Title
Set the date of June 5, 2018 at the hour of 9:00 a.m. to conduct a “Beilenson” public hearing to consider reduction and elimination of Public Health programs, effective July 1, 2018, as follows:
a. Reduction in Communicable Disease Prevention and Control program.
b. Eliminate Directly Observed Therapy (DOT) for individuals diagnosed with active tuberculosis (TB) disease.
c. Elimination of the new immigrant TB screening program.
d. Closure of the County Public Health Clinical Laboratory.
e. Elimination of the Whole Person Care program.
f. Elimination of Nurse Home Visitation Supervising Public Health Nurse
g. Direct the Clerk of the Board to publish notice. (ADDED VIA ADDENDA)
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Set the date of June 5, 2018 at the hour of 9:00 a.m. to conduct a “Beilenson” public hearing to consider reduction and elimination of Public Health programs, effective July 1, 2018, as follows:
a. Reduction in Communicable Disease Prevention and Control program.
b. Eliminate Directly Observed Therapy (DOT) for individuals diagnosed with active tuberculosis (TB) disease.
c. Elimination of the new immigrant TB screening program.
d. Closure of the County Public Health Clinical Laboratory.
e. Elimination of the Whole Person Care program.
f. Elimination of Nurse Home Visitation Supervising Public Health Nurse
g. Direct the Clerk of the Board to publish notice.
SUMMARY/DISCUSSION:
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 reduction to the level of medical services provided by the County for the care of indigents.
Beginning May 22, 2018, a public notice for this hearing will be advertised by the Clerk of the Board and hearing notices will be posted at the entrances of County facilities where residents access these services. The notice will include a description of services to be eliminated.
Reduction in Communicable Disease Prevention and Control program. This program provides disease surveillance, investigation, prevention, and control services for communicable diseases. The program also provides infection control guidance to schools, hospitals and skilled nursing facilities. This reduction will lead to delayed detection and treatment of communicable diseases, resulting in more people getting sick, more deaths due to preventable diseases, and higher medical costs. Individuals who are infectious with Salmonellosis, E coli infections, and other enteric illnesses will work in the agriculture and food service industries and pass their illnesses on to others through contamination of food and food products. Children with pertussis and mumps will attend school and pass their illnesses on to other students and teachers. Local medical providers, when facing new or re-emerging diseases, will have no one to contact for guidance on how to isolate travelers who have been in contact Ebola or how to screen pregnant women exposed to Zika virus. Victims of dog and wildlife bites will not be evaluated for risk of rabies exposure and assured of appropriate preventative treatment. College students exposed to meningococcal meningitis will not be identified and therefore will not be offered preventative treatment.
Eliminate Directly Observed Therapy (DOT) for individuals diagnosed with active tuberculosis (TB) disease. This program assures individuals with active TB disease take their anti-TB medications regularly and as prescribed by their TB clinician. Elimination of this program would lead to people with TB disease being inadequately treated, resulting in an increase in the spread of TB disease in our communities. In addition, because some people with TB disease may only receive part of their treatment, drug-resistant strains of TB would develop and circulate in higher proportions.
Eliminate the new immigrant TB screening program. This program provides screening and linkage to treatment services for new immigrants arriving from highly TB-endemic countries who have been identified as at-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 US born individuals. Without the new immigrant TB screening program, the incidence of active TB disease will increase in Monterey County. More people will get sick and spread the disease to others. Incidence of drug-resistant TB is high in many other countries. Therefore, costs associated with treating and controlling TB disease will increase as well.
Close the County Public Health Clinical Laboratory. The Clinical Laboratory provides testing of patient specimens from hospitals, health care providers and public health practitioners. Lab tests include bacteriologic testing to identify residents with infectious E. coli, salmonella and other communicable diseases. The laboratory also performs highly complex tests to quickly identify viral pathogens such and hepatitis A, Influenza, and measles. The lab conducts testing of samples to detect infectious tuberculosis for the four local hospitals. The lab tests the brains of animals that have bit humans to determine if there has been an exposure to rabies. Reduction in the Laboratory’s level of service would result in decreased health provider access to lab testing, reduced quality of test results and could delay proper diagnosis and treatment of infectious diseases in Monterey County.
Eliminate the Whole Person Care program. This nurse home visitation program provides case management to homeless residents that are also suffering from mental illness, substance abuse and multiple chronic diseases. Nurses conduct comprehensive health assessments and develop case management plans. Nurses provide vaccinations, referrals to homeless services agency for placement in housing, and referral and assistance in seeking primary care and specialty care services. The program decreases the cost of health care to the most vulnerable residents in the county. Elimination of the program would result in fewer housing placements, fewer homeless residents entering drug dependency treatment and mental health treatment, and higher health care costs.
Eliminate the Nurse Home Visitation Supervising Public Health Nurse. this position provides vaccinations, conducts comprehensive health assessments and supervises public health nurses that conduct nurse home visitation. Elimination of the position would result in a reduction in the number of residents vaccinated against influenza and other infectious disease, and would provide less supervision to the public health nurses.
There are no identified alternatives for Monterey County residents to receive these services if they are reduced or eliminated.
This action is unlikely to support the Monterey County Health Department’s 2011-2015 Strategic Plan Initiatives.
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed the report.
FINANCING:
County Counsel has reviewed the report.
FINANCING:
The following cost information includes the complete amount, including salaries, benefits, and overhead. The proposed reductions to Communicable Disease Control and Prevention and TB Control programs would cost $682,512 to fund in FY 2018-19. The proposed reductions to the Public Health Laboratory would cost $134,282 to fund in FY 2018-19. The proposed reductions to Whole Person Care would cost $775,000 to fund in FY 2018-19. The proposed reductions to 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, 4585
Approved by: Elsa Jimenez, Director of Health, 4526