Gran Jurado del Condado de San Mateo
2019-2020
From the annual report
The consolidated year-end volume. The individual investigations it contains are listed separately below.
📑 Year-End Report
The full consolidated volume; individual reports are listed below.
Individual reports (6)
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Recomendaciones adicionales
2
No vinculadas a hallazgos específicos.
R1:
Each of the governmental entities in San Mateo County with an IT department or IT function (whether in-house, handled by another government unit or outsourced to a private enterprise) as listed in Appendix F, should by November 30, 2020, make a request for a report from their IT organization that addresses the concerns identified in the report, specifically: 1. System Security (Firewalls, Anti-malware/Antivirus software, use of subnets, strong password policies, updating/patching regularly) 2. Backup & Recovery (In the event of an attack, can you shut down your system quickly? What is being backed up, how it is being backed up, when are backups run, and where are the backups being stored? Have backups been tested? Can you fully restore a Server from a backup?) 3. Prevention (turning on email filtering, setting up message rules to warn users, providing employee training on phishing and providing a reporting system to flag suspect content)
R2:
These confidential internal reports should be provided to the governing body by June 30, 2021. This report should describe what actions have already been taken and which will be given timely consideration for future enhancements to the existing cybersecurity plan. . APPLICABLE RESPONDING AGENCY FOLLOW-UP RESPONSES RECOMMENDATION City of Atherton R2 Implemented. City of Belmont R1 Implemented.
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Recomendaciones adicionales
11
No vinculadas a hallazgos específicos.
R1:
timeline for compliance.
R2:
Will implement by January 31, 2021. San Mateo County R3 Will implement by January 31, 2021. Board of Supervisors R4 Will implement by September 30, 2021.
R3:
Because the homeless move from place to place, the BOS should request that the County Sheriff and Police Chiefs convene a task force to increase cross-jurisdictional coordination and communication. As part of this collaboration, they should determine if the number and training of officers is sufficient to address homeless outreach and crisis management in those localities where homelessness is the biggest problem. The task force should hold an initial meeting by December 31, 2020 and regularly thereafter to exchange information and best practices. Regarding hospitalization, discharge options and SB 1152
R4:
By June 30, 2021, the County’s Human Services Agency (HSA) should collaborate with the Governing Board of the Health Plan of San Mateo (HPSM) to create a standard option as a housing address proxy for the homeless and ill homeless so County hospitals and services can be reimbursed for services.
R5:
Will implement after R4 completed. 2021/22
R6:
Will complete by September 30, 2021. 2021/22 Generally agrees but no implementation plan.
R7:
Recommendation did not indicate a timeline for compliance. A Slow-Moving Catastrophe:
R8:
In the planned design and rebuilding of the Maple Street Shelter, the BOS should direct the County Manager to work with departments to prioritize addressing the needs of ill homeless, especially vulnerable women and the elderly by December 31, 2020.
R9:
The County’s Department of Housing should evaluate the feasibility of securing added board and care type housing facilities to provide long-term care, staffed with appropriate medical personnel, for homeless with chronic medical and mental illness needs by December 31, 2020. Regarding WPC
R10:
The County Manager’s Office should work with the relevant County departments to determine if it is possible to permanently fund the integration of psychiatric personnel into all outreach efforts/teams given the high presence of mental health issues among the homeless and should have the relevant County departments publicly report the results of this effort to the Board during a regularly scheduled Board meeting by March 31, 2021.
R11:
The County Manager should prioritize the completion of the integrated data systems (i.e., Health Information Exchange and Enterprise Data Warehouse) which were begun under the auspices of the WPC and report back to the Board in a public meeting by December 31, 2020, whether the funding of such integration is possible and, if so, by which date it will be completed. Applicable Follow up Responding Agency Response Recommendation Year
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Hallazgos & Recomendaciones
7 hallazgos
F1:
The enrollment data in the SMC Alert and NIXLE systems was not published public information; the Grand Jury had to request this information from the County OES. Officials of several towns/cities who were interviewed expressed interest in this data about their own residents.
Recomendaciones relacionadas (1)
R1:
By December 31, 2020, the Office of Emergency Services should publish the SMC Alert enrollment data (by city/town) on its website, with at least yearly, preferably quarterly, updates.
F2:
The County and the Cities and Towns within the County, as well as their residents, would benefit from having more residents enrolled in SMC Alert.
F3:
Other counties in the Bay Area are taking steps to increase enrollment in their emergency alert systems beyond “opt-in” enrollment and E-911 data utilized in San Mateo County. These steps include: Enrolling residents based on public utility data. Enrolling residents based on mobile phone carrier data.
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R2:
The Office of Emergency Services staff should further investigate the option of accessing mobile phone carrier data to augment the SMC Alert database (on an “opt-out basis”) and publicly present a recommendation to the Emergency Services Council by December 31, 2020.
F4:
These same sources of data may be available to San Mateo County’s OES which might enable the County to achieve 50%+ plus enrollment, although each has its costs and limitations.
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R2:
The Office of Emergency Services staff should further investigate the option of accessing mobile phone carrier data to augment the SMC Alert database (on an “opt-out basis”) and publicly present a recommendation to the Emergency Services Council by December 31, 2020.
F5:
OES has acknowledged that one possible barrier to enrollment in the SMC Alert system is language accessibility. OES is missing an opportunity to fully provide important information to residents who cannot communicate effectively in English and/or Spanish.
Recomendaciones relacionadas (2)
R3:
OES should translate the enrollment materials and then provide alerts and messages in all languages spoken by more than 5% of the County’s population, including without limitation both Chinese and Tagalog, in addition to the current languages of Spanish and English, by March 31, 2021. 10
R4:
The Office of Emergency Services staff should work with its member cities and the County to determine the viability of translating SMC Alert enrollment materials, alerts, and messages into other languages even if the prevalence of such languages does not meet the 5% threshold of the Dymally-Alatorre Bilingual Services Act and publicly present a recommendation to the Emergency Services Council by December 31, 2020.
F6:
Over 14% of the County’s residents speak Chinese or Tagalog at home, and neither the SMC Alert enrollment documentation, nor the SMC alerts themselves, are available in languages other than English and Spanish.
Recomendaciones relacionadas (2)
R3:
OES should translate the enrollment materials and then provide alerts and messages in all languages spoken by more than 5% of the County’s population, including without limitation both Chinese and Tagalog, in addition to the current languages of Spanish and English, by March 31, 2021. 10
R4:
The Office of Emergency Services staff should work with its member cities and the County to determine the viability of translating SMC Alert enrollment materials, alerts, and messages into other languages even if the prevalence of such languages does not meet the 5% threshold of the Dymally-Alatorre Bilingual Services Act and publicly present a recommendation to the Emergency Services Council by December 31, 2020.
F7:
The Dymally-Alatorre Bilingual Services Act requires local government entities to translate materials into the languages which are spoken by more than 5% of the residents it serves.
Recomendaciones relacionadas (2)
R3:
OES should translate the enrollment materials and then provide alerts and messages in all languages spoken by more than 5% of the County’s population, including without limitation both Chinese and Tagalog, in addition to the current languages of Spanish and English, by March 31, 2021. 10
R4:
The Office of Emergency Services staff should work with its member cities and the County to determine the viability of translating SMC Alert enrollment materials, alerts, and messages into other languages even if the prevalence of such languages does not meet the 5% threshold of the Dymally-Alatorre Bilingual Services Act and publicly present a recommendation to the Emergency Services Council by December 31, 2020.
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Hallazgos & Recomendaciones
15 hallazgos
F1:
Of 20 high school principals who responded to a Grand Jury survey, nine documented at least one hate incident/crime in the last five years for a total of 16 incidents. The low number of incidents reported could indicate either that County schools are not experiencing the rise in hate incidents documented by teachers nationwide, or that administrators, teachers, and students in the County are not identifying, documenting, or otherwise reporting such incidents.
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R3:
During the first quarter of the 2020-21 school year, to be more proactive in addressing school climate regarding hate, districts should take steps to ensure that: School administrators and/or teachers meet with small, diverse groups of students to understand from their perspective, the school climate and incidents of hate that may go either unnoticed by teachers and staff or unreported. At the start of each school year, students should not only receive written information, but presentations should be arranged to inform students about what constitutes a hate incident/crime, anonymous reporting, and the follow up that will occur if an incident is reported. Students in a leadership position should be required to undergo some training regarding school climate and student volunteers should be trained to provide peer counseling and presentations to groups of students regarding hate incidents and understanding diverse cultures.
F2:
Of 16 hate incidents reported by principals that occurred since 2015, 12 were reported by teachers or staff. Only four were reported by students and of these only one was reported anonymously even though 15 of the 20 schools responding to the survey have mechanisms for anonymous reporting.
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R3:
During the first quarter of the 2020-21 school year, to be more proactive in addressing school climate regarding hate, districts should take steps to ensure that: School administrators and/or teachers meet with small, diverse groups of students to understand from their perspective, the school climate and incidents of hate that may go either unnoticed by teachers and staff or unreported. At the start of each school year, students should not only receive written information, but presentations should be arranged to inform students about what constitutes a hate incident/crime, anonymous reporting, and the follow up that will occur if an incident is reported. Students in a leadership position should be required to undergo some training regarding school climate and student volunteers should be trained to provide peer counseling and presentations to groups of students regarding hate incidents and understanding diverse cultures.
F3:
Based on responses from 19 of the 20 principals responding to the Grand Jury survey, five of the six County high school districts had policies concerning how the districts will address hate-motivated behavior. Only one district, with one high school, did not have a policy. The following are characteristics of those policies: Policies affirm districts’ commitment to providing a safe learning and working environment free from discrimination and harassment; Except for one, policies do not provide clear definitions and guidelines; Policies are generally only available in English; Policies use technical and legal language and are not written for a general audience at the 7th to 9th grade reading level; and 90 https://sanfrancisco.adl.org/initiatives/no-place-for-hate-5/. Accessed March 3, 2020. None of the policies addressed hate speech or incidents anonymously targeted at a student.
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R1:
By the beginning of the 2021-22 school year, all high schools and unified school districts need clear anti-bias policies to ensure that students are safe from harm, and that administrators are prepared to act swiftly and decisively to address all incidents of hate and bias when they occur, and to proactively foster an inclusive school climate. Policies should include: Definitions of hate-motivated incidents and crimes, and hate speech; District and school responsibilities for: o Preventive measures; o Immediate response; o Information on how to specifically address hate speech and anonymous incidents targeted at a specific student; o Guidance on how to respond after an incident has occurred that includes (1) how to communicate empathy, reconciliation and support to those who have been harmed; (2) communication to students and families directly affected; and (3) how to communicate with the student body in order to reinforce messages of inclusivity and respect; o Information on how students will be educated about hate crimes, hate incidents and hate speech at least annually; o Disciplinary actions that could result from an incident; and o Student responsibilities to report incidents.
F4:
The San Mateo Union High School District’s policy was the most comprehensive, but it lacked information regarding how schools should deal with anonymous incidents or hate speech although the District’s dress code policy prohibits students from wearing clothing with hate speech.
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R1:
By the beginning of the 2021-22 school year, all high schools and unified school districts need clear anti-bias policies to ensure that students are safe from harm, and that administrators are prepared to act swiftly and decisively to address all incidents of hate and bias when they occur, and to proactively foster an inclusive school climate. Policies should include: Definitions of hate-motivated incidents and crimes, and hate speech; District and school responsibilities for: o Preventive measures; o Immediate response; o Information on how to specifically address hate speech and anonymous incidents targeted at a specific student; o Guidance on how to respond after an incident has occurred that includes (1) how to communicate empathy, reconciliation and support to those who have been harmed; (2) communication to students and families directly affected; and (3) how to communicate with the student body in order to reinforce messages of inclusivity and respect; o Information on how students will be educated about hate crimes, hate incidents and hate speech at least annually; o Disciplinary actions that could result from an incident; and o Student responsibilities to report incidents.
F5:
All school principals described activities to reinforce the messages of mutual respect and inclusivity. None cited Camp LEAD or were involved in the Anti-Defamation League’s No Place for Hate school program.
F6:
Despite efforts by schools to sensitize students to the issues of hate incidents and crimes, it was unclear whether students are aware of school policies or even if they understand what constitutes a hate incident or crime. Burlingame High School
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R2:
New materials should be written for parents/guardians and students at a 7th to 9th grade reading level, available in multiple languages, and distributed to them in print, in student handbooks and on school websites. This should be completed by the beginning of the 2021- 22 school year.
F7:
Two incidents of hate and one hate crime reported in local media occurred on the campus of Burlingame High School between January 2018 and September 2019.
F8:
Staff at Burlingame High School did not use the two hate incidents that had occurred to denounce bias or reaffirm school values on a school-wide basis.
F9:
Following the hate crime at Burlingame High School, the school and District staff responded by involving students, community members and organizations including clergy, police and the Anti-Defamation League.
F10:
After three incidents, administrative staff do not believe the incidents reflect the dominant culture of the school, although at least some students believe there is a lack of tolerance for minorities. San Mateo Union High School District
F11:
Of the schools in the District, school administrators reported programs to address school climate, although only two offered specific programming to address bias and hate.
F12:
None of the other five schools in the District used the September 2019 incident at Burlingame High School to address bias or to discuss hate incidents/crimes.
F13:
There is much variability in school programming that includes on-going efforts versus one- time programs to address school climate. Community Resources
F14:
The San Mateo Office of Education could be a resource for school districts to develop their policies to address hate incidents and hate crimes and for addressing such incidents at schools through three existing COE programs: the Coalition for Safe Schools and Communities, Respect!24/7, and Camp LEAD.
Recomendaciones relacionadas (1)
R4:
By the beginning of the 2021-22 school year, the San Mateo County Office of Education should: Work with the Coalition for Safe Schools and Communities to consider either expanding their scope of work or forming an additional group to focus on how schools address hate. Continue to include information at Respect!24/7 conferences on hate incidents and hate speech by bringing in experts to address attendees. Have the Coordinator of School Climate develop a written plan on how to bring the Camp LEAD program to District High Schools and consider how to make it more accessible during the school year.
F15:
The Anti-Defamation League offers a program, No Place for Hate, to support school climate goals with ideas for deepening understanding about diversity, building community and developing skills for students, teachers, parents, and community members. During the 2018-19 school year, 40 Bay Area schools participated in the ADL program, although none from the County.
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R5:
The SMUHSD should work with the ADL to bring its program, No Place for Hate, to at least one school in the District starting in the 2021-2022 school year as a pilot for roll-out to other schools in the District.
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Hallazgos & Recomendaciones
17 hallazgos
F1:
Following a Grand Jury Report in July 2015 and an evaluation of the PDP in December 2015, the San Mateo County Controller completed three audits of the PDP between 2016 and 2019 and found significant financial irregularities that were not resolved prior to the execution of the 2017-19 contract and the current 2019-21 contract.
F2:
Immediately following issuance of the Controller’s initial audit in 2016, The SMCBA Board: Addressed conflicts of interest of members of the SMCBA Board; Separated the SMCBA Executive Director and Chief Defender positions; Replaced the SMCBA independent auditors and accounting staff. In March 2019 the SMCBA adopted Financial Policies and Procedures.
F3:
Following issuance of the Controller’s initial audit in 2016, the San Mateo Board of Supervisors approved the County Manager’s recommendation that all of the Controller’s
F4:
A third audit by the Controller completed in June 2019 found that the SMCBA/PDP had not completed six of 12 financial recommendations and six of 12 contractual requirements. The SMCBA accounting policies and procedures were not approved until March 2019 and not implemented until FY 2020 after the Controller’s audit period. Consequently, auditors could not test whether the policies and procedures were sufficient to address deficiencies.
F5:
The current contract with the SMCBA was approved even though the Controller audits could not confirm that more than half of the initial recommendations (from 2016) had been addressed.
F6:
A fourth audit was completed by the Controller in July 2020 and found that all six outstanding financial recommendations and six contractual requirements were implemented. The PDP’s independent accountants provided a “clean opinion” on the 101 Supra, Note 4 18 financial statements for the fiscal year ending 6/30/2019 and there were no significant items in that year’s Management Letter.
F7:
The PDP did not approve written accounting procedures including voucher review procedures until March 2019 and confirmation of their implementation by the Controller did not occur until June 2020. The County continued to pay PDP invoices for nearly four years, without confirmation that the underlying financial data was correct. Operations
F8:
PDP staff have limited oversight and supervision of, and accountability for, PDP attorneys regarding education and training and the quality of their legal representation. This is due, in part, to PDP’s understanding of their independent contractor relationship with the Panel attorneys.
Recomendaciones relacionadas (1)
R6:
The Board of Supervisors should require the PDP to develop an implementation plan, timetable and resource requirements that reflect new processes, systems and performance tracking measures to enable the PDP to provide proper oversight and assume accountability for the quality of legal services provided to indigent clients. This should be completed by May 1, 2021 for review and approval by the County Manager and Board of Supervisors no later than June 1, 2021, and in any event prior to the date by which a new contract with SMCBA for PDP services must be approved for Fiscal Years 2021-2023.
F9:
There is little parity between the PDP and the San Mateo District Attorney’s Office regarding processes and systems that would enable the PDP to analyze, monitor, and report on the quality of legal representation provided by PDP attorneys.
Recomendaciones relacionadas (2)
R1:
and R4. 4 https://sixthamendment.org/the-right-to-counsel/effective-assistance-at-critical-stages/ 3 System,” details specific requirements to assure the quality of public defense representation. One of the principles set forth by the ABA is that there should be “parity between defense counsel and the prosecution with respect to resources and defense counsel is included as an equal partner in the justice system.”5 Since 1968, San Mateo County has contracted with the San Mateo County Bar Association (SMCBA) to provide attorneys to represent indigent defendants, youth appearing in juvenile court (both in delinquency proceedings as well as dependency proceedings), and those with mental health issues through the SMCBA’s Private Defender Program (PDP).6 Twenty-three counties in California contract with legal firms or individual attorneys for legal services for indigent residents7 due to the expense of a Public Defender Office for a relatively small number of cases in these counties. San Mateo County is the only county with a population over 500,000 that does not have a Public Defender Office.8 The current contract between the County and the SMCBA covers the period July 1, 2019 through June 30, 2021, and is renewable by the County for an additional two years.9 At a cost of $19.6 million per year, the PDP contract is one of the largest service contracts executed by the County and is managed by the County Manager.10 Current Makeup of the PDP The PDP has 15 employees led by a Chief Defender who oversees operations and reports to the SMCBA’s Board. The current Chief Defender was appointed in December 2019, after serving as the Assistant Chief Defender for two years. Other key staff include an Assistant Chief Defender, a Managing Attorney, and a Chief Investigator. Accounting staff are shared with the SMCBA. The approximately 100 PDP attorneys (the Panel) contract with the SMCBA as independent contractors. Cases are assigned to Panel attorneys by PDP staff. The majority of PDP attorneys have 11 or more years legal experience, and the average PDP attorney devotes 76% of his/her time to the representation of PDP clients. During the fiscal year ending June 30, 2019, about half of the 100 attorneys on the Panel worked almost exclusively for the PDP, each with a case load between 90% and 100%.11 The Panel, as a whole, has an annual caseload of approximately 20,000 cases, approximately 80% of which are misdemeanors.12 California legislation, AB 5, effective January 2, 2020, will impact employers who use independent contractors.13 PDP staff indicated this law may further limit what they perceive as the PDP’s ability to oversee individual attorneys.14 5 American Bar Association, Ten Principles of a Public Defense Delivery System, February 2002. Agreement between the County of San Mateo and the San Mateo County Bar Association, June 2019. The County of Santa Cruz currently contracts with one law office but will be migrating to a Public Defender Program by 2022 according to County of Santa Cruz, Our Public Defender System: Anticipating Structural Change, June 21, 2018. California Commission on the Fair Administration of Justice, Report and Recommendations on Funding of Defense Services in California, April 14, 2008, p 2. Agreement between the County of San Mateo and the San Mateo County Bar Association, June 2019. Grand Jury Interviews. San Mateo County Bar Association, Annual Report Fiscal Year 2018-2019 to the Board of Supervisors San Mateo County, p.7. Grand Jury interviews. Now Labor Code Section 2750.3. Grand Jury interviews. The County of San Mateo and the PDP may also be impacted by the settlement of an ACLU lawsuit on January 9, 2020, regarding the inadequate funding by Fresno County and the State of California for the public defense of indigents.15 The lawsuit alleged that Fresno County’s public defense system was not “capable of putting the prosecution’s case to meaningful adversarial testing” so that “courts cannot ensure that their decisions, judgments, verdicts and punishments are rendered fairly and accurately.”16 Fresno County agreed to increase funding of public defense by $10 million per year to close the large funding gap with its District Attorney’s Office (DA’s Office) starting in fiscal year 2019-20, a 75% increase over fiscal year 2018-19; implement six new operational requirements and nine new policies, procedures and performance guidelines; and provide extensive quarterly, semi-annually and annual reports to the ACLU beginning April 1, 2020. In addition, the State of California agreed to additional funding of indigent legal defense in the State.17 2015 Evaluation and Follow–Up Following the release of the 2014-2015 Grand Jury Report, the County Manager contracted with a retired San Mateo County judge and a former county counsel to conduct an evaluation of the PDP to determine whether the PDP remained “the most appropriate model for providing indigent defense services in San Mateo County.”18 The evaluation focused on the “historical and current structure of the PDP and contrasted it with other indigent defense models, focusing on the adequacy of representation, financial accountability, proper utilization of public funds, and the objective characteristics of the program as a business model for the provision of a required publicly funded service.”19 The evaluators issued a report on December 8, 2015. That report, however, expressly noted that the evaluation “did not undertake a detailed analysis of the quality of representation provided by individual attorneys, nor perform a financial audit to determine how the PDP funds were disbursed and utilized.”20 The evaluators did not recommend that the County transition to a Public Defender model based on: Anecdotal discussions with current and former judges, prosecutors, and criminal defense attorneys who indicated that the overall quality of representation was adequate, The evaluators’ high cost estimate of developing a County Public Defender Office, and Their conclusion that the operation of the Private Defender Program was in compliance with the American Bar Association and State Bar of California’s standards and principles. The evaluators did, however, make a number of recommendations regarding the administration of the program and the need to: 15 Carolyn Phillips et al. v State of California et al., Settlement Agreement, Fresno Superior Court, Case No. 15CECG02201, January 9, 2020. Benjamin, Marc, The Fresno Bee, ACLU lawsuit says Fresno County public defense is inadequate, July 15, 2015. Supra, Note 13. Zerne P. Haning and Thomas F. Casey, San Mateo County Private Defender Program Evaluation, December 2015. Ibid, p1. Ibid, p2. 5 Address inherent conflicts of interest between the PDP and the SMCBA; Conduct an independent review of the PDP’s finances; Establish more appropriate oversight of the program by both the SMCBA’s Board of Directors and the County.21 To address financial concerns raised by the report, the County Manager requested that the Controller’s Office conduct a financial review of the Private Defender Program. The Controller’s initial audit report was issued on September 1, 2016,22 the same day the County Manager issued a memo and its own assessment of the PDP to the Board of Supervisors.
R6:
The Board of Supervisors should require the PDP to develop an implementation plan, timetable and resource requirements that reflect new processes, systems and performance tracking measures to enable the PDP to provide proper oversight and assume accountability for the quality of legal services provided to indigent clients. This should be completed by May 1, 2021 for review and approval by the County Manager and Board of Supervisors no later than June 1, 2021, and in any event prior to the date by which a new contract with SMCBA for PDP services must be approved for Fiscal Years 2021-2023.
F10:
The District Attorney’s Office is funded at 2.2 times the PDP’s budget in FY 2019-20. Further, the PDP budget has been virtually flat since 2015 and may actually be declining in real dollars. Oversight by the SMCBA and County
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R7:
The Board of Supervisors should begin to address the large funding disparity between the defense of indigents and their prosecution, in fiscal year 2021-2022.
F11:
The SMCBA Board oversees the PDP through a Private Defender Board Committee to advise the Chief Defender. That committee is staffed by PDP attorneys and a representative from the Board.
F12:
“Performance benchmarks” delineated in county contracts require the PDP to present data without analysis or comparison to state or national defender program benchmarks.
Recomendaciones relacionadas (1)
R5:
By May 1, 2021 the Board of Supervisors should have the County Manager: Replace the “performance benchmarks” section in the 2021-2023 SMCBA contract with national and state defense performance criteria and benchmarks that are audited annually by the Controller for PDP compliance; Review the independent review report findings and recommendations to determine which should be adopted and on what time schedule; Work with the Chief Defender to identify best practice processes, systems and resource needs so the PDP can address the new performance standards; Require the PDP to report legal defense performance analytics in its Annual Report to the Board of Supervisors. If the SMCBA does not agree to these contractual changes, the County should consider providing SMCBA with a two-year notice to terminate the contract and begin developing an alternate legal defense model. 20
F13:
The County requires the PDP to report caseloads by type of case and average caseload per attorney, without reference or analysis to national caseload standards which factor in case complexity, resources, attorney activities and client outcomes.
Recomendaciones relacionadas (1)
R5:
By May 1, 2021 the Board of Supervisors should have the County Manager: Replace the “performance benchmarks” section in the 2021-2023 SMCBA contract with national and state defense performance criteria and benchmarks that are audited annually by the Controller for PDP compliance; Review the independent review report findings and recommendations to determine which should be adopted and on what time schedule; Work with the Chief Defender to identify best practice processes, systems and resource needs so the PDP can address the new performance standards; Require the PDP to report legal defense performance analytics in its Annual Report to the Board of Supervisors. If the SMCBA does not agree to these contractual changes, the County should consider providing SMCBA with a two-year notice to terminate the contract and begin developing an alternate legal defense model. 20
F14:
An evaluation of the PDP was completed in 2015 by a retired County Judge and former County Counsel. Though the contract requires an evaluation every five years, none had been scheduled for 2020 at the time of Grand Jury interviews. Quality of Representation
F15:
PDP client surveys are sent to a very limited number of clients and only in English.
Recomendaciones relacionadas (1)
R2:
The Board of Supervisors should require the PDP to translate descriptive information about the PDP and relevant written materials important for clients and their families to understand the judicial process, into multiple languages on the website to address the language needs of County residents. This should be completed by January 31, 2021.
F16:
Anecdotal reports by prosecuting attorneys and judges provide a wide range of quality assessments of PDP attorneys, from outstanding to poor.
F17:
The County has never completed a comprehensive independent review of the PDP that could: 19 Impartially evaluate the PDP against national public defense requirements; Compare the program to other models; Recommend improvements to the current model.
Recomendaciones relacionadas (2)
R3:
The Board of Supervisors should recommend that the Chief Defender review Public Defender Offices in other California counties to understand the scope and breadth of indigent legal services programs, the resources that are required to establish and measure performance and how quality oversight is conducted. Likewise, the PDP should discuss with the DA’s Office its professional development and career advancement programs for staff as well as processes, systems and resources. These reviews should be completed by January 31, 2021.
R4:
The Board of Supervisors should authorize a comprehensive, independent and impartial review of the PDP by an organization with legal, management and accounting expertise to evaluate the program against national public defense requirements and estimate costs for improving the PDP model or implementing an alternative system. This evaluation should be completed by March 31, 2021, and made publicly available.
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Hallazgos & Recomendaciones
13 hallazgos
F1:
There is no County department or division, which coordinates the County’s efforts to comprehensively address the issues faced by the homeless or ill subset. Currently, the County has at least seven departments or divisions – including HSA, the Department of Housing, SMMC, the Division of Public Health, Policy, and Planning, BHRS, and the Sheriff’s Office – involved in some part of the lives of ill homeless people. The Governor has suggested that “private wealth” step up to help fill the funding gap in homeless services; see Appendix A. 84Census Bureau ACS-5 year estimate (2017). https://datausa.io/profile/geo/san-mateo-county-ca#economy, retrieved 8/13/2020 85 Grand Jury Interview. Data varied depending on which semi-annual or annual report was analyzed.
Recomendaciones relacionadas (1)
R1:
The County Board of Supervisors (BOS) should direct the County Manager to develop a clear outline of the departments, agencies, and community partners who receive county funds involved in assisting the homeless and the specific subset of the ill homeless focusing on points of overlap and duplication of services. The Board should also direct the County Manager to report back to the Board in a public meeting, what efforts are being undertaken to better coordinate County efforts and potentially reduce bureaucracy and costs. This report from the County Manager should be publicly presented to the Board by December 31, 2020.
F2:
City police officers with duties as Homeless Outreach Coordinators and County Sheriff’s deputies who work with the Psychiatric Emergency Response Team (PERT) play a significant role in identifying the homeless, de-escalating potential conflict involving the homeless, and linking the homeless to services, including providing transportation to medical treatment entities and shelters. Some police have been trained by BHRS to work with outreach teams in the field to help deal with homeless who may be a danger to themselves or others.
Recomendaciones relacionadas (1)
R2:
The BOS should direct the County’s Budget, Policy, and Performance unit to annually determine the actual costs for helping the homeless and the specific subset of the ill homeless to the County by December 31, 2020.
F3:
Determining the financial cost to the County for treating the ill homeless is extremely difficult given the various treatment alternatives (e.g., hospitals, clinics, vans, shelters, respite care options and care delivered “on the street.”) and other programs which are managed across numerous County departments and divisions. The County’s Budget, Policy, and Performance unit estimated that approximately $54 million dollars was directed by the County to help ameliorate homelessness in 2019. According to the latest housing census, there were 1,512 homeless individuals in SMC.
Recomendaciones relacionadas (1)
R3:
Because the homeless move from place to place, the BOS should request that the County Sheriff and Police Chiefs convene a task force to increase cross-jurisdictional coordination and communication. As part of this collaboration, they should determine if the number and training of officers is sufficient to address homeless outreach and crisis management in those localities where homelessness is the biggest problem. The task force should hold an initial meeting by December 31, 2020 and regularly thereafter to exchange information and best practices. Regarding hospitalization, discharge options and SB 1152
F4:
The County invests heavily in outreach teams within and across agencies for finding the ill homeless and linking them to necessary treatment before hospitalization is required. However, it is not clearly set forth on any public website or document how these teams coordinate or interact or how their effectiveness is determined.
Recomendaciones relacionadas (1)
R4:
By June 30, 2021, the County’s Human Services Agency (HSA) should collaborate with the Governing Board of the Health Plan of San Mateo (HPSM) to create a standard option as a housing address proxy for the homeless and ill homeless so County hospitals and services can be reimbursed for services.
F5:
Of the discharge housing options available, there is a lack of appropriate shelter for individuals who are well enough to leave the hospital but still require some help to recover fully. Several County organizations, including HPSM, are funding various pilot studies for “respite” or “recuperative” care that show promise to meet this need. However, at this point, the County lacks a comprehensive plan for this service.
Recomendaciones relacionadas (1)
R5:
The County should develop a comprehensive plan for medical respite/recuperative care for the ill homeless by including key representatives from appropriate County departments to collaborate with the Health Care for the Homeless and Farmworker Program and the Hospital Consortium by June 20, 2021.
F6:
There is only one County shelter (Maple Street) that has a nurse on staff to provide a level of health care support for ill and recovering homeless. Grand Jury interviews revealed staff are sometimes put in the difficult position of having to decide to take or refuse some ill homeless patient due to their very precarious health status. Only Maple Street and two other single adult shelters are now open to residents 24/7 which allows the ill homeless a safe, clean environment to sleep and recover from illness.
Recomendaciones relacionadas (1)
R6:
HSA should allow the CES assessment to be more available outside of normal business hours and standardize its inclusion into all hospital or shelter discharge plans by October 31, 2020.
F7:
Most hospitals in the County, BHRS and WPC reserve (and pay for) beds at Maple Street Shelter or Samaritan House for their homeless patients requiring recuperative care. There is a lack of consistency in how to access these beds: some entities use the County’s Coordinated Entry System while others are able to by-pass this risk assessment interview. There are no data evaluating the cost effectiveness of this strategy in terms of county funding or agreement about the cost paid by different entities for these beds.
Recomendaciones relacionadas (1)
R7:
The County should conduct an overall evaluation of the County’s homeless shelters through the lens of the ill homeless, e.g., ability to assist with a range of medical needs and 24/7 availability of housing by June 30, 2021.
F8:
The County is in the planning stages for relocating and rebuilding the Maple Street Shelter. This will provide the County with an opportunity to reassess the needs of the homeless in general and the ill-homeless in particular. The ill homeless are complex, suffering from a variety of physical and mental disorders which impact their ability to access and maintain housing. Female homeless individuals and the elderly are especially at risk for future homelessness and resulting poor health.
Recomendaciones relacionadas (1)
R8:
In the planned design and rebuilding of the Maple Street Shelter, the BOS should direct the County Manager to work with departments to prioritize addressing the needs of ill homeless, especially vulnerable women and the elderly by December 31, 2020.
F9:
Beginning in 2015, the Medicare/Medi-Cal funded “Whole Person Care Pilot” (WPC) project offered an opportunity and significant funding for SMC to develop an integrated health care plan for vulnerable individuals, including the ill homeless. As a result of WPC, the County began implementing significantly improved collaboration among partners and developing of new programs as well as expanding existing programs for treating the target populations.
Recomendaciones relacionadas (1)
R9:
The County’s Department of Housing should evaluate the feasibility of securing added board and care type housing facilities to provide long-term care, staffed with appropriate medical personnel, for homeless with chronic medical and mental illness needs by December 31, 2020. Regarding WPC
F10:
WPC goals related to addressing Medi-Cal churn as well as HIPAA confidentiality concerns have not yet been achieved. Furthermore, The County’s WPC project lags behind other counties with regard to data sharing capabilities to support care coordination.
Recomendaciones relacionadas (1)
R10:
The County Manager’s Office should work with the relevant County departments to determine if it is possible to permanently fund the integration of psychiatric personnel into all outreach efforts/teams given the high presence of mental health issues among the homeless, and should have the relevant County departments publicly report the results of this effort to the Board during a regularly scheduled Board meeting by March 31, 2021.
F11:
In order to receive and maintain Medi-Cal benefits, a home address is required. By definition, the homeless do not have one, so they substitute temporary locations such as the SMMC, shelters, or someone else’s address. As a result, homeless individuals often do not receive important insurance and medical documents and become uninsured. This causes a critical gap which results in potentially insurable patients not being treated or the County health services unable to obtain reimbursement.
Recomendaciones relacionadas (1)
R11:
The County Manager should prioritize the completion of the integrated data systems (i.e., Health Information Exchange and Enterprise Data Warehouse) which were begun under the auspices of the WPC and report back to the Board in a public meeting by December 31, 2020, whether the funding of such integration is possible and, if so, by which date it will be completed.
F12:
Within the County, there is a lack of affordable permanent housing of various types (e.g., Board and Care type facilities, supervised group homes, single room occupancy hotels) for the homeless with chronic or long- term conditions that require support (e.g., stable mental illness, diabetes, cancer, heart disease). Without such options, the ill homeless will likely recycle back into encampments or the streets and again rely on emergency departments for needed treatment obviating any reduction in health care savings.
F13:
While the County should be applauded for reaching out to grant agencies for funding programs that support the ill homeless, it appears that such programs may not be sustainable after grant funding ends. Given that the County support system is already complex, the addition and subtraction of pilot programs without institutionalization provides only a finger in the dike and potentially adds to client and provider confusion about resources.
Recomendaciones adicionales
1
No vinculadas a hallazgos específicos.
R25-44:
age ranges are probably low paid, non-salaried workers (i.e., employed in minimum wage jobs or less) and are likely to be vulnerable to loss of employment in the current economic situation. These groups are most at risk for future homelessness and resulting poor health within the County. Alarmingly even prior to the pandemic, the WPC reported that the ill homeless participants died at three to six times the rate of their housed peers.85 Given the double hit of COVID-19 and the economic slowdown, the County may expect a severe increase in the number of residents who slide into poverty, homelessness, and potentially illness and death. Now is the time for San Mateo County to assess why everyone is working on homelessness, at what cost and to what effect. With resources likely to be strained for the foreseeable future, it is vital that the current overlapping, confusing, expensive conglomerate of services be re-evaluated with the goals of finding synergies and efficiencies. The following section summarizes the key findings of this investigation and recommendations critical to addressing the County’s current, and likely increasing, problem of caring for our vulnerable homeless population. FINDINGS F1. There is no County department or division, which coordinates the County’s efforts to comprehensively address the issues faced by the homeless or ill subset. Currently, the County has at least seven departments or divisions – including HSA, the Department of Housing, SMMC, the Division of Public Health, Policy, and Planning, BHRS, and the Sheriff’s Office – involved in some part of the lives of ill homeless people. The Governor has suggested that “private wealth” step up to help fill the funding gap in homeless services; see Appendix A. 84Census Bureau ACS-5 year estimate (2017). https://datausa.io/profile/geo/san-mateo-county-ca#economy, retrieved 8/13/2020 85 Grand Jury Interview. Data varied depending on which semi-annual or annual report was analyzed. F2. City police officers with duties as Homeless Outreach Coordinators and County Sheriff’s deputies who work with the Psychiatric Emergency Response Team (PERT) play a significant role in identifying the homeless, de-escalating potential conflict involving the homeless, and linking the homeless to services, including providing transportation to medical treatment entities and shelters. Some police have been trained by BHRS to work with outreach teams in the field to help deal with homeless who may be a danger to themselves or others. F3. Determining the financial cost to the County for treating the ill homeless is extremely difficult given the various treatment alternatives (e.g., hospitals, clinics, vans, shelters, respite care options and care delivered “on the street.”) and other programs which are managed across numerous County departments and divisions. The County’s Budget, Policy, and Performance unit estimated that approximately $54 million dollars was directed by the County to help ameliorate homelessness in 2019. According to the latest housing census, there were 1,512 homeless individuals in SMC. F4. The County invests heavily in outreach teams within and across agencies for finding the ill homeless and linking them to necessary treatment before hospitalization is required. However, it is not clearly set forth on any public website or document how these teams coordinate or interact or how their effectiveness is determined. F5. Of the discharge housing options available, there is a lack of appropriate shelter for individuals who are well enough to leave the hospital but still require some help to recover fully. Several County organizations, including HPSM, are funding various pilot studies for “respite” or “recuperative” care that show promise to meet this need. However, at this point, the County lacks a comprehensive plan for this service. F6. There is only one County shelter (Maple Street) that has a nurse on staff to provide a level of health care support for ill and recovering homeless. Grand Jury interviews revealed staff are sometimes put in the difficult position of having to decide to take or refuse some ill homeless patient due to their very precarious health status. Only Maple Street and two other single adult shelters are now open to residents 24/7 which allows the ill homeless a safe, clean environment to sleep and recover from illness. F7. Most hospitals in the County, BHRS and WPC reserve (and pay for) beds at Maple Street Shelter or Samaritan House for their homeless patients requiring recuperative care. There is a lack of consistency in how to access these beds: some entities use the County’s Coordinated Entry System while others are able to by-pass this risk assessment interview. There are no data evaluating the cost effectiveness of this strategy in terms of county funding or agreement about the cost paid by different entities for these beds. F8. The County is in the planning stages for relocating and rebuilding the Maple Street Shelter. This will provide the County with an opportunity to reassess the needs of the homeless in general and the ill-homeless in particular. The ill homeless are complex, suffering from a variety of physical and mental disorders which impact their ability to access and maintain housing. Female homeless individuals and the elderly are especially at risk for future homelessness and resulting poor health. F9. Beginning in 2015, the Medicare/Medi-Cal funded “Whole Person Care Pilot” (WPC) project offered an opportunity and significant funding for SMC to develop an integrated health care plan for vulnerable individuals, including the ill homeless. As a result of WPC, the County began implementing significantly improved collaboration among partners and developing of new programs as well as expanding existing programs for treating the target populations. F10. WPC goals related to addressing Medi-Cal churn as well as HIPAA confidentiality concerns have not yet been achieved. Furthermore, The County’s WPC project lags behind other counties with regard to data sharing capabilities to support care coordination. F11. In order to receive and maintain Medi-Cal benefits, a home address is required. By definition, the homeless do not have one, so they substitute temporary locations such as the SMMC, shelters, or someone else’s address. As a result, homeless individuals often do not receive important insurance and medical documents and become uninsured. This causes a critical gap which results in potentially insurable patients not being treated or the County health services unable to obtain reimbursement. F12. Within the County, there is a lack of affordable permanent housing of various types (e.g., Board and Care type facilities, supervised group homes, single room occupancy hotels) for the homeless with chronic or long- term conditions that require support (e.g., stable mental illness, diabetes, cancer, heart disease). Without such options, the ill homeless will likely recycle back into encampments or the streets and again rely on emergency departments for needed treatment obviating any reduction in health care savings. F13. While the County should be applauded for reaching out to grant agencies for funding programs that support the ill homeless, it appears that such programs may not be sustainable after grant funding ends. Given that the County support system is already complex, the addition and subtraction of pilot programs without institutionalization provides only a finger in the dike and potentially adds to client and provider confusion about resources. RECOMMENDATIONS Regarding Pre-Hospitalization R1. The County Board of Supervisors (BOS) should direct the County Manager to develop a clear outline of the departments, agencies, and community partners who receive county funds involved in assisting the homeless and the specific subset of the ill homeless focusing on points of overlap and duplication of services. The Board should also direct the County Manager to report back to the Board in a public meeting, what efforts are being undertaken to better coordinate County efforts and potentially reduce bureaucracy and costs. This report from the County Manager should be publicly presented to the Board by December 31, 2020. R2. The BOS should direct the County’s Budget, Policy, and Performance unit to annually determine the actual costs for helping the homeless and the specific subset of the ill homeless to the County by December 31, 2020. R3. Because the homeless move from place to place, the BOS should request that the County Sheriff and Police Chiefs convene a task force to increase cross-jurisdictional coordination and communication. As part of this collaboration, they should determine if the number and training of officers is sufficient to address homeless outreach and crisis management in those localities where homelessness is the biggest problem. The task force should hold an initial meeting by December 31, 2020 and regularly thereafter to exchange information and best practices. Regarding hospitalization, discharge options and SB 1152 R4. By June 30, 2021, the County’s Human Services Agency (HSA) should collaborate with the Governing Board of the Health Plan of San Mateo (HPSM) to create a standard option as a housing address proxy for the homeless and ill homeless so County hospitals and services can be reimbursed for services. R5. The County should develop a comprehensive plan for medical respite/recuperative care for the ill homeless by including key representatives from appropriate County departments to collaborate with the Health Care for the Homeless and Farmworker Program and the Hospital Consortium by June 20, 2021. R6. HSA should allow the CES assessment to be more available outside of normal business hours and standardize its inclusion into all hospital or shelter discharge plans by October 31, 2020. R7. The County should conduct an overall evaluation of the County’s homeless shelters through the lens of the ill homeless, e.g., ability to assist with a range of medical needs and 24/7 availability of housing by June 30, 2021. R8. In the planned design and rebuilding of the Maple Street Shelter, the BOS should direct the County Manager to work with departments to prioritize addressing the needs of ill homeless, especially vulnerable women and the elderly by December 31, 2020. R9. The County’s Department of Housing should evaluate the feasibility of securing added board and care type housing facilities to provide long-term care, staffed with appropriate medical personnel, for homeless with chronic medical and mental illness needs by December 31, 2020. Regarding WPC R10. The County Manager’s Office should work with the relevant County departments to determine if it is possible to permanently fund the integration of psychiatric personnel into all outreach efforts/teams given the high presence of mental health issues among the homeless, and should have the relevant County departments publicly report the results of this effort to the Board during a regularly scheduled Board meeting by March 31, 2021. R11. The County Manager should prioritize the completion of the integrated data systems (i.e., Health Information Exchange and Enterprise Data Warehouse) which were begun under the auspices of the WPC and report back to the Board in a public meeting by December 31, 2020, whether the funding of such integration is possible and, if so, by which date it will be completed. REQUEST FOR RESPONSES Pursuant to Penal Code Section 933.05, the Grand Jury requests responses within 90 days from the following: County Board of Supervisors: R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11 The governing bodies indicated above should be aware that the comment or response of the governing body must be conducted subject to the notice, agenda, and open meeting requirements of the Brown Act. METHODOLOGY Documents Reviewed the 2017 and 2019 San Mateo County One Day Homeless Count and Survey which identified and categorized the homeless in the County. Reviewed the Whole Person Care grant proposal and Mid-Year 4 and Year 4 Annual progress reports. Reviewed the 2014-2014 Marin County Grand Jury Report “Homeless in Marin-A Call for Leadership,” Public Release Date: April 23, 2015. Reviewed the Policy Guidelines of the San Mateo Medical System “Discharge and Transfer” which outlines compliance guidelines for SB 1152 for homeless patients (02/27/2020). Reviewed San Mateo County Health Care for the Homeless and Farmworker Health Program 2018 Annual Report. Site Tours Visited the Maple Street Shelter, San Mateo Medical Center and Santa Clara Valley Medical Center. Interviews Reports issued by the Civil Grand Jury do not identify individuals interviewed. Penal Code Section 929 requires that reports of the Grand Jury not contain the name of any person or facts leading to the identity of any person who provides information to the Civil Grand Jury. During the course of the investigation, the Grand Jury conducted 24 interviews including meetings with representatives from: ● Multiple County departments involved with health and/or the homeless ● Police officers ● Homeless shelter staff members ● A Health Maintenance Organization ● A community organization serving many of the County’s homeless including providing shelter beds ● A representative from the Whole Person Care (WPC) grant ● Personnel from three area hospitals including San Mateo Medical Center, Stanford Hospital and Santa Clara County’s Valley Medical Center. The Grand Jury identified the following San Mateo County agencies as significantly interacting with the ill homeless: ● City Police and Sheriff’s officers ● The San Mateo Medical Center (SMMC) ● Behavioral and Human Recovery Services (BHRS) ● Department of Public Health, Policy and Planning ● Human Services Agency (HSA) Department’s ‘“Core Agencies” (including Samaritan House, the lead of the Core) and the Center on Homelessness ● The Health Care for the Homeless Program and Farmworker Program ● The Hospital Consortium ● The Health Plan of San Mateo (HPSM) BIBLIOGRAPHY E. Chuang, B. O’Masta, E.M. Alberston, I.A. Hale, C. Lu C., and N. Pourat N. Whole Person Care Improves Care Coordination for Many Californians. 2019. Los Angeles, CA: UCLA Center for Health Policy Research County of San Mateo, Health Care for the Homeless & Farmworker Health Program, 2018 Annual Report, 1-8 Robert A. Hahn, “Two Paths to Health in all Policies: The Traditional Public Health Path and the Path of Social Determinants,” American Journal of Public Health, Vol 109, No. 2 (2019): 253- 254 Cynthia Hubert. “Homeless Patients Were Left On The Streets By Hospitals. This Law Could End ‘Dumping. The Sacramento Bee, October 09, 2018 Marin County Civil Grand Jury report 2014-2015 –"Homeless in Marin-A Call for Leadership. " http://www.marincounty.orgdepts/gj/reports-and-responses/reports-responses/2014-15/homeless- in-marin San Mateo County Health System. “Mid-Year Report PY4.” State of California - Health and Human Services Agency Department of Health Care Services Whole Person Care Grant. September 6, 2019 San Mateo County Health System. Whole Person Care Grant Application, 2015. https://www.dhcs.ca.gov/provgovpart/Documents/SanMateoWPCApplication.pdf San Mateo County Health Services Agency, Center on Homelessness Mateo County: 2019 One Day Homeless Count and Survey, https://hsa.smcgov.org/sites/hsa.smcgov.org/files/2019%20One%20Day%20Homeless%20Count %20report.pdf “Special Initiatives.” The Health Plan of San Mateo. Accessed March 25, 2019. https://www.hpsm.org/special-initatives Stacie Weeks, Marie Zimmerman, and Jennifer Ryan. Medicaid’s Critical Role in Addressing the COVID-19 Pandemic (blog). http://www.harbageconsulting.com/medicaid-critical-role-in- addressing-the-covid-10-pandemic/. March 19, 2020.