Score: +1 (1/4/0)
Santa Cruz County Grand Jury • 2004-2005

PDF of complete 2004-05 Grand Jury Final Report

Published: June 24, 2005 167 pages Consolidated Report
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Note: Missing finding numbers detected: F5

Findings and Recommendations 6 findings

F1 Page 1
Shades of Gray: Dominican Santa Cruz Hospital/Jail Medical Facility - 9 2004-2005 Santa Cruz County Grand Jury Final Report 44. The Sheriff’s Department, Netcom and AMR, a local ambulance service, will be further analyzing local data and processes that lead to emergency room use. Alternatives in Santa Cruz County 45. Project Connect, a new program of the county’s Homeless Person’s Health Project, is a grant program administered through the Health Services Agency, designed to reduce misuse of emergency services such as ambulance, emergency rooms and fire services. 46. Project Connect seeks out individuals who have had five or more ER visits in one year and enrolls them in an intensive case management process. Project Connect is funded by a $300,000 grant from the California Healthcare Foundation and The California Endowment. The funds pay primarily for staff who connect participants with outside agencies providing many services. 47. In its first year of operation, Project Connect has seen a 43 percent decrease in emergency room visits, a 35 percent decrease in jail bookings and a 25 percent decrease in ambulance transports by its participants. Project Connect takes a holistic approach, helping people access primary health care but also supporting constructive life changes. 48. In November of 2004, Santa Cruz County started a Serial Inebriate Program in hopes of decreasing the jail population and beginning some meaningful rehabilitation. This program is funded by a grant through HSA and involves the Probation Department, the District Attorney’s Office, the Public Defender’s Office and the Sheriff’s Department. 49. In the Serial Inebriate Program, sentenced inmates can choose to serve their time at a sobering facility in Santa Cruz, located on 7th Avenue, in lieu of jail. For instance, they might have a choice of a specified jail sentence or serving the same amount of time in the rehabilitation program. According to detention personnel, the program is working well; although sometimes inmates have two or three failures before they commit to treatment. 50. Under the Serial Inebriate Program, inebriates who are arrested three times go to detoxification or jail. Serial Inebriate Program in San Diego County 51. Started in January 2000, the Serial Inebriate Program is an innovative effort involving the City and County of San Diego, the San Diego Police and Sheriff's Departments, San Diego County Superior Courts, San Diego County Health and Human Services and Mental Health Systems, Inc. A number of agencies and treatment partners work in tandem with SIP. This collaborative effort provides a less expensive and more appropriate alternative to emergency departments and jails for treatment of homeless chronic inebriates. This program has had a dramatic effect on San Diego emergency - 10 Shades of Gray: Dominican Santa Cruz Hospital/Jail Medical Facility 2004-2005 Santa Cruz County Grand Jury Final Report departments.12 In San Diego, the first year of the program saw 144 people enter the program. A year later, 58 percent had had no contact with police since leaving treatment. 52. The goals of the Serial Inebriate Program (SIP) are to: • slow or stop the revolving door cycle of chronic alcoholics going in and out of detoxification centers, county jail and emergency rooms; • divert this population off the street and into county-funded treatment programs; • significantly reduce the uncompensated costs, time constraints and manpower burdens to San Diego County's healthcare, law enforcement and judicial infrastructure caused by homeless, chronic alcoholics; and • give people who routinely live on the street an opportunity to create a stable mainstream lifestyle. 53. The program strategy offers treatment in a joint City/County-funded program in lieu of custody time resulting from a guilty verdict for public intoxication. Once in treatment, clients are provided with wraparound services designed to help their recovery from alcoholism and begin moving them toward re-entering society as a sober community member. Conclusions 1. Providing medical care for serial inebriates, especially if they are medically indigent, raises Dominican Hospital’s operating expenses significantly. Those costs are absorbed by the consumer. 2. Providing services to serial inebriates negatively impacts Emergency Department operations. 3. Dominican Hospital and county personnel have different understandings of who is responsible for paying for medical care for patients who have been placed in custody but not booked. 4. Dominican Hospital could improve its reimbursement rate by expanding the hours of staff who assist patients with the Medi-Cal and Medi-Cruz process. 5. Since taxpayers and medical consumers ultimately cover uncompensated medical expenses, a cost-effective alternative to using the Emergency Department to treat inebriates would be a sobering center in the county. This would reduce the financial and workload burden on Dominican Hospital and Detention staff. HSA Director, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and Public Inebriates, April 14, 2003. City of San Diego, “Federal Government Lauds Local Efforts to End Chronic Homelessness,” September 4, 2004, http://www.sandiego.gov/press/040914.shtml. Shades of Gray: Dominican Santa Cruz Hospital/Jail Medical Facility - 11 2004-2005 Santa Cruz County Grand Jury Final Report 6. Alternative programs in Santa Cruz County have been successful in reducing the number of frequent Emergency Department users. These programs depend on continued funding from Santa Cruz County or the State of California. 7. Alternative programs in other cities and counties have been successful in reducing the number of serial inebriates. Drawing from the experience of these programs could prove beneficial to Santa Cruz County.
No recommendations for this finding
F2 Page 14
The current independent audit firm has provided services for seven years.
No recommendations for this finding
F3 Page 14
The 2001-2002 Santa Cruz County Grand Jury Final Report recommended that retention of an independent auditor should be reviewed every three years and changed at least every six years.
No recommendations for this finding
F4 Page 14
This Request for Proposal process was to select an independent auditor to prepare an annual audit for the County of Santa Cruz beginning with the fiscal year ending June 30, 2005. The contract would be awarded for one to three years, whichever would be the most cost effective for the county. - 2 Counting Your Dollars: Contracting for the Services of an Independent Auditor of County Finances 2004 – 2005 Santa Cruz County Grand Jury Report 5. The independent audit firm provides various reports to the Santa Cruz County Audit Committee throughout the year. These reports require County Audit Committee review.
No recommendations for this finding
F6 Page 15
The Request for Proposal process began with preparation of the bid documents that: • outlined the requirements of the county; • described the basis on which the bids would be judged; and • requested the qualifications of the bidders. Invitations to Bid were sent to 44 qualifying accounting firms, locally and throughout northern and central California. Four bidders attended the bidders’ conference on December 10, 2004. Proposals were received on January 14, 2005 from all four firms present at the bidders’ conference. The proposals were evaluated according to the criteria established in the bid documents as outlined in Appendix A. Using this comprehensive criteria, the County Audit Committee recommended awarding the contract to the firm that best met the county’s needs: Bartig, Basler, and Ray.
No recommendations for this finding
F7 Page 15
Two members of the Santa Cruz County Grand Jury are active members of the County Audit Committee. Conclusions 1. Response to Santa Cruz County’s request for proposals was minimal.
No recommendations for this finding

Conclusions 117

Agency Responses 9

Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.

No Responses Found 3

Government entities assigned to respond to this report. No response documents have been linked in our database.

Santa Cruz County County
Santa Cruz County Auditor-Controller Elected County Office
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