Sonoma County 2005-2006 - California Grand Jury Reports

Recommendations, Page 44-45 R1. Create a clear delineation of program responsibilities between corrections and the

8 pages 17 recommendations

Additional Recommendations 17

Not linked to specific findings.

R1: Create a clear delineation of program responsibilities between corrections and the medical provider. RESPONSE: The recommendation has been implemented and has been in place since the inception of the contract with the medical service provider. The Grand Jury report is correct in stating that medical treatment for inmates is mandated by Section 6030 of the California Penal Code, and the standard for that care be set in Title 15, of the California Code of Regulations (CCR). Section 1200(a), of Title 15, establishes the responsibility for health care Services. Section 1200 Responsibility for Health Care Services. (a) In Type II facilities, the facility administrator shall have the responsibility to ensure provision of emergency and basic health care services to all inmates. Medical, dental, and mental health matters involving clinical judgments are the sole province of the responsible physician, dentist, and psychiatrist or psychologist respectively. The Sheriff’s Department, as well as CFMG, has separate Policy and Procedure Manuals, which address the responsibilities of both parties. Section 1029 of Title 15 - CCR, mandates the development of policy and procedures for the facility. California Medical Association (CMA) – Institute for Medical Quality (IMQ), Section 104 mandates that there be specific health services manual of policies and defined procedures approved by the health authority to address all essential health standards. It is the Sheriff’s opinion that there is a clear delineation of program responsibilities between corrections and the medical provider, as outlined in both parties’ policies and procedures.

R2: Consider a study to determine the most efficient and economical method to address jail medical issues. RESPONSE: The recommendation has been implemented. The Department is currently working with the County Administrator’s Office (CAO), County Counsel, Department of Health Services and the Risk Management Division of General Services, to determine the most efficient and economical method to provide 1 catastrophic medical services i.e. services provided in an urgent care or hospital facility. A project specifically geared toward evaluating costs the county pays for catastrophic level medical services has begun. The project will focus on whether greater cost efficiencies or cost reductions can be achieved, which is consistent with the original intent of SB 159. For routine medical services available to inmates on a daily basis within the county’s detention facilities, the county has already determined that contracting with a private provider for these services is the most efficient and economical method to provide these services. During the first quarter of FY 06-07, the Sheriff's Department will begin the Request For Proposal (RFP) process to solicit competitive proposals, from qualified providers, for the contract period beginning February 1, 2008.

R3: Consider retaining a consultant, possibly an actuary, who is able to do a cost benefit analysis on the alternatives for handling jail medical costs. RESPONSE: The recommendation has been implemented. The County Administrator agrees that a cost benefit analysis is a worthwhile approach to determining the most efficient and effective delivery of hospitalization or catastrophic level services for inmates, and has considered this approach. In the fall of 2005, the County began a study to evaluate costs associated with inmate catastrophic medical care. The study, which is organized in phases, involves County staff from multiple disciplines: detention operation and administration, health services, risk management and legal. It is anticipated that a consultant will be retained in future phases of this work. Further, as mentioned in R2, the Sheriff's Department will solicit competitive proposals through a RFP process.

R4: Consider the use of a physician-monitor to review and assess the quality and appropriateness of medical care. RESPONSE: The recommendation has been implemented and has been in place since the inception of the contract with the medical service provider. This recommendation has already been accomplished by the established peer review process already in place, as mandated by Section 106 of the CMA-IMQ standards. Dr. Rick Flinders, an independent physician in the community, comes on site quarterly, to assess the appropriateness of decision-making and the overall quality of health care for inmates treated in and outside the detention facilities. Dr. Flinders also serves on the Quality Assurance Committee and reports his objective findings to both the Sheriff’s Department and CFMG. 2

R5: Examine the possibility of obtaining catastrophic insurance coverage for jail medical. RESPONSE: The recommendation has been implemented. Risk Management together with the Sheriff’s Department and County Administrator’s Office reviewed the availability of insurance coverage for this exposure in 2005 and determined this option not to be cost effective.

R6: Audits should be conducted by an agency independent of the medical provider. RESPONSE: The recommendation has been implemented and has been in place since the inception of the contract with the medical service provider. Audits of the jail medical programs are conducted by agencies independent of the medical provider as follows: The Public Health Department: has the responsibility of annually auditing the jails medical program to insure it meets the minimum standards of care directed by Title 15 - CCR. The report is provided to the Corrections Standards Authority (CSA) and is maintained on file at the Detention Facilities. The Corrections Standards Authority: conducts audits every two years of both Detention Facilities. These operational audits include, medical and mental health treatment services, to insure they are within the standards set by Title 15. The California Medical Association – Institute of Medical Quality: conducts audits every two years of both facilities to insure that our medical and mental health services are meeting the community standard of care.

R7: Make quarterly quality meetings mandatory, with an agenda, attendance log, and minutes, which shall be kept for future reference. All affected departments will send a representative, if the department head cannot be present. RESPONSE: The recommendation has been implemented and has been in place since the inception of the contract with the medical service provider. CFMG and Sonoma County officials have conducted these required meetings every quarter since the contract with CFMG began in February 2000. Attendees include representatives from the Sheriff's Office, Detention Medical, Detention Mental Health, Public Health, and County Counsel. In almost all cases where the actual department head could not attend, there was a representative present. There is always an attendance log for each meeting, as well as an agenda. Minutes are taken and are on file with CFMG at their corporate offices in Monterey, California. 3

R8: Negotiate contracts with off-site providers pursuant to SB 159 regarding pricing. A study conducted by the County Administrator (actuarial consultant) will be used to determine whether a contract or no-contract agreement is most advantageous for the county. RESPONSE: The recommendation has been implemented. The Sheriff's Department was successful in negotiating an amendment to our existing agreement with Sutter Hospital, Santa Rosa in December of 2005 to reduce the county’s reimbursement obligation from 80% to 55% of billed charges. Sutter Hospital is the primary care facility for the off-site treatment of inmates requiring hospitalization. The County has been closely monitoring the catastrophic costs for over a year and was closely monitoring SB 159 during the drafting and approval process. While SB 159 has addressed cost issues that were problematic statewide (legislation limits hospital charges to counties for the care of inmates to 110% of hospital costs) this legislation sunsets in 2008. The legislation also only applies to hospital charges if a contract is not currently in place. The County has been under contract with Sutter for about 10 years, the term of which expires in 2016. The project, referenced in R2, will address the issue of negotiating favorable catastrophic care contracts with local hospitals.

R9: Develop quantifiable, objective, and empirical standards for measuring the success of the medical program. RESPONSE: The recommendation has been implemented and has been in place since the inception of the contract with the medical service provider. The Corrections Standard Authority (CSA) has established specific standards with respect to inmate health care services. As already indicated, those standards are found in Title 15 -CCR. The Institute of Medical Quality (CMA-IMQ) also has developed additional standards that need to be met before a facility can be accredited. Both CSA and CMA-IMQ perform on-site surveys of the health care delivery system at our facilities to assess how compliant our systems are with those standards. These on-site inspections include: patient medical records; policies and procedures for both the medical program and detention operations; review of records for patients housed in safety and sobering cells; and interviews with the medical, mental health, custody staff, and inmates. The goal of CSA and CMA-IMQ in inspecting our health care systems is to evaluate its overall effectiveness, and the quality and appropriateness of medical care in the jails, based upon established standards. The Departments continued accreditation speaks to the success of delivering quality health care to inmates in our detention facilities. 4

R10: Develop quantifiable, objective, and empirical standards for the most economical method for handling jail medical services. RESPONSE: The recommendation has not yet been implemented, but will be implemented in the future. The department conforms to the minimum standards of care as defined in Title 15 in addition to IMQ standards as described in response to R1 and R9. Standards are also described in the department’s policies and procedures manual. Economic evaluations listed in this recommendation related to catastrophic care will be addressed in the components of the project referenced in the response to R2 which is expected to be completed by December 2007. As mentioned, economical methods of delivering day-to-day care to inmates will be addressed through the competitive bid process.

R11: Develop a method for determining the actual cost of the medical program to the County. RESPONSE: The recommendation has been implemented. All costs components of inmates medical care already exist in various budget units. The Fiscal Unit of the Department will develop a procedure to compile all inmate medical costs, into one report, that will be prepared on a quarterly basis. The report will include: CFMG contract, catastrophic medical, Mental Health, Inmate Psychiatric Unit (Norton Facility), and transportation of inmates for medical treatments. This will be completed and implemented during the first quarter of FY 06-07.

R12: Require expense-based information to be used to determine whether the contract price is commensurate with the cost of services rendered. RESPONSE: The recommendation has not yet been implemented, but will be implemented in the future. A formal request for quarterly information will be sent to the medical services provider, California Forensic Medical Group, requesting an accounting of expenses relative to the contract with the County. This request will be transmitted during the month of August 2006. 5

R13: Develop a list of preferred physician providers. RESPONSE: The recommendation has been implemented and has been in place since the inception of the contract with the medical service provider. CFMG maintains a list of competent and stable professional medical specialists in Sonoma County who are willing to accept inmates as patients.

R14: The Sheriff's Department and Information Systems Department should explore and develop technological improvements in tracking county jail medical services. RESPONSE: The recommendation has been implemented. The Sheriff and Information Systems Department (ISD) meet regularly to discuss improvements to the existing Integrated Justice System. The Sheriff’s Department has also submitted a request for the purchase of a new jail management software system. The Board of Supervisor’s will consider this request during final budget hearings in August 2006. In anticipation of this new system, the Sheriff’s Department and ISD are working to identify and prioritize system functions. The bid request will include a provision for a program to track county jail medical services.

R15: The Sheriff's Department and medical provider should develop alternative methods of distribution for other-than-prescription medications - specifically distribution through commissary or vending machines. RESPONSE: The recommendation will not be implemented because it is not warranted. Non-prescription medications are currently distributed by CFMG and the cost is included in the annual contract. They are given to the inmates at no cost. If these medications were distributed by the Commissary or through vending machines, numerous inmates would not be able to afford the medication and the Inmate Welfare Trust would have to absorb the cost. In addition, inmates would have the ability to “hoard” medications and possibly use them to create other substances or to inflect personal harm by overdosing. The possibility of using the commissary and vending machines, for distribution of non- prescription medication, was reviewed the Inmate Welfare Trust Committee in January 2006. For all the reasons mentioned above, the unanimous vote, of the Committee, was that it was in the best interest of the inmates and the Trust not to pursue this option.

R16: Obtain from the medical provider the required insured endorsements. RESPONSE: The recommendation has been implemented. Responsibility for contract management, including obtaining required insurance certificates, is the responsibility of the contract manager in each contracting department. CFMG has maintained the appropriate insurance and waivers, however updated documents were not provided to the department. Upon request, CFMG immediately provided the insurance certificates that are currently on file with the Sheriff’s Department.

R17: Create a task force to examine the changing realities effecting health care in the county detention facilities. RESPONSE: The recommendation has been implemented and has been in place since the inception of the contract with the medical service provider. The attendees of the quarterly Quality Assurance Meeting provide the functions that would be addressed by a task force. The attendees include: representatives of the Sheriff’s Department, CFMG, County Mental Health, County Public Health, County Counsel, Doctor Flinders (Sutter Hospital) and others as needed. During these meetings, current practices are evaluated and discussed, concerns and issues are presented and any new information regarding correctional health services are reviewed. When appropriate, subgroups are formed to evaluate identified concerns, new ideas or proposals. These subgroups report to the larger body with findings and recommendations for further discussion and possible implementation. Since the initiation of the project mentioned in R2, several costs saving measures have been implemented. The department was successful in negotiating an amendment to the Sutter agreement, reducing the County payment obligation for catastrophic care by 25% as previously mentioned. A survey of other counties has been conducted to better understand the full range of issues and cost saving options that could be used to improve our project analysis and outcomes. Additionally, the Mental Health Division in cooperation with the Sheriff, District Attorney, and Public Defender is implementing an on site mental health treatment program that will more efficiently and effectively provide intensive mental health services to inmates who previously could only receive these services at the Norton IPU. This change is expected to save the county over $380,000 annually in hospitalization costs as well as provide other transportation and court processing efficiencies. The participants of the Quality Assurance Meeting have responded to the changing realities effecting health care in the County’s detention facilities. c: Board of Supervisors Court Executive Officer County Administrator County Clerk Signatories 7

September 02, 2006 — Community Redwood Health

3 pages

Quick View Full Details →

Findings and recommendations not yet extracted.

June 27, 2006 — Fatal Incident Protocol June 27, 2006

3 pages 4 findings 2 recommendations

Quick View Full Details →

Findings & Recommendations 4 findings

F1: The “Law Enforcement Employee-Involved Fatal Incident Protocol” requires that investigations be conducted "free of conflicts of interest." 2

Related Recommendations (1)

R1: The Grand Jury recommends that they continue to be notified as soon as an incident protocol is initiated.

F2: The primary agency that employed the officers involved conducted their own administrative investigation to determine: • If the agency’s policies and procedures were followed • If there could be improvement in those policies and procedures • If any disciplinary action should be imposed against a particular individual or individuals.

Related Recommendations (1)

R2: The District Attorney continues to provide the grand jury with a copy of the Fatal Incident Report Status Log on a monthly basis. Required Responses to Findings and Recommendations None )¹ Sonoma County Law Enforcement Chief’s Association’s Protocol: 93-1 Revised 06/2004 “Law Enforcement Employee-Involved Fatal Incident Protocol Investigation” 3

F3: The District Attorney’s Office, based on the evidence, reached its conclusions and issued a report for all the reviewed fatal incidents.

F4: The Fatal Incident Report Status Log was sent quarterly from the District Attorney’s Office to the Grand Jury. Conclusions The District Attorney’s Office concluded there was not sufficient evidence of criminal liability on the fatal incidents reviewed. The grand jury found that the fatal incident reports reflected thorough, detailed, and unbiased investigations by those assigned to the cases. The conclusion of the District Attorney’s Office is clearly based on all aspects of submitted evidence, photographs, witness statements and reports by involved personnel. The grand jury found that established protocol was followed in the incidents reviewed.

June 27, 2006 — Shaping the County’s Future June 27, 2006

11 pages 18 findings 8 recommendations

Quick View Full Details →

Findings & Recommendations 18 findings

F1: State and Federal mandates are issued periodically and incorporated in General Plan updates as fast as feasible. The Housing Element is governed by mandate of the State Department of Housing and Community Development. New, or modified requirements are issued frequently, asking for an almost annual update of this element. Main thrust is the availability of affordable housing.

F2: The three additional elements included in General Plan ’89 were found to be valid and useful for the County. They will be continued under General Plan 2020.

F3: The General Plan is viewed more as a policy document, a guideline, for the Elements covered by it. There are few, if any, measurable goals or standards. An evaluation of the General Plan performance is, therefore, more subjective than based on tangible data.

F4: The work plan and budget developed by staff for the update and development of General Plan 2020 was adequate in scope and fiscally sound. It was approved as submitted by the Board of Supervisors.

F5: The logic and phasing of the update process follow a sensible path and incorporate all possible resources at the disposal of the County. Especially the use of a Citizens’ Advisory Committee to solicit public input is commendable.

F6: Timelines and milestones are reasonable and generally met. Since timing is well beyond the General Plan 1989 expiration, and finalization of General Plan 2020 will not happen before the end of 2006, the update process and time schedule should be reviewed.

F7: The opportunity for input by the general public is provided and publicized through mailings, the press, and word of mouth. Representatives of interest groups and citizens groups attend most of the meetings, both pursuing a special amendment rather than a general policy.

F8: About 35,000 property owners potentially affected by changes in the General Plan 2020 were invited to a public hearing on the Draft EIR. The notice did not identify why a property could be affected, causing an overflow crowd to show up for the hearing at a venue with limited occupancy. Many citizens were turned away, prompting a very negative reaction in the press. (See Sonoma West Times and News, Volume 117, No. 20)

Related Recommendations (2)

R7: Improve public notices about meetings on the General Plan to specifically state the topic and only invite affected property owners to avoid overcrowding.

R8: Evaluate pre-meeting feedback to hearing notices (e-mails, phone calls, personal visits) and provide meeting facilities to safely accommodate participants. Required Responses to Findings Chairman, Board of Supervisors

F9: Sonoma County has failed to meet mandated housing requirements since 1992. Repeated attempts to satisfy State requirements were not successful, resulting in a zoning moratorium. The County anticipates succeeding in meeting State Housing mandates with General Plan 2020.

F10: Land Use policies for County land bordering property in a City’s area of influence occasionally create controversy. Every effort is made by both authorities to minimize undue inconvenience to the property owner. There is no formal approach, though, to address these issues.

Related Recommendations (1)

R4: Negotiate with affected Cities and Municipalities to establish and implement a formal process to coordinate mutually relevant issues such as traffic, zoning of adjacent properties, etc.

F11: Resolution of General Plan conflicts in adjacent jurisdictions is handled on a case-by- case basis and is usually resolved successfully. There is no formal approach to address these issues.

Related Recommendations (1)

R4: Negotiate with affected Cities and Municipalities to establish and implement a formal process to coordinate mutually relevant issues such as traffic, zoning of adjacent properties, etc.

F12: The 15 members of the Citizens’ Advisory Committee are serving as volunteers without compensation or mileage reimbursement. In the case of the CAC 2020, members served for almost 70 months and conducted/attended over 40 meetings in different locations.

Related Recommendations (1)

R5: Include a mileage consideration for all General Plan-related Committee members in future General Plan-related budget requests.

F13: From the documents reviewed, the General Plan update process was officially launched in fall of 2001. The General Plan 2020 will not be ready for review by the Board of Supervisors before the end of 2006, two years after the expiration of General Plan 1989.

F14: The review process by the Citizens’ Advisory Committee was expected to take about one year but lasted almost five years.

F15: Staff informed the grand jury, that there is no documented “road map” for the General Plan update process. Staff is familiar with what needs to be done and proceeds accordingly.

Related Recommendations (1)

R1: Formalize and document the Sonoma County General Plan update process in an electronic or hard copy document or flow-chart, with easy access by the public.

F16: State mandate requires that the Housing Element status be reported on annually. A similar, periodic General Plan implementation status report to the Board of Supervisors and the public is not prepared.

Related Recommendations (2)

R3: Adopt the General Plan implementation tracking mechanism approved by the Citizens Advisory Committee in their August 19, 2004 meeting.

R6: Develop and implement a periodic General Plan update report for review by the Board of Supervisors.

F17: The active involvement and General Plan oversight function by members of the Board of Supervisors appears to be rather limited, dealing mostly with manpower and budget issues. The planning staffs address implementation and fulfillment issues. Conclusions Because of the enormous complexity of the General Plan update process only major process steps could be evaluated for their integrity, sequencing, and timing. Some major phases emerge in the General Plan review. They include among others: • Recognition of new State and Federal legislative requirements for some Plan Elements • Economic and ergonomic changes • An evaluation of the previous plan status • Development of an update work plan and budget • Presentation of plan and budget for review/approval by the Board of Supervisors • Development of revised plan Elements, in cooperation with the Citizens’ Advisory Board • Analyses of the environmental impact of revised policies • Planning Commission Review, and finally, • Presentation of the Plan 2020 to the Board of Supervisors. Each one of these major steps is well documented, backed up by relevant statistical data, and satisfactorily implemented. Because of the duration of this process over several years, it is not always easy to retain public interest and participation. Once final drafts of the Environmental Impact Report and the General Plan 2020 were presented in open hearings, public interest became reinvigorated as demonstrated on the occasion of the Planning Commission meetings in February and March of this year. It would be helpful for the public as well as other interested parties, if there were a general overview of all significant update phases and milestones. Such documents, in easy to understand format, would assist in anticipating relevant events and milestones of the update process. It would also serve as a guide for staff new to the process, should current staff be re- assigned or retire. Communication with the general public and with property owners affected by proposed changes has to be conducted in clear language and terms understood by laypersons. Public meetings must be identified as to subjects covered, and conducted in adequate facilities. Commendations The grand jury would like to thank all those who assisted in providing valuable information towards this report. PRMD management and staff were very cooperative, professional and skilled in their fields.

F20: F9. Sonoma County has failed to meet mandated housing requirements since 1992. Repeated attempts to satisfy State requirements were not successful, resulting in a zoning moratorium. The County anticipates succeeding in meeting State Housing mandates with General Plan 2020. F10. Land Use policies for County land bordering property in a City’s area of influence occasionally create controversy. Every effort is made by both authorities to minimize undue inconvenience to the property owner. There is no formal approach, though, to address these issues. F11. Resolution of General Plan conflicts in adjacent jurisdictions is handled on a case-by- case basis and is usually resolved successfully. There is no formal approach to address these issues. F12. The 15 members of the Citizens’ Advisory Committee are serving as volunteers without compensation or mileage reimbursement. In the case of the CAC 2020, members served for almost 70 months and conducted/attended over 40 meetings in different locations. F13. From the documents reviewed, the General Plan update process was officially launched in fall of 2001. The General Plan 2020 will not be ready for review by the Board of Supervisors before the end of 2006, two years after the expiration of General Plan 1989. F14. The review process by the Citizens’ Advisory Committee was expected to take about one year but lasted almost five years. F15. Staff informed the grand jury, that there is no documented “road map” for the General Plan update process. Staff is familiar with what needs to be done and proceeds accordingly. F16. State mandate requires that the Housing Element status be reported on annually. A similar, periodic General Plan implementation status report to the Board of Supervisors and the public is not prepared. F17. The active involvement and General Plan oversight function by members of the Board of Supervisors appears to be rather limited, dealing mostly with manpower and budget issues. The planning staffs address implementation and fulfillment issues. Conclusions Because of the enormous complexity of the General Plan update process only major process steps could be evaluated for their integrity, sequencing, and timing. Some major phases emerge in the General Plan review. They include among others: • Recognition of new State and Federal legislative requirements for some Plan Elements • Economic and ergonomic changes • An evaluation of the previous plan status • Development of an update work plan and budget • Presentation of plan and budget for review/approval by the Board of Supervisors • Development of revised plan Elements, in cooperation with the Citizens’ Advisory Board • Analyses of the environmental impact of revised policies • Planning Commission Review, and finally, • Presentation of the Plan 2020 to the Board of Supervisors. Each one of these major steps is well documented, backed up by relevant statistical data, and satisfactorily implemented. Because of the duration of this process over several years, it is not always easy to retain public interest and participation. Once final drafts of the Environmental Impact Report and the General Plan 2020 were presented in open hearings, public interest became reinvigorated as demonstrated on the occasion of the Planning Commission meetings in February and March of this year. It would be helpful for the public as well as other interested parties, if there were a general overview of all significant update phases and milestones. Such documents, in easy to understand format, would assist in anticipating relevant events and milestones of the update process. It would also serve as a guide for staff new to the process, should current staff be re- assigned or retire. Communication with the general public and with property owners affected by proposed changes has to be conducted in clear language and terms understood by laypersons. Public meetings must be identified as to subjects covered, and conducted in adequate facilities.

Additional Recommendations 1

Not linked to specific findings.

R2: Create a link on the Sonoma County Home Page that leads the visitor directly to the General Plan site, avoiding the need to navigate through the PRMD home page

June 27, 2006 — The Million Dollar Inmate?

9 pages 12 findings 17 recommendations

Quick View Full Details →

Findings & Recommendations 12 findings

F1: There is no clear demarcation of responsibilities between corrections and the medical provider except to state that detention does not make medical decisions. 6

Related Recommendations (1)

R1: Create a clear delineation of program responsibilities between corrections and the medical provider.

F2: Audits are not independent. The vendor self-audits. The outside auditor is hired by the provider. Quarterly quality meetings are voluntary and attendance is sporadic. There is no agenda. No minutes are kept. Cooperation in decisions between departments depends on good will.

Related Recommendations (1)

R2: Conduct a study to determine the most efficient and economical method to address jail medical issues.

F3: Until January 2006, the county was not involved in negotiations with outside providers regarding pricing. A third party vendor hired by CFMG negotiated what discount arrangements there were.

Related Recommendations (1)

R3: Consider retaining a consultant, possibly an actuary, who is able to do a cost benefit analysis on the alternatives for handling jail medical costs.

F4: No empirical, objective, and quantifiable standards are in place for measuring the success of the program.

Related Recommendations (1)

R4: Consider the use of a physician-monitor to review and assess the quality and appropriateness of medical care.

F5: No empirical, objective, and quantifiable standards are in place for determining what is the most effective and economical method of handling jail medical services.

Related Recommendations (1)

R5: Examine the possibility of obtaining catastrophe insurance coverage for jail medical.

F6: The county has no verifiable statistical information of the actual cost of the program to the vendor.

Related Recommendations (1)

R6: Audits should be conducted by an agency independent of the medical provider.

F7: There is no preferred provider list in place.

Related Recommendations (1)

F8: Record keeping is to a great extent manual, making it difficult to make changes or to evaluate alternatives.

Related Recommendations (1)

F9: Non-prescription (OTC) drugs are administered only by professionals.

Related Recommendations (1)

R9: Develop quantifiable, objective, and empirical standards for measuring the success of the medical program.

F10: Required additional insured endorsements are not on file.

Related Recommendations (1)

R10: Develop quantifiable, objective, and empirical standards for the most effective economical method for handling jail medical services.

F11: No study is being conducted to examine the potential impact of the changing realities facing the county detention facilities.

Related Recommendations (1)

R11: Develop a method for determining the actual cost of the medical program to the county. 8

F12: The reason for entering into a flat contract was to pass on the expense risk associated with health care. Cost overruns demonstrate that was not the result. When the county agreed to increase the contract by $685,000, they re-absorbed that risk. Conclusions It is clear that the original contract with CFMG was adopted in a hostile climate of negative media exposure, adverse public reaction to situations in the jail, and the concern about potential litigation. Under these circumstances, using CMA accreditation as a primary driver for a successful jail medical program might well have been justified. Time has moved on, however, and realities have changed. While potential litigation is always a concern, a Santa Clara survey of eight counties throughout the state indicates it is far from a primary concern. The survey further indicates that some counties have chosen to forgo meeting Title 15 and/or CMA standards in consideration of budget restraints. All counties surveyed show budget reductions and the rising cost of care to be the primary drivers. The challenges presented by the dual obligation of providing health care to inmates, and doing it in the most effective and economical way is being dealt with by county officials whose primary obligation is to provide a safe and secure community. Sonoma county statistics parallel those indicated in the survey. For the period 2000 through 2005, the average number of claims going beyond detention center administration was seven per year. Out of the forty-three claims, 29 were handled without cost to the county. While there were spikes in 2001 and 2004 in litigation costs, overall costs, even in those years remained within acceptable parameters. Health care, especially for inmates, presents challenges quite outside the scope of their primary function. The general standard set by Title 15 is that the medical care in the jail reflects that in the community. All information received by the grand jury indicates that the standard of care in the jail greatly exceeds that of the community. Changing circumstances mandate close attention to inmate medical care, especially in light of the past several years of severe cost overruns. Expert monitoring and oversight by the county have become mandatory. If that is not accomplished, it is reasonable to expect that down the road the county jail medical will have at least one “Million Dollar Inmate.” The County Administrative Office has also expressed interest in the “catastrophe” medical challenge and has begun a project to examine the issue. Commendations The grand jury reviewed possible overtime costs for transportation issues utilizing custody staff in overtime pay for fiscal year 2004/2005. A laudatory note must be given to the Sheriff’s transportation staff for conducting over 240 inmate transports, which incurred only 6.5 hours of overtime. This overtime was charged on two instances for a single inmate.

Related Recommendations (1)

R12: Require expense-based information to be used to determine whether the contract price is commensurate with the cost of services rendered.

Additional Recommendations 5

Not linked to specific findings.

R13: Develop a list of preferred physician providers.

R14: The Sheriff’s Department and Information Systems Department should explore and develop technological improvements in tracking county jail medical services.

R15: The Sheriff’s Department and medical provider should develop alternative methods of distribution for other-than-prescription medications - specifically distribution through commissary or vending machines.

R16: Obtain from the medical provider the required insured endorsements.

R17: Create a task force to examine the changing realities effecting health care in the county detention facilities. Required Responses to Findings None Requested Responses to Recommendations None Required Responses to Recommendations Sonoma County Sheriff – R1, R2, R4, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R17 Board of Supervisors – R11, R12, R17 Sonoma County Administrator – R1, R2, R3, R5, R8, R9, R10, R11, R12, R17 Sonoma County Risk Management – R1, R4, R5, R15, R16, R17 Information Systems Department - R14 9

June 27, 2006 — This Land is Your Land a Report on the Sonoma County Open Space District June 27, 2006

17 pages 8 findings 3 recommendations

Quick View Full Details →

Findings & Recommendations 8 findings

F1: The key element in the selection process employed by the Open Space District is the Acquisition Plan. The plan currently in use – Acquisition Plan 2000 - establishes four basic criteria by which properties are evaluated. These are agriculture, greenbelts, natural resources, and recreation. Maps of Sonoma County outlining key areas for land use in each of the categories are contained in the plan and the extent to which a property is located in one or more of these areas is used to establish a priority for that property. The plan is well founded and an excellent means of selecting potential acquisitions.

F2: Procedures to be followed by the district in processing applications are well established and documented. Examples of this documentation are given by the flowcharts shown in Exhibit Two following this report.

F3: The use of an independent professional appraiser to determine the current market value of properties under consideration ensures that the district will not pay more than a fair price for an easement or for a property purchase.

F4: Under the measure that was passed in 1990 all funds collected from the sales tax were to be used to purchase easements and properties. There was no provision per se for funds to be used for the maintenance of purchased easements or properties. The district has, however, developed an effective stewardship program that involves the use of volunteers and other concerned citizen organizations.

F5: At the time the original measure creating the district was passed in 1990, California law required a 2/3rds majority vote to pass any tax measure adopted by the county. However, by establishing the authority as an independent taxing agent, the sales tax measure passed with a simple majority vote. Since that time California law has been changed to eliminate this possibility so that today there is no advantage in having a separate authority. The county itself could levy the sales tax if approved by the voters and thus provide the funds needed by the district.

Related Recommendations (1)

R1: The Board of Supervisors should consider merging the Open Space Authority into the district. It served a purpose in getting voter approval of the sales tax in 1990, but that purpose no longer exists. From a purely financial standpoint the County Treasurer and Tax Collector could easily take over the role now performed by the authority. The only reason to perpetuate the authority would be for its function as an oversight agency approving the work of the district.

F6: In the early years, much of the activity of the district was centered on the obtaining of agricultural easements. In recent years, as the value of property in Sonoma County has escalated, more property owners have been interested in the outright sale of their holdings and the emphasis has shifted to the buying of property.

F7: The Citizens’ Advisory Committee was originally designed to give the general public a voice in directing the operations of the district. However, over the years its role has been greatly diminished so that today it is viewed simply as a conduit by which public opinion can be relayed to the district.

Related Recommendations (1)

R2: The Board of Supervisors should consider restructuring the Citizens’ Advisory Committee to give it greater responsibility for overseeing the work of the district. If this were done, the committee could assume the role now given to the authority. To do this it would probably be necessary to reduce the size of the committee to make it more workable.

F8: Members of the Board of Directors of the Open Space Authority are appointed to a four- year term and are generally reappointed for successive terms. Some current members of the board have served since its inception 15 years ago. Conclusions Based on our findings in this investigation, the grand jury is satisfied that the procedures put in place for evaluating properties being considered for purchase ensure that funds which are 6 available to the district are being used in an effective manner to preserve the scenic beauty and the agricultural heritage of Sonoma County. Commendations The grand jury would like to thank all those persons who gave their time and effort to enable us to conduct this investigation.

Related Recommendations (1)

R3: If the Open Space Authority is retained, there should be a two-term limit imposed on board members. Eight years is long enough for one individual to serve in this capacity. Required Responses to Findings None Requested Responses to Recommendations None Required Responses to Recommendations Board of Supervisors – R1, R2, R3 7 Open Space District Work Process Flow Chart Courtesy of Open Space District 8 Open Space District Work Process Flow Chart Courtesy of Open Space District 9 Lands protected by the Open Space District Courtesy of Open Space District 10 OPEN SPACE DISTRICT ACQUISITION INVENTORY Project Name Type Acres Price Category* Location Fiscal Year 1992-1993 Marty Easement 223 495,000 Meachem Hill, Highway 101, Petaluma/Rohnert Park McCord Easement 3,053 700,000 Mayacamas/Alexander Valley Northeast of Healdsburg Cloudy Bend Easement 368 100,000 Lakeville Highway, SE of Petaluma Fiscal Year 1993-1994 Sebastapol Railroad Easement 8 20,000 Between Highway 12 and Bike Path, Sebastopol Doerksen Easement 120 107,000 St. Helena Road, Santa Rosa Alba Lane Fee 31 635,000 Santa Rosa/Larkfield, Highway 101 White Easement 41 448,000 Santa Rosa/Larkfield, Highway 101 St. Francis Vineyards Easement 92 875,000 Highway 12 at Sonoma Creek, Kenwood Vasila Easement 200 125,000 Bloomfield Road Brown Easement 14 190,000 Horn Avenue, Santa Rosa/Rohnert Park Burns Easement 560 425,000 Spring Hill Road, West Petaluma St. Luke's Fee 33 $660,000 Old Redwood Highway, Santa Rosa/Larkfield Dougan Easement 376 350,000 Bloomfield Road Cotati Highlands Easement 317 2,080,000 Meachem Hill Highway 101, Santa Rosa/Rohnert Park Fiscal Year 1994-1995 San Francisco Fee 28 133,000 Whittier Ave., Santa Rosa Archdiocese Lorenzini Easement 221 500,000 Between Salt Point SP and Stillwater Cove, Rohnert Park De Loach Easement 75 535,000 North of Arata Lane. Windsor Ziedrich Easement 42 140,000 North of Arata Lane. Windsor Fitch Mountain Easement 4 0 Russian River, East of Healdsburg 11 Project Name Type Acres Price Category* Location Fitch Mountain Easement 179 1,030,000 Russian River, East of Healdsburg Myers Ranch Easement 373 100,000 Coleman Valley Road West of Occidental Fox Easement 22 150,000 Russian River, NE of Healdsburg Diggers Bend Easement 33 $300,000 Russian River, NE of Healdsburg Haroutunian South Fee 21 169,200 Santa Rosa/Rohnert Park Separator Stony Point Ranch Easement 285 470,000 Gravenstein Highway, Cotati Carinalli Easement 245 760,000 Laguna de Santa Rosa Vicinity Graton RR R-O-W Easement 16 174,356 Occidental Road, south of Graton and Forestville Alba Lane/ St. Easement 63 680,000 Santa Rosa/Larkfield Highway 101 Lukes(Resale) Lang Easement 243 1,250,000 Porter Creek Road Fiscal Year 1995-1996 Silberstein Easement 12 200,000 Windsor/Larkfield Separator Dutton Ranch Easement 69 315,000 Highway 116 South of Graton Freiberg & Henshaw Easement 203 1,250,000 NE face of Sonoma Mountain Moon Ranch Easement 381 1,400,000 Sonoma Mountain (west) Silacci Easement 196 495,000 Lakeville Highway Arbor Farms Easement 306 1,400,000 Napa-Sonoma Highway Santa Angelina Easement 7,877 1,725,000 Highway 128 to Lake County line McCormick Ranch Easement 1,364 1,700,000 Los Alamos Road - Hood Mountain Matteri Easement 116 342,000 Ylanda/Petaluma Hill Road Taylor Mountain Alman Marsh Easement 27 54,000 East of Highway 101 South Petaluma Unity Church Fee 21 400,000 Old Redwood Highway Santa Rosa/Larkfield/Windsor Anderson Easement 30 220,000 North Cloverdale Palm Terrace Easement 8 900,000 Laguna de Santa Rosa Sebastopol 12 Project Name Type Acres Price Category* Location Mickelsen Easement 419 670,000 Meacham and Pepper Roads Northwest Petaluma Herzog Easement 561 990,000 Lakeville Highway Southeast of Petaluma Fiscal Year 1996-1997 Knudsen Easement 221 423,000 Roblar Road East of Cotati McNear Peninsula Easement 10 184,500 Petaluma River Downtown Callahan Easement 106 550,000 North of Healdsburg Treadwell Easement 10 100,000 Russian River North of Cloverdale Weston Easement 1,160 1,650,000 South and East of Healdsburg Guttman Easement 158 400,000 Porter Creek & Franz Valley McCormick Ranch Easement 1,011 650,000 Los Alamos Road Hood Mountain Yee Easement 630 $795,000 South of Petaluma Youing/Amos Fee 45 370,000 Santa Rosa/Rohnert Park Separator Fiscal Year 1997-1998 McCrea Easement 287 1,200,000 NE face of Sonoma Mountain Geary Easement 592 2,300,000 Bennett Peak Hopper Easement 87 285,000 Estero Americano near Bodega Bay Morrison Brothers Easement 137 375,000 Santa Rosa/Rohnert Park Separator Keegan & Coppin Fee 24 550,000 Bennett Valley Road Windsor Oaks Easement 711 1,600,000 North of Windsor Wright Preservation Bank Fee 173 1,650,000 Occidental Road Magers Easement 62 80,000 Gray Creek Watershed Aggio Easement 249 485,000 Petaluma/Rohnert Park Separator Gustafsson Easement 31 134,000 Austin Creek State Recreation Area Haroutunian North Fee 18 395,000 Santa Rosa/Larkfield Separator Oken Fee 76 890,000 Santa Rosa/Larkfield Separator Fiscal Year 1998-1999 Sonoma Developmental Easement 290 255,000 Adjacent to Jack London State Park Center 13 Project Name Type Acres Price Category* Location White II Easement 15 235,000 Larkfield/Windsor Separator Dashiell/Molle Easement 83 330,000 Petaluma Hill Road Lang Easement 0 0 Porter Creek Road Amendment Bodega Bay Fire Easement 1 50,000 Bodega Bay Protection Dist. Hafey Easement 501 900,000 Knights Valley Highway 128 Monte Rio School District Easement 4 188,000 Near Monte Rio Community Center Bath/Watt Fee 46 790,000 North side Taylor Mountain Mazzetta Easement 481 990,000 Pepper and Meachem Roads Petaluma Nathanson Creek Easement 1 95,000 Park/Sonoma Valley High School Mom's Beach Easement 11 70,000 River Road NW of Forestville Skiles Easement 171 632,000 Adjacent to Jack London State Park Nahmens Easement 255 1,150,000 Canfield Road South of Sebastopol Fiscal Year 1999-2000 Nunes Fee 120 975,000 Taylor Mountain Colliss Easement 1,578 1,025,000 Coleman Valley Road Windor Town Green Easement 3 764,500 Historic Windsor Matteri Fee 116 398,000 Lower slopes of Taylor Mountain Mickelsen/Camozzi Easement 256 1,500,000 Two Rock Valley McCord Easement 3 0 Northeast of Healdsburg Fiscal Year 2000-2001 Unity Church Transfer to Old Redwood Highway Santa Regional Parks Rosa/Larkfield/Windsor Red Hill Easement 911 1,370,00 Recreation Adjacent to Sonoma Coast State Beach Grove of the Old Trees Easement 28 1,250,000 Natural Resources Fitzpatriock Lane Occidental Cook Easement 519 1,700,000 Greenbelt Lichau Road East of Rohnert Park Modini Easement 1725 1,044,000 Natural Resources Pine Flat Road Alexander Valley Glen Oaks Easement 234 1,500,000 Greenbelt Highway 12 near Glen Ellen Solak Easement 1 165,000 Recreation West County Trail Dewar Easement 40 284,750 Natural Resources Estero Americano 14 Project Name Type Acres Price Category* Location Ho Fee 30 560,000 Greenbelt Petaluma Hill Road Fiscal Year 2001-2002 Laguna Farms 1,440 0 Greenbelt Laguna de Santa Rosa Cooley Ranch Easement 19,064 5,750,000 Natural Resources Adjacent to Lake Sonoma Lelmorini Easement 1,218 1,800,00 Coastal Agriculture Highway One Richardson Easement 2 53,000 Recreation Sonoma/Marin Line Addition to Cloverdale Azevedo Easement 236 1,750,000 Coastal Agriculture River Park Fallon Road, Two Rock Valley Morelli Ranch Easement 454 2,161,000 Greenbelt Western slopes Sonoma Mountain Natural Resources Martin Ranch Easement 429 1,600,000 Coastal Agriculture Valley Ford Two Rock Valley Balletto Easement 253 2,600,00 Greenbelt Laguna de Santa Rosa Bianchi Easement 631 1,518,000 Coastal Agriculture Highway One Freestone Valley Ford Fiscal Year 2002-2003 Paulin Creek Fee 9 1,575,000 Recreation Open Space Preserve Scott Easement 533 3,345,000 Greenbelt, Western slopes of Sonoma Agriculture Mountain McCullough Easement 284 2,898,500 Natural Resources Mark West Creek Keiser Park Easement 7 1,140,000 Recreation Town of Windsor Rigler Easement 415 850,000 Recreation Coleman Valley Road Natural Resources Riverfront Park Easement 305 3,803,000 Recreation Russian River Girouard Easement 1 18,500 Recreation Cloverdale River Park Keen Easement 61 350,000 Natural Resources Norrborn Road North of Sonoma Prince Memorial Easement 1 4,000,000 Recreation Downtown Santa Rosa Greenway Grossi Easement 48 315,000 Greenbelt Petaluma Hill Road Agriculture Sunset Beach Easement 21 616,000 Recreation Russian River County Regional Parks Asbomo Fee 98 4,250,000 Recreation North of Healdsburg Johnson Fee 297 3,000,000 Recreation Expansion of Hood Mountain Regional Park 15 Project Name Type Acres Price Category* Location Johnson Access Fee 3 1,025,000 Recreation Expansion of Hood Mountain Regional Park Carrington Fee 335 4,800,000 Recreation Highway One Sonoma Beach to Salmon Creek Brayton Easement 130 1,301,500 Agriculture Pepper Road Petaluma Fiscal Year 2003-2004 Indian Valley Easement 24 465,000 Natural Resources Laguna de Santa Rosa Connolly Easement 63 250,000 Greenbelt Dutcher Creek Road Cloverdale Jacobs Ranch Fee 168 4,878,000 Greenbelt Sonoma Mountain Area Fox Pond Fee 53 2,880,000 Recreation Healdsburg Ridge Flocchini Easement 153 780,000 Agriculture Petaluma River Wetlands Skiles State Park Fee 47 0 Recreation Adjacent to Jack London (State Coastal Conv. Grant) Martinelli Fee 261 1,092,000 Natural Resources Lakeville Highway Petaluma Recreation Wilroth Easement 240 2,220,000 Natural Resources Adjacent to Fairfield Osborne Greenbelt Preserve Barella/Roblar Ranch Easement 758 2,269,500 Agriculture Petaluma Valley Ford Road Eliot Trust(Donation) Easement 71 0 Agriculture Sonoma Mountain Greenbelt Fiscal Year 2004-2005 Van Hoosear Wildflower Easement 160 3,300,000 Natural Resources Base of Sonoma Mountain Preserve Beltane Ranch Fee 1,290 9,115,000 Recreation Potential Addition to Sugarloaf Ridge State Park Sebastopol Skate Park Fee 1 125,000 Recreation City of Sebastopol Maffia, Eda Easement 245 1,150,000 Agriculture Dickson Fee 648 2,800,000 Natural Resources Sonoma Baylands Wilroth (Donation) Fee 11 0 Greenbelt Adjacent to Fairfield Osborne Natural Resources Preserve Cooper's Grove Fee 226 4,865,000 Recreation Sonoma Mountain Road Summer Home Park Fee 3 365,000 Recreation Sunset Beach Regional Park Easement 69 Willow Creek Fee 3373 10,225,000 Recreation Sonoma Coast State Beach Easement 515 225,000 Tolay Lake Ranch Fee 17,737 11,176,018 Recreation Cannon Lane East of Petaluma 16 Project Name Type Acres Price Category* Location Lawson Fee 247 1,160,000 Recreation Addition to Hood Mountain Regional Park Prince Gateway Park Fee 1 405,000 Recreation Downtown Santa Rosa Camp Gulala Easement 425 400,000 Natural Resources Skaggs Spring Road East of Annapolis Montini Ranch Fee 152 11,300,000 Greenbelt Borders City of Sonoma Easement Natural Resources Saddle Mountain Fee 960 9,213,000 Natural Resources Calistoga Road Near Santa Rosa Recreation * Acquisition Plan Categories are those in Acquisition Plan 2000. These were not used prior to 2000. 17

June 27, 2006 — This Land is Your Land a Report on the Sonoma County Open Space District June 27, 2006

17 pages 8 findings 3 recommendations

Quick View Full Details →

Findings & Recommendations 8 findings

Related Recommendations (1)

June 27, 2006 — Through the Healthcare Looking Glass Healthcare in Peril June 27, 2006

9 pages 13 findings 6 recommendations

Quick View Full Details →

Findings & Recommendations 13 findings

F1: In a recent survey by the Sonoma County Medical association, 47% of doctors surveyed are considering discontinuing their practices within the next five years.

F2: Specialty care providers in some specialties are scarce. Consumers may wait for 6-8 weeks for an appointment.

F3: Hospitals are caught in a fiscal squeeze. Higher costs for patient care are not keeping pace with flat reimbursement rates.

F4: There is only one contractually obligated hospital to care for the uninsured in Sonoma County.

F5: The county funds help to support eight (outpatient) community clinics in our county. Each operates as a separate entity, duplicating administrative and billing services. Each clinic operates with different payment options.

Related Recommendations (1)

R3: The grand jury recommends that the Board of Supervisors create an independent, interdisciplinary agency that oversees healthcare resources, coordinates communications, and problem-solves among healthcare providers to conserve resources in the county.

F6: One community clinic closed its doors to new patients. It never reported to anyone that it was “full to capacity.”

F7: Some ERs (Sutter and Kaiser) can arrange an appointment to provide follow-up care. 6

F8: The resident M.D. training program has been downsized. These practitioners have historically provided care to low income and uninsured patients. Many of the resident physicians will not stay in Sonoma County to start medical practices because of the high cost of living and the low reimbursement rates.

F9: The Jewish Community Free Clinic sees patients that cannot afford care elsewhere. They report that patient numbers are steadily increasing. This indicates that the concept of the “safety net” for medical care is not working.

Related Recommendations (1)

R1: The grand jury recommends that within the next year, the Board of Supervisors organize a healthcare symposium with stakeholders to discuss approaches to healthcare issues in Sonoma County. The grand jury recommends that the Board of Supervisors attempt to coordinate with Sonoma State University on such a symposium.

F10: Fewer employers are providing health insurance as a benefit.

F11: Eligibility for assistance programs is based on income according to federal poverty guidelines. The high cost of living in Sonoma County is unsustainable for workers at poverty level.

F12: One community clinic has a waiting list of 200 patients for mental health counseling services.

F13: Dental services for people with low income, Medi-Cal, or without insurance are very difficult to obtain. Conclusions The healthcare organization in Sonoma County is broken. The healthcare providers are overburdened and are not able to offer reorganization changes. Sonoma County does not have an organized healthcare system. Because there is no organized system, costly services are duplicated and patient information exchange is impeded. The outpatient clinics serve as a “safety net” to provide primary healthcare when that care cannot be obtained otherwise. There is no mechanism that can determine when the outpatient clinics have reached their limit in accepting new patients and when a new clinic should be formed. There is no provision within the county for establishing a new primary care clinic or a network of clinics. If there were adequate healthcare services, then the “free clinics” would not have a need to exist. The free clinics do not openly advertise their existence, but even so, their capacity is stretched to the limit. The Board of Supervisors is only partially addressing the problem of the lack of healthcare for the uninsured when it sends money to the local clinics and subscribes to the CMSP program. The Board may wish to investigate and support changes involving the mentioned issues. By encouraging the creation of an organized system, taxpayers would ultimately benefit. It is reassuring to think that Alice escaped the underground insanity of Wonderland with its cat and rabbit that kept disappearing. She was able to return to a safe and stable above-ground world. It is time for the citizens of Sonoma County to seek a safe and stable solution to the problem of healthcare access. There are alternatives to CMSP. One such program exists in Santa Cruz County. Perhaps other models are available for comparison. Commendations 1. Emergency room personnel do attempt to refer patients to medical assistance programs if patients identify that they are in need. 2. Application Assistants are available to help with assistance forms. 3. Multiple language translation is available in all clinics. 7 4. Volunteers and local healthcare providers donate their time, and local medical and nursing students staff the Jewish Community Free Clinic. 5. Sonoma State University has an extensive consortium and program that is studying the problems of healthcare in Sonoma County. 6. Redwood Community Health Coalition is a coalition of outpatient clinic representatives in Sonoma and neighboring counties that meet monthly to discuss problems of mutual concern.

Related Recommendations (5)

R2: The grand jury recommends that the Board of Supervisors develop written critical pathway system concerning healthcare access in Sonoma County.

R4: The grand jury recommends that the Public Health Department and the Board of Supervisors work to develop a central information center for consumers.

R5: The grand jury recommends that Information Services Department create an Internet link on the official Sonoma County website to give general information about CMSP and the clinics that will accept this program.

R6: The grand jury recommends that Human Services and the Board of Supervisors research alternatives to current CMSP that will be more accessible to consumers and cost-effective to taxpayers. Required Responses to Findings None Requested Responses to Recommendations Sonoma State University – R1 Redwood Community Health Consortium – R3 Required Responses to Recommendations Board of Supervisors – R1, R2, R3, R6 Public Health Department – R2 Public Health Department – R4 Information Systems Department (ISD) for the County of Sonoma – R5 Human Services Department – R6 8 Access to Healthcare Facilities? It depends!!---Who are You? Comparative $$$ $$ $ $$ Cost Emergency Urgent Free Primary Specialty Care Care Clinics Care Care (Single (Single Visit) Visit) Children Yes Yes Unnecessary Yes Yes Employed Yes Yes Unnecessary Yes Yes, with Insurance with limits Employed Yes Yes Yes Notes 1 and Note 2 5 without Insurance Medicare Yes Yes Unnecessary Note 1 Note 3 Covered Indigents Yes Yes Yes Yes Yes Undocumented Yes Yes Yes Notes 4 and Notes 4 and 5 5 Prison Inmates Unlimited --- --- Unlimited Unlimited Free Free Free Veterans and Coverage Coverage Coverage Dependents Note 6 Note 6 Note 6 Note 6 Note 6 Notes: 1. May be difficult to receive care in a timely manner 2. If paying, may be seen without primary care referral 3. Requires primary care referral 4. Requires payment 5. CMSP coverage possible 6. Eligibility for VA benefits depends upon individual circumstance 9

June 27, 2006 — The Impact of Yesterday’s Promises June 27, 2006

6 pages 5 findings 5 recommendations

Quick View Full Details →

Findings & Recommendations 5 findings

F2: California Public Employees Retirement System (CalPers) is the pension plan of choice. During our interviews it became apparent, that actuarial expertise and plan management were highly respected.

Related Recommendations (1)

R2: The grand jury recommends that the Board of Supervisors and/or City Councils enlist actuarial expertise to audit this asset/obligation disclosure.

F3: Health care coverage costs have doubled in the past five years and are projected to double again in the next five years. Insurance providers blame this on the costs of new technology.

Related Recommendations (1)

R3: The grand jury recommends that the advice of an expert should be solicited to consider the fairest most equitable way to offer health care benefits to public employees. This should be disclosed.

F4: The State of California, as quoted in the Sacramental Bee, sees the way out of this situation of unsustainable health care promises: the solution, “just quit promising health care for life. That’s what the Medicare system is for.”

Related Recommendations (1)

R4: The grand jury recommends to build a secure structure for maintenance of employee benefits should not be deferred.

F5: Reserve funding will be mandatory for all employing entities offering benefits for life. This is nothing new to pension providers, however, it will be new for health care, dental care, life insurance or any other promises for life. A mismatch between assets and liabilities has to be addressed. Full disclosure will provide this information.

Related Recommendations (1)

R5: The grand jury recommends full disclosure of each entities total benefit obligations along with information describing provisions to secure them. We are requesting this information between the end of each entities current fiscal year and December 31, 2006: • Number of employees eligible for pension premiums • Number of retired employees receiving pension benefits • Financial obligation • What reserves are in place to insure these pension obligations • Obligation for health care coverage • Reserve amount in place • Amount required by federal authorities to secure these health care benefits. Required Responses to Recommendations Sonoma County Board of Supervisors

F6: Both current employees and retired employees will benefit from the security of knowing that what they expect and have been promised is not dependent on the whims of the future. Conclusions In the past, employees in the private sector set the standards for the public sector employees in wages, hours and working conditions. In order to attract the most qualified workers, employers often competed with generous benefit offerings. In addition, upon retirement benefits were maintained for life as a way of showing appreciation for their loyalty. These generous offerings have collapsed in the private sector. Public municipalities will have to raise taxes, cut other services and layoff workers, if there are not enough assets or reserves to meet the requirements of the new accounting laws. Reportedly, this has happened in other states. Private sector employees have had to experience sacrifices in companies including, but not limited to Hewlett-Packard, General Motors, IBM, United Airlines, Verizon, etc. Perhaps public employees would not be subject to this, if the problem were addressed now and not deferred to future taxpayers. The grand jury found a bleak outlook for the continuance of generous promises. Actuarial information is that future costs will continue to rise and securing already made promises will likely include higher deductibles from the employee for care along with cost sharing premiums. The impact would be less take home pay. Figures furnished to the jury by providers indicated that driving up these costs are early retirements without Medicare eligibility. Boomers and the age group between 50 and 65 out-spend health care premiums by 164% and the figure for all retirees out-spending health care premiums is 131%. Overhead for insurance companies has tripled since 1993 according to the data furnished to us. This is also a reason for escalating health care benefit costs. Commendations The grand jury would like to acknowledge the City of Rohnert Park for publicly disclosing the findings of a recent actuarial study regarding the City’s financial status. Reports are that the City is currently $52 million short of what is needed to cover health care promises now on the books. They are looking for ways to address this deficit by cutting services and/or asking for an additional sales tax.

Additional Recommendations 1

Not linked to specific findings.

R1: The grand jury recommends that Supervisors, Council members and financial officers should verify that health or other lifetime benefit promises are secured properly and in compliance with reserve funding standards.