HomeMy WebLinkAboutMINUTES - 06032003 - SD6 TO: BOARD OF SUPERVISORS fContra
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FROM: William Walker, MD Costa
Health Services Director 'w,
DATE: June 3, 2003Fc- µ' County
SUBJECT: Detention Health Services Request
SPECIFIC REQUEST(S)OR RECOMMENDATIONS)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
(1) ACKNOWLECE that the Health Services Department has evaluated all reasonable
options for the Improvement of detention health services at the Martinez Detention
Facility (MDF) and the Implementation of a new healthcare system at the West County
Detention Facility (WCDF).
(2) AUTHORIZE the implementation of an augmented healthcare system with the
following:
a. Daily sixteen hour nursing staff at WCDF.
b. Twenty hours per week of mental health coverage at WCDF
c. Twenty-four hours per clay mental health coverage at MDF.
d. Establishment of an on-site Health Care administrator in the command
hierarchy.
(3) APPROVE the addition of the positions necessary to implement recommendation
two above.
(4) AUTHORIZE the Health Services Director, or his designee, to execute a contract
with Santa Clara County for the provision of inpatient mental health services in Module
8A of the Santa Clara Main ,tail, in an amount not to exceed $500,000, for the period
from July 1, 2003 through June 30, 2004.
(5) ACKNOWLEDGE that the Health Services Department has issued and evaluated
proposals by private companies to staff the WCDF.
CONTINUED ON ATTACHMENT: kn:- t n_ SIGNATURE: `
__-------__------_.___.-__-. ------___-___------------------------------------------__„____---------------...---_-------___-------___.________-------__-__
__j,::---f;`ECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
__,APPROVE OTHER
SIGNATURES}•;.......,_ � r-�..�� `mss..
ACTION OF BOAR"DN JUNE 3, 2W3 —APPROVE AS RECOMMENDED OTHER
SEE ATTkM ADDENI E
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSENT } AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: ABSTAIN:
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ATTESTEDAINE 3, 2003
CONTACT. V JOHN SWEETEN,CLERK OF THE
BOARD OF SUPERVISORS AND
CC: COUNTY ADMINISTRATOR
BY DEPUTY
(6) DIRECT the Sheriff-Coroner and the Health Services Department to develop a plan
for implementation that includes:
L An interdepartmental MOU concerning policies, procedures, and limitations
upon census,
ii. A legislative solution to the cast of off site care of inmates,
iii. A new administrative structure that includes a health administrator in the
command structure,
iv. A timeline for implementation and a plan for reassessment at regular
intervals,
v. A utilization plan for the WCDF that will allow essentially all females to be
cared for at that facility,
vi. A plan to provide those higher levels of health services as the inmates may
need in alternative manners such as agreements with surrounding agencies.
(7) DIRECT the Sheriff-Cop y` and the Health Services Director to report back to the
Beard in six months on the success of the program enhancements.
FISCAL. IMPACT:
Cost savings of approximately $750,006 will be realized. The anticipated savings have
been included in the Departments 2003/04 budget request.
BACKGROUND:
The Main Detention Facility (MDF) in Martinez is overcrowded. The facility is rated by
the California Board of Corrections to house 655 inmates, but average inmate
populations range from 800 to 855. The overpopulation at MDF, and the special needs
of that population, make adequate custodial supervision and medical/psychiatric care
exceedingly difficult.
Because MDF is overcrowded, the sheriff would like to have the ability to transfer as
many inmates as possible to the West County Detention Facility (WCDF). There are a
number of limitations that prevent the unimpeded transfer of all inmates to WCDF.
Those limitations are.
L Facility concerns. WCDF is a medium security facility with a relatively small
number of"wet" cells (cells that have water and sewer services inside the cell).
The facility is designed so that inmates must be mobile in order to move from
building to building.
ii. Custodial concerns. Certain higher risk inmates are not appropriate for Dousing
at WCDF.
iii. Medical concerns. There are really three levels of medical concerns that
currently limit the use of WCDF. First, inmates with unstable medical or
psychiatric conditions that need to be monitored carefully cannot receive that
care at WCDF. Second, inmates who need psychiatric or narcotic medications in
evening hours cannot currently go to WCDF because there is no way to pass
those medications during those hours. Third, inmates who develop unexpected
medical or psychiatric problems during evening and weekend hours at WCDF do
not currently have medical or psychiatric services available at this site.
There has been an assumption that the only reasonable way to deal with these three
medical concerns is to propose a solution that would address all the concerns at once—
such as providing 24/7 nursing care at WCDF. However, in order to test this
assumption, we reviewed all of the medical needs of the MDF inmates on a sample
basis in March. This review enabled us to develop a fact-based assessment of the
health care needs of the inmates.
2
The Data:
Our sample included the total papulation at MDF of 840 inmates—including 101 women
and 739 men. Of this total group, 28 women and 181 men had medical issues that
would currently preclude their transfer to WCDF. When we looked at the specific
reasons that precluded transfer, the fallowing results were found:
Reasons Not Cleared for Transfer Women Men Total
Psychiatric medicine during evening shift 22 113 135
Narcotic medicine during evening shift 1 10 11
Insulin dependent diabetes 0 16 16
Methadone 5 4 9
Dialysis 0 0 0
Unsafe condition---primarily on M module 0 38 38
Thus, although this is just a sample of the inmate needs at a point in time, it is apparent
that the primary medical need that precludes transfer is the need for an evening pill
pass--not the inherent medical instability of a large number of inmates at MDF.
Analysis & Conclusion Regarding Relocation of Inmates:
The data would suggest that, if we focus upon the provision of an evening pill pass
opportunity for inmates at WCDF, essentially all of the women and 93% of the men
currently at MDF Could be housed safely and appropriately at WCDF.
We would continue to keep all medically and psychiatrically unstable inmates at MDF.
Inmates who need hospitalization would be primarily cared for at Contra Costa regional
Medical Services (CCRMC). We would also continue to rely upon EMS to deal with
unexpected emergencies at WCDF.
Additionally, due to the recent labor unrest at Doctors Hospital in San Pablo (Tenet) the
Registered Nurse staffing situation has changed. County recruitment efforts have been
successful and we do not anticipate a loss of staff at the conclusion of the Tenet
contract dispute.
The provision of nursing services at WCDF for 16 hours per day 365 days per year
would allow for all of the needed medication dispensing and monitoring. It would also
almost triple the amount of time at WCDF that would be covered by a nurse. In order to
assure adequate and prompt mental health assessment of all inmates, we would also
increase the coverage at MDF to 24 hours per day and we would add a relatively small
amount of mental health coverage at WCDF.
This approach would not change the WCDF medical concerns about unstable inmates
or inmates with unexpected problems. However, with careful screening, this approach
would enable the housing of most men and essentially all females at WCDF.
Inpatient Psychiatric Red Needs:
One component of the system of mental health care that we have always had difficulty
providing is what is called "forensic mental health care." This level of care is needed for
inmates who have severe psychiatric conditions that would normally require
hospitalization if the inmate were not incarcerated. Essentially, these inmates require a
hospital inside the detention facility.
In the past, we have attempted to utilize the psychiatric units at CCRMC in order to
provide this care. However, there are times when this is not passible due to the nature
of the alleged crime or the violence of the inmate. Thus, in order to meet this need, we
are proposing a contract relationship with Santa Clara County Corrections. At their
Main Jail, they have a forensic mental health unit that provides this type of care and is
currently operating under Capacity.
We have been in discussions with representatives from Santa Clara Concerning such a
contact and we have structured an agreement that will meet our anticipated needs in
this area.
3
On-Site Detention Health Administrator.
In order to manage and coordinate the entire Detention Health program in the most
effective manner, we need to revisit the administrative structure of the system. Based
upon numerous internal suggestions and upon outside consultant reports, we are
suggesting a reporting system that emphasizes communication and coordination
amongst the detention team. The new structure will include an on-site Detention Health
Administrator who will be a focal point person responsible for management of
physicians, nurses, pharmacy, mental health clinical specialists, psychiatrists, medical
records, clerical, dentists and all medical ancillary support at all three detention sites,
and the two probation sites, in the County. This individual will report to the Hospital and
Clinics Division of Health Services and will be responsible for communication and
coordination with Custody Division and with Probation. The presence of such a
manager will facilitate the efficient and effective coordination of detention health
services.
Request for Proposal Response and Evaluation.
9n December 3, 2002, a formal Request for Proposal (RFP) was issued to identify
prospective vendors to supply 24-hour, 7-day per week, health care services at WCDF.
The RFP was sent to 10 nationally known providers, was advertised in 3 major
newspapers, the NACo County/News, and was posted on the Internet, including the
RFP service on corrections.com. Following a question-and-answer conference call and
site visit/tour conducted for 5 interested providers in January; formal competitive
proposals were received from 3 serious vendors on January 31, 2003. These vendors
submitted additional RFP clarifying information by March 10, 2003, at the request of the
Health Services Department. These proposals were then evaluated and all 3 vendors
were found to be capable of providing comprehensive health care services at the WCDF
for an 884-inmate average daily population, at an annual contract base cost ranging
from $2,840,090 to $2,845,750 in the first year (plus stop loss provisions).
The HSD determined that the services could be provided in-house at less cost through
the use of County staff, and due to the change conditions, the Department now has
ability to recruit and retain staff
4
A.D IDENDUM TO ITEM SD.b
Jure 3, 2003
On this day the Board of Supervisors considered authorizing implementation of
augmented detention health services at the Martinez and West County detention
facilities including additional positions as specified; and approving and
authorizing the Health Services Director, or designee, to execute a contract with
Santa Clara County in an amount not to exceed$500,000 to provide inpatient
mental health services at the Santa Clara Main Jail for the period July 1, 2003
through June 30, 2004.
The Board of Supervisors acknowledged that the Health Services Department had
evaluated all reasonable options for the improvement of detention health services
at the Martinez Detention Facility and the implementation of a new healthcare
system at the West County Detention Facility.
Dr. Jeffrey Smith from Health Services Department and Commander George
Lawrence presented the report.
The Board discussed the history of the issue and requested clarifications of
various relative items from staff.
The Chair invited comments from the public, and the following people spoke:
Rollie Katz, (P.E.U. Local 1)P.O. Box 222, Martinez;
Jim Hicks, (AFSCME 2700), 1000 Court Street, Martinez
After further discussions, the Board took the following actions:
(1) AUTHORIZED the implementation of an augmented detention
healthcare system with the following:
• Daily sixteen hour nursing staff at the West County Detention
Facility.
• Twenty hours per week of mental health coverage at the West
County Detention Facility.
• Twenty-four hours per day mental health coverage at the Martinez
Detention Facility.
• Establishment of an on-site Health Care Administrator in the
command hierarchy.
(2) APPROVED addition of the positions necessary to implement the
above recommendations.
( ) AUTHORIZED the Health Services Director, or his designee,to
execute a contract with Santa Mara County for the provision of
inpatient mental health services in Module 8A of the Santa Clara Main
Jail, in an amount not to exceed$500,000, from July 1, 2003 through
June 30, 2004.
(4) ACKNOWLEDGED that Health Services Department issued and
evaluated proposals by private companies to staff the West County
Detention Facility.
(5) DIRECTED the Sheriff-Coroner and the Health Services Department
to develop a plan for implementation that includes:
a. An interdepartmental Memorandum of Understanding
concerning polices,procedures, and limitations upon census.
b. A legislative solution to the cost of off site care of inmates.
e. A new administrative structure that includes a health
administrator in the command structure.
d. A.timeline for implementation and a plan for reassessment at
regular intervals.
e. A utilization plan for the West County Detention Facility that
will allow essentially all females to be cared for at that facility.
f A plan to provide those higher levels of health services as the
inmates may need in alternative manners such as agreements
with surrounding agencies.
The Board also DIRECTED the Sheriff-Coroner and the Health Services Director
to report back to the Board in six months on the success of the program
enhancements.
Supervisor Glover moved to mare the following recommendations,which was seconded
by Supervisor Gioia.
Motion passed.
WILLIAM B. WALKER, M. D. PERSONNEL SERVICES
HEALTH SERVICES DIRECTOR
SHELLEY P(�IGHIN 1320 Arnold Drive, Suite 251
PERSONNEL OFFICER _.
Martinez, California
5 -5537CONTRA COSTA Ph {925) 957-52#8
Fax (925) 957-Sliv
HEALTH SERICE
To: Dorothy Sansoe, Senior Deputy County Administrator ,
From: Charley Taylor, Health Services Personnel Analyst`
Cw.
Date: May 13, 2003
Subject: P-300 Request Approval of the attached Health Services Detention
Package.
The attached package provides additional positions and increased position hours
to support changes in West County Detention Facility/Main Detention Facility:
Annual cost estimate is $ 861,334
0301 funds are General County Funds
Please place this item on the next available Board Agenda. If you have any
questions, I can be reached at 357-5245.
cc: William Walker, MD
Jeff Smith, MD
Chris Grazzini
Patrick Godley
Shelley Pighin
Sylvia Luz
LaVerta Guy
Linda Bates
Larry Daniel
Terrina Marcor
• Contra Costa Community Substance Abuse Services • Contra Costa Emergency Medical Services Contra Costa Environmental Health + Contra Costa Health Plan
• Contra Costa Hazardous Materials Programs •Contra Costa mental Health • Contra Costa Public Health • Contra Costa Regional Medical Center + Contra Costa Health Centers
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CONTRA COSTA COUNTY
HUMAN RESOURCES DEPARTMENT
McBrien Administration Building
551 Fine Street, 2nd Floor
Martinez CA 94553-1292
FAX: (925) 335.1797
DATE: May 22, 2003
UNION NOTIFICATION
To: Francisco Ugarte
Employee Organization: CNA
Fax Number: 510-663-1681
From: Terrina Manor, Human Resources Analyst
Telephone: (925) 335-1737
P300 Action:
ADD the following positions:
( ) 32/40 Registered Nurse— Experienced Level (VWXD)
(2) 24140 Registered Nurse — Experienced Level (VWXD)
(1) 40/40 Clerk Experienced Level (JWXC)
(1) 32/40 Mental Health Clinical Specialist (VQSB)
(2) 24/40 Mental Health Clinical Specialist (VQSB)
(1) 40/40 Mental Health Clinical Specialist (VQSB)
(1) 40140 Health Services Administrator— Level C (VANH)
(2) 40/40 Medical Records Technician (VNTB)
INCREASE the hours of the following positions:
Pharmacist I position # 8914 from 24140 to 32140
Exempt Medical Staff Physician #8617 from 1140 to 32140
Mental Health Clinical Specialist #8910 from permanent intermittent to permanent part
time 30{40.
Scheduled for Board Agenda: June 3, 2003
POSITION ADJUS'T'MENT REQUEST
NO. 5 '
DATE C~ 0-3
C-a
DEPARTMENT NO./ COPERS
DEPARTMENT: Health Services/Hospital&HC BUDGET UNIT NO. 0301 ORG NO. Various AGENCY NO. A-18
ACTION REQUESTED: Arave attached Health Services Detention bac '
di"""im%for expansion at West County Detention Facility. c
PROPOSED EFFECTIVE DATE:
CLASSSIFICATION QUESTIONAIRE ATTACHED:YES 0 NO O/Cost is within dept budget: Yes 0 No 0
TOTAL ONE TIME COSTS(non-salary)ASSOCIATED WITH REQUEST: S 0 --
ESTIMATED TOTAL COST ADJUSTMENT(salarylbenefits/one-time):
TOTAL ANNUAL COST $ 861,334 NET CG:7VNTY COST S 861.334
TOTAL THIS FY $ 0 N.C.C.THIS FY S 0
SOURCE OF FUNDING TO OFFSET ADJUSTMENT General County funds
DEPARTMENT MUST INITIATE NECESSARY ADJUSTMENT AND SUBMIT TO CAO. , t
USE ADDITIONAL SHEET FOR FURTHER EXPLANATIONS OR COMMENTS.
Charley 4Tayor, soel Services Analyst,.)
(for)DEPARTMENT HEAD
REVIEWED BY CAO AND RELEASED TO HUMAN RESOURCES DEPARTMENT
DEPUTY COUNTY ADMINISTRATOR DAFTE
HUMAN RESOURCES DEPARTMENT RECOMMENDATION: DATE ay2, X13
Additional Information on Second Page:
Amend Resolution 71/17 establishing positions and resolutions ally ti classes to the Ba s xempt salary schedule.
Effective: Day fallowing Board Action
} {date)
(f DIRECTOR OF HUMA SOURCES
COUNTY ADMINISTRATOR RECOMMENDATION DATE: 0'
"Approve Recommendation:of Director of Human Resources
0 Disapprove Recommendation of Director of Human Resources
D Other:
r{
for) COUNTY MINSTRATOR
BOARD OF SUPERVISORS ACTION: John Sweeten,Clerk of the Board of Supervisors/County Administrator
AdjustmeDto APPROVED 0 DISAPPROVED C
DATE; tom'. C BY;
1
APPROVAL OF THIS ADJUSTMENT CONSTITUTES A PERSONNEL/SAVARY RESOLUTION AMENDMENT
POSITION ADJUSTMENT ACTION TO BE C0—M-P-LTED BY HUMAN RESOURCES DEPARTMENT FOLLOWING
BOARD ACTION. Adjust classes)/position(s)as follows;
IF REQUEST IS TO ADD PROJECT POSITIONS/CLASSES,PLEASE COMPLETE OTHER SIDE
P300 #19562
Add the following positions:
(2) 32/40 Registered Nurse— Experienced Level (VWXD) XD-2386
(2) 24144 Registered Nurse— Experienced level (VWXD) XD-2338
(1) Clerk— Experienced Level (JWXB) XA-1677
(1) 32/40 Mental Health Clinical Specialist (VQSB) M25-2050
(2) 24/40 Mental Health Clinical Specialist (VQSB) M25-2050
(1) Mental Health Clinical Specialist (VQSB� M25-2050
(1) Health Services Administrator—level C (VANH) M25.2393
(2) Medical Records Technician (VNTB) XB-1868
Increase the hours of the following positions:
Position #8914 Pharmacist I (VYWA) from 24/40 to 32/40
Position #8617 Exempt Medical Staff Physician ((VPW9) from 1/40 to 32/40
Position #8910 Mental Health Clinical Specialist (VQSB) from permanent
intermittent to permanent part-time 30/40