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Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
⚠️ 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 6 findings
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providing health care services that are cost-effective and higher in quality of care than would otherwise be Lower physician productivity in teaching possible. than non-teaching settings was cited as a finding in several of the research papers and abstracts One reason for local public agencies to enter we reviewed. The terms in which such findings into medical school affiliations is that it would be very were expressed included reduced productivity difficult -- and might be impossible -- for a county such per physician, increased time spent per patient, as Los Angeles to recruit enough qualified physicians to physician cost as a higher percentage of total provide the wide range of medical care it requires were cost, and increased personnel costs. Only three it not for these affiliations. Specialists in numerous papers reported no significant difference in fields are needed with trauma care imposing a productivity at teaching-affiliated clinics. particularly heavy requirement for physicians in certain specialities. Nonetheless, taken together, the studies seem to show that greater amounts of physician Another important and related benefit of the time are required in teaching settings than non- teaching affiliation is the high quality of care resulting teaching ones. This finding conforms to from the level of competence of both attending common-sense expectations since: physicians and later-year residents. Residents are less experienced than fully The remainder of this section describing Finding qualified physicians No. 1 consists of two parts. The first describes higher cost factors while the second deals with offsetting Attending physicians and residents at savings and revenues. times see patients together Higher Cost Factors A. Attending physicians teach in the classroom as well as see patients In conducting this study we reviewed 22 reports and report abstracts from research that looked into the Some attending physicians conduct cost of teaching-affiliated health care service. Several research 44 2, Number of Tests Ordered 5. & 6. Floor Space and Non-Monetary Benefits to Residents The ordering of more tests by residents than by fully qualified physicians was widely Increased floor space requirements for cited as a potential increased-cost factor by research and teaching add to facility costs. In individuals we interviewed for this study. One addition, student dormitories are provided for possibility mentioned was that of a resident residents. Also, according to the 1990 DHS ordering a broader array of tests in his or her report, residents are provided with meals at attempt to diagnose a condition than would a County expense. more experienced doctor В. Offsetting Savings and Revenues
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should be designed to provide 30 AC/H with the ability Supervisors take corrective action to implement to increase to 60 AC/H." the Public Works Report recommendations and ensure that the facilities meet all health and "A new facility with state of the art safety, and seismic requirements. HVAC systems large enough to accommodate the Coroner's increasingly demanding workload In addition to funding recommended in No. 1 should be seriously considered as a viable above, the Board of Supervisors needs to set aside existing sufficient funding to replace or substantially rehabilitate solution to the deteriorated under-capacity HVAC at the CME building." the Department's facilities and HVAC support systems. Inadequate space and a deteriorating building environmental system affects the quality of services, In addition, a review of the Department's vehicle inventory indicates that many of the vehicles are staff morale, and the responsiveness of the Department outdated, have extensive mileage, and are in need of to the Public. replacement (see Exhibit D). Many vehicles, especially transportation vans, exceed 100,000 miles.
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The Grand Jury recommends that the Board of An accumulation of high-mileage vehicles could create a Supervisors set aside sufficient funding in the situation where many vehicles become inoperable at the vehicle replacement fund to begin the gradual same time. replacement of existing aged vehicles. The Department's vehicle inventory includes
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survey reported in the 1990 DHS study One individual we interviewed cited the indicated that residents worked an average of 71 hours per week. Even assuming 71 hours per possibility that medical schools request and sometimes receive payment from the County for week, the average salary-plus-employee benefit per-hour cost to the County for residents is less newer, more sophisticated, and therefore more expensive medical equipment than would be than $12. provided were medical services being provided by a non-teaching cadre of physicians. The 1988 professional services agreement between
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Floor space It appears clear, based on previous County studies and on research conducted throughout the Non-monetary benefits to residents
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nation, that affiliations with medical schools give local government such as Los Angeles County a way of Physician Productivity
Recommendations 5
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R1- . EDIT COMMITTEE (from left): Donald Hinkley, Morton Bernheim, Maria Veronica Magallanes. EDIT COMMITTEE The effectiveness of this year-long task is now The several committees of the Grand Jury have been diligently at work serving their unique and ready for publication and distribution to the Board of important role as watchdogs for the citizens of Supervisors. The report of the 1995-96 Grand Jury of Los Angeles County. Committee findings have been Los Angeles County will now be available and on file at studied in depth, carefully developed, and recommen- the office of the Grand Jury, the City of Los Angeles dations have evolved from their observations and Public Library, the Los Angeles County Law Library, and at various university libraries. experiences. All of us have recognized the critical need for credibility and independence in decision-making. One of the reports, "The Evolution of Quality Control in Rail Construction" was released early in the After all was said and done, the Edit Committee provided final touches here and there but always mindful term since it covered a subject significant to the work of the Metropolitan Transit Authority. not to change or distort the intent of the report. Ultimately that is each committee's purpose and function. The Edit Committee decided to have a full-color photo of Los Angeles County taken from a space satellite. Thanks to the contacts of one of the Grand It was the Edit Committee's good fortune that Jury members the print was made available to us by the most of the reports were submitted on schedule in time Chevron Petroleum Technology Company. to meet deadlines for the absolute publication date of June 30th. . . ENVIRONMENT COMMITTEE . MEMBERS Donald R. Hinkley, Chair Maria Veronica Magallanes Marvin Polak Manning Silver . ENVIRONMENT COMMITTEE (from left): Donald Hinkley, Manning Silver, Maria Veronica Magallanes, Marvin Polak. ENVIRONMENT COMMITTEE The 1995-96 Grand Jury Environment with its other dam operations to maximize rainwater Committee reviewed the needs of the Los Angeles conservation. County residents for a permanent and reliable water supply. In its review it considered the 1993-94 Grand The 1994-95 Final Report admonished future Jury comprehensive audit, with the help of an outside Grand Juries to obtain assurances that MWD pursue the audit firm, which asked and answered many critical announced commitment to local water conservation. It concerns about many aspects of our water supply and is important to learn whether DPW's feasibility study of the whys and hows of necessary changes to the Freshwater Harbor Project (to capture and store accommodate future water needs. It was noted in the Los Angeles River runoff in a reservoir in Long Beach 1994-95 Grand Jury Report that on July 1, 1995, Harbor) has borne fruit. Metropolitan Water District (MWD) increased the wholesale water rate by 6% over the previous year. If The agency responsible for supplying the bulk of this portends a trend, the County's water bill will nearly wholesale water in Southern California and the primary double by the year 2005. The report also stated these planning agency is the MWD. MWD planners have interesting items. developed a document said to be the most ambitious water planning document in agency history. It is called The County uses less than half its local water the Integrated Resources Plan (IRP) and is the blueprint resources. For instance, the County Flood for water resource allocation for the next 25 years. The Control District reports that 280,000 acre feet plan evaluates projected demand, alternate resource per year of rainwater is allowed to flow strategies as well as water conservation, aqueduct uncaptured down the Los Angeles River to the improvements, regional storage, costs, risks, the need for flexibility and many other aspects of the plan. sea. Waste water treatment plants are producing far MWD is making a strategic shift from being a more reclaimed water than is being used. The water supplier to a water manager. This reflects the size claim is made that despite public calls for action, and breadth of MWD's resources, its political leverage there is no coherent water policy in Los Angeles and the need for more sophisticated water planning to County. address impending shortages. MWD, in response to a letter from the 1995-96 Grand Jury asking numerous Some of the 1993-94 Committee findings and questions, sent volumes of information outlining the recommendations dealt with the management of four IRP, including the ambitious East Side Reservoir dams under the control of the Army Corps of Engineers Project in Southeast Riverside County, desalinization (C.O.E.). Unlike the Department of Public Works plans, reclamation projects, etc. The 1996-97 Grand (DPW) County dams, the C.O.E. does not manage its Jury may well wish to investigate these further. dams for water storage during the rainy season. The C.O.E. is conducting a feasibility study which may We, on the Environment Committee of the address this problem but unfortunately it will not be 1995-96 Grand Jury have found objections to some completed until 1998 at the earliest. This delay could aspects of suggested methods of curing the water cost the County a water loss of 48,000 acre feet of shortage. For instance, it is possible that people living water with a current value of $13.8 million. The below the dams, reservoirs and spreading grounds Secretary of the Army supports the proposition that the would loudly object to increasing the capacity of these entities because of potential flood damage. Possibly, the County take control of these dams and coordinate them 28
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R2Accordingly, Dade County maintains nearly 40% of Los Angeles County's staffing level. Medical Examiners in Dade County perform 250 autopsies a year, while Los Angeles County Medical Examiners perform 360 autopsies a year, 110 above the national average recommended by the National Association of Medical Examiners.
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R3Los Angeles County Coroner handles nearly six times as many more homicides as Dade County. Homicides are the most complex and time consuming cases investigated by the Department. ٠ 39 . HEALTH SERVICES COMMITTEE MEMBERS Nancy L. Janney, Chair Irene L. Dilsworth Maria Veronica Magallanes Marvin Polak James M. Sirotta Morton K. Bernheim 40
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R4In re-negotiating its contract with USC, DHS standard would equate to the State's should establish specific means for monitoring mandate for the University of the amount of work provided by staff The contracts with all physicians. In the current contract, the number California. schools should include of FTEs is a key element used to determine the medical incentives and consequences to ensure annual payment to USC. At the same time, as full participation as is feasible by the however, the current contract does not schools in working with the County to specifically require that the University demonstrate or attest to its having provided a meet its targets. minimum of 40 hours per week for each FTE
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R5The County should attempt to negotiate by the Auditor-Controller and the Chief consistent contracts with all three medical Administrative Officer in their "Comprehensive schools. Currently, the agreements with UCLA Review of the Department of Health Services, and Drew are similar to each other, but the Phase I" report dated April 1995. Quality of contract with USC differs in important ways from the other two. Having similar provisions care can be assessed by peer review and patient for payment, standards of performance and surveys, among other means. There are many other factors would simplify and possibly measures of service costs that can be used, reduce the cost of contract administration. including cost per in-patient day, cost per admission, cost per out-patient visit and FTE staff per in-patient day, cost per admission, cost per out-patient visit and FTE staff per in- patient and out-patient visit. EXHIBIT 1 RESIDENT POSITIONS IN PRIMARY CARE VERSUS ALL OTHER FIELDS Fiscal Yr. Fiscal Yr. Fiscal Yr. Pcnt. of Pcnt. of Pont. of TOTAL 1997-98 1995-96 TOTAL 1996-97 TOTAL LAC/USC 71 8.2 Obstetrics/Gyn. 8.7 70 79 8.0 3.8 60 6.9 34 60 Pediatrics 6.9 26.8 235 Internal Medicine 242 27.0 235 27.0 0.0 Q Family Medicine Q 0.0 Q 0.0 39.3 355 366 42.0 Subtotal 365 41.9 60.7 Others 505 549 58.0 506 58.1 100.0 904 871 100.0 Total 871 100.0 HARBOR/UCLA 29 7.1 Obstetrics/Gyn. 29 7.5 29 8.1 8.0 Pediatrics 33 33 8.5 33 9.2 71 17.3 Internal Medicine 71 18.3 71 19.9 Family Medicine 29 7.1 29 7.5 29 8.1 Subtotal 162 39.4 162 41.8 162 45.4 Others 249 60.6 226 58.2 195 54.6 Total 411 100.0 388 100.0 357 100.0 KING/DREW Obstetrics/Gyn. 20 6.2 16 5.2 16 5.2 Pediatrics 44 13.7 41 13.4 41 13.4 Internal Medicine 48 14.9 48 15.7 48 15.7 Family Medicine 19 5.9 19 6.2 19 6.2 Subtotal 131 40.7 124 40.5 124 40.5 Others 191 59.3 182 59.5 182 59.5 Total 322 100.0 306 100.0 306 100.0 OLIVE VIEW/UCLA Obstetrics/Gyn. 15 10.3 14 10.9 14 11.4 Pediatrics 17 11.7 16 12.5 15 12.2 Internal Medicine 54 37.2 49 38.3 49 39.8 Family Medicine 6 4 1 2 1.6 Q 0.0 Subtotal 92 63.4 81 63.3 78 63.4 Others 53 36.6 47 36.7 45 36.6 Total 145 100.0 128 100.0 123 100.0 TOTAL Obstetrics/Gyn. 143 8.0 130 7.7 129 7.8 Pediatrics 128 7.2 150 8.9 149 9.0 Internal Medicine 415 23.3 403 23.8 403 24.3 Family Medicine 54 3.0 50 3.0 48 2.9 Subtotal 740 41.5 733 43.3 729 44.0 Others 1.042 58.5 960 56.7 928 56.0 Total 1,782 100.0 1,693 100.0 1,57 100.0 50