Mendocino County Grand Jury • 2007-2008

Clinics, the 43% Solution:

Published: May 22, 2008 7 pages
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Findings and Recommendations 48 findings

F1
The Alliance for Rural Community Health (ARCH) supports six rural health clinics in Mendocino County by acting as an advocate. It also assists the clinics in grant writing.
No recommendations for this finding
F2
Four of the six clinics are Federally Qualified Health Centers, a program that requires the clinic to treat uninsured patients.
No recommendations for this finding
F3
Under Federal law, no patient at these clinics may be turned away.
No recommendations for this finding
F4
Federally Qualified Health Centers are defended against medical malpractice suits by the Federal Government.
No recommendations for this finding
F5
The clinics provide medical and dental health services; in addition they address mental health, alcohol and drug dependency problems, and offer domestic violence programs, some family planning, and counseling. The clinics offer a full range of vaccinations.
No recommendations for this finding
F6
There is no County funding except County Medical Services Program (CMSP) for indigent patients who are single adults on general assistance and who do not qualify for Medi-Cal or other programs.
No recommendations for this finding
F7
No money from Proposition 63 is allocated to the clinics for the mental health initiative.3
No recommendations for this finding
F8
The clinics do not receive any Proposition 36 money for drug treatment.4
No recommendations for this finding
F9
Most patients seeking treatment are low-income or uninsured. A portion of those patients may be covered by Medicare/Medi-Cal, CMSP, and/or programs for children such as CalKids and Healthy Families.
No recommendations for this finding
F10
Patients, who have no insurance and who are not eligible for Medicare/Medi- Cal, may be charged on a sliding scale.
No recommendations for this finding
F11
Clinics located in areas near hospital facilities relieve some of the strain on emergency room services.
No recommendations for this finding
F12
Both Clinics have bilingual staff.
No recommendations for this finding
F13
Each Clinic is audited annually by outside certified public accountant firms and government agencies.
No recommendations for this finding
F14
The Clinics are extensively regulated by State and Federal agencies.
No recommendations for this finding
F15
The Clinics do not prescribe marijuana. Federal funding could be jeopardized.
No recommendations for this finding
F16
The outlying clinics experience more transportation concerns than those in the urban centers.
No recommendations for this finding
F17
Clinics call outside ambulance services when necessary.
No recommendations for this finding
F18
Neither Clinic visited has X-ray diagnostics for orthopedics. Their budgets do not allow for the purchase of expensive X-ray equipment nor the required lead-lined room. Proposition 63 is a California mental health program funded by taxation of 1% on personal income over $1,000,000 4 Proposition 36 provides State funds to local government for the management of non-violent drug offenders Long Valley Health Center
No recommendations for this finding
F19
LVHC is a sole provider; meaning there are no other health facilities or doctors in its service area.
No recommendations for this finding
F20
LVHC offers chiropractic and acupuncture services.
No recommendations for this finding
F21
LVHC served 3,062 patients with a total of 16,880 patient visits in 2006.5
No recommendations for this finding
F22
LVHC dental clinic was found to be a modern facility with the latest equipment. The clinic employs two full time dentists and other staff.
No recommendations for this finding
F23
LVHC dental clinic is located directly across from the medical clinic on Branscomb Road. Patients and staff frequently need to cross between these facilities. There is no marked crosswalk for pedestrians.
Related Recommendations (1)
R1
a crosswalk be painted on Branscomb Road in Laytonville between the LVHC medical clinic and the LVHC dental clinic. (Finding 23)
F24
The LVHC has Memorandums of Understanding (MOU) with other agencies, including the local fire department, schools, and doctors.
No recommendations for this finding
F25
Native Americans who live in the Laytonville area use Indian Health Service Clinics and travel to Ukiah or Covelo for routine care. LVHC has an MOU with the Consolidated Tribal Health Program (CTHP) for non- routine care.
No recommendations for this finding
F26
Recruitment of medical staff for the LVCHC is difficult, due to the remote location, the high cost of housing, and non-competitive wages. About 50% of the staff are long-term employees. There is a high turnover rate among the others.
No recommendations for this finding
F27
LVHC does not provide patient’s with transportation.
No recommendations for this finding
F28
LVHC spearheaded planning for emergency response in the Laytonville area with cooperation of the school, fire department, law enforcement, and community members. Final planning is in progress, and on June 18, 2008 there is a planned community meeting for public comment.
No recommendations for this finding
F29
LVHC has a backup generator in case of loss of normal electrical supply. Laytonville Volunteer Fire Department
No recommendations for this finding
F30
On 14 occasions in 2006 and 13 times in 2007, the LVFD provided emergency ambulance service from LVHC to the nearest hospital. Ambulance service is billed directly to the patient or their insurance carrier. Medi-Cal and Medicare insurance pay a minimal amount of the ambulance bill. Underpayments from insurances and no payment from the uninsured, make 75% of the billings uncollectible.
No recommendations for this finding
F31
LVFD provides ambulance service to an area twice as large as the size of the fire district, and may transport patients as far north as the closest hospital, which is in Garberville (in Humboldt County). Areas outside the fire district do not pay property taxes to the district.
Related Recommendations (1)
R2
the County continue to supplement the LVFD budget necessary for ambulance service. (Findings 31, 34) Comments The Grand Jury found that the LVHC and the MCHC offer a valuable service to the community despite their budgetary and staffing limitations. Recently, the State of California has announced mid-year budget cuts that will further inhibit the clinics’ ability to serve. 6 http://www.oshpd.ca.gov/hid/Products/Hospitals/Utilization/PC_SC_Utilization.html Ambulance service is a necessary and valuable component of health care emergency response. LVHC is a remote clinic without access to private ambulance service. LVFD readily provides this service even with their budgetary constraints.
F32
Some service calls are in areas where access is difficult. An air ambulance may be called to assist in patient transport when deemed necessary.
No recommendations for this finding
F33
LVFD has a close working relationship with other fire services and law enforcement, and is frequently called out to auto accidents. 5 http://www.oshpd.ca.gov/hid/Products/Hospitals/Utilization/PC_SC_Utilization.html
No recommendations for this finding
F34
Long Valley Fire District requested that the ambulance service budget be augmented with some County funding in 2007. The Board of Supervisors (BOS) approved $55,000 to supplement the ambulance service.
No recommendations for this finding
F35
Two full time paramedics are employed for the ambulance service. All firefighters are volunteers.
No recommendations for this finding
F36
LVFD participates in community emergency response planning.
No recommendations for this finding
F37
LVFD has a backup generator in case of loss of power. Mendocino Community Health Clinic/Hillside Health Center
No recommendations for this finding
F38
MCHC/Hillside in Ukiah has two satellite offices, Little Lake Health Clinic in Willits and Lakeside Health Clinic in Lakeport.
No recommendations for this finding
F39
Hillside uses a van to provide transportation for patients who have an appointment.
No recommendations for this finding
F40
Hillside has an outreach program for the homeless.
No recommendations for this finding
F41
Hillside, served 13,134 patients with 62,425 visits in 2007. With its satellite offices, it served 21,092 patients with 120,000 visits in 2007.6
No recommendations for this finding
F42
Hillside does not have a psychiatrist on staff for the treatment of patients, but may use a psychiatrist through telemedicine for children’s mental health treatment.
No recommendations for this finding
F43
Hillside does not have an onsite acupuncturist, ophthalmologist, radiologist, optometrist, audiologist, or an endocrinologist.
No recommendations for this finding
F44
Specialists on the staff include a dermatologist and an orthopedist.
No recommendations for this finding
F45
Hillside dental clinic is adequately equipped. It employs four dentists and support staff.
No recommendations for this finding
F46
Hillside bills on a sliding scale if a patient has no insurance.
No recommendations for this finding
F47
Hillside recently started billing private insurance companies. Prior to this action they billed privately insured patients directly.
No recommendations for this finding
F48
Hillside participates in "disaster and/or emergency" drills.
No recommendations for this finding

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