Health and Human Services Committee

Recommendations 5

• R1

  Page 38
  An independent fiscal and compliance audit needs to be conducted to determine whether the city has met the stated fiscal goals and whether development has actually been completed and built in a timely and proper manner. This audit needs to be conducted by persons versed in land use and development, fiscal issues related to development, and familiar with municipal financing. Further, the audit needs to be conducted and overseen by some entity or independent persons not in association with the city. The audit should observe the actual results of development and compare the results to the stated goals for developing North Natomas. The following issues need to be addressed in the audit: 1. Has the development enhanced the city’s ability to attract major industrial employers? 2. Does the area contain optimum amounts of land devoted to parks, recreational facilities and open space? 3. What has been and will be the fiscal impacts of the development on the city, i.e., is the revenue derived from the development supporting not only the capital cost of the infrastructure required for the development, but also the ongoing cost of maintaining that infrastructure including the development and maintenance of the regional park? 4. Do the actual tax revenues generated by the development of North Natomas provide an ongoing revenue surplus for use throughout the city? 5. Has the jobs-to-housing ratio goal of 60% been achieved? 6. Have the various fiscal devices that the city used to assist the developers provided a clear audit trail to determine that builders/developers did what they were supposed to do with the money and in a timely and proper manner? The audit report should be made readily available to the public at the same time it is given to the city.
• R2

  Page 38
  The city should develop and then conduct, on a regular basis, an analysis of the water, sediments and soil in the drainage detention basins and provide that information to the Central Valley Water Quality Control Board. 28
• R3

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  The city should immediately stop allowing any further building in the North Natomas flood plain. The restriction should remain in effect until the federal government certifies the flood protection as meeting the minimum 100-year flood level. The city could allow for continued planning, and the maintenance of existing structures. In addition, the city should build or retrofit community buildings to a height sufficient to enable the buildings to act as a shelter for people to gather until help arrives. Response Requirements Penal Code sections 933 and 933.05 require that specific responses to both the findings and recommendations contained in this report be submitted to the Presiding Judge of the Sacramento Superior Court by October 1, 2007, from: • Sacramento City Council 29 Sacramento County Sheriff’s Department Work Release Division Issue The Grand Jury evaluated the Sheriff’s Department Work Release Division to determine whether the department is efficient, properly staffed and sufficiently promoted in the community. Reason for Investigation California Penal Code section 919(b) requires the Grand Jury to inquire into the condition and management of county jails. Method of Investigation The Grand Jury toured the Work Release Division facility and spoke to the following individuals: • Administrative Supervisor, Work Release • Supervisor and Field Coordinator, Work Project • Sheriff’s Deputies, Toy Project • Finance and Collections Supervisors, Revenue Collections Unit • Supervisor, Home Detention Program • Supervisor, Revenue and Recovery Warrant Unit • Civilian booking employee • Inmate The Grand Jury also reviewed: • The Work Release Division Grand Jury Tour Booklet, August 23, 2006 • Sacramento County Sheriff’s Department 2005-2006 Budget Background and Facts In August 2006, the Grand Jury conducted its mandatory tour of this correctional facility. The staff and deputies interviewed were enthusiastic and motivated about their programs. Since 1979, the Work Release Division has conducted Sacramento County’s alternative sentencing program for inmates. It allows qualified inmates to serve their sentences on electronically monitored 31 home detention or by participating in community work projects. Inmate counts usually range from 1,800-2,000 on Work Project at any one time and Home Detention is consistently over 323, and increasing. This alternative to incarceration allows the inmates to maintain employment and family relationships. The community benefits from inmate labor provided to groups such as school and park districts, churches, civic groups and other nonprofit organizations. The county benefits from reduced jail population and related incarceration. There is also a cost recovery benefit, as inmate participants are required to pay application and daily fees based on the applicant’s ability to pay.1 Home Detention Program Home Detention is an alternative to traditional incarceration. Participants are allowed to live in their homes and are monitored by electronic equipment that tracks their movements. The equipment also conducts alcohol breath tests randomly throughout each day for those inmates with alcohol related offenses. All participants are also required to provide samples for drug analysis when requested. Work Project Program The Work Project Program was created in 1978 to allow specific inmates, who are sentenced and considered low risk, to work in their community instead of serving time in Sacramento County jail facilities. Inmates are recommended by the sentencing judge to participate in the program. If accepted, they are assigned to one of more than 25 work sites throughout the county. They work one or more days per week on a work crew supervised by a deputy sheriff. Good time is computed into their sentence and release dates are adjusted accordingly.2 Participants are monitored for their attitude, dress and productivity. Currently, 84 percent of inmates complete the program, and program failures are returned to jail. There are more than 22 entities receiving the benefit of work performed by Work Project participants. The type of work ranges from cleanup after community events, weed abatement, landscape maintenance, trenching, fire breaks, trash pickup, homeless camp cleanup and debris removal. The California Penal Code limits the use of inmate labor to public domain and nonprofit entities. There are five public entity contracts for services, with each entity paying the cost of the deputy’s supervision. A sheriff’s deputy supervises all job sites. Currently, one Work Project Field Operations sergeant provides supervision to 17 full-time deputy sheriffs and as many as 19 on call deputy sheriffs over a seven day week. These 19 on call deputy 1 California Penal Code section 1208.2(g) states that participation in these programs cannot be denied due to inability to pay. According to the Sheriff’s Office, up to $40 in cost per sentence day may be assessed per inmate on Work Project, and up to $41.73 per day may be assessed to the inmate on home detention. (The actual cost of Work Project was last calculated at $61.03 per work day, and $41.73 per day for Home Detention.) After waivers due to “ability to pay,” and a small failure rate, actual collections for fiscal year 2005-2006 were approximately $30.20 per work day for Work Project and $21.16 per day for Home Detention. 2 “Good time” is time reduced from an inmate’s sentence for participating in a work program. “Worktime credits shall apply for performance in work assignments and performance in elementary, high school, or vocational education programs.” (Pen. C. §2933.) 32 sheriffs are scheduled from a changing roster of academy graduates and retired annuitants. Consequently, this sergeant may supervise 50 individuals annually. There is no other sergeant post in Sacramento County charged with supervising this many individuals over a seven day week. As noted in the Work Release Division Grand Jury Tour Booklet, the Work Project has evolved into one of the largest alternative correctional programs in the nation.3 The current average number of inmates participating in the program is over 1,800 a week. Without the program, more jail beds would be required. The benefit of the labor provided by inmate work crews is worth in excess of $5 million per year to the community. One little known fact about the Work Project Program is that during times of local/state emergency or crisis, this group can be mobilized quickly, and up to 450 people can be placed in an area within a short time period. For example, during the 2006 flooding, Work Project inmates assisted in sandbagging efforts in high water areas. The Toy Project The Toy Project is a charitable function of the Sheriff’s Department in which participants of the Work Project spend their sentence making toys, building furniture and refurbishing donated computers and bicycles. The Toy Project has operated since 1984 and has provided children in the community with over 60,000 gifts. In addition, it has refurbished and distributed over 5,300 bicycles. Last Christmas, food boxes and gifts were given to more than 1,200 families, with each child up to 17 years of age receiving an average of three gifts. Although the Toy Project emphasizes the winter holiday season, it also fills special requests throughout the year from individuals and families in need. These requests come from agencies such as the Fulfill-A-Wish Foundation, Mustard Seed School, Omni Program, River Oaks Center for Children, Sacramento Children’s Receiving Home, Trinity Foster Care, Wind Youth Services and other schools and organizations throughout the community. There are several sources of funds underwriting the Toy Project. Inmate work crews participating in the Work Project collect recyclables while doing roadside cleanup. The revenue generated from recyclables is donated to the Toy Project. Also, 10 – 15 employees of the Work Release Division volunteer once a week at a local bingo hall. From the efforts of these volunteers, approximately $600 a week is donated to the Toy Project. Partnerships with organizations such as YES (Youth Education Sports), Heald College and the Salvation Army help make Toy Project items available to children throughout the Sacramento region. The Toy Project serves as an outreach program for members of the Sheriff’s Department as they work to build strong ties with the Sacramento community. The Work Project Program has a current annual budget of approximately $6 million and generated approximately $3.7 million in fee revenues in fiscal year 2005-2006. The Home Detention Program has an annual budget of approximately $3 million per year, and generated approximately $1.2 million in fiscal year 2005-2006. Power Program The Power Program is a community correctional program that helps offenders reintegrate into the community. This innovative program also offers the offenders something tangible, increases self- esteem and encourages compliance with the Sheriff’s Department alternative custody programs. The Power Program offers educational and pre-employment skills to offenders while serving their sentence on Work Release. A wide range of resources is available such as job training programs operated by the federal government, Sacramento Employment Training Administration, California Employment Development Department and Job Club (operated by the County Department of Human Assistance). Problem Oriented Policing (POP) The POP officer is responsible for meeting with community members, schools, parks, churches, Sheriff Service Centers, and nonprofit community based organizations. The POP officer identifies and prioritizes work that could be accomplished in the community and coordinates with other community contacts and the Work Project to get the work done. The POP partners with the Sacramento County District Attorney’s Office Multi-Agency Graffiti Intervention Committee to identify areas affected by graffiti vandalism. Once affected areas are identified, the POP officer utilizes Work Release participants to remove graffiti and/or repaint the blighted areas. Graffiti removal is also provided to the elderly or financially challenged individuals at no cost. To date, POP has worked throughout the County of Sacramento in parks and trailway systems, wetland preserves and nature areas, historical buildings, memorial gardens, abandoned residential lots, churches, schools, parking accesses in the delta and roadways.
• R4

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  SAS should review the policy for assigning codes to determine if allowing IHSS recipients to decline emergency notification truly serves the best interests of the recipients and the community as a whole. Since the recipient is benefiting from services paid for by public funds, SAS should contact them in any case of an emergency. Response Requirements Penal Code sections 933 and 933.05 require that specific responses to both the findings and recommendations contained in this report be submitted to the Presiding Judge of the Sacramento Superior Court by October 1, 2007, from: • Sacramento County Board of Supervisors 55 The Sacramento County Primary Care Clinic Issue The Sacramento County Grand Jury reviewed the quality and availability of medical services at the Sacramento County Primary Care Clinic. Reason for Investigation Along with growth across all demographics in Sacramento County, the number of low income and indigent individuals has also increased. These individuals require medical services both in terms of intervention and long term health care. The Grand Jury reviewed the quality and availability of these medical services. Method of Investigation The Grand Jury interviewed: • Division Chief, Primary Health Services Division • Medical Director, Clinic Services Branch • Director, Pharmacy Services • Chief, Correctional Health Services, Sheriff’s Department • Project Manager, County Medication Management System (CMMS) The Grand Jury reviewed: • Primary Care Clinic brochures and information packets • Eligibility packets • Memorandum from the County Pharmacist regarding pharmacy staffing • Request for Proposal (RFP) for the CMMS, January 10, 2005 • CMMS contract, October 10, 2005 • Pharmacy Computer Service, Inc. of Oregon (PCSI) response to the RFP • PCSI RX 3000 open item log • Department of Health and Human Services Information Technology organization chart, April 2, 2007 • Letter from Chief, Primary Health Services Division to PCSI regarding PCSI’s failure to demonstrate the RX 3000 outpatient/inpatient application functionality, December 7, 2006 • Letter from PCSI to Chief, Primary Health Services Division, December 11, 2006 57 Background and Information The purpose of the County Medically Indigent Services Program (CMISP) is to provide medically necessary care to all eligible residents of Sacramento County. All recipients of General Assistance (GA) are automatically eligible for CMISP clinic services. Other indigent persons who need to apply for CMISP may do so at the time they request medical service at one of the following clinics: • Primary Care Clinic ● South City Health Center 4600 Broadway 7171 Bowling Green Drive Sacramento, CA 95852 Sacramento, CA 95823 • Del Paso Health Center ● Capital Health Center 3950 Research Drive 1500 C Street Sacramento, CA 95838 Sacramento, CA 95814 • Northeast Health Center ● Sacramento Dental Clinic 7805 Auburn Boulevard 1500 C Street Citrus Heights, CA 95610 Sacramento, CA 95814 On November 1, 2003, the County of Sacramento opened the new Doctor Paul F. Hom Primary Care Clinic (PCC). PCC is the center of the health support facilities in Sacramento County. PCC is open from 8:00 a.m. until 9:00 p.m., Monday through Friday. Along with indigent patients, the clinic also serves the working poor who are not eligible for Medi-Cal benefits. On an average day, besides a full schedule of office visits, the clinic will serve as many as 150 additional walk-in patients for treatment. Of these walk-in patients, as many as 50 are new patients and an enormous amount of work is required to document their medical histories. The clinic also receives follow-up patients from area emergency rooms. In an average year, PCC will provide medical support to over 50,000 patients. While the clinic has a full spectrum of services such as laboratory (outsourced), radiology and pharmacy, the staff also facilitates referrals for services beyond the scope of the PCC. This would include services such as chemotherapy, radiation therapy, advanced diagnostics and inpatient care. Additional points of interest include: • The clinic does not have patient transportation available but provides vouchers for taxis and public transit. • The staff at the clinic can translate over a dozen languages and a phone translation service is available for others. • The Chest Clinic is the primary county caregiver for patients with tuberculosis regardless of the patient’s income or insurance. • The clinic has many active volunteers, both lay individuals and health care professionals. County residents are encouraged to volunteer at 874.9670. 58 • The 2007 budget of the clinic through the Department of Health and Human Services is $93 million. Problems in Pharmacy Staffing Staffing During tours and interviews with the clinic staff, the Grand Jury learned that there is currently a shortage of pharmacists working for Sacramento County. These pharmacists are responsible for dispensing prescription requests from all of the county clinics and the county correctional facilities. Currently, 25% of the authorized positions are vacant. Within the next two years, retirement and work hour cut-back requests will further decrease the existing staff. Pharmacy staffing is problematic for the following reasons: • There is a severe shortage of licensed pharmacists in the Sacramento area. Even with an attractive benefit package and work schedule, the county has not been able to attract candidates. • Sacramento County pharmacist salaries are not competitive with area agencies: • Area hospitals currently pay 25-35% more than the county. • Retail sources pay 20-40% more than the county. • Temporary hires are paid 30-50% more than county pharmacists. • Neighboring San Joaquin County pays 10% more to its pharmacists. If the county has to resort to outsourcing a substantial amount of the pharmacy workload, the consequences would be extremely costly. During the labor action at the county clinics in September 2006, the health clinics were forced to send many prescriptions to outside retail pharmacies. The cost of these medications rose by an estimated 287%. New Pharmacy Software Adding to the difficulties in the pharmacy department is the failure of the CMMS. In January 2005, the Department of General Services issued an RFP on behalf of the Department of Health and Human Services (DHHS) for a CMMS to manage the pharmacy system in institutional and outpatient environments. The county received three bids. The Grand Jury reviewed the RFP issued on January 10, 2005, and the awarded vendor response. It is clear that the documents were not reviewed for clarity or information technology procurement best practices: • On page four of the RFP, “. . . the County Department of Health and Human Services for which this RFP is prepared and which will be the end user of the voting machine sought . . . .” This is not a bid for a voting machine. • On under “2.3 Health Insurance Portability and Accountability Act (HIPAA) COMPLIANCE,” the county requests that the system support HIPAA standards. However, the RFP document does not require the vendor or support staff to be HIPAA certified. 59 • On , under “6.2.2.3 Availability and Disaster Recovery,” the reference should be “planned downtime,” not “planned downtown.” • On , “4.2.1 Criteria” and , “5.1 Contract Execution,” the county states that the awarded vendor must post a performance bond. This condition is mandatory but not met. • It is also noted that PCSI did not provide several required financial documents: a recent corporate annual report including an auditor’s unqualified opinion or a copy of an auditor’s review signed by a CPA demonstrating either net worth of $2.5 million or annual gross revenue of $7.5 million and an annual net profit of $1 million. Based on a review of the bid, the county awarded the contract for CMMS to PCSI. The value of the contract was approximately $690,275. That winning bid should have been deemed non-responsive because the vendor did not include the cost of the required performance bond in the cost portion of its bid. The vendor stated an effort would be made to secure the bond after the contract was awarded and that the county would have to pay for that bond. The awarded vendor did not comply with the mandatory RFP requirements and should not have been awarded the contract. After more than a year, the outpatient software is described as 85% functional. This means that 15% of the contracted systems are not working. As of March 2007, the county paid the PCSI $174,000. The inpatient software has proven to be nonfunctional. In February 2007, the Sheriff’s Department withdrew its participation from the inpatient system development and is pursuing other solutions. The juvenile and mental health facilities have also withdrawn participation in the inpatient modem. The primary problem, as described to the Grand Jury, is that the vendor switched from a character base data system to a windows base data system, with Sacramento County being the first customer on this system. The vendor is therefore using Sacramento County Medical Services to do its beta testing.
• R5

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  The City of Sacramento should make all agreements the city has made with the developer and others related to the development of the railyard available to the public. Response Requirements Penal Code sections 933 and 933.05 require that specific responses to both the