and to assist with the contact interviews.
We will be carefully monitoring the patient load at this clinic and
making staffing adjustments as appropriate.
SERVICES AT THE RICHMOND AND PITTSBURG HEALTH CENTERS
VD investigators from the Sexually Transmitted Disease staff will
be stationed from 10: 00 a.m. to 2 : 00 p.m. Monday through Friday at
the Richmond and Pittsburg Health Centers. These staff will be
available to take referrals from physicians and nurse practitioners
at the health centers. They will do on site contact interviews
for. patients receiving diagnosis or treatment for sexually
ATTACHMENT A
transmitted diseases. The staff are also all trained and certified
HIV testing counselors, and will provide confidential HIV testing
services at these health centers on a daily basis. There has not
been Public Health Sexually Transmitted Disease services in
Pittsburg for more than ten years. The stationing of a VD
investigator daily at the Pittsburg Health Center actually
represents an enhancement of sexually transmitted disease services
in East County.
ACCESS TO SEXUALLY TRANSMITTED DISEASE CLINICAL SERVICES
Patients presenting to the health centers for diagnosis or
treatment of Sexually transmitted diseases will be evaluated by the
triage nurse and referred to a financial counselor to determine if
there is a third party payor. Patients referred to the health
centers by the VD investigators as known cases or contacts to cases
can be provided with a Financial Waiver form by the VDI to cover
the cost of diagnosis and treatment of sexually transmitted
disease, if the client has no other source of payment. In
addition, protocols are being developed by the STD Program for the
triage nurse, so that she can provide Financial Waiver forms to
patients presenting at triage if they have no source of payment
and meet the priority criteria of the Sexually Transmitted Disease
Program. All patients presenting for STD treatment who meet the
triage criteria will be seen that day, either in Urgent Care or as
a drop-in in Family Practice clinic.
COMMUNITY PREVENTION AND CASE FOLLOW-UP
The VD investigators ' staff time has been prioritized as follows:
1) pregnant women with syphilis
2) babies with reactive blood test for syphilis
3) primary syphilis
4) secondary syphilis
5) penicillin resistant gonorrhea
If there is any other VD investigator time available, other
sexually transmitted disease cases will be followed. Syphilis is
the most serious sexually transmitted disease in Contra Costa .
County other than AIDS. These priorities focus on syphilis,
especially congenital syphilis in infants.
We are supplementing our VD investigator community outreach with
efforts to use the media to educate the community on the importance
of coming into the health centers for the diagnosis and treatment
of sexually transmitted disease, despite the closure of the
specific dedicated Sexually Transmitted Disease clinics. We have
ATrAQ MENT A
put out a press release to all Bay Area media and have followed up
with an interview with the West County Times urging persons who
may have sexually transmitted disease, even asymptomatic disease,
to come into either Planned Parenthood or the Richmond Health
Center for diagnosis and treatment.
We feel that the above outlines the most responsible approach to
dealing with sexually transmitted diseases in Contra Costa County
that we can provide, utilizing the resources that are available to
both the Public Health and Hospital and Clinics Divisions.
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