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Home My WebLink AboutMINUTES - 04012008 - D.4 II . 1 TO: BOARD OF SUPERVISORS (` Contra FROM: DENNIS M. BARRY, AICP COSta .r 4;r COMMUNITY DEVELOPMENT DIRECTOR `'1' County DATE: APRIL 1, 2005 SUBJECT: HEARING ON THE RECOMMENDATION OF THE EAST COUNTY REGIONAL, PI_,ANNING COMMISSION: ON A REQUEST TO REZONE_, A 9.9-ACRE PARCEL FROM HEAVY AGRICULTURE (A-3) TO GENERAL AGRICULTURE (A-2) AT 215 EAGLE LANE WITHIN THE UNINCORPORATED AREA OF KNIGHTSEN. TOM POWERS (APPLICANT) AND PHILL_IP & BARBARA HANSEN (OWNERS) COUNTY FILE #RZ06-3182 (DISTRICT III) SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDATIONS A. OPEN the public hearing and receive testimony on the rezoning. B. ADOPT the Mitigated Negative Declaration as adequate for the purposes of compliance with the California Environmental Quality Act as recommended by the East County Regional Planning Commission. CONTINUED ON ATTAC'HMEN'r: \ YES SIGNATURE COMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE: AI'PROV OTHER q): t-� SIGNATURE: S ACTION OF B7 ON O' APPROVED AS RECOMMENDED O'I' . ;R VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND UNANIMOUS(ABSENT-J-.14 CORRECT COPY OF AN ACTION 'TAKEN AND AYES: NOES: ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN r Contact: Dari in Myers(335-1210) ATTESTEDZO� cc: Building Inspection JOHN CULLEN, ERI{OF THE BOARD OF Public Works SUPERVISORS AND COUNTY ADMINISTRATOR Tom Powers Phillip& Barbara Hansen BY ;BEPUTY April 17 2008 Board of Supervisors County File RZ06-3182 Pa,,c 2 C. ADOPT the recommendation of the East County Regional Planning Commission, as contained in Resolution No. 1 1-2008 to rezone a 9.9-acre parcel from Heavy Agriculture (A-3) to General Agriculture (A-2). D. INTRODUCE Ordinance No. 2008-12 giving effect to aforesaid rezoning, waive reading, and adopt the ordinance. E. ADOPT findings contained in;thc East County Regional Planning Commission Resolution No. 11-2008 as the basis for the Board's action. F. DIRECT the Community Development Department to post a Notice of Determination with the County Clerk. It FiSCAL IMPACT There is no fiscal impact. The applicant is responsible for the cost of processing the development application. 111. BACKGROUND/R.EASONS FOR RECOMMENDATIONS This application proposes to rezone a 9.9 acre parcel from A-3 to A-2. In an associated submittal, . the applicant requested approval to subdivide the site in to two lots. The site is designated Agricultural Lands (AL) in the County General Plan. This land use designation has a minimum lot size of 5 acres. As proposed,;the project would have a density of 4.95 acres, slightly below the base requirement. Given the uniqueness of the property in this localized neighborhood and the fact that there was an additional subdivision in the immediate vicinity that was approved with similar circumstances, the .Department felt it was appropriate to recommend approval of the Subdivision. The rezoning from A-3 to A-2 is consistent with the County General Plan and with the zoning in the area. Furthetnlore, there are two legally established residences on the subject property, each of which is served by existing private water wells and septic systems that were approved by the County Health Services Department and found to comply with its regulations., Should the proposed rezoning be approved, the intensity of the use would not increase. The two existing residences would be ort separate parcels. There would be no change in traffic circulation or runoff from the site. The East County Regional Planning Commission approved the rezoning recommendation and the subdivision and on its consent calendar. The Community Development Department has not received any letters from the general public in opposition to the request to rezone the property and associated minor subdivision. "rhe second residence on the site was legally established atter approval of LP 2034-87 by the Zoning Administrator (approved on September 14, 1987 subject t6 ten conditions of approval). maps Figure #1 : MS06-0021 & :RZ06-3182 Flood Zones & ULL 1 El - I � ' Delta Rid► �\ - <.�+ oSu sn etand —I a . o oa�s SITE Chestnut St �B e. Balfour Rd rp `•':' Legend ' Site j ; MParcels` j, Ucban>Limit Line - 1 Of[�C_ontoucs, 1pTsi F1,ddTlains �^ State Hwy 4 a HA2 I �38 � N Miles created 7/6/2006 by Contra Costa County Community Development,GIS Group 0.2 �.4 �•$ .2 .v 651 Pine Street,4th Floor North Wing,Martinez,CA 94553-0 09 5 37:59:48.455N 122:06:35.384W This map contains copyrighted information and may not be altered. It may be reproduced in its current state if the source is cited.Users of this map agree to read and accept the County of Contra Costa disclaimer of liability for geographic information. '•� " Figure #2 MS06-0021 & RZ06-3182 General Plan Cei�RJ ��LI SMS �K�nli.g h�tse n .�1. SITE � AL Sunset Rd� Eagle Ln ALFi S� CO 0 I 3' j PS 0 � r CCFh,�j'Cn:Qjt'-Ct I PR r i ;r Legend Q Site Parcels c C� SM � Imp � - - - - 0 SH ~— IDiscov.e:.ry B:a��/ Ll – ® PS .—Y I � PR OS i 6Hw.y 4 [� AL — 0 IMO AC I� / —1� d � DR WA / N Map created 7/6/2006 ,. by Contra Costa County Community Development,GIS Group 0 950 1,900 3,800 5,700 7,600 651 Pine Street,4th Floor North Wing,Martinez,CA 94553-0095 Feet 37:59:48.45514 122:06:35.384W This map contains copyrighted information and may not be altered. It may be reproduced in its current state if the source is cited.Users of this map agree to read and accept the County of Contra Costa disclaimer of liability for geographic information. ''' SITE [win \..�■ 11:��111�1111 _ -Ilii •••■ ■ 111 ® Nino „ . . z. � lry�f� fl egend Site Parcels Zoning ' � 1 x' n - r . " �1, •�. .� 11. Y dV IMP — � TV { _ l S -! �o• _ '�.. y ,�y�'p ,r, t -- --rte 5 YH .i i' � -: \��. `�''�� :t�,+r-ter ...t - '1 •_ __ l � i- i b -� r I r �• r}7 01 LegendSite Lry � Parcels j i I Figure #5 MS06-0021 & RZ06-3182 Noise Contours . I SITE I I I I � . I I - i I I . I I I Legend Parcels c J 0 Site d N —+— Railroads I w .� Map created 7/6/2006 0 95 190 380 570 760by Contra Costa County Community Development,GIS Group 651 Pine Street,4th Floor North Wing,Martinez,CA 94553-0095 Feet 37:59:48.455N.122:06:35.384W This map contains copyrighted information and may not be altered. It may be reproduced in its current state if the source is cited.Users of this map agree to read and accept the County of Contra Costa disclaimer of liability for geographic information. ° t t , Rezoning Ordinance No. 2008-12 v �✓uv u.v� ,.v. (Re-Zoning Land in the Knightsen Area) The Contra.Costa County Board of Supervisors ordains as follows: SECTION I: Page K-27 of the County's 2005 Zoning Map(Ord. No. 2005-03) is amended by re-zoning the land in the above area shown shaded on the map(s)attached hereto and incorporated herein (see also Community Development Department File No. RZ - 063182 ) FROM: Land Use District A-3 ( Heavy Agriculture ) TO: Land Use Distract A-2 - ( General Agriculture and the Community Development Director shall change the Zoning Map accordingly, pursuant to Ordinance Code Sec. 84.2.002. a A-2 i A-2 ; A-3 e � i J4-2 a A12 - � B i O � i m As- 1 w I SECTION II. EFFECTIVE DATE. This ordinance becomes effective 30 days.after passage, and within 15 days of passage shall be published once with the names of supervisors voting for and against it in the Cvnkrti GCS4z T: vv%le5 , a newspaper published in this County. PASSED on p r► l l )-ad& by the following vote: Supervisor Ave No Absent Abstain 1. J. Gioia ( ) ( ) ( ) 2. G.B. Uilkema ( ) ( ) ( ) 3. M.N. Piepho 4. S. Bonilla ( ) ( ) PQ ( ) 5. F.D. Glover ( ) ( ) ( ) ATTEST: JohCullen, County Administrator L /n and Clerk.o Board of Supervisors �(J Chairman of the Board By Dep. (SEAL) 1 ORDINANCE NO. 2008 . 12 RZ 063182-Tom Powers Findings Map o ..........------ ................... 1 J e A-2 a A-2 i W A-3 �mm mmmmm®�-m®.em®s ®.o o m -fes 0 e o v v II 0 A-2 A.2 0 0 0 0 O� 9 e♦ OO ®e ee �e Aq,3 e A-3 ®eee °tee® A-3 ♦ ee � e Rezone from A-3 to A-2 ® Knightsen Area I, Walter MacVittie Chair of the East County Regional Planning Commission, State of California do hereby certify that this is a true and correct copy of page K-27 of the County's 2005 zoning map. indicating thereon the decision of the Contra Costa County Planning Commission in the matter of Tom Powers (Applicant) -,County File # RZ 06-3182 ATTEST: Secretary of the Contra Costa County Planning Commission, State of Calf. i i i i i East County iRegional Planning Commission Resolution No. 11-2008 i i i I I RESOLUTION NO. 11-2008 I I RESOLUTION OF 'T'HE EAST COUN'T'Y REGIONAL, PLANNING COMMISSION OF THE COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA, INCORPORATING FINDINGS AND RECOMMENDATION OF THE REQUESTED CHANGE IN ZONING AND APPROVAL: OF A MINOR SUBDIVISION BY TOM POWERS (APPLICANT) AND PHILLIP & BARBARA HANSE:N (OWNERS) (COUNTY FILES RZ06-3182 AND MS06-002.1) IN THE ORDINANCE CODE SECTION PERTAINING TO THE PRECISE ZONING FOR THE KNIGHTSEN AREA OF SAID COUNTY. I WHEREAS, on ,lune 13, 2006 the Contra Costa County Community Development Department received a request by Tom. Powers (Applicant) to rezone a 9.9-acre parcel from Heavy Agriculture (A-3) to General Agriculture (A-2); and I WHEREAS, for ,purposes of compliance with the provisions of the California Environmental Quality Act and the State and County CEQA Guidelines, a Mitigated Negative Declaration was prepared and circulated for review and comments between August 20, 2007 and September 10, 2007 and the Commission adopted the Mitigated Negative Declaration at their meeting on Monday, November 5, 2007; and I WHEREAS, after notice having been lawfully given, a public hearing was scheduled before the East County Regional Planning Commission on November 5, 2007, where all persons interested therein might appear and be heard; and I WHEREAS, on Monday, November 5, 2007 the East County Regional Planning Commission having fully reviewed, considered and evaluated the evidence submitted in this matter; I NOW, THEREFORE, BE IT RESOLVED, that the East County Regional Planning Commission: I 1. FINDS that the ,proposed Mitigated Negative Declaration is adequate for the purposes of compliance with the California Environmental Quality Act and adopts same; I 2. RECOMMENDS, to the Board of Supervisors the APPROVAL of the rezoning of the site fi-om Heavy Agriculture (A-3) to General Agriculture (A-2) District; 3. APPROVES the 'two-lot minor subdivision contingent upon the Board approving the rezoning; i I I I I I I I i I � I BE IT FURTHER RESOLVED that the reasons for this recommendation are as follows: I The General Plaii allows for a maximum density of 1111111 per 5 acres of lands in the AL categol.y. Two residences on the 9.9-acre property do not sleet this standard (i.e., the parcel size requester! for approval by Me applicant is I percent less than the required densilv). However, this rezoning and subdivision is consistent with another project in the immediate vicinit.y. The memorandlan f•oln the County Health Services Department I indicates that w1aler and septic system. must corrlply with County requirements. In I this case there are two existing residences. Each has water wells and septic systems that were approved by the Health Services Department. Over the years the wells and septic systems have per forined satisfactorily. Tll,e County Public Works Department have standards for private roads, drainage and stor in water control. The applicant is ill agreement with those requirements. The County FPD has standards for emergency water supply for fighting a structural fire, and related issues. The applicant is iii agreement with those standards. I BE IT FURTHER RESOLVED that the Chairperson and Secretary of this Planning Commission will sign and attest the certified copy of this resolution and deliver the same to the Board of Supervisors, all in accordance with the Government Code of the State of California. I The instructions by the Planning Commission to prepare this resolution was given by motion of the East County Regional Planning Commission on Monday, November 5, 2007 by the following vote: I � AYES: MacVittie, Day, Hanna, Stevens I NOES: None ABSENT: Kinsey I ABSTAIN: None I I I I Walter MacVittie Chair, East County Regional Planning Commission County of Contra Costa, State of California I ATTEST: I I So-/Dennis M. Barry, Secretary County of Contra Costa I I I I i i i i i i , , Findings 'and Conditions of Approval Adopted by East County ;Regional Planning Commission J; 1 FINDINGS AND CONDITIONS OF APPROVAL FOR MINOR SUBDIVISION MS06- 0021 AND RZ06-3182 AS APPROVED BY THE EAST COUNTY R.EG.IONAL PLANNING COMMISSION ON NOVEMBER 5, 2007 A. Findings to Approve a Rezoning (Ord. Ref 26-2.1806) i 1. Required Finding: The change proposed will substantially comply with the General Plan. The General Plan Land Use Map designates the property AL and the proposed lots are approximately 4.95 acres each. Therefore,the proposed density is not within the allowable range.. For that reason, the rezoning request raises policy issues. However, the project proponent was previously granted a land use permit for a second residence (see Appendix C for th'e conditions of approval of LP20343-87).That permit allowed a second residence on a 9.9-acre parcel prior to establishment of the density standard of 0.2 units/acre in the IAL land use district. After approval of the land use permit,the Hansen's complied with the conditions of approval and were issued a building permit fora second residence. In doing so, the applicant a) provided septic systems and water wells for each residence in compliance with the requirements of the Health Services Department;lb) paid park dedication fees; c) met the requirements of the Public Works Department for drainage, road improvements and utility installation; and d) complied with the requirements of the Building Inspection Department. The CEQA Initial Study prepared for the pending applications identified a potential geologic impact (liquefaction). The project proponent has agreed to abide with the mitigation measures(see Appendix B,Mitigation Monitoring Program). Finally,the applicant anticipates no difficulty complying with the requirements of County agencies (Public Works, Building Inspection, Health Services and Community Development Departments), as well as those of the County Fire Protection District and the East Contra Costa Irrigation District. Finally,the second residence was developed nearly 20 years ago. Over that period of time the water well and septic systems have functioned properly,and over that period of time the property has generated vehicle trips from two legally-established residences. A primary objective of the General Plan density standard in areas designated "Agricultural land'' was to protect the quality of life in rural areas of the . county, protect nearby agricultural operations from issues associated with ranchette development, and constrain traffic for properties that are outside of the Urban Limit Line. Controlling density also serves to protect groundwater resources. In this case there are no conflicts with commercial agricultural operations. (Nearby parcels are used for horse setups or are fallow.) The historic use on the site indicates the property can sustain water wells and septic systems for two residences, and no increase in traffic on local roads is anticipated. Based on the preponderance of the I I evidence the finding can be made that the zoning change will substantially comply with the general plan. 2. Required Finding: The uses authorized or proposed in the land use district are compatible within the district and to uses authorized in adjacent districts. As Figure 2 indicates,the site and adjacent lands are designated"Agricultural Land" (AL) by the Land Use Element. The Land Use element states that all agricultural zoning districts are consistent with the AL designation. The Eagle Lane area is characterized by a mixture of the following zoning districts: A-2 (General Agriculture) and A-3 (Heavy Agriculture). In summary, from a policy perspective, A-2 and A-3 districts are compatible. It should also be recognized the site is in the Eagle Lane area which is characterized by ranchette use. Widespread ranchette uses are not compatible with the infrastructure and environmental resources of.the Knightsen area, but the request appears compatible with the established pattern development in this"neighborhood". B. Findings to Approve a Tentative Map 1. Required Finding: The tentative map shall not be approved unless the Zoning Adminlstratorl`nds that the proposed subdivision, together with the provisions for its design and improvement, is consistent with the applicable general and specific plans required by law. In this case the VTM indicates two developed lots (proposed Parcels A and B). No improvements are proposed on these lots at this time. On Parcels A and B the front yard setbacks are 5.5 and 165 feet, respectively, from the Eagle Lane right-of-way. The stable on Parcel A is setback 20 feet from the proposed Parcel A/Parcel B boundary. The existing barn on proposed Parcel B(labeled"permitted")is setback 20 feet from the south property line. It should also be recognized that there are 12 parcels in the Eagle Lane neighborhood that are less than 5 acres; there is no Specific Plan for the area; there are no biologically-sensitive areas near the site; and(with the exception of the density issue) the project is consistent with General Plan policies. I 3 C. Growth Management Performance Standards 1. Traffic: The project will not generate any change in the AM and PM peak hour trips. (This assumes the no new residences on the site and 1.0 peak hour trips per unit.) Therefore,the applicant is not required to prepare a traffic report pursuant to the 1988 Measure C requiremei ts. 2. Drainage and Flood Control: No portion of the site lies within a special flood zone designated by the Federal Emergency Management Administration (FEMA). Drainage is by a roadside swale which conveys runoff to the north. The swale outfalls into a ditch owned by the ECCID. 3. Water and Waste Disposal. Proposed Parcels A and B have developed residences. The existing water wells and septic systems were previously approved by the County Health Services Department. 4. Fire Protection: The site is in the State Responsibility Area(SRA). The parcels are subject to the requirements of both California Department of Forestry and the County Fire Protection District. Because the site is not located within either a suburban, urban or central business district area, no special fire protection measures under the County's Growth Management policies are required. 5. Public Protection: The project poses no expanded law enforcement problems. 6. Parks & Recreation: Park dedication fees were paid for the existing residences. (Reference Growth Management Element of the General Plan) D. Findings to Approve a Variance (Ord. REF. 26-2.006) I The Zoning Ordinance,Article 84-38.608, indicates that the uses prescribed by Chapter 84- 38 are allowed only on lots which equal or exceed 5 acres. The applicant request all uses allowed under Article 84-38.4 for the proposed parcels which are 4.95 acres each. 1. Required Finding. That any variance authorized shall not constitute a grant of special privilege inconsistent with the limitations on other properties in the vicinity and the respective land use district in which the subject property is located. There are 12 parcels in the Eagle Lane area that are less than 5 acres and nearly all of them have developed residences and accessory structures. Granting of the permitted uses in Article 84-38.402 is consistent with the other properties in the Eagle Lane area. , 4 i 2. Required Finding. That because of special circumstances applicable to the subject property because of its size, shape, topography, location or surroundings, the strict application of the respective zoning regulations is found to deprive the subject property of rights enjoyed by other properties in the vicinity and within the identical land use district. i Figure 7 identifies nearby minor subdivisions that have been approved since 1990 in the Eagle Lane area. Two of these applications in the A-2 district granted approval that included parcels of less than 5 acres in the Eagle Lane area after adoption of the 1990-2005 General Plan. One of those projects was directly across Eagle Lane from the Hansen property. The proposed parcels are 4.95 acres, are larger than the parcel sizes in MS 170-90, MS 171-90, MS 172-90, MS 9-94 and Parcel B of MS 4-92. Strict application of the 5-acre parcel standard would not be consistent with these previous project approvals. i 3. Required Finding. Tliat any variance authorized shall substantially meet the intent and purpose of the perspective land use district in which the subject property is located. Failure to so find shall result in a denial. (Ord. 1975;prior code Section 2204.30: Ord 917) The proposed parcels are 4.95 acres. In other respects the parcels comply with the standards of the A-2 district, and the two existing residences comply with the required setback standards. There are no conflicts with Ranchette Policies of the Conservation Element, and no biologically-sensitive lands on or immediately adjacent to the site. The property is not to a FEMA special flood hazard area, and the parcels drain to an existing irrigation ditch owned by the ECCID. The two existing water wells and septic systems were installed under permits from the Health Services Department and the approval of the variance will not trigger any construction or additional traffic. CONDITIONS OF APPROVAL FOR MS06-0021 and RZ06-3182 i Administrative i 1. The application for approval of a two-lot Vesting Tentative Parcel is approved(date-stamped received by the County on September 25,2006), subject to confirming approval of the rezoning request by the Board of Supervisors (A-3 to A-2). Unless otherwise indicated, the following conditions of approval require compliance prior to filing the Parcel Map for two lots. i i i i I 5 I Variance I 2. Article 84-38.608 states that the uses allowed in the A-2 district are restricted to parcels which equal or exceed 5 acres. The allowed uses in the A-2 district are defined in Article 84-38.4. A variance is granted to allow those'uses on Parcels.A and B of MS04-0021. I Indemnification I ` 3. Pursuant to Government Code Section 66474.9, the applicant(including the subdivider or any agent thereof) shall defend, indemnify, and hold harmless the County, its agents, officers, and employers from any claim, action or proceeding against the Agency (the County) or its agents, officers, or employees to attack, set aside, void or annul, the Agency's approval concerning this subdivision map application, which action is brought within the time period provided for in Section 66499.37. The County will promptly notify the subdivider of any such claim, action, or proceeding and cooperate fully in the defense. Compliance Report I 4. At least 60 days prior to filing a Parcel Map, submit a report on compliance with the conditions of approval with this permit for the review and approval of the Zoning Administrator. Except for those conditions administered by the Public Works Department, the report shall list each condition followed by a description of what the applicant has provided as evidence of compliance with that condition. Unless otherwise indicated, the applicant will be required to demonstrate compliance with the conditions of this report prior to filing a Parcel Map. The Zoning Administrator may reject the report if it is not comprehensive with respect to applicable requirements. i The permit compliance review is subject to staff title and material charges, with an initial deposit of$500 which shall be paid at time of submittal sof the compliance report. A check is payable to the County of Contra Costa. i Archaeology I 5. If any significant cultural materials such as artifacts,human burials,or the like are encountered during construction operations, such operations shall cease within 10 feet of the find,the Community Development Department shall be notified within 24 hours and a qualified archaeologist contacted and retained for further recommendations. Significant cultural materials I I I i 6 include, but,are not limited to, aboriginal human remains, chipped stone, groundstone, shell and bone artifacts,concentrations of fire cracked rock, ash, charcoal, shell, bone and historic features such as privies or building foundations. 6. Prior to requesting approval of grading permits or foundation plans, submit evidence that the "General Notes" on those plans encompass the archaeologic mitigation measures. Geotechnical 7. A. Prior to recordation of the Parcel Map the applicant shall prepare a draft deed disclosure statement for review and approval of the Zoning Administrator. The deed disclosure, as approved by the Zoning Administrator, shall be recorded concurrent with recordation of the Parcel Map. It shall advise prospective buyers and owners of both parcels, of the risk of liquefaction, and of the requirement for a geotechnical investigation prior to issuance of a building permit for a residence. i B. At least 30 days prior to issuance of a building permit for a residence, submit a preliminary geology, soil, and foundation report meeting the requirements of Subdivision Ordinance Section 94-4.420 for review and approval of the County Peer Review Geologist. Improvement, grading,and building plans shall carry out the recommendations of the approved report. This report shall include evaluation of the potential for liquefaction, seismic settlement and other types of seismically- induced ground failure, along with analysis of expansive soils and corrosive soils by recognized methods appropriate to soil conditions discovered during subsurface investigation. Noise 8. A. Prior to recordation of the Parcel Map the applicant shall prepare a deed disclosure for review and approval for the Zoning Adininistrator. The deed disclosure shall be recorded concurrent with the recordation of the Parcel Map. It shall advise prospective buyers of the noise environment of Parcels A and B, and of the requirement for an acoustical report prior to issuance of a building permit for any future residence within the portion of the site exposed to noise levels exceeding 60 dB. It shall also advise the potential buyer or owner of the need to design the improvements to provide a useable outdoor area, . I along with measures to protect the interior of the residence from train noise and ensure regulatory compliance B. At least 30 days prior to issuance of a building permit for a residence within the area exposed to noise levels greater than 60 dB, submit an acoustical report that provides site-specific data on the noise environment and compares that noise monitoring data with the standards in the Noise Element of the General Plan, and provides measures to reduce interior and exterior noise levels to the"generally acceptable"range for residences, should such measures be warranted. The scope of the acoustical study is to include monitoring of noise during train operations on the segment of track immediately east of the site. Fire Protection 9. Prior to filing a Parcel Map, submit a draft of a deed disclosure for review and approval of the Zoning Administrator. The statement shall advise the owner/prospective buyer that prior to the issuance of a building permit for any new residence,the applicant shall provide evidence that the design of the improvements are in compliance with the provisions of the Contra Costa Fire Protection District regulations as they pertain to driveways, gates, turnarounds, defensible space and water for suppression of fires. The approved deed restriction shall be recorded concurrently with the Parcel Map. I East Contra Costa Irrigation District 10. Provide documentation of compliance with the requirements of the East Contra Costa Irrigation District. Agricultural Disclosure I 11. Concurrent with recordation of the Parcel Map, the following statement shall be recorded at the County Recorder's Office for each parcel to notify future owners of the lots that they own property in an agricultural area: "This document shall serve as notification that you have purchased land in an agricultural area where you may regularly find farm equipment using local roads; farm equipment causing dust; crop dusting and spraying occurring regularly;burning associated with agricultural activities; noise associated with farni equipment and aerial crop dusting and certain animals and flies may exist on surrounding properties. This statement is, again,notification that I 8 this ispart of the agricultural way of life in the open space areas of Contra Costa County and you should be fully aware of this at the time of purchase." Application Processing Fees 12. This application is subject to a deposit of$5,496.50 (MS) and $2,5000 (RZ), which was paid with the application submittal, plus time and material costs if the application review expenses exceed 100% of the initial fee. Any additional fee due must be paid within 60 days of the permit effective date or prior to use of the permit whichever occurs first. The fees include costs through permit issuance plus five working days for file preparation. You may obtain current costs by contacting the project planner. If you owe additional fees, a bill will be sent toyou shortly after permit issuance. PUBLIC WORKS RECOMMENDED CONDITIONS OF APPROVAL FOR SUBDIVISIONS'MS06-0021 AND RZ06-3182 Applicant shall comply with the requirements of Title 8,Title 9,and Title 10 of the County Ordinance Code. Any exceptions must be stipulated in these conditions of approval. Conditions of Approval are based on the revised Vesting Tentative Map received by the Community Development Department on September 25, 2006. COMPLY WITH THE FOLLOWING CONDITIONS OF APPROVAL PRIOR TO RECORDATION OF THE PARCEL MAP: General Requirements 13. Improvement plans prepared by a registered Civil Engineer shall be submitted to the Public Works Department,Engineering Services Division,if necessary, along with review and inspection fees, and security for all improvements required by the County Ordinance Code for the conditions of approval of this subdivision. These plans shall include any necessary traffic signage and striping plans for review by the Transportation Engineering Division. Roadway Improvements (Eagle Lane) 14. Applicant shall improve Eagle Lane along the project frontage to provide for a:20 foot wide roadway with 2-foot wide shoulders in accordance with the County's Policy on Private Rural Road .Design Standards, as well as any necessary pavement transitions. 9 Access to Adjoining Property Proof of Access 15. Applicant shall furnish proof to Public Works of the acquisition of all necessary rights of way, rights of entry,permits and/or easements for the construction of off-site, temporary or permanent, public and private road and drainage improvements. . 16. Applicant shall furnish proof to Public Works that legal access to the property is available from Byron Highway. Sight Distance 17. Applicant shall provide sight distance at the intersections of the private driveways with Eagle Lane in accordance with Chapter 82-18 '`Sight Obstructions at Intersections" of the County Ordinance Code. The applicant shall trim vegetation,as necessary, to provide sight distance at this intersection, and any new signage, landscaping, fencing, retaining walls,or other obstructions proposed at these intersections shall be setback to ensure that the sight line is clear of any obstructions. Underground Utilities 18. All new uiility distribution facilities shall be installed underground. Maintenance of Facilities 19. Property Owner shall record a Statement of Obligation in the form of a deed notification, to inform all future property owners of their legal obligation to maintain the private roadway (Eagle Lane) and on-site private driveways,storm drainage,landscaping,clean water facilities,and any street lights. Drainage Improvements Collect and Convey 20. Division'914 of the County Ordinance Code requires all storm water entering and/or originating on this property to be collected and conveyed without diversion and within an adequate storm drainage system, to an adequate natural watercourse having a definable bed and banks, or to an existing adequate public storm drainage system which conveys the storm waters to an adequate natural watercourse. 10 Exception The applicant shall be permitted an exception from the collect and convey requirements'of the County Ordinance Code as no new impervious surface area is proposed,provided that the increase in area of impervious surface is less than 1;500 square feet, that there are no known drainage problems on-site currently,the existing drainage pattern is maintained and additional concentrated storm water runoff is not discharged onto adjacent properties. Miscellaneous Drainage Requirements 21. Applicant shall design and construct all storm drainage facilities in compliance with the Ordinance Code and Public Works Design Standards. 22. Applicant shall prevent storm drainage from draining across driveway(s) in a concentrated manner. 23. A private storm drain easement, conforming to the width specified in Section 914-14.004 of the County Ordinance Code, shall be dedicated over any surface or subsurface storm drain facility traversing the site. National Pollutant Discharge Elimination System (NPDES) 24. The applicant shall be required to comply with all rules, regulations, and procedures of the National Pollutant Discharge Elimination Systems (NPDES)for municipal,construction and industrial activities as promulgated by the California State Water Resources Control Board,or any of its.Regional Water Quality Control Boards (San Francisco Bay Region or Central Valley Region). Compliarice shall include developing long-term best management practices (BMPs) for the reduction or elimination of storm water pollutants. The project design shall incorporate, wherever feasible, the following long-term BMPs in,accordance with the Contra Costa County Clean Water Program for the site's'storm water drainage: Minimize the amount of directly connected impervious surface area. - Stencil advisory warnings on all catch basins and storm drains. Construct concrete driveway weakened plane joints at angles to assist in directing runoff to landscaped/pervious areas prior to entering the street curb and gutter. - Prohibit or discourage direct connection of roof and area drains to storm drain systems or through-curb drains. - Shallow roadside and on-site grassy swales. 11. Distribute public information items regarding the Clean Water Program to buyers. Other alternatives, equivalent to the above, as approved by the Public Works Department. Provision "C.3" of the NPDES Permit 25. The applicarit shall incorporate Integrated Management Practices(IMPs) or Best Management Practices(BMPs)to the maximum extent practicable into the design of this project, implement them, and provide for perpetual operation and maintenance for all treatment IMP/BM.Ps. 26. A Stormwater Control Plan received on March 12, 2007 by the Public Works Department was reviewed and determined to be preliminarily complete. Although the Stormwater Control Plan has been determined to be preliminarily complete, it is subject to revision during the preparation of improvement plans, as necessary, to bring it into full.compliance with C.3 stormwater requirements. 27. All construction plans (including but not limited to: site, improvement, structural, mechanical, architectural, building, grading and landscaping plans) shall comply with the preliminarily approved Stormwater Control Plan (SWCP) or any subsequently revised SWCP, the County's Storrnwater Management and Discharge Control Ordinance, the "C.3 Guidebook" and the requirements of the Regional Water Quality Control Board. All construction plans shall include details and specifications necessary to implement all measures of the SWCP, subject to the review and approval of the County. 28. Any proposed BMP/IMPs shall be located on-site,and shall be prohibited from being located within the 30'foot wide area along the project frontage dedicated to the County for roadway purposes. 29. . Any proposed water quality features that are designed to retain water for longer then 72 hours_shall be subject to the review of the Contra Costa Mosquito & Vector Control District. 12 ADVISORY NOTES PLEASE NOTE ADVISORY NOTES ARE ATTACHED TO THE CONDITIONS OF APPROVAL, BUT ARE NOT ;A PART OF THE CONDITIONS OF APPROVAL. ADVISORY NOTES ARE PROVIDED FOR THE PURPOSE OF INFORMING THE APPLICANT OF ADDITIONAL ORDINANCE AND OTHER LEGAL REQUIREMENTS THAT MUST BE MET IN ORDER TO PROCEED WITH DEVELOPMENT. A. The applicant shall be required to comply with all rules,regulations,and procedures of the National Pollutant Discharge Elimination System .(NPDES) for municipal, construction and industrial activities as promulgated by the California State Water Resources Control Board, or any of its Regional Water Quality Control Boards (San Francisco Bay B Region;II or Central Valley B Region V). B. Additional requirements:rnay be imposed by the Fire District or the Building Inspection Department. It is advisable to check with these departments prior to requesting a building permit or proceeding with the project. C. The Building Inspection Department will require three sets of building plans which must be stamped by the Community Development Department and by the County Health Department. D. Comply with the requirements of the Health Services Department, Environmental Health Division. E. The applicant is required to pay an environmental review fee of $1,875.00 for the Department of Fish and Game at the end of the appeal period. Failure to do so will result in fines. In addition, the approval is not final or vested until the fee is paid; nor may the County post a;Notice of Determination until the fee is paid. A check for this fee shall be submitted to the Community Development Department made out to Contra Costa County for submittal with the final environmental documents. F. The approval of this vesting tentative map confers a vested right to proceed with development in substantial compliance with ordinances, policies, and standards in effect as of March 12,;2007, the date the vesting tentative parcel map was accepted as complete by the Community Development Department. The vested rights also applies to development fees which the County has adopted by ordinance. These fees are in addition to any other development fees which may be specified. in the conditions of approval. An estimate of the fee charges for each approved lot may be obtained by contacting the Building Inspection Department at 335-1192. I I I I 13 G. Pursuant to Section 66452.;6(8)of the Subdivision Map act,the rights conferred by the vesting tentative map as provided by Chapter 4.5 of the Subdivision Map act shall last for an initial period of two (2) years following the recording date of the final/parcel map. These rights pertain)to development fees and regulations. Where several final maps are recorded on various phases of a project covered by a single vesting tentative map,the initial time period shall begin for each phase when the final map for that phase is recorded. At any time prior to the expiration of the initial time period, the subdivider may apply for a one-year extension. The application shall be accompanied by the applicable filing fee. Ifthe extension is ddnied by an advisory agency, the subdivider may appeal that denial to the Board of Supervisors by filing a letter of appeal with the appropriate filing fee with the Clerk of the Board within 15 calendar days. The initial tiTne period may also be subject to automatic extension pursuant to other provisions of Section fi,'6452.6(g) relating to processing of related development applications by the County. . I At the expiration of the vesting time period,remaining development(i.e.,new building permits)within the subdivision shall be subject to development fees and regulations in effect at that time. H. Some of the roadways that are used to access the subject property are private roads that may have a vehicle weight limit. You should be aware of those weight limits and your responsibility for road repairs when you bring construction equipment and materials onto your site. i J. This project may be subject to the requirements of the Department of Fish and Game. It is the applicant's responsibility to notify the Department of Fish and Game,P.O. Box 47, Yountville,California 94599,of any proposed construction within this development that may affect any fish'and wildlife resources, per the Fish and Game Code. J. This project may be subject to the requirements of the Army Corps of Engineers. It is the applicant's responsibility to notify the appropriate district of the Corps of Engineers to determine if a permit is required, and if it can be obtained. K. The applicant will be required to comply with the requirements of the Bridge/Thoroughfare Fee Ordinance for the East County,and.ECCRFFA/RTDIM Areas of Benefit as adopted by the Board of Supervisors. These fees shall be paid prior to issuance of a building permit. I L. Comply with the Bridge/Thoroughfare Fee Ordinance requirements for the East County, and East Contra Costa Regional Fee and Financing Authority/Regional Transportation Development Impact Mitigation fee (ECCRFFA/RTDTM), as adopted by the Board of Supervisors. These fees must be paid prior to issuance of building permits. I i i 14 i M. Although the Stormwateri Control Plan has been determined to be preliminarily complete, it remains subject to future revision,, as necessary, during preparation of improvement plans in order to bring it into full compliance with C.3 stormwater requirements. Failure to update the SWCP to match any revisions made on the improvement plans may result in a substantial change to the County approval, and the project may be subject 'to additional public hearings. Revisions to California Environmental Quality Act (CEQA) documents may also be required. This may significantly increase the time and applicant's costs associated with approval of the application. i N. NOTICE OF 90-DAY OPPORTUNITY TO PROTEST FEES, DEDICATIONS, RESERVATIONS,OR OTHER EXACTIONS PERTAINING TO THE APPROVAL OF THIS PERMIT. I i This notice is intended to advise the applicant that pursuant to Government Code Section 66000, et. seq, the applicant has the opportunity to protest fees, dedications, reservations,and/or exactions required as part of this project approval. The opportunity to protest is limited to a ninety-day (90) period after the project is approved. i The.90-day period in which you may protest the amount of any fee or imposition of any dedication, reservation, or other exaction required by this approved permit,be on the date this permit was approved. To be valid, a protest must be in writing pursuant to Government Code Section 66020 and delivered to the Community Development Department within 90 days of the approval date of this permit. i G:\Current Planning\curr-plan\Staff Reports\MS060021_RZ063182rpt.doc Approved 11/05/07 hl 11/8/07 i i i i i i i i i i i Staff Report for the ECRFC Dearing (November 5, 2007) Agenda Item# Community Development Contra Costa County EAST CONTRA COSTA COUNTY REGIONAL PLANNING COMMISSION MONDAY, NOVEMBER 5, 2007 1. INTRODUCTION TOM POWERS (Applicant) and PHI.LLIP & BARBARA HANSEN (Owners), County File #MS06-0021 & RZ06-3182: The applicant and owners request rezoning of the property from Heavy Agriculture (A-3) to General Agriculture (A-2). In a related application they request vesting tentative parcel map (VTM) approval to subdivide 9.90 gross acres into two parcels. Both parcels comply with the lot dimension standards of the proposed A-2 zoning district, but they do not comply with the minimum parcel size standard. Therefore,applicant requests approval of a variance to the parcel size standard of the A-2 District(5 acres required;4.95 acres proposed). The property fronts for 750 feet on the west side of Eagle Lane, approximately '/a-mile south of the right-angle bend in the alignment of Eagle Lane. The property is located in the N''/2 Section 10, TIN, R3E, Mt. Diablo B&M, and is addressed 215 Eagle Lane, in the Knightsen area(A-3) (ZA:K-27 & M-28m) (CT 3040) (Parcel 015-110-026). 11. RECOMMENDATION Adopt a motion that: A. On the basis of the whole record before it, including the Initial Study and the comments received,the East County Regional Planning Commission finds that there is no substantial evidence that the project will have a significant effect on the environment and that the mitigated negative declaration reflects the County's independent judgment and analysis. The documents or other material that constitute the record of proceedings upon which the Planning Commissign's decision is based may be found at the Community Development Department, 651 Pine Street, Martinez, CA. B. Adopt the Mitigated Negative Declaration for purposes of compliance with CEQA. C. Approve the tentative map subject to conditions of approval and subject to approval of the rezoning request by the County Board of Supervisors. D. Adopt the Mitigation Monitoring Program. S-2 III. GENERAL INFORMATION A. General Plan: The property is outside the urban limit line, and is designated Agricultural Land (AL). This lands use designation includes most of the privately- owned rural lands in the County, excluding private lands that are composed of prime soils or lands that are located in or near the Delta. Most of the AL lands are in hilly portions of the County and are used for grazing livestock, or dry grain farming. The category also includes non-prime agricultural lands in flat East County areas,such as the Knightsen area. The purpose of the Agricultural .Lands designation is to preserve and protect lands capable of and generally used for;the production of food, fiber, and plant materials. The title is intended to be descriptive of the predominant extensive agricultural uses that take place in these areas, but does not exclude other types of open space or non- urban uses. The maximum allowable density in this category is one dwelling unit per 5 acres. The uses that are allowed in the Agricultural Lands designation include all land-dependent and non-land ;dependent agricultural production and relative activities. The following standards shall apply to all uses allowed in the Agricultural Lands designation: (1) Any subdivision of lands shall include conditions of approval which conform with the requirements of the "Ranchette Policy," which is outlined in the "Agricultural Resources"section of the Conservation Element(Chapter 8);and (2) Residential and non-residential uses proposed in areas of special flood hazards, as shown on FEMA maps, shall conform to the requirements of the County Floodplain ManagementOrdinance (County Ord. #87-45). The General Plan contains policies that form a context for the proposed minor subdivision. Policies most applicable to the project are summarized below. 1. Land Use Element. The Land Use Element contains policies whose intent is to ensure that the ranchette development that does occur is compatible with preservation of agriculture, along with environmental protection. 2. Safety Element. The Safety Element of the General Plan includes a number of policies that require evaluation of geologic hazards for proposed land development projects in areas of potential hazards. On page 10-25 the Safety Element states that geologic conditions should be a priman�determinant of land use. Table 1 presents ground failure policies from the Safety Element that are most applicable to the project. S-3 Table 1 SELECTED SAFETY AND OPEN SPACE ELEMENT POLICIES Safetv Element Policies—Liquefaction 10-18 'Fhis General Plan shall discourage urban or suburban development in areas susceptible to high liquefaction dangers and where appropriate subject to the policies of 10-20 below,unless satisfactory mitigation measures can be provided,while recognizing that there are low intensity uses such as wzitcr-related recreation and agricultural uses that are appropriate in such areas. 10-19 'Yo the extent practicable,the construction of critical facilities,structures involving high occupancies,and public facilities shall not be sited in areas identified as having a high liquefaction potential,or in areas underlain by deposits classified as having a high liquefaction potential. 10-20 Any structures permitted in areas of high liquefaction damage shall be sited,designed and constructed to minimize dangers from damage due to earthquake-induced liquefaction.; 10-21 Approvals to allow the construction of public and private development projects in areas ofhigh liquefaction potential shall be contingent on geologic and engineering studies which define and delineate potentially hazardous geologic and/or soils conditions, recommend means of mitigating these adverse conditions,and on proper implementation of the mitigation measures. Overall Open Space Policies 9-1 permanent open space shall be provided within the County for a variety of open space uses. 9-2 Historic and scenic features,watersheds,natural waterways,and areas important for the maintenance ofnatural vegetation and wildlife population shall be preserved and enhanced. 9-5 'file visual identities of urban communities shall be preserved through the maintenance of existing open space areas between cities and/or communities. 9-7 Open space shall be utilized for public safety,resource conservation and appropriate recreation activities for all segments ofthe community. 9-8 Development project environmental review will consider the effect of the project on the County's open space resources, whenever the project proposes to convert substantial amounts of land from an open space designation to an urban development designation. 3. Open Space Element. The most appropriate uses in"Open Space"areas involve resource management, such as maintaining natural water courses or habitat for special status species (see Table 1 for Open Space Policies). 4. Transportation and Circulation Element. According to this Element of the General Plan, the.Byron Highway is the only officially designated scenic route in the project vicinity. Other designated scenic routes include Marsh Creek Road, State Route 4 and Vasco Road. 5. Conservation Element. This element is concerned with issues regarding the identification,preservation and management of natural resources. According to General Plan Figure 8-1; the site is not identified as a significant ecological area, but it is identified a,s an important agricultural area Oprimarily grazing. The Conservation Element contains implementation measures for rural residential lots. Those measures include documentation of an adequate water source,adequate road access,septic tank leach fields that meet the requirements of the Health Services !Department, evidence that the proposed parcels are S-4 reasonably free of hazards, adequate fencing to contain domestic animals and other measures (see General Plan, pages 8-42 and 8-43). B. Zoning: .Heavy Agricultural (A-3).;"Che Table 2 Ordinance Code provisions governing SUMMARY OF TONING STANDARDS standards in the A-3 district are presented FORTH E A-3 DISTRICT in Chapter 84-40. Table 2 presents a • No structure shall be permitted in the A-3 district on a lot less than 140 feet in average width (84- summary of zoning standards. The 40.604). minimum standard parcel size is 10'acres. . There is no minimum lot depth standard (84- The applicant and owners request 40.606). rezoning of the property to General . There is no maximum building and structure height Agriculture (A-2). A summary of restriction(84-40.802). • No side yard shall be less than 25 feet: barns. standards of the A-2 District are presented stables or other buildings used to house livestock, in Table 3. In a related application they grain-fed rodents or poultry shall be setback 50 feet from the boundary ofany residential land use request vesting tentative map (VTM) district(84-40.1002). approval to subdivide 9.90 gross acres . The front yard setback shall be at least 25 feet(84- into two lots of 4.95 acres each. Both lots 40.1004). comply with the lot dimension standards • The rear yard setback shall be at least 25 feet(84- 40.1002). of the proposed A-2 zoning district, but • Variances to lot dimension and setback standards they do not comply with the 5-acre can be granted in accordance with Chapter 82-6 minimum parcel size standard. In (84-40.1202). summary, approval of they minor subdivision requires approval' of the Table 3 SUMMARY OF TONING STANDARDS rezoning (from A-3 to A-2) and granting FORTH E A-2 DISTRICT of a variance to the minimum standard Uses allowable under Article 84.38.4 shall be parcel size in the A-2 District. permitted in the A-2 district only on lots which equal or exceed all of the following: C. CEQA. An Initial Stud prepared b staff 5 acres in area,250 It in average width and Y P P Y 200 ft depth(84-38.608). was completed on August 6, 2007. The . No structure or building in an A-2 district shall Initial Study is presented in Appendix A. exceed 2i stories or 35 ft height.whichever is It identified potential geology and soils greater(84-38.802). ac im ts and identified mitigation • There shall be an aggregate side yard width of 40 P g ft. No side yard shall be less than 25 ft:barns, measures. The project proponent stables or other buildings used to house livestock, submitted a letter agreeing to the grain-fed rodents,bees,birds or poultry shall be setback 50 fl from the boundary of any residential mitigation measures,which allowed for the land use district(84-40.1002). tiling of a Notice of Intent to Adopt a . The front yard setback shall be at least 25 feet Proposed Mitigated Negative;Declaration (84-38.1006). on August 20, 2007. The period for • variances to lot dimension and setback standards can be ranted in accordance with Chapter 82-6. accepting comments on the;adequacy of the environmental documents extended to 5 p.1n. on September 10, 2007. During the 20-day comment period, no written comments were received. The Mitigation Monitoring Program is presented in Appendix B. S-5 D. Regulatory Programs. 1. Flood Hazards. The project site is designated Flood Zone C. (Source: FIRM Panel #360B, dated July 16, 1987.) 2. Active Fault Zone. The project site is not within an Alquist-Priolo Earthquake Fault Zone. (Source: CDMG Special Report 442, 1994.) 3. Noise Hazard. According to the Noise Element of the General Plan, the site is not within an area experiencing noise levels of> 60 dB LnN from highways. (Source: Noise Element, page 1 1-23). The Union Pacific railroad track that passes along the east boundary of the property is identified as a significant noise source. Noise levels are 73 LPN at 100 feet, and the distance to the 60 LnN noise contour extends 650 feet from the track. Figure 11-6 of the Noise Element indicates that noise levels of up to 75 LDN are "normally acceptable" for an agricultural area; conditionally acceptable" from 67'/2 to 77%2 LnN- 4. Hazardous Wastes: The site does not appear on the Hazardous Waste and Substance(Cortese)List published by the California Environmental Protection Agency. It lists all sites of contaminated water or soil that are known to the State of California. 5. Liquefaction Potential: With regard to liquefaction potential, the Safety Element of the General Plan divides Contra Costa County into three categories: "generally high,""generally moderate to low,"and"generally low." According to this map, the site and vicinity are in the "generally moderate to low" category. This map is used as a "screening criteria" by Contra Costa County during the processing of land development applications. The County requires rigorous evaluation of liquefaction potential in areas of"high potential", and less comprehensive investigations are demanded in the '.moderate to low" category. The classification "generally high" liquefaction does not imply the presence of liquefiable sands on a parcel. The map attempts to be conservative of the side of safety, and where geologically recent alluvial and esturine deposits are shown on soils maps of the County,the map considers the property to be in the"generally high"category. Site specific investigations are needed to determine if liquefiable sands are present and to provide stabilization measures where liquefiable sands: are confirmed. Because no portions of the site fall within in the "generally high" category, detailed quantitative evaluation of liquefaction potential is not required at this time. However, empirical evaluation of liquefaction potential is routinely required in the "generally moderate to low" category. In the experience of the County peer review geologist, only 1 acre of every 1,000 acres in the "generally moderate to low" i S-6 category have the unique set of conditions required for liquefaction of sands to be a hazard, and geotechnical measures are available to avoid/control the risk of damage. E. Previous Applications: 1. MS 46-86: The parcel that is the subject of RZ06-3182 and MS06-0021 is Parcel B of MS46-86. This was a three-lot subdivision of a 29.7-acre property. The parcel map was recorded on March 16, 1987. 2. LP2034-87. This application was a request for a second resident for a family member. The application was tiled by M & M Hansen. The request was approved by the Zoning Administrator on September 14, 1987 subject to ten Conditions of Approval (see Appendix C for the permit). COA #3 states the only persons living in the second residence shall be relatives within the third degree of consanguinity of the'owner of the primary residence. When LP2034- 87 was tiled the applicant submitted a Site Plan that shows the existing and proposed residences, driveways, water wells, leach .fields and accessory structures (see Figure 8). 3. LP05-2055. This application was a request for a home occupation on the subject parcel. It was filed by John Roberts on July 31, 2005, and denied on September 8, 2005. IV. AREA AND SITE DESCRIPTION Figure 1, Vicinity Map, shows the location of the site with respect to nearby communities in the East County area. It also shows 'the "urban limit line" (ULL) and the location of areas subject to inundation by the 100-year flood. According to this map the site is a) outside of the urban area, and b) is not subject to flooding. Figure 2, General Plan Map, shows the location of the site with respect to the Knightsen and Discovery Bay areas. It also shows the names of major roads and the prevailing parcel sizes. The parcel is located in the southeast quadrant of the Byron Highway/Eagle Lane intersection. Parcels in the Eagle Lane area range from 1.65 to more than 20 acres. Note that the site is within an area designated "Agricultural Land" (AL) by the General Plan. "The site is approximately 41,000 feet north of lands designated "Agricultural Core" (AC). Figure 3, Zoning Map, indicates the site is zoned A-3 (10-acre minimum standard parcel size). The property is in a developing area of rural ranchettes, with many owners stabling personal horses. Currently there are 18 parcels in the Eagle Lane neighborhood that are zoned A-2. Twelve of those A-2 parcel's are less than 5 acres in area. The remainder of the area is zoned A-3. The existing single;family residences vary in age, size and condition. S-7 Figure 4, Aerial Photograph, indicates the existing character of the site and vicinity at a scale of 1 inch = 1,000 feet. There are existing residences in the eastern portion of both proposed parcels. The site is fallow ground and covered with annual grasses with some ornamental trees and shrubs. Approximately 350 feet southwest of the property is the Union Pacific Railroad track. Figure 5, Noise Contours, indicates that the portion of the site within 650 feet of the railroad track is exposed to noise levels:of> 60 LDN. It also shows the 73 LnN noise contour(which is 100 feet from the railroad property). The existing residences on the site are within areas exposed to noise levels of less than 60 LDN- V. PROJECT DESCRIPTION The applicant and owner request approval to rezone a 9.90-acre parcel from A-3 to A-2, along with approval of Parcel Map to create two 4.95-acre parcels (see Figure 6). The VTM indicates that elevations on the site range from +20 to +22'/2 feet. (Total relief 2'/2 feet.) A variance is required to the minimum standard parcel size in the A-2 District (5 acres required; 4.95 acres proposed). Both proposed parcels are 572 feet deep and have average widths of 398 feet. VI. AGENCY COMMENTS A. Contra Costa County Fire Protection District. In a letter dated July 5, 2006, the .District outlines its requirements for this project. Those requirements include: a) District approval of plans prior to issuance of building permits;b)all-weather access with a width of 16 I:eet (minimum), c) specifications provided for visibility of property addresses; d) residences,to be sprinklered; e) if water well cannot supply 5 gallons/minute, a minimum 5,000-gallon reserve water supply tank is required per dwelling of up to 5,000 square feet; and f) homeowners shall maintain an effective firebreak. Because there are two residences on the site, there is no anticipated construction. Should building permits be required in the future,these requirements of the FPD would be operative. B. Public Works Department. In a'memorandum dated July 11, 2006 the department provided the following comments on traffic and circulation,drainage and storm water management: ■ Ti-afc and Circulation. The subject property fronts on Eagle Lane,a private road that also serves 25 to 30 other parcels from Byron Highway, approximately 0.6 miles to the north and west. Eagle Lane was previously constructed as a 16-foot- wide all-weather roadway. Many subsequent subdivisions in the vicinity of the proposed project have been required to construct off-site improvements to Eagle I S-s Lane to widen 100 feet of Eagle lane to a 204bot width with shoulders in accordance with County private rural road design standards. ■ Drainage. Currently, storm water runoff from the site is conveyed northerly via a roadside swale to an irrigation ditch owned and maintained by the East Contra Costa Irrigation District (ECCID). An exception from the collect and convey requirement of the County Ordinance Code may be appropriate in this case since no new impervious surfaces are 1proposed, provided that the existing drainage pattern is maintained and concentrated storm water runoff is not discharged onto adjacent properties. C. County .Health Services Department. In a memorandum dated July 13, 2006, the Department outlined its requirements for water supply and wastewater disposal. Because the water wells and septic systems are existing, the routine requirements of the Health Services Department would not be needed, but documentation of some type could be required (e.g. water quality or flow rates confirmed). D. East Contra Costa Irrigation District. In an e-mail dated July 12, 2006,the District's Development Services coordinator (states that stormwater runoff from the site is conveyed northerly via a roadside swale to the ditch which is owned and maintained by the District. As a condition of approval of other subdivisions in the area, the County has required that drainage rights be obtained. Currently 14 of the parcels located north and west of the Hansen parcel have entered into an agreement with the District for such services. Should the County condition the Hansen split in such a manner, the District would require that the landowner enter into an agreement with the District and pay the required fee's. The District also requests that the landowner submit a copy of the title report for the property to ensure that any easements no longer needed by the District are adequately quit-claimed. I E. California Historical Resources Information Center(CHRIS). In a letter dated July 5, 2006 CIIRIS states that the project area has a low possibility of containing unrecorded archaeologic sites and therefore no further study of archaeologic resources is recommended. The CHRIS letter indicates that the site could have historic structures if there are buildings that are 45 or more years old. Staff reviewed 1973 aerialphotographs of the site and found there were no structures on the property at that time (34 years ago). On thatbasisit is established that there are no historic structures on the property. I F. Office of the Sheriff. In a memorandum dated June 30, 2006, the Sheriff's office indicates they have no comments on this application. G. Knightsen Town Advisory Council (TAC). In a letter dated August 25, 2006 the Knightsen TAC indicates that they support the approval of the application. I i S-9 VII. STAFF CONSIDERATIONS A. Consistency with General Plan. The General Plan allows for a maximum density old 1 unit per 5 acres of lands in the AL category. Two residences on the 9.9-acre property do not quite meet this standard. The memorandum from the County Health Services Department indicates that water and septic system must comply with County requirements. In this case there are two existing residences. Each has water wells and septic systems that were approved by the Health Services Department. Over the years the wells and septic systems have performed satisfactorily. The County Public Works Department have standards for private roads, drainage and storm water control. The applicant is in agreement with those requirements. The County FPD has standards for emergency water supply for fighting a structural fire,and related issues. The applicant is in agreement with those standards. Figure 7, Annotated Parcel Map, indicates that there are several lots in the site vicinity that are less than 5 acres. Six of these lots are in minor subdivisions MS 170- 90,MS 171-90 and MS 172-90. These applications were tiled and deemed complete prior to adoption of the 1990-2005 County General Plan, which was adopted on January 29, 1991. it was the adoption of that General Plan that established the 5-acre standard for construction of a residence on AL designated land. These three minor subdivisions were consistent with the County General Plan that was in effect when those applications were deemed complete. The six parcels created by these three minor subdivisions range from 4.5 to 4.72 acres. In 1993 the County approved rezoning application 2982-RZ, which changed the zoning designation of a 9.36-acre parcel from A-3 to A-2. The following year an application was filed on the 2982-RZ site for approval of a minor subdivision(MS9-94). It was a request to approve a two- lot minor subdivision, creating lots of 4.68-acres each. MS 9-94 was approved largely because of its relationship to MS 170-90,MS 171-90 and MS 172-90. "Those properties are immediately south and east of the MS 9-94 project site. The justification for granting approval of this project was a) prevailing lot sizes in the immediate area, and b) the MS 9-94 site has been rezoned from A-3 to A-2 in 1993. In &,ranting approval of the minor subdivision application's;the Zoning Administrator considered of the Board of Supervisor's decision in approving the rezoning application; that approval was considered evidence of Board support for the minor subdivision application.) The site of another minor subdivision, MS 4-92, is located across Eagle Lane from the Hansen property. It was a request to divide 11.98 acres into two parcels. The eastern 5 acres of that site was in the PG&E easement that includes 130-foot-tall towers and high voltage lines. No buildings can be allowed in that easement. In recognition of the limitations inherent to such casements, the County granted approval of a 4.40-acre and a 7.58-acre parcel. The overall density of that project is consistent with the intent of the General Plan. The 4.40-acre parcel is nearly flat with no li►nitations for its use. The 7.58-acre parcel had approximately 2.58 acres that was i i S-10 available for a rural residence.'and accessory structures,with the remainder of the site available for grazing by domestic animals and serves as a private open space. With regard to zoning,the applicant is requesting a rezoning of the property from A-3 to A-2. (The provisions of the proposed A-2 District are presented in Appendix D.) In the A-2 district the minimum standard parcel size is 5 acres. IIowever,the parcels that would be created by approval of the application do not meet this standard. The proposed parcel size is 4.95 acres (see Figure 6). According to the Zoning Ordinance, Chapter 84-38, Article 84-38.608, uses allowable on A-2 zoned parcels are permitted only on parcels which equal or exceed 5 acres in net area. On that basis, a building permit for a residence, for example, could not be issued without the granting of a variance application. Based on the circumstances that exist in the Eagle :Lane area, the project appears compatible with applicable General Plan policies. B. Agency Comments. The agency comments do not oppose the application. They have outlined their requirements, and the applicant has indicated a willingness to comply. C. CEQA Comments. The responses were received that challenge the adequacy of the Initial Study or NOI. The only significant impact identified in the Initial Study is the potential for liquefaction sands in the subsurface. The mitigation measure is described on page 10 of;the Initial Study (see Appendix A). The Mitigation Monitoring Program is presented in Appendix B. The applicant has agreed to the mitigation measures. D. Staff Evaluation. The project represents one additional parcel in an area where ranchette development is occurring. The local road network consists of rural roads that are not designed for high traffic volumes. However, there are two existing residences, so no increase:in traffic is anticipated. It should be recognized that approval of each minor subdivision in this area serves as encouragement for other property owners to submit applications for their parcels. Nevertheless, the request' appears to comply with the intent and purpose of the General Plan policies and with agency requirements. No variances to the standards of the A-2 District are proposed, with the exception of the proposed parcel size. The parcel size requested for approval by the applicant is 1 percent less than a 5-acre lot. The property is gently sloping (1%), and has no biologic resource issues and no apparent conflicts with ranchette policies. i i i i i i i i CEQA Determination And Initial Study Community Contra tommuM ,loP ent-Dir dor Development Costa LJ L Department County IJ County Administration Building S�,L AUG 2 0 2001 651 Pine Street •"'� • -�' 4th Floor, North Wing �,J., WEIR COUNTY CLERK "�f! �` is y Martinez,California 94553-0095 � _��' •,-��I" NT _.ASTA COUNTY 9c. gY - - DEPUTY ssv _ .. . Phone: srA-csiir�`'` (925) 335-1210 August 20, 2007 i NOTICE OF PUBLIC REVIEW AND INTENT TO ADOPT A PROPOSED MITIGATED NEGATIVE DECLARATION County File #MS06-0021 & RZ06-3182 Pursuant to the State of California Public Resources Code and the"Guidelines for Implementation of the California Environmental Quality.Act of 1970"as amended to date,this is to advise you that the Community Development Department of Contra Costa County has prepared an Initial Study on the following project: i TOM POWERS (Applicant)and PHILLIP(&BARBARA H_A TSEN(Owners),County File 4MS06- 0021 & RZ06-3182: The applicant and; owners request rezoning of the property from Heavy Agriculture (A-3) to General Agriculture (A-2). In a related application they request vesting tentative parcel map (VTM) approval to subdivide 9.90 gross acres into two parcels. Both parcels comply with the lot dimension standards of the proposed A-2 zoning district,but they do not comply with the minimum parcel size standard. Therefore, applicant requests approval of a variance to the parcel size standard of the A-2 District(5 acres required; 4.95 acres proposed). The property fronts for 750 feet on the west side of Eagle Lane, approximately '/4-mile south of the right-angle bend in the aligninent of Eagle Lane. The property is located in the N'/2 Section 10, TIN, R3E, Mt. Diablo B&M, and is addressed 215 Eagle Lane,in the Knightsen area (-A-3) (ZAX-27 & M-28m) (CT 3040) (Parcel 01--110-026). The Initial Study identifies a potential geologic impact and proposes mitigation measures to reduce the impact to less-than-significant levels. The project proponent has submitted a letter agreeing to the mitigation measures. A copy of the Negative Declaration and all documents referenced in the Negative Declaration may be reviewed in the offices of the Community Development Department, and Application and Permit Center at the McBrien Administration Building;North Wing, Second Floor, 651 Pine Street, Martinez, during normal business hours. i i Office Hours Monday- Friday: 8:00 a.m. - 5:00 P.M. Office is closed theist, 3rd & 5th Fridays of each month I I I I I I I i I I I Public Comment Period-The period for accepting,comments on the adequacy of the environmental documents extends to 5:00 P.117, Monday; September 10, 2007. Any comments should be in writing and submitted to the following address: vName: DARWIN MYERS Community Development Department Contra Costa County 651 Pine Street. North Wing, 4th FIbor Martinez, CA 94553 I I It is anticipated that the proposed MitigatedllNegative Declaration Arill be considered for adoption at a meeting of the East County Regional Planning Commission on ?November 5,2007.The hearing of the Planning Commission is to be held at the Antioch City Council Chambers, 3rd and H Streets, in the City of Antioch. It is expected that the Commission will also conduct a hearing on the Mitigation Monitoring, Plan and applications at that same meeting. I I i I 1 v \ I I I DARNA,IN MYERS Project Planner cc: County Clerk's Office (2 copies) I I C:`J0E\D.4R\�'IN\CCCn"\N4SOG-0021 RZ06-3152 Notice.doc I I I I ' I I I I I i i I I i I I I I I I I I I I • I i ENVIRONMENTAL CHECKLIST FORM 1. Project Title: County File#MS06-0021 & RZ06-3182 2. Lead Agency Name and Address: Contra Costa County,Community Development Department,651 Pine Street, 4th Floor,N. Wing, Martinez, CA 94553. 3. Contact Person and Phone Number: Darwin Myers(925)335-1210 i 4. Project Location: The property fronts for 750 feet on the west side of Eagle Lane,approximately 1/4- mile south of the right-angle bend in the alignment of Eagle Lane. The property is located in the N'/2 Section 10,TIN,R3 E,Mt.Diablo B&M,and is addressed 215 Eagle Lane,in the Knightsen area(A- 3)(ZA:K-27 &M-28M)(CT 3040)(Parcel 015-110-026). 5. Project Sponsor's Name and Address: Tom Powers, 5371 Stonehurst Drive, Table l LAND USE&CONSERVATION ELEMENT Martinez, CA 94553. POLICIES APPLICABLE TO PROJECT I Land Use Element 6. General Plan Designation: Agricultural Policy 349. The density and development of single-family homes in the East County area,in lands designated for residential or other urban uses,shall be related to service availability criteria,as defined Land (AL). This is the designation below: Service.Availability Minimum Allowable Parcel Size applied to most privately-owned No public water or sewer connection available. 5 acres agricultural laud in the County. The:AL One public service(sewer or water)connection 1 acre available. Minimum parcel size consistent with the specified category includes non-prime agricultural Both public water and sewer connections General Plan densities,as well as drainage,health, available and other applicable standards. lands in flat East County areas, such as Conservation Element outside Oakley, which are planted in Policy 8-29. Large contiguous areas of the County should be encouraged to remain in agricultural : production,as long as economically viable vineyards and orchards. Some ofithe Policy 8-30. In order to reduce adverse impacts on agricultural and environmental values,and to reduce urban costs to taxpayers,the County shall not designate land located outside the ULL for an urban land Agricultural Lands east of Oakley and use. Byronare included in the 100- ear fibUd Policy 8-31 Urban development in the future shall take place within the Urban Limit Line and areas J 00-year by this plan for urban growth. plain, as mapped by the Federal Policy8-32. Agriculture shall be protected to assure a balance inland use.The policies ofMcasure C- 1 1990 shall be enforced. Emergency 'Management Agency Policy R-33.The County shall encourage agriculture to continue operating adjacent to dnckipingurban (FEMA). The Land Use Element states 8fea, PolicyR-34. Urban developments shall be required to establish effective buffers between them and land (on page 3-23) that the maximum planned for agricultural uses. Policy 8-35. Residents in or near agricultural areas shall be informed and educated regarding the allowable density in this category is,one potential nuisances and hazards associated with nearby agricultural practices. dwelling unit per 5 acres. The purpose Policy 8.36. Agriculture shall be protected from nuisance complaints from no land uses. Agricultural Resource Implementation Measures of this designation is to preserve 1 and Policy 8-v Requests for subdivision of lands designated for agricultural or open space uses shall be protect lands capable of and generally 1 reviewed for consistency with this plan according to the following criteria: 1 (1) Cities should be informed in a timely manner when applications are filed and consulted as to their used for the production of food, fiber ultimate plans in the relevant area. 1 (2) Agricultural/Open Space subdivisions arc considered a long-ter ,rural/residential use of land. and plant materials. The followins ng Parcel size shall be a minimum of 5 acres in lands designated Agricultural Lands and 20 Acres in standards shall apply to all uses allowed lands designated Delta Recreation and 40 acres in lands designated prime productive agricultural lands. in the AL designation: 1 (3) Anvapplication for parcels to be separated from a larger parcel or parcels under the same ownership : shall indicate on the plan all of the contiguous land held by the applicant. (4) Prior to the filing of the Final or Parcel Map the applicant must comply with the following: 1 a) Each parcel must have an"on-site"producing well yielding 3 gal./min.and meeting water (1) Any subdivision of lands :shall quality standards(Title 22,Section 64433);or include conditions of approval b) Have verifiable water availability from adjacent parcels;or c) In addition to the above,have a hydrogeological evaluation,which will address seasonal as well which conform with ; the as yearly variations. requirements irements of the "Ranchette (7) The land must be suitable for septic lank use according to the County Ordinance Code criteria and 9 Health Services Department Regulations. Percolation tests must be passed on all IoLs prior to the Policy", which is outlined in the filing of the Parcel or Final Map. : (13)Exception to any ofthe above Rural Residential Ranchette criteria may be considered by the hearing "Agricultural Resources"section of body upon a showing,in writing,of unique or unusual circumstances relative to.the subject the Conservation Element (Chapter property. 8); and : I 2 (2) Residential and non-residential uses proposed in areas of special flood hazards, as shown on FEMA maps,shall conform to the requirements of the County Floodplain Management Ordinance (County Ord.487-45)and the further requirements outlined in the"Delta Recreation"section(d) (5). in the case of the subject property, it is not subject to flooding: General Plan Policies that appear most applicable to the project are listed in Table 1. 7. Zoning: Heavy Agricultural(A-3). The Table 2 Ordinance Code provisions governing SUMMARY OF ZONING STANDARDS FOR THE A-3 DISTRICT standards in the A-3 district are presented in Chapter 84-40. Table 2 No structure shall be permitted in the A-3 district on a lot less than 140 presents a summary of zoning standards. feet in average width(84140.604). The minimum standard parcel size in the There is no minimum lot depth standard(84-40.606). A-3 District is 10 acres. There is no maximum building and structure height restriction(84- 40.802). • No side yard shall be less than 25 feet;barns,stables or other buildings 8. Description of Project:The applicant and used to house livestock,grain-fed rodents or poultry shall be setback 50 owners request rezoning of the property feet from the boundary of any residential land use district(84-40.1002). from Heavy Agriculture(A-3)to General The front yard setback shall be at least 25 feet(84-40.1004). Agriculture (A-2). A summary of • The rear yard setback shall be at least 25 feet(84-40.1002). standards of the A-2 District are Variances to lot dimension and setback standards can be granted in presented in Table 3. In a related accordance with Chapter 82-6(84110.1202). application they request vesting tentative parcel ]nap approval to subdivide 9.90 gross acres into two lots of 4.95 acres Table 3 each. The map indicates a 30-foot-wide SUMMARY OF ZONING STANDARDS strip is to be dedicated to the County FOR THE A-2 DISTRICT along, the east flank of the site for the Uses allowable under Article 84.38.4 shall be permitted in the A-2 ultimate width of Eagle Lane. This district only on lots which equal or exceed all of the following: dedication amounts to an area of 0.52 5 acres in area,250.ft in average width and 200 ft depth(84- 38.608). acres. Both lots comply with the lot • No structure or building in an A-2 district shall exceed 2%z stories or35 dimension standards of the proposed A- ft height,whichever is greater(84-38.802). 2 zoning district,but they do not comply • There shall be an aggregate side yard width of 40 ft. No side yard shall with the 5-acre minimum parcel size be less than 25 ft; barns, stables or other buildings used to house standard. In summary, approval of the livestock,grain-fed rodents.bees,birds or poultry shall be setback 50 ft minor subdivision requires approval of from the boundary of any residential land use district(84-40.1002). the rezoning (from A-3 to A-4) and • The front vard setback shall be at least 25 feet(84-38.1006). *ranting of a variance to the minimum • Land Use permits and variance permits granted in accordance with standard parcel size in the A-2 District. Chapter 82-6 (84-38.1202). (There is no provision to variance to section 84-38.608). 9. Surrounding Land Uses and Setting: Prevailing parcel sizes in the Eagle Lane neighborhood range from 1.65 to 20 acres. Currently there are 31 parcels.in a triangular shaped area that is bounded by the AT & SF railroad tracks (on the southwest), high voltage lines (on the east) and by the east-west oriented segment of Eagle Lane (on the north). The property is in a developing area of rural ranchettes, with many owners stabling personal horses. Currently there are 18 parcels in the neighborhood that are zoned A-2 including parcels immediately north of the site, and across Eagle Lane from proposed Parcel A. Nine of those A-2 parcels are less than 5-acres in area. The remainder of the area is zoned A-3. The existing single-family residences of vary in age, size and condition. Topographically the property is on the floor of the San Joaquin Valley and the site is nearly level (elevation +20 feet). i i 3 10. Other Public Agencies Whose Approval is Required: Building Inspection Dept. for grading and building permits; Public Works Dept. for road,drainage and clean water requirements; County Health Services Dept., for well water and septic system approval; County Fire Protection District for compliance with fire-related codes;and ECCID for drainage easement approval. . ENVIRONMENTAL FACTORS POTENTIAL AFFECTED: The environmental factors checked below would be potentially affected by this project,involving at least one impact that is a"Potentially Significant Impact" as indicated by the checklist on the following pages: ❑ Aesthetics ❑ Agricultural Resources ❑ Air Quality ❑ Biological Resources El Cultural Resources 9 Geology/Soils ❑ Hazards R Hazardous Materials ❑ Hydrology/Water Quality ❑ Land Use/Planning ❑ Mineral Resources El Noise ❑ Population/Housing ❑ Public Services ❑ Recreation ❑ Transportation/Traffic ❑ Utilities/Service Systems ❑ Mandatory Findings of i Significance DETERMINATION: On the basis of this initial evaluation: D I find that the proposed project COULD NOT have a significant effect on the environment, and a NEGATIVE DECLARATION will be prepared. O 1 find that although the proposed project COULD have a significant effect on the environment,there will not be a significant effect in this case because revisions in the project have been made by or agreed to by the project proponent. A MITIGATED NEGATIVE DECLARATION will be prepared. ❑ I find that the proposed project MAY have a significant effect on the environment, and an ENVIRONMENTAL IMPACT REPORT is required. ❑ 1 find that the proposed project MAY have a"potentially significant impact"or"potentially significant unless mitigated"impact on the environment,but at least one effect(1)has been adequately analyzed in an earlier document pursuant to applicable legal standards,and(2)has been addressed by mitigation measures based on the earlier analysis as described on attached sheets. An ENVIRONMENTAL IMPACT REPORT is required, butiit must analyze only the effects that remain to be addressed. ❑ I find that although the proposed project could have a significant effect on the environment,because all potentially significant effects(a)have been analyzed adequately in an earlier EIR or NEGATIVE .DECLARATION pursuant to applicable standards,and(b)have been avoided or mitigated pursuant to that earlier EIR or NEGATIVE DECLARATION,including revisions or mitigation measures that are imposed upon the proposed project; nothing further is required. i i 2-667 Darwin Myers, Project Planner Date i I I 1 4 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact I I. AESTHETICS-Would the project: I - A. Have a substantial adverse effect on a scenic vista? X B. Substantially damage scenic I resources,including,but not limited to,trees,rock outcroppings, and historic buildings within a I state scenic highway? I X C. Substantially degrade the existing I visual character or quality of the site and its surroundings? X D. Create a new source of substantial light or glare which would adversely affect day or nighttime views in the area? X I Summary: The Transportation and Circulation Element(Figure 5-4, pg. 5-22) identifies scenic routes and the Open Space Element(Figure 9-1,pg.9-6)identifies scenic ridges and waterways. According to these maps Byron Highway is classified as a scenic route in the project vicinity;there are no scenic ridges or waterways in the Knightsen area. With regard to terrain features,the site is a relatively level and drainage is not well defined. There are no creek corridors or wildlife corridors in the site vicinity. I The proposed project is not visible from a scenic,route and will not substantially change the visual character of the neighborhood. It is not expected to result in any change views of the site from the adjacent rural neighborhood in the foreseeable future. There is an existing residence'on each proposed lot,and no construction is anticipated at this time. Lighting in the project is typical of residential development. No streetlights are proposed.Therefore,nighttime lighting is not expected to be a significant impact. i if. AGRICULTURAL RESOURCES:In determining whether impacts to agricultural resources are significant environmental. effects, lead agencies may refer to the California Agricultural Land Evaluation and Site Assessment Model(1997)prepared by the California Dept.of Conservation as an optional model to use in assessing impacts on agricultural and farmland. Would the project: I A. Convert Prime Farmland,Unique Farmland,or Farmland or Statewide Importance(Farmland).as shown on the maps prepared pursuant to the Farmland Mapping and Monitoring Program of the California Resources Agency,to non-agricultural use? X B. Conflict with existing zoning for agricultural use,ora Williamson Act contract? X I I I I I I I I I I i 5 iLess than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact C. Involve other changes in the existing environment which,due to their location or nature,could result in conversion of Farmland, to non-agricultural use? X Summary: According to the Conservation Element(pg. 8-22)the site is classified as"important agricultural area".The property is outside of the Urban Limit Line (ULL). Agricultural resource goals are to a) encourage and enhance agricultural uses, b) conserve prime agricultural sbils that are outside of the ULL, c) minimize conflicts between agricultural and urban uses,and d)encourage cooperation between the County and cities in preservation of agricultural lands. The project will not conflict with any Williamson Act contract, and is not expected to change the range of potential uses on the site or adjacent parcels. According to the Soil Survey of Contra Costa County,the property is mapped as the Marcuse clay(Mb). It is a non- prime(Class IV)agricultural soil with slopes less than 2%. Its primary limitations for agricultural use are drainage and alkalinity(i.e. unsuited to most crops because it is affected by saline-alkali salts). Because of the small size of the site (9.9 acres)and the imitations imposed by the prevailing soil conditions, a commercial agricultural use is not feasible. With regard to engineering characteristics of the soils,the Soil Survey of Contra Costa County(1977)states that these soils are highly expansive,and are characterized by a very high corrosivity to uncoated steel(Table 5,page 82);and the shear strength of these soils is"medium to low"(Table 6,page 96). 111. AIR QUALITY-Where available,the significance criteria established by the applicable air quality management or air Pollution control district may be relief upon to make the following determinations. Would the project: A. Conflict with or obstruct implementation of the applicable air quality plan? X B. Violate any air quality standard or contribute substantially to an existing or projected air quality violation? X C. Result in a cumulatively considera- able net increase of any criteria pollutant for which the project region is non-attainment tinder an applicable federal or state ambient air quality standard(including releasing emissions which exceed quantitative thresholds for ozone precursors)? X D. Expose sensitive receptors 1.0 i substantial pollutant concentrations? X E. Create objectionable odors affecting a substantial number of people? X Summary: The project does not represent conversion of an undeveloped property. Currently there are two residences on a 9.9-acre property. No construction is proposed at this time. Normally air quality effects of a project are associated with:a)construction of structures/residences(e.g.,emission of trucks carrying building materials and equipment to the I 6 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact site;emissions of pollutants associated with operation of power tools,and grading/foundation laying equipment;vehicle emissions associated with commute trips to the project by construction workers). Over the lona term, vehicle trips associated with the residential use and emissions associated with typical residential development are anticipated(e.g., landscaping-related emissions from gas-powered equipment,barbeque/fire-place emissions,etc.). Due to the nature of the application and the fact that the residences are existing,no new emissions are anticipated. Projects of this size are not reviewed by BAAQMD because the cumulative effects are so low that the.District has elected not to respond to lead agency referrals. 1V. BIOLOGICAL RESOURCES-Would the project: A. f lave a substantial adverse effect, either directly or through habitat modifications.on any species identified as a candidate, sensitive,or special status species in local or regional plans,polices, or regulations,or by the California Department of Fish and Game or U.S.Fish and Wildlife Service? ?t B. Have a substantial adverse effect on any riparian habitat or other sensitive natural community identified in local or regional plans.policies,regulations or by the California Department of Fish and Game or U.S. Fish and Wildlife Service`? X C. 1-lave a substantial adverse effect on federally protected wetlands as defined by Section 404 of the Clean Water Act(including,but not limited to.marsh.vernal pool,coastal,etc.)through direct removal,filling,hydrological interruption,or other means? X D. Interfere substantially with the movement of any native resident or migratory fish or wildlife species or with established native resident or mieratory wildlife corridors,or impede the use of native wildlife nursery sites? X F. Conflict with any local policies or ordinances protecting biological resources,such as tree preservation policy or ordinance? X F. Conflict with the provisions of an adopted Habitat Conservation Plan,Natural Community Conservation Plan, or other approved local,regional,or State habitat conservation plan? a 7 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact Summary: Existing improvements on the site'include two residences,barns, and associated outbuildings, along with fenced horse corrals and a riding arena are als6 located on the property.A small,man-made pond is also present on the property. This pond was built circa 1987 by the Hansens to provide retention of potential winter flood waters. The first few years after the pond was built it filled a few inches deep from ground water alone. This pond no longer receives ,,round water contributions due to changes in the surrounding landscape(that is,development in the area)and only fills during heavy storm events. The County's biologic consultant,Monk&Associates(M&A)made a site visit in September 2006. At that time the pond was dry. Several;cotton less cottonwood trees(Populus deltoides)and narrow leaf willows (Salix sp.)grow in this pond,along with an emergent and herbaceous vegetative cover composed of narrowleaf cattail (Tvpha angustifolia), salt grass (Distichlis spicata), and rabbit's foot grass (Polypogon monspilensi.$), among other plants. Several ornamental tree species are present on the property, all planted by the Hansens. The property was treeless at the time the Hansens purchased it. Ornamental trees present on-site are cotton less cottonwood, weeping willow (Salix babylonica),and eucalyptus(Eucalyptus spp.). One native tree does occur on-site,a large Fremont cottonwood(Populus fremontii)tree. It is a volunteer that is located near one of the residences. The horse corrals support ruderal(weedy)vegetation typical of grazed conditions. Ruderal plants are those that thrive under continual disturbance. These are typically non-native species of Mediterranean or Asian origin. Italian rye grass(Lolitur:multi�lorum), stinking dittrichia(Dittrichia grcn-eolens), Mediterranean barley(Hof deum irrarinum gussoneanum),yellow star thistle(Centaursolslitalis), canary grass(Phalaris sp.),and bur clover(Medicago polvmor pha)were dominant species growing in the horse pastures at the time of M&A's survey. All of these species are non-native weeds. The stinking dittrichia is of very recent origin in California, first being documented in the state as recently as 1997. This plant is now rapidly spreading throughout California's open spaces. Few wildlife were observed on the propefty at the time of the September survey. A turkey vulture(Catharses aura) was soaring overhead.An American kestrel(Falcosparverius)was observed hunting over the horse pasture. A black-tailed hare(Lepus californicus)scurried into hiding when M&A approached it in the horse pasture. Finally,a flock of American crows(Corvus brachvrhynchos)was observed overhead. The Hansen property does not support any native plant communities or wildlife habitats,or any sensitive biological communities. Hence, subdivision of the;Hansen property into two lots should not have an adverse effect on biological resources. Impacts to biological resources from the proposed two lot subdivision would be less than significant pursuant to CEQA. The County has a Tree Protection and Preservation Ordinance(commencing with Article 816-6.2). Trees falling tinder the jurisdiction of this Ordinance are those that are 6'/2 inches in diameter at 4'/z feet above ground level. The Ordinance requires replacement of any,protected trees that are approved for removal. On the project site there are trees that meet these criteria, but in this case no trees are proposed for removal. V. CULTURAL RESOURCES- Would the project? A. Cause a substantial adverse change in the significance of a historical resource as defined in§15064.5? X B. Cause a substantial adverse change in the significance of an I I 8 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact archaeological resource pursuant to§15064.5? X C. Directly or indirectly destroy a unique paleontological resource or site or unique geologic feature? X D. Disturb any human remains, including those interred outside of formal cemeteries? X Summary: A memorandum issued by the California Historical Resources Information System(CHRIS)dated July 5, 2006 indicates that the site has a low possibility of containing unrecorded archaeological sites, and consequently an archaeologic survey is not recommended. Nevertheless,CHRIS recommends that: a)if artifacts are uncovered during earthwork,grading be stopped until a qualified archaeologist has evaluated the significance of the find and advised the County;and b)special regulations are operative if remains of a Native American are discovered. In this case no grading or construction is proposed. The letter from CHRIS raised a question 'about possible historic structures on the site, indicating that buildings or structures more than 45 years old may be of historic value. Analysis of aerial photographs flown in 1973(33 years ago) by the Community Development Department staff indicates that there were no structures on the property at that time. Consequently,all existing buildings were constructed within the last 33 years and hence do not require evaluation of their possible historic significance. VI. GEOLOGY AND SOILS-Would the project? A. Expose people or structures to potential substantial adverse effects, including the risk of loss, injury,or death involving:; I. Rupture of a known earthquake fault,as delineated on the most recent Alquist-Priolo Earthquake Fault Zoning Map issued by the State Geologist for the area or based on other substantial evidence of a known fault? Refer to Division of Mines and Geology Special Publication 42. X 2. Strong seismic ground shaking? X 3. Seismic-related ground failure, including liquefaction? X 4. Landslides'? X B. Result in substantial soil erosion or the loss of topsoil? X C. Be located on a geologic unit or soil that is unstable,or that would become unstable as a result of the project.and . potentially result in on-or off-site I i i 9 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact landslide,lateral spreading,subsidence, liquefaction or collapse? X D. Be located on expansive soil,as defined in Table 18-1-B of the Uniform Building Code(1994), creating substantial risks to life or property? X E. Have soils incapable of adequately supporting the use of septic tanks or alternative waste disposal systems where sewers are not available for the disposal of waste water? X Summary: The most recent map of Quaternary deposits is mapping of the U.S.Geological Survey.' According to this map,the site is underlain by basin deposits(Qhb)of Holocene age. Dune sands(Qds)of early Holocene and Pleistocene age are inferred to underlie the site at depth, and are exposed in low sand hills in the vicinity of the site. Other Quaternary deposits mapped in the Knightsdn area include natural levee deposits(Qhl)and peaty mud deposits(Qhpm), both of Holocene age. The site is not located in an Alquist-Priolo Earthquake fault zone. The nearest A-P zone encompasses traces of the Greenville fault. It is mapped approximately 14 miles southwest of the property;and the Concord and Calaveras faults pass approximately 21 and 22 miles west: ,and southwest of the property, respectively. These faults are considered capable of generating an earthquake of magnitude 6.5 to 7.0. Additionally,a seismically-active blind thrust belt underlies the Coast Range—Great Valley geomorphic boundary,and passes through the eastern portion of Contra Costa County. The precise location of the Great Valley Fault System and associated blind-thrust faults are not well known because the earthquakes on this fault system do not result in surface fault rupture at the ground surface. Earthquakes associated with the Great Valley fault system include the 1983 Coalinga earthquake and 1985 Kettleman Hills earthquake,of magnitudes 6.7 and 6.1 respectively. Additionally,two greater than 6.0 magnitude earthquakes are believed to have occurred on the fault system in 1892 near Winters and Dixon. Similar magnitude (or larger) seismic events could originate on the segment of this fault system that passes through eastern Contra Costa County. Wakabayashi and Smith (1994)have proposed preliminary segmentation of the Great Valley Fault System.z In the Alameda-Contra Costa County area,a 30- kilometer-long segment with a characteristic earthquake magnitude of 6.7 is indicated. Overall,Wakabayashi and Smith state the recurrence interval for the average Great Valley Fault segment,as estimated from historical seismicity,is 360 to 440 years. With regard to liquefaction potential,the Safety Element of the General Plan divides Contra Costa County into three categories: "generally high," "generally moderate to low," and "generally low." According to this map, the site and vicinity are in the"generally moderate to low" category. This map is used as a"screening criteria"by Contra Costa County during the processing of land development applications. The County requires rigorous evaluation of liquefaction Potential in areas of"high potential', and less comprehensive investigations are demanded in the"moderate to low" category. The classification"generally high"liquefaction does not imply the presence of liquefiable sands on a parcel. Tile map attempts to be conservative of the side of safety,and where geologically recent alluvial and esturine deposits are 'Helley E.J. and R.W.Graymer,'1997. Quaternary•Geologv of Contra Costa County and Surrounding Parts of .4lameda, Var•in, Sonoma, Solano, Sacramento and San Joaquin Counties, California,a Digital Database. U.S.Geological Survey,Open File Report 97-98. Wakabayashy,J.,and Smith,D.L., 1994,Evaluation of Recurrence Intervals, Characteristic Earthquakes, and Slip Rates.4.ssoc:iated with Thrusting along the Coast Range-Central I alley Geomorphic Boundary, California,Bulletin of the Seismological Society of America,Vol.84,No.6. 10 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact shown on soils maps of the County,the map considers the property to be in the"generally high"category. Site specific investigations are needed to determine if liquefiable sands are present and to provide stabilization measures where liquefiable sands are confirmed. Because no portions of the site fall within in the"generally high"category,detailed quantitative evaluation of liquefaction potential is not required at this time. However, empirical evaluation of liquefaction potential is routinely required in the"generally moderate to low"category. In the experience of the County peer review geologist,only 1.acre of every 1,000 acres in the"generally moderate to low"category have the unique set of conditions required for liquefaction of sands to be a hazard,and geotechnical measures are available to avoid/control the risk of damage. Environmental Analysis 1. Liquefaction Potential Potential Impact: There is an unknown,but potentially significant,risk of liquefaction because the property is within and area rated"generally moderate to low"liquefaction potential. In this case the residences are existing, the proposed parcel size is approximately 5-acres and the risks of liquefiable sands being present in the subsurface is relatively low. For those reasons it would be premature to require further geotechnical evaluation at this time. Nevertheless,evaluation of this hazard is warranted prior to issuance of a future residential building permit on either parcel. The purpose of the investigation shall be to confirm/modify the preliminary interpretation that liquefiable sands are probably not present in the subsurface. However, should loose, saturated sands be confirmed on the site the report shall provide recommendations to control/avoid settlement and ground cracking. A4itigation Measure a) Deed Disclosure. Prior to ,recordation of the Parcel Map the applicant should submit a draft deed disclosure statement advising prospective buyers and owners of both parcels of the risk of liquefaction, and of the requirement for a geotechnical investigation prior to issuance of a building permit for a residence. h) Geotechnical Report. At least 30 days prior to issuance of a building permit for a residence, submit a preliminary geology, soil, and foundation report meeting the requirements of Subdivision Ordinance Section 94-4.420 for review and approval of the County Peer Review Geologist. Improvement,grading, and building plans shall carry out the recommendations of the approved report. This report.shall include evaluation of the potential for ligtiefac•1ion, seismic .settlement and other types of seismically-induced ground.failure, along with analysis of expansive soils and corrosive soils by recognized methods appropriate to.soil conditigns discovered dur•ing.subsuiface investigation. VII. HAZARDS AND HAZARDOUS MATERIALS- Would the project: A. Create a significant hazard to the public or the environment through the routine transport,use,or disposal of hazardous materials? X 11 I..ess than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact B. Create a significant hazard to the public or the environment through reasonably foreseeable upset and accident conditions involving the release of hazardous materials into the environment? X C. Emit hazardous emissions or handle' hazardous or acutely hazardous materials,substances,or waste within one-quarter mile of an existing or proposed school? X D. Be located on a site which is included on a list of hazardous materials sites compiled pursuant to Government Code Section 65862.5 and,as a result, would it create a significant hazard to the public or the environment? X E. For a project located within an airport land use plan or,where such a plan has not been adopted,within two miles of a public airport or public use airport,would the project result in a safety hazard for people residing or working in the project area. X P. For a project within the vicinity of a private airstrip,would the project result in a safety hazard for people residing or working; in the project area'? X G. Impair implementation of or phvsically interfere with an adopted emergency response plan or emergency evacuation plan? X 13. Expose people or structures to a sienificant risk of loss,injury or death involving wildland firds, including where wildlands arc adjacent to urbanized areas 6r where residences are intermixed with wildlands? X Summary: The project site is not a known hazardous waste site. Cortese List,issued by the State of California,lists all sites of ground water and soil contamination known to the State. The nearest listed site is located in the northeast quadrant of the State Route 4./Delta Road intersection(approximately 2 miles northwest of the RZ06-3182/MS06-0021 project area). The site on the Cortese list is addressed 139 Hill Avenue;its status is"certified/operation&maintenance 12 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact as of June 28,2006". The site that is the subject of the pending rezoning/minor subdivision applications is not located with the vicinity of a public use airport,and there are no private airstrips within one mile of the site. There are no known buried fuel tanks on the site. The project is consistent with the General Plan Policies 10-61 through 10-70(hazardous materials policies);and Policies 10-83 through 10-90(public protection and disaster policies). The property is not located in a high or moderate wildfire hazard area(source: General Plan Figure 10-10,Fire Hazard Areas). VIII. HYDROLOGY AND WATER QUALITY:- Would the project: A. Violate any water quality standards or waste discharge requirements? X B. Substantially deplete groundwater supplies or interfere substantially with groundwater recharge such that there would be a net deficit in aquifer volume or a lowering of the local groundwater table level(e.g.,the production rate of pre-existing nearby wells would drop to a level which would not support existing land uses or planned uses for which permits have been granted)? X C. Substantially alter the existing drainage pattern of the site or area; including through the alteration of the course of a stream or river,in a manner which would result in substantial erosion or siltation on-or off- site? X D. Substantially alter the existing drainage pattern of the site or arca,including through the alteration of the course of a stream or river,or substantially increase the rate or amount of surface runoff in a manner which would result in flooding on-or orf-site? X E. Create or contribute runoff wafer which would exceed the capacity of existing or planned storm water drainage systems or provide substantial additional sources,of polluted runoff? X i I 13 Less than , Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact F. Otherwise substantially degrade water quality? X G. Place housing within a 100-year flood hazard area as mapped on a federal Flood Hazard Boundary or Flood Insurance Rate Map or other flood hazard delineation map? X H. Place within a 100-vear flood hazard area structures which would impede or redirect flood flows? X 1. Expose people or structures to a significant risk of loss;injury or death involving flooding, including flooding as a result of the failure of a levee or dam? X . J. Inundation by seiche,tsunami, or mudflow? X Summary: The property is not subject to inundation by the 100-year flood (Source: FEMA Panel 360B). Review of inundation maps prepared by owners of dams that fall under the jurisdiction of the State Department of Water Resources, (Division of Safety of Dams) indicates the site is not subject to flooding that results from failure of any dam in the County. The property is not subject to tsunami or seiche-related flooding.' The effect of the project on peak flows in the ECCID irrigation ditch is less than significant. The following comments provide background information on the site drainage: • The site is not located in an established drainage area. No drainage fees are required. • There is no watercourse on the site, and no well defined drainage channel in the vicinity. • Currently,runoff from the site drains to'an existing ditch on the east flank of the property. Runoff is conveyed to the north and ultimately discharges to an ECCID irrigation ditch,which conveys runoff to the east. In an July 11`x',2006 memorandum,the Public Works Department indicates the following: • An exception from the collect and convey requirement of the County Ordinance Code may be appropriate in this case since no new impervious surfaces are proposed,provided that the existing drainage pattern is maintained and concentrated storm water runoff is not discharged onto adjacent properties. • A Storm Water Control Plan (SWCP) is required. It is subject to review and approval of the Public Works Department,in compliance with the Stormwater Management and Discharge Control Ordinance,the Stormwater C.3 Guidebook, and requirements of the Regional Water Quality Control Board. The SWCP shall be certified by a licensed professional Civil En-ineer,;Architect,or Landscape Architect and accompanied by a completed SWCP checklist. The purpose of the SWCP is to specify how the ultimate built project will incorporate site design characteristics,landscape features and Best Management Practices(BMPs)that minimize imperviousness,retain or detain storm water, slow runoff rates and reduce pollutants in post-development runoff. The SWCP must incorporate measures to treat storm water runoff before it is discharged from the site. These treatment facilities must be Regional Water Quality Control Board. The SWCP must also identify responsibility for and a mechanism to 3 Ritter,J.R.and W.R.Dupre, 197?.:flaps Showing Areas of Potential Inundation by Tsunamis in the San Francisco Baty Region, California, U.S. Geological Survey,(Miscellaneous Field Studies Map MF-480). I I I . . I I 14 I I Less than l Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact I ensure maintenance of treatment facilities iIn perpetuity(this shall include any necessary land rights and funding mechanisms). The SWCP is separate from land in addition to a Storm Water Pollution Prevention Plan(SWPPP). The SWCP must be coordinated and integrated with preparation of the site layout, landscaping,and drainage. I • The applicant may attempt to demonstrate that the proposed subdivision could not result in more than one acre of impervious surface by providing easements;deed restrictions,or other encumbrances ensuring that certain areas/lots will remain pervious. I I IX. LAND USE AND PLANNING-Would I the project: A. Physically divide an established l community? l X B. Conflict with any applicable land use plan,policy,or regulation of an agency with jurisdiction over the project(including,but not limited to the general plan,specific l plan,local coastal program,or zoning ordinance)adopted for the l purpose of avoiding or mitigating an environmental effect? X C. Conflict with any applicable habitat conservation plan or natural community conservation plan? X I Summary: The project will not physically divide the community. It is a request to continue a pattern of parcel fragmentation and development of rural ranchettes in the Eagle Lane area of Knightsen. Approximately half the properties in the neighborhood are currently Zone A-2,and the soils on the property and adjacent lands are non-prime i agricultural soils. I Table 3-4 of the General Plan prescribes the density standard for each land use category that allows residential use. Resi For"Agricultural Lands"(AL),the density of residences is 0.2 units per gross acre(i.e.one residence per 5 acres). That is the maximum density consistent with the General Plan AL category. I Figure 4, Parcel Map, indicates that there are several lots in the site vicinity that are less than 5 acres. Six of these lots are in minor subdivisions MS 170-90,MS 171-90 and MS 172-90. These applications were filed and deemed complete prior to adoption of the 1990-2000 County General Plan. It was the adoption of that General Plan that established the 5- acre standard for construction of a residence on AL designated land. These three minor subdivisions were consistent with the County General Plan that was in effect when those applications were deemed complete. The site of another minor subdivision, MS 4-92, is located across Eagle Lane from the Hansen property. It was a request to divide 11.98 acres into two parcels.The eastern 5 acres of that site was in the PG&E easement that includes 130-foot-tall towers and high voltage lines. No buildings can be allowed in that easement. In recognition of the limitations inherent to such easements, the County granted approval of a 4.40-acre and a 7.58-acre parcel. The overall density of that project is consistent with the intent of the General Plan.!The 4.40-acre parcel is nearly flat with no limitations for its use. The 7.58- acre parcel had approximately 2.58 acres that was available for a rural residence and accessory structures, with the remainder of the site available for grazing by domestic animals and serves as private open space. MS 9-94 was a request I I I I I l I 15 Less than Significant Potentially with Less"than Significant Mitigation Significant No Impact Incorporation Impact Impact for approval of a two-lot minor subdivision;of a 9.36 acre parcel. MS 9-94 was approved largely because of its relationship to IVIS 170-90,MS 171-90 and MS 172-90.Those properties are immediately south and east of the MS 9-94 project site. The justification for granting approval of this project was a)prevailing lot sizes in the immediate area,and b) the MS 9-94 site had been rezoned from'A-3 to A-2 in 1993. (i.e. in granting approval of the minor subdivision application,the Zoning Administrator considered that decision of the Board of Supervisors in approving the rezoning application:that approval was considered evidence of Board support for the minor subdivision application.) With regard to zoning of the property,the applicant is requesting a rezoning the Hansen property from A-3 to A-2. In the A-2 category the minimum standard parcel size is 5 acres. However,the parcels that would be created by approval of the application do not meet this standard. According to the Zoning Ordinance, Chapter 84-38, Article 84-38.608, uses allowable on A-2 zoned parcels are permitted only on parcels which equal or exceed 5 acres in net area.On that basis,a building permit for a residence, for example,could not be issued without the granting of a variance application. X. MINERAL RESOURCES-Would the project: A. Result in the loss of availabiliric of a known mineral resource that would be of value to the region and the residents of the State? X B. Result in the loss of availability of a locally-important mineral; resource recovery site dclincafed on a local general plan,specific plan or other land use plan? X Summary: The California Department of Conservation has issued a report that classifies the mineral resource potential of lands in the San Francisco Bay Region:(DMG Open File Report 96-03). According to that report,the site is classified MRZ-1,which includes areas where"adequate information indicates that no significant mineral deposits are present or where it is judged that little likelihood exists for their presence." XI. NOISE-Would the project? A. Exposure of persons to or generation of noise levels in excess of standards established in the local general plan or noise ordinance,or applicable standards of other agencies? X B. Exposure of persons to or generation of excessive ground- borne vibration or ground borne noise levels? X C. A substantial permanent;increase in ambient noise levels in the project vicinity above levels existing without the project? X I 16 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact D. A substantial temporary or periodic increase in ambient noise levels in the project vicinity above levels existing without the project? X E. For a project located within an airport land use plan or,where such a plan has not been adopted,within two miles of a public airport or public use airport,would the project expose people residing or working in the project area-to excessive noise levels? X F. For a project within the vicinity of a private airstrip,would the project expose people residing or working in the project area to excessive noise levels? X Summarv: According to the Noise Element of the General Plan, noise levels on the site are less than 60 Loi;.. The ATRSF railroad is not identified as a significant noise source. The nearest road-related noise source is the Byron Highway. In the vicinity of the Eagle Lane, the lands within 270 feet of the Byron Highway right-of-way experience noise levels of 60 LoN(or greater). The site is approximately 2,000 feet east of the Byron Highway. The project will not involve use of earthmoving equipment for grading and installation of underground utilities or any construction in the foreseeable future. There are existing residences on each proposed parcel. In the longer-range future there may be some construction on the site. Nevertheless,the duration of the construction period would be relatively short,and hence any construction noise:is not expected to be a significant impact. It should also be recognized that noise levels of typical rural residential areas are not significant. They are chiefly limited to air conditioning condensers(fan noise), lawn mowing,and outdoor recreational use(e.g.,noise associated rear yard activities/uses, such as outdoor dining); along with noise associated with residential traffic. There can also be noise associated with farm equipment or livestock in an agricultural district. X11. POPULATION AND HOUSING= Would the project: A. Induce substantial population growth in an area,either directly(for example.by proposing new homes and businesses)or directly(for example,through extension of roads or other infrastructure)? X B. Displace substantial numbers of existincy housing,necessitating the construction of replacement housing elsewhere? X I 17 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact C. Displace substantial numbers of people,necessitating the construction of replacement housing elsewhere? X Summary: The property is one legal lot at present,with two residences. (The second residence was legally established after issuance of a land use permit.) The project will not result in any population growth on the site. The proposed rezoning and minor subdivision are intended to create a second parcel so that each existing residence would be on a legally established lot. XIII. PUBLIC SERVICES A. Would the project result in substantial adverse physical impacts associated with the provision of new or physically altered governmental facilities,need for new or physically altered governmental facilities. the construction of which could cause significant environmental impacts, in order to maintain acceptable service'ratios,response times or other performance objectives for any of the public services: X 1. Fire Protection? X 2. Police Protection? X 3. Schools? X 4. Parks? X 5. Other Public facilities? ; X Summary: The application was referred to agencies for comment,including:a)the Knightsen Town Advisory Council; b)Knightsen Elementary School District;c)East Contra Costa Irrigation District;d)Public Works Department;e)Health Services Department;f)Sheriff s Department;and g)Contra Costa County Consolidated Fire Protection District. The agency responses did not identify substantial adverse physical impacts associated with the provision of services. Rather, the comments identified routine requirements of the agencies. The Sheriff s Office did not provide 30-day comment,but the project is not expected to create any unusual law enforcement problems. With regard to the effect of the project on schools, California Government Code Section 65996 identifies payment of fees as the exclusive method of mitigating impacts to schools. XIV. RECREATION- A. Would the project increase the use of existing neighborhood;and regional parks or other recreational facilities such that substantial physical deterioration of the facility would occur or be accelerated?, X 18 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact B. Does the project include recreational facilities or require the construction or expansion of recreational facilities which might . have an adverse physical effect on the environment? X Summary: The project does not include public recreational facilities and it does not displace any existing public recreational facilities.There is no plan in place to establish a park use on the site.The project will add incrementally to demand for recreation facilities.The Subdivision Map Act,Article 3, Section 66477b(B)(7)allows for the payment of park dedication fees in lieu of land dedication for subdivisions containing 50 parcels or less. By payment of park dedication fees, future residents will be participating in a program that is aimed at improving recreational options/opportunities in the East County area.The park dedication fees were$1,350.per unit when the application was deeded complete,but they have subsequently been increased to$5,891.They are paid at the time that residential building permits are issued. In this case the residences are existing. Fees would only be collected if a permit for a new residence was requested. XV. TRANSPORTATION/TRAFFIC-Would the project: A. Cause an increase in traffic which is substantial in relation to the existing traffic load and capacity of the;street system(i.e.,result in a substantial increase in either the number of vehicle trips,the volume to capacity ratio on roads,or congestion at intersections)? X B. Exceed,either individually or' cumulatively,a level of service standard established by the County coneestion manage- ment agency for designated roads or highways? X. C. Result in a change in.air traffic patterns,including either an; increase in traffic levels or a change in location that results in substantial safety risks? X D. Substantially increase hazards due to a design feature(e.g.,sharp curves or dangerous intersections) or incompatible uses(e.g.;farm equipment)? X E. Result in inadequate emergency access? X F. Result in inadequate parking capacity? X G. Conflict with adopted policies. plans,or programs supporting 19 Less than. Significant Potentially with . Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact bus turnouts,bicycle racks)? X Summary: The residences are existing, so no increase traffic on the local road network within the site vicinity is anticipated. In a memorandum dated July 11, 2006 the Public Works Department notes that the property fronts on Eagle Lane, a private road that also serves 25-30 other pareels from Byron Highway,approximately 0.6 miles to the north and west. Eagle Lane was constructed as a 16-foot wide all-weather roadway. Many subsequent subdivisions in the vicinity of the proposed project have been required to construct off-site improvements to Eagle Lane to widen 100 feet of Eagle Lane to a 20-foot width with shoulders in accordance with County private road design standards. It is anticipated that the recommended Conditions of Approval for the proposed minor subdivision will address this issue. XVI. UTILITIES AND SERVICE SYSTEMS- Would the project: A. Exceed wastewater treatment require- ments of the applicable Regional Water Quality Control Board? X B. Require or result in the construction of new water or wastewater treatment facilities; or expansion of existing facilities,the construction or i which could cause significant! environmental effects? X C. Require or result in the construction of new storm water drainage facilities or expansion of existing facilities,the construction of which could' cause sienificant environmental effects? X D. Have sufficient water supplies available to serve the project from existing entitlement and resources, or are new or expanded entitlement needed? X E. Result in a determination:by the wastewater treatment provider which serves or may serve the liroject that it has adequate capacity to serve the project's projected demand in addition to the provider's existing commitments? X P. Be served by a landfill with sufficient permitted capacity to accommodate the project's solid waste disposal needs? G. Comply with federal.State and 20 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact local statutes and regulations related to solid waste? X Summary: The proposed rezoning and associated minor subdivision do not require annexation to utility districts. Currently there are two established residences on the site served by well water and septic systems. There is existing electrical service to the site. With regard to drainage,there are no creeks or storm drainage systems in the Knightsen area. There is a roadside ditch along the Eagle Lane frontage of the site that conveys runoff from the site (and other Eagle Lane parcels) to an irrigation ditch'owned and maintained by the East Contra Costa Irrigation District. A memorandum from the Public Works Department states that since no new impervious surfaces are proposed, and providing that the existing drainage pattern is maintained and concentrated storm water runoff is not discharged onto adjacent properties, an exception from the:"collect and convey" requirements of the County Ordinance Code may be appropriate. ?;VII. MANDATORY FINDINGS OF SIGNIFICANCE- A. Does the project have the potential to degrade the quality; of the environment,substantially reduce the habitat of a fish and: wildlife species.cause a fish or wildlife population to drop below self-sustaining levels.threaten'to eliminate a plant or animal community,reduce the number or restrict the range of a rare or, endangered plant or animal or eliminate important examples of the major periods of California history or prehistory? X B. Does the project have impacts that are individually limited, but cumulatively considerable?. ("Cumulatively considerable" means that the incremental effects of a project are considerable when.viewed in connection with the effects of past projects,the effects of other current projects,and the effects of probable future projects)? _ _ X C. Does the project have environ- mental effects which will cause substantial adverse effects on human beings,either directly or indirectly? X Summarv:Recent applications in.-the Eagle Lane area of KniQhtsen have been for rezoning(from A-3 to A-2)and for lot splits. As fragmentation of parcel size continues in this area;these projects are expected to have a minor cumulative effect on traffic,and demand for public services and utility service. While they are located outside the"urban limit line" ?1 Less than Significant Potentially with Less Than Significant Mitigation Significant No Impact Incorporation Impact Impact and are designated"agricultural land"(AL)by the County General Plan,the parcel sizes are relatively small,and the soils are non-prime agricultural soils. As a result, commercial agricultural use is not viable, unless one party were to farm several nearby parcels. For that reason the cumulative impacts of the proposed rezoning and minor subdivision are considered less-than-significant(i.e.the project is not in conflict with established or potential agricultural uses). The property is not silhouetted on the skyline;is not expected to obstruct long-range views of adjacent properties and is not expected to adversely effect the range of,potential uses on adjacent properties. For this reason the effect on human beings is considered to be less-than-significant. • ��5t �, .,�l�at1o� 1��t' ,, ` ., ,, ,, ,, �, ., `�, i i i 15110019 15110023 15110025 SANDATE JOSE LUIS & MARTHA COPELAND YVONTNE-MICHELE MEYER PATRICIA L TRE 230 EAGLE LN 2414 MONITOR DR . 205 EAGLE LN BRENTWOOD CA 94513 PARK CITY UT 84060 BRENTWOOD CA 94513 i 15110026 15110027 15110034 HANSEN PHILIP B &.BARBARA TRE NYBERG JASON A &KIMBERLY PETTIT DAVID&MARIA 215 EAGLE LN 235 EAGLE LN 195 EAGLE LN BRENTWOOD CA 94513 BRENTWOOD CA 94513 BRENTWOOD CA 94513 15110036 15110040 15110049 WAGNER ROBIN F VANDENOUDENALLER AMY D LOPEZ JOSE ANTONIO&MARTHA 160 EAGLE LN ; 204 EAGLE LN 210 EAGLE LN BRENTWOOD CA 94513 BRENTWOOD CA 94513 BRENTWOOD CA 94513 i 15110050 RENNER TIM H&ADDA PINTA MONISH SEN KNIGHTSEN TAC 229 FLAGSTONE DR P.O. BOX 170 ANTIOCH CA 94509 PUBLIC WORKS DEPARTMENT KNIGHTSEN,CA 94548 i HISTORICAL RESOURCES INFORMATION HSD, ENVIRONMENTAL HEALTH ; PUBLIC WORKS FOUNDATION CENTER,BLDG. 300 CONCORD ENGINEERING SERVICES 1303 MAURICE AVE. SONOMA STATE.UNIVERSITY . ROHNERT PARK,CA 94928-3608 i CONTRA COSTA COUNTY KNIGHTSEN ELEMENTARY SCHOOL SHERIFF OFFICE CONSOLIDATED FIRE DISTRICT 1923 DELTA ROAD ANTIOCH,CA 94509 ADMIN &COMM. SVCS. TOM POWERS PHILIP&BARBARA HANSEN 5371 STONEI-IURST DR. 215 EAGLE LIST. MARTINEZ,CA 94553 BRENTWOOD, CA 94513 i i i i /1 PROOF OF PUBLICATION (2015.5 C.C.P.) STATE OF CALIFORNIA County of Contra Costa I am a citizen of the United States and a resident of the County aforesaid; I am over the age of eighteen years, and not akparty to or interested in the above-entitled matter. I am\the Principal Legal Clerk of the Contra Costa•,Times, a newspaper of general circulation, printed and published at 2640 Shadelands Drive in the City of Walnut Creek, County\f Contra. Costa, 94598. And which newspaper has been adjudged a newspaper of general ci`culation\by the Superior Court of the County,.of Contra Costa, State.of California, under the date of June 26, 1952. Case Number 55193. The notice, of which the annexed is a printed.copy (set in``•, type not smaller thannonpareil), has been published in each regular and entire issue of said newspaper and not in any supplement thereof on the following dates,-to-wit, March 22, \ all in the year of 2008 I certify (or decla e\under penalty of perjury that the foregoing is true and correct. Executed at Walnut Creek, California. On this 31 day o March, 2008\ Signature Contra Costa Times P 0 Box 4147 �. Walnut Creek, CA 94596 (925) 935-2525 \\\ Proof of Publication of: �. (attached is a copy of the legal advertisement that published) ` \ Popp t \ \ NOTICE OF A PUBLIC HEARING BEFORE THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS ' ON PLANNING MATTERS MARTINEZ AREA te. NOTICE is hereby given thatton Tuesday,April 1, 2008'at 1:00 p.m.in the • County Administration Building,651 Pine Street, k . Room107 (Corner of Pine �•.and Escobar Streets); Martinez, Cali- fornia,the Contra Costa County Board of Super- visors will hold a public hearing to,consider the following planning mat- ter: t TOM POWERS (Appli- cant) and PHILLIP & BARBARA \ HANSEN (Owners). County File# RZ06-3182: The appli- cant\ and owners re- quest, rezoningp of the property from Heavy Ag- - riculture(A?3)toiGener- al Agriculture(A-2). The location of the;sub- ject property is within the unincorporated\..ter- ritory of\Contra Costa . County,State of Califor- nia, generally identified below (a more precise description'may be ex- amined in the Office of the Director of Commun`.. ity Development,CountyF . Administration l Building, . Martinez,California): The property fronts for 750 feet on the west side of Eagle Lane, approxi- mately A-mile south of the right-angle bend in the alignment of Eagle Lane. The property is lo- cated in the N',•i Section 10,T1N, R3E, Mt. Diablo B&M, and is addressed 215 Eagle Lane, in the Knightsen area (A-3) (ZA:K-27 & M-28m) (CT 3040) (Parcel 015-110 026). According to California " Environmental Quality Act(CEQA)guidelines,a Negative Declaration was prepared for this project. A Notice of In- . tent for public review was posted on August 20, 2007, and the com- ment period extencled to 5 p.m.on September 10, 1 2007. If you challenge the project in court, you . may be limited to rais- ing only those issues you or someone else \\. raised at the public hearing described in this notice,or in written correspondence deliv- cred to the County at,or prior to,the public hear- ing. t Prior to the hearing, Community Develop- ment Department staff will be available on Tuesday,April 1,2008 at 1 . 12:45 p.m., 651 Pine Street, 2nd Floor North - Wing Martinez, to meet with any interested par- ties in order to (1) an- swer questions; (2) re- view the hearing proce- dures used by the Board; (3)clarify the is- sues being considered by the Board; and (4) provide an opportunity to identify, resolve, or i ,T: r narrow any differences which remain in dispute. If you wish to attend ' this meeting with staff, please call Darwin Myers, Community De- velopment Department; at(925)335-1210 by 3:00 p.m. on Monday, March 31,2008 to confirm your participation. . Date: March 19,2008 John Cullen,Clerk of the Board of Supervisors and County Administrator By Katherine Sinclair, Deputy Clerk Legal CCT 2724556 Publish March 22.2008 it i NOTICE OF A PUBLIC HEARING BEFORE. THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS ON PLANNING MATTERS MARTINEZ AREA NOTICE: is hereby given that on Tuesday, April 1, 2008 at 1:00 p.m. In .the County Administration..Building, 651 Pine' Street, Room 107 (Corner or Pine and Escobar Streets), Marti nez,'California, the Contra Costa County Board of Supervisors will hold a public hearing to consider the following planning matter: TOM POWERS (Applicant) and PHILLIP & BARBARA HANSEN (Owners), County File# RZ06-3182: The applicant and owners request rezoning of the property from Heavy Agriculture (A-3) to General. Agriculture (A-2). The location of the subject. property is within the unincorporated territory of Contra Costa County, State of California, generally identified below (a more precise description may be examined in the Office of the Director of Community Development, County Administration Building, Martinez, Caliibrnia): The property fronts for 750 feet on the west side of Eagle Lane, approximately %4-mile south of the right-angle bend in the alignment of Eagle Lane. The property is located in the N'/2 Section 10, Tl N, R3 E, Mt. Diablo B&M, and is addressed 215 Eagle .Lane, in the Knightsen area (A-3) (ZA:K-27 & M-28m) (CT 3040) (Parcel 015-110-026). According to California Environmental Quality Act (CEQA) guidelines, a Negative Declaration was prepared for this project. A Notice of Intent for public review was posted on August 20, 2007, and the comment period extended to 5 p.m. on September 10, 2007. ; if you challenge the project in court,', you may be limited to raising only those issues you r someone else raised at the public hearing described in this notice, or in written correspondence delivered to the County at, or prior to, the public hearing. . Prior to the hearing, Community Development Department staff will be available on Tuesday, April 1, 2008 at 12:45 p.iii., 651 Pine Street, 2nd Floor North Wing Martinez, to meet with any interested parties in order to (1) answer questions; (2) review the hearing procedures used by the Board; (3) clarify the issues being considered by the Board; and (4) provide an opportunity to identify, resolve, or narrow any differences which remain in dispute. If you wish to attend this meeting with staff, please call Darwin! Myers, Community Development Department;.at (925) 335-1210 by 3:00 p.m. on Monday, March 31, 2008 to confirm your participation. Date: April 1, 2008 John Cullen, Clerk of the Board of Supervisors and County Administrator ByaL I Katherine Sinclair, Deputy Clerk { BOARD OF SUPERVISORS; CONTRA COSTA COUNTY, CALIFORNIA AFFIDAVIT:OF MAILING IN THE MATTER OF TOM POWERS (Applicant) and PHILLIP.&:'BARBARA HANSEN (Owners), County File# RZ06-3182: The applicant and owners request rezoning of the:property from Heavy Agriculture (A-3) to General Agriculture (A-2). Notice of hearing for Tuesday, April 1, 2008 at 1:00 p.m., was.mailed this day, Friday, March 21, 2008, I declare under penalty of perjury that I am now, and at all times herein mentioned have been, a citizen of the United States„over age 18; and that today I deposited Certified Mail with Contra Costa County Central Service for mailing by`,,the United States;.Postal Service in Martinez, California, first class postage fully prepaid, a`copy of the hearing notice, on the above entitled matter to the following: PLEASE SEE`ATTA CHED LIST I declare under penalty of perjury that the foregoing is true and correct, at Martinez; California. Dated: March 21, 2008 Katherine Sinclair, Deputy Clerk 15110019 1.5110023 15110025 SANDATE JOSE LUIS&MARTHA COPELAND YVONNE-MICHELE MEYER PATRICIA L.TRE 230 EAGLE LN 2414 MONITOR DR . 205 EAGLE LN BRENTWOOD CA 94513 PARK CITY UT 84060 BRENTWOOD CA 94513 15110026 15110027 15110034 HANSEN PHILIP B &BARBARA TRE NYBERG JASON A&KIMBERLY PETTIT DAVID&MARI.A 215 EAGLE LN 235 EAGLE LN 195 EAGLE LN BRENTWOOD CA 94513 BRENTWOOD CA 94513 BRENTWOOD CA 94513 15110036 15110040 15110049 WAGNER ROBIN F VANDENOUDENALLER AMY D LOPEZ JOSE ANTONIO&MARTHA 160 EAGLE LN 204 EAGLE LN 210 EAGLE LN BRENTWOOD CA 94513 BRENTWOOD CA 94513 BRENTWOOD CA 94513 15110050 RENNER TIM H &ADDA PIMA KNIGHTSEN TAC 229 FLAGSTONE DR MONISH SEN P.O. BOX 170 ANTIOCH CA 94509 PUBLIC WORKS DEPARTMENT KNIGHTSEN, CA 94548 HISTORICAL RESOURCES INFORMATION HSD, ENVIRONMENTAL HEALTH PUBLIC WORKS FOUNDATION CENTER,BLDG. 300 CONCORD ENGINEERING SERVICES 1303 MAURICE AVE. SONOMA STATE.UNIVERSITY ROHNERT PARK, CA 94928-3608 CONTRA COSTA COUNTY KNIGHTSEN' ELEMENTARY SCHOOL SHERIFF OFFICE CONSOLIDATED FIRE DISTRICT 1923 DELTA ROAD ADMIN& COMM. SVCS. ANTIOCH! CA 94509 - TOM POWERS PHILIP &BARBARA HANSEN 5371 STONEHURST DR. 215 EAGLE LN. MARTINEZ, CA 94553 BRENTWOOD, CA 94513 "CCT Legals" To "Kathy Sinclair"<KSinc@cob.cccounty.us> <cctlegals@bayareanewsgro ' up.com> cc 03/19/2008 11:06 AM bcc Subject RE: Publication Request--Powers AD ORDER#: 2724556 PUB DATES: 3122 ACCOUNT#: 2004197 COST: $183.40 NOTE: Please include your account number when submitting a new order. For changes or cancellations, please include your ad order number. Jennifer Watters Legal Advertising Contra Costa Times -Concord Transcript- Lamorinda SUN .Bay Area News Group- East Bay Ph: 925-943-8019 Fx: 925-952-5019 From: Kathy Sinclair [mailto:KSinc@co b.cccounty.us] Sent: Wed 3/19/2008 10:47 AM To: CCT Legals Cc: Maureen Parkes Subject: Publication Request--Powers Hello Jennifer, Please publish the attached legal notice in the CCTimes: ',Powers One day only, Saturday,March 22,2008 Reference my PO#: 2144 Please confirm receipt of request If you have any giiestion4 please give me a call. Thank you, Kathy Sinclair Clerk of the Board of Supervisors 651 Pine St.,Rm 106 Martinez, CA, 94553-1229 ph: 925-335-1902 (See attached file: Powers t. 040108 Martinez zrea.doc) NOTICE OF A PUBLIC HEARING BEFORE THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS ON PLANNING MATTERS MARTINEZ AREA NOTICE is hereby given that on Tuesday, April 1, 2008 at 1:00 p.m. in the County Administration Building, 651 Pine Street, Room 107 (Corner of Pine and Escobar Streets), Martinez, California, the Contra Costa County Board of Supervisors will hold a public hearing to consider the following planning matter: TOM POWERS (Applicant) and PHILLIP & BARBARA HANSEN (Owners), County File## RZ06-3182: The applicant and owners request rezoning of the property from Heavy Agriculture (A-3) to General Agriculture (A-2). The location of the subject property is within the unincorporated territory of Contra Costa County, State of California, generally identified below (a more precise description may be examined in the Office of the Director of Community Development, County Administration Building, Martinez, California): The property fronts for 750 feet on the west side of Eagle Lane, approximately %-mile south of the right-angle bend in the alignment of Eagle L';ane. The property is located in the N''/z Section 10, TIN, R3E, Mt. Diablo B&M, and is addressed 215 Eagle Lane, in the Knightsen area (A-3) (ZA:K-27 & M-28m) (CT 3040) (Parcel 015-110'-026). According to California Environmental Quality Act (CEQA) guidelines, a Negative Declaration was prepared for this project. A Notice of Intent for public review was posted on August 20, 2007, and the comment period extended to 5 p.m.�'pn September 10, 2007. If you challenge the project in court, you may be limited to raising only those issues you or someone else raised at the public hearing described in this notice, or in written correspondence delivered to the County at, or prior to, the public hearing. Prior to the hearing, Community Development Department staff will be available on Tuesday, April 1, 2008 at 12:45 p.m., 651 Pine Street, 2n`i Floor North Wing Martinez, to meet with any interested parties in order to (1) answer- questions; (2) review the hearing procedures used by the Board; (3) clarify the issues being considered by the Board; and (4) provide an opportunity to identify, resolve, or narrow any differences which remain in dispute. If you wish to attend this meeting with staff, please call Darwin Myers, CorirmLrnity Development Department; at (925) 335-1210 by 3:00 p.m. on Monday, March 31, 2008 to confirm your participation. Date: April 1, 2008 Jolu1 Cullen, Clerk of the Board of Supervisors and County Administrator By /I 1-1 hIJA Katherine Sinclair, Deputy Clerk TO: BOARD OF SUPERVISORS Contra �___::-�- �- FROM: Health Services Department Costa- -..�o - William Walker, M.D., Director ; ==" County ST'9 COUN'� DATE: April 8, 2008 SUBJECT: Health Services Workshop on the Future of Health Care Delivery SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: 1. RECOGNIZE that given the 24/7 nature of hospital and detention medical services and the regulatory environment, significant budget reductions are not feasible. 2. RECOGNIZE that our current model of health care service delivery throughout hospital and clinic system requires constantly increasing levels.of General Fund subsidy.: 3. RECOGNIZE that the County's ability to raise significant resources to maintain our current health care model demands consideration of alternative models for meeting our health care obligations. 4. RECOGNIZE that changes to the Basic Health Care Program are unlikely to provide current year budget relief. 5. AUTHORIZE the Health Services Department to proceed with the Public/Private budget balancing options. 6. REVIEW the pros and cons of alternative governance structures for the Hospital and develop a process to examine cost impacts, service impacts, and other potential service and cost containment options. CONTINUED ON ATTACHMENT: X YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEND TION OF BOARD COMMITTEE APPROVE OTHER r SIGNATURES ACTION OF BOA D N Q APPROVED AS RECOMMENDED OTHER r VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON MINUTES OF UNANIMOUS(ABSENT THE BOARD OF SUPERVISORS ON THE DATE SHOWN. ��N � ) AYES: NOES: ABSENT: ABSTAIN: i Contact: Dorothy ity soeSer ices D 9) cc: Community Services Department ATTESTED County Administration JOHN ULLEN,CLERK O THE BOARD OFSUPERVISORS i BY: DEPUTY i i i i Page 2 of 6 FISCAL IMPACT: No impact from this update. However, based on the direction provided by the Board of Supervisors to the Health Services Department, significant fiscal impacts may occur at a later date. BACKGROUND: The Board of Supervisors is acutely aware of the 2008%09 budget outlook. In anticipation of the upcoming budget hearings information has been requested concerning the impact on the medical delivery system operated by the Health Services Department. This report is not meant to replace the budget hearings, nor is it intended to minimize the impact of budget reductions to other areas of the Health Services Department budget such as Mental Health or Public Health. This report is intended to highlight the significant difficulties in reducing expenditures in the twenty-four hour, seven-day-a-week, medical facilities. Hospital/Detention Introduction: In contemplating reductions in the medical care provided by the Contra Costa Regional Medical Center or in the medical and psychiatric services provided to inmates incarcerated in the Jail, special consideration must be given to the regulatory and quality of care environment in which the health care profession operates. General Healthcare Environment: • The demand for County provided medical care services are at an all time high. • The County does not have the financial wherewithal to invest more and more general fund to maintain minimal service levels. • The average number of monthly births at CCRMG in 2005/06 was 178. Current year monthly births are averaging 212 -an increase of 19%. • Emergency room visits in 2005/06 averaged 3,391 per month. The current year average is 4,013-an increase of 16%. • The time to et a Specialty appointment in the clinics stem now ranges from a 100-da wait for Urology, to 9 P tY PP Y 9 Y 9Y, 60 days in ENT, to 50 days in Orthopedics. • In 2005 same day Family Medicine appointments were fully utilized by 10:00 a.m. In 2006 they were fully utilized by 8:30 a.m. Currently they are fully utilized by 7:30 a.m. • National reform to address the issue of the uninsured has not occurred. • Statewide reform to address the issue of the uninsured has not occurred. • The lack of a National or Statewide approach for the delivery of health care services to the uninsured places the County, by default, as the"provider of last resort." I I i • I I I Page 3 of 6 I i Balancinq Options at the Macro level: Generally, the only way to impact the overall cost of health care is to: (a) Reduce the unit cost of Medical Care Services, (b) Reduce the number of people covered by the County, or (c) Use a combination of(a)and (b) above. Hospital/Detention 24/7 Regulatory Staffing Requirements: • As a reference point; the vast majority of the Hospital/Detention budget is utilized to staff the facilities. Seventy-two percent(726/6)of the budget is devoted to Salary and Benefits. The balance of the budget is directed to normal operating expenses such as pharmaceuticals, blood products, dietary, etc. • Title 22 of the Health and Safety Code mandates Nurse-to-Patient Staffing Ratios in the hospital. i • State and Federal licensing and accreditation regulations mandate the standards a hospital must adhere to. The regulations by their nature effectively dictate staffing levels to insure that appropriate medical care is delivered. I i • On September 27, 2006 the hospital had a CMS validation survey. As a result.of this survey, the hospital was cited by CMS (December 18, 2006)for beingout of compliance with Medicare Conditions of Participation. An aggressive plan of correction was submitted on. January 8, 2007. Work focused on improving quality of care delivery across disciplines including patient safety, documentation, quality improvement projects, and engaging the governing_body. A re-survey was conducted on January 9, 2008. • The issues raised by CMS were primarily the result of repetitive budget reductions and the inability to adequately maintain a comprehensive quality management and safety system in the.hospital.[imi] • The citations, if not corrected, would have resulted in a loss of over$200,000,000 in federal Medicare and Medi-Cal revenues. I • Over the last 14 months the hospital, at the Board's direction, undertook at considerable expense a total re- work of the quality management and safety programs. New psychiatric physicians were hired for inpatient psychiatry and for the Crisis Stabilization Unit. Staff(medical and nursing) underwent extensive training in safety issues. A new Safety and Performance Improvement Department was created in the hospital. New systems of quality review and management were'put into place with the help of outside consultants. • January 24, 2008 CMS.issue a formal finding of compliance. All issues were resolved. i • Reductions to current staffing levels will jeopardize all the efforts recently completed to address the regulatory concerns and would again put at risk over$200,000,000 in federal and state revenues. i Basic Health Care Program: The Basic Health Care (BHC) program provides Ia structure for the provision of legally required medical care services to indigents of the County. The program attempts to link the individual to a medical home and utilize managed care principles to lower theioverall cost of care. The individual is generally enrolled at the point of service, i.e., when medical care is needed. I • The average monthly program enrollment is 5,000 individuals. i I i I . i . i Page 4 of 6 • The annual cost for this program is approximately$40,000,000. • Individuals are eligible for the program if they are at or below.300% of the Federal Poverty Level and have assets of less then $4,000. I • A sliding fee scale ranging from $0 to $75 per month is in place. • The current monthly Federal Poverty Level (FPL)for an individual is: • 100%= $ 851 • 125%= $1.,064 • 200%= $1,702 • 300%= $2,553 • Seventy-two percent(72%) of the individuals enrolled in the program are at or below 125% of the Poverty Level. • Nineteen percent (19%)of the individuals enrolled in the program are between 126% and 200% of the Poverty Level. • Nine percent(9%)of the individuals enrolled in the program are between 201% and 300% of the Poverty Level. • The County is legally required to base its eligibility standard for indigent health care on its residents' ability to pay for subsistence medical care. In order to determine the"ability to pay," a study to determine the cost of living in the County will need to be conducted. The study outcome is unknown. But even If the study indicates that the 300% of Federal Poverty level can be reduced it may not have a significant impact on the demand for County services. As long as the County runs a hospital with an emergency room, it will be legally required to provide services when patients arrive on the campus. The threat to receive a bill from the hospital may delay and possibly prevent some patient treatment requests- but how many is speculative. Conclusion: • Reducing the cost of.Health care services by $10 million is improbable given the mandatory staffing. requirements and the County employee pay and relatively high employee benefit structure. • Reducing the number of individuals covered by the County's indigent care program will be difficult and may not result in significant savings. Other Budget Options: • Public/Private Partnership: To maintain existing services and meet the budgetary constraints of the current budget, an alternative approach could be considered. The approach would utilize private sector firms to perform certain functions within the County. This approach would require a multi-year implementation process with portions of savings occurring in the current budget year with growing savings in the out years. o Process: Issue a formal Request for Proposals for the provision of services in the following areas (non inclusive): I Page 5 of 6 (a) Detention Health Services (b) Inpatient Psychiatric Services (c) Security Services (d) Medical Records Coding (e) Housekeeping Services (f) Landscaping Services (g) Facility Maintenance (h) Laboratory Services (i) Collection Services o Priority for Bid and Implementation: Tolgenerate the largest amount.of savings and to validate the potential savings associated with the use of private sector firms the first two areas to consider are as follows: (A) DETENTION MEDICAL: Provides all primary care medical services for inmates in the County's detention facilities, including diagnostic testing, treatment, nursing care, obstetrical, dental and other services. Provides assistance to the Sheriffs Department in the identification and management of the mentally ill in the County's Main Detention Facility. Services include medication management, behavior man- agement, crisis counseling, and brief therapy. A number of Counties utilize private firms for the provision of this care (e.g., Alameda). Potential budget year savings: $2,000,000 to $3,000,000. (B) INPATIENT PSYCHIATRIC: An option is to develop a new multi-program psychiatric campus. Background: Up until this last year, the County has had two psychiatric programs within the walls of its County hospital: a 43-bed acute psychiatric inpatient unit and a psychiatric emergency service, which provided 24/7 crisis services. Approximately one year ago, the Hospital closed 20 of its 43 acute inpatient psychiatric beds and converted the psychiatric emergency service to a crisis stabilization unit of the Emergency Department. Option: (1) Purchase property(sites have been reviewed and are available). (2) Build (a) a 16-bed psychiatric health facility(PHF)which would be for County residents being brought in involuntarily, (b) a 16-bed crisis residential program, which would be for individuals who have converted to voluntarystatus but who still need a 24/7 structured treatment program, and (c)a new Assessment and Recovery Center, which will provide services to both individuals being brought in involuntarily and individuals who voluntarily seek mental - health services. The Center will be set up to accommodate both levels of care by having separate entrances and egress, and separate program space for each. These three new programs will provide for a continuum of the most acute psychiatric care possible, and will allow an individual to transition from one level of care to the next as needed. (3) Utilize a Community Based Organizati ion to run the program (same model as the Oakgrove facility; the County owns the property,and a CBO runs the program). (4) Close the CCRMC inpatient unit. i Page 6 of 6 I (5) This will take eighteen to twenty-four month lead-time to accomplish. 1 (6) Potential savings of$1,000,000 annually can be achieved. I Budget Option Summary: I Utilizing the Public/Private option could potentially save $3-$4 million in the budget year. Budgetary savings in the out years could range from $6-$9 million annually. Future Planning: The health care environment is significantly different from a century ago when Contra Costa County began providing hospital care to the indigent. The health care marketplace is now more influential than ever before; regulations are much more stringent, medical care providers must now adapt to the rapid pace of change in technology and the labor market, as well as the ever-changing needs of the patient. The ability of the County to continue to deliver health cage to its residents may rest on a change to the governance structure of the Health Department. A structural change that would realign functions such as Physicians, Contracting, Purchasing and Human Resources under the Health Agency reporting to a stand- alone Board may provide the vehicle to slow the ever-increasing rise in medical costs. I Alternative Public Governance structures exist. They range.from Health Commissions (San Francisco), Stand alone Authority(Alameda), to our own local Joint Powers Authority(Doctors Hospital). The Health Services Department will continue to provide the Board of Supervisors, the community and staff with regular updates and educational sessions and materials as research develops.. I I I I I I I I I I I ADDENDUM TO ITEM DA Apri189 2008 On this day, the Board of Supervisors considered accepting report and recommendations from the Health Services Director regarding alternative governance structures for the delivery of hospital services. Dr. Walker presented an update on the impacts of the medical delivery system operated by the Health Services Department. He highlighted the significant difficulties in reducing expenditures in the County's 24 hours/day, 7 days/week, medical facilities. He went on.to say the only way to impact the overall cost of health care would be to reduce the unit cost of medical care services, reduce number of people covered by the County, or a combination of both. He explained that the majority of the Hospital/Detention budget is utilized to staff the facilities. He;said reductions to staffing levels would jeopardize efforts recently completed to address regulatory concerns and would put at risk $200 million of federal and state revenues. Dr. Walker stated the Basic Health Care Program has 5,000 individuals enrolled with an annual cost of approximately$40 million. He pointed out that reducing health care services by$10 million would be improbable and to reduce the number of individuals,covered by the County's indigent care program would be difficult. In conclusion, Dr. Walker suggested that a way to meet current budget constraints would be to utilize private sector firms.to perform certain functions within the County. He pointed out the County should issue a formal Request for Proposals for the provision of services in Detention Health services; Inpatient Psychiatric services; Security services; Medical Records Coding; Housekeeping services; Landscaping services; Facility Maintenance;'Laboratory services and Collection services. He pointed out to generate the largest savings would be to consider Detention Medical and Inpatient Psychiatric services. Dr. Walker strongly emphasized that utilizing the public/private options would potentially save $344 million and that a budget savings in the future years could range from $649 million annually. Supervisor Piepho noted that considering the circumstances at the federal and state level, the County does not have many options and said reducing staffing means the County would need to reduce services. Supervisor Gioia requested Dr. Walker to summarize a March 7, 2008 memo (attached) to the Joint Conference Committee, which was also addressed to Chair Glover and Supervisor Gioia that compared costs among public and private hospitals in the area. Dr. Walker noted that:the'memo compared information concerning the hospital's employee benefit package relative to other areas. Supervisor Gioia said the County' Health Department's leadership and hardworking staff at all levels should be proud of the quality of this County's health care system and said the County's collective;goal should be to maintain and to keep it strong. He noted his goal would be to work;with the larger community to allow the County Health System to 1 be sustainable over time. He noted that hospitals and clinics are different from other programs in what can be cut and still maintain quality care. Supervisor Bonilla asked Dr. Walker how many counties in the state of California have public hospitals. She recognized that there would be service impacts and acknowledged that the County is examining the benefits portion of compensation for each employee. She said it is premature to discuss comparing the Contra Costa Regional Medical Center (CCRMC) with an 81.7% employee benefit load with other area hospitals when we are simultaneously discussing reducing thai number. Dr. Walker responded there are about 19 public hospitals in California and that the demand for County-provided medical 'care services is at an all-time high. He cited only one public hospital closure in the last decade. He said that the department regularly tries to balance its needs with what the community needs. There are some areas in which the County is the only health care option in the area and we cannot reduce those areas. But there are some areas where we know,we cannot send our patients elsewhere. There are areas in which we propose to do something different without adversely impacting service capacity. Supervisor Gioia noted the importance to recognize that this issue exists with or without Other Post-Employment Benefits (OPEB). He said that the numbers referenced in the memo (attached) do not include OPEB and said the County is high without the OPEB issue and needs to consider the proposal irrespective of OPEB. He amplified Dr. Walker's comments and said that once Doctor's Medical Center Obstetrics closed, one- third of births in the County now occur in CCRMC. He said we cannot afford to close the County Hospital but if we continue on our current course, the County will not be able to afford to keep the hospital open. Supervisor Uilkema asked Dr. Walker if he has taken into consideration potential impacts from the State budget on this system, as currently described by him. Dr. Walker responded that the Health Services Department has not anticipated things that have not as yet been approved. Chair Glover asked the public for its opinions and suggestions, and several people offered their comments. The following people spoke regarding the proposed options to utilize private sector firms to perform Certain functions mentioned in the said Board Order; • Doran Lamb, Engineering Services Department, CCRMC; • Charles Holley, Baypoint resident; • Fred Morse, Martinez resident, handed the Board literature on SODEXHO; • Paul Adams, Antioch resident; • Paula Banks, Pittsburg resident; 2 I I I I I I I • Sunny Boyer, Martinez resident; • Roland Katz, Business Agent, Local 1, handed the Board literature on several documents about contracting out health care;. • Elio Bracho, Berkeley resident: • David Ezra, Berkeley resident: • Roberta Kayser-Stange, Pacheco resident: • Vincent Aguigui, Jr. Martinez resident; • Ralph Hoffman, Walnut Creek resident; • Lloyd Cline, Martinez resident; • Kathleen McLaughlin, Martinez resident, said the County should explore options by Dr. Walker; • Christopher E. Dodd, suggested fundraisers to meet budget needs; • Tanir Ami, President the Contra Costa Contractors Alliance/Community Clinic Consortium, encouraged the Bbard to look at how best it could provide services to the underserved, and requested the Board to look at the partners they have; • Martha Wilson, Psychologist, Mental Health, suggested the County examine the jail population to expand community clinics, and noted that the jails cost the County a lot of money. She also asked the Board to consider Health Services Department and Mental Health Services Department to work together, and • Marshariki Kurudisha, GRIP,;informed the Board she supports the previous speaker's comments. She suggested the Board discuss with cities what can be done with mental health care) She requested the Board examine the empty facilities in West County already built to develop new partnerships. Supervisor Gioia observed that this issue has been framed as an"either/or" issue, but it's really an issue of degree or level of benefits, not whether the County provides benefits or not. He maintained that OPEB is not merely an accounting issue but a real fiscal liability. He explained the County's personnel benefits are higher than competitive private and public hospitals and that has caused some of the imbalance in the County Budget. He asked everyone to think about the thousands of Contra Costa residents who would have their health care reduced or eliminated in order to support higher than average benefits for!employees. He observed that many of the people the County serves do not even have health care benefits. He said the growth in health care i 3 I i i i I and retirement costs has put the County at a higher cost level than other facilities and said he agrees with those who requested more data. He concurred that surveys should be conducted to include benefit costs and not just the compensation(wage) costs. He stressed that eliminating all management positions would not solve the problem. Supervisor Gioia noted the County should strive to achieve efficiencies at all levels and remarked the benefits for management should be cut back too. In addition, he .stated the Board would look at cutting back its own benefits and those of other non- represented staff. He pointed out that his goal is "how do we maximize our service level to the community while maintaining fair and competitive compensation." He opined that the challenge could be achieved by working together. He went on to say some of the alternatives presented by Dr. Walker should be examined and said the County should move ahead looking at the issue of Detention Medical and the issue of the psychiatric restructuring. He indicated that these two proposals merit further study. He added that where there is a need to "meet and confer", it would be done. He elaborated the alternatives would be to reduce costs in areas such as Detention Medical and Psychiatric or else more layoffs would be required: Supervisor Piepho agreed with Supervisor Gioia's remarks and referred to Dr. Walker's presentation, indicating those are often the Solomon-like decisions with which the County is faced. She add.W that the County would need to study the entire situation to gain information accurately and effectively to make good, balanced, and thoughtful decisions. She observed;that the direction before the Board is to recognize the problems, review the pros and cons of alternative governance structures for CCRMC, and develop a process to examine service impacts and other potential service and cost containment options. She opined that these actions are prudent for a county like Contra Costa that is faced with severe financial constraints from the retiree health care liability to the current budget crisis. She added that the Board is committed to make balanced, thoughtful decisions to be effective in its role of governance. i Chair Glover acknowledged that the options brought before the Board are extremely difficult and the impacts are significant, but he appreciated the opportunity to try and find a balance within those options. He observed these impacts affect the State of California and the nation, and added the Board will try to find an intelligent solution that balances employee needs with the need to maintain health care service levels. In conclusion, he concurred with Mr. Katz in terms of his analogy that the County cannot solve the national health care crisis, but reiterated the County is faced with this problem at a local level, which needs to be addressed. i Supervisor Uilkema referred to the Board Order and stated she would like more information on items "c"through "i" (see Board Order DA dated April 8, 2008 page 5). She referred to the last page, third paragraph under"future planning" and asked what the options are, and said the Board should.have other possibilities to review. Still referring to the same paragraph, Supervisor Uilkema questioned how the public hospital could become a"stand alone" authority and asked for a general description to see if'the County would pursue this issue. i I i 4 i i i i i i Supervisor Bonilla observed that Recommendation No. 5 is broad and recommends proceeding with a larger list of contracts than those specifically listed. She suggested a wording change under Recommendation No. 5 to read: AUTHORIZE the Health Services Department to proceed with researching Public/Private budget balancing options for Detention/Health and Inpatient Psychiatric (only). She emphasized she is not in favor of proceeding with this recommendation as a budget balancing option. She disagreed slightly with Supervisor Gioia regarding his statement that this is about OPEB, and pointed out in OPEB current health benefits are discussed for active employees and not only retirees. She remarked that the Board is not being given a chance to negotiate or implement what that would mean with these numbers about an 80%benefit load. She asked what the benefit percentage would be if, at certain levels, the County could renegotiate health benefits. She indicated that using the 80% figure is not a valid benefit load because it presumes that the County achieves no cost containment changes. i County Administrator John Cullen said the benefit load indicated on that memo does not include the OPEB liability, and that the memo reflects employee benefits for fiscal year 2005/06. Supervisor Bonilla responded it also'does not include any renegotiated health benefits. She said the memo is out of context and should it have been brought forward a year ago it would have been in context. She said the Board is being asked to take a course of action without the information of what the cost savings might be. She recalled her earlier concerns about it not being feasible to achieve all of the necessary cost reductions in one year. Supervisor Bonilla addressed Mr. Cullen and said some things have not been achievable. She said the Board is potentially establishing a precedent for the entire organization and that she does not want to set that precedent as a solution. She said that, at some point, there needs to be a discussion to consider whether or not the Board set cost cutting goals that were too ambitious. i Supervisor Gioia recalled that property tax and other revenue growth have slowed because of the stalled real estate market. He clarified that no one has discussed in this budget negotiation taking away-any existing health benefits. He said freezing or lowering health care cost growth significantly decreases OPEB liability, and observed that the only way to achieve that end is to ask employees to pay greater premiums for health care. He opined the County ineeds to determine the benefit structure for the 1 County. If our health care benefitsiare significantly higher than competing health care systems, we need to address that. i Supervisor Gioia suggested moving forward with the Health Services Director's recommendations, with the addition to issue a Request for Proposals for Detention/Medical and the Inpatient/Psychiatric option, as described in the Board Order. He augmented the recommendation including having a consultant initiate a total compensation survey for the hospital and health clinics. He amended I 5 i i i i i I i I i i Recommendation No. 5 to read: AUTHORIZE the Health Services Department to proceed with researching public/private budget balancing options for Detention/Health and Inpatient Psychiatric; and DIRECT staff to secure a consultant to conduct a total compensation survey for the hospital and clinic system,which includes among others c through i (page 5 of 6) and other relevant operations for the hospitals and clinic; and incorporated Supervisor Uilkema's suggestion of continual analysis on the governance issue to include health agencies among other options. Superyisor Piepho pointed out that she would like to make sure the number of employees be included in each of those classifications for the survey.. I Chair Glover advised that before any!of these actions take place it would be reported back to the Board and the Board would then move forward. i Supervisor Gioia said the Board would work with labor on a number of these issues as other solutions are explored to make the health system viable. Supervisor Bonilla said that she would like a report on Inpatient Psychiatric from the Director of Mental Health, the Mental Health Commission, and other mental health professionals, and reinforced that she would not advance any proposal without consulting Mental Health professionals in the field and listening to their recommendations. She stressed this!is not a budget issue but about the quality of our care and reiterated she would like to,hear about this regarding the Detention Medical and Inpatient Psychiatric. Supervisor Bonilla referred to suggestions made by speakers and suggested taking those'suggestions into consideration. She requested a cost analysis on one of the suggestions made on opening more clinics and whether or not doing so would be cheaper than fan emergency room treatment. She reiterated she would not move further until she sees all information related to any of these issues. i By an unanimous vote with all Supervisor present, the Board of Supervisors took the following actions: i APPROVED Recommendation Nos. 1, 2, 3, 4, 5, and 6. i • AMENDED Recommendation No. 5 to read: AUTHORIZE the Health Services Department to proceed with Public/Private budget balancing options (e.g., issuing an!RFP) for Detention/Health and Inpatient Psychiatric services. ! i INCLUDED the following additional recommendations: i • DIRECTED that a consultant be recruited to conduct a survey of total compensation for the hospital and clinic system to include among others those jobs related to Security services, Medical Records Coding, Housekeeping services,'Landscaping services, Facility maintenance, i i i 6 i I I i Laboratory services, Collection services, and other relevant operations for the hospitals and clinic; I I o Before proceeding with(c) through (i), consider results of the compensation survey in any further discussions for public/private partnership; I o DIRECTED the County Administrator's and Health Department staff to work with Supervisor Gioia to analyze alternative public governance structures; and o DIRECTED that the County Administrator and Health Services Director report back to the Board for further direction before any changes are implemented. 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This speaker's card will be incorporated into the public record of this meeting. ❑ For Name(PRINT):I -�- " ' O Against 1 �}�� r- To ensure your name is announced correctly,you Way it to include its phonetic spelling © _ 7El .I wish to speak on the subject of- Address: f Address: J�50 trig-eSt!, J City: Call co rf/ I Phone- N-S) 77 3771 I am speaking for: fi� Myself I ❑ Organization: El I do not want to speak but would like to leave comments for the Board to consider (Use the back of this form) i i REQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item#: Complete this form and laceiit in the upright box near the . 1? P , Date: speaker's podium,and wait to be called by the Chair. —/ My continents will be: 0 General Personal h formation is optional. 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This speaker's card will be incorporated into the public record of this meeting. ❑ For Name(PRINT): ElAgainst 7i7 ensure your name is announced corrvaly,you may want to include its phonetic spelling wish to speak on the subject of: Address: r City: Phone: iik 17, i I am speaking for: fu� Myself i ❑ I do not want to speak but would like to. Organization: leave comments for the Board to consider (Use the back of this forts:) REQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item#: _ Complete this form and place lit in the upright box near the Dale: speaker's podium, and wait to'be called by the Chair. My comments will be: >SC General Personal information:is optioinah 7his speaker's card will be incorporated into the public record of this meeting. ❑ For Name(PRINT): Q 6 �,Y- El Against 7o ensure your name is anhounced coy?-Wily,you Ana iit to include its pHo c spelling ❑ I wish to speak on the subject of Address: G 8 M l f J a JW city: Phone: I am speaking for: Myself ❑ Organization: ❑ I do not want to speak but would like to leave comments for the Board to consider (Use the back of this form) I i I REQUEST TO SPEAK FORM (3 Minute Limit) I wish to speak on Agenda Item#: Complete this form and place it in the upri&t box near the Date: / 9, VO speaker's podium,and wait to be called by the Chair. My cv en s will be: ❑ General Personal information is optional. This speaker's card will be incorporated into the public record of this meetutg. Y, Against r Name(kdNT): _e L D 'v� y' ` 'O To ensure vour•nameas announced correctly,you nt watt(o include-its pltonellc spelling J n 0 ❑ I wish to speak on the subject of.- Address: f:Address: Cir ✓� City: U �S ZZ Phone: / Z I atn speyking for: NlyseIf Organization: — �' ElIdo not waist to speak but would like to leave continents for the Board to consider (Use the back of this form) I i I I I • I I I I � I I � I I r^ WILtIRM_Q,..WA KE�R. NA. D. fOFFICE OF THE HEALTH SERVICES DIRECTOR I _>'Z DIKECI.OR 50 Douglas Drive,Suite 310-A Martinez,California CONTRA COSTA94553 — Ph(925)957-5405 HEALTH SERVICES Fax(925)957-5401 I I I I I I I March 7, 2008 I I I Federal Glover, Supervisor District 5 Jolui Gioia, Supervisor District 1 Chair, Contra Costa Board of Supervisors Contra Costa Board of Supervisors 315 E. Leland Road 11780 San Pablo Avenue#D Pittsburg CA 94565 El Cerrito CA 94530 I Dear Supervisors Glover and Gioia: During the meeting of the Professional Affairs Cornrnittee of the Contra Costa Regional Medical Center of February 21, 2008, you requested comparative information concerning the hospital's employee benefit package relative to other area hospitals. The following is an attempt to be responsive to that request. Summary: Employee Benefits as a percent of salary (excluding OPEB Liability) Fiscal Year Ending 2006: Contra Costa Regional Medical Center: 81.70% Alameda County Medical Center: 62.22% Santa Clara County Medical Center: 59.18% Doctors Hospital Saii Pablo: 44.20% John Muir-Walnut"Creek Campus: 48.25% John Muir- Concord Campus: 47.22% I All hospitals in California are required to arulually report detailed financial and utilization data to the Office of Statewide Health Planning.and Development(OSHPD). This report is based on a uniform reporting system (i.e.,;all hospital reports are prepared in a uniform manner,using OSHPD definitions). I IIospitals are required to submit reports,within four months of the close of their accounting period. After receipt by OSHPD they are desk audited, and the corrected data are input into the OSHPD database. In addition, if individual hospitals wish to revise their data they may. Periodically (at least annually), data files are posted on the OSHPD website. The most recent file available on the website covers hospital accounting periods ending during 2006. According to the Accot.tnting'and Reporting Manual for California Hospitals, which governs the reporting system, employee benefits are defined as,"A pension provision, retirement allowance, I I • Contra Costa Alcohol and Other Drugs 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 I ; I , FederaJ Glover, Supervisor District.5..Chair John Gioia.Supervisor District I Contra Costa Board of Supervisors March T.2008 . Pale 2 insurance coverage,paid vacation, sick leave, and holiday time off or other cost representing a present or future return to an employee,which is neither deducted on a payroll nor paid for by the employee." The OSHPD data should be viewed within the context of being self-reported and unaudited. There are no consequences for erroneously`fled reports. Accordingly, we contacted Doctors Hospital,Santa Clara Valley Medical Centel and Alameda Medical Center to validate and confirm the salary and benefit numbers contained on the attached schedule were accurate. All facilities either corrected or validated the numbers contained on the schedule. The John Muir Concord and John Muir Walnut Creek data are taken directly from publicly filed OSHPD statements. The data are believed to'be accurate but due to timing constraints independent validation did,not occur. Please note OSHPD data does not provide Salary and Benefit information at the detailed employee classification level, e.g.Nursing. Please advise if additional information or clarification is required. Sincerely, ` ALI) Patrick Godley Chief Operating Officer/Chief Financial Officer'' Contra Costa Health Services cc: William Walker, M.D., CCHS Director and Health Officer Jeff Smith,M.D., CCRMC and Health Centers Executive Director John Cullen, County Administrator Lisa Driscoll. County Finance Director Linda Ashcraft,County Labor Relations Manager I .Q C aC m m 0 c`! m i Ne Ei dao 0 V m co co .+T P co N S u O yy pi p Ih O f'i Lo V- u v y m V r14 >. c g o°',,,oq�q ri n c ai u� vi ri m o U v n Lo. rn � �IRumi� m °.° , E 8 �n o o p o vii ID a co ri ui 5 m m m N C N L U Ln p a c 0 'c0 MF VF fR tlF VF D U W f _ '+O knm In ON _ N m m D 0 n' o . . .N N L t O y �O W H O f'I n O N 0 y f y Ila n m v CL d U c c c = o ' m V V V E u m y Y m— 10 m��D vinmrv� m c o y 01 a m i n O n P W n W P C O Z O n C a Ol N U u m PN m O N Vt In 'n ` N a m N E O Do pi 1.N m00 rD mN Vl - W co pi P W p�W m m� N 'M � y � � p� j o f O tD (t+o�GO✓100 cl N O n C P m pi O �j� OJ P N .r .moi N N D, O O 3 �. o d O w � al 0)f v u � w w w ..« ate-+ ^ C W U 03 mmu:)mm tDN N a,O W U a O y D N p n N Q I n N L!1 n N L v 100rl vonoori.. III 0 til W p v L o m m n C r0 Q � -0> U N N C=yJ O F/}}�� (n A I v a rn a V m a �! a 'i� y m m U u a .. V v y > (n N m 'D W'DN-+rvv c P m y C .Ww a, w 10 W m�D P u'1 D� "J fA ' ulm LDPOP min LD m Di C W C m m m n Ln m t'�1 �D.i n_ a O P p,n 10 m 1 D D D O m v ry Ln N n Q) v rn m mNO q"V �vR R m m _ o ,0 m oi �v l co m z y Of m m c v ¢ ^ a a v v c o � A a 0 > m rJ C m c y w mw v d o a n m � c 2 Z ig na `o c u v v c v L a v o a vw 0E c o v mW u v >w u v m m c S a v m c u v C 75 C Y Y N A n C C J N ` n C E y C n �O 3 U} y mm C C. D Eni y ,C., N p,y' vmi mm� a� o.mCL n'"" mm� o� cl CL wo oayn you a v E a) ? m E ub�g a � toa v v� o _ U y m\\ 01 TL..7CCdC m�� d ?V CcvN EIC U . m y c c v o o v v= v 1° ay c c v o y v v 2 O m i 0 0 >.-a- E E v m m ti _ ¢' c - y=a OEsaa `— y�� oEL EEw — " UovaOi p C U U n C U U n N :7 L Pi L¢a U U d S u m 01 m E c o u v v o m G1 io m E c o v w v o o^„N V v of m»iiw7wo aF vi m>>iw>>sw Ko:F zoZ i t: WILLIAM._B._��ALKEK. M. D. l;' c HEALTH SavICEs DIRECTOR �`'� F F I C E O F l-HE DiPEC-FOP 50 Douglas Drive,Suite 310-A — 7i � Martinez,California C O N;T_R A COSTAPh(925)957-5405 94553 HEALTH S E R V I C E S Fax(925)957-5401 March 7,2008 Federal Glover, Supervisor District 5 Jolm Gioia, Supervisor District 1 Chair, Contra Costa Board of Supervisors Contra Costa Board of Supervisors 315 E. Leland Road 11780 San Pablo Avenue#D Pittsburg CA 94565 EI Cerrito CA 94530 Dear Supervisors Glover and Gioia: During the meeting of the Professional Affairs Committee of the Contra Costa Regional Medical Center of February 21, 2008, you requested comparative information concerning the hospital's employee benefit package relative to other area hospitals. The following is an attempt to be responsive to that request. Summary: Employee Benefits as a percent of salary (excluding OPEB Liability) Fiscal Year Ending 2006: Contra Costa Regional Medical Center: 81.70% Alameda County Medical Center: 62.22% Santa Clara County Medical Center: 59.18% Doctors Hospital San Pablo: 44.20% John Muir- Walnut Creek Campus: 48.25% John Muir- Concord Catnpus: 47.22% All hospitals in California are required to annually report detailed financial and utilization data to the Office of Statewide Health Planning and Development (OSHPD). This report is based on a uniform reporting system (i.e., all hospital reports are prepared in a uniform manner,using OS14PD definitions). IIospitals are required to submitreports, within four months of the close of their accounting period. After receipt by OSHPD they are desk audited, and the corrected data are input into the OSHPD database. In addition, if individual hospitals wish to revise their data they may. Periodically (at least annually), data files are posted on the OSHPD website. The most recent file available on the website covers hospital accounting periods ending during 2006. According to the Accounting and Reporting Manual for California Hospitals, which governs the reporting system, employee benefits are defined as, "A pension provision,retirement allowance, -F ` 'l"—� zs�l • Contra Costa Alcohol and Other Drugs Services • Contra Costa Emergency Medical Services • Contra Costa Environmental Health • Contra Costa Health Plan F'! =='AW_ � • Contra Costa Hazardous Materials Programs •Contra Costa Mental Health• Contra Costa Public Health • Contra Costa Regional Medical Center • Contra Costa Health Centers i I I II I II Fede.raJ Glover, Supervi.sor.District�..Chair John Gioia,Supervisor District 1 Contra Costa Board of Supervisors March T.2008 Pale 2 I I I'I insurance coverage,paid vacation, sick leave, and holiday time off or other cost representing a present or future return to an employee,which is neither deducted on a payroll nor paid for by the employee." III The OSHPD data should be viewed within the 'context of being self-reported and unaudited. There are_no consequences for erroneously filed reports. Accordingly, we contacted Doctors Hospital, Santa Clara Valley Medical Center arid Alameda Medical Center to validate and confirm the salary and benefit numbers contained on the attached schedule were accurate. All facilities either corrected or validated the numbers contained on the schedule. 'I'I The John Muir Concord and John Muir Walnut Creek data are taken directly from publicly filed OSHPD statements. The data are believed to be',accurate but due to timing constraints independent validation did.not occur. l I Please note OSHPD data does not provide Salary and Benefit information at the detailed employee classification level, e.g. Nursing. ,I Please advise if additional information or clarification is required. I Sincerely, I I I I I Patrick Godley II Chief Operating Officer/Chief Financial Officer Contra Costa Health Services I 'I cc: William Walker, M.D., CCHS Director and Health Officer Jeff Smith,M.D., CCRMC and Health Centers Executive Director John Cullen, County Administrator Lisa Driscoll. County Finance Director Linda Ashcrait,County Labor Relations Manager II II I I I I I I I 'I I I I I I I ' I i I II I i I I li �o I -� I - I <n II I I L � i e C moon m o e m CD m°'rn v o N Lv v m I v .q C I U F > m O li f EQh in r. vama n m C Lo .� N n I Z N IID n N .�-� a 1. 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E n m ren v C. . v E L3 m U N N C v aL 'EL y 2 u m LY C 2 m E L v Qj N W U y A w u C l L 7 2 N y C U W y 0 C u N C 0 3 uY v 1O �� m C.e> > r. LE a 'rnom.�' o oyi c u lY Y.�N a.'"' N Nti Y TL9 C C C V ICCL y IC`O 10 J p a.+ a a 10 LO J » p, CL O tC D O O 0E N U E U c cad m O C7 E O..., m�= E E U m p c `\ y ?U C C W d O A L C C C.1 O VI CI N S d i� C C N O N v N= C C O.N u V oo >cvEEmm I Loa TdL- EEo,m _ Irvc a o `I m m_ Z) o Lu _ — v U o a a p f0 C. U v Q a pEl'�`_L._y0 C U U a N L L D yQ p. V U Il S UU O U 1n m>> Lu7�LYaW'mH In m>> LU C K Fo- Z-- mav� I I I I I I I I I 1 : !'Majikthise.: Iiealth.iti prison " Paige I o . May>l.ktlhise . ,ByLindsay.Beyerstein, freelance journalist.: June.it;2005 . . ,Health in prison .. Now they tell us.Too bad.New Yoik just renewed_Prison Health Service's.contract for a third of a billion'dollars: Inmates'Medical Care Failiri in Evaluation by Health Dept. I .. A recent evaluation of the.company in charge of inmate healthcare at Rikers Island,.coining months after it was awarded a new$30o million contract,has found that it has failed to meet a number of the most basic treatment goals.City records showed that the company,Prison Health Services Inc:;did not meet standards.. on practices ranging from MIN.And diabetes therapy to the timely.distribution'.of medication to adequately. ... conducting mental health evaluations. The cityDepartment of Health and Mental Hygiene,which oversees the company's work at Rikers Island and at a jail in Lower Manhattan,found that during the first.quarter of 2005, Prison.Health failed to earn a passing grade-on i2 of.39.Performance..standards the city.sets.for treati.rig jail inmates:Some of the problems, -"like incomplete medical records orslipshod.evaluations of mentally ill.ininates,have been evident since 2004-:..- but have not been corrected,according to health department reports. Other problems identified in the department's review,involving things as serious as the oversight of ininates who have been placed on suicide watch;are more recent or had.not been evaluated by city health.aiiditors in the past. I As a result,the city is withholding$55,000 in payments to the.company,the.largest penalty for poor performance it has incurred.since 2bol, the first year of its work in New York City:-adult jails. [NYT] '. Speaking of health care in prison;I've been meaning too recommend The New Asylums;Frontline's documentary about mental services in prison:Themain focus is on Ohio's new prison-based psychiatric system:The Frontline. crew got unprecedented access to film prison officials;;health care providers;and inmates in Ohio's maximum security prisons. r. Much of the footage is.very disturbing.There's an incrddibly poignant scene of a,psychiatrist running a therapy group.for ten guys in individual cells.The doe runs the group froiri rolling chair in the hall.The scene is-especially poignant because he.does such a good job,given the constraints of the setup: Everyone'sreally giving there all to this group;but you know that even if it.works, it can't rdally help:These guys are:deeply disturbed maximum security.inmates whose mental health only matters to officials insofar as it.improves their disciplinary records: Posted by Lindsay Beyerstein:at o�:04 AM in Lav,Medicine Permalink . TrackBack ... TrackBack URL for this entry: .. :.' I http://ivww.q,pepad.Com/t/trackbaCk/24030/2626946 Listed below are links to weblogs.that reference Health in.prison: Page 2 oI''2 P} Majikthi§c :U alih in larison comments,-. ..Jesus Lindsay,how naive can you be!They don't'care ab are out access to or quality of healthcare for the average American,you . don't really expect.them'to.care about it far those in[lion white collar].prisons'd0 you?' Posted by:UI Granlcy J Jt1ne:li;2aog_at 094-4.AM Nope.Nobody canes about prisoners much.On the other hand New Yorker's don't like getting ripped off oil general principle. So there's a'wedge there.. :The Frontline docurnentary is interesting because-the people running the Ohio program do seem to care quite abit-=at any rate;much more than I'd expect of a psych staff in a sapermax prison. Ohio ended tip with so many crazy people ill their prisons that they had to create a.separafe psychiatric system within their maximum andsupermax prisons.This.goes beyond the state hospital.for the.criminally insane.It's an entire prison system for people with ongoing psychiatric.disease:About 1696 of the general population in Ohio has a'major psychiatric illness(i.e. bipolar,schizophrenia,etc.).'.. Posted by:Lindsay Be ertein J June li z, oo at_ii:zo AM What's so interesting about the group therapy scene is thaCthe shrink is'doing such a great job of delivering therapy whose core ` assumptions are inconsistent with prison{your feelings matter;we care about you as.an individual,we're here to support each other:..).Neither he nor the prisoners seem to realize the inconsistency.So;at least in the moment,the disconnect doesn't matter:.: Posted by:Lindsay_Beyerstein J June t"i2po5"at 11:20 ANt Health system is big prohtems in aI1 over the world in in country the health.department has declared the existing rate contract for the purchase of medicine five year ago birE still yet we no,receive any progress in this matters. Posted by:Andrew Spark J Febtvary 10 2006 at 0,1: AM . .. . , , .. 'III' .. • .' ( .. ' .. i . I �i . I I a i t ,., ., .. •. ... Ill .. .- .. I ` encan Civil Liberties Union:ACLU and PJC Urge Maryland http://.wwW.aciu:org/prison/gen/14742prs20050 .htm! ^ '.t'-,_ 7�x.s:u��>:a".�;r,1i=sy;P.::.,''x}szg�4 : F � ate,• :�'�'' �y t.�-'�;;" ' s, ,y h`,' ::t'.q: ' e',_. :.]e :/X:.:_. •v0 ;its URI:HIP.&wlx-acYi.org/prisorVg&1114742prs20050601.J)im1, ACLU and PJC Orge Maryland Board to Reject Contract with Company Known for.Providing Deficient Medical Care in Prisons.(611/2005) . FOR IMMEDIATE RELEASE'. Contact: media@aclu.ora ANNAPOLIS,_MD Citing Correctional Medical Services' poorrecord for:dispensing.medical care to prisoners, the American Civil Liberties Union and Public Justice Center today:urged Maiyland's Board of',Public Works to reject a proposed contract with,the for-profit company.`. : "Correctional Medical Services' histo' .bf cutting corners tor'mainfain profts jeopardizes the lives of thousands of incarcerated people across the country;" said Eiizebeth;Alexander; Director of the ACLU's National Prison Project: "Many.states have already learned a,painful lesson from their dealings with Correctional Medical Services.`Maryland`,must avoid handing over the-care of its prisoners and jail detainees ., to,a company with'a disastrous reputatibri." Correctional.Medical Services (CMS) currently holds.contracts in 27 states.In Michigan, where the company provides care to,prisoners statewide; CMS has come.under heavy scrutiny for its attempts to save,money by limiting prisoners' referrals to outside medical specialists. A federal court found that excessive delays in providing prisoners with.referrals contrib ►ted.to three deaths.during an'18-month,period. Five other prisoners who died.during the same time period also experienced signifi,carit delays in treatment.t. Last week, the Maryland Board of Public Works announced that at a meeting today it will review for approval a two-year statewide medical services contract between the-state's Department of Public Safety and Correctional Services and CMS..The new,contract is scheduled to begin July 1, 2005, - - Under the'new contract, CMS would provide'care to more-than 4;000.detainees-confined at the.Baitimore - ...... City Detention"Center, which has come-under fire in recent'years-foe providing"deficient medical care. In..:: :_ . . . _. : . August 2002, the U.S. Department of Justice cited the jail for.107 violations of health and.safety standards. Since 2002, the ACLU and Public Justice Center have been involved in litigation about the medical care provided at the Baltimore Jail by the current for-profit medical and mental health care provider, Prison Health Services. Even with the significant.rise in spending,forthe new contract, according to..the state's estimates,.health . services are still under funded by several million dollars. The ACLUacid Public'Justice Center expressed concern that simply switching for-prcift providers without increasing 1.resources to fund treatment and maintaining close contract oversight_will,leave detainees with the same poor care theyreceived under Prison Health Services. "There is,little point in changing company names if the continuation'of inadequate funding and indifference. from the state regarding detainee health remains the same,"said Sally Dworak-Fisher, an attorney with the Public Justice Center. "In an environment without consistent outside oversight and inspection, the motivations of for-profit companies like CMS and'Prison Health Services become.dangerous. Cutting corners to preserve profits but risk the health and lives of,detalnees"is inexcusable, and Maryland officials are responsible when the care.is constitutionally inadequate," Today's hearing before Maryland's Board of Public Works will be.held at 10:00 AM in the Governor's .. Reception Room; 2nd floor of the Annapolis State Ho use.` 1 oft 4/7/0$ 10:50 PM An Civil Liberties Union:ACLU and PJC Urge MarVIand..-.,,.hiip://www.aclu.org/prison/gen/`I 4744pi,,,„_ 44. ®ACLU,125 Broad Street,18th Floor New York,NY 10004 .This is the Web siteof the American Civil Liberties Union and the ACLU Foundation. - Le2rn mrre about the distinction behveen these two components of the ACLU. ' . User A greemen I Privacy Stole-menSite Pita i j. 4 i I I 4/7/0$ 10:5( 1 ..'AT&T Yahoo!Mail-judeseven@sbcglobal..hdt. http;//us.f822.mail yahoo.corn/yrp/ShowLetter?box=ln—' ,�Er it®O MAIL : ;:. Print Close Window Date:, Mon,7 Apr 2008 23:00:49.-0700(PDT) From: "Judith Jones"<judeseven@sbcg1oba1.net>: ::. To: "Judith Seba Jones"<Judeseven@sbcglobal.net> E-mail this to a friend. Healthcare. Behind Bars by DuWayne Escobedo Robert Boggon suffers a mental episode in a Dollar Tree store, whichleads to his incarceration in the Escambia County jail. Despite at one point rocking on the floor of his cell and urinating on himself and.displaying other odd behaviors, Boggon never receives a psychiatric evaluation dur'ing.the 11 days he spends in the jail and only receives . medication used to calm him down before his death Aug. 29,'records.and.testimony reveal. Jail guards end up dragging the 65-year-old trucker from his cell to the shower, stripping him, shocking his wet body with a Taser Gun, then. strapping his lifeless body,to'a.restraining chair, wrapping a towel around his head and returning him facing the back of his cell:several hours before he's found dead, aicivil suit by Boggon's family alleges. Hosea Bell, a homeless man, gets arrested Aug' 9 for urinating on a sidewalk outside Weis Elementary School. He's found mentally incompetent by a judge to stand.trial Nov. 30 but'l 1 days later the 55-year-old is taken in handcuffs by a. police car to Sacred Heart Hospital.after appearing lethargic at the Escambia County jail. He'dies at the hospital a few hours later. . Both cases are focusing the spotlight on healthcare provided.to inmates at the Escambia County jail by Prison Health Services, the nation's largest for-profit inmate healthcare company, caring for about one in every 10 people behind bars. Across Florida and.the country the company based outside Nashville has come under fire the past year for spotty and. sometimes lethal care.. Following the Boggon and Bellcases, tfie quality of the company's medical services is coming under fire locally. . . David Craig,the Community Law Enforcement Oversight president, is blunt and.concise in.his assessment of Prison Health Services medical care for.inmates. "Given their less than stellar record, OLEO feels.they would be more accurately named Prison Death Services," he says: Todd LaDouceur, the Boggon family's attorney, says the federal wrongful death lawsuit may soon extend to Prison . Health Services. It currently only names two;of the company's nurses individually, Lisa Whitlock and Elaine Gregory. . . "I've been through the Florida Department ofLaw Enforcement investigation and it appears Mr..Boggon never saw a doctor.in his 11 days in jail,".the civil rights'attorney.says. `'Clearly, from everybody's testimony, this was someone who needed to see'a doctor. I'm not sure how that works. There:may be medical negligence here. The family is very . concerned about his treatment and we don't want to close that avenue." Sharon Giraud, a Mental Health Association of West Florida client advocate;.says for years it has documented a number of cases that have alerted it to the_possibility of systemic.problems in the-jail system's..treatment, especially.of the mentally-ill.. "We are still very concerned," Giraud says.!"There's all this publicity on a regular.basis. We need special training to help them and law enforcement deal with mentally ill people." Escambia County Jail Director Dennis Williams helped privatize inmate healthcare after SheriffRon McNesby took office in 2000, saying at the time that the jail's healthcare system:then was fraught with deficiencies. Williams defends Prison Health Services, which currently is paid about $3.8 million to provide healthcare to Escambia County's jail. .. J "For Escambia County, they're doing verywell, he says.:."That's not to say there aren't places we could improve or that we get things right 100 percent of the.time." PRISON HEALTH'S.RECORD I , 'Prison Health Services is no stranger to controversy. Currently, it serves more than 310 jail and prison sites,around the country, covering approximately 214,000'inmates-.in 37 states. The Atlanta Journal-Constitution reported in Deceber in..a story-on Prison Health that twice in the past four.months, the i Gwinnett County jail was sued by the families of inmates who died in controversial Taser-related scuffles with deputies. During the same period, two other inmates died--one killing himself,with:a metal jail key and the other dying in her cell, while her cellmates begged for medical care, the Atlanta;paper found. In Mississippi, the American Civil Liberties Union sued the company this summer, alleging that inmates of a Mississippi prison were misdiagnosed and received'poor care. t The New York Times conducted a yearlong investigation of Prison Health Services, which has a.$254 million contract in a New York City, and reported its findings.last February in a three-part series. The report found in two New York City jail deaths, and eight others across upstate New York, state investigators kept discovering the same failings: medical I staffs trimmed to the bone, doctors underqualified or out of reach, nurses doing tasks beyond their training, prescription . . drugs withheld, patient records unread and employee,mi,sconduct:unpunished. In addition, the New York Times reported that substandard care by the company contributed to at least 15 inmate . deaths in 11 Florida jails since.1992. several inmate deaths in Florida cost.Prison Health Services.three county contracts, millions of dollars in settlements, Al and an apology for its part in the 1994 death of Diane Nelson. The 46-year-old was jailed in Pinellas County on-charges of 3 4/7/08 1 1:01.PM AT&TYahooiMail-judeseven@sbcglobal.net http://us.f822.mail.yahoo:com/ym/ShowLetter?box=ln... . ' I that she had.slapped her teenage daughter. She suffered a heart attack after nurses failed for.two days to order the heart medication her private..doctor had prescribed. In that case, the New York Times reports as Nelson,collapsed, a nurse told her,"Stop the theatrics."The:same nurse admitted.later in a.deposition that she had joked to the jail staff,'"We save money because we.skip the ambulance and bring them right to the morgue.": In 2004, a woman in the Hillsborough.County jail.sued Prison Health Services, blaming the company for the death of her newborn son from complications during'delivery. The baby was born over an infirmary toilet.at the Falkenburg Road jail: And in.Tallahassee, the family of Ruth Hubbs,'who died at the Leon.County Jail infirmary, recently earned a.$350,000 . settlement from Prison Health Services..The 39-year,-old Hubbs, who suffered from bipolar disorder and drug addiction was found dead.in the infirmary May 16, 2003, about a.day after deputies reported seeing her sitting on the floor of her -jail cell shirtless and yelling incoherently to herself. The company failed to.take her.blood levels, monitor or administer drugs she was prescribed and.ignored red flags raised by a therapist and two jail guards. LAWMAKERS WARY Still, Prison Health earlier this month won the Florida Department of Corrections contract to provide healthcare to about 14,000 inmates in 13 South Florida prisons. The state will pay the company $792 million over.10 years. .' The company's track record made.some.lawmakers wary, newspapers reported in South Florida. . "It all seems very suspect," Sen. Frederica Wilson, a Miami Democrat who sits on legislative panels dealing with criminal justice and corrections issues, told the South Florida Sun Sentinel. "We know the health care in the prisons already isn't what it should be. If this:company is going to under Abid all the others, then I fear we can only expect greater disappointment." . Florida Justice Institute Executive Director Randy Berg, who has fought for prisoners' rights for 28 years,'has battled .the conipany.twice for refusing to provide needed medical care to inmates.and followed the company closely. "They have a bad history of providing healthcare to.inmates," Berg says in a telephone interview with the Independent News from his Miami headquarters. "It's an odd situation. The less'healthcare they provide the.inmate population, the more money they make. Its profit motives have always concerned me." Michael Catalano, chairman, president and chief executive of America Service Group, which owns Prison Health Services, defends the company's service.'He argues that the company actually reduces costs and improves.the quality. of care. Catalano and company officials say its successes far outnumber failures and its policy is never to deny necessary medical care. And they say complaints result from the.challenging work of inmate Healthcare have mainly come from litigious inmates, 'disgruntled employees and overzealous investigators. "(Our employees) choose to render a vital public health service in their own communities," Catalano says in a statement. "This is a high calling. Out patients mustalways receive appropriate medical care. There can be no compromise of this " fundamental value. Our vision is to lead the correctional healthcare field.in reputation and results, achieving the highest standards of operational excellence, clinical quality and client service." MEDICAL RESPONSE I •A check of Escambia County Circuit.Court records found two cases involving Prison Health Services, since it took over Escambia inmate medical care in 2001.- In federal civil suits filed 1n•the Northern District of Florida, 27 cases were filed against the company since 1995, records.show. The suits, many of which were dismissed for various reasons,.largely tell of medications allegedly being withheld or claims of treatments of injuries being denied. During the Coroner's Inquest into Boggon's.death last month, one corrections officer testified that.Boggon "seemed to have a lot of mental health issues. He didn't seem.to respond. Whitlock, a Prison Health nurse who found Boggon dead, testified.that a counselor did see him. But Kimberly Cox, a corrections officer at the jail and a great niece of Boggon's, testified that a day before his.death Prison Health nurses acted uninterested in her plea for them to order a psychiatric evaluation, which she said she was told had not been done. Whitlock said on the stand at the Coroner's Inquest that Boggon would "bite, yell or.spit,"which prevented nurses from getting a complete.diagnosis of him: "He was very uncooperative," she testified."He waslonly in there.nine days. We were trying to help him. We did give him medication." .. Sources close to the Bell case, say his pleas forme; attention went unheeded at the.Escambia County jail, until corrections officers.noticed a"major.change." Once transported to Sacred Heart, repeated requests of Prison Health Services from the hospital for Bell's medical records were ignored, sources say. No lawsuit has been filed to date in Bell's case. Complaints of poor treatment, especially of the mentally ill, are not new.to Escambia County jail.In 2003, Pensacola . Junior College Police Chief Nancy Newland, then on the board directors of the Mental Health Association of West Florida, called on the jail to improve its healthcare services and training of jail employees. Newland's brother, Harold Newland ll,.a paranoid schizophrenic, died in September 2002, shortly after.being release from Jail..Newland says he was denied his prescribed medicine while in jail, despite her.waiting two hours to meet with a jail j employee to bring his doctor's prescription and medication.to the jail. Without proper medication, schizophrenics' conditionrapidly deteriorates and they exhibit bizarre behavior that might lead to further criminal charges. BETTER HEALTHCARE? More than two years later, Lakeview Center and they Mental Health Association are working with the Escambia County jail I ?of3 i. 4/7/08.11:01 PM I ATUYahoo!Mail-judeseven@sbcglobal.net ! http:/lus.f822.mail.yahoo:corri/ym/ShowLetter?box-ln. and other law enforcement agencies to'Implement a 40-hour training program started in Seminole'.County'that creates Crisis Intervention Teams to better handle mentally ill people, The Escambia County jail is planning on sending five corrections officers through the training in the beginning: The training includes a'virtual reality schizophrenic machine, which allows police officers and others.to.experience what its . tike to. suffer from the disorder:- . Williams admits the jail is reviewing.its handling of inmates after the Boggon and Hell.cases. But he points out that Prison Health Services, as required by its contract with 4Escambia County, has earned and maintained national accreditation since 2003. "We have reviewed our process;' tie says."But are we doing anything that.requires dramatic change? I don't think so.". d.u_wayne(a)-inweekty.net :. 1 I i I r ' I !I r I , t t 1. I I , - t I I 1 .. ; _F . 4/7/0$ 1 1:01 PM ATUYahoo!Mail-jucJeseven@slicglobal.net http://us.f822.mail.yahoo.com/ym/ShowLetter?box=ln... ®COQ -M 41 I� o�_, Print=Close Window ' C;, sic Date: .Mon,7 Apr 2008 23:00:49=0700(PDT) .,From: "Judith Jones"<judeseven@sbcglobal.net> To: "Judith Seba Jones <Judeseven@sbcglobal.net> E-mail this to a friend.. Healthcare Behind Bars i by Duwayne Escobedo Robert Boggon suffers amental episode in a DollarTree store, which.leads to his incarceration in.the Escambia rr;. County jail. Despite at one point rocking on:the"flood of his cell and.urinating on.himself and displaying other odd behaviors, Boggon never receives a psychiatric evaluation during the:11 days he"spends in the jail and only receives medication used to calm him down before his death Aug. 29, records and testimony reveal. Jail.guards'end up dragging the 65-year-61d trucker:from his cell to the:shower;istripping him, shocking his wet body with a Taser Gun, then strapping his lifeless body to a restraining chair, wrapping a towel around his head and returning him facing the back of, his cell several hours before he's found dead, a.civil suit by Boggon's family alleges. Hosea Bell, a homeless man,•gets arrested A4 g..9 for urinating on a sidewalk outside Weis.Elementary School'. He's found mentally.incompetent by a judge.to stand trial Nov. 30 but"11 days later the 55-year-old is taken in handcuffs by a police car to Sacred Heart Hospital after:appearing lethargic at the E%scambia County jail.He dies at the hospital a few hours later. Both cases are focusing the spotlight on healthcare provided to inmates.at the.Escambia County jail by Prison Health Services, the nation's largest for-profit inmate healthcare company, caring for about one in.every 10 people behind bars. Across Florida and the country the company based outside Nashville has come under fire the past year for spotty and sometimes lethal care. " Following the Boggon and Bell cases, the quality,of the;company's medical services is.coming under fire locally. . David Craig,the Community:Law Enforcement Oversight president, is blunt and,concise.in his assessment of Prison Health Services medical care for inmates.. ' .'Given their less than stellar record,CLEO feels they would.be more accurately,named Prison Death Services," he says. Todd LaDouceur,.the Boggon family's attorney,;says the federal wrongful death lawsuit may soon extend to Prison Health Services. It currently.only names two ofithe.company's nurses individually, Lisa.Whitlock and Elaine Gregory. "I've been through the Florida Department of Law Enforcement investigation and it appears Mr. Boggon never saw a doctor in his 1.1 days in jail,".the civil rights attorney says. 'Clearly, from everybody's testimony, this was someone who needed to see a doctor. I'm.not sure how that works. There may be medical negligence here. The family is very concerned about his treatment and we don't want to close that avenue." Sharon Giraud, a Mental Health Association of West Florida client advocate, says for years it has documented a number of cases that have alerted it'to,the possibility of systemic problems in the jail 'system's treatment;"especially of the mentally ill. _ "We are still very concerned,".Giraud says."There's all.this publicity on a regular.basis. We need special training to help them and law enforcement deal with mentally ill people.". . i Escambia County Jail Director Dennis Williams helped, privatize1nmate healthcare after Sheriff Ron.McNesby took office in 2000, saying at the time that the jail's healthcare system then Was"fraught with.deficiencies. Williams defends Prison Health Services, which currently is paid about $3.8:million to.provide healthcare to Escambia County's jail. "For Escambia County, they're doing very well ,"-he says. "That's not to.say there aren't places we could improve or"that we get things right 100 percent of the time."; PRISON HEALTH'S RECORD. Prison Health Services.is no stranger to controversy. Currently; it serves more than 310 jail and prison sites around the country, covering approximately 214,000.inmates,in 37.states. j The Atlanta Journal-Constitution reported inlDecember.in.a story on'Prison Health that twice in the past four months, the Gwinnett County-jail was sued by the families of inmates who died in controversial.Taser-related scuffles with.deputies. During the same period, two other inmates died-one killing himself with a metal jail key and.the other dying in her cell, while her cellmates begged.for medical care, the Atlanta paper found. In Mississippi, the American Civil Liberties Union sued the company this summer, alleging that inmates of a Mississippi prison were misdiagnosed and received poor care: The New York Times conducted a yearlong investigation of Prison Health Services, which has a $254 million contract in-.. 'New York City; and reported its findings la.st.February in a three-part series.: The report found in two New York City jail deaths, and eight others across upstate New York, state.investigators kept discovering the.same failings: medical staffs trimmed to the bone, doctors underqualified or out of reach, nurses doing tasks beyond their training, prescription .. �. . drugs withheld, patient records Unread and employee misconduct unpunished. In addition, the New York Times.reported;that substandard.care by the.coinpany'contributed to at.least 15 inmafe J deaths in 11 Florida.jails since'1992. ! Several inmate deaths in Florida cost Prison Health Services three county contracts, millions of dollars in settlements, and an.apology for its part in the.1994 death of Diane Nelson. The 46-year-old was jailed in Pinellas County on charges of 3 . ! 4%7/08 11:Q1 PM 4 AT&TYahoo!Mail-judeseven@sbcglobal.net :.: ' ` httpJ/us.f822.maii.yah6o.corh/ym/ShowLetter?6ox=lr that she had slapped her teenage daughter. She suffered a heart attack after nurses failed for two,days.to;order the . heart medication her private doctor had prescribed: In that case, the New-York Times reports as Nelson collapsed, a nurse told her,-"Stop.the theatrics."The same nurse admitted,later in a_deposition that she had.joked.to the jail staff, 'We save money because we skip.the ambulance and . bring them right to the morgue."., In 2004, a.woman in the Hillsborough.County jail sued.Ptison Health Services, blaming the company for the death of her newborn son from complications during delivery.'The baby was.born over an infirmary toilet at the'Falkenburg Road jail.. And in Tallahassee, the.family of Ruth,Hubbs;.who.died at the Leon County Jail infirinary;recently earned a $350,000 settlement from Prison Health Services: The 39-year-old Hubbs,"who suffered from bipolar disorder.and drug addiction was;found dead in the infirmaryMay 16, 2003, about a day after deputies reported seeing her sitting on the floor of her jail cell shirtless and yelling incoherently to herself..The company failed to take her blood levels;�monitor.or administer drugs she was prescribed and ignored red flags raised by a therapist and two jail guards.:.. 'LAWMAKERS WARY Stili, Prison Health earlier this month won the Florida Department of Corrections contrast to provide healthcare to about, .' 14,000 inmates in 13 South Florida prisons. The.state will pay the company$792 million over 10 years. :,'The.company's track record made some lawmakers wary, newspapers reported in South Florida.",. _"!t all.seems very suspect,".Sen. Frederica Wilson, a Miami Democrat who sits on legislative panels dealing with criminal justice and corrections issues; told the.South Florida Sun Sentinel,."We know the'health care in the prisons already isn't What it should be. If this company is going to under-bid all', others, then I fear we can only expect.greater disappointment.":- Florida isappointment."Florida Justice institute Executive Director Randy Berg, who has fought for prisoners' rights for 28 years, has.battled .the cornpariy twice for refusing to provide needed medical careto inmates.and followed the company closely. "They have a bad.history:of providing healthcare to.inmates,° Berg says in'a telephone interview with the Independent News from his Miami headquarters. "It's an.odd situation. The less healthcare they provide the inmate,population, the more money they make. Its profit motives have always concerned me. Michael Catalano, chairman, president and chief executive of America Service Group, which owns Prison Health Services, 'defends the company's service..He argues that the company actually reduces costs and improves the quality of care. Catalano and company officials say,its successes€ar outnumber failures and its policy is never to deny necessary medical care. And they say complaints result from the chalJenging work of inmate healthcare=have mainly come from, litigious inmates,'disgruntled,employees and overzealous investigators: "(Our employees) choose to render a vital public health service in their own communities," Catalano says in a statement, "This is a high calling. Our patients must always receive.appiopriate medical care, There can be no compromise of this, fundamental value. Our vision is to lead the correctional healthcare field in reputation and results; achieving the highest standards of operational excellence, clinical quality.and,clien#.service." MEDICAL RESPONSE A check of Escambia County.Circuit Court records found two cases involving Prison Health Services, since.it took over Escambia-inmate medical care in 2001.in federal civil suits.filed,in the Northern-District of.Florida, 27 cases were filed against the company since 1995, records show: The suits, many of which were dismissed for various reasons,1,largely tell of medications allegedly being.withheld or claims of treatments of injuries being denied. During the Coroner's Inquest into Boggon's death last month, one corrections officer.testified that Boggon "seemed to have a lot of mental health issues. He didn't seem to respond.l' Whitlock, a Prison Health nurse who found Boggon dead, testified that a counselor did see him. But Kimberly Cox, a corrections.officer.at the jail and a great niece of Boggon's, testified that'a'day before his death Prison Health nurses acted uninterested,in her plea for them to order a psychiatric evaluation; which she said.she was told had not been done. Whitlock said on the stand at the Coroner's Inquest that Boggon would "bite, yell or spit,"which prevented nurses from getting a complete diagnosis of him. ; "He was very uncooperative,"she testified. "He was only in there nine days. We'were trying to help.him, We did give him medication." Sources close to the Bell case, say his pleas for medical attention went unheeded at the Escambia County jail, until corrections officers noticed a "major..change." . . Once transported.to Sacred Heart, repeated requests of Prison Health Service's from the hospital for Bell's_medical records were ignored, sources say. No lawsuit,has been.filed to Idate in Bell's case. Complaints of poor treatment, especially of the mentally.ill, are not new to Escambia County jail. In 2003, Pensacola Junior College Police Chief Nancy Newland, then on the board directors of the Mental Health Association of West Florida, called on the jail to improve its healthcare services and ttaining of jail employees:' Newland's brother, Harold.Newland i1, a paranoid schizophrenic; died in September 2002, shorty.after being release from Jail. Newland says he was denied his prescribed medicine while in,jail, despite her waiting two hours to meet with a jail employee to bring his doctor's prescription and medication to the jail. Without proper medication, schizophrenics' condition rapidly deteriorates and they exhibit bizarre behavior that might l lead to further criminal charges. : BETTER HEALTHCARE? More.than two years tater, Lakeview Center and the Mental Health Association are working with the Escambia County jail i _ 4/7/0$ 11'Ol PM AT&T Yahoo!Mail-judese%ien@sbcglobal.net http://us.f822.mail:yahoo.com/ym/ShowLetter?box=ln... and other law enforcement agencies to implement a 40-hour'training program started in Seminole County that.creates Crisis Intervention Teams to better handle mentally ill people. The Escambia.County jail is planning on sending five corrections officers through;the training in the beginning. The training includes'a virtual reality schizophrenic.machine,lwhich allows police officers and others to experience what its like.to suffer from the disorder. Williams admits the jail is reviewing its handling of inmates after the Boggon and Bell cases. But he points out that Prison-Health Services, as required by its.contract with Escambia County, has earned and maintained national accreditation since 2003. "We have reviewed our process," he says.."But are'we.doing anything that requires dramatic change? I don't.think so." duwavneCcDinweekly:net • I t. I I I I I I ji I II J • Iii .. 1. I 1 ` .� `� :. •: .: - 'll • . . . . . - 111 I 1 � ' I f,3 .4/7/0.811:01 PM I I , Democracy Now1.� Harsh Medicine. Ncw'Yoilc 1'irnes Exposes :Ilo�v Private HealthCare :.. Pa-e ] .Of 8 ... . .: . Display full version DEMOCRACY ,. •. Eft .. - ;. . _ _ .. Parch 04 -2005- Harsh 420®5Harsh Medicine: ;New York Times Exposes HoW. ` .'Private'Health Care in Jails Can'Be"a "Death:: Sentence" for.Prisoners We take an in=depth,look:at the.for-pro fit health care.in prison and jails in this co.Uhtry. The New York Times published a series titled "Harsh Medicine" :. based on a yearlong investigation of Prison Health Services, the nation's largest for- profit provider of prisoner medical.care;`that exposes how inadequate care has resulted.in death and suicides by prisoners. [includes rush.transcript] Today, we.are going.to take an in-depth look at for-profit healthcare in prison and jails in this country. Frison.Health Services.or PHS is the nation's largest for-profit --- proVider of inmate medical care=a 2 billion dollarA vear.1ndustry...Tho have.86. . contracts in 28 states and care for237,000 Inmates=which is one.in every10.people who are incarcerated. is Earlier this week, the New.York Times published a series; titled "Harsh,Medicine. The articles; based on a yearlonginvestigation of PHS expose how.the'company provided.medical care that was widely inadequate in some cases-and deadly in others. The articles detail a range of problems.with PHS" medical services-some of _ which resulted.in.'death.or.suicides by.inmates. The�list of problems include: skeletal medical staffs .under qualified,doctors and nurses;doctors who were practicing - without proper certification;,prescription drugs being withheld from .patients; and employee misconduct that went unpunished. PHS began receiving contracts in New.York State over the last decade despite a tarnished record of providing care in' Florida and Pennsylvania: Since then, the State Commission of.Corrections.has faulted the company in 23 inmate deaths and has. recommended disciplinary action of.PHS doctors and nurses, 15 times in the.past four years. The New York Times notes that in one report; the chairman of the commission's medical review board-Frederick C Lamy-labeled the company, "reckless and. unprincipled.in its corporate pursuits; irrespective of patient care.:' . Despite this, New York`;City,renewed PHS'.contract.in January of this year: PHS declined.to make someone available for our program but they-sent us a statement which reads lin part-"since the story appeared; PHS has received calls from Clients.-around the country`.and everyone has'been.supportive and expressed: their:disagreerhent with the Times coverage " Paul von Zeilba.uer; reporter for the New York Times.:Wrote series Harsh medicine about the severe deficiencies of Prison Health Services. PHS is a private,companylth6f provides health care to prisons and jails all over the country: o Dr. Bobby Cohen,federal court.appointed doctor Who monitors health care in prisons and jails in Michigan, Ohio, Connecticut and New York. o Barbara Ferguson, sister of.Brian.Tetrault '. Inmate with Parkinson's disease ...who, she alleges; was denied proper medical care and died behind bars. PHS L7elilocracy No w! I Harsh Medicine: Now-York Times.Exp6scs.How Private Health Card"... Page 2 of 8 was the healthcare provider in ,the jail that.Brian was locked up in. RUSII.,TRANSCRIPT ,_ This transcript is available"free of charge. However, donations Help us provide closed captioning for the deaf and hard of:hearing on our TV broadcast'. Thank you for your generous contribution. Donate- $25, $50:, $100, More..: AMY:GOODMAN- Joining us in our studio is Paul'von Zeilbauer,.the reporter who wrote the series in The New York Tirnes, and Dr. Bobby Cohen,,who monitors prison health care for federal courts. On the,-phone with.us frorn Clearwater, Florida, Barbara Ferguson, whose brother died in a jail cell.,because he was denied proper.: treatment by P.H.S. staff, she alleges. We welcome you both and all of you to Democracy:Now!"Paul von Zeilbauer, this is ,quite an astounding series. t_ay out for us what you exposed; i .. PAUL VON ZEILBAUER: Okay. Well, over the course of,about 15 months,`12,to 15 months, I began looking at the jail medical the-medical the system of del iveririg < medical care*in the New York'City 'ail system .where P.N.S. is the medical provider, J and the' re•was a;serles of suicides that occurred in thefirst.half of 2003,.and..I wrote,. . ._ '... :._ I believe, one or two tarticles, one of which was about how two of these six si.licides.. were people who were on suicide`watch at the time, which,:you know, brings up the obvious question of what is suicide watch.and how does that happen: And from there, we began looking at who the actual provider is, Arison Health Services being the.contractor, and then from there, I think it just sort of naturally took a little"bit of flight. When you wonder who is doing the medical care;and you begin looking at where else they provide,it. And as it turns out, you,know, they have had contracts with upstate jails;and of course, they're a large.cbmpany, so.they have had many other contracts•that we just began looking at. And.finding other problems, yoti know, around the country. And that's how,!t began; and then, you know, like any good story, the details lead to other details, and you begin opening doors;-and that's how everything sort carne to light over time; ]UAN GONZALEZ: And you originally got on the story.because_you were covering some of those deaths as part of your regular beat, or,how did you get actually involved yourself in.the story?, . PAUL VON ZEILBAUER: Yes: Right..My job is-in the metropolitan desk at the Times is covering prisons, jails. So Rikers Island.was sort of the centerpiece of my. beat; if you want to coli it that. And so when_these suicides occurred, like I said, in the first half—six in the first half of 2001 which may not sound like a lot, but in the world of Rikers Island, it was a lot. in fact, I think I mention in the story, it was the largest-the highest rate of suicide in any six-month period since I think 1985. So, it was remarkable that occurred, and my beat was covering the jail system and, you know,,it became something obviously to look at. AMY.GOODMAN: Tell us about Jose.Cruz? PAUL VON ZEILBAUER: Jose Cruz. Jose Cruz, if.I remember correctly, was the first of the six people who killed themselves in this six months period, to da so in January, I believe, of 2003, And, let me see, I don't want to get any details wrong, but I believe Jose Cruz was a man who was arrested for an assault. He was HIV. positive. I-believe he had tuberculosis. He was in the—how do you call—it's called Maui,in the vernacular. How do you refer to--?: Democracy Now! l Harsh Medicirf' New York Times Expses'How Private Health Care... Page,3 of 8 DR.BOBBY COHEN: One of the infirmaries. PAUL..VON ZEILBAUER: Yeah he was in an infirmary; because he was contagious. And he was also put on suicide watch;,because he had become despondent over timer Whatoccurred,lif you just -1want me to give can give a quick history of what happened to him. He1was put in a cell in this medical lockdown unitthat was atthe .end of the wing where guard-where the-Jail officers couldn't.visually see him'unless they walked down and actually looked into his cell. So, while he was on suicide watch, he was effectively out of sight. And he used that opportunity, apparently, to kill himself. �. AMY GOODMAN: I-wanted to turn to Barbara Ferguson.-If you could tell us the Y of our story brother.1 What ha Y, peened to Brian.Tetra ult. _ BARBARA FERGUSON: Yeah,,Brian Tetrault. Good morning: My.,brother in November of 2001 made the mistake of going to his ex-wife's house and taking some things he.thought belonged to him. She pressed charges and had him arrested. 'My family a,d I, who live in Florida, had no knowledge of this at the tir6e. Ten days later, I got a phone call at-my.house from his ex-wife that my brother died: My:brother was very, very sick, very tli: He.'had undergone,some surgeries and things to improve his-life, quality of life, but he was an obvious ill person. We were . veiy-confused: W6hadno idea . ou.know what had ha • ppened. And it wasn't really Y until:Pa ul had come to meet with us in last July that I was able to put together"tne '.. - .whole story. We didn't-we were lied to by:his ex'-wife.about how he had gotten into jail.'We.found out exa�ctiy how that happened. But we didn't understand why he would have died there, and so when we started to pursue some of the information that we incanted, my parents, did through the Freedom of Information Act, we got more confused. Just didn't make sense. Excuse me. As, you know, it got harder and harder to get more'Information, and also being lWFlorida; it made it harder for.us to try �o figure:it.out.�And.at one point, m p. y parents tried to be the party to act'on my brother's behalf to, you know, allege a suit against the jail,-b'eca'use we knew that something had hap d, and in that pursuit niY,:`ne hew was named person arson .. .P Who.would.do that,and_he is in the suit with them currently: AMY GOODMAN: When we come back from our.break, we'll find out more about the circumstances of when he was put into jail. Our guest, Barbara Ferguson, who iosther brother.in.theiNew.York City.jall system-the New York State jail system. Dr. Bobby Cohen, whop is the federal court appointed doctor who monitors health care in the prisons, and Paul Von Zeilbauer, who.ts the reporter for The"New York .Times that.did this series for The New York Times'calied.''Harsh Treatment." [break] • AMY GOODMAN:,We"re talking about "Harsh Medicine."it's a series of exposes in The New York Times this week by'Paul von Zeilbauer about the Prison Health service, which is P.H.S., a for prison health care in in this country: And we're.looking at some of the cases he'exposed this week. We're also joined by Bobby Cohen, who is the federal monitor for prisons, as well as Barbara Ferguson, : Who has been telling us the*story of,her brother;Brian Tetrault; who died in his jail cella I'm Amy Goodman here with Juan Gonzalez. JUAN GONZALEZ: Paul, let's continue with the Brian Tetrault case. Again; how did you get on this particular case?.He was a former.nuclear scientist who had struggled with Parkinson's disease and was in jail on a minor charge. PAUL VON ZEILBAUER:-How I.got onto that— i Democtacy Now.! I Harsh Mcdicinc:.New York Time's Expgscs How Private Health Clare.... Page:4 of 8 JUAN GONZALEZ. And also, then, what you discovered about his case. PAUL VON ZEILBAUER: As I mentioned.to you,.a:fter.I began looking at the after ... the company's.record became an,issue and became relevant, I Went to the State Commission of.Correction. It's a small agency in-New York.State. Its members are appointed by the Governor, and its mission is to enforce standards in the Newyork City jails-sorry, in.the jails and prisons in.New York State. It:actually—this. . Commission.began"as or got its:current mandate after the Attica.riots,.I believe, in 1971, to prevent.that;very thing Proal happening again and to make sure there were humane levels of care;and so forth in the jails and prisons..So, what the Commission does is investigate every jail death.that occurs,.whetherit's in a,.you know, Broome County jail or whether; it's in Attica or another state prison. So, they publish..these . reports. The reports are public:.I:filed a Freedom of Information Act request for` every.report that the Commission had done that mentioned or included or referred to Prison Health Services, because like I said, the company had become a focus of :my reporting. So, Mr. Tl etrault's case became—was one of those reports. In fact it's. "interesting, you know,;there were many reports that I received. Some were more interesting than others. And Mr.`Tetrault's case was interesting because he had died in 2001; but the Commission Of Correction only.bo'came aware of his death in 2003, by mistake, really. One of their.employees read a newspaper article upstate that expiained..one of his family members had.filed.a lawsuit over the death; which was news to the Commission..And so they began looking into it and found; you know, this case. AMY GOODMAN: So in that particular:.case, the correctional authorities had not :.reported the death to the Commission? PAUL VON ZEILBAUER: Yeah. It was the Schenectady County Jail where Brian Tetrault was incarcerated. And the law in New York says that every time you have a death of an:inmate, every time an inmate dies.or. is.injured, :you have to excuse me=: . AMY GOODMAN: Turnoff your watch? PAUL VON ZEILBAUER:Yeah, turn off your watch;and then report it to.-no;.you have'to report it to the State Commission, so,that there is.no excuse for not having: a public inquiry. But in this case, Brian Tetrault was'.released—was supposedly.. . released from jail,.even though he was-in.the hospital bed by the time he died. He.. was released by the she'riff's office ten minutes before,supposedly ten minutes before he expired. AMY.GOODMAN: I wants just read those first two paragraphs of your piece, ."Private Health Care in Jails Can Be a Death Sentence.""Brian Tetrault was.44 when : he was led into a dim county jail cell upstate.New York in 2001, charged.with taking some skis and other.items from his ex-wife's home.A former nuclear scientist, who'd struggled with Parkinson's, he began to die almost immediately; and state investigators would later':discover why..The jail's. Medical Director had cut off all but a few of the 32 pills he needed each day to quell.his tremors. Over the.next ten days, Mr.:Tetrault slid into.a stupor, soaked in his own sweat and urine, but he. . never saw a jail doctor again; and the nurses dismissed him as a faker..After his heart finally stopped, investigators said corrections.officers at the Schenectady jail . doctored records to make it appear he.'had been released before he died." Dr. Bobby Cohen, how did this happen? . DR. BOBBY COHEN: Well,.I think that the problem in medical care in prisons is that . . . for a variety of reasons—and this is a general issue,::not specifically on what Paul wrote..=is that medical care operates within prisons and tends to see:its role as r7 Democracy.Now!, Harsh Medicine:Vew.Yorlc Times 4xposes IIow Private Health Circ .:. Page 5,o f S. . supporting.its client, ;which is the system, which his the jail, which is the city,.which is the state, rather than the'patient. Now, that's.not.always the case. There are. dedicated people, and you know. Paul's articletalked about.people who had:.really .. . tried.to do a good job. But the nature of.incarceration Creates a very, very difficult: situation in which to provide-medical care. It's possible, but difficult. And it is deforming to medical'staff.just as.it's deforming,to prisoners and to correctional officers.to be in these institutions; but.it's hard to understand how nurses could ignore a situation that was just described right now,.or how doctors. could ignore.a. situation that-like that, which was described. That is incredibly disturbing, and.it `happens.-It's not the usual, but it happens.,It.happens.often enough.:I think that... the task is to—in terms of,providing medical care':in .prisons—is to instill and..inspire. medical staff to understand that their:job is difficult, and it can only be done in . opposition,.actually, to the prison'.`.You cannot provide.medical. care in a..prison, if you go along with.the;prison rules. You.have to complain when patients are,not . seen. You have to complain .when transportation doesn't bring the patient to the specialist. You.have to:complain.when medications.are.not delivered. Now, I think it.. is.particularly hard for for profit companies to do-that; because.they need to have their contract re"hewed by the facility or the state or the county, and they want to be on good terms. with.them and not make their job of corrections more difficult. JUAN GONZALEZ: Well; but Paul, I'd like to ask you, I remember.years ago, I. covered quite a bit of what was going on in.the city jails at The Daily News, and I would often get calls from doctors or medical staff who worked on Rikers Island. At that time it was.Montefiore Medica! Center which had the contract. It was a non, profit voluntary hospital in New York to handle the situation and to deal—provide medical treatment to Rikers. .But there would be doctors and nurses who were definitely concerned about what was going on and the kind of.treatment that they were being.forced to deliver..What has been, from what you can tell, the impact of this move toward more-for-profit operations.moving into these jails? PAUL.VON ZEILBAUER: Well, in.the.I can speak;;in.the. context of what I have learned through my-repbrting, and what I understand is.that privatization of-if you want to call it private; I mean, it's a public company; Prison Health Services, so "private" is-a bit of a misnomer, but it seems as if the difference between a for-profit companyproviding jail or prison health care and a teaching hospital or a public hospital doing it that the staffs=the staffs,the.clinical staff seems to be smaller. I . mean, that just seems=,not just in New York City that it occurred, but it's what I found everywhere.:. AMY.GOODMAN: You used,the term "skeletal.": PAUL VON ZEILBAUER: Yes, the doctors used that term.In fact, I think it was the first article of the three here quoted. a doctor who had just resigned in Alabama. She was one of,. I think, two doctors in the.prison, the state prison in Alabama for about : 2;200 inmates who had complained about absolute skeletal staff. This is—I mean; .:. the reason we used it not because it:was an .aberratibn or a nice word it use to play gotcha;'but it really reflected what:I had heard from. medical clinicians and medical people.who worked for this company.in many places.; AMY GOODMAN: A second story in .your piece. You say,"Two:months later, after Mr. Tetrault died, Victoria:William Smith, mother.of a teenage boy was booked into. .. another upstate jail in Duchess County, charged with'smuggling drugs to her husband in prison. She, too,. had only ten days to live after she began complaining of chest pains. She phoried.friends in desperation. The medical director would not prescribe anything more potent.than Ben Gay or the arthritis medicine she had brought with her, investigators said. A nurse scorned her pleas to be hospitalized as a ploy to get drugs.:When;at last;an ambulance.was called, Ms.. Smith was"on the . DeiiiocrIicy Now! Harsh Medicine: New.Fork Tii es E poscs How Private Health Care Page G of 8 ..floor of her.cell shaking.From a heart:attack that would.kill her within an hour: She was 35.." Now, Dr. Bobby Cohen; you're the Federal Court.appointed doctor who monitors:health care in prisons and jails in Michigan, Ohio, Conhecticut, .New York: ,. . Where does`P.H.S. fit into.this? Prison Health Services. How does it compare to non- profits that run the system-. We're sorry they co.uldn't be us with, but-is this a serious crisis in this country, and should they.ha.Ve their contracts pulled? DR. SOBBY..COHEN: I have not hada chance to review all of the data that Paul looked.at, although I have no reason to believe that he did not carefully review it and thatit reflects the reality. Certainly, New York City.should have thought.very carefully about renewing it at..that time, and there should have been a process which allowed this information to get.out.1 think.that in general, the trend towards for- profit health care in the United..States is a.serious problem, that just as in other. . health care in.the United States, when you put p.rofit.lnto the situation, you.get that profit significantly.by.denying.care..And when a company"like P.H.S. or other for- profit companies go into a system,.the first thing they..establish is a utilization . review system, which all 6F.your viewers are familiar with from their own encounters With medical care. Utilization review is a really a.process of denying access to specialty care. That'sfn a contract where there's a fixed amount of money, and whatever theydon't spend, they..keep. That's a very easy way and effective way to make money: That was not the case on,Rikers Island right now,.because the previous.contractor.hld had a risk contract where..they made millions and millions of dollarsi tens.of.millions of dollars by'denying car6 cm Rikers Island..Actually,.they were kicked out.because of the serious morbidity.and mortality, many, many deaths that occurred during the St: Barnibace reign. I think that there is no room for for- . profit health care in prisons, because of the kinds'of situation.that Paul has described. The process;:when a"company goes in;.and then it gets its contract renewed after two or three years, it essentially has to underbid itself because there are other.for-profits who are willing.to come in and take the care, so it.doesn't ask • for increases in fees. When I monitored the Philadelphia jails.a .number of years ago when P.H.S. was running it, I encouraged them.to ask for additional funds when they.were renewing the contract, because they had new problems. They had to take care of HIV infection. They had to fix what was not being done..And they were extremely reluctant to do that, because they knewthat they would lose their contract.And so this—the process of competition among for-profits drives the amount of-funds.. vailable to prisoners down. And that's a serious problem. JUAN GONZALEZ: Doesn't ultimately the problem;reside in the fact that, because we are dealing with an inmate population or prisoner population that the local governments, the state governments basically don't care, and want to spend as little money as possible in maintaining the health of these inmates, and there is no constituency—organized constituency to insist on better health care? DR. BOBBY COHEN: I think that's absolutely right,.and it actually is the law in this . country. I mean' there a;re. two legal issues. One, in'.the United States, prisoners are . actually entitled to health care which is not deliberately indifferent to their serious needs. The Supreme Court ruled that in 1976, and.that's why all:of the lawsuits have been filed, and actually, P.H.S. exists because of these lawsuits,because they said, "We can fix it,"when the courts told the states"or the cities that you are providing unconstitutional care. But there's another legal issue here,"which is that the cities and states.cannot say it's P.H.S.'s fault..They.are responsible. And they have to.monitor.it. As Paul points.out in the article, previously, New York City's Board of Correction, whidh developed standards for care of medical and mental health in the jails, had a death review.board, which reviewed every death, and that process has not been continuing of.late. More of that is needed. More.involvement of-you know, I. really think the.more.non--the more people who come into prisons and see what's going on,'the more people looking the better, .because these are i f Dcmoc►-acy Now!. Harsh N4edicirid Nc�v:York Tin cs.Fxposes.How.I'rivatc:IIcalt.h Care ... Page 7.of'8 deforming, terrible.institutions that need as much fresh air:.as possible. AMY.000DMAN: Tell us about.the Philadelphia case'that you're quoted in the . article,.Dr. Robert Cdhen;'about women who were pregnant in the Philadelphia jails. Again, this Prison Health Services.provides service in this case. `.'In Philadelphia in . 1999, federal court monitors report warned the company's failure to segregate. prisoners who were suffering:from T.B. posed a public health emergency. Pregnant inmates, it said, were; not routinely tested or couhseled for HIV, endangering their babies. In fact, the women were encouraged to'refuse pelvic exams. DR. BOBBY.COHEN:J believe that I was the state monitor at that time. There's another doctor;.Robert Greifinger, who was the federal monitor at that time. My .experience..in Philadelphia, in terms of care for women in prison, was that there was a process in which women were encouraged to refuse pap tests and pelvic . examinations. I would:look at the charts and they.viould say, "refuse, refuse, refuse, refuse, refuse."And then I would ask people, and they told me.why, that there were—when supposedly these exams had taken place and they were tested for. chlamydia or gonorrhea, common illnessesamong women who were in prison, the rates were unbelievably low to zero.when we know that the rates of these are very, very high in this population. Additionally, while I was there, while I was reviewing it, .. -two women delivered in their cells who were pregnant. That's-there's—of.course, these things happen but it's usually a story,in The Daily News, when someone delivers in'a cats. This does not have to happen in,a setting with medical care present. JUAN'GONZALEZ: Paul, I'd like to ask you, who runs P.H.S.? Who are the—I mean, . there are obviously"individuals behind these companies. 'Is it part of a larger corporation, and.how did it develop? . . PAUL VON ZEILBAUER: Yeah; well, -Prison Health Services.was founded in 1978; --nQt coincidentally, I'belie' ve, two.years after the Supreme Court ruling that Dr.: Cohen.mentioned that required adequate medical care to be.provided,to all.inmates....... .: So, you know, there was an opportunity there., because g.overnments_were.n't. .:. interested.in. it, and in providing it necessarily. I mean,they had to, but they weren't eager to. Companies like Prison Health.evolved, and.currently the company—make sure I get this right, Prison Health Services is a—there's a holding company that basically owns Prison..Health Services. .The holding company.is called America Service Group. Its stock ticker is A.S.G:R.'It's based. in. Tennessee. Under:the America Service Group umbrella, there is Prison Health Services, and there is a pharmacy operation called Secure.Pharmacy Plus, which, you know, is a . complementary.businessbecause.the pharmacy provides the medicines to the jails and prisons where.P.H.S::, Prison Health Services has contracts. So, it-you know, the—.it's a public corporation. You can go on the.S.E.C. website or anywhere else—or yourAmeritrade account,;for that matter, and look up the company's performance and who owns it. It's a regular public company: s. AMY GOODMAN: Just ending"with Barbara Ferguson. What are you calling for right now in the death.of your brother? BARBARA FERGUSON: At this:point, my family, meaning myself and myparents, we are not doing any legal action. My nephew is doing that. He, I believe, and Paul, you can verify.this, because you probably have more information. They are trying to. .. ..settle a suit, I believe,.with Prison Health Services. But what'we really, really want is. that, to go along with Paul., to help these people be aware.: PAUL VON ZEILBAUER: This, I mean, as Dr. Cohen mentioned, it's just-you know When yougo into jails and prisons, it's by:almost necessity,.but certainly; there is llemocracy NoW! Harsli Medicine; NeWI'orlc Times Exposes HoW Private health Care... Page 8 of 8 not a.lot of sunlight'shed on these institutions..: AMY GOODMAN: Well, thank you for doing some of that with your series, "Harsh Medicine.".I want tolthank you, 'Paul von Zeilbau.er for joining us, reporter.for The New .York Times, wrote the series in the paper..., I PAUL VON ZEILBAUER: Sure. AMY GOODMAN: Dr. Robert Cohen, federal 'court-appointed doctor, who monitors . . health care in.prisons and jails,'and Barbara Ferguson, sister of Brian Tetrault; who is the prisoner with Parkinson's who, denied proper medical care, died behind bars. The original content of this program is licensed under a Creative Commons AttribufionL Noncommercial-No Derivative"Works 3.0 United States License. Please attribute legal copies of this work to democracynow.org. Some of the work(s) that this program incorporates, however,:may be separately licensed. For further information o, additional permissions, contact us.': i j j • 1 De- t Ont o f Economi cs,.- :•UCO Depa:Tb ental.Workiiig: Pipers ( yj Uriiversit 'of:California Santa F3a,rbara) -Yffl�,2607 aper ii'o7 J. , . Prisor `°:Health Care: =Is :Contract,ing Out - - - - 4 ea t, y; Kelly.: Bedard d - Tod E. Frecli • . . _ J. - 'University.of California, Santa Barbara ! tUniversity of California,Santa Barbara 1 This paper is.posted at lthe eScholarship Repository,University.of California..'.,'. 3 f1ttp:%/repositories:cdlib.org/ucsbecon/clwp/11-07. j Copyright ©2007 by tbe'aiuthors:. . .- . . a i 1'rison.Health'Gare: Is.Contracting Ott Healthy? • elly Bedard -H.E. FrechIII .. Department of Economics ' Department of Economics . University of California, Santa;Barbara University.of California, Santa Barbara kel.1.�!r�econ.ticsb.edu;: .. free]1Oeeco i)..ricsb.edu Septe nber 2007 Abstract:. . . U.S. Prison healthcare has recently-been in the news and in the courts. A particular issue is whetherprisons should contract out for healthcare. Contracting out has been growing over the past few decades: The stated motivation for this`change ranges from a.desire to improve-the prison health care system, sometimes in.response to..a..court.mandate,.to a .. desire to reduce costs. Thisistudy is a..irstattempt to-quantify the impact of this change ' on inmate.health: As morbidity measures:are .not readily 'obtainable, we focus on mortality.. More specifically,'we rise a panel of state prisons from.1979-1990 and a fixed effects Poisson model to estimate the change in mortality associated with increases in the. percentage of medical personnel.employed under-contract. In contrast to the first stated aim of contracting;.we.find that a 20 percent increase in percentage of medical personnel . . employed under contract increases mortality by 2 percent. Thanks are due to Mary Alice.Conroy, Ph.D., Director of Grad Studies in Forensic Psychology;Sam Houston State University and Clifford Leonard, Ph.D. Staff Psychologist, Pelican Bay;State Prison, California, for helpful discussions and . background in prison°health care. An earlier version.of this.paper.was presented.at the International Health Economics Association meetings in Copenhagen, July 9,2007: Thanks are. to participants there, especially Avi Dor. : Keywords;,prison healthcare; coritracts, managed care; outcomes;mortality JEL Numbers: 1.12, 118, K23, L14, L23 t - the notion that independent oiganizations'(often but not necessaril it-seeking firms : ....YP. g ) are more flexible ai7d.efticient.than roverninentall operated-prison healthcare.staffs.: b Y p For one thing, contract health care providers-are.allowed to pay profes.sionala.wages that exceed.state-mandated pay schedules that are'often.too low for difficult work in prisons , in isolated areas.(Gater.2005).Z.Profit=seeking firms also..havebetter incentives to ... pro care more efficient] because maria ers are allowed to kee the residual earned, p Y'.. g. p. b reducin` 'costs Alchian and Demsetz 1972 .Boardman and Vining 1989 Frech 1976 . . Y g ( g ,. . Fizel and Nunnikhoveii 1992), 1. While.there is a.subsfantial.literature examining the relative1efficiency of . .government versus private firms in the context of goods produced directly for markets, such as insurance or privatization of state-owned enferprises(Ehrlich, Gallais-Hamonno, Lieu, 1994,Boardman and Vining 1989, Frech 1976,. Shleifer 1998), to:the best of our -knowledge-only Hart; Shleifer and:'Vishn 1997 formally,-models contracting' for Y'( ) Y services that are-not bought on the.open market. They`seC'p a simple:model'-where the .--=:- provider,eithefa government employee or a private contracting firm can invest in either i improving.quality(which also tends.to raise price) or reducing cost(which also tends to reduce quality). They show that private contractors have'stronger incentives to both improve.quality and reduce;costs.than government employees..The problem is.that • private contractors-may have incentives that are too strong to reduce costs since.the ignore the adverse impact on quality....'They apply the model to:the question of privatizing . 1 entire prisons: Like contracting'out for prison health care, privatizing entire prisons'is growing.in'popttlarityin the U.S.; though itis much less-common than contracting out All these issues were raised by Judge Thelton Henderson in appointing a receiver takeover the California system(Plata v.Sc&artznegger 2005). . _ themselves:were simply ciitdown,imedicated and returned to their,cells without evaluation McDonald 1999 Anno 2004 psychological ( ) "One of the complaints of the rioters in the infamous 197.1:Attica New York prison . riot was inadequate health care. Although prisoners and prisoner advocates sued prisons on the grounds that health care vas inadequate; during this early.period the courts. . genera took a hands-off a roach.. The�le al environmenf than��ed 'abruptly when the g Y.. pp g p Y . federal courts.began to view health care through the lens of the U.S Constitution's A. Eighth Amendment prohibition of cniel and unusual punishment. An early landmark. case.in this regard'was.the federal district court decision,affirmed by.the Fifth Circuit of, Appeals,Newman v..-Skate of Alabama (1974). 'Among the factual findings of the, decision was the story of a quadriplegic who was not given intravenous feeding.iri the three days before his.death. .The court found the conditions barbarous and in violation of the Eiglitli Ainendmenf. In 1976, the Supreme Court addressedthese.issues in'Estelle v.: Gainble: They declared that"deliberate-indifference"to a prisoner's serious rriedical. ... . problem.is a Constitutional .Violation.,..Subsequent flings further established the right to "reasonably adequate inedicaLcare"(McDonald.1999).. Partly due to,the vagueness of these standards'. these legal changes initiated.an endless stream of court cases'and led to heavy involvementof the courts in forcing . . improvements iri prison health care:..Medical care is the most litigated issue involving prisons Schlan>er 2003 B' 1996,36 states were under federal court order.to improve prisons. The majority of these cases.included health care (.McDonald 1999). A survey of . ' a Most observers cite under-treatment;especially of relatively sick prisoners. But,the concept of "reasonably adequate medical care"is so vague.that surprising outcomes of any kind can occur. For. - example,in a controversial instance,the California prison system provided a heart transplant to twice convicted of anned robber;at a'cost of$1;000,000(McKneally and Sade 20U3). 5. . . fo'r this'is mixed. ,For example,death rates.iri.prisons are lower.'than for the eneral' o ulation after controlliii for race sex and a re th ppou>li the are.-higher:for infectious disease and suicide (McDonald.1999).. In a study of the.Cook County (Chicago) Jail, •"Kim et al(M06).found.a•68 percent lower adjusted.mortality rate for':inmates than.for-the general o ulatioii. "Owthe other hand, when risoners.are:released their:death rates p P P . , . jump and,become much higher than those of the general population. In a study of former.: Washington State.inniates; the adjusted death rafe for.tlie:forrrier.inmates was 3.5 times . the state's overall'death..rate:(Binswanger et al 2007); .. . . We.know of only-one nationwide analysis of prison health care costs,-done.by. i Lamb-Mechanick:and Nelson(undated). They use state level-data obtained from:a dedicated survey of state departments of corrections, plus the Federal Bureau of Prisons (BOP) in 1998. Lamb=Mechanick and Nelson report perday healthcare costs per inmate ranging from $2:.74 in.Alabama.fo $11 96 in,Massachusetts,with'a mean of$7.15 They .: also-study-the:determinants of costs using a simple OLS-model and data-from-38-states. The regressors include several measures of medical professional inputs,and whether juveniles are included in the budget.. No state socio-economic variables.are used.. For our purposes, the most interesting finding involves the.dummy variable for whether the. state used capitated'contracts (like many private sector HMOs) for ambulatory care. ;18 states report using such contracts. Iamb=Mechanick and Nelson find that states with.:. capitated contracts have 31 :percent lower costs per.inmate..While this result is interesting,.it:is reasonable to b'e quite concerned-about omitted variables:bias in this.. , contekt:and one.should therefore•interpret these estimates.with'care. i A • 7. _ and'asthma.`.E1t the sane time tll�s�contrac'tin out strate T saved,the state $215.million .. .g: by . over six.years, r. n.a.siinilar vein, as a result of prisoner protests in the Baltimore City Jail,health care was contracted out to a newly created:nonprofit organization in.1977. :A comparison of outcome`mcasures pre and.post contracting shows substantial effects.. While the number of sick visits fell.from.62.91.to 27.4 patientsper day per-1,000 inmates, the length. i 01. of time nurses spent.with patients per visit rose from 2.8 to 10:9 minutes. -At the same:: time;clinical:staffing at the.jail increased by 60 percent while:costs rose.by only 13 percent, largely because . , hospital use declined.' Overall, Freeman 1981 considers this to be'a substantial improvement in.care. Lastly, Szykula.and-Jackson(2005).detail a case study for managed mental health i to iiia large Salt.Lake City jail:.:.They report lower costs and much lower levels' Of psychotropic.medication of the inmates after the initiation of manage care: F. r 3, Inmate Mortality Data i. . . .. i We construcUa balanced:three yeah panel from the'1979 and 1-984.Census:of State Adult . I Correction Facilities and the.1990 Census of State.and Federal Adult Correction Facilities. The sample.is restrictedto these three years because:they are the only surveys that include the..necessary data.'Because federal data.are onlyreported in 1990,the panel is also restricted.to state prisons. All data are self reported.at the institution;level.:As the objective is to estimate the impact of.medical contractin on inmate mortali Nyerestrict. . P . g , the sample to facilities that are likely to offer at least some amount of medical care. Operationally this.moe ns that the.•sample is restricted to state prisons housing adults with. restncts the.sample to prisons�vitli.:a hospital; a:shared.hospital,or an infirmary.and cglumil..3::restr�cts the sample to�ust.prisons'wit}i a hospital::.Col�in�ns 4 and 5.restricf the. sam le to. .risons.with ali avera e c.a aci of 5.00+and 1.000=+ `res ectivel We..use p P g pacity p y.: these samples in Section 4:to check the.sens.;itivity.of.the:res'Its -to various sample s ecificationS. p • : as _ 4.:Fixed:Effects Poisson Model The::objcctive.is to estimate the impact ofinedical contracting in prisonso.n inrriate mortality: M. �r r,. where.i denotes prisons, t=1979; 1984, o.r.1990,�Li i.s the annual prison-level mortality.. count, cr is a vector.of prison fixed effects;; is a:vector.of ear indicators, Cis the` p. Y proportion'ofprofessional.staff employed:on.contract(ranges from 0 to 1).P..is the ; .number of.professional staff,`Xis a vector oftime=varying prison characteristics; and E is the:usual'error term. The.central'feature of our prison mortality data is that it is a non- negative count with a..large number.of zeros (see Table.3 and Figure-1). As.such; we estimate equation.(Iusing a fixed effects Poisson model. We also re ort OLS estimates I _ r comparison. . The:estimates for.equation! (1) are.reported in Table 4. Columns land 2 report ri estimates when mortali .includes:both illnesses and suicides the fixed effects Poisson ty. and excludes.suicides;:respectively. `For comparative purposes;columris,3 and 4..report .: the same„estimates:for,a linear fixed effects model.. All inodcls;are weiglited by average - .. . .. : ' capacity. 1'he sample sizes are.smaller for the Poisson:models:;conipared;to.tlie'OLS , : I capacity, 500+ inmates and 1000+..inmates, as ail alternative;to direct measiirement of • medical facilities; to focus on prisons.-that are:more likely to;provide a high proportion of medical services iii the,prison itself. :While'the point:esiimates for:large'prisoiis and'. prisons with a hospital are substantially larger than the baselinearid.the other two.less:.: :::... restrictive.sub-samples,.they are.similar in percentage.terms.�A 20-percent:increase.in ' ' n '.,. ali b 0:13 deaths or 2 ercent�relative:to a mean death count _ contracting increases mortality y p of.5.75 for prisons with a hospital and.by..0:13 deaths or:2 percent relative"to a.mean death count of 5.23 for prisons with 1000+inmates. 4.I. Medical Staff Mecrsrremefit Probleii:s. For-our puiposcs, 14primary flaw.of available data.is.the fact that inedical.staff isnot . separately identified from other professional:staff in the.1990.survey. As a result,we are forced to use all.professional-staff and.the.percentage of them'employed under contract.:` instead of isolating-medical contracting out.:..This lack of disaggregated data is unfortunate since most of the siibstantial changes:in contracting occur between 1984 and 1990. The 1979:and 1984 survey's do separate medical personnel from other professional . - staff.:.Table.61herefore:replicates'Table 4 with three,differences:..First; the sample:only .: . . .. includes the first-,two years; 1979 and 1984..:Sec:oiid;medical:staff and other professional staff enter.all models scpar'ately(rows 1 and 3)as do the percentage'of medical and other - professionals who...are under contract(row's,2-and 4). .Third, the.sample is restricted.to with ith at•l.east sonie:professiorial and medical staff in both 1979 and 1984. . Several feahires,of Table 6!warrant comment: ..FirsIt,the.;poin t estimates are less consistent across specifications . .This.is likely-due to.the limited number:of prison.. . 13 j - �1 • C ntractin-to slowthe'rise,in the:death rate:7..As:we have three years.of data, we.eati Ii riealinvestigate this possibilityb i'elatin clian esiii mortaitythier period.to',.: contracting Out choices-in the later period. ;We e'stiffiate the-following simple.tnodei::, 0.84 84 79nCi9a0 "� CAM Fr�8YeE84 4 i84 (2) where-i denotes prisons; ,AC;90V$4 is the.change iriahe.percentagc of,professiorial workers .. employed under contract from 1984 to. 1990;.A_4. is change in prison-level mortality. from 1979,to 19$4,. is a 1984 year indicator,P is the.niimber.of professional staff,Xisa . :. ... ' ` vcctor.of prison characteristics las measured,in 1984. Using equation.(2),we.ask whether ons p s that experienced increases in inmate mortality responded by,changing their:•., ;. . professional staff contracting rate._ The tedl in . . . 1 a e results are repos .columns 1 aiici 2 in-Table 7 .�Vl�iether.rriort lity iricli"des.or excludes:suicidcs there is no;relationshi between the change in mortality bettiv6en;-1979.and 19$4 and the change m medical contracthig between 1984 and._1990. . The point estimates are zero to three decimal places and the.standard'errors are small In ' order to check the sensitivity sof this finding to alternative speci leations,"co ums3 . thr of mortality 984, 1979,.both ough.$ replace the:change•in,mortality with the level in. 1 and 1979 and°19$4: The results for all'specifications are similar:.the data indicate that prisons did not.respond io.mortality changes by changing the:percentage of their medical. staff employed undercontract; at least during the.period'of for, .. ch we have data.'.± A. f 'To the eztcnt that higher mortality rates deter crime,as shown Katz,Levitt and Shustorovich(2003), it also possible that the'composifionr of prisoners is changing over time. While itis not,obvious how this would bias the reported_estimates,we have no sway to deal with'possibility of such selection.. 15 i . .. . . . "..References.... ..- Alc]Zian; Armen.A. and Harold Denisctz, 1972.:::"Production ;Information Costs, and. Economic Organization,'Alnericrill Lcorlorrlic Review 62(5) (Dec:):.77,7=.795 A 4 ."PI. Jo . nno',:B: Jaye, 200. .' ison�Iealth Services: An Overview; tirna of Col re.ctional' Health Care, 10(3) (Fall):287'301. 1; Boardman Anthon E and Aidan R. Vining, 1989: "Ownershi and Performance in; .':... Competitive Environments`.-A Comparison-of.the Performance of Private, Mixed, and:. State-Owned Enterprises,"Jour.'rlal ofL wandEcononiics;:32(1) (Apr): '1=33: . vanger;Ingrid A:,:et.al,2007:`"Release.from Prison.— High.Risk'of Death for. Bins g •d Former.Inmates,°'.N wEngland Journal fMedicitae,.356(2);(Jaii, 1.1;2007):..157-165: Bzlshwss.-Week, "'Prison Health Services' Hard.Time,".-(May 18 2005). htt /hvWm, businessweek con/b,�vdail)/dii.tlasl-/may2005/nf20050518 :2061 '8008.1itm Ehrlich,-Isaac,.Georges.Gallais-:Hamonno, Zhigiang Lieu, Randal Lutter, 1994, "Productivity Growth and Finn;Ownership: An Arial sis and:.Empirical Investigation;" Journal ofpolitical Economy; 102(5) (Oct): 1006-1038.. Estelle i..Gairlble.429.U.S 97; 97.S. Ct:.285; 50L. Ed. 2d 25,1; 1976 U.S. LEXIS 175 ;Eizel, John L. and.Thomas S. Nunnikhoven;•1992. "Technical.Efficiency of For-Profit and Non=Proft.Nursinv.Hornes,".Manng eiJal,andDecision,Econothics ;-1.3(5). Se -t. : 429-439, Fresh, H:E;:III; 1976. "The PropertyRights.Theory.of the.Firm- Empirical Results from a Natural Ex erinieni,":jolll•nalo Political Econom ; 1 84 Feb. ::143=152. Freeman, Richard,W:, et al 1.981. "Planning Health Services fora Ci Jail: Im act of,'.. Contractual Services-on Men's Sick Call,"Akdical.Cai 19.(4),(Apr.): 410=418: :'. Gater, Laura 2005:.' .Outsourcing Healthcare Services, '.Corrections Foruii, Hart, Oliver,Andrei.Shier fer and.Robert W.:V shny, "The Proper Scope of Government: Theory and an A lication to Prisons,": uarterl Iozlr�zal o Ecolioi�tics, 112 4 Nov: : pP Q Y . 1127-1161::_ Hyde; Roberta'arid Beverly.I3runifield; 2003. .Effect of Co-payment on the Use of. .. . ` 'Medical.Services b Male and Female Prisoners," Iourrlal.o .Correctional Health Care, Y ,. � 1 9(4)(Winter).371 380.= is 17 . .. .: .... . Shleifer, Aridrei;.1998, ".State veisus Private.Ownership;":Jpurncil.of Economic. Pers ecti.ue.s.12 4 Autumn 133-50 .,.. .Szykula; Steven A.':and'Dawn F. Jackson, 2005. "Managcd1Vlenfal Health Care in Large. Jails':Emplrical'Outcomes on Cost and.Quality;".JWirnal'ofCorrectbpal_Health Care 11 3. 223-240:..' . , .( ): : i Vori.Zielbauer; Paul, 2005A '.'As Care in Jails Goes Private, 10.Days Can I3e a ' Death Sentence,,'New::York Times;(Feb.27). : i ....Von Zielbauer;.Paul,-2005B.."In City"'s.'Jails; Missed Signals Open-Wa'-to Season of Suicides; ..Netiv Yof k Tiities;(Feb. 28).. . - Von Zielbauer,Paul, 20050, A Company.s Troubled Answer for Prisoners With H.I:V.".Netiv.York.Tu tel (Aug. 1 . .. U.S. Bureau'of the:Census; i 997„ •Statistical Abstract�of the,United States: 1997 d.) ` ng.to E Valhi n,.'D.C: : . i . i i - : : j .. .. .. i• 1 { , : : 19 " °i .: .: ....::.: al • Table 1.,:Contracting P,e.rcentage (Measured at the Prison Level) , 197 _ 9.;:,':'..`: . ..:'' .1.984:;: .: '.,' . ,�.'.. 1990::::' None;.: 53 . . 59 1-24.'percent:. : ..`, �' : 27. 24 25749 percent-.' .15 : 5074 percent . : .: 4 5 7 I, 75+ percent . :. .,, . . 2, 7 . nweighted. l : ,.I , l : • i I - Ta • ble 3...Prison-Level Death Counts by Year Death Count . .•1979 1984, 1990 0 251 202 163 267 I. 20 4. - ' . '... g 2 5;.;.. :...: 10 . 4: 8..: 1 4 4 16 0 19. . : 20 ` 0 _ 0 2 26 20.9.- ..32 2. :. Unweighted. . ..: ... . . ..... . - '..lo ess . .. .,.. . s . . �. .. . o pois s tn -. Table 4 Robu. i - Up 27} . 28 Wtths . :.' . 52. 039).:. 'i::..;.'.._ :..•..10951 269 rl5ons 0.3 (0• :. [ 0. le restricted to (0 036) (711] 0.345 8.. :o-. (0.138) .prison .., . .: :. 5 .29.. .. All p...: . .. 0.373.'::. p 040) ;: ::•:' .19661 0.472 ( 0.677 (0 251) ital,oc infirmary (0.03?) 16541 d hosp ail 521 0 250) 551 s ital. share L6 l L2 o p 959 55) 2551. . 331 . 1, 0 H 0 X0.0 L . 0• 04 14 Q.q,14.. . . ... (0.194) 2g4 [6151 Hospital.. ,. 3] ..... .. p 19 ) 0.369., . p p41) 0..558 8 - :� ,. '..�_L519] .`::.::. ': 0.72 (0.340) 500 5401 ... .: 522: '; ,... 0 324}. . .. .:: ..:2761 - n cap... .. prlso . 0.652: (0;047.) • . (0 044),: � '•::.. - [2611.::•... �. ..= •::.::.. : ::...:: :: Np cap 1p00+ 2701 . Yes acitY.. . L. . prison; No . - parentheses. • da d err are level ' prison capacity.Stan. r.Oeffc1ents are statistically Jude s able 3.We�9. •ays are in s9uare prackets ulcides � . • ted by... gold c. inc Deaths listed in T. I 1e s� e'aria istent.Same the 10°0level• . include the stic cons significant at odels a fe t1eteroskeda. pll m re statist�callY.. standard erros bJ. old italics. pLS -- atthe • .. � s1 nificant �. _ • 1. _ • _ Table 7. Change in Professional Contracting between 1984 and 1990 (1) (2) (3) (4) (5). (6) (7) Death Change (1984-1979) 0.000 0.000 (0.008). (0.008) Deaths in 1984. 0.007, 0.007 ' 0.009 0.015 0.005 0.002 (0.001) (0.007) X0.010) (0.011) (0.008) (0.008). Deaths in 1979. 0.006 . 0.014 (0.011) .: (0.012) Other controls measured in 1984: Professional staff. -0.001 0.001 -0.001 -0.001 -0.001 -0.001 -0.001 -0.001 ' (0.001) I (0.001) (0.001) (Q.001) (0.001) (0.001) (0.001) (0.001) Other staff.(/100) 0.004 0.004 0.002 0.002 0..004 0.004 .': 0.003 0.003 (0.016), (0.016). (0.016) (0.016) . :. (0.016) (0.016) .(0.016) (0.016) Prison population (/100) 0.012 0.012 0.012 0.012 '0.0.12 0.012 0.012 0.012'. (0.010) (0.010) (0.010) (0-010) .(0.010) (0.010) (0.010)• (0.010) Prison capacity(/100) -0.011 . ;-0.011 -0.012 -0.012 . :-0.011 -0.011 -0.011 -0.011' (0.009) (0.009) (0.009) (0.009) (0.009) (0.009) (0.009) (0.009) Inmates killed (per inmate) .. -0.336'. -0.336 -0.346 -0.341 . -0.381 -0.410 -0.372 -0.405 (0.284) (0.284) (0.282) (0.289). (0.287) (0.286) (0.287) (0.287) Medium security facility -0.002 • -0.002 0.003 0.002 0.005 0.006 0.006 ..., 0.007. (0.036) (0.036) (0.036) (0.036) (0.037) (0.037) (0.037) (0.037) Minimum security facility 0.030. 0.030 0.032 0.031 0.034 ..:.0:034 . 0.034 0.034 (0.047) !(0.047) (0.047) (0.047) (0.047) (0.047) (0.047) (0.047) Constant 0.1171' .. 10.117 0.118` . 0.118 0.115 0.116 .0.116 0.117 (0.057) ;(0.037) (0.036). (0.037) : (0.037) (0.036) (0.037) . (0.037) Sample.size.: 365 365 365 . : 365 . 365 ' 365 365.: . 365 Deaths include suicides Yes. I No Yes No - Bold coefficients are statistically significant at the 5%level and bold italics are statistically significant at the 10%level.Unweighted. . AmericanCiviiLibertiesUnion:ACLU and PJCUrgeMaryland... http://wwW:aclU.org/prison%gen/14742prs2005060.1.htm1 ?, _i}.yF r.�,i7 i'i�9;� ';:�''� ;:5( , _'.is'4Y�i,�rr �s�RF°t'Hti F' •' .. •,• .., may,. er,...'..,.rfir '" fw t.:. r •:�. .f 1'„ "�"�1'.�:'. Su i� .x'^•.Yi::::dtu:'�.39...z� •.•�h. ;'$`..' ,.� yy1� :'3:5":: - .. } •' T`�,SP± � �:N ti� ;':,:.6,>:cr: e! - x. er,::g �•.. _1 ..1 .. W. URL:'htip./twww.aciLi.org/prisarJderiil4742prs2CO5060I.tiimI .. .. ACLU and PJC.Urge Maryland Board to Reject Contract with Company Known for Providing Deficient Medical Care. in Prisons.(6/1/2005) . . FOR IMMEDIATE.RELEASE Contact: media@aclu:org ANNAPOLIS, MD -- Citing Correctional.Medical Services' poor record for dispensing medical care to prisoners, the American Civil Liberties Union and Public Justice Center today urged.Maryland's Board of Public Works to reject a proposed.contract with the for-profit company: "Correctional Medical Services' history of cutting corners to maintain.profits`jeopardizes the lives of thousands of incarcerated people across the country," said Eliza beth_Alexander, Director of the ACLU's National Prison Project. "Many states have.already learned a painfu1.lesson.from their dealings with Correctional. Medical Services. Maryland must avoid handing over the care:of its prisoners and jail detainees to a company,with.a disastrous reputation.".: Correctional Medical.Services (CMS) clurrently.holds.contracts.in 27'states..In Michigan, where the company provides care to prisoners.statewide; CMS has come under heavy scrutiny for its attempts to save money by limiting prisoners' referrals to outside.medical specialists. A federal.:court found that excessive delays in. . providing prisoners with.referrals contributed.to three deaths.during an 18-month period. Five other prisoners who died during-the same time period also experienced significant delays in treatment. Last week, the Maryland Board of Public Works announced that ata,meeting today it will review for approval. . a two-year statewide medical services contract between the state's:Department of.Public Safety and Correctional Services and CMS: The new contract is scheduled.to begin July 1,2005. Under the new contract, CMS would provide care to more-than 4,000 detainees confined.at the.Baltimore City Detention Center, which has come'underfire inrecent. years-forproviding deficient medical care. In.-. . .. _.._ .: ..._ August 2002, the U.S. Department of Justice cited the jail for 107 violations of health and safety standards. Since 2002, the ACLU and Public Justice Center have been involved in litigation about the medical care provided at the Baltimore Jail by the current for-profit medical and.mental health care provider, Prison:Health Services. i. . Even with the significant rise.in spending for the new contract, according to the state's estimates, health services are still under funded.by several milliondollars..The ACLU.and Public Justice.Center expressed concern that simply switching for-prgfit providers without increasing resources to fund treatment and . maintaining.close contract oversight will leave.detainees with the same poor care they received under Prison Health Services. "There is little.point in changing company names if the continuation of inadequate funding and indifference from the state regarding detainee health remains the same," said Sally Dworak-Fisher,ari attorney.with the Public Justice Center. "In an environment without consistent outside oversight and inspection, the motivations of for-profit companies like CMS. and Prison Health Services become dangerous. Cutting corners to preserve, profits but risk the health land lives.of detainees is inexcusable, and Maryland officials are responsible when the care is constitutionally inadequate." Today's hearing before Maryland's Board of Public Works will be held at 10:00 AM in the Governor's Reception Room; 2nd.floor of the Annapolis'State House. . .. I of 2 4/7/08.10:50 PM . 3 , an Civil Liberties.Union:ACLU and PJC Urge Maryland„.. http://www.atiu.org/prison/gen/14,744pf,�>.,._ i - 6 ACLU,125 Broad Street,18th Floor Nev York,NY 10004 This is the Web siteof the American Civil Liberties Union and the ACLU Foundation. Leal;)more'about the distinction between these two components of the ACLU. r - - User Agreeip {pmlcy star!wilelt j Fi�C1s i Sae Map I.: J. .. .. : . 4/7/0810:50 . .NGRAS LOOTS LEADERSHIP FA SO�T'TI-I CAROLINA FAIR SNARL SPECIAL OAT "PTION, FORRECOVERY: -PRESCINA iihveping. South Carg ina s Prison' Health Care Public a'nd Making It Better:' - by Marguerite-',C Rosenthal, Ph.D; Grassroots Leadership South.Carolina Fair Share: 400 Clarice Avenue' t;.. : 13381V1ain Street Suite 400: Suite 3.01 P.O. Box 36006 P.O. Box 888$ : Charlotte, NC 28236 Columbia; SC 29203 70.4=376-9206 : `, X03-252-9813 w.ww.grassrootsleadership.orgvvww.scfairshare.org ki June 10; 2004`, PRESCRIPTION FOR RECOVERY: I{eeping,South Carolina's Prison.Health Care Public And Making It Better . Executive Summary As a follow-up to our earlier Pmr criptivn for"Disaster:,Commercializing Prison Health Services in South Carolina,this icport is focused on important issues that the South Carolina Budget and Control Board should consider as it fulfils its legislatedmandate to complete a study comparing the current public prison health care system.with'privat izatio n before the South Carolina Department of Corrections [SCDC]',awards.any contract. We are very concerned that SCDC proposed privatization apparently before conducting any objective study of its own and seemingly. proceeded on ideological convictions rather than on objective,realities._Prison health care is fundamentally a public responsibilit-`,both legally and morally, and we.maintain that SCDC . should retain it. There are ongoing reports of deplorable health care provided by'the three commercial entities that. have submitted bids for SCDC's healthcare system. For example, the State Auditor in.Vermont has just released a report.that states that Correctional Medical Services has over-billed the state for non-existent staff and of&formulary.psychotropie drugs; the state's.losses'ahio.unt to almost $830,000.'. The Idaho Department of Corrections has launched three different investigations into the activities of its contractor, Prison Health Services. The third company; Wexford Health Sources, cancelled a 5-year contract with Pennsylvania.last year, hoping to extract more money from that state: Two studies that have compared prison health care costs among different states show-clearly that South Carolina's costs•are' already lower.than most and that public systems are less costly than privatized ones. A 2003 study by PriceWate'rhouseCoopers found that South Carolina's expenditures were,over$1,000 (or 43) less e Penswe than the average of six southern states. In. general the second study, conducted by Jacqueline Moore and Associates', demonstrates the financial advantages of public systems, though,the author is associated with-private prison health care. i. The current SCDC health care system has both strengths and weaknesses. Itsprincipal strength is its cadre of dedicated and loyal medical staff,.its'state-run laboratory and its own,:6fficieht pharmacy. However, because of job freezes and 'cumbersome hiring practices, the Department has left many positions unfilled, and the system is under great stress. Proactive hiring policies, creative approaches to filling positions in underserved prisons and streamlining bureaucratic regulations will ease these difficulties; Some of these_will save money by making the system more efficient. Prison health care is a public responsibility and needs sufficient support to ensure the. health and safety of prisoners and, ultimately;the public. P'r' scr�ipi�tion For Reco ell�y PRESCRIPTION FOR RECOVERY: Keeping.,South Carolina's Prison Health Care Public And Making It Bettcr... Introduction'and Update This report is a follow-up to our earlier one,Prescription for Di.raster:.Commercializing Prison Health.Services in South Carolina' .' Governor Mark Sanford and his Corrections Department Director, Jon.Ozmint;have advocated privatizingprison health services in South Carolina. . Prescription for Disaster documented the dangerous and expensive prison health care services provided by.for-profit, private corporations in South Carolina from:1986-2000 and elsewhere. This report is being written.as the South Carolina General Assembly.has required the Budget and Control Board to complete a study comparing the current public'prison health care system with privatization before the South Carolina Department of Corrections awards any contract. We are writing this report in large part because the.South Carolina Department of Corrections [hereafter SCDC] apparently conducted no.thorough study of its own before making the decision. to privatize its prison healthcare system to a private company.. Especially in light of the fact that SCDC had a troubled experience with its partially.privatized health.system in the past, we are convinced that an objective examination of the manycomplex components of any prison health care system must be conducted before.a`'major decision such as privatization goes forward. Partof.. this needed examination must include the experiences of the State of South Carolina and other states and localities that have or have noUprivatized their prison medical services.: Prescription for Disaster reported numerous examples of deplorable health care provided by the . three commercial health care companies that have submitted bids for South Carolina's prison health care contract award, Correctional Medical Services [hereafter, CMS], Prison Health Services [hereafter, PHS] and the smaller Wexford Health Sources. .Since the first report.was written, we have found other, recent examples of private prison health care companies' failures. In several cases, states and counties have had to bear expensive financial costs as a consequence of both contract non-compliances and medical malpractice. -News articles,official reports, and lawsuits against these companies are easily located on the internet. We.cite only a few, but egregious, examples below: Correctional Medical Services ➢ I.n 2003, the Philadelphia Inquirer published a report that charged that CMS was failing to inform and treat prisoners suffering from hepatitis.0 in New.Jersey's. prisons. A class action suit-against CMS and the NJ Department of Corrections on these same grounds was filed, anci`,the state was forced to pick-up thecosts for treating the hepatitis epidemic;estimated to cost between$4.5 and $8.million in 2003.2 _ ➢ -Vermont's State Auditor has just released.a review of that state's Department of Corrections.' contracts, including one with CMS. CMS was 2 Prescription For Recovery cr'iticized.for1';biliing for non-existent staff, needless expenses fortiff=formulary psychotropic drug costs and failure to submit required quarterly and annual financial reports. The state's losses amounted to almost $830,000.3 The Verrrrnont rirport's serious charges concerning CMS' practices echo those of South Carolina's 2000 Legislative Audit Report. )► The U.S. Justice Department's Civil Rights.Division, along with the American Civil Liberties Union of Eastern Missouri, is.currentlyinvestigating CMS for : alleged inadequate medical attention and care that may have led to the premature death of several prisoners at the state's Vandalia women's prison.5 . Sister Frances Burchell,prison coordinator for the Jefferson City Roman Catholic Diocese and a regular presence in the Vandalia prison, reports that CMS routinely Imposes obstacles to care. She has observed the following problems: women must line up in the early mbrning just to fill out a request to be seen by medical personnel, and only, a fraction of them actually complete the necessary forms because the time allotted for this task is much too short; women wait 4-6 months for cancer treatment, at which point their cancers have worsened and may have become terminal;tivo women have lost sight because their meningitis was misdiagnosed as a psychiatric problem;pain medication has been denied when needed; and records';have been falsified. Buschell states that.there is frequent turnover of medical staff and that the doctors are inept.`' Prison Health Services . PHS, which has contracts with many county jails as well as a few states, apparently ignored the obvious serious health problems of several Lee County, Floridaprisoners. A December 2002 article reported that several prisoners died either in the jail or very shortly after being released. A lawsuit was filed in US District Court on a claim of one former prisoner who was paralyzed from "botched medical.care.'" i ➢ The same Florida newspaper report-also cited the New York City Comptroller who, in expressing grave concerns over the medical care being provided at the infamous prison on Rikers Island,noted nation-wide criticism of PHS and questioned whether PHS;should be permitted to provide services in New York State.8 Nurses at Rikers.Island have claimed that PHS had so reduced staff that employees and prisoners were both at risk.,; { Y A nurse who once worked for PHS in St. Lucie County, Florida claimed that she was fired.for refusing to participate in illegal and unethical practices, including. ignoring a.mquest for medication, verbal abuse of prisoners,antagonizing i. mentally ill.prisoners and falsifying medical.records.1°, v in 2002,the'ACLU filed a class action against Clark County, Nevada and PHS for dreadful conditions in the jail's medical unit and inadequate medical care that caused "widespread harm." Mental health treatment was called ',atrocious and ; i P'rescript`ion For _R.e oovery. 3. uncivilized".arid the jail was said to have'no protocols for treating chronic illnesses. ii ➢ In April, 2004; ldaho's Corrections Director expressed dissatisfaction.with PHS, its contractor. The De has launched three different investigatioins, and the "Director was quoted as saying: We have employee management issues, communication issues and accountability issues.712 . Wexford Health Sources ➢ . In June, 2003, Wexford cancelled a 5-year contract'with Pennsylvania after only a little:'over,one year, hoping to renegotiate for more money.13 There-.are recent.allegations that seven death`s in Florida's jails—including.one of a'56-year-old minister and Purple Heart Vietnam ve. teran,who died when he did not receive dialysis on time-are attributed to poor medical.treatment by `Wexford.14 An article in an Illinois paper reported that;Wexford obtained a $114 million contract with the. Illinois Department of Corrections after the company contributed $10,000 to Governor Rod 131agojevich's campaign. Wexford had the lowest bid but also did not,have the highest score in the Department's evaluation.15 . What Should the Budget and Control Board Study?. We applaud the General.Assembly's,requirement that privatization should not be entered into headlong and without anAjective.evaluation of its true costs. At the same time, we have ` concerns that the focus.of the Legislature's mandate to the Budget and Control.Board is on costs - alone::South Carolina's prison health care system is already'among the,least expensive in the'- country, and it is hard to imagine that',any more financial reductions can be extracted from the system without harm. Indeed, because of frozen positions within the SCDC health care system, the.current costs are below what they should be.. Further, what cominercial companies.promise is often not what they deliver, as our earlier report documented.- Private companies have.a.ree.ord ofpromising to reduce costs and then wangling for increases once they.have gotten their contracts..They have avoided or. refused to provide needed health care services such as diagnosing and treating hepatitis.C, and they have reloaded onto.the public systems health services`that they consider too costly. Comprehensiveness and quality of services should, in other words; be important foci of any comparison, difficult as such a detailed study might prove to.be. We are concerned that SCDC's decision to privatize,its prison health care system is based upon. the ideological assumption that privatization must be more efficient and cheaper rather than upon an evidence-based.analysis. In this regard, we are very.concerned that SCDC did not carefully study the needs of its prison health care sy',stem as well as the serious problems and financial losses associated with its previous CMS contract before launching into another privatization initiative. 4� Prescription For.RecoyeryWild - There are fundamental services that are,the, duty of the"public sector to provide.-Purchasing automobiles and copyingmachines from commercialdealers is one thing; states do not manufacture and supply themselves with these sorts.of items. Running prisons;on the other hand, - Js an age-old function of the state. Caring for those in prison is,a public obligation stemming from the consequences of prisoners';losing their liberty. Selling this obligation raises.tlie specter of':, incompetent care,profits to-coiporate executives and shareholders=most of whom live and spend out of state-paid for by South Carolina,taxpayers, and exploitation of prisoner-patients. SCDC is fortunate to have many dedicated health care professionals. Some of them have thought carefi�lly about needed changes;to improve the delivery and`efficiency ofthe prison health care system: These improvements would result in reducing bureaucratic.fiinctions so that more time- can be spent un direct care. At the same time;these professionals recognize the difficulty the Department has had in attracting and employing personnel in some of the more remote parts of the state and they have suggestions io remedy these difficulties.: This report will briefly review of what is known about several prison health systems. It wil l then relate some:of the suggestions that have come from current SCDC personnel. The SCDC Prison Ilealth Care System in Comparative Perspective South Carolina's Prison Health!Care Costs are:Comparatively Low Already In January;2003,the accounting consultant firm, Price WaterhouseCoopers, issued a report, Interstate Survey of Flealth Care Costs for Inmates, commissioned y the Georgia Depart:merit of Corrections. This report, which compared prison health costs for Alabama, California, Florida, Georgia, Mississippi, South Carolina,Texas and Virginia, found that the average cost per prisoner in these states in F'Y02 was$3,523.` In South Carolina, the cost.was nearly one-third 'less: $2,280. Only Alabama and Mississippi spent less than South Carolina that year. Alabama's system was a troubled privatized one that has since switched providers, but Mississippi's was public at that time.16. . .. Another study was conducted by the firm, Jacqueline Moore and Associates, in 2003. Moore was a co-founder,of Prison Health Services (PHS) but currently.has,ties to Corrections Medical Services [CMS]." PHS and CMS are the two biggest for-profit prison medical companies, and both have submitted bids to the SC Budget and Control Board..Moore's study compared FY.2002 per prisoner health costs for 8 states! A comparison of average costs as published in this report is reproduced on the following page. iPte's'crip►tion Far Recovery Comparison.of Average Healthcare Cost Per Inmate FY 200218 ` STA .. TE ADP COSTS. EXCLUSIONSCOST/INMATE/YR. '' Idaho(P.HS) . 6297. $11,800,000 Cat Limits$251U $1,873.91 '' Inmate/Yr:�. Delaware(.First Cor- 6800. $17,000,000.. Unlimited $2,617.65 ; . . a. rectional Medical) e' Wyoming(CMS) 1070 $46,869,000 Aggregate Cap $6,419.63.:; Maine(CMS) 2170 — ;x$9,200,000 Pharmacy $4,239.63 Vermont(CMS) —-- 1436 . --I.$6,200,000 Pharmacy' $4,317.55 . North Dakota. 1032 , $7,500,000.. No Exclusions $7,267.44 ' Self O X; South Dakota 2954 $10,200,000 No Exclusions $3,452.92 (Hospital Based). y . Utah(Self Op) 5700 1 $18,288,233 No Exclusions $3,208.19 Utah 5700 '. .. '. . .-- $.17,088,233 ..:.. _ Budget Minus--- :.$2,997.93,,,....:�..... ....... . ... .. .... - . Amount Returned to UDOC 'Alli Note that Vermont, Maine,and Wyoming.contracted with CMS and paid between $4,318 (Without . pharmacy charges) and $6,420 (capped)per prisoner per year. The chart above also shows that s,. Utah, a publicly provided system, had lower per prisoner costs than the privatized systems, $2,998 (after funds allocated for clinical services but used for other purposes were returned'to tl'e Department of Corrections). Although Moore's report made some recommendations for'fiirther efficiencies, it concluded that/Utah had a cost-effective and comprehensive system that:should not be privatized. This report, available online at http://vvww.le.state.ut.us/interim/2003/pdf/00001128.pdf, could well be useful to those,reviewmg . South Carolina's prison health care system. l': :Another cost comparison is contained in the following In FY 2004, CMS was charging Missouri.. $7.84 per day per prisoner'or.$2,861.50 annually. This amount exceeds South Carolina's'costs and is more than double the charges of$3.70 per prisoner pet day.originally contracted for in'1992.19 0. 6 Prescription For Recovery, These cost analyses demonstrate that,.on its face; public prison health care is less expensive than :privatized prison health care: There may, of course, be some unique situations'in each state's system. .Nonetheless,.these studies certainly suggest that South Carolina will not save riioncy by contracting'with for-profit prison health companies. We suggest that privatizing will not save money because commercialized system necessarily ..adds costs since it must.rewar.d its investors,with profits and its executives with salaries much higher than public sector compensation.. To makeup for.these added_costs.and charge the state less, commercial companies must reduce the .quantity and quality of services, as the many stories of inadequate care cited above attest;and/or they must substantially reduce the compensation of those actually providing the.seryices. In thelatter case, dollars are removed from South . Carolina's economy. If costs canbe saved by.better management; as private compariies often claim, there is no reason. .• that the SCDC cannot itself become more efficient (see below for some suggestions). We suspect, however, that having already suffered several severe budget cuts,there'is very little else that can be cut out of the SCDC prison health system. Except as an initial loss:leader(as has happened elsewhere), how can a commercial company possibly save dollars and.reward its investors and executives e:ccept by improperly rationing services? South Carolina's Prison Health.Care Costs Have Been Dropping . Not only is South Carolina's prison health system relatively inexpensive, it has also been reducing its average.costs per prisoner. While,most of the states in the Southeast region saw increases of between 3% and.16% between:FY01 and 02,.South Carolina'.s costs dropped by 14.7%, nearly 3 times more than the only.other state to,see reductions, Tennessee:20 We note that CMS pulled out of its contract with SCDC during FY 2001: In ether words, when South Carolina took its prison - -health care system bacli f coin a private-company; its-costs went down significantly. We urge future investigators to look carefully into these reductions to determine their causes and evaluate their promises for.the future. ' We observe that South Carolina's total payments to outside medical providers such as..gene.ral hospitals'(pre§umably for emergency services and complex health services) was nearly 1/3 of its .....prison health care budget in both FY01 and FY02. . Perhaps this significant expenditure.is related. to the fact that SCDC continues to contract with Columbia Care, run.by Just:Care, Inc. of Alabama, a private health care corporation, for some of.its prisoner patients. According to. SCDC's chief accountant, private.care.was estimated to cost the state $20,000 more per prisoner per year than care in the prison system's.infirmary.2` '.Continued use of this facility,and its associated costs is certainly an area that should.be examined further. Can SCDC's Prison Health Care System Improve? . As noted above, personnel.in the current, public SCDC prison health system have.hands-on knowledge of their system and have offered this writer some suggestions for greater efficiency and cost savings. Some of these suggestions.are-presented.below, but—again—we urge-that future :investigators consult with a variety of medical and mental healthcare givers, pharmacists and laboratory technicians, particularly those currently working within the SCDC system, to gain a Prescription For Recovery i hiore.detailed description of their work while also gaining important information and recommendations for improving the system. . To begin with strengths, SCDC.medical personnel point to several important factors: ➢ Dedicated and loyal employees; i ➢ A system ofmedical directives that has fiinctione'd.well in the past (but may.be slipping currently); o-. A state-run pharmacy that runs efficiently and in a cost-cutting manner; ➢ A state-run laboratory Which, similarly; is cost-efficient since testing is done in-house; and ➢ Strong. specialty clinics. There area number of weaknesses; however, that are frequently mentioned. These include (and will be further elaborated on, below): ➢ Insufficientdirect medical personnel,!including doctors, nurses, nurse practitioners and.. psychiatrists; i ➢ Cumbersome hiring practices that dissuade applicants from seeking positions at SCDC; ➢ Hiring freezes that have left clinics understaffed, creating tremendous burdens on the loyal . staff remaining and costing SCDC substantial financial outlays for per diem hiring; . Few in dicalprotocols in place, resulting in wasted effort and time in getting approvals for prisoner care; ➢ Quality of care that.is.not always up to standard; ➢ An inadequate administrative structure with,poor linkage and communication between the Central Office and'indivdual clinics1 . ; and ➢ An overly bureaucratic system that wastes time and effort that could better be spent on A. patient care. Sui=gested Solutions Staffing problems appear to-be at the core of the.various challenges facing SCDC's medical services and, indeed, have provided at least one of the rationales for seeking to commercialize the systema These problems fall into two.categories: staffing qualifications and appropriate levels of responsibility;and hiring protocols to attract new personnel. Specifically, the following recommendations have been suggested'by current.SCDC health staff: l) Staffing the clinics: Currently, there appears to bean over-emphasis on having physicians. in each clinic. Since nurse practitioners are licensed to prescribe medication, having a nurse practitioner in each clinic would be cost effective and is more likely to result in. eliminating the large number of physician vacancies. 2) Hiring medical and mental health specialists: Staffing all the prisons, particularly those in rural areas, is admittedly:a difficult challenge. However,scholarship or loan/payback arrangements fbr students attending South Carolina's public institutions of higher education who are training for relevant specialties; such'as psychiatrists, psychologists, psychiatric nurses and social workers could assist in filling some positions. Under this arrangement, students.receiving scholarships would be obligated to work for the SCDC for a fixed amount of time after they receive their advanced training. Some may, of course, s P,>rescription For Recovery i . i choose to remain in the prison health system after they have fulfilled.their mandatory obligations. A related suggestion. is that SCDC partner with the University of South ..Carolina's Medical School and its public universities to arrange for internships. Under appropriate supervision, interns can greatly augment SCDC's medical and mental health staff. 3) Recruitment methods: More aggressive outreach, particularly through active use of the internet, is needed. Commercial prison Health care companies use the internet for .recruitment; SCDC should.use the same techniques. We note that North Carolina's Department of Corrections, which contracted with CMS.to staff its prisons in remote, rural areas, found that the private company was no more successful than it had been and therefore terminated the contract.2 3 4) Hiring incentives: SCDC:should consider`instituting sign-on bonuses to recruit.medical and mental health personnel who agree to work in hard-to-staff prisons: 5) Streamlining the hiring_process: The current hiring process takes too long and is overly bureaucratic. Especially since there is a nursing shortage in South Carolina, the red tape involved in hiring must be cut so that appropriate applicants receive job offers quickly and. are rapidly moved into their.SCDC positions. Allowing medical personnel in each facility . to hire staff would greatly.shorten the.lag time and administrative costs currently involved in employing newpersonnel. 6) Unfreezing medical records personnel positions: Nurses currently have responsibility for medical records, taking time.away from;'nursing. Shifting responsibility for medical records duties to other personnel might make sense. since they are often not fully occupied With their primary responsibilities. 7) Developing a pool of nurses: Instead ofhiring per diem nurses from a private and. ,expensive nursing agency, SCDC could develop its own pool of nurses to fill in as needed in several institutions. . 8) Allowing positions to be filled before alresigning employee leaves: Being proactive about replacing personnel would assure thatrositions are filled in a timely fashion. . 9) Filling vacant pharmacist positions with technicians: Licensing requirements allow for 3. technicians for each pharmacist; hiring.technicians this way would be cost-effective. Streamlining the bureaucracy to make medical care more efficient would allow medical personnel to attend to patient care instead of filling out request forms and waiting for approvals from central office. A key to achieving more efficiency involves having nurses use existing Medicare protocols,thus eliminating the need ifor a physician's having to review and approve consultations and treatment regimens. A specific recommendation.offered by a current nursing supervisor is to.purchase the computerized version of.McMillan, Robertson Utilization Review and to make it available to all Prescription For Recovery' 9. .. SCDC clinic physicians aiid nurse practitioners to save time on routine cases: Another suggestion is to nevamp the nursing hierarch eliminating a supervising nurse at each location and allowing the head nurse to serve'in that capacity with, perhaps, 3 or 4 nursing`supervisors for the whole system to.whorn the head nurses would report. .1ngeneral, there needs to be an evaluation of the true staffing needs to determine how many,supervisirig staff are actually needed in order to reduce ' costs associated with higher,ranking medicaI personnel: Mental health screening and appropriate placement are crucially important to the fiunctioning of the prisons. Mental health professionals such as social workers and psychiatric nurses can conduct mental health screenings, considered very important in:light of the large numbers of mentally ill and substance dependent prisoners. These professionals can be hired at.less cost than psychiatrists and,clinical-psychologists who are currently required to perform these functions. Re-instituting the accreditation process;would assure that medical services conform to standards: Assuring objectivity.in evaluations is crucial. With oversight to insure that they . remain objective; using available,SCDC_ medical staff for audits,is cost-effective, particularly .because they' can establish appropriate policies and procedures as-par(of this-function.. There needs to be more accountability in:the system; currently too many decisions pertaining.to health care are left to each warden: Establishing an independent medical services review body'that can receive, investigate and respond to-questions and complaints related to prison health care services raised by prisoners, their. families, employees and advocates is vitally important to improve the.prison health care system. and assure that health care is properly delivered and.crises are avoided Hidden Costs of Inadeauate Prison Health Care Systems. States are obligated by a U,S. Suprerne Court decision to provide prisoners with adequate health care.24 Even when prison bealth'care systems are privatized, the states continue to bear this legal responsibility. Prison health care.is not just a.matter ofpersonnel, physical facilities and medications..There are the costs of attorney and legal fees, insurance and settlement payouts, associated with malpract ice.claims and lawsuits. if the prison health-care system is.under-funded. and under-staffed, lawsuits will abound; a2id'the state will have costlydamage awards. While the currentcosts to the State.of South Carolina are not known to us, it should be cautionary.that officials in one New York County suggested doubling their,insurance,protection when it . privatized its jail's health:program.�s And then there is the matter of public health. Nearly every prisoner will be returning to his or her, community someday. .Thus,prison health care is truly a public health concern. Because of the crowded conditions of their confinement and.their poor health status, prisoners are particularly susceptible to communicable diseases.such as tuberculosis, hepatitis C and HIV1AIDS. It is therefore critical that,they get appropriate treatment. If they.do not;these illnesses will spread to. the general population. To save lives and to protect public health, health care should be efficiently but also adequately provided. These are all important factors to consider when evaluating who should be delivering prison health services;. "� Prescrip tion For Recovery Conclusion 'l'he•current SCDC prison health care system is not expensive when compared to otlier state systems. Privatizing does not save money. Indeed, giving'state money away.to-but-of-state, executives and shareholders results in further squeezing the health care system:' SCDC has:a cadre.of dedicated and thoughtful personnel,many of whom have.devoted much of their professional lives to caring,for the•state's incarcerated population. The system appears to be •functioning fairly well, but, as should be clear from the briefly outlined.suggestions'above, there: are.many areas that can be greatly improved. These suggestions, if explored in greater detail and implemented appropriately, may result in financial savings to the state. At the same time, we caution that the system appears to be seriously understaffed,particularly in the area of primary caregivers. Reducing bureaucratic functions will make more current,personnel available to perform caring•functions, but more personnel ate.clearly needed. The changes outlined above have been suggested by current_SCDC medical staff. These professionals are in the best position to provide details about their current ideas as well as to. provide additional suggestions for improvements-in the system in which they work. Establishing a task force composed of current staff representing different specialties and geographical areas of the state and outside medical experts familiar with institutional healthcare is, we feel, the best way to evaluate how to improve the SCDC health.care.system both to make it more cost-efficient and to enhance the quality of care it provides: i l � • ABOUT THE AUTHOR; Marguerite G.(Rosenthal is a Professor of Social Work at'Salem State College in Salem, Massachusetts. She,holds a Ph.D. in Social Work and Social Welfare from Rutgers University. She,has received awaNs and grants from the National Institute of Mental Health, the National Association of Sociis{Workers and the U.S Department of Health and 'Human Services. Early in her`career; sheflserved as ajuvenile probation officer with the Onondaga.County Probation Department lin Syracuse, Ne ,York and as supervisor of field staff a the State of New Jersey's Department of the Public Advocate. She has published andpresenied widely'.oh issues ofsocial policy, privatization, managed care, welfare reform,I residential care, jzrvenile ci'or•r•ectiot7s and faith-based initiatives. She is currently serving as Senior Research Fellowfor.Grasst s Leadership.while on sabbatical from Salem State Cllege. . Prescription For Recovery References 1. .Rosenthal, M.G.-(2004). Prescription or Disaster: Commercializing prison health care in South Carolina. Grassroots Leadeihip/Soiitli Carolina Fair.Share. 2. Fazloliah, M. and Lin, J. (2003).:Hepatitis C treatment may cost N:J: millions. Philadelphia Inquirer (Jan. 12); Selan, E. (2003). HepC class action suit filed in U.S. NJ District Court, retrieved at http://www.bcVinp.risori..org/doscs/classaction16oiO3.htmlloii 5/31/04. . 3. Ready,.E.M., (2004). Keys to Success: Improving accourrtability.,.,contract management and. fiscal oversight at the Department of Corrections-(May 26). 4.' South Carolina General Assembly, Legislative Audit Council (2000).-:A review of the medical.services at.the,SC-Departrnent:of Corrections. (LAC/SCDC-98-7), retrieved at http://wwww:state.sc:us/sclac/Reports/20000/SCDS.htm on 4/1%2004. 5. Dreiling, G. L. (2003). Some inmates tell horror stories about healthcare:at the women's prison in.Vandalia. Some didn't live to.tell their tales: Riverfront Times (Oct. 15); Denise Lieberman, Legal Director, ACLU of Eastern Missouri (personal communication, May 24, .2004). 6. Sr. Frances Buschell (personal communication, June 1, 2004). 7. Hoyem, M. (2002). Dying in Lee County Jail. News Press (I?ec. 22). http://www.news press.com/news/loci state/0212222j'ailmedicine.html. 8. ..:Ibid.' 9. Service Employees Union Local 1199(20.0 1). -Bad to worse at Rikers (June). 10. Pollio, M. (2002). Ex-jail nurse sues healthcare company. Retrieved at http://alhiurse§.com/ forums/showthread.php?postied=168051 on 5/28/04. 11. Geer Thevenot, C. (2002).` Class=action lawsuit:.'Jail's care deficient, ACLU says, Las . Vegas Review-Journal(May 26). .' 12. n.a. (2004). The Alaho.State.sman (Apri16). Retrieved at http-.//.www.pl ba.org/private/ rap_phs.html on 6%1/04. 13. Ransom, L. (2003). Wexford ends-inmates' health care contract. Pittsburgh Tribune-Review. (June 7). Retrieved.at hrtp://www.pittsburghlive.com/x/tribune-review/yesterday/ print_138547.html on 3/9/2004. 14.Barg, J. (2002). Scandals r,us: Seems the city can't find a prison health care provider without a troubling past.Philadelphia Weekly (Sept..4). Retrieved at http:// wwww.philadelphiaweekly.com/arficle/asp?ArtlD=4195 on 5/28/04. 12 Prescription or Recovery 15..0'Connor,.J. (2004). State awards prison contracts to:Blagoje.vich.contributor. State : Journal Register (March 9). 16. Price WaterhouseCoopers (2003). Geor lrcr.Departi?eii! of Co)rections: Interstate St.rrvey.of IIecilth Care..Co.s•t.s•for Inihates, (January 21), p. 4: 17. Broughton, A. (2003).:Privatization study advisor under scrutiny. The Salt.Lake l ribune (July 16). Retrieved at http-//ww�v.strib.com on May 28, 2004.; 18. Moore; J. and Associates (2003). Analysis of.cost.and service.within the Utah Department . of Corrections Bureau of Clinical Services. "Discussion Draft":prepared at the request of the Office of Legislative Fiscal Analyst (November 18). Table 10..p. 37. - 19. Dreiling, G. L: (2003). Some inmates tell horror stories about healthcare at the women's prison in Vandalia. Some didn't live to.tell theintales. Riveffront Times (Oct. 15). 20..Price Waterhouse.Coopers (2003). Ceorgria Department of Cor•f'C'ctions: Interestate Survey of •Health Care Costs for:Inmates: (January 21),.p. T. I 21. Price WaterhouseCoopers (2003). Georgia Department of Corrections: Interestate 5un)ey.of Health Care Costs for Inmates. (January 21), p. 8: i 22. The Post and Courier (Jan. 27, 2003): Corrections closes 5 prison infirmaries: Retrieved at http://,Vvwv.charles.ton.net/egi-b,in/printme..pl on March 31, 2004. .23. Keith Acree, Public Information Officer, North Carolina.Department of Corrections (personal communication,April 5.2004): 24. Estelle y.. Gamble, 429 U.S. 9.7, 103.(1976).- 25. 03.(1976).25. Martineu, K..(1999). Privatization.of jail infirmary,advances: The Times Union (November 24): . i J. i . Prescription For Recovery � .I - www.grass rootsleadership:org ..vWww.scfairs hare.org i I : Prescription For Recovery . ALL-iAtA 5,..AALKER M. D. ,,:.. ' ., ;. OFFICE OFTHE HEALTH SERVICES DIRECTOR < , _ Dl RECI OR. 50 Douglas Drive,Suite 310-A Martinez,California CONTRA COSTA94553 —..._ Ph(925)957-5405 HEALTH SERVICES Fax(925)957-5401 i March 7,2008 I i Federal Glover, Supervisor District 5 Jolui Gioia, Supervisor District 1 Chair, Contra Costa Board of Supervisors Contra Costa Board of Supervisors 315 E. Leland Road 11780 San Pablo Avenue 4D Pittsburg CA 94565 El Cerrito CA 94530 Dear Supervisors Glover and Gioia: During the meeting of the Professional Affairs Conunittee of the Contra Costa Regional Medical Center of February 21, 2008, youirequested comparative infomnation concerning the hospital's employee benefit package relative to other area hospitals. The following is an attempt to be responsive to that request. I Summary: Employee Benefits as;a percent of salary (excluding OPEB Liability) Fiscal Year Ending 20 1 06: Contra Costa Regional Medical Center: 81.70% Alameda County Medical Center: 62.22% Santa Clara County Medical Center: 59.18% Doctors Hospital San Pablo: 44.20% John Muir- Walnut Creek Campus: 48.25% John Muir-Concord Campus: 47.22% All hospitals in California are required to annually report detailed financial and utilization data to the Office of Statewide health Planning and Development (OSHPD). This report is based on a uniform reporting system (i.e., all hospital reports are prepared in a uniform manner,using OSHPD definitions). Hospitals are required to submit reports, within four months of the close of their accounting period. After- receipt by OSHPD they are desk audited, and the corrected data are input into the OSHPD database. In addition, ifjindividual hospitals wish to revise their data they may. Periodically (at least annually), data files are posted on the OSHPD website. Tine most recent file available on the website coveirs hospital accounting periods ending during 2006. According to the Accounting anal!Reporting Manual for California Hospitals, which governs the reporting system, employee benefits are defined as, "A pension provision, retirement allowance, " ! } :�1 • Contra Costa Alcohol and Other Drugs 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 I l• Federal Glover,Supervisor.Dislricl 5..Chair John Gioia;Supervisor District 1 Contra Costa Board of Supervisors March T.2005 Pale 2 insurance coverage,paid vacation, sick leave, and holiday time off or other cost representing a present or future return to an employee,which is neither deducted on a payroll nor paid.for by the employee." The OSHPD data should be viewed within the context of being self-reported and unaudited. There are no consequences for erroneously filed reports. Accordingly,we contacted Doctors Hospital, Santa Clara Valley Medical Center and Alameda Medical Center to validate.and confirm the salary and benefit numbers contained on the attached schedule were accurate. All facilities either corrected or validated the numbers contained on the schedule. The John Muir Concord and John Muir Walnut Creek data are taken directly from publicly filed OSHPD statements. The data are believed to be accurate but due to timing constraints independent validation did.not occur. Please note OSHPD data does not provide Salary and Benefit information at the detailed employee classification level, e.g.Nursing. Please advise if additional information or clarification.is required. Sincerely, Patrick Godley Chief Operating Officer/Chief Financial Officer Contra Costa Health Services cc: William Walker, M.D., CCHS Director and Health Officer Jeff Smith,M.D., CCRMC and Health Centers Executive Director John Cullen,County Administrator Lisa Driscoll. County Finance Director I.,inda Ashcraft, County Labor Relations Manage �o �o C� `y m o o 00oo r C 0 'e m Lq R C3, Q U O 1n tr ° N Vl O fel In V' n Ln O T g In � m�'n rmr -. a c 1a Z cl n B P N n P ra 4 r!1 M .ry U u w ro ry u n rn m rn m Ln a, m a m n p o, Io P to ui c m E BIN O 0o O ° N to m N tn p U Ln tY M N l0 a o `o' o w rr vt u yr a U w o e c 0 0 0 0 0 o o c W O Vl m Vt O N rn ADO ntp�DP6�ON'i fV L o y �O W mof rz c;r4 ,�°pp y n --°i C a E A n v ¢ V u c C o p v •�J Y ra— O ID m 01 tD P Vl m N D m C O In C.p N 2 n c, + mr g Do P M O Z O n N N V m ?Nm ON Ptn u'1 O� U u M ry w C '^ I A E to -cr V/ Vi ro 01 m mnmmconm.n m c f ro rmmn co rn m am N o n cl P m o 4— Q w N N ti to N N C O m p 9 U �1 p1 f v o ate+ o � E 'C C o B 0 0 0 0 0 0 0 dor:vcr:oori , m m w L a) ma f o m °° a o I c m y i ro ''� rE�pp ro o o =; _r fR ry d (nA � ` o _ _ w a U'� v m O N rn O m to N ry Q C v m _ c c o+ m� to co m rD P V-. tf- u 1O rn m ro v c P rn rn ro '� ry v, c m M vrn ri Ln m r+i-+�o.: rYi ra Irl o w P a,n� m6v m O m w N N a ON?V1 C O O °i tp co C V r-1 QJ U G' w .-r m m �C w �-r oo C o O L E E„ cai o w m� a u° ay o y m m c 4 w n w w w V N p d � G T H m c v N E �- c Z Z a o c c w c w c N w Y a w m m� mrY =m E- T $ . a u a H a T w m e y w mW v w >w w v'vo-i c u w ro w w v 7 c � civ rvc � c� a1O, � � u E3 awn C Y} N A n t0 Y} O n C 1�i m o n > m e p" w o a L° c 9 w m w w 9Mrp C C 9 G G HN C O C IYO J u a w H O N L y ra ovEa �YJ m R . a�iw w'ou � 0 oLb jf E U ca 'E y a uc c—a1pi� m=v Iw >uccuw EIc UrOo c y �c c w o�n w w S w .h. c c w o w w x c c0 o o T c� E E w a) m o o T a-L- E E w m c� o A u uQ aaEi'ciao:° `m C u rho nE.e v v �— �¢a Vud2 U to m>>ri w=3�� o rp w ruo m� E c o ami w w o o.^.r:r mavv F- rn m»rTw��ccc me — z..... ,t I The Yale,Hippolytic.: The Clinic and the Prison: Priva(tiza)tion by:Jeremy Kessler Page 1 of 5 d`Jea•,G r The Yale Hippolytic»Volume 1Volume iVolume iVolume O1Volume 01 »Issue 1Issue 2Issue 3Issue 04Issue 07 i The Clinic.and the-Prison:'-Priva(tiza)tion Privatization funds and ensures the brutal treatment of America's imprisoned. BY JEREMY KESSLER ' i .'When the state deprives people of their liberty, essential services cannot be contracted or outsourced. To do otherwise makes private what in this age should be public, and sacrifices individual health (and in the ease of.suicide;.survival) to profiteering. -John M. Brickman,former executive director, New York City Board of Correction, 1971-1975 . .'[M]en for days chained in place by their feet and fists. the'routine alternation between punishments and sedatives, detention/injection,..dungeon/valium (oh, tranquilizing morality);-car thieves that one transforms a0he age of twenty into delinquents for life;.suicide attempts nearly every night. -Michel Foucault ;. In 1971, th.e prisoriers at Attica state prison in New York revolted.-One of the stated . reasons.for the insurrection was;lack of adequate health care.After local and federal law- enforcers-had stormed the prison, after a massacre,the corpses.of 43 prisoners and. guards were not.the only signs.of the massive failure of the penal system. A wave of lawsuits, filed both by prisoners.'and guards of Attica, led,to'a i976"U.S. Supreme Court ruling which demanded that local governments•ensure'pirope'r medical care for the prisoners of their penal institutions. It was a victory for.both the aggrieved administrators.-and recipients of punishment: . But the ruling was also an opportunity, providing capital a"new role to play.on the stage . of.a decreasingly,,public society: Two years after the.Court ruling,Doyle Moore, a nurse from Delaware, established Prison Health Services, the first for-profit prison health-care. company. The f nancial burden that had been placed on city and state governments by the Supreme Court decision in favor of adequate medical services could now be shunted onto a private company, which, through the legerdemain.of free-market principles and corporate management.strategies. would minimize costs. The health of nation's prisoners . was to be a compromise between conscience and commodity. Since Moore started Prison Health; the for-profit prison medical industry has boomed, . and.is currently.responsible for the health"care of 40 percent of nation's inmates. Prison _ Health Services alone,the largest for-profit provider;administers care 10 percent of the U.S. prison population. Moore's corporate child has grown so large by buying up number of smaller•providers;'who sometimes.-were-operating in regions where Prison Health had been and left,often amid accusations of abuse, mismanagement or gross negligence: - Indeed,the system`of for-profit:medical-riot necessarily conducive to the pursuit of. adequate medical treatment for risoners.`Man .local overnments have.the policy,.or. q P Y g P Y� I. .. M http:Hwww.hippolytic.com/print'able/2005/05/the clinic and theprison Uriv.html 4/7/2008 The Yalc�Hippolytic: The Clinic and the Prison: Priva(tiza)tion by Jeremy.Kessle'r. Page 3 of 5 into the NYC system, and higher than that of Los Angeles County's penal system, the largest in the nation. All six of the 2oo3 suicides were committed by.inmates who had not been convicted of any crime, having been detained prior to trial.or on violations. The New York Times correctly notes that the correction system is so susceptible to suicide because"the mentally ill have flooded New York's jails ever since they city cracked down a decade.ago on lesser crimes like vagrancy.'.' Up to a quarter of the NYC jail population on an average day has "psychological ills." Of course, the flood of the mentally ill in the last decade resulted from huge cuts in funding for_mental hospitals across the country in the decades before.When hospitals were shut down, the mentally ill took to the streets, and have since been re-absorbed into.tlie clinical-penal system at a different point of entry'. That structural shift'from care to punishment, motivated by cost=cutting, suggests a more general paradigm in which to uriderstand Prison Health Services' costconscious abuse. i The Supreme Court ruling in.1976 that catalyzed the private prison medical-care industry cited inadequate medical care as a.form of"cruel and unusual punishment. Indeed,the cost-cutting sought by public governments, and practiced by private-companies like PHS,. . licenses a form of punishment supplementary to incarceration itself. Such - _- supplementarity-is.nothing new.– poor medicalcare, sub-humanliving standards; and inmate-inmate raped an unoffi tial but utterly uninhibited practice; have long been ti]e punitive remainders in.the calculus of incarceration. But post-i976, the privatization of prison medical care reveals a public attempt to shun an.expensive responsibility,both minimizing cost andinstalling.greater levels of opacity in the.prison system, through .. recourse to-corporate discipline..The move has resulted, inadvertently or otherwise,in a further:merger of the roles of the clinic and the prison, a merger iri the spirit of a time which has witnessed the incarceration and execution of the mentally ill, as well'as the enlistment of doctors into the ranks of the intelligence community. For although the expansion of private industry into the.public sphere of judgment has proven a suffi tient cause of the conspiratorial discipline of.cruel medicine, it is not a necessary cause –.other alibis have arisen in recent years.for the union of the clinic and the prison: In June 2004, the International Committee of the RedCross spent nearly a'month at the. U.S.- run detention center at Guantanamol Bay.A memo quoting details from the report, which by agreement with the U.S government.was to remain confi-dential, Was leaked to the New York Times early this.year..According to the reported contents'of the memo,. doctors collaborated with�military personnel in the course'of interrogations,providing information about prisoners'.."merital health and vulnerabilities."The Behavioral Science Consultation Team, a group.of military psychologists, acted as the conduit for this information, meeting regularly with interrogators to discuss the prisoners'medical records. i • When informed of this arrangement, Leonard S. Rubenstein; executive:director of Physicians for.Human Rights, told the Tirhos:'."The use of medicalpers6' -to•facilitate abusive interrogationsplaces.them in an untenable.position and violates.international. ethical standards." Rubenstein also worried�,about the possibility that medical staff "engaged in-calibrating levels of pain infl icted on detainees.'' i httv.://www.hippolytic.com/Orintable/2005/05/the clinic and the prison priv.liiml . 4%7/2008 T_lte"Yale.Hippolytic: The Clinic and the Prison: Priva(tiza)tion by.Jere my.Kessler Page 5 of 5 effects were'.originally effected because of.cruelty or because of greed. The privation visited upon prisoners, or upon the poor, or upon the so-calledmentally ill; is not an economic problem. It is a political one; political in the oldest sense.of the.word —that which calls the bodies of a citizenry to'account for their actions". The same goes for other potential"failures perpetrate'd.by society in the name of efficiency-social security disintegration, the undermining of public education, or the subversion of Medicaid. These possibilities are not solutions to structural problems but.new avenues for the expression of a form of incivility, of cruelty, of greed. Privatization, the vector for many such "solutions," deforms questions of the political and of civic morality through its sterile, economic rhetoric. For at the same time that privatization in its current form depends"on economic argumentation and operates in the sphere of what we call"economic policy,"-its ".`intentional" agenda, intentional in this new sense of the apriori obviousness of the cruel_. . result, is'not:solely economic and.shares an intentionality with certain non.economic policies. Secret abductions,governmental opacity, and manufactured intelligence information are all attempts.to"privatize" =they all constitute an.attack on the public sphere,the scene of politics. They do not constitute one side of a political controversy, but are a subversion of the ability to practice politics itself,the.ability of a citizenry to interact as equal and open bodies. This application of the privatization, logic to the foreign political sphere would actually,in a reversal, 'allow an economization of foreign; seemingly"[geolpolitical":problems,just as.it allowed a politicization of the domestic, seemingly"economic" problems. In this gesture,a certain argument would trace a thread through.the."war on terror,"the war in Iraq,Halliburton,'corporate interests, energy deft tits, and soon, to link the attempt to funnel public money to private corporations domestically.with..the attempt to further corporatist interests internationally.. Such'a performance will not be attempted here. In either case, the attack on the public indicated by:"privatization"cannot be blamed solely on a few moguls, robber barons, or pro-industry politicians. In'any sort of democracy thatprovides the degree of freedom that Americans still have, the attack on the public must to some degree have been licensed by thepublic: Privatization can only mask and motivate public evil.-It is stillpublic tax money that goes to fund private corporations:.It is.the public and its"appointed ministers who allow them to operate:American.money has funded,and American policy has licensed, the torture of foreigners. .:. American money-has funded,-and Amlerican policy has licensed, the brutal treatment of America's own imprisoned citizens. Its is not irony; but the cruel economy of. imprisonment and,the selfish.imprisonment of economy which have dictated-that.the country.whose rhetoric most valorizes liberty.brutalizes those,it has deprived of freedom.. http://www.hippolytic,.coiii/prinfable/2005/05/the clinic and the::prison Priv.htnil. ` 4/7/200.8 , . X11&TYah'oo!Mail-judeseven@sbcg!okial.net htt'p://us.:f822.mail.yahoo.com/yrn/ShowLetter?box=ln i . MAIL -Print-Close Window Date: . Mon,7 Apr 200823:00:49-0700(PDT) = From: "Judith Jones"<)udeseven@sbcglobal.net> - y Toi "Judith Seba Jones".<Judeseyen@sbcglobal.net> E-mail this.to a friend l Healthcare.Behind Bars. by Duwavne Escob6do ly Robert Boggon suffers a mental episode in a Dollar Tree store,.which leads to his incarceration in the Escambia County jail. Despite at one point rocking on the floor of his cell and urinating on himself anis displaying other odd behaviors, Boggon never receives a psychiatric evaluation'during the 11 days he'spends in the jail and only receives medication used to calm him down before his death Aug. 29, records and testimony reveal. Jail guards end up dragging 'the 65-year-old truckerfroin his cell to the shower; stripping him, shocking his wet body with a Taser Gun, then strapping his lifeless body to a restraining chair, wrapping a towel around his head and returning him facing the back of his cell several hours before he's found dead, a civil suit by Boggon's family alleges... Hosea Bell, a homeless pian, gets arrested Aug. 9 for urinating on a sidewalk outside Weis Elementary School. He's found mentally incompeteni'by a judge to stand trial Nov. 30 but 11 days later the 55-year-old is taken in handcuffs by a police car to Sacred Heart Hospital after appearing lethargic'at the Escambia County jail._He dies,at the hospital a few hours later. Both cases are focusing the spotlight on healthcare provided to inmates at the Escambia County jail by Prison Health Services, the nation's largest for-profit inmate healthcare company, caring for about one in every 10 people behind bars. Across Florida and the country the company based outside Nashville has come underfire the past.year for,spotty and sometimes lethal care. Following the Boggon and Bell cases, the,quality,of the company's medical services is"coining under fire locally. David Craig, the Community Law Enforcement Oversight.president, is blunt and concise in his assessment of Prison Health Services medicalcare for inmates. . 'Given their less than stellar record;CLEO.feels they would.be.more accurately named Prison Death Services," he says. . Todd LaDouceur, the Boggon family's attorney, says the federal wrongful death lawsuit may soon extend to Prison Health Services. It currently only,names two'of the company's.nurses individually,Lisa Whitlock and Elaine Gregory. "I've been through the Florida Department of.Law Enforcement investigation and it appears Mr.,.Boggon never saw a doctor.in his 11 .days in jail," the civil.rights.attorney says."Clearly;tram.everybody's testimony, this was someone who needed.to see a doctor. I'm not sure how that;works. There may be medical negligence here. The family is very concerned about his'.treatment and we don't want to close that avenue. Sharon Giraud, a Mental Health Association of;West Florida client advocate, says•for years it ha's documented a number of.cases that have alerted if to the possibility of systemic problems in tfie jail system's treatment,especially of the mentally ill. - . ... ... . .. ......._; .'We are still very concerned," Giraud_says. "There's all.this publicity'on'a regular basis. We.need special training to help them and law enforcement deal with mentaliy'ill 'people." j Escambia County Jail Director Dennis Williams helped privatize inmate healthcare after Sheriff Ron Mc'Nesby took office i in 2000, saying at the time that the jail's healthcare system then was fraught with deficiencies. Williams defends Prison Health Services, which currently is.paid about$3.8 million to provide healthcare to.Escambia County's jail. "For Escambia County, they're doing very well," tie says. "That's not to say there aren't places we could improve or that we get things right 100 percent of the time." PRISON HEALTH'S RECORD Prison Health Services.is no stranger to controversy. Currently; it serves more than'310 jail and prison sites around the country, covering approximately 214,000.inmates in 37 states. The Atlanta Journal-Constitutionr'ported in December in a story on Prison Health'.that twice in the past four months, the Gwinnett County jail was sued by the families of inmates who died in controversial Taser-related scuffles with deputies. During the same period, two other inmates died-cine killing himself with,a metal'jait.key and the other dying in her cell, while her cellmates begged for medical care, the Atlanta paper found In Mississippi, the American Civil Liberties Union sued the company this summer, alleging that inmates of a Mississippi f prison were misdiagnosed and received poor care. ` The New York Times conducted a yearlong investigation of Prison Health Services,which has a $254 million contract in New York City, and reported its findings' last February in a three-part series. The report found in two•New York City jail deaths,and eight others across upstate New York, state investigators kept discovering the same failings:medical i staffs trimmed to the bone, doctors underqualified or out of.reach, nurses doing tasks beyond their training, prescription drugs withheld, patient records unread and employee misconduct unpunished:. In addition, the New York Times reported that substandard care by the company contributed to at least-15 inmate deaths in.11 Florida jails since 1992. Several inmate deaths in Florida cost Prison Health Services three county contracts,.rbillions of dollars in settlements, and an apology,for its part in the. 1994 death of Diane Nelson. The 46-year-old was jailed in Pinellas,County on charges 4/7/0811:01 PM -AT&T Yahoo!Mail-judeseven@sbcglobal'!net http:%%us.f822.mail.yahoo.com/ym/ShowLetter?boz=ln... that she had slapped her"teenage daughter. She suffered a heart attack after nurses failed for two days to order the heart medication her private doctor.had.piescribed. .. In that case,.the New York Times.reports as Nelson collapsed, a nurse told her, "Stop the theatrics." The same nurse admitted later in a deposition that she had joked to the jail staff, "We save money because we skip the ambulance and bring them right to the morgue." In 2004, a woman in the Hillsborough County jail sued Prison Health Services, blaming the company for the death of her newborn son from complications during delivery. The baby was born over an infirmary toilet at the Falkenburg Road jail. And in Tallahassee, the family of Ruth Hubbs, who died at the Leon County Jail infirmary, recently earned a $350,000 settlement from Prison Health Services. The 39-year-old Hubbs, Who suffered from:bipolar disorder and drug addiction was found dead in the infirmary May 16, 20,03, about a day after deputies reported.seeing her sitting on the floor of her jail cell shirtless and yelling incoherently to herself:The company failed to take her blood levels, monitor or administer . drugs she was prescribed and ignored red,flags raised by a therapist.and two jail guards. LAWMAKERS WARY . Still, Prison Health earlier this month won the iFlorida Department of Corrections contract to.provide healthcare to about 14,000 inmates in 13 South Florida prisons. The state will pay the company$792 million over 10 years. The company's track record made some lawmakers wary, newspapers reported•in'South Florida. "It all seems verysuspect," Sen. Frederica Wilson, a Miami Democrat who sits on legislative panelsdealingwith criminal justice and corrections.issues, told the South Florida Sun Sentinel. "We know the health care in.the prisons already isn't .what it should be. If this company is going to under-bid all the others, then I fear we can only expect greater disappointment." Florida Justice Institute Executive.Director Randy,Berg, who has fought for prisoners'.rights for 28 years, has battled the company twice for refusing to provide neede&medical.care to inmates and followed the.company closely: "They have a bad history of providing healthcare to inmates," Berg.says in a telephone interview with the Independent News from his Miami headquarters. "It's an odd situation. The less healthcare they provide the inmate population, the more money they make.'Its profit motives have always concerned me." Michael Catalano,.chairman, president and chief executive of America Service Group, which owns Prison Health Services,:defends the.company's service. He argues.that the company actually reduces costs and improves the quality of care. Catalano and company officials say its successes far,,outnumber failures and its policy is never to deny necessary medical care. And they say complaints result from the`jchallenging work.of inmate healthcare have mainly come from litigious inmates, disgruntled employees and overzealous investigators. "(Our employees) choose to render a vital public.healtfi service in their own communities," Catalano says'in a.statement. "This is a high calling. Our patients must always receive,appropriate medical care. There can be no compromise of this fundamental value. Our vision is to lead the correctional,,healthcare field in reputation and.results, achieving the highest standards of operational excellence, clinical quality and client service." MEDICAL RESPONSE A check of Escambia County Circuit Court records found two cases involving Prison Health Services, since,it took over _Escambia inmate medical care in 2001. In federal civil suits filed.in'the Northern District of-Florida; 27 cases were filed against the company since 1995, records show: The suits, many of which were dismissed for various reasons, largely tell.of.medications allegedly being withheld or claims of treatments of injuries being denied. During the Coroner's Inquest into Boggon's death last month, one corrections.officer testified.that Boggon "seemed to have a lot of mental health issues. He didn't seem to respond." Whitlock, a Prison Health nurse who found Boggon dead,-testified that a counselor did see him. But Kimberly Cox, a corrections officer at the jail and a great niece..of Boggon's, testified that a day before his death Prison Health nurses acted uninterested in her plea for them to order a psychiatric evaluation, which she said she was told had.not been done. Whitlock said on the stand at the Coroner's Inquest that Boggon would "bite, yell or spit,"which prevented nurses from " getting a complete diagnosis of him. "He was very uncooperative," she testified.'"He was only in the4nine days. We were trying to help him.,We'did give him medication." . Sources close to the Bell case, say his pleas for medical attention went unheeded at the Escambia.County jail, until corrections.officers noticed a "major change." Once transported to Sacred Heart, repeated requests of Prison Health Services from the hospital for Bell's-medical records.were ignored, sources say. No lawsuit has been filed to date in Bell's case: Complaints of poor treatment, especially of the mentally ill, are not new to Escambia County jail. In 2003, Pensacola Junior College Police Chief Nancy Newland,then on the board directors of the Mental Health Association of West Florida; called on the jail to improve its healthcare services and training of jail employees. Newland's brother,Harold Newland II, a paranoid schizophrenic, died•i,n September 2002, shortly after being release from jail..Newland says he was denied his prescribed medicine while in jail,`despite her waiting two hours to.meet with a jail. employee to bring his doctor'sprescription and medication to the jail. :1, Without proper medication, schizophrenics'.condition rapidly deteriorates and they exhibit bizarre behavior that might lead to further criminal charges. ` BETTER HEALTHCARE? More than two.years later, Lakeview Center and the Mental Health Association are working with the Escambia.County jail ?of 3 4%7%0811:01 PM AUTY' ahoo!Mail-judeseven@sbcglobal.net. http://usJ822.maii.yahoo.com/ym/ShowLetter?box=ln... and other law enforcement agencies tol,implement a 40-hour training program started in. Seminole County that creates Crisis Intervention Teams to better handle mentally ill people. . The Escambia County jail is planning on,sending five corrections.officers through the training in the beginning. The training includess-a virtual,reality.schizophrenic machine, which allows police officers and;others to experience what its like to suffer from the disorder. Williams admits the jail is reviewing its handling of inmates after the Boggon and-Bell cases. But he points out that Prison Health Services, as required by its'''=ntract with Escambia County; has earned and maintained.national accreditation since.2003. "We have reviewed our process," he says.'',,"But are we doing anything that requires.'dramatic change? I don't think so." . duwayne(cDinweeklv.net.. j S 4/7/0811:01 PM .1 The.Yale Hippolytic: The Clinic and the Prison: Priva(tiza)tion by Jeremy.Kessler Page 1 of 5 � . The Yale Hippolytic».Volume 1Volume Wolume 1Volume O1Volume 01 »Issue 1Issue 2Issue 3Issue 04Issue 7 » I ' The ,Clinic:and the Prison: Priva(tiza)tion .. ..... .. .. Privatization funds and ensures the brutal treatment of America's;imprisoned. BY JEREMY KESSLER When the state deprives people of their liberty,.essential services cannot be contracted or outsourced To do otherwise makes private what in this age should be public, and sacrifices individual health (and in the case of suicide, survival) to. . . profiteering: " C -John M Brickman,former,executive director, New.York City Board.of Correction; ' 1971-1975 "[MJeh for days chained in place by their feet and fists. `. . the routine alternation between punishments acrd sedatives, detention/injection, dungeon/valium:(oh, tranquilizing morality);;car thieves that one transforms at the age of twenty into delinquents for life, suicide attempts nearly every night. " -.Michel:Foucault.:...._::..! In 1971,the prisoners at Aftica state prison in New York revolted. One.of the stated reasons for the insurrection was lack of adequate health care.After local and federal law- enforcers had stormed the!prison, after a massacre,'.the corpses of 43 prisoners and guards were not the only.signs of the massive failure of the penal system. A wave of lawsuits, filed both by prisoners and guards of Attica,led to a 1976 U.S..Supreme Court ruling which demanded that local governments ensure proper medical care for the prisoners of their penal institutions. It was a victory for both the aggrieved- administrators ggrievedadministrators and recipients of punishment. But the ruling was also an opportunity, providing capital a new role to play,on the stage of a decreasingly public society. Two years after the Court ruling,Doyle Moore, a nurse from Delaware,established Prison Health Services; the first for-profit prison health-care company. The financial burden that had been placed,on city and state governments by the Supreme Court decision in favor of adequate medical services could now be shunted onto.a private company, which, through the legerdemain.of free-market principles and' corporate management strategies, would minimize costs. The health of nation'.s.prisoners was to be a compromise.between conscience and commodity. Since Moore started•:Prison.Health; the for-profit prison medical.industry has boomed, ..and-iscurrentlyresponsible for.the health care.of 40 percent of nation's inmates: Prison Health Services alone;;the largest for-profit provider, administers'care.to percent of.the. U.S. prison population: Moore's corporate child has grown so large by buying up number of smaller providers;who sometimes were operating in.regions.where:Prison Health had been and.left, often amid accusations of abuse, mismanagement or gross negligence. Indeed-,the system'of for-profitmedical not necessarily.conducive to the pursuit of adequate medical treatment for prisoners.' Many.local governments have the policy, or i I http:/%www.hippolytic:com/printable/2005%05/the clinic and the risori riv.htinl 4/7/2008 -'. . .P . P The.YaIle Hippolytic: The Clinic and the Prison: Priva(tiza)tion by Jeremy Kessler. Page 3 of 5 into the NYC system,.and higher than that of Los Angeles County's penal system, the largest in the nation.All-six of.the 2003suicides were committed by inmates who had•not been convicted of any.crime; having been detained'pribr to:trial.or on violations.:. . The New York Times.correctly notes that the correction system is so susceptible to suicide because-"the mentally.ill.have flooded New York's jails ever since they city cracked down a decade ago on lesser crimes like vagrancy., Up to a quarter of the NYC jail population . on an average day has "psychological ills.".Of course, the flood of the mentally ill in the last decade resulted from huge cuts in.funding for mental hospitals across the country in the decades before. When hospitals were shutdown, the mentally ill took to the streets, . and have since been re-absorbed into the clinical-penal system at a different point.of entry.That,structural shift from care to punishment, motivated by cost-cutting, suggests. a more general paradigm in which to understand Prison Health Services'costconscious abuse. i The Supreme Court ruling ir,i 1976 that catalyzed the private prison medical-care industry cited inadequate.medical tate as a form of"Cruel and unusual punishment." Indeed, the cost-cutting sought by public governments; and practiced by private companies .like PHS, licenses a form of punishment supplementary to.incarceration itself. Such - supplementarity is-nothing new.= poor medical care,sub-human living standards, and - inmate=inmate rapes an unoffi tial but utterly uninhibited practice, have long been the punitive remainders in the calculus of incarceration. But post-i976,.the privatization of prison medical care reveals.a public attempt to shun an expensive responsibility, both minimizingcost and installing greater levels of opacity.in the prison system, through. recourse to corporate.discipline. The move has resulted,inadvertently or otherwise, in a further merger of the roles of the clinic and the prison, a merger in the spirit of a time which has witnessed the incarceration and execution.of the mentally ill,.as.well as the _ enlistment of doctors into the ranks of the intelligence community. For although the expansion of private.industry into the public sphere of judgment has proven a sufficient cause of the conspiratorial.discipline of cruel medicine, it isnot a necessary cause - other. alibis have arisen in recent years for the union of the clinic and the prison. ' In June.20.04, the International Committee of the Red Cross spent nearly a month at the U.S.-run detention center at Guantanamo Bay..A,memo quoting details from the report, . which by agreement with the U.S:government was to remain confi dential,was leaked to the New York Times early this year.According to the reported contents of the memo, doctors collaborated with military personnel in the course of.interrogations, providing information about prisoners'."mental health and vulnerabilities."The Behavioral Science Consultation Team, a group'.of.military psychologists,.acted as the conduit for.this information,meeting regularly with interrogators to.discuss the prisoners' medical records. . .:.. � . .. When informed of this arrangement, Leonard S. Rubenstein, executive director:,of Physicians for Human Rights,told the Times: "The use of medical personnel to facilitate abusive interrogations.places them in an untenable-position and violates international .- ethical standards. Rubenstein also worried about the possibility that niedical.staff "engaged-in calibrating levels of pain-infl icted oin'detainees." ...:... . .. i http://vvww..hippolvtic.com/printable%2005%05/the.clinic. and..the. prison priv.html. 4/7/2008 the Yale Hippolytic: The.Clinic and the Prison:.Priva(tiza)tion by.Jeremy.Kessler Page 5 of 5 I effects were originally effected because of cruelty or because.of greed. The privation visited upon prisoners,,or upon the poor, or upon the so-called mentally ill, is not an economic problem. It is apolitical one, political in the oldest'sense of the word — that which calls the bodies of a citizenry to account for their actions. The same goes for other potential failures perpetrated by society in the name.of.efficiency social security 'disintegration, the.underrimining of public education, or the subversion of Medicaid.. These possibilities are not.solutions to.structural problems but new avenues for the. expression of a form.of incivility, of cruelty, of greed.. Privatization, the vector for many such "solutions," deforms questions of the political and of civic morality through its sterile, economic rhetoric.. For at the same time that privatization in its current form depends on economic argumentation and operatesiin the sphere of what we call "economic policy," its .. 'intentional"agenda, intentional in this new sense of the a priori obviousness of the cruel result, is not solely,economic and shares an intentionality with certain non-economic policies. Secret abductions, governmental opacity,and manufactured intelligence . information are all attempts Ito. "privatize — they all constitute an attack on the public sphere, the scene of politics.!They do not constitute one side of a political controversy,but are a subversion of the ability to practice politics itself,the ability of a citizenry to interact as-equal and open-bodies. This application of the,privatization "logic to the foreign - political`s here would actually, in a reversal allow an economization of foreign;'.. P P , Y, �. seemingly`.`[geolpolitical"problems,just as it allowed a politicization of the domestic, see mingly"economic"problems. In this gesture, a certain argument would trace a thread through the "war on terror, the war in Iraq, Halliburton, corporate interests , energy deft tits, and so on, to link the attempt to funnel public money to private corporations domestically with the attempt to further corporatist interests internationally. Such a performance will not be attempted here: . ...in either.case;the attack on the public indicated by"privatization" cannot be-blamed solely on a few moguls, robber barons, or pro-industry politicians. In any sort of democracy that provides the degree of freedom that Americans still haves.the attack on the public must to some degree have been licensed by.thp public. Privatization can-only. -motivate.public.evilAt'is still public tax money that goes :. to.fiind private corporations. It is the public and its appointed ministers who allow them" to operate:Ainericari money has funded, and Arrierican policy has licensed, the torture of. foreigners. American money has funded; and American-policy has licensed; the brutal treatment of America's own imprisoned citizens. It isnot irony,but the'cruel economyof imprisonment acid the selfish imprisonment of economy which have'-dictated that the. country whose rhetoric most valorizes liberty brutalizes those it has'deprived of freedom. http://wwW.hippolytic coi4/printablo./2005/05/tlie clinic and:.the. prison priv.html' 4/7/2008. , Sodexho A Corporate Profile Healthcare Both the National Health Service (NHS) and private healthcare have provided Sodexho with rrurnerous contracts. Healthcare.worldwide provides Sodexho with 18% of its revenue.92 In the UK, Sodexho operate at 130 hospital sites, with half of the contracts "multiple"—with Sodexho providing more than orie service. Typically tile services 'they provide include housekeeping, vending, portering, non-emergency patient transport, car parking, security and grounds maintenance, reception and switchboard.93 In January 2002, Sodexho's healthcare subsidiary in the U.K. gained notoriety in Scotland after a joint union-management inspection team found filthy conditions at the Glasgow Royal Infirmary According-to-reports-inrthe-Glasgow-Evening-Times;94-bloody-surgical-scrubs-were --- -- found dumped inan elevator used to transport patient meals; piles of waste were stored in tunnels under the hospital making it a fire hazard; patients complained of dirty wards and staff members were reassigned directly from cleaning toilets to bringing patients rneals. Hospital staff and their union, UNISON, attriti'uted the problems to staff shortages brought about by the private contractor milking profits fro'n't an under-funded system. This accusation bought reprisals on the union, as rioted by Carolyn, Leckie in the section above. In a Guardian newspaper report issued in April 2001, Sodexho was identified as the cleaning sub-contractor at Broadgreen University Hospital in Liverpool, cited as one of the tens filthiest hospitals in the National Health Service.95 Incidently, four out of the five 'filthiest' hospitals were 'cleaned' by private contractors. In June 2002, South Manchester Community Health Council found stains and debris on the floor of an acute ward and stained toilet seats, dusty ventilation areas, debris under beds and open waste bins used to wedge open fire doors in a high observation ward just after it had been cleaned.96 This is not lust in the UK. Sodezho was reported by the nursing division of Stanford Hospital, California to be using linen contaminated with faecal smears, blood, hair, dirt and tagpe.97 In Hamilton, in the Canadian province of Ontario, Sodexho had a contract for all housekeeping at Chedoke hospital and 40 per cent of l'nc��laster University medical Cerl'tre. �vlike'J'valteFs, a Union Rep., who represented hospital cleaners in Hamilton said "Sodexho doesn't do a good job of cleaning,lie areas they're supposed,to. They prioritise what gets cleaned and what doesn't. In practice that means Sodexho cleaners are directed away from cleaning corridors, stairways and doctors offices, because they are not a priority. Sometimes public employees are called in to clean up areas the private contractor has left behind. They've found blood and urine left on the walls in areas that Sodexho was supposed to have cleaned."98 In April 2003, UNISON reported that patients`�had launched a£1m legal action against Scottish hospital officials, alleging negligence for cutting back cleansing contracts acid allowinig bugs to flourish in dirty wards.The action is being led by Robert Cuthbert, who may lose his leg after contracting PviRSA following major surgery at'',Glasgow's victoria Infirmary. Conirienting on the state of the hospital, where cleaning was carried out by Sodexho, he said: "The walls and floor were covered in a thick fitrll of dirt and dust. If`',you rubbed the walls or floor with your finger, you literally li fted the fifth and grime off, leaving a clean mark."99 T r Co Y-\PD fctt, t: WtL lAM..a._NA-LA Er.. til. D. K f HEALTH SERVICES DIRECTOR OFFICE O F THE `" DIRECTOR; 50 Douglas Drive,Suite 310-A i Martinez,California CONTRA COSTA94553 — Ph(925)957-5405 HEALTH SERVICES Fax(925)957-5401 March 7,2008 Federal Glover, Supervisor District 5 Jolui Gioia, Supervisor District 1 Chair, Contra Costa Board of Supervisors Contra Costa Board of Supervisors 315 E. Leland Road 11780 San Pablo Avenue#D Pittsburg CA 94565 El Cerrito CA 94530 Dear Supervisors Glover and Gioia: During the meeting of the Professional!Affairs Connnittee of the Contra Costa Regional Medical Center of February 21, 2008, you requested comparative information concerning the hospital's employee benefit package relative to other area hospitals. The following is an attempt to be responsive to that request. Summary:Y� Employee Benefits as a ercIent of salary (excluding OPEB Liability) Fiscal Year Ending 2006: I Contra Costa Regional Medical Center: 81.70% Alameda County Medical Center: 62.22% Santa Clara County Medical Center: 59.18% Doctors Hospital San Pablo: 44.20% John Muir-Walnut Creek Campus: 48.25% John Muir-Concord Carnpus: 47.22% All hospitals in California are required to annually report detailed financial and utilization data to the Office of Statewide Health Planning and Development(OSHPD). This report is based on a unifornn reporting system (i.e., all hospital reports are prepared in a uniform manner,using OSHPD definitions). Hospitals are required to submit reports, within four months of the close of their accounting period. After-receipt by OSHPD they are desk audited, and the corrected data are input into the OSHPD database. In addition, if individual hospitals wish to revise their data they may. Periodically (at least annually), data files are posted on the OSHPD website. The most recent file available on the website covers hospital accounting periods ending during 2006. According to the Accountingand n.d Reporting Manual for California Hospitals, which governs the reporting system, employee benefits are defined as,"A pension provision,retirement allowance, Contra Costa Alcohol and Other Drugs Services Contra Costa Emergency Medical Services Contra Costa Environmental Health Contra Costa Health Plan c,,: • Contra Costa Hazardous Materials Programs •Contra Costa Mental Health• Contra Costa Public Health • Contra Costa Regional Medical Center • Contra Costa Health Centers I i ! III Federal Glover,Supervi.sor.District 5..Chair I, John Gioia,Supervisor District I i Contra Costa Board of Supervisors Marcli 1,2008 I .Pale 2 I, I insurance coverage,paid vacation, sick leave, and holiday time off or other cost representing a present or future return to an employee,which is neither deducted on a payroll nor paid for by the employee." The OSHPD data should be viewed within the context of being self-reported and unaudited. There are no consequences for erroneously filed reports. Accordingly, we contacted Doctors Hospital, Santa Clara Valley Medical Center,and Alameda Medical Center to validate and confirm the salary and benefit numbers contained on the attached schedule.-were accurate. All facilities either corrected or validated the numbers contained on the schedule. IIII The John Muir Concord and John Muir Walnut Creek data are taken directly from publicly filed OSHPD statements. The data are believed to be accurate but due to timing constraints independent validation did•not occur. I'll Please note OSHPD data does not provide Salary and Benefit information at the detailed employee classification level, e.g.Nursing. . II II Please advise if additional information or clarification.is required. Sincerely, l I I'I Patrick Godley Chief Operating Officer/Chief Financial Officer Contra Costa Health Services II • II cc: William Walker, M.D., CCHS Director and Health Officer Jeff Smith,M.D., CCRMC and Health Centers 1✓Ixecutive Director John Cullen, County Administrator Lisa Driscoll.County Finance Director Linda Aslicrait,County Labor Relations Manager 'I I'I II I II II I II I'II 1 I'. I I'I III II II 'I • II I 'I N m O I'I II I � I o y Z O I'i v Z9 ap C O o Oca Go S U m t0 Ca.�-.C�T O N A G M vi C a m o N vM yr F `a I U .. .. v > I E EoQs M Im v aiO�+ m m o C S q� Z Ln L) w n.. 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I p ryp Y N O— N N u p C 2 m W do I'I y C L 2 N p T w v �w v N m•y C U d (U C C fC N O 3 � Y} a12 L N 9 N nC-I C C M "C" C C O C IO�J OCna` Co-.i IIII fOmJ 7-aC� C`� � O NaOr` ovE uYl�19 nu_ C'O uvii U m U E r`- m u C7 E o .. m O m c c m r c c CC1 o ul d N 2 C d >U C C N C O U O N.L.. y d ahc c aoLuu2w c0 p •o0a oc� EEwm Coo Ta EEvm ¢� c� c r`o dmDq EYvav_ y �Q_mEEw— rias Uouu V N d ruo n" E c o w v w 0 A d u u U C,W O 0 U d 2 to m>>U, mm Ec vrvuo o^,v of cc rn m»iw� szmt o I II 'I . II I ISI I II I De artrnent .of Economics UCSB i ers De a1 tmental Woikin P .. (Vniyeisity:of,California, Santa Barbara Year 200. : Pa er`i 1'o T. Prison Hec h Care: m Is Contracting Out Healthy? Kelly rd:* Tcd E. I'i cch .t Bela ' r `University of California,Santa Barbar a i t.University of California, Santa 13arbata.; This paper is posted at the eScholarship Repository, University of California. • .. i http://repositories.cdlib.org/ucsbecon/dwp/11,07.' Copyright ©2007 by the authors. :.: . .Prison Health Care: Is Contracting Out Healthy? . .`. Kelly Bedard .H.E' FrechJII::: :'...: . Department of Ecoiiomics Department of Economics ': :- University of California, Santa.Barbara University of California, Santa Barbara ke11 (Reco.n:ucsb.edu i:recllLi ecoi.�.ucsh.edu :. September.200.7 Abstract U.S. Prison health.care'has recently been in.the,news and in the courts.. A�particular issue is whether prisons should contract out for.health care:.Contracting.out has been.-growing. :. over.the past few decades:. The stated motivation for this change ranges from a desire"to improve the prison health,`care system,.sometimes.iri resporise .to..a,court:mandate,:to...a- desire-to reduce costs. .This.study is.a:first attempt to quantify the impact of this change. on inmate health. As..morbidity. measures are not readily obtainable; we .focus on mortality. .More specifcally,�ve.use a panel'of state prisons from•1979-1990 and a fixed', effects Poisson model to estimate.the than e in mortality associated with increases in the i. g percentage.of medical personnel employed under.contract. In contrast.to.the first stated aim of contracting,.we.find that a.20 percent increase in percentage.of medical.personnel... employed under contract increases mortality.by 2 percent. Thanks are due to Mary Alice Conroy,.A.D.,Director of Graduate Studies.in Forensic Psychology, Sam Houston.State.Universi.ty and Clifford Leonard,;Ph.D. Staff. :.' : : Psychologist,Pelican Bay State Prison,California, for helpful discussions and'. background in prison.health care. An earlier-version of this paper was..presented at the-.,. OF International,Health Economics Association meetings in.Copenhagen, July 9, 2007. .. i g Thanks are'due.to participants there;'especially Avi Dor:.:: .Keywords: prison health care, contracts, managed,care; outcomes, mortality JEL Numbers:. I12, I18, K23, L14,L23 I .,:, ... ...:: i ahc.notion ahat independent organ%nations (often, but not necessarily'profit=seeking firms) are moleflexibl&arid efficient than governmeiltally,opetated prison he' tli care staffs. : For o'nb.thing, contract.health care providers are allowed-to payprofessianals.wages that,. exceed state-nlapdated.pay schedules.that are often too low for difficult work inprisons in isolated areas5(Gater 2005):2 Profit-seeking firms also have better in'dnti.vesto pro duce`care more,efficientiybecause.managers are:all to keep the residual.earned . by reducing costs,(Alchian and Deimetz 1972,Boardman and Vining:1989i'Frech 1976; Fizel and Nunnikhoven.1992).: :: While there is a substantial literture examining'the relative:efficienc of govermnent`versus private.firms in.the`context o f goods produced directly for markets, such'as.insurance or privatization of state=owned enterprises (Ehrlich, Gallais Hamonno, Lieu, 1994, Boardman and Vining 1989; Frech 1976, Shleifer 1'098 to the hest 'four . . - knowledge'only Hart,,Shieifer and Vishny (1997):formally models contracting fqr . "ices-that-are not boitglifon'the open.market. .They set up a simple:modei:where the'..: provider, either,a government employee or a private contracting firm can invest;in either .- improving quality',(which also d.s to raise price}o'r.rediiding cost(which also"tends to 'reduce.quality). They show that private contractors Ave stronger"incentives to both improve quality and reduce costs than government employees.- The pibblem is that.. private contractors may have'incentivesthat are too-strong'to reduce costs, since they. ignore the adverse im g.. pact on`quality. .They apply;the model to the question of privatizing i ent' • .. . . ire risons. Like c _ p ontracting.out for prisonhealth care;privatizing,entire,prisons-is f growing inpopularity in the U.S�.;.'though it is much:less'common than'contracting oiit_ J i - i • All these issues were raised by Judge.Thelton Henderson in appointing a receiver to take.over the California system(Plata v. Schwariznegger 2005). 3 themselves vete.simply,cut down, medicated and'retumed to their cells without sy p. chological evaluation(McDonald 1999,Anno 2004). One of the.complaints of the rioters in the infamous 1971::Attica.New.York prison q. iiot.was inadequate health care: Although prisoners and prisoner advocates sued prisons o ad during this early period the courts . n the grounds that healthcare was.tn I equate, generallytook'a hands-'off approach. :Thelegal-environment changed abruptly when the . federal courts began to view.health car through the lens of the U S:Constitution's:. Eighth Amendment prohibition of cruel and unusual punishment: An early landmark case in this regard was the federal:district court decision, affirmed by.the Fifth Circuit of.'. Appeals;:NevM ati.:v. State-ofAlabatna (119.74).,.Arnong the factual findings oflhe.: decision-was the story of a quadriplegic who was not given intravenous..feeding.in.the three days before his.death. The,court f and the conditions barbarous' and in violation of the Eighth Amendment. In'19.76, the Supreme Court.addressed these issues in Eitelle'v. Gaiii:ble .They declared that. deliberate indifference"to aprisoner's serious.medical problem is a Constitutional violation. Subsequent rulings further established.the right to,, ,. i "reas.oiiably adequate medical care"(McDonald 1999).. : .. .Partly,due to the vagueness of these standards,4�:these legal changes im iated an endless stream of court cases and led to heavy involvement of the courts in forcing improvements in prison health care. Medical care.is the most litigated.issue involving prisons.(Schlanger 2003): By 1996,36 states were under federal.court order to improve prisons. The majority of these cases.incltt�ded health care (McDonald.1999).: A;survey.of Most observers cite under-treatment'.especially of relatively sick prisoners. But;the concept.of. "reasonably adequate niedical.caie".is so vague that surprising outcomes of any kind can occur. For. example;in a controversial instance,the'alifornixprisori system provided a heart transplant to twice convicted of armed-robber,at a cost of$1,000,000(McKneally*and Sade 2003). s. 5. - for this is mixed.;For-example, death Irates in prisons are lower than for.the general population after controlling for race,.sex;and agc; though.they'are higher for irifectiorrs disease and suicide (McDonald 1.9 ),I In a.st i.dy of.the;Cook County.,(Chicago) Jail; Kim et al(2006) found a 681iercent lower adjusted mortality'rate for inmates than for the I .. general population: On the.other hand,)when prisoners are released,';their death rates" jump and become much higher than those,of the general population."In a:study of former Washington State inmates, the.adjustedideath rate for the former-inmates was 3.5 times the'state's:overall death rate (Binswanger et al 2007). We'know of only.one nationwide analysis ofprison health care costs,.done by Lamb and Nelson (undated),I They use.state level data obtained frorn a dedicated survey of state,departments of corrections,plus the Federal Bureau of Prisons (BOP) in 1998. Lamb-Mechanick and Nelson report per day health care.costs per inmate ranging from$2.74!in Alabama.to $11.96 in Massachusetts, with a mean of$7:15. .They. also-stridy the determinants of:costs usmgja simple OLS model and data:from.38 states. The regressors include several measures of medical professional inputs;;and.whether. " juveniles are..included in the budget: :No state socio-economic variables.are used. For : . our purposes, the most.interesting finding involves the dummy variable.for whether the. . staten used capitated'co tracts (like many private sector.HMOs) for ambulatory care.. 18 states report using such contracts:.:Iamb-Meclranick and Nelson find that states with . capitated contracts'have3l percent'lower costs per inmate. While-this result is interesting, it isreasonable to be quite conceIrned about omitted v.ariables:bias in.this"... . context and one should therefore interpret these estimatesyvith care. :: ks 7 } • i 'I I . acid asthma. Atthe.saine time,.this contracting oiit strategy:'savcd the'state. 215•.mIll ion over.six..years: In a similar vein;.as a result of prisoner protests in the Baltimore'City Jail, health. care was contracted out to a newly created nonprofit organization in:197.7.. .A.comparison of outcome measures pre and post:contracting shows substantial effects:;.While the; number of sick visits fell:from 62.016 27.4 patients per day per 1;000 inmates,.the length . of time nurses spent with patients per.visit rose from 2.8.to 10.9 rhinutes. :At.the same .time; clinical staffing at the.jailincreased.by.60 percent while costs rose-by only 13 pe en lar el because:hos'hospital use declined:'Overall Freeman (198.1) considers.this to P g Y p , be a substantial improvement in care. II Lastly, Szykula and Jackson:(2005) detail a case study for managed n1ental.health .. techniques in a large Salt Lake..Cityjail. .They.report lower costs and riuch lower levels of psychotropic.niedicatiori.of the inmates after the initiation of manage care:`_ 3. Inniate Mortality Data. We construct a balanced three year panel frorh the 1979 And 1984 Census of State.Adult Correction Facilities:and the 1990 Census of State.and Federal Adult Correction:. Facilities.' The sample is,restricted to these)three.years liecause they are the.only surveys that include the necessary data. Because federal data are.only reported in 1990,:the panel.:. is also restricted to state prisons. All data are self reported at the institution level. ,As the. objective is to esti mate the impact of medical contracting.on inmate mortality,:we.reshict the sample to,facilities that are likely to offer at least.some amount of medical care.:- Operationally this.means that the sample is restricted to state prisons housing adults with 9. I.. j. Ini restricts tlic sample.to.prisons with a hospital, a shared hospit,1, or an iii.frmary and column 3jesiricts the safni)le to just pHsoins.��ith a hospital..'Colut'ns 4 and 5 restrict the sample fo,prisons:with an average capacity of 500+.aiicl 1000+, resbectively.. We iise: these saiiiples�iri Section 4-to check•the sensitivity of the'results to various sample specifications. .::...::.. ss 4. Fixed Effects Poisson Model :. The objective is to estimate the impact of medical contracting in prisons on inniate. mortality:. { i. _ , + where i denotes prisons,1=197% 1.984, or 1it 990;:Mis the annual prison-level mortality count, �,is a vector of prison fixed effects, is a vector of year iridic_ators, C is the I p fessional staff employed ori contract(ranges from 00.1) P is the..:: roportion.of pro number.of.professional staff,Xis.a vector of time-varying prison characteristics, and cis the usual error term.. The central feature'of our prison:mortality data.is:that it is a non negative count.with.a large number of zeros(see:Table 3.and Figure 1').• As such, we. .. I1p estimate equation(1) using a fxed effects Poisson model. We also.report OLS estimates. for comparison: 'The estimates.fore uation(1):are re orted in,Table:4. Columns l and 2 re ort �... .. .. .�.) : . P p. the fixed,effects Poisson estimates.when mortality includes both illnesses.and suicides. _ and excludes suicides, respectively. ..For comparative purposes,columns 3.and 4 report the same estimates for a linear eked effects model, All models.are weighted by average caact The am le sizes are smaller for the Poisson models.compared to the OLS P h'� sP : - " I capacity, 500+.inmafes.and 1000+-inmates,-as an alternative.to:direct measurement of medical:facilities, to focus.oil prisons that„are.more likely to..provide.a high:proportion of medical services in the prison itself While the point estimates"for:large,prisons and prisons with a hospital.are.substantially larger than'the baseline-andthe other.two less I restrictive sub-samples; they are`similar in percentage,terrh A`20 percent'increase.in . contracting increases mortality.by•0.13 deaths or 2 percent relative to a mean death count =' of 5.75 forprisons with a hospital and by 0.13:deaths or 2 percent relative'to a mean ,j death count of 5.23 for prisons.withll 1000+.inmates. I :._:. 4.1:Medical Staff Measrcrement Problems For our purposes,.the primary flaw of available data is the fact that medical staff is not separately identified from other profe'ssional staff in the. 1990 survey. As.a result,.we are. forced to.use all professional-staff and the.percentage of thm employed finder contract • instead of isolating medical'contracting.out. This:lack.of disaggregated data :is . unfortunate since most'of the substantial changes in contracting occur between 1984 and. 1990.- The 1979 and.1984 surveys do separate medical personnel from other professional. staff Table 6.therefore replicates Table 4 with three differences.: First,the sample only i . includes the first two years, 1979 and 1984. Second, medical staff and other professional staff enter all models separately(rows 1 Iand 3) as do the per centage:of inedical and other. professionals who are under contract(rows 2 and 4). Third, the sample is restricted"to : prisons with at least some professional.and medical.staffin both 1979,and.1984. i . Several features6 warrant comment.: First, the point estimates are less consistent:across spec ifications....This is likely due to the limited number of priso�i . a i : II.. -13 1 " contracting to slow.the rise in the death rate.'.As.we'have three years'of.data,:wc can: investigate this,possibility by relating changes in:mortality iri:the earlier pei`iod to: - coritracting..oitt choices.in the later period.:'We estimate the following simple model: - OC90-S4 LY+084.+ 7LAA1�84-79 +YI'84 +'Xi840+Ersa: '' ;'. . ... :(2) where i denotes prisons,.�C9o'sa is the change in the percentage of professional workers employed under contract from 1984to. 1990, Ot11;84-79 is change in prison level mortality : I . . . from 1979 to 1984, 0 is a 1984 year indicator,Pis the'ntimber of professional staff,Xis a vector of prison characteristics as measured in.1984.:.Using equation(2), we.ask'whether. prisons that experienced increases in inmate mortality responded by changing their ..I i .. ,. . . . professional staff contractin rate:, The•results are reported in columns'1 and 2 in.Table 7: .Whether mortality. includes orexcludes suicides,there is no relationship.between the change in mortality:. ..-...; between 1979 and 1984 and the change.in medical contracting between 1984 and 1990.. :; The point estimates are zero to three decimal places and the standard errors are small.- In . order to check the sensitivity of this finding to alternative.specifications,.columns.3.'. . . through 8.replace the change in rriortatity:with the level of mortality.in 1984, 1979,.both j. and 1979 and 1984:. The results for all�Ispecifications are similar: the data.indicate that prisons did not fespond.to mortality changes by changing the percentage of their medical staff employed under contract, at least during the period of for which we have.data:` I .I . III • I. • To the extent that higher mortality rates.deter crime,as shown.Katz,Levitt and Shustorovich(2003),it is also possible that the composition of prisoners is changing over time.-while-it is not.obvious how this • would bias'the reported estimates,we have no way to deal with.possibility of such selection: •15 - I References :. Alchian; Armen A. and Harold Demsetz;1.972:.°`Production, Information Costs, and. Economic Organization,Arimerican-Economic Review 62(5) (0e6.):.777-705. Anno,B..Jaye,2004.: °.`Prison Health Services:.An Overview, '.dournal ofcorrectional. health.Care;.10(3) (Fall): 287-301.: .: Boardman' Anthony E. and Aidan.iR.-;Vining; 1989. `..`Ownership and Performance in Competitive Environments: A Comparison of the Performance.of Private;Mixed, and State-Owned Enterprises,"Jour'nal'ofLaw and:Economics, 320) (Apr): 1-33. Binswanger, Ingrid A., et,al, 2007. `Release from Prison-A High Risk.of Death for Former Inmates,".New- n land Journal.o Medicine, 356 2 Jan 11 2007): 1.57-165. Btcsirzess Week, "Prison Health Services' Lard Time,"(May 18,2005): http:/hvww.biisinessrveel<.cciiii'bwdaily/dnflaslilmay2005%nf20050518 2061 8008.1itm' Ehrlich, Isaac;`Georges Gallais-Hamonno,LhigiangLieu, Randal Lutter, 1994:. "Productivity Grow'th.an Firm Ownership: Aii Analysis and Em'p'irical Investigation," Jozrrrial of Political Economy, 1102(5 (Oct.): 1006-103.8.` ' Estelle v. Gamble 429.U.S.97, 97.S. Ct.285; 50 L.Ed. 2d 251;1 1976 U.S. LEXIS 175 F�zel; John La.nd Thomas S. Nunniklioven .1992. ".Technical Efficiency.ofFor-Profit. and Non-Profit ursin Homes'.'.Maria er ial and Decision Economics 13 5 : Se t. Nursing . �.. ( ) ( P ). 429-439. I6.1 Fresh; H: E.:II1, 1976: ."The Property Rights:Theory of the Firm: Empirical Results firom a Natural Experiment,".Azirnal of Political Econorn , 84(l) Feb: 143-152. Freeman Richard W.' et al'1981.:°`Plai nih Health Services for a Ci Jail: Irii act of , , g �' P . Contractual Services onMen's.SickCall;"'Medical.Care 19`(4) (Apr,): 410=418., Gater, Laura, 2005. "Outsour6ing Healthcare.Services,' Corrections Forzzm, Jl /Au ust u 53-59. ( y . g. ) �. Hart, Oliver, Andrei Shleifer aiid RobertiW. Vishny, `.'The Proper Scope"of Government:,: Theo. and an A lication to Prisons'.'.-Qzzarteil Jo{zrrial_o Lcoizomics 112(4) (Nov,):. Theory Pp Y .� 1127-1161. Hyde;Roberta and Beverly.Brumfie'ld, 2003. "Effect of Co;payment on the Ilse of. ' Medical Services by Male and Female;Prisoners Journal of.Correcfiorial Health Care,' ` 1 .9 4 Winter 371=380. , i 17. u III. hleifer, Andrei;.1998;"State veisus Private Ownership,"Journal of Economic: Persvectives:12(4) (Autumn):- 133-50.. . Sz -ula; Steven'A:'and Dawn F. Jackson,2005.:"Managed Mental Health.Care in Large Jails:`Empirical Outcomes on Cost and Quality,"Joairnc�l of Car rectonal Health.Care 11 • (3): 223-240. Von Zielbauer Paul;.2005A "As Health Care in Jails Goes Private; lO.Days Can Be a Death Sentence,"New York Tifnes j.(Feb:•27). Von Zielbauer,'Paii1, 2005B. "In City's.Jails, Missed Signals Open Way oto Season of Suicides,"Nei' York Titnes, (Feb.28). . Von Zielbauer,Pahl, 2005C. "A Company's Troubled Answer for-Prisoners With H.I.V.".New YorkTiine.s, (Aug.-1). , .. U.S. Bureau of the Census, 1997; Statistical Abstract of the United States: 1997(117`h Ed.)Washington;D.C.' : ..-...... . 19 . II ,I , i li •I � �evelj at the priso e�pneasured. 1990.. : percenta9 19g4 31, Taple 1•Gontractin9 1g7g . 59:.: 41 1 11 7. 5 .. �;.'. � ...7..".. :.�� - 1.24 percent 4.. 49.percent 1 25 .. 50.74 Percent. -. 1 75�percent 'U�WeighCed On `1. II •111• .. I. • " - yl: 11. 1 I : Table 3. Prison-Level Death.Cpunts by Year Death Count -.1979 . . 1984 1990 p . . i ... 251 .202 . .:. 1g3. 2 0 ... 37. 36. .. -3 .24 4 i, i;.'20 8 � '13 17. 11 5 g 7 9 2 . 5 10 . 7 . 8 • , 5. 5 - 2 1 '. 0 • 10 . 11 i 1 2 2 13 �. : . 14 I. 0 . 1. 3 15 ;2 '.� p 1 0 18 . :i, . . .0 .. p 3.. : 20. ;. :... 0 0 2 . 22 p ..: p .. . 26. 0 I 29 0 I p p 1, . 38 . 42 0 p 1 : I Ali Unweighted. ' IIS. I II .. I I _ I • I Table 4:Robustness �.. '.Poisson OLS: log(1+deaths) Sample restricted to prisons'with: All prisons 0.352 ..: .> 0.284 0.307 ;. 0.243 (0.036) ..'' (C039)'. (0.125}, (0:127) [750] :: [71'1j z,[1095].. .. [1095] Hospital, shared tiospital,.or infirmary :.::'`, '037 3 ..:,. 0.298. 0.345 :0.269 . .::(0.037)..'.. (4.440). (0:13$} '.' .. (0.140) .' [684] , [654] [966] [966] " Hospital ': -`. :•.'( 0 659. : . 0.521 ?.;'. 0.677'1: 0.472. ll (0 051)• '(0.055) (0•250). •. (0.251) t2131 : ' [201]: (2551 [255] Prison capacity500+.,, '. :' .' { 0.369..: .' '0.294 0.414 0.331 ,. ._ . (0.038) {0.041} .:' (Q.191} . (0.194) . [544] [519] [615] [615]. Prison capacity 1000+ 0.652 0.522 0.728 0.558 (0.044) .. (0.047) (0.324) (0.340) :. [270],' [261] [276] Deaths include suicides: ) Yes No. Yes No All models include the.variables listed in Table.3.•Weighted by average,prison capacity.Standard.erros are in parentheses. i OLS standard erros are heteroskedastic.consistent.Sample sizes are in square brackets.Bold coeffcients are statisticallyleve! . _ I . significant at the 5%and bold italics are.statisticaliy significant at the 10°lo Level: v , , • - - j I '` I. 01 I Table 7. Change in Professional Contracting between 1984 and 1990 (1). (2) (3). (4) ,(5) (6) . .. (7) (8) ,Death Change(1984-1979) 0.000 0.000 .(0.008) .... 0.008) Deaths in 1984 0.007. :0.007. 0'009 0.015 0.005 0.00.2 (0.007) (0.007) (0.010) (0.011) (0.008) (0.008) Death's in1979 ... I 0.006' 0.014 . (0.011) (0.012) . :. Other controls measured in 1984: Professional staff -0.001 -0.061 -0.001 -0.001 -0.001 -0.001 -0.001 -0.001 (0.001) ' (0.001) .(0.001) (0.001) (0.001) (0.001) (0.001) (0.001) Other staff.(/100), 0.004 0�004 0.002 0.002 0.004 0.004.. 0.003. 0.003 (0.016) (0.016) (0.016) (0.016) .(0.016) (0.0.16) (0.016) .(0.016) Prison population (/100) 0.012 01012. .0.012 0.012 0.012 0.0.12 0.012 0.012 (0.010) (0010) (0.:010) (0.010) (0.010) "(0.010) (0.010) (0.010) Prison capacity(/100) 0.011 -0:011 0.012- .-0.012 0.01.1 -0.011 -0.011 -0.011 (0.009) Ao 009) (0.009) :.(0.009) (0.009) (0.009) (0.009) (0.009) " Inmates killed.(per..inmate) . -0.336 -0.1336 -0.346 =0.341 -0.381 -0.410 . -0.372 -0.405 (0.284) (0.284)': (0.282) (0.282) (0.287) (0.285) (0.287) (0.287) Medium security facility -0.002 -0.002 . 0.0031 0.002 0.005 . 0.006 0.006. 0.007. (0.036) (0.036) (0.036) (0.036) (0.037) .(0.037) (0.037) (0.037) Minimum security facility .0.030 0.030 '... .0.032-. 0.031 , :0.034 0.034 :0.034 0.034 i (0.047). (0.047) (0.047) (0.047) .(0:047) (0.047) (0.047) (0.047) Constant 0.117 . . .0.117 .0.118 0.118 0.115 0.116 0.116 0.117 (0.037): (0.037) (0:036) (0.037) (0.037) (0.036) (0.037) (0.037) Samplesize . . 365 - 365 365 365 365 365 365 365 Deaths include suicides Yes No .'- Yes. . . No, Bold coeffcients are statistically significant at the 5%level and bold italics are statistically significant at the 10%level.Unweighted. I .'Maiilclhise Health ill prison Page' 1.of2 I. Majikthise By Lindsay Beyerstein, freelance journalist. s . June 11, 2005 ; Health in.prison Now they tell us.Too bad New York just renewed_Prison Health Service's contract for a.third of a.billion dollars: i. Inmates'Medical Care Failing in Evaluation by Health:DeM. A recent evaluation of the company in charge of inmate healthcare at Bikers Island,coming months.after it was awarded anew$300 million contract,has found.that.it has failed to'meet a number of the most basic treatment goals.City records showed that the coinpam Prison Health Services Inc.,did not meet standards. on practices ranging from H.I.V.and diabetes therapy to the timely distribution of medication to adequately. conducting mental health evaluations. ::`. The city Department of Health and!Mental Hygiene,which oversees the company's work at Rikers Island and at a jail in.Lower�Manhattan;found that during the first quarter of 2005, Prison Health failed to earn a . . -p.assing grade ori is of..39 perform�iice..standards:the.city.sets.for treating jail inmates:Some of the.problems, _ "like incomplete rriedical records.or'sli shod evaluations of mentall i11 inmates have been evident since.2oo Y , :but have not been corrected,according to health department reports: Other problems identified in the departinent's review, involving things as serious as the.oversight of inmates who:have been placed ori suicide watch;are recent or had not.beeri evaluated by city health auditors in the past. As a result the city is withholdings$55,000 in payments to the company,the largest penalty for poor performance.it has iricurred.sincei200.i,the first year of its work in New York City.adult jails.:[NYT] Speaking of health care in prison,I've been meaning to recommend The New MYIums;Frontline's documentary about mental services in prison:The.main focus is on Ohio's new prison-based psychiatric system.The Frontline. crew got unprecedented access to film!prison officials,'health care providers,.and inmates in Ohio's maximum security prisons. . Much of the footage is.very disturbing.There's an incredibly poignant scene.of a psychiatrist running a therapy group for ten guys-in individual cells.The doc runs the group from rolling chair in the hall.The scene is especially: poignant because he does such a good job,given the constraints of the setup:-Everyone's really giving there all to this group,but you know'that even.if it works,it can't really he]p.These guys are deeply disturbed maximum security inmates whose mental health only niattersi.to officials insofar as it improves their disciplinary records. Posted by Lindsay Beyerstein at.07:04 AM in Law,Medicine I _Permalink.: TrackBack TrackBack URL for this entry: http://wmv.typepad.com/t/trackbacIC/2,4639/2626946 Listed below are links to weblogs that reference Health in ison: ( . Majilcthise Ilealth ill prison . Page 2 of 2 . Comments:. ....:. Jesus Lindsay,how naive can you be!They don't care about access to.or quality of healthcare for the average American,you don't really expect them to care about it for those in[no>i white collar]prisons.';doyou? . Posted by:01 Cranky I June ii,2605 29-4-4 AM Nope.Nobody cares about prisoners much.Q>i the other hand New Yorkers don't like getting ripped off on general principle. .. S.o there's a wedge there.' The Frontline docu,tientary is interesting because the people running the Ohio_program do seem to care quite a bit--at any rate,much more.ihaii I'd expect of a psych staff in a superrri.ax prison:` Ohio ended up with so many crazypeople-in their prisons that they had to create a separate.psychiatric system within their maximum and supermax prisons.This goes Beyond the state hospital for the criminally insane.It's an entire prison system for people with ongoing psychiatric disease..About 16%of the general population in Ohio has,a major psychiatric illness.(i.e.. bipolar,schizophrenia,etc.). ... Posted.by:Lindsay Beyersteia June 11 2, 005 at ii_io AM What's so interesting about the group therapy scene is that the shrink is doing such a great job of delivering therapy whose core assumptions are inconsistent with prison(your feelings matter,we care about you as an individual,we're here to support each other...)..Neither he nor the prisoners.seem to realize the inconsistency,So,at least in the moment,the disconnect doesn't matter: Posted by:Lindsay lie tein i June ii.2001 at t 11:2o A1VI: I' I `• Health system is big problems in all over the world in iliy country the health department has declared the existing rate contract for the purchase of medicine.five.yeae ago but still yet•we no receive any progress in this matters.'. Posted b Andrew Spark I I'ebrua 10,2oo6 at 0.,3:,91 AM _ I i . I I I . • i.: i I I ' 1Vlajikthise : Ifealth ill prison f Page 1 of 2 ajikthise By Lindsay Beyerstein, freelancejournalist. JUJie 11, 2005 .. Health in prison j Nota they tell us.Too bad New York just rene ed Prison Health Service's contract for a'third of a billion dollars: Inmates'Medical Care Failing in Evaluation byHealth Dept: '... A recent evaluation of the company in charge of.inmate healthcare at Rikers:Island,coming months after it was awarded a ne�v$300 million contract,has found that it has failed to nieeta number:of the most basic i. treatment goals. City records showed that the any,Prison Health Services Inc.,did not meet standards . on practices ranging from H.I.V.and diabetes therapy to the timely distribution of medication to adequately. conducting mental health evaluations:;. 1. . I� . J. The city Department of Health and Mental Hygiene,which oversees the company's work at Rikers Island and i at a jail in Lower Manhattan,found that during the-first quarter of 2005, Prison Health failed to earn a passing grade 6n:i2 of 39 performance..standards.the city sets.for treating jail inmates.Some of the problems, _ like incomplete-medical-records,orsiipshod evaluations of mentally ill inmates,have been evident'since.20o4. - but have not been corrected,according tolhealth.department"reports. Other problems.identified in the department's review,involving things as serious as the oversight of inmates ..who have beenplaced on suicide Watch,are more recent or had not been evaluated by city health auditors in the past. I As a result,the city is withholding$55,000 in payments to the company;the largest penalty for poor performance it has.incurred.since 2001,the.first year of its work in New..York City adult jails. [NYT] Speaking of health care in prison,I've been meaning to recommend The NewAsAunis Frontline's documentary about mental services in prison.The main focus is on Ohio's new prison-based psychiatric system.The Frontline crew got.unprecedented access to:film,prison officials,health care providers,and inmates in Ohio's maximum.. security prisons: Much of the footage is very disturbing..There's an incredibly poignant scene of a psychiatrist running a therapy,. group for ten guys iri individual cells.The doc duns t11e group from rolling chair in the hall.The scene is especially poignant because he does suc11 a good job,given the constraints of the setup Everyone's really giving there all to this group,but you know that even if it works,it can't really help:These guys are deeply disturbed maximum. security.inmates whose mental health only matters to officials insofar as it improves their disciplinary records: Posted by Lindsay Beyersteiri.at 0704 AM iri Law;Medicine I Permalink TrackBack 3 .TrackBack URL for this entry:. : �: . http://www.typepad.coni%t/trackback/24o39/2626946 Listed below are links to w.eblogs,that reference Health in .rison: j Majilcthise ` Health in prison Page 2 of 2 . .. Comments • � II Jesus Lindsay;how naive can you be!They don't care about access to or quality of healthcare for the average American,you. don't reallj expect them to care about it for those in[non white collar]prisons,do you?'.. Posted by:Ol_'Cranky I June ii,200.5 at o4-4_4AM Nope.Nobody cares about prisoners much.On the other hand. New Yorkers don't like getting ripped off on general principle. So there's a,wedge there. The Frontline docurnentaryis interesting because the people running the Ohio program do,seem to care quite a bit--at any rate,much more than I'd expect of a psych staff in a supermax prison. Ohio ended tip with so many crazy people in'their prisons that they had to create a separate psychiatric system within their maximum and supermax prisons.This.goes beyond the state hospital for the.criminally insane..It's an entire prison system for People with ongoing psychiatric disease.About 16%of the general population in Ohio has a'inajor psychiatric illness(i.e. bipolar,schizophrenia,etc.). Posted by:Lindsay BeerY stein Juneii,2005 at ii_io AM!I What's so interesting about the group'therapy scene is thatlthe shrink is doing such,a great job of delivering therapywhose core -assumptions are inconsistent with prison(your feelings'matter,we care about you'as an individual,we're here to support each . other...).Neither he nor the prisoners seem to realize the inconsistency:So,at least in the.moment,the disconnect doesn't . matter. I. Posted by:Lindsay Reyerstein I June 12005 at 11:20 AM. • 1 . . Health system is big problems in all over the world in my countrythe health:department has declared the existing rate contract ' for the purchase of medicine five year ago but still yet we no receive any progress in this matters: Posted by:Andrew Spark I February 10,2oo6_at_o3 3i AM I I II. I . .• .., . .. .. -till . .. .. I: I �I I I . .�l Page 1'o f 2 Majtl<thise : I4ealtl} to prison. - Ma�ikthise By Lindsay Beyerstein, freelance journalist. R111e 11, 2005. " J . Health in.prison . II ... Nowthey tell us.Too bad New.York just renewed Prison_Health Service's contract for a.third of a billion dollars: Inmates'Medical CareFailing in Evaluation by Health Dept: ' A recent evaluation of the company,in charge of inmate healthcare at Rikers Island,coming months after it : was awarded a new$300 million contract;has found that it has failed to.nieet a number of the most basic treatment goals. City records showed that th6company1Prison Health Services Inc.,did not meet standards: on practices ranging from H.I.V.:and.diabetes'6era to the timely distribution of medication to ade uatel PY: .... Y q Y conducting mental health evaluations: The city Department of Health and Mental Hygiene,which oversees the company's work at Rikers Island and at a jail in Lower ManhattanJound that during the.first quarter of 20o8, Prison Health failed to earn a passing grade ori12,of:39P : erformance.:standards:the city sets.for treating jail inmates:Some of the problems, Aike in complete-medical re:cords.orslipshod evaluations of mentally ill inmates,:have been evident since.2oo4. . . but have not been corrected,according to health department reports... Other problems identified in the de art involving things as serious as the oversight of inmates Who have been placed on suicide watch,are more recent or had not been evaluated by city health.auditors in the past. . As a result,the city is withholding$55,00o inpayments to the company,the largest penalty for poor performance it has incurred.since 2001,the first year of its work in New York.City.adult jails. [NM Speaking of health care in prison,I've been meaning to recommend.The New Asvlu_ms;Frontline s documentary about mental services in prison:The main focus is on Ohio's new prison-based psychiatric:system.The.Frontline. crew got unprecedented access to film prison officials,health-care providers,and inmates in Ohio's maximum security prisons.. . Much of the footage.is.very disturbing.There's an incredibly poignant scene of a psychiatrist•running a therapy. group for ten guys in individual cells.The doe runs the-group from rolling chair in the.hall.The scene is:especially . ! poignant.because'he doe's such a good job,given the constraints of the setup.Everyone's really giving there all to this group,but you know that even,if it works,it can't really help.These guys are.deeply disturbed maximum security inmates whose.mental health only matters to officials insofar as it improves their disciplinary records... Posted by,Lindsay Beyerstein at oy:04 AM,in Law,Medicine I Pe''rmalink - TrackBack TrackBack URL for this entry litt www. ad.coni trackbck 2 039/2626946 P�// tYPe t a .P /./ � / 4 . it .Listed below are links.to weblogs that reference Health in_mis6n: Ma'ikthise : I3ealth in� risoil .: Page 2 of 2 Coininents is Jesus I.indsay,how naive can you be!They don't',care about access to or quality of healthcare for the average American,you 'don't r•eallj expect them to care about it for those in[noir white collar]prisons,do you? ..,. Posted by:nl Crah ry i June ti,2005 at 4-9.9.4 Nope.Nobody cares about prisoners much.On the other hand New Yorkers don't like getting ripped o.ff on general principle. So there's a wedge there: The Frontline documentary is interesting because the people running the Ohio program do seem to care quitea bit--at any rate,much more than I'd expect of a psych staffin a stipermax prison. Ohio ended tip with'so many crazy people in their prisons that they had'to create a separate psychiatric system within their. maximum and supermax prisons.This goes beyond the state hospital for the.criminally insane.It's an entire prison system for .people with ongoing psychiatric disease.'About.16°o;of the general population in Ohio has a major psychiatric illness(i.e. bipolar,schizophrenia,etc.). I.:. .. Posted by::Lindsay Beyersteii I.JLfneii,2005 at li:to AM Wha.t.'s so interesting about the r.ou .theraPYs.cene is that the shrink is doin s.uch a reatJob of delivering therapy whose core .assumptions are inconsistent with prison(your feelings matter,we care about you as an individual,we're here to support each other...).Neither he nor the prisoners seem to realize the inconsistency.So,at least in the moment,the.disconnect doesn't matter. Posted b Lincisa Be erstein Jun 3'�.-----y--�—�-- �-----e ii 200 .at ia:2o AM Health system is big problems in all over the woi]d in iiiy country the health.departriierithas declared the existing rate contract for the purchase of medicine five year ago but still yet we no receive any progress in this matters. Posted by:Andrew Spark i Febniaiy io,2oo6 at o3_3i AM �� i i nerican Civil Liberties Union:ACLU and PJC Urge Maryland.:.,http://www.aclu.brg/prison/gen/l 4742prs20050601.html . i .,; 4 �;. ,; . ,. ::�. tip:. .- a •,,.. ' t -::e-.i;•.s.'"':.,. .�n�.. . .1.' t '.¢� :tai'.}:;: ': -L-'-�:i. . r�.�" ^•�., I, •:� rn �1�: •:'/ �il Vii`- 'ly�L: .N��.Y:,,.0�f '•0 ''x�'r'i'�{r . •pl�yy. }}i`•'+ :: :•. .:A':: .:r •"rAyr .� 7?,. .P•. •�� .>.Yr , CSO.� ..'.Lh„.�r.......•".'.kxa:rsr.9.�'Lx....� 't; - y. '•F,d"n� +�� ?:m'"��-p�y;, h„ t' ' F .t , �w :•:3F:'.1'?:!ia.J]v��i t'l•:t1�.i •t.' I,,.Fv'!1 �.Sr3+.,�T�};i;9 - ' '•yls :;:CY F:l .L- a.{..r•�Y-,�.,. !:'l�-, �:L.:.�4J - '�4.`.1' ureFx URL:hl1p:/1.w.aw.aclu.org1prisoNperJ.14742prs200.`.C60thiml; id ACLU and PJC Urge Maryland Board to Reject Contract with Company AKnown for Providing Deficient Medical Care .... in Prisons(6i1i2005) FOR IMMEDIATE RELEASE . Contact: media@aclu.org ANNAPOLIS;.MD -= Citing:C.orrectional:Medical Services':poor record1.for dispensing :medical care to prisoners, the American Civil Liberties Union and..Public Justice Center today urged Maryiand's.Board of Public Works to. reject'a proposed contract with the for-profit company.'. "Correctional Medical Services' history:of cutting corners tomaintain'profits jeopardizes the lives of: . thousands of incarcerated people across the country,” said Elizabeth Alexander, Director of the ACLU's. National Prison Project. "Many states have already learned a painful lesson from their dealings.with Correctional Medical Services. Maryland must avoid.handing over the care of its prisoners and jail detainees to.a company with a.disastrous reputation.." . , Correctional Medical Services.(CMS)currently holds contracts in 27 states. In Michigan, where the company provides care to prisoners statewide, CMS has come under heavy scrutiny.for its attempts to save money-by limiting prisoners' referrals to outside medical specialists..A federal court found that excessive delays in providing prisoners.with referrals contributed to three deaths during!an 18-month period. Five other . :..,... prisoners who died,during the.same.timl period also experienced significant delays in treatment. Last week,the Maryland Board of Public(Works announced,that at a meeting today it will review.for approval a two-year statewide medical.services contract between the state's Department of Public Safety and Correctional Services and CMS. The new, contract'is scheduled.to begin July 1; 2005:. Under the new contract, CMS.would provide care to more than 4,000 detainees confined at the Baltimore.:__: : City Detention-Center; which.ha's come under fire ih recent years for providing deficient medical care. In August 2002, the U.S. Department of justice cited the jail for 107 violations of health and.safety standards. Since 2002, th&ACLU.and Public Justice Center have been involved in litigation about the medical care provided at the Baltimore Jail by the current for-profit medical and mental health.care provider, Prison.Health. .' Services. Even with the significant rise in spending..for the`new contract,according to the state's estimates, health services are still underfunded by several million dollars. The ACLU and.Public Justice.Center expressed concern.that simply switching for =profit providers.without increasing resources to fund treatment and. maintaining close'contract.oversight will.leave detainees with.the same-poor care they received under Prison Health Services. .. I. "There is little point in changing company�l names if the continuation of'inadequate funding and indifference from the state regarding detainee health remains the same," said Sally,Dworak-Fisher;.an attorney with the :. Public Justice Center.."In an environment without consistent outside oversight and inspection, the motivations of for-profit tom pan ies.like.CMS and Prison Health Services,become dangerous. Cutting.corners -to preserve profits but risk the health and lives of detainees:is inexcusable, and.Maryland officials-are responsible when the care is constitutionally inadequate. ! Today's hearing before Maryland's Board of Public Works will be held at 10:00 AM in.the Governor's Reception Room' 2nd floor of the Annapolis State House. 1 oft 4/7/0810:50 PM - •. Iii l :ripari Civil Liberties Union ACLU and PJC Urge Maryland:.: http://www.a.du.org%prison/gen114742prs20050601.htmi 0 ACLU{125 Broad Street,18th Floor Nev York,NY 10004 -This is the Web siteof the American Civil Liberties Union and the ACLU Foundation team more about the distinction between these hvo components of the ACLU. User Agreemen I PrivaciStatement(FAQs j Site MaP - t i .. i ; , i .` 2 of 2 `� 4/7/0$ 10:50 PN I. I I f,. J. ARA OO S LEADERSHIP SOUTH CAROLINA: FAIR SHARE .. SPECIAL REPORT1 PRIESCIOPTION FORRECOVERY'os -. Keep I - in Sutlhr� liu 's P g o -ffealth. �ulbllc a d Manu 1t Batt r I g . I - Y Marguerite C1 Rosenthal, Ph.D.,. L " j Grassroots Leadership South Carolina .Fair Share 400 Clarice Avenue 1338 Main Street Suite 400 l ' Suite 30 P.O. .Box 36006 P.O.:Box 8888 Charlotte, NC 28236Colum.b.ia,-SC, 29203 I 704-376-9206 4. 803 252-981.3 www.grassrootsleadershi .or� www.scfairshare.or i - I i • une. 10, i PRESCRIPTION FOR RECOVERY: Keeping South Carolina's Prison Health Care,Public And Making It Better Ezeciitive Summary.' As a follow-lip to our earlier Prescriplion for Disaster.: ComniercialLingPrison Health Services -in South Carolina,this report is focused on important issues that the South Carolina Budget and Control Board should consider as'it fulfils.its legislated-mandate to complete a study comparing the current public prison health care system with privatization before the South Carolina Department of Corrections [SCDC] awards any contract, Weare very concerned that.SCDC proposed privatization apparently_Before conducting any,objective study of its own and.seemingly proceeded on ideological convictions rather than,on objective realities. Prison health care is fundamentally a public responsibility both legally and morally, and we maintain that SCDC should retain it. There are ongoing reports'ofdeplorable health care provided by the three commercial entities that= have submitted bids for SCDC health care system. For example, the State Auditor in Vermont has just released a report:that states that Correctional Medical Services has over-billed the state for non-existent staff and off-formularypsychotropic drugs; the state's losses amount to'almost . $830,000: The Idaho.Department of Corrections has-launched three different investigations into the activities of its contractor, Prison Health Services. The third company, Wexford Health Sources; cancelled a:5-year contract'with Pennsylvania last year; hoping to extract more money from that state. i Two studies tllatliave compared:prison health"care;costs among'different states show clearly that South Carolina's costs are already lower than most and that public systems are less'costlythan privatized ones. 'A 2003-study by Price WaterhouseCoopers found that South Carolina's expenditures were over$1,000,(or 113),less expensive than the.average of six southern states. In general the second study, conducted by Jacqueline Moore and Associates, demonstrates the financial advantages of public systernI though the author is associated with private prison health. care. . .The current SCDC health care system,has both strengths and weAknesses. Its principal strength is its cadre of dedicated and loyal medical staff,its state-run laboratory and its own, efficient pharmacy. However,because,of job freezes and.cumbersome hiring practices, the Department has left many positions.unfilled, and the system is under great.stress. Proactive hiring policies, creative approaches to filling positions in underserved prisons-and streamlining bureaucratic regulations will ease these difficulties.i.Some of these will save money by making the system more efficient. Prison healthcare is.a public,responsibility and needs sufficient support to ensure the. health and safety of prisoners and,ultimately,the public. i Prescription For Recovery f" ,I ESC PR RIPTION FOR RECOVERY: Keeping South Carolina's Prison Health Care Public And Making It Better Introduction and Update This report is a follow up to our earlier one,Prescription for Disaster: Commercializing Prison Health Services in South Carolinu.Il Governor�Mark Sanforci.and his Corrections Department Director, Jon Ozmint, have advocated privatizing prison health services in South Carolina: Prescription for Disaster documented the dangerous and expensive prison health care services provided by for-profit; private corporations in South Carolina from 198672000 and elsewhere. This report'is being written as the South Carolina General-Assembly has required,the Budget and Control Board to complete a study comparing the current public prison health care system with privatization before the South Carolina Department,of Corrections awards any contract. We writing,this report in large part.because the South Carolina Department of Corrections [hereafter SCDC] apparently conducted no thorough study of its own before making the decision to privatize its prison healthcare system to a private company.-,Especially in light of the fact that SCDC had a troubled experience with its partially privatized health system in the past, we are convinced that an objective exam nation.of the many complex components of any prison health.. care system must be conducted before a major decision such as privatization goes forward. Part of this needed examination must include.the.experiences'of the State of South Carolina and other states and localities that have or have not privatized their prison medical services. Prescription for Disaster reported numerous examples of deplorable healthcare provided by the three commercial health care companies that have submitted bids for South Carolina's prison health care contract award, Correctional Medical Services [hereafter,CMS], Prison Health Services [hereafter, PHS] and the smaller Wexford Health Sources. Since the first report.was written, we have found other, recent examples:of private prison health care companies'•failures. In several cases,.states and counties have had to bear expensive financial costs as a consequence of both contract non-compliances and medical malpractice. News articles, official reports, and lawsuits against these companies are easily located on the internet. We cite only a-few, but egregious, examples below: I �I Correctional Medical Services i ➢ In 2003, the Philadelphia'Inquirer published a report that charged that CMS was failing to inform and treat prisoners suffering from hepatitis C in New Jersey's prisons. -A class actioni suit against CMS and the NJ Department of Corrections on these same grounds was filed, and the state was forced to pick up the costs for treating the hepatitis epidemic, estimated to. cost between $4.5 and $8 million in. 2003.2 ➢ Vermont's State Auditor has just released a review•:of that state's. Department of Corrections'.contracts, including one with CMS. CMS was.. I 2 Prescription For Recovery i I - criticized for billing for non-existent staff,needless-expenses for off-formulary psychotropic.drug costs and failure to,submit required quarterly and annual financial reports. IThe state's.:losses amounted to almost.$830,000.3 The Vermont report's serious charges concerning MS' practices echo.those of South Carolina's 2000 Legislative Audit Report.4 Y The U.S: Justice Department's Civil Rights Division, alongwith the American Civil Liberties Union of Eastern Missouri, is.currently investigating CMS for alleged.inadequate medical attention and care that may have led to the premature death of several prisoners at the state's Vandalia. ,women's prison.5 . y. Sister Frances Buschell, prison,coordinator for the Jefferson City Roman Catholic Diocese'and a regular presence in the Vandalia prison, reports that CMS routinely imposes obstacles to care. She has observed the following problems: women must lineup in theearly morning just to fill out a request to be seen by medical. personnel, and only,a fraction of them actually;complete the necessary forms because the time allotted for this task is much too short; women wait 4-6 months for cancer treatment, at which point their.caricers.have worsened and may have become terminal; two women have lost sight because their meningitis was misdiagnosed as a psychiatric problem;pain medication has been denied when needed; and records have been.falsified. .Buschell states that there is frequent turnover-of medical)staff and that the doctors are inept.b I Prison Health Services . Y PHS, which has contracts with many county jails as well as a few states, apparently ignored the obvious serious health problems of several Lee County, Florida prisoners. A December 2002 article reported that several prisoners died either in the jailor very shortly after being released. A lawsuit was .filed in US , District Court on a claim of one former prisoner who.was paralyzed from "botched.medical care."' Y. The same Florida newspaper report also cited the.New York City Comptroller who,'in expressing grave concerns over the medical care being provided at the infamous prison on Rikers Island, noted nation-wide criticism of PHS and questioned whether PHS should.be permitted tolprovide services in New York State.8 Nurses at Rikers Island have claimed that PHS had so reduced staff that employees and prisoners were both at risk.9 A nurse who once worked for PHS in St. Lucie County, Florida claimed that she . was fired for refusing!to participate in illegal and.unethical practices, including, ignoring a request for medication,:verbal abuse of prisoners,antagonizing . mentally-ill prisoners and falsifying.medical records.10 Y In 2002, the ACLU filed a class action against Clark County, Nevada and PHS for. dreadful conditions inithe jail's medical unit and inadequate'medical care that caused "widespread.harm." Mental health treatment was called "atrocious and I rpt<onRecovelyPresc . I uncivilized" grid the jail was said to have no protocols for treating chronic- illnesse's.2 i In April;2004,Idaho's Corrections Director expressed dissatisfaction with PHS, its contractor. The Department has launched three,different investigations; and the Director was quoted as saying: "We have employee management issues, communication,issues and accountability,issues.".�` Wexford Health Sources : In June; 2003, Wexford cancelled a 5-year.contract with.Pennsylvania after only a little over one year; hoping to renegotiate for.more maney,13 S= There are recent allegations that seven cieaths.inFlorida's jails-including one of a 56-year-old minister and Purple Heart Vietnam veteran who died when he did not receive dialysis on time -are attributed to poor medical treatment by Wexford:14 i An article in an Illinois'paper reported that Wexford,obtained a$114 million contract with the Illinois Department of Corrections after the company contributed. $10;000 to.Governor Rod Blagoje,vich's campaign: Wexford had the lowest bid , but also did not have the highest score in'the Department's evaluation.'' . . What Should the Budget and Control Board Study? We applaud.the General Assembly's requirement that privatization should.not be entered into headlong and without an objective evaluation of its true costs. At the same time, we have concerns that the.focus-of the Legislature's mandate to the Budget and Control Board is,on costs- alone, South Carolina's prison-health care system is already among the least expensive in the country,and it is hard to imagine that any more financial reductions can be extracted from the system without harm.. Indeed, because of frozen positions within the SCDC health.care system, the current costs are below what they should be. Further,1whaf commercial companies promise is often not what they deliver, as our earlier report documented. Private companies have a record of promising to reduce. costs and then wangling for increases once they have gotten their contracts. They have avoided or refused to provide needed health care services such as diagnosing and treating he C, and they have reloaded onto the public systems health services that.they consider too costly. Comprehensiveness and quality of services should, in other,words, be important foci of.any comparison, difficult as such a detailed study might prove to be. . We are concerned that SCDC's decision-to privatize its prison healthcare system is based upon the ideological assumption that privatization must.-be inose efficient and cheaper rather than upon an evidence-based analysis. In this regard, we arevery concerned that SCDC did not carefully study the needs of its prison healthcare system as well as the serious problems and,financial losses associated with its previous CMS contract before launching into another.pri vat ization initiative. Prescription For Recovery. L There are fundamental services'tHat are the duty of the public sector to provide.Purchasing automobiles and copying machines from commercial dealers is one thing; states do not manufacture and supply themselves with these•sorts of items. Running prisons, on the other hand, is an age-old function of the state. Caring for those in prison is a-public obligation stemming from the consequences of prisoners'.losing their liberty. Selling this obligation raises the specter of incompetent care, profits to corporate executives and shareholders—most of whom live and spend out.of state--=paid for by South Carolina taxpayers, and exploitation of prisoner-patients: SCDC is fortunate to have many d!dicated health care professionals. Some of thein have thought carefully about.needed_changes to improve the delivery and efficiency of the prison health care . system. These improvements would result in reducing bureaucratic functions so that.more time can be spent in direct care. At the.same time, these professionals recognize the difficulty the Department has had iIi attracting and employing personnel in' some of the more remote parts_of the state and they have suggestions to,remedy these difficulties. This report will briefly review of what is known about several prison health systems. It will then . relate some of the.suggestions that have come.from current SCDC personnel. The SC.DC Prison Health Care System in Comparative Perspective i South Carolina's Prison Health Care Costs are Comparatively.Low Already In January,.1003,the accounting consultant firm,'PriceWaterhouseCoopers, issued"a report, 'Interstate Survey of Health Care C6s.is far Tnrnates,"commissioned by the Georgia Department of Corrections. This report, which compared prison health costs for Alabama, California, Florida, Georgia, Mississippi, South Carolina, Texas and Virginia, found that the average cost per prisoner in these states in FY02 was)$3,523. In South Carolina, the cast was'nearly one-third less: $2,280. Only Alabama and Mississippi spent less than South Carolina that year. Alabama's system was a troubled privatized one that has since switched providers;but Mississippi's was public at that time.i6 Another.study was conducted by the firm, Jacqueline Moore and Associates; in 2003: Moore was a co-founder of Prison Health Services{.PHS) but currently has ties to Corrections Medical Services [CMS].'.' PHS and CHIS are the two biggest for-profit prison medical companies;and both have submitted bids to the SC Budget and Control Board. Moore's study compared FY 2002 per prisoner health costs for 8.states.I A comparison of average costs aspublished in this report is reproduced on the following page. . j Pres Icription for Recovery 5 Comparison of Average Healthcare Cost.Pci Inmate FY 2002'$ STATE ADP . I COSTS EXCLUSIONS COST/INMATE/YR Idaho(PHS) 6297 $11;800,004 Cat Limits$25K/. $1;873.91 . ' Inmate/Yr ' 1 Delaware..(First Cor- ' 6860 (' $17,000,040 ~ 'Unlimited $2,617.65 sectional Medical) Wyoming(CMS) 070 ' $46,869,040 ,..Aggregate Cap. $6,419.63 . Maine -' T .170 $9,200,000 _Phm $4,239.63.. , ' Vermont(CMS) -J436,1 $6,200,060 Pharmacy . $4,317.55 North Dakota' 1032 : $7,500,000 No Exclusions $7,267.44 (Self Op) South.Dakota 2954 $10,260,000 No Exclusions.W� — - $3,452.92. (Hospital Based).. 1 Utah (Self Op) 5700 $18,288 Exclusions Exclusions $3,208.19 Utah 5700.'. . $17;088,233. . . ,:.: L .Budget Minus. ..,. . .. ..........$2,997.93. :._. _. Amount Returned to - - UDOC Note that Vermont, Maine.and Wyoming contracted with CMS and paid between $4,318 (without pharmacy charges) and $6,420(capped)per prisoner per year. The chart above also shows that Utah, a publicly provided system, hIad lower per prisoner costs than the privatized systems, $2,998 (after funds allocated for clinical services but used for other purposes were returned to the Department of Corrections). Although Moore's report made some recommendations for further efficiencies, it concluded that Utah had a cost-effective and comprehensive system that should not be privatized. This report, available online at ' http;//Www.le.state.ut.us/interiniJ20031pdf/00001128.pdf, cauld.well be useful to those reviewing South Carolina's prison health care system. Another cost comparison is contained in the following:.In FY 2004, CMS was charging.Missouri $7.84 per day per prisoner or$2,861.50 annually.This amount exceeds South Carolina's costs.and- is more than double the charges of,$.3.70 per prisoner per.day originally contracted for in 1992.19 i re�scription For Recovery i These cost analyses'demonstrate that, on its face, public prison.health care is less expensive than ..privatized prison health care. There may, of course, be some`.uniqsituations in each state's ue syste1.m. Nonetheless, these studies certainly suggest that South Carolina will.not 'save money by contracting with for-profit prison health companies. We suggest that privatizing will not save money because a commercialized.system necessarily adds. costs since it must reward it&investors with profits and its executives with salaries Much . higher than public sector compensation. To makeup for these added.costs and charge.the state less, commercial companies must reduce the quantity and quality of services, as the many stories of inadequate care cited above attest, and/or they must substantially reduce the compensation of. those.actually providing the services. .In the latter.case, dollars are removed from South Carolina's economy: If costs can be saved by.better managernent, as.private companies often claim, there is no reason that the SCDC cannot itself.become more efficient (see below'for some suggestions). We suspect, however, that having already suffered several severe budget cuts, there is very little else that can be cut out of the SCDCprison Health system. Except as an initial loss leader(as has happened elsewhere), how can a commercial;company possibly save dollars and reward its investors and executives except by improperly rationing services? South Carolina's Prison Health Care Costs Have Been Dropping Not only is South Carolina's prison health system relatively inexpensive, it has also been reducing its average costs per prisoner. While most of the states in the.Southeast region saw increases of between 3% and 1.6% between FYO] and 02, South Carolina's;costs dropped by 14.7%, nearly 3 times more than the only other state to see reductions, Tennessee.20 We note that CMS pulled out. of its contract with SCDCduring FY.2001. In other words, when South Carolina took its prison liealtli care,systeth-back from a private co-mpany, its-costs went down significantly. We urge future _. investigators to look carefully into these reductions to determine their causes and evaluate their promises for the future. We observe that South Carolina's total payments to outside medical providers such as general hospitals (presumably for emergency services and complex.health services) was nearly 1/3 of its prison health care budget in both 0'01 and FY02.2.. Perhaps this significant expenditure is related to the fact that SCDC continues.'to contract with Columbia Care, run by Just Care, Inc. of Alabama, a private health care corporation, for some of its prisoner patients. .According to SCDC's chief accountant, private care was estimated.to cost the state $20,000 more per prisoner per.year than care in the prison system' s�infirmary.22 Continued use of this facility and its associated costs is certainly an area that should be examined further. Can SCDC's(Prison Health Care System Improve? I : As noted above,personnel in the.current; public. SCDC prison health system have hands-on knowledge of their .system and have'offered this writer some suggestions for greater efficiency and cost savings. Some of these'suggestions are presented below, blit—again—we urge that future investigators consult.with a variety of medical and mental health care givers, pharmacists and laboratory technicians, particularlythose currently working within the SCDC system, to gain a I Prescription For. Recovery' ?. more detailed description of their work while also gaining important information and recommendations for improving the system. : To begin with strengths, SCDC medical personnel point to several important factors.: ➢ Dedicated and loyal employees; ➢. A system of medical directives that has functioned well in the past.(butmay be slipping currently); ➢ A state-run pharmacy that runs efficiently and in a cost-cutting manner;. .: ➢ A state-run laboratory which,similarly,is cost-efficient since testuig is done in-house; and ➢ Strong specialty clinics: . There are a number of weaknesses,however, that are frequently mentioned. These include (and Will be further elaborated on,'below): ➢ Insufficient direct medical!personnel, including doctors,nurses,nurse practitioners and psychiatrists; Cumbersome hiring practices that dissuade applicants;from seeking positions at SCDC; ➢ Hiring freezes that have left clinics understaffed, creating tremendous burdens on the loyal staff remaining and costing SCDC substantial financial outlays. for per diem hiring; ➢ Few medical protocols in place, resulting in wasted effort and time in getting approvals for prisoner care; Quality of care.that is not,always.up to standard; ➢ An inadequate administrative structure with poor linkage.and communication between the Central Office.and individual clinics; and ➢ .An overly bureaucratic system that wastes time and effort that could better.be spent on patient.care. Suumested-Solutions Staffing problems appear to be at the.core of the various challenges facing SCDC's.medical services and, indeed, have provided at least one of the rationales for seeking to commercialize the system. These problems fall into two categories: staffing qualifications and appropriate levels of. responsibility; and hiring protocols to attract new personnel. Specifically, the following recommendations have been suggested by current SCDC health staff: . 1) Staffink the clinics: Currently, there appears to be an over-emphasis on having physicians. in each clinic. Since nurse,practitioners are licensed to prescribe medication, having a nurse practitioner in each clinic would be cost effective and is more likely.to result in eliminating the large number of physician vacancies. 2) Hiring medical and mental health specialists: Staffing all the.prisons, particularly those in. rural areas, is admittedly aidifficult challenge. However, scholarship or loan/payback arrangements for students attending South Carolina's public institutions of higher education who aretraining for relevant specialties, such as psychiatrists, psychologists, psychiatric nurses and social workers;could assist in filling some positions. Under this arrangement, students receiving scholarships.would be obligated to work for the SCDC for a fixed amount of time after they receive,their advanced training. Some may, of course, 8 Prescription For Recove>t-y i is choose to remain.' the prison.health system after they have.fulfilled their mandatory obligations. A related suggestion is that SCDC partner with the University of South Carolina's Medical School and its public universities to.arrange for internships. Under appropriate supervision,,interns can greatly augment SCDC's medical and mental health staff. 3) Recruitment methods: More aggressive outreach;particularly through active use of the internet, is needed. Commercial prison health care companies use the internet for recruitment; SCDC should use the same techniques..: We note that North Carolina's Department of Corrections, which.contracted with CMS to staff its prisons in remote, rural areas, found that the private company was no more successful than it had been and therefore terminated the.contra.ct.2 3 4) Hiririy, incentives: SCDC should consider instituting'sign-on bonuses to recruit medical and mental health personnel who agree to work in hard-to-staff prisons. 5) Streamlining the hiring process: The'current hiring process takes too long and is overly bureaucratic. Especially since there isa nursing shortage_in South Carolina, the red tape involved in hiring must be cut so that appropriate applicants receive job offers quickly and are rapidly moved into their SCDC positions.Allowing medical personnel in each facility to.hire staff would greatly shorten the lag time and administrative costs currently involved in employing new personnel. 6) Unfreezing medical records personnel positions: Nurses currently have responsibility for medical records,.takirig time away from nursing. Shifting responsibility for medical records.duties to other personnel might make sense since they are often not fully occupied with their primary responsibilities. 7) Developing_a pool of nurses: Instead of hiring per diem nurses from a private and expensive nursing agency,!.SCDC could develop its.own pool of nurses to fill in.as needed in several institutions. 8) Allowing positions to be filled before a resigning employee leaves: Being proactive about :replacing personnel wouldassure that positions are filled in a timely,fashion. 9) Filling vacant pharmacist positions with technicians: Licensing requirements allow for 3 technicians for each pharmacist; hiring technicians this way would be cost-effective. Streamlining the bureaucracy tol make medical care more efficient would allow medical personnel to attend to patient care instead of filling out request forms and waiting for.approvals from central office. �.A key to achieving more efficiency involves having nurses use existing Medicare protocols, thus eliminating the need for a physician's having to review and approve consultations and treatment regimens. A specific recommendation offered by a current nursing supervisor is to purchase the computerized version of McMillan, Robertson Utilization Review and to make it available to all P>r6cription Folr.Recovery 9 SCDC clinic physicians and nurse practitioners to save time.on routine.cases. Another suggestion is to revamp,the nursing Hierarchy, elimiiiating.a`supervis.ing nurse at each.location and allowing the head nurse to serve in that capacity with, perhaps, 3 or,'4 nursingsupervisors for the whole system to whom the head.nurses would report. In general;there needs to be an evaluation of the true staffing needs to determine how.many supervising staff are actually needed,in order to reduce costs associated with higher ranking medical personnel. Mental health screening and..appropriat.e placement are:crucially important to the functioning of the prisons. Mental health professionals such as social workers and psychiatric nurses can conduct mental health screenings, considered very important in light of the large numbers of mentally ill and substance-dependent prisoners. These professionals can be hired at less cost than... psychiatrists and clinical psychologists.who are currently-required to perform these functions.. Re-instituting the accreditation process would assure that medical services conform to standards. Assuring objectivity in evaluations is crucial. lWith oversight to insure that they remain objective; using available SCDC.medical staff for audits is cost-effective, particularly. because they can establish appropriate policies and procedures as part of this function. There needs to be more accountability, in the system; currently too many decisions pertaining to.health care are left to each warden.. Establishing an independent medical services review body that can receive, investigate and respond to questions and.complaints.related to prison health care services raised by prisoners, their. . families, employees and advocates is vitally important to improve the:prison health care system and assure that health care is properly delivered and crises are avoided :Hidden Costs of Inadequate Prison Health Care Systems States are obligated by a U.S. Supreme Court decision to provide prisoners with adequate health ca.re.24 Even when prison health care systems are privatized,the states continue'to bear this legal responsibility. Prison healthcare is not jus(a.matter of personnel, physical facilities and medications. There are the costs of attorney and legal fees;..insurance and settlement payouts associated with malpractice claims and lawsuits. If the prison health care system is under-funded and under-staffed,lawsuits will abound, and the'state will have costly damage awards. While the current.costs to the State of South Carolina are not known to us, it should be cautionary that Officials in one New York County suggested doubling their insurance protection when it privatized.its jail's health program.25 And then there is the matter of public.health:. Nearly every prisoner will be returning to his or her. community someday. Thus, prison health care is truly a public health concern. Because of the crowded conditions of their confinement and their poor health status, prisoners are particularly susceptible to communicable diseases such as tuberculosis, hepatitis C and HIV/AIDS. .It is therefore critical that they.get appropriate treatment.. If they do not,these illnesses will spread to. the general population. To save lives and to protect public liealth, health care should be efficiently but also adequatelyprovided. 1'liese are all.important factors to consider when evaluating who should be delivering prison health services. 10 I rescription For Recovery Conclusion The current SCDC prison health care system is not expensive when compared;to other state systems: 'Privatizing does not save money.; Indeed,giving state money away to out-of-state executives and shareholders results in further squeezing the health care.systerri. SCDC has a cadre of dedicated and thoughtful personnel, many of.whom have devoted muchof their professional lives to caring for the state's incarcerated population. The system"appears to be functioning fairly well, but, as should be 1cleanfrom the briefly outlined suggestions,above; there are many areas.that can be greatly improved. These suggestions; if explored in greater detail and implemented appropriately, may result in financialsavings to.the state. At the same time,we caution that the system appears to be seriously understaffed, particularly in the area of primary caregivers. Reducing.bureaucratic functions.will,make more current personnel available to perform caring functions, but more personnel are clearly.needed. The changes outlined above have been suggested by current SCDC medical staff These professionals are:in the best position to provide details about their current ideas:iaswe11 as to, provide additional suggestions for improvements in the system in which they work. Establishing a task force composed'of current staff representing different specialties and geographical areas of the state and outside medical experts familiar with institutional health care is, we feel, the best way to evaluate how to.improve the SCDC health care system both to make it more cost-efficient and to enhance the quality of care it provides. ABOUT THE AUTHOR: Marguerite.G.:Rosenthal is a Professor of Social Work at.Salem State College in Salem, Massachusetts. She holds a.-Ph.D..in Social Work and Social Welfare from Rutgers University. She has received awards- and gr tints from the National Institute of Mental Health, the National Association of Social Workers and the U.S. Department of-Health and. Human,Services. Early in her career, she served as a juvenile.probation officer:with the Onondaga County Probation Department in Syracuse, New York and as supervisor of field staff at . .the State of•New dersey's Department of the Public Advocate. She has published and presented widely on issues of social policy,privatization, managed care, welfare.refoim, residential care, juvenile corrections and•faith-based initiatives. She is currently serving as Senior Research Fellow for Grassroots Leadership while ohl.s•abbatic•al fr•orn Salem State College.' i J .Preesenptlon For Recovery - �� ! References. L Rosenthal, M.G. (2004). Press ription for Disaster:.Comme)-czali?ing prison health care in South Carolina. 'Grassroots Leadership/South Carolina Fair Share. 2. Fazloliah M. and Lin J." 2003 He atiiis C treatment may,cost N.J. millions. Philadelhici _ { ) p Y 1� Inquirer,(Jan.,12); Selan. E. (26,03).'-HepC class action.sdit filed in U.S. NJ District Court, retrieved at http://cvww.hcvinprson.org/doscs/classaction100103.html on 5/31/04. ysSIrpr3: :Ready, E.M.;(2004). .Kemung accountabilht v contract management and fiscal oversight at the Department of Corrections. (May 26}. 4. South.Cairo Iina General Assembly,Legislative.Audit Council(2000V A revie"I of the medical services at the SC Department of.Corrections: (LAC/SCDC-98-7), retrieved at http:,//wwww.state:sc.us/seldc/Reports/20000/SCDS.htmon4/1/)004.:! _ 5. Dreiling, G. L. (2003). :Some.inmaies tell horror stories about healthcare at the women's prison in Vandalia: Some didn't Iive to tell their tales. Riverfront.Tirries(Oct. 15); Denise Lieberman,:Legal Director, ACLU of Eastern Missouri (personal communication, May 24, 6. Sr..Frances Buschell (personal communication, June 1, 2004). 7. Hoyem, M. (2002). Dying'in Lee County Jail. News Press-(Dec. 22). http://www.news- pressXom/news/loca state/0212222jailmedicine.html., 1 . • 8. Ibid: 9. Service Employees Union Locall 1199 (200.1). Bad to worse at Rikers.(June). 10. Pollio; M. (2002). Ex jail nurse sues healthcare company. Retrieved at http://allnurses.com/ forums/showthread.php?postied=168051.on 5/28/04. 11. Geer Thevenot, C. (2002). Class-action lawsuit: Jail's.care deficient, ACLU says. Las Vegas Review-.1ow-nal(May 26)x. 12. n.a. (2004). The Idriho Statesman.(Apri16). Retrieved at http://www.flpba.org/private/ rap_ahs.litml on 6/1/04. 13: Ransom, L.�(2003). Wexford ends inmateshealthcare contract. PiltsburgTh Tribune-Revieu (June 7) Retrieved at http.//w,,m,.pittsbiirghlive.com/x/tribune-review/yesterday/ print_l38547.html on.3/9/2004. " i 1.4. Barg,J. (2002): Scandals r us:.Seems the city can't find a prison healthcare provider Without a troubling past. Philadelphia Weekly (Sept. 4). Retrieved at http:// w,,vwvv.philadelphiaweekly.com/article/asp?AitlD=4195.on 5/28/04. i 12 Pres�cripition For.Reco;very :15. O'Connor, J. (2004). State awards prison contracts to Blagojevich contributor. State Journal Register (March 9).. 16. Price WaterhouseCoopers(2003). Georgia,Department of Corrections.-.Interstate..Survey,9f Health Care Costs for lnmcrte.s. (January 21), p. 4. 17. Broughton, A. (2003). .Privatization study advisor under scrutiny. The.Salt Lake Tribune . (July 16): Retrieved at http://w,�vw.strib.com on May 28,2004. 1.8. Moore, J. and Associates (2003). Analysis of cost and service within the Utah Department of Corrections Bureau of Clinical Services. "Discussion Draft"prepared at the request of the . Office of Legislative Fiscal Analyst (November 18). Table 1 O: p:-37.: 19. Dreiling, G. L. (2003). Someuimates.tell horror stories about healthcare at the women's prison in Vandalia.. Some didn't live to tell their tales. Riverfront Times (Oct. 15).. 20. PriceWaterhouseCoopers (2003). Georgia Department of Corrections: Interes•tate Survey of Health Care Costsfor Inmates.!(January 21), p. T 21. Price WaterhouseCoopers(2003;). Georgia Department of Correction's: Interestate Survey of Health Care Costs for Inmates.1panuary 21),P...8. 22. The Post and Courier.(Jan: 27, 2003). Corrections closes 5 prison infirmaries. Retrieved at http://www.charlesion.net/cgi-b�ir/printme.pl on March 31,.2004. 23. Keith Acree, Public lnforinatiori Officer North Carolina Department of Corrections (personal communication,-April 5,2004). - 24. Estelle V. Gamble, 429 U.S. 97,E 103 (1976). 25. Martineu, K. (1999).; Privatization of jail infirmary advances. The Times Union (November 24). i - 13 Prescription'For Recovery. 4 .. ,w,gr'assrootslead..rslh�p.org alrshare:org w�wv�'•sc 1 1 1 , 1 1i Presc iptiori For. ecove ' JOHN GIOIA CALENDAR FOR THE BOARD OF SUPERVISORS Ist DISTRICT CONTRA.COSTA COUNTY FEDERAL D.CHAIR GAl'LE B.UILIkEMA GLOVER 2nd DISTRICT AND FOR MARY N.IS PACT SPECIAL DISTRICTS,AGENCIES,AND 3rd DISTRICT AUTHORITJOHN CULLEN SUSAN A.BONILLA IES GOVERNED BY THE BOARD CLERK OF THE BOARD 4th DISTRICT BOARD CHAMBERS ROOM 107,ADMINISTRATION BUILDING,651 PINE STREET AND FEDERAL D.GLOVER MARTINEZ, CALIFORNIA 94553-1229 COUNTY ADMINISTRATOR 5th DISTRICT (925)335-1900 Supplemental Calendar of Closed Session Items For The Board of Supervisors of Contra Costa County and for Special Districts, Agencies and Authorities Governed by the Board Tuesday, April 8, 2008, 9:30 a.m. and thereafter Board Chambers Room 107 and Room 101 Administration Building, 651 Pine Street, Martinez, California A. CONFERENCE WITH LABOR NEGOTIATORS 1. Agency Negotiators: Lori Gentles and Linda Ashcraft. Employee Organizations: Contra Costa County Employees' Assn., Local No. 1; Am. Fed., State, County, & Mun. Empl., Locals 512 and 2700; Calif. Nurses Assn.; Service Empl. Int'I Union, Local 535; District Attorney's Investigators Assn.; Deputy Sheriffs Assn.; United Prof. Firefighters, Local 1230; Physicians' & Dentists' Org. of Contra Costa; Western Council of Engineers; United Chief Officers Assn.; Service Empl. Int'I Union United Health Care Workers West; East County Firefighters' Assn.; Contra Costa County Defenders Assn.; Probation Peace Officers Assn. of Contra Costa County; and Contra Costa County Deputy District Attorneys' Assn. 2. Agency Negotiators: Lori Gentles and John Cullen. Unrepresented Employees: All unrepresented agency management employees (Resolution No. 2008/147, including its Exhibits), unrepresented nursing classification employees, and all other unrepresented agency employees. B. CONFERENCE WITH LEGAL COUNSEL--EXISTING LITIGATION (Gov. Code, § 54956.9(a)) Sandrino Angeli v. Contra Costa County, W.C.A.B. Nos. WCK#60171, WCK#69271