Butte County Grand Jury
• 2009-2010
Butte County Grand Jury Report 2009-2010 Butte County Department of Behavioral Health
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 26 findings
F1
The response to the report of the 2008/2009 Grand Jury from the Butte County Board of Supervisors, the Butte County CAO, and the first DBH Interim Director each stated that the Department of Behavioral Health Medical Director position was anticipated to be filled by November 2009. Recruitment was initiated in November 2009 but was suspended within three months without filling the position.
Related Recommendations (1)
R1
Recruit for and fill the Medical Director position without further delay.
F2
The Medical Director position description as it is written does not carry the authority or responsibility to make clinical decisions.
Related Recommendations (1)
R2
Write the Medical Director position description to carry the authority and responsibility to make the final clinical decisions.
F3
Butte County did not recruit to fill the position of the Permanent DBH Director during the two years while there was an interim director for the DBH.
Related Recommendations (2)
R3
Develop a policy to initiate the recruitment for a permanent director immediately upon notice that a vacancy will occur in the position.
R5
The recruitment for a permanent director should not be suspended while there is an Interim Director.
F4
The first Interim Director served under an open-ended contract.
Related Recommendations (1)
R4
Develop a policy to hire interim directors only with end-dated contracts.
F5
The DBH had to adjust to the first and the second Interim Directors, and will have to adjust again when a permanent Director is hired, continuing the instability of the department.
No recommendations for this finding
F6
Documents requested from administrators were often provided to the Grand Jury after long delays and the material often was not what the Grand Jury requested.
Related Recommendations (1)
R6
Provide training in fiscal transparency for the DBH administrators.
F7
Medical staff is often unable to obtain fiscal and statistical data.
Related Recommendations (2)
R6
Provide training in fiscal transparency for the DBH administrators.
R7
Develop and adhere to a written policy for transparency with regard to fiscal and statistical data.
F8
The administrators sometimes failed to provide the correct financial reports as requested by the Grand Jury, even though the correct reports have the titles the Grand Jury used in making the request.
Related Recommendations (2)
R6
Provide training in fiscal transparency for the DBH administrators.
R8
The administrators should produce, refer to, and discuss reports using only standardized accounting terminology.
F9
The DBH amends contracts after service has been provided and writes them to cover the invoices submitted by and paid to the contractor.
Related Recommendations (1)
R9
Develop a policy that does not allow contractors to provide or bill for services unless there is a current and complete contract in effect.
F10
Several psychiatrists on staff and under contract are ready to retire and there is a critical shortage of psychiatrists.
Related Recommendations (1)
R10
Develop and implement an aggressive and creative plan to hire psychiatrists.
F11
Mentally ill patients in crisis often wait excessively long periods at hospital emergency rooms before the DBH will accept them at the Crisis Stabilization Unit.
Related Recommendations (1)
R11
Establish relationships with the local hospitals that will ensure an efficient transition for mentally ill patients who are in crisis from emergency rooms to the Crisis Stabilization Unit.
F12
Patient transfers out-of-county are excessive, very costly, and increasing in number.
Related Recommendations (2)
R12
Make it a priority to keep youths and adults in Butte County when they need to be hospitalized for mental illness.
R13
The department should set a priority on the establishment of more treatment facilities within the County and utilize current facilities to full capacity.
F13
Often children and youth Medi-Cal patients are sent out-of-county, which reduces the quality of their care and is more expensive for the County.
Related Recommendations (2)
R12
Make it a priority to keep youths and adults in Butte County when they need to be hospitalized for mental illness.
R13
The department should set a priority on the establishment of more treatment facilities within the County and utilize current facilities to full capacity.
F14
Hope Cottage is a resource, that if fully and properly utilized, has the potential of serving the needs of youth better than sending them out of County for psychiatric hospitalization. It would save money for the County each year.
No recommendations for this finding
F15
Hope Cottage is fully operational but funded for only three of its six beds.
Related Recommendations (1)
R14
Fully fund the six beds at the Hope Cottage youth facility.
F16
Transportation for out-of-county hospitalizations is an expensive yearly cost to the County that could be used to fund in-county alternatives; yet the costs are not separately tracked in the budget, thus making it difficult to know exactly how much money might be available.
Related Recommendations (1)
R15
Develop a separate expense account number for out-of-county transportation of patients.
F17
The contract for the review of the DBH fiscal operations was excessively costly and ultimately did not result in an “accepted” final report.
No recommendations for this finding
F18
The security, storage, and backup of the data that is produced and used by the DBH is insufficient. Plans exist to build an improved system, but the DBH plans do not take advantage of the existing comprehensive Butte ISD system.
Related Recommendations (1)
R16
Utilize the existing Butte ISD system for security, storage, and backup of the data that is produced and used by the DBH.
F19
The Avatar electronic health record system is being blamed by DBH administrators for not being able to provide Client and Services Information (CSI) reporting data to the California Department of Mental Health as required.
Related Recommendations (1)
R17
Comply with the California Department of Mental Health CSI reporting requirements in a timely manner.
F20
The DBH converted to the Avatar electronic health record system and stopped using its prior system prematurely, creating a lack of ready access to vital information for CSI reporting.
Related Recommendations (1)
R17
Comply with the California Department of Mental Health CSI reporting requirements in a timely manner.
F21
The DBH IS staff does not work closely or coordinate with the Butte ISD, and does not take advantage of experienced staff, expertise, and leadership of the Butte ISD.
Related Recommendations (1)
R18
The DBH should coordinate information systems and technology with the Butte ISD to take advantage of experienced staff and share IS/IT expertise.
F22
The DBH has been successful in obtaining publicly funded state and federal grants.
No recommendations for this finding
F23
Unnecessary and expensive out-of-town trips have been made and paid for by tax - supported, publicly funded state and federal grants.
Related Recommendations (1)
R19
The future expenditures on out-of-county group trips by the publicly-funded state and federal grant programs should be eliminated.
F24
The DBH Advisory Board often takes direction from the DBH administrators instead of taking the initiative to pursue their full advisory function as provided for in the California Welfare and Institutions Code § 5604.2.
Related Recommendations (1)
R20
The DBH Advisory Board should pursue their full advisory function as provided for in the California Welfare and Institutions Code § 5604.2.
F25
This is the second consecutive Grand Jury to have concerns about the operations of the DBH.
No recommendations for this finding
F26
Among the administrators there seems to be a lack of value for the medical component of mental health treatment.
Related Recommendations (1)
R21
The DBH administration should structure and operate its programs so as to reflect a high value for the medical component of mental health.
Conclusions 1
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CL1 Page 30The 2009/2010 Grand Jury believes that the staff of the DBH care deeply about the youths and adults in Butte County who need their services. In addition, the 2009/2010 Grand Jury concludes that while it did not have sufficient time to fully investigate all of the issues within the DBH, it did confirm some of the findings of the 2008/2009 Grand Jury, specifically: The department is in need of its own healing. ! The department fails to be transparent about its operations, fiscal decisions, and ! policy changes. The administrators are choosing not to recognize the value of the medical ! education and experience of their psychiatrists. As a result, the 2009/2010 Grand Jury recommends that the Butte County Board of Supervisors or the State of California conduct an investigation of the Butte County Department of Behavioral Health by an independent firm with credentials in financial and behavior health issues.
No Responses Found 1
Government entities assigned to respond to this report. No response documents have been linked in our database.
Butte County Board of Supervisors
Elected County Office