Stanislaus County Grand Jury
• 2001-2002
Reason for Investigation The Stanislaus County Civil Grand Jury received a written complaint from a medical
⚠️ 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 24 findings
F1
According to the California Health and Safety Code Section 1441, the County may establish a county hospital; however, it is not required to do so.
No recommendations for this finding
F2
For financial reasons, the County closed Stanislaus Medical Center and sub- contracted all hospital services to Tenet through the Omnibus Agreement.
No recommendations for this finding
F3
The Omnibus Agreement, signed November 30, 1997 by the CEO of Stanislaus County and the CEO of DMC, outlines each party=s responsibilities and duties pertaining to health care in Stanislaus County as outlined below: a. This is a twenty (20) year agreement with automatic renewals each year thereafter. b. Tenet can cancel the agreement if the County fails to pay any amount due DMC. c. ADMC shall be the exclusive supplier to the County of all inpatient services required by County for the patients of the Clinics mostly at MediCal rates, emergency care and certain other free support functions for law enforcement and the coroner.@ d. DMC paid $12,000,000.00 to the County for this exclusive right as stipulated in this agreement. e. DMC and the County shall jointly publicize that DMC now provides the health care services the County once provided. f. For those patients at DMC who become qualified as eligible indigents, the County will pay for inpatient care (subject to free patient days) retroactive to the date of the inpatient admission at DMC. The County does not pay for emergency care or related transportation.
No recommendations for this finding
F4
If patients are found to be ineligible for any County program and have no insurance, they shall be considered part of DMC=s normal charity care.
No recommendations for this finding
F5
Because DMC operates as a hospital, it cannot refuse to see any patient based on ability to pay as required in the Emergency Medical and Treatment Active Labor Act (EMTALA).
No recommendations for this finding
F6
The Omnibus Agreement does not address the issue of payment of emergency room physicians= fees.
Related Recommendations (2)
R1
CERP seek restitution from DMC for unreimbursed expenses and/or uncollectable fees.
R6
Routine meetings be re-established to discuss ongoing patient issues and improve the level of communication between DMC and the County. CERP should be included in these discussions.
F7
There is no written agreement between the County and CERP.
Related Recommendations (2)
R1
CERP seek restitution from DMC for unreimbursed expenses and/or uncollectable fees.
R6
Routine meetings be re-established to discuss ongoing patient issues and improve the level of communication between DMC and the County. CERP should be included in these discussions.
F8
Prior to the signing of the Omnibus Agreement, the CEO of DMC stated publicly at a Stanislaus County Board of Supervisors meeting that DMC would cover all costs related to ER services. 3
No recommendations for this finding
F9
The California Healthcare for Indigents Program and Rural Health Services Program (Proposition 99) allocates funds to participating counties. These funds are collected from a tobacco tax imposed on cigarettes.
No recommendations for this finding
F10
Senate Bill 2132 (SB2132) and Assembly Bill 75 (AB75) define how funds collected by Proposition 99 can be used.
Related Recommendations (1)
R2
CERP continue to seek reimbursement from Stanislaus Foundation for Medical Care for monies provided by state legislation.
F11
The State of California Maddy Fund, created by Senate Bill 612 (SB612), has available funding for emergency medical services including emergency room physicians= fees.
Related Recommendations (1)
R2
CERP continue to seek reimbursement from Stanislaus Foundation for Medical Care for monies provided by state legislation.
F12
Funds from these legislative actions are distributed by the Stanislaus Foundation for Medical Care.
Related Recommendations (1)
R2
CERP continue to seek reimbursement from Stanislaus Foundation for Medical Care for monies provided by state legislation.
F13
In California, hospitals cannot employ physicians; therefore, all ER physicians must contract with the hospital to use the facilities. DMC contracted with CERP to fulfill this obligation.
No recommendations for this finding
F14
The services provided by the ER physicians are billed separately by CERP.
No recommendations for this finding
F15
DMC bills patients separately for rooms, equipment and supplies.
No recommendations for this finding
F16
It is the responsibility of DMC to insure that the emergency room is staffed.
No recommendations for this finding
F17
The County has never paid for, nor is it obligated to pay for, emergency services for MIA patients.
No recommendations for this finding
F18
From the documents produced by the complainant, the $659,352.00 in billing fees were for CERP services only.
No recommendations for this finding
F19
The County=s eleven (11) health care clinics are designed to handle non-emergency health care issues.
Related Recommendations (2)
R3
County clinic referrals to DMC ER should only be given to patients who warrant emergency treatment.
R4
The County extend the hours at the health care clinics to enhance patient services and to lessen the non-emergency patient load in the emergency rooms throughout the county.
F20
The County health care clinics, as well as the urgent care(s), are not required to treat patients before checking their ability to pay.
Related Recommendations (3)
R5
The County actively publicize and promote the clinic locations, types of services available, and fees. This information should be available in all clinic locations.
R7
SCHSA aggressively identify and enroll eligible MIA residents.
R8
The County=s internal auditors provide annual oversight in the MIA eligibility process. RESPONSE REQUIRED per Section 933 [c] and 933.05 of the California Penal Code: Stanislaus County Health Services Agency (SCHSA). This final report will be available for public review on the Civil Grand Jury website located at: http://www.co.stanislaus.ca.us/COURTS/courts/grandjury/index.html and at the Stanislaus County Main Library, 1500 I Street, Modesto, California 95354. '933. Comments and Reports on Grand Jury Recommendations [c] No later than 90 days after the grand jury submits a final report on the operations of any public agency subject to its reviewing authority, the governing body of the public agency shall comment to the presiding judge of the superior court on the findings and recommendations pertaining to 6 matters under the control of the governing body, and every elective county officer or agency head for which the grand jury has responsibility pursuant to Section 914.1 shall comment to the presiding judge of the superior court, with an information copy sent to the board of supervisors, on the findings and recommendations pertaining to matters under the control of that county officer or agency head and any agency or agencies which that officer or agency head supervises or controls. In any city and county, the mayor shall also comment on the findings and recommendations. All such comments and reports shall forthwith be submitted to the presiding judge of the superior court who impaneled the grand jury. A copy of all responses to grand jury reports shall be placed on file with the clerk of the public agency and the office of the county clerk, or the mayor when applicable, and shall remain on file in those offices. One copy shall be placed on file with the applicable grand jury final report by, and in the control of the currently impaneled grand jury, where it shall be maintained for a minimum of five years. '933.05 Response to Grand Jury Recommendations--Content Requirements A. Section 933.05 of the California Penal Code requires that a responding person or entity shall indicate one of the following: (1) The respondent agrees with the finding(s); or (2) The respondent disagrees wholly or in part with the finding(s). If this response is chosen, the respondent will specify that portion of the
F21
The County health care clinics charge a fee for MIA patients determined by their ability to pay. There is a sliding scale fee based on the number of family members, asset limits and income.
Related Recommendations (3)
R5
The County actively publicize and promote the clinic locations, types of services available, and fees. This information should be available in all clinic locations.
R7
SCHSA aggressively identify and enroll eligible MIA residents.
R8
The County=s internal auditors provide annual oversight in the MIA eligibility process. RESPONSE REQUIRED per Section 933 [c] and 933.05 of the California Penal Code: Stanislaus County Health Services Agency (SCHSA). This final report will be available for public review on the Civil Grand Jury website located at: http://www.co.stanislaus.ca.us/COURTS/courts/grandjury/index.html and at the Stanislaus County Main Library, 1500 I Street, Modesto, California 95354. '933. Comments and Reports on Grand Jury Recommendations [c] No later than 90 days after the grand jury submits a final report on the operations of any public agency subject to its reviewing authority, the governing body of the public agency shall comment to the presiding judge of the superior court on the findings and recommendations pertaining to 6 matters under the control of the governing body, and every elective county officer or agency head for which the grand jury has responsibility pursuant to Section 914.1 shall comment to the presiding judge of the superior court, with an information copy sent to the board of supervisors, on the findings and recommendations pertaining to matters under the control of that county officer or agency head and any agency or agencies which that officer or agency head supervises or controls. In any city and county, the mayor shall also comment on the findings and recommendations. All such comments and reports shall forthwith be submitted to the presiding judge of the superior court who impaneled the grand jury. A copy of all responses to grand jury reports shall be placed on file with the clerk of the public agency and the office of the county clerk, or the mayor when applicable, and shall remain on file in those offices. One copy shall be placed on file with the applicable grand jury final report by, and in the control of the currently impaneled grand jury, where it shall be maintained for a minimum of five years. '933.05 Response to Grand Jury Recommendations--Content Requirements A. Section 933.05 of the California Penal Code requires that a responding person or entity shall indicate one of the following: (1) The respondent agrees with the finding(s); or (2) The respondent disagrees wholly or in part with the finding(s). If this response is chosen, the respondent will specify that portion of the
F22
All non-MIA patients are required to make a $40.00 (originally $50.00) co-payment before they are seen at the county health care clinics.
No recommendations for this finding
F23
Two of these clinics receive federal funds which allow non-MIA patients to be seen 4 without a co-payment.
No recommendations for this finding
F24
SCHSA has recently established a pilot program at DMC to help enroll eligible patients into the MIA program. CONCLUSIONS The Civil Grand Jury concluded that:
No recommendations for this finding
Conclusions 6
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CL1 Page 5The agreement between DMC and the County clearly states that the County shall not be financially responsible for any emergency care.
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CL2 Page 5If seriously ill patients come into a County clinic, a referral to DMC ER may be needed.
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CL3 Page 5The goal of the health care providers is to ensure patients are referred to the appropriate facility for treatment in a timely manner.
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CL4 Page 5In many cases, patients are going to area emergency rooms for non-emergency medical conditions instead of using one of the County clinics.
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CL5 Page 5The County established a program to have staff available at DMC to aid in enrolling people in the MIA program.
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CL6 Page 5Initially there were weekly meetings between DMC and the County which have since been discontinued. The emergency room physicians group were never included in these meetings.
No Responses Found 2
Government entities assigned to respond to this report. No response documents have been linked in our database.
Stanislaus County
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Stanislaus County Board of Supervisors
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