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MINUTES - 11161999 - D2
TO:, 'ARD OF SUPERVISORS Contra FROM: Costs. PHIL BATCHELOR, COUNTY ADMINISTRATOR County DATE: November 15, 1999 SUBJECT: UPDATE ON CONSTRUCTION OF TENANT IMPROVEMENTS AT LOS MEDAN'OS HOSPITAL SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMEN_DATIQNS: , 1. RECOGNIZE that the County's existing Medical Center located at 550 School Street, Pittsburg, is obsolete, crowded, in poor condition, and has outlived its useful life. 2. ACKNOWLEDGE that maintaining the health and well-being of the residents of East County requires the continued presence of medical resources in that area of the County. 3. ACKNOWLEDGE that the construction of a new 85,000 square foot ambulatory care facility in East County, which would house the same number of clinics and programs planned for the Los Medanos Health Center, would cost at least $29.7 million exclusive of land acquisition costs, assuming an estimated project cost of $3517 per square foot. 4. ACKNOWLEDGE that on February 10, 1993, the Board of Supervisors authorized the Director of general Services to execute a Lease with the Los Medanos Hospital District for use of its farmer hospital located at 2311 Loveridge load, Pittsburg, as a County Medical Center for residents of East County. CONTINUED ON ATTACHMENT: _k YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR -RECOMMENDATION OF BOARD COMMITTEE _Y_APPROVE OTHER Z`4 SIGNATURE$:&2� ACTION OF BOARD ON dila U f-M h W-C 1 / APPROVED AS RECOMMENDED S_ 4ZW VOTE OF SUPERVISORS 1 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 �� '%� // Y� Contact: PHIL BATCHELOR,CLERK OF TIME BOARD OF CC: SUPERVISORS AND COUNTY ADMINISTRATOR BY / ;w. a ,DEPUTY s. 5. RECOGNIZE that the resulting lease of the 130,900 .square foot hospital facility and grounds that was executed on July 31, 1998, includes the following provisions: • Lease term of twenty years with a ten year renewal option; • Annual lease rate of$100,000; • The County is responsible for the cost of all tenant improvements, maintenance, repairs and other costs of occupancy. 6. RECOGNIZE that during the lease negotiations with the Hospital District and the trustee representing the bondholders of Hospital Building Corporation, the County agreed to repair a range of deferred maintenance items identified by the trustee's facilities consultant, but that this list did not identify either the mechanical or above- ground waste pipe systems as requiring major repairs. 7. ACKNOWLEDGE that the Director of general Services executed a consulting agreement with Fong & Chan Architects effective December 15, 1397, for a space utilization study for Tenant Improvements of 2311 Loveridge Road, Pittsburg, for the Health Services Department, and that this consulting agreement was subsequently amended on August 11, 1998 by the Board of Supervisors to include architectural services related to the design and construction of the Los Medanos Health Center. 8. ACKNOWLEDGE that the Board of Supervisors on December 1,1998, approved a consulting service agreement with RGM and Associates to provide project management services for Tenant Improvements at 2311 Loveridge Road, Pittsburg, for the conversion of the Los Medanos Hospital into the Los Medanos Health Center. 9. RECOGNIZE that RGM and Associates reported to the County in late November 1998 that: • There appeared to be a problem with cracking of the cast iron waste pipe in the facility and that it appeared to be widespread and significant; • The preliminary cost was estimated at $750,000 to correct the cracked waste pipe in the building; • Since much of the suspect piping was concealed in walls, RGMpointed out that it would require fairly extensive investigation and selective demolition once the contractor was selected and on board in order to know if the problem was more severe than preliminarily estimate. 10. RECOGNIZE that preliminary cost estimates prepared on December 30, 1998, by RGM and Associates and Fong & Chan Architects forecast a $8.9 million project budget to convert Los Medanos Hospital into an ambulatory care center, including $5.7 million in tenant improvements and $3.2 million in deferred maintenance work required to open and operate the facility. 11. ACKNOWLEDGE that the December 30, 1998 cost estimate for deferred maintenance was based on preliminary investigations and analysis by both County staff and RGM and Associates regarding known maintenance problems at the Hospital including. • Extensive repairs to the electrical, mechanical, fire alarm and elevator systems; • Landscape maintenance improvements on the land adjacent to the Hospital; • Suspect cast iron waste pipelines in various parts of the building that appeared to be leaking and cracking. 2 1 :_0 12. ACKNOWLEDGE that Mechanical Consulting Company was retained by the County on December 1, 1998 to provide on-site investigation of the existing HVAC system at Los Medanos Hospital, including investigation of the chillers, air handlers, return fans, exhaust fans, hot water heating boilers, chilled and hot water pumps, hot and chilled water pressure test, reheat coils, ductwork and the existing control system. 13. ACKNOWLEDGE the report by Mechanical Consulting Company dated February 5, 1999, and the subsequent report by RGM and Associates of March 8, 1999, that enumerated numerous unanticipated problems with the existing mechanical plant and control system at Los Medanos Hospital that would need to be addressed in a Phase It Tenant Improvement bid package in order not to delay the preparation of the original tenant improvement bid package scheduled to go out to bid on April 20, 1999. 14. RECOGNIZE that the Board of Supervisors authorized the sale of Contra Costa County Public Financing Authority Lease Revenue Bonds, Series 1999A, on December 8, 1998, of which $8,000,000 was allocated for the remodeling of Los Medanos Hospital into the Los Medanos Health Center. 15. ACKNOWLEDGE that bids were received for Phase I Tenant Improvements on May 27, 1999, and that the Board of Supervisors awarded the construction contract to the low bidder Lem Construction, Inc. in the amount of$4,155,842, which was considerably below the revised construction estimate of$5,663,600, and that a notice to proceed was issued to Lem Construction, Inc. on July 19, 1999, 16. ACKNOWLEDGE that on September 29, 1999, RGM and Associates informed the County that the plumbing subcontractor, in the course of work related to demolishing and replacing sections of cranked cast iron waste pipe, discovered an extraordinary degree of internal corrosion and blockage in the waste pipe lines and waste vent pipes that is highly unusual for a relatively new building and that brought into question the continued use of any of the existing waste pipe in the hospital building. 17. RECOGNIZE that, based on RGM and Associates notification of September 29, 1999, the County Administrator directed RGM and Associates to conduct an investigation as to the probable cause of the waste pipe damage, and to recommend a course of corrective action. 18. ACCEPT the report of RGM and Associates, dated November 5, 1999, reviewing the investigations of the Cast Iron Soil Pipe Institute and of Ken Pytlewski, a corrosion engineer with Forensic Technologies International/Anamet Laboratories, which found that the internal corrosion and subsequent cracking of the waste pipe appears to be caused by the presence of a strong acidic solution which remained stagnant in the facility's waste pipes for several years. 19. RECOGNIZE that the replacement of the entire above-ground waste pipe and vent system will increase the project budget by approximately $3 million and delay the completion of the project by approximately six months. 20. DIRECT the County Administrator and the Director of General Services to initiate the process to replace the entire existing above-ground waste pipe and vent system of the Los Medanos Hospital. 21. RECOGNIZE that the radiology equipment at the existing 550 School Street clinic is 30 years old, obsolete, in poor condition, and not repairable, and upon 3 examination of the equipment on site at Los Medanos, it was revealed that it was in similar poor condition. 22. ACKNOWLEDGE that providing adequate radiology services in the remodeled Los Medanos Health Center will require purchasing new equipment at a cost of $707,000, and that financing the radiology equipment through lease revenue bonds results in a lower cost than through equipment vendor financing. 23. RECOGNIZE that the mental Clinic now at 550 School Street was to have been moved to another location after School Street closed, but that staff has not been able to identify an available dental facility location convenient to the new Los Medanos Health Center. 24. ACKNOWLEDGE that remodeling a portion of the Los Medanos facility to accommodate a Dental Clinic will require additional project funding of$300,000, but that this approach allows the County to avoid on-going rental costs for a dental clinic in East County. 25. RECOGNIZE that the cost estimates for the replacement of the above-ground waste pipe and vent system ($3 million), the purchase of new radiology equipment ($707,000), and the addition of a dental clinic at Los Medanos Health Center ($300,000), will increase the project budget from $9 million to $13 million. 26. CONCLUDE that, while the revised project budget of$13 million for the remodel of Los Medanos Hospital into an ambulatory care center is considerably above the initial budget estimate for the project, it nevertheless remains a cost-effective alternative compared to new construction of a similarly sized ambulatory care facility. 27. CONCUR that the revised project budget of$13 million will be financed from the following revenue sources: $8 million in 1990 Contra Costa County Public Facility Authority Lease Revenue Bonds • $2 million in redevelopment funds passed through the City of Pittsburg • $3 million in additional lease revenue bonds that will be sold in 2000 28. ACKNOWLEDGE that plains and specifications for Phase 11 Tenant Improvements are being prepared by Fong & Chan Architects, including central mechanical plant system repairs and the construction of a dental suite. 29. ACKNOWLEDGE that the cost estimate for the initial construction contract for Phase II Tenant Improvements is under $1,050,000. 30. ACKNOWLEDGE that the Berard has previously found on February 18, 1996 that the project is a California Environmental Quality Act (CEQA) Class 1 a Categorical Exemption, and that the Director of Community Development has filed a Notice of Determination with the County Clerk. 31. AUTHORIZE the Director of General Services or his designee to solicit bids for Phase 11 Tenant Improvements at a future date. 32. DIRECT the Director of General Services or his designee to publish at the appropriate time a Notice to Contractors in accordance with Section 22037 of the Public Contract Code, inviting bids for Phase 11 Tenant Improvement work. 33. DIRECT the Director of General Services or his designee to mail notices to the construction trade journals specified in Section 22036 of the Public Contract Code at least 30 days before the date of opening bids for the Phase 11 Tenant Improvement work. 4 34, AUTHORIZE the Director of General Services or his designee to issue bid Addenda, as needed, for clarification of the Phase I# Tenant Improvement contract bid documents, provided the involved changes do not significantly increase the cast estimate for the initial construction contract. Contact: LAURA W. LOCKWOOD cc. County Administrator Health Services Dept General Services Dept County Counsel ItGM and Associates 5 File: 345-9802/B.4.1 THE BOARD OF SUPERVISORS CONTRA.COSTA COUNTY,CALIFORNIA Adapted this Order of November 16,1999,by the following vote: AYES: SUPERVISORS GIOIA, UILKEMA, CIESAULNIER and CANCIAMILLA NOES: NONE ABSENT: SUPERVISOR GERBER ABSTAIN: NONE RESOLUTION NO. 99/584 SUBJECT: Authorizing the Director of General Services to Advertise for Bids for Phase H Tenant Improvements at Los Medanos Health Center 2311 Loveridge Road,Pittsburg (CP#98-1 l) Budget Line Item No. 6973-4604 Authorization No. 0927-WH604B WHEREAS plans and specifications for Phase II Tenant Improvements at Los Medanos Health Center, 2311 Loveridge Road, Pittsburg, are being prepared by Fong & Chan Architects; and WHEREAS Phase II Tenant Improvements may include second floor dental suite improvements in addition to mechanical central plant improvements; and WHEREAS the cost estimate for the initial construction contract is under $1,050,000,00; and WHEREAS the Director of General Services or his designee will obtain the appropriate general prevailing rates of wages,which shall be the minimum rates paid on this project; and VtHEREAS the Board has previously found on February 18, 1998 that the project is a California Environmental Quality Act(CEQA) Class 1a Categorical Exemption, and the Director of Community Development has filed a Notice of Determination with the County Clerk; IT IS BY THE BOARD RESOLVED that the Director of General Services or his designee is hereby AUTHORIZED to solicit bids for this project at a future date, and is DIRECTED to publish at the appropriate time a Notice to Contractors in accordance with Section 22037 of the Public Contract Code, inviting bids for said work. The Director of General Services is further directed to mail notices to the construction trade journals specified in Section 22036 of the Public Contract Code at least 30 days before the date of opening the bids. IT IS FURTHER RESOLVED that the Director of General Services, or his designee, is AUTHORIZED to issue bid Addenda, as needed, for clarification of the contract bid documents, provided the involved changes do not significantly increase the cost estimate for the initial construction contract. �rf-by certify that this to a tnre and eorrect Copy o: r actfosr MKOA enc 8"Mfto on It* minutes of the Soard of Super on ft da%shown. ATTESTED: ���.�.rn'n�w ��,/g'.4E� .»�... PHIL SATCFIE.CtR Clark of tKe Board Of Supanirf"and County A04"oustrator Orig. Dept.: General Services Dept. -Architectural Division cc: General Services Department Architectural Division G.S. Accounting File: 345-9802/A.5 Auditor-Controller Community Development J. Frattini Health Services Department(Via A.D.) Consultants('Via A.D.) SJ:tb EI;\I9981345980218L002200b.doc RESOLUTION NO. 99/584 JIX 7 GENERAL SERVICES DEPARTMENT Architectural Division 1224 Morello Avenue, Suite 100 Martinez, California 94553-4711 (925) 313-7240 FAX: (925) 313-7299 MEMORANDUM Date: November 5, 1999 File: 345-9802B.4.1 TO: Phil Batchelor, County Administrator ffi&_�o ; & FROM: Barton J. Hilbert, Director of General Services SUBJECT: TENANT IMPROVEMENTS AT LOS MEDANOS HEALTH CENTER, 2311 LOVERIDGE ROAD, PITTSBURG, FOR HEALTH SERVICES (WH604B); Mechanical Central Plant, Dental Suite, and Cast Iron Soil Pipe Report As of November 5, 1999, the construction of the Phase I Tenant Improvements is approximately 7% complete. Bid documents for the mechanical central plant portion of the Phase II work are complete and ready for bidding. We are currently obtaining a quote from the Tenant Improvement contractor for the dental portion of the Phase II work. If we are unable to obtain a competitive price from the contractor, we will bid the dental portion of the Phase II work as a separate package. During construction of the Phase I Tenant Improvement work, the contractor discovered a pre- existing problem with the building's cast iron soil pipe system. The piping is clogged, pitted, and corroded to the extent that repair is not possible: replacement is required. The problem is building-wide, with the exception of the underslab piping and most of the piping that serves the fifth floor. Our consulting project management firm, RGM and Associates, has investigated the cast iron soil pipe situation. RGM has determined the probable cause of the damage, and recommended a course of corrective action. Attached is a copy of their report, which also discusses the budget and schedule implications of correcting this problem. S7:tb Attachment Attachments: "Report on Damaged Cast Iran Soil Pipe System, Las Medanos Health Center, 2311 Loveridge Road, Pittsburg, for Health Services Department", four 8%2x11 inch pages dated November 5, 1999 plus attachments. cc: County Administrator's Office General Services Department L. Lockwood K. Brown Health Services Department G. Bender Dr. W. Walker County Counsel F. Puglisi D. Schmidt S. Harris H:\1998\3459802\8L002201m.doc Date: November 5, 1999 TO: Bart Gilbert, Director Contra Costa County General Services Department FROM: Greg Cheifetz, Project Manager RGM and Associates SUBJECT: REPORT ON DAMAGED CAST IRON SOIL PIPE SYSTEM; LOS MEDANOS HEALTH CENTER, 2311 LOVERIDGE ROAD, PITTSBURG FOR HEALTH SERVICES DEPARTMENT INTRODUCTION The existing above-ground cast iron soil and vent piping system at the Los Medanos Health Center, currently being remodeled, is substantially damaged by internal corrosion. The CAO has directed RGM to investigate the corrosion and blockage of the existing cast iron waste and vent piping system: what happened,why it happened,how to correct it, and how to make sure it won't happen again. RGM is scheduled to give a presentation on� this subject to the Board of Supervisors on November 16, 1999. A. What Happened 1. The Los Medanos Community Hospital opened for business in 1979 and shut down in early 1994. There was apparently no orderly decommissioning and preventative maintenance program undertaken; rather it appears that the maintenance personnel were not present following the shutdown. This conclusion is based on the observed condition of the cast iron soil pipe system and the mechanical central plant equipment. 2. The County General Services Department undertook a"due diligence"inspection of the building and grounds in 1996, and again in early 1998,with an eye towards the County repairing and maintaining the facility. Grounds Maintenance Division, Building Maintenance Division(electricians,pipe fitters, carpenters, and door and hardware specialists), Stationary Engineers Division, Telecommunications Division, and alarm technicians toured the building and conducted non- destructive investigations of the various building systems. Also in early 1998, the County hired consultants to perform certain specialized investigations. These included a Phase 1 Environmental Assessment, a building-wide asbestos and lead assessment, and an assessment of the emergency generator's underground fuel storage tank for compliance with current regulations. In late 1998, a consultant was hired to do a detailed investigation of the mechanical central plant equipment. 3. During lease negotiations between the County and the Hospital District, the County and the Building Corporation Board of Directors agreed upon a list of PAGE 1 OF 4 D L'bS MEDANOS HEALTH CENTER 11/5/99 J items requiring repair by the County. The list was incorporated into the Lease as an attachment. That list of items was based on a report prepared by MacLellan Wolfson Associates, a professional consulting firm hired by the Building Corporation. The list did not identify the above-ground cast iron soil pipe system as a problem. 4. After the County executed a lease for the facility, several cast iron soil pipes and fittings, mainly in horizontal reals,were found to be cracked along their length. Others had developed pinholes, revealed due to rust on the pipe exterior. The County General Services Department was called in by the caretaker to remove and repair these damaged sections of pipe. General Services brought the extent and type of damage to the attention of RGM in November 1998. 5. RGM undertook an examination of the underslab cast iron soil pipes by using a video camera probe sent through the pipes from several access points. No unusual corrosion or other conditions were found. 6. RGM undertook a visual survey of the above-ground cast iron piping system to determine the extent of damage. Those pipes and fittings that were observed to be corroded or split were indicated in the bid documents to be replaced. 7. When demolition of parts of the existing above-ground cast iron waste and vent piping was begun by the contractor, extraordinary amounts of internal corrosion were found, along with partial or complete blockage of many of the pipes. This blockage was in the form of a"rust foam"partially or completely filling the pipes. This blockage was especially prevalent in the vent pipes. B. Why it happened: the probable cause 1. The Cast Iron Soil Pipe Institute, located in Chattanooga, Tennessee, was very helpful in giving some possible causes for this problem. Bill Levan of the Institute visited the building in early October and observed the site conditions. A copy of his letter is attached. To paraphrase his statement, the damage was most likely caused by corrosive sewer gas, or corrosive cleaning agents used by the Hospital staff. The building being abandoned exacerbated these factors: the lack of continual flushing of the pipes allowed whatever corrosive environment existed to act on the iron without interruption. 2. Ken Pytlewski, a corrosion engineer with Forensic Technologies International/ Anamet Laboratories in Hayward, also examined the pipes, undertaking scientific analysis of the corrosion products found in the pipes. A copy of his report is attached. To summarize his report, the cause of the internal corrosion appears to be the use of strong acidic cleaning solutions, or perhaps a"microbiologically influenced corrosion," and possibly a combination of these two mechanisms. PAGE 2 OF 4 LOS MEUANOS HEALTH CENTER 11./5/94 3. Mohammed Ali, a corrosion engineer with JDH Corrosion Consultants of Concord,was brought on as a subconsultant by Ken Pytlewski to investigate the exterior corrosion of the undersiab cast iron pipes due to soil conditions. A copy of his report is attached. To summarize his report,while there is corrosion on the exterior of the pipe, it is a normal condition for a 20-year old building, and does not indicate any extraordinary conditions that will lead to a premature failure of the drainage system. 4. Conversations with personnel at the Delta-Diablo Sanitary District(operator of the sewage trunk line and processing plant) and the City of Pittsburg(operator of the branch sewer system that serves the city, including Los Medanos)reveal no extraordinary levels of sewer gas, nor have they received complaints by other nearby building occupants of corrosion due to corrosive sewer gases. The possible conclusion on this subject is that,while Qg rUpigd-buildings have not had problems with sewer gas, it is possible that this unoccupied building has been affected by the normal levels of sewer gas found in the system. C. What to do about it 1. The CAO directed RGM to develop a work plan for the proposed solution to this problem: full replacement of the entire existing above-ground waste and vent system. RGM proposes that the work to replace the cast iron soil pipe system be divided into four packages: a. A change order to the general contractor(LCI) for the demolition of all of the waste and vent lines on the first four floors, and the vent lines only on the fifth floor(the waste lines on the fiffih floor are much newer and in much better condition). Demolition of finishes required to gain access to the pipe system will be included. b. A change order to LCI for the replacement of the cast iron soil pipe system on the first floor only. This will allow LCI to complete the remodeling of the first floor. c. A separate bid package for the replacement of the cast iron soil pipe system on floors two through five. d. A change order to LCI to patch the finishes in the occupied areas of floors two through five. 2. Concerns: a. Schedule: The critical path of the project schedule is through the cast iron soil pipe system replacement and the tenant improvement work. The projected date for opening the Health Center is now in late February 2401. PAGE 3 OF 4 LUS MEDANOS HEALTH CENTER 11/5/99 a� b. Budget: The project budget is increased by approximately$3,000,000 for the replacement of the cast iron soil pipe system c. Delay: Every day that the major decisions are not made, or authorizations to proceed are not given, is an additional day added on to the project duration. It may also be an additional day of a delay claim by LCL D. Hove to make sure it won't happen again 1. Institute an educational program for site personnel and housekeeping staff regarding the pouring of corrosive materials, acid or alkaline, into the waste pipe system. 2. Periodically monitor the Ph of the effluent leaving the building to confirm that it is not strongly acidic or alkaline. 3. If in the future the building will be unoccupied for an extensive amount of time, initiate a maintenance program of flushing the waste lines and keeping the plumbing traps full of water. Attachments: 1. Report from Bill LeVan of the Cast Iron Soil Pipe Institute, 2 pages, dated October 14, 1999. 2. Report from Ken Pytlewski of FTUAnamet Laboratories, 2 pages, dated November 5, 1999. 3. Report from Mohammed Ali of JDH Corrosion Consultants, 4 pages, dated October 25, 1999. CC with attachments: County Administrator's Office Laura Lockwood General Services Department Architectural Division Steve Jordan Health Services Department Frank Puglisi Steve Harris PAGE 4 OF 4 FTI '' Anamet . 1!-Vis✓ ,�s Materials .Engineering & Laboratory Testing 3400 INVESTMENT BOULEVARD• HAYWARD, CALIFORNIA 945453811 • (510)887-8811 . FAX (510) 887-8427 Report No. 5003.1483 November 5, 1999 METALLURGICAL EVALUATION OF CORRODED SEWER PIPE AND FITTINGS REMOVED FROM THE SITE OF THE FORMER LOS MEDANOS HOSPITAL Customer Authorization: herbal Report To; RGM and Associates Attn. Greg Cheifetz 3230 Monument Way Concord, CA 94518 1.0 SUMMARY Several pieces of gray cast iron pipe from the sewer system in the former Los Medanos Hospital were submitted for a metallurgical evaluation of the internal corrosion product and of longitudinal, through-wall cracking at several locations on the pipe sections. The pieces examined in this investigation included a 7' (approximate) section of 4" diameter pipe, a 4"-to-2" diameter drain fitting and a 4" diameter vent section with a 2" diameter branched connection. These pieces were reportedly removed from locations in the piping system somewhere between the first and fifth floors of the building. Several other pieces reportedly removed from underneath the building were submitted a week later. These included. a 6"-to-4" diameter branched fitting, a 1' long section of 2" diameter pipe, and a 4"-to-4" diameter branched fitting. All pieces were manufactured by AB & I and were marked with the manufacturer's name and insignia. Chemical analysis of the internal corrosion product and metallographic examination of smaller pieces cut from the pipes were performed in this investigation. 2.0 EVALUATION 2.1 Visual Examination Figures 1 through.3 show the as-received pipe sections evaluated in this investigation. Figure lb shows a longitudinal crack in the 7' long , 4" diameter section of pipe. The open crack ran along This report shall not be reproduced,except in full,without the written approval of FTI Anatmet. F 7 ! A n a m e t Report No.5003.1483 .�r 11- ri HAYWARD,CALIFORNIA Page 2 just over one-half of the length of the section and branched into two cracks in a "Y" configuration at approximately the mid-point of the section. A tighter, less obvious crack was observed on the outside surface just past the branched crack and ran along the remaining half of the pipe. Voluminous, loosely adhered orange and brown colored corrosion product, typical of the appearance of FeOH,or common"rust", was observed on the inside surfaces of the pipe. The corrosion product readily flaked off the inside surface of the pipe. underneath the loose corrosion product was a dark brown to black colored, tightly bound layer. The layer could be pried off the surface with a knife producing small, brittle chips. The chips were found to be magnetic and most probably contain an oxide of iron known as magnetite, or Fe,O,,, as a constituent. The pipe was split longitudinally, 90° to the crack, for closer inspection of the internal surfaces. Various type of debris including paper products, fragments of broken glass, and pieces of plastic were observed in the pipe section. Figure 2 shows the section identified as the vent section. A 2" branch-connection is made with pipe clamps and rubber gasket material which is a common method for joining cast iron pipe and fittings. The white arrows in the figure point to longitudinal cracks in the 2"branch. Orange and brown colored corrosion product was also observed on the internal surfaces of the vent but was more adherent to the surface and less voluminous. The same dark brown to black colored, tightly bound layer was observed under the orange colored corrosion product. Figure 3 shows the section identified as the floor drain. This section had a short length of 2" diameter pipe clamped to the 4" diameter drain fitting. The white arrow indicates a longitudinal crack in the 2" pipe section. A significant amount of voluminous, loosely adhered corrosion product was observed inside this section. The corrosion product nearly constricted the 2" diameter orifice. The same dark brown to black colored, tightly bound layer was observed under the orange colored corrosion product. 2.2 Chemical Analysis F T I A n a m e t Report No.5003.1483 y� r HAYWARD,CALIFORNIA Page 3 Samples of the loose, orange and brown corrosion product were removed from three sections of pipe for chemical analysis. Several instrument and rivet chemical techniques were used in these analyses including Fourier Transform Infrared (FT-IR) spectroscopy and wet chemistry precipitation techniques, as well as visual and olfactory observations during the wet chemistry procedures. In addition, a chip of the black colored, tightly bound layer and an area of clean metal surface were analyzed. Table 1 summarizes the results of the analyses of the orange and brown corrosion product removed from the three sections of pipe: Table I Chemical Analyses of the Orange and Brown Corrosion Product from the Inside Surfaces of the Cast Iron Sewer Pipe 7"section—Darner 7' Section—Lighter Floor Drain Vent corrosion product corrosion product ! ! Primary constituent Iron oxides Iron oxides Iron oxides Iron oxides pH 3.82 2.78 2.85 3.04 Sulfate(soluble) minor positive negative positive negative j Sulfide negative negative negative negative Thiosulfate negative positive negative positive SO2 odor negative positive minor positive positive Chloride negative negative minor positive negative Phosphate positive minor positive minor positive minor positive Organics minor positive positive positive positive Minor constituents aluminum,silicates aluminum,silicates carbonates, silicates ( silicates Table 2 summarizes the results of the analyses of a chip representative of the black colored, tightly bound layer removed and a ground clean region of uncorroded metal, both from the 7' long section of pipe. Table 2 Chemical Analysis of Black Layer and Uncorroded Metal Element Black Layer(wt. %) Uncorroded Metal(wt. %) Carbon (C) 2.69 Manganese(Mn) -- j Phosphorus (P) _- Sulfur(S) -- I Silicon(Si) -- f Iron(Fe) ; balance balance flux`tlJ 08 I f .w I Muni I I I MiTM. 51 F T ! A n a m a t Report No.5003.1483 _. . HAYWARD,CALIFORNIA Page 4 2.3 Metallography Samples from the 7' long section of pipe and the vent were removed for metallographic evaluation. The samples were mounted in a transverse orientation (to view the cross-section of the pipe wall) and metallographically prepared for examination. Figure 4 shows the microstructure of the pipe near the inside surface, etched to reveal the constituents or phases of the microstructure. The microstructure in the upper three-quarters of the micrograph, away from the inside wall, consists of graphite flakes of a random distribution as well as in "rosette" configurations in a matrix of ferrite, and regions of lamellar pearlite. This microstructure is considered normal for unannealed gray cast iron pipe. Figure 5 shows micrographs of the cross-section of the 2" vent pipe wall (near the location of the white arrow in Figure 2), at successively higher magnifications. The inside surface of the pipe is toward the bottom of the micrographs. The black layer toward the lower half of the micrograph is a graphite and iron oxide rich layer. The white layer is the typical microstructure for unannealed, gray cast iron in the unetched state. The black layer was originally (at the time of installation) the same as the white layer, but has undergone a process known as graphitic corrosion. Approximately one-third of the wall thickness in this location has undergonq this form of corrosion. The consequences of this on the integrity of the pipe is discussed later in this report. The cracking observed in this sample from the vent section progresses from the inside surface toward the outside surface. Figure 6 shows micrographs of the cross-section of the 4" diameter, 7' long pipe along the wide, longitudinal crack, at successively higher magnifications. The left-hand side of the micrograph is the fracture surface of the crack. The inside surface of the pipe is toward the bottom of the micrographs. The innermost black layer is severe graphitic corrosion. The lighter gray layer is a combination of graphitic corrosion and oxidation of the iron constituent. The white layer is the typical microstructure for unannealed, gray cast iron in the unetched state. Approximately three- quarters of the wall thickness in this l cation has undergone graphitic corrosion and oxidation, leaving only a quarter of the original cast iron wall thickness'. The higher magnification micrograph shows the interface between "good" cast iron material and the graphitic/oxidized layer. The corroded layer is breaking away from the "good" material farming cracks in the circumferential direction in addition to the catastrophic radial cracks observed in this and the previous figure. These circumferential cracks develop at the interface of the "good" and °`corroding" material due to stresses from the volumetric mismatch between the corrosion product and the parent metal. Though no partial cracks (i.e., cracks that had not completely propagated through the pipe wall) were found on the 7' long section, the severe graphitic corrosion and oxidation of the internal ' Per ASTM A 74,the nominal wall thickness of 4"diameter extra-heavy cast iron pipe and fittings is 0.25". .Wy VJ SJ 1 t F T C A n a m e t Report No.5003.14$3 HAYWARD,CALIFORNIA Page 5 surfaces would indicate the cracking observed in this section most probably originated on the internal surface and propagated radially outward, also. 2.4 Scanning Electron Microscopy and Energy Dispersive Spectroscopy Figure 7 shows micrographs of the fracture surface of the wide crack in the 7' long section of pipe. The inside surface is toward the bottom of the micrograph. Circumferential cracking was observed on the fracture surface, as described in Section 2.3 above and is seen as horizontal cracks in the micrograph. The higher magnification micrograph in the figure is the graphite-rich substructure (primarily graphite flake surrounded by iron oxide) that remains after the iron-rich matrix (known as ferrite) transforms into iron oxide during the graphitic corrosion process. Figures 8 through 10 are energy dispersive x-ray spectroscopy (EDS) spectra of the corrosion product from the 7' section of pipe, the vent and the drain, respectively. iron (Fe) is the primary element detected in all the samples of corrosion product with minor amounts of sulfur(S), silicon (Si) and aluminum (Al). The EDS technique used here is qualitative and indicates the presence of elemental species only. Compounds of the elemental species are not indicated by this technique. The chemical analysis results presented in section 2.2 above in fact confirmed that the iron and sulfur are not in their elemental state (as pure iron and sulfur) but rather as compounds of these elements (oxides, sulfates, sulfides and thiosulfates). 3.0 DISCUSSION The low pH of the corrosion product found inside the pipe sections is consistent with the voluminous, loosely adhered iron oxide corrosion product observed visually and confirmed by chemical analysis. Gray cast iron corrodes rapidly in acidic aqueous environments of pH 4.5 and below. in water environments of pH between 4.5 to 8.5, corrosion is mild. The corrosion product generated from exposure to environments above pH 8.5 is typically very adherent to the surface of the metal, and is considered the most desirable environment for cast iron. Graphitic corrosion occurs in the mildly acidic pH range where corrosion rates are comparatively low, typically on the order of 50 mils per year (mpy). Below pH of about 4.0, the corrosion becomes so severe that the entire surface is corroded away, including the graphite. Graphitic corrosion is the selective corrosion of the iron-rich matrix of the cast iron microstructure. As the iron phase (ferrite) corrodes, the network of graphite flares and rosettes remain, gradually forming a carbon and iron oxide layer. In the low pH environment, this noble graphite layer acts as a cathode to promoting the corrosion of iron around it. This process is most common in gray cast iron where the interconnected substructure of graphite flakes inherently exists in the microstructure. Figures 4 and 5 in this report are classic representations of this form of attack of gray cast iron. I1VY VJ 03 1l 6V 1 WWI i I I RNtn,e...�.... v..+ .,.., �''j'�`... i:d R 3 F T.,{ A n a to e t Report No.5003.1483 HAYWARD,CALIFORNIA Page 6 The graphitized layer is brittle and has little strength. The metal therefore loses its structural integrity and load bearing capability. Stresses in the pipe, whether residualstress inherent in the unannealed, cast structure, or from external loading, will readily act as the driving force for cracks to propagate through the graphitic layer. In the case of the pipe sections, cracks propagated from the graphitic layer through the remaining "good" cast iron material. The locations where cracks were observed were typically the thinnest cross-sections on the pipe, that is, the regions of most severe graphitic corrosion. There was not enough wall thickness to resist the residual stresses in the pipe, so cracks propagated through the pipe wall. In sewer pipe, many farms of bacteria are present. Some of these bacteria are capable of causing the graphitic corrosion process, because they create a mildly acidic condition in the pipe. Collectively, these bacteria cause a process known as microbiologically influence corrosion or "MIC". The chemical analyses obtained from the corrosion products does not provide strong support for bacteria-influenced corrosion in this case, though. Typically, MIC occurs in less acidic environments than was found in these pipe sections, however, the presence of sulfides and some sulfate, the stagnant flow conditions, as well as the presence of tubercles within the corrosion layer support an MIC type of attack. Tubercle formation can be found in the corrosion product of cast iron that has been in high pH environments where no MIC-related corrosion has been found, though, so the presence of tubercles is not in itself a definite indicator of MIC. This pipe could have experienced high pH environments at some time during its service life from exposure to industrial cleaning products. Further testing may not confirm or rale out the presence of MIC mostly due to the age of the samples. It is probable that strong cleaning agents were used within the hospital while it was in operation. Typically, cleaning products have a pH in the basic range and are very compatible with cast iron. This fact is contrary to the low pH found in the corrosion product extracted from the inside surfaces of the pipe. However, an odor of SO2 is associated with the presence of the products of decomposition of anionic detergents or the presence of a thiosulfate, which is often associated with photographic developing chemicals. When anionic detergents biodegrade, they often leave behind other sulfur compounds which can undergo further chemical reactions to form acidic compounds. In addition, if iron sulfide was once present (though the chemical analysis detected no presence of it now), this compound can be oxidized producing an acidic environment. The details of these reactions are beyond the scope of this report, however, this piece of information was gained from a conversation with the chemist that performed the chemical analyses of the corrosion products and from available technical literature'. This is one possible explanation for the acidic environment found in the pipe sections. z Environmental Chemistry in Toxic Mine Drainage: Chemistry and Treatment,Colorado School or Mines,internet URL http://gn.mines.colorado.edu/fs-home/jhoran/chl26/amd.hnnl F T 1 A n a m e t Report Na 5003.1483 y HAYWARD,CALIFORNIA page 7 ` 4.0 CONCLUSIONS I. The voluminous, loosely adhered scale on the inside surface of the pipe sections examined was predominantly iron oxide with some sulfides, thiosulfates and minor amounts of various other compounds. An odor of SO,was detected in some of the samples. 2. Sulfides and thiosulfates are commonly found in anionic detergents and photochemicals, respectively. The breakdown and recombination of detergents may be responsible for the acidic environment, and hence the large amounts of corrosion product found in the pipe sections. A long period of stagnation of the contents of the sewer system would facilitate many reactions not common in active, flowing systems. 3. Thinning of the pipe wall was caused by graphitic corrosion. Cracks that started in the brittle, graphite and iron-oxide layer on the inside surface propagated outward and through the remaining metal at the thinnest locations on the pipe. 4. Future recurrence of this corrosion can mostly be mitigated by maintaining near-neutral pH conditions in the pipe by water flushing or diluting very high or very low pH materials introduced into the piping. Long-tern, stagnant conditions of sewage products inside the pipe should also be avoided. Prepared by Kenneth R. Pytlewski,P.E. Metallurgist FTIIAnamet JDH Corrosion Consultants Incorporated October 25, 1999 RGM and Associates 3230 Monument Way Concord, CA 94518 Fax: 925 6717788 Attention: Mr. Greg Cheifetz Subject: Los Medanos Hospital Underground Sewer Piping External Corrosion Evaluation i Dear Mr. Cheyfitz: In accordance with your request, we have conducted a brief corrosion evaluation for the subject piping system. Our findings are presented herein for your consideration: 1.0 PURPOSE The purpose of this evaluation was to evaluate the probable condition of the underground ductile iron, sewer piping from an external corrosion point of view. The piping has been in use for approximately 20 years. The investigation consisted of the following: 1. Site inspection and visual examination of a small section of the recently excavated piping. 2. In-situ soil resistivity measurements to determine the soil corrosivity. 3. Laboratory measurement of soil resistivity of a sample obtained from the site to determine the soil corrosivity. 4. Pipe-to-soil potential measurements to determine the corrosion pattern. 2.0 TEST PROCEDURES Pipe was inspected after a thorough cleaning with a wire brush. A welding hammer was used to sound the pipe and to remove any graphitization. Photographs were obtained which are included in Appendix "A", along with all other data obtained in the field and the laboratory. Pipe-to-soil potentials were obtained with respect to a copper-copper sulfate reference electrode with a high input impedance voltmeter(Fluke model 77). PMB 272, 5400-A4B Ygnacio galley Road, Concord, CA 94521 • Tel. 925.672.5251 • Fax. 925.672.5940 In-situ soil resitivities were measured using the Wenner "4 pin" method. An Associated Research model Vibroground resistance meter was used. Laboratory "as found" and 100% saturated resistivity was obtained using a soil box and the above meter. 3.0 FINDINGS A 60' section of the piping system was inspected. Sounding the pipe revealed a section of pipe with a 20-30% loss of wall thickness due to corrosion (graphitization). This indicates that external corrosion has a high probability of being a significant factor, with respect to the remaining useful life of the subject piping system and should be considered in the evaluation of the piping system. Pipe-to-soil potential measurements obtained ranged from-2.34 to—360 mV, with respect to a copper- copper sulfate reference electrode. The values are typical for a corroding piping system, which has been underground for a number of years and does not indicate any extra ordinary conditions. The soil resistivity values obtained range from 600-2000 Ohm-cm. These values indicate that the soils are corrosive to ductile and cast iron pipes. These values also indicate that significant external corrosion damage should be expected on the piping system. 4.0 DISCUSSION AND ANALYSIS An underground piping system such as the subject piping can be subject to the following different types of corrosion.: 4.1 Galvanic Corrosion Galvanic corrosion is defined as corrosion accelerated by the potential difference of two metals which are in electrical contact with each other and exposed to the same electrolyte. In piping systems this generally occurs when the underground piping is in contact with copper grounding, reinforcing bars in concrete, etc. In such instances, copper ground or rebar will act as a cathode, whereas the piping system will act as an anode and will corrode at an accelerated rate. In the subject piping system the type of pipe joints used are electrically discontinuous. This indicates that the galvanic effect, if any, will be very limited to small sections of pipes, such as concrete slab penetrations, etc. 4.2 Stray Current Corrosion Stray current occurs when (generally) a DC current from an external source flows onto the subject structure in an electrolyte and then flows away from the structure into the electrolyte. Stray current corrosion occurs at the point where the current flows away from the structure into the electrolyte. In our given conditions, the source of DC current could be any medical device being operated in the hospitaland connected to 2 -x6 �' lr the subject piping system. However due to the fact that the piping system is electrically discontinuous, the stray current effects will be insignificant. 4.2 General Corrosion (graphitization) Graphitic corrosion, or graphitization, is a form of dealloying of gray cast iron. In this case the iron corrodes, leaving behind a matrix of graphite. Graphitization occurs in many environments including soils, especially those containing sulfates and sulfate reducing bacteria. The subject piping is exposed to corrosive soil conditions with a soil resistivity of 600-2000 Ohm-cm. This type of corrosion is expected to be predominant on the subject piping system. 5.0 CONCLUSION& RECOMMENDATION The underground ductile iron sewer piping is in a corrosive environment. External corrosion has a high probability of being a significant factor with respect to the remaining useful life of the piping system and therefore should be considered in the evaluation of the piping system for long term continued use. 6.0 DISCLAIMER The conclusions and recommendations contained in this report are based on the information referenced herein and on the inspections referenced in this report. All services provided herein were performed by persons who are experienced and skilled in conducting these types of investigations and in accordance with the standards of workmanship in this profession. However, we cannot guarantee that every defect and or cause related to the above case has been uncovered and addressed in this report and we provide no warrantees with regards to the recommendations contained herein. We thank you for the opportunity to be of service and trust that the information is satisfactory. If you have any questions concerning this report or if we can be of further assistance, please feel free to call us at (925) 927-6630. Respectfully Submitted, Mohammed Ali, P.E. Senior Corrosion Engineer JDH CORROSION CONSLTTA.NTS 3 APPENDIX "A" FIELD INSPECTION DATA 1.0 Pipe-to Soil Potentials Sr No. Structure Description Potential {mV} 1. 6" mainline, 5' below grade, east side i -347 ! 2 6"mainline, 5' below grade, east side -300 3 6" mainline, 5' below Eade, center -276 4 6"mainline, 5' below grade, west side -256 5 4" lateral, 2' below_grade, east side -360 6 4" lateral, 2' below-grade, east side -320 7 , 4" lateral, 2' below gEade, east side -260 8 j 4" lateral, 2' below Eade, east side -234 Note: All potentials were stable. No fluctuating potentials were noted. 2.0 Visual Inspection Approximately 60 feet of 4" and 6" ductile/cast iron pipe in a trench was cleaned with a wire brush, inspected and photographed. The pipe was found to be corroded as expected. In general the corrosion was not very deep with some graphitization. One 4" pipe was found severely graphitized, with a measured reduction in wall thickness of 20-30%. 3.0 In-Situ Soil Resistivity Measurements West of the hospital building in grassy area. Depth of 5 ft. 600 Ohm-Cm Depth of 10 ft. 600 Ohm-Cm South of the hospital building in sandy soil: Depth of 5 ft. 2000 Ohm-Cm Depth of 10 ft. 1000 Ohm-Cm 4.0 Laboratory Soil Resistivity Measurements (Soil Box) As found 2000 Ohm-Cm 100% saturation 1800 Ohm-Cm 4 r x x w I FTG 1: 6-inch Pipe, 5 ft below grade in good condition 4 `+ iI fr k.^t'a. 3h „ A5 y`yu FTG 2: 6-inch Pipe, 5 ft below grade in good condition FIG 3: 4-inch Elbow, Z ft below grade in good condition FIG 4. 4-inch Elbow, 2 ft below grade showing moderate corrosion. ' f f hF' FIG 5: 4-inch Elbow, 2 ft below grade showing moderate corrosion/graphitization ,t FIG b: 4-inch Pipe, 2 ft below grade showing severe graphitization, with a 20- 30% loss of wall thickness Oct-15-99 10: 27A CISPI 423-892-07817 P.01 CAST IRON SOIL PIPE INSTITUTE 5959 SHALLOWFORD ROAD, SUITE 419 CHATTANOOGA, TENNESSEE 37421 TELEPHONE (423) 992-0137 FAX (423) 892-0817 October 14, 1999 Greg Cheifetz RECENED RGM and Associates OCT 15 1999 3230 Monument Way Concord, CA 94518 RGM & ASSOC. Subject: Los Medanos Hospital Dear Greg, As we discussed during my visit on Tuesday, the failures of the cast iron soil pipe and fittings on the subject building are due to internal corrosion. Although we are unable to pinpoint a specific cause, we feel the failures are related to either sewer gas or corrosive cleaners used during the hospital's operation. The possibility that either or a combination of both is the cause for the failure. The fact that the galvanized steel vents are also corroded leads us believe that sewer gas was at least part of the problem. If sewer gas was present in the public sewer it would have escaped through the building vents. Sewer gas sometimes contains hydrogen sulfide gas. This gas when condensed forms sulfuric acid, a gond source of corrosion. The gas also contains moisture, which over the period of years the hospital was closed wetted and dried the pipe walls. This wetting and drying probably added to the accumulation of tuberculation that appears in the pipe and with no flow of waste water caused the buildups we found. This tuberculation is the products of corrosion deposited on the pipe walls. When analyzed it will be ferrous oxide. There is a possibility organic materials were left in the lines after the hospital closed. This organic material which was not flushed with continuous use as would have occurred in a functioning building would have decayed, generating hydrogen sulfide which became sulfuric acid and resulted in corrosion if any of the slopes on the branch lines were flat or with reversed flow, this condition would have been more prevalent. There is a possibility that corrosive cleaning agents were used and this could be another cause of the corrosion. Cleaners that have a pH below 43 will cause corrosion of iron. When these cleaners are used we always recommend flushing following use. Since the hospital was closing, a final cleaning was probably done, the Oct-15-99 10: 28A CISPI 423-892-0817 P.02 cleaners washed away from the tub, floor, and sink surfaces into the piper where they remained. Unlike a functioning building, all activity stopped and the cleaners remained in the pipe until they dried or were re-wetted from the sewer gas. The result was corrosion. We hope this has been useful as a possible explanation of the causes for the problems related to the building. Sincerely, William H. LeVan Executive Vice President WHI.1j s Copy: Don Wixson Gary Wickham RECEIVED S.. . NOV 16 1999 roc .a-nciz: :.fl-, Chaim Contra Costa County Board of Supervisors �NFSAcs isc�s I Pine St., Room 107 Martinez, CA 94553-1229 Dear Chairman Canciamilla and Honorable BoardMembers: Please complete the renovations of the Los Med nos Health Center to help fill a vital need in the Pittsburg/Bayo Point area as quickly as possible. "hank you for all you have done already. Please direct your Health Service staff to solicit agreements from Kaiser and other health plans for use of the clinics at the health Center. Please cooperate with the Los Med nos Health Care District, if it chooses to continue, as I believe it should and must, to coordinate and expand wellness, prevention and early detection efforts in this area. Thank you for your courtesy and special thanks to Chairman Canciamilla for his outstanding efforts to improve health opportunities for his district. Sincerely, " r,�.. M.S. Lengyel 545 Central Ave. Pittsburg, CA 94565 Attachments 71' _ -YY b Outreach-6 Los Medanos Health Care district Health Center Services Steve Harris, planning and evaluation director for Contra Costa Health Services, provided the following list of services that will be available at the Los Medanos Health Center. i Los Medanos Health Center Services To Be Provided Family Practice Medical Care Prenatal Care Immunizations Specialty Care Allergy high-Risk OB Arthritis/Loin Back Immunodeficiency Audiolog), Internal Medicine BracelOrthotics Neurology Chest Ophthalmology Dermatology Orthopedics Bars, Nose& Throat Plastic Surgery Family PlanningSTD Podiatry Gastroenterology Rehabilitation Glasses Surgery Consultations j Gynecoloo, Urology Pediatric Primary Care Dentistry Extended flours Clinics WIC- Women, hifants& Children Supplemental Food Program Ancillary Services Diagnostic Imaging(including Pharmacy hfanimograply& Ultrasound) Physical Therapy Laboratory Patient Support Services Dietitian Healthy Start/Born Free Eligibility Worker HIV Counselor Financial Counseling Medical,Social Worker Health Education Administrative Support Services Administration/Business Office Medical Records Registration Outreach-5 Los Medanos Health Care District Who Can Use Los Medanos Health Center The landmark hospital building on Loveridge Road in Pittsburg, which closed as a hospital on April 28, 1994, now is undergoing major renovations in a project the county says is costing about $9 million. It is scheduled to open next summer as the Los Medanos Health Center. The county is leasing the building from the hospital district. The 20-year lease has a base rent of $100,000 a year and the cost of all maintenance and repairs is the sole responsibility of the county, according to Steve Harris, planning and evaluation director for Contra Costa Health Services. The 20-gear lease expires July 31 , 2018. and the county has two five-year options to extend the lease beyond that date at fair market value for the building in its then-condition, Harris said. Anyone will be able to use the health services. They may have to pay a fee. It will be the largest outpatient clinic in Contra Costa County in a beautiful setting with expanded hours and about 100,000 square feet of sloace, according to Harris. Anyone %vho Y,,Valks through the door will be able to get an array of non- emergency outpatient medical and dental services but service is not free. There is no such thing in this country as universal free health care, Harris noted. Harris estimated that about 60 percent of the people living in the Pittsburg area would be eligible for free or reduced charges under Medicare, Medi-Cal or the county health plan. The remainder would face "retail" rates, which range from $62 to $256 per visit under the current fee schedule. Harris said about one-third of Pittsburg area residents are covered by Kaiser and are required to use only Kaiser facilities by that plan, leaving about seven to 10 percent of the local population that would have to pay full rate unless their health plans, if they have one, wished to enter a contract with the county for service at the renovated facility. .. ......... ......... ......... ............................................................................................................................................................................................................................................................................................................................ Outreach-4 Los Medanos Health Care District WHAT WE DIE FROM (Data from Contra Costa Health Services web site for zipcode 94565.) Total in 1997 for Pittsburg/Bay Point residents, 407 deaths. Causes of Pittsburg/Bay Point deaths in 1997 Heart Disease, 106 deaths. Cancer, 90 deaths. Stroke, 39 deaths. Pneumonia and influenza, 20 deaths. Chronic obstructive pulmonary disease, 17 deaths. Unintentional injuries, 20 deaths. Diabetes mellitus, 7 deaths. Chronic liver disease and cirrhosis, 4 deaths. Suicide, 8 deaths. Homicide, 9 deaths. AIDS, 8 deaths. All other causes, 79 deaths. HEALTH TRENDS (From Contra County County Epidemiology, Surveillance and 'Health Data Unit) Tuberculosis cases reported from 1993-98: Pittsburg, 57 cases; Bay Point, 8 cases; countywide total, 634 cases. People living with AIDS in Pittsburg, 74, deceased 102; people living with AIDS in Bay Paint, 19, deceased, 43, as of 7/12/99. Highest cumulative incidence of AIDS in Contra Costa per 1 ,000 population: Richmond, 5, San Pablo 4.4, Pittsburg, 3.2. Reportable communicable diseases by Contra Costa region for Jan.-,lune, 1999, top five in east county: Hepatitis C (carrier), 221 cases; Hepatitis B (carrier) 30 cases; campylobacter, 11 cases; tuberculosis, 9 cases; giardiasis and Hepatitis A, 8 cases each. �t Outreach-3 Los Medanos Health Care District WHO WE ARE (As of the 1990 U.S. Census for Pittsburg/Bay Point zip code 94565) Population: 63,949. Households: 21 ,382. Races, Ethnicity: white, 38,899; Hispanic origins, 14,717; black, 10,467; Asian or Pacific Islander, 7,599; American Indian, 537; other race, 6,447. Language Spoken at Home: (Top three for persons 5 years and over) English only, 41,333; Spanish, 9,848; Tagalog, 2,969. Sex: Female, 32,371 ; male, 31 ,570, Age: 5 years old and younger, 7,842; 65 years old and older, 5,075. Income: median household income in 1989, $36,201 . WHERE WE LIVE (Percentages based on voter registration numbers of 27,748 as of 10/27/99 in Los Medanos Community Health Care District.) Pittsburg, 73.24 percent (20,322); Bay Point, 22.33 percent (6,197); Clayton, 1 .94 percent (539); Clyde, 1 .25 percent (348); Antioch, 0.51 (142); Concord, 0.37 percent (103); unspecified, 0.35 percent (97). Pittsburg/Bay Point total, 95.57 percent. q ............................................................................................................................................................... ........................... .................................................................................................................................. Outreach-2 Los Medanos Health Care District 8. The Health District will sponsor an annual Fall Health Fair each October at the Los Medanos Health Center, in cooperation with the county and other entities, to foster screenings, immunizations and awareness, and to connect district residents with agencies that can directly help them. 9. The Health District will sponsor classes and screenings in its portion of the Los Medanos Health Center and at a site to be determined in Bay Point. 10. The Health District will construct and maintain an Internet web site and automated phone system to provide updated health information and referral services to district residents and to allow feedback on health issues. PAIN AND PERIL (From the 1999 Contra Costa Collaborative Community Assessment prepared by the Northern California Council for the Community.) East Contra Costa has the lowest per capita rate of primary care physicians in the county at 21 physicians per 100,000 people. The statewide average is 67 primary care physicians per !00,000 people. Bay Point, with a population over 18,000, has none. (Volume 1 , pages 277-78) The lack of health coverage in California is most prevalent among young adults, lower income families, Latinos, African Americans and Asian Americans. (Executive Summary, page 8) While asthma can occur at any age and has a higher mortality rate among older persons, it more commonly first occurs in children and youth. Asthma is a leading chronic childhood disease and the leading cause of hospital admissions among children in California. About 2 million Californians have this disease. (Volume 1 , page 225) African American infants in the county are almost twice as likely to die before their first birthday as infants in other groups. (Executive Summary, page 5) Outreach-1 Los Medanos Health Care District Proposal and Report October 28, 1999 TEN PATHWAYS TO BETTER HEALTH 1 . The Health District in the future will concentrate on education, prevention, wellness, early detection and intervention, and direct assistance through grants to community-based organizations to improve the health of residents of the district 2. The ;Health District will conduct an annual survey, using questionnaires, phone interviews and other available means, to keep abreast of health conditions and needs in the district. 3. The Health District will prepare an annual plan and report on how to address those needs and will act as advocate for district residents in order to meet those needs. 4. The Health District will provide liaison to other entities active in the district and will work to coordinate efforts of all entities to encourage comprehensive attention to the health needs of all district residents. 5. The Health District each year will establish a per capita figure on spending of district tax funds for health needs and will confine its normal operations to funding generated by that figure, as may be supplemented by other sources. For example, a target figure of $2 per resident would limit spending to about $150,000. 6. The Health District will utilize consultants or personnel of other agencies to the maximum extent possible in carrying out its operations. 7. The Health District will select the topic and host a community forum each year to address a major health concern of district residents and will issue a report afterwards. Suggested topic for April 2000: "Is there a doctor in the house?/Strategies for overcoming the shortage of family practice doctors in Pittsburg and Bay Point." ,21q ............................................................................................................................................................................................................................................................................................................................ ..... ................................... ... . ........ _ _ _ _ _.. _ ..._. ._.. _ __. CA West C,.,.o•=,W residents well-served by district By Jim Beaver members serve on the Tenet GOV- QjUEST COMM AW erninBoard at the hospital. iN DECEMBER 1995 the Board of While these oversight mecha- Directors of the healthcare district nisms are not absolute guarantees that owned and operated Brook- they represent an unprecedented side Hospital faced a dear and fright- level of corporate involvement In the e n: public process. qui y,to find aner to run the In the two years since the affilia- hniital,It would 9"forced to close. tion Jenet has proved to be a coop- er tm Medanos had faced a sim. erative and responsive corporate filar situation and It was now bank. partner. rapt and padlocked. The company has Invested more At stake was a community,pub- than$10 million In needed facility licly operated hospital serving tens and equipment upgrades and has ac- of thousands of West County resi- fively met Its obligations in the lease dents annually — the only West agreement. County hospital offering range The district has spent much of the of acute-care services;medical,sur. Past two years wrapping up the com- gical,Intensive can,emergency and Plex financial,legal,contractual and obstetrics,as well as burn an can. r tory issues involved in running aV r cer centers. a pital for 40-plus years, Brookside was the only full-ser. it Is important to remember that vice hospital In the community that, the district's first and foremost re- sponsibility Is that It remains the in addition to serving Medi-Cal and ner of the hospital. Medicare patients,also had a com. ow Should Unet meet any of the con- mitment to serving the uninsured. At stake too were the nearly 1,000 nitrons that allow It to get out of the full-and part-time jobs and the$56 lease,the hospital reverts to the dis- trict. minion annual payroll they gener. Among numerous other re. ated in the community sponsibilities,the district carries the A little over one year later,in Jan sion liabill p%afar a 700-plus member pen- nary 199.7, the affiliation between ter dozens of workers compensation • Brookside Hospital and Unet Health- aim from the hospital. Systems saved this full-service corn- The district Is also paying back$5 munity hospital from bankruptcy. million in debt that was built up over X it also left Intact the West Contra theyears that Brookside continued Costa Healthcare District, whose to provide services to the community mission,just as when the district op- even when it was not receiving ade. < erated Brookside,remains to provide quate payment for doing so, 0 access and support programs on be. Z That repayment will take five to half of those West County residents seven years and is paid from the crr who are too often left out of the property tax allotment the district healthcare system—the underin• has historically received. sured,the uninsured, the working It is the future after the hospital poor. debt has been repaid that holds In the bargain,the affiliation also tremendous promise for the district created Important mechanisms that and community will ensure continued public over. That is when the district's fund. sight of the hospital's operations. ing will be able to be targeted for The healthcare district board, a , healthcare problems in-the commu. publicly elected body that answers nity to the people of West County, had Anyone who serves in any health. understood that there was really no related capacity In West County un- choice—the hospital had to survive* derstands the Immense number of It conducted an extensive public health problems and needs facing process leading to the affiliation. out community. This public Input led to a series They also understand the des. of affiliation goals that gave the dis" erate lack of resources and fund- trict some needed leverage when available to meet those needs. only one hospital system, Tenet, The=ty for a directed source came forward with an affiliation pro- i ,overseen by locally elected posal. representatives presents an un. The 30-year lease agreement be, precedented opp6itunity. tween Unet and the district for the When It ran Brookside Hospital, continued operation of Brookside the district used its tax support to Hospital — now Doctors Medical fund programs for the uninsured and Center San Pablo—gives the dis. underhaured.The dWct,s new mis, trict and the community an Impor- slon statement and guiding princi. tant oversight role at the hospital, ples am a dear statement of its con- Tenet must hold a public hearing tinued commitment to the process if It wishes to dose a licensed underserved in Wiest County service at the hospital and not re- In addition to providing leader. place It In the community;Tenet is ship and oversight for healthcare Is. committed to ptovidin $2.5 million sues throughout the district, the in charity care annuat with an In- board will be an advocate for those flation factor built In;Tenet meets who are left out of the healthcare quarterly with the Community Ad- system. v1sory Board in public session to pro. vide Information about plans at the Beaver Is the executive director of hospital and to listen to community the West Conou Cbsta,He.althCare. concerns; and two district board, Ustrict ------------ flow can the community provide itiptit inio the futupe of the J-1ospital District, tke facility and community health care services .? efore ma#ing a decision on Its future, the Board plans to hold a number of public meetings, as well as provide a series of mailings to the community. Board meetings are open to the public, and you can also contact the five Board members through the District office. Because of the Importance of this Issue, the public is encouraged to become involved In the declsion-making process, Upcoming meetings to which the public is Invited include: DiSSOIIA ion CVa1UQti0n COMtnittee Thursday, October 21, 7:00 to 9:00 p.m. Los Medanos Community Hospital Cafeteria Community Clutmach Committee Thursday, October 28,7W to 9:00 p.m. Los Medanos Community Hospital Cafeteria Board of Directors ,Fleeting Second Monday of Every Month, 6:00 p.m. Los Medanos Community Hospital Board Room #fi uestions regarding the District and the potential dissolution should be directed to the District office at 925-432-2200, The office Is not regularly staffed and calls are returned periodically. Dissolution/Continued Operation Decision Makin "Process ,#lily 16 September 13 October 11 November December 13 January 10 Board Meeting Board Meeting Board Meeting Board Meeting Board Meeting Board Meeting >✓ormed Regular Meeting Regular Meeting Receive input Possible Decision Possible Decision Committees. from Committees And Board Action And Board Action Dissolution October 21 DEC and COC DEC and COC Evrat xYbn Carryfte G in"untly MOO" Reports to Board Committees Sunset (DEQ (DEC) Community October 2$ Outer Committee Community Meeting (COQ (COG) CONTRA COSTA COUNTY- STATUS REPORT r'✓ %' Building Healthy, Safe and Self Sufficient Communities ' The table below contains an initial set of success indicators of healthy,safe and self-sufficient communities as illustrated by the characteristics of such communities. These indicators were developed by a working group of individuals from throughout the Bay Area. They represent an initial effort to demonstrate both the importance and feasibility of measuring success over time They are included here to provide people in the county with some initial tools to do this and as catalyst to raise questions about their use. Are there better measures? Are there ways to collect information about these and other success measures by neighborhood,by city,by population,etc? Here,at least is a start. Goats and Indicators for Building Healthy&Self-Sufficient Communities Year Contra Costa Bay Area 1 All Children Succeed in School and are Prepared for Lifelong Leaming Percent of eligibte children enrolled in Head Start 1997 52.1% 47.D1% Percentage of 4th graders scoring>50%on reading element of STAR 1998 54.0% 50.5% Percentage of 8th graders>50"1/6 on reading element of STAR 1998 60.0% 57.1% High school graduation rates:percent graduating In four years 1997 75.5% 88.6% 2 Families of all Kinds are Strengthened,Preserved and Flourish Percentage of single-parent headed households with children 1990 12.0%6 13.7% Number of children placed in foster homes for: 1996 Neglect Physical abuse 382 3'94499 Sexual Abuse 28 325 Other 8 454 Total 469 4,730 3 People Acquire and Retain.lobs and Achieve Economic Independence Number and percentage of knowledge-based industries by population group 1997 70,692 853,694 24.1%of All,lobs 30%6 of Ail Jobs 4 The Cycle of Violence is Ended # %of total Homicide 1996 71 18% 405 Rape 276 12% 2,257 Robbery 1,734 6%6 27,528 Aggravated Assault 3,327 12% 28,193 Burglary 8,253 15%6 53,352 Motor Vehicle Theft 4,452 12% 37,515 5 Frail,Disabled 8 Chronically-Ill are Ensured Independence and Dignity In-dome Supportive Services(IHSS)cases 8/1997 4,086 32,035 Supplemental Security Income(SSI) cases 8/1997 20,500. 194,983 6 Discrimination and Inequality are Eliminated Income per capita by race/ethnicity: 1990 White $22,964 $22,051 African American $12,054 $11,760 Asian/Pacific Islander $16,451 $14,922 Native American $14,674 $14,126 Latino $12,412 $10,994 Other $10,967 $9,683 7 People Achieve and Maintain Optimum Mental and Physical Health Number of hospital discharges categorized as co-indigent 1996 1,003 11,181 Percentage of healthy birth-weight babies 93.8% 93.8% Percent who have health insurance 16% 15.8% 8 individuals and Neighborhoods are Prepared to Respond to Emergencies and Disasters Number of people prepared to respond to emergencies and disasters 1997 719 7,004 9 People Play an Active hole in Community Life Percentage of people who volunteered in the last 12 months 1997 NA 14,788 Percentage of people eligible to vote who voted in local elections 1996 58.1% 56.2%6 10 All People Access Affordable and Safe Dousing Vacancy rate 1990 6.4%6 4-6% Availabilty of housing for special needs populations: Elderly Units Needed 1995 NA NA Mentally lit Units Needed NA NA Physically/Developmentally Disabled Units Needed NA NA Housing for people with AIDS Units Needed NA NA Percent of renters paying more than 30%of income on rent 1990 45.9% 45.2% Percent housing stock which is substandard 1993 2.1% 0.5-4.6% Estmated number of homeless people per year 1997 15,000 NA (Alameda:9,000-27,000;Marin:2,500;San Francisco 11,000-16,000 San Mateo:8.665;Santa Clara:9,000) 11 All People Enjoy the Benefits of Clean Air,Clean Water,and a Healthy and In Development Sustainable Environment A r `;,y The Contra Costa County United Way/Hospital Council Collaborative has adopters a set of goals and principles that represent the foundation for a more successful approach to building healthy and self-sufficient communities throughout Contra Costa County. They provide a framework for the assessment and a broad perspective around which we organize our work. BUILDING HEALTHY AND SELF-SUFFICIENT COMMUNITIES • All children succeed in school and are prepared for lifelong learning. • Families of all kinds are strengthened, preserved and nourish. • People acquire and retain jobs and achieve economic independence. • The cycle of violence is ended. • The frail, disabled and chronically-ill are ensured independence and dignity. • Inequality and discrimination are eliminated. • People achieve and maintain optimum mental and physical health. • Individuals and neighborhoods are prepared to respond to emergencies and disasters. People play an active role in community life. • All people have access to affordable and safe housing. • All people enjoy the benefits of clean air,clean water and a healthy and sustainable environment. WHAT W©RKSI PRINCIPLES FOR COMMUNITY BUILDING • Focus on outcomes. • Build on assets. • Involve and invest in communities and neighborhoods. • Provide comprehensive support for families and individuals. • Collaborate at all levels: policy, providers, community. Be culturally competent. • Integrate services. • Rebuild systems-and bring model projects to scale. + Promote region wide access to economic vitality. Source:Bay Area Partnership.Building Healthy and Self-Sufficient Communities:Principles for Designing and Delivering Successful Community Programs. l�!fY The United Way of the Bay Area 1998-99 Contra Costa County Leadership Board Jim Bouquin John Mason Executive director Marketing New Connections Linda Brewer Carol Newkirk Executive Director Executive Director San Ramon Chamber of Commerce YWCA,Marin,SF&San Mateo Counties John Cullen Yvette Radford Director Community&Government Relations leader Contra Costa County Social Services Kaiser Permanente Jon Deusenberry Mary Rocha NW Reg.Finance Manager Mayor of Antioch and Healthy Start Coordinator United Parcel Service East Bay Perinatal Council Joe Gogtio Lou Rosas Director,AFL-CIO Public Affairs Director Contra Costa Central Labor Council Pacific Telesis&Pacific Bell Roger Henry,Jr. Theodore Schmidt Facility Compliance Coordinator Retired-J.C.Penney Chevron U.SA Paul Lewis Charles Stephenson MA/MFCC Consultant Youth Services Bureau-Richmond Robin MacGillivray Kathy Stout Vics President,Business Services Group Systems Director Pacific Bell Bank of America Ginger Marsh Dr.K.M.Tan Chair Asst.Physician&Chief Continuum of Care for Contra Costa County Kaiser Permanente The Hospital Council 1899 Bast Bay Section Executive Committee Cha1r Chair-Ei20 Tony Paap Gary Sloan President/CEO Chief Executive Officer Children's Hospital Doctors Medical Center Treasurer Past Cif Michael Smart Linda Horn Chief Executive Officer Administrator Alameda County Medical Center Sutter Delta Medical Center Marcy Felt Frank Puglisi,Jr. Chief Executive Officer Executive Director Valley Care Health System Contra Costa Regional Medical Center Sandi Small Kelly Mather Senior Vice President/Area Manager Chief Executive Officer Kaiser North East Bay CSA San Leandro Hospital Martin Diamond George Bischaianey Chief Executive Officer Chief Executive Officer John Muir Medical Center Eden Medical Center Contra Costa County United Way/Hospital Council Collaborative Community Assessment Executive Summary: A Call to Action 1999 Prepared and distributed by. Northern California Council for the Community 50 California Street, Suite 200 San Francisco, CA 94111 Phone: 415.772.4430 Fax: 415.391.9929 www.nccesf.org Contact the NCCC about other volumes of the Contra Costa County United Way/Hospital Council Collaborative Community Assessment Executive Summary Volume 1: Health, Social and Economic Indicators Report Volume 2: Inventory of Community Institutions Volume 3: Annotated Bibliography 5x99 Acknowledgments This publication was made possible with funding from The Hospital Council and United Way of the Bay Area Yael Buchman, Judy Pope and Ellen Irie wrote the Executive Summary. Diane Reed, Tony Daysog, James Miller, Yael Buchman, Nancy Frank and Anne Frey researched, wrote, and edited Volume 1: Health, Social and Economic Indicators Report with the assistance of Community Assessment Team members Jennifer Balogh, Selina Toy, Robert Toyama and Reggie Valmores. Mary Suloway supervised and coordinated its production. 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See i�'r�vta� #7�rs#a#tia� �+>t� strii�ea �"��*�'�# tee = �€k'�ncge<r,�€�ZEer:`� €,�s�tors'A�Ie�i€cai Csiusr Ohre£ ciizt V�xiric �rviix oai Gsii# is#tyostitsiiiity qac€ai �tpiut#tt# ittis �s#Iiscss i�Rtstwisritioii�ioiuu �r+iis 'iiirixt m........ t�tr#~fir £Siv# tyit#4laisag+x lxrc�►irzI'll�i�r Wis#farix i�iit#��tu#ii�g s3x#sUt €it#d CsecZoasiisti: ityciisi;Svic �� � ��' �� � ���� � �� t � � ��m� ar�ed �� ��e�����t�� ����� � �dry �� . - ��`� � �� t �3 � � u Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Contra Costa County: The Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Equity, The Life Cycle, and Risk Factors: Understanding the Challenges to Building a Healthy Contra Costa County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Equity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 TheLife Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Risk Factors and Prevention Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Appendix: Healthy People 2000 Coals . . . . . . . . . . 15 Mortality. Contra Costa County has achieved national Healthy People 2000 goals to lower mortality in several areas, including overall infant mortality, deaths among adolescents and young adults, and deaths due to suicide, unintentional injuries, motor vehicle accidents, coronary heart disease, and all cancer deaths, including lung cancer. Contra Costa County has not met national goals to lower black infant deaths and deaths due to homicide, firearm injury, drugs, stroke and female breast cancer(indicated in bold). Table 2. Contra Costa County Mortality Rates*(per 100,000 persons) Compared with California Rates and Healthy People 2000 Goals California Healthy People 2000 (1994-1996) (1994-1996) Objective Infant Mortality bate(1MD) 5.8 7.0 7/1,000 African American IMD** 11.5 15.4 11/1,000 Adolescentlyoung adult 84.3 na 85 (15-24)deaths Homicide 12.7 11.8 7.2 Suicide 8.9 10.7 10.5 Unintentional Injury 22.7 26.6 29.3 Firearm Injury 15.8 15.0 11.6 Motor Vehicle Related 10.5 13.2 14.2 Drug Delated 6.9 8.0 3.0 Coronary Heart Disease 82.9 100.8 100.0 Cerebrovascular(stroke) 28.2 26.3 20.0 Cancers (all combined) 116.5 115.9 130.0 Female Breast Cancer 22.0 19.7 20.6 Lung Cancer 29.9 31.8 42.0 *Age-Adjusted rates were calculated using the 1940 United States population. **For all other racieUethnic groups, the Alameda County birth Cohort infant death rates were lower than the Califomia state rate. Source:Califomia Department of Health Services, County Health Status Profiles 1998 i Morbidity. Contra Costa has achieved Healthy People 2000 goals to recline morbidity in several areas, including AIDS incidence, gonorrhea, including among adolescents, chlamydia, measles, rubella, and asthma discharge rates for all ages and racial/ethnic groups with the exception of African Americans. Contra Costa has not yet met national goals for late prenatal care, low birthweight, immunizations, tuberculosis, and asthma hospitalization among African Americans of all ages. Table I.Contra Costa County Morbidity Rates'(per 100,000 persons) Compared with California Rates and Healthy People 2000 Coals Contra Costa California Healthy People 2000 (1954-1996) (1994-1996) Objective Late prenatal care 16.3 20.9 10% Low birthweight 6.2 6.1 5% Mack low birthweight 11.3 na 9% (1997) Immunization.(199+6) 66.9 57.3 90% up-to-date by 24 mo. AIDS incidence 27.7 29.4 39.2 (1993-1995) Gonorrhea(1997) 63.4 55.3 100 Gonorrhea 15-19 yr olds 312 207.7 750 Chlamydia 162.2 210.7 170 Tuberculosis(1993-1995) 11.9 14.4 3.5 Measles(9997) 0 na 0 Rubella(1997) 0 na 0 Asthma hospital discharges(1991-1994) White 96 112 160 African American 336 375 265 Latino 102 114 265 Asian/Other 115 119 265 Asthma hospital discharges(1951-1994) Children 0-94 White 152 185 225 African American 551 704 225 Latino 155 187 225 Asian/Other 203 209 225 Sources:California Department of Health Services:County Health Status Prortles 1998; Cetifamie County Asthma Hospitalization Chart Book,August 1997;Immunization Levels of CalUbmia Toddlers in Counties Conducting Expanded Kindergarten Retrospective Surveys,August 1996;and STD Control Program. Contra Costa County Communicable Disease Control Section Contra Costa County United Way/ Hospital Council Collaborative Community Assessment Executive Summary Appendix Healthy People 2000 Goals Healthy People 2000 is a national effort involving professionals, citizens,private organizations and public agencies. National goals are set for improvement in health by the year 2000. Work on the report Healthy People 2000:National Health Promotion and Disease Prevention Objectives fpubfishad by the U.S. Department of Health and Human Services)began in 1987. The report lists 226 measurable objectives and that are possible to track progress towards achievement. The purpose of Healthy People 2000 is to increase the span of life, reduce health disparities and achieve access to preventative services for all Americans. This appendix tracks Contra Costa County's progress towards achievement of Healthy People 2000 goals in the areas of morbidity and mortality, 15 Violence in the Community There are many aspects of violent or abusive behavior. One significant aspect includes homicide and gang activity in the county. Many are concerned that while conviction rates for gang members in the county are rising, the homicide rate for youth ages 15-24 still remains high. Another important aspect is the intergenerational nature of violence, particularly family violence. Not only do different forms of family violence such as child abuse and domestic violence frequently occur alongside one another within the same family, but victims of child abuse are at greater risk of committing violence themselves, thus perpetuating the cycle of violence. A 1992 U.S. Department of Justice Report found that a majority of youths arrested had a prior history of abuse and neglect. The same study reported that childhood abuse increased the odds of future delinquency and adult criminality overall by 40%. It also indicated that abused girls fare worse, . with 77%of female child abuse victims more likely to be arrested as juveniles. Another study found that men who have witnessed their parents' domestic violence are three times more likely to abuse their own partners than children of non-violent parents. Programs and services aimed at breaking the cycle of violence in families before it reaches "crisis" levels can offer protection and a greater sense of security to residents in Contra Costa County. • In 1997-1998, more than five times as many domestic violence calls (27,222 calls by 11,675 women)were made to the Battered Women's Alternatives crisis hotline than to 911 in the county. Approximately 20% of all incoming domestic violence calls were from senior women. • Senior women currently comprise 15% of support group members at Battered Women's Alternatives in Contra Costa County. • All categories for child abuse Emergency Response System calls have increased since 1990, with neglect(7,482 calls in 1990; 11,009 calls in 1996) and physical abuse (3,852 in 199O; 5,726 in ,1996) experiencing the largest net increases. • Homicide and gang-related violence are an increasing concern in Contra Costa County. For example, some estimate that over the past eight years, 100 of the;murders committed in the city of Richmond were due to gang activity. 14 ......... ................................................................. ........................ 2 L Unemployment The unemployment rate in Contra Costa County in 1998 was 3.6%, the lowest in ten years. However, a strategic plan (such as the one proposed by the Workforce Development Advisory Panel in Contra Costa County) can help ensure a continued low unemployment rate and individual economic self-sufficiency_ In order to develop a strong economy, Contra Costa County benefits from a trained workforce that is able to find and keep jobs that pay a living wage. • Retail, finance, insurance and real estate (F.I.R.E.), and service jabs constitute a larger percentage of all current jobs in Contra Costa County. • Retail jobs are projected to become a greater proportion of all county jobs in the year 2000. • A significant gap exists between what is paid in fast growing occupations (such as retail sales) in Contra Costa County and the cost of living in the county. • A major challenge for policy makers is in devising a ladder for vocational advancement from entry-level positions to more permanent and benefit-ladden jobs. • Transportation costs and distances between home and workplace can pose as barriers to employment. According to the Contra Costa Transportation Alliance, the majority of entry level job opportunities are located in Central and South County, while many individuals seeking work live in West and East County. High School Dropout Rates For the past ten years, high school dropout rates have been decreasing in Contra Costa County and throughout the Bay Area. It is agreed that dropout rates have steadily decreased for all ethnic groups, although the rates are still disproportionately higher for African Americans and Latinos. Efforts to support all students to graduate from high school could be beneficial for future efforts at employment and self-sufficiency. For example, the Contra Costa County Office of Education provides programs for students who have needs that are not addressed by the traditional public school system. In varying degrees, these types of programs aim to increase self-esteem, break the pattern of failure, reduce high school drop-out rates, integrate students into the community, and introduce them to the work world. • The rise in income inequality in California is partially due to the fall in wages for workers without a high school diploma. Improving education and the opportunity to finish high school can help counteract this trend in the state. • There are greater job opportunities for persons in Contra Costa County with a high school degree or some college education. • High school dropout rates vary according to geography, with highest rates (3.0 in 1995- 1996) for Pittsburg Unified high school students and West Contra Costa Unified high school students (2.9 in 1995-1996). In comparison, high school dropout rates in Central County are low, with a 0.6 dropout rate in 1995-1996 for Martinez Unified school students, and a 0.1 dropout rate for Acalanes Union High School students. Ibid. 13 particularly in the county's African American communities where the low birthweight birth and infarct mortality rates are twice that of other race/ethnic groups in the county. In addition, pregnant Asian/Pacific Islanders teens are fess likely than other teens to seep early prenatal care, resulting in significantly higher low birthweight births among this group. Efforts to encourage greater usage of prenatal care must begin by examining and addressing the social, cultural and economic harriers which are preventing these women from seeking prenatal care. To the extent that the women not receiving prenatal care are low income, they should be encouraged to take advantage of Medi-Gal's and other public programs. = Contra Costa County showed a slight decline in the percentage of pregnant women beginning prenatal care after the first trimester, from 16.7% in 1991-1993 to 16.3% in 1994-1996. While well below state averages for these years (25.1% and 20.95% respectively), Contra Costa County experienced a much slower rate of decline than the statewide trend. = A higher proportion of teens (under 20 years ofd) received very late or no.prenatal care (4.9%), than did women ages 20-34 (2.7%) or women 35 and over (2%) in the county. • The African American rate of low birthweight infants (11.3%) is higher than the rate for Asian/Pacific Islanders (6.4%), for Whites (5.6%), and for Latines (5.1%). Lack of Immunizations Immunization is the most effective and inexpensive tool for the prevention of communicable diseases. Contra Costa County children, however, are not taping full advantage of this health prevention strategy, as demonstrated by the fact that only two-thirds (65%) of kindergartners in 1996 were folly up-to-elate with their immunizations at two years of age. lack of access to health care is a key reason why immunization levels are not higher, but this is not the only factor. Beliefs that immunization may actually be harmful also impede immunization efforts. These barriers must be better understood in order to initiate efforts which can help to break them down. In addition, low and/or no-cost access to immunizations must continue to be promoted so that the county can reach optimal levels of childhood immunizations. • African Americans (47%) and Latinos (50%) have lower early immunization rates than Whites and Asian/Pacific Islanders (both 71%). Sexually Transmitted Disease Sex education can improve the health of Contra Costa County residents by helping to prevent unsafe sexual practices and sexually transmitted diseases. Providing information on how to protect against sexually transmitted disease and increasing access to contraceptives can potentially lower these rates. = The chlamydia case rate among 15-19 year olds in 1997 (982/100,000);was over six times higher than the county's rate for all ages (1591100,000). • Gonorrhea and chlamydia are more prevalent among female ,adolescents and young adults than among males. 12 disability, physical and language isolation, lack of transportation, living alone, and daytime isolation (even when living with extended family). Risk Factors and prevention Opportunities There are a significant number and wide variety of circumstances negatively affecting the lives of individuals, families and communities that are the result of individual behaviors and community practices. The following describes conditions in Contra Costa County that could be addressed by changing behavior and practice. Risk Factors • Alcohol, Tobacco and Other Drugs Lack of Prenatal Care • Lack of Immunizations • Sexually Transmitted Disease • Unemployment • High School Dropout Rates • Violence in the Community Alcohol, Tobacco and Other Drugs The effects of the use and abuse of alcohol, tobacco and other drugs are far-reaching. In addition, these substances affect not only the Individuals who use them directly, but also those around them, and our communities (for example by increased violence due to drug-seeking behaviors). While there has been much public attention on the"war on drugs" in recent years, alcohol, and particularly tobacco, claim more lives than do other drugs. While it is encouraging that smoking among the general population has been declining in recent years, smoking prevalence among teens is up. This is of particular concern due to the fact that 901% of adult smokers begin smoking before their 19th birthday. • In 1993, smoking prevalence among youth in Contra Costa County was reported to be 9%, an increase from 8% in 1990. • Between 1991-1995, there was a steady increase in the rate of drug deaths in Contra Costa County. Twenty percent of drug deaths during this time period were due to opiates. Death due to opiates more than tripled from 7 deaths in 1991 to 25 deaths in 1995. • Heroin and other opiates made up 26% of drug-related hospital discharges during 1991- 1995, followed by cocaine (17%) and amphetamines (16%). • The number of persons killed or injured in alcohol-related automobile accidents has been steadily declining and remains below the statewide rate. • Alcohol and substance abuse is associated with significant percentages of juvenile crime, homicides, and motor vehicle accidents. Lack of Prenatal Care Early, comprehensive prenatal care can significantly reduce rates of infant and maternal illness and death. Contra Costa County is experiencing the adverse effects of having 16% of its pregnant women begin prenatal care after their first trimester. These effects are being felt 1'# f • Firearms are the leading cause of injury death among Whites, Latinos,;and African Americans in the county, with the majority between the ages of 15-24 years old. • Homicide accounted for 30% of all deaths for adolescents/young adults ages 15-24 in 1995-1996 combined. This compares to the Solana County adolescent/young adult homicide death rate of 21% during the same time period. • Suicide accounted for 18 of 184 deaths (or 10% of all deaths)for adolescents/young adults ages 15-24 in 1995-1996 combined. For comparison, the suicide rate in Soiano County was 14% (12 of 88 deaths) in 1995-1996 combined for this age group. Among all Contra Costa County adults: • Heart disease and cancer are tate leading causes of death in the county. However, the county's heart disease mortality rate (83/100,000) is below moth the California state rate and the Healthy People 2000 goal (100/100,000). The mortality rate for all cancers (116.5/100,000) in Contra Costa County is also below the Healthy People 2000 goal of 130/100,000. • Approximately one in five deaths in Contra Costa County is attributed to smoking. Since 1990, fewer people in the county smoke each year. • The rate of drug-related deaths (6.9 per 100,000 population) is more than twice the Healthy People 2000 goal of 3 deaths per 100,000 population. Deaths from drug overdose are highest among 35-44 year olds in Contra Costa County, as well as in Alameda, Soiano, and Marin counties. • Contra Costa County's tuberculosis rate of 11.9/100,000 does not achieve the Healthy People 2000 goal of 3.5/100,000. • The overall crime rate(2,277/100,000) has declined somewhat in recent years in the county. • The homicide rate in Contra Costa County (12.7 deaths per 100,000 population) is nearly twice the Healthy People 2000 goal (7.2/100,000). • While new AIDS/HIV cases among White men who have sex with men are declining each year, the proportion of new AIDSIHIV cases among heterosexuals, women and people of color in Contra Costa County is increasing, The West County cities of Richmond and San Pablo have the highest cumulative incidences of AIDS in the county. Issues of concern for seniors include transportation and cancer: • Ninety percent of Centra Costa County's prostate cancer cases are among men over 60 years old. African Americans have significantly higher prostate cancer rates than do other groups. • Breast cancer is the leading farm of cancer in the county, and nearly half of all breast cancer cases are among women ages 60 and alder. The county's breast cancer incidence (118/100,000) is higher than the statewide average (105/100,040). • In all California and Contra Costa County Office on Aging surveys, transportation is listed as the top-ranking "serious" problem for seniors in the county. • A 1996 Contra Costa County Office on Aging survey showed marked increases in two problem areas for seniors: 1) communication about access to services and supports and 2) isolation and loneliness. Isolation and loneliness was found to be affected by frailty, 10 • Nearly 13% of California's children are uninsured, despite the fact that, as a federal study suggests, nearly 40% of them qualify for Medi-Cal. No local data on this topic are available. = Lack of transportation in Contra Costa County is reported to be a deterrent to receiving adequate care, especially for elderly and homebound people. • The Centra Costa County Mental Health Division reports that the majority of consumers who access mental health services are single or female heads of households between the ages of 25 and 56. Efforts are being made to improve services to the following populations who are underrepresented in the mental health system: Asians, Latinos, African Americans, and children under 18 years. • The need for diverse and culturally sensitive mental health services for immigrants in the county is especially apparent when language needs are considered. Asian, Pacific Islander and Latino immigrant clients often prefer to speak in their native language. The Life Cycle Major issues are clustered according to four age groups: 1) infants and children; 2) adolescents; 3) adults; and 4) seniors. When categorizing health issues according to Stages in the life cycle, it is importanttokeep in mind that a number of the critical issues fit under more than one age category. For example, issues such as crime,transportation and physical health impact Contra Costa residents of all ages. This section of the summary looks at the data showing the strongest linkages between age and the critical health issues. Indicators of concern for infants and children include: • The level of early childhood immunizations in Contra Costa County (65%) is higher than the statewide level (57%) but still falls short of the Healthy People 2000 goal of 90%. • Sixteen percent of pregnant women in Contra Costa County begin prenatal care after their first trimester, while the Healthy People 2000 goal is to have no more than 10% of pregnant women beginning prenatal care after the first trimester. • Monument Corridor in Central County has the highest percentage of late prenatal care in the county (31%), followed closely by West County's Iron Triangle/North Richmond/Coronado area(29%). • The average cost of child care in the county is between $111-$159 a week per child. At this rate, a minimum wage earning worker with one child will pay 56% of annual take- home pay on child care. = Additional child care opportunities are needed, particularly subsidized slots. Currently there are 5,936children benefiting from subsidized care in Contra Costa County, satisfying approximately 25% of demand. It is estimated that the number of eligible children for subsidized care in East County alone increased from 8,145 in 1990 to 23,290 in 1998. For adolescents, critical issues deserving attention include sexually transmitted disease, death due to homicide and firearm injury and suicide: • Contra Costa County teenagers (ages 15-19) have a chlamydia infection rate over six times higher than all other age groups. This is similar to other Bay Area counties (San Francisco teenage rate is 5.5 times higher than other age groups, Solano County rate is over 6 times higher, Alameda County rate is 7 times higher than ether age groups). 9 (43% of all public high school graduates). The number of students throughout the state completing these courses was at its highest level in 1997 as well"(36% of all public high school graduates). • Twenty-three percent of all jobs in Contra Costa County require a Bachelor's degree, a lower rate than: Catifomia (24%) and the Bay Area (26%). It is estimated that the number of jobs requiring a Bachelor's degree or some college will increase. Family Amuse • Calls reporting possible child abuse, neglect, or abandonment in the county have increased 44% since 1990, while statewide the number of calls increased 28% in the same time period. • The rate of calls (20,382 reports or 61 per day) reporting possible child abuse is currently the second highest in the Bay Area. • The majority of child abuse calls (54%) in 1996 reported neglect, followed by physical abuse (28%) and sexual abuse (14%). • In 1998, Children's Protective Services in Contra Costs County received a total of 8,139 referrals including 1,173 immediate referrals (cases in which a'child is at immediate risk). West County received 396 immediate referrals, Central County received 362 immediate referrals and Bast County received 415 immediate referrals for this time period. • Domestic violence-related arrests have more than doubled since 1992 I(527 arrests in 1992; 1,218 arrests in 1997). Domestic violence-related arrests have also increased throughout the Bair Area. The Contra Costa County cities with the most domestic violence calls to 911 in 1996 were. Concord, Richmond, and Antioch. • Reports of elder abuse in Contra Costa County have increased from 110 in 1994, to 514 in 1996.4 Increases in elder abuse reporting has also occurred in other Bay Area counties. • The most prevalent types of abuse inflicted upon the elderly in the county are physical abuse (31%), financial abuse(24%), and neglect(24%). Access to Health Care Servicer • Centra Costa County residents may find it difficult to access physical and mental health services because of economic, service, or social barriers to care. Among these barriers are; tack of service in poor communities, language and cultural barriers, immigrant status, transportation, lack of awareness of services. • Californians are disproportionately more likely to be uninsured than other Americans. • Approximately 18% of residents in West Contra Costa County do not have health insurance, with the majority of these households in Richmond and San Pablo. • The lack of health coverage in California is most prevalent among young adults, lower income families, Latinos, African Americans and Asian Americans. 4 See Life Cycle Section for more detail on the frail elderly. f Geography • West County is one of the most ethnically diverse areas in the Bay Area, with an estimated 65% of residents being people of color, to 1998, West County's population was 35% White, 19% Latino, 19% Asian/Pacific Islander, and 26%African American. • According to 1998 estimates, South County has the highest median incomes, ranging from $83,0383 to $136,376, while West County has the lowest range of median incomes, (making only one-third to one-half of South County incomes) from $24,919 to$69,113. • Those living in poverty tend to be concentrated in West County and the northern area of East County. • Bethel Island is the only neighborhood with a higher percentage(22%) of adults ages 65 and over than percentage of children and youth ages 0-17(15%). • Areas of Contra Costa County with the largest proportion of homeless include. Richmond, North Richmond, Bay Point, Pittsburg, San Pablo, and Pacheco. One half of all Superfund sites in Contra Costa County are located in Richmond. • During the 1996-1997 school year, West Contra Costa Unified School District had the highest percentage of limited English proficiency students (21%) in the county. Education • Wades for California residents without a high school diploma declined by one-third between 1969 and 1997, while wages for residents with a bachelor's degree remained stable.' • There were a total of 14,557 limited English proficiency (LEP)students enrolled in Contra Costa County public schools, representing 1010%of all students. This is lower than the proportion of LEP students in Alameda County (18.5%) and the proportion of LEP students in California (24.6%). The greatest majority of LEP students in Contra Costa County speak Spanish (70%). • The county public high school graduation rate of(76%) is higher than the California rate (66%). • African Americans (53%) and Latinos (64%) have the lowest public high school graduation rates in the county. Graduation rates for African Americans and Latinos in other Bay Area counties follow a similar trend. For example, African American and Latino high school graduation rates in Alameda County are 46.9% and 58% respectively, as compared to the overall Alameda County rate of 66%. • In the 1996-1997 school year, many more Centrad County high school seniors took the Scholastic Aptitude Test (SAT), compared to West County high school seniors (e.g., 9 out of 10 students at Mirsmonte High School took the exam,white 1 in 5 students attending Richmond High School took the exam that same year). • The number of twelfth grade graduates in the county completing California State University and University of California required courses was at its highest level in 1997 3 Public Policy Institute of California ."Income Inequality in the Golden State:Why the Gap has Widened Between Rich and Poor."February 1999. 7 .E� L d • The asthma-related hospital discharge rate for African American children in Contra Costa County (551/100,000) is more than twice the Healthy People 20030 goal, while rates for other population groups come close to the target. • Over half of Contra Costa County's 1,983 children in foster care are African American. • The death rate(209.6/100,000) for African American youth is 2.5 times the national objective of 85/100,000. • From 1995-1996,the most significant increases in tuberculosis (TB) cases in the county were in African American women, ages 18-25, and in children, ages 7-18. All of the 25 African American women and 16 children with TB lived in West County. • African American men suffer from rates of hospitalizations for cardiovascular disease strokes, hypertension, heart diseases and diabetes that are significantly higher than the state rates, and have the highest rate of prostate cancer of all groups in the county.. • African American families in Contra Costa County live in neighborhoods with far fewer physicians than the state and national averages. The state average is 266 physicians per 100,000 people, compared to Best County with 21.2 per 100,000 people, and West County with 49.3 per 100,000 people. • African Americans are sharply over-represented in homicide data. While making up only 9.1% of Contra Costa County's 1998 population, African Americans accounted for 50.3% of homicide victims, and African American males made up 43.9% of all reports. A majority of these victims were between the ages of 15-24. • People of color make up increasing proportions of people with AIDS each year in Contra Costa County. In 1996 and 1997, people of color made up over half of all new cases reported-- with African Americans making up the majority (44%) of these cases. Other Vulnerable Populations • The county has become increasingly more ethnically diverse in the 1990s.According to the population estimates, people of color now make up 36.5% of county residents, in comparison to 30% in 1990. • Latina teens (under age 20) had the highest number(397 of 1,070) of teenage births in 1997. This represented 37% of all births in this age group in the county'. • Asian/Pacific Islander pregnant teens are less likely to receive prenatalcare than are teenagers and women of other race/ethnicities in Centra Costa County. to 1597, 14% of Asian/Pacific Islander teens received late or no prenatal care, as compared to Latina teens (5%), White teens (5%), and African American teens (5%). • Gay and.lesbian youth are reported to have higher suicide rates than other teenagers. • In California, Latina women with breast cancer are more likely to be diagnosed at a late- stage, regardless of socioeconomic status. In 1996, 44% (186)of tuberculosis cases in the county were from foreign-born residents. Of these foreign-bom cases, 37% (69) were from the Philippines and 15% (27)were from Mexico. • Pear of deportation, language barriers and cost prevent many undocumented individuals from seeking physical and mental health care. Children of immigrant families have fewer referral services, are less likely to seek care, and are more likely to be uninsured. • According to the 1990 Census, there are 9 persons between the ages of 16-64 who are mobility impaired for every 1,000 non-impaired individuals in the county! 6 ............................................................... . ...................... . . r %eff✓erg . �N x Equity, The life Cycle, and Risk Factors: Understanding the Challenges to Building a Healthy Contra Costa County In order to give coherence and meaning to the complex, voluminous inforrnation presented in Volume 9: Health, Social and Economic Indicators Report, here is Contra Costa County's data presented from three different perspectives: (1) equity, (2) the life cycle, and (3) risk and prevention. Equity Not all people have equal access to conditions that promote health or to health care services. Some do not benefit from care that would ensure healthy and fully productive lives, or receive the assistance needed to treat chronic and acute illnesses. Differences based upon income, race/ethnicity, geography, and education can mean that poor people, people of color, and people with limited English language shills are more vulnerable to disease and less able to access services than other county residents. The following.are a number of significant variables affecting an individual's access to conditions that promote health: Poverty • Although Contra Costa County shares in the economic recovery enjoyed by the rest of California, many of the jobs being created do not pay enough to allow families to become economically self-sufficient Public subsidy programs based on federal poverty guidelines are inadequate to meet the costs of living in the county. • There are higher concentrations of people living in poverty in West County and in parts of East County. • Racially and ethnically diverse neighborhoods have the highest rates of poverty in the county. For example, more than 50% of all people living in census tracts in North Richmond and parts of San Pablo live below the poverty line. The population in North Richmond for 1998 was estimated to be 14%White, 13% Latino, 16%Asian/ Pacific Islander and 58%African American. The population in San Pablo for 1998 was estimated to be 23%White, 35% Latino, 19%Asian/Pacific Islander and 22%African American. • Children are disproportionately represented among the county's impoverished. In 1993, 41% of persons living in poverty were children. • In 1993, Contra Costa County had a 9% poverty rate, up from 7%c in 1990. • On any given night, some estimate there are up to 6,000 homeless individuals in the county, with children representing 40-50% of this homeless population. Others estimate that between 13,000-15,000 people experience homelessness in a given year in the county. African Americans • African American infants in the county are almost twice as likely to die before their first birthday than infants in other groups. 5 } 4,e Income • According to the 1990 Census, median household income in Centra Costa County ($45,087) was 26% higher than the statewide median ($35,798). • In 1998, South County had estimated median incomes ranging from $83,083 to $136,376; East County had estimated median incomes ranging from $43,676 to $110,667; Central County had estimated median incomes ranging from $35,657 to $106,762; and West County had estimated median incomes ranging from $24,919 to $69,'113. • The neighborhoods with the lowest range of median incomes in 1998 were North Richmond (ranging from $10,483 to $71,450), Iron Triangle (ranging from $14,717 to $48,378) and Monument Corridor(ranging from $19,139 to$42,857). Families • The proportion of families living in Contra Costa County has grown at twice the California rate (16% increase in the county; 8% increase in the state) from 1990 to 1998.The number of families settling in both South County and East County during the 1990s increased by 26%a • Subsidized child care programs serve only 5,936 children for an estimated 34,050 that are eligible for subsidized care in Contra Costa County. • In Contra Costa County, the average cost of full-time care for a child under 2 in a licensed care center is $159 a week, approximately 80% of the annual net wage of a person earning minimum wage. Education • Contra Costa residents have higher levels of education than do ether Californians. Higher percentages (21%) of Contra Costa residents have graduated college and have a graduate or professional degree (10%) than do their statewide counterparts (15% and 8% respectively). • The county's high school dropout rates have been declining over the past ten years, to 1.5%, lower than California's rate of 3.9%. • African Americans(3.1%) and Latinos (2.7%) have the highest public high school dropout rates in the county. Environment • There are twenty-two Superfund cleanup sites in Contra Costa County, three of which are on the national priorities list. • Nineteen of twenty-two uuperfund sites in Contra Costa County are looted in West County--with eleven sites locatedin Richmond. 4 Centra Costa County: The Context... Demographics • The county has an estimated population of 903,477, a 13% increase from 1990. This is faster than the rate of growth for California(9%) and the Bay Area (8%).2 • Both East and South County had high rates of growth between 1990 and 9998 (25% and 23% respectively), nearly double the county's rate. • In 1998, it is estimated that Central County made up 37% of the population of Contra Costa County, followed by East County (26%), West County (25%%) and South County (12%%). Age • The population is aging, with particularly large increases (58.4% between 1990 and 1998) in the number of residents ages 85 and older. This increase, while reflecting a statewide trend, is higher than the state rate of 49.9%. • Children also represent an increasing proportion of the population, with the percentage of 0-4 year olds (4.4%), 5-9 year olds (14.8%), 10-14 year olds (19.5%), and 15-17 year olds (19.3%) growing at a greater rate than in the Bay Area and the rest of California between 1990 and 1998. Ethnic Diversity • The county is becoming increasingly ethnically diverse. in 1998, the county's population was estimated to be 64%White, 15% Latino, 12%Asian/Pacific Islander, 9%African American. This compares to the 1990 population in the county which was 70% White, 11%d Latino, 9%Asian/Pacific Islander, and 9% African American. • For regional comparison, West County's population in 1998 was estimated to be 35% White, 19% Latino, 19%Asian/Pacific Islander, and 26%African American while Central County's population in 1998 was estimated to be 77% White, 11% Latino, 10% Asian/Pacific Islander, and 2%African American. • In East County, El Pueblo and Village Drive have twice the proportion of Latinos (46% and 44.5% respectively) of the total East County percentage (21.5%). Asian/Pacific Islanders are most concentrated in Bay Point (12%) and Bethel Island (13%), compared to the 8% regional proportion. • According to the 1990 Census, 3% of Contra Costa County residents speak a primary language in the home other than English, compared to 9% statewide. In some neighborhoods, such as EI Pueblo and Village Drive, over 10% of residents are primarily Spanish speakers. 2 Sources for data or findings noted in the Executive Summary can be found in Volume I Health,Social and Economics Indicators Report. 3 /�94,v 14 �SfJ, / This Executive Summary: A Call to Action is designed to offer a picture of the;overall health of /F . the County as a means to learn what most requires our concern and attention! We do this by employing three separate but related prisms to first examine and then present data. The sections which follow provide information that helps us to understand the health of individuals, families, and communities in our County based upon: • Geography, race, gender, ethnicity and income status: The Equity Section • Conditions related to infants, youth, adults, parents, seniors: The Life Cycle Section • Circumstances that are brought about by the'behavior and practices of individuals and institutions: The Risk Factors and Prevention Opportunities Section Methodology In addition to this Executive Summary, this assessment work includes three volumes. They are: Volume f:Health, Social and Economic indicators Report, Volume 2: Inventory of Community Institutions and Volume 3: Bibliography. The primary organizing principle of this report are indicators of community health and wellbeing, as defined on page 1. Every attempt was made to include all relevant findings that impact specific populations. The content of the indicator report is a compilation of secondary data from various public and private sources. The scope of the assessment did not allow for personal interviews or focus groups. However, community organizations and hospitals were asked to provide such data for inclusion in the assessment. The data sources (e.g. Bureau of the Census, Department of tabor, Department of Health Services, Health Insurance Policy Program) are cited in the footnotes throughout Volume 9: Health, Social and Economic Indicators Deport and highlighted in Volume 3:Bibliography. As new significant information becomes available, it will be included in subsequent editions. Geographic Boundaries In Contra Costa County Our approach uses two units of analysis for defining Contra Costa County's geographic boundaries: the census tract and the zip code. Most of the sub-county geographic analysis within this report is dependent upon zip codes for geographic boundaries, and divides the county into four regions: Central County, East County, South County and West County. For certain data sets, in order to accomplish a smaller unit of geographic analysis, we used seven areas by zipcode : Bay Point/El Pueblo, Bethel Island, Iron Triangle/Coronado/North Richmond, MonumentCorridor, Rodeo(Old Town Area), San PablolBayviewlMontalvin Manor, and Village Drive. For other data sets ten areas by census tract were used: Bay Point, Bay ViewiMontalvin Manor, Bethel Island, EI Pueblo, Iron Triangle/Coronado, Monument Corridor, North Richmond, Rodeo, San Pablo, and Village Drive. 2 . Introduction The Contra Costa County United Way/Hospital Council Community Assessment is the first broadly collaborative assessment produced in the county. Partners in the assessment include the Contra Costa County hospitals, the United Way of the Bay Area, Contra Costa Health Services, the Department of Social Services, other governmental agencies, health and social service providers, philanthropic foundations and a variety of business and community organizations. This community assessment reflects the diversity and broad scope of our collaborative effort and organizes data around the broadest definitions of health for people, families and neighborhoods. The data collection effort and this overview are founded on our commitment to make Contra Costa County healthy, safe and self-sufficient. Healthy communities offer their members economic, social, and emotional security. They are places where children grow up educated, healthy acid prepared for the responsibilities of work, family and citizenship. They offer neighborhoods that are safe and welcoming places. Preceding this introduction is a listing of the Goals of Healthy, Safe, and Self-Sufficient Communities. These are goals against which communities can measure the success of our efforts and are representative of the way we organize our work. Healthy communities are the product of efforts that not only include but also transcend the design of specific programs and services.Perhaps most important, they are brought about through the articulation and achievement of agreed upon community goals; through the actualizing and mobilizing of existing community assets.' In addition, our commitment to action is founded on the understanding that such communities are created through institutions working together and the belief that no single sector, institution or agency can do it alone. This community assessment and executive summary offer a set of indicators in order to determine where some focal points for action can be taken in Contra Costa County. These documents do not propose prescriptions for solutions. They can be used as a tool for community residents, organizations and leaders to think and act collectively in addressing their areas of concern. The status report on the preceding page represents a general picture of healthy and self- sufficient communities, which can serve as a first list of success indicators. In the appendix is a set of Healthy People 2000 benchmarks--national goals set by the U.S. Department of Health and Human Services for improvement in health by the year 2000. The reader can refer to both of these charts to get an initial sense of the quality of life in Contra Costa County as compared to the Bay Area as a whole and the national standards set by Healthy People 2000. The data from the community assessment provide a number of critical areas in which Contra Costa County varies: from other communities, from past Contra Costa County data, or from generally accepted benchmarks. While the data show that Contra Costa County is doing better than the state or Bay Area in a number of areas, the data also demonstrate significant intra- county differences based upon geography, socio-economic status, ethnicity and other measures. I It is important to note that we have assembled in Volume 2:Inventory of Community Institutions an extensive listing of community assets:organizations,public institutions, service clubs,etc. This list is not a substitute for the variety,richness and diversity of the assets already found in neighborhoods,families and population groups. 1 F _...... _ _ _.._. f� ` � ��-�� �1 `�"� ::�� �� '�h�1p �1��€�ai����e as�ct s� s����rt �srr€�€t��€�+��trt��€�8ay.�$bar€r� rovtr� ���R��► �IEGT��tS �� �'��� ��ur�lt �Stit€� �e�t; P��g d�ut �n� .�� �V1 �t� ('tE�3,� flan�.�u� ��#�9�} €��n �r Y P��fi�has�� �may Adm€���� �'����) �'t��re f��rbe�# :��t��� �� S �r�r'�I�a���tatva�c t� rt�ne�f t�€„�bs�r Sari�'r�n�lsas�dit D��r Haut� �I �i#�;�� lnrtin �' >�€rete .€c�sn:l�tu�r€�I�sfrt�€� r ;�r��►; tr�ty;�€ee€tEt��€� I . P b;CSU � � iy �#�� ��&f�rpt�"i£�f ski �'€6�€�'f p��:: BIRt �8�'.�t��f afbY�s�G�►CCII�t €#I�m�#€�srn[a utrt�#Vit' ���ts� �€cs�r� €s�Er�rni������t�e �r €�a�` vv� Nerx€�€rnt mere ler�'���#e� <I&€��r ��ht fle€i��zrnra�tsun�i€;f�rt#t� ��z�€t� �+€vr€�Ser°���t�€ctirr�€a �r��l�rtt�� rn� �i, r5 West County residents £� weff-served distril- By Jim Beaver members serve on the Tenet Gov- oMsr coMrrraaY ernirig Board at the hospital. N DECEMBER 1995 the Hoard of while these oversight mecha- Dlrrectors of the healthcare district nisms are not absolute,guarantees that owned and operated Brook- they represent an unprecedented side hospital faced a clear and fright- level of corporate Involvement In the ening decision:If they did not act,and public process. quic ,to find a partner to run the In the two years since the affilia- hospital,it would be forced to close, tion Tenet has proved to be a coop- Earlier Los MWanos had faced a sim- erative and responsive corporate filar situation and It was now bank- partner. rapt and padlocked. The companyhas invested more At stake was a community,pub- than$10 million in needed facility licly operated hospital serving tens and equipment upgrades and has ac- of thousands of West County resi- met las obligationsin the lease dents annually — the only West agreement- County hospital offering a M range `Me+mac has spent much of the of acute-care services;medial,sur- past two Jew wrapping up the com- gical,Intensive care,emerge and plex financial,legal,contractual and obstetrics,as well as bum can. regulatory issues Involved in running cer centers. a hospital for 40-plus years. Brookside was the only full-ser- it is important to remember that vice hospital in the community that, the district's first and foremost re- in addition to serving Medl-Cal and sponsibility is that It remains the Medicare patients,also had a corn.- owner of the hospital. mitment to serving the uninsured. Should Tenet meet any of the con- At stake too were the nearly 1,000 ditions that allow it to get out of the ` s full-and part-time jobs and the$56 lease,the hospital reverts to the dis- trict. Among numerous other re.million annual payroll they genes- ated in the community sponsibilitles,the district carries the o. liability fora 7410-phis member pen- a A little over one year later,in Jan- sion plan and continues to adminis- uary 1997,the affiliation between ter dozens of workers compensation • Brookside Hospital and'ienet Health- ayes from the hospital. Systems saved this full-service com- The district is also paying back$5 w munity hospital from bankruptcy. million in debt that was built up over It also left Intact the West Contra the years that Brookside continued Costa healthcare District, whose to provide services to the community mission,just as when the district op- even when it was not receiving ade- d ersted Brookside,remains to provide queue payment for doing so. access and support programs on be- That repayment will take five to half of those West County residents seven years and Is paid from the who are too often left out of the property tax allotment the district healthcare systems--the underin- has historically received, x sured, the uninsured, the working It is the future after the hospital poor. In the bargain,the affiliation also debt has been repaid that holds tremendous pro created important mechanisms that and for.the district and community will ensure continued public over. sight of the hospital's operations. That is where the districts fund- sight will be aisle to be targeted for The healthcare district board, a publicly elected body that answers ni althCare ms In the corrimu- y. to the people of West County, had understood that there was really no Anyone who serves In any health- choice---the hospital had to suruive. related sthcapacity in rest County un- choice conducted an extensive public derstands the immense number of process leads a the extensive public health problems and needs facing p This publicinputled to a series our They also the des- of affiliation goals that gave the dis- perate lack of resources and fund- trict some needed leverage when Ing available to meet those needs. only one hospital system, Tenet, The op ty for a directed source came forward with an affiliation pro- of fun ,overseen by locally elected posal. representatives presents an un- The 30-year lease agreement be- precedented opportunity. tween'tenet and the district for the When it ran Brookside Hospital, continued operation of Brookside the district used its tale support to Hospital-- now Doctors Medical fund programs for the uninsured and Center San Pablo—gives the dis- underinsured.The districts new mis- trict and the community an impor- sloe statement and guidin princi- tant oversight rule at the hospital, ples are a clear statement o its con- Tenet must hold a public hearing tinued commitment to the process If it wishes to close a licensed underserved in gest County. service at the hospital and not re- In addition to providing leader- place It In the community;Tenet Is ship and oversight,for healthcare is. committed to providing$2.5 million sues throughout the district, the in charity care annually with an In. board will be an advocate for those flation factor built in;Tenet meets who are left out of the healthcare quarterly with the Community Ad- mem, visory Hoard In public session to pro- vide information about plans at the Beaver to the executtve director of hospital and to listen to community the`Voest COMM Costa Hees dWare, concerns; and two district board. District. ✓ ' a ide input into flie futtipe of ike flosplital District, tke facill4l and commum*4� 1ACCIlth Cape SCIMCCS2 efore making a decision on its future, the Beard plans to hold a number of public meetings, as 13well as provide a series of mailings to the community. Board meetings are open to the public; and you can also contact the five Board members through the District office. Because of the Importance of this issue, the public Is encouraged to become involved In the decision-making process. Upcoming meetings to which the public Is invited Include: 'issolution evaluation Committee Thursday, October 21. 7.0,'3 to 9:00 p.m. Los Medanos Community Hospital Cafeteria Community Outreach Committee Thursday, October 28, 7:00 to 9:00 p.m. Los Medanos Community Hospital Cafeteria Board of Divectovs Meeting Second Monday of Every Month, 6:00 p.m. Los Medanos Community Hospital Board Room i uestions regarding the District and the potential dissolution should be directed to the District office at 925-432-2200, The office is not regularly staffed and calls are returned periodically. .�.■,,,fir Dissolution/Continued l pei*ation Decision-Making Piwess I!J%Wdy 1 SSeptember 13 October 11 November 8 December 13 January 10 Meeting Board Meeting Board Meeting Board Meeting Board Meeting Board Meeting Formed Regular Meeting Regular Meeting Receive Input Possible Decision Possible Decision Committees: from Committees And Board Actlon And.Board Action October 21 C�tssoiutlon DEC and COC DEC and COCEvdtx*6nCrxm tttee ComInitY MOO" Reports to Board Committees Sunset community October 28 Outreach Cerra rhe Community Moe" {COC} (CCC) REQUEST TO SPEAK FORM (THREE(3)MINUTE LIMIT) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. A Name: : . �s< - Phone: ` r` '31 Address: � :s _ City: , I am speaking for myselfor organization: (name Of Mian) CHECK ONE: `a i wish to speak on Agenda Item# Date: My comments will be: general for against I wish to speak on the subject of I do not wish to speak but leave these comments for the Board to Consider: