Los Angeles County Grand Jury • 1981-1982 • Agency Response

Final Report 1981 -1982*

Published: February 16, 2010 113 pages Consolidated Report

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Note: Missing finding numbers detected: F8

Findings 18 findings

No specific impact studies regarding the consequences of the intended cuts were made prior to the abrupt curtailment of services in July 1981; only broad, descriptive generalizations of services to be cut were provided. The Grand Jury realizes that the Board was responding to abrupt reductions of funding; however, STATE OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE P the Department of Health Services had been warned to prepare projections for various anticipated levels of cutbacks at least six months in advance. A STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE Los Angeles has a large population of immigrants from countries where diseases such as amoebic dysentery, malaria, typhoid and salmonella are endemic. The Jury believes that a curtailment of services could have a serious impact on the . health of the entire community. For example, it should be noted that Los Angeles County is experiencing a rise in the rate of tuberculosis while other major urban areas are experiencing a decrease. The CAO has twice recommended elimination of the requirements of the

Beilenson Act, which calls for a 90-day notice of hearing and 60 days concurrent waiting period prior to closure or reduction of facilities and level of care. The Act gives those who would be adversely affected an opportunity to give vital input about where and how much the level of services would be decreased. The CAO recommended that the County seek repeal of the Act "so that counties can The state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of t have needed flexibility in their allocation of limited resources among all service programs," (letter dated December 5, 1980). In another letter dated June 25, 1981, it once again referred to side-stepping the specifics required under the Beilenson notification requirements. The Grand Jury believes the Board must STATE STATE OF fulfill its legal obligation to the community to provide adequate warning and opportunity for review by meeting the Act's requirements. PERSONAL PROPERTY.

The Jury has been unable to obtain an explanation of conflicting budget figures. The final budget adopted by the Board on July 3, 1981, shows a final figure of $4,595,599,459 with 72,300 positions budgeted. Yet in a letter dated July 23, 1981, to Assemblyman Art Torres, the CAO shows 1981-82 adopted figures STATE OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE P totaling $4,717,248,750 with 73,788 positions. This represents an increase of $121,649,291. Considering that the Health Services budget was cut by $56 million, to what extent was this additional amount allocated to restore the . health cuts? A document received from the CAO's Office showed the total number of people A CONTRACTOR on the payroll in September 1981 was 74,432. A second document from the Auditor-Controller showed the County payroll for the October accrual was 77,293. Since we understand a freeze had been put on County hiring, we are puzzled by the addition of 2,861 workers in one month's time. SUPPLY OF STREET Health care is generally considered a right of every citizen, whether privately or

publicly rendered. Medi-Cal was supposed to provide equal access for all; how- 1 ever, many private providers are unwilling to accept Medi-Cal patients because they are considered "unprofitable." In the past, the County has filled the gap for those unserved by the private sector. The current trend is to contract out these services in an effort to save money. The Jury has some serious concerns about the effects of contracting out health services. One university professor of Public Health states, "The history of contracting out has been miserable." He has said the cost of regulating the contract, added to the cost of the contract itself, can cost the County more than providing the services in its facilities. According to him, the cost in California and and a of delivering services at a private hospital is greater than the cost at a County facility. The Jury's fundamental concern is: Who will ensure that the private contractor will provide services to those unable to pay, who receive services in County- operated facilities? The Jury believes contracting out health services might make them financially inaccessible for many, and could result in higher costs to the County. As the professor put it, "The overwhelming motive can't be -- what can we get rid of that no one will see... County facilities were set up to provide services no one else wants to provide. The people provided for in County facili- ties are historically those not profitable for the private providers."

The Jury believes that certain cutbacks in services could be short-sighted, result- ing in increased costs later on. For example, the elimination of health educators, nutritionists and social workers could pose a serious problem. These three occupations are crucial in helping people learn how to take care of their health problems before they become serious. Preventive medicine is the most cost-effective and efficient way of serving the community. Curtailing or eliminating health prevention programs results in hospitalization later, at much greater cost to the County. The Jury finds particularly alarming the elimination of pharmacy services at all but the comprehensive health centers. Almost all out-patient pharmacy services have been eliminated at hospitals, and drug dispensing at health centers is now limited to public health drugs only. Medical facilities and physicians serving the poor find it essential to supply medications. A patient with no definite symp- toms, such as one with hypertension, is not likely to purchase expensive medi- cation until he becomes acutely ill and requires hospitalization. The Grand Jury has learned the County can provide medication at a substantially lower cost than that charged by private pharmacies. Medication has been provided either in a lump sum Medi-Cal billing (under the Los Angeles County waiver which waives the necessity for itemized billing) or is included in the all-inclusive clinic fee. Rather than eliminating the dispensing of medication, the Jury believes the County should explore the feasibility of charging pharmacy fees somewhere between the actual County cost and the much higher fees authorized by Medi-Cal. The result would be a savings for the taxpayer, and the markup could be used to fund medication for those unable to pay and ineligible for entitlement programs. In addition, the Grand Jury has information that a gap in service has resulted because many medications pre- scribed at County facilities are not available in community pharmacies. For example, cancer patients cannot get the narcotics they need in many areas of the County because the pharmacies do not stock them.

Clinic fees as currently structured are exorbitant and unrealistic. Patients have been billed for later collection with extremely low collection rates. The experi- mental program of collecting a $20 up-front cash fee, instituted in April 1981 has reportedly been extremely successful. The vast majority of patients have been willing to pay the fee, and substantially higher revenues are being generated. Therefore, the Grand Jury recommends:

the number of committees to which any member may belong should be restricted so that committee meetings can be scheduled and conducted on a single day as a rule. Response: The Grand Jury agrees.

Recommendation: The Audit Committee should require attendance by the contract auditor at regularly scheduled meetings and other meetings where planned, current or completed reviews are discussed. Response: The Grand Jury agrees. The 1981-82 Grand Jury has been following this practice.

F10

Recommendation: Representatives of the Grand Jury should participate in the early phases of any exami- nation undertaken by the contract auditor in order to gain a first-hand understanding of the issues and the officials involved in the matter being reviewed. Response: The Grand Jury agrees. The 1981-82 Grand Jury has been following this practice.

F11

Recommendation: Representatives of the Grand Jury should communicate with representatives of the CAO Management Services Division, Auditor-Controller's Office and Economy and Efficiency Commission early in the year to discuss the schedules of each organization for reviews and examinations during the year and to establish cooperative arrangements for sharing of information. Response: The Grand Jury agrees. The 1981-82 Grand Jury's Audit Committee took into consideration work recently done or planned by these offices in developing its list of proposed audits, and representatives of the Grand Jury accompanied the contract auditor on interviews of representatives from the Chief Administrative Office and the County Auditor-Controller as one of the early steps in each audit.

F12

Recommendation: The Auditor-Controller's Office and the CAO's Management Services Division should be consulted as one of the first steps in most reviews. Response: The Grand Jury agrees and, as noted in response to Recommendation No. 11, has followed this practice.

F13

Recommendation: Grand Jury examinations should concentrate on the areas outlined in applicable sections of the Penal Code while avoiding detailed department-wide organizational and operational reviews. Response: The Grand Jury agrees. The Grand Jury and its contract auditor have conducted preliminary overviews of departments selected for audit to determine which areas of those departments would be most productive to review, Resources have been concentrated on reviewing those areas. 121

F14

Recommendation: The Grand Jury and its separate committees should focus on areas to be examined and begin work on them as early as possible. Response: The Grand Jury agrees.

F15

Recommendation: The Grand Jury should evaluate the appropriateness of receiving full-time legal advice from a Deputy District Attorney and consider the advisability and feasibility of alternatives. Response: The Grand Jury does not agree. The Jury agrees that full-time services of a Deputy District 200000 Attorney are not now needed, and would point out that at present the Deputy serving the Jury does other work for the District Attorney as well. He estimates that other work has taken approximately 30 percent of his time this year. TO SECTION However, the Jury strongly believes it needs an "on site" legal counsel, i.e., stationed in Grand Jury quarters. Questions involving criminal law do not arise solely in connection with indictment proceed- 47.5 ings. Of the many communications received from the public, most allege some kind of wrongdoing, and require legal advice before reply can be made. The Jury also needs review by counsel of many outgoing communications to make certain they are legally sound, and of almost all press releases. It is true that not all legal questions involve criminal law, and that some information now obtained from the District Attorney could be provided by the CAO or County Counsel. However, the Jury believes its day-to-day work would be greatly impeded if it did not have a single, readily available source of advice. Two advantages in having a Deputy District Attorney as the Jury's counsel are that (1) probably the majority of legal questions which arise involve criminal law and (2) it is logistically more efficient, where counsel does not provide full-time service for the Jury, that he be from a department which is housed in the same building. This facilitates his providing service to both his office and the Jury.

F16

Recommendation: Officials and departments that are the subjects of examinations should be given the opportunity to review draft reports before interim or final reports are issued. Response: The Grand Jury agrees. The 1981-82 Grand Jury has been following this procedure.

F17

Recommendation: Interim reports should be completed and submitted to the Board of Supervisors as early in the Grand Jury's term as possible. Response: The Grand Jury agrees.

F18

Recommendation: The Grand Jury should consider issuing less elaborate final reports than have been prepared in recent years. ì Response: The Grand Jury agrees. The 1981-82 Grand Jury, early in its term adopted a simple, one-color format for the current year's report. In the opinion of the Grand Jury, adoption of a standard format for Grand Jury annual reports would make the reports more identifiable and simpler to prepare.

F19

Recommendation: Near the end of its term each Grand Jury should schedule a meeting with the Board of Supervisors to present the final report. Response: The Grand Jury agrees. DEPARTMENT OF CHIEF MEDICAL EXAMINER-CORONER The Chief Medical Examiner-Coroners Office was established in 1956 as an independent County department, with responsibilities previously performed under the Public Administrator. Its duties are prescribed in the Government Code and the Health and Safety Code. The Coroner determines the circumstances, manner, and causes of all deaths other than natural, and has both mandatory and discretionary powers to perform autopsies. The office is required to perform an autopsy when it is requested and paid for by the next of kin, even though the death was not originally a Coroner's case. The Medical Examiner-Coroner also runs alcohol or drug tests on all traffic deaths where the victim is over 15 years of age and dies within 24 hours of the accident. In all cases, the Medical Examiner-Coroner issues a death certificate as soon as possible after examination of a body. The Department is organized into six separate divisions: Executive Office, Investigations, Forensic Medicine, Forensic Laboratories, Public Services and Inquest. No. The second The Medical Examiner-Coroner's Department had never been the subject of a Grand Jury audit. In 1976 the Department was audited by the Controller's Office and in 1978 its operations were reviewed by the Chief Administrative Officer. On August 31, 1981, the Grand Jury approved the Department of Medical Examiner-Coroner as one of those to be audited. OBJECTIVES STATE OF STATES The objective of this review was to identify areas for overall improvement in departmental operations and to make recommendations necessary for the implementation of improvements. Included was an examination of the general procedures and standards for the investigation of in-custody deaths, the operation of the Coroner's Automated Information System-Data Processing Section (CAIN), and delays in the preparation of transcripts of inquest proceedings which impeded investigations by other County departments and government agencies. STATE OF STREET APPROACH Shortly after finalization of the work plan for a review of the Medical Examiner-Coroner's Office by the Grand Jury's contract auditor in November 1981, the operations of the Department came under increased public scrutiny as a result of a series of articles in the news media. These articles began to appear in December 1981, and focused public attention on the Department. The Board of Supervisors ordered the County's Chief Administrative Officer (CAO) to conduct an in-depth management review of departmental operations. The Grand STATE OF STATE OF Jury's contract auditor (Peat, Marwick, Mitchell, & Co.) and the CAO conducted independent reviews of the Chief Medical Examiner-Coroner's Department but met on several occasions to clarify the scope of the respective reviews and to avoid duplication of effort. The Grand Jury's review was not a result of any adverse publicity about the performance of duties by the Chief Medical Examiner-Coroner or the Department. The Jury did not review A STATE OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE issues relating to allegations of the Chief Medical Examiner's absence from his office or regard- ing his conduct. Nor did the Grand Jury attempt to evaluate his performance as a manager. CANAL STREET

Recommendations 30

R1

The Grand Jury therefore recommends that the Museum Trustees and the County resolve the following issues: 1000 • What is an adequate level of funding for both Museum Associates and Los Angeles County with respect to current operations?
R2

That sufficient funding be restored to the target areas of Pico Rivera, Lynwood, East Los 2000 Angeles, Lennox and Norwalk to allow the addition of 10 deputy district attorneys to Operation Hardcore. A COLUMN
R3

That the Board of Supervisors support legislation which would amend sections of the Welfare and Institutions Code relating to sentencing and court jurisdiction to provide for placement in the state prison system of violent young offenders for whom jurisdiction A STATE OF of the Youth Authority is inappropriate.
R4

That a study be made by a task force appointed by the Board of Supervisors of the Repeat 10000 Offenders Court Program in use in Cook County, Illinois, with the possibility of adopting it in Los Angeles County for prosecution of gang violence cases. Frances Courtney, Chair Mildred Light Rose Black Barbara Lurvey Carmelita West Susan Dixon Pina Fisher James Wilcott Richard Halpin
R5

Conduct a campaign to educate the public to modify its purchasing habits, e.g., avoid buying single-use disposable products, and buy items that are durable, recyclable or repairable.
R6

Adopt as policy that Supervisors will encourage planning commissions, city councils and permit issuing authorities in their districts to facilitate siting of resource recovery and recycling centers through appropriate zoning and special simplified procedures for obtaining conditional use permits.
R7

Encourage the promotion of waste-to-energy projects within the County, and the develop- ment of energy conversion sites wherever feasible.
R8

Encourage recycling centers to expand their drop-off and buy-back programs for news- papers, metals, glass, aluminum and plastics. C. HAZARDOUS WASTE
R9

That DMH work with state hospitals to assist in taking patients for preplacement visits to community care facilities.
R10

That DMH take any additional steps possible to move patients into less restrictive, less i expensive settings whenever therapeutically appropriate. B, CONDITIONS AT THE SUPERIOR COURT'S MENTAL HEALTH DEPARTMENT
R11

That the County Personnel Department conduct an overall review/formal survey of positions and salaries within the Department. Such review should focus on the comparability of wages and duties within the overall County personnel structure and considering similar agencies in surrounding counties. The results of such review should be used in setting wages and salaries in the future.
R12

That the Department establish a specific retention policy for photographs, x-rays, bullets, death instru- ments, personal clothes, inquest reporter notes of inquest hearings, and other data and materials created in daily operations.
R13

That the Department improve storage practices by consolidating all storage areas of vital evidence into one central area. Storage bins should be secured and inventory records maintained.
R14

That the Department develop and submit to the County of Los Angeles Board of Supervisors a request for additional operating space to meet the immediate and long-term requirements.
R15

That the Department develop scheduling and parking arrangements for Coroner's vans and mortuary vehicles to accommodate reasonable peak loads.
R16

That the Department create and maintain a master log report (management information report) that reports the number of deferred certificates and final death certificates issued by examining pathologists and lists pending deferred death certificates and remaining tests and reports ordered by days outstand- ing.
R17

That the Department develop and implement performance standards for completion of internal medical tests (like histopathology) and, when necessary, secure additional support or overtime work to assure timely performance. Such standards should be developed with the help and input of outside agencies (e.g., law enforcement, hospitals, etc.) to develop mutually acceptable time standards for receipt of their respective reports that are critical to the completion of deferred death certificates.
R18

That the Department numerically order death certificates and maintain records to improve internal control procedures.
R19

That pathologists review copies of completed death certificates. If discrepancies are identified in review- STATE OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE P ing the death certificate, an amendment should be issued. That the Department strive to rigidly enforce the requirement for immediate notification of the Coroner. 100000000000000000000000000000000000000
R20

The Department should be requested to report to the 1982-83 Los Angeles County Grand Jury its progress toward implementing the recommendations contained in this report. No. DEPARTMENT OF MENTAL HEALTH 20201000 The County is experiencing major difficulties in maintaining mental health care service levels for its residents under current financial conditions. More than 85 percent of the $142 million Section 1 1981-82 budget administered by the Department of Mental Health comes from revenue sources external to the County, including Federal and non-Federal Medi-Cal, Short-Doyle and State General Fund monies.
R21

That the Department accumulate in a single reference book a Departmental Policy and Procedures Manual; such manual should include tasks and standards for Coroner's Investigators and Senior Coroner's A CONTRACTOR Investigators.
R22

That the Department develop and monitor an evaluation system that tracks and enforces staff investi- gating performance against documented policies, procedures and standards. ACCOUNT. That the Department require payment in full before the preparation of inquest transcripts.
R23

The AAA Advisory Council should more actively seek to inform participants of its role and to improve its communication with them.
R24

That the Auditor-Controller develop a billing rate for first-time requests for inquest transcripts that is 200 consistent with the actual costs of preparation.
R25

That the Department work with other County departments requesting autopsy and transcript reports to determine if the volume of reports is excessive and if such volume cannot reasonably be reduced.
R26

That the Department's request for $85,000 in capital expenditures for the forensic laboratory equipment be approved. Such equipment is necessary to assure accurate and timely toxicology test results.
R27

That the Department develop a plan to implement the recommendations of this report that specifies
R28

That the Coroner's Office continue with the development of the "CAIN" system and the documenta- tion of its internal operating procedures. The detail design phase of "CAIN" development should be scheduled to begin after management changes in operating procedures resulting from this study have been made.
R29

Senior citizens should be provided opportunities for meaningful service commensurate with their skills and 200 experience. Miscellaneous
R30

The Department should consider developing guidelines for its contractors who may be willing to promote shared housing as a means to alleviate the shortage of affordable housing for seniors. The Department should consider requesting each of its contractors to furnish a plan for employing seniors as paid personnel. This review was conducted by Grand Jurors Rebecca Allen, Chair, Patsy Edwards, Mildred Light, and Carmelita ( $ 2 West with the assistance of the contract auditor.) GROUP II - PRELIMINARY REVIEWS DEPARTMENT OF BUILDING SERVICES TOTAL STATE The Department of Building Services (DBS) provides custodial and related services to approximately 400 County-owned facilities, including health care facilities. In 1978 the County electorate passed Proposition A which allowed services being rendered by County personnel to be contracted to private enterprise. It subsequently became the policy of the Board of Supervisors to encourage such contracting. OBJECTIVES The objectives of the Grand Jury were to:

* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.