Los Angeles County Grand Jury
2013-2014
Quick View
Full Details →
Additional Recommendations
1
Not linked to specific findings.
R15:
6 Expand the catering services to outside groups, including courts and other municipal and government agencies. SOUTH DISTRICT GOVENOR GEORGE DEUKEMEJIAN COURTHOUSE 275 MAGNOLIA AVE. LONG BEACH, CA 90802
Quick View
Full Details →
Additional Recommendations
1
Not linked to specific findings.
R15:
12 The Probation Department needs to continue and expand rehabilitation programs at the Challenger camps. AFFLERBAUGH CAMP (CAMP AFFLERBAUGH) 6631 N. Stephen Ranch Rd. La Verne, CA 91750
Findings & Recommendations
7 findings
F1:
The Department of Health Services has developed and is implementing an electronic health record system. It will allow all providers within the DHS system to access patient records. The system is known as ORCHID. The first hospital and set of clinics is scheduled to begin implementation of ORCHID in August 2014, with the expectation of full implementation by the end of the first quarter of 2016.
F2:
The Board of Supervisors’ decision to allow DHS up to a 120 day extension on the “Go-Live” date could delay the full implementation of ORCHID beyond the scheduled target completion date.
F3:
Implementation of the DHS’s EHR will greatly improve access to patient data throughout DHS facilities and remove the silo-effect of the six separate entities in their current health information system.
F4:
Through the leadership of the Chief Information Office and the Chief Executive Office, the Countywide Master Data Management system is being developed and will soon be implemented. It will provide a roadmap to identify a “single view of the client”.
F5:
The Department of Health Services, Sheriff’s Department, and Probation Department are each using Cerner as their individual contractor for electronic health records.
F6:
Cerner has a contractual agreement to electronically connect these systems in the afore mentioned departments with minimal or no increased costs. 19 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT A HEALTH INFORMATION EXPRESSWAY OR LIFE IN THE SLOW LANES
F7:
In 2009, the Board of Supervisors directed the Chief Executive Office to develop LANES to facilitate a countywide HIE between public and private health care providers. LANES, as it is currently constituted, has implementation limitations, which include: a. Limited resources to implement and sustain LANES; b. Lack of sustainable funding; c. Absence of a full-time director; d. Indeterminate financial support from on-going stakeholders and buy-in from other potential health care providers; and e. Uncertainty as to whether the current Federated technology architecture employed by LANES has the capacity to deliver patient information in a timely fashion.
Additional Recommendations
18
Not linked to specific findings.
R1:
Utilize DHS’s electronic billing system, Affinity Adjustment Codes on all accounts for classifying and better explaining the reasons for all write-offs.
R2:
Update the DHS write-off procedure to include all Reason Codes, including new Codes, as they are developed.
R3:
Expand the scheduled availability of Patient Financial Service Worker staff at all hospitals.
R4:
Develop and track a Reason Code classifying write-offs for denied or late claims that are billed by the DHS Consolidated Business Office without Treatment Authorization Requests (TARs) or InterQual Reviews (IQRs) demonstrating the medical necessity of the services provided.
R5:
Formalize the point at which Medi-Cal fee-for-service accounts are retrospectively reviewed for patients still in the Department hospitals.
R6:
Conduct a Utilization Review staffing analysis at county hospitals as an increase in staff may substantially increase Department cash flow by decreasing backlogs and increasing the timeliness of billings. SECTION TWO Incomplete or No Medical Records DHS write-offs due to Incomplete or No Medical Records totaled $101,568,377 in gross charges between FY 2008-09 and FY 2012-13. During the fiscal years reviewed, write-offs of Medicare accounts totaled $57,673,677, or over 56 percent of the write-offs, because of Incomplete or No Medical Records. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT iv A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION The CGJ found three primary causes of Incomplete or No Medical Records write-offs:
R7:
Utilize available systems and tools, and require DHS physicians to report their National Provider Identifier (NPI) number and complete the 855R form linking the NPI number to DHS, as required for Medicare billing purposes, prior to commencing work at a DHS facility.
R8:
Monitor the processing of Medicare claims to ensure that the implementation of ORCHID, the Department’s new electronic health record system is aiding and providing Medicare itemized claims.
R9:
Track the backlog for coding at all facilities through regular reports, similar to those produced by Los Angeles County/USC Medical Center. Aggregate and analyze coding backlog data at all facilities for resulting trends and to identify any problem areas.
R10:
Perform a staffing analysis in DHS Health Information Management (HIM) divisions at all DHS facilities to assess whether additional staff might ameliorate the current HIM backlogs and delays in coding. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT v A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION SECTION THREE “No Authorization for Services” No Authorization for Services is the most common reason for write-offs in the “Failed to Bill for Third Party Requirements” write-off classification. Between FYs 2008-09 and 2012-13, the Department wrote off $68,247,162 in gross charges because it had not obtained authorization from the patient’s third party payer prior to providing non-emergency inpatient and outpatient services. A total of $58,567,426, or 85.8 percent of write-offs due to “No Authorization for Services” was Medi-Cal Managed Care accounts. Factors contributing to the “No Authorization for Services” write-offs include:
R11:
Implement an electronic notification method for alerting physicians of the patients’ required authorization from third party payers when follow-up services are required.
R12:
All physicians must be trained on the new electronic notification system and accountability measures should be implemented to ensure that physicians schedule follow-up services appropriately. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT vi A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION
R13:
Require all DHS facilities to regularly pre-screen scheduled outpatient appointments to ensure that authorization is obtained or the patient is referred to a more appropriate provider.
R14:
Evaluate effective and efficient staffing models to support the need for obtaining authorization from third party payers for inpatient services; such as a designated unit, a centralized staff, or an independent utilization review unit.
R15:
Determine the cost-effectiveness of implementing third party payers’ online authorization tools to ensure timely authoriza- tion for inpatient services.
R16:
Collaborate with Cerner, the Department’s vendor for its new electronic medical record system, ORCHID, to determine if enhancements in the new system could facilitate online processing of health care plan authorizations for DHS services. SECTION FOUR County Financial Incentive Policies Historically, DHS has ended a fiscal year with surplus revenue. It was able to retain these surplus funds for DHS operating expenditures in subsequent years and the county General Fund contribution to the DHS budget was not reduced in subsequent years to offset the retained surplus funds. The Board of Supervisors could vote to reduce the county General Fund contribution to the DHS budget, subsequent to fiscal years with surplus revenue, as long as the total County contribution still meets the required minimum contribution amount per its agreement with the State of California. RECOMMENDATIONS To provide financial incentives for DHS to improve revenue collections, the County Board of Supervisors should:
R17:
Consider the advantages and disadvantages of adopting a formal policy to allow for a minimum level of annual General Fund contributions to the DHS budget.
R18:
Allocate a portion of the funds to DHS, if additional revenue is obtained through improved collection efforts, that are beyond the required contributions by the state and irrespective of any additional revenue DHS is able to obtain through improved collection efforts. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT vii A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION TOPIC OF INVESTIGATION The Los Angeles County Board of Supervisors approved write-offs totaling $285,421,607 in gross charges billed to third party payers by the Department of Health Services for the five fiscal years from FY 2008-09 through FY 2012-13. An average of $57,058,431 in gross charges was written off per year for the past five fiscal years. After a preliminary investigation, the 2013-2014 Los Angeles County Civil Grand Jury (CGJ) initiated an audit to investigate and analyze the Department of Health Services (DHS or Department) annual write-offs, processes, and systems used for electronic health records and billing for third party payers. These third party payers include Medi-Cal, Medi- Cal Managed Care, Medicare, and private insurance.
Findings & Recommendations
5 findings
F8:
Overall, Medicare gross charges of the Incomplete or No Medical Documentation write-offs are the highest among all payers, accounting for $101.6 million in DHS gross charge write-offs between Fiscal Years 2008-09 and 2012-13.
F9:
The audit sample of Incomplete or No Medical Records write-offs demonstrated key trends that aligned with problems reported by DHS staff involved in managing and executing the patient billing processes.
F10:
Approximately $24.5 million in gross charge write-offs between FY 2009-10 and 2012-13 was attributed to physicians without National Provider Identifier numbers and required authorization with DHS for billing of services to Medicare.
F11:
Barriers or complications in coding accounts by Health Information Management divisions.
F12:
Coding backlogs in Health Information Divisions.
Additional Recommendations
2
Not linked to specific findings.
R1:
Outpatient services include emergency and urgent care services.
R2:
The Ambulatory Care Network consists of the Multi-Service Ambulatory Care Centers, Comprehensive Health Centers, and Health Centers DHS patients whose services are reimbursed by a third party are generally covered by Medi-Cal and Medi-Cal Managed Care. These programs require authorization for services provided outside of the health plan’s network. The majority of No Authorization for Services write-offs, is attributed to Medi-Cal Managed Care patients. A total of $58,567,426 of the $68,247,160, or 85.8 percent of write-offs due to No Authorization for Services over the past five fiscal years, was for Medi-Cal Managed Care inpatients, outpatients and ambulatory care network patients. Medi-Cal Managed Care and private insurance companies will reimburse DHS for services provided if authorization is obtained in a 60 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Quick View
Full Details →
Findings & Recommendations
5 findings
F13:
Physicians reportedly scheduling follow-up outpatient services, after basic needs are met through emergency room/urgent care or after a patient has been discharged from the hospital, when the patient does not have prior authorization.
F14:
The Department of Health Services is not obtaining timely authorization for high dollar value inpatient services due to the inability of Patient Financial Services staff to obtain prior authorization or redirect patient’s to facilities in the patient’s health plan’s network prior to all schedule outpatient appointments.
F15:
Insufficient or inadequate allocation of resources and tools for Utilization Review nurses to obtain timely authorization from other health care plans for inpatient.
F16:
Write-offs for Medi-Cal Managed Care patient accounts due to no authorization for services have increased over time. As Medi- Cal Managed Care enrollment is expected to increase over time, it is imperative that DHS improve its business processes to ensure timely authorization and billing for Medi-Cal Managed Care patients.
F17:
Because the Board of Supervisors is able to decrease subsequent fiscal year General Fund contributions to offset increased DHS revenues from prior fiscal years, such Board actions could potentially serve as a disincentive for DHS staff to increase revenue collections.
Findings & Recommendations
1 findings
F8:
Litigation related payouts or expenditures from the City’s General Fund have increased rather than decreased since 2007, when Executive Directive No. 9 was issued. Exhibit 8 shows the trend in general fund expenditures for litigation, by fiscal year. Clearly, Exec9 has not been effective in achieving its stated intent of ensuring “further progress in preserving City resources by reducing and preventing claims against City operations and employees”. Exhibit 8 Litigation General Fund Expenditures by Fiscal Year $100.0 $91.0 $90.0 In Millions $80.0 $70.0 $57.9 $56.9 $60.0 $49.1 $50.0 $45.0 $41.2 $36.6 $36.8 $40.0 $34.3 $33.5 $30.0 $20.0 $10.0 $0.0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Note: The spike in payouts for FY 2010 was the result of several lawsuits with substantial payouts. This included two lawsuits related to landslides, several cases involving civil rights or discrimination, and several related to personal injuries. Source: Analysis of amounts paid in judgments, verdicts, and/or settlements over the past 10 years provided by the Los Angeles City Attorney’s office as of October, 2013. 114 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS
Additional Recommendations
8
Not linked to specific findings.
R1:
Implementing the practices described in this Executive Directive;
R2:
Tracking all claims and litigation related to department employees and/or programs, including regularly seeking and receiving updates from counsel and reviewing critical discovery, such as depositions of department employees;
R3:
Serving as liaison to defense counsel, whether City Attorney or conflict counsel, in claims or litigation involving department employees and/or programs;
R4:
Serving as liaison to the Mayor's Office and the CAO with respect to all matters related to litigation risk management;
R5:
Representing the department before the Claims Board whenever department- related litigation is before the board;
R6:
Ensuring that appropriate department personnel are available and attend court hearings, mediations, depositions, and other legal proceedings when requested by the City Attorney's Office or Mayor's Office;
R7:
Ensuring the conduct and quality of all litigation-related reviews of policies, practices, and /or employee conduct to yield appropriate action, as described in this Executive Directive; 2 119 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Mayor Antonio R. Villaraigosa Executive Directive No. Page3
R9:
Developing and implementing, in consultation with Mayor's Office, CAO, and Personnel, other department-specific loss control and risk management practices. Each Department Head shall submit the name and contact information of the designated Litigation Risk Manager to the Mayors Office (Office of Counsel to the Mayor), with a copy to the City Attorney and to the CAO by no later than January 31,
Findings & Recommendations
8 findings
F1:
In 2009, First 5 LA adopted a five-year Strategic Plan that called for making significant investments in a Place-Based Strategy. The new plan called for discontinuing funding of initiative-based direct services on a countywide basis and to concentrate funding to targeted communities with the goal of making a greater impact with the Agency’s investments.
F2:
The Implementation Plan called for spending $405 to $540 million over five years, or an average of $81 to $108 million per year on Place-Based activities in 14 high needs communities. $270 to $405 million per year were also allocated to Countywide Strategies, aimed at improving policies and services for children ages 0–5 in the 14 communities and beyond.
F3:
The budgeted amount for both Place-Based activities and Countywide Strategies for the three years ending in FY 2012-13 was $158 million, but actual expenditures were significantly below that amount, at $61.4 million, or only 39 percent of the amount budgeted.
F4:
Most of the $61.4 million in actual expenditures went towards funding Countywide Strategies policy and advocacy work; the amount expended on Place-Based activities in the 14 communities was only $14.6 million over the three years ending in FY 2012-13, significantly lower than the $65.1 million budgeted for activities in the 14 communities during those three years.
F5:
The new Strategic Plan included a roadmap for ending support to Prior Strategic Initiatives grants. The Agency has not implemented this component of the Plan and continues to fund several of these grantees. In addition, the Agency adopted other 156 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY? Countywide Initiatives in 2010. Spending on these two categories of grants has greatly exceeded spending on Strategic Plan components as a percentage of annual expenditures.
F6:
During the Agency’s “pause” on Place-Based Strategy funding in FY 2012-13, it appears that the right questions were raised, as to the core results to be achieved for families and communities. It took First 5 LA several years after implementation of the Place-Based Strategy to ask these questions and to develop quantitative metrics to monitor impact suggests insufficient planning for the new strategy. It contributed to a loss of momentum in activities for the newly formed Community Partnerships in the 14 designated communities.
F7:
The Agency’s own inquiry into implementation of the Place- Based Strategy, known as the Listening, Learning, Leading (L3) effort, concluded that the Strategic Plan was not being used as a guide to Agency funding and that new performance measures needed to be adopted. The Agency has adopted new performance measures after three years of minimal assessment of outcomes for its Place-Based Initiatives but the new measures have yet to be reported on. These measures do not cover the Countywide Initiatives that still comprise the bulk of what First 5 LA is funding.
F8:
While this audit was underway, the First 5 LA Commission adopted new Governance Guidelines that call for new programs and initiatives to be aligned with the Agency’s strategic plans, to have implementation timelines and to have specific outcomes and performance measures. If followed, all of these guidelines should help the Agency avoid some of the problems encountered in rolling out its Place-Based Strategy.
Additional Recommendations
4
Not linked to specific findings.
R1:
Family Strengthening
R2:
Community Capacity Building
R3:
Systems Improvement Initiatives The Strategic Plan also included Countywide Strategies as a separate, but complimentary, component of the plan. In the 2010 Implementation Plan for the 2009-2015 Strategic Plan, the Family Strengthening and Community Capacity Building components are described in greater detail. The Systems Improvement Initiatives were combined with the Countywide Strategies. According to the early strategic documents, First 5 LA envisioned that the Countywide Strategies would develop strong, coordinated and responsive systems to support families and improve outcomes for children prenatal through five years of age. Figure 2.1 presents brief descriptions of the three components of First 5 LA’s Place-Based Strategy. 159 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY? Figure 2.1: Description of the Place-Based Components and Countywide Strategies Strategy Component Description Place-Based Strategy The Place-Based Approach is comprised of the three components below. Family Strengthening Investments to provide intensive, direct services to at-risk families. This component consists primarily of support for the “Welcome Baby!” and other home visitation programs. Community Capacity Seen as a vehicle for partnering Building with communities. Goal is to organize and train residents and organizations to advocate for themselves. Investments in this area have primarily supported the development of 14 Community Partnerships. Systems Improvement Activities designed to impact the larger structures affecting child well-being in the 14 communities. Countywide Strategies The countywide strategies are to consist of investments in seven areas, namely 1) Public Policy, 2) Public Education, 3) Resource Mobilization, 4) Workforce Development, 5) Data Systems Integration, 6) Health Access, and 7) Information Resource and Referral. Source: FY 2009-2015 Strategic Plan and 2010 Implementation Plan The components of the Place-Based Strategy and Countywide Strategies have not been presented consistently in budget and expenditure documents, thus making it difficult to track spending by activity over time. In fact, less detail has been presented over time in the Agency’s budget documents. A review of Agency budgets and expenditure reports illustrates this point. The names given to the Place-Based Initiative components changed between FYs 2010-2011 and 2013-2014. In the final two years, the investments in this category are referred to in a single line item as Best Start. 160 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY? This change is consistent with the restructuring of the Place-Based Strategy that occurred upon the adoption by the Commission of the Best Start Family Framework in June, 2013. However, collapsing spending records for different program elements into one budget category reduces the transparency of the Agency’s financial documents, as well as the Commission’s ability to provide oversight, and the level of disclosure provided to the public. Figure 2.2 presents budgeted amounts for the various program components that comprised Place-Based Initiatives in FYs 2010-11 through 2013-14, including program components that were transferred in and out of the Place-Based Initiative category. Figure 2.2: Changes in Budget Presentation for Place-Based & other Initiative Expenditures, FYs 2010-11 through 2013-14 FY 2010-‐11 FY 2011-‐12 FY 2012-‐13 FY 2013-‐14 Place-‐based Initiatives (PBI) Partnership Development 1 0,303,500 4 ,340,000 not disclosed not disclosed Community Capacity Building 3 ,545,000 9 ,680,000 not disclosed not disclosed Data Systems Integration 2 0 0,000 moved to: CWS moved to: CWS moved to: CWS Public Education 1 ,550,000 moved to: CWS moved to: CWS moved to: CWS Transition 1 ,700,000 one year only one year only one year only Family Strengthening -‐ 2 ,815,000 not disclosed not disclosed Best Start not disclosed shown in Prior SP 3 1,119,349 2 2,851,676 Total Place-‐based Initiatives 1 7,298,500 1 6,835,000 3 1,119,349 2 2,851,676 Prior Strategic Plan Investments (PSP) Best Start 5 6,538,000 9 ,465,000 moved to: PBI moved to: PBI Countywide Strategies (CWS) Data Systems Integration in PBI 1 ,165,000 3 7 5,000 1 ,436,150 Public Education in PBI 2 ,100,000 3 2 0,000 2 ,459,500 Source: Unaudited financials, and Agency budget documents, FYs 2010-11 to 2013-14 Between FY 2010-11, (the first year of the Place-Based Strategy) and FY 2013-14, details on spending in each of the key components changed. It contained decreasing levels of detail of how the monies were being spent in the latter two years. It is not possible to discern from Agency documents how funding was allocated between the distinctly different components of Family Strengthening, Community Capacity Building, and Partnership Development in FYs 2012-13 and 2013-14. Expenditures for these components were folded into the single “Best Start” budget line item. The term Best Start was also used in budget documents for the pilot program in Metro LA, which contained the same three components of the Place-Based Strategy. Collapsing this expenditure information in 161 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R7:
Information Resource and Referral. Source: FY 2009-2015 Strategic Plan and 2010 Implementation Plan The components of the Place-Based Strategy and Countywide Strategies have not been presented consistently in budget and expenditure documents, thus making it difficult to track spending by activity over time. In fact, less detail has been presented over time in the Agency’s budget documents. A review of Agency budgets and expenditure reports illustrates this point. The names given to the Place-Based Initiative components changed between FYs 2010-2011 and 2013-2014. In the final two years, the investments in this category are referred to in a single line item as Best Start. 160 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY? This change is consistent with the restructuring of the Place-Based Strategy that occurred upon the adoption by the Commission of the Best Start Family Framework in June, 2013. However, collapsing spending records for different program elements into one budget category reduces the transparency of the Agency’s financial documents, as well as the Commission’s ability to provide oversight, and the level of disclosure provided to the public. Figure 2.2 presents budgeted amounts for the various program components that comprised Place-Based Initiatives in FYs 2010-11 through 2013-14, including program components that were transferred in and out of the Place-Based Initiative category. Figure 2.2: Changes in Budget Presentation for Place-Based & other Initiative Expenditures, FYs 2010-11 through 2013-14 FY 2010-‐11 FY 2011-‐12 FY 2012-‐13 FY 2013-‐14 Place-‐based Initiatives (PBI) Partnership Development 1 0,303,500 4 ,340,000 not disclosed not disclosed Community Capacity Building 3 ,545,000 9 ,680,000 not disclosed not disclosed Data Systems Integration 2 0 0,000 moved to: CWS moved to: CWS moved to: CWS Public Education 1 ,550,000 moved to: CWS moved to: CWS moved to: CWS Transition 1 ,700,000 one year only one year only one year only Family Strengthening -‐ 2 ,815,000 not disclosed not disclosed Best Start not disclosed shown in Prior SP 3 1,119,349 2 2,851,676 Total Place-‐based Initiatives 1 7,298,500 1 6,835,000 3 1,119,349 2 2,851,676 Prior Strategic Plan Investments (PSP) Best Start 5 6,538,000 9 ,465,000 moved to: PBI moved to: PBI Countywide Strategies (CWS) Data Systems Integration in PBI 1 ,165,000 3 7 5,000 1 ,436,150 Public Education in PBI 2 ,100,000 3 2 0,000 2 ,459,500 Source: Unaudited financials, and Agency budget documents, FYs 2010-11 to 2013-14 Between FY 2010-11, (the first year of the Place-Based Strategy) and FY 2013-14, details on spending in each of the key components changed. It contained decreasing levels of detail of how the monies were being spent in the latter two years. It is not possible to discern from Agency documents how funding was allocated between the distinctly different components of Family Strengthening, Community Capacity Building, and Partnership Development in FYs 2012-13 and 2013-14. Expenditures for these components were folded into the single “Best Start” budget line item. The term Best Start was also used in budget documents for the pilot program in Metro LA, which contained the same three components of the Place-Based Strategy. Collapsing this expenditure information in 161 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Findings & Recommendations
8 findings
F9:
The categories used to describe the Place-Based components in budget and expenditure documents changed between FYs 2010- 11 and 2013-14, making it difficult to track expenditures by activity over time.
F10:
In Fiscal Years 2012-13 and 2013-14, all budget line items for the Place-Based Strategy were collapsed into a single line item documented as, Best Start. This provides the Commission and the public with few details about how funds were being used. It minimizes the means for First 5 LA management to expend funds in accordance with specific Commission direction. A transmission letter to the First 5 LA Commission presented more detail on Place-Based budgeted expenditures for FYs 2012-13 and 2013-14 however, this information was not included in the budget document itself and therefore not compared to actual expenditures.
F11:
Place-Based Strategy budget and actual expenditure information for all years reviewed do not represent Agency operating budget expenditures, which averaged $2.8 million per year for the first three years of the rollout.
F12:
Budget and actual expenditure documents presented to the Commission do not track Place-Based Strategy spending per each of the 14 communities being served. This practice makes it impossible for the Commission to compare the level of funding with the outcomes achieved in each community.
F13:
Not until FY 2012-13 did budget documents provide a greater level of detail as to how funding for the Place-Based Strategy was being spent. In that year, budget detail showed that approximately half of the funds were being spent on marketing, communications, and research and evaluation for the Place- Based strategy. 169 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY?
F14:
The Agency provided insufficient evidence to the Commission about the potential effectiveness of and challenges inherent in the Place-Based Strategy and its ability to improve services for children aged 0-5. It cited the work of private foundations, which may not be an appropriate comparison for an agency that receives public funds.
F15:
Documents presented to the Commission prior to the adoption of the Place-Based Strategy did not adequately list the potential impacts involved, including the extended period of time for results to materialize.
F16:
Implementation of the Place-Based Strategy and the Community Capacity Building work in particular, is time-consuming and challenging. It is difficult to measure the effectiveness of the Community Partnerships and their ability to improve services. Some Community Partnership representatives have expressed frustration at the slow pace of development and their concern that the implementation plans will not be funded once completed.
Additional Recommendations
11
Not linked to specific findings.
R1:
Front gate at Sylmar was aligned correctly to close on impact
R2:
Installed a rain gutter and down spout on the warehouse
R3:
Replaced ice machine in main kitchen area
R4:
Repaired large pothole adjacent to the kitchen
R5:
Installed a freezer condenser and compressor in the kitchen
R6:
Installed electrical conduit and heaters in the warehouse
R7:
Installed razor wire atop communication riser a-b
R8:
1 The Los Angeles County Assessor and Board of Supervisors should request the California State Legislature to revise the law to require reassessment, when real property is purchased/transferred to different structural ownership at the conclusion of a transaction. Reassessment should be based on the purchase/transfer of real property—not the structure of ownership involved. (i.e. the greater than 50+% ownership formula currently in place.) Certification of Professionals Responsible for Determining Change in Ownership
R9:
Repaired air conditioning unit on Administration building roof
R10:
Installed earthquake valve
R11:
Installed new phone line at North School 189 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT MAINTENANCE ISSUES AND LIVING CONDITIONS AT JUVENILE HALLS EXHIBIT III Housing Unit Repairs Completed at Barry J. Nidorf (as of January 31, 2014)
Findings & Recommendations
7 findings
F1:
The Department of Health Services has developed and is implementing an electronic health record system. It will allow all providers within the DHS system to access patient records. The system is known as ORCHID. The first hospital and set of clinics is scheduled to begin implementation of ORCHID in August 2014, with the expectation of full implementation by the end of the first quarter of 2016.
F2:
The Board of Supervisors’ decision to allow DHS up to a 120 day extension on the “Go-Live” date could delay the full implementation of ORCHID beyond the scheduled target completion date.
F3:
Implementation of the DHS’s EHR will greatly improve access to patient data throughout DHS facilities and remove the silo-effect of the six separate entities in their current health information system.
F4:
Through the leadership of the Chief Information Office and the Chief Executive Office, the Countywide Master Data Management system is being developed and will soon be implemented. It will provide a roadmap to identify a “single view of the client”.
F5:
The Department of Health Services, Sheriff’s Department, and Probation Department are each using Cerner as their individual contractor for electronic health records.
F6:
Cerner has a contractual agreement to electronically connect these systems in the afore mentioned departments with minimal or no increased costs. 19 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT A HEALTH INFORMATION EXPRESSWAY OR LIFE IN THE SLOW LANES
F7:
In 2009, the Board of Supervisors directed the Chief Executive Office to develop LANES to facilitate a countywide HIE between public and private health care providers. LANES, as it is currently constituted, has implementation limitations, which include: a. Limited resources to implement and sustain LANES; b. Lack of sustainable funding; c. Absence of a full-time director; d. Indeterminate financial support from on-going stakeholders and buy-in from other potential health care providers; and e. Uncertainty as to whether the current Federated technology architecture employed by LANES has the capacity to deliver patient information in a timely fashion.
Findings & Recommendations
12 findings
F1:
Medi-Cal accounts represent the majority of write-offs for the Untimely Billing write-off sub-classification.
F2:
The Department does not use Affinity Adjustment Codes or Reason Codes in all “Failed to Bill” for Time Constraints (WFB) classifications uniformly, making it difficult to accurately assess weaknesses in business processes contributing to DHS write- offs. By properly assigning stipulated codes and reviewing the data on write-offs, DHS management may be able to better address recurring internal problems.
F3:
The sample of Untimely Billing write-offs analyzed demonstrates key trends that align with reported problems in interviews. 47 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION
F4:
Vendors are not following-up on some denials and information provided by the vendor does not enable DHS to determine causes for the denial.
F5:
Facility Patient Financial Services is not processing some accounts in a timely fashion
F6:
The Department’s Consolidated Business Office is not processing some claims in a timely fashion.
F7:
Facility Utilization Review divisions maintain a substantial backlog on patient medical records in need of review for medical necessity
F8:
Overall, Medicare gross charges of the Incomplete or No Medical Documentation write-offs are the highest among all payers, accounting for $101.6 million in DHS gross charge write-offs between Fiscal Years 2008-09 and 2012-13.
F9:
The audit sample of Incomplete or No Medical Records write-offs demonstrated key trends that aligned with problems reported by DHS staff involved in managing and executing the patient billing processes.
F10:
Approximately $24.5 million in gross charge write-offs between FY 2009-10 and 2012-13 was attributed to physicians without National Provider Identifier numbers and required authorization with DHS for billing of services to Medicare.
F11:
Barriers or complications in coding accounts by Health Information Management divisions.
F12:
Coding backlogs in Health Information Divisions.
Additional Recommendations
18
Not linked to specific findings.
R1:
Utilize DHS’s electronic billing system, Affinity Adjustment Codes on all accounts for classifying and better explaining the reasons for all write-offs.
R2:
Update the DHS write-off procedure to include all Reason Codes, including new Codes, as they are developed.
R3:
Expand the scheduled availability of Patient Financial Service Worker staff at all hospitals.
R4:
Develop and track a Reason Code classifying write-offs for denied or late claims that are billed by the DHS Consolidated Business Office without Treatment Authorization Requests (TARs) or InterQual Reviews (IQRs) demonstrating the medical necessity of the services provided.
R5:
Formalize the point at which Medi-Cal fee-for-service accounts are retrospectively reviewed for patients still in the Department hospitals.
R6:
Conduct a Utilization Review staffing analysis at county hospitals as an increase in staff may substantially increase Department cash flow by decreasing backlogs and increasing the timeliness of billings. SECTION TWO Incomplete or No Medical Records DHS write-offs due to Incomplete or No Medical Records totaled $101,568,377 in gross charges between FY 2008-09 and FY 2012-13. During the fiscal years reviewed, write-offs of Medicare accounts totaled $57,673,677, or over 56 percent of the write-offs, because of Incomplete or No Medical Records. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT iv A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION The CGJ found three primary causes of Incomplete or No Medical Records write-offs:
R7:
Utilize available systems and tools, and require DHS physicians to report their National Provider Identifier (NPI) number and complete the 855R form linking the NPI number to DHS, as required for Medicare billing purposes, prior to commencing work at a DHS facility.
R8:
Monitor the processing of Medicare claims to ensure that the implementation of ORCHID, the Department’s new electronic health record system is aiding and providing Medicare itemized claims.
R9:
Track the backlog for coding at all facilities through regular reports, similar to those produced by Los Angeles County/USC Medical Center. Aggregate and analyze coding backlog data at all facilities for resulting trends and to identify any problem areas.
R10:
Perform a staffing analysis in DHS Health Information Management (HIM) divisions at all DHS facilities to assess whether additional staff might ameliorate the current HIM backlogs and delays in coding. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT v A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION SECTION THREE “No Authorization for Services” No Authorization for Services is the most common reason for write-offs in the “Failed to Bill for Third Party Requirements” write-off classification. Between FYs 2008-09 and 2012-13, the Department wrote off $68,247,162 in gross charges because it had not obtained authorization from the patient’s third party payer prior to providing non-emergency inpatient and outpatient services. A total of $58,567,426, or 85.8 percent of write-offs due to “No Authorization for Services” was Medi-Cal Managed Care accounts. Factors contributing to the “No Authorization for Services” write-offs include:
R11:
Implement an electronic notification method for alerting physicians of the patients’ required authorization from third party payers when follow-up services are required.
R12:
All physicians must be trained on the new electronic notification system and accountability measures should be implemented to ensure that physicians schedule follow-up services appropriately. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT vi A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION
R13:
Require all DHS facilities to regularly pre-screen scheduled outpatient appointments to ensure that authorization is obtained or the patient is referred to a more appropriate provider.
R14:
Evaluate effective and efficient staffing models to support the need for obtaining authorization from third party payers for inpatient services; such as a designated unit, a centralized staff, or an independent utilization review unit.
R15:
Determine the cost-effectiveness of implementing third party payers’ online authorization tools to ensure timely authoriza- tion for inpatient services.
R16:
Collaborate with Cerner, the Department’s vendor for its new electronic medical record system, ORCHID, to determine if enhancements in the new system could facilitate online processing of health care plan authorizations for DHS services. SECTION FOUR County Financial Incentive Policies Historically, DHS has ended a fiscal year with surplus revenue. It was able to retain these surplus funds for DHS operating expenditures in subsequent years and the county General Fund contribution to the DHS budget was not reduced in subsequent years to offset the retained surplus funds. The Board of Supervisors could vote to reduce the county General Fund contribution to the DHS budget, subsequent to fiscal years with surplus revenue, as long as the total County contribution still meets the required minimum contribution amount per its agreement with the State of California. RECOMMENDATIONS To provide financial incentives for DHS to improve revenue collections, the County Board of Supervisors should:
R17:
Consider the advantages and disadvantages of adopting a formal policy to allow for a minimum level of annual General Fund contributions to the DHS budget.
R18:
Allocate a portion of the funds to DHS, if additional revenue is obtained through improved collection efforts, that are beyond the required contributions by the state and irrespective of any additional revenue DHS is able to obtain through improved collection efforts. LOS ANGELES COUNTY 2013-2014 CIVIL GRAND JURY FINAL REPORT vii A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION TOPIC OF INVESTIGATION The Los Angeles County Board of Supervisors approved write-offs totaling $285,421,607 in gross charges billed to third party payers by the Department of Health Services for the five fiscal years from FY 2008-09 through FY 2012-13. An average of $57,058,431 in gross charges was written off per year for the past five fiscal years. After a preliminary investigation, the 2013-2014 Los Angeles County Civil Grand Jury (CGJ) initiated an audit to investigate and analyze the Department of Health Services (DHS or Department) annual write-offs, processes, and systems used for electronic health records and billing for third party payers. These third party payers include Medi-Cal, Medi- Cal Managed Care, Medicare, and private insurance.
Quick View
Full Details →
Findings & Recommendations
5 findings
F1:
Who: Your Name: _______________________________________________________________________ Address: _______________________________________________________________________ City, State, Zip, Code: _______________________________________________________________________ Telephone: ( ) Extension: ______________
F2:
What: Subject of Complaint. Briefly state the nature of complaint and the action of what Los Angeles County department, section, agency, or official(s) that you believe was illegal or improper. Use additional sheets if necessary. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
F3:
When: Date(s) of incident: ________________________________________________________________________
F4:
Where: Names and addresses of other departments, agencies or officials involved in this complaint. Include dates and types of contact, i.e. phone, letter, personal. Use additional sheets if necessary.
F5:
Why/How: Attach pertinent documents and correspondence with dates. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____________________ Rev 01/17/2013 276 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CITIZENS COMPLAINT COMMITTEE Complaint Guidelines Communications from the public can provide valuable information to the Civil Grand Jury. Any private citizen, government employee, or officer may submit a completed complaint form to request that the Civil Grand Jury conduct an investigation. This complaint must be in writing and is treated as confidential. Prior to submitting the Complaint Form to the Grand Jury office, please retain a copy for your records if needed. Receipt of all complaints will be acknowledged. If the Civil Grand Jury determines that a matter is within the legally permissible scope of its investigative powers and would warrant further inquiry, additional information may be requested. If a matter does not fall within the Civil Grand Jury's investigative authority, or the jury determines not to investigate a complaint, no action will be taken and there will be no further contact from the Civil Grand Jury. The findings of any investigation conducted by the Civil Grand Jury can be communicated only in a formal final report published at the conclusion of the Grand Jury's term, June 30th. Some complaints are not suitable for civil grand jury action. For example, the Civil Grand Jury has no jurisdiction over judicial performance, actions of the court, or cases that are pending in the courts. Grievances of this nature must be resolved through the established judicial appeal system. The Civil Grand Jury has no jurisdiction or authority to investigate federal or state agencies. Only causes of action occurring within the County of Los Angeles are eligible for review. The jurisdiction of the Civil Grand Jury includes the following: -Consideration of evidence of misconduct against public officials within Los Angeles County. -Inquiry into the condition and management of the jails within the county. -Investigation and report on the operations, accounts, and records of the officers, departments or functions of the county including those operations, accounts, and records of any special legislative district or other district in the county created pursuant to state law for which the officers of the county are serving in their ex officio capacity as officers of the districts. -Investigation of the books and records of any incorporated city or joint powers agency located in the county. Mail complaint form to: Los Angeles County Civil Grand Jury Clara Shortridge Foltz Criminal Justice Center 210 West Temple Street, Eleventh Floor, Room 11-506 Los Angeles, CA 90012 277 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT CONTINUITY COMMITTEE Nancy M. Coleman Chairperson Darrel D. Kelty Secretary James Carter Char H. McCarthy Robert J. Taub James P. Thomas Alicia F. Thompson CONTINUITY COMMITTEE CONTINUITY COMMITTEE TOPIC To fulfill its responsibilities, the Continuity Committee of the 2013- 2014 Los Angeles County Civil Grand Jury performed the following functions:
Findings & Recommendations
5 findings
F13:
Physicians reportedly scheduling follow-up outpatient services, after basic needs are met through emergency room/urgent care or after a patient has been discharged from the hospital, when the patient does not have prior authorization.
F14:
The Department of Health Services is not obtaining timely authorization for high dollar value inpatient services due to the inability of Patient Financial Services staff to obtain prior authorization or redirect patient’s to facilities in the patient’s health plan’s network prior to all schedule outpatient appointments.
F15:
Insufficient or inadequate allocation of resources and tools for Utilization Review nurses to obtain timely authorization from other health care plans for inpatient.
F16:
Write-offs for Medi-Cal Managed Care patient accounts due to no authorization for services have increased over time. As Medi- Cal Managed Care enrollment is expected to increase over time, it is imperative that DHS improve its business processes to ensure timely authorization and billing for Medi-Cal Managed Care patients.
F17:
Because the Board of Supervisors is able to decrease subsequent fiscal year General Fund contributions to offset increased DHS revenues from prior fiscal years, such Board actions could potentially serve as a disincentive for DHS staff to increase revenue collections.
Findings & Recommendations
8 findings
F1:
Only two (2) City Departments or Bureaus fully complied with the requirements to designate a LRM by January 31, 2007, and designate a new LRM within 30 days of the current manager leaving. As shown in Exhibit 3, as of February, 2014, only Airports and Recreation and Parks, are in full compliance with this requirement of Exec9. The Department of Transportation has not designated a LRM at all. Five departments or bureaus designated litigation risk managers, but submitted the name of the designated LRM to the Mayor’s Office after the deadline of January 31, 2007. The Bureau of Engineering 101 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS had some lapses over 30 days in reporting the senior staff member designated as LRM. Exhibit 3 Designation of Litigation Risk Manager Requirement Under Mayor’s Executive Directive No. 9 102 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. Designated senior- level staff to serve Yes Yes Yes Yes NR Yes Yes Yes No NA as LRM. 2. Submit designated LRM to the Mayor’s Yes No No No NR Yes No No No NA Office by January 31, 2007. 3. Designate a new LRM within 30 days of the current Yes No Yes Yes NR Yes Yes Yes No NA manager leaving the department. Notes: NR = No Response to our request for information was received from the department in this area. NA = Not Applicable for the Department of Water and Power, which chose not to implement Exec9. Source: Review of responses and documentation provided by each city department or bureau, as of February, 2014. Protocol with the City Attorney’s Office It was required by Exec9 that each department, through its LRM, develop a protocol with the City Attorney’s Office. This included timely notice and ongoing evaluation of all claims or litigation served on the city that relate to department employees and/or programs. Exec9 defines specific requirements that must be included in this protocol. EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS
F2:
Only one of the city departments or bureaus fully complied with the requirements to develop a protocol with the City Attorney’s Office for timely notice and ongoing evaluation of all claims or litigation. As shown in Exhibit 4, as of February, 2014, only the Police Department is in full compliance with this requirement of Exec9. Three departments, Airports, Recreation and Parks, and Transportation, did not develop the protocol with the City Attorney. Other departments or bureaus developed protocols, but not to the specific requirements outlined in Exec9. In discussions with department and bureau LRMs, the CGJ was informed that some requirements of Exec9 are not realistic, and are therefore not incorporated into protocols. These requirements are mainly focused on time periods that are not realistic compared with actual claim and case management experience. 103 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 4 Development of Protocol with the City Attorney Department Protocol Requirement Under Mayor’s Executive Directive No. 9 104 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. Receives timely notice and a copy of any claim, No Yes Partial Partial Yes No Yes Yes No NA generally within 10 days 2. Cooperates with defense counsel in reviewing No Yes Yes Yes Yes No Yes Yes No NA allegations and investigation 3. Discusses and determines with counsel whether early mediation or other settlement No Yes Yes Yes Yes No Yes Yes No NA discussions would be appropriate, generally within 90 days 4. Discusses and determines with counsel whether a statutory No Partial Yes Yes Yes No Partial Partial No NA offer of settlement should be recommended 5. Engages in ongoing discussions with assigned defense No Yes Yes Yes Yes No Yes Yes No NA counsel about mediation or other settlement negotiations 6. Reviews all deposition transcripts and all significant opposition No No Yes Yes Yes No No No No NA produced discovery documents 7. Discusses with counsel whether an appeal No Partial Yes Yes Yes No Partial Partial No NA should be filed 8. Presents and discusses with assigned defense counsel any proposed change in policy or No Partial Yes Yes Yes No Partial Partial No NA practice and any proposed employee discipline or retraining Notes: NA = Not Applicable for the Department of Water and Power, which chose not to implement Exec9. Source: Review of responses and documentation provided by each city department or bureau, as of February, 2014. EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Internal Protocol for Litigation Risk Management Each city department was also required by Exec9 to develop an internal protocol for claims or litigation served on the city that relate to department employees and/or programs. The intent of this internal protocol was to ensure that departments and bureaus implemented a successful LRM system, and to ensure completion of the five key practices identified earlier in this report.
F3:
Only one department developed an internal protocol for LRM that met all the requirements of Executive Directive No. 9. As shown in Exhibit 5, as of February, 2014, only the Fire Department is in full compliance with this requirement of Exec9. Airports, Recreation and Parks, and Transportation did not develop any internal protocol at all. Each of the other departments or bureaus developed protocols, but the specific requirements outlined in Exec9 are not completely included. The CGJ was informed by department and bureau LRMs that some requirements of Exec9 are not realistic, and are not incorporated into protocols. These requirements are mainly focused on time periods that are not realistic compared with actual claim and case management experience. 105 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 5 Development of Internal Protocol Department Protocol Requirements Under Mayor’s Executive Directive No. 9 106 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. That an early and thorough investigation is No Partial Yes Yes NR No Partial Partial No NA completed 2. Evaluates carefully and thoroughly whether the allegations suggest the advisability of a change in No No Yes No NR No No No No NA policy or practice, or the need for new or renewed training 3. Timely develops and implements any warranted changes in No No Yes No NR No No No No NA policy, practice, and/or training 4. Warranted changes in policy, practice, and/or training are evaluated for budgetary impact and No No Yes No NR No No No No NA included in the department's budgetary planning 5. Evaluates carefully and thoroughly the advisability of discipline, reassignment, or No No Yes No NR No No No No NA retraining of individual employees whose actions contributed to potential liability 6. Timely pursues any warranted discipline, reassignment, or retraining of individual No No Yes No NR No No No No NA employees whose actions contributed to potential liability 7. Evaluates carefully and thoroughly the advisability of the city seeking a change in No No Yes Yes NR No No No No NA federal, state, or municipal law or regulation EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 5 Development of Internal Protocol Department Protocol Requirements Under Mayor’s Executive Directive No. 9 107 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW Notes: NR = No Response to our request for information in this area was received from the department. NA = Not Applicable for the Department of Water and Power, which chose not to implement Exec9. Source: Review of responses and documentation provided by each city department or bureau, as of February, 2014. Quarterly Reporting on Litigation Risk Management Each city department was also required to submit a confidential quarterly report to the Mayor’s Office. This report indicated each filed claim or litigation that related to department employees and/or programs. These quarterly reports were required to include very specific information about each claim or litigation case.
F4:
City Departments or Bureaus have not fully complied with the requirements to submit quarterly Litigation Risk Management reports to the Mayor’s Office. As exhibit 6 shows, as of February 2014, none of the city departments or bureaus are in full compliance with the quarterly reporting requirements of Exec9. Fire, Harbor, Recreation and Parks, and Transportation did not submit any quarterly reports. Reports were submitted by other departments, but none of them included all of the elements required by Exec9. In the CGJ discussions with LRMs, some of these elements are identified as being unrealistic (example, timelines that are not possible to meet), or beyond the purview of the LRMs, due to personnel or other rules and regulations (example, employee discipline issues). EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 6 Quarterly Reporting Quarterly Reporting Requirements Under Mayor’s Executive Directive No. 9 108 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. The date the claim or litigation was filed, the date it was served, the date the department was No Yes No No Partial No Yes No No NA notified of the claim or litigation, and any scheduled trial date. 2. The specific claims alleged in the claim or Yes Yes No No Partial No Yes Yes No NA litigation. 3. Whether the early investigation and consideration of early settlement process was No No No No Partial No No No No NA completed, including whether any early settlement process was pursued. 4. Whether evaluations of the claim or litigation for warranted changes in policy, practice or training, or individual employee discipline or No No No No Partial No No No No NA training have been completed, including when completed, whether any such steps were pursued and the status of any such steps. 5. Whether evaluations of the claim or litigation for the advisability of seeking a change in federal, No No No No Partial No No No No NA state, or municipal law or regulation, including any
F5:
In review of the claim and litigation files, as of February, 2014, none of the city departments or bureaus have fully complied with the specific requirements of Executive Directive No. 9. The CGJ asked each of the departments or bureaus if any files that demonstrated compliance with the requirements of Exec9 were maintained. Harbor, Recreation and Parks, and Streets responded that they did not maintain any LRM files. For the departments or bureaus that stated they did maintain LRM files, the CGJ randomly selected a total of 20 claims or cases to review. Exhibit 7 shows that none of the city departments or Bureaus are in full compliance with the requirements of Exec9. Engineering and Transportation are not in compliance with most of the requirements of Exec9. Airports, Fire, and Sanitation are partially in compliance with the requirements of Exec9. 110 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 7 Review of Litigation Risk Management Files Sample of Department / Maintain Files Summary of Review Results Bureau Files Reviewed Airports maintained files for all cases selected. The files were well Airports Yes Yes documented and organized. In practice, Airports is partially in compliance with the protocols. Engineering maintained files for some cases but not all. Files were not maintained for 10 out of 20 cases selected because the information was Engineering Partial Partial not forwarded from the City Attorney’s office. In practice, Engineering is not in compliance with most of the protocols. Fire maintained files for some cases but not all. Files were not available for review for 15 out of 20 cases selected because the information was Fire Partial Partial either not forwarded from the City Attorney’s office or in archive. In practice, Fire is partially in compliance with the protocols. All files are maintained by the City Harbor No No Attorney. No Police No N/A Response Recreation and No No N/A Parks Sanitation maintained in the database files for all cases selected. In Sanitation Yes Yes practice, Sanitation is partially in compliance with the protocols. Streets No No N/A Transportation maintained files for some cases but not all. Files were not maintained for 10 out of 20 cases selected because the information was either not forwarded from the City Transportation Partial Partial Attorney’s office, not LADOT cases, or not determined if they were LADOT cases. In practice, Transportation is not in compliance with most of the protocols. Water and Not Applicable, Chose not to N/A N/A Power implement Exec9. 111 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Mayor’s Office Follow-Up, Review and Revision of Executive Directive No. As discussed above, Exec9 establishes specific requirements and specific due dates for their completion and submission to the Mayor’s Office. Exec9 created the expectation that there would be follow-up with departments if the required elements were not completed and submitted to the Mayor’s Office.
F6:
The Mayor’s Office, since issuing Exec9, has not adequately followed-up nor has it enforced implementation and compliance with Executive Directive No. 9 by City Departments. The CGJ found the overall level of compliance with Exec9 by city departments and bureaus reviewed to be abysmal. Transportation and Water and Power did not implement any of the required elements of Exec9. The Department of Water and Power chose not to implement Exec9 because the Mayor merely requested City proprietary departments, which DWP is, to implement the Directive. The general city departments were directed to implement it. Airports, Recreation and Parks, and Transportation have not developed or sent either of the required protocols to the Mayor’s Office. Fire, Harbor, Recreation and Parks, and Transportation have not submitted any quarterly reports to the Mayor’s Office as required by Exec9. The Police Department submitted quarterly reports from 2007 to 2009. They then discontinued quarterly reporting. For the city departments and bureaus that did develop and submit the required protocols and quarterly reports, only a few met all of the requirements outlined in Exec9. City departments and bureaus tend to be very responsive to directives and requests from the Mayor’s Office. However, they are also adept at determining what is truly important to the Mayor’s Office, based on the follow-up and attention given to an issue or directives. Implementation and compliance with Exec9 did not appear to be a priority for the Mayor’s Office. The city departments and bureaus responded accordingly. 112 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS
F7:
The Mayor’s Office has not yet revised Exec9 to be more effective. As part of this investigation, the CGJ met with staff of the Mayor’s Office to discuss Exec9 and compliance with it. The CGJ was informed that the new mayoral administration was in the process of reviewing and potentially revising all Executive Directives inherited from previous administrations, including Exec9. It was suggested that the Mayor’s Office draw on the LRM talent within the city and substantially revise Exec9 to provide a more meaningful set of requirements. This would also likely improve the level of department and bureau compliance with Exec9. As discussed earlier in this report, the intent of Exec9 (see attached), was to ensure “further progress in preserving City resources by reducing and preventing claims against City operations and employees.” Exec9 also outlined key mechanisms or practices that a successful LRM system should include. Exec9 then outlines a very specific list of requirements to purportedly establish these mechanisms or practices within city management. However, it is uncertain that these very specific requirements are the most effective way to develop a successful LRM system. The list of requirements in Exec9 is very specific. These requirements are also very focused at the individual claim or case level. Finally, Exec9 provides no focus on the outcome or end result of LRM. There is no tracking or reporting on whether claim and litigation payouts are actually being reduced, or the degree to which changes in department or bureau operations are being implemented to avoid future claims or litigation. Performance indicators, focused on these outcomes or results, would be more effective measures. 113 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS
F8:
Litigation related payouts or expenditures from the City’s General Fund have increased rather than decreased since 2007, when Executive Directive No. 9 was issued. Exhibit 8 shows the trend in general fund expenditures for litigation, by fiscal year. Clearly, Exec9 has not been effective in achieving its stated intent of ensuring “further progress in preserving City resources by reducing and preventing claims against City operations and employees”. Exhibit 8 Litigation General Fund Expenditures by Fiscal Year $100.0 $91.0 $90.0 In Millions $80.0 $70.0 $57.9 $56.9 $60.0 $49.1 $50.0 $45.0 $41.2 $36.6 $36.8 $40.0 $34.3 $33.5 $30.0 $20.0 $10.0 $0.0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Note: The spike in payouts for FY 2010 was the result of several lawsuits with substantial payouts. This included two lawsuits related to landslides, several cases involving civil rights or discrimination, and several related to personal injuries. Source: Analysis of amounts paid in judgments, verdicts, and/or settlements over the past 10 years provided by the Los Angeles City Attorney’s office as of October, 2013. 114 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS
Additional Recommendations
9
Not linked to specific findings.
R1:
The pre-release packet for each inmate scheduled to be released to the County is sent from the CDCR to the Probation Pre Release Center. The Post Released Supervised Person (PSP) packet provides pertinent information, such as release date, criminal history, social history, medical and mental health issues, and legal status. The staff then evaluates the data and develops an individualized case plan. The information is used to determine risk levels, supervision conditions, monitoring requirements, and the verification of address to determine local office designation. Conditions of release, supervision, instruction, and reporting responsibilities are returned to the respective PSP for signature.
R2:
An individualized treatment case plan is finalized during the Screening, Intake and Assessment process. The PSP’s past criminal record is reviewed. The entire record is reviewed to determine the assignment of a risk level. (Tier O – very high; Tier I – high; Tier II – medium; Tier III – Low). The following Risk Level Chart shows the monthly standards for supervision. CHALLENGES OF REALIGNMENT 87 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT MINIMUM MONTHLY STANDARDS TIER SUPERVISION OFFICE FIELD DRUG ASSESSMENT LEVEL VISITS VISITS TESTS PRE & POST Orientation and Cognitive 0 Very High 1 1 1-2 Behavioral Therapy (CBT) completion I High 1 1 1-2 Orientation and CBT completion II Medium 1 Quarterly 1-2 Orientation and CBT as needed III Low 1 None 2 per Orientation quarter Records of the PSP are scanned into the Adult Probation System (APS). All records regarding PSPs are maintained in the APS. This system enables the DPO to access a number of screens to input accurate and comprehensive data from each contact, in order to maintain current information.
R3:
The PSP is mandated to report to one of the four Probation HUBs within two business days of release. The HUB is a collaborative group of agencies, consisting of the Department of Mental Health (DMH), Department of Public Health Services (DPH), and Department of Public Social Services (DPSS). An orientation is conducted with the PSP. During this orientation, referrals are made to Community Based Organizations for mental and physical health services, substance abuse, and the assignment of a Deputy Probation Officer (DPO) is completed. In addition, any other emergent needs (housing and transportation) are identified and addressed. If the PSP requires mental health treatment as a condition of their release, a referral to DMH is completed. The PSP must be registered within five working days to participate in mental health treatment. CHALLENGES OF REALIGNMENT 88 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Refusal of the PSP to enroll or participate in a mental health program could result in intermediate sanctions, Flash Incarceration, and Revocation. Intermediate sanctions are imposed as a result of the PSP violating conditions of their post release plan. Flash Incarceration is a period of detention in county jail, for up to ten days, for violating conditions of post-release supervision. Flash Incarceration applies to PSPs only, and requires approval by the Supervising Deputy Probation Officer. Revocation returns the PSP to jail. This process requires court approval. If a PSP fails to comply with the conditions of their case plan, the DPO can impose intermediate sanctions up to and including, Flash Incarceration and Revocation. If the PSP requires substance abuse treatment, the DPO ensures that this condition is added to the APS, and provides a referral to the local Community Assessment Service Center. The PSP has five working days to report for assessment. During this process, thorough instructions are given to the PSP. All referrals, instructions, and documents are signed by the PSP, and the PSP is given a copy. The PSP has the opportunity to request additional services. A referral is submitted for housing and employment through the various departments who offer contracted services. The PSP may be eligible for, but not limited to, the following:
R4:
1 The Probation Department must continue to obtain funds and fill staff positions based on the mandated program needs. Post-Release Community Supervision Procedures The LACPD in coordination with the County’s Public Safety Realignment Team developed case intake to case termination procedures. As previously stated, AB 109 legislation modified parole statutes and created a Post-release Community Supervision Program under the auspices of the County. LACPD responsibilities and procedures include the following: 1. The pre-release packet for each inmate scheduled to be released to the County is sent from the CDCR to the Probation Pre Release Center. The Post Released Supervised Person (PSP) packet provides pertinent information, such as release date, criminal history, social history, medical and mental health issues, and legal status. The staff then evaluates the data and develops an individualized case plan. The information is used to determine risk levels, supervision conditions, monitoring requirements, and the verification of address to determine local office designation. Conditions of release, supervision, instruction, and reporting responsibilities are returned to the respective PSP for signature. 2. An individualized treatment case plan is finalized during the Screening, Intake and Assessment process. The PSP’s past criminal record is reviewed. The entire record is reviewed to determine the assignment of a risk level. (Tier O – very high; Tier I – high; Tier II – medium; Tier III – Low). The following Risk Level Chart shows the monthly standards for supervision. CHALLENGES OF REALIGNMENT 87 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT MINIMUM MONTHLY STANDARDS TIER SUPERVISION OFFICE FIELD DRUG ASSESSMENT LEVEL VISITS VISITS TESTS PRE & POST Orientation and Cognitive 0 Very High 1 1 1-2 Behavioral Therapy (CBT) completion I High 1 1 1-2 Orientation and CBT completion II Medium 1 Quarterly 1-2 Orientation and CBT as needed III Low 1 None 2 per Orientation quarter Records of the PSP are scanned into the Adult Probation System (APS). All records regarding PSPs are maintained in the APS. This system enables the DPO to access a number of screens to input accurate and comprehensive data from each contact, in order to maintain current information. 3. The PSP is mandated to report to one of the four Probation HUBs within two business days of release. The HUB is a collaborative group of agencies, consisting of the Department of Mental Health (DMH), Department of Public Health Services (DPH), and Department of Public Social Services (DPSS). An orientation is conducted with the PSP. During this orientation, referrals are made to Community Based Organizations for mental and physical health services, substance abuse, and the assignment of a Deputy Probation Officer (DPO) is completed. In addition, any other emergent needs (housing and transportation) are identified and addressed. If the PSP requires mental health treatment as a condition of their release, a referral to DMH is completed. The PSP must be registered within five working days to participate in mental health treatment. CHALLENGES OF REALIGNMENT 88 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Refusal of the PSP to enroll or participate in a mental health program could result in intermediate sanctions, Flash Incarceration, and Revocation. Intermediate sanctions are imposed as a result of the PSP violating conditions of their post release plan. Flash Incarceration is a period of detention in county jail, for up to ten days, for violating conditions of post-release supervision. Flash Incarceration applies to PSPs only, and requires approval by the Supervising Deputy Probation Officer. Revocation returns the PSP to jail. This process requires court approval. If a PSP fails to comply with the conditions of their case plan, the DPO can impose intermediate sanctions up to and including, Flash Incarceration and Revocation. If the PSP requires substance abuse treatment, the DPO ensures that this condition is added to the APS, and provides a referral to the local Community Assessment Service Center. The PSP has five working days to report for assessment. During this process, thorough instructions are given to the PSP. All referrals, instructions, and documents are signed by the PSP, and the PSP is given a copy. The PSP has the opportunity to request additional services. A referral is submitted for housing and employment through the various departments who offer contracted services. The PSP may be eligible for, but not limited to, the following: 1. Bus tokens or transportation provided by the Mobile Unit 2. Housing assistance 3. Employment and job placement 4. Clothing, uniforms, and tools for employment 5. Medication and medical supplies 6. Enrollment fees (e.g. Community College/GED Classes/Vocational Schools) 7. Identification fees (e.g. CA driver’s license/ID card, birth records/certificates, social security cards) CHALLENGES OF REALIGNMENT 89 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT If the PSP fails to report, the DPO conducts due diligence and submits a petition for a warrant. The petition is submitted to the courts within five working days. The LACPD assists the PSP in becoming accountable, working towards rehabilitation by case management, supervision, and monitoring. The DPO is responsible for making routine home calls and compliance checks at the reported residence of the PSP. The number of home calls depends on the risk, need level cooperation and adjustment of the PSP in the community. The routine home calls are generally made by two DPOs. The Compliance Checks include additional DPOs and law enforcement that have search, seizure, and arrest authority. The purpose of the home calls are to ensure that the PSP is residing at the reported address. The PSP must be in compliance with conditions of their case plan, participating and receiving their collaborative services. The LACPD has developed a list of violations which is a guideline to ensure that consistent application of sanctions is followed. There must be a balance between rehabilitative casework and the appropriate level of sanction and rewards for compliance and noncompliance. DPOs must address all violations appropriately and comply with supervision conditions. If warranted, the DPOs make referrals to the Court for Revocation proceedings. Sanctions and Revocation can be imposed for failure to comply with any of the following: 1. Employment/education conditions 2. Gang affiliation/membership/activity conditions 3. Victim related conditions 4. Sex offenders conditions 5. Substance abuse conditions 6. Mental Health conditions 7. Weapons violation: PSP in possession of weapon CHALLENGES OF REALIGNMENT 90 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 8. Weapons violation: PSP in presence of weapon 9. General Conditions of supervision a. reporting b. residence c. identification d. misdemeanor arrests e. felony arrests f. registration conditions The application of sanctions including verbal, intermediate sanctions and revocation are progressive. All verbal and/or written admonishments are documented. The PSP must be discharged from Probation at 12 months if no custodial violations, sanctions or infractions have occurred. If the PSPs violate the condition of their release, the LACPD may initiate the revocation processes through the court.
R5:
Medication and medical supplies
R6:
Enrollment fees (e.g. Community College/GED Classes/Vocational Schools)
R7:
Identification fees (e.g. CA driver’s license/ID card, birth records/certificates, social security cards) CHALLENGES OF REALIGNMENT 89 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT If the PSP fails to report, the DPO conducts due diligence and submits a petition for a warrant. The petition is submitted to the courts within five working days. The LACPD assists the PSP in becoming accountable, working towards rehabilitation by case management, supervision, and monitoring. The DPO is responsible for making routine home calls and compliance checks at the reported residence of the PSP. The number of home calls depends on the risk, need level cooperation and adjustment of the PSP in the community. The routine home calls are generally made by two DPOs. The Compliance Checks include additional DPOs and law enforcement that have search, seizure, and arrest authority. The purpose of the home calls are to ensure that the PSP is residing at the reported address. The PSP must be in compliance with conditions of their case plan, participating and receiving their collaborative services. The LACPD has developed a list of violations which is a guideline to ensure that consistent application of sanctions is followed. There must be a balance between rehabilitative casework and the appropriate level of sanction and rewards for compliance and noncompliance. DPOs must address all violations appropriately and comply with supervision conditions. If warranted, the DPOs make referrals to the Court for Revocation proceedings. Sanctions and Revocation can be imposed for failure to comply with any of the following:
R8:
Weapons violation: PSP in presence of weapon
R9:
General Conditions of supervision a. reporting b. residence c. identification d. misdemeanor arrests e. felony arrests f. registration conditions The application of sanctions including verbal, intermediate sanctions and revocation are progressive. All verbal and/or written admonishments are documented. The PSP must be discharged from Probation at 12 months if no custodial violations, sanctions or infractions have occurred. If the PSPs violate the condition of their release, the LACPD may initiate the revocation processes through the court.
Quick View
Full Details →
Findings & Recommendations
8 findings
F1:
In 2009, First 5 LA adopted a five-year Strategic Plan that called for making significant investments in a Place-Based Strategy. The new plan called for discontinuing funding of initiative-based direct services on a countywide basis and to concentrate funding to targeted communities with the goal of making a greater impact with the Agency’s investments.
F2:
The Implementation Plan called for spending $405 to $540 million over five years, or an average of $81 to $108 million per year on Place-Based activities in 14 high needs communities. $270 to $405 million per year were also allocated to Countywide Strategies, aimed at improving policies and services for children ages 0–5 in the 14 communities and beyond.
F3:
The budgeted amount for both Place-Based activities and Countywide Strategies for the three years ending in FY 2012-13 was $158 million, but actual expenditures were significantly below that amount, at $61.4 million, or only 39 percent of the amount budgeted.
F4:
Most of the $61.4 million in actual expenditures went towards funding Countywide Strategies policy and advocacy work; the amount expended on Place-Based activities in the 14 communities was only $14.6 million over the three years ending in FY 2012-13, significantly lower than the $65.1 million budgeted for activities in the 14 communities during those three years.
F5:
The new Strategic Plan included a roadmap for ending support to Prior Strategic Initiatives grants. The Agency has not implemented this component of the Plan and continues to fund several of these grantees. In addition, the Agency adopted other 156 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY? Countywide Initiatives in 2010. Spending on these two categories of grants has greatly exceeded spending on Strategic Plan components as a percentage of annual expenditures.
F6:
During the Agency’s “pause” on Place-Based Strategy funding in FY 2012-13, it appears that the right questions were raised, as to the core results to be achieved for families and communities. It took First 5 LA several years after implementation of the Place-Based Strategy to ask these questions and to develop quantitative metrics to monitor impact suggests insufficient planning for the new strategy. It contributed to a loss of momentum in activities for the newly formed Community Partnerships in the 14 designated communities.
F7:
The Agency’s own inquiry into implementation of the Place- Based Strategy, known as the Listening, Learning, Leading (L3) effort, concluded that the Strategic Plan was not being used as a guide to Agency funding and that new performance measures needed to be adopted. The Agency has adopted new performance measures after three years of minimal assessment of outcomes for its Place-Based Initiatives but the new measures have yet to be reported on. These measures do not cover the Countywide Initiatives that still comprise the bulk of what First 5 LA is funding.
F8:
While this audit was underway, the First 5 LA Commission adopted new Governance Guidelines that call for new programs and initiatives to be aligned with the Agency’s strategic plans, to have implementation timelines and to have specific outcomes and performance measures. If followed, all of these guidelines should help the Agency avoid some of the problems encountered in rolling out its Place-Based Strategy.
Additional Recommendations
7
Not linked to specific findings.
R1:
The OIG recommends that the Department review Executive Directive No. 9 for all sections applicable to LAPD and implement policies and procedures designed to bring the Department into compliance with the Mayor’s directive.
R2:
The OIG recommends that the Department implement the Employee Mediation Program to reduce the number of employee-related lawsuits proceeding to settlement or trial. The program, developed by the OIG in consultation with the Department, the City Attorney’s Office and the Los Angeles Police Protective League, will provide a mechanism for the development of internal remedies for employee grievances, where appropriate.
R3:
The OIG recommends that the Department and the City Attorney’s Office conduct formal case reviews whenever a case has a scheduled settlement conference or trial approaching. In order to quickly identify those cases suitable for settlement, the formal review should require the parties to discuss the facts of the case, all claims and defenses, the City’s potential financial exposure and the attorney’s valuation of the case for settlement.
R4:
The OIG recommends that the Department create a document retention plan specifically for the litigation files and related notes for each employment-related case.
R5:
The OIG recommends that the Department implement a system to ensure that the significant information for each lawsuit is timely and accurately entered into the appropriate fields within the Claim/Lawsuit Information System or a comparable database.
R6:
The OIG recommends that the Department evaluate all employment-related complaints, regardless of outcome, to identify possible areas for improvement and then provide managers the targeted training necessary to implement those improvements.
R7:
The OIG recommends that the Department review with the City Attorney’s Office the facts and circumstances for each lawsuit where there is a settlement or verdict adverse to the City to determine the specific issues that created the liability or litigation risk. Furthermore, the OIG recommends that training is developed to address the “lessons learned” in each case and that such training is disseminated to Department staff members in a relevant manner with a goal of preventing similar future behavior. 135 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Employment Litigation Audit EXHIBIT A Data Completion Rates of 30 CLIS Data Fields Tested (sorted from lowest to highest completion rate) %(cid:3) (cid:3)(cid:3) Data(cid:3)Field(cid:3) Complete 1(cid:3) Incident(cid:3)Time(cid:3) 0 2(cid:3) Date(cid:3)Claim(cid:3)Concluded(cid:3) 7 3(cid:3) Final(cid:3)Cause(cid:3)of(cid:3)Action(cid:3) 15 4(cid:3) Incident(cid:3)Date(cid:3) 19 5(cid:3) Claim(cid:3)No.(cid:3) 26 6(cid:3) Date(cid:3)Claim(cid:3)Filed(cid:3) 30 7(cid:3) Location(cid:3)of(cid:3)Occurrence(cid:3) 33 8(cid:3) Area(cid:3)of(cid:3)Occurrence(cid:3) 37 9(cid:3) Verdict(cid:3)Status(cid:3) 37 10(cid:3) Verdict(cid:3)for:(cid:3) 41 11(cid:3) Trial(cid:3)Date(cid:3) 44 12(cid:3) Appeal(cid:3) 60 13(cid:3) Supervisor(cid:3)Review(cid:3) 63 14(cid:3) Complaint(cid:3)No.(cid:3) 70 15(cid:3) Date(cid:3)Lawsuit(cid:3)Concluded(cid:3) 74 16(cid:3) Payouts(cid:3)Completed(cid:3) 85 17(cid:3) LAD(cid:3)Investigator(cid:3) 93 18(cid:3) City(cid:3)Attorney(cid:3) 93 19(cid:3) Case(cid:3)Status(cid:3) 96 20(cid:3) Date(cid:3)IAG(cid:3)Response(cid:3) 96 21(cid:3) Date(cid:3)of(cid:3)Report(cid:3) 100 22(cid:3) Claim/Case(cid:3)Name(cid:3) 100 23(cid:3) Type(cid:3)of(cid:3)Case(cid:3) 100 24(cid:3) Jurisdiction(cid:3)Court(cid:3) 100 25(cid:3) Case(cid:3)No.(cid:3) 100 26(cid:3) Date(cid:3)Lawsuit(cid:3)Filed(cid:3) 100 27(cid:3) Plaintiff(cid:3)Attorney(cid:3) 100 28(cid:3) Initial(cid:3)Cause(cid:3)of(cid:3)Action(cid:3) 100 29(cid:3) Involved(cid:3)Persons(cid:3)Listed(cid:3) 100 30(cid:3) Complaint(cid:3)to(cid:3)IAG(cid:3) 100 136 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY? Alicia F. Thompson Chairperson Robert J. Taub Co-Chairperson Jeffery N. Wallace Secretary Henry Buffett Nancy M. Coleman FIRST 5 LA SERVING THE COMMUNITY? FIRST 5 LA SERVING THE COMMUNITY? EXECUTIVE SUMMARY The 2013-2014 Los Angeles County Civil Grand Jury (CGJ) conducted an audit to discern the effectiveness of the 2009-2015 Strategic Plan adopted by First 5 Los Angeles (First 5 LA). The new direction outlined a complete shift away from First 5 LA’s traditional role as a grant- awarding agency that provided funding to organizations that served the needs of children from ages 0-5 years, throughout Los Angeles County. Of primary concern to the CGJ is First 5 LA’s (Agency) excessive existing fund balance as a result of a suspension of providing services during the “re-tooling” of its Strategic Plan, and the untimeliness of full implementation. As an example, for fiscal years 2010-11 and 2012-13, the Agency budgeted $61.5 million for Place-Based activities during the three year period, but only spent $14.6 million during that time, or 23.7 percent of the budgeted amount.
Findings & Recommendations
8 findings
F1:
Only two (2) City Departments or Bureaus fully complied with the requirements to designate a LRM by January 31, 2007, and designate a new LRM within 30 days of the current manager leaving. As shown in Exhibit 3, as of February, 2014, only Airports and Recreation and Parks, are in full compliance with this requirement of Exec9. The Department of Transportation has not designated a LRM at all. Five departments or bureaus designated litigation risk managers, but submitted the name of the designated LRM to the Mayor’s Office after the deadline of January 31, 2007. The Bureau of Engineering 101 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS had some lapses over 30 days in reporting the senior staff member designated as LRM. Exhibit 3 Designation of Litigation Risk Manager Requirement Under Mayor’s Executive Directive No. 9 102 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. Designated senior- level staff to serve Yes Yes Yes Yes NR Yes Yes Yes No NA as LRM. 2. Submit designated LRM to the Mayor’s Yes No No No NR Yes No No No NA Office by January 31, 2007. 3. Designate a new LRM within 30 days of the current Yes No Yes Yes NR Yes Yes Yes No NA manager leaving the department. Notes: NR = No Response to our request for information was received from the department in this area. NA = Not Applicable for the Department of Water and Power, which chose not to implement Exec9. Source: Review of responses and documentation provided by each city department or bureau, as of February, 2014. Protocol with the City Attorney’s Office It was required by Exec9 that each department, through its LRM, develop a protocol with the City Attorney’s Office. This included timely notice and ongoing evaluation of all claims or litigation served on the city that relate to department employees and/or programs. Exec9 defines specific requirements that must be included in this protocol. EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS
F2:
Only one of the city departments or bureaus fully complied with the requirements to develop a protocol with the City Attorney’s Office for timely notice and ongoing evaluation of all claims or litigation. As shown in Exhibit 4, as of February, 2014, only the Police Department is in full compliance with this requirement of Exec9. Three departments, Airports, Recreation and Parks, and Transportation, did not develop the protocol with the City Attorney. Other departments or bureaus developed protocols, but not to the specific requirements outlined in Exec9. In discussions with department and bureau LRMs, the CGJ was informed that some requirements of Exec9 are not realistic, and are therefore not incorporated into protocols. These requirements are mainly focused on time periods that are not realistic compared with actual claim and case management experience. 103 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 4 Development of Protocol with the City Attorney Department Protocol Requirement Under Mayor’s Executive Directive No. 9 104 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. Receives timely notice and a copy of any claim, No Yes Partial Partial Yes No Yes Yes No NA generally within 10 days 2. Cooperates with defense counsel in reviewing No Yes Yes Yes Yes No Yes Yes No NA allegations and investigation 3. Discusses and determines with counsel whether early mediation or other settlement No Yes Yes Yes Yes No Yes Yes No NA discussions would be appropriate, generally within 90 days 4. Discusses and determines with counsel whether a statutory No Partial Yes Yes Yes No Partial Partial No NA offer of settlement should be recommended 5. Engages in ongoing discussions with assigned defense No Yes Yes Yes Yes No Yes Yes No NA counsel about mediation or other settlement negotiations 6. Reviews all deposition transcripts and all significant opposition No No Yes Yes Yes No No No No NA produced discovery documents 7. Discusses with counsel whether an appeal No Partial Yes Yes Yes No Partial Partial No NA should be filed 8. Presents and discusses with assigned defense counsel any proposed change in policy or No Partial Yes Yes Yes No Partial Partial No NA practice and any proposed employee discipline or retraining Notes: NA = Not Applicable for the Department of Water and Power, which chose not to implement Exec9. Source: Review of responses and documentation provided by each city department or bureau, as of February, 2014. EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Internal Protocol for Litigation Risk Management Each city department was also required by Exec9 to develop an internal protocol for claims or litigation served on the city that relate to department employees and/or programs. The intent of this internal protocol was to ensure that departments and bureaus implemented a successful LRM system, and to ensure completion of the five key practices identified earlier in this report.
F3:
Only one department developed an internal protocol for LRM that met all the requirements of Executive Directive No. 9. As shown in Exhibit 5, as of February, 2014, only the Fire Department is in full compliance with this requirement of Exec9. Airports, Recreation and Parks, and Transportation did not develop any internal protocol at all. Each of the other departments or bureaus developed protocols, but the specific requirements outlined in Exec9 are not completely included. The CGJ was informed by department and bureau LRMs that some requirements of Exec9 are not realistic, and are not incorporated into protocols. These requirements are mainly focused on time periods that are not realistic compared with actual claim and case management experience. 105 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 5 Development of Internal Protocol Department Protocol Requirements Under Mayor’s Executive Directive No. 9 106 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. That an early and thorough investigation is No Partial Yes Yes NR No Partial Partial No NA completed 2. Evaluates carefully and thoroughly whether the allegations suggest the advisability of a change in No No Yes No NR No No No No NA policy or practice, or the need for new or renewed training 3. Timely develops and implements any warranted changes in No No Yes No NR No No No No NA policy, practice, and/or training 4. Warranted changes in policy, practice, and/or training are evaluated for budgetary impact and No No Yes No NR No No No No NA included in the department's budgetary planning 5. Evaluates carefully and thoroughly the advisability of discipline, reassignment, or No No Yes No NR No No No No NA retraining of individual employees whose actions contributed to potential liability 6. Timely pursues any warranted discipline, reassignment, or retraining of individual No No Yes No NR No No No No NA employees whose actions contributed to potential liability 7. Evaluates carefully and thoroughly the advisability of the city seeking a change in No No Yes Yes NR No No No No NA federal, state, or municipal law or regulation EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 5 Development of Internal Protocol Department Protocol Requirements Under Mayor’s Executive Directive No. 9 107 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW Notes: NR = No Response to our request for information in this area was received from the department. NA = Not Applicable for the Department of Water and Power, which chose not to implement Exec9. Source: Review of responses and documentation provided by each city department or bureau, as of February, 2014. Quarterly Reporting on Litigation Risk Management Each city department was also required to submit a confidential quarterly report to the Mayor’s Office. This report indicated each filed claim or litigation that related to department employees and/or programs. These quarterly reports were required to include very specific information about each claim or litigation case.
F4:
City Departments or Bureaus have not fully complied with the requirements to submit quarterly Litigation Risk Management reports to the Mayor’s Office. As exhibit 6 shows, as of February 2014, none of the city departments or bureaus are in full compliance with the quarterly reporting requirements of Exec9. Fire, Harbor, Recreation and Parks, and Transportation did not submit any quarterly reports. Reports were submitted by other departments, but none of them included all of the elements required by Exec9. In the CGJ discussions with LRMs, some of these elements are identified as being unrealistic (example, timelines that are not possible to meet), or beyond the purview of the LRMs, due to personnel or other rules and regulations (example, employee discipline issues). EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 6 Quarterly Reporting Quarterly Reporting Requirements Under Mayor’s Executive Directive No. 9 108 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW 1. The date the claim or litigation was filed, the date it was served, the date the department was No Yes No No Partial No Yes No No NA notified of the claim or litigation, and any scheduled trial date. 2. The specific claims alleged in the claim or Yes Yes No No Partial No Yes Yes No NA litigation. 3. Whether the early investigation and consideration of early settlement process was No No No No Partial No No No No NA completed, including whether any early settlement process was pursued. 4. Whether evaluations of the claim or litigation for warranted changes in policy, practice or training, or individual employee discipline or No No No No Partial No No No No NA training have been completed, including when completed, whether any such steps were pursued and the status of any such steps. 5. Whether evaluations of the claim or litigation for the advisability of seeking a change in federal, No No No No Partial No No No No NA state, or municipal law or regulation, including any
F5:
In review of the claim and litigation files, as of February, 2014, none of the city departments or bureaus have fully complied with the specific requirements of Executive Directive No. 9. The CGJ asked each of the departments or bureaus if any files that demonstrated compliance with the requirements of Exec9 were maintained. Harbor, Recreation and Parks, and Streets responded that they did not maintain any LRM files. For the departments or bureaus that stated they did maintain LRM files, the CGJ randomly selected a total of 20 claims or cases to review. Exhibit 7 shows that none of the city departments or Bureaus are in full compliance with the requirements of Exec9. Engineering and Transportation are not in compliance with most of the requirements of Exec9. Airports, Fire, and Sanitation are partially in compliance with the requirements of Exec9. 110 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 7 Review of Litigation Risk Management Files Sample of Department / Maintain Files Summary of Review Results Bureau Files Reviewed Airports maintained files for all cases selected. The files were well Airports Yes Yes documented and organized. In practice, Airports is partially in compliance with the protocols. Engineering maintained files for some cases but not all. Files were not maintained for 10 out of 20 cases selected because the information was Engineering Partial Partial not forwarded from the City Attorney’s office. In practice, Engineering is not in compliance with most of the protocols. Fire maintained files for some cases but not all. Files were not available for review for 15 out of 20 cases selected because the information was Fire Partial Partial either not forwarded from the City Attorney’s office or in archive. In practice, Fire is partially in compliance with the protocols. All files are maintained by the City Harbor No No Attorney. No Police No N/A Response Recreation and No No N/A Parks Sanitation maintained in the database files for all cases selected. In Sanitation Yes Yes practice, Sanitation is partially in compliance with the protocols. Streets No No N/A Transportation maintained files for some cases but not all. Files were not maintained for 10 out of 20 cases selected because the information was either not forwarded from the City Transportation Partial Partial Attorney’s office, not LADOT cases, or not determined if they were LADOT cases. In practice, Transportation is not in compliance with most of the protocols. Water and Not Applicable, Chose not to N/A N/A Power implement Exec9. 111 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Mayor’s Office Follow-Up, Review and Revision of Executive Directive No. As discussed above, Exec9 establishes specific requirements and specific due dates for their completion and submission to the Mayor’s Office. Exec9 created the expectation that there would be follow-up with departments if the required elements were not completed and submitted to the Mayor’s Office.
F6:
The Mayor’s Office, since issuing Exec9, has not adequately followed-up nor has it enforced implementation and compliance with Executive Directive No. 9 by City Departments. The CGJ found the overall level of compliance with Exec9 by city departments and bureaus reviewed to be abysmal. Transportation and Water and Power did not implement any of the required elements of Exec9. The Department of Water and Power chose not to implement Exec9 because the Mayor merely requested City proprietary departments, which DWP is, to implement the Directive. The general city departments were directed to implement it. Airports, Recreation and Parks, and Transportation have not developed or sent either of the required protocols to the Mayor’s Office. Fire, Harbor, Recreation and Parks, and Transportation have not submitted any quarterly reports to the Mayor’s Office as required by Exec9. The Police Department submitted quarterly reports from 2007 to 2009. They then discontinued quarterly reporting. For the city departments and bureaus that did develop and submit the required protocols and quarterly reports, only a few met all of the requirements outlined in Exec9. City departments and bureaus tend to be very responsive to directives and requests from the Mayor’s Office. However, they are also adept at determining what is truly important to the Mayor’s Office, based on the follow-up and attention given to an issue or directives. Implementation and compliance with Exec9 did not appear to be a priority for the Mayor’s Office. The city departments and bureaus responded accordingly. 112 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS
F7:
The Mayor’s Office has not yet revised Exec9 to be more effective. As part of this investigation, the CGJ met with staff of the Mayor’s Office to discuss Exec9 and compliance with it. The CGJ was informed that the new mayoral administration was in the process of reviewing and potentially revising all Executive Directives inherited from previous administrations, including Exec9. It was suggested that the Mayor’s Office draw on the LRM talent within the city and substantially revise Exec9 to provide a more meaningful set of requirements. This would also likely improve the level of department and bureau compliance with Exec9. As discussed earlier in this report, the intent of Exec9 (see attached), was to ensure “further progress in preserving City resources by reducing and preventing claims against City operations and employees.” Exec9 also outlined key mechanisms or practices that a successful LRM system should include. Exec9 then outlines a very specific list of requirements to purportedly establish these mechanisms or practices within city management. However, it is uncertain that these very specific requirements are the most effective way to develop a successful LRM system. The list of requirements in Exec9 is very specific. These requirements are also very focused at the individual claim or case level. Finally, Exec9 provides no focus on the outcome or end result of LRM. There is no tracking or reporting on whether claim and litigation payouts are actually being reduced, or the degree to which changes in department or bureau operations are being implemented to avoid future claims or litigation. Performance indicators, focused on these outcomes or results, would be more effective measures. 113 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
F8:
Presents and discusses with assigned defense counsel any proposed change in policy or No Partial Yes Yes Yes No Partial Partial No NA practice and any proposed employee discipline or retraining Notes: NA = Not Applicable for the Department of Water and Power, which chose not to implement Exec9. Source: Review of responses and documentation provided by each city department or bureau, as of February, 2014. EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Internal Protocol for Litigation Risk Management Each city department was also required by Exec9 to develop an internal protocol for claims or litigation served on the city that relate to department employees and/or programs. The intent of this internal protocol was to ensure that departments and bureaus implemented a successful LRM system, and to ensure completion of the five key practices identified earlier in this report. Finding 3: Only one department developed an internal protocol for LRM that met all the requirements of Executive Directive No. 9. As shown in Exhibit 5, as of February, 2014, only the Fire Department is in full compliance with this requirement of Exec9. Airports, Recreation and Parks, and Transportation did not develop any internal protocol at all. Each of the other departments or bureaus developed protocols, but the specific requirements outlined in Exec9 are not completely included. The CGJ was informed by department and bureau LRMs that some requirements of Exec9 are not realistic, and are not incorporated into protocols. These requirements are mainly focused on time periods that are not realistic compared with actual claim and case management experience. 105 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXECUTIVE DIRECTIVE No. CITY OF LOS ANGELES LAWSUITS Exhibit 5 Development of Internal Protocol Department Protocol Requirements Under Mayor’s Executive Directive No. 9 106 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT tropriA gnireenignE eriF robraH eciloP skraP & noitaerceR noitatinaS steertS noitatropsnarT rewoP dna retaW
Additional Recommendations
9
Not linked to specific findings.
R1:
The pre-release packet for each inmate scheduled to be released to the County is sent from the CDCR to the Probation Pre Release Center. The Post Released Supervised Person (PSP) packet provides pertinent information, such as release date, criminal history, social history, medical and mental health issues, and legal status. The staff then evaluates the data and develops an individualized case plan. The information is used to determine risk levels, supervision conditions, monitoring requirements, and the verification of address to determine local office designation. Conditions of release, supervision, instruction, and reporting responsibilities are returned to the respective PSP for signature.
R2:
An individualized treatment case plan is finalized during the Screening, Intake and Assessment process. The PSP’s past criminal record is reviewed. The entire record is reviewed to determine the assignment of a risk level. (Tier O – very high; Tier I – high; Tier II – medium; Tier III – Low). The following Risk Level Chart shows the monthly standards for supervision. CHALLENGES OF REALIGNMENT 87 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT MINIMUM MONTHLY STANDARDS TIER SUPERVISION OFFICE FIELD DRUG ASSESSMENT LEVEL VISITS VISITS TESTS PRE & POST Orientation and Cognitive 0 Very High 1 1 1-2 Behavioral Therapy (CBT) completion I High 1 1 1-2 Orientation and CBT completion II Medium 1 Quarterly 1-2 Orientation and CBT as needed III Low 1 None 2 per Orientation quarter Records of the PSP are scanned into the Adult Probation System (APS). All records regarding PSPs are maintained in the APS. This system enables the DPO to access a number of screens to input accurate and comprehensive data from each contact, in order to maintain current information.
R3:
The PSP is mandated to report to one of the four Probation HUBs within two business days of release. The HUB is a collaborative group of agencies, consisting of the Department of Mental Health (DMH), Department of Public Health Services (DPH), and Department of Public Social Services (DPSS). An orientation is conducted with the PSP. During this orientation, referrals are made to Community Based Organizations for mental and physical health services, substance abuse, and the assignment of a Deputy Probation Officer (DPO) is completed. In addition, any other emergent needs (housing and transportation) are identified and addressed. If the PSP requires mental health treatment as a condition of their release, a referral to DMH is completed. The PSP must be registered within five working days to participate in mental health treatment. CHALLENGES OF REALIGNMENT 88 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Refusal of the PSP to enroll or participate in a mental health program could result in intermediate sanctions, Flash Incarceration, and Revocation. Intermediate sanctions are imposed as a result of the PSP violating conditions of their post release plan. Flash Incarceration is a period of detention in county jail, for up to ten days, for violating conditions of post-release supervision. Flash Incarceration applies to PSPs only, and requires approval by the Supervising Deputy Probation Officer. Revocation returns the PSP to jail. This process requires court approval. If a PSP fails to comply with the conditions of their case plan, the DPO can impose intermediate sanctions up to and including, Flash Incarceration and Revocation. If the PSP requires substance abuse treatment, the DPO ensures that this condition is added to the APS, and provides a referral to the local Community Assessment Service Center. The PSP has five working days to report for assessment. During this process, thorough instructions are given to the PSP. All referrals, instructions, and documents are signed by the PSP, and the PSP is given a copy. The PSP has the opportunity to request additional services. A referral is submitted for housing and employment through the various departments who offer contracted services. The PSP may be eligible for, but not limited to, the following:
R4:
1 The Probation Department must continue to obtain funds and fill staff positions based on the mandated program needs. Post-Release Community Supervision Procedures The LACPD in coordination with the County’s Public Safety Realignment Team developed case intake to case termination procedures. As previously stated, AB 109 legislation modified parole statutes and created a Post-release Community Supervision Program under the auspices of the County. LACPD responsibilities and procedures include the following: 1. The pre-release packet for each inmate scheduled to be released to the County is sent from the CDCR to the Probation Pre Release Center. The Post Released Supervised Person (PSP) packet provides pertinent information, such as release date, criminal history, social history, medical and mental health issues, and legal status. The staff then evaluates the data and develops an individualized case plan. The information is used to determine risk levels, supervision conditions, monitoring requirements, and the verification of address to determine local office designation. Conditions of release, supervision, instruction, and reporting responsibilities are returned to the respective PSP for signature. 2. An individualized treatment case plan is finalized during the Screening, Intake and Assessment process. The PSP’s past criminal record is reviewed. The entire record is reviewed to determine the assignment of a risk level. (Tier O – very high; Tier I – high; Tier II – medium; Tier III – Low). The following Risk Level Chart shows the monthly standards for supervision. CHALLENGES OF REALIGNMENT 87 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT MINIMUM MONTHLY STANDARDS TIER SUPERVISION OFFICE FIELD DRUG ASSESSMENT LEVEL VISITS VISITS TESTS PRE & POST Orientation and Cognitive 0 Very High 1 1 1-2 Behavioral Therapy (CBT) completion I High 1 1 1-2 Orientation and CBT completion II Medium 1 Quarterly 1-2 Orientation and CBT as needed III Low 1 None 2 per Orientation quarter Records of the PSP are scanned into the Adult Probation System (APS). All records regarding PSPs are maintained in the APS. This system enables the DPO to access a number of screens to input accurate and comprehensive data from each contact, in order to maintain current information. 3. The PSP is mandated to report to one of the four Probation HUBs within two business days of release. The HUB is a collaborative group of agencies, consisting of the Department of Mental Health (DMH), Department of Public Health Services (DPH), and Department of Public Social Services (DPSS). An orientation is conducted with the PSP. During this orientation, referrals are made to Community Based Organizations for mental and physical health services, substance abuse, and the assignment of a Deputy Probation Officer (DPO) is completed. In addition, any other emergent needs (housing and transportation) are identified and addressed. If the PSP requires mental health treatment as a condition of their release, a referral to DMH is completed. The PSP must be registered within five working days to participate in mental health treatment. CHALLENGES OF REALIGNMENT 88 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Refusal of the PSP to enroll or participate in a mental health program could result in intermediate sanctions, Flash Incarceration, and Revocation. Intermediate sanctions are imposed as a result of the PSP violating conditions of their post release plan. Flash Incarceration is a period of detention in county jail, for up to ten days, for violating conditions of post-release supervision. Flash Incarceration applies to PSPs only, and requires approval by the Supervising Deputy Probation Officer. Revocation returns the PSP to jail. This process requires court approval. If a PSP fails to comply with the conditions of their case plan, the DPO can impose intermediate sanctions up to and including, Flash Incarceration and Revocation. If the PSP requires substance abuse treatment, the DPO ensures that this condition is added to the APS, and provides a referral to the local Community Assessment Service Center. The PSP has five working days to report for assessment. During this process, thorough instructions are given to the PSP. All referrals, instructions, and documents are signed by the PSP, and the PSP is given a copy. The PSP has the opportunity to request additional services. A referral is submitted for housing and employment through the various departments who offer contracted services. The PSP may be eligible for, but not limited to, the following: 1. Bus tokens or transportation provided by the Mobile Unit 2. Housing assistance 3. Employment and job placement 4. Clothing, uniforms, and tools for employment 5. Medication and medical supplies 6. Enrollment fees (e.g. Community College/GED Classes/Vocational Schools) 7. Identification fees (e.g. CA driver’s license/ID card, birth records/certificates, social security cards) CHALLENGES OF REALIGNMENT 89 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT If the PSP fails to report, the DPO conducts due diligence and submits a petition for a warrant. The petition is submitted to the courts within five working days. The LACPD assists the PSP in becoming accountable, working towards rehabilitation by case management, supervision, and monitoring. The DPO is responsible for making routine home calls and compliance checks at the reported residence of the PSP. The number of home calls depends on the risk, need level cooperation and adjustment of the PSP in the community. The routine home calls are generally made by two DPOs. The Compliance Checks include additional DPOs and law enforcement that have search, seizure, and arrest authority. The purpose of the home calls are to ensure that the PSP is residing at the reported address. The PSP must be in compliance with conditions of their case plan, participating and receiving their collaborative services. The LACPD has developed a list of violations which is a guideline to ensure that consistent application of sanctions is followed. There must be a balance between rehabilitative casework and the appropriate level of sanction and rewards for compliance and noncompliance. DPOs must address all violations appropriately and comply with supervision conditions. If warranted, the DPOs make referrals to the Court for Revocation proceedings. Sanctions and Revocation can be imposed for failure to comply with any of the following: 1. Employment/education conditions 2. Gang affiliation/membership/activity conditions 3. Victim related conditions 4. Sex offenders conditions 5. Substance abuse conditions 6. Mental Health conditions 7. Weapons violation: PSP in possession of weapon CHALLENGES OF REALIGNMENT 90 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 8. Weapons violation: PSP in presence of weapon 9. General Conditions of supervision a. reporting b. residence c. identification d. misdemeanor arrests e. felony arrests f. registration conditions The application of sanctions including verbal, intermediate sanctions and revocation are progressive. All verbal and/or written admonishments are documented. The PSP must be discharged from Probation at 12 months if no custodial violations, sanctions or infractions have occurred. If the PSPs violate the condition of their release, the LACPD may initiate the revocation processes through the court.
R5:
Medication and medical supplies
R6:
Enrollment fees (e.g. Community College/GED Classes/Vocational Schools)
R7:
Identification fees (e.g. CA driver’s license/ID card, birth records/certificates, social security cards) CHALLENGES OF REALIGNMENT 89 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT If the PSP fails to report, the DPO conducts due diligence and submits a petition for a warrant. The petition is submitted to the courts within five working days. The LACPD assists the PSP in becoming accountable, working towards rehabilitation by case management, supervision, and monitoring. The DPO is responsible for making routine home calls and compliance checks at the reported residence of the PSP. The number of home calls depends on the risk, need level cooperation and adjustment of the PSP in the community. The routine home calls are generally made by two DPOs. The Compliance Checks include additional DPOs and law enforcement that have search, seizure, and arrest authority. The purpose of the home calls are to ensure that the PSP is residing at the reported address. The PSP must be in compliance with conditions of their case plan, participating and receiving their collaborative services. The LACPD has developed a list of violations which is a guideline to ensure that consistent application of sanctions is followed. There must be a balance between rehabilitative casework and the appropriate level of sanction and rewards for compliance and noncompliance. DPOs must address all violations appropriately and comply with supervision conditions. If warranted, the DPOs make referrals to the Court for Revocation proceedings. Sanctions and Revocation can be imposed for failure to comply with any of the following:
R8:
Weapons violation: PSP in presence of weapon
R9:
General Conditions of supervision a. reporting b. residence c. identification d. misdemeanor arrests e. felony arrests f. registration conditions The application of sanctions including verbal, intermediate sanctions and revocation are progressive. All verbal and/or written admonishments are documented. The PSP must be discharged from Probation at 12 months if no custodial violations, sanctions or infractions have occurred. If the PSPs violate the condition of their release, the LACPD may initiate the revocation processes through the court.
Findings & Recommendations
5 findings
F9:
The categories used to describe the Place-Based components in budget and expenditure documents changed between FYs 2010- 11 and 2013-14, making it difficult to track expenditures by activity over time.
F10:
In Fiscal Years 2012-13 and 2013-14, all budget line items for the Place-Based Strategy were collapsed into a single line item documented as, Best Start. This provides the Commission and the public with few details about how funds were being used. It minimizes the means for First 5 LA management to expend funds in accordance with specific Commission direction. A transmission letter to the First 5 LA Commission presented more detail on Place-Based budgeted expenditures for FYs 2012-13 and 2013-14 however, this information was not included in the budget document itself and therefore not compared to actual expenditures.
F11:
Place-Based Strategy budget and actual expenditure information for all years reviewed do not represent Agency operating budget expenditures, which averaged $2.8 million per year for the first three years of the rollout.
F12:
Budget and actual expenditure documents presented to the Commission do not track Place-Based Strategy spending per each of the 14 communities being served. This practice makes it impossible for the Commission to compare the level of funding with the outcomes achieved in each community.
F13:
Not until FY 2012-13 did budget documents provide a greater level of detail as to how funding for the Place-Based Strategy was being spent. In that year, budget detail showed that approximately half of the funds were being spent on marketing, communications, and research and evaluation for the Place- Based strategy. 169 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT FIRST 5 LA SERVING THE COMMUNITY?
Findings & Recommendations
3 findings
F14:
The Agency provided insufficient evidence to the Commission about the potential effectiveness of and challenges inherent in the Place-Based Strategy and its ability to improve services for children aged 0-5. It cited the work of private foundations, which may not be an appropriate comparison for an agency that receives public funds.
F15:
Documents presented to the Commission prior to the adoption of the Place-Based Strategy did not adequately list the potential impacts involved, including the extended period of time for results to materialize.
F16:
Implementation of the Place-Based Strategy and the Community Capacity Building work in particular, is time-consuming and challenging. It is difficult to measure the effectiveness of the Community Partnerships and their ability to improve services. Some Community Partnership representatives have expressed frustration at the slow pace of development and their concern that the implementation plans will not be funded once completed.
Additional Recommendations
11
Not linked to specific findings.
R1:
Front gate at Sylmar was aligned correctly to close on impact
R2:
Installed a rain gutter and down spout on the warehouse
R3:
Replaced ice machine in main kitchen area
R4:
Repaired large pothole adjacent to the kitchen
R5:
Installed a freezer condenser and compressor in the kitchen
R6:
Installed electrical conduit and heaters in the warehouse
R7:
Installed razor wire atop communication riser a-b
R8:
1 The Los Angeles County Assessor and Board of Supervisors should request the California State Legislature to revise the law to require reassessment, when real property is purchased/transferred to different structural ownership at the conclusion of a transaction. Reassessment should be based on the purchase/transfer of real property—not the structure of ownership involved. (i.e. the greater than 50+% ownership formula currently in place.) Certification of Professionals Responsible for Determining Change in Ownership
R9:
Repaired air conditioning unit on Administration building roof
R10:
Installed earthquake valve
R11:
Installed new phone line at North School 189 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT MAINTENANCE ISSUES AND LIVING CONDITIONS AT JUVENILE HALLS EXHIBIT III Housing Unit Repairs Completed at Barry J. Nidorf (as of January 31, 2014)