HomeMy WebLinkAboutMINUTES - 10191993 - IO.1 TO: BOARD OF SUPERVISORS I.O.-1
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Contra
INTERNAL OPERATIONS COMMITTEE i
FROM:
Costa
4° Count
October 11, 1993
DATE:
SUBJECT: REPORT ON THE FUNDING OF THE POISON CONTROL CENTER
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1 . AUTHORIZE the County' s Emergency Medical Services (EMS) Agency
to continue to provide access to the San Francisco Poison
Control Center (PCC) for 9-1-1 calls .
2 . DIRECT the Health Services Director to request that the John
Muir Medical Center hold in abeyance its community service
financial commitment until the Board of Supervisors determines
whether other funding is available which, alone or combined
with John Muir's funding, will provide for the reestablishment
of the public PCC hotline on an ongoing basis. Should such
funding not be identified by March 31, 1994, DIRECT the Health
Services Director to seek an, amendment to the John Muir
Medical Center trauma center contract redirecting John Muir
Medical Center' s community service commitment to another
program or activity. REQUEST John Muir Medical Center to
continue to accrue the funds which they have committed to
community service while the Board of Supervisors determines
the most appropriate and highest priority program to
receive those funds .
3 . DIRECT the County Administrator to include in the County' s
1994 Legislative Program support for efforts to establish
permanent funding for a State PCC Program.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE THER
SUNNE WRIGHT MC PEAK JEFF SMITH
SIGNATURE(S):
ACTION OF BOARD ON- October- 19, 1993 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED IT'-►-ur-, Z. / f
Contact: See Page 3 . PHIL.BATCHELOR,CLERK OF THE BOARD OF
CC: SUPERVISORS AND COUNTY ADMINISTRATOR
BY DEPUTY
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4 . AUTHORIZE the Chairman of the Board of Supervisors to sign a
letter to the State EMS Authority asking that the Authority
take steps to assure that the residents of Contra Costa County
have the same level of access to poison hotline services
afforded through the State Regional Poison Control Center
Program as do residents of the other 57 counties in
California.
5 . DIRECT the Health Services Director to explore with other
counties in the Bay Area the extent of interest in going out
to bid with a Request for Proposals (RFP) to establish a less
expensive alternative to the San Francisco PCC.
6 . DIRECT the Health Services Director to explore with other
counties in the Bay Area the extent of interest in
consolidating the San Francisco, Santa Clara and U.C. Davis
PCC ' s in an effort to improve service levels and reduce costs .
7 . DIRECT the Health Services Director to publicize with
hospitals and physicians in the County the availability of
poison control center services from other centers within
California as well as the availability of services from
similar centers in other states, and how hospitals, physicians
and individuals can access those alternative services at
little or no cost.
8 . DIRECT the Health Services Director to engage in a process
which will identify the highest priority for receipt of the
redirected funds from John Muir Medical Center if the Board of
Supervisors were to decide to undertake such a redirection.
9 . DIRECT the Health Services Director to explore with other
health plans which operate in Contra Costa County, including
Kaiser, their willingness to pay for calls to the San
Francisco PCC they initiate on a per call basis, as does the
Contra Costa Health Plan.
10 . DIRECT the Health Services Director to investigate the
specific incident that was presented to our Committee by Cathy
Bookbinder regarding the unwillingness of the 9-1-1 operator
to stay on the line when a call is transferred to the San
Francisco PCC and more generally the extent to which 9-1-1
operators are following the established protocol of staying on
the line whenever they make a transfer to a secondary resource
until the caller has completed his or her business and is
prepared to terminate the call .
11 . DIRECT the County Administrator to forward this report, along
with a cover letter, to each member of the legislative
delegation of the 10 counties which use the San Francisco PCC,
explaining the inequity of having to pay for services which
apparently every other local jurisdiction in the United States
is able to make available for free to its residents and send
a copy of this letter and report to the Board of Supervisors
and County Administrator of each of these ten counties, asking
for their support with the members of their legislative
delegation.
12 . DIRECT the Health Services Director to prepare a letter and
AUTHORIZE the Chairman of the Board of Supervisors to sign a
letter to the Director of the State EMS Authority, protesting
the inequity of allowing the San Francisco PCC to charge for
its services as a condition of making them available to the
residents of a county, a condition which exists nowhere else
in California and perhaps nowhere else in the United States .
13 . REQUEST the Health Services Director and County Administrator
to report back to our Committee on January 3, 1994 regarding
the progress which has been made in following up on each of
these referrals .
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BACKGROUND:
On July 20, 1993, the Board of Supervisors provided direction to
staff regarding following up on the unwillingness of the San
Francisco Poison Control Center (PCC) to continue to provide
services to the residents of any county which was unable to provide
funding to the PCC on the terms dictated by the PCC. The Health
Services Director was directed to report back to our Committee on
the status of these referrals, including the availability of
funding from the State as a result of action by the Legislature.
On October 11, 1993, our Committee met with Dr. Walker, Art Lathrop
and Janiece Nolan from John Muir Medical Center. Mr. Lathrop
reviewed with us the attached report from the Health Services
Director. Mr. Lathrop emphasized the fact that poison control
services are still available to hospitals on a direct line and are
also available to those who call 9-1-1, which in turn, transfers
callers asking about poison related issues to the San Francisco PCC
for a fee which is paid by Contra Costa County. However, it seems
clear that the majority of individuals who used to call the PCC no
longer have access to those services because they do not call 9-1-1
and are not generally at a hospital when they need the services .
We noted that the San Francisco PCC is the only one in California
and perhaps in the country which, in effect, charges for its
services by restricting access to its services from those counties
which are unable to pay for what the PCC considers the county' s
share of its costs . It was also noted that since other PCC' s do
not charge for their services and do not restrict access to their
services, if an individual knew the telephone number to call, one
could receive services from the Santa Clara, U.C. Davis or any
other PCC in California or the United States .
Our Committee continues to believe that economies of scale could be
achieved if regional PCC' s were consolidated. In any case, we
believe that the Bay Area counties might be able to regain control
over the services which are provided to their residents if the
counties were to bid out their PCC services to that center which
was willing to provide the counties with the most cost effective
arrangement.
We are also unwilling to have John Muir Medical Center contribute
to the San Francisco PCC on behalf of the County until we are sure
that the services will be available to the residents of the County
and until we are convinced that PCC services are the highest
priority for John Muir Medical Center's community contribution.
We also heard from a woman who is a mother and a nurse who had a
difficult encounter with 9-1-1 and the San Francisco PCC in that
the 9-1-1 operator did not stay on the line once the transfer was
made to the PCC, contrary to established policy. This necessitated
another call to the PCC (at a cost of $25) in order to receive
information which should have been available for free.
As a result of the attached report and our discussion on this
subject, we have formulated the above recommendations, which we
urge the Board of Supervisors to adopt. We will return further
recommendations following our next meeting on this subject.
cc: County Administrator
Health Services Director
William B. Walker, M.D. , County Health Officer
Art Lathrop, Director, EMS
Janiece Nolan, Chief Operating Officer
John Muir Medical Center
Contra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers, 1st District
Jeff Smith,2nd District �,E_.s-.._,c Mark Finucane, Director
Gayle Bishop,3rd District >_ 20 Allen Street
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Sunne Wright McPeak,4th District Martinez,California 94553-3191
''� �/`�.
Tom Torlakson,5th District --__ _
n. -' (510)370-5003
FAX(510)370-5098
County Administrator ;,
Phil Batchelor �OSr•-.__-_ .----cP`�
County Administrator a �ouv�t
September 21, 1993
TO: Internal Operation C mittee
FROM: Mark Finucane, ealth Services Director
SUBJ: Poison Control Center Funding
On July 12, 1993, Health Services Department staff reported to the I.O. Committee on
funding for the Bay Area Poison Control Center (PCC) and the steps John Muir Medical Center had
taken to meet the terms of its community obligation as a condition of being designated the County's
trauma center. Based upon that meeting and approval of the I.O. Committee report by the full Board,
it was decided:
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(1) That no funding by or on behalf of the County would be committed to the poison
center until final determination of funding available from the State;
(2) That the County would resume dealing directly with the San Francisco PCC rather
than using John Muir as an intermediary;
(3) That the Health Services Director would explore options for poison control center
services, including increased funding by Kaiser for calls from Kaiser members; and
(4) That the Health Services Department would report back to the 1.0. Committee on
September 27, 1993.
Background Information
The Regional Poison Control Center (PCC) Program was established with the enactment of
SB 1124 passed by the State legislature in 1984. This bill directed the State EMS Authority to
establish minimum standards and geographical service areas for poison centers and to set criteria for
designation of Regional PCC's. Of 11 poison center programs in existence at that time, 7 were
designated as Regional PCC's to serve the seven geographic areas of the state established by the State
EMS Authority. SB 1124 further provided that programs not designated as Regional PCC's could not
hold themselves out to the public as providing poison advice services.
Merrithew Memorial Hospital&Clinics Public Health • Mental Health • Substance Abuse Environmental Health
Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics
A-345 (2/93)
The San Francisco PCC, operated by the San Francisco Department of Public Health and the
U.C.S.F. School of Pharmacy, was designated to serve 10 counties including Alameda, Contra Costa,
Del Norte, Humboldt, Marin, Mendocino, Napa, San Francisco, San Mateo, and Sonoma. Other
Regional PCC's were designated by the State in Fresno, Los Angeles, Santa Clara, Davis, Irvine, and
San Diego. PCC funding was provided by grants from the State EMS Authority and by the PCC host
organizations - typically a public hospital or teaching institution.
Prior to reductions resulting from the State budget crisis in 1992, State funding was made
available through the EMS Authority to cover about 40 percent of the operating costs of PCC's. The
remaining costs were absorbed by the host agency. In an effort to cover some of the remaining costs,
the SF PCC has solicited donations, established hospital memberships, and requested funding from
counties. For several years, Alameda County was the only county within the region (other than San
Francisco as host county) which provided support.
In FY 1990-91, the PCC requested Contra Costa to provide funding at $10.00 per call for
nonhospital calls. This would have amounted to $81,250 for human exposure calls only, or $96,000
for all calls. One potential source of funding for this request was CSA EM-1 (Measure H). The
Measure H Oversight Committee recommended against this since PCC services did not meet the
criterion of new or enhanced EMS services. However, a one-time contribution of$30,000 was made
to the PCC using funds available to the County through the consent agreement between I.T.
Corporation and the State Department of Health Services. The following year, a $61,200 contribution
($30,000 cash and the remainder a fundraising guarantee) was made to the PCC on behalf of Contra
Costa County by John Muir Medical Center in connection with the community services provision of
its trauma center agreement.
Meanwhile, efforts were being made by Bay area health officials and others to establish
permanent State funding for PCC's. One bill supported by Bay area health officials would have
enabled the State to charge PCC costs back to manufacturers. This bill was passed in the 1991-92
legislative session, but vetoed by the Governor. In 1992, State funding for PCC's was cut in half to
$1 million. Two bills introduced in the 1992-93 legislative session failed to pass out of committee.
AB 2377 would have raised $8 - $9 million for PCC's through a new 9-1-1 tax. SB 1016 would have
enabled PCC's to tap into a surplus in the State 9-1-1 fund.
As a result of cuts in State funding, the failure of legislative efforts to establish permanent
funding, and San Francisco's unwillingness to continue funding services benefiting other counties, the
SF PCC obtained permission from the State EMS Authority to discontinue public poison hotline
services in those counties not contributing to the cost of those services. In letters dated June 28,
1993, each of the counties served by the SF PCC was invoiced for its share of cost for FY 1993-94
and given notice that service would be terminated on August 1, 1993, if a commitment was not
received for payment of the invoiced amount. Contra Costa's invoiced amount was $124,440 based
upon the number of nonhospital calls originating from within the county.
Current Status of PCC Services
Effective August 4, 1993, public access to the SF PCC was terminated by restricting the 800
telephone number used for this purpose. Prior to this cutoff, arrangements were made with the PCC
to establish a separate 800 number which would be available to public safety answering points
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(PSAP's) to conference with the PCC on 9-1-1 calls involving a poisoning emergency. These calls
represent only a small fraction of the some 9,000 human exposure calls received annually from
Contra Costa residents, but are calls involving actual emergencies or perceived emergencies. The
County has agreed to pay $25.00 per call for these calls. Prior to the termination of the public
hotline, the number of 9-1-1 calls conferenced with the PCC was about 200 to 300 per year.
Preliminary figures indicate that, with termination of the public poison hotline, the number of 9-1-1
callers has doubled or tripled.
All hospitals in Contra Costa County, including Merrithew Memorial, are paid members of
the PCC and, therefore, have access to a special 800 number designated for hospitals. The Contra
Costa Health Plan has also established an arrangement for access by its advice nurse to the PCC on a
charge per call basis.
Currently, Contra Costa and Del Norte Counties have not committed to paying the PCC
charges, although some counties have committed only on a quarter by quarter basis.
Impact of Discontinuation of Poison Hotline
While full data is not yet available on the impact of discontinuation of the PCC public hotline
in Contra Costa, it appears that there have been increases in calls to 9-1-1, calls to the Kaiser advise
nurse services, and calls to hospitals and pediatricians. Prior to discontinuation of the public hotline,
the PCC received about 150 calls per week from the public in Contra Costa County. Since the
discontinuation, calls placed through 9-1-1 have increased from only a few per week to about 20 per
week. Calls received by the PCC from hospitals in the county have increased from about 33 per
week to about 67 per week. That leaves an expected 100 calls per week which are being handled
without referral to the SF PCC. These potential callers may have their questions answered directly
by a physician or by an advice nurse, or may be obtaining information from another source.
Arrangements to provide access to the PCC via 9-1-1 have insured that poison center
assistance is available in managing actual emergencies. While there were three documented cases of
unnecessary EMS response to reported poisonings during the first three weeks following
discontinuation of the hotline, these responses may have occurred in any case.
One impact of the discontinuation of the public hotline has been that pediatricians and other
physicians no longer have access to the PCC except when calling from a hospital.
PCC Fundina Status
Since last reported to the I.O. Committee, there has been no additional State funding made
available for PCC's. Kaiser representatives have indicated that: some review of their support for
PCC's beyond the level of hospital membership is underway. Kaiser is only willing to address this
issue on a regional basis, not county-by-county. Currently, all Kaiser Foundation hospitals within the
10-county SF PCC service area are paid members. This covers the costs of services to those
hospitals, not the cost of calls directly to the PCC from Kaiser Health Plan members.
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A new potential source of funding may be available under SB 456 which is awaiting signature
by the Governor. This is an administration bill which would allow the California Medical Assistance
Commission (CMAC) to consider PCC services reimbursable when provided by hospitals with
disproportionate MediCal patients loads. In effect, this would provide an additional $600,000 in
Federal matching funds for the State's PCC contributions. If signed, this would not take effect until
next year.
The SF PCC's FY 1993-94 proposed operating budget based upon services to and support
from all 10 counties was as follows:
REVENUE
County government support $ 790,151
Hospital membership 205,889
State EMS Authority 138,333
UCSF 74,100
Court settlement 44,000
Donations .2,530
Other anticipated revenue 28.947
Total $1,283,950
EXPENSES
Poison Info Specialists 941,700
Other personnel 236,250
Telephone service 42,000
Reference materials 17,000
Staff development/training 10,000
Education materials 5,000
Data processing 2,000
Office supplies/newsletters 30.000
Total $1,283,950
Failure to receive funding from Contra Costa and Del Norte Counties would reduce revenues
by up to $129,672. This loss, offset by any increased revenues from Contra Costa's payment for
9-1-1 calls or increased payments by the Kaiser system, would result in corresponding decreases in
expenditures accomplished by staff reductions.
Options,
Use of other poison centers. HSD staff have explored affiliation with other poison centers,
including UC Davis, Santa Clara Valley Medical Center, and Rocky Mountain. None of these
centers would be willing to provide services to Contra Costa at a lower cost than the service is
available through San Francisco. The San Francisco PCC is generally regarded as providing an
efficient and high quality service when compared to other PCC's in the state or nation. However, at
this time, the SF PCC appears to be the only poison center which limits access to 800 numbers. This
means that an individual can access other poison centers by dialing the appropriate long distance
number.
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Industry funding. HSD staff have explored the possibility of obtaining contributions through
the major petroleum and chemical industries in Contra Costa County. At this point, there has been
interest expressed by at least one major refinery, but no commitment.
Hospital funding. All Contra Costa County hospitals currently are paid members of the SF
PCC at a cost of about $5,000 each. The PCC has informed its member hospitals that charges would
be increased for hospitals which generate significantly increased numbers of calls to the PCC as a
result of discontinuation of the public hotline within their counties. The PCC has not provided data
on this yet, but has indicated that there has been a major increase in calls from Kaiser Foundation
hospitals in Contra Costa County.
Count operated poison hotline. HSD staff have considered the feasibility of operating a
poison hotline through the County Health Plan, but have concluded that the cost of operating such a
service would exceed by a considerable amount the proposed charges from the SF PCC. A County-
operated poison hotline would require approval by the State. Staff is continuing to explore the
purchase of computer poison index for use by the CCHP advise nurse as an adjunct and backup to
PCC services. This would also provide backup for the 9-1-1 system in the event that PCC services
were not available.
Consolidation of PCC's to reduce costs. The State EMS Authority recently concluded a study
of the potential cost saving through consolidation of PCC services. That study concluded that there
would not be a significant savings through consolidation. A major consideration in this regard is that,
under the existing system, overhead and even some direct costs (space) are not charged by the host
organizations to the PCC programs.
County_responsibility for 9-1-1 access only. By providing 9-1-1 dispatchers the ability to
conference with the PCC, the County can assure appropriate emergency response for callers with
actual emergencies while avoiding costs for nonemergency services.
Recommendations
1. That the County EMS Agency continue to provide access to a PCC for 9-1-1 calls.
2. That John Muir's community service commitment to PCC funding be held in abeyance until it
is determined if other funding is available which, either alone or combined with John Muir
funding, will provide for reestablishment of the public hotline on a ongoing basis. Should
such funding not be identified by March 30, 1994, the HSD would seek a amendment to the
John Muir trauma center contract redirecting Muir's community service commitment to
another program or activity.
3. The County should support legislative efforts to establish permanent funding for a State PCC
program.
4. The County should request the State EMS Authority to take steps to assure that residents of
Contra Costa County have the same level of access to poison hotline services afforded through
the State Regional Poison Control Center program as residents of the other 57 counties of the
State.
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