Nevada County Grand Jury
• 2000-2001
Public Health Protection in Nevada County Reason for Investigation*
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 17 findings
F1
Nevada County did not have a health plan at the time of the Grand Jury investigation. A health plan has been promised by June 2001. According to the California Code of Regulations and the California Health and Safety Code. each county is required to have a county health officer.
Related Recommendations (1)
R1
The Grand Jury recommends that the county prepare a comprehensive health plan that includes specific duties, responsibilities, goals and activities of the county health officer and the county health department.
F2
Code, each county is required to have a county health officer. Agree. There is no consistent interpretation of the Code throughout the state that the Health Officer must be a full-time position and/or be the administrator of the County public health agency. There are presently only three doctors Statewide administering County public health agencies and one will be replaced by an administrator upon retirement. Ward/other/gi0001-IR8-Public Health The Nevada County Health Officer position was vacant for at least two years despite a
Related Recommendations (1)
R2
The Grand Jury recommends that the county use available funds to hire a full-time county health officer to establish and direct priorities in public health.
F3
The Nevada County Health Officer position was vacant for at least two years despite a California Department of Health Services letter (Appendix A) and a California Conference of Local Health Officers letter (Appendix B) stating the requirement for a full-time county health officer.
Related Recommendations (1)
R3
The Grand Jury recommends that the county assure that no administrator or officer is allowed to interfere with the county health officer's public health decisions for any political or other consideration.
F4
In the absence of a full-time county health officer, the county contracted with a physician to provide four hours per week of health clinic coverage.
Related Recommendations (1)
R4
In the absence of a full time County Health Officer, the County contracted with a physician to provide four hours per week of health clinic coverage. Response: Partially Disagree An Interim Health Officer was hired for 4 hours a week. He was a locally contracted physician. He provided a wider range of services than just clinic coverage including the rewrite of protocols and coordination with the Placer County Health Officer regarding additional coverage for the County. The Grand Jury was told by a health official that during the absence of a full
F5
The Grand Jury was told by a health official that, during the absence of a full-time county health officer, the professional staff and facilities such as schools were handicapped by lack of medical and professional guidance.
Related Recommendations (1)
R5
time County Health Officer, the professional staff and facilities such as schools were handicapped by lack of medical and professional guidance. Response: Disagree Coverage was coordinated for all services by the department. This office has heard no concerns regarding levels of service from the department or the community. The Nevada County Board of Supervisors appointed a qualified individual to
F6
The Nevada County Board of Supervisors appointed a qualified individual to fill the county health officer position on a part-time (46%) temporary basis effective November 9, 2000. The current county health officer cannot work more than part-time for Nevada County due to personal obligations.
Related Recommendations (1)
R6
fill the County Health Officer position on a part-time temporary basis effective November 9, 2000. Response: Agree The part-time temporary status changed in May 2001 to a .6 FTE position.
F7
The current county health officer cannot work more than part-time for Nevada County due to personal obligations. Agree. On May 9, 2001, Dr. Charles Johnson has hired as the permanent Health Officer and is presently budgeted to work 1248 hours annually (.6 FTE). Since his appointment, Dr. Johnson has actually worked closer to 60% time based on financial savings in the first part of the fiscal year. Dr. Johnson is also reachable by pager and back up coverage is always provided when he is on vacation or otherwise not available. He is also available to work extended hours if needed. This recently occurred during the recent Meningitis outbreak in Truckee when he worked three consecutive 15-hour days.
Related Recommendations (1)
R7
The current County Health Officer cannot work more than part-time for Nevada County due to personal obligations. Response: Partially Disagree The position is less than full-time because administrative duties are fulfilled by other staff. All medical duties are handled by the .6 FTE Health Officer. The Grand Jury learned that key Community Health positions are unfilled.
F8
The Grand Jury learned that key public health positions are unfilled.
Related Recommendations (1)
R8
Response: Disagree While there are always periods of transition, currently all key management positions are filled. The total Nevada County Human Services Agency Budget is $38 million; of
F9
The total Nevada County Human Services Agency budget is $38 million; of this total, the public health budget is $3.5 million of which $61,000 (less than 2%) comes from the county general fund (county taxpayers). The remainder comes to the county from federal and state grants.
Related Recommendations (1)
R9
this total, the Community Health budget is $3.5 million of which $61,000 (less than 2%) comes from the County General Fund (County Taxpayers). The remainder comes from Federal and State grants. Response: Partially Disagree The total Nevada County Human Services budget for FY 01/02 is $30 million. The actual County General Fund contribution is $1.1 million. The Community Health FY 01/02 budget is $5.7 million of which $116,000 represents County General Funds. The department also receives realignment funds from the State which are considered local funds and there are also fee revenues locally generated from clinics operated by the department. The Grand Jury learned that money is available through Tobacco and
F10
The Grand Jury learned that money is available through Tobacco and Realignment Funds to employ a full-time county health officer and fill needed public health positions at competitive compensation.
Related Recommendations (1)
R10
Realignment Funds to employ a full-time County Health Officer and fill needed Community Health positions at competitive compensation. Response: Disagree The funds identified above are used for direct service to clients. Services could be curtailed to fund a full-time Health Officer, but since administrative duties are handled by the Director and his staff there is no need at this time for a full-time Health Officer. Should clinics be expanded, the department will consider funding a full-time Health Officer at that time.
F11
As classified by the California Government Code, the county health officer is an officer of the county, on a level with the elected positions of sheriff, district attorney, tax collector and assessor, who have full authority over their departments.
Related Recommendations (1)
R11
As classified by the California Government Code, the County Health Officer is an officer of the County, on a level with elected positions of Sheriff, District Attorney, Tax Collector and Assessor, which have full authority over their departments. Response: Disagree The Board of Supervisors has the discretion to allow and authorize a different organizational structure. This practice is common statewide particularly with counties of our size. Although he is an officer of the County, the current Nevada County Health
F12
Although he is an officer of the county, the current Nevada County Health Officer, a medical doctor with an additional degree in public health, reports to the Director of Community Health, a non-medical administrator who is not an officer of the county.
Related Recommendations (1)
R12
Officer, a medical doctor with an additional degree in Community Health, reports to the Director of Community Health, a non-medical administrator who is not an officer of the County. Response: Agree The Board of Supervisors has the discretion to allow and authorize a different organizational structure. The Health Officer oversees the medical aspects of the department. The Community Health Director has extensive experience administering Community Health Programs.
F13
An admission was made to the Grand Jury that public health decisions might be dependent upon political implications. ---
Related Recommendations (1)
R13
An admission was made to the Grand Jury that Community Health decisions might be dependent on upon political decisions. Response: Disagree If such a comment was made, it was made in error. Politics must never be confused with policy. Community Health decisions should be made on the basis of sound Community Health policies and practices. - -- Under State law, the County Health Officer holds authority for preventive
F14
Under state law, the county health officer holds authority for preventive medicine, substance abuse programs, disease control, food safety, and environmental health and safety to ensure the public health.
Related Recommendations (1)
R14
medicine, substance abuse programs, disease control, food safety, and environmental health and safety to ensure the Community Health. Response: Agree To accomplish this, the Health Officer collaborates with other County departments such as Behavioral Health and Environmental Health. Under current County organization, many of the above programs have been
F15
Under current county organization, many of the above programs have been fragmented and parceled out to other departments. For example, the Environmental Health Department is responsible for food establishment inspections. Currently such inspections are scheduled to be carried out once a year. As another example, the Behavioral Health Department carries out mental health medical functions under the supervision of a non-medical administrator.
Related Recommendations (1)
R15
fragmented and parceled out to other departments. For example, the Environmental Health Department is responsible for food establishment inspections. Currently such inspections are carried out once a year. As another example, the Behavioral Health Department carries out mental health medical functions under the supervision of a non-medical administrator. Response: Disagree The programs are fragmented and have not been parceled out, but rather they have been assigned to the appropriate departments. These assignments are commonplace statewide. Behavioral Health has always contracted psychiatric services, but the Board just authorized a full-time Medical Director for that department and that recruitment is underway. The California Code of Regulations and the California Health and Safety
F16
The California Code of Regulations and the California Health and Safety Code specify 10 county duties and responsibilities (Appendix C) and 38 county health officer duties and responsibilities (Appendix D).
Related Recommendations (1)
R16
Code specify 10 County duties and responsibilities (Appendix C) and 38 County Health Officer duties and responsibilities (Appendix D). Response: Agree There is a broad description of duties in the State law. Title 17, Chapter 3, California Code of Regulations states that the County
F17
Title 17, Chapter 3, California Code of Regulations states that the county health officer should devote "full time to official duties and these duties shall constitute his primary responsibility and no other activities shall interfere with performance of his official duties". CONCLUSIONS The fragmentation of public health duties and responsibilities across county departments
Related Recommendations (1)
R17
Health Officer should devote "full time to official duties and these duties shall constitute his primary responsibility and no other activities shall interfere with performance of his official duties". Response: Agree The issue of how this County and others in the State handle this matter has been previously addressed. Recommendations The Grand Jury recommends that the County prepare a comprehensive health
Conclusions 8
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CL1impedes the development and implementation of a coordinated county health plan. The Grand Jury believes that the county's responsibilities are not being met. See Appendix 2. €.
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CL2Nevada County has lacked the guidance and professional leadership that would be available from a full-time county health officer.
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CL3The Grand Jury is concerned by information received that political implications would be considered before making public health decisions.
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CL4The Grand Jury is convinced that a part-time county health officer cannot carry out the full range of duties listed by the National Association of County and City Health Officials and by State Regulations. See Appendix D.
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CL5Disagree with the conclusion. The health officer works across county departments to fulfill his official duties and will continue to do so. As stated previously, there is no requirement for a health plan, the grand jury may be referencing a code section requiring annual reports in the environmental health division scope of responsibilities but other than that, there is no requirement for a county health plan. Despite that, a health status report detailing our goals for improving the health of the community is and has been an agenda for the department. This report will be completed during the current fiscal year.
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CL6Strongly Disagree. Appendix C Items 1-10 are being handled by either the Community Health department or the Environmental Health department. Occupational health is a specialty field which is contracted out by the county. These obligations are being met in this county. Regulations specific to environmental health issues are enforced by the Environmental Health Department and the health officer is involved when any irregularity or food borne illness issue arises. Routine notification of items of interest to each department already occur and will continue to occur in the future. Disagree. The issue of whether leadership is best provided by a full-time health officer or by a team of health professionals which include a health officer is an individual county policy decision. The majority of counties in California have a system of administration similar to ours with a health officer as a part of a team, not the director of the department. I continue to believe that we are best serving the needs of the public and of our staff by using the current configuration of staffing.
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CL7Neither agree nor disagree. The information received by the Grand Jury regarding this question is not known to me so I cannot comment on whether it is true or untrue. However as earlier stated, when it comes to the health of the public, political implications are not deciding factors in decision making. There is a significant list of required responsibilities which the health officer is well versed in and attends to as his primary responsibilities.
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CL8Disagree. The health officer can and does carry out his full range of duties.
* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.