Crystal Creek Regional Boys’ Camp Reason for Inquiry:

Note: Missing finding numbers detected: F6, F10, F12, F13, F14, F20, F21, F22, F23, F24, F25, F26, F27, F28, F29, F30, F31, F32, F33, F34, F35, F36, F37, F38, F39, F40, F41, F42, F43, F44, F45, F46, F47, F48, F49, F50, F51, F52, F53, F54, F55, F56, F57, F58, F59, F60, F61, F62, F63, F64, F65, F66, F67, F68, F69, F70, F71, F72, F73, F74, F75, F76, F77, F78, F79, F80, F81, F82, F83, F84, F85, F86, F87, F88, F89, F90, F91, F92, F93, F94, F95, F96, F97, F98, F99, F100, F101, F102, F103, F104, F105, F106, F107, F108, F109, F110, F111, F112, F113, F114, F115, F116, F117, F118, F119, F120, F121, F122, F123, F124, F125, F126, F127, F128, F129, F130, F131, F132, F133, F134, F135, F136, F137, F138, F139, F140, F141, F142, F143, F144, F145, F146, F147, F148, F149, F150, F151, F152, F153, F154, F155, F156, F157, F158, F159, F160, F161, F162, F163, F164, F165, F166, F167, F168, F169, F170, F171, F172, F173, F174, F175, F176, F177, F178, F179, F180, F181, F182, F183, F184, F185, F186, F187, F188, F189, F190, F191, F192, F193, F194, F195, F196, F197, F198, F199, F200, F201, F202, F203, F204, F205, F206, F207, F208, F209, F210, F211, F212, F213, F214, F215, F216, F217, F218, F219, F220, F221, F222, F223, F224, F225, F226, F227, F228, F229, F230, F231, F232, F233, F234, F235, F236, F237, F238, F239, F240, F241, F242, F243, F244, F245, F246, F247, F248, F249, F250, F251, F252, F253, F254, F255, F256, F257, F258, F259, F260, F261, F262, F263, F264, F265, F266, F267, F268, F269, F270, F271, F272, F273, F274, F275, F276, F277, F278, F279, F280, F281, F282, F283, F284, F285, F286, F287, F288, F289, F290, F291, F292, F293, F294, F295, F296, F297, F298, F299, F300, F301, F302, F303, F304, F305, F306, F307, F308, F309, F310, F311, F312, F313, F314, F315, F316, F317, F318, F319, F320, F321, F322, F323, F324, F325, F326, F327, F328, F329, F330, F331, F332, F333, F334, F335, F336, F337, F338, F339, F340, F341, F342, F343, F344, F345, F346, F347, F348, F349, F350, F351, F352, F353, F354, F355, F356, F357, F358, F359, F360, F361, F362, F363, F364, F365, F366, F367, F368, F369, F370, F371, F372, F373, F374, F375, F376, F377, F378, F379, F380, F381, F382, F383, F384, F385, F386, F387, F388, F389, F390, F391, F392, F393, F394, F395, F396, F397, F398, F399, F400, F401, F402, F403, F404, F405, F406, F407, F408, F409, F410, F411, F412, F413, F414, F415, F416, F417, F418, F419, F420, F421, F422, F423, F424, F425, F426, F427, F428, F429, F430, F431, F432, F433, F434, F435, F436, F437, F438, F439, F440, F441, F442, F443, F444, F445, F446, F447, F448, F449, F450, F451, F452, F453, F454, F455, F456, F457, F458, F459, F460, F461, F462, F463, F464, F465, F466, F467, F468, F469, F470, F471, F472, F473, F474, F475, F476, F477, F478, F479, F480, F481, F482, F483, F484, F485, F486, F487, F488, F489, F490, F491, F492, F493, F494, F495, F496, F497, F498, F499, F500, F501, F502, F503, F504, F505, F506, F507, F508, F509, F510, F511, F512, F513, F514, F515, F516, F517, F518, F519, F520, F521, F522, F523, F524, F525, F526, F527, F528, F529, F530, F531, F532, F533, F534, F535, F536, F537, F538, F539, F540, F541, F542, F543, F544, F545, F546, F547, F548, F549, F550, F551, F552, F553, F554, F555, F556, F557, F558, F559, F560, F561, F562, F563, F564, F565, F566, F567, F568, F569, F570, F571, F572, F573, F574, F575, F576, F577, F578, F579, F580, F581, F582, F583, F584, F585, F586, F587, F588, F589, F590, F591, F592, F593, F594, F595, F596, F597, F598, F599, F600, F601, F602, F603, F604, F605, F606, F607, F608, F609, F610, F611, F612, F613, F614, F615, F616, F617, F618, F619, F620, F621, F622, F623, F624, F625, F626, F627, F628, F629, F630, F631, F632, F633, F634, F635, F636, F637, F638, F639, F640, F641, F642, F643, F644, F645, F646, F647, F648, F649, F650, F651, F652, F653, F654, F655, F656, F657, F658, F659, F660, F661, F662, F663, F664, F665, F666, F667, F668, F669, F670, F671, F672, F673, F674, F675, F676, F677, F678, F679, F680, F681, F682, F683, F684, F685, F686, F687, F688, F689, F690, F691, F692, F693, F694, F695, F696, F697, F698, F699, F700, F701, F702, F703, F704, F705, F706, F707, F708, F709, F710, F711, F712, F713, F714, F715, F716, F717, F718, F719, F720, F721, F722, F723, F724, F725, F726, F727, F728, F729, F730, F731, F732, F733, F734, F735, F736, F737, F738, F739, F740, F741, F742, F743, F744, F745, F746, F747, F748, F749, F750, F751, F752, F753, F754, F755, F756, F757, F758, F759, F760, F761, F762, F763, F764, F765, F766, F767, F768, F769, F770, F771, F772, F773, F774, F775, F776, F777, F778, F779, F780, F781, F782, F783, F784, F785, F786, F787, F788, F789, F790, F791, F792, F793, F794, F795, F796, F797, F798, F799, F800, F801, F802, F803, F804, F805, F806, F807, F808, F809, F810, F811, F812, F813, F814, F815, F816, F817, F818, F819, F820, F821, F822, F823, F824, F825, F826, F827, F828, F829, F830, F831, F832, F833, F834, F835, F836, F837, F838, F839, F840, F841, F842, F843, F844, F845, F846, F847, F848, F849, F850, F851, F852, F853, F854, F855, F856, F857, F858, F859, F860, F861, F862, F863, F864, F865, F866, F867, F868, F869, F870, F871, F872, F873, F874, F875, F876, F877, F878, F879, F880, F881, F882, F883, F884, F885, F886, F887, F888, F889, F890, F891, F892, F893, F894, F895, F896, F897, F898, F899, F900, F901, F902, F903, F904, F905, F906, F907, F908, F909, F910, F911, F912, F913, F914, F915, F916, F917, F918, F919, F920, F921, F922, F923, F924, F925, F926, F927, F928, F929, F930, F931, F932, F933, F934, F935, F936, F937, F938, F939, F940, F941, F942, F943, F944, F945, F946, F947, F948, F949, F950, F951, F952, F953, F954, F955, F956, F957, F958, F959, F960, F961, F962, F963, F964, F965, F966, F967, F968, F969, F970, F971, F972, F973, F974, F975, F976, F977, F978, F979, F980, F981, F982, F983, F984, F985, F986, F987, F988, F989, F990, F991, F992, F993, F994, F995, F996, F997, F998, F999, F1000, F1001, F1002, F1003, F1004, F1005, F1006, F1007, F1008, F1009, F1010, F1011, F1012, F1013, F1014, F1015, F1016, F1017, F1018, F1019, F1020, F1021, F1022, F1023, F1024, F1025, F1026, F1027, F1028, F1029, F1030, F1031, F1032, F1033, F1034, F1035, F1036, F1037, F1038, F1039, F1040, F1041, F1042, F1043, F1044, F1045, F1046, F1047, F1048, F1049, F1050, F1051, F1052, F1053, F1054, F1055, F1056, F1057, F1058, F1059, F1060, F1061, F1062, F1063, F1064, F1065, F1066, F1067, F1068, F1069, F1070, F1071, F1072, F1073, F1074, F1075, F1076, F1077, F1078, F1079, F1080, F1081, F1082, F1083, F1084, F1085, F1086, F1087, F1088, F1089, F1090, F1091, F1092, F1093, F1094, F1095, F1096, F1097, F1098, F1099, F1100, F1101, F1102, F1103, F1104, F1105, F1106, F1107, F1108, F1109, F1110, F1111, F1112, F1113, F1114, F1115, F1116, F1117, F1118, F1119, F1120, F1121, F1122, F1123, F1124, F1125, F1126, F1127, F1128, F1129, F1130, F1131, F1132, F1133, F1134, F1135, F1136, F1137, F1138, F1139, F1140, F1141, F1142, F1143, F1144, F1145, F1146, F1147, F1148, F1149, F1150, F1151, F1152, F1153, F1154, F1155, F1156, F1157, F1158, F1159, F1160, F1161, F1162, F1163, F1164, F1165, F1166, F1167, F1168, F1169, F1170, F1171, F1172, F1173, F1174, F1175, F1176, F1177, F1178, F1179, F1180, F1181, F1182, F1183, F1184, F1185, F1186, F1187, F1188, F1189, F1190, F1191, F1192, F1193, F1194, F1195, F1196, F1197, F1198, F1199, F1200, F1201, F1202, F1203, F1204, F1205, F1206, F1207, F1208, F1209, F1210, F1211, F1212, F1213, F1214, F1215, F1216, F1217, F1218, F1219, F1220, F1221, F1222, F1223, F1224, F1225, F1226, F1227, F1228, F1229, F1230, F1231, F1232, F1233, F1234, F1235, F1236, F1237, F1238, F1239, F1240, F1241, F1242, F1243, F1244, F1245, F1246, F1247, F1248, F1249, F1250, F1251, F1252, F1253, F1254, F1255, F1256, F1257, F1258, F1259, F1260, F1261, F1262, F1263, F1264, F1265, F1266, F1267, F1268, F1269, F1270, F1271, F1272, F1273, F1274, F1275, F1276, F1277, F1278, F1279, F1280, F1281, F1282, F1283, F1284, F1285, F1286, F1287, F1288, F1289, F1290, F1291, F1292, F1293, F1294, F1295, F1296, F1297, F1298, F1299, F1300, F1301, F1302, F1303, F1304, F1305, F1306, F1307, F1308, F1309, F1310, F1311, F1312, F1313, F1314, F1315, F1316, F1317, F1318, F1319, F1320, F1321, F1322, F1323, F1324, F1325, F1326, F1327, F1328, F1329, F1330, F1331, F1332, F1333, F1334, F1335, F1336, F1337, F1338, F1339, F1340, F1341, F1342, F1343, F1344, F1345, F1346, F1347, F1348, F1349, F1350, F1351, F1352, F1353, F1354, F1355, F1356, F1357, F1358, F1359, F1360, F1361, F1362, F1363, F1364, F1365, F1366, F1367, F1368, F1369, F1370, F1371, F1372, F1373, F1374, F1375, F1376, F1377, F1378, F1379, F1380, F1381, F1382, F1383, F1384, F1385, F1386, F1387, F1388, F1389, F1390, F1391, F1392, F1393, F1394, F1395, F1396, F1397, F1398, F1399, F1400, F1401, F1402, F1403, F1404, F1405, F1406, F1407, F1408, F1409, F1410, F1411, F1412, F1413, F1414, F1415, F1416, F1417, F1418, F1419, F1420, F1421, F1422, F1423, F1424, F1425, F1426, F1427, F1428, F1429, F1430, F1431, F1432, F1433, F1434, F1435, F1436, F1437, F1438, F1439, F1440, F1441, F1442, F1443, F1444, F1445, F1446, F1447, F1448, F1449, F1450, F1451, F1452, F1453, F1454, F1455, F1456, F1457, F1458, F1459, F1460, F1461, F1462, F1463, F1464, F1465, F1466, F1467, F1468, F1469, F1470, F1471, F1472, F1473, F1474, F1475, F1476, F1477, F1478, F1479, F1480, F1481, F1482, F1483, F1484, F1485, F1486, F1487, F1488, F1489, F1490, F1491, F1492, F1493, F1494, F1495, F1496, F1497, F1498, F1499, F1500, F1501, F1502, F1503, F1504, F1505, F1506, F1507, F1508, F1509, F1510, F1511, F1512, F1513, F1514, F1515, F1516, F1517, F1518, F1519, F1520, F1521, F1522, F1523, F1524, F1525, F1526, F1527, F1528, F1529, F1530, F1531, F1532, F1533, F1534, F1535, F1536, F1537, F1538, F1539, F1540, F1541, F1542, F1543, F1544, F1545, F1546, F1547, F1548, F1549, F1550, F1551, F1552, F1553, F1554, F1555, F1556, F1557, F1558, F1559, F1560, F1561, F1562, F1563, F1564, F1565, F1566, F1567, F1568, F1569, F1570, F1571, F1572, F1573, F1574, F1575, F1576, F1577, F1578, F1579, F1580, F1581, F1582, F1583, F1584, F1585, F1586, F1587, F1588, F1589, F1590, F1591, F1592, F1593, F1594, F1595, F1596, F1597, F1598, F1599, F1600, F1601, F1602, F1603, F1604, F1605, F1606, F1607, F1608, F1609, F1610, F1611, F1612, F1613, F1614, F1615, F1616, F1617, F1618, F1619, F1620, F1621, F1622, F1623, F1624, F1625, F1626, F1627, F1628, F1629, F1630, F1631, F1632, F1633, F1634, F1635, F1636, F1637, F1638, F1639, F1640, F1641, F1642, F1643, F1644, F1645, F1646, F1647, F1648, F1649, F1650, F1651, F1652, F1653, F1654, F1655, F1656, F1657, F1658, F1659, F1660, F1661, F1662, F1663, F1664, F1665, F1666, F1667, F1668, F1669, F1670, F1671, F1672, F1673, F1674, F1675, F1676, F1677, F1678, F1679, F1680, F1681, F1682, F1683, F1684, F1685, F1686, F1687, F1688, F1689, F1690, F1691, F1692, F1693, F1694, F1695, F1696, F1697, F1698, F1699, F1700, F1701, F1702, F1703, F1704, F1705, F1706, F1707, F1708, F1709, F1710, F1711, F1712, F1713, F1714, F1715, F1716, F1717, F1718, F1719, F1720, F1721, F1722, F1723, F1724, F1725, F1726, F1727, F1728, F1729, F1730, F1731, F1732, F1733, F1734, F1735, F1736, F1737, F1738, F1739, F1740, F1741, F1742, F1743, F1744, F1745, F1746, F1747, F1748, F1749, F1750, F1751, F1752, F1753, F1754, F1755, F1756, F1757, F1758, F1759, F1760, F1761, F1762, F1763, F1764, F1765, F1766, F1767, F1768, F1769, F1770, F1771, F1772, F1773, F1774, F1775, F1776, F1777, F1778, F1779, F1780, F1781, F1782, F1783, F1784, F1785, F1786, F1787, F1788, F1789, F1790, F1791, F1792, F1793, F1794, F1795, F1796, F1797, F1798, F1799, F1800, F1801, F1802, F1803, F1804, F1805, F1806, F1807, F1808, F1809, F1810, F1811, F1812, F1813, F1814, F1815, F1816, F1817, F1818, F1819, F1820, F1821, F1822, F1823, F1824, F1825, F1826, F1827, F1828, F1829, F1830, F1831, F1832, F1833, F1834, F1835, F1836, F1837, F1838, F1839, F1840, F1841, F1842, F1843, F1844, F1845, F1846, F1847, F1848, F1849, F1850, F1851, F1852, F1853, F1854, F1855, F1856, F1857, F1858, F1859, F1860, F1861, F1862, F1863, F1864, F1865, F1866, F1867, F1868, F1869, F1870, F1871, F1872, F1873, F1874, F1875, F1876, F1877, F1878, F1879, F1880, F1881, F1882, F1883, F1884, F1885, F1886, F1887, F1888, F1889, F1890, F1891, F1892, F1893, F1894, F1895, F1896, F1897, F1898, F1899, F1900, F1901, F1902, F1903, F1904, F1905, F1906, F1907, F1908, F1909, F1910, F1911, F1912, F1913, F1914, F1915, F1916, F1917, F1918, F1919, F1920, F1921, F1922, F1923, F1924, F1925, F1926, F1927, F1928, F1929, F1930, F1931, F1932, F1933, F1934, F1935, F1936, F1937, F1938, F1939, F1940, F1941, F1942, F1943, F1944, F1945, F1946, F1947, F1948, F1949, F1950, F1951, F1952, F1953, F1954, F1955, F1956, F1957, F1958, F1959, F1960, F1961, F1962, F1963, F1964, F1965, F1966, F1967, F1968, F1969, F1970, F1971, F1972, F1973, F1974, F1975, F1976, F1977, F1978, F1979, F1980, F1981, F1982, F1983, F1984, F1985, F1986, F1987, F1988, F1989, F1990, F1991, F1992, F1993, F1994, F1995, F1996, F1997, F1998, F1999, F2000, F2001, F2002, F2004

Conclusions 1

• CL1
  Prior to, and since the release of our report, public interest in the delivery of mental health services to County residents continues to make news. In April 2005, the BOS held a workshop on mental health issues and listened to patient and provider complaints. In May, the BOS, in conjunction with local hospitals and the Shasta Community Health Center, agreed to seek funding for an outside consultant to review the operations of SCMH. The Grand Jury commends the review and hopes its findings will lead to an improved delivery of care. In July, SCMH psychiatrists finally applied for privileges at one local hospital, but not at the other. A claimed “lack of collegiality” at the hospitals was offered as the reason SCMH physicians had not previously applied for privileges. An unfriendly response is not a reason to seek or deny privileges, nor has it prevented other specialists from attempting to do so. This slow pace of psychiatrist integration into general medicine, and a similar disinterest of the medical community to “buy-in” to the public delivery of mental health care provided by SCMH, remains a significant obstacle to further progress. For example, the declining interest in establishing a joint-partnership, community- sponsored, detoxification center underscores the level of mistrust between providers, SCMH and local government. The integration of mental illness into mainstream medicine cannot occur without willing and effective leadership from all sides. Over the summer months, anecdotal stories from citizens about their inability to access care at SCMH continued to be heard by the BOS. Claims by SCMH administrators that “payer source” is not a factor in the decision to treat patients have been contradicted by both community physicians and families. The Grand 16 Jury remains concerned that there will be no resolution of SCMH bureaucracy and, therefore, gaps in coverage will continue. On a positive note, SCMH will hold a Mental Health Services Act (Proposition 63) public hearing and release its community action plan for funding in October. The Grand Jury applauds the effort by SCMH in soliciting broad community involvement over the past year and looks forward to the presentation of the plan. A major goal of our report was to expand the community discussion about mental health. We believe this has been accomplished. However, discussion is only the first step. Productive action by local government is still lacking. Even with re-opening an inpatient facility, the poor communication between SCMH and the medical community, the ongoing problems with patient access, and an overly bureaucratic mental health department, continue to stymie progress. Report No. 3: Redding Land Purchases The Grand Jury reported on the increasing number of land purchases by the City of Redding, specifically the purchase of an 82-acre vacant parcel along Interstate 5. The parcel, ostensibly purchased as a buffer zone to the City’s southern boundary, is situated mostly in a flood plain and lies outside the city limits. The $1.5 million purchase was funded by a loan to the City’s general fund from the Redding Electric Utility (REU) reserve fund. The report also focused on the use of Redevelopment funding for the purchase of two other properties. The City of Redding responded to four recommendations by letter submitted to the presiding judge of the Superior Court by the Mayor of Redding on July 20, 2005. Recommendation 1: The City Council needs to be more forthright in letting the public know why it is accumulating property for development and/or speculation in competition with private parties. Response: The City of Redding is not accumulating property for speculation in competition with private parties. Furthermore, the City of Redding has an excellent record of fully complying with the Ralph M. Brown Act (i.e., California’s “open meeting law”). The rationale for each decision that the City Council makes is contained in a written report that is made available to the public (via the City Clerk’s Office and via the City of Redding’s web site). In addition, the agenda for each City Council meeting is provided to the media in advance of each meeting. For the reasons outlined above, the City of Redding respectfully disagrees with the Grand Jury’s statement that the City of Redding needs to be more “forthright.” The City of Redding already conducts business in a forthright and highly ethical manner. 17 GJ Reply to the Response: The findings and recommendations in the report made no accusations of Brown Act noncompliance or violations. The 2004/2005 Grand Jury expressed concern about the apparently inflated purchase price, the appraisal process and the short escrow. “Speculation” was suspected after many interviewees agreed that a buffer zone was not the intended reason behind the purchase. Non- published staff documents obtained by the 2004/2005 Grand Jury described the parcel with a heading entitled “Riverside Auto Mall.” The Grand Jury disagrees with the response and does not concur that “forthright” is an appropriate adjective when describing the City’s explanation of property acquisitions. Recommendation 2: Redevelopment Funds should be used for redevelopment only, not for development. Response: The City of Redding disagrees with recommendation No. 2. The two redevelopment projects referenced in the Report fully comply with both the “letter” and “spirit” of Community Redevelopment Law. Redevelopment agencies throughout California undertake similar activities on a regular basis. Thus, the City of Redding does not intend to implement this recommendation. GJ Reply to the Response: The Grand Jury accepts the response with the understanding that redevelopment agencies and policies, when used appropriately, can be useful tools for revitalizing neighborhoods and business areas. However, we caution that redevelopment policy can also be subject to potential abuses. Recommendation 3: Borrowing of REU reserve funds for speculative land acquisition is an unsound business practice. When used for such purposes, these funds are unavailable for use by the utility for years. The Grand Jury recommends that the City Council utilize excess funds to lower electric rates instead of making real estate purchases. Response: The City of Redding disagrees with Recommendation No. 3. The use of internal loans is a sound business and management practice. Such loans can save the taxpayers of the City of Redding a significant amount of money. It would be more expensive to the taxpayers if the City of Redding borrowed these funds from a bank or another financial institution. As noted in the Report, the funds in question are being held in reserve, in part, for future capital projects and equipment purchases. Therefore, it would not be prudent to use these funds to “lower electric rates” at this time. This would simply result in higher electric rate increases in the future. Thus, the City of Redding does not intend to implement this recommendation. 18 GJ Reply to the Response: The Grand Jury is partially satisfied with the response. We note that, not only would it have been more expensive to borrow “...these funds from a bank or another financial institution,” under the circumstances, it would have been impossible. In the process of considering and granting loans, financial institutions require valid appraisals, collateral, appropriate loan documents, etc. – all of which the Grand Jury found incomplete or unavailable in support of this transaction. The Grand Jury acknowledges that REU rates tend to be lower than state averages, but we anticipate that REU rates, along with energy prices statewide, will increase over time. Capital projects and equipment purchases will certainly be a factor in the future success of REU. However, depleting the REU reserve fund by diverting money to unrelated land purchases is inconsistent with the defined purpose of the fund and confirms that at least some portions of the fund are, indeed, surplus. Instead of utilizing these surplus funds for unrelated discretionary purposes, the 2005/2006 Grand Jury believes rate relief to REU customers is the preferred alternative. Recommendation 4: The City Council must ensure full and timely repayment of the loan to Redding Electric Utility. Fees charged by public entities may not exceed the cost of providing the service. If the debt is forgiven by City Council, then the ratepayers will have paid in excess of the cost of electricity. Response: The City of Redding concurs with Recommendation No. 4. It has always been the City of Redding’s intent to fully repay the loan described in the Report in a timely manner. Thus, this recommendation has already been implemented. For the sake of accuracy, however, it should be noted that the second sentence in Recommendation No. 4 is not correct. The California Supreme Court has ruled that a municipal utility can generate a “profit” (see Hansen v City of San Buenaventura). (Included in the response, the City of Redding objected to Finding No. 1 in the Report) …the City of Redding has never indicated or implied that it intends to forgive the aforementioned loan at some point in the future. The City of Redding has made a number of loans between different City funds in the past. None of these loans have ever been forgiven. GJ Reply to the Response: The Grand Jury is not satisfied with the response. We do not consider the recommendation implemented until after the loan is repaid in full. Our concern is based on the fact that the City Council has “forgiven” loans made from other funds in the past. For example, the City Council recently forgave loans made to the Shasta County Women’s Refuge. The first loan of $75,000 was made in 1983 and a second loan for $74,459 was made in 1995. As stated by an Assistant City Manager in the minutes of the July 20, 2004, City Council meeting: “… the City Council has previously 19 forgiven a $75,000 loan, but severe budget constraints are forcing the Refuge to ask forgiveness of the $74,459 loan, as well.” The Assistant City Manager recommended, and the Council agreed, to forgive the second loan. The Grand Jury is not commenting on the appropriateness or advisability of the Council’s action; we are simply documenting that loan forgiveness has occurred more than once. Report No. 4: Safety First The Burney Fire Protection District (BFPD) report focused on ambulance fees and discussions involving turf issues/cross-coverage with the California Department of Forestry and Fire Protection (CDF). GJ Reply to the Response: The Grand Jury finds the BFPD response particularly disjointed; therefore, we are unable to utilize the format used in our other replies. The BFPD Board objected to most of the report’s findings. The Board’s response rationalized the District’s behavior, claimed the report contained many factual inaccuracies, and made numerous accusations against the 2004/2005 Grand Jury. We emphasize that the alleged inaccuracies were based on data supplied by the interviewed BFPD representatives themselves. The Grand Jury notes that there is increased community interest in the District Board elections. Pertaining to the three Grand Jury recommendations, the District failed to state whether each recommendation would be implemented, not yet implemented, required further analysis, or not be implemented as required by Section 933.05 of the Penal Code. Report No. 5: Water, Water, Everywhere The Anderson-Cottonwood Irrigation District (ACID) Report involved issues of subscriber dissatisfaction, possible Brown Act violations, and water delivery. In 2004 the ACID Board renewed a 40-year contract with U.S. Bureau of Reclamation that includes a reduction in water supply. The District responded to the Grand Jury recommendations on August 24, 2005. Recommendation 1: The District and its Board should expediently and thoroughly research the facts surrounding subscriber’s expressed concerns, and announce solutions and/or decisions at the earliest possible board meeting. 20 Response: The District agrees with this finding, and the General Manager and Board members will make themselves more aware and familiar with District policies, State water law and Constitution. Recommendation 2: ACID Board of Directors should review the Brown Act with regard to public participation. The public must be allowed to comment on agenda items as they are being considered prior to a vote; this is in addition to the Public Participation portion of the meeting reserved for discussion of non-agenda items. Response: This recommendation has been implemented, as each Board member has been provided with a copy of the Brown Act, and will make itself (sic) more familiar with open meeting laws along with comment periods during agenda items as well as the Public Participation portion of the meeting. Recommendation 3: All members of the Board of Directors should adopt and maintain a professional demeanor during public meetings. In addition, a review of the Decorum in Debate section of The New Robert’s rules of Order could be helpful in establishing Board debate protocol. Response: The District agrees with this finding, and this recommendation has been implemented, as each Board member has been provided with a copy of The New Rules of Order. Recommendation 4: The District should publish via newsletter, billing insert, or website, explanations of issues about which subscribers express confusion. Such repeated education could result in less friction and time-consuming discussion during board meetings. Response: The District agrees with this finding. The District has, for several years, included a management letter in its annual application/agreement packet that is mailed to its customers each February. The District is developing a website, and will be adding additional information to it as time permits. The District will also consider the development of a newsletter. GJ Reply to the Responses: The Grand Jury acknowledges receipt of all the responses. Report No. 6: Innovative Education 21 The Grand Jury looked at three charter schools sponsored by a local school district. This increasingly popular alternative to traditional public education has both positive and negative characteristics. In exchange for curriculum flexibility, each charter school surrenders business and administrative fees to its sponsor for supervisorial oversight. Recommendation 1: Each charter school should obtain financial/business training and expertise with regard to the operation of a charter school and its financial relationship with the sponsoring district. One form of training can be provided by the California Association of School Business Officials (CASBO). An outside consultant could also be considered. Response from Redding School of the Arts (RSA) (received August 24, 2005): (RSA Administrators)…have been proactive in increasing their knowledge of charter school finance through workshops and consultants. Both administrators attended a charter school finance workshop in Los Angeles in March 2005. Additional staff from RSA has attended CASBO and California Charter Schools Association workshops this past spring. To further strengthen the school’s financial expertise a consulting firm has been retained by RSA for the 2005-06 school year to work with the charter school and the Shasta Union High school District (SUHSD). Response from University Preparatory School (UPS) (received September 29, 2005): In response, our leadership intends to follow the recommendation of the Grand Jury and will obtain financial/business training and expertise with regard to the operation of UPS and its financial relationship to Shasta Union High School District. We intend to meet this goal by attending an appropriate training program and consulting outside experts in the areas of charter school finance and business as the need arises. GJ Reply to the Response: The Grand Jury acknowledges and appreciates the details of the responses. Recommendation 2: The District and RSA need to improve communication. Total revenue, supervisorial changes, and which specific funds the District should have access to, should be reviewed and fully understood by both parties. Response from RSA: RSA, its consulting firm, and the Chief Business Officer will continue to meet bi-monthly or as necessary to improve communication during the 2005- 06 school year. RSA and SUHSD will be negotiating the Memorandum of Understanding this fall in hopes of clarifying which funds the district should have access to. It is hoped that the consulting firm can help clarify laws surrounding revenues, federal grants, district costs and supervision. RSA would very much appreciate the Superintendent and/or the Chief Business manager attending the regularly scheduled 22 board meetings. It would also be RSA’s wish that the SUHSD board liaison to RSA resume regularly scheduled attendance at RSA Governing Board meetings. Response from SUHSD (received on August 15, 2005): Beginning August 2004, the District’s Chief Business Official and the Budget Analyst met regularly with the two RSA directors, special education psychologist, and a parent volunteer. The frequency of the meetings was an agreed upon attempt to improve communication and provide training in charter finance and budget. The District’s business staff will continue to offer regularly scheduled meetings for the RSA directors and other charter employees. GJ Reply to the Response: The Grand Jury is satisfied with the responses. Recommendation 3: The Superintendent and/or Chief business Official of the District should attend board meetings of the charter schools at least two to three times per year. Response from SUHSD: Both the Superintendent and Chief Business Official have attended board meetings of the charter schools during 2004-05. When requested, they have presented information or training at both regular charter board meetings and at special charter study sessions. The District will continue to provide this service on an ongoing basis. In summary, the Board will continue with the existing communication practices already in place. Specifically, Board members will continue to act as liaisons with the charter school boards. The liaisons sit on the charter boards as non-voting members. In addition, the Board will continue to encourage the charter schools to attend and present at District Board meetings. The Board and administration will also continue their open-door policy. GJ Reply to the Response: The Grand Jury acknowledges the response. Report No. 7: West Nile Virus Reaches the North State The increasing spread of West Nile Virus across the western United States prompted this investigation of Shasta County’s preparedness against this mosquito-borne illness. The Grand Jury was impressed by the readiness of the largest (and best financed) of the three Vector Control Districts in the County to meet this threat. In summary, the Grand Jury recommendations encouraged increased public education of the disease and prompted the two smaller districts to consider various avenues of funding for improved control of mosquitoes. 23 Responses from the Districts (received July 20, 2005, from the Burney Basin Mosquito Abatement District (BBMAD) and August 29, 2005, from the Shasta Mosquito and Vector Control District (SMVCD)): In summary, the SMVCD outlined many of its ongoing public education and research programs. The BBMAD replied that “ the Board of Directors…chooses at this time, not to seek a Benefit Assessment Tax,…and is seeking additional funding from the State.” GJ Reply to the Responses: The Grand Jury accepts the responses and acknowledges the financial constraints of small districts. We applaud the districts for the low prevalence of West Nile cases in Shasta County compared to other north state counties. The Pine Grove Mosquito Abatement District failed to respond to the Grand Jury’s recommendation. This non-response violates Penal Code section 933.05. Report No. 8: Ready to Respond This Grand Jury Report identified some problems at the Cottonwood Fire Protection District (CFPD) including sloppy record keeping, deficient policies and procedures, lack of elections for Board positions, and the need for a formal planning process. Recommendation 1: The CFPD should make it a priority to find at least part-time clerical personnel, whether paid or volunteer. This would help mitigate the poor record keeping and general lack of organization found by the Grand Jury. More importantly, it would allow time for the Chief and Captain to focus on CFPD’s emergency response responsibilities while addressing matters discussed in Findings 2, 3 and 4. Response from the District (received September 20, 2005): Now as to the first recommendation, the Board and staff totally agree with the finding that the Department would greatly benefit by having clerical help to assist the Chief…such that he could better concentrate on operational duties and responsibilities. We will elaborate more on this issue in the fourth recommendation. Recommendation 2: Effective policies and procedures are needed to comply with legal mandates and to promote good practice generally. It is not enough to just have policies and procedures. “Effective” means well-defined policies (statements that provide managerial guidance) and procedures (operational reflections of those policies) that are written, well organized, crystal-clear, and well communicated. CFPD should begin the process of developing and writing its policies and procedures and set a date by which they will be completed. 24 Response: As stated in the second recommendation, much of our policies and procedures are fragmented and in some cases vague. Our Department agrees that we can upgrade and update the documents from a Mission statement through Operational Policy and Procedures by no later than February of 2006. GJ Reply to the Response: The Grand Jury accepts the response. Recommendation 3: Board elections are prescribed by state law and CFPD’s by-laws. The Grand Jury finds that elections are preferable to appointments to ensure that the Board does not stagnate and become ineffective. Simply posting the required legal notices when a board seat becomes vacant is insufficient. CFPD should take steps necessary to generate publicity and enthusiasm for Board service. Response: Our Department agrees that elections are preferable to appointments, however, unless there are issues that adversely affect members of the community, people aren’t interested in serving in a public position for no monetary compensation. Due to budget constraints over the years, our Board members have elected to remain non-paid, this savings being directed toward Department operations. There will be an election this year. GJ Reply to the Response: The Grand Jury accepts the response. Recommendation 4: A formal strategic planning process should be created and then implemented. A planning team should be established and team members should be drawn from local business people, District Board, fire personnel, and especially, residents. A strategic plan would review all areas and issues necessary to set the future direction of CFPD. The results can be formulated into a clear vision, with mission and value statements, that would be a guide for many years. This collaborative effort would greatly improve CFPD’s relationships and communications with the business community and residents. Public support for funding initiatives necessary to execute the plan would follow. Response: It has been this administrations goal to return to a compliment of three full time employees. By hiring the 3rd employee, this will reduce the operational burdens on the Chief and free up time for more administrative duties. Based on our recent review of the 2005/06 operating budget, this will strongly be considered to occur this fiscal year. The District is currently researching another project that will generate additionally sustained revenues such that part time clerical could follow as well. Our Board recently met again with all members of the Department for a brainstorming session to compile a list of present and future needs for the Department and community. From this list, we intend to formulate our next ten year plan…the last ten year plan had 25 twenty-one items, twenty have been completed with the remaining item being the new main fire station. In reference to our long term strategic planning, the new, main station is to not only house the Fire department, but it will have provision for an office for a Shasta County Sheriff sub-station, the Citizen’s Patrol, and possibly an office to house an ambulance company. At this point, we understand that the community needs to be involved and this administration will be advertising our approach to this project. GJ Reply to the Response: The Grand Jury accepts the response. Report No. 9: And… This Report summarized several minor Grand Jury investigations and generated only a single recommendation concerning the installation of radio towers in the Jones Valley area and the use permit appeal process in Shasta County. Recommendation: That the Shasta County Board of Supervisors reduces the fee for appeal of use permits and lengthens its appeal period. Response from the Board of Supervisors: No response received. GJ Reply to the Response: The Board of Supervisors did not respond to the Grand Jury’s recommendations regarding the $400 fee and five-day window for appealing use permits. This non-response is in violation of Penal Code section 933.05. 26

Commendations 38

• CM1 Page 1
  The District continues to maintain accounts that are significantly past due. In the fiscal year 2001/2002 annual audit of the District, it was recommended that old accounts be aggressively collected or “written off” as bad debt. The District has not implemented this recommendation.
• CM2 Page 1
  The District uses two cellular phones for general communication. The Grand Jury reviewed three months of cellular phone bills and found that they were in excess of $300 per month.
• CM3 Page 1
  The District does not maintain an accurate subsidiary ledger of customer deposits. This list shows customer deposits since the 1970’s. All annual audits reviewed by the Grand Jury recommended that the District update the customer deposit ledger. The District has not implemented this recommendation.
• CM4 Page 1
  The District does not maintain an accurate subsidiary ledger of inventory and does not have a process in place for an annual inventory. The fiscal year 2002/2003 audit recommended the District keep a year-end fiscal inventory and maintains an inventory subsidiary ledger. The District has not implemented this
• CM5 Page 1
  The District has had to sell off a portion of its investments each year to service the District’s operating expenses. This is depleting the cash balance of the District. The District does not generate sufficient revenue to cover debt service on the 1973 and 1979 bonds and the 1973 Drought Relief loan. The debt service for fiscal year 2003/2004 is $42,782.00. Annual audits reviewed by the Grand Jury recommended that the District take the steps necessary to generate sufficient revenue to cover debt service and operating expenses without depleting cash reserves. The District increased water and sewer rates by 15% in August 2001 and by 20% in November 2003. The former District Manager and the Auditors stated that the rate increases would be insufficient to cover the District’s expenses.
• CM6
  During the Grand Jury investigation the District Manager submitted his verbal resignation to the Board of Directors, and left his position on March 22, 2004. The Board of Directors has employed a new District Manager.
• CM7
  During the Grand Jury investigation it was reported that several board meetings were cancelled due to a lack of a quorum. The Grand Jury reviewed the minutes for January through December 2003 and determined that three meetings out of twelve were cancelled due to lack of a quorum. To encourage attendance the board changed its monthly meeting time and day to accommodate one of its members.
• CM8
  The District does not have a Policy and Procedures Manual. At the time of the investigation, the District staff were reviewing a Policy and Procedures Manual from another water district. After personalizing the manual to the District, it will be presented to the board for adoption.
• CM9
  The former District Manager had never received a performance appraisal during his 25 years of employment with the District.
• CM10
  The former District Manager reported he used his personal vehicle to conduct District business for approximately one year, due to a lack of funding for District vehicle repairs. During this time, the former District Manager used the District’s gas card to fuel his vehicle in lieu of claiming reimbursement for mileage. The former District Manager used the District vehicle for the remainder of his employment.
• CM11
  The District continues to maintain accounts that are significantly past due. In the fiscal year 2001/2002 annual audit of the District, it was recommended that old accounts be aggressively collected or “written off” as bad debt. The District has not implemented this recommendation.
• CM12
  In the 2000/2001, 2001/2002 and 2002/2003 annual audits, the auditing firm noted that the District’s bond agreements require that certain amounts be maintained by the District as reserve or restricted cash to meet current interest and principal requirements. The audit report reviewed by the Grand Jury recommended accounts for note funds, reserve funds, operation and maintenance funds, and a surplus fund. The District has not implemented this
• CM13
  During the interviews, employees and board members told the Grand Jury that payroll advances were seldom used. However, the auditing firm provided a ledger prepared by the District showing 39 payroll advances during fiscal year 2002/2003. In all of the annual audits reviewed by the Grand Jury, the auditing firm recommended discontinuing the practice of payroll advances. The District has not implemented this recommendation.
• CM14
  The District has no formal policy for purchasing those items needed for the District’s use. The District maintains several open charge accounts at various local businesses.
• CM15
  The District uses two cellular phones for general communication. The Grand Jury reviewed three months of cellular phone bills and found that they were in excess of $300 per month.
• CM16
  The District has no long-term Master Water Plan. A Master Water Plan is an engineering study of the water system that includes preliminary plans with scheduling and cost estimates for future system maintenance, repairs, equipment replacements, and major capital improvements. A plan helps ensure that the community’s present and future water quality and supply needs are met in an efficient and economical matter. This practice allows the District to properly prepare and budget for its future needs.
• CM17
  The District does not maintain an accurate subsidiary ledger of customer deposits. This list shows customer deposits since the 1970’s. All annual audits reviewed by the Grand Jury recommended that the District update the customer deposit ledger. The District has not implemented this recommendation.
• CM18
  The District does not maintain an accurate subsidiary ledger of inventory and does not have a process in place for an annual inventory. The fiscal year 2002/2003 audit recommended the District keep a year-end fiscal inventory and maintains an inventory subsidiary ledger. The District has not implemented this
• CM19
  The District has had to sell off a portion of its investments each year to service the District’s operating expenses. This is depleting the cash balance of the District. The District does not generate sufficient revenue to cover debt service on the 1973 and 1979 bonds and the 1973 Drought Relief loan. The debt service for fiscal year 2003/2004 is $42,782.00. Annual audits reviewed by the Grand Jury recommended that the District take the steps necessary to generate sufficient revenue to cover debt service and operating expenses without depleting cash reserves. The District increased water and sewer rates by 15% in August 2001 and by 20% in November 2003. The former District Manager and the Auditors stated that the rate increases would be insufficient to cover the District’s expenses.
• CM20
  For the fiscal years ended June 30, 2001, 2002 and 2003, the District had an excess of expenses over revenue of $84,912, $70,034 and $82,041 respectively.
• CM21
  SCDPH used flyers, office signs, radio and television ads to educate the public on the fluoridation of drinking water.
• CM22
  Subdivision (a) of Government Code Section 8314 provides: "It shall be unlawful for any elected state or local officer, including any state or local appointee, employee, or consultant, to use or permit others to use public resources for a campaign activity, or personal or other purposed which are not authorized by law." Subdivision (d) of Government Code Section 8314 provides: "Nothing in this section shall prohibit the use of public resources for providing information to the public about the possible effects of any bond issue or other ballot measure on state activities, operations, or policies, provided that (1) the informational activities are otherwise authorized by the constitution or laws of this state, and (2) the information provided constitutes a fair and impartial presentation of relevant facts to aid the electorate in reaching an informed judgment regarding the bond issue or ballot measure."
• CM23
  The Shasta County Employee Handbook, dated July 2003, in the section entitled "Political Activities" notes that there are state and federal laws, which place restrictions on the political activities of public employees. As a matter of County policy, the handbook provides that employees and officers may participate in management of a candidate for public office, may contribute money to political campaigns or organizations, may attend political fund raising functions, may actively campaign for candidates and may otherwise participate in the political process, all on their own time. However, officers and employees may not engage in these or any other political activities during working hours, on County premises or using County facilities or equipment. However, employees and officers who perform duties in connection with activities funded by the Federal Government are subject to the Hatch Act. The Hatch Act provides, among other things, that an officer or employee may not: a. Use his or her official authority or influence for the purpose of interfering with or affecting the results of an election or a nomination for office: b. directly or indirectly coerce, attempt to coerce, command, or advise a state or local officer or employee to pay, lend or contribute anything of value to a party, committee, organization, agency, or person for political purposes.
• CM24
  Several private action groups such as Shasta Oral Health Task Force, Shasta Community Health Center, and Redding Citizens for Healthy Smiles promoted water fluoridation during 2001/2002.
• CM25
  Shasta Oral Health Task Force and Shasta Community Health Center work very closely with SCDPH to make the best use of public and private resources for the health care of Shasta county citizens.
• CM26
  The Grand Jury's investigation into the involvement of county employees use of public funds in the fluoridation campaign did not find unauthorized use of public funds.
• CM27
  The February 5, 2004 BOC Inspection Report reviewed by the Grand Jury revealed SCJH to be compliant with Titles 15 and 24 of the California Code of Regulations Minimum Standards for Juvenile Facilities and an improvement in living conditions, schooling, safety and staff morale since April, 2003.
• CM28
  The jail received a two year accreditation in March of 2003 from the American Medical Association’s institutional medical quality review board.
• CM29
  In April 2003, the facility passed the bi-annual Board of Corrections Inspection.
• CM30
  In August 2003, the facility passed the annual Health and Nutrition Inspection done by the Shasta County Public Health Department.
• CM31
  From July 7, 2003 through March 23, 2004 there was one suicide, one attempted suicide, and one death from natural causes in the jail. In addition, there was one death from natural causes within 13 hours of the inmate’s release from jail.
• CM32
  The Shasta County Main Jail staffing includes: • One Captain • One Lieutenant • Five Sergeants • 24 Deputy Sheriffs • 21 Correctional Officers (appointed, not peace officers) • 25 Service Officers (appointed, no inmate contact, no peace officer powers) • One Administrative Secretary • Eight Cooks/Laundry Officers • One Support Services Manager
• CM33
  The jail’s budget for the fiscal year 2003/2004 is $9,808,153. This is scheduled to be reduced by $179,000 due to a funding reduction by the State.
• CM34
  The current contract with CFMG for medical and psychiatric services for inmates is for $1,159,575 annually.
• CM35
  CFMG has incorporated Tele-Psychiatry into its mental health program. This allows an inmate to be evaluated by a psychiatrist utilizing closed circuit television.
• CM36
  The Booking Fee is currently $128. This is the fee that a city pays to have a suspect arrested by city police booked into the jail. State and federal law enforcement agencies (such as the CHP) are exempt from this fee.
• CM37
  Currently, it costs $63 per day to house an inmate.
• CM38
  The California Department of Corrections and the California Department of Forestry are commended for their cooperative efforts and team approach resulting in a successful joint agency program. We Said, They Said: Reply to Responses from the 2004/2005 Grand Jury Report INTRODUCTION: California Penal Code Section 916 requires that problems identified in a grand jury report be accompanied by suggested recommendations for their resolution. Official responses to grand jury recommendations are governed by California Penal Code sections 933 and 933.05. All responses are submitted to the presiding judge of the Superior Court. Elected officials are required to respond to the report’s findings and recommendations within 60 days and governing bodies within 90 days. Responders must state whether they agree or disagree with each finding and recommendation and any disagreements must be explained. Moreover, each responder must state the extent to which the recommendation has been implemented, or when it will be implemented, or why it will not be implemented. The 2004/2005 Shasta County Grand Jury Final Report was presented to the presiding judge of the Superior Court on June 25, 2005, as prescribed by California Penal Code Section 933.05. All entities investigated by that grand jury received copies of the report on the same date. The present 2005/2006 Grand Jury believes that releasing a report presenting the responses to last year’s report would be of public interest. What follows is a summary of each of the 2004/2005 reports, which contained recommendations for the resolution of problems identified by the Grand Jury. Recommendations are restated (in italics) followed by the corresponding responses for each recommendation and the current Grand Jury’s evaluation of each response (in boldface). The full text of the reports can be accessed on the Grand Jury web site at www.co.shasta.ca.us. RESPONSES TO REPORTS: Report No. 1: Memory Park Subdivision: Playing Monopoly with the City of Redding The Grand Jury investigated a citizen’s complaint against the City of Redding regarding a proposed “planned, in-fill development” subdivision (Memory Park), which received Planning Department approval, but was eventually rejected by the City Council. Neighborhood opposition to the proposed subdivision was led by a former city employee who was, at the time, a McConnell Foundation board member. The City of Redding responded to the three recommendations on July 20, 2005. Members of the current 2005/2006 Grand Jury (including carryover members from 2004/2005) were in attendance when the Redding City Council voted to accept the responses by a 3-0 vote (two abstentions). During his interview by a Grand Jury committee in 2004, one council member repeatedly recused himself from responding to most questions on the subdivision investigation because of a perceived “conflict of 1 interest.” Despite his previous recusal, this same council member voted in favor of the City Council response a year later. Recommendation 1: The City Council should not derail well designed Infill and Planned Developments. Response: Concur, if they meet the General Plan and other development policies as determined by the public’s elected representatives who are selected to make these decisions. The Grand Jury’s finding on this matter (No. 6) has substantial factual errors. The City Council determined that the project was not consistent with the General Plan. The design of the project contained aspects that did not comply with the General Plan policy. GJ Reply to the Response: The Grand Jury finds the City Council’s response unacceptable. The Grand Jury determined that the project was consistent with the General Plan. Furthermore, if “…the project was not consistent with the General Plan,” as stated above, then it should not have been approved by the Planning Department in the first place. Recommendation 2: The Planning Department should attempt to expedite the permit approval process. The City’s Ombudsman report on recommended process changes should continue to be implemented. Response: Grand Jury Finding No. 9 states that “the City’s Ombudsman Report on Recommended Process Changes was presented to the City Council for consideration on October 25, 2004. …Some of these recommendations are being implemented by the City’s Development Services Department.” In fact, all of these measures are being implemented with the exception of the permit tracking system. The tracking system is extremely expensive, which is why it has taken longer than the other points mentioned in the Grand Jury’s findings. However, the City Council will be discussing this issue as the City looks at planning and engineering fee increases in the next few months. GJ Reply to the Response: The Grand Jury finds the response acceptable and looks forward to the implementation of the permit tracking system. Recommendation 3: Political influence should not override sound planning decisions. Response: Concur. Grand Jury Finding No. 8 states that, “strong political influence was exerted on the Planning Commission and City Council to disapprove this project.” This is obviously a statement of opinion. It would be equally valid to say that strong political pressure was exerted on the Planning Commission and City Council to approve the 2 project. Concerns for and against projects will very likely continue as the City entertains more infill projects. GJ Reply to the Response: The Grand Jury finds the response acceptable. However, it remains our “opinion” that the front-row presence of McConnell Foundation executives at the City Council meeting regarding opposition to this project represented undue “strong political influence” against the project’s approval. Report No. 2: Haste Makes Waste In a lengthy report, the 2004/2005 Grand Jury investigated the closure of the Shasta County Psychiatric Hospital Facility (PHF) and its impact on inpatient care of the acutely mentally ill. The overall operation of the Shasta County Mental Health Department (SCMH) was also investigated. The required response from the Shasta County Board of Supervisors (BOS) was sent to the presiding judge of the superior court on September 27, 2005. The Director of SCMH was also invited to respond to certain recommendations; the response was received on August 29, 2005. Recommendation 1: The County Board of Supervisors (BOS), the Mental Health Advisory Board (MHAB) and SCMH should increase public education about mental impairment. This should concentrate on understanding the disease, reducing its stigma, procuring a diagnosis and accessing treatment. County Government and SCMH should focus on improving public education through grants, requesting volunteer media exposure and improvements in the ineffective SCMH Web site. SCMH and the BOS should support and promote Mental Health Awareness Week each October. The Grand Jury recommends the MHAB institute a regularly reporting, public education subcommittee. Response from the BOS: The BOS concurs with the Grand Jury’s findings that the BOS, MHA, and the SCMH Department should increase public education about mental impairment. Currently, the SCMH conducts and participates in many educational and public outreach activities. (The response lists 10 educational activities involving staff and other professionals as well as a 10-page proposed Mental Health Education and Outreach Plan). The Board concurs with the Grand Jury recommendation to improve the quality of and expand the use of electronic communication through a web site. SCMH will be working with Trilogy Integrated Resources, a contractor selected by the State Department of Mental Health to develop a local web site titled “Network of Mental Health Care,” which will be funded by the State’s Mental Health Services Act funds. This web site will be of value to individual patients, families, and the community in general to provide a resource directory as well as other valuable features customized for Shasta County. 3 GJ Reply to the Response: The Grand Jury accepts the response and eagerly awaits the implementation of a comprehensive web site. The 2005/2006 Grand Jury is concerned that the level of general public education about mental illness remains inadequate. We encourage further efforts by the BOS and SCMH to educate all the public, not only those with Internet access, about available services. Recommendation 2: SCMH needs to improve its relationship with the local medical community by encouraging input from private-practice psychiatrists, emergency room physicians and primary care practitioners involved in treating the mentally impaired. A more collaborative interaction with local hospitals and area clinics is further recommended. We find that improved communication between SCMH and community physicians could be the foundation for future cooperation. The Grand Jury strongly suggests that, like other physician specialists, all psychiatrists employed by the County obtain clinical privileges at local hospitals and directly attend to patients in the emergency room. SCMH should reinstate 5150 authority to non-county psychiatrists and emergency room physicians. Accomplishing the above would promote the integration of mental health care into mainstream medicine. Response from the SCMH Director: SCMH agrees that communication is the key to quality patient care. In conjunction with the North Valley Medical Association (NVMA), SCMH will continue to expand efforts in the area of training for physicians in order to bring together SCMH psychiatrists and medical practitioners in Shasta County. NVMA in conjunction with an attorney with knowledge of …5150 authority, presented training on involuntary detention and treatment on July 20, 2005. The training, although well marketed by NVMA, was not well attended by area physicians. This training was intended to stimulate dialogue regarding the legal aspects of involuntary detention and treatment. (A list of in-service training for county hospital emergency department physicians was included). The SCMH Medical Chief currently has Medical Staff Privileges at all three hospitals in the county. The SCMH Medical Staff will continue to explore an expanded role with the community clinics and Mayers Memorial Hospital through telemedicine. SCMH Medical Staff are also pursuing hospital consultation privileges with Shasta Regional Medical Center and urgent consultation availability to community physicians. GJ Reply to the Response: The Grand Jury finds the response inadequate. It is not surprising that 5150 training would be poorly attended by emergency room physicians and private practice psychiatrists. These practitioners previously held, then were stripped of 5150 authority by the SCMH Director prior to the closure of the PHF. The confusion and delay in reinstating this privilege to a local private psychiatrist at the request of the BOS (September 2005), and the continued lack of 5150 privileges among emergency room physicians, is not an indication of a cooperative effort on the part of SCMH. 4 The Grand Jury further notes that integration at the physician level remains inadequate; we remain convinced that obtaining staff privileges is an essential step toward the integration of mental health care into mainstream medicine. As of October 10, 2005, only one SCMH psychiatrist, the Medical Chief, holds privileges at both major area hospitals. Indeed, at one hospital, no other SCMH psychiatrists have even begun the staff application process. This lack of participation underscores the ineffective leadership at SCMH. Recommendation 3: SCMH should hire some primary care practitioners or physician assistants in lieu of more costly psychiatrists and incorporate these front-line providers into the SCMH structure. SCMH should focus on the critical role case managers play in maintaining continuity of care for out-of-county inpatients once their acute care is completed and they return to Shasta County. Response from the SCMH Director: SCMH is committed to maintaining the highest level of psychiatric services for its clients and, as a result, will continue to employ and contract with physicians who have completed an approved residency in psychiatry. SCMH concurs with the recommendation regarding the critical role that case management plays in coordinating discharge planning for patients transitioning from acute care. In an effort to identify, treat, and provide psychosocial supports for frequent utilizers of the local emergency departments, SCMH is developing a coordinated case management plan in collaboration with the Shasta Community Health Center, NVMA, and other community providers. Connecting theses patients with additional community supports and directs access to treatment through collaborative efforts will reduce emergency response costs by approximately 42 percent and provide stability to this vulnerable population. GJ Reply to the Response: The Grand Jury applauds the emphasis on case management by SCMH. However, the Grand Jury recommendation to augment the SCMH psychiatry staff with general practitioners represents another step to integrate mental impairment into general medicine. This would allow more attentive treatment of co-morbid conditions such as hypertension, diabetes and emphysema. Here is another missed opportunity to integrate the more common and easily treated mental illnesses such as depression, anxiety and stress disorders into general medical care. Recommendation 4: The Shasta County BOS should consider privatizing, in part or in total, the delivery of mental health services to the citizens of the county. With proper oversight, this would offer a more efficient overall operation. Assurances that all patients requiring treatment actually receive treatment would be necessary. The Grand Jury feels an extensive and well-planned transition program, with input from the general public and all providers of mental healthcare delivery, must precede any transfer from public to private operation. 5 Response from the BOS: Currently 54 percent of the SCMH budget is devoted to contract services, and this has consistently increased over the past 2-3 fiscal years. As a result, SCMH is more than half “privatized.” With each contract for services entered into by the BOS, SCMH must assure that services are delivered in accordance with State Department of Mental Health requirements, which govern target population, service delivery, and the receipt of State and federal funds. SCMH provides mental health services to the residents of Shasta County in compliance with three State Department of Mental Health contracts. These contracts include very specific terms and conditions and are renewed annually with the approval of the BOS. (A one-page description of the contracts accompanied the response). The Grand Jury notes in its findings a number of perceptions regarding the role of SCMH in the delivery and authorization of inpatient mental health services that are not consistent with this contract and SCMH’s practice. The first and most important misperception is related to access to psychiatric hospitalization for all Medi-Cal eligible Shasta county residents. There are no pre-authorization requirements for emergency admissions to psychiatric inpatient hospitals for Shasta County Medi-Cal beneficiaries. SCMH provides post-admission review of written Treatment Authorization Requests submitted by hospitals as required by the State prior to payment by EDS (Electronic Data Systems). Since SCMH is no longer a provider of psychiatric hospital services, independent practitioners affiliated with the private treating facilities now make the determination of the patient’s admission and continued stay. GJ Reply to the Response: The Grand Jury disagrees with the response. The intent of the recommendation was to consider privatizing the entire mental health delivery system in Shasta County, including its administration. The privatization discussed by the BOS was, in part, necessitated by the closure of the PHF; patients who require hospitalization for acute mental illness now need to be hospitalized out-of- county (i.e., “privatized”). SCMH does serve as the managed care provider and pre-authorizer for Medi-Cal beneficiaries in Shasta County. This was confirmed by the SCMH Director (on two occasions), Deputy Director, and by multiple psychiatrists during the investigation; the Director of the NVMA concurred during a public forum held by the BOS in April 2005. Recommendation 5: The Grand Jury recommends the SCMH Director improve lines of communication to ensure that SCMH policies affecting the medical community and other public agencies are uniform and consistent. We encourage SCMH to continue to improve access to its crisis intervention teams to reduce emergency room transfer delays. Moreover, to improve the continuity of patient care, we suggest that SCMH expedite the transfer of medical information (history, diagnosis and prescriptions) along with patients requiring out-of-county care. Conversely, SCMH should demand that discharge summaries accompany its patients returning from out-of-county facilities. Additionally, 6 the Grand Jury discourages the indiscriminate delegation of 5150 authority by the SCMH Director. Response from the SCMH Director: SCMH concurs with the recommendation regarding communication with the medical community and out of county facilities. SCMH will promote collaborative efforts with the NVMA to provide education and training for area physicians regarding the treatment of psychiatric illness. As stated in Response No. 3, another solution to the local emergency department congestion and transfer time delays is the implementation of a coordinated case management system that will provide wraparound medical and behavioral healthcare, and psychosocial supports to a population identified as frequent utilizers of the Mental Health emergency response system. SCMH, in collaboration with North State counties, looks forward to the opening of the North Valley Behavioral Health and Sequoia Psychiatric Center PHF in Yuba City, both of which will exclusively treat our patients. This will greatly enhance the continuity of care and communication of critical patient care issues on admission and discharge for Shasta County patients. GJ Reply to the Response: The Grand Jury generally agrees with the response, however, the indiscriminate delegation of 5150 authority was not addressed. Recommendation 6: SCMH should establish written cost-sharing policies with the County Jail, Juvenile Hall, Probation department and other agencies for inpatient care and transportation of their mentally impaired inmates or clients. SCMH should improve its service to county agencies affected by the PHF closure, e.g. attend to inmates at the Main Jail and Juvenile Hall. Response from the SCMH Director: The Shasta County Sheriff’s Department and Probation Department maintain a contract with Prison Health Services for the provision of health and mental health services in the jail and juvenile hall. This contract is comprehensive in scope and specifies the responsibility of the provider in the provision of all planned and urgent medical services, including psychiatry. The contract includes the responsibility of the provider for reimbursement of hospital services for inmates and wards in custody, but excludes the contact provider from responsibility for reimbursement for psychiatric hospitalization. As a result, there is a serious gap in coverage for jail inmates in custody and juvenile wards in custody. SCMH works cooperatively with jail and juvenile hall staff to address this gap on a case-by-case basis, following written protocols that were developed collaboratively between the Sheriff’s Department, Probation Department, and Mental Health. SCMH also provides the services of a psychologist in juvenile hall and SHIFT (Shasta Housing Intervention For Transition) Program services in the jail to assist Prison Health Services and the courts with inmate/ward mental health issues. 7 GJ Reply to the Response: The above response is inadequate. It does not address transportation protocols and/or cost sharing between SCMH and incarceration facilities since the closure of the PHF. The problem of court ordered on-site psychiatric evaluations is also not addressed. Jail representatives were unable to produce written protocols for inmate evaluation and treatment. Recommendation 7: The BOS and SCMH should closely monitor the costs (including all transportation costs) of out-of-county inpatient care. The Grand Jury offers the following options for reestablishing inpatient psychiatric services for which the County still holds State licensure: iReopen the 15-bed PHF at the previous site on Breslauer Way by deleting its Medicare designation and adopting strict admission criteria for adult inpatients. This would reduce the average daily cost of care by 50 percent (to $2 million per year) and also minimize patient safety issues. Medicare inpatients requiring hospitalization would be cared for at other facilities. iOpen a 15-bed basic PHF on Breslauer way as a combined adult/child inpatient facility by designating 10 beds for adults and five for children. iOpen a 15-bed basic PHF on Breslauer as the only north state child inpatient facility. Costs would be more manageable and there is a very low risk of associated physical co- morbidity in this age group. The BOS should obtain sufficient information to determine whether or not to renew the SCMH $1.3 million yearly contract for the Elpida Crisis Residential Center. Any option to reopen a PHF would necessitate either closing or relocating this center. The Grand jury recommends closure. In that event, inpatient psychiatric services could be funded using current SCMH revenues generated by increasing efficiency, reducing out-of-county inpatient care, substituting primary care practitioners for some psychiatrists and eliminating costly Medicare staffing. Moreover, additional funding may become available beginning in 2005/2006 through the Mental Health Services Act. The Grand Jury believes that County residents could, and should, have local access to both inpatient and outpatient mental health services. Inpatient child psychiatric services have been identified as woefully inadequate for decades and the Grand Jury invites Shasta County to take the initiative and establish a child/adolescent inpatient facility. A north state regional, multi-county proposal for Mental Health Services Act funds (perhaps orchestrated by the SCMH Director) could establish a geographically centered, acute care facility for children with mental impairment. Benefits of such a facility to the overall mental health of children include earlier recognition and treatment of impairment and an improved continuity of care. Enhanced case management, better social rehabilitative services, access to intensive family psychotherapy and recruitment of more child psychiatrists could result from a successful program. This is an opportune time for Shasta County to address the psychiatric needs of north state children. 8 Response from the BOS: SCMH has submitted the planned budget to the Shasta County Administrative Office including projected expenditures and revenues for fiscal year 2005/2006. In this budget, the SCMH department does not recommend that it operate a staff a psychiatric health facility during fiscal year 2005/2006. The BOS concurs that an involuntary mental health acute care inpatient unit is needed in Shasta County but realizes that patient safety is of the utmost importance. In an effort to meet the medical needs of all patients, the delivery of mental health treatment services (involuntary or voluntary) should be integrated with emergency and primary health care. The County PHF was not licensed to provide emergency medical or primary health care services, therefore, reopening the facility is not viable. SCMH, in collaboration with the Shasta County Administrative Office and the North Valley Medical Association (NVMA), has facilitated contacts between interested providers of inpatient behavioral health services and the administrators of the local general hospitals. The goal of this collaboration is to integrate acute care psychiatry into mainstream primary health care so that those suffering from mental illness have the opportunity to receive treatment for all of their medical needs in an environment where they are not stigmatized or isolated form medical care. The BOS agrees that a regional approach to specialty psychiatric care is viable for target populations. An example of the potential in this area is the soon to open North Valley Behavioral and Sequoia Psychiatric Center PHF. SCMH has taken a strong leadership role in this 4-year effort and the SCMH Director sits on the steering committee that has been responsible for the planning and implementation of these facilities. Specifically regarding the viability of a regional facility for children, SCMH has promoted three regional options. The first option was the establishment of a regional locked community treatment facility, which was not supported at a regional level. The second option was the dedication of one of the new regional psychiatric facilities to children, which was also not regionally supported. The third option is the establishment of a regional interagency crisis assessment center for children. This option may be considered as a priority focus under the Mental Health Services Act. GJ Reply to the Response: The Grand Jury disagrees with the response. Adequate revenue exists for the reestablishment of a local, scaled-down (i.e., non-Medicare) PHF. Strict admission criteria would greatly reduce patient safety issues. The BOS talks of integrated care, but the SCMH Director’s responses to recommendations 2, 3 and 5 above, do little to promote integration with primary health care. The BOS response claims the County PHF is not licensed for emergency medical or primary health care and therefore, reopening it is not a viable option. The Grand Jury notes that while none of the State PHFs are licensed for emergency medical or primary health care services, they continue to provide acute psychiatric inpatient care. The Grand Jury further notes that the North Valley Behavioral and Sequoia Psychiatric Center, to which Shasta County sends inpatients for treatment, is not a full-service hospital providing integrated health care. Moreover, the BOS response does not address the recommended closure of the Elpida Crisis Center. 9 The Grand Jury suggests that the BOS need only look as far as Butte County to consider a functioning non-Medicare designated PHF. The Butte County PHF exists because of support by both the general public and the Butte County Mental Health Director. The integration with mainstream medical care for their patients with co-morbidities is easily obtained because of a positive relationship with the medical community of that County. Recommendation 8: Other inpatient psychiatric services could include: iThe reopening of inpatient services for Medicare patients at a local rehabilitation facility. iA truly collaborative effort between SCMH and the local medical community too begin laying the groundwork for an inpatient psychiatric unit in one of the local full-service hospitals. Response from the BOS: The Shasta County BOS concurs with the recommendation that a local inpatient facility should be pursued. This facility should have the capacity to treat patients flexibly, which is best done in a licensed general hospital. SCMH, in conjunction with the Shasta County Administrative Office, has facilitated contracts with three corporations that are providers of behavioral health services that would like to develop a local inpatient facility. At a recent presentation, one provider made it clear that the provision of behavioral health services in a licensed general hospital with more than 100 beds is financially viable and of economic benefit to the hospital. NVMA representatives have made it contact with this provider and will facilitate meetings in an effort to promote the proposal, gain support from local hospitals, and encourage community involvement in this potential opportunity. GJ Reply to the Response: The Grand Jury accepts the response and awaits the outcome of this potential effort. The SCMH department is working with the NVMA to facilitate contacts between interested psychiatric providers and local hospitals. The Grand Jury applauds this portion of the response, but as noted in our report, the establishment of a psychiatric unit in a local full-service hospital is a three-year process. Recommendation 10: The Grand Jury suggests that the BOS pay a site visit to the County-contracted Elpida Crisis Residential Center and closely evaluate the benefits of the contract’s automatic renewal after fiscal year 2004/2005. Should Elpida remain open, the Grand Jury also recommends adoption of a formal lease between the County and Elpida’s private sponsor and establishment of an Elpida Policies and Procedures Manual. 10 Response from the BOS: Representatives from the BOS, County Administrative Office, and Mental Health Advisory Board participated in a tour of the Elpida Crisis Residential Center on September 7, 2005, as recommended by the Grand jury. The Elpida crisis residential Center maintains a policy and procedures manual that addresses the areas required by State regulation. GJ Reply to the Response: The Grand Jury finds the response inadequate. Only two Supervisors participated in the Elpida tour and no evaluation of the benefit of extending the contract was made. The response did not address a lease between the County and Elpida’s private sponsor. The Grand Jury is still awaiting receipt of the Policy and Procedures Manual from Elpida. Recommendation 11: The Grand Jury recommends the County BOS and SCMH consider both financial and staffing support of a proposed County Detoxification Center. This center would afford opportunity for an improved collaboration between SCMH and both the local medical community and city governments. Establishment of a detoxification center would reduce the congestion in local hospital emergency rooms. Mental Health Services Act (Proposition 63) funding could be an additional source of financial support. Response from the BOS: The BOS, SCMH, and the Shasta County Alcohol and Drug Programs (SCADP) are in complete support of expanding the social model detoxification program in Shasta County. This is consistent with the “Community Action Plan” developed by representatives of Mercy Medical Center, Shasta Regional Medical Center, Shasta Community Health Center, the Good News Rescue Mission, SCMH, and the SCADP. A memorandum of understanding (MOU) has been developed by SCADP and circulated to the participants and other recommended collaborative partners. To date, only the City of Shasta Lake and the Shasta County Administrative Office have responded with support. The role of the Mental Health Services Act (Proposition 63) funding in this service expansion will be determined once the State Department of Mental Health guidelines for application for funding have been finalized and distributed. Additionally, the input received from stakeholders at more than 30 State required focus groups, conducted by SCMH, must be considered when prioritizing areas of need for mental health services expansion. This process targeted for completion in October to allow for a timely submission to the State Department of Mental Health. GJ Reply to the Response: The Grand Jury is satisfied with the response. We are also discouraged that only two collaborators have committed financially to a project that received unanimous support from all interviewees. Recommendation 12: The Grand Jury recommends that County and City Government guarantee public safety at all times by ensuring law enforcement personnel attend to 11 5150-designated patients while they are treated in, and until they are transferred from, local “unlocked” emergency rooms. Response from the BOS: The process for transfer of law enforcement 5150 detentions is governed by an interagency agreement developed by local law enforcement agencies in collaboration with representatives of SCMH, Shasta regional Medical Center, Mercy Medical Center, and Mayers Memorial Hospital District. Less than half of the calls to the emergency departments are the result of this process. More than half of the calls for SCMH crisis response are for patients who have presented to the emergency departments without law enforcement involvement. Thus, law enforcement personnel are not present in these cases while the emergency department examines the patient to determine if an emergency medical condition exists consistent with the federal requirements under the Emergency Medical Treatment and Labor Act. In these cases, SCMH determines the legal status of the patient if the emergency department physician decides that transfer or discharge to a specialty psychiatric facility is necessary. Response from the City of Redding: The Grand Jury recommendation requires further analysis. The Police Chief cannot guarantee that law enforcement personnel attend to 5150-designated patients while they are “treated in, and until they are transferred from, local unlocked emergency rooms.” It would mean that police officers would need to be diverted from our neighborhoods and businesses to attend to individuals who should be at a detoxification center or at a mental health facility for as much as 24 to 30 hours. Currently, police officers remain at the hospital with a 5150-designated patient until the patient is stabilized and no longer believed to present a threat to themselves or anyone else. Since the closure of the County PHF, police time necessary to handle these calls has already increased 66%. Remaining at the hospital to await transportation would further tax resources by doubling the average amount of time spent by police with each patient. We agree with the hospitals that the solution is not more police officers, but rather more and better health care. Specifically, patients need to be evaluated much quicker as to the cause of their illness (drugs, alcohol, or mental health) and the patients need to be transferred, where appropriate to a detoxification center or a mental health facility. Having patients come to a hospital emergency room, waiting much too long for evaluation, and having a police officer sit in an emergency room and spend time with that patient for hours and hours is a poor use of the public’s limited resources and is not a solution to the premature closure of the County’s Mental Health Facility. Response from the City of Anderson (received August 18, 2005): Just like the Grand Jury, the City of Anderson, as well as our Chief of Police, are very concerned about public safety. As such, we cannot guarantee that Anderson Police Department (APD) officers can attend to 5150-designated patients “until they are transferred from local ‘unlocked’ emergency rooms.” To meet this recommendation, police officers would need top be diverted from our neighborhoods and businesses to attend to individuals who 12 should be at a detoxification center or at a mental health facility for a minimum of several hours and/or as much as twenty-four to thirty hours. Diverting officers from their patrol duties would not guarantee public safety, but instead would decrease public safety in our own neighborhoods by reducing the number of officers available for law enforcement. Typically, ADP deploys two to three officers on each twelve-hour shift. These officers’s primary responsibility is the safety and security of the Community of Anderson. Currently, when an arrest is made, or a 5150-designated patient is taken into civil arrest custody, the shift coverage is reduced to two officers, and too often to just one officer, remaining in the City. Obviously this represents not only an “officer safety” issue but a “community safety” issue as well. Currently, an ADP officer will remain at the hospital with a 5150-designated patient until the patient is stabilized and no longer believed to present a threat to himself or herself or anyone else. Since the premature closure of the Shasta County Mental Psychiatric Facility, without adequate planning, the amount of time a police officer must spend at the hospitals handling 5150-designated patient calls has already increased. Remaining at the hospital to await transfer, as recommended by the Grand Jury, would further tax APD’s resources, typically doubling the average amount of time spent by the officer with each 5150-designated patient. The Anderson City Council appreciates the opportunity to respond to Grand Jury Recommendation Number 12 and hopes that our response is helpful. Response from the City of Shasta Lake (received July 28, 2005): The City of Shasta Lake agrees with the recommendation. Law enforcement services for the City of Shasta Lake are provided by the Shasta County Sheriff’s Department. The Sheriff has provided these services since the City’s incorporation in 1993. It is currently the policy of the Shasta County Sheriff’s department to provide law enforcement personnel to attend 5150-designated persons while they are treated in, and until they are transferred from local unlocked emergency rooms. GJ Reply to the Responses: The Grand Jury accepts the responses from the representatives of law enforcement in the County. We acknowledge the extra time and cost of attending to 5150-designated patients. We remain concerned that persons, who by definition are a risk to themselves or others, even when stabilized, are left unattended in area emergency rooms. A potential for harm within the hospital setting, or after a 5150 designee decides to leave against medical advice, remains a public safety issue. Recommendation 13: The MHAB needs broader community representation. Private physician, local hospital and clinic, and law enforcement inclusion would strengthen the MHAB role as the community advocate for mental health issues. The Grand Jury encourages the BOS to improve the MHAB composition and strongly urges the MHAB to carefully review all major contracts entered into by SCMH. 13 Response from the BOS: the BOS concurs with the Grand Jury’s recommendation regarding the expansion of community representation on the Mental Health Board. The Chairperson will work with the Mental Health Board Membership Committee to recruit a broader cross-section of community members. The MHAB will continue to review the State Department of Mental Health Performance Contract, which governs aspects of the operations of the SCMH Department before it is submitted to the BOS for approval. GJ Reply to the Response: The Grand Jury is satisfied with the response and again encourages MHAB input on all major contracts entered into by SCMH. Recommendation 14: Citizens of Shasta County can take advantage of a new source of state funding for expanded mental health services through the Mental Health Services Act. Similar to new library construction funding a few years ago, this Act awards state tax revenues to individual or joint county proposals for services based on the merits of the plans submitted. Shasta County citizens rallied impressively to support the library and the Grand Jury strongly recommends the BOS encourage a similar community effort. This is an excellent opportunity for increasing access to local services that are both desperately needed and chronically under funded. Mental health services should be prioritized through the public input sessions sponsored by SCMH. The BOS and MHAB should incorporate this community input into any proposal being submitted. Response from the BOS: The BOS concurs with the Grand Jury recommendations regarding the Mental Health Services Act. GJ Reply to the Response: The Grand Jury appreciates the response. The Grand Jury is concerned that a broad community effort to mobilize for real change in local mental health service delivery is not a priority. The BOS consistently ignores community needs for access to local inpatient care by allowing SCMH to export inpatients to out-of-county facilities. While purporting to support the active integration of mental illness into mainstream medicine, BOS policies and SCMH decisions continue to impede this integration. If the BOS, SCMH and area providers cannot unite to address this problem, it is unlikely that cohesive community support will follow. Recommendation 15: The BOS should not rely entirely on staff recommendations when considering future funding and direction of mental health policy in Shasta County. Assigning large, long-term, mo-bid contracts for untried services (Elpida) and closing the super PHF against the recommendations of the MHAB and a citizen’s Community Committee do not represent the best interests of County residents. Since the prior BOS (with the exception of one member) felt economic considerations superceded community recommendations to maintain an inpatient facility, the Grand jury encourages the current BOS (with two new members) to reexamine the issue. From the data presented in this 14 report, the Grand Jury recommends the BOS reconsider the economic factors that led to the decision to close the PHF. We fully appreciate the patient safety issues of the inpatient facility as it was configured prior to its closure. However, our investigation indicates that reopening a basic PHF (non-Medicare) with strict admission criteria is an economically viable and safe alternative to having no local locked inpatient facility at all. Establishing appropriate and affordable local inpatient hospital services would improve patient access ands care and alleviate the problems generated by the closure of the PHF. In conclusion, the Shasta county Grand jury asks the BOS to examine all the facts and govern for its constituents, and not for what benefits SCMH. Response from the BOS: The BOS does not rely solely on the recommendations of staff when considering funding or policy changes. The Board follows an extensive process of review to include a departmental staff report, County Administrative Office review and concurrence, County Counsel review, and Risk Management review. In addition, the Board receives and considers constituent feedback, including Advisory Board input, and public input regarding all Shasta County issues. The BOS voted 4-1 to close the PHF after considering all of the information and several factors including patient safety due to the lack of emergency medical care and the subsequent exposure to litigation. Continued operation of the PHF would require significant funding reductions in other areas of the Mental Health Department. Mental Health Outpatient services would have to be eliminated to ensure the ongoing financial viability of the inpatient unit. Discontinuing outpatient treatment programs would impact a larger population than the closure of the PHF. The loss of outpatient treatment services would impact approximately 87 percent of the total SCMH patient population receiving preventative services, case management, therapy, life management skills, medical management skills, counseling, and other specialty services that minimize or eliminate the need for emergency mental health treatment. Without outpatient treatment the need for emergency mental health treatment services would increase exponentially and exceed the capacity of the PHF. The legal, social, and fiscal impact on law enforcement, social support agencies, and the community in general would be significant. The Grand jury recommendation states that the Elpida contract was a large, long-term, no-bid contract for untried services. The initial term for the Elpida Crisis Residential contract commenced July 1, 2004, and ended on June 30, 2005. The contract was renewed for the same term length for fiscal year 2005-2006 on July 1, 2005. The Elpida Crisis Recovery Center is a subsidiary organization of Crestwood behavioral Health, Inc. Shasta County has had many contractual agreements with Crestwood for similar residential psychiatric services. The Elpida contract was approved by the Board in an amount not to exceed $1,124,200. This amount represents a cost savings for inpatient services that were provided at the PHF. GJ Reply to the Response: The Grand Jury disagrees with the response. With the exception of this final recommendation, all the responses received from the BOS 15 appear to have been provided solely by SCMH; they are taken almost verbatim from a set of responses received earlier from the SCMH Director. This is an indication of a continued over-reliance on staff recommendations. We feel compelled to point out that the Elpida Center is not licensed as a locked inpatient acute care facility (i.e., a PHF) and is not similar to other Shasta County- Crestwood psychiatric ventures. And although some patients are transferred from local emergency rooms directly to Elpida, it remains our contention that expenditures for this facility do little to address the need of County residents for acute inpatient treatment. The Grand Jury remains convinced that developing our own inpatient services is preferable to renting them. We contend that reopening a basic PHF is economically viable, as the yearly cost for a similar facility in Butte County is around $2 million. This represents less than 10 percent of the total SCMH budget, and less than the County is now spending for Elpida and out-of-county inpatient facilities. It is our belief that this will not impact the delivery of outpatient mental health services as described in the response. Conclusion: Prior to, and since the release of our report, public interest in the delivery of mental health services to County residents continues to make news. In April 2005, the BOS held a workshop on mental health issues and listened to patient and provider complaints. In May, the BOS, in conjunction with local hospitals and the Shasta Community Health Center, agreed to seek funding for an outside consultant to review the operations of SCMH. The Grand Jury commends the review and hopes its findings will lead to an improved delivery of care. In July, SCMH psychiatrists finally applied for privileges at one local hospital, but not at the other. A claimed “lack of collegiality” at the hospitals was offered as the reason SCMH physicians had not previously applied for privileges. An unfriendly response is not a reason to seek or deny privileges, nor has it prevented other specialists from attempting to do so. This slow pace of psychiatrist integration into general medicine, and a similar disinterest of the medical community to “buy-in” to the public delivery of mental health care provided by SCMH, remains a significant obstacle to further progress. For example, the declining interest in establishing a joint-partnership, community- sponsored, detoxification center underscores the level of mistrust between providers, SCMH and local government. The integration of mental illness into mainstream medicine cannot occur without willing and effective leadership from all sides. Over the summer months, anecdotal stories from citizens about their inability to access care at SCMH continued to be heard by the BOS. Claims by SCMH administrators that “payer source” is not a factor in the decision to treat patients have been contradicted by both community physicians and families. The Grand 16 Jury remains concerned that there will be no resolution of SCMH bureaucracy and, therefore, gaps in coverage will continue. On a positive note, SCMH will hold a Mental Health Services Act (Proposition 63) public hearing and release its community action plan for funding in October. The Grand Jury applauds the effort by SCMH in soliciting broad community involvement over the past year and looks forward to the presentation of the plan. A major goal of our report was to expand the community discussion about mental health. We believe this has been accomplished. However, discussion is only the first step. Productive action by local government is still lacking. Even with re-opening an inpatient facility, the poor communication between SCMH and the medical community, the ongoing problems with patient access, and an overly bureaucratic mental health department, continue to stymie progress. Report No. 3: Redding Land Purchases The Grand Jury reported on the increasing number of land purchases by the City of Redding, specifically the purchase of an 82-acre vacant parcel along Interstate 5. The parcel, ostensibly purchased as a buffer zone to the City’s southern boundary, is situated mostly in a flood plain and lies outside the city limits. The $1.5 million purchase was funded by a loan to the City’s general fund from the Redding Electric Utility (REU) reserve fund. The report also focused on the use of Redevelopment funding for the purchase of two other properties. The City of Redding responded to four recommendations by letter submitted to the presiding judge of the Superior Court by the Mayor of Redding on July 20, 2005. Recommendation 1: The City Council needs to be more forthright in letting the public know why it is accumulating property for development and/or speculation in competition with private parties. Response: The City of Redding is not accumulating property for speculation in competition with private parties. Furthermore, the City of Redding has an excellent record of fully complying with the Ralph M. Brown Act (i.e., California’s “open meeting law”). The rationale for each decision that the City Council makes is contained in a written report that is made available to the public (via the City Clerk’s Office and via the City of Redding’s web site). In addition, the agenda for each City Council meeting is provided to the media in advance of each meeting. For the reasons outlined above, the City of Redding respectfully disagrees with the Grand Jury’s statement that the City of Redding needs to be more “forthright.” The City of Redding already conducts business in a forthright and highly ethical manner. 17 GJ Reply to the Response: The findings and recommendations in the report made no accusations of Brown Act noncompliance or violations. The 2004/2005 Grand Jury expressed concern about the apparently inflated purchase price, the appraisal process and the short escrow. “Speculation” was suspected after many interviewees agreed that a buffer zone was not the intended reason behind the purchase. Non- published staff documents obtained by the 2004/2005 Grand Jury described the parcel with a heading entitled “Riverside Auto Mall.” The Grand Jury disagrees with the response and does not concur that “forthright” is an appropriate adjective when describing the City’s explanation of property acquisitions. Recommendation 2: Redevelopment Funds should be used for redevelopment only, not for development. Response: The City of Redding disagrees with recommendation No. 2. The two redevelopment projects referenced in the Report fully comply with both the “letter” and “spirit” of Community Redevelopment Law. Redevelopment agencies throughout California undertake similar activities on a regular basis. Thus, the City of Redding does not intend to implement this recommendation. GJ Reply to the Response: The Grand Jury accepts the response with the understanding that redevelopment agencies and policies, when used appropriately, can be useful tools for revitalizing neighborhoods and business areas. However, we caution that redevelopment policy can also be subject to potential abuses. Recommendation 3: Borrowing of REU reserve funds for speculative land acquisition is an unsound business practice. When used for such purposes, these funds are unavailable for use by the utility for years. The Grand Jury recommends that the City Council utilize excess funds to lower electric rates instead of making real estate purchases. Response: The City of Redding disagrees with Recommendation No. 3. The use of internal loans is a sound business and management practice. Such loans can save the taxpayers of the City of Redding a significant amount of money. It would be more expensive to the taxpayers if the City of Redding borrowed these funds from a bank or another financial institution. As noted in the Report, the funds in question are being held in reserve, in part, for future capital projects and equipment purchases. Therefore, it would not be prudent to use these funds to “lower electric rates” at this time. This would simply result in higher electric rate increases in the future. Thus, the City of Redding does not intend to implement this recommendation. 18 GJ Reply to the Response: The Grand Jury is partially satisfied with the response. We note that, not only would it have been more expensive to borrow “...these funds from a bank or another financial institution,” under the circumstances, it would have been impossible. In the process of considering and granting loans, financial institutions require valid appraisals, collateral, appropriate loan documents, etc. – all of which the Grand Jury found incomplete or unavailable in support of this transaction. The Grand Jury acknowledges that REU rates tend to be lower than state averages, but we anticipate that REU rates, along with energy prices statewide, will increase over time. Capital projects and equipment purchases will certainly be a factor in the future success of REU. However, depleting the REU reserve fund by diverting money to unrelated land purchases is inconsistent with the defined purpose of the fund and confirms that at least some portions of the fund are, indeed, surplus. Instead of utilizing these surplus funds for unrelated discretionary purposes, the 2005/2006 Grand Jury believes rate relief to REU customers is the preferred alternative. Recommendation 4: The City Council must ensure full and timely repayment of the loan to Redding Electric Utility. Fees charged by public entities may not exceed the cost of providing the service. If the debt is forgiven by City Council, then the ratepayers will have paid in excess of the cost of electricity. Response: The City of Redding concurs with Recommendation No. 4. It has always been the City of Redding’s intent to fully repay the loan described in the Report in a timely manner. Thus, this recommendation has already been implemented. For the sake of accuracy, however, it should be noted that the second sentence in Recommendation No. 4 is not correct. The California Supreme Court has ruled that a municipal utility can generate a “profit” (see Hansen v City of San Buenaventura). (Included in the response, the City of Redding objected to Finding No. 1 in the Report) …the City of Redding has never indicated or implied that it intends to forgive the aforementioned loan at some point in the future. The City of Redding has made a number of loans between different City funds in the past. None of these loans have ever been forgiven. GJ Reply to the Response: The Grand Jury is not satisfied with the response. We do not consider the recommendation implemented until after the loan is repaid in full. Our concern is based on the fact that the City Council has “forgiven” loans made from other funds in the past. For example, the City Council recently forgave loans made to the Shasta County Women’s Refuge. The first loan of $75,000 was made in 1983 and a second loan for $74,459 was made in 1995. As stated by an Assistant City Manager in the minutes of the July 20, 2004, City Council meeting: “… the City Council has previously 19 forgiven a $75,000 loan, but severe budget constraints are forcing the Refuge to ask forgiveness of the $74,459 loan, as well.” The Assistant City Manager recommended, and the Council agreed, to forgive the second loan. The Grand Jury is not commenting on the appropriateness or advisability of the Council’s action; we are simply documenting that loan forgiveness has occurred more than once. Report No. 4: Safety First The Burney Fire Protection District (BFPD) report focused on ambulance fees and discussions involving turf issues/cross-coverage with the California Department of Forestry and Fire Protection (CDF). GJ Reply to the Response: The Grand Jury finds the BFPD response particularly disjointed; therefore, we are unable to utilize the format used in our other replies. The BFPD Board objected to most of the report’s findings. The Board’s response rationalized the District’s behavior, claimed the report contained many factual inaccuracies, and made numerous accusations against the 2004/2005 Grand Jury. We emphasize that the alleged inaccuracies were based on data supplied by the interviewed BFPD representatives themselves. The Grand Jury notes that there is increased community interest in the District Board elections. Pertaining to the three Grand Jury recommendations, the District failed to state whether each recommendation would be implemented, not yet implemented, required further analysis, or not be implemented as required by Section 933.05 of the Penal Code. Report No. 5: Water, Water, Everywhere The Anderson-Cottonwood Irrigation District (ACID) Report involved issues of subscriber dissatisfaction, possible Brown Act violations, and water delivery. In 2004 the ACID Board renewed a 40-year contract with U.S. Bureau of Reclamation that includes a reduction in water supply. The District responded to the Grand Jury recommendations on August 24, 2005. Recommendation 1: The District and its Board should expediently and thoroughly research the facts surrounding subscriber’s expressed concerns, and announce solutions and/or decisions at the earliest possible board meeting. 20 Response: The District agrees with this finding, and the General Manager and Board members will make themselves more aware and familiar with District policies, State water law and Constitution. Recommendation 2: ACID Board of Directors should review the Brown Act with regard to public participation. The public must be allowed to comment on agenda items as they are being considered prior to a vote; this is in addition to the Public Participation portion of the meeting reserved for discussion of non-agenda items. Response: This recommendation has been implemented, as each Board member has been provided with a copy of the Brown Act, and will make itself (sic) more familiar with open meeting laws along with comment periods during agenda items as well as the Public Participation portion of the meeting. Recommendation 3: All members of the Board of Directors should adopt and maintain a professional demeanor during public meetings. In addition, a review of the Decorum in Debate section of The New Robert’s rules of Order could be helpful in establishing Board debate protocol. Response: The District agrees with this finding, and this recommendation has been implemented, as each Board member has been provided with a copy of The New Rules of Order. Recommendation 4: The District should publish via newsletter, billing insert, or website, explanations of issues about which subscribers express confusion. Such repeated education could result in less friction and time-consuming discussion during board meetings. Response: The District agrees with this finding. The District has, for several years, included a management letter in its annual application/agreement packet that is mailed to its customers each February. The District is developing a website, and will be adding additional information to it as time permits. The District will also consider the development of a newsletter. GJ Reply to the Responses: The Grand Jury acknowledges receipt of all the responses. Report No. 6: Innovative Education 21 The Grand Jury looked at three charter schools sponsored by a local school district. This increasingly popular alternative to traditional public education has both positive and negative characteristics. In exchange for curriculum flexibility, each charter school surrenders business and administrative fees to its sponsor for supervisorial oversight. Recommendation 1: Each charter school should obtain financial/business training and expertise with regard to the operation of a charter school and its financial relationship with the sponsoring district. One form of training can be provided by the California Association of School Business Officials (CASBO). An outside consultant could also be considered. Response from Redding School of the Arts (RSA) (received August 24, 2005): (RSA Administrators)…have been proactive in increasing their knowledge of charter school finance through workshops and consultants. Both administrators attended a charter school finance workshop in Los Angeles in March 2005. Additional staff from RSA has attended CASBO and California Charter Schools Association workshops this past spring. To further strengthen the school’s financial expertise a consulting firm has been retained by RSA for the 2005-06 school year to work with the charter school and the Shasta Union High school District (SUHSD). Response from University Preparatory School (UPS) (received September 29, 2005): In response, our leadership intends to follow the recommendation of the Grand Jury and will obtain financial/business training and expertise with regard to the operation of UPS and its financial relationship to Shasta Union High School District. We intend to meet this goal by attending an appropriate training program and consulting outside experts in the areas of charter school finance and business as the need arises. GJ Reply to the Response: The Grand Jury acknowledges and appreciates the details of the responses. Recommendation 2: The District and RSA need to improve communication. Total revenue, supervisorial changes, and which specific funds the District should have access to, should be reviewed and fully understood by both parties. Response from RSA: RSA, its consulting firm, and the Chief Business Officer will continue to meet bi-monthly or as necessary to improve communication during the 2005- 06 school year. RSA and SUHSD will be negotiating the Memorandum of Understanding this fall in hopes of clarifying which funds the district should have access to. It is hoped that the consulting firm can help clarify laws surrounding revenues, federal grants, district costs and supervision. RSA would very much appreciate the Superintendent and/or the Chief Business manager attending the regularly scheduled 22 board meetings. It would also be RSA’s wish that the SUHSD board liaison to RSA resume regularly scheduled attendance at RSA Governing Board meetings. Response from SUHSD (received on August 15, 2005): Beginning August 2004, the District’s Chief Business Official and the Budget Analyst met regularly with the two RSA directors, special education psychologist, and a parent volunteer. The frequency of the meetings was an agreed upon attempt to improve communication and provide training in charter finance and budget. The District’s business staff will continue to offer regularly scheduled meetings for the RSA directors and other charter employees. GJ Reply to the Response: The Grand Jury is satisfied with the responses. Recommendation 3: The Superintendent and/or Chief business Official of the District should attend board meetings of the charter schools at least two to three times per year. Response from SUHSD: Both the Superintendent and Chief Business Official have attended board meetings of the charter schools during 2004-05. When requested, they have presented information or training at both regular charter board meetings and at special charter study sessions. The District will continue to provide this service on an ongoing basis. In summary, the Board will continue with the existing communication practices already in place. Specifically, Board members will continue to act as liaisons with the charter school boards. The liaisons sit on the charter boards as non-voting members. In addition, the Board will continue to encourage the charter schools to attend and present at District Board meetings. The Board and administration will also continue their open-door policy. GJ Reply to the Response: The Grand Jury acknowledges the response. Report No. 7: West Nile Virus Reaches the North State The increasing spread of West Nile Virus across the western United States prompted this investigation of Shasta County’s preparedness against this mosquito-borne illness. The Grand Jury was impressed by the readiness of the largest (and best financed) of the three Vector Control Districts in the County to meet this threat. In summary, the Grand Jury recommendations encouraged increased public education of the disease and prompted the two smaller districts to consider various avenues of funding for improved control of mosquitoes. 23 Responses from the Districts (received July 20, 2005, from the Burney Basin Mosquito Abatement District (BBMAD) and August 29, 2005, from the Shasta Mosquito and Vector Control District (SMVCD)): In summary, the SMVCD outlined many of its ongoing public education and research programs. The BBMAD replied that “ the Board of Directors…chooses at this time, not to seek a Benefit Assessment Tax,…and is seeking additional funding from the State.” GJ Reply to the Responses: The Grand Jury accepts the responses and acknowledges the financial constraints of small districts. We applaud the districts for the low prevalence of West Nile cases in Shasta County compared to other north state counties. The Pine Grove Mosquito Abatement District failed to respond to the Grand Jury’s recommendation. This non-response violates Penal Code section 933.05. Report No. 8: Ready to Respond This Grand Jury Report identified some problems at the Cottonwood Fire Protection District (CFPD) including sloppy record keeping, deficient policies and procedures, lack of elections for Board positions, and the need for a formal planning process. Recommendation 1: The CFPD should make it a priority to find at least part-time clerical personnel, whether paid or volunteer. This would help mitigate the poor record keeping and general lack of organization found by the Grand Jury. More importantly, it would allow time for the Chief and Captain to focus on CFPD’s emergency response responsibilities while addressing matters discussed in Findings 2, 3 and 4. Response from the District (received September 20, 2005): Now as to the first recommendation, the Board and staff totally agree with the finding that the Department would greatly benefit by having clerical help to assist the Chief…such that he could better concentrate on operational duties and responsibilities. We will elaborate more on this issue in the fourth recommendation. Recommendation 2: Effective policies and procedures are needed to comply with legal mandates and to promote good practice generally. It is not enough to just have policies and procedures. “Effective” means well-defined policies (statements that provide managerial guidance) and procedures (operational reflections of those policies) that are written, well organized, crystal-clear, and well communicated. CFPD should begin the process of developing and writing its policies and procedures and set a date by which they will be completed. 24 Response: As stated in the second recommendation, much of our policies and procedures are fragmented and in some cases vague. Our Department agrees that we can upgrade and update the documents from a Mission statement through Operational Policy and Procedures by no later than February of 2006. GJ Reply to the Response: The Grand Jury accepts the response. Recommendation 3: Board elections are prescribed by state law and CFPD’s by-laws. The Grand Jury finds that elections are preferable to appointments to ensure that the Board does not stagnate and become ineffective. Simply posting the required legal notices when a board seat becomes vacant is insufficient. CFPD should take steps necessary to generate publicity and enthusiasm for Board service. Response: Our Department agrees that elections are preferable to appointments, however, unless there are issues that adversely affect members of the community, people aren’t interested in serving in a public position for no monetary compensation. Due to budget constraints over the years, our Board members have elected to remain non-paid, this savings being directed toward Department operations. There will be an election this year. GJ Reply to the Response: The Grand Jury accepts the response. Recommendation 4: A formal strategic planning process should be created and then implemented. A planning team should be established and team members should be drawn from local business people, District Board, fire personnel, and especially, residents. A strategic plan would review all areas and issues necessary to set the future direction of CFPD. The results can be formulated into a clear vision, with mission and value statements, that would be a guide for many years. This collaborative effort would greatly improve CFPD’s relationships and communications with the business community and residents. Public support for funding initiatives necessary to execute the plan would follow. Response: It has been this administrations goal to return to a compliment of three full time employees. By hiring the 3rd employee, this will reduce the operational burdens on the Chief and free up time for more administrative duties. Based on our recent review of the 2005/06 operating budget, this will strongly be considered to occur this fiscal year. The District is currently researching another project that will generate additionally sustained revenues such that part time clerical could follow as well. Our Board recently met again with all members of the Department for a brainstorming session to compile a list of present and future needs for the Department and community. From this list, we intend to formulate our next ten year plan…the last ten year plan had 25 twenty-one items, twenty have been completed with the remaining item being the new main fire station. In reference to our long term strategic planning, the new, main station is to not only house the Fire department, but it will have provision for an office for a Shasta County Sheriff sub-station, the Citizen’s Patrol, and possibly an office to house an ambulance company. At this point, we understand that the community needs to be involved and this administration will be advertising our approach to this project. GJ Reply to the Response: The Grand Jury accepts the response. Report No. 9: And… This Report summarized several minor Grand Jury investigations and generated only a single recommendation concerning the installation of radio towers in the Jones Valley area and the use permit appeal process in Shasta County. Recommendation: That the Shasta County Board of Supervisors reduces the fee for appeal of use permits and lengthens its appeal period. Response from the Board of Supervisors: No response received. GJ Reply to the Response: The Board of Supervisors did not respond to the Grand Jury’s recommendations regarding the $400 fee and five-day window for appealing use permits. This non-response is in violation of Penal Code section 933.05. 26