HomeMy WebLinkAboutMINUTES - 10162007 - C.50 ,� cEAL
TO: BOARD OF SUPERVISORS �'==f��`-�==°'° Contra
FROM: LORI GENTLES- Assistant County Administrator - :;uf� . _z Costa
Director of Human Resources
" County
spA,cotiK`�
DATE: September 25, 2007
SUBJECT: P300 #20431-Health Services Department
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Adopt Position Adjustment Resolution Number 20431, CANCELLING eight(8) Mental Health Clinical Specialist(VQSB)positions
(#7511,#7947,#8156,#9876,#9895,#10335,#11601, and#12062)at salary level QT21361 ($4.152-$6,164) [Represented]and
ADDDING four(4)40/40 Medical Social Worker II (X4VH) positions, one(1) 30/40 Medical Social Worker II position, and (1) 20/40
Medical Social Worker II position at salary level 255 1590($5,056-$6,146).[Represented]
DISCAL IMPACT:
Upon approval,this action will result in a net savings of$165,066 due to the cancellation of the MH Clinical Specialist positions.
9ACKGROUND:
These positions are being added pursuant to Title 22 regulations which require that all non physician clinicians assigned to in-patient
psychiatric services must have a background in Medical Social Services. The current staffing of the in-patient psychiatric services
consists of MH Clinical Specialist positions and since this staffing pattern no longer meets the Title 22 regulations, the Department is
requesting to cancel the MH Clinical Specialist positions and replacing them with Medical Social Worker II positions. The Medical
Social Worker II positions will continue to provide services to the patients of the Crisis Stabilization and In-patient psychiatric units.
CONSEQUENCE OF NEGATIVE ACTION:
If this request is not approved, the Division will not be in compliance with Title 22 regulations.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD ICOMMITTY
APPROVE OTHER
SIGNATURES :
ACTION OF BOR ON dVQ. APPROVED AS RECOMMENDED JTHER
VOTE O SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT
COPY OF AN ACTION TAKEN AND ENTERED ON MINUTES OF
THE BOARD OF SUPERVISORS ON THE DATE SHOWN.
UNANIMOUS(ABSENT )
AYES: r:�� NOES:
ABSENT. ABSTAIN:
Contact: Christine 1°.�ab1>sr,7-5257(Health Services)
Teji O'Malley,5-1723(HR)
Cc: Health Services ATTESTED "� ' '`��-� �'`�f ✓ ��
Human Resources "JOHN CULLEN,CLERK 91F THE BOARD OF SUPERVISO S AND
COUATY ADMINISTRATOR
BY DEPUTY
L
r
ie CUI.�nA,..GWrA:�-
1 RECEI`E
POSITION ADJUSTMENT.REQUEST --
S EP 7
NO.
J�
DATE 08/20/07
CE OF
COUNTY ADMINISTRATOR
DEPARTMENT NO./ COPERS
DEPARTMENT: Heallh Services/I"Iospital & Clinics BUDGET UNI`]'NO. 0540 ORG NO. 6381 AGENCY NO. A-18
ACTION REQUESTED: ADD four 4 40/40, one 1 30/40and one 1. 20/40 Medical Social Worker 11 X4VH ositiotts., Gr�
6 C.> CYI� -V�Lc�iilT ����� ; �1-L.. p11� ,l V�� �f��fii✓� `�`� � �� 1. PROPOSED EFFECTIVE DATE:
rxLtA ��t�IirU- sk\/q,;- -
CLASSIFICATION QUESTIONNAIRE ATTACHED: YES❑ NO X Cost is within dept budget: Yes X No❑
TOTAL ONETIME COSTS (non-salary)ASSOCIATED WITH REQUEST: $ -0-
ESTIMATED TOTAL COSI'ADJUSTMENT(salary/benefits/one-time): c.:?
(31 _ -0
-6
cos,S-Ulp(F TOTAL ANNUAL-89�ST' cs�9-36�I��- NET COUNTY COSI' $ -0- ,,
TOTAL THIS FY Sa��r,P e�'�''. S-4&.—� N.C.C.THIS FY $ -0-
SOURCE OF FUNDING TO OFFSET ADJUSTMENT: Funding offset from b 6 full-time-and 2 part time
Mental Health Clinical Specialist vacancies. �r+
Ln
DEPARTMENT MUST INITIATE NECESSARY ADJUSTMENT AND SUIBMIT'0 CA9.
USE ADDITIONAL SHEET FOR FURTHER EXPLANATIONS OR COM •S
I (for)William.B. Walker, M.D.,Health Services Director
REVIEWED BY CAO AND RELEASED TO HUMAN RESOURC EPARTMENT
DE TY COUNTY ADMINISTRATOR AT
HUMAN RESOURCES DEPARTMENT RECOMMENDATION: DATE
Cancel eight (8) !ental Health Clinical Specialist (VASE) positions (;7511 , #7947 ,
#S156, 790376 #9895 ; #10335 :, #11601 , and ;12062) at salary level n12 1361 ($4 ,152-$6 ,164)
(Represented) and ADD four (4) 40/40 MEdi Cal Social Worker II k94VH) positions , one (1)
30/40 ME-diCalSoical ''Worker II position .. and one (1) 20/40 tEdiCal Social Worker II position
at salary level 255 1590 ($5 ,056-$6 ,146) (Represented)
Amend Resolution 71/17 establishing positions and resolutions allocating classes to the Basis/Exen t sal y schedule.
Effective: El Day following Board Action
(date)
(for) DIRECTOR OF HUMAN RESOURC
COUNTY ADMINISTRATOR RECOMMENDATION DATE: rfji.?jG
Approve Recorrunendation of Director of Human Resources J -�
❑ Disapprove Recommendation of Director of Human Resources �)
❑Otlicr: �? / �/
(for) COUNTY ADMINISTRATOR
BOARD OF SUPERVISORS ACTION: John Cullen,Clerk of the Board of Supervisors/County Administrator
Adjustment APPROVED DISAP' OVED C
DATE: r?I j(,7/ �wO BY:
APPROV AI-10t TI IS: DSUSTME.'T CONSTITUTES A PERSONNEL/SALARY RESO UT10N AMENDMENT
POSITION ADJUSTMENT ACTION TO BE COMPLETED BY HUMAN RESOURCES DEPARTMENT FOLLOWING
BOARD ACTION. Adjust class(es)/position(s) as follows:
IF REQUEST IS TO ADD PROJECT POSITIONS/CLASSES, PLEASE COMPLETE 0.1.1-IER SIDE
ADDENDUM to Consent Item 50
October 16, 2007
On this day, the Board of Supervisors considered adopting Position Resolution No. 20431
canceling eight Mental Health Clinical Specialist (MHCS) positions (represented) and
adding four Medical Social Worker 11 (MSW)positions, and one part time (30/40) and
one part time (20/40) Medical Social Worker 1I positions (represented) in the Health
Services Department.
A member of the public, Rollie Katz, Public Employees Union, Local 1, pulled this item
from the Consent agenda.
Supervisor Gioia requested a staff report.
Dr. Jeff Smith, Executive Director, Health Contra Costa Regional Medical Center, said
the proposal before the Board is to realign the positions available in Crisis Stabilization
as a direct result of a visit from CMS [the federal agency responsible for regulating
Medical and Medicare expenses]. He said the CMS evaluation forced a change to the
model of care in the Psychiatric Emergency area(now called Crisis Stabilization) from a
community care model to a medical model because the federal regulatory agencies and
the state regulatory agencies go by the code called Title-22. He explained Title-22, a
California Code of regulations, requires evaluation of patients in a hospital setting to be
done by doctors and sometimes clinical psychologists on the medical staff. In the past he
said the community care model was based on Title-9 needs, proper for an off-site crisis
unit or psychiatric emergency unit away from the hospital. He said in the community
care model MHCS are allowed to do diagnosis and recommendations for treatment but
the medical model does not allow that. He said because these positions do not match the
medical model he requested the Board to consider removing the MHCS position to be
replaced by Medical Social Service positions. He said the HSD is required by both
models to provide Social Services for individuals seen in Crisis.
Supervisor Gioia said the concern is that someone less qualified is doing diagnosis, but
he noted the model has been changed and the Psychiatrists make the diagnosis.
Dr. Smith explained in the Title-9 model there is one person who does the diagnosis,
treatment recommendations and placement and said that has been historically the MHCS.
Dr. Smith noted Title-22 regulations are strict and clearly medical model based. He said
the Hospital is dividing the jobs done previously by the MHCS, and the doctor would do
diagnosis and treatment, and placement would be done by an MHSW. He continued in
the medical model, the psychiatrist does the clinical assessment and come up with a
treatment plan that would be implemented by nursing, the psychiatrist, and other
members of the team. He explained in the community-based model the focus is not on
psychiatrist development.
Supervisor Gioia asked Dr. Smith to clarify other tasks needed under the medical model.
1
Dr. Smith responded that tasks that need to be done are called social work services and
these services are different from diagnosis and treatment, far different from what the
MHCS has done in the past which was to interview the patients and family, make a
diagnosis, suggesting treatment plans and only getting the psychiatrist involved if that
treatment plan involved a prescription drug.
Supervisor Gioia said he will hear the speakers, but said he is not an expert in this area
and for speakers to expect the Board to override the recommendation of the Health
Officer in an issue of quality of care, could put hospital services in jeopardy.
Supervisor Bonilla stressed the importance of making sure the Board has been provided
with accurate information on items such as this ahead of time, and added
the Board is a governing body now with responsibilities.
Ms. Gentles said the eight positions the Board is being requested to cancel are vacant and
she reminded the Board that no employee is in harms way because the positions are
vacant. She said this is a matter of proper classification.
Chair Piepho asked for a comparison of the medical model to the community based
model from the patient's belief.
Dr. Smith said currently the medical model is in place. He said the medical model is
based on the belief that when a patient comes in crisis for a 72-hour hold or when they
are brought in involuntarily that medical evaluation by a psychiatrist treatment with
medications is the proper first step. He said the community-based model suggests that
might not be true and that therapeutic intervention with talk, discussion and social
support psychotherapy might be suitable first involvement. He said in the past the unit
did a little of both, and had an inconsistent model and therefore the citation. Dr. Smith
said the community-based model is helpful in many situations and said there is a strong
argument to be made from a policy perspective the County would do well to invest in an
off-site unit to provide community-based crisis intervention. He said the Hospital must
follow rules to do crisis intervention but if done outside there would be some flexibility
withTitle-9 regulations, which allow more of a community-based model. He said if these
services are provided in a hospital they have to follow Title-22 regulations.
Chair Piepho asked if providing the services off-site is an option.
Dr. Smith said it is being looked at both financially and structurally, adding that a
location would have to be close enough to a medical care in case it is needed, and said
that it would also have to be accepted by the community, which can be difficult. But, he
said, the possibility is being discussed.
Supervisor Gioia recommended the Board have an afternoon session once a month in
their role as the governing Board for the Hospital to go over the broad issues about
2
quality and finances at the Hospital. He noted Dr. Walker would be coming forward at a
future meeting with that recommendation.
Chair Piepho called for comment. The following people spoke:
Roland Katz, Public Employees Union, Local 1, said the issue before the Board is
not an issue of compliance, but an issue of quality of care. He said the debate is
not about medical versus community-based model, but said the question is
whether one is better served with LCSW or MCSW.
The following people spoke in opposition to the Board adopting Position Resolution No.
20431.
■ Suzanne H. Davis, Concord resident;
■ Kathi McLaughlin, Mental Health Commission;
■ Teresa Pasquini, El Sobrante resident;
■ Joe Appel, Pleasant Hill resident;
■ Janet Marshall Wilson, Mental Health Consumer Concerns;
■ David Kahler, Concord resident;
■ John Gragnani, Local 1 President.
The following person did not speak but gave his concerns in writing.
■ Peter Mantas, San Ramon resident.
Supervisor Gioia asked Dr. Smith to respond to any issues raised by the speakers.
Dr. Smith said the main issue is that these positions are empty and no one has filled these
positions, and it is important to have these positions changed and filled to have the
resources to care for the individuals.
Supervisor Gioia said he appreciates the passion of all the speakers but said there needs
to be a decision based on'the recommendation of the Health Officer, otherwise the
funding for the hospital could be jeopardized.
Supervisor Bonilla asked Dr. Smith if Title-22 forbids the County from having Clinical
Specialists in the Social Work job category.
Dr. Smith said the issue is whether that classification involves a lot more than doing
social work.
Supervisor Bonilla asked Dr. Smith if continuing to fill those positions of Clinical
Specialists would risk funding.
3
Dr. Smith said if the positions are filled it would be permissible but the difficulty would
be having those individuals refrain from any actions that would be considered diagnosis
and treatment,because those actions could risk the funding
Supervisor Bonilla said she would not support the recommendation but would support
monthly discussions at the Board level on the issue of health care. She said given what
has been heard today in regard to the high staff turnover, low morale and frustration in
the Mental Health community, she suggested looking at instituting a quality management
team to look at these issues. She said she doesn't see that it is necessary to act on this
item now and said would prefer to wait and make this decision after a quality
management team has made an evaluation.
Supervisor Uilkema said said she would like to move forward with the recommendations,
but also take the concerns expressed by the speakers into consideration. She asked how
modifiable the recommendations could be.
Supervisor Bonilla said she agrees trust is put in our department heads, but said the Board
also carries responsibilities when it hears there are problems from the county psychiatrists
and consumers. She reiterated she needs more clarity to make a decision on this item.
Chair Piepho asked Dr. Smith for his opinion on the need to move forward on this
recommendation.
Dr. Smith said he could not give a definitive answer but said CMS would return to make
a validation survey in the next weeks to months and said they would look at whether the
Hospital has complied with all the regulations and requirements it has been asked to
comply with. He said this was a labor issue and a not quality of care issue.
Supervisor Bonilla said she appreciated Dr. Smith's comments but said trying to
characterize this as a labor issue is a mischaracterization.
Supervisor Gioia said his responsibility is to run the hospital that provides the greatest
quality of mental and physical health services and said beginning monthly discussions at
the Board meetings would be favorable.
By an unanimous vote with Supervisor Bonilla dissenting, the Board took the following
action:
ADOPTED Position Resolution No. 20431 canceling eight Mental Health Clinical
Specialist (MHCS) positions (represented) and adding four Medical Social Worker II
(MSW) positions, and one part-time (30/40) and one part-time (20/40) Medical Social
Worker I1 positions (represented) in the Health Services Department.
4
A PETITION FROM FAMILIES IN CONTRA COSTA
COUNTY TO THE BOARD OF SUPERVISORS
The undersigned individuals who reside in Contra Costa County
declare their opposition to eliminating any licensed Mental Health
Clinical Specialist positions and adding unlicensed Medical Social
Worker positions to work in Contra Costa Regional Medical Center's
CSU. We believe that the Board of Supervisors needs to be concerned
about keeping the community safe and should not expose the county to
great risk and liability by using unlicensed staff in the CSU.
NAME ADDRESS
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13. «6 `q/�}=,G�,=�.s,� y� 6 3/ 7 S Y Toia i=L s�i3r1 9 4��6
PETITION TO BOARD OF SUPERVISORS
OCTOBER 16, 2007
NAME_ ADDRESS
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TO: All CSU Staff
FROM: Miles
DATE; 5-22-07
Things have continued to be difficult and often chaotic on CSU of late. It is my sincere hope
that we are fast approaching a time when things will stabilize significantly and we can return the bulk
of our focus to business of taking care of patients.
Since the first visit from CMS in December of 2004,the goal has been to transition the
Outpatient.PES into a CSU service operated in partnership with the medical Emergency Department.
This goal and transition itself in controversial at all levels and while trying to operate a mental health
crisis service under hospital regulations is far less than optimum, it is the option we have.
This transition to a new model of care and new set of regulations has been slow to develop as
we tried to make less dramatic changes and reach a level of compliance. These efforts have failed and
prompted the recent operational merge with the medical ED, largely due to our inability to staff a
psychiatrist 100%of the time. So,here's the plan.
Medical Staff:
On 6-15-07,.Traditions Behavioral Health will assume responsibility for 100%of our
psychiatrist staffing on both CSU and inpatient psychiatry.Traditions will operate significantly
differently from our prior contractor,not only coordinating their contracts,but locum tenens and per
diem doctors, assuming 100%of the clinical responsibility for our physician services and guaranteeing
that we'll be staffed every shift,every day.
Social Services:
The transition from Title-9 to Title-22 dramatically changes the operating parameters for the
CSU service changing the"Therapists" into Social Services.Staff. (See attached for a detailed
discussion of this change.) 1Se change in scope sn some opportunities in the market have left six of
the nine CSU MHOS positions vacant. It is highly unlikely that future MRCS recruits will want a
position that is best described as"ER Social Work." At present,the MHCS list has been exhausted
and does not expire until September.-e_,OUFW,working on bringing in registry staff and thankfully;
some folks from the clinics have been good enough to help out. The future may see us trying to
recruit more social work positions or trying to select MRCS staff that is interested in the hospital
work.
7 7•:7
j:i is 7 n
The change in scope will come with a completely new set of paper work and should constitute
an easier job for MRCS folks. The docs will have to pickup much of this slack and we've been
holding on putting in the new paperwork until.we get enough does.
Nursing-:
The Merge with the medical ED complicates and expands the role of nursing on the CSU.
Under Title-22 regulations,nursing has a comprehensive scope of practice just like elsewhere in the
hospital. However,the flow and hand off processes for nursing is stili in need of review, formalization
in policy and evaluation to monitor effectiveness. Beginning on 5-21-07, a consultant from Brinks,
Inc.will begin assessing our nursing and patient care processes in both the ED and CSL` with a
particular focus on how we do business in this new combined model. These recommendations are
likely to focus on the need for additional support and I'm hopeful this support will be forthcoming.
€teconstUction•
As many of you may recall,part of the plan of correction from 11/2005 was the reconstruction
of the PES (now CSU)space to improve visibility and make the space on the unit more conducive to
.safety and patient care. After substantial delay,I'm informed that the construction will begin on 8-15-
07. Attached you'll find the final architectural drawing that outlines the new model for the CSU. At
present, I can't share details on the operational plan for CSU during the reconstruction because they
haven't been developed yet!!!I Details to followl
Summary:
During these sustained difficult times, the temptation to revert back to the old ways is strong
and must be avoided. I know there seems to be a great deal more madness than method in the changes
of late and X hate to ask for yet more patience but I must The outcoiiies we're seekinghere are not
optional and the pressure to deliver on promises made in-the multiple plans of correction we've filed is
quite clear.
The following is some discussion of how we got here.
7 _ i7 .7.'7 %J-�7v SII ��,1 "I.lil I 1 11)1}7
o Therapists/Social Workers(MRCS's)cannot determine disposition, ie: "Patient is
acutely psychotic at this time,and requires an inpatient hospitalization." A therapist
agy recommend a disposition, ``Patient's current psychosocial stressors appear to
exceed their demonstrated ability to function in a.community, will discuss placement
options with attending MD."
What May MCHS Staff Do?
Therapist0ocial Workers (MRCS's) may provide and document the following.
a Psychosocial Evaluation
0 Community Functioning Evaluation
a Eligibility Determination
o Discharge planning
0 1:1 Psychotherapy
C Group Psychotherapy
s Case Management
Crisis Intervention Counseling .
• Brokerage&Linkage Services
Information& Referral Services
So do Nursing Services have To Change Too?
Yes! However,under Title-22 Nursing actually has a broader scope of practice than MRCS
personnel. Nursing may conduct medical screening exams, assessments and develop nursing
diagnoses. But nursing also cannot deliver care without a physician's order beyond triage and
specific standardized procedures. Under the old model therapist(MRCS)staff opened the
back door and conducted the triage assessment,this is no longer legal. Part of the rationale
behind shifting the patient flow through the medical part of the ED was the established and
well-tested triage system.
What About Doctor's Do They Have to Work Differently Too!
YES!11 The practice of psychiatrists will change most dramatically under this new model.
The physician must be in constant control of the usrit, must determine the appropriate level of
care, patient disposition,diagnosis and course of treatment in addition to ordering any can for
each patient. In the past,our MD's have been available to consult with,.providing clinical
support and medication evaluation. Now, MD's must be the orchestra's conductor,team
leader and unit operational supervisor. This shift in practice has been encouraged for the past
two years but has been slow to develop, largely due to unit culture and short staffing. At
present,we are VERY short staffed, We have trouble staffing a single MD for each shift. Our
target will be two(2) Psychiatrists for every shift!
• CSU is now part of the Hospital's emergency department. We cannot refuse patients for any
reason. Any patient presenting at CSU must have a medical screening exam pursuant to
EMTALA. We also must assess and discharge or transfer any patient who presents or requests
services regardless of etiology,this rneans everyone is "our patient,"internally we may decide
patients are better served by medicine or psychiatry but EVERYONE is screened the same
way.
7 +. 7!,•7r7 USil; jii': L . .�7 L
• Forr many years,the mission of the crisis services/PES was to provide emergency 24-hour
stabilization and intervention for persons experiencing a crisis related to a mental health
condition. Patients who were primarily substance abusers were considered,"not our patients."
However,federal regulations for emergency hospitals are quite clear:
• Some intoxicated individuals may meet the definition of"emergency medical condition"
because the absence of medical treatment may place their health in serious jeopardy,result in
serious impairment of bodily functions, or serious dysfunction of a bodily organ.Further, it is
not unusual for intoxicated individuals to have unrecognized trauma. Likewise,an individual
expressing suicidal or homicidal thoughts or gestures, if determined dangerous to self or
others,would be.considered to have an emergency medical condition. This delegation should
be set forth in a document approved by the governing body of the hospital. If the rules and
regulations of the hospital are approved by the board of trustees or other governing body,those
personnel qualified to perform these examinations may be set forth in the rules and regulations,
instead of placing this information in the hospital by-laws. It is not acceptable for the hospital
to allow informal personnel appointments that could frequently change.
• Does our new"status"mean we don't participate in the inter-county residency agreements that
we've followed for years?
NO,Federal law states: "If a community-wide plan exists for certain hospitals to treat certain
emergency medical conditions,then the individual should be screened, stabilized,or
appropriately transferred to the community-plan hospital."
• is moving someone from.the ED to CSU a"Transfer?"
NO—"If a patient is moved to another part of the hospital, the transfer requirements are not applicable
because technically the patient has not been transferred." §489.24 (d)(2)(i)
7 .,�.I 1;;1'- yC-y? u u _ . r,� ;r i;•��III II II l lil;i7 / I
What has happened to PES?
After the suicide in 2004,DHS reclassified PES from a Title-9 Licensed Outpatient Crisis
Clinic to a Title-22 Emergency Room. Under the Title=9,"Mental Health Model,"Mental
Health Clinical Specialists ran the unit,they were referred to as `Team Leaders,"and they
were completely in charge,nursing supported the patients medically and behaviorally while the
MRCS conducted their evaluation and planning,the psychiatrist was available"if needed,"to
lift 5150's prescribe emergency medicines etc. On some shifts,there wasn't a doctor and this
all occurred in compliance with Title-9.
PES
Outpatient CCRMC(CSU)Emergency
Mental Health Clinic Department
TITLE-9 ONLY Title-9—Billing
Titic-22—Licensing "
42CFR—Participation in Medicaid i
What's The Difference Title-9,Title-22? 1CAH0-ACcreditetion
The portions of Title 9 relevant to mental health comprise a set of California codes that define
the claiming and operational parameters for montal health programs. They are often general
descriptions and guidelines.. The relevant portions of Title-22 comprise another set of
California codes primarily describing the licensing minimums for health care facilities. Since
CCRMC's compliance with Title-22 allows us to claim Medicaid(Medi-Cal), the applicable
parts of Title-22 Flow from Section 482 of the CFR(Consolidated Federal Register) and
therefore,in all situations,Title-22(While a State Code,trumps Title-9)because it's directly
linked to the federal laws.
§42 CFR
Federal Medicare&
Medicaid Law
Califomla Title-9 California Title-22
Mental Health Claiming& Facility Licensing&Operations Regulations
Operations Regulations
So Why Should Therapists Do Anything Different Then They Used to?
In hospitals,all care that is provided must flow from a physician's assessment and order. This
is easy to see in nursing services; they assess and educate patients as directed by a physician,
carry out physician orders and document their compliance with physician orders. Only
physicians may document an assessment leading to a diagnosis. This fact has led to a whole
set of nursing diagnoses. Doctor says, "Asthma,"Nurse Says, "Ineffective Airway."
• Therapists/Social Workers(MRCS's)cannot conduct a clinical assessment(Yes, all
MRCS staff are LPHA's pursuant to Title-9) but in a hgsoital setting,a mental status
examination leading to a multi-axial diagnosis is reserved for physicians only.
• Only a physician can determine a diagnosis,therapists/MHCS personnel may not. A
therapist can write,"Chart review indicates a history of Chronic Paranoid
Schizophrenia, writer's prior experience with patient is consistent with this
presentation."
`i 7 �`:� 7 7�- %J-=�4. r , Ui U ri �i1C; iy,�; 1 �1�1� 't [ •1 )0
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CiD �0 J U,5,5 ,ion
Comments to the Board of Supervisors
Provided by
Kathi McLaughlin, Co-Chair
Contra Costa Mental Health Commission
October16, 2007
Members of the Contra Costa Board of Supervisors, I am the Co-Chair of the Mental
Health Commission. My Co-Chair, Karen Sloma, is unable to be here today, but has
reviewed and approved these comments (as they relate to the Mental Health
Commission). The Commission hasn't taken a stand on this issue because we didn't
know about it in time to agendize it for our September meeting. Our next meeting is on
October 25th and we plan to discuss it then. It is important to note that we would have
known about it if Dr. Smith had kept his commitment to the Commission, made last
January/February, to keep the Commission informed about the hospital and the crisis
stabilization unit on a regular basis. and to get our input on any important changes. Dr.
Smith attended only one meeting, and then failed to appear or send a report with a
representative. We understood that things were going as well as could be expected,
given the requirements of the federal reviewers, and we did not want to add to what was
clearly an already overwhelming burden for an overextended staff, so we discontinued
requesting his presence. We fully expected Dr. Smith to fulfill his commitment to keep
the Commission informed of any major changes by informing the Commission Chairs, or
requesting time on our agenda, so we were extremely surprised to be confronted with
this item on the Board's consent calendar.
The Mental Health Commission is the only body required by the state Welfare and
Institutions code, andlocally appointed to provide oversight and recommendations to
the Board of Supervisors, and the Health Department, on issues pertaining to
psychiatric services—both those provided by the Mental Health Division, and the
hospital and clinics.
We do not have-enough information from the hospital and Health Department
administration to fulfill our obligation to you and to the community Given ur concerns,
I would like to request that you postpone any decision until after the Commission can
discuss this information at a public meeting on October 25th, with the hospital Director
and Health Department Director present, so that we can review all of the information
and make an informed recommendation to you.
My next comments are made as an informed member of the community, and not as a
member of the Mental Health Commission. As a member of the community, and a
former mental health services consumer, I have to express my deep concern about
reducing the level of education and licensing that this item would require—and the way
this item is being addressed (as a consent calendar item, that implies a non-
controversial staff recommendation). I am aware that Local 1 has discussed this issue,
and tried to work with hospital administration to reach a compromise, and has been
thwarted in their attempt. This issue requires a full and public airing, and concerns the
very basis of service that we provide to our citizens with mental health needs. To imply,
as this request does, that CRISIS needs can be met by unlicensed staff flies in the face
of all known research.Ifail to understand how this can be in the best interest of our
consumers, and can only believe that cost alone is driving this recommendation. I beg
the Board to consider the potentially devastating consequences that enacting this
recommendation might engender and decide to reject this recommendation outright, or
at least wait until the Mental Health Commission can review it and advise the Board of
their findings.
REQUEST TO SPEAK E ORM (3 Minute Limit) I wish to speak on Agenda Item
Complete this Form and place it in the upright box near the Date: 44 - 0
speaker's podium, and wait to be called by the Chair.
My conunents will be: ❑ General
Personal information is optional. This speaker's card tivill be
incorporated into the public record of this `meeting. EJ For
Name (PRINT): 1 -
ffi
,-e j--lj 1 Against
To ensure your nante is arinouttced con•ectly,you rttcrywant to include its phonetic spelling
❑ I wish to speak on the subject of
Address: 5Ltt &,,-n, IJ
city: filO�rh k) .9Z
Phone: a" � Aob-
I
alts speaking for: ❑ Myself
Organization: !='j (�i1 C�t�f ' ❑ I do not want to speak but would like to
leave continents for the Board to consider
(Use the back of thus form)
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11iformation for Speakers:! in lieu,of speaking, I wisli to submit these comments:
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1. Deposit this form into the upright box next to the
speaker's podiwn before the B'oard's consideration of
your item
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2. Wait to be called I by the chair. Please speak into the
microphone at the podiwn.
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3. Begin by stating your name and your city or area of
residence, and whether you are speaking for yourself or
on behalf of an organization.
4. If you have handout materials,!give thein to the Clerk.
i
5. Avoid repeating comments made by previous speakers.
6. The Chair may limit the time allocated to speakers so
that all may be heard.
REQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item #:
Complete this fonn and place it in the upright box near the Date: LT190
speaker's podium, and wait to be called by the Chair.
My comments will be: ❑ G er
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incorporated into the public record of this meeting. ❑ r
Name (PPJN-f): V Z-A t-gN Ir—_ �r�y l S us Against
To ensur=e your•name is amu ounced con•ectly,you may wart to inchtde its phonetic spelling
Lel I wish to speak on the subject of.
Address: b.�Giy.k- Ra cJ.K CJtt L
ci A S. ' CA rte.
city: �.o"C'.0 � L( C. �YS Z/ II-- rr 1
C/rt:(-t�
.Phone: ��� � �� — � 2 � �
S/ZEc
I ani speaking for: Myself CC-C <De-eo--k-� CRS (oA�ti
(�
El Ido not want to speak but would like to
Organization: C Ogrt
yy 'q leave conunents for the Board to consider
(Use the back of this form)
Information for Sneakers: I In lieu of speaking, I wish to submit these comments:
1. Deposit this form into the upriglit box next to the
speaker's podium before the Board's consideration of
your item
2. Wait to be called by the chair. Please speak into the
microphone at the podium.
I ,
3. Begin by stating your name anis your city or area of
residence, and whether you are speaking for yourself or
on behalf of an-otganization.
4. If you have liandout materials,i;give thein to the Clerk.
5. Avoid repeating comments made by previous speakers.
6. The Chair may limit the time allocated to speakers so
that all may be heard.
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1ZLQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item #:�.�✓`��
Complete this form and place it in the upright box near the Date: ljqli D;_-7 \
speaker's podium, and wait to be called by the Chair. /
My connnents will be: ❑ Getler �/
Personal information: is optional. This speaker's card tivill be
i imporated into the public record of this meeting. El For
Name(PRINT . , / [B Against
7o ensm eyour nan:e iso mounted co+v ectty,yo++ +cry w ndt+de its phonenic spelling
�/ ,� &e3X'
I wish to speak on the subject ofAddress: ( . U -
City: T/i��Z
Plione: 10a 5--- 7,-,3
3
I ani speaking for: ElMyself
0-1-,0,
Organization.: ❑ I do not want to speak but would like to
��� /� leave connnents for the Board to consider
G� �rlirrLtraa� (Use the back of this form)
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Information for Sneakers: i In lieu of speaking, I wish lo.submit these comments:
i
1. Deposit this form into the upright box next to the
speaker's podium before the Board's consideration of
Your item I
2. Wait to be called by the chair. Please speak into the
microphone at the podium.
3. Begin by stating your name and your city or area of
residence,and whether you are;speaking for yourself or
oil behalf of an organization.
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4. If you have handout materials, give Diem to the Clerk.
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5. Avoid repeating comments made by previous speakers.
6. The Chair may limit the time if to speakers so
that all may be heard.
REQUEST TO SPEAK F01W (3 Minute Limit) I wish to speak on Agenda Item #:
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My comments will be: ❑ General
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incorporated into the public record of tlri neeting. ❑ For
Name(PRINT): I CiS Agar
To ensure your narne is announced correctly,you mciy want to include its phonetic spelling
❑ I wish to speak on the subject of.-
Address:
f:Address: J5-3(o d�_(' ..
L.
city: �c ;I ��a;)�` 6(A C
Phone: Jam) a co
I am speaking for: Myself
❑ I do not want to speak but would like to
El Organization: leave continents for the Board to consider
(Use the back of this forth)
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Information for-Sneakers:
In lieu of speaking, I swish to submit these comments:
I. Deposit this Conn into the upright box next to the
speaker's podium before the Board's consideration of
your item i
2. Wait to be called by the chair. Please speak into the sy
microphone at the podium.
3. Begin by stating your name and your city or area of
residence, and whether you are speaking for yourself or
on behalf of an organization.
I
4. If you have handout materials, give them to the Clerk.
I
5. Avoid repeating comments made by previous speakers.
6. Chair may limit the time alldcated to speakers so that
all may be heard.
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RE QUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item #: G
Complete this,form and place it in the upright box near the Date: 10 I u
speaker's podium, and wait to be called by the Chair.
My cormnents will be: ❑ al
Personal information is optional. This speaker's card will be
incorporated into the public record of this meeting. ❑ For
Name (PRINT): �C� K-- A ? P e� eB Against
I'o ensure your name is announced correctly,you may want to include its phonetic spelling
�I wish to speak on the subject of:
Address: I I D O 3 i-AGK P. ,ja— �.,, vv[^ 1.� c�,n5 e� M�.t.�.a L-
City: Le—A Salt`'�k lei L4-,-N G l i A,I LA
I'Ltone: 316 1 - t CO L c A I sT s A
I ant speaking for: Myself
❑ I do not want to speak but would like to
❑ Organization: leave comments for the Board to consider
(Use the back of this forst)
Information for.Spealcers: !
In lieu of speaking, I wish to submit these comments:
1.. Deposit this firm into the upright box next to the ;
speaker's podium before the 13oa�d's consideration of.
your item 1
Z. Wait to be called by the chair. Please speak into the
microphone at the podium.
3. Begin by stating your name and your city or area of
residence,and whether you are speaking for yourself or
on behalf of an organization.
4. If you have handout materials, give them to the Clerk.
5. Avoid repeating comments made by previous speakers.
i
6. Chair may limit the time allocated to speakers so that
all may be heard.
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ILEQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item #: g O
Complete this.form and place it in the upright box near theZ D (
Date:
�
Speaker's podium, and wait to be called by the Chair.
My cotmnents will be: ❑ G dal
Personal information: is optional. .1his speaker's card will be
incorporated into the public record of this m V v t meeting. / ❑ For
Name (PRIN'r): V LuI1 til (!HCi.CChCW (SD b) Against
T'o ensure yore•ranee is anerorneced correctly,you nuiy wan[ro ierclude irs pliclwlic spelling
O I wish to speak on the subject of:
' Address: l-O 'A o t,L
11
City: %\C-
Phone: 2� �j LA l.p "
S �
1 am speaking for: ❑ Myself
❑ I do not want to speak but would like to
Organization: Mwv-tcJ . E_GI_C4C-\ leave continents for the Board to consider
(Use the back ofthisform)
i •
information for.Snealcers: i
In lieu of speaking, I wish to submit these comments:
1. Deposit this firm into the upright box next to the
speaker's podium before the Boa Ird's consideration of i
your item
i
2. Wait to be called by the chair. Please speak into the
microphone at the podium.
3. Begin by stating your name and your city or area of
residence, and whether you are speaking for yourself or
on behalf of an organization.
4. If you have handout materials, give them to the Clerk.
5. Avoid repeating comments made by previous speakers.
6. Chair may litnit the time allocated to speakers so that
all may be heard. j .
REUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item #: CJD
Complete this,form and place it in the upright box near the Date: I �6. 0
speaker's podium, and wait to be called by the Chair.
My comments will be: Ge rail
Personal information is optional. this speaker's card Nrill be
incorporated into the public record of this meeting. / ❑ F
Name (PP tN1'): 12 / u i D —� I (= ❑ Against
T'o ensure yarn•name is announced correctly,you pray wart/to dude its p o tic spelling
❑ I wish to speak on the subject of:
Address: 110 4(C
City: ('_ o /t Q-- o f,� Dn�CA(Ti9L f I(:9Z- 77 '
Phone:
I am speaking for: *- Myself
❑ I do not want to speak but would like to
❑ Organization: leave continents for the Board to consider
(Use the back of this form)
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Information for.Spealcers: j
In lieu of speaking, `I wish to submit these comments:
1. Deposit this form into the upright box next to the
speaker's podium before the Board's consideration of.
your item
2. Wait to be called by the chair. Pllease speak into the
microphone at the podium. j
3. Begin by stating your name and your city or area of
residence, and whether you are speaking for yourself or
on behalf of an organization. i'
I
4. If you have handout materials, give them to the Clerk.
5. Avoid repeating comments made by previous speakers.
I
6. Chair may limit the time allocated to speakers so that
all may be heard.
i
1tCQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item #: C' s®
Complete this fvnn and place it in the upright box near the Dale: PD ] ��
speaker's podium, and wait to be called by the Chair.
My convnents will be:. ❑ General
Personal information is optional. Ais speaker's card will be
incorporated into the public record of this meeting. ❑ For
Name(PRINT): 7CA VI LYAnG,wl Against
1'o ensure your name is announced correctly,you maymuJio include its phonetic spelling
❑ I.wish to speak on the subject of.
Address:
City:
Phone:
I ani speaking for: ❑ Myself
4aaOrganization: 1"teC ❑ I do not want to speak but would like to
_ Lleave connnents for the Board to consider
"ti �T �GA_L (Use the back of this form)
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Information for Sneakers: i In lieu of speaking, I wish to submit these comments:
i
I. Deposit this form into the upright box next to the
speaker's podium before the Board's consideration of
your item
i
2. Wait to be called by the chair.iPlease speak into the
microphone at the podium.
i
3. Begin by stating your name and your city or area of
residence, and whether you are speaking for yourself or
on behalf of an organization.
4. If you have handout materials, give them to the Clerk.
5. Avoid repeating comments niade by previous speakers.
6. The Chair may limit the timejallocated to speakers so
that all may be heard.
46
REQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item
Complete this form and place it in the upright box near the Date: Lo
speaker's podium, and wait to be called by the Chair.
My conunents will be:. ❑ Gen
Personal information is optional. This speaker's cdrd will be
incorporated into the public record of thi
s meeting. El For
G
Name(PRINT): ' V,-+V-�_. ❑ Against
To ensure your name is armounced con•ectly,you may want to inchide its phonetic spelling
r� El wish to speak on the subject of:
Address: 3b 3 Y—reSi- CraeV Lia -
City:
tn _City:- a_vwotn� CA
Phone: 7f LI S 1 -7 6
I air speaking for: L`1 Myself
❑ Organization: Ido not want to speak but would Jike to
leave continents for the Board to consider
(Use the back of this form)
i
Information for Sneakers: ! In lieu of speaking, I wish to submit these comments:
i
1. Deposit this form into the upright box next to the I kit= OLL,P-151tn tti 92—{S �CL t
speaker's podium before the Board's consideration of
your item qt�-e,
u-
2. Wait to be called by the chair. Please speak into the
microphone at the podium. I
3. Begin by stating your name and your city or area of
residence, and whether you arelspeaking for yourself or
on behalf of an organization.
4. If you have Handout materials,give them to the Clerk. -- S 1 Lo S f eA,-N.(.
5. Avoid repeating comments made by previous speakers.
i
6. The Chair may limit the time allocated to speakers so
that all may be heard. rl �
i
i