Title
a. Conduct a public hearing, pursuant to California Health and Safety Code section 1442.5 (Beilenson Act), beginning on June 5, 2018 at the hour of 9:00 a.m., to receive public input on the proposed elimination of and/or proposed reduction in the level of medical services provided by the County, effective July 1, 2018, in the following programs of the Monterey County Health Department, Public Health Bureau (“Public Health Programs”).
1. Reduce Communicable Disease Prevention and Control program.
2. Eliminate Directly Observed Therapy (DOT) for individuals diagnosed with active tuberculosis (TB) disease.
3. Eliminate the New Immigrant TB Screening program.
4. Reduce the County Public Health Clinical Laboratory.
5. Eliminate the Whole Person Care Case Management program.
6. Eliminate One Nurse Home Visitation Supervising Public Health Nurse.
b. Provide direction to staff relative to the proposed elimination of and/or proposed reduction in the level of medical services provided by the County, effective July 1, 2018, in the Public Health Programs, including, among other things:
1. Approve elimination or reduction in the level of medical services provided by the County or, alternatively, continue matter for further consideration and review at a later Board meeting;
2. Direct staff to provide further reports or information to the Board at a later Board meeting;
3. In the event of an elimination of and/or reduction in the level of medical services provided by the County, designate the Monterey County Health Department to provide a 24-hour information service that can give eligible people immediate information the available services and access to them;
4. In the event of an elimination of and/or reduction in the level of medical services provided by the County, designate the Monterey County Health Department to receive and respond to complaints from people eligible for services of County medical facilities;
5. In the event of an elimination of and/or reduction in the level of medical services provided by the County, designate the Monterey County Health Department to arrange for all facilities or individuals contracting to provide services to indigent people to be listed in the local telephone directory under county listings, and specify therein that the facilities or individuals fulfill the obligations of county facilities.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Conduct a public hearing, pursuant to California Health and Safety Code section 1442.5 (Beilenson Act), beginning on June 5, 2018 at the hour of 9:00 a.m., to receive public input on the proposed elimination of and/or proposed reduction in the level of medical services provided by the County, effective July 1, 2018, in the following programs of the Monterey County Health Department, Public Health Bureau (“Public Health Programs”).
1. Reduce Communicable Disease Prevention and Control program.
2. Eliminate Directly Observed Therapy (DOT) for individuals diagnosed with active tuberculosis (TB) disease.
3. Eliminate the New Immigrant TB Screening program.
4. Reduce the County Public Health Clinical Laboratory.
5. Eliminate the Whole Person Care Case Management program.
6. Eliminate One Nurse Home Visitation Supervising Public Health Nurse.
b. Provide direction to staff relative to the proposed elimination of and/or proposed reduction in the level of medical services provided by the County, effective July 1, 2018, in the Public Health Programs, including, among other things:
1. Approve elimination or reduction in the level of medical services provided by the County or, alternatively, continue matter for further consideration and review at a later Board meeting;
2. Direct staff to provide further reports or information to the Board at a later Board meeting;
3. In the event of an elimination of and/or reduction in the level of medical services provided by the County, designate the Monterey County Health Department to provide a 24-hour information service that can give eligible people immediate information the available services and access to them;
4. In the event of an elimination of and/or reduction in the level of medical services provided by the County, designate the Monterey County Health Department to receive and respond to complaints from people eligible for services of County medical facilities;
5. In the event of an elimination of and/or reduction in the level of medical services provided by the County, designate the Monterey County Health Department to arrange for all facilities or individuals contracting to provide services to indigent people to be listed in the local telephone directory under county listings, and specify therein that the facilities or individuals fulfill the obligations of county facilities.
SUMMARY/DISCUSSION:
The Fiscal Year 2018-19 proposed budget for Public Health reflects a combination of decreased Health Realignment revenue and increased operational costs. California’s expansion of Medi-Cal and implementation of Covered California provides new health insurance to Monterey County’s indigent population. Covering the indigent population with health insurance generates new revenue for health care providers and reduces the County’s use local revenue to pay for health care for indigent patients. Assembly Bill 85, chaptered in 2013, requires that the State retain a share of Monterey County’s Health Realignment revenue to cover the State’s cost of expansion of health insurance for the indigent population. In Fiscal Year 2018-19, the State will retain $5,980,819 of revenue that would have otherwise been received by the county. In addition, the County is experiencing rising costs due to increases in employee health insurance, disability insurance, worker’s compensation and negotiated salary increases.
Under the California Health and Safety Code 1442.5, a “Beilenson” public hearing is required prior to the closure of a County health facility, or elimination of and/or proposed reduction in the level of medical services provided by the County.
Beginning May 22, 2018, fourteen days prior to this hearing, a public notice for this hearing was posted at the entrance to all County health care facilities. The notice included a description of the medical services that the County proposes to eliminate or reduce.
At the June 5, 2018 Beilenson hearing, he Board of Supervisors will hear public comment regarding the proposed reductions and/or eliminations. Following the Beilenson hearing, the Board may approve the following proposed eliminations and/or reductions, in whole or in part.
1. Reduce the Communicable Disease Prevention and Control program.
Description:
This program provides surveillance, investigation, prevention, and control of communicable diseases countywide. The program also provides infection control guidance to child care programs, adult care programs, health care providers, schools, correctional facilities, local hospitals, skilled nursing facilities and restaurants.
Sites:
Health Department, 1270 Natividad Rd., Salinas CA 93906.
Numerous public and private locations countywide.
Nature of proposed change:
Reduce the number of employees that prevent the spread of communicable diseases.
Staff reductions:
1.0 FTE Public Health LVN
1.0 FTE Public Health Nurse III (underfilled with a PHN II)
1.0 FTE Public Health Nurse III
Persons affected:
The proposed reduction will lead to delayed detection and treatment of communicable diseases, resulting in more people getting sick and more deaths due to preventable diseases. Individuals who are infected with Salmonella, E. coli and other enteric illnesses will not be restricted from working and will continue to work in agriculture and food service industries, will contaminate food products and will pass their illnesses to other people. Children with whooping cough, measles and mumps will not be identified and will continue to attend school and will pass their illnesses to teachers and other students. Local medical providers will have no experts to contact for guidance on how to deal with challenging cases such as travelers exposed to Ebola virus or pregnant women exposed to Zika virus. Victims of dog and wildlife bites will not receive the benefit of a public health evaluation of their risk of rabies exposure and may not receive the appropriate treatment to prevent death due to rabies. College students exposed to meningococcal meningitis will not be identified, will not be offered treatment to prevent illness, and may develop meningitis.
Every county resident and visitor will be at increased risk for exposure to infectious diseases.
Expected annual savings:
$430,490.
Lost Revenue:
$0.
2. Eliminate Directly Observed Therapy (DOT) services for individuals diagnosed with active tuberculosis (TB) disease.
Description:
This program assures that individuals with active TB disease take their TB antibiotics as prescribed by their doctor.
Sites:
Health Department, 1270 Natividad Rd., Salinas CA 93906.
Numerous public and private locations countywide.
Nature of proposed change:
Eliminate public health employees that watch and confirm that tuberculosis patients take their prescribed antibiotics.
Staff reductions:
2.0 FTE Community Service Aide IV
Persons affected:
Elimination of this program will lead to inadequate treatment of people with TB disease, resulting in an increase in the spread of TB disease in the county. In addition, some people with TB disease will receive incomplete treatment, resulting in more drug-resistant strains of TB circulating among county residents and visitors.
Approximately 26 county residents with TB disease each year will not be observed by public health employees to confirm that they take their antibiotic medications as prescribed. County residents and visitors will be at increased risk for exposure to people with TB disease that is inadequately treated.
Expected annual savings:
$153,762.
Lost Revenue:
$0.
3. Eliminate the immigrant TB screening program.
This program provides initial TB screening for new legal immigrants arriving from countries where the incidence of tuberculosis is often very high. These recent immigrants were identified as being at increased risk for TB disease in their country of origin prior to immigration. Rates of TB disease are about 10 times greater among newly arrived immigrants than among individuals born in the United States. The program refers these immigrants to local doctors that then evaluate the immigrant for TB and treat as appropriate.
Sites:
Health Department, 1270 Natividad Rd., Salinas CA 93906.
Numerous public and private locations countywide.
Nature of proposed change:
Eliminate public health employees that screen and refer newly arrived legal immigrants with latent TB and infectious TB to health care providers.
Staff reductions:
1.0 FTE Public Health LVN.
Persons affected:
Elimination of this program will increase the number of people with undiagnosed infectious TB in Monterey County. More people will get sick and spread the disease to others. Since the rate of drug-resistant TB is high in many countries of origin, the rate of drug-resistant TB is also expected to increase in Monterey County.
Approximately 75 new legal immigrants each year will not be screened by public health officials or referred to health care providers for evaluation and treatment of TB. Health care workers, county residents and visitors will be at increased risk for exposure to undiagnosed cases of infectious tuberculosis.
Expected annual savings:
$98,260.
Lost Revenue:
$0.
4. Reduce County Public Health Clinical Laboratory services.
The Clinical Laboratory provides testing of patient specimens from local hospitals, health care providers and public health officials. The Laboratory tests patient specimens to identify people with E. coli, Salmonella and other bacteria that cause infectious diarrhea. The laboratory also performs highly complex tests to quickly identify pathogens such and measles virus, influenza virus and Valley Fever. The Laboratory uses test methods that are not available at private laboratories, including genetic typing and drug resistance testing to track and prevent further spread of diseases. The laboratory tests patient specimens from four hospitals to help doctors diagnose and isolate patients with infectious tuberculosis. The laboratory also tests the brains of animals that have bitten people to determine if there has been an exposure to rabies virus.
Site:
Public Health Laboratory, 1270 Natividad Rd., Salinas, CA 93906.
Nature of proposed change:
Reduce the number of public health employees that perform clinical laboratory tests in the Monterey County Public Health Clinical Laboratory.
Staff reductions:
1.0 FTE Public Health Microbiologist.
1.0 FTE Laboratory Assistant.
Persons affected:
Reduction in the Laboratory’s level of service will result in decreased health care provider access to prompt laboratory testing, reduced quality of test results and delayed diagnosis and treatment of infectious diseases in Monterey County.
Approximately 2,000 patients each year in Monterey County will have their specimens rerouted to laboratories in other counties and will wait longer for confirmation of their diagnosis.
Expected annual savings:
$148,760.
Lost Revenue:
$57,550.
5. Eliminate the Whole Person Care Case Management program.
Description:
This nurse home visitation program provides comprehensive case management to homeless county residents that also suffer from mental illness, substance abuse and chronic medical conditions. Nurses conduct comprehensive health assessments and develop case management plans. Nurses also provide vaccinations, refer clients to homeless services agencies for housing placement, and assist clients in seeking primary care and specialty care services. The program increases patient access to primary care, decreases utilization of ambulance and emergency room services, decreases hospitalizations and decreases the cost of health care for the county’s most vulnerable residents.
Sites:
Health Department, 1270 Natividad Rd., Salinas CA 93906.
Numerous private residence locations countywide
Numerous homeless encampments countywide.
Nature of proposed change:
Eliminate public health employees that provide comprehensive case management to homeless individuals that struggle with mental illness, drug addiction and poor health.
Staff reductions:
4.0 FTE Public Health Nurse II (2.0 FTE underfilled with Clinic Nurse).
1.0 FTE Behavioral Health Aide.
4.0 FTE Public Health LVN.
1.0 FTE Supervising Public Health Nurse.
1.0 FTE Office Assistant III.
Persons affected:
Elimination of the program will terminate comprehensive case management for up to 600 homeless individuals with mental illness, substance abuse disorders and chronic medical conditions.
Expected annual savings:
$775,000.
Lost Revenue:
$591,286.
6. Eliminate one Nurse Home Visitation Supervising Public Health Nurse.
Description:
This public health employee provides vaccinations and supervises public health nurses that conduct nurse home visitations for pregnant women, mothers and their babies. Women that receive these services develop better parenting skills, are more likely to delay subsequent pregnancies, and more likely to graduate from high school. The babies of these women are less likely to fall victim to child abuse or neglect.
Sites:
Health Department, 1270 Natividad Rd., Salinas CA 93906.
Numerous private residence locations countywide.
Nature of proposed change:
Eliminate one public health employee that provides and supervises delivery of comprehensive case management to women and their babies.
Staff reduction:
1.0 FTE Supervising Public Health Nurse (underfill Public Health Nurse II).
Persons affected:
Elimination of the position will result in a reduction in the number of mothers and children vaccinated against influenza and other infectious diseases, and will decrease supervision of public health nurses.
Expected annual savings:
$94,000.
Lost Revenue:
$67,726.
These proposed actions are unlikely to support the Monterey County Health Department’s 2011-2015 Strategic Plan Initiatives.
These proposed actions are not a “project” within the meaning of the California Environmental Quality Act (“CEQA”) and therefore are not subject to CEQA requirements, inasmuch as they are organizational or administrative activities of government that will not result in either direct or indirect physical changes in the environment.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved the report as to form.
FINANCING:
The following cost information includes salaries and benefits. The proposed reduction to Communicable Disease Control and Prevention would cost $430,490 to fund in FY 2018-19. The proposed reduction to both TB Control programs would cost $252,022 to fund in FY 2018-19. The proposed reduction to the Public Health Clinical Laboratory would cost $148,760 to fund in FY 2018-19. The proposed reduction to Whole Person Care would cost $775,000 to fund in FY 2018-19. The proposed reduction to Nurse Home Visitation would cost $94,000 to fund in FY 2018-19.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Edward Moreno, Health Officer and Director of Public Health, x4585
Approved by: Elsa Jimenez, Director of Health, x4526
Attachments:
Beilenson Public Notice English is on file with the Clerk of the Board
Beilenson Public Notice Spanish is on file with the Clerk of the Board