HomeMy WebLinkAboutMINUTES - 07131993 - IO.3 i T _ O _ - 3
TO: BOARD OF SUPERVISORS Contra
FROM: Internal Operations Committee Costa
oi,• - S
County
28une
DATE: J , 1993 �rrqcdiin`� �
SUBJECT: Proposed Response to the 1992-93 Grand Jury Report "The Need
for Management Audits in Contra Costa County"
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION
Adopt this report of our Committee as the Board of Supervisors '
response to the 1992-93 Grand Jury Report #9304 "The Need for
Management Audits in Contra Costa County"
BACKGROUND
On April 20, 1993 the Grand Jury filed report #9304 which was
reviewed by the Board of Supervisors on March 16 , 1993 and referred
to the County Administrator and Internal Operations committee.. On
May 24, 1993 our Committee met to discuss the recommendations and
review proposed responses . At the conclusion of those discussions,
we prepared this report utilizing a format, suggested by a former
Grand Jury, which clearly specifies:
a. Whether the recommendation is accepted or adopted;
b. If the recommendation is accepted, a statement as to who will
be responsible for implementation and a definite target date;
C. A delineation of constraints if a recommendation is accepted
but cannot be implemented within the calendar year; and
d. The reason for not adopting a recommendation.
CONTINUED ON ATTACHMENT: X YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMIT-ME-7;_4
APPROVE OTHER
SIGNATURE(S): c+rr*r*Tn r.Tn c_ n
�RIGI;F MG PEAK ,-aarrrrmlwil
ACTION OF BOARD ON July 13, 1993 APPROVED AS RECOMMENDED OTHER
Supervisor McPeak requested. that the County Administrator be advised that
the Board desires to have the performance standards back by the end of July when it
adopts the budget for each department.
VOTE OF SUPERVISORS
�f I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS(ABSENT Y ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. _.
ATTESTED 13 9 f 3
Contact: Dean Lucas 646-4077 PHIL BATCHEL CLER OF THE BOARD OF
CC: County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR
Presiding Judge of Superior Court
Grand Jury Foreman
BY ,DEPUTY
The Need for Management Audits in Contra Costa County
Report Number 9304
The Contra Costa County Grand Jury recommends that the Board of
Supervisors:
RECOMMENDATION #1
Within six months, establish a Management Audit Program that
insures that monies expended will result in a net saving to the
County.
RESPONSE:
A. This recommendation is accepted.
B. The Board of Supervisors is in favor of management audits if
by management audits the Grand Jury has in mind the fixing of
the purpose of a department or program, agreeing on a set of
objectives and measurable outcomes and then periodically
reviewing the progress of the department or program in
achieving each of the agreed-upon objectives .
On April 22, 1993, the Board of Supervisors adopted the
attached guidelines for a Performance-Based Budget, which
includes the identification of the 3-5 most important
measurable service outcomes or performance standards for each
department. In addition, Performance Objectives should be
adopted for each department. These Performance Objectives
include the identified service outcomes and performance
standards, but also include other management objectives, such
as affirmative action and the delivery of courteous service to
the public.
The formulation of such a Performance-Based Budget and the
periodic review of the extent to which the Performance
Objectives are being achieved in each department is the
essence of the type of management audit which we believe the
Grand Jury has in mind.
The Board of Supervisors has directed that the initial set of
performance standards for the 1993-94 fiscal year be brought
to the Board of Supervisors for approval as a part of the
budget adoption process later this month.
Apart from this more formalized process of Performance-Based
Budgeting, evaluation of the systems and efficiencies of all
departments and programs is part of the difficult budget
process we pursue annually as we continually trim departments
and cut back programs . This, by necessity, has increased
productivity and will continue to do so until we reach a point
of diminishing returns as we keep asking our departments to do
more with less .
For example, the Municipal Court Administration was
reorganized with one office assuming the administrative
responsibility for four courts in January, 1988 . The Marshal
was merged with the Sheriff 's Department in August, 1988 .
Most recently, the fire service reductions and functional
integration plan reduced management positions by 34% and
reduced chief officer positions from 11 to 4 for the five
merit system fire protection districts. The projected cost
savings targeted by the Board of Supervisors is approximately
$4 .5 million annually.
RECOMMENDATION #2
The recommendations of the Management Audit Program should be made
to the highest level of responsibility.
RESPONSE:
A. This recommendation is accepted.
SUNNE WRIGHT McPEAK ���+�-� Board of Supervisors
Supervisor, District Four
2301 Stanwell Drive Costa la
Concord, California 94520 County
(510) 646-5763
(510)646-5767 (FAX)
TO: Phil Batchelor, CAO
Board of Supervisors
FROM: Sunne Wright McPeak
DATE: April 19, 1993
SUBJECT: "Performance-Based" Budgeting
Over the years, we have instituted several methodologies to improve the county
budget process and to encourage improved productivity. These methodologies
include:
- Modified Zero-Based, Program Budgeting
- Performance, Evaluation, and Productivity (PEP) Program
- Productivity Investment Fund
- Reform of Civil Service System to Merit System
- Department Head Evaluations and Performance Pay
- Review of Management Ratios
- TIME-OUT and Employee Involvement Regarding Service Outcomes
While the above list is not exhaustive, it does give an overview of various efforts
to improve our budget process. However, with severe budget cuts caused by
property tax shifts which occurred last year and are proposed again this year, there
is a need to totally review and revise our approach to the budget process as we
have previously discussed.
Before last year, we deployed a zero-based program budgeting process. When the
state proposed the property tax shift and other severe cuts last year, we appointed
a Citizen Budget Task Force and accepted their recommendations to reduce the
budgets of departments in proportion to the reductions in revenues used to support
particular.services. While there was good reason for this approach last year, there
must be a different focus now.
Memo re "Performance-Based" Budgeting
April 19, 1993
Page Two
A "Performance-Based" Budget coupled with a realignment of revenues with
highest priorities will provide the foundation for a fiscal management program that
is focused on outcomes. The Board of Supervisors and County Administrator
should discuss and implement a Performance-Based Budget.
A Performance-Based Budget would involve the following components:
a. Identification of the 3-5 most important measurable service-outcomes
(performance standards) for each department after consultation with
department heads, management, and labor (the TIME-OUT exercise
was aimed at starting this process).
b. Adoption of Performance Objectives, including the identified service
outcomes and performance standards, for each department. The
Performance Objectives would include other management objectives,
such as affirmative action and delivery of courteous service to the
public in addition to the service outcomes. The Performance
Objectives would be the framework for annual evaluation of the
department head and the department.
C. Negotiations about the level of productivity for the 3-5 important
service outcomes and the cost of delivering the services.
d. Approval of a "contract" between the Board of Supervisors and each
department that (1 ) incorporates the Performance Objectives and
budget based on performance, productivity, and cost of delivering
services and (2) a commitment to allow the department to retain a
portion of the savings achieved during the fiscal year because of
improved productivity not anticipated or measurable at the beginning
of the fiscal year.
If a Performance-Based Budget approach is adopted as outlined above, there will
be a greater clarity for everyone about what we are doing with the public's
resources. Further, there will be an objective basis on which to evaluate
department's performance and to deliberate budgets in the future.
SWM:vIb
TO: Phil Batchelor, CAO
Board of Supervisors
FROM: Sunne Wright McPeak
DATE: April 19, 1993
SUBJECT: "Performance-Based" Budgeting
Over the years, we have instituted several methodologies to improve the county
budget process and to encourage improved productivity. These methodologies
include:
- Modified Zero-Based, Program Budgeting
- Performance, Evaluation, and Productivity (PEP) Program
- Productivity Investment Fund
- Reform of Civil Service System to Merit System
- Department Head Evaluations and Performance Pay
- Review of Management Ratios
- TIME-OUT and Employee Involvement Regarding Service Outcomes
While the above list is not exhaustive, it does give an overview of various efforts
to improve our budget process. However, with severe budget cuts caused by
property tax shifts which occurred last year and are proposed again this year, there
is a need to totally review and revise our approach to the budget process as we
have previously discussed.
Before last year, we deployed a zero-based program budgeting process. When the
state proposed the property tax shift and other severe cuts last year, we appointed
a Citizen Budget Task Force and accepted their recommendations to reduce the
budgets of departments in proportion to the reductions in revenues used to support
particular services. While there was good reason for this approach last year, there
must be a different focus now.
A "Performance-Based" Budget coupled with a realignment of revenues with
highest priorities will provide the foundation for a fiscal management program that
is focused on outcomes. The Board of Supervisors and County Administrator
should discuss and implement a Performance-Based Budget.
A Performance-Based Budget would involve the following components:
a. Identification of the 3-5 most important measurable service-outcomes
(performance standards) for each department after consultation with
department heads, management, and labor (the TIME-OUT exercise
was aimed at starting this process).
b. Adoption of Performance Objectives, including the identified service
outcomes and performance standards, for each department. The
Performance Objectives would include other management objectives,
such as affirmative action and delivery of courteous service to the
public in addition to the service outcomes. The Performance
Objectives would be the framework for annual evaluation of the
department head and the department.
C. Negotiations about the level of productivity for the 3-5 important
service outcomes and the cost of delivering the services.
d. Approval of a "contract" between the Board of Supervisors and each
department that (1 ) incorporates the Performance Objectives and
budget based on performance, productivity, and cost of delivering
services and (2) a commitment to allow the department to retain a
portion of the savings achieved during the fiscal year because of
improved productivity not anticipated or measurable at the beginning
of the fiscal year.
If a Performance-Based Budget approach is adopted as outlined above, there will
be a greater clarity for everyone about what we are doing with the public's
resources. Further, there will be an objective basis on which to evaluate
department's performance and to deliberate budgets in the future.
SWM:vlb
Contra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers, 1 st District
Jeff Smith,2nd District *E,..F,E,,c."0' Mark Finucane, Director
Gayle Bishop,3rd District <% a .TF. 20 Allen Street
Sunne Wright McPeak,4th District \•. Martinez, California 94553-3191
Tom Torlakson,5th District
i' (510)370 5003
FAX(510)370-5098
County Administrator, ,. Jy- _W-doe
•.:
Phil Batchelor
County Administrator
DATE: July 12, 1993
TO: InteVialOperati Committee
FROM: Ma i ucall
Health Services Director
SUBJECT: Poison Control Center Funding
This report responds to your request for information regarding funding for the Bay Area
Poison Control Center and what steps John Muir Medical Center has taken to meet the
terms of its community obligation as a condition of being designated as a trauma center.
1. Poison Control Center
Poison Control Centers have been in existence since the 1950s and began to be regulated
by the EMS Authority in 1988 when seven regional centers were established. Although state
funding has never completely covered the costs of the poison control centers, state funding
dropped by 40% in 1992 and now represents only 17% of the total.
The SF Bay Area Regional Poison Control Center (SFBARPCC) requested that each
County provide funds to the Center commensurate with the percentage of calls made by
county residents. For FY 1992-93, Contra Costa's share was determined to be $144,944.
Approximately $23,660 was credited to Contra Costa from state funds, resulting in a request
for $121,284.
As part of the agreement developed between John Muir and the County to be designated
a trauma center, John Muir Medical Center pledged a total of $61,200 for the PCC --
$31,200 of which was a cash payment and $30,000 of which would be raised. On June 28,
John Muir made its final $30,000 payment to the PCC, thereby meeting its obligation. Of
the 9 counties (other than San Francisco) that utilize the SFBARPCC, we believe that only
San Mateo County has made full payment. Contra Costa, Alameda and Del Norte counties
made payments constituting more than half of their "fair share", and Humboldt, Marin,
Mendocino and Napa have not paid.
Merrithew Memorial Hospital R Clinics Public Health • Mental Health • Substance Abuse Environmental Health
Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics
-2-
The SFBARPCC requested and was granted permission by the State Emergency Medical
Services Authority to restrict services of the PCC to only those counties which have made
full "fair share" contributions as determined by the PCC, effective next month. We are
currently reviewing a number of options for providing access to poison information for the
residents of Contra Costa County, in light of this recent decision. We will come back to the
IO Committee within one month with a recommendation on how to proceed.
Although there were a number of bills pending to identify state funding sources for the
PCCs, it's not clear if any will be enacted. AB 2377, one of the Budget Trailer bills, had
included $8- 9 million for PCCs through a new 9-1-1 tax,but that section was deleted. Still
pending is SB 1016, which will go before the Assembly Revenue and Taxation Committee
this afternoon. This bill would allow PCC services to be funded under the current 9-1-1
emergency telephone phone srutax. As much as $4 to $5 million could be generated from
this account, which currently has a surplus. The bill would not increase or establish a new
tax.
2. John Muir Medical Center.
As stated above, for FY 92-93, Muir agreed to make a cash contribution of $31,200 plus
conduct a direct mail fundraising campaign for the Poison Control Center with a guarantee
of $30,000. The full contribution of $61,200 has been paid. Muir's obligation to provide
Contra Costa County's share of funding for the Poison Control Center was a condition of
granting Muir the trauma center designation last year.
In addition, Muir pays an annual fee -- $75,000 -- which is the highest in the state. Finally,
Muir agreed to pay $30,500 each year to fund a County injury prevention program. Not
including the $30,000 fundraising guarantee for the Poison Control Center, Muir's cash
payment requirements to be the designated trauma center total $135,000 -- the highest in
the state and nearly double the second highest designation fee charged by Sacramento
County. Other counties' trauma fees range from zero to $41,560 a year with an average
of $17,800 a year.
JOHN 1601 Ygnacio Valley Road • Walnut Creek, California 94598-3194 • (510) 939-3000
MUIR
MEDICAL
CENTER
June 3, 1993
Claude Van Marter
Assistant County Administrator
651 Pine Street, 11th Floor
Martinez, CA 94553
Dear Claude:
Enclosed please find the information we discussed:
• Board Order (5/18/92) listing specific expanded services to the community (from our
Trauma Contract with the County) that. John Muir agreed to do.
• Section C "Service to the Community" from our proposal to the County for
permanent Trauma Center designation. The document discusses our services to the
community above and beyond the Trauma Center and expanded services agreement
above.
In terns of fulfilling the specific expanded services to the community in the Trauma Center
contract, we have complied in all four areas:
• Poison Control Center:
John Muir has been very involved in helping to establish stable funding for the
Poison Control Center. I am on their Oversight Board. We have assumed the
County's role in negotiating Contra Costa's share of support. We are guaranteeing
$6.1,200 to the Poison Control Center for July 1992 - June 1993, and have paid
$30,600 with the rest awaiting a fundraising campaign (copies of letters attached).
• Injury Prevention Programs:
John Muir provides $30,500 annually to the County Health Services Department for
Injury/Violence Prevention programs. A presentation was made at the Childhood
Injury Prevention Coalition Open House held at John Muir in May.
A not-(or-profit medical center serving the commmity since 1965
Claude Van Marter
Assistant County Administrator
June 3, 1993
Page Two
• Medical Helicopter Service:
Contra Costa County now enjoys a medical helicopter based at Buchanan Field
twenty-four hours a day. CALSTAR is funded by John Muir and three other
regional medical centers.
• "Trauma Team Talks Tough Program:"
The John Muir Injury Prevention Program costing $50,000/year is meeting all
milestones/goals listed on page 30 of our proposal (attached). We reached over
10,000 children and adults this year with the message of injury prevention.
John Muir Medical Center is committed to community service through the Trauma Center
and the patients it serves, through the additional commitments we made in the permanent
designation contract and through many other programs described in the attachments.
Please let me know if you need any further information.
Sincerely,
C G ms s. �
Janie a S. Nolan
Chief Operating Officer
JSN/bg
Attachments
Board Order
May 18, 1992
Hospital Agreement 029-325-2
Board Order
Page 2
A staff review of John Muir's Trauma Center Designation proposal has
determined that the proposal meets the requirements of the County' s
RFP. Muir' s proposal includes certain expanded services to the
community in the areas of education and injury prevention, poison
control, and improved medical helicopter response. These include:
(1) Poison Control Center. John Muir will provide the lead agency
role in negotiating Contra Costa County's share of support to the
Regional. Poison Control Center and will provide the level of
support negotiated.
(2) Injury Prevention Programs. John Muir will provide $30, 500
annually to the County for use in funding programs to decrease
violence or prevent injury.
(3) Medical Helicopter Service. John Muir will actively promote the
basing of a medical helicopter within Contra Costa County, and
will commit up to $50, 000 over and above Muir's regular $100, 000
annual contribution to CALSTAR if needed to offset any CALSTAR
program deficits that occur because of the Contra Costa County
helicopter.
(4) Trauma Team Talks Tough Program. John Muir will expand its
"Trauma Team Talks Tough" educational program conducted through
the schools by committing $50, 000 annual funding. (This
represents increased funding of approximately $49, 500 since the
existing program .has been conducted on a volunteer basis. )
The John Muir Trauma Center has recently undergone an annual site
review conducted by the Health Services Department using an
independent review team. John Muir meets the six-year previous
designation requirement specified in the RFP for a hospital to be
considered for permanent trauma center designation. The Health
Services Department recommends permanent Level II Trauma Center
designation for John Muir Medical Center. Such designation will be
subject to Muir' s continued compliance with standards set forth in
their contract.
D
To: BOARD OF SUPERVISORS O
FROM: Mark Finucane, Health Services Director Contra
By: Elizabeth A. Spooner, Contracts AdministratorCosta
DATE: May 18, 1992 County
SUBJECT: Approval of Trauma Center Designation and Hospital Agreement #29-
325-2 with John Muir Medical Center
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve permanent designation of John Muir Medical Center as a Level
II Trauma Center and authorize the Chair to execute on behalf of the
County, Hospital Agreement #29-325-2 with John Muir Medical Center for
the term May 22 , 1992 through May 21, 2012 with automatic renewal each
year thereafter.
II. FINANCIAL IMPACT:
Upon execution of the agreement and annually thereafter, John Muir
Medical Center will pay County a $75, 000 designation fee plus $30, 500
for use by County in funding programs to decrease violence or to
prevent injury for a total of $105, 500 annually.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On January 14 , 1992 , your Board approved a Request for Proposal (RFP)
for Level II Trauma Center Designation. The standards and
requirements of the RFP were similar to those which have been in
effect for the trauma system' s first six years of operation except for
(1) the addition of a "service to the community" requirement, and (2)
provision for permanent designation following two three-year contract
periods. The deadline for proposal submission was March 30, 1992,
although the RFP contained a provision for extension of the deadline
based upon submission of a written request and payment of the
application fee. A Bidders ' Conference was held to answer any
questions regarding the RFP or application procedure. Copies of the
RFP were provided to all hospitals in Contra Costa County.
John Muir Medical Center, the County' s existing Level II Trauma
Center, was the sole hospital to submit a proposal. There were no
requests for extension of the proposal submission deadline, nor were
inquiries regarding trauma center designation received from any other
hospitals. John Muir was the sole hospital represented at the
Bidders ' Conference.
Section C
Service To The Community
i
Excerpt From:
John Muir Medical Center
(Trauma Center) Proposal
for Permanent Designation
submitted to the County of
Contra Costa March, 1992
SECTION C
SERVICE TO THE COMMUNITY
SECTION C
SERVICE TO THE COMMUNITY
INTRODUCTION
This section of the proposal describes the hospital's commitment to medical and health care for the
Contra Costa County population, as required by the request for proposal. As further defined during
the January 27th bidders' conference conducted by Contra Costa County, the community-service
commitment should be directly related to trauma and emergency care.
John Muir Medical Center offers the following evidence of its community-service commitments, past,
present and future.
HISTORICAL COMMITMENT
The mission of John Muir Medical Center is to serve the healthcare needs of the people of Contra
Costa County. This means that John Muir provides or supports the delivery of a broad range of health
care services throughout the county and surrounding areas. This mission recognizes the special needs
of an aging population. John Muir strives to achieve the highest standards of excellence in service and
performance,with special emphasis on quality in all operations of the Medical Center; optimizing the
skills and experience of our medical and professional staff through advanced technology, education
and leadership; preserving personal dignity and individual rights; and promoting a warm, caring and
healing environment. In short, John Muir strives to be the preeminent regional health-care
organization in its service area.
For 26 years, the hospital's services to the community have continued,despite revolutionary changes
in the capabilities and complexities of the medical-care field. Through these changes, John Muir
Medical Center has kept in sight its responsibility as a provider of caring and personalized services to
the people in the communities it serves.
Extensive resources are devoted each year to programs which organize and deliver free and subsidized
benefits to community residents. These include programs in the following areas:
Emergency Services
Rehabilitation Center
Information and Referral Services
Educational Services
Support Services
Sponsoring of Community Events
Other Health Services
After a brief review of each program, future plans for community service related to trauma and
emergency services are outlined and will be subject to further discussion with the County.
EMERGENCY SERVICES
John Muir Medical Center has a long history of commitment and leadership in the arena of emergency
medical services. In addition to an emergency department serving 26,000 patients a year without
regard to ability to pay, five outstanding programs are described below:
John Muir Medical Center
Page 23
1. Trauma Center Services
The Trauma Center at John Muir Medical Center,serving all of Contra Costa County, has functioned
effectively since July, 1986. During that time, the hospital has developed extensive resources for the
management and treatment of trauma patients. The hospital has treated 5,500 trauma patients during
that time. In response to our commitment to Trauma,we have added a second intensive care nursing
unit at a cost of$3.3 million, and this year plan to expand the.Emergency/Trauma Department for
another $2 million. The original philosophy of applying for, and maintaining the trauma center
designation, was as a service to the community, undertaken at a considerable financial risk. Due to
the payor mix for trauma, a significant hospital financial contribution continues to be made to this
program.
2. Paramedic Base Hospital
John Muir Medical Center was the first paramedic base hospital in the county in 1976, and has
continued to provide these services at no charge for the past 16 years. Directing the paramedics in the
field requires an additional 1.5 full-time equivalent positions of Mobile Intensive Care Nurses(MICN)
in the Emergency Department, as well as providing for MICN training for all registered nurses on all
shifts. Substantial numbers of hours each month (estimated at 25 hours) are directed to paramedic-
training programs, coordination, and case audits.
Since 1985,John Muir Medical Center has undertaken a second zone of coverage as the base hospital
for paramedics in Richmond, when the hospital in that zone (Brookside) was unable to continue to
serve as a Base Hospital. In November of 1991, John Muir Medical Center took on the additional
responsibility as a base hospital for all trauma calls, county-wide, as a means of providing continuity
of medical direction from the field to the center. This commitment has also meant adding additional
MICN resources to the Emergency Department.
3. CALSTAR Helicopter Program
John Muir Medical Center is one of the founders and four sustaining members of CALSTAR
(California Shock/Trauma Air Rescue). The hospital's contribution to CALSTAR has been in excess
of$100,000 per year for the past 8 years. Without that support,CALSTAR would not exist. Through
an arrangement with CALSTAR, the nurses are John Muir Medical Center employees, and the
hospital provides the liability insurance coverage for the program. The hospital has made this
significant financial commitment to the program because of its belief in the necessity for this service
as an adjunct to both emergency and trauma services.
John Muir's Vice President of Clinical and Administrative Services is currently a Board member of
CALSTAR and helps provide direction to the program.
4. John Muir/Fire Department Partnership
In 1985,John Muir joined with the San Ramon Valley Fire Department to provide paramedic services
to an area of the county that had not had this service. San Ramon Valley Fire has the contract for
emergency services with the county and,in turn,contracts with John Muir for the paramedics,who are
John Muir employees. This service is economical for the public sector, since it avoids the expense of
fire-fighter paramedics and provides a consistent not-for-profit approach to emergency medical care.
The County is in the process of comparing this model with others in a fire service EMS model
assessment by a consultant(who was engaged by the County in response to a request from the mayors
in relation to Measure H assessments). This is another example commitment and innovation in the
arena of emergency services that was not without financial risk.
John Muir Medical Center
Page 24
5. Emer;;i-Center
From 1985 to 1991,John Muir Medical Center maintained a freestanding emergency center in the San
Ramon Valley, complete with helipad in response to the communities there stating the need for
emergency services. During its last year of operation, an average of 60 patients a day were treated by
emergency department physicians. Due to the community need for a 24-hours service, a significant
financial contribution had to be made by John Muir to provide this service. When a hospital opened
in the valley with emergency services, and the need no longer existed, it was converted into a private
practice with extended hours. The Emergi-Center is another example of John Muir's commitment to
its various communities in the arena of emergency.services.
REHABILITATION CENTER
A non-emergency service, but directly related to trauma and emergency services, is rehabilitation.
John Muir has had a licensed comprehensive (inpatient and outpatient) Rehabilitation Center since
1985. In 1990 it received CARF (Commission on Accreditation of Rehabilitation Facilities)
accreditation. This service is•a good example of a medical service directly related to trauma and
emergency services.
At Contra Costa County's request in 1990, John Muir entered into a contract with Contra Costa
County to provide rehabilitation services to county patients at John Muir's Rehabilitation Center.in
order to allow the county hospital, Merrithew Memorial Hospital, to close its rehabilitation facilities
and utilize the beds for other patients. This agreement has resulted in a substantial increase of
MediCal rehabilitation patients at John Muir. Since MediCal payments do not cover costs, care of
these patients is provided as a substantial community service. It should be noted that John Muir is
the onlyfacility in the county which takes MediCal inpatient rehabilitation patients.
INFORMATION AND REFERRAL SERVICES
John Muir Medical Center's contribution to the community also comes in the form of information and
referral services. Anyone may use these services to determine what type of medical care they need
and how to receive it. Sample programs include:
Tel-Med Program (a 24-hour recorded health information service)
Public Service Articles (in the local newspapers)
"Muir Moments" (quarterly publication to 100,000, providing health
information on subjects such as cancer, rehabilitation and birthing)
"Muircare 65" Newsletter (distributed to 13,000 homes, three times a
year) providing information to those with Medicare coverage
Physician Referral Service
Senior Information and Referral provided in conjunction with the Contra Costa County
Office on Aging
EDUCATIONAL SERVICES
Another community service commitment at John Muir Medical Center is provided in the form of
educational programs. Employees, patients, their families, and the community at large are all
beneficiaries of John Muir Medical Center's educational programs. These programs encompass such
activities as:
John Muir Medical Center
Page 25
Bereavement Counseling
Pre-Conception Planning Effort
Teen Trauma Prevention Program (i.e. "Heads Up" program, "Trauma Team Talks
Tough")
Monthly educational programs targeted at older adults and their care givers
Numerous other programs, such as:
Continuing education for health care professionals
Student education for allied health professionals in training
Community speaker's bureau
Adoption counseling
Adult and pediatric oncology education groups
Special cancer education seminars
Education for high-risk mothers
Rehabilitation education and support services for families of
patients
SUPPORT SERVICES
Support Services are also a substantial statement of the hospital's community service. John Muir
Medical Center's support services are aimed at helping people to help themselves in a variety of ways.
"I-Can-Cope" Classes
Elsa U. Pardee Foundation Grant Administrator for Contra Costa County
Wellness Community (oncology support group) Grant
Parents, Kids, and Drugs Classes
Medical Equipment Support
Programs for Care Givers to the Frail Elderly
Other Services
Initial assessment of adolescents
Financial and insurance counseling
Prenatal care and support to incarcerated women
Drug Hotline
24-hour pastoral care
OB home visits
SPONSORSHIP OF COMMUNITY EVENTS
Another source of John Muir Medical Center's community service is acknowledged through
sponsorship of community events. Reaching out to its public,John Muir Medical Center has a growing
reputation for its sponsorship of community events. Such programs include:
Bi-Annual Medical Film Festival (recently reorganized)
Halloween Candy Screening Program
Making Available Meeting Facilities to Community Groups (i.e., stroke support,
Alzheimer training, other support groups).
John Muir Medical Center
Page 26
OTHER HEALTH SERVICES
High-risk Obstetrics
Case Management for Frail Elders
Community Service Fund
Chemotherapy
Health Fairs and Screening
FUTURE PLANS FOR ADDITIONAL COMMUNITY SERVICE
(Related to Trauma and Emergency Services)
John Muir Medical Center, in addition to the historical hospital and trauma center commitment to
community services,described above has the following plans for additional community service related
to trauma and emergency services.
1. Expand the "Trauma Team Talks Tough" Program
John Muir Medical Center and its volunteer trauma-team members began this program six
months ago to initiate a change in injury patterns among school-age children county-wide. The
program detailed elsewhere in this proposal (please see Section E.17., Outreach Programs),
was originally organized around a group of volunteers (hospital and non-hospital staff)with
hospital support. John Muir Medical Center plans to expand this commitment, and plans to
increase annual funding to$50,000. Please see Table 9 for the proposed budget and Table 10,
first-year's milestones.
2. CALSTAR Relocation
Due to John Muir Medical Center's own desire to better serve Contra Costa County,
arrangements are being made to secure a second CALSTAR helicopter and locate it in Contra
Costa County. As discussed above,John Muir is a major sponsor of CALSTAR ($100,000 per
year). By mid-April 1992, CALSTAR will endeavor to add a second helicopter, with both
helicopters initially based at the Hayward Airport. This addition will provide expanded
coverage to Contra Costa .County and to the greater CALSTAR area. Unless there are
substantial factors to the contrary, 12 hours a day service of a second medical helicopter,based
in Contra Costa County,should begin as early as June, 1992,and remain so long as there is the
demand and financial ability to do so.
3. Poison Control Center Assistance
The 9-County Regional Poison Control Center is located at San Francisco General Hospital
and requires considerable financial support from the areas it serves. John Muir has supported
the Poison Control Center for about 10 years with a current assessment of$3200 per year. We
understand that county governments have been asked to provide additional subsidy in
proportion to the number of calls coming from each county. As this county's trauma center,
John Muir Medical Center would be willing to take a leadership role and become Contra Costa
County's link with the Regional Poison Control Center. John Muir Medical Center would
negotiate directly with the Regional Poison Control Center with regard to any subsidy requests
of Contra Costa. John Muir Medical Center would expect to contribute over and above our
assessment as a hospital, but reserve the right to negotiate directly with the Regional Poison
Control Center.
John Muir Medical Center
Page 27
4. Designation Fees/Fundin2 Injury Prevention
The Trauma Center annual designation fee in Contra Costa County (currently $100,000 per
year, and now proposed at $115,000 per year) are among the highest in the State (see Table
11). The County's Injury Prevention program (Health Service Injury Prevention Program,
Department of Public Health) has made a substantial contribution toward injury prevention,
but there are still unmet needs. John Muir Medical Center proposes to work cooperatively
with the Contra Costa County EMS Agency to reduce their costs of monitoring the trauma
program and,therefore,the designation fees. The hospital would offer these fee savings to the
County's injury-prevention program. Funds could be designated for specific prevention
programs or specific areas of the County (i.e., North Richmond).
5. Other Emergency and Trauma-Related Services to be Discussed with the Countv
It should be noted that the above community services commitments align with the mission of
John Muir Medical Center and reflect the maturing of trauma center commitments at John
Muir Medical Center. John Muir Medical Center is open to discuss other services that might
be of mutual benefit to the community and the hospital.
John Muir Medical Center wishes to work with Contra Costa County to meet the community service
needs of the County,particularly in the trauma and emergency care area. Our historical commitments
and future plans are a direct validation of our resolution.
John Muir Medical Center
Page 28
Table 9
John Muir Medical Center
Injury Prevention Program
"Trauma Team Talks Tough"
BUDGET-
Program Coordination $31,400
Printing/Graphics $12,100
Miscellaneous
(i.e. telephone, travel, office
supplies, audio visual materials,
conferences) $6,500
Total 12—month budget: $50,000
John Muir Medical Center
Page 29
S '
Table 10 From JMAZC's Permanent
Trauma Center Designation
John Muir Medical Center Proposal
"Trauma Team Talks Tough"
MILESTONES I GOALS
1. Further develop program
a. Define mission and goals
b. Develop program plan
j c. Develop/define target market
2. Develop campaign materials
a. Brochures
b. Slides
c. Audiovisual enhancements
3. Coordinate with other community injury—prevention programs(i.e.Childhood Injury
Prevention Project — Contra Costa County)
i 4. Develop/enhance volunteer network for conducting classes
15. Conduct programs as follows:
a. Provide age appropriate injury prevention programs reaching 10,000 school children
throughout the county.
b. Provide injury prevention programs as part of the driver education programs offered
through the public schools in the county.
c. Provide injury prevention programs reaching 1,000 adults,especially young parents
throughout the county.
d. Serve as a resource for providing injury prevention programs to any other interested
agencies and/or organizations throughout the county.
e. Coordinate efforts with related projects and programs locally and throughout the
state and nation.
6. At the conclusion of one "Trauma Teams Talk Tough" presentation,learners will be able to:
a. Describe one or more behaviors that will reduce their chances of a major injury.
b. Discuss injury prevention behaviors associated with the following activities
(based on learners'ages):
Driving
Diving
Other water safety
Bicycling
Skateboarding/roller skating
Walking
Winter/wilderness activities
c. Discuss appropriate first aid procedures(age appropriate)should they
witness or become involved in an injury situation.
7. Participate in other injury—prevention projects as needs and data,based on
John Muir Medical Center's trauma registry,define.
John Muir Medical Center
Page 30
Poison Control Center
Copies of Letters
JOHN 1001 Y;nacio `'ailey Road • \%---;nut Geek Caliiorni a 9'359S-3i9 ,-;10' 939-3000
MUIR
MEDICAL
CENTER
December 10, 1992
Thomas E. Kearney, Pharm.D.
Managing Director
San Francisco Bay Area Regional
Poison Control Center
San Francisco General Hospital
1001 Potrero Avenue
San Francisco, CA 94110
Dear Dr. Kearney:
Enclosed is a check for $30,600 representing six monthly payments of $5,100 from July 1,
1992 through December 31, 1992.
This payment is made pursuant to my letter of October 15, 1992 (attached). We are still
waiting to have a seat on a new regional oversight advisory body to the PCC.
Sincerely,
Janiece . Nolan, Ph.D.
Chief Operating Officer
JSN/bg
cc: J. Kendall Anderson
Mark Finucane
Dan Smiley
,4 not-for-proRt medical center serving the community since 1965
U ll-J
October 15, 1992
Thomas E. Kearney, Pharm.D.
Managing Director
San Francisco Bay Area Regional
Poison Control Center
San Francisco General Hospital
1001 Potrero Avenue
San Francisco, CA 94110
Dear Dr. Kearney:
John Muir Medical Center, in its role as the Regional Trauma Center for Contra Costa
County, has accepted the lead agency role in negotiating Contra Costa County's contribution
to our Regional Poison Control Center (PCC). Your September 11 letter to Contra Costa
County's Director of Health Services was forwarded tome for response. We are supportive
of the PCC and wish to voluntarily contribute to its operation in 1992-93 in behalf of Contra
Costa County. I think you realize that the threat of selectively discontinuing services was not
a good approach and. I believe we can put those thoughts behind us and work with you in
developing a firm financial base for the PCC.
John Muir is prepared to provide:
1. $31,200 voluntary contribution in behalf of Contra Costa County which is at the
level of last year's funding plus. a 4% increase for cost of living.
2. $30,000 through a direct mail fund raising campaign in Contra Costa County
undertaken by the John Muir Foundation, at its own expense, in the spring of
1993. In the professional opinion of our Foundation Director, at least $30,000
can be raised from a direct mailing to Contra Costa residents, provided you do
not duplicate this effort centrally and cooperate with us in developing
information for the mailer. There is a distinct possibility that a great deal more
could be raised, but we are willing to guarantee only $30,000 at this time.
3. Possible $30,000 in increased Contra Costa County hospital contributions. We
will utilize our relationship with the East Bay Hospital Conference to attempt
to increase the individual hospital contributions by $5000 per hospital times six
hospitals.
4. We also believe that a Health Maintenance Organization (HMO) such as Kaiser
covering 30-40% of the population, should be considered for a higher level of
funding rather than as a sum of 15 member hospitals at $3000 each. Other
HMO's and insurance agencies should also provide a share of funding related
to savings derived from reduced emergency department use.
The total of$61,200 from items 1 and 2 that we are willing to guarantee can be paid to the
PCC in monthly payments of$5100, retroactive to July 1. If you accept this proposal, we will
send you a check for four months for $20,400, on or about the first of November, and
continue with $5400 monthly payments through June, 1993. If we raise more money in fund
raising for the PCC we will forward it to you.
Contingent upon this funding is the following:
• John Muir Medical Center, as a voluntary participant in your funding program,
will have a seat on a new regional oversight advisory body to the PCC. We
want to help you look 'at ways of reducing cost, improving service, and
developing stable funding.
• John Muir Medical Center's name is to appear along with other major
supporters on the letterhead of the PCC. We are prepared to assist in payment
for the cost of stationary changes.
• You will to send us on a routine basis detailed reports on the types of calls from
our county.
Again, let me state that we are supportive of the PCC and the work that it does, and trust that
our relationship will be cooperative and productive. We look forward to your response.
Sincerely,
Janiece S. Nolan, Ph.D.
Chief Operating Officer
JSN/bg
cc: J. Kendall Anderson
Mark Rnucane
Dan Smiley
• "Trauma Team Talks Tough"
�• .
T acie 10From JoL'NIC's Permanent
Trauma Center Designation
John Muir Medical Center Proposal
"Trauma Team Talks Tough"
MILESTONES / GOALS
1. Further develop program
a. Define mission and goals
b. Develop program plan
c. Develop/define target market
` Develop campaign materials
a. Brochures
b. Slides
c. Audiovisual enhancements
3. Coordinate with ocher community injury—prevention programs (i.e. Childhood Injury
Prevention Project — Contra Costa County)
4. Develop/enhance volunteer network for conducting classes
5. Conduct programs as follows:
a. Provide age appropriate injury prevention programs reaching 10,000 school children
throughout the couniv.
b. Provide injury prevention prograr„s as part of the driver education programs offered
through the public schools in the county.
c. Provide injury prevention progra:ns reaching 1.000 adults, especially young parents
throughout the county.
i
d. Serve as a resource for providing injury prevention programs to any other interested
agencies andior organizations throughout the county.
i
e. Coordinate efforts with related projects and programs locally and throughout the
state and nation.
I
6. At the conclusion of one "Trauma Teams Talk Tough" presentation,learners will be able co:
I
a. Describe one or more behaviors that will reduce their chances of a major injury.
b. Discuss injury prevention behaviors associated with the following accivicies
(based on learners' ages):
Driving
D ivin g
I Other water safety
Bicycling
Skaceboarding/roLler skating
Walking
I Winceri vilderness activities
c. Discuss appropriate first aid procedures (age appropriate)should they
witness or become involved in an injury situation.
I '. Participate in ocher injury—prevention projects as needs and data, based on
John Muir Medical Center's trauma registry, define.
Jolla Muir Medical,Center
Page Ja