San Benito County Grand Jury
2015-2016
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Findings & Recommendations
3 findings
F1:
presenting higher risk of vehicular pedestrian injury. The speed limit on Memorial Drive does not reflect the use of existing speed risk
F2:
data or any risk analysis. Perception by some residents is that local government is either unaware of the
F3:
risks to pedestrians on Memorial Drive or is unconcerned. There is a lack of vehicle calming methods to assist pedestrian safety.
Additional Recommendations
5
Not linked to specific findings.
R1:
to the park to a speed based on a combination of studies and surveys, not just the speed summary.
R3:
bumps and/or advisory signs, paint the speed limit on the asphalt, yellow flashing lights during events.
R4:
conditions while driving on Memorial Drive given the presence of events and pedestrians
R5:
fatality occurs on the Memorial Drive segment adjacent to Veterans Park before addressing the speed issue. Local government should acknowledge and further evaluate safety and the speed to prevent and not wait to react to accidents. Local government should decide if conditions warrant another E&TS be done before 2017.
R6:
typical event and on a regular day. Count the traffic during a typical event and on a regular day. Research the risk of injury based on the number of pedestrians in proximity to the number of cars. Determine if any benefits exist in a speed limit of 40mph. Responses Required: The San Benito County Board of Supervisors (90 days to respond) • The City Council of Hollister (90 days to respond)
Findings & Recommendations
6 findings
F1:
The SBCGJ was impressed with the ED operations and facilities at HHH. More than one experienced, local, medical professional has referred to HHH ED as "the jewel on the hill" that the people in SBC do not realize they have.
Related Recommendations (1)
R1:
(F1) The HHH should encourage SBC residents to be aware of the positive, medical professional recognition Hazel Hawkins Hospital receives.
F2:
The ED management company after many years of service was finally replaced after alleged reported poor performance and staffing issues. Current HHH research data shows that conditions are improving and patient satisfaction scores have improved since the new management company took over.
Related Recommendations (1)
R2:
(F2) Maintain an open dialogue with the new management company to ensure that the ED continues its excellent performance.
F3:
The SBCGJ found there have been many state-of-the-art improvements and more effective policies and procedures put in place that are greatly improving operations and patient healthcare at the ED.
Related Recommendations (1)
R3:
(F3) Keep the community informed to improve public perception of HHH and the ED.
F4:
Hospital ratings are much more complex than citizens realize. Public perception of a poor rating is detrimental to the overall reputation and economic well-being of the institution.
Related Recommendations (1)
R4:
(F4) Disseminate the hospital's rating results and corrective actions to the general public through local media sources, public relations presentations to various local community organizations, and public periodicals published by HHH.
F5:
The 5150 patient situations are not being addressed in a timely manner between the ED and BH, causing the ED an extra burden and increased expenses. The ED 57 Medical Director does not have the authority to assign and release 5150 holds. This lack of authority adds to unnecessarily longer hold times and higher expenses for 5150 patients at the ED.
Related Recommendations (1)
R5:
(F5) The ED Medical Director or ED Physician on duty should also have the authority to assign and release 5150 holds. By sharing this authority with BH, a higher operational efficiency and potentially large healthcare cost savings could be realized by the ED.
F6:
There is no clear, agreed upon protocol between HHH ED and SBC BH regarding the treatment, handling, and associated costs of 5150 patients confined in the ED.
Related Recommendations (1)
R6:
(F6) HHH ED and SBC BH need a comprehensive written agreement addressing the responsibilities of each organization as to the confinement, treatment, handling, and associated costs of 5150 patients brought into the ED. REQUEST FOR RESPONSES Pursuant to Penal Code section 933.05, the grand jury requests responses as follows: From the following governing bodies: Hazel Hawkins Memorial Hospital Board of Directors (response required within 90 days) Board of Supervisors, County of San Benito (response required within 90 days)
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Findings & Recommendations
6 findings
F1:
Mounds and holes made by typical gopher activity presents a hazard of injury to HSD children playing and taking PE classes on school recreational fields.
F2:
HSD has an ongoing problem controlling the prevalence of the number of pocket gophers living in recreational fields and/or the number of holes made by gophers in those fields daily.
F3:
Weekends are not enough to address gopher prevalence. It is too little time spent and some of that time may be compromised by weekend athletics.
F4:
The number of injuries to children from gopher damage is underreported to the schools.
F5:
Follow up regarding the effectiveness or ineffectiveness of current measures in place for gopher abatement/control is not being tracked.
F6:
Long term plans to abate gophers from school fields and prevent persistent mounds in newer fields is needed.
Additional Recommendations
6
Not linked to specific findings.
R1:
F1, F2, F3, Address the numerous gopher mounds in HSD fields on a daily prevention basis as well as a weekly basis.
R2:
F1, F2, F3, Reduce/eliminate the hazardous mounds and holes made by the gophers.
R3:
F4, F5 Educate HSD children and staff to recognize the gopher mounds, report the mound, and report all tripping and falling over the mounds or into the holes to a designated staff member.
R4:
F5, HSD facilities management should place its own tracking system on a sample of mounds and holes on a regular basis to track how quickly and effectively GPC and the bait works to resolve the gopher issue.
R5:
F6, HSD should determine and report the cost of placing wire mesh on all existing recreational fields. Compare this cost to the contract of contracting GPC over a 10-year period. R6. F6, Follow the Master Plan layout of funds for the school site improvements.
R7:
F6, All new school fields built should include wire mesh in the cost of construction. RESPONSE REQUIRED The California Penal Code subsection (933) requires that a response to the findings and recommendations made in this final report be delivered to the Presiding Judge of the San Benito County Superior Court. Board of Directors, Hollister School District (response required within 90 days) •
Findings & Recommendations
1 findings
F2:
In its review of records the Grand Jury found no case of bias as a result of ethnicity, race or type of disability. F3. The IEP and associated rules have the effect of distributing over 20% of the Education department budget to 10% of the students in the district with no attempt to evaluate the effectiveness of the increased services.
Additional Recommendations
3
Not linked to specific findings.
R1:
While all the information regarding compliance was available it required several requests from different sources to obtain it. Regardless of the record keeping requirements under the various provisions the Districts should have detailed master file electronic records on each IEP student identifying critical dates and the plan requirements.
R2:
The Grand Jury found no evidence of any kind to suggest that anyone had been the subject of discrimination. This determination would be more transparent and easier to make had the Districts kept the electronic records suggested in
R3:
It was not clear from documentation provided how many students were from outside the districts and were receiving services on a pay as you go basis. It is also not clear how the children receiving these services progressed as a group or by disability. In other words does this program provide the benefits promised? Government seems consumed by process not results. The Districts should make an attempt to track the success and failure of the various recommendations.
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Findings & Recommendations
4 findings
F2:
The county jail staff excellently runs the jail without critical resources. Though admirable, this cannot nor should not last indefinitely. SBCGJ recognizes the county jail for what it is: a vital community agency, which renders superb service to the public 24 hours a day/7 days a week. The jail staff is commended. F3. Incidents of correctional officers injured due to lack of training/use of the safety chair used for violent inmates. Though urgently needed, there is no acceptable and workable protocol for WIC
F4:
5150 Psychiatric holds.
F5:
Additional staffing needed. Required duties performed per shift indicate the ratio of staff to inmates is at unsafe levels during known influx times.
F6:
Inmate complaints about the quality and portions of food provided at the jail seem warranted.
Additional Recommendations
5
Not linked to specific findings.
R1:
F1, Employ a full-time, dedicated maintenance person for both preventative maintenance and routine repairs. The employee has his main office at jail and work on other outside Public Works jobs, if needed; not the other way around as is now. Note: If governing bodies plan to address this recommendation with a statement that simply refers to "lack of funds", SBCGJ also recommends this be accompanied by a cost/risk/benefit analysis using hours CO spend on repairs versus other duties; associated risk with CO's taken off the floor to do maintenance and the safety risk of skipping repairs; cost of major repairs due to lack of preventative maintenance; and a list of critical equipment's most recent preventive maintenance and calibrations.
R2:
F2, F5, Provide the jail with needed resources and staff. The BOS should not become complacent and assert because the jail staff runs the jail well doesn't mean they don't need the additional assets that they continue to request. They make it work because it is a matter of life or death. Not providing the jail with assets penalizes staff for a job well done and keeps the jail running at high stress levels. Staffing is needed specifically during daytime court transports and in the evening for the additional duties specific during the night hours (i.e. when no nurse, medical, or behavior health personnel is on site). Additional staffing should also be regularly provided for planned events when it is known there is a large influx of people into the community, such as the bike rally weekend. Required duties performed per shift clearly indicate the ratio of staff to inmates is at unsafe levels during influx times.
R3:
F3, Provide the jail staff with needed training. Provide training in extraction and restraint for hostile inmates, specifically in regard to utilizing the safety restraint chair. Having no policy or training on a safety chair used for violent inmates has already led to staff injury. Use of the Restraint Chair is necessary and therefore appropriate training is required.
R4:
F4, Collaboration is vital to determine a workable system for WIC 5150 inmate evaluation and treatment. An agreement needs to be reached between the County Jail and Behavioral Health that is acceptable to both parties in regard to call out procedures; to evaluate suicidal inmates in a more timely manner so that correctional staff is not used for prolonged monitoring of a suicidal inmate or inmates needing other special psychiatric care.
R5:
F6, It is time for SBC governing agencies to analyze carefully the potential high costs of the poor quality of food given to people in lock-up. The pervasiveness of food quality complaints by inmates in the SBC Jail is a call for stepped up external oversight. Not simply relying on reports generated by the contractor, the BOS should conduct an in depth management analysis of taxpayers' money spent for inmates in a service contract. This evaluation should review OSHA guidelines for quality assurance; proper food handling; food safety; and that FDA guidelines for nutrition are being provided to inmates. The BOS is strongly encouraged to opt for inspection from an outside nonprofit organization, such as the American Correctional Association.
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Findings & Recommendations
4 findings
F1:
There is no clear understanding on what the status is on the project to fix the basketball court and cement over the dangerous, hole filled grass area.
Related Recommendations (1)
R1:
(F1) Get an update from Capital Projects on what is needed to complete the resurfacing and repairs.
F2:
The shower in the intake area needs to be remodeled for safety reasons.
Related Recommendations (1)
R2:
(F2) Remodel the shower in the intake area in a timely manner.
F3:
There has been recent training for the staff, but continuous and additional training would be beneficial. F4. There is no regular facility maintenance employee.
Related Recommendations (1)
R3:
(F3) Provide additional training for the staff, both in the corrections area and in the juvenile counseling area. R4. (F4) Provide additional funding for a full time maintenance employee. R5. (F5) Update and shorten the mission statement REQUEST FOR RESPONSE: PURSUANT TO PENAL CODE SECTION 933.05, THE GRAND JURY REQUESTS RESPONSES AS FOLLOWS: FROM THE FOLLOWING GOVERNING BODIES: Chief Probation Officer, San Benito County (response within 60 days) San Benito County Board of Supervisors (response in 90 days) 82
F5:
The Mission Statement is outdated
Related Recommendations (1)
R3:
(F3) Provide additional training for the staff, both in the corrections area and in the juvenile counseling area. R4. (F4) Provide additional funding for a full time maintenance employee. R5. (F5) Update and shorten the mission statement REQUEST FOR RESPONSE: PURSUANT TO PENAL CODE SECTION 933.05, THE GRAND JURY REQUESTS RESPONSES AS FOLLOWS: FROM THE FOLLOWING GOVERNING BODIES: Chief Probation Officer, San Benito County (response within 60 days) San Benito County Board of Supervisors (response in 90 days) 82
Findings & Recommendations
33 findings
F1:
The San Benito County Board of Supervisors is out of compliance with California State Law; specifically the CA Welfare and Institution Code. F2. No written directive is in place from the County Administration Officer for designation of the county health care professional as required by California State Law (CA WIC paragraph (1) of subdivision (a) of Section 5150), and which also mandates the BOS certify whom the CAO designates as the county health professional.
F3:
A written policy is needed from the BOS to specifically designate the treatment facility to receive WIC 5150 holds in SBC.
F4:
San Benito County needs a clearly defined program to care for persons that need to be held involuntarily for mental care assessment (5150), through to evaluation and treatment (5151, 5250, and so on.)
F5:
Agencies and departments such as the ED, BH, SB County Jail, LE; all that come into contact with individuals who may need mental health assessment or treatment do not have updated, and consistently relevant to one another's, policies and procedures on file.
F6:
Conflicting policies and procedures exist with particular reference to 5150 holds among agencies, districts, and SBC departments.
F7:
General communication between departments, agencies and districts are lacking.
F8:
Negotiated Memorandums of Understanding (MOUs) do not exist for providing mental health care in SBC and between agencies under different boards, county, or state authority.
F9:
The time between initial custodial hold and admission as an inpatient for a person in an involuntary hold under WIC often exceeds 72 hours in SBC, and not infrequently goes beyond a week. Reports indicate that patients are being held waiting in the HHH ED for as long as 14 days for further mental health evaluation and treatment. F10. The SBC Behavioral Health Department is writing consecutive WIC 5150s.
F11:
Patients on a temporary involuntary hold in SBC hold may not know their legal rights under the CA WIC laws of civil commitment. F12. There is a possible violation of Patient's Rights when under a temporary involuntary hold in SBC being violated, under the CA WIC laws of civil commitment. 109
F13:
The HHH ED staff is using a pamphlet derived from Santa Cruz County to distribute to patients on WIC 5150 holds about their civil rights.
F14:
The HHH ED staff may be releasing WIC 5150 hold patients that exceed 72 hours due to concerns about violations of patient's rights.
F15:
BH does not have official authorization or paperwork from any authority to support the claim that they may stack 5150s. F 16. There is a lack of adequate county psychiatric health facilities, crisis centers, and/or inpatient psychiatric beds based upon the previous, current, and the rapidly growing SBC population. F 17. Mental health patients may have to wait a long time to be medically cleared. F 18. Mental health patients who come in, or are brought in, consecutively to the HHH ED may 'backup' in the ED while waiting for medical clearance and assessment. F 19. Healthcare and security manpower requirements at HHH increase when monitoring and holding an individual on a WIC 5150 involuntary hold, and increase at a more rapid rate when exceeding the allowed 72 hours. F 20. A backlog of individuals on a WIC 5150 involuntary hold results in mental health patients in the ED with no place to wait creates general HHH ED crowding, financial, and security risks. F 21. The ED can be holding multiple psychiatric patients in ED beds, creating a longer wait time for medical treatment for other types of ED patients. F 22. HHH or the HHH Emergency Department or does not have a psychiatrist on staff. F 23. The San Benito Health Care District, Board of Directors, is not involved enough in the oversight and disposition of HHH ED individuals in a WIC 5150 temporary involuntary hold and persons needing mental health care assessment, evaluation, and treatment or transfer. F 24. The Mayor of Hollister and City Council of Hollister are not systematically involved in the impact Hollister residents experience from alimited mental health program and dysfunction of the communications and protocols among the agencies. F 25. Jail psychiatric support is lacking. F 26. Correctly updated written SBC Jail policies and procedures in Section 609 are not possible in the current climate of a broken mental health care program in SBC. F 27. BH providing one-way directives to the Jail or other agencies such as LE or HHH ED that significantly impact the other's resources is not appropriate nor in the best interest of the SBC mental health care system. F 28. The current BH policy incurring significant limits to the Jail staff in making calls to clinicians AND the expanded timeframe the Jail staff endures while waiting for clinicians to arrive at the Jail for assessment has had a substantially negative impact on the Jail. F 29. Our local government is not considering the strain placed on County Jail Correctional Officers at the SBC Jail due to BH policies, and HHH limitations or as part of a comprehensive SBC mental health care program. F 30. Inmates are waiting in a safety cell for a mental health assessment for too long. F 31. Requiring Jail Corrections Officers to conduct 15-minute checks to the Jail's Safety Cell on an extended basis while waiting for mental health clinicians to perform a mental health assessment is unacceptable. F 32. Transportation logistics are inadequate. Obtaining and funding the appropriate type of transportation for mental health patients to other facilities with an available bed is problematic. F 34. Inmates are not provided with an adequate facility per Title 15 to accommodate psychiatric evaluation and treatment. F 33. There is no established, dedicated, and collaborative committee to confer and effect solutions under BOS oversight to remedy current mental health care problems and to explore the future mental healthcare needs of the county.
F16:
There is a lack of adequate county psychiatric health facilities, crisis centers, and/or inpatient psychiatric beds based upon the previous, current, and the rapidly growing SBC population.
F17:
Mental health patients may have to wait a long time to be medically cleared.
F18:
Mental health patients who come in, or are brought in, consecutively to the HHH ED may 'backup' in the ED while waiting for medical clearance and assessment.
F19:
Healthcare and security manpower requirements at HHH increase when monitoring and holding an individual on a WIC 5150 involuntary hold, and increase at a more rapid rate when exceeding the allowed 72 hours.
F20:
A backlog of individuals on a WIC 5150 involuntary hold results in mental health patients in the ED with no place to wait creates general HHH ED crowding, financial, and security risks.
F21:
The ED can be holding multiple psychiatric patients in ED beds, creating a longer wait time for medical treatment for other types of ED patients.
F22:
HHH or the HHH Emergency Department or does not have a psychiatrist on staff.
F23:
The San Benito Health Care District, Board of Directors, is not involved enough in the oversight and disposition of HHH ED individuals in a WIC 5150 temporary involuntary hold and persons needing mental health care assessment, evaluation, and treatment or transfer. F 24. The Mayor of Hollister and City Council of Hollister are not systematically involved in the impact Hollister residents experience from alimited mental health program and dysfunction of the communications and protocols among the agencies.
F25:
Jail psychiatric support is lacking.
F26:
Correctly updated written SBC Jail policies and procedures in Section 609 are not possible in the current climate of a broken mental health care program in SBC. 110
F27:
BH providing one-way directives to the Jail or other agencies such as LE or HHH ED that significantly impact the other's resources is not appropriate nor in the best interest of the SBC mental health care system.
F28:
The current BH policy incurring significant limits to the Jail staff in making calls to clinicians AND the expanded timeframe the Jail staff endures while waiting for clinicians to arrive at the Jail for assessment has had a substantially negative impact on the Jail.
F29:
Our local government is not considering the strain placed on County Jail Correctional Officers at the SBC Jail due to BH policies, and HHH limitations or as part of a comprehensive SBC mental health care program.
F30:
Inmates are waiting in a safety cell for a mental health assessment for too long.
F31:
Requiring Jail Corrections Officers to conduct 15-minute checks to the Jail's Safety Cell on an extended basis while waiting for mental health clinicians to perform a mental health assessment is unacceptable.
F32:
Transportation logistics are inadequate. Obtaining and funding the appropriate type of transportation for mental health patients to other facilities with an available bed is problematic.
F33:
There is no established, dedicated, and collaborative committee to confer and effect solutions under BOS oversight to remedy current mental health care problems and to explore the future mental healthcare needs of the county. F35. SBC Law Enforcement and HPD LE are out of compliance with WIC 5150 by not transporting persons placed under involuntary hold to a facility where the person may receive a mental health evaluation. F36. SBC government does not have an area set aside to construct the augmented infrastructure needed for a psychiatric treatment facility. F37. COG has not considered SBC LTA as an option for transportation in a comprehensive mental health care program nor a temporary solution in the shortfall of transportation logistics in SBC for mental health care patients. RECOMMENDATIONS R1. F1, F2, F3, F4. The BOS should review Division 5 of the CA Welfare and Institutions Code (CA W&I). R2. F1, F2, F3, F10-12, F14, F23, F35. The BOS should make the appropriate designations for both the SBC Mental Health Director and the treatment facility to receive SBC 5150 holds made by LE. Each designation should be official and produced by the BOS in writing. If the facility designated by the BOS is under San Benito Health Care District, Board of Directors (i.e. HHH) management, then both Boards should take note that HHH is not a licensed facility for evaluation or treatment of patients placed in a temporary involuntary hold for mental health reasons. The BOS should be aware that the result of designating HHH as the treatment facility may be to direct LE out of CA WIC compliance, and may result in patient's rights infringement by exceeding 72-hour limits while attempting to deliver patient care. R3. F1, F4. The BOS should provide a detailed plan of action indicating steps and initiatives taken in the public interest that put SBC in compliance with Division 5 of the California Welfare and Institutions Code and augments mental health care in SBC. This plan of action should be made in response to this investigation and submitted to the public in time for a review for continuity by the SBC Civil Grand Jury 2016-17. R4. F1, F4. The BOS should research and confer with BH to effectively get the attention of the State of CA to provide immediate resources to SBC for psychiatric mental health care assistance. R5. F5, F23, F24. LE and HHH ED should begin regularly providing data available to the BOS to track the number of WIC 5150 cases brought to the ED, and the disposition of each one, including total length of stay. R6. F5, F23, F24. HHH and BH ensure that LE receives information about all WIC 5150 individuals that released without further evaluation. R7. F4, F5, F6, F23, F24. As a result of collaboration, ALL agencies, and departments that come into contact with those whom may need mental health assessment or treatment should have relevant policies and procedures updated and relevant to one another's on file and shared with other agencies to minimize procedural conflict. R8. F4, F6, F7, F23. The LE, ED and BH Departments and the Jail are key relationships to one another. Policies and procedures between these agencies should be made with particular attention and supported with a close oversight of the BOS that reflects these dependencies to ensure mental health care program efficiency and success. R9. F1, F4, F5, F6, F7, F23. Collaborative effort should begin immediately from all parties for the health and welfare of SBC. R10. F4, F7, F8, F23. SBC BOS establish clear Memorandums of Understanding (MOUs) written by and for the involved agencies, districts that have a separate board, and counties, (i.e. those not operating under the SBC BOS direct authority) to determine and establish agreement upon, and compliance with, local protocol. Also, that the BOS effect policy to maintain these MOUs until superseded by subsequently negotiated agreements. R11. F1, F4, F10, F11, F12, F14, F23. "Stacking" 5150 holds is bad practice, and may be in violation of CA law. SBC should cease taking liberties with CA legislation concerning persons placed on 5150 holds. All methods available to agencies and departments should be implemented to attempt not to exceed the 72-hour maximum elapsed time from when the hold is initiated by LE, or otherwise, until the point of completed disposition of the patient. R12. F1, F4, F10, F11, F12, F14. F15. BH should not look for, or be compelled to find, creative ways to circumvent the law to extend the 5150 72-hour hold due to SBC's lack of psychiatric treatment resources. BH should not "fudge the start time of the 5150 hold" nor argue that the start time or "hold lift time" is ambiguous. BH's good intention is clear, but working with the BOS to gain the facilities for an outstanding mental health program is optimal. Anything else may be counterproductive to achieving a long-term viable and quality program in SBC. If SBC BH does obtain written official temporary authorization to stack 5150s from the state, SBC should still employ a more strict 5150 72 hold time, and county agencies work together to increase our quality of mental health care under this time constraint. If BH obtains formal approval to stack 5150s given our dire lack of resources, BH's use of the temporary waiver should be done so understanding that it to be used in parallel to a dedicated lobby for establishment and implementation of permanent solutions for SBC. R13. F9, F10. Recommended that SBC adopt a model such as Monterey County to consider weekends and holidays as part of the 72-hour period of a 5150 hold regardless of SEIU bargaining demands. R14. F1, F4, F10, F12, F23, F32. Both the ED and BH should be responsible for researching and locate bed availability to transfer 5150 persons who cannot receive needed care in SBC. Both departments should be held equally accountable for delays or wait time in the 72 hours to research and find a bed. This policy should be written in a formalized protocol and enforced by the BOS in oversight of the county mental health care program. R15. F1, F10, F11, F12, F14, F15, F23. If individuals object to being involuntarily held during or beyond the 72 hours on a 5150 hold, then the use of the patient's legal rights to judicial review (filing a writ of habeas corpus) process should be brought (again) to the patient's attention by the ED staff. In particular, when medical clearance has 113 processed but a BH assessment is not complete. That is, according to WIC the patient may be reminded that: "If held longer than 72 hours, you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided to you free of charge." Notification by the individual to the County Public Defenders office or any other attorney should not be interfered with or discouraged. The individual may also be reminded that if demanding a writ of habeas corpus, the decision whether to file it lies solely with the SBC Public Defender. R16. F1, F4, F11, F12, F13, F23. The San Benito Health Care District in conjunction with BH and the BOS should develop its own, customized, patient's rights pamphlet to distribute to individuals on a WIC 5150 hold in the ED instead of using what was prepared specifically for Santa Cruz County. R17. F1, F14, F18, F23, F24. The HHH ED should cease developing plans to release individuals in need of psychiatric care by "lifting the hold" on WIC 5150s. Any authorization for the ED to use this type of protocol should be made as a result of the SBHCD Board of Directors and the SBC BOS joint approval following multi- departmental, agency, and district collaborations held with The Director, Behavioral Health. When any release is made, LE is to be notified immediately. R18. F1, F4, F9, F10, F11, F12, F13, F14, F15. Request immediate assistance from the State of CA, Department of Health and Human Services, before SBC has legal issues regarding patients' civil rights for involuntary detainment beyond the 5150 72- hour holds; and failing to admit a patient for evaluation and treatment because SBC does not have a necessary psychiatric treatment facility. R19. F1, F4, F5, F6, F7, F8, F14, F23, F24. Recommend preparation of negotiated agreements among the agencies that share the responsibility of WIC Division 5 management and agreement should include confidentiality in ARTICLE 7. Legal and Civil Rights of Persons Involuntarily Detained [WIC 5325 - 5337] especially Section 5328. This agreement should be established within the meaning of California Civil Code so that one agency may not unilaterally change established procedures which affect any other agency without a new negotiated agreement among the agencies. R20. F17, F19, F23. As the designated treatment facility HHH should provide resources to medically clear 5150 hold patients as soon as possible. R21. F16, F18, F23, F35. HHH should consider setting up a licensed inpatient area and move 5150s to 5151s for an added 72 hours of evaluation for treatment - then, if necessary, transfer the patient. R22. F17, F18 F19 F20, F21, F22, F23, F35. HHH should consider becoming a licensed psychiatric facility with 7 to 10 beds to help alleviate problematic county mental health issues. R23. F1, F17, F18 F19 F20, F21, F22, F23. It is recommended to take pressure off of the ED and BH clinicians by SBC finding at least ten beds for psychiatric care. The SBC 114 BOS and SBHCD Board of Directors should understand that SBC needs to augment mental health care now. El Dorado County has a 10-bed PHF, and Sacramento has a 12-bed PHF; this is a basis to understand CA counties can get the state's support for county mental health care needs. R24. F1, F16, F17, F18, F19, F20, F21. Recommended that BOS capture the attention of the state on the basis of the CA Law WIC 5770 which reads: "Notwithstanding any other provision of law, the State Department of Health Care Services may directly, or by contract, with any public or private agency, provide any of the services under this division [WIC Division 5] when the state determines that the services are necessary to protect the public health, safety, or welfare." R25. F1, F17-24, F35. SBC leadership and elected officials undergoing the impact of this lacking psychiatric mental health care system together implement an immediate and temporary solution. They should establish locations for a psychiatric crisis center for LE to bring 5150 holds needing assessment and a place to admit patients who require mental health evaluation and treatment as a result of the information provided in this report until effecting permanent solutions.
F34:
Inmates are not provided with an adequate facility per Title 15 to accommodate psychiatric evaluation and treatment.
F35:
SBC Law Enforcement and HPD LE are out of compliance with WIC 5150 by not transporting persons placed under involuntary hold to a facility where the person may receive a mental health evaluation.
F36:
SBC government does not have an area set aside to construct the augmented infrastructure needed for a psychiatric treatment facility.
F37:
COG has not considered SBC LTA as an option for transportation in a comprehensive mental health care program nor a temporary solution in the shortfall of transportation logistics in SBC for mental health care patients. 111
Additional Recommendations
33
Not linked to specific findings.
R1:
F1, F2, F3, F4. The BOS should review Division 5 of the CA Welfare and Institutions Code (CA W&I). R2. F1, F2, F3, F10-12, F14, F23, F35. The BOS should make the appropriate designations for both the SBC Mental Health Director and the treatment facility to receive SBC 5150 holds made by LE. Each designation should be official and produced by the BOS in writing. If the facility designated by the BOS is under San Benito Health Care District, Board of Directors (i.e. HHH) management, then both Boards should take note that HHH is not a licensed facility for evaluation or treatment of patients placed in a temporary involuntary hold for mental health reasons. The BOS should be aware that the result of designating HHH as the treatment facility may be to direct LE out of CA WIC compliance, and may result in patient's rights infringement by exceeding 72-hour limits while attempting to deliver patient care.
R3:
F1, F4. The BOS should provide a detailed plan of action indicating steps and initiatives taken in the public interest that put SBC in compliance with Division 5 of the California Welfare and Institutions Code and augments mental health care in SBC. This plan of action should be made in response to this investigation and submitted to the public in time for a review for continuity by the SBC Civil Grand Jury 2016-17.
R4:
F1, F4. The BOS should research and confer with BH to effectively get the attention of the State of CA to provide immediate resources to SBC for psychiatric mental health care assistance.
R5:
F5, F23, F24. LE and HHH ED should begin regularly providing data available to the BOS to track the number of WIC 5150 cases brought to the ED, and the disposition of each one, including total length of stay.
R6:
F5, F23, F24. HHH and BH ensure that LE receives information about all WIC 5150 individuals that released without further evaluation.
R7:
F4, F5, F6, F23, F24. As a result of collaboration, ALL agencies, and departments that come into contact with those whom may need mental health assessment or treatment should have relevant policies and procedures updated and relevant to one another's on file and shared with other agencies to minimize procedural conflict.
R8:
F4, F6, F7, F23. The LE, ED and BH Departments and the Jail are key relationships to one another. Policies and procedures between these agencies should be made with particular attention and supported with a close oversight of the BOS that reflects these dependencies to ensure mental health care program efficiency and success. 112
R9:
F1, F4, F5, F6, F7, F23. Collaborative effort should begin immediately from all parties for the health and welfare of SBC.
R10:
F4, F7, F8, F23. SBC BOS establish clear Memorandums of Understanding (MOUs) written by and for the involved agencies, districts that have a separate board, and counties, (i.e. those not operating under the SBC BOS direct authority) to determine and establish agreement upon, and compliance with, local protocol. Also, that the BOS effect policy to maintain these MOUs until superseded by subsequently negotiated agreements.
R11:
F1, F4, F10, F11, F12, F14, F23. "Stacking" 5150 holds is bad practice, and may be in violation of CA law. SBC should cease taking liberties with CA legislation concerning persons placed on 5150 holds. All methods available to agencies and departments should be implemented to attempt not to exceed the 72-hour maximum elapsed time from when the hold is initiated by LE, or otherwise, until the point of completed disposition of the patient.
R12:
F1, F4, F10, F11, F12, F14. F15. BH should not look for, or be compelled to find, creative ways to circumvent the law to extend the 5150 72-hour hold due to SBC's lack of psychiatric treatment resources. BH should not "fudge the start time of the 5150 hold" nor argue that the start time or "hold lift time" is ambiguous. BH's good intention is clear, but working with the BOS to gain the facilities for an outstanding mental health program is optimal. Anything else may be counterproductive to achieving a long-term viable and quality program in SBC. If SBC BH does obtain written official temporary authorization to stack 5150s from the state, SBC should still employ a more strict 5150 72 hold time, and county agencies work together to increase our quality of mental health care under this time constraint. If BH obtains formal approval to stack 5150s given our dire lack of resources, BH's use of the temporary waiver should be done so understanding that it to be used in parallel to a dedicated lobby for establishment and implementation of permanent solutions for SBC.
R13:
F9, F10. Recommended that SBC adopt a model such as Monterey County to consider weekends and holidays as part of the 72-hour period of a 5150 hold regardless of SEIU bargaining demands.
R14:
F1, F4, F10, F12, F23, F32. Both the ED and BH should be responsible for researching and locate bed availability to transfer 5150 persons who cannot receive needed care in SBC. Both departments should be held equally accountable for delays or wait time in the 72 hours to research and find a bed. This policy should be written in a formalized protocol and enforced by the BOS in oversight of the county mental health care program.
R15:
F1, F10, F11, F12, F14, F15, F23. If individuals object to being involuntarily held during or beyond the 72 hours on a 5150 hold, then the use of the patient's legal rights to judicial review (filing a writ of habeas corpus) process should be brought (again) to the patient's attention by the ED staff. In particular, when medical clearance has 113 processed but a BH assessment is not complete. That is, according to WIC the patient may be reminded that: "If held longer than 72 hours, you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided to you free of charge." Notification by the individual to the County Public Defenders office or any other attorney should not be interfered with or discouraged. The individual may also be reminded that if demanding a writ of habeas corpus, the decision whether to file it lies solely with the SBC Public Defender.
R16:
F1, F4, F11, F12, F13, F23. The San Benito Health Care District in conjunction with BH and the BOS should develop its own, customized, patient's rights pamphlet to distribute to individuals on a WIC 5150 hold in the ED instead of using what was prepared specifically for Santa Cruz County.
R17:
F1, F14, F18, F23, F24. The HHH ED should cease developing plans to release individuals in need of psychiatric care by "lifting the hold" on WIC 5150s. Any authorization for the ED to use this type of protocol should be made as a result of the SBHCD Board of Directors and the SBC BOS joint approval following multi- departmental, agency, and district collaborations held with The Director, Behavioral Health. When any release is made, LE is to be notified immediately.
R18:
F1, F4, F9, F10, F11, F12, F13, F14, F15. Request immediate assistance from the State of CA, Department of Health and Human Services, before SBC has legal issues regarding patients' civil rights for involuntary detainment beyond the 5150 72- hour holds; and failing to admit a patient for evaluation and treatment because SBC does not have a necessary psychiatric treatment facility. R19. F1, F4, F5, F6, F7, F8, F14, F23, F24. Recommend preparation of negotiated agreements among the agencies that share the responsibility of WIC Division 5 management and agreement should include confidentiality in ARTICLE 7. Legal and Civil Rights of Persons Involuntarily Detained [WIC 5325 - 5337] especially Section 5328. This agreement should be established within the meaning of California Civil Code so that one agency may not unilaterally change established procedures which affect any other agency without a new negotiated agreement among the agencies.
R20:
F17, F19, F23. As the designated treatment facility HHH should provide resources to medically clear 5150 hold patients as soon as possible.
R21:
F16, F18, F23, F35. HHH should consider setting up a licensed inpatient area and move 5150s to 5151s for an added 72 hours of evaluation for treatment - then, if necessary, transfer the patient.
R22:
F17, F18 F19 F20, F21, F22, F23, F35. HHH should consider becoming a licensed psychiatric facility with 7 to 10 beds to help alleviate problematic county mental health issues. R23. F1, F17, F18 F19 F20, F21, F22, F23. It is recommended to take pressure off of the ED and BH clinicians by SBC finding at least ten beds for psychiatric care. The SBC 114 BOS and SBHCD Board of Directors should understand that SBC needs to augment mental health care now. El Dorado County has a 10-bed PHF, and Sacramento has a 12-bed PHF; this is a basis to understand CA counties can get the state's support for county mental health care needs.
R24:
F1, F16, F17, F18, F19, F20, F21. Recommended that BOS capture the attention of the state on the basis of the CA Law WIC 5770 which reads: "Notwithstanding any other provision of law, the State Department of Health Care Services may directly, or by contract, with any public or private agency, provide any of the services under this division [WIC Division 5] when the state determines that the services are necessary to protect the public health, safety, or welfare."
R25:
F1, F17-24, F35. SBC leadership and elected officials undergoing the impact of this lacking psychiatric mental health care system together implement an immediate and temporary solution. They should establish locations for a psychiatric crisis center for LE to bring 5150 holds needing assessment and a place to admit patients who require mental health evaluation and treatment as a result of the information provided in this report until effecting permanent solutions. R 26. F24 The COH should be involved in and conferred with to play a more active role in collaboration, financing, and in establishing plans for future facilities.
R26:
F24 The COH should be involved in and conferred with to play a more active role in collaboration, financing, and in establishing plans for future facilities. R27. F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. Recommended that the SBC Sheriff or his SBC Jail representative be present at collaborative meetings when determining SBC mental health care program specifics that include the Jail. A further recommendation is that the Jail update policies and procedures section 609 correctly and reflective of a working mental health care system. R28. F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. BH should no longer provide one-way directives to the jail or other agencies as LE, HHH ED, that significantly impact the other's resources. The January 2016 directive to the Jail should be rescinded and re-negotiated and re-established in a collaborative manner. If this includes union bargaining members, the BOS and its council should be notified, consulted and involved. R29. F1, F25-F31, F34. Recommended that related elected officials consider augmenting Jail psychiatric mental health care, either temporarily or permanently, by expanding the existing CFMG medical health care contract. CFMG currently offers this service and SBC currently is in contract with CFMG for other medical care. R30. F1, F4, F5, F7, F14, F28, F29, F30, F34. The recommendation is that every action is taken to eliminate significant delays at the Jail, including but not limited to, policies that exclude BH from being called into the Jail overnight, weekends or holidays until such time that SBC's mental health care program is viable. Also, until such time when it is determined conclusively by further investigation that WIC 5150s released from the ED are no longer turning up at the jail needing BH to complete a previously 115 truncated assessment and/or from making arrangements for an appropriate psychiatric evaluation and treatment plan. R31. F1, F28, F29, F30, F31, F33, F34. BOS consider looking elsewhere for the Jail's mental health (inpatient or outpatient) needs as it does with other medical needs and establish a contract with an outside private facility to refer patients that will agree to work during the night to meet the SBC goals to work to achieve sound mental health care for inmates. If current BH union staff does not wish to assess inmates as needed, not simply adopting a procedure based on the minimums of related law, other resources should be used or shifted, and perhaps BH staff decreased. R32. F1, F4, F7, F8, F9, F10, F12, F18, F23, F24, F32. Recommend that a milestone be that the 72-hour hold is no longer significantly extended after finding a bed and transportation is the only consideration left. BOS should allocate funds from the county's general fund and request, through the Council of Government, that City of Hollister funds also is allocated this year for either BH or SBHCD (HHH) to manage for transport. After locating a patient bed, transport of mental health patients should be readily accessible, efficient, safe and conducted as soon as possible for the patient. The amount of funds needed annually approximates $300,000. It is understood this expenditure can reduce as state-funded facilities (such as a PHF) are established in SBC and wherein SBC can conduct mental health evaluations locally. R33. F1, F8, F14, F16, F23, F32, F33. BOS establish directed protocol that ensures no mental health patient in SBC will forfeit an available bed in another county, to simply be released from the ED specifically due to lack of transport. R34. F1, F24, F33. BOS and COG evaluate and consult with BH and the Local Transportation Authority (LTA) for possible transport of some types of patients to facilities for voluntary mental health care. R35. F33, F34 Is it recommended that the BOS have research continued to help determine the concerns of the SBC Juvenile Hall (JH) and the SBC Probation Department policies and procedures in mental health care. Both departments should be consulted and interviewed by independent, nonaligned researchers. Both departments should also participate in future collaboration and planning. The mandates and policies for the mental health care for minors held in detention and parolees stayed outside the scope of this report only due to time constraints. Members of the SBC Grand Jury 2015-16 working on this research have volunteered to assist with further impartial research and reporting on the needs and impact on these departments if requested. The SBC Grand Jury Foreperson has 2015-16 has contact information. R36. F36. Recommend that due to the inherent delays associated with the construction of a Homeless Facility that SBC local government together identify and the BOS approve an area and property ready to allow the building of a psychiatric treatment facility as soon as state assistance is secured. R37. The Grand Jury recommends that the BOS, in conjunction with the Council Of Government, evaluate the use of LTA to assist SBC in transportation as part of a temporary or permanent solution to the inherent and problematic logistics of a Mental Healthcare Program in SBC. R38. F5, F6, F7, F24, F27, F30, F32, F33. For the good of our community, the SBC BOS establish a committee with members from HHH, BH, City Council, COG, County Jail, LE, Health and Human Services, SBC Probation Department, and three representative members from or appointed by the BOS. The initial meetings should validate Grand Jury findings and compare existing research and documentation surrounding the various issues relevant to the departments, agencies and special districts about 5150, and general mental health care management in our county. The Grand Jury recommends these committee members (or representative) ratios to explore viable resolutions and report to the county: 1 City of Hollister Police Department (HPD) 1 San Benito County Sheriff's Department (SD) 2 Board of Directors, Hazel Hawkins Hospital (HHH) 3 San Benito County Board of Supervisors (BOS) 1 San Benito County Council of Governments (COG) 1 Hollister City Council 1 SBC Department of Health and Human Services 1 San Benito County Probation Department 2 Behavioral Health Department A formally established Director should be hired as an unbiased county employee consultant to direct the meetings and mediate and negotiate solutions. The BOS should confer with and select an individual to have knowledge, impartial bias, authority, and ability to travel to Sacramento to meet with relevant state authorities to obtain support and meet with all SBC community agencies ensuring their needs met. An ad hoc or permanent committee should be formed as soon as possible, and remain working with authority until formalized solutions for a viable public mental health care system are established from the beginning to end to correctly manage individuals in a temporary involuntary hold placed in SBC's responsibility. No appointees should have cognitive bias from an existing government, agency, or district to avoid counterproductive or ineffective resolution. RESPONSES REQUIRED Deliver responses to the findings and recommendations made in this final report to the Presiding Judge of the Superior Court within the following timeframes: Board of Directors, Hazel Hawkins Hospital (HHH) (90 days) San Benito County Board of Supervisors (BOS) (90 days) San Benito County Council of Governments (COG) (90 days) Mayor of Hollister and the City Council of Hollister (COH) (90 days) City of Hollister, Chief of Police Department (60 days) San Benito County, Sheriff (SD) (60 days) SBC, Director of Health and Human Services (HHS) (60 days) SBC, Director of Behavioral Health (60 days) Executive Director, SBC Local Transit Authority (60 days) 118
R27:
F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. Recommended that the SBC Sheriff or his SBC Jail representative be present at collaborative meetings when determining SBC mental health care program specifics that include the Jail. A further recommendation is that the Jail update policies and procedures section 609 correctly and reflective of a working mental health care system.
R28:
F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. BH should no longer provide one-way directives to the jail or other agencies as LE, HHH ED, that significantly impact the other's resources. The January 2016 directive to the Jail should be rescinded and re-negotiated and re-established in a collaborative manner. If this includes union bargaining members, the BOS and its council should be notified, consulted and involved.
R29:
F1, F25-F31, F34. Recommended that related elected officials consider augmenting Jail psychiatric mental health care, either temporarily or permanently, by expanding the existing CFMG medical health care contract. CFMG currently offers this service and SBC currently is in contract with CFMG for other medical care.
R30:
F1, F4, F5, F7, F14, F28, F29, F30, F34. The recommendation is that every action is taken to eliminate significant delays at the Jail, including but not limited to, policies that exclude BH from being called into the Jail overnight, weekends or holidays until such time that SBC's mental health care program is viable. Also, until such time when it is determined conclusively by further investigation that WIC 5150s released from the ED are no longer turning up at the jail needing BH to complete a previously 115 truncated assessment and/or from making arrangements for an appropriate psychiatric evaluation and treatment plan. R31. F1, F28, F29, F30, F31, F33, F34. BOS consider looking elsewhere for the Jail's mental health (inpatient or outpatient) needs as it does with other medical needs and establish a contract with an outside private facility to refer patients that will agree to work during the night to meet the SBC goals to work to achieve sound mental health care for inmates. If current BH union staff does not wish to assess inmates as needed, not simply adopting a procedure based on the minimums of related law, other resources should be used or shifted, and perhaps BH staff decreased. R32. F1, F4, F7, F8, F9, F10, F12, F18, F23, F24, F32. Recommend that a milestone be that the 72-hour hold is no longer significantly extended after finding a bed and transportation is the only consideration left. BOS should allocate funds from the county's general fund and request, through the Council of Government, that City of Hollister funds also is allocated this year for either BH or SBHCD (HHH) to manage for transport. After locating a patient bed, transport of mental health patients should be readily accessible, efficient, safe and conducted as soon as possible for the patient. The amount of funds needed annually approximates $300,000. It is understood this expenditure can reduce as state-funded facilities (such as a PHF) are established in SBC and wherein SBC can conduct mental health evaluations locally.
R33:
F1, F8, F14, F16, F23, F32, F33. BOS establish directed protocol that ensures no mental health patient in SBC will forfeit an available bed in another county, to simply be released from the ED specifically due to lack of transport.
R34:
F1, F24, F33. BOS and COG evaluate and consult with BH and the Local Transportation Authority (LTA) for possible transport of some types of patients to facilities for voluntary mental health care.
R35:
F33, F34 Is it recommended that the BOS have research continued to help determine the concerns of the SBC Juvenile Hall (JH) and the SBC Probation Department policies and procedures in mental health care. Both departments should be consulted and interviewed by independent, nonaligned researchers. Both departments should also participate in future collaboration and planning. The mandates and policies for the mental health care for minors held in detention and parolees stayed outside the scope of this report only due to time constraints. Members of the SBC Grand Jury 2015-16 working on this research have volunteered to assist with further impartial research and reporting on the needs and impact on these departments if requested. The SBC Grand Jury Foreperson has 2015-16 has contact information.
R36:
F36. Recommend that due to the inherent delays associated with the construction of a Homeless Facility that SBC local government together identify and the BOS approve an area and property ready to allow the building of a psychiatric treatment facility as soon as state assistance is secured. 116
R37:
The Grand Jury recommends that the BOS, in conjunction with the Council Of Government, evaluate the use of LTA to assist SBC in transportation as part of a temporary or permanent solution to the inherent and problematic logistics of a Mental Healthcare Program in SBC.
R38:
F5, F6, F7, F24, F27, F30, F32, F33. For the good of our community, the SBC BOS establish a committee with members from HHH, BH, City Council, COG, County Jail, LE, Health and Human Services, SBC Probation Department, and three representative members from or appointed by the BOS. The initial meetings should validate Grand Jury findings and compare existing research and documentation surrounding the various issues relevant to the departments, agencies and special districts about 5150, and general mental health care management in our county. The Grand Jury recommends these committee members (or representative) ratios to explore viable resolutions and report to the county: 1 City of Hollister Police Department (HPD) 1 San Benito County Sheriff's Department (SD) 2 Board of Directors, Hazel Hawkins Hospital (HHH) 3 San Benito County Board of Supervisors (BOS) 1 San Benito County Council of Governments (COG) 1 Hollister City Council 1 SBC Department of Health and Human Services 1 San Benito County Probation Department 2 Behavioral Health Department A formally established Director should be hired as an unbiased county employee consultant to direct the meetings and mediate and negotiate solutions. The BOS should confer with and select an individual to have knowledge, impartial bias, authority, and ability to travel to Sacramento to meet with relevant state authorities to obtain support and meet with all SBC community agencies ensuring their needs met. An ad hoc or permanent committee should be formed as soon as possible, and remain working with authority until formalized solutions for a viable public mental health care system are established from the beginning to end to correctly manage individuals in a temporary involuntary hold placed in SBC's responsibility. No appointees should have cognitive bias from an existing government, agency, or district to avoid counterproductive or ineffective resolution. 117
Findings and recommendations not yet extracted.
Findings and recommendations not yet extracted.