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HomeMy WebLinkAboutMINUTES - 08111992 - 1.42 /.cfL THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on August 11, 1992 by the following vote: AYES: Supervisors Powers, Fanden, .Schroder, Torlakson, McPeak NOES: None ABSENT: None ABSTAIN: None SUBJECT: Beilenson Notice The Board received a letter dated August 7, 1992 from the Health Services Director with respect to the Beilenson Notice drafted by the Health Services Department staff. IT IS BY THE BOARD ORDERED that the aforementioned notice is ADOPTED and the Health Services staff is DIRECTED to post the adopted Beilenson Notice in accordance with the applicable legal requirements; and SET September 11, 1992, at 2: 00 p.m. as the hearing date for the Phase II reductions set forth in the Beilenson Notice. I hereby certify that this is a true and correct copy of CC• County Administrator an action taken and entered on the minutes of th3 Boar.. of Supervisors on the dates own. Health Services Director ATTESTED: PHIL BATCHEL .Clerk of th Board of Supervisors and County Administrator Deputy e- . Contra The Board of Supervisors Costa Health Services Department Tom Powers,1st District County OI 11 1t\/ Nancy C.Fanden,2nd District �V! l l� ���/ OFFICE OF THE DIRECTOR Robert I.Schroder,3rd District s-- c Sunne Wright McPeak,4th District. Mark FInUCane, Director Tom Torlakson,5th District - Administrative Offices o' County Administrator 'S 20 Allen Street • �° i' California 94553 C Phil Batchelor O�TA'C(jUN� RECEB�ygynr,��■( E415),_— County Administrator n X. (415) 70-5098 .5 DATE: August 7, 1992 AUG 1 1 1992 CLERK BOARD OF SUPERVI TO: Board of Supervisors �i CONTRA COSTA CO. FROM: Mark Finucane, Dire or Health Services Department SUBJECT: Health Services Department Phase II Reductions The enclosed Beilenson notice has been prepared at your direction to give required public notice of the proposed Phase 1I reductions for the Health Services Department. We are also including reductions in public health programs which County Counsel advises us are not covered by the Beilenson requirements. These non-Beilenson reductions will be posted with the Beilenson notice but are identified as such. Later this week we will be providing you with our recommended cuts to the mental health system which will also be posted. The nature and magnitude of the cuts are devastating to the county's health care system. I realize, of course, that the specter of state reductions to counties, as well direct health care cuts that are under consideration by the Legislature make it necessary for us to be prepared to further reduce the Health Services Department's budget. On August 11, 1.992 following the Board's action on the proposed Beilenson notice, my staff will post the Beilenson notice at the appropriate health care facility sites to meet the state requirements for a 30 day posting before the scheduled September 11, 1992 hearing date. MF:LB Distribution Supervisor Tom Powers Supervisor Nancy Fanden Supervisor Robert I. Schroder Supervisor Sunne Wright McPeak Supervisor Tom Torlakson cc: Phil Batchelor A-345 (10/90) August 11, 1992 INSTRUCTIONS TO HEALTH SERVICES DEPARTMENT AND CONTRACT FACILITY STAFF The attached Notice of Public Hearing, must bg vosted on August 11. 1992 and must remain posted continuously prior to the date of the hearing which will be held by the County Board of Supervisors on September 11, 1992. You are responsible for seeing that this Notice is posted and remains posted continuously prior to September 11, 1992. If there is more than one entrance to your facility, please photocopy the Notice and post it at all entrances. Additional postings at your facility may, be desirable (e.g., bulletin boards, special services entrances, etc.). Make extra copies in case any of the posted copies disappear and need to be replaced. Thank you. Mark Finucane, Director, Health Services Department Telephone: 370-5053 BEILE\.POS • August 11, 1992 NOTICE OF PUBLIC HEARING T'he Board of Supervisors of the County of Contra Costa will conduct a PUBLIC HEARING pursuant to Health and Safety Code Section 1442.5, on the elimination of and/or reductions in the level of health services provided by the County, and/or the closing of County health facilities. The hearing will:be held at the following place and time: Board of Supervisors Chambers Room 107, Administration Building 651 Pine Street Martinez, California 94553 September 11, 1992 - 2:00 p.m. At the hearing, the Contra Costa County Board of Supervisors will consider the impact on the health care needs of the County's indigents of the implementation of the changes set forth in the attached summary. The Board does not consider all of the program changes in the attached summary to be within the required coverage of Health and Safety Code Section 1442.5. Its scheduling of this Hearing, giving this Notice of Public Hearing, the holding of a Hearing, and the making of any findings, shall not be construed as -an admission by the County of Contra Costa, or the Board of Supervisors, that any of the actions included in the attached summary are subject to the hearing provisions of Health and Safety Code Section 1442.5. 13E,LE. m HEALTH SERVICES DEPARTMENT BEILENSON SUMMARY FISCAL 1992/93 ANNUAL PROGRAM SAVINGS (1) Eliminate Health Plan Referrals $1,000,000 (2) Remove BACs from Health Plan 2,200,000 3(A) Reduce Urgent Care Services 700,000 3(B) Close Brentwood Health Center 500,000 3(C) & (D) Reduce Ambulatory Care Services 25% 3,200,000 3(E) Eliminate Transportation Services 225,000 4(A) Place Children on Inpatient Adult Units 400,000 4(B) Stop Accepting No-pay Transfers 1,500,000 (5) STD Service Reduction 40,000 (6) Reduce Public Health Lab 85,000 (7) Reduce Family Planning 75,000 (8) Reduce Public Health Nurses 1,200,000 TOTAL $11 ,125,000 sb CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT REDUCTIONS FISCAL YEAR 1992-93 1. ELIMINATE ALL HEALTH PLAN OUT-OF-PLAN REFERRALS The Contra Costa Health Plan (CCHP) refers approximately 2,850 patients annually to providers in the community for non-emergency outpatient medical (including psychiatric)and dental specialties and more than 67,000 non-emergency prescriptions are filled annually for CCHP patients by community pharmacies. Nature of the Reduction or Change: All of the Contra Costa Health Plan patients needing non-emergency outpatient medical (including psychiatric), dental, and pharmacy services would be directed to Merrithew Memorial Hospital and Clinics for these services, instead of to the approximately 330 out-of-plan (community) providers. Patients Affected: The Health Plan refers more than 2,850 members/patients to out-of-plan (community) providers annually for non-emergency medical (including psychiatric) and dental services, and fills more than 67,000 prescriptions at out-of-plan (community) pharmacies. All of those patients would be redirected to County services and facilities for those services. Appointment backlogs and waits for pharmacy services at County facilities would increase for all of the approximately 56,300 people who use the County medical, dental, and pharmacy services annually. EVected Annual Savings: $1.000.000 2. REMOVE BASIC ADULT CARE (BAC) PROGRAM FROM CONTRA COSTA HEALTH PLAN The BAC Program is health care services provided under the County's contract with Contra Costa Health Plan for General Assistance and Medically Indigent Adult eligibles as described in Board of Supervisors Resolution 85/376. BAC members receive the minimum health care services and benefits required of all federally qualified HMO's, including coverage for medical emergencies. 1 Nature of the Reduction or Change: This change would remove all the BAC members from the Health Plan in order to relieve the County from the responsibility of paying for out-of-plan emergency services provided to former BAC members. Patients Affected: The number of BAC members enrolled in the Health Plan at any one time is approximately 5,000. Any former BAC member receiving emergency services at a non-County facility after removal from the Health Plan would share liability for the cost of those services with the treating facility and physician. Emergency services would still be available to former BAC members at Merrithew Memorial Hospital. erected Annual Savings $2,200,000 3. REDUCE AMBULATORY CARE SERVICES This program provides primary care and specialty services to the clients of the Health Services Department. Clinic services are generally provided between the hours of 8:00 a.m. and 4:00 p.m., Monday through Friday. &tg5: Clinic Sites: Martinez, 2500 Alhambra Avenue Richmond, 38th & Bissell Streets Pittsburg, 550 School Street Concord, 3052 Willow Pass Road Brentwood, 118 Oak Street This program is administered by the Division of Hospital and Clinics of the Health Services Department. A. Nature of the Reduction or Change: The Pittsburg, Richmond, and Martinez ambulatory care clinics would stop providing urgent care services and convert to an appointment-only basis. Approximately 10,400 annual provider hours (7,280 physician (MD) hours and 3,120 family nurse practitioner(FNP) hours) of urgent care services would be eliminated. RHC PHS MtZ Total Hours MD 4,160 2,080 1,040 7,280 FNP -- 2.080 1.040 3.120 Total 4,160 4,160 2,080 10,400 2 As a further result, the number of registered nurses (RN's) and licensed vocational nurses (LVN's) who provide support to the physicians and family nurse practitioners would be decreased. i; I Staff Reductions: 3.5 Full Time Equivalent Physicians 1.5 Full Time Equivalent Family Nurse Practitioners (FNP's) 1.5 Full Time Equivalent Registered Nurses (RN's) 3.0 Full Time Equivalent Licensed Vocational Nurses (LVN's) .5 Registration Clerk ResultingiReductions by Clinics: I' Pittsburg Health Center: 1.0 Full Time Equivalent Physician 1.0 Full Time Equivalent FNP 2.0 Full Time Equivalent LVN Richmond Health Center: 2.0 Full Time Equivalent Physician 1.0 Full Time Equivalent RN 1.0 Full Time Equivalent LVN Martinez Health Center: .5 Full Time Equivalent Physician .5 Full Time Equivalent FNP .5 Full Time Equivalent RN .5 Full Time Equivalent Registration Clerk Patients Affected: Approximately 7,000 patients are seen annually in the Urgent Care Clinics at the Martinez (1,600 patients), Richmond (2,400 patients),;.and Pittsburg (3,000 patients) sites. Patients requiring immediate medical services would be directed to the closest emergency department. Patients who are not in need of same day service would be given the first available appointment in a family practice clinic. This change would increase the average appointment waiting time from 6 - 10 weeks to approximately 12 18 weeks. Expected Annual Savings: $700,000 B. Nature of the Reduction or Change: The Brentwood Health Center would be closed. Consequently , approximately 4,576 annual provider hours (2,912 physician! hours and 1,664 family nurse practitioner hours) would be eliminated. 3 Staff Reductions: 1.4 Full Time Equivalent Physicians .8 Full Time Equivalent FNP 1.0 Full Time Equivalent RN 1.1 Full Time Equivalent LVN's 4.0 Full Time Equivalent Clerical (Medical Records, Registration, Supervising Clerk) .5 Full Time Equivalent Housekeeper Patients Affected: Approximately 1,800 patients are seen annually at the Brentwood Health Center. These patients would be directed to the Pittsburg Health Center. These additional appointments, along with other reductions at the Pittsburg Health Center set forth herein, would increase the appointment waiting time at the Pittsburg Health Center from 8-10 weeks to approximately 12 - 18 weeks. Expected Annual Savings: $500,000 C. Nature of the Reduction or Change: The staffing and hours at the Richmond, Pittsburg, and Concord family practice clinics would be reduced by 25% or by 8,112 annual provider hours. Specifically: RHC PHQ CHC Total Hours MD 3,120 3,328 416 6,864 FNP 520 520 208 1.248 Total 3,640 3,848 624 8,112 In addition, the staffing and hours of the specialty clinics in Martinez would be reduced by 25% or by 4,160 annual physician provider hours. These reductions would then reduce the number of registered nurses, licensed vocational nurses, clerical, laboratory and other ancillary staff at those clinics. Staff Reductions: 5.3 Full Time Equivalent Physicians .6 Full Time Equivalent FNP 3.8 Full Time Equivalent RN's 3.7 Full Time Equivalent LVN's 6.35 Full Time Equivalent Clerical (Registration) 6.5 Full Time Equivalent Clerical (Medical Records) .9 Full Time Equivalent Financial Counselor 4 2.75 Full Time Equivalent Housekeeper 1.4 Full Time Equivalent Laboratory Techs .51 Full Time Equivalent Medical Social Worker 2.25 Full Time Equivalent Pharmacists .50 Full Time Equivalent Public Safety Officers 1.0 Full Time Equivalent Radiology Tech Resulting lReductions by Clinic: i. Pittsburg Health Center: 1.5 Full Time Equivalent Physicians .25 Full Time Equivalent FNP 1.5 Full Time Equivalent RN's. 1.0 Full Time Equivalent LVN's 1.9 Full Time Equivalent Clerical (Registration) 2.0 Full Time Equivalent Clerical (Medical Records) .40 Full Time Equivalent Financial Counselor 1.25 Full Time Equivalent Housekeeper .60 Full Time Equivalent Laboratory Tech .26 Full Time Equivalent Medical Social Worker 1.0 Full Time Equivalent Pharmacist .25 Full Time Equivalent Public Safety Officer .50 Full Time Equivalent Radiology Tech Reduction in the Pittsburg Family Practice Clinic Hours: Eliminate ten (10) clinic hours per week. Current Hours - Monday-Friday 8:00 a.m. - 5:00 p.m. Reduced Hours - Monday-Friday 8:00 a.m. - 3:00 p.m. ii. Richmond Health Center: 1.6 Full Time Equivalent Physicians .25 Full Time Equivalent FNP 1.0 Full Time Equivalent RN 1.5 Full Time Equivalent LVN's 3.05 Full Time Equivalent Clerical (Registration) 5 4.0 Full time Equivalent Clerical (Medical Records) .50 Full Time Equivalent Financial Counselor 1.50 Full Time Equivalent Housekeeper .80 Full Time Equivalent Laboratory Tech .25 Full Time Equivalent Medical Social Worker 1.25 Full Time Equivalent Pharmacists .25 Full Time Equivalent Public Safety Officer .50 Full Time Equivalent Radiology Tech Reduction in the Richmond Family Practice Cliric Hours: Eliminate ten (10) clinic hours per week. Current Hours - Monday-Friday 8:00 a.m. - 5:00 p.m. Reduced Hours - Monday-Friday 8:00 a.m. - 3:00 p.m. iii. Concord Health Center: .2 Full Time Equivalent Physicians .1 Full Time Equivalent FNP .3 Full Time Equivalent RN .2 Full Time Equivalent LVN .4 Full Time Equivalent Clerical (Registration) .5 Full Time Equivalent Clerical (Medical Records) Reductions in the Concord Family Practice Clinic Hours: Eliminate eleven clinic hours per week. Current Hours: Monday, Tuesday, Friday - 8:00 a.m. - 5:00 p.m. Wednesday 1:00 p.m. - 8:00 p.m. Thursday 8:00 a.m. - 4:00 p.m. Saturday 9:00 a.m. - 1:00 p.m. 6 Reduced Hours: Monday, Tuesday, Friday: 8:00 a.m. - 3:00 p.m. Wednesday 1:00 p.m. - 6:00 p.m. Thursday 8:00 a.m. - 5:00 p.m. Closed Saturdays iv. Martinez Special Clinic: 2.0 Full Time Equivalent Physicians 1.0 Full Time Equivalent RN 1.0 Full Time Equivalent LVN 1.0 Full Time Equivalent Clerical (Registration) Reductions in the Martinez Specialty Clinic Hours: Eliminate; ten (10) clinic hours per week. Current Hours: Monday - Friday - 8:00 a.m. - 5:00 p.m. Reduced Hours: Monday - Friday - 8:00 a.m. - 3:00 p.m. Patients Affected: Approximately 4,282 patients annually would be impacted by the combined family practice clinic reductions. • Richmond.Health Center: 2,592 patients • Concord Health Center: 226 patients • Pittsburg Health Center: 1,464 patients These reductions would increase the overall waiting time for routine family practice appointments from 6 - 8 weeks to approximately 12 - 18 weeks. Patients who needed to be seen before their scheduled appointment would be directed to the emergency departments of local hospitals. Approximately 1,639 patients annually would be impacted by the Specialty Clinic reductions. Appointment waiting times for specialty services would increase from approximately 4 - 6 weeks to approximately 8 - 10 weeks. Expected i:Annual Savings: $3,200,000 (in conjunction with the modification of the clinic appointment system set forth hereafter). D. Nature of the Reduction or Change: The clinic appointment system would be modified to allocate visits by financial class. Insurance/MediCal/Medicare/ Health Plan (excluding BAC's)would be allocated 100% of the appointments used by those patients in FY 1991-92 or 85,700 appointments. Uninsured patients would be allocated 20% of the appointments used by BAC patients in fiscal year 1991-92 (29,608) to a new level of 5,922 appointments. 7 Staff Reductions: See the staff reductions listed in the family practice and specialty clinic reductions set forth in Section 3.0 above. No additional staff reductions are anticipated. Resulting Clinic Reductions: See the clinic reductions listed in the family practice and specialty clinic reductions set forth in Section 3.0 above. No additional clinic reductions are anticipated. Patients Affected: Approximately 5,000 former BAC members would have their access to available appointments reduced by 80%. EQected Annual Savings: $3,200,000 (in conjunction with the reductions in the family practice and specialty clinics set forth above). E. Nature of the Reduction or Change: Eliminate all non-urgent transportation service, including taxi and van service,between outlying health centers and the hospital specialty services. Urgent transportation services would be retained at current levels. Because of the reduction in the specialty services at Martinez, there will be fewer patients needing transportation. Staff Reductions: There would be no staff reductions as a result of this change. Resulting Transportation Reductions: Eliminate all taxi service, approximately 2,557 trips annually. Eliminate ten (10) van trips per week, per health center. Current number of van trips per week: Pittsburg Health Center: 25 Richmond Health Center: 25 Reduced number of van trips per week: Pittsburg Health Center: 15 Richmond Health Center: 15 Patients Affected: Approximately 350 non-urgent care patients per week would no longer be provided with van and taxi services for transportation between the outlying regional centers (Pittsburg and Richmond) and Martinez Specialty Services. These patients would use alternative means of transportation, including public transportation. The use of public 8 transportation would increase travel time by approximately two hours (round trip)fromPittsburg Health Center and approximately three hours(round trip) from Riclimond Health Center. erected Annual Saving5: ..$225,000 4. Inpatient Care Services. Merrithew Memorial Ho5Rital Merrithew Memorial Hospital provides acute inpatient medical, surgical, obstetrical, gynecological, pediatric, geriatric, and psychiatric services. Patients are admitted by practicing physicians on the medical staff of Merrithew through the Emergency Department, as well as through the Ambulatory Care System. Patients are also admitted to Me�crithew from other hospitals in Contra Costa County, and on occasion, from hospitals outside of Contra Costa County (the latter for residents of Contra Costa County only). Hospitals in Contra Costa County also transfer stabilized patients from their emergency departments to Merrithew for admission. Merrithew operates 24 hour's per day, 7 days per week. Merrithew is located at 2500 Alhambra Avenue, in the City of Martinez. This program is administered by the Division of Hospital and Clinics of the Health Services Department. A. Nature of the Reduction or Change: The County's contract with Walnut Creek Hospital for inpatient care to children requiring acute psychiatric hospitalization would be canceled. All children requiring acute psychiatric hospitalization would be admitted to the inpatient psychiatric units (I & J) of Merrithew Memorial Hospital. Approximately 37 children would be admitted to I & J Wards annually. I & J Units at Merrithew currently provide acute psychiatric services to adults. With a State waiver,adult psychiatric units may admit children. Resulting I Inpatient Hospital Reduction: Loss of 24 beds on each unit (I & J). Patients Affected: This change would result in the admission of approximately 37 children annually to the adult inpatient psychiatric units (I & J) at Merrithew Memorial Hospital. I & J units currently have an average daily census of 37 adults, with 40 available beds. Children admitted to I & J units would be separated from the adults. As a result, approximately 2 - 4 existing beds, per unit, would be eliminated in order to provide enough space and security for the children. Annually, this would have a residual impact on the admission of 50 adults in need of acute psychiatric hospitalization. 9 Fgpgcted Annual Savings: $400,000 B. Nature of the Reduction or Change: Merrithew Memorial Hospital would stop accepting transfers from other hospitals of the approximately 5,000 former BAC members. Merrithew Memorial Hospital would stop reimbursing local hospitals for acute hospitalization of former BAC members. Ancillary support and nursing staff at Merrithew Memorial Hospital would be reduced, as more particularly set forth below, since the number of patients admitted to the hospital would be reduced. Reimbursements to local hospitals which total approximately $1,000,000 annually would be eliminated. Merrithew Memorial Hospital, 2500 Alhambra Avenue, Martinez Staff Reductions: 7.0 Full Time Equivalent Registered Nurses 2.0 Full Time Equivalent Licensed Vocational Nurses 6.0 Full time Equivalent Ancillary Support (Medical Records, Registration, etc.) Patients Affected: Approximately 1,068 patients, annually would no longer be admitted to Merrithew Memorial Hospital. The only former BAC members who would be admitted to Merrithew would be those presenting themselves to the Merrithew Emergency Department. Since fewer patients would be admitted to the hospital, the reduction of ancillary support and nursing staff would have no effect on patient care. The local hospitals, who currently are paid by the County for acute hospitalization of BAC members, would no longer receive payment from the County for hospitalization of former BAC members. ExFected Annual Savings: $1,500,000 5. REDUCE SEXUALLY TRANSMITTED DISEASES PROGRAM SERVICES Annually this program provides diagnosis and treatment of sexually transmitted disease for 3,500 Contra Costa County residents as well as field follow-up and contact investigation. Sites: 38th & Bissell, Richmond 550 School Street, Pittsburg 2355 Stanwell Circle, Concord 10 Nature of Reduction: The clerical staff of the Sexually Transmitted Disease program would be reduced by 53% or one clerk. The clerical staff is responsible for receiving, verifying, and following up reported cases of Syphilis, Gonorrhea, and Chlamydia. Staff Reduction: 1 FTE Experienced Level Clerk Patients Affected: Elimination of this clerical position would result in a one to two week delay in the verification and follow-up of the County's 3,200 annual Sexually Transmitted Disease cases. The delay in follow-up could result in additional cases of infection of up to two or three individuals per patient. erected Annual Savings $40,000 6. REDUCE PUBLIC HEALTH LABORATORY SERVICES The Public Health Laboratory provides primary and reference laboratory testing for the Hospital and:Clinics, Planned Parenthood, private medical providers, and other laboratories in ! Contra Costa County. The laboratory provides testing for tuberculosis, sexually transmitted diseases, and viral illnesses such as hepatitis, herpes, and rubella, as well as enteric parasites and bacteria. it 1111 Ward Street, Martinez Nature of Reduction or Change: The Public Health laboratory technician staff would be reduced by 2$% or one laboratory technician. The microbiologist staff would be reduced by 15% or one microbiologist. Staff Reduction: 1 FTE Public Health Microbiologist 1 FTE temporary Laboratory Technician Patients Affected: The reduction in laboratory staff would increase the turnaround time for test results from the current 4 days to 10 days. The longer turnaround time would result in a.delay of approximately 7-10 days in the diagnosis and treatment of 38,000 patients seen annually at Merrithew Memorial Hospital, the Public Health Clinics, Planned`Parenthood, and other private providers. Expected Annual Savings $85,000 7. REDUCE FAMILY PLANNING SERVICES The Family Planning program provides health services primarily to low-income women. The services provided include HIV testing, STD testing and treatment, 11 contraceptive services and supplies, and diagnosis and treatment of reproductive health problems. Clinic Sites: 118 Oak Street, Brentwood 550 School Street, Pittsburg 2355 Stanwell Circle, Concord Juvenile Hall, 200 Glacier Dr., Martinez 38th & Bissell, Richmond Nature of Reduction or Change: The Concord Clinic would be closed on Wednesdays, thereby reducing family planning services at that clinic by four (4) hours. The Pittsburg Clinic would reduce its hours of operation by two (2) hours per week. Staff Reductions: .15 FTE Physician .25 FTE Registered Nurse .25 FTE Public Health Aide .30 FTE Exp. Level Clerk Clinic Reductions: Eliminate four clinic hours per week at Concord Clinic: Current Hours - Tuesday, 2-10 p.m. Wednesday, 4-8 p.m. Thursday, 9 a.m.-12 Noon Reduced Hours - Tuesday, 2-10 p.m. Closed Wednesday Thursday - 9 - 12 Noon Eliminate two clinic hours per week at Pittsburg Clinic: Current Hours - Friday, 8:30 am. to 2:30 p.m. Reduced Hours - Friday, 8:30 a.m. to 12:30 p.m. Patients Affected: Approximately 15 - 20 low income women per week (780-1,040. annually) would be unable to obtain or would experience delays in obtaining family planning services. Patients affected by clinic site (on an annual basis) would be: Brentwood 450 people Pittsburg 620 people 12 Concord 1,400 people Martinez 200 people Richmond 2,400 people Expected Annual Savings: $75,000 8. REDUCE PUBLIC HEALTH NURSING SERVICES Public Health Nurses provide nursing services to countywide programs, clinics, and services including: Child Health screening, Tuberculosis, Communicable Diseases, Immunization, Employee Occupational Health, Health Care for the Homeless, High Risk Infant, Home Health Agency, Child Abuse follow-up, Child Health and Disability Prevention (CHDP)/Early Periodic Screening,Diagnosis, and Treatment (EPSDT), Healthy Start, Family Planning, School Based health programs, CCHP Advice Nurse, Well Child Care, Refugee/Migrant Health, Acute care follow-up, AIDS, and California Children's Services. Public Health Nurses are the vital link between the prevention/early detection Public Health services and follow-up care and treatment, making in excess of 104,000 patient encounters, i.e. visits, telephone follow-ups, per year. Nature of Reduction or Change: The Public Health Nursing staff would be reduced by 31% or 16 positions. This reduction would result in the following: . Tuberculosis Follow-up: Approximately 120 people annually in Contra Costa County are infected with;'tuberculosis. This reduction would result in a delay of 3 - 4 weeks in the follow-up of infected people. The delay in follow-up will increase the chance of spreading TB ;throughout the community. The elimination of TB education and the provision of TB medication only in clinics will increase non-compliance among patients with the!-possible result of an increase in multiple drug resistant TB. Refugee Program: Each year, 800 - 1000 new refugees receive health screening and follow-up services. More than 90% of new refugees are found to have health conditions. Home visits and follow-up care by Public Health Nurses for TB and enteric pathogens would be eliminated for all new refugees. Prenatal Programs: This reduction would eliminate education annually to 1,200 new mothers of high nsk infants. Follow-up would be limited to children with identified health problems!!who are in the hospital, only. This reduction would result in an average delay of. 1 - 2 months in the identification of developing problems and response to apptoximately 2,300 infants annually and many (approximately 750, annually) at risk infants would not be evaluated. Home based new mother prevention education would be eliminated. Home Health Agency: Reduced in-home care services to 1,150 people annually who are the homebound frail elderly, acutely ill, infants and children, recent hospital discharges, drug involved newborns and mothers and women with medical problems. The result would be prolonged illnesses, increased physician, clinic and hospital visits, 13 hospital admissions, and lengthened hospital stays through convalescence (4,600 annual visits would be eliminated). Patients Affected on an Annual Basis: Tuberculosis Follow-up: 720 people Refugee Program: Approximately 80071000 new refugees. Prenatal Programs: 1,200 people Home Health Agency: 1,150 people Staff Reductions: 16 FTE Public Health Nurses (31%) General Public Health Nursing: 12 FTE Public Health Nurses (39% reduction) Home Health Agency: 4 FTE Public Health Nurses (19% reduction) Expected Annual Savings: $1,200,000 14 r CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT REDUCTIONS FISCAL YEAR 1992-93 The reductions listed on the following pages are not subject to the Beilenson requirements, Sections 1442 and 1442:5 of the Health and Safety Code. However, in order to inform interested parties of these reductions, they are being posted with this Beilenson notice. NON-BEILENSON ITEMS AUGUST 11, 1992 PUBLIC HEALTH LABORATORY The Public Health Laboratory provides primary and reference laboratory testing for County Medical Services, Planned Parenthood, private medical providers and other laboratories in Contra Costa County. The laboratory provides testing for tuberculosis, sexually transmitted diseases and viral illnesses, such as hepatitis, herpes, and rubella as well as enteric parasites and bacteria. Sites: Lab - 1111 Ward Street, Martinez 1. STD Clinic - 38th & Bissell, Richmond STD Clinic - 2355 Stanwell Circle, Concord STD Clinic - 550 School Street, Pittsburg Nature of Reduction or Change: One Public Health Microbiologist will be on maternity leave ;for six months from September 1992 through March 1993, five months of which will not be covered by leave accruals and will not be backfilled. In addition, effective September 1, 1992 three weekly evening STD Clinics which have each historically; required staffing by a Public Health Microbiologist receiving overtime pay, will be staffed via flex-time. Staff Reduction: 1 FTE Public Health Microbiologist - 5 Months (mid-October 1992 through mid-March 1993) Scheduled Microbiologist O.T. - STD Clinics. Patients Affected: Each action further increases turnaround time for test results leading to longer time for diagnosis and treatment of patients seen at Merrithew Memorial Hospital and Public Health Clinics such as the Sexually Transmitted Disease Clinics. Expected Annual Savings: $40,000 PUBLIC HEALTH CLINIC SERVICES Provides combined health clinic management and staffing for Immunization, Sexually Transmitted Diseases, Family Planning, Tuberculosis, Refugee, and Teen Age Program. 1 Clinic Sites: 118 Oak Street, Brentwood 550 School Street, Pittsburg 2355 Stanwell Circle, Concord .. Juvenile Hall, 200 Glacier Drive, Martinez 38th & Bissell, Richmond Nature of Reduction or Change: Eliminate clinic staff overtime through improved clinic scheduling and staffing practices. Staff Reductions: Clinic Services staff overtime Patients15ervices Affected: No Direct Impact Expected Annual Savings: $20,000 IMMUNIZATION PROGRAM Provides low cost childhood immunizations to children throughout the county, with particular focus on infants and those entering school. Across the nation and in this county children are not adequately immunized. Sites: Richmond, 38th & Bissell Concord, 2355 Stanwell Circle Pittsburg, 550 School Street Nature of Reduction: Reduce total Immunization Clinic hours from 64 per month to 24 per month ( a 63% reduction). Remaining clinics will be two clinics per month in each location. Site Before After Reduction Richmond 24 hrs./mo. 8 hrs./mo. 16 hrs./mo. Concord 30 hrs./mo. 10 hrs./mo. 20 hrs./mo. Pittsburg 10 hrs./mo. 6 hrs./mo. 4 hrs./mo. Staff Reductions: Reduce hours of two staff RN's 40 hours per month each. Reduce clerical hours by 80 hours per month for two clerks. Patients IServices Affected: Reverses a positive trend toward increased childhood immunizations and decreased immunization-preventable disease. Increased clinic hours in the past two years have resulted in 13,000 additional immunizations, a 39% increase. This increase was instituted following 108 cases of measles resulting in 2 deaths in one year. Most cases were not immunized. The County rate of immunizations for children ready to enter kindergarten has markedly improved with 2 1 the increased clinic hours preventing untold incidents of childhood illness and death. This reduction would result in 15,000 to 20,000 individuals not immunized. Expected Annual Savings: $45,000 PUBLIC HEALTH NURSES Provide Nursing support to countywide programs, clinics, and services including: Child Health Screening, Tuberculosis, Communicable Disease, Immunization, Employee Occupational Health, Health Care for the Homeless, High Risk Infant, Home Health Agency, Child Abuse follow-up, CHDP/EPSDT, ADAPT, Healthy Start, Family Planning, , School Based Health Programs, CCHP Advice Nurse, Well Child Care, Refugee/Migrant Health, Acute Care follow-up, AIDS, and California Children's Services. Public Health Nurses provide the vital link between the prevention/early detection Public Health programs and services, and access to and follow-up of treatment. Sites: Pittsburg, 550 School Street Richmond, 38th & Bissell Concord, 2355 Stanwell Circle Nature of Reduction or Change: Reduce nursing overtime through improved scheduling, program and clinic staffing practices. Staff Reductions: Nursing Overtime. Patients/Services Affected: No Additional Impact. Expected Annual Savings: $50,000 HOME HEALTH AGENCY Delivers multifaceted professional medical, supportive and social services to homebound patients by nurses; physical, occupational, and speech therapists; home health aides, and medical social workers. The client population includes the frail elderly, infants and children, the acutely ill, and patients recently discharged from hospitals. The agency further provides visits to drug exposed newborns and mothers, and to women with medical problems. is Sites: Pittsburg, 550 School Street Richmond, 38th & Bissell Concord, 2355 Stanwell Circle Nature of Reduction or Change: Reduce in-home visits to the indigent by Home Health Aides and Public Health Social Workers from 3,700 visits annually to 1,500 visits annually. Specifically 1,800 annual Home Health Aide visits and 400 annual PH Social Worker visits to non-payor covered clients would be eliminated. Eliminate Account Clerk position thus causing delays in billing multiple payors, interrupted cash flow and possible denial of reimbursement. Eliminate agency staff overtime. Staff Reductions: 2 FTE Home Health Aides .5 FTE PH Social Worker 1 FTE Acct. Clerk III Staff Overtime Patients IServices Affected: On annual basis, about 550 people would be affected. Home Health Aides and Public Health Social Workers provide social and supportive services to home-bound clients. F,Qected Annual Savings: $160,000 COMMUNICABLE DISEASE/AIDS The Communicable Disease program offers prevention education for people at highest risk for STD and HIV/AIDS. Provision of brochures and "safety" kits for people at risk is a major part of this program. A full range of support and care services are offered which better enable people to cope with their infection or the infection of a family member. Sites: Concord - 2355 Stanwell Circle Richmond - 38th & Bissell Pittsburg - 550 School Street Nature of Reduction: Effective September 1, 1992,a reduction of outreach, education and referral activities to persons at-risk for HIV infection. Reduce the number and availability to other programs and the community of STD and AIDS Brochures and education materials, and reduce by 50% the number of Bleach kits provided IV Drug Users. Eliminate support groups for people with HIV and their families. Staff Reduction: 1 FTE PH Aide - AIDS Outreach Worker 1 FTE Patient Financial Services Spec. - AIDS .175 FTE Temp. Sr. Health Ed. Spec. - AIDS .075 FTE Temp. Health Ed.Specialist - AIDS Communicable Disease/AIDS staff overtime Patients/Services Affected: On annual basis 14,000-15,000 persons most at risk for HIV infection and Sexually Transmitted Disease would be affected. 4 DEVELOPMENTAL DISABILITIES COUNCIL Sites: Martinez - 597 Center Avenue Richmond - George Miller Center-West Nature of Reduction: Effective September 1, 1992, eliminate county/department staff support to the Developmental Disabilities Council. Staff Reduction: .5 FTE Executive Assistant, Developmental Disabilities Council Patients Affected:Advocacy and services coordination for services to developmentally disabled recipients throughout the county. Expected Annual SavinEs: $ 40,000 PREVENTION PROGRAM Sites: Pleasant Hill - 75 Santa Barbara Rd. Richmond - 38th & Bissell Nature of Reduction: Effective September 1, 1992, eliminate Administrative Intern providing media"and public relations support. Staff Reduction: Temporary part-time Administrative Intern Patients Affected: None Expected Savings: $ 16,000