HomeMy WebLinkAboutMINUTES - 04191994 - IO.14 TO: BOARD OF SUPERVISORS . 1 .0.-14 5----t Contra
ir:J 'fir t.
FROM: INTERNAL OPERATIONS COMMITTEE Costa
County
DATE: April 11, 1994
SUBJECT: REPORT ON THE STATUS OF EFFORTS TO OBTAIN FUNDING FOR THE
REGIONAL POISON CONTROL CENTER
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1 . APPROVE a special project to study Poison Control Alternatives
to be carried out by the Health Services Department with
federal block grant funds received through a State EMS
Authority grant.
2 . AUTHORIZE the Health Services Director to negotiate an
amendment to the existing John Muir Trauma Center Designation
Agreement redirecting John Muir' s community services
obligation from support of the Poison Control Center to
. another county program related to trauma care and/or
prevention, preferably in the .violence prevention area.
3 . REQUEST the Health Services Director to make a further report
to our Committee on this subject during the month of July,
1994, updating us on the special project study,
disproportionate share funding possibility, and other
legislative efforts to fund Poison Control Centers.
BACKGROUND:
The San Francisco Regional Poison Control Center has terminated
services to residents of Contra Costa County, as is described in
the attached report from the Health Services Director. When the
Board of Supervisors approved the last report from the Internal
Operations Committee on this subject October 19, 1993, the Health
Services Director was asked to provide the Internal Operations
Committee with a status report on possible funding options for the
County' s required contribution to the Poison Control Center.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMH%SThATO RE MENDATION OF BOARD COMMITTEE
APPROVE OTHE
SIGNATURE(S):
JEFF SMITH MARK DeSAULNIER
ACTION OF BOARD ON Apz fl X.7 1994 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
/. I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED
Contact: PHIL BATCHEL99 CLERK OF THE BOARD OF
CC: SUPERVISORS AND COUNTY ADMINISTRATOR
See Page 2
BY DEPUTY
I .O.-14
-2-
On April 11, 1994 , our Committee met with William B. Walker, M.D. ,
County Health Officer, and Art Lathrop, Director of Emergency
Medical Services for the Health Services Department. Dr. Walker
reviewed the attached report with our Committee, including the
recommendations which are made on page 1 of the report. Dr. Walker
noted that the County has been granted $87,000 by the State
Emergency Medical Services Authority, but that this money can only
be used for "new" services . The Health Services Department is
going to argue that since Contra Costa County is not now being
served by the San Francisco Regional Poison Control Center, the use
of the funds to study the impact of Contra Costa' s new 9-1-1
transfer procedure and to evaluate two alternative delivery models
to regional poison control screening would be appropriate:
♦ Model 1 - Advice Nurse: This model will explore use of the
"nurse screening" system in place with the Contra Costa County
Health Plan.
♦ Model 2 - 9-1-1 PSAP: This model will explore use of trained
Emergency Medical Dispatchers at the San Ramon Valley Fire
Protection District.
This study will proceed while the Health Services Department staff
explore other funding possibilities . Longer term funding
possibilities include the use of the disproportionate share
hospital funding through the federal government, which could double
the San Francisco Regional Poison Control Center' s budget through
the infusion of new federal funds . This is still being studied and
has some mechanical complications that have to be worked out in
terms of which county would be in a position to fund the program in
order to receive the additional federal funds.
Mr. Lathrop noted that the Kaiser Hospitals are all members of the
Poison Control Center, but do not want to voluntarily pay more
money for a service which they receive for free elsewhere in
California.
The Board has previously agreed that the contribution John Muir
Medical Center has been making to the Poison Control Center should
be diverted to some other purpose. Our Committee believes strongly
that these funds should be used in the violence prevention area and
hope that the negotiations with John Muir can focus in this area.
We have formulated the above recommendations based on our
discussion with Dr. Walker and Mr. Lathrop and our review of the
attached report and prior materials on this subject.
cc: County Administrator
Health Services Director
William B. Walker, M.D. , County Health Officer
Art Lathrop, Director, Emergency Medical Services
County Counsel
Contra Costa County
The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR
Tom Powers, 1st District Mark Finucane, Director
Jeff Smith,2nd District �E--s-••-•c °
Gayle Bishop,3rd District 20 Allen Street
Sunne Wright McPeak,4th District Martinez, California 94553-3191
i Tom Torlakson,5th District (510)370-5003
;J,m,n sem•::_
County Administrator ,,. " 403 FAX(510)370-5098
Phil Batchelor s4
County
•
County Administrator COUx�
DATE: April 5, 1994
TO: Internal Operations Committee
FROM: Mark Finucane _
Health Services irector �'�
SUBJECT: Poison Control Center Funding
This is to update the 1994 Internal Operations Committee on the status of funding for
Poison Control Center (PCC) services as recommended by the 1993 Internal Operations
Committee in its report on the disposition of remaining matters and to recommend
further steps to be taken at this time.
Recommendations
1. Authorize the Health Services Director to negotiate an amendment to the
existing John Muir Trauma Center Designation Agreement redirecting John
Muir's community service obligation from support of the PCC to another
county program related to trauma care and/or prevention.
2. Approve a special project to study Poison Control Alternatives to be carried out
by the Health Services Department with federal block grants funds received
through a State EMS Authority grant.
Background
The San Francisco Bay Area Poison Control Center is one of 7 Regional Poison
Control Centers established by the State Emergency Medical Services Authority
(EMSA) under SB 1124 passed in 1984. The San Francisco PCC, jointly sponsored
by the University of California School of Pharmacy and San Francisco General
Merrithew Memorial Hospital&Clinics Public Health • Mental Health • Substance Abuse Environmental Health
Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics
A-345 (2/93)
t
Hospital, is designated by the State EMSA to serve 10 northern California counties
including Contra Costa. In July 1993, following cutbacks in State funding to Regional
Poison Control Centers, the San Francisco PCC received permission from the State
EMSA to discontinue its public poison advise lines to counties which did not agree to
payments covering the unfunded costs of these services. The proposed charge to
Contra Costa County was $124,000 for FY 1993-94.
While Contra Costa County made a voluntary contributions to the PCC in the
two prior years - $30,000 in FY 199.1-92 and $61,200 by John Muir Medical Center
on the County's behalf in FY 1992-93 - the Board of Supervisors determined that the
County could not commit to these new charges in the face County budget constraints
and other program priorities. Public access to the PCC's poison advice lines from
Contra Costa County telephone prefixes was subsequently cut off on August 3, 1993..
Following its decision not to commit to additional. PCC funding, the Board
approved recommendations of the Internal Operations Committee that included the
following:
- Continuing access to the PCC for emergency calls via the 9-1-1 system.
- Pursuing new funding sources and alternatives to existing PCC services.
- Requesting that John Muir hold in abeyance its payments to the PCC on
the County's behalf under the Trauma Center Designation Agreement
pending possible redirection of those funds to benefit other programs.
A more detailed discussion of the background on the matter is contained in my
report to the Internal Operations Committee dated September 21, 1993..
Current Status of PCC Services
Contra Costa County remains the only county in the State without public access
to a designated PCC via an 800 number. PCC services continue to be available to the
public via 9-1-1 and to hospitals which pay a separate fee for access. Access via
9-1-1 was arranged by the County Emergency Medical Services Agency at a cost of
$25.00 for each call transferred to the PCC by a 9-1-1 operator. This is currently
being funded using County Service Area EM-1 (Measure H) funds. Cost for
FY 1993-94 will run about $60,000 for 2,400 calls. (About 9,000 calls annually were
received from Contra Residents prior to discontinuation of the public advice line.)
2
While services may be available to county residents calling any one of the many
other PCC's in California or the nation using a regular long distance number, this had
not been widely promoted since poison centers generally discourage calls from outside
their designated areas and the County has no way of monitoring the continuing
: availability of those services. As of this time, however, only San Francisco blocks
access from outside its designated area.
Other Funding Sources
Both Health Services Department staff and San Francisco PCC staff have
pursued other funding sources, including private industry contributions, payments by
health insurers and HMO's for services to their members, and legislation to provide
permanent funding.
- Following some initial interest expressed by the chemical and petroleum
industry after last year's General Chemical incident, this group has not
been responsive to funding PCC services in Contra Costa County.
- Health insurers and HMO's are reluctant to fund a service in Contra
Costa County which is available at no cost in the rest of the State.
- Legislative efforts to secure funding for PCC's through charges to
producers of toxic products, increasing the 9-1-1 telephone tax, and
tapping into the existing State 9-1-1 fund have been unsuccessful. One
potential funding source was created the passage of SB 456 which
provides up to $2,435,000 for State EMSA funding for increased PCC
services beginning in 1995. The State EMSA is apparently taking the
position that these funds are for new services only.
One potential funding source which the State PCC's are attempting to tap into is
Medi-Cal disproportionate share matching funds. While proposals were due April 1,
1994 for FY 1994-95 funding, the PCC's, with the support of the State EMSA, are
continuing to negotiate with the California Medical Assistance Commission to establish
a funding formula for PCC's. If successful, this mechanism could provide funding for
up to 50 percent of the San Francisco PCC's $650,000 annual operating budget. The
outcome of these negotiations is likely to be known by April 15th.
3
a
Alternatives to Existing PCC Services - Special Project Grant
County EMS staff have explored alternatives to existing PCC services
including:
- contracting with another PCC (either alone or jointly with one or more
other Bay area counties); and
- providing some level of poison advice services locally.
From discussions with other PCC's, including UC Davis, Santa Clara County,
and Rocky Mountain in Denver, it appears that their cost factors would result in
charges as high as or higher than those of the San Francisco PCC. One PCC also
indicated that it would be reluctant to take on any significant expansion of services
without a long term funding commitment.
Review of local alternatives has focused on use of either an existing advice
nurse service or 9-1-1 dispatchers to screen calls so that only the more difficult cases
would be referred to a PCC. Because of the complexity of the issues involved, the
Health Services Department has applied for a State EMSA federal block grant special
project to study these alternative more depth. The Poison Control Alternatives grant,
which we have just learned has been approved by the State, would be a one-year grant
for $87,000 to study the impact of Contra Costa's new 9-1-1 transfer procedure and
would evaluate two alternative delivery models to regional poison control screening.
Model 1 - Advice Nurse: This model will explore use of the "nurse screening"
system in place with the Contra Costa County Health Plan.
Model 2 - 9-1-1 PSAP: This model will explore use of trained Emergency
Medical Dispatchers at San Ramon Valley Fire.
Results of this special project will be available to the State as well as to the County to
develop alternatives to the existing model of regional services.
John Muir Medical Center Commitment
As recommended by the Internal Operations Committee and approved by the
Board, John Muir Medical Center has been directed to hold in abeyance its
community services financial commitment under the Trauma Center Designation
Agreement until it could be determined if other funding would be available to restore
4
PCC services for Contra Costa County. Such funding has not been identified at this
point. Funding the transfer of 9-1-1 calls is an appropriate use of CSA EM-1
• (Measure H) funds and can therefor be used to continue this level of service. It is
appropriate at this time, therefore, to renegotiate John Muir's community service
commitment and direct funding to another county program.
5