HomeMy WebLinkAboutMINUTES - 11011983 - 2.4 TO: BOARD OF SUPERVISORS
FROM: M. G. Wingett, County Administrator Contra
Costa
DATE: October 27, 1983 County
SUBJECT: Hearing Pursuant to Health and Safety Code
Sections 1442 and 1442.5 "Beilenson Hearing"
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Fix Tuesday, December 6, 1983, at 2:30 p.m. as the date and time to conduct a hearing
pursuant to Health and Safety Code Sections 1442 and 1442.5; adopt description of health
programs subject to reduction or elimination, and order Health Services Director to post
the notice of hearing at all County health facilities in the County pursuant to Health
and Safety Code Section 1442.5 by 5 p.m. Friday, November 4, 1983.
BACKGROUND/JUSTIFICATION:
The adopted County Budget for 1983-84 provides approximately $5.8 million less in funds
for Health and Medical services than was provided for in the Finance Committee's report
on the Proposed Budget for 1983-84. Some reductions will be made as a result of the
"Beilenson" hearing being held on Mental Health, Drug and Alcohol programs November 1 , 1983.
The Health Services Director is, therefore, proposing the reduction or elimination of the
programs listed on the attached summary. Additional reductions which are believed not to
impact the provision of services to indigents are also being made.
CONTINUED ON ATTACHMENT: X YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S) 6i.(ZUA e
ACTION OF BOARD ON ovem er 1 , 1963 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT; ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
OF SUPERVISORS ON THE DATE SHOWN. 191
CC: Health Services Director ATTESTED �`f 'J / / r1f`3
County Counsel J.R. OLSSON, COUNTY CLERK
County Administrator AND EX OFFICIO CLERK OF THE BOARD
/Auditor—Controller
M382/7•83 BY �(1'• ��-�``�L�*-�" DEPUTY
NOTICE OF PUBLIC HEARING
The Board of Supervisors of the County of Contra Costa will conduct a
PUBLIC HEARING pursuant to the Health & Safety Code Section 1442. 5 on
proposed elimination and/or reduction in the level of health services
provided in the County. The hearing will be held at the following time
and place:
Board of Supervisors Chambers
Room 107, Administration Building
651 Pine Street
Martinez, California 94553
December 6, 1983 2:30 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 by implementation
of the proposed changes contained in the attached summary. More detailed
information on these proposed changes is available for review at the office
of Mr. Gordon Soares, 2500 Alhambra Avenue, Martinez, California 94553 during
regular business hours (generally Monday through Friday, 8 a.m. to 5 p.m. ) .
The Board does not consider all of the program changes in this Notice to
be within the required coverage of Health and Safety Code Section 1442. 5.
Its scheduling of this Hearing, giving this Notice of Hearing, the holding
of a Hearing, or the making of any finding as to the program changes in this
Notice shall not be construed as an admission by the County of Contra Costa,
or the Board of Supervisors, that any other program changes covered by the
Notice are subject to the hearing provisions of Health and Safety Code
Section 1442.5.
This Notice may be amended from time to time before the Public Hearing in
order to clarify or reduce its impact. The proposals may be rejected or
modified by the Board of Supervisors before the Public Hearing.
FILED
NOV 1983
J. R. •LSSON
CLERIC to
OF SUPERVISORS
9 T�-IA Si CO
192
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PROPOSED REDUCTIONS FY 1983-84
INTRODUCTION
The budget reductions shown below, while reducing the Health Services
Department budget by approximately $5.5 million, will not inordinately
affect direct patient services. Many reductions are in the area of
non-patient expenses where discretion allows reductions or deferred
payments that won't affect patient care. Other expenses which are in
the patient care area were reduced on the application of standards which
take into account patient demand. (Housekeeping per 1000 square feet of
N occupied hospital beds, or productive hours per unit of service, or
setting staffing levels to meet varying patient census or visits, are
examples.) Thus, where reductions are being made, the Department's
ability to provide service was considered foremost. That is not to say
that some effects on patients will not occur; however. For instance,
one type of effect, while no services will be denied may be instances
where waiting times for appointments throughout the hospital and out-
patient clinics are extended as much as one or two weeks.
GENERALIZED DEPARTMENT REDUCTIONS - $1.9 MILLION
1. Reduction in Social Services Costs . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . $ 600,000
The Health Services budget was predicated on an inter-
departmental arrangement with the Department of Social
Services to do eligibility for county Basic Adult Care
patients (MIA's) . The Health Services Department .has
determined that it has the capacity to do the eligibility
screening at less cost. Patient care will not be affected
by this reduction.
2. Reduction in Department Malpractice Insurance $ 500,000
The county self-insures itself against malpractice.
The malpractice fund has sufficient money to meet
anticipated 83-84 payments and, therefore; the amount
budgeted for 83-84 may be reduced. This insurance fund
does not affect patient care.
3. Health Plan Reinsurance Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 500,000
A part of the state allocation to the county for the Basic
Adult Care (MLA) premium has gone to pay for reinsurance to
cover catastrophic illnesses exceeding a certain amount. The
elimination of this reinsurance rust will not effect patient
care but the insurance risk will be absorbed by the Health Plan.
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4. A) Elimination of 31 Temporary Employees . . . . . . . . . . . . . . . . . . . $ 250,000
B) Unfunding Vacancies in the Department F $ 293,000
Eliminating Overtime Costs
C) Reduction in Use of County Counsel $ Auditor Charges . . . . $ 2800000
These reductions do not effect patient care. Since
the positions being unfunded are currently vacant, they
obviously had no incumbents and, therefore, no patients
are affected.
Temporary employees represent excess staffing and,
therefore, may be eliminated without detriment to
M
services.
OFFICE OF THE DIRECTOR AND MANAGEMENT $ ADMINISTRATION REDUCTIONS - $ 450,728
1. Elimination or Reduction of Consultant Contracts. . . . . . . . . . . . . . . . $ 262700
These consultant contracts were for non-patient related
services.
2. Reduction of two FTEs in Research $ Evaluation. . . . . . . . . . . . . . . . . . . . $ 44,300
These two FTEs performed special studies in the area of
Department objectives. The incumbents will be reassigned
in the Department to do higher priority work.
3. Reduction of Medi-Cal planning staff in Office of the Director. . . . $ 19,443
Cancellation of equipment leases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13,300
These costs were a part of Medi-Cal planning for the
county's proposal to manage the Medi-Cal program at the
county level. The project is all but complete and budgeted
costs for the remainder of the year may be eliminated.
4. Unfunding of Volunteer Coordinator Positions (9 months) . . . . . . . . . . . $ 16,830
The Hospital Volunteer Coordinator position was recently'
vacated by a resignation. The duties will be assumed by
another Department employee doing less priority work.
Thus, one salary is saved without affecting the Hospital
Volunteer Program or patients.
S. Reduction of Department Dues t; Subscriptions. . . . . . . . . . . . . . . . . . . . . . S 25,000
Elimination of county cars to Health Serviccs . . . . . . . . . . . . . . . . . . . . $ 20,0()0
These are non-patient items .
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6. A) Elimination of Vacant MSA-B Position for Capital Projects. . . . $ 11,960
(8 months)
B) Elimination of Clerical Salary (7 months) . . . . . . . . . . . . . . . . . . . $ 11,228
C) Elimination of Budget Officer Position (6 months) . . . . . . . . . . . . $ 18,000
D) Rent Savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 10,000
E) Elimination of Payroll Clerk Position 8 Secretary. . . . . . . . . . . . $ 24,264
Clerk (8 months)
F) Elimination of three Security Guards (8 months) . . . . . . . . . . . . . $ 39,416
G) Elimination of Storeroom Clerk Position (8 months) . . . . . . . . . . . $ 9,952
H) Elimination of Copy Center Clerk Operator f. . . . . . . . . . . . . . . . . $ 30,072
HSA-C Administrator (8 months)
These positions do not serve patients. The Budget Officer
position will be filled from within the Department's :urrent
staff. The elimination of three Security Guards may,affect
patients because some clinic areas will have insufficient
security to assure patient safety at all times. ,
7. Savings of Employee Benefits for Above Eliminated Staff . . . . . . . . . . $ 58,263
8. Reallocation of Department Safety Officer P, Management $ 581000
Development Specialist to County Personnel Activities
The current budget was predicated on the Health
Services personnel unit being limited to Health Services
Department activities only. An exchange of Health Services
personnel unit staff for Safety F, Management Development
to assist County Personnel has resulted in staff savings
to the Health Services Department and assures a continuing
viable Safety Program for patients and staff.
9. 20% Salary Reduction of Director of M&A, Administrative Assistant. .$ 14,000
and other management staff in M&A for Three Months
MEDICAL CARE DIVISION - $ 2,300,000
1. Reduction in Need for Pharmacy Supplies due to Advanced. . . . . . . . . . . .$. 125,000
Purchases in 82-83
Since these pharmaceuticals and patient supplies are
in stock now for the 83-84 budget year, patient care
will not be affected by this reduction.
2. A) Re-staffing of Registered Nurses, I.VNs and Hospital . . . . . . . . $ 1,225,000
Attendants to reflect variable staffing and acuity needs
based on fluctuating census in Hospital
The variable staffing plan will effect 75 RN, LVN and
HA positions resulting in shift changes, adjustments of
full-time positions to permanent part-time and some
limited-term appointments. The variable staffing will
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allow for increased flexibility in meeting
patient demand, therefore this is seen as not
affecting patient care, but being better able
to serve patients and the hospital .
B) Consolidation of C Ward (Surgical) $ D Ward (Ped/GYN) . . . . . . . . . $ 200,000
Due to low patient census, this consolidation. will
result in the change of the nurse staffing mix on
the combined ward to accommodate acuity of patients.
This will shift 13 nursing positions as a part of
variable staffing plan outlined above.
3. The elimination of one social worker and the shifting of four. . . . . $ 125,000
additional social workers to other divisions will result in
savings to the Hospital.
The Hospital budget currently carries the costs of all
outpatient Social Service staff. This adjustment removes
the costs from the hospital budget and shifts it to
Ambulatory Care. One FTE social worker will be eliminated
and others may be affected. Caseloads for the remaining
social workers will increase correspondingly resulting in
some delay in patient discharges from the hospital .
4. Elimination of HSA-C level positions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 60,000
This administrator does not provide patient services
S. Reduction of supplies as a result of closing C Ward. . . . . . . . . . . . . . $ 15,000
6. Reduction of contract payment for EKG services. . . . . . . . . . . . . . . . . . . $ 14,000
Both number five and six above are predicated on current
census level and estimated revenues for the Department
83-84 budget. The reductions, therefore, do not affect
patient care since they reflect costs for services
currently not in demand. As patient census increases,
revenue will be associated with it so that needed services
to meet patient demand can be reinstated.
7. Elimination of ten (10) Housekeeping staff in Hospital. . . . . . . . . . . $ 150,000
Based on Ilousckeeping staff per 1000 square feet of liosl;it:: l
space as compared to comparable facilities, this staff may
be eliminated without detriment to patient care. Daily
cleaning of administrative space to once a week cleaning
only .ill result .
This reduction will not affect the Hospital 's ability
to provide housekeeping in occupied hospital rooms.
b. Generalized budget reductions in the ilospital for various. . . . . . . . . 25,000
office and administrative supplies, management contracts
(non-service related) and office equipment
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9. Change in linen contract from laundry service to full . .. . . . . . . . . . $ 77,000
linen service and the elimination of five laundry positions
over nine months.
The current laundry contract is for laundering and
pressing of linen only. The contract requires the
Health Services Department to have staff to sort,
deliver and pick up linen. The proposed contract is
for full linen service including delivery and—inventory
by ward. Thus, a more useful service will be available
to better serve patients' needs. Staff will no longer
be needed by June 1984.
.10. Eliminate one FTE nurse in Utilization Review . . . . . . . . . . . . . . . . . . . . $ 22,807
Current reorganization of Quality Assurance and Utiliza-
tion Review functions allow for the reduction of one FTE
nurse in Utilization Review who can now serve patients.
This will result in savings and a better capability to
directly serve patients.
11. Eliminate .S FTE in medical library. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . $ 6,763
This is a support function to staff and will not affect
patient care.
12. Reduce anesthesiology contract payment limit to reflect actual. . . . .$ 10,000
costs for services needed.
: 13. Reduce supplies needed in eye prosthesis cost center as a . . . . . . . . $ 9,233
result of contracting for cataract surgery.
.14. Reduction in miscellaneous supplies in Pathology Lab. . . . . . . . . . . . . . $ 24,148
1S. A reduction in the payment limits for specialty contract. , , , . , , , , . $ 160,000
physicians.
The above reductions (11 - 15) are the result of limiting
payment levels on "open ended" contracts for services.
Projected service need is shown to have declined in these
areas and increase will result in new revenue to reinstate
them as needed for patients' demand.
16. The outpatient health centers (clinics) except those in Martinez,
will be closed to all but Health Plan members. No reductions will
be made in transportation services , thus transportation to Martinez
will be available for any indigent who is not a Health Plan member.
DIVISION OF ALCOHOL/DRUG ABUSE/MENTAL HEALTH * - $413,388
* These reductions were the subject of prior Beilenson hearings and
the total is shown here for clarification only and to illustrate total
reductions to cover the Department' s deficit.
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CCHP E AMBULATORY CARE DIVISION - $523,000
1. Reduction in out-of-plan expenses for Health Plan enrollees. . . . . . . .$ 350,000
This will require CCHP enrollees to obtain more care
at CCHP sites. No service reduction will occur, only
the place of service for some patients.
2. Reduction of one FTE in Concord Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5,808
3. Elimination of one FTE medical staff physician and supplies. . . . . . . $ 54, 192
in Richmond Clinic
The reduction of this FTE will reduce utilization by
3,176 patient visits, while no patients will be -iefused
service, waiting for an appointment may be extended.
4. Pittsburg Clinic staff reductions. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . $ 53,000
The staff reductions and savings are:
- reduce two dietitians by 12 hours . . . . . . . . . . . . . $ 6,089
- cancellation of four hours of physician. . . . . . . . $ 3,700
time/week in a GYN clinic
- cancellation of four hours/month of allergy
testing:
-- one FTE Hospital Attendant . . . . . . . . . . . . . .$ 13,380
-- Reduction of 20% LVN . . . . . . . . . . . . . . . . . .. .$ 5,266
- reduction of 33% Clerk . . . . . . . . . . . . . . . . . . . . . . . .$ 4,000
- elimination of one vacant Supervising Nurse. . . .$ 15,000
position
The above reductions will affect the clinic's capacity in
Brentwood and Pittsburg td serve approximately 750 patients.
As with Richmond, no services will be denied, but waiting
.times for appointments may be extended.
INFORMATION SYSTEMS - $145,000
1 . Elimination of temporary clerical and management employees. . . . . . . . .$ 60,000
2. Elimination and/or reductions in payment limits to contractors. . . . .$ 65,0110
providing consultation to the Department on automated systems
replacement.
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