HomeMy WebLinkAboutMINUTES - 06261984 - T.8 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on June 26, 1984 , by the following vote:
AYES: Supervisors Powers , Schroder, McPeak, Torlakson
NOES: Supervisor Fanden
ABSENT: None
ABSTAIN: None
SUBJECT: BEILENSON HEARING--JUNE 19, 1984
The Board on June 19, 1984, having conducted a hearing pursuant to
Health and Safety Code Sections 1442 and 1442.5 (Beilenson Hearing) and at the
conclusion of the Hearing having referred all testimony to the County Counsel
to prepare findings and having requested the County Administrator to report
back on specified subjects; and
The County Counsel having forwarded a proposed Resolution for the
Board's consideration containing proposed findings; and
The County Administrator having filed a letter dated June 25, 1984
with the Board, a copy of which is attached and incorporated by reference into
this Order, providing the information requested by the Board and making
several recommendations;
IT IS BY THE BOARD ORDERED that the recommendations of the County
Administrator are APPROVED.
I hereby certify that this is a true and correct copy of
an action. !a:kon sand entared on the minutes of the
Bcard cf Suporvisors on tho date shown.
ATT STED June 26 , 1984
J.l'. C: :_ COUA-7Y CLERK
and Fi oiiicio Cierk of the Board
By��.'a- -.``� ?�L''� - , Deputy
Orig. Dept.: County Administrator
cc: Acting Health Services Director
County Counsel
State Dept. of Health Services
(via CAO)
00 327
Board of Supervisors
County Administrator Contra ;stns°w°n
County Administration Building (`(�Sta Nancy C.Fanden
Martinez, California 94553
vo 2nd District
(415) 372-4080 County Robert 1.Sehroder
3rd District
C. E. Dixon Sunne Wright McPeak
interim County Administrator 4th District
Tom Tortakson
5th District
June 25, 1984
Board of Supervisors
Administration Building
Martinez, CA 94553 1290
Dear Board Members:
Re: Follow-Up to Beilenson Hearing
I. INTRODUCTION:
At the conclusion of the Beilenson Hearing on June 19 your
Board directed that a number of actions be taken and that
several additional pieces of information be provided to you.
This letter and the additional attachments provide the
requested information. In addition, we are making recom-
mendations for action your Board should take on June 26 and
+ei background information to support our recommendations.
II. RECOMMENDATIONS:
Referring now to Dr. Walker's June 1 memo supplying priorities
for balancing the Health Services budget and the listing of
impact statements supplied to
., p pp your Board June 19, Dr. Walker _
and I recommend the following:
1. Adopt the Findings proposed by County Counsel and
direct the County Administrator to transmit the Findings
and any additional documentation required to the State
Department of Health Services pursuant to Health &
Safety Code Sections 1442 and 1442.5.
2. Balance the Health Services Department budget for 1984-85
by approving reductions contained in priorities 3 , 4 , 6 ,
plus $100,000 of priority 5 and $300,000 of priority 9,
as detailed in Dr. Walker' s June 1 memo.
0:0 3 2`8
Board of Supervisors
June 25 , 1984
Page 2
II. RECOMMENDATIONS : (continued)
3. Direct action to abolish all positions necessary to
implement the reductions under priorities 1, 2 ,. 3, 4 ,
6 , $100 ,000 of priority 5 , and $300,000 of priority 9
effective close-of-business Tuesday, July 31, 1984 , and
order the Director of Personnel and Acting Health Services
Director to issue the required notices and take all other
necessary related actions .
4. Adopt an Order directing the Acting Health Services Director
to issue 30-day cancellation notices to all contractors
affected by the reductions under priorities 1, 2 , 3 , 4 , 6,
and $39,572 of priority 9 (as described in Attachment II)
effective close-of-business Tuesday, July 31, 1984 , and
to negotiate contracts with any or all of the affected
contractors for any continuing programs at reduced levels ,
such contracts to be returned to the Board not later than
July 31, 1984 for further consideration.
5. Authorize the County Administrator to effectuate the
withdrawal of layoff notices and/or contract cancellation
notices in the order of priority specified by the Acting
Health Services Director to the extent that any or all
of the following occur:
A. The 1984-85 State Budget contains more than a 2.3%
cost-of-living adjustment for AB-8 County Health
Services .
B. - The 1984-85 State Budget contains a cost-of-living
adjustment for the Medically Indigent Services
program.
C. The 1984-85 State Budget contains an augmentation,
apart from a cost-of-living adjustment, to the
Medically Indigent Services program and there is
evidence that Contra Costa County will receive
some amount of that money.
D. The cost-of-living adjustments for Alcohol, Drug
Abuse, and Mental Health programs in the aggregate
contained in the 1984-85 State Budget as they pertain
to Contra Costa County will exceed $1,100,000.
6 . Order the County Administrator to report to the Board
July 10, 1984 specifying what actions have been taken as
a result of recommendation 5.
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Board of Supervisors
June 25, 1984
Page 3
Attached is a listing of the specific dollar amounts needed to balance
the budget as well as attachments showing the assumptions used in reaching
our recommendations, and additional background information in support of
these recommendations.
Respectfully,
PHIL BATCHELOR W—ILLIAMM B. WALKER,..M.D.
County Administrator Acting Health Services Director
PJB:clg
Y}
Enclosures
4
'i
1984-85 BUDGET*
PROJECTED DEFICIT $3.6
Reductions taken June 19:
Administrative (item #1 6/1 Memo) .7
Hospital (item #2) .6
SUBTOTAL REDUCTIONS 1 .3
Cost-of-Living Adjustment:
Mental Health/Alcohol/Drug Abuse 1 .1
Recommended Reductions:
Ambulatory Clinic (item #3 ) .2
Mental Health Clinic (item #4) .3
Public Health (item #5) . 1
Mental Health Contracts (item #6) .3
Mental Health (item #9) .3
SUBTOTAL 1 .2
TOTAL OF ABOVE ACTIONS $3.6
*
See attached page for assumptions
00 331
ASSUMPTIONS/FOOTNOTES
TO BUDGET DEFICIT
(1 ) Required matching County contribution is calculated
assuming a 2.3% cost-of-living adjustment on AB-8 funds.
(2) The recommended reductions will allow the County to maintain
a 50-50 matching ratio without the necessity or risk of
holding a 60-40 AB-8 hearing.
(3) No provision for a cost-of-living adjustment for the MIA
funds has. been made in the forecast.
(4) The cost-of-living adjustment for Mental Health is felt
to be reasonable; in the event funding at the $1 .1 million
level is not realized, additional reductions may be required.
(5) The projections assume both long-term and short-term interest
is non-allowable for AB-8 match purposes:
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ATTACHMENT I
w. Health Services Department
- OFFICE OF THE DIRECTOR
Hospital 8 Administration
A
2500 Alhambra Avenue
`R Martinez, California 94553
t?�STA` ��•� (415) 372-4200
�
#2 Assumptions used in formulating the Department's priority list of
service reductions:
A. For the original Beilenson list we were asked to provide you with
$3.6 million worth of reductions in AB-8 programs, in addition to
the Mental Health reductions of $1 .6 million. Beyond $2 million of
AB-8 reductions, it was impossible to reach the target figure with-
out a major clinic or program closure.
< >: Richmond Health Center was targeted because:
1 ) West County has relatively more Medi-Cal private providers as
well as the Martin Luther King Clinic, whereas East County is
still a Federally-designated underserved area.
2) Central County Clinic budgets do not approximate the $1 .6 mil-
lion target, whereas the entire amount could be saved by one
clinic closure in Richmond.
3) It was and is unnecessary to have listed so many AB-8 cuts,
as we argued at the time. It is now clear that we will be
quite limited in the amount of AB-8 program reductions that
we will be permitted to take.
B. For the priority list up to $2.7 million - Public Health and Mental
Health were each given.target figures approximating their COLA's.
' Each Division was then asked to prioritize its reductions to meet
that target. These two Divisions have explained below how they
formulated their lists.
C. The Department Director then met with the Division Directors to
formulate the final priority list. This was done without regard
to AB-8 restrictions, but was based entirely on judgements of the
relative impacts on services of the various reductions.
Administrative and Hospital reductions were felt to have the least
service impacts and were, therefore, listed first.. Beyond that,
the list consists of various reductions in Ambulatory Clinics,
A/DA/MH and Public Health listed from lowest to highest priority
based on the Division Directors and Health Services Director's best
judgement of service impact. It is not a random list, and is not
politically motivated. It represents an honest attempt to priori-
tize reductions proposed on top of the many reductions taken
throughout the year.
333
A-345
►=: ATTACHMENT II
CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
To: William Walker, M.D. Date: June 22, 1984
Acting Health Services Director
From: Stuaft M:Cullough Subject: $200-400,000 Reduction
Assistant Health Services Director fiat No. 9 in Your
A/DA/MH Division June 1, 1984 Memo
: i In order to reach the $300,000 reduction from the remaining $900,000
(No. 9 in your June 1 memo to C. E. Dixon) I recommend the following:
Credit A/DA/MH Division with
$78,428 in vacated positions as
per February payroll and as
submatted to you as part of
$1.6 million reduction $78,428
Central County Outpatient Clinic
(Cost Center 381)
1 FTE MHTS B 32,000
West County Outpatient Clinic
(Cost Center 401)
1 FTE MHTS B 32,000
1 20/40 1*1TS B 16,000
1 24/40 MHTS B 20,000
1 FTE MHTS C 37,000
-163;Ebb
West County Case Management
(Cost Center 493)
1 FTE MHTS B 32,000
West County Psychiatric Emergency
(Cost Center 405)
1 20/40 NM PI 13,000
Center for Hunan Developmnt 39,572
Total $300,000
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A-41 3/81
..., ATTACHMENT III
ADDITIONAL A/DA/MH
REDUCTIONS
IN PRIORITY ORDER
Proposed FTE's Reduced or Estimated
Reduction Eliminated Savings
1. Administrative 1 Deputy Mental E 78,428
Reductions Health Director
.5 Executive Assistant
to the Drug Abuse Board
2. Central County 1 MHTS B 32,000
Outpatient Clinic
3. West County 2.1 MHTS B 143,000
Outpatient Clinic 1 MHTS C
.5 Psychiatrist
4. West County 1 MHTS B 32,000
Case Management
5. West County 1 MHTS P.I . 13,000
Psychiatric Emergency
6. Reduction in contract with 101,572
Center for Human Development
7. Additional CHD reduction 65,428
(cancels entire contract)
8. West County 1 MHTS B 36,000
Outpatient Services for Children .1 Psychiatrist
9. Additional West County .5 MHTS B 16,000
Outpatient reduction
10. Additional West County 1 ITC 63,000
Psychiatric Emergency reduction .75 Psychiatrist
11 . Reduction in contract with 5,000
Crisis and Suicide Intervention
12. Reduction in contract with 51000
La Cheim School
Total Estimated Savings $590,428
00 335
Disproportionate Cuts in Public Health in West County - Point #10
Family Planning services to be eliminated in west county, because an alternative
exists in Planned Parenthood at Hilltop Mall . Specific Sexually Transmitted
Disease services can be replaced by the availability of physicians trained in
Sexually Transmitted Disease protocols at the Richmond Health Center. The two
specialized Sexually Transmitted Disease clinics per week will be maintained at
Concord, because they are very well utilized and cost effective. However, the
Sexually Transmitted Disease staff have repeatedly requested to establish spe-
cialized Sexually Transmitted Disease clinics in Richmond. The allocation of
available Sexually Transmitted Disease resources will be revisited on the basis
of an evaluation of the effectiveness of Richmond Health Center staff in meeting
Sexually Transmitted Disease needs in that community.
Additional Information for Point #8
Family Planning Clinics
Savings - 2 nursing positions $ 84,000
1 Family Planning Aide 15,000
1 Clerk 20,000
119,000
Estimated Revenue Loss -50,000
Estimated Savings $ 69,000
Points #2, 7, 8
These are addressed in the statement of the impact of proposed Public
Health reductions.
Y
June 22, 1984
00 336
Response to Point #12- Fees in Public Health
We have implemented a $20 fee for Sexually Transmitted Disease clinic visits
this fall , and presented a fee schedule to the Board of Supervisors last month
for fees for STD laboratory services to private practitioners and community cli-
nics. Immunizations are still given fees; however, we have been studying impo-
sition of fees in that program and have decided in principle to do so. We are
still discussing the appropriate magnitude for fees, probably we will decide on
$2 to $5, which will generate on the order of $20,000 revenue.
Response to the Recommendations of the Public Health Nursing spokesperson:
Point #11
1) Do not cut Public Health Nursing any further. We agree with this recommen-
dation for the reasons we presented in our statement of the impact of Public
Health reductions. There are only 18.5 - 20.0 FTE Public Health Nurses
available for general preventive public health nursing county-wide. This
is already an inadequate amount and substantially below the numbers avail-
able in the surrounding counties.
2) Reduction of Administration in Maternal Child and Adolescent Health.
Unfortunately, there are not major savings to be realized here. We
eliminated Dr. Kathy Armstrong, Chief of Children Services, from this
program in February, 1984. Dr. Kathy Malloy, who took over the additional
duties of Director of Maternal , Child and Adolescent Health in February,
already had a full time job as Director of the Miller Centers.
Norma Kruse, Director of the Disabilities Unit, has filled in behind
Dr. Malloy, to free up some of her administrative responsibilities in the
Miller Centers. Sue Hayes assists Norma Kruse in the maintenance of the
A California Children Services. The other administrators and program spe-
cialists positions are largely or wholly funded from non-county revenues.
I would like to comment, particularly, on the Maternal Child Health Co-
ordinator, who is currently Tom Wangerin, since this was referred to spec-
ifically in the handwritten notes included with the memo. The MCN Co-ordinator
is 80% state funded under our MCH contract with the state. That contract
requires that our division analyze vital statistics data by census tracts, make
an analysis of MCH Public Health data for planning purposes, review and report
on MCH priorities, and provide staff for the MCAH Advisory Board. It is unli -
kely that if we elimiinated that position, we would be able to maintain our
state contract of $55,000.
Public Health Nursing administration, and evidently also at least some staff,
are of the opinion that the MCH Co-ordinator function shuld be carried out by a
nurse, which the incumbent is not. Although that view has been discussed, and
will continue to be discussed, it is not the view of Dr. Malloy, the state MCH
consultants, or myself, and is not division policy.
Point $3 - addressed by HSD Director .
Point #4 - already discussed
6/21/84
00 337
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PUBLIC HEALTH CUT TARGETS AND IMPACT ON THE COMMUNITY
The Public Health Division has been asked to propose cuts of $419,000 for the
fiscal year of 84-85. The impact of these cuts will be discussed at a Bielensen
hearing scheduled for June 19, 1984. The staff of the Public Health Division
has attempted to determine the best ways to absorb the proposed service cuts
with the minimal damage to the community. The following statement reflects our
professional evaluation of what services should, if necessary, be eliminated,
and what would be the probable impact of these cuts on the community.
These proposed cuts come in the context of budget and program cuts of 5491,000
that the Division has already made in fiscal year 83-84 in the form of positions
cancelled or vacancies maintained for fiscal reasons. The proposed total reduc-
tion for FY84-85 of $910,000 comes from a total county contribution of 4.2
million dollars in fiscal year 83-84.
We are constrained in determining where to make those cuts by the necessity to
yo
select from the minority of our programs that are county funded. Unfortunately,
it is the traditional Public Health programs, and often those highly ranked by
the Blue Ribbon Committee, that find themselves so financed. Public Health
Nursing, which provides the arms and legs of Public Health programs, is largely
county funded. The proposed elimination of a total of 13.5 nursing positions
this year will inevitably imply a substantial reduction of public health ser-
vices and protections.
MATERNAL, CHILD, AND ADOLESCENT HEALTH
Family Planning Services
Eliminate subsidized family planning clinics and all family planning nursing
outreach services in West and Central County. Maintain East County clinic and
outreach services at the current level of services.
Positions eliminated: 2 Nursing
1 Aide
1 Clerk
Impact
After careful analysis of the various MCAH programs, family planning services in
West and Central County were chosen for elimination because it was determined
that this reduction in service would have the least devastating impact on the
health of mothers and children in the county. Nonetheless, these proposed cuts
will have a significant health and fiscal implication, which cannot be avoided.
Subsidized family planning clinics and education services were slated for elimi-
nation in West and Central County, and maintenance of effort in East County was
decided on because there are more alternative services available in West and
Central County. There are extremely limited alternative family planning ser-
vices accessible to our patients in East County, which includes a federally
designated medically underserved area.
00 338
There were 3374 subsidized clinic visits for family planning services . in West
and Central County in 1983. The Central County clinic is run in concert with
volunteer staff from Diablo Valley College. Elimination of the clinic will
disrupt this close collaboration with the community. Although there are a
large number of private physicians and facilities available in Central County
for alternative family planning services, many of our clients there are young
people who, for cultural reasons, do not wish to visit the same physicians who
attend their parents. The well-known confidentiality of the Public Health cli-
nics makes that service available to important segments of the community, who
otherwise would have no acceptable alternative.
West County is an area of extremely high need for subsidized family planning
services on the basis of ethnicity, socio-economic status, and perinatal mor-
tality rate. Clients previously- served in our clinics may require up to a two
hour trip by public transportation to access the alternative non-county services
in their area.
In the high risk populations served by these clinics, referral for prenatal
care is an extremely important objective. Prenatal referral and counseling will
no longer be provided in West and Central County, since the elimination of
family planning services includes the elimination of pregnancy test counseling.
One of the benefits of pregnancy testing services is to identify high risk
mothers and facilitate their obtaining needed medical care. In 1983, 1311
pregnancy tests and counseling sessions were provided in West and Central
County.
Because of organizational structure and attendant loss of revenue, elimination
of clinical services requires that all community based family planning educa-
tion, counseling, and outreach activities also be eliminated. For example.,
p. during a postpartum nursing visit to a high risk mother, family planning issues
could no longer be discussed. These are the mothers who are considered by
federal and state health planners to have the greatest need for family planning
education and services in order that they have optimal pregnancy outcomes.
The result of these cuts will impact heavily on the range of services available
to the Pregnant Minor Programs run in conjunction with the school system in West
and Central County, where family planning issues could no longer be discussed'
with adolescent mothers. Elimination of family planning services in West and
Central County also forces the elimination of any telephone consultation on fami -
ly planning related issues and referrals.
Decreasing available family planning services will result in an increase in the
incidence of problems associated with unwanted children such as abandonment,
child abuse, and foster placement, and would also be expected to increase the
incidence of pregnancies that are terminated by abortion. In 1981, the induced
abortion rate for Contra Costa County was minimally estimated at 29.9/1000
births.
It is predicted that in addition to the clinical impact described above, elimi-
nation of these services will result in a reduction of 86% of the revenue
realized from the Office of Family Planning grant for a total additional loss of
revenue to the department in excess of $82,000 per year. The cascading effect
of this loss of revenue will necessitate additional cuts in personnel and the
associated loss of health services to the community.
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00 039
yr
Child Health Nursing Services
1 .5 FTE Nursing Positions Will Be Cut From Child Health Nursing Services.
Maternal , Child, and Adolescent Health (MCAH) Public Health Services were ana-
lyzed and l)rioritized in this county. Family planning services and child health
nursing services were selected to be eliminated or reduced, only because there
were no other possibilities for reductions in other programs available, using
the criteria of funding mandates, community alternatives, or enough program
expenditures to permit budget reductions in the amount required.
During 1983, 6.5 PHN FTE's provided a wide variety of health services to 19,118
individuals. The PHN services included anticipatory guidance, health promotion
and education, which resulted in early identification of possible neglect and
child abuse cases, as well as prevention of potential handicapping conditions or
illnesses. PHN's also provided nursing services to families of children with
developmental problems, premature infants, children with low birth rates, and
followup home nursing visits for children with various diagnosed conditions. Of
s the available Public Health Nursing FTE's , 3 to 3.5 are allocated to and funded
by the Child Health and Disability Program (CHOP), and must be used in accor-
dance with the restricted state mandates of that program. After the proposed
reductions, there will be only 1.5 FTE's left available to provide for services
around child abuse, California Children Services' referrals, Sudden Infant
Death, and followup on the many children who do not meet any of the above
program eligibilities.
There are many families now referred for nursing care, who are known to require
intensive nursing intervention to enable them to use health resources effec-
tively to keep their children in good health and to obtain treatment early when
needed. These families need the comprehensive support and education given
through nursing to be able to provide their children with a healthy, safe environ-
ment in which to grow. Without such intervention, it is known that there will
be an increased incidence of preventable accidents, child abuse, and chronic,
a incapacitating illness. There will be fewer children who receive regular health
checkups, with immunization against preventable disease and early detection of
conditions of diseases which, if not treated, lead to permanently disabling
conditions. Many children will no longer receive followup nursing care after
hospital discharge for nursing treatments and monitoring of progress. .=There
will be an increase of expensive re-hospitalizations, which could have been
avoided by nursing intervention at home.
There are no other sources of home health supervision for children available in
this community. The Public Health Nurse is the sole health professional, in
the patient 's home, who provide health assessments, skilled nursing, and a plan
for continuing care. Public Health Nursing has been a vital resource for health
care providers, public and private, to assist in improving the physical and emo-
tional health of children of this county. This resource will be reduced to a
nearly ineffective level if Public Health Nursing staffing is reduced to the
extent proposed.
- 00 3.4.0
All
PUBLIC HEALTH GERIATRIC CHRONIC DISEASE PROGRAM
Three to five FTE Public Health Nursing positions will be eliminated from this
program.
In 1983, approximately 4.5 Public Health Nursing full time equivalents were
assigned to the Geriatric Chronic Disease Program. In that year, these Public
Health Nurses serviced 11,333 individuals. With a maximum of 1.5 nursing FTE's
available to continue that service, the program will be virtually eliminated.
The geriatric program, although highly valuable to the community, is entirely
county funded with more than 200,000 dollars being expended in that program
area. Significant budgetary savings can be effected by eliminating the
geriatrics program, and thus sparing the necessity of liquidating an even larger
number of equally valuable alternative programs.
The population of Americans over 65 years of age is growing at a very rapid
rate. The elderly population of Contra Costa County is 88,000 and comprises
r='s population. While the Contra Costa Count
13.5% of the total y population grew
18% in the past 10 years, those over 65 increased by 34%. A great proportion of
seniors cannot afford wellness care, since this aspect of health care is not
allowed under Medicare or most other health insurances. The goals of the Public
Health program have therefore been twofold: 1 ) To promote health and prevent,
delay, or control prevalent disease conditions among older adults in the com-
munity and 2) To enable older adults and adults over 60 years of age with chro-
nic illness to practice preventive self-care and utilize health care systems
effectively.
. With the elimination of Public Health Nursing positions, the following services
will be discontinued:
Public Health Nurse Senior Site Visits
Public Health Nurses are assigned to Senior Centers and make visits on a regular
basis, usually monthly, to identify, counsel , and/or refer older adults with
health problems so an optimum level of health care can be attained or main-
tained. The Public Health Nurse activities include medication, counseling,
hypertension screening with referral when indicated, classes on specific
diseases, health counseling, information about community resources and nutrition
counseling.
Public Health Nurse Home Visits
Public Health Nurses make home visits for preventive, supportive, and thera-
peutic care. They followup on positive findings from screening clinics and
senior center Public Health Nurses, as well as referrals from physicians,
social workers, family members, and others. The Public Health Nurse does health
screening in the home, and makes complete assessment of needs, provides health
education, assures provision of safety measures, and adequate 24 hour home carer
When needed, the PHN coordinates all home aspects of services and facilitates
comprehensive care for each patient.
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00 341
:.r
The unavailable or inaccessible public transportation in many parts of the
county is a serious problem to the senior population. The PHN is virtually the
only health professional that provides health assessment, skilled nursing, and
followup in the home. As a result, early detection of health problems for
seniors that are not consistently seen by other health professionals will be
eliminated. The monitoring of uncontrolled hypertension, diabetes, emphysema,
heart disease, poor nutrition, and depression will cease. Patients will more
readily be hospitalized in a deteriorating state, resulting in increased hospi-
tal admissions for longer lengths of. t.ime. The lack of health promotion, health
prevention will lead to a greater financial burden on the community and, most
importantly, a deterioration in the living conditions of our elderly citizens.
There are no alternatives in the community to the Public Health Nursing services
provided in this program. Geriatric nursing visits which can be reimbursed by
third party payors are already followed by the Home Health Agency or other pri -
vate community agencies.
Vignettes in Public Health Nursing
Eighty-four year old man with hypertension and recent rib fracture after fall ,
attempting continuing care of 68 year old wife with bilateral above the knee
amputation and diabetes. Wife essentially bed bound. Both patients under great
deal of stress due to above. Need in-home care, but not eligible through Social
Service. Cannot afford cost of private care. Also not eligible for gero-psych
services.
Sixty year old male, bilateral amputee. Total care. Depressed. Wife is only
caretaker. Patient has multiple open ulcers on buttocks, stump, and in groin.
Poor coping abilities. Not eligible for in-home care.
Elderly couple, 79 and 77, who were both referred for weight loss due to poor
nutrition. Financially marginal couple living on fixed income continue to func-
tion marginally because they do not qualify for Social Service resources.
Family needs "push" toward medical compliance, nutrition maintenance, as
depression and physical disabilities, due to age, tend to have family drop back .
?? into old patterns of missing meals, and "vegetate" at home.
A seventeen year old girl, self-referred to Public Health Nursing from parenting
classes. Was molested from age two through age fifteen by stepfather. Finally
told mother. Stepfather in jail for conviction. Girl lives with sixteen year
old boyfriend and ten month old baby. Boyfriend beats girlfriend. Protective
Services involved due to total situation. Baby has had no immunizations.
Mother keeps breaking appointments. Mother will allow only PHN in the home as
she has established a trusting relationship. This girl is pregnant again, and
only came for a pregnancy test at PHN' s insistence. Public Health Nurse con-
tinues to be involved to coordinate needed action with Protective Services and
to ensure adequate child care.
Extremely obese three year old. All other family members thin. Identified as
possible endocrine problems in Child Health Screening. Not eligible for any
services, no money for care. California Children Services will not cover this
child. As a result of PHN home assessment and nutritional guidance in Spanish,
child has begun to lose weight. Will be monitored in Child Health Screening for
progress.
-s- 00 344
ACUTE COMMUNICABLE DISEASE
Impact of Eliminating 1 FTE Epidemiologist
The epidemiologist in the Acute Communicable Disease Program functions within
the Sexually Transmitted Disease Branch (STD) and functions to provide followup
to contacts to reported cases of sexually transmitted disease and to do educa-
tion within the community. The STD clinics see 5,000 to 7,000 patients per year
for total screening. Each client is -interviewed by an STD epidemiologist. In
addition, the epidemiologist followup includes 1400 to 1500 visits to patients
in contacts yearly.
The elimination of the epidemiologist position will mean that the mean time to
reach a VO contact will rise from 3 to 5 days to 10 to 14 days, and that the
number never reached will increase from approximately 20% to greater than 50%.
Since there are an average of 3 contacts to VD case, and the incubation time to
infectivity is about 10 days, the chain of transmission of even the reported
rid
sexually transmitted disease cases will essentially remain unbroken.
Pelvic infection is the leading cause of involuntary sterility in young women,
with gonnorhea infections more common in the lower socio-economic groups, and
chlamydia infections more prevalent in the middle and upper economic sections.
The decrease in Public Health STD services will undoubtedly result in some
increase in sterility in the population, with the impact being felt in all parts
of the county.
Specific .STD VD services will be eliminated in West County, and the current plan
to implement such services in East County will be abandoned. Two STD clinics
per week can be maintained in Concord.
h
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00 �
. .r
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
June 26, 1984
Adopted this Order on , by the following vote:
AYES: Supervisors Powers , Schroder, McPeak, Torlakson
NOES: Supervisor Fanden
ABSENT: None
ABSTAIN: None
SUBJECT: Health and Safety Code )
Section 1442.5 Hearing ) RESOLUTION NO. 84/3 81
Findings )
Pursuant to Health and Safety Code Section 1442.5, the Board conducted a
public hearing on June 19, 1984 on proposed changes to programs in the County's
Health Services Department. The Board started the hearing and:
A. Declared their intent to not close the Richmond Health Clinic at this
time;
B. Adopted as a definition of "indigent" for purposes of this hearing the
definition set forth in Resolution 83/1139; and
C. Opened the hearing for public comment.
I. The Board received written and oral evidence, as follows:
A. Written documents were received into the record and filed with the
Clerk of the Board of Supervisors, including:
1. Memorandum dated March 26, 1984 from Claude Van Marter to Contra
Costa Grand Jury; subject: Mandated Health Services.
2. Memorandum dated April 5, 1984 from C.E. Dixon to all Departments;
subject: Budget Targets for Fiscal Year 1984-1985.
3. Memorandum and attachments dated April 13, 1984 from William B.
Walker, M.D. to Finance Committee; subject: 1.984-1985 Budget.
4. Memorandum and attachments dated April 30, 1984 from Patrick Godley
to C.L. Van Marter; subject: AB-8. .
5. Memorandum dated May 1, 1984 from Patrick Godley to C.E. Dixon;
subject: 1984-1985 Budget.
6. Memorandum and attachment dated May 1, 1984 from Claude Van Marter
to C.E. Dixon; subject: AB-8.
7. Letter and attachments dated May 7, 1984, from C.E. Dixon to Board
of Supervisors; subject: Analysis of Health Services Department
Budget Projections.
8. Letter and attachments (including notice of Beilenson Hearing)
dated May 14, 1984 from C.E. Dixon to Board of Supervisors; sub-
ject: "Beilenson" Hearing and AB-8 Match Requirements.
Orig. Dept.: County Counsel
cc: County Mininistrator
State Dept . of Health Services
Acting Health Servides Director
W,9=.ION N0, 84 3 81
00 344
9. Board Order dated May 15, 1984 fixing date for, Hearing pursuant to
Health and Safety Code Section 1442 and 1442.5.
10. Letter dated May 17, 1984 from C.E. Dixon to Peter Rank, Director,
State Department of Health Services
11. DMH Letter No: DMH 84-12 and attachments dated May 23, 1984 from
D. Michael O'Conner, M.D, Director, State Department of Mental
Health to Local Mental Health Directors and others; subject:
1984-1985 Fiscal Planning Estimates.
12. Memorandum and attachments dated May 30, 1984 from Patrick Godley
to C.L. Van Marter; subject: 1984-1985 Budget Request.
13. Memorandum dated June 1, 1984 from William B. Walker, M.D. to C.E.
Dixon; subject: Beilenson Cut Priorities.
14. Memorandum and attachment dated June 7, .1984 from C.E. Dixon to
members of the Board of Supervisors; subject: "Beilenson" Hearing
June 19, 1984.
15. Budget Message for the Fiscal Year 1984-1985 from the County
Administrator to the Board of Supervisors.
16. An undated Health Services Department summary report entitled,
"Proposed Reductions in Health Services Department in Priority
Order" (7 pages).
17. A June 19, 1984 memo from Wendel Brunner, M.D.; subject: Proposed
Public Health Cuts and Their Probable Impact.
18. A June 19, 1984 letter to the Board of Supervisors from .the Contra
Costa County Contractors' and Friends Alliance.
19. A June 17, 1984 memo to the Board of Supervisors from the Mental
Health Association of Contra Costa County.
20. A June 19, 1984 letter to the Board of Supervisors from Billie
Wilson, Public Health Nurse.
21. A June 19, 1984 letter to the Board of Supervisors from Lee
Johnson-Kaufman, Ph.D., on behalf of the Human Services Advisory
Commission.
22. A June 19, 1984 memo to the Board of Supervisors by Steve Tremain,
M.D.
23. June 19, 1984 letters to the Board of Supervisors from clients of
the East County Activity Center.
24. An impact statement to the Board of Supervisors from the Center for
Human Development. .
25. A June 19, 1984 letter to the Board of Supervisors from Rubicon
Programs, Inc.
26. Two June 19, 1984 letters to the Board of Supervisors from the City
of El Cerrito supporting the Rubicon Garden Center and public
health nursing services.
27. A written statement to the Board of Supervisors from John Lee,
M.D.
28. A June 19, 1984 letter to the Board of Supervisors from Donald L.
Christen of the Contra Costa Taxpayer's Association.
UPOLUTI.ON N0. 84 /381
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B. Oral testimony was received, including that which is summarized as
follows:
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 and recommended
that the Richmond Clinic not be targeted for closure at this
time.
Claude L. Van Marter, Assistant County Administrator-
Human Services, advised that the potential deficit remains at
$3.6 million. He referred to the prioritized list of reduc-
tions 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 $900,00 more in reductions in the
Mental Health Division or closure of the Richmond Clinic,
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 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,
Vickie 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 contractual programs.
Reg Parks, Public Health Division, spoke on the impact
on Public Health clinics, particularly how they would affect
those clinics treating venereal diseases.
Allen Longshore, M.D., supported the previous speaker
and expressed opposition to any cuts in Public Health ser-
vices.
Carl Hanson, REACH Project and Chairman of the Antioch
Cham3ei—rof Commerce, commented on the support of the com-
munity and the assistance of volunteers with respect to drug
abuse and prevention programs.
Henry Clarke, General Manager, Contra Costa Employees
Association Local 1, expressed disagreement as to the amount
of money to be allocated to the Reserves in lieu'of funding
Mental Health programs proposed for reduction.
Grant Wybom, 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 implementation of treatment soon
thereafter.
Wendell Brunner, M.D., Director, Public Health Division
of the Health Services Department, commented on the adverse
impact reductions in the Public Health nursing staff could
have on services provided to children and the elderly.
Lela Sater, Nutrition Advisory Council, requested that
consideration be given to not cutting Public Health nursing
services to the elderly, and particularly those confined to
their homes.
U SOLUT I ON NO, 84,.-/381
-3- 00 34.6)
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.
Ruth Croci, representing the Advisory Council on Aging,
expressed concern with the proposed elimination of three
Public Health nurses who work with the elderly.
Billie Wilson, Public Health Nurse, spoke on the ser-
vices provided to the elderly and the role of the .Public
Health nurse in family planning and communicable disease
clinics. She recommended the raising of fees in selected
programs, such as charging a fee for immunization.
Donald F. Goldmacher, M.D. , requested that the Board not
cut prevention programs. He suggested that where program
reductions are necessary the Board consider the recommen-
dations of its management staff.
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 if it means cutting
non-mandated direct service programs.
Jean B. Siri, City of El Cerrito, advised that the El
Cerrito City Council unanimously recommends continued funding
for the Rubicon Garden Center and the continued funding of
Public Health services in the El Cerrito area.
Cathy Lee Hodge, representing the East County Regional
Advisory Board on Alcohol, Mental Health and Drug Abuse,
expressed opposition to the proposed reductions in Mental
Health programs.
Frances Dalecio, representing the Maternal Child
Adolescent Health Board, commented on the services provided
at Public Health clinics and requested that they be
maintained.
Leigh Lutz, a participant in the Alcohol Abuse Program,
commented on the benefits he received through his par-
ticipation in the program and requested that alcoholism
program cuts not be made.
Steven TremainL_M.D., Chairman, Medical Quality
Assurance Committee, advised that priority items 1 and 2
dealing with administration and hospital contracts could be
eliminated or reduced without adverse impacts, but expressed
reservations with respect to the remaining items. on the
priority list.
Stanley T. Hutter, Ph.D., Mental Health 'Tr eatm ent
Specialist and representative of Contra Costa Employees
Association Local 1, expressed the belief that the cuts as
proposed would have an adverse impact on the indigent popula-
tion in this County. He suggested that the Mental Health
Division be separated from the Medical Health Services.
Belle Lipsett, representing the Maternal Child
Adolescent Health Advisory Board, commented on the impact the
proposed reductions would have on West County ;family planning
and pre-natal clinics.
I
j: .
Peggy Sargent, representing Alcohol Program Providers,
expressed opposition to the proposed reductions in alcohol
programs.
PIESQTIUTj:ON NO. 84/381
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00 347
Sherrin Bennett, representing the Center for Human
Development, opposed the recommendations to eliminate or
reduce the contract with the Center for Human Development and
commented on the service provioea ana the population served.
Willie May Jones, Center for Human Development, spoke on
prevention conferences and the pre-natal care services pro-
vided to the economically disadvantaged.
Donna Leary, Center for Human Development, spoke on the
support received from parents clubs and school boards in con-
ducting education programs about drugs and alcohol.
Joanne Maerkley, 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
Facility, requested that child health and development
programs be retained.
Mona Reeva, Director of the Rubicon Garden Center
Vocational Services, spoke of the success of the program in
training and placing its clients in suitable occupational
positions.
Ellie Strauss, Rubicon Garden Center, requested that the
Board not make any reductions in the program until all budg-
etary facts have been reviewed.
Sarah Houghton, private citizen, advised that she has
been very satisfied with the Garden Center's services and
suggested that the deficit be made up outside the Health
Services Department.
Michael Bennet, recovered 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, private homes,
and the absence of an occupational program in the mental
health wards. He requested that there be no additional cuts
in the Mental Health programs.
Lolita Davidson, recovered alcoholic, spoke on the bene-
fits she received in the Bi-Bett Recovery Program and
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.
Jerry Marks, Patients' Rights Advocates, suggested that
revenue be sought outside the County to fund Mental Health
programs, and that patients be asked to make some payment for
the services received.
RE$OLUTTON NQ. 84/381
_5_ 00 348
Ann LaPlant, representing Sunrise House, suggested that
the Board-Twd prevention programs in lieu of supporting
those people in jail, County hospital,,,or_other more expen-
sive facilities. _
II. On the basis of the foregoing evidence, the Board makes the following
findings:
A. Notices of Public Hearing were postd on or before May 19, 1984 and such
posting complied with Health and. Safety Code 51442.5.
B. "Indigents" are those persons defined in Resolution 83/1139.
C. "Detrimental impact" means a severe or substantial affect on basic medi-
cal services which impacts indigents to a greater degree than the
County's general population.
D. "Health Care" means the basic medical services commonly available in the
County to the non-indigent population. It does not include "enriched"
medical care not commonly available, "social services" or
"transportation" related to health but not involving direct medical
treatment, nor does it include mental health care by non-physicians.
E. "Level of Services" means the totality of health care services provided
by the County's Health Services Department, and .not any particular ser-
vice alone.
F. Pursuant to Health and Safety Code 51442.5, all interested persons were
allowed to speak and/or provide written comments at the hearing on June
19, 1984.
G. The program reductions or changes considered at the June 19, 1984 public
hearing were those contained in the notice approved by the May 15, 1984
order of this Board, excluding only the closing of; the Richmond Health
Clinic.
H. The County faces a continuing financial crisis in the Health Services
Department which must be addressed or it will bei come more acute.
I. "Hospital" Items 1, 20 3, and 4 and the "Administrative Actions" (Points
1 and 2 in Document No. 13, above) affect various administrative func-
tions or expenditures which do not involve direct patient care and are
not subject to 51442.5 hearings. Nevertheless, these changes will have
no detrimental impact on the health care needs of the County's indi-
gents.
J. "Clinic" Items 1 and 2 (Document #13's point 3) .will change the availa-
bility of certain speciality clients but will not reduce the overall
level of services provided by the County health care system and, there-
fore are not subject to 51442.5 hearing. Nevertheless, the changes will
not have a detrimental impact on the health care needs of the County's
indigents.
K. "Alcohol/Drug Abuse/Mental Health" items 5(b), (e), and (f) (Document
#13's point 4) involve County operated Mental Health outpatient ser-
vices. Mental Health Services are not part of the County's Health and
Safety Code obligation; they are required (if at all) by the Welfare and
Institutions Code and are not subject to 51442.5 hearings. Neverthe-
less, these reductions will have a detrimental impact on the health
care needs of some of the County's indigents.
L. "Public Health" item 1 (Document #13's point 5) :will reduce both physi-
cian and Public Health nursing services to patients. There will be a
detrimental impact on the health care needs of the County's indigents,
but that impact is not greater than the detriment suffered by County
residents as a whole.
Ut59LUT�QN NQ. 84.-/381
-6-
L`�
M. "Alcohol, Drug Abuse, and Mental Health" items.3, 4 a-d, 5a, d, and g
(Document #13's point 6) reduce various contracted mental health ser-
vices. Mental Health Services are not. r—*rt of the and
Safety Code obligation, they are required (if at all) by the Welfare and
Institutions Code and are not subject to 51442.5 hearings. Nevertheless,
these reductions will have a detrimental impact on the health care needs
of some of the County's indigents.
N. "Clinics" Items 1 and 2 (Document #13's point 7) will further reduce
availability of physicians and public health nursing services and could
cause some delays in service but will not reduce the overall level of
services available from the County health care system. Therefore, these
reductions will not have a detrimental impact on the health care needs
of the County's indigents.
0. "Public Health" item 2 (Document #13's point 8) will significantly
impact the County's communicable disease control program. This program
is of significance to the County's population generally. Although some
indigents will be adversely affected by the change, the detriment to the
indigents is not greater than the detriment to County residents as a
whole.
P. "Alcohol, Drug Abuse, and Mental Health" items 1, 3, 4, and 5 (Document
#13's point 9) will further reduce both County operated and contracted
Mental Health Services. Mental Health Services are not part of the
County's Health and Safety Code obligation, they are required (if at
all) by the Welfare and Institutions Code and are not subject to 51442.5
hearings. Nevertheless, these reductions will have a detrimental impact
on the health care needs of some of the County's indigents.
III. If any findings, or any part of a finding, herein is held invalid, such
invalidity shall not affect findings as to other items which can be given
effect without the invalid provision, and to this end, the invalid find-
ings, or part of a finding, as to an item is severable.
IT IT BY THE BOARD ORDERED that neither inclusion of a proposed change in
a program in the Notice of Hearing, the holding of a hearing with respect
to a change in a program included in the Notice of Hearing, nor the making
of a finding as to such a change is to be construed as an admission by the
County of Contra Costa or the Board that any of the program changes
covered by the Notice are subject to the hearing provisions of Health and
Safety Code 51442.5.
IT IS FURTHER ORDERED that this resolution be included as a part of- the
official public hearing record.
!.hat this is s
the
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and e; O,rIC;i; c�,ii"3 pt ►r ca vi�rc+
By �`�" . Deputy
P-XP0Z,UTX.0N NQ, 84/381