Silvano Marchesi, County Counsel, outlined the history of the County’s Better Government Ordinance adopted in 1995, which sets policy exceeding the requirements of the California Public Records Acts, notably in setting a very prompt initial response time to acknowledge the receipt of the request and information on the subsequent actions being taken to fill the request.

Chair Bonilla said the County has for many years had a strong commitment to providing public access to records above and beyond state requirements.

Dr. Walker, Health Servicecs Director, said his report would cover three main topics today: public access to records, ongoing efforts in regard to safety and quality of care in the Emergency Department Crisis Stabilization Unit, and the current status of the property at 20 Allen Street.

Dr. Walker recounted recent events in attempting to fill a records request from the Contra Costa Times regarding all Unusual Occurance Notification reports from the emergency department and inpatient psychiatric unit that were submitted to the state from 2004 until the present. To ensure compliance with patient confidentiality laws, the department sought the assistance of a law firm experienced with the handling of patient records and submitted the redacted records in accordance with the firm’s advice. The Contra Costa Times objected to the amount of redaction. The department sought review from County Counsel. The records were resubmitted with fewer redactions. The department has six more records that will be provided to the Times by week’s end. Dr. Walker said he believed the Times is now satisfied it’s request had been fulfilled. Dr. Walker further noted the challenges of not only protection of patient privacy, but over a span of years changing laws in regard to what information is gathered, the level of detail of information gathered, multiple changes to the report names, and new and more restrictive laws as time progresses.

The Board did not disagree with the decision made to retain outside counsel with expertise in the very sensitive area of patient confidentiality. The Board did request that in the future County Counsel be advised and included when legal opinions are deemed desirable or necessary, and that Counsel keep the Board informed of such matters.

Juliette Kelly, Interim Program Chief of Psychiatric Services reported on the current state and future plans for the Emergency Department’ Crisis Stabilization Unit:

The emergency department is the only intake location in Contra Costa County for psychiatric emergencies. Patients in crisis are brought to the emergency room, medically assessed and then taken to the other half of the emergency department, the Crisis Stabilization Unit (csu). After being stabilized, some patients are admitted to Contra Costa Regional Medical Center’s (CCRMC) psychiatric inpatient unit while others are placed in more appropriate places offsite, in accordance with their care needs. The csu is open 24 hours a day year-round. At this time the unit is for both children and adults, and patients are seen initially in the emergency department. The department derives its guidelines of operations from the Institute of Medicine’s Performance and Improvement Initiatives. The guidelines are safe, timely, efficient and effective care. The unit has adopted prior initiatives from the Institute in relation to staff education and weekly case conferences. The unit works closely with the mental health division to improve care throughout the County and achieve continuity of care when the patient leaves hospitalization. This year the unit has worked toward forming healthcare partnerships with patient families and medical and psychiatric care providers and volunteers in order to create the best support and case management for the patient.

Future plans for the unit include continuing to pursue comprehensive partnerships with all medical staff and volunteers to develop and sustain the best treatment and case management for the patient. Futher efforts will be made to improve the specialized “Code Gray” psychiatric emergency response teams and to standardize the precautions taken in the psychiatric emergency area for patients and staff members.

Dr. Walker updated the Board on the current status of the property at 20 Allen Street, Martinez. December 31, 2009 is the deadline for acquisition of the site. The Health Services Department has had ongoing conversations with the Board of Supervisors, the Mental Health Commission, The Mental Health Services Act Consolidated Planning Advisory workgroup, the Capital Facilities workgroup and community stakeholders concerning the disposition of the site. The site is very advantageous in its location adjacent to the hospital and the purchase price has recently become more affordable. A board order will be brought before the Board on December 15, 2009 regarding acquisition of the property.

Chair Bonilla called for public comment. The following people spoke:

Ralph Hoffman, International Association for the Advancement for Creative Maladjustment; Robert Heaston, Jr., resident of Walnut Creek (written material provided); Brandi Draper, resident of Brentwood; James Wogan, Mt. Diablo Unified Foster Youth Services; Frank Barham, M.D., Child & Adolescent Task Force; Ryan Nestman, Child & Adolescent Task Force; Kathi McLaughlin, Child & Adolescent Task Force (written material provided); Stuart McCollough, on behalf of youth homes.

All speakers were in favor of locating a psychiatric receiving center at the 20 Allen Street site.

Dr. Walker will apprise the Board of how the concerns of Mr. Heaston regarding his child’s experience in the Crisis Stabilization Unit and inpatient stay are addressed, staff interaction with patients and family members, and policies in place regarding separation of a child in psychiatric crisis from the parent/guardian.

The Board thanked staff and the public speakers for their participation and took the following actions: