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HomeMy WebLinkAboutMINUTES - 06191984 - 3.6 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on June 19 , 1984 by the following vote: AYES: Supervisors Powers,. Fanden, Schroder, Torl'akson NOES: None ABSENT: Supervisor McPeak ABSTAIN: None SUBJECT: Elm Tree Preventive Maintenance and Replanting Program - Crockett Area -The Board received a June 6 , 1984 letter from Alan Brasesco, President, Crockett Improvement Association, P.O. Box 132 , Crockett 94515 , inquiring about the availability of funding for implementation of a preventive maintenance program to save the remaining elm trees in the Crockett area and a replanting program to replace the healthy trees that have been removed. Mr. T. J. Nelson, 25 Emerson, Crockett 94525 , appeared before the Board and requested the Board to resolve the question of juris- diction in the problem of diseased elm trees . Supervisor Nancy C. Fanden stated that she has been in contact with John deFremery, County Agricultural Commissioner, requesting that no further trees be cut in the County until a thorough study has been made into the possibility of a preventive maintenance program. Supervisor Fanden informed the Board that Mr. deFremery had advised her that the State Department of Forestry has final jusrisdiction in the matter of dutch elm disease problems , and that he was requesting the Department of Forestry office to transmit information to the County in regard to the use of Lignasan in pre- ventive maintenance programs in other communities . As recommended by Supervisor Fanden, IT IS BY THE BOARD ORDERED that the aforesaid matter is REFERRED to the County Agri- cultural Commissioner for report back to .the Board on the use of Lignasan and efforts being made to save elm trees which are not diseased. 1 hereby certify that this Is a true and correct copy of an action taken and entered on the minutes of the cc: Alan Bresesco Board of Suparvlsors on the date shown. T. J. Nelson ATTESTED: Q� County Agricultural Commissioner J.R. OLSSCM, COUNTY CLERK County Administrator erd ex otflclo Clcavk of the Board By 4zt:� _.___.._ , Deputy "r THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on _June 19, 1984 by the following vote: AYES: NOES: (See Below for vote) ABSENT: ABSTAIN: ------------------------------------------------------------------ ------------------------------------------------------------------ SUBJECT: Hearing on Proposed Reductions in the Health Services Department The Chair convened the hearing on proposed reductions in the Health Services Department (as referenced in the Notice of Public Hearing) pursuant to Health and Safety Code .Sections 1442 and 1442 . 5. Philip Batchelor, County Administrator, commented on 'the County' s financial condition and actions the Board must take for the County to be financially solvent as well as retaining a high rating on its marketable securities; the amount of revenue required to fund programs; referred to the reductions in personnel and services required of County departments in personnel and services required of County departments to make as a result of the passage of Proposition 13 in 1978 in comparison to the' Health Services Department where there was an increase in personnel for that period; the overmatch of County money allocated to certain programs in the Health Services Department; proposed reductions in areas outside the Health Services Department that will be considered during budget deliberations; and recommended that the Richmond Clinic not be targeted for closure at this time but that the Board consider a target figure of $2.7 million in reductions. . Claude Van Marter, Assistant County Administrator-Human Services, advised that the potential deficit remains at $3. 6 million and that if actions are not taken to increase revenues or reduce expenditures by $3 .6 million it is projected that the Health Services Department will end the 1984-1985 Fiscal Year on June 30, 1.985 with a deficit as stated. He referred to the prioritized list of reductions submitted by the Acting Health Services Director, Dr. William Walker, noting that the first eight items on said list total approximately $2.7 million, while the ninth item provides the alternative of $900,000 more in reductions in the Mental Health Division or closure of the Richmond Clinic. Mr. Van Marter noted that the proposed County Budget for the 1984-1985 Fiscal Year does not anticipate any cost of living increases in State Medically Indigent Adult funds or Short-Doyle funds. He pointed out that once the Governor signs the State Budget,. many of the uncertainties with respect to State allocations for County programs will be resolved. Mr. Van Marter cautioned that the County' s AB-8 match problem has not been resolved and that a decision is pending before the State Department of Health Services on this issue. Mr. Van Marter recommended that the Board take the following actions: 1. Express the intent of the Board not to close the Richmond Health Clinic and not to take the remaining reductions in the Mental Health Division reflected in Dr. Walker's priority No. 9 in his June 1 memo; 2. Adopt as a definition of indigent for purposes of this hearing the definition set forth in Resolution No. 83/1139, namely those persons eligible for General Assistance in this County and those persons defined by the 1 Board as Medically Indigent Adults for medical care purposes ; and 3 . Incorporate into the hearing record- the list of documents placed before the Board. Board members being in agreement to Mr.. Van Matter' s recommen- dations, IT IS SO ORDERED. Passed by the following vote: AYES: Supervisors Powers, Fanden, Schroder, Torlakson NOES: None ABSENT: Supervisor McPeak Supervisor Robert I . Schroder referred to the reductions proposed and suggested that individuals presenting testimony also suggest where the cuts could be made. Supervisor Fanden advised that she has come to the conclusion that the Beilenson Hearing scheduled today is premature for the reasons that the Board has not been presented to date with the proposed County budget, and that the proposed lay-offs do not deal . with the full impact on the total community of Contra Costa County, and therefore she recommended that the hearing scheduled for this day be postponed until the uncertainties cited above are resolved. The motion died for lack of a second. ' The Chairman declared the hearing open. Bill Taylor, representing the Alcohol, Drug Abuse and Mental Health Advisory Boards, expressed opposition for any cuts proposed for said programs. He referred to cuts sustained in the aforesaid programs for the last three years and did not believe any addition- al cuts would be cost effective. He suggested that reductions to offset the deficit should be County-wide and not limited to the Health Services Department. B. Cook concurred with the previous speaker. Vicki Smith, representing Contra Costa Contractors and Friends Alliance, expressed opposition to the cuts and suggested that the reductions be made equally between the County programs and contrac- tual programs, and also that the County negotiate for cost-of- living provisions in the contracts. Reg Parks, Public Health Division, spoke on the impact on Public Health clinics, particularly how it. would affect those clinics treating venereal diseases, and also urged that the Board look outside the Health Services Department to resolve the deficit problem. Allen Longshore, M.D. , Public Health Division, supported the previous speaker and expressed opposition to any cuts in Public Health Services. Carl Hanson, REACH Project and Chairman of the Antioch Chamber of Commerce, commented on the cooperation of the City of Antioch and the Antioch Unified School District with respect to drug abuse and prevention programs. He commented on the support of the community and the assistance of volunteers in enabling said juris- dictions to maintain a high level of service at a reduced cost. He realized that the Board must establish priorities and must do so in the most cost effective way possible. Henry Clarke, General Manager, Contra Costa Employees Associa- tion, Local 1, expressed disagreement as to the amount of money to be allocated to the Rc.'Ierves in lieu of funding Mental Health programs proposed for reduction. He felt that reduced services, 2 particularly in the out-patient clinics, will impact adversely on the population served by these welfare programs. He suggested that the Board not take any action on the proposed reductions prior to the presentation of the proposed County Budget. Grant Wyborny, representing East City School Intervention, spoke on the cooperative relationship between his organization and the schools in providing services to children, particularly the early identification of children with problems and the implementa- tion of treatment soon thereafter. He also recommended that methods be sought to provide more services in this problem area. Wendel Brunner, M.D. , Director, Public Health Division of the Health Services Department, commented on the reductions proposed in Public Health nursing staff and the adverse impact it could have on services provided to children and the elderly. Lela Sater, Nutrition Advisory Council, request that consider- ation be given to not cutting Public Health nursing services to the elderly, and particularly those confined to their homes. Reverend Julius L. Pender, Mental Health Association of Contra Costa .County, requested that Mental Health services be sustained at their present level. Caroline Haskell recommended that family planning clinic services not be reduced. She spoke in favor of counseling programs for sexually abused children and felt that reductions in this area require further evaluation. Ruth Croci, .representing the Advisory Council on Aging, expressed concern with the proposed elimination of three Public health nurses who work with the elderly and inquired as to the cost effectiveness of this proposed reduction. Billie Wilson, Public Health Nurse, spoke on the services provided to the elderly and the role of the Public Health nurse in family planning clinics and communicable disease control and prevention. She noted that the demands for the Public Health nurse are increasing, and she recommended the reduction of administrative costs in County funded programs such as the Maternal Child Health Program, reductions in managerial positions in the health Services Administration, the raising of fees in selected fee-for-service programs, and suggested charging a fee for immunizations. Donald Goldmacher, M.D. , requested that the Board not cut prevention programs. He noted that the County has fiscal planning capability and referred to the need to have program planning capability. Dr. Goldmacher recommended that cost-of-living in- creases be included in both County operated programs and contract programs. He also suggested that the Board consider the recommen- dations of its management staff with respect to elimination of certain programs and in those areas where program reductions are being considered that consideration also be given to the proposal for job-sharing. Lee Johnson-Kaufmann, Ph.D. , Chairperson, Human Services Advisory Commission, conveyed the position of the Commission supporting prevention programs, particularly in the area of Mental Health and Public Health, even it if means cutting non-mandated direct service programs. Jean B. Siri, representing the City of E1 Cerrito, advised that the E1 Cerrito City Council unanimously recommends continued funding for the Rubicon Garden Center in E1 Cerrito and the contin- ued funding of Public health programs and services in the El Cerrito area. Cathy Lee Hodge, representing the East County Regional Adviso- ry Board on Alcohol, Mental Health and Drug Abuse, expressed opposition to the proposed reductions in Mental Health programs. 3 Frances Dalecio, representing the Maternal Child Adolescent Health Board, commented on the level of service provided at Public Health clinics, particularly in the area of pre-natal care and counseling services. She requested that Public Health services be maintained at tha existing level Leigh Lutz, a participant in the Alcohol Abuse Program, commented on the benefits he received through his participation in the programs and requested that cuts not be made, particularly in the Alumni Program, if which he is an active member. Steven Tremain, M.D. , Chairman, Medical Quality Assurance Committee, advised that priority items 1 and 2 dealing with admin- istration and hospital contract could be eliminated or reduced without adverse impact, but expressed reservations with respect to the remaining items on the priority list. Stanley T. Hutter, Ph.D. , Mental Health Treatment Specialist and representative of Contra Costa Employees Association, Local 1 , expressed the belief that there is a double standard of care between that given to the rich, the poor, and the medically indi- gent adults, and that cuts as proposed would have an adverse impact on the indigent population in this County. He commented on the increased number of patients seeking mental health services and the resultant impact on I and J Wards. Rather than laying off quali- fied personnel he suggested that the reductions in staff be made through the attrition process. Dr. Hutter suggested that the Mental Health Division be separated from the Medical Health Servic- es. He also questioned the recommendation of Moody's Rating Service and the County' s Reserves be increased to the detriment of Health Services programs. Belle Lipsett, representing the Maternal Child Adolescent Health Advisory Board, commented on the impact the proposed reduc- tions would have on the population served in West County, particu- larly the service provided by Public Health nurses in Family planning and pre-natal clinics. She suggested that the Board seek help from the County' s legislative representatives to keep these programs in the Governor' s budget. . Peggy Sargent, representing Alcohol Program Providers, ex- pressed opposition to the proposed reductions in alcohol programs and commented on the number of people on the waiting list desiring to participate in the programs offered by her organization. She expressed concern that many of these people would be turned away. Sherrin Bennett, representing the Center for Human Develop- ment, opposed the recommendations of the Acting Health Services Director to eliminate the contract with the Center for Human Development for community prevention services in order to save $287 ,000. She commented on the services provided and the popula- tion served. Willie Mae Jones, also representing the Center for Human Development, spoke on prevention conferences sponsored by the Center and the services provided to the economically disadvantaged with respect to pre-natal care. She recommended against the program reduction. Donna Leary, representative from the Center for Human Develop- ment, spoke on the support the Center has received from parents clubs and school boards in conducting education programs about drugs and alcohol, particularly those education programs for children in the fourth and fifth grades. Joanne Maerkley, representative from the Center for Human Development, spoke on the support programs for single parents and suggested that alternatives be considered to acquire funds from the private sector. Wilda Davisson, Cambridge Commercial Center Child- Care Facili- ty, requested that child health and development programs be 4 retained in this County and spoke of the role of the day care centers in providing a learning experience : for children as well as the development of social skills while their parents are at work. Mgna Reeva, Director of. the Rubicon Garden Center Vocational Services, spoke of the success of her program in training and placing its clients in suitable occupational positions. She requested that it be funded at the same level as in the 1983-1984 fiscal year. Ellie Strauss, representative of Rubicon Garden Center, requested that the Board not make any reductions in the programs until all budgetary facts have been reviewed. Sarah Houghton, private citizen, advised that she has been very satisfied with her utilization of the, Garden Center' s services and suggested that the deficit be made up outside the Health Services Department. Michael Bennett, recovery alcoholic and drug abuser, spoke of the benefits he received as a participant in the program. Donald L. Christen, Executive Vice President of the Contra Costa Taxpayers Association, spoke in favor of building up the County' s reserve funds in order to preserve the fiscal integrity of the County and its taxpayers. Brian Wynne, Re-entry Services, Inc. , expressed concern that the proposed reductions will impact severely on the population served. Bill Brudney, representing the Concord City Council, spoke in support of continued funding for the Phoenix Program and the Diablo Valley Crisis Center. John Lee, M.D. , representing the Medical staff, expressed concern about care in the clinics and in the home and the absence of an occupational programs in the mental health wards, and re- quested that there. be no additional cuts in Mental Health programs. Lolita Davidson, recovered alcoholic, spoke on the benefits she received in the Bi-Bett Recovery Program and of her working as a volunteer in a recovery house. She also requested that funds for alcohol programs not be reduced. Laverne Priebe, a recovered alcoholic, described the success she achieved as a participant in the alcohol program enabling her to return to the work force. Jerry Marks, representing Patients' Rights, suggested that revenue be sought outside the County to fund Mental Health pro- grams, and also to ask patients to make some payment for the services received. Ann LaPlant, representing Sunrise House, suggested that the Board fund prevention programs in lieu of supporting those people in jail, County Hospital, etc. At the conclusion of the speakers' presentations, the Chair noted that written comments were received from the following: Evelyn Ruizler, Contra Costa Legal Services; H. Dean Grissett, Mental Health Advisory Board; Gary Poole, Nienka House; Dr. Richard Morril, Developmental Disabilities Council of Contra Costa; Andrew Childress, West Pittsburg; Luther Wilson, Family Carehomes; Edgar T. Monk, Nutrition Project for the Elderly Advisory Council; Linda Miller, East Contra Costa County School Intervention Program in the Elementary Schools; 5 Cwilie Jackson, East County Mental Health Program; Christina Vega Vera, President, Board of Directors, Familias Unidas/Desarollo Familiar, Richmond; Ben Russell, Phoenix Programs; Tracy McCune, Valle Verde Sci--ool, Mt Diablo School District; Letters with petitions requesting funding at the current level for the Familias Unidas Program; Petitions signed by parents urging the continuation of prevention programs for children in the area of substance abuse; Petitions signed by West County residents protesting cuts in health services affecting their area; and Petitions submitted by the West Contra Costa County Committee to preserve alcohol, drug abuse, and mental health services. The Board then discussed the proposed reductions and the need for additional information on the programs proposed for reductions and therefore would defer making a decision this day. There was consensus among Board members that the Richmond Health Clinic should not be closed and that Priorities Nos. 1 and 2 be approved. IT IS BY THE BOARD ORDERED that the hearing on proposed reductions in health services is CLOSED and decision deferred to June 26, 1984 at 2: 30 p.m. with County Counsel being instructed to prepare appropriate findings. IT IS FURTHER ORDERED that Priorities Nos. 1 and 2 on the prioritized list of proposed reductions in the Health Services Department are APPROVED. IT IS FURTHER ORDERED that the County. Administrator and Health Services Director are REQUESTED to provide information on the programs proposed for reduction. The three actions were approved by the following vote: AYES: Supervisors Powers, Fanden, Schroder, Torlakson NOES: None ABSENT: Supervisor McPeak B hemby certHy that this is a true and correci comul nn ,ncuon taken and entered on the minutes of u,'ae of stipervisors on the date shown- cc: Health Services Director 1� County Administrator E D: County Counsel CouNT'Y CLERK and c::; o";-.Z„o C9er;�of the Board By' Deputy 6 ==IS mmw AND/ M CZplEm Person s wishing to address the Board or present testimmy Rmst moplete this form. place it in the boat near thespeaker's ` before addressing the Board. 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JyuyS�S I wish to, speak in favor of Agenda Item # I wish to speak in apposition to Agenda Item # I do not wish to speak but leave these comients for the Board's consideration (continue on reverse side) PLO= SUPW Mr MRrIM 1 MUS4W TO THE CZEM June 19, 1984 Board of Supervisors Contra Costa County Ladies and Gentlemen of the Board: My name is Billie Wilson and I am a Public Health Nurse working in Pittsburg. The Public Health Nurses have prepared a statement which I would like to read to you today. Some of you may not know the wide variety of people that Public Health Nurses help: 1. Have you ever known someone who had a terminal disease and wanted to die at home. 2. Do you have a family member who just started on insulin injections and needs instructions? 3. Has your child ever come home from school with lice? 4. Have you ever worried about an elderly neighbor? 5. Have you ever contracted food poisoning from a restaurant? 6. Have you ever known anyone who lost a child to Sudden Infant Death Syndrome? 7. Do you have a neighbor with a pregnant thirteen year old daughter? 8. Have you ever been exposed to TB or needed a TB test for your job? 9. Have you ever had your blood pressure taken at a Senior Citizen Center? 10. Have you ever known anyone with a sick premature baby? 11. Have you ever thought your neighbors were abusing or neglecting their children and you wanted to help? 12. Has your child ever received free immunizations from the Public Health Department? 13. Have you ever thought you might have been exposed to a social disease? These are typical examples of referrals received from hospitals, clinics, doctors, Social Service and the citizens of Contra Costa County to which Public Health Nurses respond every day. Typical Examples of Some of our Cases: A five month old Laotian infant was referred to Public Health Nursing by relatives because she was "always sick". The infant was known to have Down's Syndrome with multiple cardiac defects. Even though she was under the care of the doctor, the parents were overwhelmed with the care of a chronically ill infant and the-American medical systun. They were undecided as to whether to allow the heart surgery. Many visits with an interpreter were necessary to teach the parents how to care for the infant, explain procedures and to insure medical compliance. Who will this family call.when the Public Health Nurse is no longer available? A thirteen year old juvenile diabetic was referred to Public Health Nursing because of the need for blood testing three times per day, insulin adjustment and insulin administration. The family needed extensive education and supervision as this child was frequently hospitalized with life threatening diabetic com- plications. Without the close supervision of a PHIS, this child could have suffered permanent disabilities or death. At present the child's diabetes is well controlled and he is functioning normally in the community. Who is this family going to call when the Public Health Nurse is no longer available? An eighty-seven year old woman received Public Health Nursing services to arrange a transfer from a nursing home to her daughter's home after a hip fracture. A home evaluation and appropriate referrals were accomplished and the patient was later transfered into her own apartnent where she remains today. Her Public Health Nurse visits on a bi-monthly basis, during which medication compliance, blood pressure, diet, home safety and the ability to manage independently are assessed. Timely intervention has limited rehospitalization to two short stays since January. Thus, extended costly hospitalization and nursing home placement was avoided as well as supporting a senior citizen in her choice to live inde- pendently. • I .. i An eighteen month old male was referred to PubliJ Health Nursing by the WIC program because of chronic nausea, vomiting and an enlarged abdomen. The parents I. were employed, making minimum wage, had no healthl insurance and owed the child's pediatrician several hundred dollars. They were not eligible for Medi-Cal or California Children's Service at that time. The physician suggested the child go to Children's Hospital, but the family had no financial resources. Through Public Health Nursing, the patient and his family were found to have intestinal parasites and money for the expensive treatment was obtained from the emergency family needs fund. Arrangements were made by the PubliclHealth Nurse for diagnostic studies at Children's Hospital, including a liver biopsy. Who will this family call when Public Health Nursing Services are no longer available? I A referral was received from Children's Hospital Newborn Intensive Care Nursery for a home evaluation. for a critically ill preemie whose parents were not visit- ing the hospital. The Public Health Nurse visited the family and found that this was the fifth child of a twenty-two year oldimother who had previously I lost a child to sudden infant death. The importance of visiting the hospitalized child was explained and the mother was instructedl. in available means of transport- ation. Now as this infant's discharge is eminent, the parents have been encouraged I to increase the frequency of their visits and to learn cardio-pul mnary I. resuscitatim and how to operate the breathing monitor with which this infant will be discharged. After the infant is home thejfamily will require intensive I nursing instruction and supervision. Who will Children's Hospital call when Public Health Nurses are no longer available? I I I i I i Four years ago there were seventy Public Health Nurses performing the functions just mentioned. Over 61,000 individuals were served by Public Health Nurses. Today, there are fifty-five positions, some of which are assigned in special jobs, such as doing discharge planning in hospitals, or working in clinics, and these mrses are not available to make home visits. Yet, 10,000 more encounters were Tnade in 1983, and the count will be up another 10,000 in 1984. These figures show 'that Public Health Nurses are already providing more services with less, in response to increased demand by the residents of this county, demands that can be expected to increase even further with the changes in Medicare and Medi-Cal. The proposal has been made to further reduce PHNs -by 12%. . .How can even fewer nurses continue to provide a safe level of care to those who require our services? We fully understand the County's severe fiscal constraints and we feel that we have a responsibility to assist in resolving this financial crisis. However, Public Health Nursing has consistently assumed the burden of financial cutbacks including in 1982 when five physician administrators were eliminated and public health nurses assumed most of their duties at a cost savings of $500,000 to the County. Additionally, Public Health Nursing administration has been reduced by 33% with resultant increases in their responsibilities and decreased cost to the County. We recommend the following: 1. Do not cut Public Health Nursing any further. 2. Reduction of administration costs in County funded programs such as the Maternal Child Health Program. 3. Further reduction in high cost managerial positions in Health Services Administration. 4. Raise fees in selected fee-for-service programs. The trend continues to balance the budget by reducing the number of Public Health Nurses. The attached diagrams reflect the dramatic decline in nurses available for preventative health care in Contra Costa County. The emphasis is turning to more costly crisis-oriented care. The question is "Do we want Public Health Nurses in Contra Costa County to promote the health of the citizens or provide only the much more expensive alternatives?" The level of health care that would be provided under current proposed cuts to Public Health Nurses would be unsafe, unethical, and border on malpractice. We think the Board and this community should consider the consequences carefully. c 0 41 L U% CL N �1 N. t 7 �p V d t mar Q aP � •-S O L d ca Z N N N Z cc cc 1.' 9L CD _ W LLS S N °o Q — p Q m d Q d � J LLIJ Q F- 2 Z ~ O D W V = O a � . N ui W O Q � V w W o� W d H v Q C Z L Q1 CL nn a+ y c �n in al ep rn 41 E v as 0 Go in In u Q1 r0 L y m _ OOinOLc C 2 dQ in � Na+ •� d t V L O V .0 v 41 E 0 — u •— � — L CL C C 4.0 L 7 10 41•- t d E •— C N a+ a+ E L =•— M.0 d O L d. II / 1� CITIZEN'S MErIMW ANDAR C1M*WIS Persons wishing to address the Board or present testimony must aomplete this form. Place it in the box near the speaker's _ before addressing the Board. rM PH # CITY z�z' IF other, FGMWEMNG: Self Other specify Check and aomplete the line applicable to pour presentation: I wish to speak cn Agenda Item # t��. ���so� f�e��`•�' I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these oomnents for the Hoard's consideration (continue cn reverse side) Nmm SST ANY WRIT= BUMUM TO THE CLM crrizsN�s �sn�nr x�/� ac�rs �� Persons wishing to address the Board or present testimony joust Complete this fom8. place it in the bon near the span_ = before addressirs- the n= I la 1Dee- LLa�L,, Pw. S_— A�o ,v- CMif G: self _ other '! specify 4Lx k/,a.vt S'C�_r J 1-c- e. S Check and cmvlete the line sppliasble to, pour presentation: II wish to speak an Agenda Item # y I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these oomnents for the Board's consideration (continue on reverse side) PLE& B S Bt+IIT ANY 12RITIM 8'!gl'1BMW TO TBE CLW ..�. rr�atrc I'i/�tZl Cq NTAA COSTA COUNTY Rin Services L�dvisory �a�ssion A •.• County Administration Building 651 PINE STREET, 8th FLOOR MARTINEZ, CALIFORNIA 94553 (415) 372-2918 June 19 , 1984 A LOOK TO THE FUTURE In a time of financial stress whther it is at the county level or at the family level , there is a tendency to blame the ."other" for one' s woes . There simply are no easy answers . There is not enough money to fund all the worthwhile and needed programs which are to be heard from today. The Human Services Advisory Commission, as policy advisors to the Board of Supervisors , wishes to underscore the necessity of maintaining a longer term perspective even if the cry is "PANIC. " Yes , Contra Costa County needs services for the mentally ill: residential beds , day treatment programs and medication clinics . Yes , our d earth of resources is costing. county residents and taxpayers more money every year because of additional costs incurred at NAPA and in the jails . The bleak financial situation in the Health Services Department and in the county in general cannot and should not be used as justification for eliminating prevention programs , because most of those programs are aimed at children. Prevention is cost effective , whether we are talking about dollars saved, lives saved or facilities that will not have to be built . Human Services Advisory Commission, Presentation to the Board of Supervisors , June 19 , 1984 . page 2 The results may or may not be dramatic but it is clear that programs which support young growing egos are .helping to support the next generation. At this time , HSAC wishes to acknowledge the tremendous support for prevention by this Board which has propelled Contra Costa County into the National spotlight. Can we afford to move backwards? This time of desperation will not go on forever. We may never again have the funds to publicly support human services as it was in the past; But as with the choices a family or an individual must make when finances are diminished, the future must be considered. The Human Services Advisory Commission wishes to go on record in support of the prevention programs now being fiscally supported by ADAMHA and Public Health, even if it means cutting non-mandated direct service programs . The Board has announced its support of. community involvement . For the future of our county as we approach the next century, community involvement by citizens is a critical necessity. There are no programs currently funded by county dollars which support community involvement more than the prevention programs , most of which are private non-profit contractors . HSAC urges the Board of Supervisors to support citizen involvement through its continued support of prevention oriented programs . THANK YOU Lee Johnson-Kaufmann Ph.D. Chairperson =ZE1'S MTII43IY ANDAM COMM � Persons wishing to address the Board cc present testimony must omVlete this r form. Place it in the- box near the speaker's rostrum before addressing the Board. DAME NAND # CITY If other, Self Other specify Check ,an/complete the line applicable to your presentation: v I wish to speak on Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these omrents for the Board's consideration (continue on reverse side) PIFASE SLW= ANY mpxr SQ BTATD=r 70 THE CLERK C) CITE( OF EL CERRITO , o p 10890 SAN PABLO AVENUE, EL CERRITO, CA 94530 (415) 234-2323 'a o v ' June 19, 1984 Board of Supervisors Contra Costa County Administration Building 651 Pine Street Martinez, CA 94553 Dear Board Members: The El Cerrito City Council unanimously recommends to your Board continued funding for the Rubicon Garden Center in E1 Cerrito. This gardening rehabilitation program for the mentally disabled has proven to be a very good use of taxpayers money and we .strongly urge the Board to favorably consider its continuation. ;Si•ncerely yours, Robert C. Bacon o Mayor Pro Termpore RCB: lq O CITY OF EL CERRITO p 10890 SAN PABLO AVENUE, EL CERRITO, CA 94530 (415) 234-2323 �.., .B o June 19, 1984 Board of .Supervicors Contra Costa County Administration Building 651 Pine- Street Martinez, CA 94553 Dear Board Members: The E1 ' Cerrito City Council would like to point out to the Board of Supervisors how much we appreciate the public health nurse services the County provides in this area. The nurses provide preventative health services :to the elderly at lunch programs at St. John's, at Christ Lutheran, ,and at our own Open House. The Coun.ty should understand how -their expenditure for nurses for these programs is greatly .leveraged, multiplying the health benefits received per dollar spent. By providing a building, by promoting the services, and by helping the elderly attend through various kinds of transportation assistance, these local programs .make the County services .far more cost-effective than could be possible in a traditional hospital or clinic setting.We would urge that you retain sufficient funding to continue _ County funding of public helath nurse programs and services in the City of E1 Cerrito. Sincerely yours, Robert C. Bacp"n Mayor Pro Tempore RCB:lg CITIZBp'S YFSPnM AmI t COMM persons wishing to address the Board or present testimony must onuplete this form. Place it in the, box near the speaker's rostrua before addressing the Board. WE - g ME mums Cm If other, - / G: Self Other ✓ specify L s4- Cr a '�� ! �.n j u;1'5�* 04 A(Calv /Re,(A QL- 0 Check and complete the line applicable to ym presentation: I wish to speak on Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish tD speak but leave these =mints for the Hoard's consideration 7"k Llffc,.4 Cos,'�, /�c(y S o ,; k- Ne a 11� /,.S.,- �L �Ut- s b G s e4 S.'o -� /U�� 'F� C�� -4Q- 13- ,-,( M-��� Co , C� rr cJ• f'� 0�G5 G�rc(S CV+ ,l f� (r S�' /J•-kr6 of CAS (continue an reverse side) PLERM SMW ANY WRrf= ST79aTP TO I= CLM ref: FNM (3/83) MIZEN'S MPMMY ANDAM Mmmm CL), Persons wishing to address the Board cc present testimony must aomplete this form. Place it in the box near the MEa�_ker's rostrm before addressing the Hoard. — L& # ADDRESS I other, Self Other V-11 apecifyLz� p,, Check and complete the line applicable to pour/presentation: I wish to speak an Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these aolments for the Board's r consideration (continue en reverse side) PLOM SUPW ANY "PITTM 9B19TP TO M QAC i9 CITIZEN'S WrMwr MAX an*rrrs Persons wishing to address the Hoard or present testimony must complete this form. Place it in the box near the speaker's rostrum before addressing the Board. Wn 9/6 AMM s 3 tip, . , Ire crn s I other, FaDIESENTM: Self Other specify Check and cmggate the line applicable to pots presentation: I wish to speak on Agenda Item # I wish to speak in favor of Agenda Item # 64��� I wish to speak in a%nsiticn to Agenda Item # I do not wish to speak but leave these omm ents for the Hoard's consideration (continue on reverse side) PLEM SUBMIT ANY WRITIM 8'D08+A Rr 70 'W CLM cmzsN,s T rn wRr Amim ITIS Persons wishing to address the Board or present testimony must =gplete this form. Place it in the box near the speaker's = before addressing the Board. f DMJava .. ADoEss :' S� � crrr / if other, MPFaMM NG: Self ` Other _ specify V4d 54vt-R' �a { g L u rlLue-, C,6 kv, e� Check and ete the line applicable to your prea : I wish to speak an Agenda Item # FLs-� �-�- I wish to speak in favor of Agenda Item # I wish to speak in apposition to Agenda Item # I do not wish to speak but leave these comments for the Board's consideration (continue on reverse side) PLEASE SM IIT Apr WaTM 011 ►TEMETTr TO M C LM =� CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT To: Clerk of the Board of Supevisors Date: June 19, 1984 Contra Costa County From: Steven Tremain/Assurance . , Chairman 9 Subject: Beilenson Hearing-- Medical Qualit Committee Health Services Department Proposed Cuts (Copy of testamony given June 19, 1984, before the Board of Supervisors) My name is Dr. Steven Tremain; I am Chairman -of the Medical Staff Quality, Assurance Committee. Last month I came before you and cited reasons why further cuts that would adversely affect health care delivery to the indi- gent should not be considered. —You have chosen to consider them. I have read and am familiar with those cuts proposed by the Health Services Director--at the direction of the County Administrator's -Office. After conferring with Dr. Walker, I have been convinced that Items number 1 and 2 on the priority list--those dealing with certain administrative and hospital contract reductions--can be sacrificed without adverse impact. Beyond that, however, after all the cuts this Department has had over the last nine months, there remains nothing left to cut without causing detri- ment to health care delivery. Items numbered 3 through 9 are-not acceptable. In noway can these pro- posed reductions in services be carried out without resultant adverse impact on health care delivery to the indigent and public .health services to the community. It's time to focus on the KEY POINT. We have the money to avoid detrimen- tal reductions. The choice before you is simple--avoid these reductions-- or put the money into the bank. Let me draw- a parallel . The head of a household which already has had drastic reductions in the family budget--goes to a financial counselor--who recommends that an amount equal to 3-6 months income (a standard recommen- dation) needs to be placed in a reserve account; in order to do this, he recommends that this family cut down to two meals per day until this reserve is established. Does it make sense to save money while the family starves? Does it make sense to save money while this Department starves? If there was a time to use this money--it is now! ! ! ! ! ! I URGE YOU TO ACCEPT ITEMS 1&2 BUT REJECT ITEMS #3-9. Our .backs are against the wall--we must preserve health care delivery for the indigent and public health ser- vices to the community. ST:plm A-41 ;if 81 C ZBRIS TE9rDVW AMAR Cogs Persons wishing to address the Hoard or present testimony gust complete this Plaoe it in the box near the `_s rostrm before addressing the Hoard. �i a 4 XWRMS J,�- Po,^ Akdoj� cm Self Other specifheyr. Check and complete the line applicable to your presentatian: I wish to speak on Agenda Item # &j;L- OV" — C-u* I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these cmumts for the Hoard's consideration (continue an reverse side) PUUM SIFT ANY NPITM STRTEM TP TO 7W CEM ref: ITIS (3/83) CrrlZEN's Tfipmm Am/CPt yrs a� a� Persons wishing to address the Board or present testimony not complete this form. Place it in the box near the speaker's rostrum before addressing the Board. Atmos G� my Iother, �G:: Self .- Other specify -�7777 77 Check and the line li a to esentation: �1� aPP Y�r pr I wish to speak on Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these cauu nts for the Board's consideration (continue on reverse side) PLEASE SUBMIT ANY VPJT= STRT BWP 70 THE CL M ref: ITIS (3/63) Cl'PIZ&i'S MWVWY AMAM CMMV S Persons wishing to address the Hoard or present testimony must amoplete this form. Place it in the box near the speaker's rostrmbefoare addressing the Hoard. ADDRMS A1,T 1 crrr If other, J� : Self Other specify /�.(� ,/; .�G Check and couplete the line applicable to Your presentation: I wish to speak an Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in apposition to Agenda Item # I do not wish to speak but leave these comments for the Hoard's consideration (continue on reverse side) Plagm suom Apr MIT= SH4'1'HI+H u,TO Tm CIF.ESC .. . ............ .. . I � i Persons wishing to address the Board cc present testimony gust aomplete this form. Place it in the, box new the speaker's rostruiti, before _addressing the Board. DM 6AWMV3 Peon # 2TS3'?v 40 Ams 3-7a2. MT• DIMW AWD. CITY If other, MWSDMNG: Self Other specify Cy1m' fire— Mvm u) D' OmeNr Check and =g4ete the line applicable to pour pcesentaticn: i I wish to speak on Agenda Item # i I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these counents for the Board's consideration f I I (continue on reverse side) i PTMSE S[m+lIT ANY MIT= STATmW TO ME CLEIiTC ref: C240M (3/83) i ® I i I I CENTER FOR HUMMN DEVELOPMENT 3704 MT DIABLO BOULEVAHD•SUITE 201 -LAFN0-TTE CA 94549-(415)283-3104 IMPACT STATEMENT AN ESTIMATE OF THE INCREASED HUMAN AND FISCAL COSTS TO BE REALIZED BY CONTRA COSTA COUNTY DU,E TO THE TERMINATION OF THE CENTER FOR HUMAN DEVELOPMENT COMMUNITY PREVENTION SERVICES CONTRACT CCG-HSD ADAMH 74-211 -12 I I Introduction : i The recommendation to eliminate the Center for Human Development Community Prevention Services Contract to " save" $287 , 000 County dollars , can only be considered a very serious , short-sighted , ill - informed expediency that by conservative estimate will cost Contra Costa County more than twice the amount next year . 1 The purpose of this document is not just to again justify and rescue the CHD prevention contract but to raise more serious questions to the County Board of Supervisors , the Health Services Department and thousands of people who make up the " prevention network" or constituency that now exists throughout all socio-economic cultural populations in this County. The major question is : I DO WE WANT TO DO PREVENTION AT ALL? Now that this the County is being acknowledged both nationally and state-wide ( see page 3 ) for having developed a state-of-the-art model for prevention ' services , are we ; really ready to scuttle it just, as the impact is beginning to be ; realized? Does it matter at all . . . . . that now there are 470 identified volunteers , 7 . Prevention Councils composed of 94 people ( 64% of whom are minorities in low income communities ) and 117 organizations working in a partnership with CHD and the HSD Prevention Team to conduct alcohol , drug abuse , mental . health , & other health programs in their own communities . i Is this County actually ready to discount massive epidemiology research stating that 60% of all health problems are preventable? Is the Board of Supervisors ready to justify that although 99 . 6% of Health Services dollars are spent on the treatment of illness and 4/ 10 of 1 % on community prevention programs, it is prevention that is. too costly and must be eliminated? i And is this County . willing. to have its schools and communities lose not only $287 , 000 worth of preventioniservices but also the , $150 ,000 - $300 ,000 each year that CHO is willing and capable of securing from foundations , corporations and outside grants in order to augment the HSD-ADAMH contract? i i i I The Board of Directors and the administratlion of the Center for Human Development are convinced that it would be: irresponsible not to frame the threatened termination of the 12 year ;old CHD Community Prevention Services contract in the questions above . i We urge the Board of Supervisors to consider the question " Do we want to do prevention at all in our schools and communities . " And if so , then as the major contractor for these services , we urge that the Board charges the Health Services Department to : ( 1 ) Define a 5 year Community Prevention/Health Promotion Plan focusing on lessening preventable health problems throughout Contra Costa communities . ( 2 ) Define a policy statement committing and designating a minimal fixed percentage of revenues to the Plan each year . Unless this current funding crisis can lead to long-range planning for a policy commitment bn the prevention of health problems , we are convinced that it is actually unethical for us to only defend the CHD contact . To continue longer without a def fined policy commitment , preventive approaches by CHD , other Contractors and the Health Services Department. prevention matrix team itself will continue to be the first to be put on the chopping block whenever there is a f.i.scal crisis . ( Indeed , this is the third time ininine months that CHD has had to justify its existence and on-going funding for schools and community prevention programs . ) To protest;, to justify , to stand at more Beilensen hearings and repeatedly watch the community' s hopes in their own power to curtail human sufferingand health costs . . . . be discounted and eroded away is unethical . I This time we want the County and all of the prevention network constituency to raise the challenge and talk about the power , effectiveness and only alternative to health problems . . . . PREVENTION . To that purpose we submit this paper even though for the current threat again we must focus on the Center for Human Development contract . This document is composed of two sections : I I . Estimate of the human and fiscal impact that shall be realized .by the County, our schools and communities if the CHD contract and the coordination of major prevention efforts are terminated . i II . Summary of Accomplishments � I I i -2- I • li SECTION I . Estimate of the human and fiscal impact that shall be realized by the county, its schools and communities if the CHD contract and the coordination of major prevention efforts are terminated . A. Loss of Contra Costa ' s Leadership and Credibility The prevention services model initiated by CHD and the Division of ADAMH three years ago has become a recognized model for many other Counties throughout this state and receives inquiries from many other agencies . CHD is , has been , or is; invited to provide technical assistance , articles , or presentations to the following to showcase the Contra Costa communityjempowerment model : I, Eldorado County San Francisco County Yolo County . Santa Clara County Alameda County . California Primary Prevention Network Director ' s Task Force on Alcohol -Related Problems ( ADP -State ) Department of Education ( DOE -State ) National Committee On Mental Health Education i I In addition , CHD programs receive many ;inquiries per year and awards . On May 2nd the Parent Educator Drug Education Program was presented with the National Community Health Promotion Award from the U .S . Department of Human Service and'iCenter for Disease Control . The Tribes program is a primary drug abuse prevention model selected by NIDA and used in 22 other states . In short , Contra Costa will lose the capacity and leadership of CHD to meet community needs . It will lose the - Center 'for Human Development : its recognized expertise in prevention programming , organizational development , curriculum design , materials development , evaluation , data-base health profile information system , connections to other funding sources , capacity to generate supplemental funds , innovation and fortitude . B . Loss of the School /Community Prevention ; Network , Hundreds of Volunteers and Core Prevention Resources /Coordination The termination of the CHD contract will eliminate the School /Community Prevention Network so carefully developed over the last three years under this contract , San Francisco Foundation , Wells Fargo Foundation , East Bay Junior !League and State ADP grants . The loss is so immense it can only be enumerated in broad terms : II -3- i i I i o An empowered community network composted of seven ( 7 ) Community Prevention Councils ( 94 people ) in North Richmond , Central Richmond , Pittsburg!, Antioch , Concord , Martinez and the Delta area communitiies ; the jobs of local community organizers in each community. ( See page 7 for activities ) . ' i o Support and coordination for more than 375 identified and trained parent volunteers teaching alcohol and drug education in elementary schools (Parent Educator/DECIDE program ) . ! o Linkage and coordination to more thanl' 117 other organizations committed to preventing! alcohol , drug , mental health & health problems . ,o 12 years of on-going support to 18 school districts for alcohol and drug education , peer counseling programs , teacher training , parent courses , presentations to school /community groups , policy development with school boards on substance abuse issues . o The availability of films , articles , curricula , pamphlets , speakers , and conference coodination for school , community groups , and other human service agencies . o Training for staffs in public sponsored daycare and preschool programs (S.ee page 7 ) . o Liaison to other counties , state and federal prevention/health promotion program resources and networking . i C . Loss of Leveraging Other Funds & Current Dilemmas Throughout the years the ADAMH-HSD contract has been regarded as the County ' s core prevention project which each year leveraged supplemental project funds from a wide-range of other sources . The leveraged foundation and state grants usually do not allow administrative/operational costs or theisupplanting of existing County costs . The dilemma for CHD is that even though we have brought in $546 , 000 during the last 3 years ( 40-50% over the amount -of the County . con_tract/year ) . HSD-ADAMH � labels the contract as " non-revenue producing" ; thus , each fiscal crisis the CHD contract is cited as expendable . It does not meet the " beds and heads " criteria applicable to treatment and counseling programs ! Supplemental funds secured from foundations or other sources FY 1981 -4 areas follows : Community Prevention Network ( San Francisco Foundation ) $ 100 , 000 I East County Family Network ( Alcohol /Drug Programs State-ADP ) $149 ,000 Youth Educator Program ( ADP ) $211 ,6001 Parent Educator Project ( Wells Fargo F„oundation ) $18 ,000 -4- i I I Parent Educator Project ( East Bay Juniior League ) $ 11 ,500 Parent Educator Project (Community Ealst Bay Foundation ) $5 , 000 Prevention Resource Center ( Sweetland; Memorial Fund ) $11 , 000 Community Prevention Councils Planning/Data Base ( ADP ) $20 ,000 At the present time all of the above grants run out June 30th except one more year on the Youth Educator ADP project ( $70 ,600 ) and the new 2 year ADP $40 ,000 data-base planning contract . The latter was awarded to CHD just last month to demonstrate an advance in community planning methodology with our 7 Prevention Councils . Without the councils , the County will need to turn back the funds to another County still caring about the prevention of alcohol -related problems . i We have been planning and writing a new foundation proposal to provide more program funds for the Prevention Council ' s priority issues in West County. The effort , of course , will not continue if the main contract is terminated . I D. Estimate of actual costs to Contra Costa County during FY 1984-5 : Repeatedly prevention programs are discounted and totally undervalued because the uninformed wi W say "prevention can ' t prove it will save any costs . " We often wonder how treatment or counseling programs prove that they work , keep people from returning to clinics or save costs ; somehow the main question asked remedial programs is " how may beds werel. kept full for how long" or " how may heads were counted this month . ' Nevertheless , impressive epidemiology research , national and state studies , and demographic data. can help us to predict rather accurately the probable cost savings asirelated to prevention strategies being implemented among high=risk populations . i The charts on the following pages identify some few CHD prevention programs now being conducted for some of our county populations . You will note that very conservative estimates have been made of the minimum number of persons who reached by the prevention program can be expected not to require medicalior other County services next year . ( Most of the estimates use only a 1 % figure) . The costs to be saved on private treatment or placement are not included in the County cost estimate , nor are the incalculable costs of deaths , _accidents , and injuries . i The estimates have been made through the CHD Data-Base system which can correlate census track information and epidemiology studies . I Data sources are noted on page 11 of thi's report . * The conclusion from the following chartslis that the elimination of the Center for Human Develonment Contract will conservatively cost Contra Costa County $766 , 000 in FY 1984-5 more than twice the contract funds . It is more likely that the figure its actually triple that amount if analysis were made for all prevention programs supported and implemented under the ADAMH contract . Only a few have been used for this brief study. -5- i I CD C) o o - Z rn O o = U ,� O O lzd- O +-) O > LO In I C3, L U U U r0 O C C N b4 3 O •� to LA 1 O . U C t (3) (1) t 4- a) L .. Q) + b 0 r0 E L c CJ) ro + > 0) C C a) ro C (I) C C L +-) L U Ln O +-� d , U +-) (1) •-y .- O > r• c v ro a) O ro C S- V) -0 L t71 () to L. a) -4 Q) C a) E -0 U c + a) 3 '--r QJ L d 3 M b e •'. 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(V L N a a) In L ro ca.-M ••+ L O +) ro -) +) N E 7 ro '0 +--) +-) 4- .+ a) a) C a) C C 0 -0 (n L O C -+ Q) a) ut C1 (0 +-•) ••r •- O ro . +•3 +-J (V C -0 +--) ro a a) +� > > •.-r C CM 0 0) V) 0 -0 a--) (1) O Y >) C + ) C +•J O O S... .-r C v1 L •-+ to + ) ) L 00 4-) •- +.-) O + C ro V) a) O ro T +--) jo .- -• v) C (1) C 7:) Vt 4-'L tea) C a) EU :n U >, c � o - (T3 o L0ca) 0 roo jZ � E U S- U 3 4 ca.L-) i SECTION II SUMMARY OF ACCOMPLISHMENTS i Since 1972 the Center for Human Development has been pioneering and providing a wide-range of substance abuse and mental health development services to schools , community organizations and human services agencies throughout Contra CostaiCounty. Our community organization philosophy and methodology is key to being able to achieve the magnitude of services this year under the contract ' s three goals and 20 measurable objectives . I Goal 1 : . Community Prevention Services : To enable existing community organizations to take concerted action in reducing risk factors that influence health among high-risk populations . 1 . 1 . A Network of Volunteers : This year a network of more than 470 'identifiable volunteers and 117 partnership organizations is !being coordinated and supported with resource information alnd technical assistance to implement prevention strategies appropriate to the needs of their respective populations . CHDIvolunteers alone under the community and school programs prolvided approximately 13 ,524 hours per year of time or the ;equivalent of 11 . 5 FTE positions excluding vacation /sick time . This time alone estimated at minimum salary/fringe belnefits of $ 18 , 000/year would be the equivalent of $207 , 000 in it were paid professional time . 1 . 2 . Programs Sponsored by Local Community� Prevention Councils : i Seven local Prevention Councils composed of 9.5 people from 74 organizations plus a number of unaffiliated persons have assessed alcohol , drug , mental healthland other health issues within their communities . They have selected key issues for improvement and have awarded $49 , 000 iin small grants to 32 local organizations for prevention/he'alth improvement projects . 64% of the council members are of minority populations- in - low- income communities;. The Councils have been established in North Richmond , Central Richmond , Pittsburg , Antioch , Concord and the Delta communities . Lists and descriptions of the mini -grants are available . The type of programs and numbers of persons reached this year are summarized in the following chart . -6- Mini -Grant Program Type # Persons Involved youth activities ( alternatives to drugs ; recreational , peer support , emotional! development ) ; on-going meetings 215 i senior support services ( cross -generational , social support for isolated elderly) ; 51 single parents , refugee families and seniors : outreach & recruitment for existing s'.ervices or development of new services 1000 assault prevention programs in daycare centers , elementary and junior high schools 3700 workshops , community conferences and one-time only events 570 development of school climate and school curriculum to build self-esteem , emotional development , alcohol /drug free life §tyles ( 5 public daycare centers , 4 elementairy and 2 high schools ) 19678 community education & information programs through local libraries 5 , 000 Total : 12 , 160 1 . 3 . Targeted Community Grants Aimed at Priority Needs : In addition , there are five special projects conducted for priority community needs raised by Prevention Council or regional Prevention Networks : o An Anti -Stigma Campaign coordinated; by mental health consumer concerns to develop community support and reduce the stigmatization and labelling of users of psychiatric services . A community-wide conference was attended by 400 family members , service providers and consumers of services . A speakers bureau has made presentations to a variety of community groups reaching 525 people . o Support to TALLAY , a self-help support group for consumers of mental health services ; 15-20 active members ; 200 persons receiving newsletter and announcements . i I: i i -7- i i I o Perinatal workshop sponsored by the West County Prevention Network ; attended by 70 people from 50 organizations . Participants are meeting in subcommittees to develop a perinatal services resource guide , jto coordinate existing services and advocate for needed change . I. o Fetal Alcohol Syndrome workshops (2 ) were held with a nationally recognized expert speaking on these totally preventable defects . Workshops will train both community people and health and social service providers to train others . o Social Environment and Health conference was held in East Contra Costa County and attended by 100 people from 50 organizations . On-going committeeslof the East County regional Prevention Network were formed from the conference . These groups are now strategizing on a variety of issues : the isolated elderly, child care and child abuse , perinatal support systems , unemployment and vehicular safety. 1 .4 . Collaborative Partnership of CHD andlthe HSD Regional Prevention Matrix Team . All of the above activities have had the involvement of the Health Services Department Prevention Matrix Team, coordinated by Mr . Larry Cohen . The linkage of HSD personnel and clinics to the community preventi,,on councils and regional networks provides an effective support and technical assistance . The. partnership with theICHD staff has been essential to the effective implementation of so many community programs and to bringing relevant HSD resources to community issues and problems . Goal 2 : School -Based Prevention Services To enable Contra Costa County schools to conduct an increased number of constructive programs to ipromote the mental , emotional , social and physical healith . of children and youth and to support choices for present ;and future alcohol drug-free life-styles . 2 . 1 . Alcohol and• Drug Education : Although the FY ' 83-4. contract calls ifor training 100 volunteer parents in a 21 hour ( 6 week ) course to teach a drug education curriculum ( Stanford DECIDE Program ) in elementary classrooms , CHD trained 302 . Parents are working in more than 28 schools and shall reach approximately 6500 children with 8 to 16 classroom hoursiof instruction . Evaluations by the Mt . Diablo Unified i District states that -8- I i i I' 100% of all teachers and administrators want the program to continue ; 86% of the children say that the program has given them the knowledge and courage to say " no when pressured by peers . The CHD Parent Educator Program has just won the National CommunityHealth Promotion Award from the U . S . Health and Human Services . ( It was presented to two parents in Sacramento on the same day that we were notified the CHD Prevention Contract would be eliminated ! ) I 2 . 2 . Preschool and daycare training : 60 preschool and daycare workers within public supported centers in low income communities were given 24 hours ( over 6 weeks ) of comprehensive training in the national CHD model program , Tribes . The program builds self-esteem , prosocial skills and lessens behavioral problems whenever used consistently with young children . A lack of self-esteem correlates to emotional and behavioral problems as well as low academic achievement . Few daycare centers have training for their staffs at all , and a deeply appreciative of this mental health training . 2 . 3 . Consultation to school districts : More than 100 hours of consultation time is being provided to districts and school boards to assess the existing policies on drug abuse and drug education curriculum. In addition , throughout each year the CHD staff makes dozens of talks and presentations to parent and teacher groups on the prevention of alcohol /drug abuse and developmental concerns . i. Goal 3 . School /Community Prevention Support Services : To provide state-of-the art resource information and technical assistance for the development of comprehensive and effective school and community prevention programs . During this year the CHD Prevention Resource Center has : o responded to community requests for; mental health , physical health , substance abuse resource materials , including pamphlets , brochures , books , sample curricula a selected audio-v i s-u al - materials . o -films from the CHD Prevention Resource Center have been checked out 392 times this year . i o 39 different organizations have used our films 1 to 5 times . i i li o more than 5000 informational brochures on alcohol , drugs , parenting and mental health concerns have been distributed . o organized displays and present atiorrs at community health fairs , Alcohol Awareness Day , regional prevention conferences , youth substance abuselconference and school ; district events . o Sponsored and organized the Prevention Institute to provide training for the county prevention network , ADAMH staff , prevention council members and other agency staff . Well known expert speakers presented a wide range of topics key to effective prevention programming and work with the community. Topics : working with people in human systems , evaluation of prevention programs , istrategic planning , primary preventive care , social support and wellness , multicultural prevention programming , community development and networking . o Evaluation of all CND sponsored prevention programs is an on-going responsibility coordinated, by two staff members ( Ph . D . candidate and M. S . W. ) . with consultation from the Prevention Research Group and School of Public Health , Berkeley. j I o The Prevention Resource Center also;. published the Community . Health Connection for one and a half years , distributing 5000 copies of the publication to tjhe community network , agencies , corporations and schools .! Cutbacks in the CHD County contract last July eliminated County support ; two more quarterly editions were completed by CHD under San Francisco Foundation funds this year . The paper was an invaluable resource and link to theicommunity network acknowledging the impact of their prevention activities . i I i I -10- • it DATA SOURCES: 1 . "Health Data Summaries for California Counities 1982", Center for Health Statistics, Department of Health Services, State of California. 2. "Five Leading Causes of Death by Sex and Age, California 1978" - Death Records - Department Health Services, State of California. I 3. "National Health Status Objectives for 1990; An Assessment of Californi-a 1981 " Center for Health Statistics, Department of Health Services, California. 4. "Healthy People, The Surgeon General ' s Report" USDHEW Public Health Service 1979. 5. "1981 Annual Report of Fatal and Injury Motor Vehicle Traffic Accidents", California Highway Patrol . 6. "Medi-Cal Services and Expenditures ReprotjJan 81-Dec 81 for Contra Costa Health Services Department, " California Department of Health Services.. 7. "Medi-Cal High Users as Identified by Aid Code" Liz Rottger, Based on 5% sample of Contra Costa Medi-Call eligibles 1980-81 California Department of Health Services. i CHD 1983 i Persons wishing to address the Board or present testimony nest complete this form. Place it in the box near the speaker's rostrm before addressing the Board. nKIE Im U" Mae )y1w Peon # ADDrM my w If other, lwk�UNU: Self Other specify Check and complete the line applicable to your presentation: I wish to speak on Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these oomnents for the Board's consideration (continue on reverse side) PIZM SUBMIT ANY WRITTEN STAI'ffiMWT TO WE CUM ref: COIMS (3/83) RUBICON PROGRAMS, INC. 2400 BISSELL AVE. RICHMOND, CA 94804 PHONE (415) 235-1516 6/19/84 To: Board of Supervisors Contra Costa County From: Rubicon Programs, Inc. Re:Proposed defunding of Rubicon Garden 'Center Vocational Services I. am Mona Reeva, LCSW, MPH, Executive Director of Rubicon Programs. I am here today to speak to the proposed defunding of Rubicon . Programs Garden Center Vocation Services (GCVS) . I and others have appeared before you on numerous occassions regarding this issue during the past year. We have not brought a large group of people today to represent Rubicon. There are but a few of us to speak to you today. We felt that we count not, in good conscienceask our clients or staff to come here again. The stress and exceedingly high level of anxiety that has been generated during this past year is too much for even the healthiest individual to bear. The toll has been great. In the course of our presentations, we have endeavored to provide you with all the cogent information that will assist you in your decision making processes. Let me briefly recap: l .GCVS is a cost effective program that provides vocational rehabilitation to primarily the mentally disabled of West Contra Costa County. It serves a group of disabled individuals who have no other option available in this section of the county for rehabilitation and job training. 2 .WCCC, particularly Richmond, is a pocket of high poverty and exceedingly high unemployment. JTPA monies are primarily geared to the able bodied and are not available for this group. 3 .The GCVS is utilized to its fullest based on available funding from the A/DA/MH Division. For FY 82-83 we exceeded our contractual obligation for units of service. 4 .The Vocational Rehabilitation continuum is now in place. From pre-vocational to work readiness, work adjustment,. work evaluation through horticulture therapy, we are able to place our trainees into real work settings and subsequently real work positions through our business endeavors. - A NON- PROFIT.COMMUNITY SERVICE AGENCY page 2 of 2 i 5.The GCVS business endeavors include a retail nursery, private landscaping work, and three federal government contracts for grounds maintenance. These allow up to place 7-9 disabled individuals in a real work situation at any given time. 6 . In a relationship established with Rehab of Northern California, with the National program "Horticulture Hiring of the Disabled" we will have job placements in industry. 7.The program is based on sound fiscal principles. Of the total program, the county is currently investing 21% or $63 ,988 .This money can be further decreased by moving more into state funding. This can be accomplished through redefin- ition of certain program componants. f 8 .The business revenue constitutes over 50% of our total operating budget. It is important to understand that the federal contracts are not funding. (These are business contracts for work performed, and work that must be performed at high quality, inspected twice daily and subject always to loss of contract for nonperformance. 9 .The remainder of the funding .part, constituting 16% is State funding of $46 , 757. i. 10 .Your investment of 21% brings a 5: 1 return on your dollar for a total operating budget of almost $300 , 000 . L Rubicon will not be able to operate this current program without your investment. We will not be able to serve your county mentally disabled without your investment. I I urge you now, as I have done) in the past - as the two evaluationtask forces, one mandated by you, have done - fund this program. It makes no fiscal or programmatic sense to deinvest in a service that opens door's to people, that . provides hope, that provides the building of self-esteem and that provides training in real work expe�Friences. Rubicon Programs, Inc. , ask that you immediately pass an amendment that would include the GCVSjin the novation clause of Rubicon' s contract. I ask further that you encourage - no - mandate the evaluation of all programs within the A/DA/MH Division so that all effort can be brought to bear on improving the mental health continuum of. services in this county. i If you do not continue. to fundithe GCVS - what will you provide to your mentally disabled asl, an exit to the revolving door? A door that means higher costs, more criminalization, and no way out. Where will the .people go? r . i ........... - --- cMZBR'S MTD43RY AM COMM Persons wishing to address the Board or present testimony must caaplete this form. Place it in the box near the speaker's rostrum before addressing the Board. - tam PWM # 0 -7 3k AEDFM 6o Cur IT-3—ther, 102� IPC: Self _ Other specify l ' Check-ard/ ete the line icshle to pour/presentation: v I wish toepee k an Agenda Item # (tee I wish to speak in favor of Agenda Item # I wish to speak in apposition to Agenda Item # I do not wish to speak but leave these ommients for the Board's consideration (continue on reverse side) PLASS smmT ma wxT= gniZBem TO 'm CLm crnzm1's AND/ persons wishing to address the Hoard ar present testimony lust complete this form. Place it in the- box near the speaker's rostrum before addressing the Hoard. N 4 r tiF6TIy P m # ,,2133 44�0 / - XICIVALAO- if other, R �Ii s N M: SelfLl— other . specify Check and camipl.ete the line applicable to pour Presentation: I wish to speak on Agenda Item # df, (Ar a r n a e74 k Q�I h r� h I wish to speak in favor of Agenda Item # Ce�te►— I wish to speak in c;F mition to Agenda Item # I do not wish to speak but leave these amts for the Board's i consideration (continue on reverse side) PLEASE S[j*1IT ANY WRITTEN 1T TO TSE CLM ref: COMMENTS (3/83) cmzm;'s mmmwN r x®/tt COORM Persons wishing to address the Board or present testimony art aamplete this form. Place it in the box near the speaker's rostrm before addressing the Board. q DATE lum a07 MUMS Z CITY eo jCWjQtzW",rj W2: selfOther _ specify Check. and aamplete the line applicable to your presentation: I wish to speak cn Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not sh to speak but ve these cowents for the Board's consideration f . i (continue on reverse side) PLEM SUMIT ANY WITTE l sTATM4W TO THE CUM ref: COMM (3/83) f cI zmvs sssmmm Amim— ami2 s I Persons wishing to address the Board or present testimony must maplete this form. Plaoe it in the box near the Zenker's rostrmbefore addressing the Board. ' tq Iq mmD un d J L . C/m►Sf, Y AMMS 8D.0 Ma;ti. S� CITY Ma�4 ON c If other, FXPRESENTmG Self Other specify �X �Sln., I Check and cmgAete the line apprlicable bo pour presentation: I I wish to speak on Agenda Item # rn S CAA, �, I„ o I wish to.speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these oomnents for the Hoard's consideration f i ' 1 (continue on reverse side) PAYERS BOX 27.• MARTINEZ, CALIFORNIA 94553,1,- 415-228-5610 J u'n e 1'9 , 11,984 . . ' Honorable Tom Torlakson Chairman`, Board of . .Supervisors I. am Don. :Christen , Executive Vice President of' .the Contra Costa Taxpayers.: As.sociation . The ' Associa.tion :supports staff recommended cutbacks in the Health Services Department in order to allow the 1984-85 budget. to be balanced. with at least a $10 million prudent reserve . The.. Board only-needs to consider sucli potential 1984-85 contingencies as a '$10.='$12 mil Iion'. shortfall , in County property tax revenues if Jarvis IV passes in November ; matching funds for. a' new County jai 1 . .under Propos-i ti on 16 ; .another, shortfall . . in Health Services Department. revenue.. orll;a judgment: which is . adverse to the. County: i n the P=6- case. to ;!.rea.1 i ze that a prudent. reserve is ab-sol utel,y .necessary• to the . f s.c.aI integrity of `the­ County and i.ts taxpayers . SJn ce r e l'Y . Donald L . Christen Executive :',.V.ice President q. DLC T" Ji.' cc. Nancy Fanden Sunne:,.M.cPeak Tom .P.owers r Robert Sch`roAer i I I T"PAYEnzo BOX 27 • MARTINEZ, CALIFORNIA 94553 415-228-5610 i June 19., 1!984 Honorable Tom Torlakson Chairman , Board of Supervisors I I am Don Christen , Executive V.ice . Priesident of the Contra Costa Taxpayers Association . The Association supports staff recommended cutbacks in the Health Services Department in order to allow the 1984-85 budget to be balanced with at least a $10 million prudent reserve . The Board only needs to consider such potential 1984-85 contingencies as a $10,-$12 million shortfall in County property tax revenues if Jarvis. IV passes in November ; matching funds for a new County jail u.nde..r Proposition 1'6 ; another shortfall in Health Services Department revenue or.,a judgment which is adverse to the County in the P-6 case toirealize that a prudent reserve is absolutely necessary to the fiscal integrity of the County and .:its taxpayers . Sincerely ,; Donald L . ;Christen Executive !Vice President i I i i I I I DLC/jc cc : Nancy Fanden Sunne McPeak Tom Powers Robert Schroder C3TIzEQ's 'f m7mcuY 7 mAxt ammPis Persons wishing to address the Board or present testimony :east complete this form. Place it in the box near the spear = before addressing the Board. ?am �3<- Peon AMFWS W2- C o Co.r d \J-li>. CITY C©rj C o:rcl, If other, Self ✓ Other —1L specify k Check and ete the line applicable to your pcesentatian: I wish to speak on Agenda Item # V c--h or1 `t N e%r•v 1 Lc S I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these omments for the Board's emnsideration (continue on reverse side) PLEASE SUBMIT ANY WRITTW SM0DW TO 7HE CLMIK ref: Q MMEZM (3/63) CITIZEN'S AmAxt camas 3 b Persons wishing to address the Board or present testimony not complete this form. Place it in the box near the speaker's rostrum before addressing the Board. 3 i LL 13 e-V b ov / Peon # � 7 ! 3 ArAA'F S C `ry o F my If other, Self Other v specify Cb nJCO�CD C/ P-1 CDU /UG�L, Check and caaplete the line applimble to Your presentation: V'I wish to speak an Agenda Item # �IeDPaS L, [/ LT s F�(/l Cu �S I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these c muents for the Board's consideration (continue on reverse side) PLEASE SUBMIT ANY WRrr N STATO TT TO 2HE C LEM ref: ITIS (3/83) CMZBri'S MS nVff AMM ITIS `-9- Persons wishing to address the Board cc present testimony must complete this form. Place it in the box _ the speaker's rostrumbefore addressing the Board. lum Ir other, / r G: Self Other specify �'� Check and 9a lete the line applicable to your presentaticn: I wish to speak on Agenda Iter # 591, I wish to speak in favor of Age da Item # I wish to speak in opposition to Agenda Item # I do not wish to speak but leave these comeents for the Board's consideration (continue on reverse side) PLEASE SUBMIT MY URrP 1 OTMEMMU''10 7M CLEM I am John Lee representing the Medical Staff, As Chairman :Q of the Department of Ambulatory Family Practicef I am especially concerned about care in the clinics and in the home. As documented on page five of the handoutp the census is up in both medical and Mental Health clinics. Mental Health visits have risen from 541000 to 691000 in the last year or 28%; medical clinic visits have risen from 167..000 to 1921000 or 15%. Also outpatient surgeries have quadrupled up to 1x450 over three years aQo. Howevert we cut provider time in March and are being asked to cut again. With the proposed cutst provider time in medical clinics will drop 16%. Add to .that the 15% increase in demand and you get an increased work load of 31%. The resulting decrease in access to care will be more costly in the long run. The proposed cuts in Public Health Nursing ar-eequally short- s ighted., hort-sighted. Who believes that cutting Family Planning clinics is cost-effective? Similarlyp the proposed reduction in home visiting will eliminate early intervention in high risk patients. We will have to settle for crisis intervention for our geriatricp immigrantypediatric and hospice patients. With delayed response timet early discharge of our hospitalized patients will become more problematic than it already is. Againp the long range cost implications are predictable. The proposed cuts for the hospital overlook many current needs. One that recently came to. the attention of the Medical 1 Staff is the need to restore the occupational and recreational rehabilitation programs on the Mental Health wards* state-wide figures from 1981 were presented to you in previous testimony. They showed us to already be well below the average expenditure per capita of other counties. Why then are we being asked to cut so deeply? The only way we can make sense of it is to assume we are supposed to be punished for the deficit caused by financial planners.. We who deliver services did not benefit from the mistakes of .the planners. There were no "cost over-runs" as implied by some who should know better. Since we believe a misunderstanding . of the nature of the deficit is behind these drastic proposalsf I 'd like to spend a few more moments discussing it. The sixth page of the handout graphs two things. The lower line shows the unrealistic expected decrease in County Contribution planned for the last two years. This plan to cut which was based on erroneous datap is the least understood .and least reported aspect of . the deficit. The Arthur Young audit stated* This magnitude of improvement could not have been reasonably expected by the management of Health Services or any one else in County government. . . considering the Medi-Cal and MIA program changes. " In facts because of those changes by the State in reimbursement policy for Medi-Cal and MIA patients* an increase in County assistance was required. This increase is shown in the upper line. On an annual percentage basist both Hu-Med and Arthur Young& Co. place the increase at 12-15% for these two years. Not goods but understandable considering the changes in State reimbursement policy. The gap between these two lines represents . a deficit of $11..6 million. The next page breaks the deficit into two partst allowing a. conservative 7% increase in assistance to cover inflation in the medical industry. You can see 80% of the deficit was due to the erroneous assumption that cuts could be made and 20% a failure to foresee a drop in future revenues due to changes in State reimbursement policies. The people .who deliver services had nothing to do with eitherof these failures. The last page of the handout adds the proposed County Contribution for 84-85 which amounts to a 27% reduction in assistancet without even taking inflation into account. This is more than million dollars less than we received in 1981-82. How can this much of a cut be ."maintenance of effort" by anyone 's definition? You have already taken action in dealing with the accounting errors and revenue problems. An annualized $9. 2 million in cutst savings and improved revenue have already been implemented in the last 6 months. These are the fruits of cooperation between the Health Service employeest NuMed and the Medical Staff. The final report of the Medical Staff's Revenue Generation Task Force was presented at the last Joint Conference Committe meeting, it will 3 serve as the baseline document for ongoing efforts to improve in this critical area, The Arthur Youngaudit noted excellent opportunities to improve revenue without decreasing services. We have seized these opportunities in a spirit of cooperation. A policy of moderation .and fair-play 'on your part can preserve that spirit. Therefore} the Medical Staff urges you to reject all these Proposed cuts. HEALTH SERVICES VISIT DATA: 1981/82 ACTUAL TO 1983184 ESTIMATED - 1983/84 ESTIMATED ; 1982183 ACTUAL 1 1931182 ACTUAL 1 1 CLINICS OTHERS TOTAL CLINICS OTHERS TOTAL S CLINICS OTHERS OTAL .; 1 1 1 • ; ------------- - ---------------------------------------------- AUTO ACCIDENT ; 8 0 8 31 0 31 ; 34 0 34 i WORK ACCIDENT ; 39 0 39 ; 79 0 79 ; 29 0 29 OTHER ACCIDENT ; 54 0 54 1 311 2 313 1 412 0 4111 1 ALLERGY ; 91:119 133 1,177 1,047 332 1,3-9 ( 1,126 560 1,636 ; ARIHR;TIS/LOWM ; 162 837 1,599 6115 692 1,307 ; 941 618 1,619 1 CARDIAC CARE ; 5 3 3 ; 4 8 12 ; 6 2 8 ; CARL'IOL�GY ; 2 198 200 ; 1 6 7 1 0 8 8 ; I CHILD DEVELOPMENT 1 0 0 0 ; 0 1 1 1 0 0 0 1 ; MEDT-S�:REEI'J ; 2,861 9 2,870 ; 2,810 0 2,810 3,168 0 3,lt8 1 Cl�ES1 ; 573 252 125 ; 492 252 744 ; 752 186 938 ; DENTISTRY 1 9,696 5,9;7 15,653 ; 8,996 5,911 14,907 ; 9,607 6,023 15,t30 ; DERMf110LOGY ; 1,700 716 2,415 ; 1,761 654 2,415 ; 1,934 635 2,619 ; DYCFtA31A ; 0 3s 33 ; 0 0 0 ; 0 0 0 ; EMERGENCY ; 149 19,265 19,413 ; 129 11,514 11,703 ; 191 14,003 24,200 ; EAR HOSE AND THROAT1 835 951 1,836 ; 821 953 1,114 ; 997 . 828 1,825 1 OPTHALMOGY _ ; 2,901 2,615 5,516 ; 2,546 1,746 4,292 ; 1,377 1,633 4,010 ; GASTROE171EROLOGY 1 29 0 29 ; 0 0 0 ; 0 0 0 1 GERIATRICS ; 5 0 5 ; 0 0 0 1 0 0 0 ; GE11ER(Y.. ILLNESS ; 11 0 11 ; 5,436 5 5,441 ; 1,531. 5 1-126 ; GENERAL PRACTICE 93,501 1,215 6 ; 66,622 5,269 71 91 ; 64,335 6,701 71,086 ; 1 GytlECOLOGY ; 1,886 1,372 4,:57 ; 1,262 2,343 ,605 ; 2,643 2,661 5,304 HEMOIOLOGY ; 3 80 83 ; 2 60 62 I 0 35 35 1 INTENSIVE CARE ; 24 98 121 ; 26 86 112 1 10 76 86 ; INJECTION ; 5 311 315 ; 0 0 0 ; 0 0 0 I ISOLATION 1 0 1 1 ; 0 0 0 ; 2 1 3 ; MATERNITY I 69 113 1S2 ; 59 92 151 ; 24 55 79 ; I -DICAL ';' I 666 2,156 2,822 ; 1,565 462 2,02; 1 13466 ` 259 1,725 ; tia''ROLOGY , ; 832 423 1,310 ; 761 . 340 1,101 ; 650 358 1,008 S NEUR9 ERY `� 1 8 315 323 1 9 261 270 16 271 293 r: OBSTETRICS ; 0 33 323 ; 475 0 475 ; 854 0 854 ; ORTHOPEDICS 1 1,831 1,472 4,353 ; 1,603 1,824 3,427 ; 844 1,775 2,619 ; I OTHER ; 3,702 1,379 5,081 ; 4,151 1,839 5,990 I 4,797 : 1,652 6,449 ; 1 PE -MF 1 33 18 56 1 20 11 32 1 � 6 11 11 ; I PZ DS-Sl_>RG I 3 3 11 1 9 b 15 1 1 4 5 1 1 PEDIATRICS 1 1,205 8 1,214 ; 2,794 6 1,800 1 3,715 15 3,130 ; PODIATRY 1 1,614 11 1,625 ; 1,306 66 1,372 1 1,453 402 1,K-5 1 1 PREVENTABLE MEDICAL PROBLEM 1 0 0 0 ; 3,571 11 3,582 5,034. 14 5,043 1 1 PLASTIC SIJRGERY 1 187 405 692 ; 297 272 5F�9 ; 160 177 337 ; POST-NAIAL(OB) 1 1::3 5 143 ; 162 9 171 I 104 40 144 1 1 PRE-NATAL(OB) 1 2,358 518 2,876 1 1,607 452 3,059 1 2,472 658 3,130 I kESF'IRATORY CARE 1 0 26 26 1 0 20 20 1 0 0 0 1 1 REl1r?BILITATI011 744 1,079 1,8231 696 1,037 1,733 ; 535 1,082 1,667 1 :', SJ11i� RY 1 1,676 2,012 3,187 ; 1,632 1,604 3,236 1 2,168 1,287 3,455 1 I Tlti"OR 6 5 Il ; 0 1 1 I 3 1 4 1 URGENT CARE 1 54 8,307 8,311 1 85 12,014 12,149 3 449 452 1 1 UROLOGY 1 849 407 1,256 1 409 394 803 300 335 635 1 1 Vri"01AR SURGERY 1 3 0 3 ; 0 5 5 ; 0 52 52 1 1 ;.'ELL BABY 1 47 0 47 ; 72 1 73 1 119 0 119 1 1 WELL CARE 1 3 0 3 1 290 0 290 1 511 1 512 ; SUBTOTAL REGULAR 1)EALTH 1 137,319 55,032 1!L!0) 1 11.6,564 50,672 167,236 1 115,4 -6 52,989 163,425 1 lot fif'lifffiifififffffiiffffffffffifiofMiff fit m IIi$tiff,Fffif nfifflifffiiiiifffifto-1174m ffffifif#fitmffiffiif#iffiff4 ALC.ufICL;c71 ; 0 19,451 19,451 0. 13,961 13,961 ; 0 9,694 9,694 1 DRUG ABUSE 1 0 .51 51 U 22,504 22,504 1 0 51,71. 51,71. ; 1 LIFE CRISIS 1 0 6,336 6,336 ; 0 6,01()5 6,805 ; 0 1,253 1,253 ; a MENIAL DISTURBAKE 0 41,636 41;636 ; 0' 32,514 32,514 ; 0 28,132 28,132 ; 1 MEIJTAL RETARi,ATION 1 0 1,416 1,436 1 0 3139 389 ; 0 42 42 1 S SUBTOTAL MENTAL HEALTH 1 0 K.- 907 tcv,,909 0 76,173 76,173 ; 0 96,842 96,842 1 1 t'ENTAL HEALTH WITHOUT DF'Jf3S ; C t8,S5o 63,3.$ ; 0 53,669 53,169 1 0 .45,121 45,121 1 1 1 , y 1 1 1 1 1 1 HEALTH SERvICES 10TFt ; 137;315 123,9, u 251,?0a 115,564 126•,875 2„L3 4-1. ; 115,436 149,831 265,217 1 IXzXXXZX%XXZXXzzzzzXX%XXXzzXXXXz►zXz�zczxx�ArzzXAk:xzxzzz;►xZTzzzzzzzazzxCzzxzzzzzzYz�XXzXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX%XXXXXXX fiifiififfffiffiftttiififffiiifitifiaiefie�cfafcririfcairci5ocfaseffanf�arsiffiifiiifirffiiffiffffitiitiiiiififfififitffiffit �.z�Tll C�/'..% CI (`ll�!` G!r•('d`?�.'I��.n•)..� "nll?C:'T'::,� lir •1C i: 1!!nr,l . . - �e� C o��v,--�y C o 5 �- - r- l G. S�e r�►'C es 13015 . year' �� •r1^�lf(a✓+ 7 ► fL�,e ' }u x �t Y . 109 f Q - 6 - Ne--f- Co Av,4 y C c, T3dS2. year Q rea d ow ►-� OF' GfffG i •+ pow+�o�., o F- I� A1 �ow �+� -7J cre %o usG' G�< �ci '� a.� e fo c r f c•S C i r• C o -+- a4- r i r► rC V C LA e . A\ Po/'j t�7�"+ b T De is ► c4,-,c -le- 131 pa41C' f rrovfi f bused o " ) ,morcuV- ce 12 i � c i i { �v• 7 - I - • I1 e-i-- 4�/ Cos �- - f-1 e u 1-1 G, Se r�► C es T3�rs� >/ear : IR Fl - Z L S. i IY4, _. i 13 E I - ,2-73 _ 8 _ Persons wishing to address the Board cc present bestimny :oust eamplete this form. Plage it in thL- box near the s,�eaker.s rostrum be addressing the Board. y Cm Anss ,( �1/'.�� ._ I---- --ether, R !QTiZA1G: Self Other sgeci!°y Check acid camprIeL•e the line applicable to your presentation: I wish to speak on Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda Item # i I do not wish to speak but leave these ooaments for the Board's consideration (continue on reverse side) Ptd S 11T ANY WRITTEN STATE M TO TBE tLM ref: Co MERM (3/83) CITIY.6N's 'IDB ncm m wA—m anam 3� persons wishing to address the Board or present testimony must 0MVIete this form. Place it in the box near the speaker's rostrata before addressing the Board. _ DRI AMRMS ,5"9rY R-P, CITY C o/Y c0,P If other, G: Self Other t-- specify Check and oamplete the line applicable to yaw presentation: I wish to speak on Agenda Item # .c I wish to speak in favor of Agenda Item # I wish to speak in opposition to Agenda item # I do not wish to speak but leave these ommmrts for the Board's consideration (continue on reverse side) PLEASE SLMW ANY MPJTM STRTEMERr 10 'IDE C[M ref: ITIS (3/83) V ' AND CIMOM IS R'1'I�1 � 'iTl�1Y , Persons wishing to address the Hoard or present testimony must complete this form. Place it in the box near the speaker's = before addressing the Hoard. DATE c /ig' 1e� AMMSS 2'1 Z 7 1 o ,, C c, cm If other, G: Self Other specify Co 9ia Co. Q -11A.5 P- Check and complete the line applicable to Your presentation: I wish to speak on Agenda Item # I wish to speak in favor of Agenda Item # I wish to speak in opinsition to Agenda Item # I do not wish to speak but leave these comments for the Board's consideration (continue on reverse side) PIMSE SL*IIT ANY MITM STRTWW 70 'ice QEESC . I CMZ8RIS WMTDr as xrs cq� persons wishing to address the Board or present testimony asst complete this form. place it in the box near the weaker's = before addr= the Board. 5 5 ga y AEDFws 717 crrsrif —� • Self Other specify Crock and complete the line applicable to your presentation: I wish to speak on Agenda Item # I wish to.speak in favor of Agenda Item � I wish to speak in opposition to Agenda Iter # I do. not wish to speak but leave these amuents for the Board's consideration (continue on reverse s4e) PL&M smwT ANY IB rrm BTA7werP TO 'm aim i .rF. rr�cwrc ��/air