Loading...
HomeMy WebLinkAboutMINUTES - 06122001 - C.5 C.5 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on June 12, 2001, by the following vote: AYES: Supervisors Gioia, Gerber, DeSaulnier, Glover and Uilkema NOES: None ABSENT: None ABSTAIN: None ACCEPTED the report from the Grand Jury, Report No. 0103, "The Health Services Department Financial Management Performance," and REFERRED to the County Administrator. I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. Attested: June 12. 2001 John Sweeten,Clerk of the Board of Supervisors and County Administrator By: �)ZWWI(Z Deputy Clerk J - cs A REPORT BY THE 2000-01 CONTRA COSTA COUNTY GRAND JURY 725 Court Street Martinez, California 94553 RECEIVED Report No. 0103 MAY 2 9 2001 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. THE HEALTH SERVICES DEPARTMENT FINANCIAL MANAGEMENT PERFORMANCE APPROVED BY THE GRAND JURY: Dater a2 p. - '' --cy / CAROL THEWS GRAND JURY FOREMAN ACCEPTED FOR FILING: Date: 2!` Zoo, _ MICHAEL R. COLEMAN JUDGE OF THE SUPERIOR COURT SECTION 933.(C) & 933.05 STANDARD CALIFORNIA CODE Section 933. Comments and Reports on Grand Jury (4)The recommendation will not be implemented Recommendations because it is not warranted or is not reasonable,with an explanation therefor. (c)No later than 90 days after the grand jury submits a final report on the operations of an}'public (c)However,if a finding or recommendation of agency subject to its reviewing authority,the governing the grand jury addresses budgetary or personnel matters of body of the public agency shall comment to the presiding a county agency or department headed by an elected judge of the superior court on the findings and officer,both the agency or department head and the board recommendations pertaining to matters under the control of of supervisors shall respond if requested by the grand jury, the governing body,and every elected county officer or but the response of the board of supervisors shall address . agency head for which the grand jury has responsibility only those budgetary or personnel matters over which it has pursuant to-Section 914.1 shall comment within 60 days to some decision making authority. The response of the the presiding judge of the superior court,with an elected agency or department head shall address all aspects information-copy sent to the board of supervisors,on the of the findings or recommendations affecting his or her findings and recommendations pertaining to matters under agency or department. the control of that.couittyloflicer or agency head and any agency.or agencies which that officer or agency had (d)A grand jury may request a subject person or supervises or controls, In an},city and county,the mayor entity to come before the grand jury for the purpose of shall also comment on the findings and recommendations. reading and discussing the findings of the grand jury report All of these comments and reports shall forthwith be that relates to that person or entity in order to verify the submitted to the presiding judge of the superior court who accuracy of the findings prior to their release. impaneled the grand jury. A copy of all responses to grand jury reports shall be placed on file with the clerk of the (c)During an investigation,the grand jury shall public agency and the office of the.county clerk,or the meet with the subject of that investigation regarding the mayor when applicable,and shall remain on file in those investigation,unless the court,either on its own offices. One copy shall be placed oil file with the determination or upon request of the foreperson of the applicable grand jury final report by,and in the control of grand jury,determines that such a meeting would be the currently impaneled grand jury,where it shall be detrimental. maintained for a minimum of five years.Leg.11.1961 ch. 1284, 1963 ch.674. 1974 chs.393, 1396,1977 chs. 107, (f)A grand jury shall provide to the affected 187,1980 ch.543, 1981 ch.203, 1982 ch. 1408,1985 ch. agency a copy of the portion of the grand jury report 221, 1987 ch.690, 1988 ch. 1297,1997 ch.443,1988 ch. relating to that person or entity two working days prior to 230. - its public release and aflcr the approval of the presiding judge. No officer,agency,department,or governing body Section 933.05(Partial)Response to Grand Jury of a public agency shall disclose any contents of the report Recommendations-Content Requirements... prior to the public release of the final report. (a)For purposes of subdivision(b)of Section 933,as to each grand jury finding,the responding person or entity shall indicate one of the following: (1)The respondent agrees with the finding. (2)The respondent disagrees wholly or partially with the finding,in which case the response shall specify. the portion of the finding that is disputed and shall include an explanation of the reasons therefor. (b)For purposes of subdivision(b)of Section 933,as to each grand jury recommendation,the responding person or entity shall report one of the following actions: (1)The recommendation has been implemented, with a summary regarding the implemented action. (2)The recommendation has not yet been implemented,but will be implemented in the future,with a timeframe for implementation. (3)The recommendations requires further analysis,with an explanation and the scope and parameters of an analysis or study,and a timeframe for the matter to be prepared for discussion by the officer or head of the agency or department being investigated or reviewed, including the governing body of the public agency when applicable. This timeframe shall not exceed six months from the date of publication of the grand jury report. CONTRA COSTA COUNTY GRAND JURY REPORT NO. 0103 The Health Services Department Financial Management Performance BACKGROUND The Health Services Department is the largest Contra Costa County Department and has the largest budget of more than half a billion dollars. The Department derives the majority of its revenue from Federal, State and private source reimbursements for the services it renders. The balance comes from Federal grants, State grants, subsidies and approximately 15% from the County General Fund. FINDINGS 1. In fiscal year 1999-2000, the Health Services Department exceeded its authorized budget by approximately $10 Million, requiring augmentation by the Board of Supervisors from the General Fund. This budget overrun was equivalent to approximately 22% of the funding already supplied from the County's General Fund to the Health Services Department. 2. In Fiscal year 2000/2001, the Health Services Department anticipates a budget overrun in excess of$17 Million that will also need to be satisfied by diverting General County funds from other uses. This budget overrun is equivalent.to approximately 30% of the funding already supplied the Department from the County's General Fund. 3. Expectations by the Health Services Department indicate funding from Federal and State sources will not increase sufficiently to keep up with escalating health care costs or may even decrease. 4. The Health Services Department anticipates demand for its services will continue to increase as the county population and in-migration to the County increases. 5. The following table reflects findings of actual and budgeted dollars for the Health Services Department from the County's 2000-2001 Budget-proposed by the Department,recommended by the Finance Committee and approved by the Board of Supervisors for expenditures from the County's General Fund. (Detailed explanations for each Budget unit are contained in the County Budget documents). HEALTH SERVICES DEPARTMENT(Net Cost to County in$Millions) Budget Actual Actual 2000-2001 Budget Unit# Budget Description 1998-1999 1999-2000 Propos'd Recomnd'd Approved 0301 Hlth Svcs-Detention 6.5 7.2 7.1 6.8 6.8 0450 Public Health 11.6 11.7 12.8 11.1 11.1 0451 Conservatorship 1.0 .9 1.2 1.0 1.0 1452 Environmental Hlth ( .0 ( .02) ( .06) ( .06) ( .06) 0460 Child Services 1.1 .9 1.0 .9 .9 0463 Homeless 1.7 2.2 1.9 1.9 1.9 0465. Hospital Subsidy 13.7 17.9 33.5 18.6 31.7 0466 Substance Abuse 1.1 1.8 2.4 1.5 1.5 0467 Mental Health 3.7 3.2 5.3 4.0 3.9 0468 CHIP AB75 Tobacco ( .02) .04 0 0 0 0469 CHIP AB75 Tobacco ( .04) ( .04) 0 0 ( .04) 0471 Emergency Medical ( .07) ( .1 ) 0 0 0 TOTAL 26.0 45.6 65.1 45.8 58.8 6. There is a pattern of substantial and continuing increases in the County's net cost to support the Health Services Department. The Approved Budget for FY 2000-2001 increased by 126% over Actual Expenditures of two years ago and increased by 66% over the last fiscal year when the projected $17 Million projected budget overrun is included. 7. The "Proposed" budget as submitted by the Health Services Department for FY 2000- 2001 was reduced by $6.3 Million or a reduction of approximately 11% compared to the budget approved by the Board of Supervisors. 8. The Health Services Department Budget anticipates an overrun of$17 Million for FY 2000-2001. This represents an increase of 29% over its approved County portion of the budget. 9. The Audit Trail Listings (a detailed listing of all budget items) for the Health Services Department for the FY 2001-2002 Budget reflects the overwhelming majority of line items are subject to an across-the-board cost increase based on inflation with no reason given. 2 CONCLUSIONS 1. The Health Services Department is a very large and complex organization, with many programs and responsibilities. Continuous budget overruns of the magnitude experienced in the last two years cannot be sustained without damaging other important activities, services, and infra-structure for which the County is also responsible. 2. The Grand Jury could find no significant effort by the Health Services Department to critically examine its internal organizational structure and processes, maximize the recovery of reimbursable costs from Federal and State sources and from clients who are not entitled to free services, reduce costs and provide services within the Approved County Budget. 3. The Health Services Department is relying almost totally upon Federal and/or State Governments for a solution to the financial crisis and may be discouraging efforts to look within itself for discretionary cost saving measures to eliminate annual budget overruns. 4. It seems clear that the Health Services.Department will not be able to continue providing the level of health services they now do without causing significant budget reductions in other critical County activities, services, and infrastructure. The inevitable alternative would be to raise County taxes. 5. The Health Services Department has not scaled back departmental costs to a level that can be reasonably met within existing and anticipated funding from Federal, State and County sources. RECOMMENDATIONS The 2000-2001 Contra Costa County Grand Jury recommends the Board of Supervisors: 1. Initiate a comprehensive management audit of the Health Services Department by an independent firm. This independent management audit should focus on operational and organizational effectiveness. 2. Perform the management audit in logical organizational parts so that implementation of any change would not be delayed pending completion of the total audit. 3. Approve a realistic budget for the Health Services Department and require the Department operate within that budget. 4. Require the independent audit firm make quarterly oral and written presentations to the Board of Supervisors until the Health Services Department is operating with the approved budget. 3 5. Consider requiring the Health Services Department utilize"zero-based" budget justification procedures in preparing its Proposed FY 2002-2003 Budget to assist in identifying those line items requiring reduction and/or controls in order to operate within its authorized budget. These"Zero-based" budget justification procedures require each line item of the budget be reduced to zero and any proposed expenditure be fully justified as to need and amount. 4 -Grand Jury725 Court Street Contra P.O.Box 911 Costa Martinez, CA 94553-0091 County RECEIVED MAY. 3 020o ' CLERK BOARD May 29 2001 r''''�'cou�t' CONTRAOCOSTA CO.SUPERVISORS Board of Supervisors 651 Pine Street Martinez, CA 94553 Dear Board of Supervisors: Attached is a copy of Grand Jury Report No. 0103, "The Health Services Department, Financial Management Performance" prepared by the 2000-2001 Contra Costa Grand Jury. In accordance with California Penal Code Section 933.05, this report is being provided to you at least two working days before it is released publicly. Section 933.5(a) of the California Government Code requires that (the responding person or entity shall report one of the following actions) in respect to each finding: (1) "The respondent agrees with the finding." (2) "The respondent disagrees with the finding." (3) "The respondent partially disagrees with the finding." In the cases of both (2) and (3) above, the respondent shall specify the portion of the finding that is disputed, and shall include an explanation of the reasons therefor. In addition, Section 933.05(b) requires that the respondent reply to each recommendation by stating one of the following actions: 1. The recommendation has been implemented, with a summary describing the implemented action. 2. The recommendation has not yet been implemented, but will be implemented in the future, with a time frame for implementation. 3. The recommendation requires further analysis. This response should explain the scope and parameters of the analysis or study, and a time frame for the matter to be prepared for discussion. This time frame shall not exceed six months from the date of the publication of the Grand Jury Report. Board of Directors May 29, 2001 Page 2 4. The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation thereof. Please be reminded that Section 933.05 specifies that no officer, agency, department or governing body of a public agency shall disclose any contents of the report prior to its public release. Please insure that your response to the above noted Grand Jury report includes the mandated items. We will expect your response, using the form described by the quoted Government Code, no later than August 27, 2001. To aid you in responding to this report, we have attached a copy of "Guidelines for Responding to a Grand Jury Report." Failure to conform to these requirements could result in your having to resubmit your response. You are also advised that your response becomes a public record upon receipt by the Presiding Judge of the Superior Court. Sincerely, CAROL HEWS, Foreman 2000-2001 Contra Costa County Civil Grand Jury GUIDELINES FOR RESPONDING TO A GRAND JURY REPORT Penal Code section 933.05 governs and gives precise instructions for responses to a Grand Jury Report. Any response not in compliance with section 933.05 will be returned by the Grand Jury for revision. To help you avoid having to revise your response to comply with section 933.05, the Grand Jury provides the following guidelines. Grand Jury reports include Findings and the Recommendations. Penal Code section 933.05 requires you to respond to each Finding and each Recommendation. A. You are required to respond to each FINDING in one of the following three ways: 1) Agree with the finding. No further explanation is required. 2) Wholly disagree with the finding. The reasons for your dispute must be explained. 3)Partially disagree with the finding. The portion disputed must be specified. The reasons for your dispute must be explained. Note the following examples of acceptable responses and explanations: Example 1: Finding: The [agency] employs 208 workers and has offices in three areas of Contra Costa County. Response: Agree. Example 2: Finding: The [agency] owns the building and the surrounding land. Response: Wholly disagree. The [agency] leases the building and the surrounding land. [Another entity] owns the building and surrounding land. Example 3: Finding: All employees are required to attend training seminars every year to keep current on changing laws. Response. Partially disagree. All employees but supervisors are required to attend training seminars every year. Supervisors are required to attend training seminars once every two years. B. You are required to respond to each RECOMMENDATION in one of the following four ways: 1) The recommendation has been implemented. A summary of the implemented action must be stated. 2) The recommendation has not yet been implemented, but will be implemented in the future. A time frame for implementation must be stated. 3) The recommendation requires further analysis. An explanation,the scope, and the parameters of the future analysis or study must be set forth. The time frame for preparation of the matter for discussion(including by applicable governing bodies)must be stated. The time frame may not exceed six months from the date of the publication of the Grand Jury report. 4. The recommendation will not be implemented. You must describe why it is not warranted and/or not reasonable and the reasons for not implementing the recommendation must be explained. Note the following examples of acceptable responses and explanations: Exam 1: Recommendation: Yearly training should be made mandatory for all employees. Response: The recommendation has been implemented. Last month,this [agency] adopted and distributed new written policy requiring yearly training for all employees. Example 2: Recommendation: The [agency] should hire additional bilingual employees. Response: The recommendation has not yet been implemented, but will be implemented. The [agency] is currently interviewing employment applicants who are bilingual. We expect to extend employment offers to two such applicants by the end of the current month. Assuming the employment offers will be accepted, this will bring the total of bilingual employees to seven. Example 3 Recommendation: The [agency] should implement security measures for the protection of staff and clients during nighttime hours. Response: The recommendation requires further analysis. The [agency] has begun a study of the feasibility of providing nighttimelecurity. The study is analyzing our security needs, the use of security guards versus security systems,the costs involved, and the potential sources of funding. We will complete the study by the end of this month and it will be discussed and acted upon by the end of next month. Example 4: Recommendation: The [agency] should acquire the property north of the current parking lot to provide additional parking for staff and clients. Response: The recommendation will not be implemented because it is not warranted or reasonable. The property north of the current parking lot is not for sale. The property is owned by [another agency] that plans to begin construction of an office building on the site in the next two months. However, we are currently negotiating our purchase of the property east of the current parking lot to provide additional parking for staff and clients.