San Bernardino County Grand Jury
• 2008-2009
Department of Public Health Finding 1 The Board of Supervisors agrees with this finding. Finding 2 The Board of
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings 9 findings
F1
The Board of Supervisors agrees with this finding.
F2
The Board of Supervisors disagrees with the impression created by the finding that the county’s response to the August 2008 tuberculosis incident in Needles was somehow “hampered by poor communication and coordination.” In fact, the incident was resolved with the utmost dispatch and with the best outcome possible in terms of mitigating the threat to the public’s health and safety. Within 13 hours of confirming that the patient was not complying with an Isolation Order, the Department of Public Health secured a civil order of detention, served the order on the patient, transported the patient to Arrowhead Regional Medical Center in Colton, and assigned the patient to an isolation pod for treatment and observation. This process was accomplished under the supervision of the County Administrative Officer and with the consultation and cooperation of the Department of Public Health, the Sheriff’s Department, County Counsel’s Office, the Inland Counties Emergency Medical Agency, and ARMC.
F3
The Board of Supervisors disagrees with an element of the finding. The finding refers to a position alternately labeled “Chief Medical Health Officer” and “Chief Medical Officer”. The position of “Chief Medical Officer” was eliminated several years ago during a reorganization. Since that reorganization, the county has had a “Health Officer” position, which is a position mandated and defined by state law. The qualifications for a county Health Officer are contained in at least two areas of California law. Section 101005 of the California Health and Safety Code reads in its entirety: “The county health officer shall be a graduate of a medical college of good standing and repute. His or her compensation shall be determined by the board of supervisors.” California State Code of Regulations Department of Health Services Title 17, Chapter 3, Subchapter 1, Article 3, Section 1300 reads: “The health officer shall be a graduate of a medical school of good standing and repute and shall be eligible for a license to practice medicine and surgery in the State of California; provided however that those health officers on a full-time basis as of September 19, 1947, shall be considered as meeting the requirements of this section.” 1 The County of San Bernardino minimum requirements for the Health Officer are as follows: “A licensed physician in the State of California with a minimum of two years of administrative experience in a public health environment supervising physicians or various public health professionals.” It should be noted that the requirements for the County of San Bernardino Health Officer exceed those of the State of California for a county health officer, and that the current Health Officer meets those requirements by having been Chair of the Women's Health Department at Riverside Regional County Medical Center for more than three and a half years. In this capacity he supervised physicians and professional staff in clinical service delivery for indigent populations in a county facility in a public health environment.
F4
The Board of Supervisors disagrees with this finding. Clinical staffing composition is the result of a number of criteria. These criteria include but are not limited to grant funding, general fund costs, grant requirements, budgetary limitations, scope of work, staff licensure, labor memorandums of understanding, skill mix, staffing levels at numerous locations, staff availability, continuing education training schedules, unanticipated staffing shortages, and emergency response. Program-level managers often do not take all of the criteria into consideration when advocating staffing for their individual programs as administrators must. Staffing decisions are never made arbitrarily and are the result of consultation with affected programs and only after considerable due diligence by departmental administration.
F5
Although the finding states that the grand jury “made no determination whether or not such conduct was pervasive throughout DPH”, the Board of Supervisors disagrees with the impression that may have been created by the finding. The Board of Supervisors believes that any discomfort that was expressed to the grand jury was the result of an adjustment to a new manager, who had been tasked with carrying out a bold initiative – integration of services provided by Public Health, Behavioral Health, and Arrowhead Regional Medical Center. It should be noted that in order to improve morale in the face of change, the executive staff of Public Health has sponsored employee appreciation events, an employee recognition program, a Public Health newsletter, and included staff at all levels regarding policy decision-making.
F6
The Board of Supervisors disagrees with this finding. The Public Health Director denies making the statement attributed to him in the finding. In an effort to facilitate better departmental communications at all levels, the new Director of 2 Public Health instituted weekly executive staff meetings, continued to perform monthly Program Manager’s meetings, regularly attends program staff meetings, and conducts weekly site visits to every Public Health office, clinic, and facility county-wide. In many cases, employees that have been with the Department of Public Health for decades have commented that these site visits are the first and only instances in which they have met and spoken with a Director of Public Health.
F7
The Board of Supervisors cannot corroborate this finding.
F8
The Board of Supervisors agrees with this finding.
F9
The Board of Supervisors disagrees with elements of this finding. The County’s health services Integration Project was conceived and is designed to bring health-related services from three County departments – Public Health, Behavioral Health, and Arrowhead Regional Medical Center – under one roof into each of five regional clinics. Under this concept, Public Health would provide preventative health services, Behavioral Health would supply mental health services, and ARMC would offer primary care services to these County facilities. At this time, no involvement of Community Based Organizations (CBOs) in the integrated county clinic facilities is envisioned. The H Street Clinic is but one of many CBOs that participated in a Request For Proposals (RFP) to contract for the delivery of services under the Ryan White Program for HIV/AIDS services. Under law, contracts for services must undergo a competitive process. The Ryan White Program is jointly administered with Riverside County under the direction and supervision of a federally mandated Planning Council which consists of community members appointed by each county’s Board of Supervisors. Under the provisions and scoring of RFP ASP 07-02 for the Ryan White Program Part A, Part B, Minority AIDS Initiative HIV/AIDS Healthcare and Support Services released in January 2008, the H Street Clinic CBO scored last in every category and therefore did not receive funding. Currently, the Department of Public Health holds contractual agreements with 11 qualified CBOs to deliver services. Regular and predictable RFPs are released to the public in an effort engage the CBO community to deliver health-related services to promote the health and well-being of San Bernardino County residents. 3
Recommendations 5
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R1The City of Rancho Cucamonga Redevelopment Agency followed a similar process when dealing with a piece of RDA-owned land on Foothill Boulevard adjacent to I-15. The City’s RDA partnered with Forest City and Lewis Homes, and eventually created the Victoria Gardens regional lifestyle center, which has been a huge economic success.
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R2The County of Orange Flood Control District has issued an RFQ to seek a developer who can entitle more than 1,600 acres of surplus land located in the City of Highland. The proposed process is similar to that proposed by San Bernardino County.
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R3Under Policy F-51, the County of San Diego mandates that surplus property sold by the County be zoned to its highest and best use whenever possible and whenever such zoning will materially increase the chances of selling the property for the highest price possible. This example (see ATTACHMENT IV) is very similar to the process proposed by San Bernardino County for the 1,200 acres because it involves working 23 with an incorporated City and a qualified developer to enhance the value of a piece of County-owned land through the entitlement process. The County of San Bernardino’s Surplus Real Property policy does not require the County to use an auction process. In fact, the word “auction” is not in the County’s Surplus Real Property policy. However, #6 under Policy Amplification (08-18) does state that property disposal methods shall be used to achieve the best possible return consistent with statute. In that regard, the County was following a procedure outlined by state law (G.C. 25515) for the entitlement and sale of this property. This law, which was enacted in the early 1980s, specifically states that counties can realize additional revenue from land sales by entering into joint-venture agreements to develop surplus property: G.C. 25515 The Legislature finds that counties are faced with critical revenue shortages and a need for additional revenue sources to provide basic and essential public services. The Legislature finds that counties own property which, if permitted to be developed by a joint venture agreement between private enterprise and commercial, industrial, and cultural uses, would provide a means to produce additional revenue sources for the benefit of the counties owning such property, and aid the economic well-being of the state generally. The Legislature further finds that due to reductions in personnel or programs counties own or lease properties which are totally or partially vacant but which could be used by compatible private persons, firms or corporations through lease arrangements or joint venture developments which would generate revenue. Therefore, the Legislature finds that the provisions for residential, commercial, industrial, and cultural development of public property owned by counties constitutes a valid public purpose. It is clearly in the best interest of the County and taxpayers to ensure that surplus property sold by the County brings the highest price possible. Selling potentially valuable surplus public land at auction without knowing the true value of the property could, in this Board’s opinion, be tantamount to a gift of public funds.
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R5A time-line of important dates in the assessment process found on other county’s websites was helpful to understanding the assessment appeals process. The Assessors of Ventura, San Diego and several other counties now display time-lines on their websites. The county agrees with this finding.
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R6All the information a property owner needs to process his own assessment appeal, without third party assistance, is on the county’s website. The county agrees with this finding. ATTACHMENT I 2008-09 GRAND JURY REPORT RESPONSE FORM GROUP AUDIT/FISCAL DATE JULY 31, 2009 DEPARTMENT ASSESSOR RECOMMENDATION NO. 09-08 SUBMITTED BY DENNIS L. DRAEGER RESPONSE 09-08 Utilize a private legal firm, or County Counsel personnel, knowledgeable in the field of appraisal and assessment appeals, to represent the Office of the Assessor during major appeals. The County will not implement this recommendation. The Assessors office does employee appraisal staff trained and certified by the State Board of Equalization in all aspects of appraising from the simplest to the most complex appraisals. The cost to hire a private legal firm would be prohibitive. Some of the more complex assessment appeals would cost in excess of $50,000 for a private firm to appraise and would incur additional cost for the presentation of the appraisal to the assessment appeals Board. The current member of the Assessors staff that presents the majority of the Assessors appraisals at the assessment appeal hearings has in excess of 31 years in the office and more than 16 years as the assessors specialist for the presentation of assessment appeals. ATTACHMENT I 2008-09 GRAND JURY REPORT RESPONSE FORM GROUP AUDIT/FISCAL DATE JULY 31, 2009 DEPARTMENT ASSESSOR RECOMMENDATION NO. 09-10 SUBMITTED BY DENNIS L. DRAEGER RESPONSE 09-10 Post a permanent and more detailed notice on Assessor’s website, warning that third-party vendors are not necessary in the assessment appeals process.. The County will implement this recommendation. The assessor will make changes to the website to include additional and stronger notices in