Los Angeles County Grand Jury Gounty of Los Angrees*

R1

The current level of staffing security and custodial positions should be evaluated by county officials.

R2

The Court Security Committee should meet on a regular basis to share information and should seek the participation of local school administrators, Compton City officials and residents.

R3

Security should be increased in the parking lot and a central entrance and exit should be established to control the use of the facility by persons who have business at the court complex.

R4

Separate areas in the cafeteria and parking facility should be set aside for the use of citizens on jury duty.

R5

A special clean-up project should be instituted to remove graffiti, correctly designate restrooms and dispose of accumulated debris.

R6

Police officers coming to the building to testify should be encouraged to use the public elevators. Approximately six weeks after its initial visit, the Committee returned to assess the situation at the Compton Court complex. The Committee was gratified to see evidence of significant improvements in the management and appearance of the complex. In the parking facility, a driveway was closed and a staffed guard booth was installed. These changes, along with the issuance of parking passes upon entering the lot and their collection upon leaving, had helped control access and improve security. The stairwells had been cleaned and graffiti had been removed from the interior and exterior walls. The signs on the restroom doors had been replaced. A separate area in the parking lot and a separate portion of the cafeteria had been set aside for the exclusive use of jurors. Other facts came to the Committee's attention that indicate the need for further monitoring and evaluation. Current funding limitations won't permit increasing the security and custodial staff at this time. Law enforcement officers continue to use the private staff elevators, thereby, minimizing the deterrence factor created by having uniformed officers on the elevators and in the hallways. The Court Security Committee is not meeting regularly but convenes on an as-needed basis. THE GRAND JURY RECOMMENDS THAT THE APPROPRIATE POLICE OFFICIALS DIRECT ALL OFFICERS UNDER THEIR COMMAND TO USE THE PUBLIC ELEVATORS WHEN THOSE OFFICERS ARE SUBPOENAED TO APPEAR AT THE COMPTON COURT COMPLEX. THE GRAND JURY RECOMMENDS THAT THE COMPTON COURT SECURITY COMMITTEE MEET ONCE A MONTH TO DISCUSS ISSUES AFFECTING THE SECURITY CONDITIONS AND THE APPEARANCE OF THE COMPTON COURT COMPLEX. Alice M. McCormick, Chairman Jerry L. Adams Geraldine L. Branton Isabel G. Callahan Mary J. Dorsett Horace S. Smith EDUCATION COMMITTEE PURPOSE The Education Committee is delegated by the Grand Jury to examine and comment on the operations of the County Superintendent of Schools, local school districts and college districts within Los Angeles County. This committee also studies topics which affect local public education. FOCUS OF REVIEW School Attendance Problems Student Body Funds School District Operations School Attendance Problems The Education Committee is concerned about the problems related to pupil absenteeism in the County's elementary, intermediate and secondary schools. This interest prompted a study of the subject including proposals to improve school attendance. The members of the Committee visited schools, attended workshops and seminars related to school attendance issues and reviewed publications prepared by the State Department of Education, the State Auditor-General and the Office of the County Superintendent of Schools.

R22

Determine implications of these findings for other County departments,

R23

Consider including in the next legislative action program a request for broader conflict-of-interest controls. THE GRAND JURY RECOMMENDS THAT THE CHIEF ADMINISTRATIVE OFFICER MONITOR THE STATUS OF THE CONFLICT-OF-INTEREST SECTION OF THE DEPARTMENT OF COMMUN- ITY DEVELOPMENT. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF COMMUNITY DEVELOPMENT REVIEW RECENT ORGANIZATIONAL CHANGES WITHIN THE DEPARTMENT. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF COMMUNITY DEVELOPMENT REVIEW THE IMPACT, IF ANY, ON ITS OUTSIDE AUDITING APPROACH IN LIGHT OF FEDERAL OFFICE OF MANAGEMENT AND BUDGET CIRCULAR A-102, ATTACHMENT P. The complete 11-page report on the Department of Community Development was sent to Judge William Keene, the Board of Supervisors, the Chief Administrative Officer, the Director of the Department of Community Development, and other County officials on March 31, 1980. DEPARTMENT OF COMMUNICATIONS STUDY SCOPE AND APPROACH The 1977-78 Grand Jury, with the assistance of its contract auditor, Arthur Young and Company, reviewed the operations of the Department of Communications. The Audit Committee directed its contract auditor to review the status of the 30 recommendations offered by the 1977-78 Grand Jury. During the course of this review the contract auditor discussed the current status of the recommendations with DOC staff and studied the material developed by the department. STATUS OF MAJOR RECOMMENDATIONS Of the 30 recommendations, 8 have been implemented, 10 are in the process of being implemented or have been partially implemented, and 12 have not been addressed. However, 10 of the unaddressed recommendations require actions by the CAO, coordinated participation of other County agencies, and Board approved changes in County policy. The majority of these unaddressed recommendations were rejected as either impractical or undesirable in the CAO's letter to the 1977-78 Grand Jury dated April 11, 1978, which summarized the viewpoints of both the CAO and the DOC. County-Wide Issues This category of recommendations pertains to all those issues which require decisions or action by either the Board of Supervisors or the Chief Administrative Officer, as well as the Department of Communications. Only two of the eight recommendations offered have been implemented. One of the two recommendations which have been implemented called for the County to allocate resources so that DOC and the CAO could prepare a comprehensive analysis of the most cost-effective approach to telephone system procurement for each location and a recommendation for in-house or contractual provisions for maintenance. The contract auditor observed a significant improvement in the completeness of the cost and payback analyses currently performed for telephone equipment procurement alternatives in comparison with those performed during the 1977 operational review. The alternative of lease purchasing telephone equipment from private vendors instead of renting similar equipment from the telephone company is considered and analyzed in virtually all situations where new or replacement equipment is required. All relevant cost factors are included in the analyses including installation and maintenance costs (materials, labor and overhead); monthly lease purchase payments; inflation factors; and savings on toll and minimum multiple-unit calls, removal of leased telephone lines and reductions in required operator staffing. Although all equipment acquisitions are evaluated for cost justification over a 10 year period, the basis for deciding whether to lease purchase telephone equipment or rent comparable equipment from the telephone company is a fiscal year cost comparison of the two alternatives. The other recommendation from this section of the report dealt with improvements in the internal accounting systems so that users would receive sufficient explanation of charges with bills. Enhancements of the computerized Telephone Billing System continue and currently the bills provided to user departments include a detailed breakdown of charges. Fiscal and Administrative Services There were four recommendations in this category and all but one have been partially or fully implemented. The principal benefits of the actions taken in response to these recommendations have been a reduction in the accounting staff by four positions and a significant improvement in management reports and user department billing detail. The major actions which resulted in these improvements included implementation of the computerized Telephone Billing System, implementation of the computerized Project Task Accounting System, implementation of a computerized inventory control system and implementation of a procedure for a monthly random sampling of telephone bills for audit of other credits and charges. Operations Seven of the recommendations offered in the initial report remain applicable to the Operations branch of the Department of Communications and they pertain to the mail/messenger service and telephone switchboard personnel. Only one of these seven recommendations has been implemented. This recommendation was to maintain funding for those position filled in November, 1977 in the mail/messenger function. Budgetary restriction in the past two years have caused the Department's funded positions today in the mail/messenger service to be equal in number to the filled positions of two years ago. The reasons for not implementing the other recommendations are largely contained in the CAO's response letter to the Grand Jury dated April 11, 1978. The recommendation that the DOC conduct a study of mail system reliability was not implemented because both the DOC and CAO contended that our study provided sufficient evidence to indicate that the system's reliability was acceptable. In their opinion, corroboration of this finding by conducting an additional study would not be cost-effective. With respect to the recommendations that the CAO consider the consolidation of the mail/messenger services of the Road Department and the Municipal Court, the CAO and DOC collectively felt that the delivery requirements of these users would not be effectively accommodated by the County-wide system. According to DOC staff, the consolidation of the Health Services messenger function to eliminate positions has not been pursued since the Grand Jury recommended that such efforts be continued. The overall recommendation that the CAO consider the transfer of all mail/messenger personnel to DOC has not resulted in any significant further actions toward centralizing the mail/messenger function within the County. The proposed new centralized facility for the County-wide mail/messenger function, under study by the CAO and DOC at the time of the review, has not been pursued because of the fiscal limitations imposed by Proposition 13. RECOMMENDATIONS OF THE 1979-80 GRAND JURY THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS INSTITUTE A "TELEPHONE SYSTEMS SAVING FUND" TO FINANCE CAPITAL REPLACEMENT OF RENTAL EQUIPMENT. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS PURSUE ALL AVAILABLE MEANS TO SECURE FROM PACIFIC TELEPHONE COMPANY MAGNETIC TAPES CONTAINING CONSOLIDATED DETAILED BILLINGS FOR SERVICES PROVIDED. THE GRAND JURY RECOMMENDS THAT ALL MAIL/MESSENGER FUNCTIONS BE CONSOLIDATED IN THE DEPARTMENT OF COMMUNICATIONS. THE GRAND JURY RECOMMENDS THAT EXPENDITURE CONTROL PROCEDURES ON TELEPHONE OPERATOR POSITIONS BE REVISED. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF COMMUNICATIONS EXAMINE THE FEASIBILITY OF REINSTITUTING MANAGEMENT REPORTING BY PROJECT. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF COMMUNICATIONS CONTINUE EFFORTS TO IMPROVE INVENTORY CONTROLS. The complete 20-page report on the Department of Communications was sent to Judge William Keene, the Board of Supervisors, the Chief Administrative Officer, the Director of the Department of Communications and other County officials on April 1, 1980. DISABILITY RETIREMENT defenda STUDY SCOPE AND APPROACH The 1977-78 Grand Jury studied the disability retirement portion of the County's retirement system. The Audit Committee directed Arthur Young and Company to review the status of the 8 recommendations made by the 1977-78 Grand Jury. The scope of this review was limited to an assessment of the responses of County officials to the proposals offered by the Grand Jury to improve the disability and retirement program. Legislation aimed at amending the retirement program was examined and discussions were conducted with representatives of the Department of the Treasurer and Tax Collector, the Chief Administrative Officer's staff, and attorneys from the County Counsel's Office. STATUS OF MAJOR RECOMMENDATIONS Corrective action has been taken on most of the recommendations presented. Such actions range from forming task forces for further study and implementing specific corrective actions to supporting legislation aimed at changing the Retirement Law. The positive effect of these actions, in any, is difficult to quantify. The Audit Committee believes the process is a continuing one which requires further attention both internally and from future Grand Jury inquiries. RECOMMENDATION OF THE 1979-80 GRAND JURY It is apparent from the Grand Jury's review two years ago, and the Audit Committee's follow up this year, that the major impediment to reforms to the disability retirement system is the evolving philosophy regarding such retirements. Over the years the system has evolved from one designed to compensate employees for specific, job related injuries to one which compensates employees for an inability to perform their job, regardless of the reason. The Board of Supervisors should make an explicit policy decision regarding the purpose of the disability retirement system. If it is determined by the Board that disability should compensate an employee for an inability to perform his job for any reason, as is currently the policy, such a decision should be explicitly stated. If it is determined by the Board that disability should compensate an employee only for specific, job related injury, then the Board should take such action, including legislative proposals, to implement this policy and reverse the current trend. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS MAKE AN EXPLICIT POLICY STATEMENT REGARDING THE PURPOSE OF THE DISABILITY RETIREMENT SYSTEM. The complete 11-page report on the disability retirement portion of the County's retirement system was sent to Judge William Keene, the Board of Supervisors, the Chief Administrative Officer, the Treasurer-Tax Collector, the members of the County Retirement Board, and other County officials on April 1, 1980. "THE PENSION BALLOON" (Town Hall Study) STUDY SCOPE AND APPROACH In April of 1979, Town Hall of California published "The Pension Balloon." This 79 page report analyzed the pension plans of the City of Los Angeles Fire and Police Departments, the City of Los Angeles employees, the Los Angeles County employees, and the City of Los Angeles Department of Water and Power. The Audit Committee asked its contract auditor to perform a study to determine the extent of the County's compliance with the recommendations offered by Town Hall on the subject of pension benefits for public employees. The contract auditor discussed the findings contained in the Town Hall report with the Treasurer-Tax Collector and the County Counsel, and their respective staffs. STATUS OF MAJOR RECOMMENDATIONS The report contained three recommendations applicable to the Los Angeles County Employees' Retirement Plan: Cost-of-living and post-retirement medical benefits should be funded. At present, these two benefits are paid for from the Plan's investment earnings in excess of 5 1/8% per annum. — Benefits offered by the Plan should be brought into "rough parity" with the benefits offered by the plans of selected commercial enterprises headquartered in Southern California. This recommendation would result in a reduction both in the amount and nature of the benefits available to public employees. The reduced benefit levels contemplated above should be applied prospectively to both current and

R1977

It provides necessary information for individuals, hospitals, and agencies throughout the County. Approximately 90% of all skilled nursing homes are registered with NHIRS which operates five days a week and handles as many as 500 calls per day. The service provides information free of charge to both vendors and the patients. A computer maintains a storehouse of information on skilled nursing homes which participate in this program including records of all deficiencies and violations of the nursing home code and regulations. When the number of notices for a particular facility reaches a certain level, patients are no longer referred to that nursing home. Availability of skilled nursing home beds is adversely affected by the lack of alternative care facilities and programs. It has been estimated that a minimum of 25 percent of all placements are inappropriate and would be better served by alternatives to institutional care. Such alternatives include adult day care facilities, adult day health care programs, long-term care facilities, custodial care facilities, sheltered care facilities and in-home support services. The existing shortage of skilled nursing beds would be substantially improved if alternatives were developed for those who require constant supervision but not skilled nursing care. Alternative care facilities and services should be a priority budget item within the County. The inappropriate placement of individuals in skilled nursing facilities is an unnecessary financial burden to the taxpayer as well as a drain on the supply of beds available to those who require skilled nursing care. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT APPROPRIATE COUNTY DEPARTMENTS TO DEVELOP ALTERNATIVES TO SKILLED NURSING HOMES AND THAT THE BOARD OF SUPERVISORS PROVIDE FUNDING FOR ALTERNATIVES. Karen M. Durfee, Chairman Marlyene Goodman Arnett C. Iversen Evelyn F. Schreiber Ralph D. Webster 79 JAILS COMMITTEE PURPOSE The Jails Committee is delegated by the Grand Jury to review the conditions and management of all detention facilities in Los Angeles County and to insure the timely arraignment of all persons in custody. These duties are authorized by Penal Code Sections 919 and 921. The committee also investigates complaints from inmates and makes appropriate recommendations to correct the reported grievances. FOCUS OF REVIEW Inspection of Jails Complaints of Prisoners Rotation of Deputies Assigned to County Jail Affirmative Action Sentencing Options Inspection Of Jails Members of the Jails Committee made unannounced visits to each of the 106 detention facilities in Los Angeles County. These jails are maintained by the Los Angeles County Sheriff's Department, the Los Angeles Police Department and the other city police departments in the county. During the committee's visits, members made visual inspections of the areas within the jail, reviewed booking sheets and spoke with officers on duty and persons in custody. The Jails Committee recognizes that several agencies inspect jail facilities within the County including the State Board of Corrections, the County Institutional Inspection Commission, the County Health Department and local fire departments. Each agency has a particular concern. This system of multiple inspections of jails has resulted in a system in this County that is far superior to custodial systems in other large metropolitan areas. The Committee found that the officers responsible for administering these facilities were well-trained, sincere and dedicated. They should be commended and encouraged in that many work under difficult administrative and financial limitations. FINDINGS AND RECOMMENDATIONS LOS ANGELES COUNTY SHERIFF'S DEPARTMENT AVALON SUBSTATION This small and inadequate facility on Santa Catalina Island was built in the mid-1920s and has never been substantially improved. It is adequately maintained considering its antiquated condition. It has been condemned by fire, building & safety and health agencies. In 1973, Sheriff Peter J. Pitchess stated that the jail situation in Avalon has been ignored far too long. It appears that steps are now being taken to correct this problem. The Committee learned that an application has been made for a Federal grant to assist in constructing a new jail. The Board of Supervisors and the Sheriff's Department should intensify their efforts to improve this situation. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS AND THE SHERIFF'S DEPARTMENT REPLACE THE OUTDATED JAIL FACILITY ON SANTA CATALINA ISLAND. LOS ANGELES POLICE DEPARTMENT PARKER CENTER JAIL This centrally located detention facility has three large cells, each accommodating approximately sixty persons. The Committee noted that the double bunks were not secured to the floor as suggested in the Department of Corrections standards. There were insufficient sanitary facilities for the number of prisoners placed in these cells. The department is considering replacing the sworn officers who staff this facility with civilian personnel. There is a serious concern about the training that will be given these new employees and whether they will be able to adequately handle any disturbances. THE GRAND JURY RECOMMENDS THAT THE LOS ANGELES POLICE DEPARTMENT CONSIDER MODIFICATIONS IN THE PARKER CENTER JAIL THAT WILL ALLEVIATE CROWDING AND IMPROVE SAFETY CONDITIONS FOR THE INMATES. THE GRAND JURY RECOMMENDS THAT THE LOS ANGELES POLICE DEPARTMENT PROVIDE ADEQUATE TRAINING PROGRAMS FOR CIVILIAN JAIL PERSONNEL. LONG BEACH CITY JAIL On September 29, 1979, the Jails Committee inspected the Long Beach City Jail located in the Public Safety Building. This facility has space for 202 males on the third floor. The fourth floor can accommodate 60 females in one section and 60 juveniles in another. The portion of the jail designated for male prisoners appeared to be in good condition and met the standards established by the State Department of Corrections. Conditions on the fourth floor needed immediate attention. The Committee observed a deteriorated fire hose, poor lighting and improper ventilation. Several small children were present during this inspection and only one officer was on duty in the juvenile section. He had responsibility for answering the phone, feeding and checking on the condition of the juveniles as well as changing infants, who were temporarily detained pending appropriate placement. In the Committee's opinion, the numerous tasks involved in caring for these youngsters could not be adequately performed by a single officer. The adult booking area was in close proximity to the juvenile detention section, which exposed children to unruly drunks, disorderly females and other unpleasant circumstances associated with the processing of adult and juvenile arrestees. These conditions were brought to the attention of the lieutenant in charge of the jails who indicated that requests for additional personnel and funds to make necessary improvements had been turned down by city administrators. On October 2, 1979, the Jails Committee, the Foreman of the Grand Jury, the Criminal Justice Committee and members of the County Institutional Inspection Commission met at the Long Beach City Jail to discuss the conditions with police and city officials. A representative from MacLaren Hall and Commissioner Reuben Ortega were present to inspect the conditions in the juvenile section. The Presiding Judge of the Juvenile Court, Richard Byrne, had requested Mr. Ortega to inspect the jail to determine if it met the standards for use as a juvenile detention facility. Commissioner Ortega concluded that corrections needed to be made in the physical condition and operation of the facility. Officials were given 60 days to correct the situation. On January 11, 1980, the Committee visited the Long Beach City Jail and found that the police department and city had corrected all the deficiencies noted by the Committee during earlier visits. Seven officers had been added to the fourth floor staff. A large window had been installed near the area for small children which permitted the desk officer to observe the children but prevented them from seeing the activities in the booking area. New video and sound equipment had been installed and the nursery was fully equipped to adequately care for babies and small children. PASADENA CITY JAIL On August 27, 1979, the Committee visited the Pasadena City Jail which is located on the fourth floor of the police building. Broken lights, unbolted bunks, inferior mattresses and a broken lock on one of the holding cells were noted. No emergency evacuation plan existed. A male officer was responsible for watching both the men and women prisoners. State law mandates the presence of a woman employee when a man enters the women's section of a jail. The male officer on duty on the fourth floor had to wait for a female clerk to come from the first floor if he needed to enter the 82 The chart shows improvement in all areas. The ethnic imbalance becomes greater in the upper promotional brackets, but is more difficult to overcome because budget cuts have led to the elimination of approximately 140 positions of sergeant and above, resulting in a reduction of the number of possible promotions. All hiring and promotions must be within the constraints of Civil Service rules and regulations which further complicate the situation. The Los Angeles County Grand Jury commends the Los Angeles County Sheriff's Department for its efforts to comply with the Board of Supervisors' Statement of Policy on Affirmative Action. Sentencing Options The Jails Committee reviewed post-conviction programs and sentencing alternatives available in Los Angeles County for situations where time in custody is imposed by Municipal or Superior Court judges. The Committee met with judges, representatives of the Probation Department and members of the Sheriff's Department to gather information on the Work Furlough Program and Weekend Sentences. FINDINGS AND RECOMMENDATION WORK FURLOUGH PROGRAM The Work Furlough Program, which is administered according to the guidelines established by Penal Code Section 1208, was instituted in Los Angeles County in 1964. Sentenced prisoners who wish to participate in the program are referred by the sentencing judge to the Probation Department. An investigation is conducted to explore the individual's background and work experience so that the potential for success can be evaluated by the Court. The risk to the community of daily release is also considered. A report is then filed with the Court and the judge makes the final decision whether the inmate will be placed on work furlough. Once in the program, the inmate is released daily at 6:00 a.m. to report to his or her outside employment. The person must return to the jail no later than 7:00 p.m.. Custodial officials receive the inmate's wages and, after deducting $6.00 for meals, forward the remainder to the inmate's family or hold the money for the prisoner upon completion of the sentence. The Jails Committee found that the Work Furlough Program was well managed and provided an excellent opportunity for sentenced prisoners to avoid termination of a job, thereby, ensuring continued employment after release. Further, the wages earned by the prisoner provide financial support for families and in many cases keeps them from turning to welfare grants to pay for housing, food and other needs. WEEKEND SENTENCES Rather than imposing a continuous period of time in custody, many judges specify that a person's sentence can be served on weekends. This sentencing alternative allows a person to continue working and residing in the community and fulfills the need for some punishment by incarceration in county jail. The Sheriff must honor the order of a judge that time be served on a weekend. This responsibility to receive, house and release prisioners on a short-term basis causes some staffing problems at Biscailuz Center where most weekenders serve their time. The current number involved in this program is approximately 400 persons per weekend. The Sheriff's Department is continuing to work on resolving some of the problems associated with the weekend program. A recommendation has been made to the courts that community public service be ordered in lieu of time in custody. The final decision on such a change in sentencing alternatives rests with the legislature and the courts. THE GRAND JURY RECOMMENDS THAT THE MUNICIPAL AND SUPERIOR COURT JUDGES, THE SHERIFF'S DEPARTMENT AND THE PROBATION DEPARTMENT MEET REGULARLY TO DISCUSS THE WORK FURLOUGH PROGRAM AND WEEKEND SENTENCES AND WORK TOGETHER TO RESOLVE PROBLEMS IN THE ADMINISTRATION AND OPERATION OF THESE SENTENCING OPTIONS. Geraldine L. Branton, Chairman William C. Bullock Lillian Gindler Joseph Lee, Jr. Evelyn F. Schreiber Ralph D. Webster 85 SOCIAL SERVICES AND JUVENILE JUSTICE COMMITTEE PURPOSE This Committee is delegated dual responsibilities by the Grand Jury; to study the County departments concerned with social services and to examine the components of the juvenile justice system including the courts, involved county departments and local law enforcement agencies. FOCUS OF REVIEW Inter-Agency Council on Child Abuse and Neglect Information and Referral Adult Day Health Care Concentrated Efforts in the Prosecution of Gang Violence Foster Home Care Hard to Place Children Private Institutional Care for Children Inter-Agency Council On Child Abuse and Neglect The Social Services and Juvenile Justice Committee's concern about the increase of child abuse and neglect led to a review of the current status of the Inter-Agency Council on Child Abuse and Neglect (ICAN). This study was also a follow-up to the report on ICAN prepared by the Social Services Committee of the 1977-78 Grand Jury. FINDINGS AND RECOMMENDATIONS In February of 1977, the Los Angeles County Board of Supervisors established the Inter-Agency Council on Child Abuse and Neglect as the County's official agent to provide overall County-wide guidance and coordination in the development and improvement of services for families and victims of child abuse and neglect. The Director of the Department of Public Social Services was designated as the Council Chairperson. From a small base, ICAN has developed active representation from over 20 public and private agencies in Los Angeles County providing legal, law enforcement, social services, educational, health and mental health services. ICAN has generated active participation on its Policy Committee by department heads and on its Operation Committee by child abuse specialists from the numerous county departments involved in the area of child abuse and neglect. The combination of professional expertise, department-head endorsement and support of the Board of Supervisors has enabled the Council to effect broad-based positive changes throughout the County's child-protection system. During the past two years the accomplishments of ICAN have included: - Development of the first inter-agency on child abuse treatment program in Los Angeles County - Development of a county-wide effort to improve and coordinate child abuse services within the mental health system. - Development of a coordinated and ongoing effort in the County Department of Health Services to improve prevention and treatment services to families and victims of child abuse and neglect. - Development of a comprehensive directory of community resources for the prevention and treatment of child abuse and neglect in Los Angeles County - Development of guidelines for use by county departments and agencies for evaluating pending legislation affecting child abuse and neglect. In 1979, ICAN established a unique relationship with the community and private industry through the creation of ICAN Associates, a privately incorporated, fund-raising arm of the Council. A group of well-known and highly respected citizens in the business and entertainment fields organized for the purpose of securing private and corporate funds to support programs endorsed by ICAN. In its first six months of existence, ICAN Associates raised approximately $400,000 in cash and in-kind donations for the ICAN endorsed child abuse programs. NEIGHBORHOOD FAMILY STRESS CENTERS Under the sponsorship of ICAN, a study was conducted by ten inter-disciplinary child abuse specialists in Los Angeles County. This team of experts focused on developing recommendations for a program which would provide immediate protective intervention and follow the family through the treatment system. One specific program proposal called for the establishment of twelve neighborhood family stress centers, each offering a complete spectrum of public and private services to abusing and potentially abusing families on a 24-hour basis. Each center would be locally administered, and funded by a private corporation. Professional services would be provided by public agencies such as DPSS, law enforcement, Health Services and Mental Health. These centers would facilitate the provision of maximum protection for children with minimum disruption of the family unit. They would provide a locally accessible resource for families who would receive a continuum of comprehensive, protective, preventive and treatment services. The continuum of services is of major importance because abusing and potentially abusing families, often isolated and reluctant to seek help, are ill-equipped to follow through with a complicated and segmented program involving multiple referrals and disconnected treatment efforts. Cedar House, located in Long Beach, was designated by ICAN as a model for its proposed network of Neighborhood Family Stress Centers. Cedar House has been in operation since January of 1975. As a result of financial support from Los Angeles County, the cities of Long Beach and Lakewood, the Junior League of Long Beach and Mattel Corporation and a dedicated staff of specialists, the needs of abused children and their families are being addressed on an out-patient basis with specialized counseling and continuing support. Many families who have been in the program at Cedar House are now willing and even eager to speak to groups about their experiences. Some have volunteered to take part in other groups to help get them started. Large numbers of volunteers from the community have done very sensitive work with the families at Cedar House. There is a large and ever-growing corps of people in this community who can draw on their own experience to help look for answers to the problems of child abuse and child neglect. It has taken the combined efforts of many people to make Cedar House work. With the interest, dedication and commitment of many people, Cedar House continues to keep children safe and families together. The Social Services and Juvenile Justice Committee commends the Inter-Agency Council on Child Abuse and Neglect and the ICAN Associates for their outstanding efforts in the continuation and funding of unique approaches for identifying, treating and preventing child abuse and neglect. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS CONTINUE TO RECOGNIZE AND SUPPORT THE EFFORTS OF THE INTER-AGENCY COUNCIL ON CHILD ABUSE AND NEGLECT (ICAN) IN PROMOTING A COOPERATIVE AND COORDINATED COUNTY-WIDE RESPONSE TO THE NEEDS OF ABUSED AND NEGLECTED CHILDREN AND THEIR FAMILIES. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS CONTINUE TO SUPPORT THE DEVELOPMENT OF NEIGHBORHOOD FAMILY STRESS CENTERS. Information And Referral The 1977-78 Grand Jury recommended that the Board of Supervisors direct appropriate County departments to work with United Way to develop a county-wide comprehensive information and referral service with a toll-free line and community outreach to assure that any person in need would get help. The Social Services and Juvenile Justice Committee, although aware of the magnitude of this project and the necessity for long-range planning, is concerned that the service has still not been implemented. The committee met with representatives of the Department of Public Social Services and the Department of Senior Citizens Affairs. Reports of the Information and Referral Federation Steering Committee were reviewed, as well as a Guide for Senior Citizens prepared and distributed by the Los Angeles City Council. FINDINGS AND RECOMMENDATIONS Information and Referral is a general term used in human and social services to describe the process of informing people about appropriate resources. Usually these resources are social service agencies which can help with a particular set of problems. Information and Referral (I & R) service may be given in person, by telephone, or in writing. It is currently performed by a wide variety of agencies and individuals 88 causing a fragmentation in the delivery of service. The primary purpose of some agencies is to provide I&R services; in others, it is but one of many programs within the agency. The precise nature of I&R service varies greatly depending upon the persons seeking help, their problems and the skill and knowledge of the providers. In July, 1976, a plan for a joint study by the Department of Public Social Services and United Way to ascertain the need for a single, comprehensive I & R service within Los Angeles County was approved by the Board of Supervisors. The study actually began in February of 1977 and the results were presented to the Board of Supervisors on April 26, 1979. The Board approved the concept and requested DPSS to explore all components necessary for implementation. DPSS and United Way have established an Information and Referral Federation Steering committee which is meeting on a regular basis. This committee is composed of representatives of local, state and federal agencies and private industry. The Federation, a nonprofit corporation with a Board of Directors composed of volunteers from both the public and private sectors, would create a 24-hour, comprehensive I & R Nucleus which would be accessible by means of a local telephone number. The function of this information and referral nucleus is to provide an entry point for people who do not know where to turn for help. The committee determined that to perform its function effectively, the nucleus must provide immediate response to all callers, have the capability to handle crisis situations, be available 24 hours a day, seven days a week, have sufficient telephone and staff capability to prevent busy signals, provide quality caring response to everyone, be inventive and aggressive on behalf of the caller to assure access to service and have bi-lingual language capabilities available on staff. All those involved with the I & R Federation Steering Committee believe it is the responsibility of the existing 253 I & R providers and their funding sources to commit themselves to this joint effort. Some of those providers include Help-Line Contact Clinic, City and County Area Agencies on Aging (AAA), Senior Line and Libraries. The I & R Federation Steering Committee study has identified the critical technical features, developed job descriptions and calculated costs. When implemented, the current plan calls for the use of federal funds (Title XX) for 75% of the cost and United Way funds for 25% of the cost. The target date for implementation is January, 1981, when all contracts must be signed by United Way and the Board of Supervisors. The necessity exists to provide a centralized, 24-hour I & R service with a toll-free line and community outreach to assure that any person in need can get appropriate help. There is also a need to pull the fragmented pieces of the many existing providers together into a coherent, effective I & R system which will serve the needs of the entire community. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE DEPARTMENT OF PUBLIC SOCIAL SERVICES TO AGGRESSIVELY WORK TO COMPLETE ALL NECESSARY PLANNING TO IMPLEMENT THE CONSOLIDATION OF INFORMATION AND REFERRAL SERVICES WITHIN THE COUNTY. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS APPROVE THE CONTRACT WITH UNITED WAY, THEREBY, ASSURING THE CONSOLIDATION OF INFORMATION AND REFERRAL SERVICE BY THE TARGET DATE OF JANUARY, 1981. Adult Day Health Care The Social Services and Juvenile Justice Committee is concerned that Los Angeles County has not implemented the California Adult Day Health Care Program which was adopted by the Board of Supervisors on October 10, 1978. Adult day health care (ADHC) is a community-based daytime program for citizens over the age of 55. It provides therapeutic, social and health activities and services to elderly persons with functional impairments, either physical or mental, for the purpose of restoring or maintaining maximum independence. The Committee visited several private adult day health care centers and spoke with members of the administrative staffs of these facilities. Information was also obtained from the Department of Public Social Services and the Department of Health Services. FINDINGS AND RECOMMENDATION Long-term institutional care facilities, skilled nursing homes and other types of custodial care programs are overly utilized by many older persons who are capable of living at home. This results in a shortage of space for those persons who really need institutional care as well as being costly in financial and human terms. Destruction of continuing family relationships and loss of the capacity to live independently are often the consequence of premature institutionalization. Adult day health care serves as an option to a long-term institutional care facility when 24-hour skilled nursing care is neither medically necessary nor viewed as desirable by the recipient or his family. When provided on a short-term basis, adult day health care can serve as a transition from a health facility or home health program to personal independence. Adult day health care is not a mandated service. The Board of Supervisors in each county must initiate action to establish a public adult day health care program. The California Adult Day Health Care Act gives the County Board of Supervisors the authority to initially appoint a planning council. The 15-member Los Angeles County Council was established on April 1, 1980, and is responsible for developing a county plan according to State guidelines. The development of a county-wide plan is a prerequisite to the licensing of any adult day health care center within the County. All license applications received by the State are referred to the Planning Council for review and recommendation. Any city, county, or nonprofit corporation may apply to operate an ADHC center. The Planning Council is expected to provide a priority list of the names and addresses of potential city, county and nonprofit adult day health care providers and a potential operation site for each. The Council's recommendations significantly influence the decision of the State review committee whether to approve individual license applications. The County plan must show the existence of a need for adult day health care centers and the extent of that need. It must also demonstrate a plan to show the coordination of these centers with existing health and social support services, suggest a system to utilize existing resources and demonstrate that centers will be located in a manner which will make them accessible to the greatest concentration of the economically disadvantaged elderly persons. The State review committee must approve the proposed plan before the adult day health care services can be provided in the community. The law provides reimbursement under the Medi-Cal program to those persons who apply and receive eligibility certification from the State Department of Health Services. No license can be issued or renewed for an adult day health care center which is not approved as a Medi-Cal provider of these services. The State Department of Health Services is required to report to the legislature on the progress of the implementation and success of the Adult Day Health Care programs. The first report was submitted in March, 1980, and the second is due in March of 1982. This program will remain in effect only until January 1, 1983, unless further legislation is enacted. The stated intent of the legislature is to evaluate the report submitted in March, 1982, to determine whether adult day health care programs conducted under provisions of this Act have had sufficient positive impact to warrant their continuation. The sunset provision written into the legislation makes time of the essence in establishing a viable adult day health care program in Los Angeles County. A successful program will help convince the Legislature of the need to continue this worthwhile program. The Social Services Committee believes that a critical need exists to establish a community based system of quality day health care which would provide a viable alternative to institutionalization for those older persons with medical or psychiatric impairments. Many of these persons could live at home with aid of appropriate health care or rehabilitative and social services. These services could be provided at less monetary expense to the taxpayer and less emotional expense to the individual and family. Thus, the implementation of an adult day health care program would enhance the quality of life for many elderly citizens of Los Angeles County. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS SUPPORT THE PLANNING COUNCIL IN ITS EFFORTS TO DEVELOP AN ADULT DAY HEALTH CARE PROGRAM IN LOS ANGELES COUNTY. Concentrated Efforts In The Prosecution Of Gang Violence The Social Services and Juvenile Justice Committee learned of the alarming growth of street gang violence in Los Angeles County and undertook a study of the steps taken by local law enforcement agencies to investigate and prosecute these senseless crimes. FINDINGS AND RECOMMENDATION The dramatic growth of gang violence is staggering. Statistics indicate it is the single most identifiable cause of violence on the streets in Los Angeles County. During 1979, in excess of 250 persons were killed as a result of gang violence, which constituted a 30 percent increase over 1978. Approximately 50% of the victims were not gang members. Captain Tom Ferry of the Gang Activities Section of the Los Angeles Police Department described the gang problem in the City of Los Angeles in the following manner: "The chances of becoming a statistic as a result of gang violence in a large metropolitan city is greater today than ever before. During the period of January through September of 1979, this city has experienced 1,439 violent gang crimes. This figure includes 85 homicides involving known gang members. Gang-related homicides have increased 35 percent over last year, January through September, and 60 percent in the last two years, January through September. Police files are jammed with reports of random gunshots being fired into homes, knifings, shootings and unprovoked attacks at parks and on school grounds. Gang homicide victims range in age from a 15 year old youth to a 65 year old woman who was beaten to death during a burglary. Gangs are no longer restricted to urban areas but have spread like cancer throughout the state. The problem of violence perpetrated by members of gangs is one of the most serious social and crime problems facing our city today." Sheriff Peter J. Pitchess, in a report presented to the State Senate Committee on Children and Youth, described the gang crime problem in the following words: "In the past decade gang violence has increased at an alarming rate. Where in the past gang fights involved fists, feet, chains, some knives, and very few guns, today's gangs are well armed. Once a death due to gang warfare was rare. Today hardly a week goes by without one or more deaths occurring due to gang violence. Brutal, senseless, wanton acts of violence are becoming a daily occurrence rather than the exception." The committee focused its attention on the Hardcore Gang Section of the Los Angeles County District Attorney's Office. This unit was formed in January of 1979, as a response to the drastic increase in the number of violent gang-related crimes. Initial funding was provided by a grant from the Law Enforcement Assistance Administration. The attorneys assigned to this section work closely with police investigators to identify cases which fit the criteria for assignment to this specialized section. Cases generally involve a serious gang-related felony, such as murder, robbery or aggravated assault. Another factor considered is whether a firearm was used during the commission of the crime. Once the case is filed, the same attorney handles the case to conclusion. This concept is known as "vertical prosecution". This differs from most cases in the District Attorney's Office, where one attorney might file the case, another might present the evidence at the preliminary hearing and still another attorney might represent the prosecution at the trial. Vertical prosecution permits a coordinated effort by the police and the prosecution in the litigation of the case in court and the protection of witnesses. Successful prosecution of violent hardcore gang offenders is often hampered by intimidation of witnesses. In most cases, the persons who can relate the facts necessary to prove the commission of a crime are either hostile gang members or terrified civilians residing in gang territory. Special efforts have been taken by the personnel assigned to this unit to give special attention to the needs of these witnesses. In some instances, money has been allocated to relocate witnesses. In other situations, transportation to and from court is provided along with protection for the witnesses and their families. During the first year of operation, the Hardcore Section has tried 54 hardcore gang members with a record of 53 convictions and one acquittal. This is a dramatic change from the conviction rate of just under 50% in 1977 and 1978 for gang-related murders in the City of Los Angeles. This success is attributable to the concentrated vertical prosecution, the increased investigation, and the efforts of the attorneys and other personnel assigned to the Hardcore Section to recognize and deal with the witness problems inherent to cases involving violent hardcore gang offenders. The Los Angeles County Grand Jury commends the Hardcore Gang Section attorneys, investigators and staff for their significant achievements in the prosecution of gang-related crimes. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS CONTINUE TO SUPPORT AND FUND THE HARDCORE GANG SECTION OF THE DISTRICT ATTORNEY'S OFFICE. Foster Home Care The Social Services and Juvenile Justice Committee is concerned about the problems related to the placement and care of children in the Foster Home program. In studying this topic, the Committee reviewed articles, books and audio-visual materials and met with administrators and staff of the Department of Public Social Services and foster parents. In addition, the members of the Committee attended a Foster Parents Seminar where foster parents openly discussed their difficulties in caring for and coping with the youngsters entrusted to them for shelter, nutrition and around-the-clock care. FINDINGS AND RECOMMENDATIONS In March of 1980, the Department of Public Social Services was responsible for the placement and treatment of 9,584 children with about 80 percent of these young people residing in foster homes in Los Angeles County. Foster parents currently attend an initial one-day orientation program conducted by the Foster Care staff of the Licensing Division of Department of Social Service and are required to complete a minimum of eight hours of training per year. This training is offered through the 11 chapters of the Foster Home Association with each chapter offering training sessions. County-wide conferences are held twice a year as part of a continuing education program. Early Childhood Education courses given in local colleges meet the criteria established under current Foster Parent training standards. This training is adequate for the average placement but is not sufficient for foster parents caring for the increasing number of emotionally disturbed children. These youngsters have deep-seated problems. Many have been victims of physical or sexual abuse. Special abilities are required to work with the special problems presented by these children. In 1977, DPSS observed this critical need for specialized training and began working with UCLA on the development of a comprehensive foster parent training curriculum. There is pending federal legislation, HR 3434, which carries a foster parent training provision. If successful, Federal and State funds will be provided to develop this necessary program. This additional training will make a substantial and measurable contribution to the alleviation of many placement problems currently faced by DPSS. The payment structure now in effect for foster homes ranges from $213 to $325 per month for the average placement; $402 for the developmentally disabled and physically handicapped child; $478 for the severely developmentally disabled or physically handicapped child who has exceptional physical problems; $613 for the severely developmentally disabled or extremely physically handicapped child who also is in need of psychiatric treatment; and $726 for the developmentally disabled or physically handicapped child with all the above problems and who is also nonambulatory. The present allotment for foster care is linked to the rate of Aid to Families with Dependent Children payments, so the needed increase in foster placement rates cannot be granted unless the AFDC payments are also increased. In the current foster home licensing structure, a license is valid for one year. Regulations state that renewals are to be issued only after a restudy of each home and family. This regulation is not being strictly enforced and the Committee found that licensing becomes practically automatic after the initial license is issued. The Department of Public Social Services operates an emergency Hot Line for foster parents, which is funded under Title XX. The foster parent in need of assistance places a call to a County operator who then connects the party with the social worker on duty. Foster parents expressed continued frustration in their efforts to reach a social worker through this Hot Line. In interviews with foster parents, the Committee learned that foster children need constant adult supervision and that foster parents must be available 24 hours a day, seven days a week. The use of therapeutic day treatment programs should be considered as a means of offering both a respite for foster parents and a different environment for the child for part of the day. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS REQUEST THE STATE DEPARTMENT OF SOCIAL SERVICES TO ESTABLISH ADDITIONAL TRAINING STANDARDS FOR FOSTER PARENTS LICENSED TO CARE FOR CHILDREN WITH SEVERE EMOTIONAL PROBLEMS. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS PROPOSED LEGISLATION WHICH WILL REMOVE THE LINK BETWEEN THE AID TO FAMILIES WITH DEPENDENT CHILDREN FUNDS AND THE AMOUNT OF PAYMENT AVAILABLE FOR FOSTER CARE. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE FOSTER HOME LICENSING DIVISION OF THE DEPARTMENT OF PUBLIC SOCIAL SERVICES TO STRICTLY ENFORCE THE PROCEDURES FOR THE RESTUDY OF EACH FOSTER HOME IN THE COUNTY PRIOR TO THE ANNUAL RENEWAL OF THE FOSTER HOME LICENSE. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE DEPARTMENT OF PUBLIC SOCIAL SERVICES TO PROVIDE SUFFICIENT STAFFING FOR THE FOSTER PARENTS EMERGENCY HOTLINE. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS SUPPORT HR 3434 WHICH WILL PROVIDE ADDITIONAL FUNDS FOR FOSTER PARENT TRAINING. Hard To Place Children In an effort to learn about the available facilities for Hard to Place children, the Social Services and Juvenile Justice Committee visited Dependency Court and inspected institutional care facilities, such as MacLaren Hall, Maryvale, McKinley Home for Boys and Children's Village. The members of the Committee spoke with Juvenile Court judges and commissioners, administrators and staff of child care facilities and psychologists and psychiatrists who specialize in the treatment of emotionally disturbed children. FINDINGS AND RECOMMENDATIONS The Hard to Place Child is a product of the societal changes which encompass a broken home with the single parent working, a lack of summer school and after-school activities, less supervision, and an increase in drug abuse. Using current surveys developed by the Department of Public Social Services, the Mental Health Department and the Probation Department, social workers have identified approximately 1,150 children as having characteristics of the "hard to place". The characteristics of this group include a history of running away, assaultive behavior, homosexual or aberrant sexual behavior, fire-setting, self-destruction, and profound retardation. There are some children whose behavior creates such problems that nobody want them. Mental hospitals, such as Camarillo, do not accept a patient who is not "treatable." If a child is given this label, where can he go? MacLaren Hall, the only county-operated multi-purpose facility for non-delinquent, dependent children is administered and staffed by the Department of Public Social Services. This facility, located in El Monte, provides a broad range of services from intake through short-term placement of 21 days or less to long-term placement which exceeds 30 days. The cost of these services is approximately $3,000 per child per month, which includes medication and schooling. There are a total of five consulting psychiatrists at MacLaren Hall who spend a total of 48 hours per week at the facility. Twenty-four hour psychiatric counseling and treatment service is not currently available at MacLaren Hall. Children coming into MacLaren Hall today have multiple problems. They may be mentally ill or developmentally disabled. These children are diagnosed by either a psychiatrist on the premises, an outside psychiatrist or a court-ordered psychiatrist. The diagnoses include depressive neurosis, schizoid personality, severe character and personality disorders, psychotic depression, schizophrenia, mental retardation and combinations of these; also, patterns of chronic assaultive, suicidal or homocidal behavior are not unusual. MacLaren Hall is not a psychiatric hospital. Its primary purpose is to be a temporary home for children awaiting a court decision or an alternative placement. Although it was understood that some of the more troubled children might not do as well in foster care and would need the more intensive program of the Youth Services Center, the intent was never to offer an on-site psychiatric unit. While the DPSS should not be in a position of offering such a service, it is in no position to turn away children who have no other 93 place to go. The only possible means of handling these children was to convert eight of the fourteen infirmary rooms to an Intensive Care Unit. The infirmary was not designed for this purpose. The staff is providing close supervision and continues to seek more appropriate long-term placements. MacLaren Hall may house children for a period varying from a few hours to several months, depending on the case situation and the problems encountered in placement. Due to the special needs or more serious problems of some children and the scarcity of other placement resources, youngsters may be referred by their Children's Service Worker to the Youth Services Center. The YSC treatment program, which can handle a maximum of 47 children, encompasses a six-month schedule of specialized treatment. Youngsters 13 to 18 years of age, who have experienced placement difficulties due to behavior problems, but who appears to be amenable to change within the six-month treatment period, are referred to the center. Individualized treatment plans keyed to the identified problems of each individual child are provided in an effort to prepare these children for successful community placement. State mental hospitals have the responsibility for treatment of the mentally ill and the regional centers have the responsibility of meeting the needs of the developmentally disabled. When there is a dual diagnosis and neither of these resources accept the responsibility for treatment of these children, they are returned to MacLaren Hall where they are placed in the Intensive Care Unit apart from the other children. There are a number of existing private facilities whose administrators have expressed a willingness to consider providing more intensive services to severely disturbed children; however, these facilities require an increased rate of placement to attract qualified staff and develop an appropriate physical environment. Among the criteria for Certified Treatment Counselors is a Master's Degree in Social Work or one year's experience in child care. Civil Service class specifications dictate that Certified Treatment Counselors I work with primary children and Certified Treatment Counselors II work with junior children. There is no provision permitting an employee who is promoted to the level of Certified Treatment Counselor II to continue to counsel and treat primary children. This creates a problem, in that, as CTC I's are upgraded, it necessitates staff reassignment. This practice prevents the best utilization of staff resources and causes an almost never-ending changeover of staff in the primary cottages at MacLaren Hall. The Department of Public Social Services is working with the Civil Service Commission and the Department of Personnel to eliminate this problem in classification of counselors. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS ALLOCATE FUNDING FOR 24 HOUR PSYCHIATRIC STAFF AT MAC LAREN HALL AND THAT ONCE THE FUNDING IS MADE AVAILABLE, THE DEPARTMENT OF PUBLIC SOCIAL SERVICES FILL THESE POSITIONS. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS SUPPORT THE DEPARTMENT OF PUBLIC SOCIAL SERVICES IN THEIR NEGOTIATIONS WITH CIVIL SERVICE AND THE DEPARTMENT OF PERSONNEL TO IMPLEMENT A CHANGE IN THE CIVIL SERVICE REQUIREMENTS FOR CHILDREN'S TREATMENT COUNSELORS. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS INITIATE STATE LAW CHANGES TO ESTABLISH AGENCY RESPONSIBILITY FOR CHILDREN WITH DUAL DIAGNOSIS PROBLEMS INCLUDING EMOTIONALLY DISTURBED AND DEVELOPMENTALLY DISABLED CHILDREN. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS URGE THE APPROPRIATE STATE AGENCIES TO ALLOCATE SUFFICIENT FUNDS TO PROVIDE THE RESOURCES TO CARE FOR PROFOUNDLY MENTALLY RETARDED AND SERIOUSLY MENTALLY ILL CHILDREN. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS SUPPORT LEGISLATIVE CHANGES TO ASSURE INCREASED PLACEMENT RATES FOR INSTITUTIONS WILLING TO DEVELOP SPECIAL PROGRAMS FOR HARD TO PLACE CHILDREN. Private Institutional Care For Children The Social Services and Juvenile Justice Committee studied the subject of private institutional care for children. Los Angeles County contracts with private treatment facilities to care for children who are too severely abused and psychologically damaged to function in a family situation. Many of these youngsters have repeatedly failed in foster care placement and need a structured and professionally supervised environment. Current contract institution rates vary from $864-$1,704 per month, with $1,200 being the average monthly payment. FINDINGS AND RECOMMENDATION The Committee visited three of these institutions, McKinley Home for Boys, Maryvale and Children's Village U.S.A. McKinley Home for Boys is a private, non-profit, children's agency specializing in residential care for boys, ages 8 to 18. They have the capacity to care for 99 children. Three educationally handicapped classrooms are provided on the grounds; all others attend public schools in the area. A psychiatrist is at the facility on Monday, Tuesday morning, Tuesday evening and on call the remainder of the time. Maryvale is a private, non-profit, residential center with the capacity to care for 95 children with special needs; girls ages 3 to 18 years of age and boys 3 to 8 years old. There are three high school classrooms, three elementary and junior high classrooms and an intensive pre-school program conducted at the facility. Psychiatric care is provided by two psychiatrists two day a week and two psychologists two days a week. Children's Village, which has a capacity of 72 children, is a comprehensive interdisciplinary, residential treatment center not only for chronically disturbed children ages 2 to 12 but also for their troubled families. There are two specialized classrooms plus a pre-school on the grounds. Psychological care is provided by one live-in psychologist plus three additional full-time psychologists who interact with the children and an additional psychologist who provides therapy for parents. This program for parents is a distinguishing feature of Children's Village. Eventual reunification of the family unit is encouraged by participation of the parents and children with this psychologist in weekend therapy sessions. This program is enhanced by the availability of overnight facilities for the family and transportation for those parents unable to arrange their own. Children's Village also has a Research and Development Division which is concerned primarily with applied research, which means that the principal focus is on what is happening to parents, children and staff in various treatment settings. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS INCREASE CONTRACT PLACEMENT RATES FOR PRIVATE INSTITUTIONS WILLING TO DEVELOP PROGRAMS FOR THE EMOTIONALLY DISTURBED CHILD: FURTHER, THAT THESE PRIVATE INSTITUTIONS BE UTILIZED IN SITUATIONS WHERE SPACE IS NOT AVAILABLE IN COUNTY FACILITIES. Arnett C. Iverson, Chairman Marlyene Goodman Alice M. McCormick Elizabeth H. Woodside 95

R1980

PROBATION DEPARTMENT STUDY SCOPE AND APPROACH This review of the Probation Department focused primarily on the service levels which could be expected to be provided by this Department both now and over the next few years. The contract auditor studied workloads, staffing and budgets for the last ten years. The Audit Committee tried to identify problems and offer solutions which will permit this department to keep pace with the increasing demands for probation services. MAJOR FINDINGS AND RECOMMENDATIONS Purpose and Organization Probation is the process by which society provides corrective assistance to individuals in conflict with the law and at the same time affords protection to the community. Probation seeks to rehabilitate persons convicted of crimes by returning them to society for a period of supervision rather than simply sending them to jails or prisons. Probation is imposed by the courts in lieu of incarceration and as a control mechanism following jail or prison terms. Foremost among the responsibilities of the Probation Department are the investigation of adults convicted of crimes; juveniles alleged to be delinquent, in danger of becoming delinquent or in need of protection; and the supervision of such individuals upon determination that formal supervision is needed. The department has additional responsibilities in delinquency prevention and in certain actions regarding adoptions, guardianship conciliation, and mentally deficient or mentally ill persons. The Probation Department has an operating budget of $79,155,314 and an allocation of 3,973.2 positions for the fiscal year 1979-80. The Department, under the direction of the Chief Probation Officer, has a Juvenile Field Services Division, an Adult Field Services Division, a Detention Services Division, Residential Treatment Services Division and an Administrative Services Division. Expenditure Growth The Probation Department's growth since its founding in 1912 has paralleled that of Los Angeles County. From an initial staff of 19 including 17 Deputy Probation Officers (DPO's), and an operating budget of $41,000, the Department has grown to a high of 4,946 budgeted positions and an operating budget of $83,331,329 in fiscal year 1975-76. Since that time the Department has found it necessary to reduce its staff and operating budget due to financial constraints placed upon Los Angeles County. During the growth period, as could be expected, the Department underwent significant administrative and functional changes. New and permanent juvenile detention facilities were constructed and decentralized area probation offices were established in different parts of the county, all with the intent of better serving Time I the client and community. The attempt for greater outreach to the client community during this period brought with it the introduc- tion of a wide variety of special programs. Nationally it was thought that the quality of probation services The second was limited by the lack of community resources and large caseloads of Probation Officers. Legislation was enacted to provide financial resources to help reduce the rising cycle of arrest-conviction-detention. During the 1970's national and state policies changed and many of the financial resources that were previously committed to these programs were withdrawn. Consequently the County was left with the responsibility of either assuming a greater financial burden for providing these special services or eliminating the programs. Many of the special programs were eliminated as outside funding sources evaporated. Revenues The four major restricted revenue sources that augment Los Angeles County's General Fund in support- ing the Probation Department's activities are subventions from the State of California (AB90), reimburse- ments from parents for the costs incurred for juvenile detention and placement, collection of court ordered fines and penalties and payments from the federal and state governments for the categorical grants and special programs. However, even with these additional sources of revenue, 79% of the Department's operating funds are currently supplied from the County's General Fund. The net effect of Proposition 13 and Proposition 4 will be to further restrict the availability of monies in the General Fund. The financial impact of these revenue restricting measures upon Los Angeles County's General Fund, and in particular the Probation Department, is significant. Since the fiscal year 1976-77, the Probation Department has been required to reduce its personnel complement in an effort to reduce the increase in the Department's operating budget. Compounding the problem of cost reduction has been the spiraling cost of inflation with respect to materials and supplies, and increased personnel costs due to negotiated settle- ments and legally binding contracts that determine the allowable workload for Department personnel. Alternatives In an era of diminishing financial resources, the County has limited alternatives. The levels of service can be reduced to meet the appropriate reduction in revenue. New revenue sources can be developed to offset new reduction in existing revenues. The productivity of personnel can be increased or salaries can be reduced. It is also possible that caseloads can be reduced either because crime decreases or because judges believe that alternative methods are more effective. Employee Productivity. Personnel related costs account for 86% or $68.7 million of the Probation Department's operating budget. The current number of probation officers and their levels of employee workload are determined quarterly by a formula. This formula generally provides for dividing the total number of cases in each of several categories by the number of probation officers indicating what the current workload is per employee in each category. This calculation must coincide with the allowable standards defined in Article XIV of the Memorandum of Understanding (MOU) between the County and the Probation Officers Association. Any department employee assigned a caseload in excess of the criteria outlined in Article XIV may by right file a grievance and refuse to accept the assignment. The caseload standards were originally numbers incorporated into the first MOU negotiated between the County and Probation Officers in 1972. These figures were arbitrarily selected and agreed to by both management and the Association. An informal survey of the surrounding counties of Orange, San Bernardino, Riverside, Ventura and San Diego indicate that Probation Officer caseload standards are not a provision of the Memorandum of Understanding with their respective employee groups. However, while there may well be differences in the definition of caseloads between counties, it appears that Los Angeles County has at least an average workload per employee. The question as to the most appropriate number of cases assigned to probation officers has long been a point of concern for both management and employee. The Department has undertaken numerous studies to analyze and determine the optimum number of cases. These reports have been either inconclusive in their findings or prohibitive in terms of cost to implement. If the Department is to survive as an effective control element over criminals, it must be able to experiment with various novel techniques for allowing a Deputy Probation Officer to provide effective supervision to more cases. It is clear that the continuing revenue reduction in "constant dollars" will require that such techniques be developed or that service levels be reduced. The Department currently has as high an effective workload as possible with current techniques. New and creative methods for handling workloads must be developed with joint commitment by both management and employees. Various experimental programs must be implemented and analyzed. THE GRAND JURY RECOMMENDS THAT PROGRAMS TESTING CREATIVE NEW METHODS OF FIELD SUPERVISION AND OFFENDER INVESTIGATION BE DEVELOPED AND IMPLEMENTED AT THE AREA OFFICE LEVEL. In a period of declining revenue and fixed expenditure levels, the County cannot afford to tie its hands on service level and productivity improvement issues. The Probation MOU effectively places a public policy issue — the level of monitoring provided to those on probation — on the union negotiating table. By implication, Article XIV in the MOU prevents any management reorganizations which would allow more than 150 cases. Neither of these types of limitations are proper for the MOU process. THE GRAND JURY RECOMMENDS THAT THE PROVISIONS IN ARTICLE XIV IN THE MEMORAN- DUM OF UNDERSTANDING WITH THE COUNTY AND THE PROBATION OFFICERS ASSOCIA- TION BE ELIMINATED FROM ANY FUTURE CONTRACT WITH AN EMPLOYEE ASSOCIATION. Revenue It is assumed that the County's General Fund will continue to provide the major source of support for the Probation Department. Therefore, to minimize as much as possible the impact of the declining revenues in this fund, it is strongly recommended that the Department examine its services and develop a program for implementing fees and charges whenever possible. Although it is quite unlikely that the Department will be solely supported by subventions and fees it is possible that any future increase in revenue may be the difference between the continuation or elimination of a current program. The Department estimates that it costs $21.50 per month to supervise an adult and twice that for a juvenile. These figures represent the direct costs; the total costs, including Department and general County overhead, would be about twice those amounts. The original investigation done by Probation to recom- mend to the Court whether jail or probation is appropriate costs approximately $150-$200 per investiga- tion. The Department currently collects some fees for its institutional services for juveniles. It collects no fees for performing the background investigations necessary to determine whether an individual warrants probation versus confinement. There also are no fees for supervision of those of probation. The revenue from these fees, even recognizing that not all could pay, could be significant. Interpretations of section 1203.01 of the Penal Code prohibit judges from charging a defendent the costs of prosecution, including probation fees. Therefore, legislation would be necessary to permit such charges. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DRAFT AND SUPPORT LEGISLATION THAT WILL PERMIT IMPOSITION OF USER-FEES AND CHARGES FOR ALL PROBATION SERVICES. Reduction in Levels of Service Given the existing set of circumstances, it is probable that the mode of delivering existing probation services must change. The extent that this alternative will be implemented is contingent upon increased employee productivity and the development of new revenue sources. However, in discussing the necessary changes for the Probation Department, the Audit Committee would be remiss if it did not elaborate on long-term outlook for the entire Criminal Justice System. Currently there are a number of County departments that contribute to the overall functioning of the Criminal Justice System. These departments, in addition to Probation, include the District Attorney, the Public Defender's Office, the Municipal and Superior Courts, Sheriff and other local police agencies, the Department of Public Social Services, the Child Welfare Office, and the Schools. Some of these departments will also be affected by the decline in financial resources. Others, such as law enforcement, may not be if the Police/Fire initiative passes. This may lead to new "intake" decisions to reduce the number of individuals reaching the Courts. Probation and other departments which have to reduce their staffs. Concurrent with the changes needed in the Probation Department, the Justice System Advisory Group should be given authority to review, analyze and prioritize the delivery of services that are going to be provided in the Criminal Justice System. A system that maximizes all of its existing resources jointly will be the key to success in both the Probation and other County department's ability to maintain existing levels of service in a period of declining revenues. SPERMENT LOS Specifically, the County Justice System Advisory Group should attempt to avoid gross disparities in increases or decreases in budgets and resources between various portions of the Justice system by reporting their findings to the Board of Supervisors. THE GRAND JURY RECOMMENDS THAT THE COUNTY JUSTICE SYSTEM ADVISORY GROUP ACTIVELY COORDINATE THE ANNUAL BUDGET REDUCTIONS OR INCREASES AMONG THE COUNTY DEPARTMENTS THAT COMPRISE THE CRIMINAL JUSTICE SYSTEM. The complete 13-page report on the Probation Department was sent to Judge William Keene, the Board of Supervisors, the Chief Administrative Officer, the Acting Chief Probation Officer, and other County officials on March 31, 1980. - 27 USE OF CHAUFFEURS BY COUNTY OFFICIALS STUDY SCOPE AND APPROACH In January, 1980, questions were raised concerning the use of chauffeurs by County officials. The Audit Committee requested Arthur Young and Company to review the use and cost of chauffeurs by County departments and commissions. Information on budgeted positions was obtained from the Chief Administrative Officer. A questionnaire was circulated to seventy County departments and commissions to determine if other members of department staffs were being used as chauffeurs on a full or part-time basis. Estimates of the cost of chauffeur service were based on the wage rate of all persons involved in providing chauffeur service plus 24.57% overhead. This cost was compared to the cost of private chauffeur services to determine if the total cost could be reduced. Chauffeur service is generally defined as the transportation of one or more persons in a vehicle by another person. This broad definition is divided into two classifications. One classification covers chauffeur service provided to an individual in a County automobile. This classification of chauffeur service is typically provided to department heads, commissioners, and dignitaries. The other classification of chauffeur service involves transporting groups in County vans and buses. This service is provided for County employees, jury members, and other special groups such as mental health patients and probation- ers. In Los Angeles County the three sources of chauffeur services are chauffeurs in department budgets, pool chauffeurs from Mechanical Department, and other members of department staffs who perform chauffeur duties. MAJOR FINDINGS AND RECOMMENDATIONS County Policy There is no formal County policy on the use of chauffeurs. Informal policy has restricted budgeted chauffeur positions to elected officials and certain individuals who can justify use of a chauffeur. Reported justifications for the use of chauffeurs by individuals are that a vehicle is required to perform part of the individual's duties, that a driver is required for safety reasons in times where there may be a fatigue factor and that certain officials have a right to County supplied transportation. Reportedly use of chauffeurs has allowed these officials and individuals to better perform their duties. In addition to these budgeted positions, certain departments and commissions have made use of the Mechanical Department chauffeur pool. A formal policy on the use of chauffeurs should be established. This policy should take into account the distance traveled on county business, the purpose of the trip, the economy of chauffeur use, the potential for fatigue, and any special transportation requirements. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS ESTABLISH A FORMAL POLICY FOR THE USE OF CHAUFFEURS BY COUNTY OFFICIALS, DEPARTMENT STAFF AND COMMISSIONERS. Mechanical Department Policy The Mechanical Department provides chauffeurs for county officials if the regular driver is not available. Chauffeur service is also available for visiting dignitaries, selected members of county commissions, and County officials on specific special occasions. Authorization for automobile chauffeurs is determined on prior experience and whether the requesting department has a billing code. THE GRAND JURY RECOMMENDS THAT ONCE THE BOARD OF SUPERVISORS HAS ESTAB- LISHED ITS POLICY ON USE OF CHAUFFEURS, A NEW APPROVED LIST OF CHAUFFEUR USERS SHOULD BE DEVELOPED. Currently, requests for a bus and driver must be forwarded in writing to the main office of the Mechanical Department for approval. In addition, arrangements must be made with the supervisor of drivers at the Alameda Garage. The usual practice is for the official authorization to be given after the bus service has been rendered by the Mechanical Department. The contract auditor believes user departments should continue to submit formal requests for bus service. However, authority to approve requests should be assigned to the Alameda Garage supervisor, provided that this person has verified that the user department has the ability to pay for the service. The guidelines that are now being used to determine whether bus service will be provided are outdated and in need of revision. THE GRAND JURY RECOMMENDS THAT THE PROCEDURES FOR AUTHORIZING THE USE OF BUS CHAUFFEURS BE FORMALIZED BY THE BOARD OF SUPERVISORS. Cost of Chauffeurs The total labor cost to the County of chauffeurs is approximately $181,000. This is based on an approxi- mate average annual earnings of $14,400 for the nine full-time chauffeurs' positions reported (3 depart- mental and 6 mechanical pool) plus an applicable percent of the average annual earnings of the 1.05 full-time equivalent persons who perform chauffeur duties part-time. An out-of-pocket fringe benefit factor of 24.57% was added to the total. This total cost is divided into the three components of department cost of $73,000, Mechanical automobile chauffeur cost of $54,000, and Mechanical bus chauffeur cost of $54,000. It is important to note that typically 35% to 50% of chauffeur's time is spent on nonchauffeur, but related, duties. These duties include pickup and delivery of materials, storekeeper, and vehicle maintenance and preparation. Also, the Mechanical Department charges the users of its chauffeur service based on the hourly rate of the driver plus a burden factor which varies with the user department. The current private industry rate for a driver and a limousine is $20.00 per hour, or $1.00 per mile, whichever is greater. Rates for drivers and cars other than limousines may be lower. However, this may not provide the degree of immediacy provided by the County pool service. In certain instances, it may be beneficial to contract out for the entire service, such as when the vehicle and driver are not needed to travel excessive distances or when a large vehicle is needed. This may allow the County to eliminate some vehicles in the fleet, or change the vehicle mix to include smaller, more economical vehicles. To determine the economic feasibility of contracting out for chauffeur services, a more detailed study of the costs and feasibility is necessary. Aspects that need to be studied in greater detail include the cost to the County, the ability of a private contractor to meet the needs of the County, and the potential savings for the County because of reduction in staff, fleet and mileage expenses. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS INVESTIGATE THE SUBJECT OF CONTRACTING FOR CHAUFFEUR SERVICES. THE GRAND JURY RECOMMENDS THAT WHEREVER POSSIBLE COUNTY CHAUFFEURS BE PRODUCTIVELY EMPLOYED RATHER THAN WAITING FOR PASSENGERS. THE GRAND JURY RECOMMENDS THAT THE ACCOUNTING PROCEDURES OF THE MECHA- NICAL DEPARTMENT BE REVISED TO PROVIDE THOROUGH AND ACCURATE INFORMATION ON THE USE OF COUNTY CHAUFFEURS. The complete 13-page report on the use of chauffeurs by County officials was sent to Judge William Keene, the Board of Supervisors, the Chief Administrative Officer, the Director of the Mechanical Department, and other County officials on April 17, 1980. CIVIL SERVICE RULES Collective Bargaining Process The Audit Committee directed the contract auditor to conduct a review of the Interim Civil Service Rules currently in place, major changes in the rules as proposed by the Personnel Department and the collective bargaining process. The contract auditor examined administrative responsibility, promotion criteria, hiring practices, the step-pay plan and areas of potential conflicts of interest between the County's certified employee organizations and the Board of Supervisors. A draft of this report is under discussion within the Audit Committee. Because of a printer's deadline for publication of the Final Report, the Findings and Recommendations are not included in the Audit Committee report. SMALL CRAFT HARBORS DEPARTMENT Marina Del Rey Leases Topics related to the administration of county leases at Marina Del Rey came to the attention of the Audit Committee. A meeting was held by the committee with the Director of the Small Craft Harbors Depart- ment and his staff to discuss the operations of his department. The contract auditor was directed to review a variety of subjects related to the County's role in the administration of leases for residential and commercial property at Marina Del Rey. The scope of this review included an in-depth analysis of data to determine if the County of Los Angeles is receiving a reasonable rate of return on its investment in Marina Del Rey and to consider whether rates being charged the public at the Marina, particularly boat slip rates, are too high or too low. A draft of this report is under discussion within the Audit Committee. Because of the printer's deadline for publication of the Final Report, the Findings and Recommendations are not included in the Audit Committee report. METROPOLITAN WATER DISTRICT The subject of the efficient and economical delivery of water to the residents of Los Angeles County was discussed by the Audit Committee. The contract auditor was directed to review the operation of the Metropolitan Water District. This special district is composed of 14 member cities and 12 municipal water districts, many located in whole or part within the county. The members of the District serve nearly 11 million people over an area of 5,100 square miles. The study involved two major questions: - Have the residents of Los Angeles County paid disproportionately more for service from the Metropolitan Water District than residents of other counties served by the District? What would be the impact on residents of Los Angeles County if all water sold by the Metropolitan

R3269

In October, 1978, State Supreme Court ruling Hoyem vs. Manhattan Beach City School District held that school districts may be liable for injuries suffered by a truant student. Senator John Nejedly has introduced legislation (Senate Bill 60) to limit a school districts' liability when a student leaves the school property during school hours without the permission of school authorities. A prompt resolution of this subject will affect school attendance responsibilities. THE GRAND JURY RECOMMENDS THAT THE COUNTY BOARD OF EDUCATION AND THE OFFICE OF THE COUNTY SUPERINTENDENT OF SCHOOLS CONTINUE TO SUPPORT THE RECOMMENDATIONS AND LEGISLATIVE PROPOSALS INCLUDED IN "A COMPREHENSIVE SCHOOL ATTENDANCE IMPROVEMENT PLAN." Student Body Funds The Education Committee of the Grand Jury reviewed the independent, annual audits of all Los Angeles County school districts and noted many recommendations for improvement in the management of student body funds. A study was begun to try to determine the problems involved in accounting for student body organization funds. The Committee met with the County Superintendent of Schools, members of the County Schools financial services staff and representatives of an accounting firm experienced in auditing school districts. Publications reviewed were the California State Department of Education Audit Review (1977-78), the Los Angeles County Schools Audit Reviews (1977-78), and the State Department of Education 1979 Edition of Accounting Procedures for Student Organizations. FINDINGS AND RECOMMENDATIONS Authorization for fund-raising activities by student organizations is provided by Section 48932 of the Education Code which states, "The governing board of any school district may authorize any organization composed entirely of pupils attending the schools of the district to maintain such activities, including fund-raising activities, as may be approved by the governing board. The governing board of any school district may, by resolution, authorize any student body organization to conduct fund-raising activities on school property during school hours provided that the governing board has determined that such activities will not interfere with the normal conduct of the schools." The Education Code also specifies the manner in which student funds shall be deposited or invested and Section 48933 states, "The funds shall be expended subject to such procedure as may be established by the student body organization subject to the approval of each of the following three persons which shall be obtained each time before any of such funds may be expended: an employee or official of the school district designated by the governing board, the certificated employee who is the designated advisor of the particular student body organization and a representative of the particular student body organization." Supervision and audit of student funds are mandated in Education Code Section 48937 which states that the governing board shall provide supervision of student body organization funds and that the cost of such supervision may be charged to the district. Student body funds may be generated through student body fees, store sales, proceeds from athletic events, receipts from advertising, subscriptions or photographs in school publications, social activities, vending machine sales, donations, receipts from special events, and interest earned on investments or savings accounts. Trust accounts are set up to hold money generated by the students. The student body organization is designated trustee for these accounts. Generally, trust accounts fall into the categories of scholarship accounts, class accounts, club accounts, and other trust accounts. Scholarship accounts are used for funds donated specifically for scholarships, class accounts are those which are used for funds for the activities of individual classes and collections and disbursement of funds for club activities is processed through the club accounts. Several difficulties in student fund accounting were commonly referred to by private auditors. Trust funds allocated for long-range projects have been withdrawn for current expenditures. Trust fund accounts collected are not designated for specific current and future projects, balances of inactive accounts or accounts of graduated classes are not transferred to the general student body funds. In other instances, excessive funds are carried over from year to year and are not designated for specific projects. Large amounts of money are placed in noninterest bearing accounts. Minutes of student body financial actions are not always complete or on file. Student body fund checks have been made payable to cash rather than to specifically named vendors and blank checks were presigned. Prior approval of the student governing body is not always obtained before expenditure of student body funds. Most student body organizations are involved in receiving, spending and accounting for money. In California, student body organization business involves large sums of money. For example, the financial statement of District A showed student body organization funds in the amount of $144,879. In District B as of June 30, 1979, the financial statement showed student body organization funds to be $81,411. The 1979 Edition of Accounting Procedures for Student Organizations prepared by the California State Department of Education is an excellent reference source for school districts to use to provide a basis for their student fund accounting practices. It suggests principles to govern student body fund finances, defines the responsibilities of those involved in the administration of student body financial activities, offers an accounting system for student body funds, addresses the preparation and control of student body budgets and explains auditing of student body organization accounts. The Education Committee believes this manual provides a framework to allow school districts to institute proper fiscal control over student body organization funds. THE GRAND JURY RECOMMENDS THAT THE COUNTY SUPERINTENDENT OF SCHOOLS PROVIDE COPIES OF THE CALIFORNIA STATE DEPARTMENT OF EDUCATION PUBLICATION "ACCOUNTING PROCEDURES FOR STUDENT BODY ORGANIZATIONS," (SCHOOL BUSINESS ADMINISTRATION PUBLICATION NO. 3) TO THE GOVERNING BOARDS OF ALL LOS ANGELES COUNTY SCHOOL DISTRICTS. THE GRAND JURY RECOMMENDS THAT THE COUNTY SUPERINTENDENT OF SCHOOLS ENCOURAGE THE GOVERNING BOARDS OF ALL LOS ANGELES COUNTY SCHOOL DISTRICTS TO REVIEW THEIR MANAGEMENT AND ACCOUNTING PRACTICES FOR THE SUPERVISION OF STUDENT BODY ORGANIZATION FUNDS TO INSURE COMPLIANCE WITH THE GUIDELINES CONTAINED IN THE PUBLICATION NO. PREPARED BY THE STATE DEPARTMENT OF EDUCATION. School District Operations Each of the 82 public school districts in Los Angeles County is tax-supported and governed by an elected Board of Trustees which holds regular public meetings to discuss and vote on the financial, personnel and educational aspects of each district's operations. District business records including Board policies, budgets and curriculum summaries are available for public inspection as well as the district Financial Statement which is filed annually with the County Superintendent of Schools. Section 933.5 of the Penal Code permits the Grand Jury to examine the books and records of any school district in the County and to investigate the method or system of performance of duties within a district. The Education Committee studied audit reports from several school districts within the county. After this initial screening, particular attention was focused on individual school districts, including the Bellflower Unified School District and the Inglewood Unified School District. BELLFLOWER UNIFIED SCHOOL DISTRICT In response to written complaints about the operation of the Bellflower Unified School District, the Education Committee attempted to schedule an informal meeting with the members of the District Board of Trustees and the Superintendent. The purpose of this meeting was to discuss the scope of a possible Grand Jury review of the district. It was emphasized that the allegations did not involve misconduct of district officials and would be a civil review by the Grand Jury rather than a criminal investigation. At the request of the attorney retained by the district, a copy of the proposed agenda for the meeting was sent to him to present to the members of the Board. It was further explained that the initial meeting would last approximately an hour to an hour and a half. The members of the Governing Board, through their 58 attorney, declined to meet with the Education Committee. The reason given by district officials was that the District did not have the personnel or resources to cooperate with the Grand Jury in an open-ended review of District operations. The Board did provide copies of the books and records of the District for inspection by the Grand Jury, including copies of the Board minutes, District policies, a Personnel Directory, budgets, audit reports and other documents. After the committee analyzed the District books and records, a list of questions was submitted to the Board of Education. The Governing Board replied with detailed written responses to the Committee's questions. Included was a discussion of the steps taken by the District to correct the exceptions noted in prior audit reports and citation of specific Board policies, where applicable. INGLEWOOD UNIFIED SCHOOL DISTRICT In the latter part of 1979, the Los Angeles County District Attorney's Office opened an investigation regarding allegations of misappropriation of funds and official misconduct within the Inglewood Unified School District. This investigation was concluded in February, 1980, with a finding that there was insufficient evidence for criminal prosecution. However, weaknesses in internal controls on the use of District personnel and property were uncovered. The Education Committee examined the District's combined Financial Statement for the fiscal year ended June 30, 1979, and observed that the firm of Peat, Marwick, Mitchell & Co. commented on the portions of the District's operations dealing with the handling of payroll forms, warrants, cash receipts and bank records as well as the procedures for inventory control. The Education Committee communicated with the Board of Education to ascertain what action had been taken to correct the problems noted in the audit report. The Grand Jury received a prompt written reply explaining in detail the action taken by District officials to address the weaknesses noted by the auditing firm retained by the District. Horace S. Smith, Chairman Mary J. Dorsett Elmer E. Drickey Karen M. Durfee Willard E. Fowler 59 ENVIRONMENT COMMITTEE PURPOSE The Environment Committee is delegated by the Grand Jury to study issues which influence the environmental quality of life in Los Angeles County, including the operations of all county agencies and special purpose districts which have responsibility in the areas of planning, traffic, energy, pollution, waste disposal and related areas. FOCUS OF REVIEW Hazardous Materials Landfills Resource Recovery Hazardous Materials The Environment Committee is concerned with the lack of uniform regulations for the transportation. storage and disposal of hazardous materials. All substances which constitute a threat to life, health or property are described as hazardous materials. Information on this subject was gathered from many sources including on-site inspections, attendance at regulatory and legislative hearings, interviews with city, county and state officials, meetings with private citizens and reviews of local, state and federal regulations. FINDINGS AND RECOMMENDATIONS TRANSPORTATION OF HAZARDOUS MATERIALS The risk of accident in the transportation of hazardous materials presents an inherent and continuing danger to the citizens of Los Angeles County. Not only is there danger from the large amount of hazardous materials being transported in the county annually but this danger is compounded by the inadequate and confusing regulations of federal, state and county agencies. The volume of hazardous materials being transported in the United States is expected to increase from two to four billion tons each year. Of this amount, ten million tons of hazardous materials are shipped into, out of or within the boundaries of Los Angeles County annually, equaling approximately 25 percent of all commodities shipped in this County. The exteriors of vehicles transporting hazardous materials often are not labeled to indicate their contents. This labeling can be in the form of a symbolic code. Bills of lading do not spell out the chemical contents. At the scene of many accidents, drivers do not know that their cargo includes hazardous materials. Los Angeles County emergency response personnel are not adequately trained or equipped to handle a spill properly. However, the Los Angeles City Fire Department has a specially trained and equipped "Hazard Unit" to respond to all hazardous spill incidents. Local ordinances in some cities do not prohibit overnight parking of vehicles containing toxic materials in residential areas or close to schools. This situation creates an additional danger to the community. Many shippers of hazardous materials make every effort to comply with existing regulations. However, because of the complex nature of the federal, state and local regulations concerning the transportation. handling and identification of these materials, many shippers are unable to comprehend the confusing regulations. The Committee wishes to commend the Los Angeles County Board of Supervisors for its support and approval of the Report on Transportation of Hazardous Materials issued January 19, 1979. The Committee believes this report was instrumental in causing the enactment of legislation to address numerous environmental issues. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS TAKE APPROPRIATE ACTION TO REQUIRE THAT ALL VEHICLES TRANSPORTING HAZARDOUS MATERIALS WITHIN THE COUNTY HAVE A PLACARD AFFIXED WHICH IDENTIFIES THE SPECIFIC CONTENTS OF THE VEHICLE. THE GRAND JURY RECOMMENDS THAT THE APPROPRIATE FEDERAL, STATE AND COUNTY OFFICIALS ADOPT REGULATIONS WHICH WILL REQUIRE ALL PERSONNEL INVOLVED IN THE TRANSPORTATION OF HAZARDOUS MATERIALS TO COMPLETE A COMPREHENSIVE TRAINING PROGRAM IN THE HANDLING OF HAZARDOUS MATERIALS AND THAT LICENSING TO CARRIERS BE CONDITIONED ON THE SUCCESSFUL COMPLETION OF THIS PROGRAM BY THEIR EMPLOYEES. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS ESTABLISH WITHIN THE COUNTY FIRE DEPARTMENT A SPECIALLY TRAINED AND EQUIPPED "HAZARD UNIT" SIMILAR TO THE UNIT CURRENTLY IN OPERATION IN THE LOS ANGELES CITY FIRE DEPARTMENT. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS ENACT AN ORDINANCE TO PROHIBIT OVERNIGHT PARKING OF VEHICLES CONTAINING HAZARDOUS MATERIALS IN RESIDENTIAL AREAS OR CLOSE TO SCHOOLS IN UNINCORPORATED COUNTY AREAS. STORAGE OF HAZARDOUS MATERIALS In response to a citizen's complaint concerning a possible violation of hazardous material zoning ordinances, the members of the Committee visited a large, private transfer and storage facility in the county. Company officials cooperated fully during the on-site inspection by conducting a tour of the entire facility and supplying data related to the materials handled on the premises, safety procedures followed by employees and company compliance with requests from regulatory agencies. The Committee met with the Chief of the Los Angeles City Fire Department Fire Prevention Bureau, who supplied the Committee with copies of all pertinent regulations, inspection records and fire safety rules imposed on companies which store, transport and dispose of hazardous substances within the city limits. The Committee spoke to the enforcement officer of the Air Quality Management District to learn about the type and frequency of citizen complaints regarding noxious odors caused by accidental spills and careless handling of hazardous substances. The imposition of penalties and other regulatory actions was explained during this meeting. Regulatory agencies concerned with hazardous substances are providing protection for public health and safety within the limits of present laws and established means of control. However, there is a lack of uniformity in labeling buildings, tanks and other facilities where hazardous substances are processed and stored. While various codes now exist for such labeling, they are not uniform. There are residential developments located immediately adjacent to some hazardous storage facilities, with inadequate buffer zones separating residences from the facility. There are insufficient controls to keep developers from building homes close to already existing storage facilities or the building of storage facilities close to established residential areas. Residents living in these areas often complain of noxious odors and express great anxiety over the possibility of imminent fire or explosion. Public health and safety would be enhanced and the work of the County Fire and Health Departments would be decreased if more care were exercised by the Planning Commission in providing buffer zones between residential developments and hazardous material storage areas. The Los Angeles County Fire Department would be better able to protect life and property if a uniform code were devised and adopted for the labeling of all facilities involved in the storage of hazardous substances. This labeling should indicate the volatile nature of the materials involved and, in case of a fire, explosion or other emergency, the dangers inherent in controlling the situation. Efforts in the development of this labeling must be directed towards an agreement among the involved local, state and federal agencies. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS ADOPT COMPREHENSIVE REGULATIONS FOR ALL FUTURE RESIDENTIAL AND COMMERCIAL DEVELOPMENTS IN THE UNINCORPORATED AREAS OF THE COUNTY THAT WILL PROVIDE AN ADEQUATE BUFFER ZONE BETWEEN RESIDENCES AND AREAS WHERE HAZARDOUS SUBSTANCES ARE MANUFACTURED OR STORED. DISPOSAL OF HAZARDOUS MATERIALS Many of the Class I sites now available for disposal of liquid hazardous material wastes are either being closed in the near future or are having serious difficulty in obtaining permits for needed expansion. Permits are issued by a combination of county, state and federal agencies. The County Sanitation District site at Palos Verdes will close in the latter part of 1980, when it is expected to be filled to capacity. A permit for expansion and continued use of the Calabasas site is jeopardized by the strong opposition of residents in adjacent housing developments. Permission to develop a private disposal site in the Santa Clarita Valley has to date been denied because of community opposition and a fear that ground water will be contaminated. The technology for disposal of hazardous materials by means other than Class I landfills now exists, but is much more costly to operate. Hazardous waste engineers estimate that the cost per ton could be as much as six times greater. The BKK Corporation, a private firm that collects and disposes of much of the County's liquid hazardous waste, is in constant danger of losing its operating permits. In addition, they are in competition with the Sanitation District for the solid waste products needed to absorb their liquid waste input. Some of the larger chemical plants are exchanging their hazardous waste materials with other firms that have a need for these substances, thereby reducing the total volume that would otherwise be discarded. This tends to reduce costs as well as the amount of waste that must be discarded. The citizens of Los Angeles County face a serious threat to their health if the hazardous waste disposal problem is not addressed more forcibly in the immediate future. This threat stems from the fact that there will soon be inadequate disposal sites for the many tons of hazardous materials that accumulate daily in this area. THE GRAND JURY RECOMMENDS THAT THE COUNTY SANITATION DISTRICTS SEEK NEW METHODS AND PROCESSES FOR NEUTRALIZATION OR ELIMINATION OF HAZARDOUS WASTES AS AN ALTERNATIVE TO THE METHODS CURRENTLY USED AT CLASS I LANDFILLS. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS SEEK WAYS TO EXPEDITE PENDING CLASS I SITE PERMITS TO PROVIDE FOR HAZARDOUS WASTE DISPOSAL SITES PENDING THE DEVELOPMENT OF OTHER DISPOSAL ALTERNATIVES. THE GRAND JURY RECOMMENDS THAT THE COUNTY SANITATION DISTRICTS CONDUCT RESEARCH ON METHODS FOR REDUCING THE VOLUME OF LIQUID WASTES THROUGH THE EXTRACTION OF WATER AND OTHER NONTOXIC LIQUIDS. THE GRAND JURY RECOMMENDS THAT THE COUNTY SANITATION DISTRICTS COORDINATE THEIR RESEARCH AND PLANNING EFFORTS WITH THOSE OF PRIVATE DISPOSAL FIRMS. Other Recommendations: THE GRAND JURY RECOMMENDS THAT THE APPROPRIATE FEDERAL, STATE AND COUNTY OFFICIALS WORK TOGETHER TO SIMPLIFY, CONSOLIDATE AND ENFORCE REGULATIONS FOR THE TRANSPORTATION, HANDLING AND STORAGE OF HAZARDOUS MATERIALS. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE APPROPRIATE COUNTY DEPARTMENTS TO DEVELOP A UNIFORM SYMBOLIC CODE TO IDENTIFY BUILDINGS, STORAGE TANKS, VEHICLES AND OTHER CONTAINERS USED IN THE MANUFACTURE, STORAGE AND TRANSPORTATION OF HAZARDOUS SUBSTANCES; AND FURTHER, THAT THE BOARD OF SUPERVISORS SEEK THE ENACTMENT OF LEGISLATION REQUIRING ALL CONCERNS LOCATED IN THE UNINCORPORATED AREAS OF THE COUNTY WHICH ARE ENGAGED IN THE MANUFACTURE, STORAGE OR TRANSPORTATION OF HAZARDOUS SUBSTANCES TO DISPLAY THE IDENTIFICATION CODING ON BUILDINGS, STORAGE TANKS, VEHICLES AND OTHER CONTAINERS OF HAZARDOUS SUBSTANCES. Landfills The Environment Committee studied the subject of landfills, which are disposal sites for solid waste. While they are a necessary part of our culture, at least for the foreseeable future, the problems related to their operations threaten to stifle or even halt their use. FINDINGS AND RECOMMENDATION The general public is only concerned about landfills when the development or expansion of this type of disposal site will affect their daily lives because it is located near their residence or business. Objections center around concerns such as added air pollution, increased truck traffic on city streets and the offensive odors that occasionally drift into residential area. The increased scavenger bird population attracted by landfills is also a nuisance to nearby residents. On the positive side, landfills, when properly designed and operated, help to control water run-off and soil erosion. They provide the least expensive method developed to date for the disposal of solid waste. When filled to capacity landfills can be converted to parks, golf courses and botanical gardens. Approximately half of the items dumped into landfills consists of inert materials such as dirt, rock, and concrete. Ten percent consists of recyclable substances such as glass, paper and metal. The remaining forty percent is made up of organic material such as grass cuttings and sewer system solids, which eventually turn to soil. Nearly forty percent of the existing landfill capacity in Los Angeles County's seven sites will be eliminated because of site closures. Proposed new sites are either inaccessible, strongly opposed by nearby residents or located too far away to be economically feasible. Additionally, the cost of site qualification is great because of stringent state and federal regulations. The need for landfills will be reduced by increased emphasis on reclamation of reusable portions of the solid waste materials. The huge volume of dirt, rock and concrete could be diverted to future county and private development projects. The County must conduct and maintain an ongoing study of new disposal methods now available through increased technology. The closing of many landfill sites and difficulty in establishing new sites leaves no other alternative to this continuing problem. THE GRAND JURY RECOMMENDS THAT THE MEMBERS OF THE BOARD OF DIRECTORS OF THE COUNTY SANITATION DISTRICTS CONTINUE THEIR EFFORTS TO DEVELOP NEW DISPOSAL METHODS, SEEK ALTERNATIVE USES FOR REFUSE MATERIALS AND INTENSIFY THEIR EFFORTS TO EDUCATE THE CITIZENS OF THE COUNTY ABOUT THE NECESSITY FOR CAREFUL PLANNING AND DEVELOPMENT OF LANDFILLS. Resource Recovery The Environment Committee studied the subject of resource recovery as a possible solution to the projected water shortage, the increasing cost of energy and the diminishing capacity of existing landfills. FINDINGS AND RECOMMENDATIONS The potential for resource recovery extends to many substances and by-products, including water, metals, glass, paper, chemicals and methane gas. The Environmental Protection Agency (EPA) has approved a grant for the Los Angeles County Sanitation District to study the feasibility of source separation of recyclables from trash before they are discarded. Source separation involves the placing of glass, cans, paper and other items in separate containers by residents and commercial establishments. The cost per ton of solid waste disposal in Los Angeles County is very low compared to other areas. However, there is a decrease in available landfill sites close to populated centers. The cost of solid waste disposal will increase as more costly methods of disposal are implemented. The increased cost should be financed by imposing collection fees on those who generate the solid waste. The revenue generated should be utilized to develop alternate methods of disposal and resource recovery facilities. The U.S. Supreme Court has ruled that a portion of Colorado River water will revert to Arizona in 1985; this will result in a significant loss of water to the residents of Los Angeles County. Authorization for completion of the State Water Project which was to replace Colorado River water with an increased flow from northern California has been repeatedly delayed. Authorization and financing for the project have been delayed by conflicting water use philosophies. Authorities estimate that approximately three hundred thousand acre-feet of the one million acre-feet of water now being channeled through Los Angeles-Orange County sewer systems could eventually be available for reuse by industrial plants, parks and recreational areas. Existing reclamation facilities presently produce slightly more than twelve percent of this amount. A joint Los Angeles-Orange County survey indicates that once reclamation and distribution facilities are expanded, a ready market exists for the recovered water by municipal greenbelts, industrial plants, ground-water recharge sites and sea water intrusion barriers. Approximately ten percent of the total solid wastes going to the landfills consists of materials such as metals, glass and paper that can be recycled and reclaimed to reduce energy consumption. A limited amount of methane gas is now being recovered from landfills and sewage sludge digestion facilities but the potential exists for even greater recovery. Methane gas is used to generate electricity for operation of sewage treatment plants and surplus methane is sold to utility companies for power generation. Recently, Los Angeles City received approval of and matching federal funds for construction of a solid waste disposal resource recovery facility in the Sepulveda Basin. This facility will reduce the volume of sewage solid waste that is now dumped into the ocean through the Hyperion outfall. The solid wastes will be reduced in volume and rendered harmless by sewage sludge digestion facilities designed to recover methane gas generated by the process. Water reclamation for industrial and greenbelt use is also incorporated in the plans for these new facilities. There is a federally-funded study now in progress for a resource recovery facility to be located in Long Beach. This demonstration project, tentatively identified as the Southwest Resource Recovery Facility, would burn trash to generate both steam and electricity. The study includes the identification of customers for the steam and electricity to be generated and most comparisons to present methods. The proposed Long Beach Resource Recovery Facility is a positive approach to energy conservation, landfill overloading and long-haul transportation of solid materials to remote sites. The present scarcity and high cost of energy makes resource recovery an attractive partial solution to the increasing public service costs and more stringent regulations for the development of new disposal sites. Southern California will suffer an acute water shortage unless additional water sources are found in the next five years. One source could be the extension of water reclamation from existing sewage treatment plants. To accomplish this, new water reclamation facilities should be constructed. THE GRAND JURY RECOMMENDS THAT THE MEMBERS OF THE BOARDS OF DIRECTORS OF THE SANITATION DISTRICTS IN THE COUNTY PURSUE THE ENACTMENT OF ORDINANCES MANDATING SOURCE SEPARATION OF SOLID WASTES BY RESIDENTIAL AND COMMERCIAL USERS; FURTHER, THAT THESE ORDINANCES PERMIT THE IMPOSITION OF FINES FOR USERS WHO FAIL TO SEPARATE SOLID WASTES. THE GRAND JURY RECOMMENDS THAT THE MEMBERS OF THE BOARDS OF DIRECTORS OF SANITATION DISTRICTS IN THE COUNTY IMPOSE FEES FOR REFUSE COLLECTION. THE GRAND JURY RECOMMENDS THAT THE MEMBERS OF THE BOARDS OF DIRECTORS OF SANITATION DISTRICTS IN THE COUNTY SEEK FEDERAL FUNDS FOR THE EXPANSION OF SEWAGE TREATMENT AND RESOURCE RECOVERY FACILITIES FOR THE RECLAMATION AND DISTRIBUTION OF RECLAIMED WATER AND METHANE GAS. THE GRAND JURY RECOMMENDS THAT THE MEMBERS OF THE BOARDS OF DIRECTORS OF SANITATION DISTRICTS IN THE COUNTY MAKE LONG-RANGE PLANS FOR CONSTRUCTION OF FACILITIES FOR CONVERTING SOLID WASTE INTO ENERGY. Ruby R. Renetzky, Chairman Elmer E. Drickey Lillian Gindler Joseph Lee, Jr. Elizabeth H. Woodside 65 GOVERNMENT ORGANIZATION COMMITTEE PURPOSE The Government Organization Committee is delegated by the Grand Jury to follow up on selected recommendations of past grand juries and to study proposals including legislation in areas of concern not addressed by other committees. FOCUS OF REVIEW Sheriff-Marshal Consolidation Paramedics Alcoholism Sheriff-Marshal Consolidation The Government Organization Committee studied whether one county department should perform the necessary tasks of serving civil process and providing bailiffs for the courts, rather than continuing the current practice of using both deputy marshals and deputy sheriffs to provide these services. The Committee recognizes that this subject has been studied by past grand juries and that enabling legislation granting the County the authority to consolidate these services has not been enacted by the State legislature. Reduction in revenue to fund local services makes this issue an urgent one for prompt attention and resolution. FINDINGS AND RECOMMENDATIONS The Sheriff's Department serves process and provides bailiffs for the Superior Court system in Los Angeles County with 24 officers, 324 sworn deputies and 43 civilian employees. The 1979-80 budget for this portion of Sheriff's Department services is $7,785,077. Leadership responsibility for this function is with the County Sheriff, who is elected every four years in a county-wide election. The Marshal's Department serves process and provides bailiffs for the municipal courts in the 26 judicial districts in Los Angeles County with 65 officers, 404 sworn deputies and 127 civilian employees. The 1979-80 budget for these services is $12,931,908. Leadership responsibility for this function is with the County Marshal, who is appointed by the judges of the Municipal Court. Approximately 85% of the process served by the Marshal's Department generates revenue which goes to the County general fund. In contrast, 75% of the process served by the Sheriff's Department is "no charge" governmental process resulting in no returned revenue. In addition, the Sheriff's Department must serve all process for the Juvenile Court and by law no fee can be charged for this service. The Committee noted that both departments have offices in 12 of the same buildings and have duplicate administration, accounting, supply, payroll, training and investigation services. Deputy marshals and deputy sheriffs often serve process in the same areas, on the same streets and at the same time. Estimated annual savings of consolidating the Marshal's into the Sheriff's Department from past proposals were: Citizens Economy and Efficiency Commission - 1971 (2 million) Los Angeles Area Chamber of Commerce - 1975 (3 million) Economy and Efficiency Commission - 1978 (3.5 million) Sheriff-Marshal Consolidation Position Paper - 1979 (4 million) (prepared by the Sheriff's Department) The County has proposed State legislative action a number of times to allow the Board of Supervisors to consolidate the two departments. It is reported that these attempts failed because of lobbying efforts by the Marshals' Association and the Municipal Court Judges' Association. In January of 1979, the Board of Supervisors, the Sheriff, the Presiding Judges of the Superior and Municipal Courts and the Grand Jury of Ventura County unanimously adopted a proposal to merge the Marshal's Office with the Sheriff's Department. Assemblyman Charles R. Imbrecht, R-Ventura, introduced Assembly Bill 1493 which will, if passed, give the Board of Supervisors the authority to accomplish this merger. This action will apply only to Ventura County but it sets a precedent to be followed by other counties. A second major benefit of merging the Marshal's Department into the Sheriff's Department would be the increased flexibility offered by the transfer of about 400 uniformed officers and over 200 vehicles resulting in increased visibility and availability of law enforcement throughout the County. It was the opinion of the Committee that the transfer of civil process and bailiff's services of the Sheriff's Department into the Marshal's Department would require a major expansion of the Marshal's Department, whereas the Sheriff's Department could absorb the Marshal's Department with minimum adjustments. The Grand Jury commends the Superior Court, the Board of Supervisors, the Chief Administrative Officer and the Department of Personnel for developing a pilot program to replace 42 Sheriff's bailiffs in certain civil courts with court attendants. This will save Los Angeles County approximately $420,000, which is a sufficient amount to offset the County's annual cost for 25 additional judges. This program is patterned on one implemented by Santa Clara County a year ago. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS PROPOSE LEGISLATION WHICH WILL GIVE THE BOARD THE AUTHORITY TO CONSOLIDATE THE MARSHAL'S OFFICE INTO THE SHERIFF'S DEPARTMENT IN LOS ANGELES COUNTY, WORK WITH OTHER COUNTIES SEEKING SIMILAR LEGISLATION AND ACTIVELY PURSUE ENACTMENT OF THIS LEGISLATION. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS EFFECT THE MERGER OF THE MARSHAL'S OFFICE INTO THE SHERIFF'S DEPARTMENT ONCE THE AUTHORITY TO DO SO IS PROVIDED. Paramedics The Government Organization Committee is concerned about the problems involved in providing paramedic services in Los Angeles County. Interest in this topic was generated by a review of the 1978-79 Grand Jury report on Emergency Medical Services. The Committee visited the Paramedic Training Institute, Harbor-UCLA General Hospital and the USC County Medical Center emergency rooms and base stations. Interviews were conducted with the following persons: directors and staff of the Harbor-UCLA General Hospital Base Command Station, the Paramedic Training Institute, Chief of Emergency Services at USC County Hospital, representatives of the Department of Health Services, Emergency Medical Services Division, the director for the UCLA Emergency Medical Center, the president and vice president of the United Paramedics of Los Angeles, former members of the Paramedic Commission and the Los Angeles County Emergency Medical Commission and the chairman of the Health and Hospitals Committee of the 1978-79 Grand Jury. Among the reports studied by the Committee were the following: The February 28, 1979, Report of the Fire Commission Emergency Medical Services Committee, statistical data of the Los Angeles City Fire Department for 1977-78, copies of the Education and Training Requirements for Mobile Intensive Care Paramedics in California, a study written in August, 1979, on Pre-hospital Care of Cardiovascular Emergencies prepared by Touche-Ross for the United Paramedics of Los Angeles and other articles and manuals on the subjects of emergency care and paramedic services. FINDINGS AND RECOMMENDATIONS There are 33 providers of paramedic services in the County. They neither operate in the same manner nor have uniform procedures. There is a lack of medically-oriented supervision in the various fire departments and the private ambulance companies. The best approach to coordinate paramedic services is to establish a countywide, uniform system with medically-oriented supervision under the overall control of the fire departments. This will allow better utilization of the existing manpower. The bulk of a fireman's duty time is stand-by service. Statistics indicate that one hour and fifteen minutes per day is spent on emergency service, of which at least 50% are for paramedic service and nonfire emergencies. In the City of Los Angeles there are 2,200 firemen and 194 paramedics. State legislation passed in 1970, authorizing pilot paramedic programs throughout the State, expired by its own terms as of December 31, 1979. There is no legal mandate requiring local jurisdictions to provide paramedic service. Presently, six communities in the county — San Marino, San Gabriel, Sierra Madre, Alhambra, Lynwood and Avalon — do not provide paramedics. There is no legal mandate requiring the regulation of paramedic programs or services. Uniform standards regarding the type of mobile equipment, the number of units per 100,000 population and the minimum distance where paramedic units are stationed with relation to the area served do not exist. The service is handicapped by jurisdictional boundaries and in some cases the nearest paramedics are not permitted to respond to a given location. Some mutual aid agreements are in effect and others are being worked on. Initially paramedic systems were instituted to provide rapid, extensive care in the field to patients with cardiac emergencies. These systems have grown into general purpose, pre-hospital care units. There were 183,908 paramedic runs in the county during 1979, of which approximately 35,000 involved cardiac arrest patients. The other responses covered a range of medical and social problems, particularly trauma, respiratory emergencies and psychosocial ailments. The mortality rate from primary cardiac arrhythmias, which are variations from the normal electrical rates and sequences of cardiac activity, is the basic measurement of the overall effectiveness of paramedic programs. Los Angeles County's current reporting system fails to acquire data and measure effectiveness. In order to determine if the paramedic system is being used effectively, it is necessary to compile a data bank. Every element must be recorded, including the facts leading to the decision to administer care and all services rendered by the paramedics and the emergency room staff. This will permit better allocation of resources and determine citizen access and paramedic performance. During a visit to the Paramedic Training Center, located on the grounds of Harbor-UCLA General Hospital in Torrance, the Committee noted critical space problems and conditions which were not conducive to learning. The Paramedic Training Institute located at the Training Center deals with the techniques that must be implemented to save lives in Los Angeles County. It is of utmost importance that the facilities used to train students in necessary life-saving skills be adequate. The 30 paramedic students presently enrolled in the training phase are instructed in a 1,200 square-foot prefab building which contains classrooms, office space, a restroom and a student lounge. Workshops and simulations must be conducted in hallways, offices and outdoors. There are four toilets, two of which have no partitions. The lounge and study space, with an area of about 300 square feet, is inadequate. Because of a lack of space, audio visual materials and study aids are not set out permanently for ready use by the students and, therefore, are not fully utilized. The Paramedic Training Institute is responsible for the training needs of prospective paramedics and the Mobile Intensive Care Nurses or base hospital nurses. Emergency Medical Technician I refresher courses, as well as special and continuing education courses, are given at this location. The physical plant of the Institute consists of three joined trailers totaling 1,650 square feet and a prefab building about 4,500 square feet in size. The trailers are crowded and noise from the air conditioner makes it almost impossible to hear the instructor. The trailer roof had major leaks with rain water seeping through light fixtures. It has recently been retarred. Water from faucets in both units is rusty and there is no water in the trailers. Leased trailers presently located at Martin Luther King Hospital will soon be vacated. To relieve the overcrowded conditions at the Center, at least three of these trailers should be relocated at the paramedic site in Torrance. The center also needs to develop and implement a data processing system to facilitate the processing of program exam results, certification and recertification deadlines. Triage is the classification of wounded, ill or injured persons in order to insure the efficient use of medical and nursing manpower, equipment and facilities. Triage is a difficult job as it requires quick decisions. This assignment system is the responsibility of the dispatchers who answer emergency calls; therefore, they need proper training to help them in their dispatch responsibilities. Some cases are critical while in others time may not be of essence. This is a diverse new field so a representative group from major emergency medical institutions and paramedics should devise a training course and establish the series of protocols to be used by dispatchers to determine appropriate responses. In the past, "cardiac arrest" was considered to be untreatable outside a hospital, but it has been proved that patient survival depends on the speed and appropriateness of the care delivered. Experts and data suggest that 43% of these victims could be resuscitated and survive if cardiopulmonary resuscitation (CPR) is started within four minutes and if paramedics reach the patient within eight minutes. Statistics indicate that a broad community knowledge of basic CPR is useful in saving lives and providing more effective pre-hospital care. Section 51202 of the Education Code, passed in 1977, requires that CPR instruction be provided for all school children at the appropriate elementary and secondary grade levels if appropriate equipment is available. Some school districts in Los Angeles County have no CPR program; others offer a range of instruction. Glendale School District teaches CPR to all students, 4th grade through high school. Instruction is also given at Glendale City College. Many districts are acquiring equipment and training teachers to conduct these classes. A uniform instruction program throughout the county should be the goal with an additional adult program promoted through all communities under the auspices of the various fire departments. A current problem exists for a person who is in an unfamiliar area and needs to place an emergency call at a public telephone. Many times it is difficult to determine which fire department has jurisdiction in the area. Until the 911 emergency phone system is developed, the Board of Supervisors should work with telephone companies and fire departments to institute a program of posting the emergency number for the immediate area on every public phone in the county. The Emergency Medical Services Commission has proposed that the number of base hospitals be expanded from the current number of 29 to 38. The designation of a facility as a base hospital entails an initial investment of at least $75,000 with more than $100,000 needed annually to provide the necessary physicians, intensive care nurses and emergency medical technicians. Base hospitals are the paramedic's link to medical instructions and directions to stabilize the patient's condition. If necessary, the patient can be transported from the base hospital to the nearest hospital able to provide the needed care. Some authorities feel that four or five base hospitals could serve the needs of the County adequately. Hospital costs, already high, are increasing. Designation of additional base hospitals is a duplication of services which would not generate additional benefits. The commission should reconsider its proposal to increase the number of base hospitals. Trauma Centers are 24-hour emergency medical and surgical facilities staffed and equipped to handle major injuries, burns and gunshot wounds. The Department of Health Services has been studying the classification and location of strategic hospitals to facilitate the delivery of the patients to the most appropriate site for treatment. Trauma patients are now taken to several hospitals within the County but no hospital has been designated as an official Trauma Center. The need for trauma centers is evidenced by studies which indicate that lives can be saved when more comprehensive medical care is available at a designated site. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS ESTABLISH A COUNTY-WIDE CAREER PARAMEDIC SERVICE WITH A MEDICALLY-ORIENTED SUPERVISORY STAFF UNDER THE OVERALL MANAGEMENT OF THE FIRE DEPARTMENT: FURTHER, THAT MEMBERS OF THIS SERVICE NOT BE CLASSIFIED AS FIREFIGHTERS. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS SUPPORT STATE LEGISLATION AUTHORIZING COUNTIES TO SET UNIFORM STANDARDS FOR PARAMEDIC SERVICE WITHIN THEIR JURISDICTION. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS REQUIRE THAT ANY NEW MOBILE INTENSIVE CARE UNITS ESTABLISHED WITHIN THE COUNTY JURISDICTION HAVE PATIENT TRANSPORTATION CAPABILITIES. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS REQUIRE THAT A DATA BASE SYSTEM BE DEVELOPED TO DOCUMENT ALL EMERGENCY CARE CALLS, NONRESPONSES AND SERVICES RENDERED, INCLUDING NONTREATMENT AND POST-TRANSPORTATION RESULTS, AND THAT THIS DATA BASE BE MONITORED AND PERIODICALLY EVALUATED BY THE EMERGENCY MEDICAL SERVICES COMMISSION. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF HEALTH SERVICES IN CONJUNCTION WITH THE PARAMEDIC TRAINING INSTITUTE DEVELOP A DATA PROCESSING SYSTEM. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF HEALTH SERVICES AUGMENT THE PARAMEDIC TRAINING INSTITUTE FACILITIES BY TRANSFERRING THREE TRAILERS, INCLUDING RESTROOMS, FROM MARTIN LUTHER KING HOSPITAL TO THE PARAMEDIC TRAINING INSTITUTE. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE EMERGENCY DISPATCHERS OF THE COUNTY FIRE DEPARTMENT TO USE CALL SCREENING PROTOCOLS SO THAT A TIERED RESPONSE SYSTEM CAN BE IMPLEMENTED. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS THROUGH APPROPRIATE COUNTY DEPARTMENTS PROVIDE SPECIAL TRAINING AND MEDICAL SUPERVISION FOR THE EMERGENCY DISPATCHERS. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS INSTITUTE A COUNTY-WIDE BASIC CARDIOPULMONARY RESUSCITATION (CPR) PROGRAM PROMOTED UNDER THE AUSPICES OF THE COUNTY FIRE DEPARTMENT. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE COUNTY SUPERINTENDENT OF SCHOOLS TO DEVELOP A UNIFORM PLAN SO THAT THE REQUIREMENT THAT CPR INSTRUCTION BE PROVIDED TO ALL SCHOOL CHILDREN WILL BE FULLY IMPLEMENTED IN THE COUNTY. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS, WORKING WITH THE TELEPHONE COMPANIES AND THE FIRE DEPARTMENTS IN THE COUNTY, INSTITUTE A PROGRAM TO POST THE EMERGENCY NUMBER FOR THE IMMEDIATE AREA ON EVERY PUBLIC PHONE. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF HEALTH SERVICES REFRAIN FROM DESIGNATING ANY ADDITIONAL BASE HOSPITALS AND EVALUATE AND IMPROVE THOSE NOW IN EXISTENCE. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE DEPARTMENT OF HEALTH SERVICES TO ESTABLISH TRAUMA CENTERS TO PROVIDE MORE COMPREHENSIVE MEDICAL SERVICES TO THE SEVERELY INJURED. Alcoholism The Government Organization Committee's interest in alcoholism and its related problems began as a follow-up study of the 1978-79 Grand Jury report concerning the continuing shortages of facilities and services for the public inebriate, particularly in the Central Los Angeles area where the problem is greatest. The Committee considered the subjects of alcoholism, the public inebriate, the proposed El Rey Project and Occupational Alcoholism and Employee Assistance programs in the County. The Committee visited the Volunteers of America Detoxification and Recovery Center and the Long Beach General Hospital. Representatives from the Center for Law in the Public Interest, several labor unions, Indian Service groups, the National Council on Alcoholism, the County Employee Assistance Program, the Sheriff's Alcoholism Program and the County Office of Alcohol Abuse and Alcoholism (OAAA) were interviewed. The proposal for the El Rey Project, the Grand Jury report of 1978-79, proposed legislation dealing with alcoholic services funding, studies concerning public inebriates and programs for them and reports of the Inter-Tribal Council of California Inc. and the Department of Health Services (DHS) were reviewed. FINDINGS AND RECOMMENDATIONS Statistics tell us that one of every ten persons becomes an alcoholic. It is estimated that there are a half-million alcoholics in Los Angeles County. The American Medical Association acknowledged alcoholism as a "disease" in 1956 and later this was affirmed by the World Health Organization, the National Department of Health, Education and Welfare, the American Psychology Association and endorsed by the American Bar Association. Although the cause is not known, it is a complex, chronic and progressive disease with psychological and sociological aspects. It is the third top killer after cancer and heart disease. If untreated, permanent damage, physical incapacities and even death may result. The National Council on Alcoholism (NCA) and other noted authorities reveal that the alcoholic usually is powerless to stop the progression of alcoholism without assistance. Studies reveal the 40% of state mental hospital admissions suffer from alcoholism and 50% of all child and wife abuse cases, domestic violence, automobile deaths and murders are alcohol related. Seventy-five to eighty percent of all social, economic, health, personal and financial problems of the American Indian are directly related to the usage and abuse of alcohol. According to the American Medical Association, consumption of alcohol by expectant mothers is a cause of mental retardation (Fetal Alcohol Syndrome). The California Board of Equalization reports per capita consumption of alcohol has increased 45% since 1960. Currently, the liquor tax that is collected by the Board of Equalization goes into the State General Fund. Cities and counties receive 90% of the proceeds from liquor license fees and fines to enforce Alcoholic Beverage Control Board (ABC) laws and the remaining 10% is earmarked for the State General Fund to support the ABC statewide. New license and transfer fees directly support the ABC Board. It appears appropriate that a user's tax be levied on liquor to finance long-term permanent alcoholic treatment programs and services. Senate Bill 1745, authored by State Senator Alan Sieroty and sponsored by Los Angeles County, addressed this issue but was defeated in committee. If efforts to achieve state legislation on this subject continue to fail, then the initiative process should be considered to get needed financing for these programs. The cost effectiveness of civil diversion alternatives for alcoholics has been publicly acknowledged by all major city and county officials and has been documented by studies in scores of jurisdictions. Estimates show that the cost of jail confinement per arrestee for a 72 hour period would be $232 which can be compared to approximately $83 for a person treated at a detoxification center. Hospitalization costs would amount to $400 per day. The Sundance vs. Municipal Court decision stated that criminal processing of public inebriates makes no social sense and stressed that the proper approach to the problem is "treatment instead of punishment". The Volunteers of America of Los Angeles (VOA) have provided a humane alternative with their Detoxification and Recovery Center located on Skid Row. The VOA can accommodate six to eight females in the detoxification center and ten in the long-range residential recovery program. This represents between 10 to 15 percent of the total VOA program and the number of women that use these facilities. These figures should not be used to estimate the number of skid row women in need of this type of service as many find housing by other less desirable means. As a result of the Sundance decision, the visibility of the public inebriate has increased five-fold with deaths and injuries on skid row tripling. The El Rey Project will be able to provide the all-inclusive programs to address the multifaceted needs of some public inebriates. The DHS, through the OAAA, administers all alcoholic services contracts and it is important that this department set definite objectives for all contracts issued with a mechanism to monitor these programs. In response to the need for a larger humane treatment center near Skid Row for the public inebriate, the Volunteers of America will manage the proposed El Rey Project. The hotel, an 11-story, 621 room building valued at 21/2 million dollars, has been donated by the Weingart Foundation, which has also agreed to spend up to $1 million to refurbish it into a detoxification center with a network of coordinated alcoholic treatment services. The Los Angeles Community Redevelopment Agency (CRA) will fund the housing portion with the Federal Bureau of Community Health Services (BCHS) providing finances to establish the clinic. Modeled on the present VOA programs, plans for the El Rey include expanded services such as shelter, treatment and rehabilitation to as many as 500 public inebriates per day. Supportive services will include screening for medical and mental health problems, meals, counseling, job training and placement, legal and consumer assistance, a DPSS outstation, a clinic and a bank. One-third of the existing floor space would be set aside for low-income housing. Ongoing financing of this project and its components must be provided by city, county, federal and private sources. At present, there appears to be a need for additional alcoholism treatment services for women. All phases of the rehabilitation of alcoholic women should be reviewed to determine if adequate services are provided. Alcoholic parents are hampered by the shortage of day care and foster home facilities to care for their children while the alcoholic parent seeks rehabilitation. This prevents many from participating in necessary treatment. The lack of a sufficient number of foster homes and day care centers must be 72 considered when alcoholism treatment programs are formulated. Providing children with counseling similar to that offered by Alateen or Alanon while at these locations would help both parent and child to make the necessary adjustments when they are reunited. Occupational Alcoholism Programs are proving to be an effective method in addressing the destructive course of alcoholism. The main thrust of Occupational Employee Assistance is to identify those with problems in the early stages and to offer them the option of participating in treatment by trained personnel with the assurance of total confidentiality. These steps may alleviate the problem before it becomes so severe that job termination is required. The success of these programs, both public and private, arises from the fact that a job is valuable to the alcoholic who is motivated to avoid ultimate job loss and the resulting loss of income which he uses to buy liquor. The alcoholic employee is absent two to four times more often, involved in on-the-job accidents two to four times more often and receives sickness and accident benefits three times greater than the nonalcoholic. This adds up to $250 million in annual costs to industry in Los Angeles County. Of the 71,000 persons employed by the County, 70% consume alcohol, 10% become problem drinkers and 5% have problems of physical health, family/marital, financial, legal or emotional nature. Using these statistics, the minimum annual cost to the taxpayer for employees directly affected by active alcohol related problems is set conservatively at approximately $40 million. This is based on a 25% performance decline factor for employees directly affected by the problem. The County has an Employee Assistance Program but its availability is not effectively promoted and publicized. Although some departments have a statement of policy that guarantees that participation in the program will not jeopardize job security and promotional opportunities, there is no general statement of policy at this time. This deficiency could be a factor in the program's underutilization. To insure better participation in the County's existing Employee Assistance Program, it is important that the Board of Supervisors review the Statements of Policy existing in various departments and initiate a general policy statement which assures all county employees that their job security and promotional opportunities will not be jeopardized by participating in the available substance abuse treatment programs and that confidentiality will be maintained. Use of the job situation as a motivational tool is shown in the National Council of Alcoholism Labor-Management Task Force report which indicates that the average rehabilitation rate of those participating in 16 selected alcoholism treatment programs has been 74.8% compared with a recovery rate among jobless alcoholics of only 25%. The focus of these programs is job performance and the company's concern with alcohol is limited to its effect only in this area. Clearly no segment of our society is free of the problem of alcoholism as 45% of the nation's alcoholics are in the professional, managerial and technological fields. Occupational Alcoholism Programs not only save and salvage lives but are cost effective as they restore the employee to full job efficiency. Management and unions work together to restore the individual into a healthy, productive employee. The Committee has concluded that society must try to eliminate the social stigma of alcoholism so persons afflicted with this disease will feel free to seek treatment. Some provision must be made to create a safer environment for alcoholics so that they do not bring harm to themselves or to the community. The Los Angeles County Grand Jury commends the Los Angeles County Board of Supervisors and the Los Angeles City Council for their efforts in obtaining funds for the El Rey Hotel Project. Those in the field of Occupational Alcoholism cite Hughes Aircraft Company's program as an outstanding example of a well-run system. The Los Angeles County Grand Jury commends them for their foresight and humanitarianism. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS CONTINUE TO ACTIVELY SUPPORT LEGISLATION TO FUND ALCOHOLIC TREATMENT SERVICES THROUGH AN INCREASE IN THE TAX ON RETAIL SALES OF ALCOHOLIC BEVERAGES. IF EFFORTS TO INCREASE THE ALCOHOLIC BEVERAGE TAX ARE NOT SUCCESSFUL, THE GRAND JURY RECOMMENDS THAT THE COUNTY SUPPORT LEGISLATION WHICH WILL EARMARK FOR ALCOHOLIC TREATMENT SERVICES A PERCENTAGE OF THE PRESENT TAX ON RETAIL SALES OF ALCOHOLIC BEVERAGES. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS CONTINUE TO SUPPORT THE EL REY HOTEL PROJECT, A MULTISERVICE ALCOHOL TREATMENT AND DETOXIFICATION CENTER. THE GRAND JURY RECOMMENDS THAT THE DEPARTMENT OF HEALTH SERVICES CLOSELY MONITOR THE ALCOHOLIC TREATMENT SERVICES PROVIDED AT THE EL REY HOTEL. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE DEPARTMENT OF HEALTH SERVICES TO MAKE A DETERMINATION OF THE NEED FOR ALCOHOLIC TREATMENT SERVICES FOR WOMEN. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS PROVIDE DAY CARE AND FOSTER HOME SERVICES FOR CHILDREN WHOSE PARENTS ARE RECEIVING ALCOHOLIC TREATMENT SERVICES. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS PROMULGATE A POLICY STATEMENT TO ASSURE ALL COUNTY EMPLOYEES THAT THEIR JOB SECURITY AND PROMOTIONAL OPPORTUNITIES WILL NOT BE JEOPARDIZED BY PARTICIPATION IN SUBSTANCE ABUSE TREATMENT PROGRAMS AND FURTHER, THAT AN EMPLOYEE'S PARTICIPATION IN SUCH PROGRAMS WILL BE KEPT CONFIDENTIAL. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS EXPLORE NEW APPROACHES TO PUBLICIZE THE AVAILABILITY OF ALCOHOLIC TREATMENT SERVICES THAT ARE OFFERED AS PART OF THE COUNTY EMPLOYEE ASSISTANCE PROGRAM. Irene M. Almeida, Chairman Jerry L. Adams Mayme Lou Bruce Isabel G. Callahan Kathleen M. Ragsdale Ruby R. Renetzky 74 HEALTH SERVICES COMMITTEE PURPOSE The Health Services Committee is delegated by the Grand Jury to review the operations of all components of the Los Angeles County health care system including hospitals, clinics and support services. The committee also studies programs administered by the Department of Health Services and the Department of Mental Health. FOCUS OF REVIEW Mental Health Court Tuberculosis Nursing Homes Mental Health Court The members of the Health Services Committee are concerned about conditions at the Mental Health Court and the emotional impact of these conditions on the people who appear in this court under the provisions of the Lanterman-Petris-Short Act. FINDINGS AND RECOMMENDATIONS The Mental Health Department of the Superior Court (Departments 95 and 95A) is located in a converted factory building at 1150 North San Fernando Road. The 27 year old building, which was originally a food processing plant, became the site of the Mental Health Court in 1976. It is the only court in the world that exclusively handles mental health cases, allowing court personnel to develop a measure of expertise in handling cases where the litigant may be heavily sedated or suffering from a mental illness. Of the approximately 7,000 separate cases heard per year in these courtrooms, about 6,000 are Lanterman-Petris-Short (LPS) cases. Under LPS, legal decisions about the patient's mental competency are determined by the Court. The only criteria used are danger to self, danger to others, or gravely disabled, which means that the person is unable to provide basic needs of food, shelter or clothing. The Superior Court has the primary responsibility for providing services at this facility. The Sheriff is responsible for staffing the custody area. Other County departments involved in the daily operations are the County Counsel, District Attorney, Public Defender, County Clerk, Health Services, Mental Health, and Public Social Services. Money for capital outlay projects is difficult to obtain because of severe County budget limitations. Building modification plans to improve the conditions in this facility have not been approved in past years because of the cost considerations. Arguments that improvements to the Mental Health Court are not of sufficient priority to be funded do not seem reasonable. The constitutional right to a fair hearing must be provided for those individuals who, by definition, require the protection of the legal system. The committee is concerned that the fragile state of these individuals is easily disturbed by an unpleasant and chaotic environment Modifications were not made four years ago when the use of this facility was changed from an arraignment court to the Mental Health Court. Neither courtroom has sound amplification equipment and the courtrooms have high ceilings, bare walls, and uncovered floors which create noise problems. Acoustics in the courtrooms must be improved. Sound-deadening materials need to be installed. Additionally, microphones for the witness stand, the judge's bench and the attorney's table should be installed in each courtroom. Patients, witnesses and visitors use a central lobby which is adjacent to the courtroom as a waiting area. This room is large, stark, and furnished with uncomfortable benches. The committee found that patients awaiting court hearings come by bus from Camarillo and Metropolitan State Hospitals. As many as 30 hearings may be heard on a given day and patients must wait for substantial lengths of time in the central lobby. Persons appearing in this Court are taking medication, have trouble concentrating, are confused, speak indistinctly, or may be agitated. Hearings are sometimes complicated and testimony is technical. On occasion, noise from the lobby area interferes with the conduct of the court proceedings. The small rooms for doctor and attorney interviews are not used because the acoustical conditions make conversation impossible. Interviewing now takes place in hallway areas. The tenuous state of mind of those served by this court demands a suitable environment which is not now provided. It is imperative that the patient be physically comfortable to promote a positive mental state. If implemented, existing plans for structural modifications will create a new patient waiting area separate from the main lobby. This should improve safety and noise conditions. Agitated patients often need more space to move about than is available. These patients are now put in small rooms in the Sheriff's section of the building because the central lobby is not secure. Easy access exists from the lobby of the Mental Health Court to a parking area and beyond that to San Fernando Road, which is a busy thoroughfare. The Health Committee was informed that some patients have managed to run out of the lobby, cross the street, vault the fence and escape into the railroad yard which is directly opposite the court building. The proposed structural modifications for the new patient waiting area would also place new barriers between the patient and San Fernando Road, making escape more difficult. During visits to this Court and from discussion with individuals working in or visiting the facility, the Committee became concerned about the safety of individuals and protection of property at this site. Vandalism was apparent. The Committee was informed of several thefts from the building and parking area. The addition of a fence around the parking areas will result in a more secure situation. The Committee believes that this fence, along with the structural modifications in the patient waiting area will provide another barrier to street access and thereby reduce the number of attempted escapes. Transportation is provided back to the hospital for those persons who are successful in having their detention set aside, but there is no provision for transportation to any other destination. Often these persons have been disowned by family and friends because of their illness, and many individuals, who choose not to return to the hospital, are unable to get home or to another safe place. The Committee feels compassion for those persons found by this Court to no longer require involuntary incarceration in a hospital because there is no system to return them to a suitable environment. Individuals with mental problems often improve dramatically while in the hospital where medication is routinely administered; however, symptoms frequently return when the patient leaves the hospital and stops taking medication. To compound the problem, individuals who have improved in a therapeutic setting often cannot function without support in the community. In the past, personnel assigned to the Mental Health Court developed a follow-up plan for patients released from involuntary commitment. Budget constraints have eliminated this service, leaving a void in the continuity of care available to individuals attempting to readjust to society. Individuals released from mental facilities need a follow-up plan to allow them to remain in the community rather than in mental health hospitals. Crisis evaluation and intervention services and outpatient treatment programs should be included. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS TAKE ACTION TO IMPROVE ACOUSTICS AND INSTALL A SOUND AMPLIFICATION SYSTEM IN DEPARTMENTS 95 AND 95A. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS TAKE ACTION TO IMPROVE THE WAITING ROOM AREAS OF THE MENTAL HEALTH COURT. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS TAKE ACTION TO PROVIDE SUFFICIENT SPACE IN THE DETENTION AREA OF THE MENTAL HEALTH COURT FOR AGITATED PATIENTS WHO REQUIRE FREEDOM OF MOVEMENT. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS TAKE ACTION TO IMPROVE THE ACOUSTICS IN THE INTERVIEW ROOMS AT THE MENTAL HEALTH COURT. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS TAKE ACTION TO INSTALL A FENCE TO ENCLOSE THE PARKING LOT AT THE MENTAL HEALTH COURT. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE APPROPRIATE COUNTY DEPARTMENTS TO DEVELOP PROCEDURES WHICH WILL PROVIDE TRANSPORTATION TO AN APPROPRIATE DESTINATION FOR THE PERSONS RELEASED FROM CUSTODY WHO DO NOT WISH TO RETURN TO THE HOSPITAL AND THAT NECESSARY FUNDING BE PROVIDED FOR THIS SERVICE. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS DIRECT THE APPROPRIATE COUNTY DEPARTMENTS TO PROVIDE FOLLOW-UP SUPPORT SERVICES FOR PERSONS RELEASED BY THE MENTAL HEALTH COURT AND THAT NECESSARY FUNDING BE PROVIDED. Recent court decisions Jamison vs. Farabee and Doe vs. Gillinot indicate that there are some concerns about the Lanterman-Petris-Short Act apart from the philosophical differences often found between legal and medical opinions. Although further judicial and legislative review is conceivable, the committee believes that such action would not affect the recommendations of this Grand Jury. Tuberculosis The Health Services Committee continued the study of tuberculosis which was begun by the 1978-79 Grand Jury. In addition to reviewing the recommendation of the prior grand jury and the response from the Board of Supervisors, the Committee considered the potential for an increase in the rate of active infection in the four sub-groups of the county population where tuberculosis is of particular concern. These sub-groups are immigrants from Southeast Asia, illegal immigrants from Mexico, Central and South America, the public inebriate and school age children. These groups are of particular concern because they are at greater risk to contract tuberculosis than the rest of the population. FINDINGS AND RECOMMENDATION Tuberculosis is a serious illness, associated with poverty, crowded living conditions and stress. It is an airborne bacillus transmitted by excretions from the respiratory tract to those who live in close contact with the infected person. Those who are infected may experience no outward sign of disease for several years; however, during the infected stage the disease may be transmitted to others with none of those infected feeling sick or realizing that they are contagious. Tuberculosis infection is determined easily by a positive reaction to a tuberculin skin test. Tuberculosis disease is the terminology used to describe the person who is made ill by gross changes in any of his organ systems by the tuberculosis organism. In Los Angeles County, the percentage of the population with tuberculosis disease is greater than in other metropolitan areas and it is estimated that approximately 15 percent of those infected will become diseased. Consequently, tuberculosis is a public health concern for the county and efforts must be continued to detect, treat, and prevent further occurrence and spread of the disease. The immigrant population is the factor in Los Angeles County which appears to have caused the tuberculosis rate to increase here when it is decreasing in most other areas. Screening of the immigrants from Southeast Asia prior to their entry to the United States was either not done, or if done, the test results were not communicated to public health officials who could then provide follow up testing and care in Los Angeles County. Screening of the illegal alien population is difficult because this group desires anonymity. Public inebriates are a high risk group because they do not provide for their basic nutritional needs causing them to be more susceptible to infection. Since the Sundance decision, which required the public inebriates be offered an alternative to jail, there have been fewer persons incarcerated long enough to test for tuberculosis, thereby cutting down on this method of identification. In Los Angeles County, a greater percentage of infection is found among school age children than is the case in other metropolitan areas. The Queen of Angels Hospital has made significant efforts to test and treat the Southeast Asian immigrants with support from the Department of Health Services. The success of the program appears to hinge on the use of medical personnel who can speak to the immigrants in their native languages. Follow-up and treatment services are provided by the Department of Public Health and sponsoring agencies. Efforts to educate the illegal alien population have been undertaken by both the Department of Public Health and Los Angeles Unified School District. Fear of identification as an illegal alien may keep this group from seeking medical care even after they become diseased making it a difficult task to test and treat those suspected of having been exposed to an infected person. To make the task even more difficult, immigrant populations tend to be highly mobile making contact follow-up programs costly and complicated. Additionally, language barriers create problems with the public education programs. The public inebriate is virtually impossible to treat because of his dependence on alcohol and related personality traits which do not encourage concern with health or facilitate routine medication. It is hoped that screening and treatment programs can be incorporated into detoxification programs where public inebriates may remain long enough to receive supervised treatment. Los Angeles Unified School District has provided skin tests (Mantoux) for 40 years. This is not a mandated program and is offered to students in selected schools. Schools are selected on a rotational basis using those geographic areas with high incidences of positive reactors as the determining factor. Children are also given physical examinations as part of the Child Health and Disability Prevention Program and as a part of this examination they are offered the skin test. When a positive reactor is found, x-rays are provided. When an active case is found, a contact program is initiated and the entire school is tested the following year. All positive reactors are referred to the Los Angeles County Health Services Department for preventive treatment. Active cases are excluded from school until proven non-communicable and must be reviewed by the Advisory Chest Board before readmission to school. The Chest Board is a volunteer group of physicians who specialize in chest medicine. Several areas of concern exist for the school screening program: it is not mandated and school finances are extremely limited; the school nurse may be eliminated as finances are reduced; and testing requires parental consent, which has resulted in fewer than 50 percent of the students in the participating schools being tested. A skin test for tuberculosis is not among the immunizations for diseases required by the state before a child can be admitted to school. Efforts to test, follow-up and treat tuberculosis in Los Angeles County have been successful and have resulted in a relatively constant incidence rate of those manifesting the diseased stage of the illness. Yet, the incidence of infection continues to rise. This is the group from which 90-95 percent of those who will become diseased will come and approximately 10 percent of those who are infected will become diseased within five years. Prevention is easily accomplished with proper testing and medication when those who are at risk are willing to participate in the programs which are available. THE GRAND JURY RECOMMENDS THAT THE BOARD OF SUPERVISORS CONTINUE TO SUPPORT AND PROVIDE FUNDING FOR TUBERCULOSIS TESTING AND TREATMENT OF IMMIGRANTS FROM SOUTHEAST ASIA, ILLEGAL IMMIGRANTS FROM MEXICO, CENTRAL AND SOUTH AMERICA, PUBLIC INEBRIATES AND SCHOOL AGE CHILDREN IN SELECTED SCHOOLS. Nursing Homes A skilled nursing home provides comprehensive nursing care under continuous supervision by registered nurse or licensed vocational nurse. The Health Services Committee is concerned that nursing homes meet the minimum standards of patient care required by State regulations. In addition, the Committee is concerned about the availability of 24-hour skilled nursing care for those who require it. FINDINGS AND RECOMMENDATION The State Department of Health Services is responsible for the certification and licensing of skilled nursing homes. All enforcement positions are funded by the State Department of Health Services and the Federal government. Inspections are conducted by the Health Facilities Division of the Department of Health Services in Los Angeles County by contractual agreement with the State Department of Health Services. State and Federal regulations establish the standard of performance which must be met by nursing homes. Inspectors from the Health Facilities Division inspect all skilled nursing homes in the county on a regular basis each year and make follow-up visits when necessary to assure that problems observed on earlier visits have been corrected. Disciplinary actions are taken against facilities which do not correct deficiencies within a reasonable time limit. The annual inspection is conducted by at least two persons. Two days are needed to complete the 180-page survey which is being reviewed by the State Department of Health Services with the goal of reducing the time, personnel and expense required for the current inspection procedures. A shorter survey form would reduce the number of hours spent on inspections. While streamlining the inspection process might be cost effective, care must be taken to insure that the survey remains sufficent to determine and document compliance with minimum standards. During the 1979 calendar year, the Health Facilities Division initiated actions which resulted in 14 criminal convictions, 16 referrals to the District Attorney and 12 misdemeanor referrals to the City Attorney. An additional 24 misdemeanor complaints were under investigation. The Division recommended nonrenewal of Medicare/Medi-Cal licenses for 52 skilled nursing homes, collected $52,550 in penalties for violations, and conducted 111 informal office conferences with licensees. It is often difficult to ascertain how many skilled nursing home beds are available in a particular area. It is misleading to use the number of licensed beds because that figure is often different from the total number of occupied beds. A patient may require a private room because of physical, emotional or social problems which precludes maximum utilization of beds. Certain patients have difficulty obtaining a suitable placement because of multiple physical or mental impairments. Additionally, certain geographical locations have large populations of elderly persons who create a greater demand for skilled nursing care than is available in the region. The Health Facilities Division organized the Nursing Home Information Referral Service (NHIRS) in