PDF of complete 2007-08 Grand Jury Final Report

Conclusions 136

• CL1 Page 17
  A growing backlog of unresolved code compliance complaints can cause county residents to lose confidence in the effectiveness of the resolution process.
• CL2 Page 17
  Some of the delay in complaint resolution is unavoidable because it is built into the system. Code Compliance Enforcement 7
• CL3 Page 18
  Without accurate data management reports, future department budget and staff planning decisions cannot be as informed as they should be.
• CL4 Page 18
  Data management reports will not provide useful information if the underlying violation data entry is delayed, inaccurate or miscoded.
• CL5 Page 37
  The County made a sincere effort to qualify as a demonstration site. Consolidation and Simplification 2000-2001 Grand Jury Recommendation 2: The Board of Supervisors should direct the Health Services Agency (HSA) to develop a plan for incremental consolidation and eligibility simplification of categorical health plans. • This plan should be based on prepaid capitation payments and a local public commission should govern its operations. • Eligibility requirements should be simplified and extended to a term of at least one year. • Eligibility should be based on family income, rather than assets, and tied to federally designated poverty guidelines. • The entire family, not individual members, should be designated as the beneficiary for health service coverage. • The Central Coast Alliance for Health and its principles of practice should be used as a model for the administration of other categorical health programs. • The Board of Supervisors should urge the state to engage an independent non- governmental entity with credentials in the healthcare field to monitor the demonstration and track its impacts on both program costs and clinical outcomes. The Medical Information Management System should facilitate this tracking. County Response: This recommendation had not yet been implemented, but will be implemented in the future. 2007-2008 Grand Jury Findings
• CL6 Page 37
  While the County has pursued a goal of consolidating categorical health plans and simplifying eligibility requirements, there is no published plan or public commission in place to oversee it. Response from the County: DISAGREES. A Promise Kept 27 The Public Health Commission is charged with overseeing the operation of preventative health programs, medical clinics and medical programs, which includes review of eligibility requirements and categorical health plans.
• CL7 Page 38
  Eligibility requirements for health plans have not been simplified in any significant way, but the County has structured resources to guide applicants through the maze of health services and health insurance programs that are offered by non-profits and various government agencies.
• CL8 Page 38
  Santa Cruz County now uses One-e-App, a web-based system for connecting families with a range of publicly funded health and social service programs. Applicants, usually with the help of Certified Application Assistants or county eligibility workers, enter their personal information to learn about and apply for programs that best meet their family's needs. System administrators, supervisors, and case management staff, can run reports and determine eligibility.
• CL9 Page 38
  Santa Cruz County Health Care Outreach Coalition expands access to health care coverage for uninsured county residents, promotes awareness of government- funded health insurance programs and conducts outreach to schools, community-based organizations, businesses, faith-based organizations, childcare providers, and the general community.
• CL10 Page 38
  The Benefits Call Center was established in 2000 to provide an easily accessible source of information for Medi-Cal recipients and to ensure that recipients complete all program requirements to maintain their coverage.
• CL11 Page 38
  There is no new program, or expansion of an existing program, to extend health care to entire families instead of just individual members. California’s Medicare system, Medi-Cal, is governed by federal rules because it is mainly funded by the federal government. Medi-Cal has not acted to extend health care coverage to low-income families.
• CL12 Page 38
  In 2008, Medicare’s Hospital Insurance Trust Fund (HI) is scheduled to pay out more in hospital benefits and other expenditures than it receives in taxes and other dedicated revenues. Growing annual deficits are projected to exhaust HI reserves in
• CL13 Page 38
  Private health care providers, both physicians and dentists, have been recruited to treat patients who can’t afford to pay. They do this without remuneration as a community service.
• CL14 Page 38
  In order to simplify access to categorical health programs, the 2000-2001 Grand Jury recommended using the Central Coast Alliance for Health as a model for administering them. Health Services Agency determined it would accomplish the same goal to make those programs part of the Alliance where possible.
• CL15 Page 38
  Some Grand Jury recommendations hinged on the county becoming a demonstration site for the integrated provision of local health services subsidized by state and 28 A Promise Kept
• CL16 Page 39
  Since the most pressing concern today is from where the money will come to maintain Medicare and Medicaid services for those who qualify under today’s system, extending it to include low-income families is not being discussed.
• CL17 Page 39
  Santa Cruz County public, non-profit, and for-profit medical resources have worked together to make health care more accessible to low-income families.
• CL18 Page 40
  Because Healthy Families is a state and federally funded health plan, Santa Cruz County cannot change the eligibility requirements for the program.
• CL19 Page 40
  The 2000-2001 report recommended, “Coverage should be maintained during short periods of seasonal unemployment.” But, in fact, qualifying seasonal workers are covered while unemployed. They risk losing coverage when employed because their income may exceed guidelines. That issue has not been addressed by Medi-Cal or any county agency.
• CL20 Page 40
  A public/private partnership exists in the county to provide affordable access to health care for low-income individuals and families. 30 A Promise Kept
• CL21 Page 42
  While low reimbursement rates for medical providers inhibit the delivery of adequate health care to Medi-Cal and Healthy Families beneficiaries, county residents must depend on state and federal entities to resolve the problem. Coalition for Health Care Outreach 2000-2001 Grand Jury Recommendation 5: The Coalition for Health Care Outreach should be supported in the budget of the Health Services Agency upon expiration of the Packard Foundation grant. County Response: This recommendation is being implemented. 2007-2008 Grand Jury Findings
• CL22 Page 42
  In June of 2001 the Packard Foundation grant expired. In 2007-2008, funding for the Coalition for Health Care Outreach (Coalition) came from two sources, First 5 California (First 5) and Medi-Cal Administrative Activities.
• CL23 Page 42
  The budget for fiscal year was $403,000. First 5 funded $300,000, and the Coalition hopes to receive the additional $103,000 from Medi-Cal Administrative Activities.
• CL24 Page 42
  The County works as a middleman for both sources of Coalition funding. Medi-Cal Administrative Activities
• CL25 Page 42
  During the month of September, the Coalition completes a “time survey” to establish the annual cost of outreach activities in excess of what First 5 already pays. The federal government agency Medi-Cal Administrative Activities is billed that excess cost. The turnaround for payment is generally about three years.
• CL26 Page 42
  The County supports various organizations associated with the Coalition throughout the year and receives the money from Medi-Cal Administrative Activities. Many 32 A Promise Kept
• CL27 Page 43
  The State of California retains 20 percent of the money First 5 receives, and 80 percent is distributed to the 58 counties throughout California based on the number of children born in the county. Santa Cruz receives approximately $2,700,000 annually.
• CL28 Page 43
  First 5 has three established goals: healthy children, children learning and ready for school, and healthy families. Allowing for local decision-making, the First 5 Santa Cruz County Commission determines how to distribute funds based on a three-year strategic plan and annual contracts. Money provided to the Coalition by First Five has been designated as outreach funds.
• CL29 Page 43
  First 5 reimburses the County for payments made to community agencies for contracted services.
• CL30 Page 43
  In the fall of 2008, First 5 will create a new three-year strategic plan. This may or may not result in continued funds for the Coalition for Health Care Outreach.
• CL31 Page 43
  Since the Packard Foundation grant expired, the Coalition for Health Care Outreach has secured funds to continue successful operation in Santa Cruz County.
• CL32 Page 44
  Clinic operations are no longer confined to daytime hours. The three clinics each offer some lunchtime and/or evening hours. All offer Saturday appointments as well.
• CL33 Page 44
  The inconsistencies of the posted clinic hours confuse and possibly inconvenience patients.
• CL34 Page 46
  Services are limited by the lack of funding, and there are still unserved and under- served people in the county.
• CL35 Page 46
  More dental care is offered to low-income individuals and families now than was offered when the 2000-2001 Grand Jury investigated, but there is still a significant part of the county population that is not being served.
• CL36 Page 46
  Low-income families and individuals of Santa Cruz County are receiving excellent care from two quality agencies and several private dentists.
• CL37 Page 48
  Despite decreasing resources, the County has significantly reduced the number of uninsured residents during the past seven years. Mental Health Services 2000-2001 Grand Jury Recommendation 9: The total lack of primary mental health services needs to be addressed both in County and community clinics. An intensive program should be mounted to attract mental health professionals to the County with an emphasis on the recruitment of family-oriented therapists to provide services in clinics that serve low-income clients. County Response: This recommendation is being implemented. 2007-2008 Grand Jury Findings
• CL38 Page 48
  The Mental Health and Substance Abuse Services (Division), a division of the Santa Cruz County Health Services Agency, works with and through many groups to offer a wide range of mental health care services including emergency shelter, transitional housing, supported housing, dual diagnosis treatment, crisis intervention, case management, and peer support. Other services available to clients are assessment, counseling, medication support, and referrals. Spanish translation is offered, as is an Appeal Resolution Process for anyone who is denied assistance. The following is a partial list of these resources. Adult residential treatment is offered at • Transition House, 10 beds • Paloma House, 12 beds • Pioneer House, eight beds • Opal Cliffs, 15 beds • El Dorado Center, 16 beds • Darwin House, 15 beds 38 A Promise Kept • Front St., Inc., 11 beds • River Street Shelter, 20 beds reserved for people referred by County Mental Health Outpatient treatment and/or social rehabilitation are available at • North County Mental Health Center • South County Clinic • Community Support Services • Dominican Hospital Behavioral Health • Pioneer House Dual Diagnosis Day Program • Community Connection Academy • Front Street Day Rehabilitation Program Self help resources include • Mental Health Client Action Network • Mariposa Activity Center • Community Connection Mental Health Resource Center and Career Services • Community Support Services Community Organizers Program Ongoing services for the protection of low-income mentally ill residents include • Advocacy, Inc. (Patient Rights) • Public Guardian’s Office
• CL39 Page 49
  It is hard to retain staff; therefore, continual training programs are necessary. Many new employees come from the Cabrillo College Health Science/Community Health programs.
• CL40 Page 49
  Various federal, state, county and private agencies fund mental health treatment in our county. Mental health has made effective use of these grants and programs. Some of these sources (known as funding streams) are designated for specific and limited uses. Clients often present with a variety of issues and staff sometimes has difficulty matching funds to the specific needs of the client. Services offered to individuals and families will be further restricted by potential state and county budget cuts in the coming year.
• CL41 Page 49
  Training in cultural sensitivity is emphasized and employees are trained within their department as well as by outside resources.
• CL42 Page 49
  Some families have difficulty acknowledging the existence of a mental health problem. This can be a cultural issue or a matter of pride. Successful mental health outreach and education programs have worked as a part of the network of general health services.
• CL43 Page 49
  Access to services is difficult for South County residents because most service sites are located in Santa Cruz. Public transit offers only a few routes and limited hours of operation. The Division is attempting to expand county services and to create more partnerships with community agencies in South County.
• CL44 Page 49
  The Division works with Senior Network Services but does not yet have an early intervention program for seniors. A Promise Kept 39
• CL45 Page 50
  Among the ongoing concerns of the Division is the ever-present worry of patients exhibiting unexpected antisocial behavior.
• CL46 Page 50
  The County’s mental health program is active and in good hands and is continually adapting to the changing needs of the community.
• CL47 Page 50
  The Division works well, has effective coordination with many nonprofit organizations in the county, and maintains a constant effort for structural improvement.
• CL48 Page 50
  Financing mental health programs is a continual struggle. Clients sometimes have problems finding appropriate services because they do not meet the funding requirements. Mental health staff strive to find creative ways to match client needs in spite of restrictions placed on various funding sources.
• CL49 Page 50
  The Division recognizes cultural issues in treating county mental health patients. This perspective is important to ensure the effective delivery of services because cultural issues may make that more difficult, such as when families feel embarrassed by a member with a mental illness and may not acknowledge it as a legitimate health problem.
• CL50 Page 50
  Effective programs have been developed that recognize the importance of family relationships. Both children and adults are treated. Establishing more peer counseling is a priority.
• CL51 Page 50
  A comprehensive approach is the most pressing need in the system. Along with counseling and medication, affordable housing, tenured living spaces, and job development are all necessary for proper treatment.
• CL52 Page 54
  While all “safety net clinics” are not geared toward families, they are putting forth their best efforts to meet the various needs of the uninsured and Medi-Cal patients in Santa Cruz County.
• CL53 Page 54
  Santa Cruz County needs to recruit more specialists and internists because of the increase in the number of elderly patients with complex health problems. 44 A Promise Kept
• CL54 Page 55
  The Health Services Agency is able to recruit adequate medical staff and negotiate appropriate wage and benefit packages under very difficult circumstances. A Promise Kept 45
• CL55 Page 56
  The County has found innovative ways to meet the medical needs of low-income residents through grants and creative staffing. Anticipated budget cuts threaten this tenuous balance, but the Grand Jury believes that the County is going to be able to continue to provide a basic level of staffing to meet the minimal needs of low-income residents.
• CL56 Page 74
  Booking. A more efficient booking process would reduce time officers unavailable to perform services in their own jurisdictions.
• CL57 Page 74
  Staffing. Although hourly welfare checks are being performed, and shift supervisors routinely check to ensure rounds are being done, other activities such as cell searches are being delayed due to lack of staff.
• CL58 Page 74
  Operations. The General Services Department should respond to complaints about and perform maintenance of the HVAC system in a more timely manner.
• CL59 Page 74
  Operations. Some shower areas are in need of immediate repair and many need to be kept in better sanitary condition.
• CL60 Page 74
  Inmate Services. The kitchen was originally built to accommodate 90 inmates. It needs to be enlarged and updated to serve the state-rated capacity of 311 inmates.
• CL61 Page 74
  Medical Services. An additional exam room is needed for speedier delivery of medical services.
• CL62 Page 74
  Medical Services. Because of the lack of alternative facilities, mentally ill inmates on a 5150 hold are kept in solitary confinement in the medical unit for long periods of time. The Main Jail is not licensed to provide ongoing care for this type of inmate. 64 Main Jail
• CL63 Page 75
  Overcrowding. Inmate overpopulation has led to reduced usability of common areas and inmates locked in their cells for longer periods.
• CL64 Page 75
  Overcrowding. Even though the current population exceeds the state-rated capacity, the Sheriff’s Office, along with the Probation Department, has made substantial progress in reducing the number of inmates.
• CL65 Page 75
  Overcrowding. The crowding problem strains the facility’s infrastructure and the staff’s ability to deliver services to the inmates. Because of the facility’s age and deteriorating condition and the impact of inmate overpopulation, increased maintenance will be needed in the future.
• CL66 Page 82
  Correctional officers and civilian workers at Rountree Detention Center appear to be respectful of inmate rights, experienced in dealing with inmates, and well trained in security procedures.
• CL67 Page 82
  Inmate visits in both facilities are well managed and beneficial to both the inmates and their families.
• CL68 Page 82
  The maintenance and cleanliness of all areas of both facilities is good.
• CL69 Page 82
  There are a commendable variety of constructive activities and skill building classes for inmates although few are conducted by Spanish-speaking teachers.
• CL70 Page 82
  Because the Rountree jail inmate populations are consistently under capacity, the facilities could be better utilized to relieve the overcrowding at the Main Jail.
• CL71 Page 82
  The staffing of the facilities is inadequate to properly oversee, protect, and transport the inmate population.
• CL72 Page 82
  Onsite medical care is currently available 40 hours a week. The newly approved nursing weekend hours are needed to assure that medical problems are properly assessed and expeditiously treated. This weekend coverage will allow qualified inmates who need mental health maintenance medications to be transferred from the Main Jail to Rountree.
• CL73 Page 82
  The video surveillance system has been noted to be inadequate in earlier Grand Jury reports, but it has still not been improved.
• CL74 Page 82
  Installation of fencing around the facility would prohibit the public from entering the facility without permission and would deter contraband from entering the facility.
• CL75 Page 82
  The Grand Jury agrees with the Environmental Health Report that the shower posts, flooring and support walls at the Jail Farm are in need of repair and replacement.
• CL76 Page 89
  Juvenile Hall is well managed and operated by a professional and caring staff.
• CL77 Page 89
  The Juvenile Hall program strives to provide detained juveniles with a safe and secure environment, free of fear, trauma, intimidation or abuse, and in the least restrictive environment consistent with public safety.
• CL78 Page 89
  The facility is well maintained despite its age.
• CL79 Page 89
  The Santa Cruz County Probation Department emphasizes keeping children with their families and in their communities.
• CL80 Page 89
  A covered outside area would provide a better place for physical activity during poor weather conditions. Juvenile Hall 79
• CL81 Page 90
  Fencing around the upper field would allow the detainees to use the spacious grassy area, a basketball hoop and volleyball net and have access to a general open air feeling not found in the rest of the facility.
• CL82 Page 90
  Video monitoring is inadequate and should be upgraded to ensure safety and security. This is being implemented.
• CL83 Page 90
  Intercom systems would provide better security and safety; installation of intercoms is being implemented.
• CL84 Page 90
  Modifying some of the doors to the rooms so they swing out into the hall rather than into the rooms not only freed up living space but also removed the possibility that the occupant could bar the door, assuring safety for the staff.
• CL85 Page 90
  Juvenile Hall staff strives to provide a safe and humane environment. It recognizes and respects the dignity of the youths in detention.
• CL86 Page 90
  The Probation Department continues to work with the community to enhance and develop alternatives to detention.
• CL87 Page 96
  Compliance with the California Corrections Standards Authority recommendation to allow medium security inmates to be moved to Blaine Street has helped relieve overcrowding at the Main Jail.
• CL88 Page 96
  At the time of the Grand Jury visit, Blaine Street was clean, orderly and had a non- institutional feel.
• CL89 Page 96
  Although the supervisor does a commendable job, Blaine Street would be well served by a full-time supervisor.
• CL90 Page 96
  Because of the policy to rotate corrections officers among county jail facilities, there is little consistency in the staff at Blaine Street. 86 Blaine Street
• CL91 Page 97
  Given the large number of Hispanic inmates, the fact that detention staff is not required to speak Spanish may be a problem.
• CL92 Page 97
  The women are well served by numerous support programs.
• CL93 Page 97
  An automated external defibrillator (AED) would enhance the safety of staff and inmates.
• CL94 Page 102
  The facility is well maintained and clean.
• CL95 Page 102
  The staff is professional, well trained, and knowledgeable performing day-to-day operations as well as skilled at interacting with inmates.
• CL96 Page 102
  The inmate restraint system implemented approximately a year and a half ago has resulted in fewer escape attempts and violent incidents.
• CL97 Page 102
  Moving drug court cases to the Main Jail has reduced the number of inmates transported and processed through the main courthouse and Court Holding.
• CL98 Page 102
  Because the deputies in Court Holding have to maintain a high level of attention while handling potentially dangerous prisoners, rotating assignments in Court Holding seems to be beneficial. This procedure enables deputies to remain alert and fresh while gaining valuable experience.
• CL99 Page 102
  Equipment for recording and storing video of holding cell activity would be useful for training and evidence gathering purposes.
• CL100 Page 106
  An additional van would be beneficial to facilitate more efficient transportation of inmates to the Court Holding facility.
• CL101 Page 106
  This Court Holding facility has provided appropriate inmate separation according to classification.
• CL102 Page 106
  The facility has incorporated the latest security features for maximum protection of the inmates, staff members and the public.
• CL103 Page 110
  The facility is operated by a conscientious and professional staff who have an excellent rapport with inmates.
• CL104 Page 110
  The food provided to the inmates on the day of the Grand Jury visit was good.
• CL105 Page 110
  The camp’s work crews provide a valuable service to the community.
• CL106 Page 110
  More cameras are needed for the rear of the facility.
• CL107 Page 110
  The grounds are extremely clean and well-kept.
• CL108 Page 117
  The permanent extension of the sales tax measure devoted to library funding is essential to maintain library operations and enable long-term planning. The City of Watsonville could not afford to support current library operations without this supplemental funding.
• CL109 Page 117
  The allocation of sales tax revenue directed to the library should increase with the growing population of Watsonville since the allocation is based on population size.
• CL110 Page 117
  The materials budget for 2008 is very modest. No additional funds were designated for the purchase of materials for the new library. It would be helpful and efficient to have public input on purchasing materials. Watsonville Public Library 107
• CL111 Page 118
  The City of Watsonville and the Watsonville Public Library suffered a loss of approximately $170,000 by not submitting the necessary grant documents to the California Cultural and Historical Endowment in a timely manner.
• CL112 Page 118
  The Main Library has more than doubled in size without additional staffing. This increase requires employees to work some hours on the floor with the public, reducing their time available to complete other duties. Concerns for daily library operations exist, such as covering a shift for an absent worker, or having enough time to effectively address a patron’s needs.
• CL113 Page 118
  Some safety challenges exist at the new facility: • Monitoring the expansive space on two floors. • Ensuring all patrons have left the building prior to closing. • Ensuring staff and patrons can walk safely to the unattended parking garage at night.
• CL114 Page 118
  Some programs would not exist without volunteer participation (e.g., tutors in the Homework Center, Literacy Center, and Library Link program).
• CL115 Page 118
  There is still a need for a homework center at the Main Library based on previous demand. It would be a valuable community resource because of the impending Watsonville elementary school library closures.
• CL116 Page 118
  The public may be inconvenienced by the closure of the libraries on Sundays.
• CL117 Page 118
  The custodian has limited time to service both branches and to respond to unexpected maintenance needs.
• CL118 Page 118
  Fulfilling public expectations for the CAWHC will be a long-term commitment. The center has the potential to attract researchers who would use and add to the collection of historical resources.
• CL119 Page 118
  The Literacy Center provides a safe and welcoming environment for adults who desire to learn to read and write.
• CL120 Page 118
  The video-on-demand service would be improved if it were accessible to more than Microsoft Windows operating system users.
• CL121 Page 118
  The Library Board appears to function in an advisory rather than an administrative manner, which is contrary to the city charter.
• CL122 Page 118
  More conference rooms are available at the new facility; however, limited staff time may slow the development of additional programs or services for these rooms.
• CL123 Page 118
  Adding a drive-up book drop outside the Main Library would help patrons return books without the need to park and enter the building.
• CL124 Page 137
  “County Fire” is a confusing term, implying the existence of a single department responsible for fire protection in the rural areas of the county.
• CL125 Page 137
  Because fire safety personnel are listed incorrectly on the year-round Schedule A agreement, the true cost of the Amador Plan is not clear.
• CL126 Page 137
  The 2007-2008 County Fire contract total of $2,870,629 is misleading due to the inclusion of Pajaro Dunes. Pajaro Dunes is a Local Responsibility Area and not a State Responsibility Area. The Pajaro Dunes Schedule A agreement is $840,275, close to one-third of the total County Fire contract.
• CL127 Page 137
  A significant cost factor in the Amador Plan is the length of the state-declared fire season. For example, a fire season extended by one month could equal a savings to the county of approximately 15 percent on the original contracted amount.
• CL128 Page 137
  Significant capital spending to replace aging equipment is overdue.
• CL129 Page 137
  Proposition 172 funds seem disproportionately distributed.
• CL130 Page 137
  The call reports presented to the Board of Supervisors by County Fire management are incomplete. These reports do not show all the responses made to emergency incidents. Volunteer, mutual/automatic aid and ambulance responses are critical in evaluating County Fire performance.
• CL131 Page 137
  Emergency responses are delayed due to the additional time required for Netcom to relay calls to the Cal Fire ECC.
• CL132 Page 137
  Though Paradise Park is located in CSA 48, the Santa Cruz City Fire Department can reach this community much faster than the more distant County Fire stations, so contracting fire protection to the city is appropriate.
• CL133 Page 137
  Because other agencies also benefit from the work of the addressing clerk, it is inequitable that the cost of this position is borne entirely by CSA 48.
• CL134 Page 137
  Active input to the Fire Department Advisory Commission (FDAC) from a Health Services Agency representative is necessary because medically related incidents comprise a major component of County Fire responses.
• CL135 Page 137
  Because Cal Fire officers concurrently manage both state resources and those of County Fire, conflicts may arise when decisions are made to prioritize issues involving the state and county fire protection resources. County Fire 127
• CL136 Page 138
  An effective way to enhance the public’s understanding of County Fire is to create a page on the county government website.

Commendations 61

• CM1 Page 39
  The Human Services Department and the Health Services Agency are to be commended for ongoing focus on the delivery of adequate health care services to Santa Cruz County residents. Health Insurance Coverage 2000-2001 Grand Jury Recommendation 3: The Healthy Families Program should include parents in its coverage. Premiums should be set at more affordable levels in order to accelerate enrollment of families without insurance. Coverage should be maintained during short periods of seasonal unemployment. The Central Coast Alliance for Health should approach local employers to continue premium payments for families during short periods of seasonal unemployment to keep insurance coverage from lapsing. It should continue to expand the participation of specialists in its programs. County Response: This recommendation has been implemented. 2007-2008 Grand Jury Findings
• CM2 Page 39
  The Healthy Families Program does not include parents in its coverage. Healthy Families insurance premiums vary depending on the health plan selected. Families receive a discounted premium if they select the local Community Provider Plan, which is the Central Coast Alliance for Health (the Alliance) in Santa Cruz County. The Alliance’s maximum monthly premium for a family with three or more children is $36 (or $108 per quarter).
• CM3 Page 39
  Recent local funding contributions to the Healthy Kids program, which came primarily from Sutter Santa Cruz and Dominican Hospital, will allow the Alliance to move 295 children off the waiting list and into enrollment.
• CM4 Page 39
  Seasonal unemployment only affects the eligibility of adults in a family receiving Medi-Cal. The Alliance reports that their Medi-Cal membership fluctuates by about five percent each year according to the growing season and migration of Medi-Cal recipients out of the area. Typically, a seasonal employee becomes eligible for Medi- Cal when the work season ends or slows down because the worker’s income A Promise Kept 29
• CM5 Page 40
  Medi-Cal has no provision for continued eligibility if an adult no longer meets the criteria. However, children can maintain Medi-Cal eligibility for 12 months even if the adults in the family are terminated due to an increase in income or assets.
• CM6 Page 40
  Although families pay no premiums for the Medi-Cal program, there are premiums associated with the Healthy Families and Healthy Kids programs. However, regardless of changes in family income, once a child is deemed eligible for Healthy Families or Healthy Kids, that child remains eligible for 12 months unless he or she becomes eligible for no-cost Medi-Cal, is covered by other health insurance, or turns
• CM7 Page 40
  In 2000, the Santa Cruz County population was 255,602. In 2007, the population increased slightly to an estimated 264,125 (3.3 percent). But the supply of health care specialists for Alliance programs has increased by almost 30 percent since that year. In 2000, the Alliance had an average of 499 specialists available to serve Santa Cruz County residents. As of March 2008, 697 specialists are available.
• CM8 Page 40
  The Alliance collaborates with over 60 community coalitions and organizations to promote its programs, including the Santa Cruz County Human Services Department. It also promotes health care resources to the public at events, such as farmers’ markets, health fairs, community block parties, and other festivals. In addition, the Alliance publishes a provider bulletin in which providers are urged to encourage their Healthy Families and Healthy Kids patients to stay enrolled and thereby continue their health care coverage.
• CM9 Page 40
  Children also lose Healthy Kids eligibility and coverage when they move out of Santa Cruz County.
• CM10 Page 41
  It is admirable and impressive that Central Coast Alliance for Health has been able to expand local coverage to improve low-income families’ access to health care at a time when statewide reform has failed to gain traction. Increased Reimbursement Levels 2000-2001 Grand Jury Recommendation 4: In order to assure that appropriate care is provided at the least costly level, the outpatient services of local hospitals need to be reimbursed at a higher percent of reasonable costs. The same is true for on-call private physicians who provide care to indigent patients in need of admission to the hospital. The level of reimbursements to private health service providers must be set at a reasonable A Promise Kept 31
• CM11 Page 42
  Since Medi-Cal and Healthy Families reimbursement rates are set by state and federal government agencies, the County of Santa Cruz has no authority to revise them.
• CM12 Page 42
  Congressman Sam Farr, the California Medical Association (CMA), and others have called the reimbursement fee schedules for county doctors inequitable and continue to work to require that the U.S. Department of Health and Human Services fix a system viewed as unfair to local qualified participants.
• CM13 Page 47
  The Grand Jury commends both Dientes Community Dental Care and Salud Para La Gente for providing excellent dental care to low-income residents of Santa Cruz County.
• CM14 Page 47
  Dientes and Salud are to be commended for combining Medicare, Medi-Cal, and county funding with grants and other resources to meet the dental care needs of a significant portion of low-income families and individuals.
• CM15 Page 47
  Since the 2000-2001 Grand Jury report, dental care services available to low-income families and individuals have expanded significantly. Health Services Agency and the Board of Supervisors are to be commended for assisting with this expansion. Expanded Health Insurance Coverage 2000-2001 Grand Jury Recommendation 8: The County should continue to collaborate with community health organizations, local employers and organized labor to expand the numbers of individuals and working families covered by health insurance which includes mental health and dental benefits. County Response: This Recommendation has been and will continue to be implemented. A Promise Kept 37 2007-2008 Grand Jury Findings In 2000, the United Way Community Assessment Project estimated that:
• CM16 Page 48
  Seventeen percent of county residents had no health insurance. That figure dropped to 11 percent in 2007, a decrease of 35 percent in uninsured individuals.
• CM17 Page 48
  One-third of the county residents who could not access health care when they needed it attributed that problem to lack of insurance. The percentage dropped to 18.6 percent in 2007, a decrease of 44 percent.
• CM18 Page 48
  Thirty percent of the county’s low-income families had no health insurance. That estimate dropped to 22 percent in 2007.
• CM19 Page 51
  The County is to be commended for developing and supporting vibrant mental health programs managed by experienced and dedicated staffs. The programs are dynamic and flexible enough to keep up with the demands of clients and changing methods of treatment. Clinic Reconfiguration 2000-2001 Grand Jury Recommendation 10: County clinics should be reconfigured to family-oriented primary and preventive care, backed by clinical specialties and case- managed group therapy for persons at high risk or suffering chronic and recurring illness. These measures will require the recruitment of full-time county physicians and allied practitioners. County Response: This recommendation is being implemented. 2007-2008 Grand Jury Findings
• CM20 Page 51
  In the County of Santa Cruz, “safety net clinics,” (i.e., county or nonprofit clinics), take patients that are uninsured regardless of their ability to pay.
• CM21 Page 51
  Current public and non-profit clinics, as a whole, have not been reconfigured to family-oriented and preventative care, but rather each clinic has an area or multiple areas of concentration which are listed below. Santa Cruz Clinics A Promise Kept 41
• CM22 Page 54
  Santa Cruz Women’s Health and Planned Parenthood specialize in women’s health, family care, and reproductive health.
• CM23 Page 54
  Specialists are available when necessary, usually through Sutter Maternity & Surgery Center, which provides some free services to the community.
• CM24 Page 54
  The County of Santa Cruz currently employs 20 full-time doctors: five primary care physicians (including two pediatricians), and 15 psychiatrists, four of which are bilingual.
• CM25 Page 54
  The recruitment of allied health practitioners and full-time county physicians is often a challenge. Response from the County: AGREES. The Health Services Agency and the Personnel Department have developed a number of successful initiatives to increase the County’s ability to recruit for various classes of health practitioners and physicians.
• CM26 Page 54
  The high cost of housing in Santa Cruz County makes recruiting primary care physicians difficult.
• CM27 Page 54
  Psychiatry has only one vacant position, and nurse practitioner positions are filled through a “feeder program” from San Jose State University.
• CM28 Page 55
  The Grand Jury commends Sutter Maternity & Surgery Center for providing the services of medical specialists to those in need. Medical Staff Recruitment and Salaries 2000-2001 Grand Jury Recommendation 11: In the recruitment of health care professionals, salary surveys conducted in nearby agricultural counties are no longer pertinent to this County. In the next round of County salary negotiations, surveys should be conducted that use counties more comparable to the emerging characteristics of Santa Cruz County. County Response: The County has utilized the nine-County comparison for over thirty years, and this long-term base of information is useful in evaluating salaries. The nine- County comparison is used as a guide along with other information such as the Consumer Price Index, turnover statistics, recruitment and retention rates, the relationship between positions within the County, changes in classifications, and operational changes. Other jurisdictions are also surveyed, as appropriate. 2007-2008 Grand Jury Findings
• CM29 Page 55
  Currently Santa Cruz County uses eight nearby counties in salary surveys: Monterey, Santa Clara, Alameda, Napa, Sonoma, Marin, Solano and San Mateo. For the most part, these are more similar to Santa Cruz than the nine counties formerly used in that they are not strictly agricultural and have living costs comparable to Santa Cruz.
• CM30 Page 55
  Recruiting and retaining physicians and other medical professionals is uniquely difficult in Santa Cruz County because it is labeled by Medicare as a rural county. The Medicare reimbursement rate is the same as Butte, Imperial and other counties with a much lower cost of living.
• CM31 Page 55
  The county health programs must compete with Dominican and Sutter for physicians and other medical professionals. Hospitals are in a unique position to pay higher salaries as their Medicare reimbursements are based on actual costs. A national Medicare study released in 2007 shows hospitals in Santa Cruz County have the highest labor costs in the country, which local health officials say means higher medical costs and insurance premiums for patients. This situation creates a difficult challenge when it comes to recruiting medical professionals.
• CM32 Page 55
  Salaries and working conditions for physicians and other medical professionals employed by the County are negotiated with the respective unions.
• CM33 Page 56
  The Grand Jury commends the Health Services Agency for the innovative way it has succeeded in providing quality health care to county low-income residents despite financial limitations.
• CM34 Page 76
  Booking. The Sheriff’s Office is to be commended for implementing administrative safeguards along every step of the booking process for the protection of staff and detainees.
• CM35 Page 76
  Operations. The Sheriff’s Office personnel are to be commended for providing quality care to inmates despite overcrowded conditions and the age of the facility.
• CM36 Page 76
  Medical Services. The Sheriff’s Department and the Health Services Agency are to be commended for their delivery of quality medical services to inmates. 66 Main Jail
• CM37 Page 77
  Medical Services. The Board of Supervisors is to be commended for increasing medical staffing at the Main Jail.
• CM38 Page 77
  Overcrowding. The Sheriff’s Office and the Probation Department are to be commended for their ongoing efforts to provide alternative programs, which have reduced crowding.
• CM39 Page 77
  Classification/Discipline. The Sheriff’s Office is to be commended for adding a classification supervisor position.
• CM40 Page 91
  The Grand Jury commends the Probation Department and Juvenile Hall staff for their professionalism and dedication to the young people they serve, their families and the community.
• CM41 Page 91
  The Grand Jury commends the Juvenile Hall staff and the Probation Department for securing outside funds and grants for diversion programs and other support programs for the youth and their families.
• CM42 Page 97
  During the tour, the Grand Jury noted that the inmates were treated with dignity and respect.
• CM43 Page 97
  The Grand Jury concurs with the California Corrections Standards Authority that Blaine Street is a “well run and clean facility” and commends the staff’s management.
• CM44 Page 102
  The Grand Jury commends the Sheriff’s Office for its professional and well-trained staff.
• CM45 Page 102
  The Grand Jury commends the Sheriff’s Office for the new inmate restraint policy.
• CM46 Page 102
  The Grand Jury commends the Sheriff’s Office for moving drug cases to the Main Courthouse.
• CM47 Page 102
  The Grand Jury commends the Sheriff’s Office for the policy of rotating deputies in Court Holding.
• CM48 Page 110
  The Grand Jury commends the California Department of Corrections and Rehabilitation for providing a positive alternative to prison incarceration and a valuable service to the local community.
• CM49 Page 110
  The Grand Jury commends Camp 45 staff for their dedication and effective management of the facility and inmates. 100 Camp 45
• CM50 Page 123
  The City of Watsonville is commended for recognizing the need to replace the previous library and organizing the team required to secure funding, develop plans, obtain agreements between multiple parties, and build a modern Main Library.
• CM51 Page 123
  The City of Watsonville is commended for its commitment to support a library that is an essential community resource, serving the educational and recreational needs of the public, and offering public meeting rooms.
• CM52 Page 123
  The Grand Jury commends the planning team for the thoughtful interior design of the new library. The lighting fixtures, furniture and color schemes chosen create a pleasant ambiance.
• CM53 Page 123
  The library staff is commended for its team spirit and dedication to serving the public. The Grand Jury gives special recognition to the employees who have made commitments to serve the library for many years and to those staff who took the initiative to apply for and receive grant funding for various programs or services.
• CM54 Page 123
  The Grand Jury commends the library staff responsible for obtaining the technology grant that tripled the number of computers available to the public. Watsonville Public Library 113
• CM55 Page 124
  The Library is commended for the “Human Book Chain” event to move books from the old library to the new one, generating positive publicity and interest in the new facility while involving the community in a fun activity.
• CM56 Page 124
  The Friends of the Library is commended for organizing ongoing book sales to supplement library funds.
• CM57 Page 124
  The Literacy Center is commended for receiving national accreditation for its “Opportunity to Read” program from ProLiteracy America, validation for meeting high standards for the center’s planning and performance.
• CM58 Page 124
  The Main Library is commended for providing push-walkers with baskets to patrons.
• CM59 Page 143
  The Grand Jury commends all firefighters for performing a vital service and for their willingness to put their health and lives at risk.
• CM60 Page 143
  We especially commend the volunteer firefighters for providing essential fire protection and emergency rescue services, and for making major contributions of time devoted to training and certification.
• CM61 Page 143
  The Grand Jury commends the volunteer fire company auxiliaries for their fund- raising efforts and support of their local volunteer firefighters and fire stations.

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