June 6, 2005

NOTICE OF PUBLIC HEARING

The Board of Supervisors of the County of Contra Costa will conduct a PUBLIC HEARING pursuant to Health and Safety Code Section 1442.5, on the elimination of and/or reductions in the level of medical services provided by the County, and/or the closing of County health facilities. The hearing will be held at the following time and place:

Tuesday, June 21, 2005, at 1:00 p.m.

Board of Supervisors Chambers

Room 107, County Administration Building

651 Pine Street

Martinez, CA 94553

At the hearing, the Contra Costa County Board of Supervisors will consider the impact on the health care needs of the County’s indigents of the implementation of the changes set forth in the attached notice.

The Board does not consider all of the program changes in the attached notice to be within the required coverage of Health and Safety Code Section 1442.5. Its scheduling of this Hearing, giving this Notice of Public Hearing, the holding of a Hearing, and the making of any findings, shall not be construed as an admission by the County of Contra Costa, or the Board of Supervisors, that any of the actions included in the attached notice are subject to the hearing provisions of Health and Safety Code Section 1442.5.

BEILENSON NOTICE

FISCAL YEAR 2005/06

1. REDUCE PUBLIC HEALTH OUTREACH AND EDUCATION COLLABORATION (PHOEC) PROGRAM

(Item #10 on HSD Program Reduction List)

PHOEC staff work with high-risk communities and key Health Services programs to improve patient access to health services and build community skills to utilize county health services and address community health problems.

Site:

Countywide

Nature of change:

Reduce community improvement and health care access outreach services

Staff reductions:

0.4 FTE Community Health Worker II

Patient services affected:

Approximately 500 community residents will receive less community building assistance in addressing community health problems

Expected annual savings:

$52,000

2. REDUCE CALIFORNIA CHILDREN’S SERVICES (CCS) PROGRAM

(Item # 11 on the HSD Program Reduction list)

Occupational and physical therapists in the CCS program provide occupational and physical therapy services to children with physical disabilities who qualify for this program.

Site:

Castro Medical Therapy Unit

1435 Lawrence St.

El Cerrito

Nature of change:

Eliminate 30 hours of Occupational and physical therapy treatment at the Castro Medical Therapy Unit.

Staff reductions:

0.5 FTE Occupational Therapist I

0.15 FTE Occupational Therapist II

0.5 FTE Physical Therapist I

1.0 FTE Occupational Therapist II

Patient services affected:

Currently, the Castro Medical Therapy Unit sees an average of 100 children per week. It will be necessary to establish a waiting list for services, should the remaining staff be unable to treat all the children who need therapy services.

Expected annual savings:

$74,000

3. CANCEL NON-EMERGENCY TRANSPORTATION CONTRACTS

(Item #14 on the HSD Program Reduction List)

The Health Services Department contracts with West Contra Costa Transit Authority, Eastern Contra Costa Transit Authority dba Tri-Delta Transit, Concord Yellow Cab Inc., Medic-Mobile, Inc., and Bay Medic Transportation for non-emergency transportation services (taxicab, ambulance transport, and public transportation). These non-emergency transportation services are used to help patients access medical care at the hospital and health centers and return home.

Sites:

Contra Costa Regional Medical Center

Brentwood Health Center

Antioch Health Center

Pittsburg Health Center

Bay Point Health Center

Concord Health Center

Martinez Health Center

North Richmond Health Center

Richmond Health Center

Nature of change:

Cancel the non-emergency transportation contracts with West Contra Costa Transit Authority, Eastern Contra Costa Transit Authority dba Tri-Delta Transit, Concord Yellow Cab Inc., Medic-Mobile, Inc., and Bay Medic Transportation.

Staff reduction:

None

Patient services affected:

It may be more difficult for some patients to access medical care and return home.

Expected annual savings:

$175,000

4. REDUCE TEENAGE PROGRAM (TAP)

(# 19 on HSD Program Reduction List)

TAP staff provide health education presentations in high schools focusing on responsible decision making, substance abuse prevention, tobacco use prevention, reproductive health, drinking/driving risks, and communication skills. TAP provides mentoring to high school students in health and legal fields. TAP has a Junior Health Facilitator Program that provides intensive job training and economic development skills to high school youth.

Site:

Countywide

Nature of change:

Reduce the number of health presentations at high schools. Eliminate the Mentor Program and the Junior Health Facilitator Program.

Staff reductions:

4 FTE Student workers

3 FTE Administrative Interns

Patient services affected:

Presentations to approximately 9,000 high school students will be eliminated. Mentoring services on health issues to approximately 75 high school students will be eliminated. The Junior Health Facilitator Program will be eliminated.

Expected annual savings:

$240,000

5. REDUCE PUBLIC HEALTH CLINIC SERVICES

(Item #20 on HSD Program Reduction List)

The Health Services Department operates mini-Family Planning Clinics for low income, underserved, medically vulnerable women and teenagers in order to provide access to medical care. Patients are given information on birth control and disease prevention. Services are provided to young women on the prevention of unwanted pregnancies and other female health issues.

A. PITTSBURG HEALTH CENTER

Site:

Pittsburg Health Center

2311 Loveridge Road

Pittsburg

Nature of change:

Eliminate Pittsburg mini-Family Planning Clinics on Mondays, Tuesdays, Wednesdays, Thursdays, and Fridays, 9am - noon.

Staff reduction:

0.4 FTE RN

0.4 FTE Clerk Experienced level

Patient services affected:

Birth control information and disease prevention information will not be provided to approximately 800 women and teenagers.

Expected annual savings:

$50,201

B. RICHMOND HEALTH CENTER

Site:

Richmond Health Center

38^th and Bissell

Richmond

Nature of change:

Eliminate Richmond mini-Family Planning Clinics on Mondays, Tuesdays, Wednesdays, and Fridays, 9am - noon.

Staff reduction:

0.4 FTE RN

0.4 FTE Clerk Experienced level

Patient services affected:

Birth control information and disease prevention information will not be provided to approximately 800 women and teenagers.

Expected annual savings:

$50,201

C. BAY POINT HEALTH CENTER

Site:

Bay Point Health Center

215 Pacifica Ave

Bay Point

Nature of change:

Eliminate Bay Point mini-Family Planning Clinics on Wednesdays, 9am - noon.

Staff reduction:

0.1 FTE RN

0.1 FTE Clerk Experienced level

Patient services affected:

Birth control information and disease prevention information will not be provided to approximately 200 women and teenagers.

Expected annual savings:

$12,702

D. BRENTWOOD HEALTH CENTER

Site:

Brentwood

Nature of change:

Eliminate Brentwood mini-Family Planning Clinics on Tuesdays, 9am - noon.

Staff reduction:

0.1 FTE RN

0.1 FTE Clerk Experienced level

Patient services affected:

Birth control information and disease prevention information will not be provided to approximately 200 women and teenagers.

Expected annual savings:

$12,702

Total

$125,806

6. REDUCE CHILDREN’S ORAL HEALTH PROGRAM

(Item # 21 on HSD Program Reduction List)

The Children’s Oral Health Program currently provides dental prevention and educational services to approximately 20,000 children, and dental screening services to approximately 16,000 children, annually, in pre-schools and elementary schools. Most of the services are provided to low income children who may have no other source of dental care.

Site:

Countywide

Nature of change:
Reduce staff in the Children’s Oral Health program, which will reduce the number of dental screenings and dental referrals.

Staff reduction:

1.0 FTE Sr. Public Health Dental Assistant

1.0 FTE Sr. Health Education Specialist – Project

Patient services affected:

Eliminate 9,000 annual dental screenings. Eliminate dental health education sessions to 10,000 children, annually.

Expected annual savings:

$164,000

7. REDUCE CHILD HEALTH AND DISABILITY PREVENTION (CHDP) PROGRAM

(Item #22 on HSD Program Reduction List)

The CHDP Program provides outreach services and assistance to families with children who do not have medical insurance or a health care source in order to obtain access to health care for their children. CHDP also provides education on health care and resources. Many of these families are mono-lingual Spanish speaking.

Site:

Countywide

Nature of change:

Reduce assistance to low income families in obtaining necessary health care for their children. Eliminate Spanish language interpreters who assist with health care access for mono-lingual Spanish speaking families.

Staff reduction:

4.0 FTE Community Health Worker I

1.0 FTE Clerk Experienced level

Patient services affected:

Approximately 600 children who do not have medical care resources will lose assistance in enrolling in health care insurance coverage and receiving linkage to health care providers. Health care assistance for children in non-English speaking families will be limited and the wait time for this assistance will increase.

Expected annual savings:

$200,000

8. REDUCE TUBERCULOSIS (TB) CONTROL PROGRAM

(Item #26 on HSD Program Reduction List)

The Tuberculosis (TB) Control Program provides TB case management to persons with active tuberculosis, including home testing and treatment of TB contact, and daily monitoring of persons taking their TB medications.

Site:

All services in the cities of Richmond, El Cerrito, San Pablo, Pinole, and Hercules.

Nature of change:

Eliminate one public health nurse. Reduce monitoring of patients with tuberculosis.

Staff reduction:

1.0 FTE Public Health Nurse

1.0 FTE Sr. Disease Intervention Technician

Patient services affected:

Approximately 134 people who are at highest risk for tuberculosis will not be provided education, testing, or preventive TB treatment by a Public Health Nurse. Approximately 110 patients with TB infection will not receive directly observed therapy, monitoring assurance, or educational services.

Expected annual savings:

$248,801

9. REDUCE IMMUNIZATON PROGRAM OVERSIGHT

( Item #27 on HSD Program Reduction List)

The Immunization Program provides technical assistance to childcare centers and schools on immunization requirements for children, technical assistance to public and private medical providers, outreach to under-immunized populations, and educational campaigns to promote immunizations for children and adults.

Site:

Countywide

Nature of change:

Eliminate education and technical assistance to schools and childcare providers. Reduce outreach services, technical assistance, and immunization education/promotion to childcare providers. Reduce outreach services to under-immunized populations. Potential overall reduction in immunization rates for children in Contra Costa County.

Staff reduction:

1.0 FTE Public Health Nurse Program Manager

Patient services affected:

Approximately 10,000 children will not have their immunization records reviewed, with follow up outreach on needed immunizations. Approximately 150 physicians will not receive immunization education and expert consultation on vaccine preventable diseases.

Expected annual savings:

$152,659

10. INCREASE FEES FOR IMMUNIZATION CLINICS

(Item #28 on HSD)

Immunization clinics provide childhood immunizations to children throughout the county for school and day care entry and to travelers needing immunizations to enter foreign countries. Many children who do not have health care coverage and children whose health care providers do not stock vaccines receive services at these clinics.

Site:

Concord (Stanwell Clinic)

2355 Stanwell Circle

Concord

Nature of change:

Increase fees to cover the costs of administering and consulting on vaccines for travelers and of administering immunizations to children.

Staff reduction:

None

Patient services affected:

Families will pay higher fees for vaccine administration for their children and travelers will pay higher fees for needed vaccines and a fee for vaccine consultations.

Expected annual savings:

$100,000

11. REDUCE MEDICALLY VULNERABLE INFANT PROGRAM (MVIP)

(Item #29 on HSD Program Reduction List)

Pediatric nurses of MVIP provide long-term home visiting and infant health monitoring and care coordination to infants throughout the County. These infants have been cared for in neonatal intensive care units after birth and are at highest risk for developmental and neurological disabilities. MVIP also provides parenting and bonding education to parents of these special needs children.

Site:

Countywide

Nature of change:

Eliminate one public health nurse.

Staff reduction:

1.0 FTE Public Health Nurse

Patient services affected:

Approximately 50 special needs infants will not receive health monitoring and care coordination. Approximately 50 families with special needs children will not receive parenting/bonding educational services.

Expected annual savings:

$100,000

12. REDUCE MEDICALLY VULNERABLE INFANT PROGRAM (MVIP)

(#31 on HSD Program Reduction List)

Pediatric nurses of MVIP provide long-term home visiting and infant health monitoring and care coordination to infants throughout the County. These infants have been cared for in neonatal intensive care units after birth and are at highest risk for developmental and neurological disabilities. MVIP also provides parenting and bonding education to parents of these special needs children.

Site:

Countywide

Nature of change:

Eliminate the full time equivalent of 2.8 Public Health Nurses.

Staff reduction:

2.8 FTE Public Health Nurse

Patient services affected:

Approximately 150 special needs infants will not receive health monitoring and care coordination. Approximately 150 families with special needs children will not receive parenting/bonding educational services. The elimination of these Public Health Nurses will result in a dramatic reduction in health care monitoring and care coordination for high risk infants and a correspondingly dramatic reduction in parenting/bonding educational services to families with special needs children. As a practical matter, this reduction, if implemented, will result in the closure of MVIP and the loss of $250,000 in state matching funds.

Expected annual savings

$162,000

13. REDUCE CHILD HEALTH AND DISABILITY PREVENTION (CHDP) PROGRAM

(Item #32 on HSD Program Reduction List)

CHDP provides outreach services and assistance to families with children who do not have medical insurance or a health care source, in order to obtain access to health care for their children. CHDP also provides education on health care and resources. Many of these families are mono-lingual Spanish speaking.

Site:

Countywide

Nature of change:

Reduce assistance to low income families in obtaining necessary health care. Eliminate Spanish language interpreters who assist with health care access for mono-lingual Spanish speaking families.

Staff reduction:

3.0 FTE Community Health Worker I

Patient services affected:

Approximately 400 families with children who do not have medical care resources will lose assistance in enrolling their children in health care insurance coverage and receiving linkage to health care providers. Approximately 400 non-English speaking families will lose health care assistance for their children.

Expected annual savings:

$86,000

14. REDUCE PUBLIC HEALTH CLINIC SERVICES

(#34 on HSD Program Reduction List)

Public Health Clinic Services staff provide language translation for non-English speaking patients in the pediatric clinic and the women’s health clinics. In addition, these staff provide education and clerical support in the pediatric clinic, the women’s health clinics, the sexually transmitted disease(STD) clinics, and the mini-Family Planning Clinics. RN staff are used to provide patient education on pregnancy prevention, disease prevention, and family planning methods.

Site:

Brentwood Health Center

Bay Point Health Center

Pittsburg Health Center

Concord Health Center

Richmond Health Center

Nature of change:

Reduce language translation services.

Staff reduction:

3.0 FTE Community Health Worker

0.5 FTE RN

1.0 Clerk (contract)

Patient services affected:

Appointments for approximately 400 patients needing translation services will be delayed. Provider assistance in obtaining medical information from non-English speaking patients will be reduced and/or delayed.

Expected annual savings:

$280,519

15. REDUCE LIMITED ENGLISH ACCESS PROGRAM (LEAP)

(# 36 on HSD Program Reduction List)

LEAP staff provide translations, health education, and outreach services to newly-arrived refugees and immigrants, and others with limited English skills, to insure needed health care access and coordination. Staff work in clinics at CCRMC, Public Health, and in the community.

Site:

Countywide

Contra Costa Regional Medical Center

Martinez Health Center

Pittsburg Health Center

Richmond Health Center

Concord Health Center

Nature of change:

Reduce translation services in clinics and reduce outreach and coordination of care to persons who speak Laotian, Khmu, Vietnamese, Mien, and Spanish.

Staff reductions:

3.0 FTE Community Health Worker II

Patient services affected:

There will be a decrease in the ability to provide timely health services to approximately 300 non-English speaking people. Approximately 300 non-English speaking patients will not receive outreach and client navigation services. Appointment times for patients with translation needs will be delayed in the health centers.

Expected annual savings:

$200,000

16. LOWER ELIGIBILITY INCOME CEILING FOR BASIC HEALTH CARE (BHC) PROGRAM

(Item #38 on the HSD Program Reduction List)

The County’s indigent health care program is called the Basic Health Care (BHC) Program. The eligibility standards for the BHC Program currently provide that residents of Contra Costa County whose income is less than 300% of the Federal Poverty Guidelines may be eligible for the BHC Program, so long as they meet all other eligibility requirements.

Site:

Countywide

Nature of change:

The income ceiling for the BHC Program will be reduced from 300% of the Federal Poverty Guidelines to 200% of the Federal Poverty Guidelines.

Staff reduction:

None

Patient services affected:

Approximately 1,200 individuals who now qualify for the BHC Program will no longer qualify.

Expected annual savings:

$2,000,000