ADDENDUM
D.1 and D.2 March 17, 2009
The Board of Supervisors chose to consider items D.1 and D.2 together.
David Twa, County Administrator, presented the staff report (PowerPoint presentation attached).
Supervisor Uilkema asked if the recently announced State budget imbalance of $8 million was addressed in today’s proposed budget.
Mr. Twa said it was not and it would be likely that the Board would need to make additional adjustments when final figures are available.
Mr. Twa invited the Health Services Director, Employment and Human Services Director, the District Attorney and the Sheriff to address the Board regarding their respective departments.
Joe Valentine, Employment and Human Services Department Director, informed the Board that the heavy increase in applications for services is overwhelming the processing capabilities of existing staff. Mr. Valentine cited a 46 % increase in food stamp applications, a 24% increase in CalWORKS financial assistance applications, and a 44% increase in General Assistance applications in January and February. He said that as the unemployment rate continues to rise the demand for services will rise also.
Chair Bonilla acknowledged the recent report to the Board’s Family and Human Services Committee on the impacts of the December budget cuts and asked what impacts he anticipates going forward.
Mr. Valentine responded that even without the additional reductions to staff in today’s proposal, it is not currently possible to keep up with the volume of incoming applications which has resulted in a backlog and a continually increasing delays in aid reaching citizens. He noted that this in turn has the effect of a delay in the flow of money into the County economy at many levels including the expenditure of food stamps and general assistance money and payments to medical service providers. He said that according to the state’s own formula for the annual calculation of the cost of doing business, the gap between the state allocations and the actual county cost for fiscal year 2009/2010 is $37.3 million or the equivalent of 370 staff positions.
Chair Bonilla asked how the Federal stimulus package might affect the department.
Mr. Valentine said the stimulus package will increase the federal matching rate for a number of health and social service programs of which it is speculated that the state will absorb those increases to offset state costs. He said that three areas the money will come directly to the County: Head Start, Workforce Development, and In Home Supportive Services (IHSS). He said projections are for $2 million to increase Head Start slots, $4 million for workforce training and education programs and possibly $4.5 million in matching funds for IHSS.
Mr. Valentine said that the department is doing all it can to shift costs away from the County to utilize state and federal dollars. He said any reductions in staff will be in the administrative area versus any case-load bearing personnel who are needed to get applications processed and funds flowing. He acknowledged the difficult policy decisions faced by the Board and the policy shift toward public safety, and requested as mandatory and discretionary services are reviewed the Board keep in mind the services that affect the health, safety and basic needs of thousands of residents in the midst of this recession.
Dr. Walker, Health Services Director, said that the County is working in the context of economic decline and a decline in revenues that none of us have seen before. He noted a redistribution of County General Fund support from health and human services to law and justice to cover the budget gap caused by projected savings or adjustments that did not materialize. He said the Board directed public safety be a priority in budget planning and he emphasized the opinion that access to health and human services is part of public protection.
Dr. Walker said that the Beilenson notice provided did not reflect a proposed $2 million reduction in mental health services because that reduction does not mandate not a posting requirement and the request for an additional $6 million dollars reduction was received after the publication of the notice. He said the result is a hoped-for $2 million reduction is costs of service for the West County Detention Facility (WCDF) and the additional $6 million reduction will result in an $8.6 million gap going forward from today’s budget proposal. He said that there are no longer funds to provide health care on site at WCDF and that attempts to find a viable solution such as contracting out those services has not been successful, due in part to employee union opposition. He said he would therefore look at eliminating those services and redistributing the inmates with the highest need for health care.
Dr. Walker continued, saying he would not be making suggestions to cover the gap in funds yet because it would be premature to act before knowing what funds might be offered from the federal stimulus package and how much might filter down from the state level. He said that today the Board is considering the items included in the Beilenson notice encompassing reductions in public health; hospital staffing, particularly in regard to specialty services; and a reduction in access to health care.
Dr. Walker said that the most difficult proposal of his career is the proposed reduction of basic health care program access to undocumented adult immigrants. He clarified that services for children, pregnant women, and breast cancer and AIDS/HIV patients were not included and would continue to be provided. He explained that the changes are not scheduled to take effect until May 1, 2009 and those currently in the basic health careprogram will remain until the expiration date of their current term of enrollment. He said they would be notified of the coverage termination a month before their enrollment ends.
Supervisor Glover clarified that the expirations would then be staggered depending on when enrollment was initiated.
Dr. Walker said that the increase in demand for services has overwhelmed the clinics and the hospital on a daily basis and it is necessary to seek assistance from community partners such as John Muir/Mt. Diablo, Sutter Delta, Kaiser Permanente and community based organizations, especially in the areas of access to primary care and specialty care.
Supervisor Gioia commented on the his admiration for the role Dr. Walker has taken in his career to expand health care services in Contra Costa County and agreed that from the standpoint of public protection, access to health care is an important part of that. He reminded everyone of the criticism the Board received from the Grand Jury in previous years for devoting some of the County’s General Fund monies to the health system, while the majority of counties restrict funding to those services that are mandated and funded with state and federal dollars. The Supervisor acknowledged the dismay of the Board and County staff that for the first time in Contra Costa County history, a distinction is being made between residents that are documented or not.
Supervisor Glover said the difficulties in providing access to health care has been a long term problem and reform on the national level has been needed for years. He thanked Dr. Walker for his efforts in collaborating with the community to provide as many services as possible. He asked what the possibility was of covering a portion of the funding gap with the assistance of community health care partners.
Dr. Walker said he didn’t feel the gap could be completely closed but that partnership could help. He said an official planning process is now underway for the expansion of the County clinic in East County and he is hopeful it will be expedited by the federal stimulus package. He also expressed hope for the possibility of expansion of the Sutter Delta urgent care clinic that currently exists next to its emergency room, and noted that Kaiser could assist with emergency department, primary care and specialty care needs. He said that John Muir/Mt. Diablo does not have a facility but said he hopes their mobile van staffed by volunteer physicians could be put to more frequent use. He said the department will be considering all service venues available.
Supervisor Uilkema asked if there is funding for which clinics or community-based organizations qualify that the County does not.
Dr. Walker said that community clinics do quality for health center funding and for an expansion of the funding in the stimulus package that is not available to the County and said he hopes that will result in new resources coming to Contra Costa County.
Chair Bonilla asked Dr. Walker to explain how he came to decision to reduce the basic health care coverage, especially in light of his reluctance to do so, and asked how he calculated the potential for increased costs in the long term resulting from lack of early care particularly in people diagnosed with chronic disease.
Dr. Walker said the department examined the impact of decreasing the basic health care services incrementally based on poverty levels but determined that doing so would not result in any real decrease in the number of patients. He said in addition, the system is currently overwhelmed on any given day and there are not appointments available in our clinic system. He said that in accordance with direction from the county administrator to review which services are mandated, there are not state or federal government mandates for anyone to provide access to healthcare for the undocumented except for emergency Medi-Cal services. Therefore, he said, there are no funds at all for these services provided by the state or federal government and while we are all aware that we rely on immigrant workers for many services in our community, access to health care for them is a community obligation, not a County one, which is why our community partners are being sought to help with the crisis.
Chair Bonilla asked the County Administrator to speak to the issue mentioned by Dr. Walker that the proposed reductions place the larger burden on health and human services and less on the law enforcement side.
Mr. Twa reiterated the Board’s direction to return on March 31 with a report exploring ways to lessen the impact of cuts on public safety and protection. He said the current proposed cuts do have a dramatic impact on law and justice services and trying to lessen the impact on public protection necessitated finding the money somewhere else. He said that as indicated in his report, when 83% of the General Fund Revenue goes to just a few departments the options are very limited. He noted that even if all 17 smaller departments were eliminated it still would not total enough money to balance the budget.
Chair Bonilla asked the County Administrator to address issue of the uniqueness of services that county provides, as opposed to the fact that they may be provided in other forms within the community.
Mr. Twa said that identifying mandatory and discretionary obligations has long been a systemic issue. He said t is an ongoing challenge in terms of what services the county should be delivering, what services should be provided by the community, and, how those services are delivered. He said it is his intention is to address these issues and added that a lot will depend on the ability to restructure how the County does business.
Sheriff Rupf expressed his respect for Dr. Walker’s service and his understanding for the funding crisis in the health care arena. He enumerated the vast responsibilities of the Office of the Sheriff, including operation of the jails, civil process, coroner functions, waterways, infrastructure protection for the petrochemical industry, operational law enforcement mutual aid coordination, and administrating the services of over 300 citizen volunteers who support a variety of activities ranging from search and rescue operations to security and delivery of first aid at public parades. He noted that the Sheriff’s Department provides general law enforcement services to the unincorporated areas of the County spanning a population in excess of 170,000 and spread across a 700-square-mile area from 29 different work locations. Sheriff Rupf said that the vast majority of services provided must be delivered on a 24-hour non-stop schedule. He added that his department has responsibilities that cannot be discontinued, and in most circumstances cannot be contracted out or transferred to another agency.
He said that for the last six consecutive years, the cost of maintaining the previous years’ level of service has exceeded the County’s funding level, which has been addressed by decreasing the number of his staff in order to cover the increase in costs with over 100 positions held vacant. He said this has resulted in an approximate reduction of 10% of his staff and the elimination of many programs, particularly those associated with crime prevention and community quality of life issues. He said today’s proposed budget will reduce staffing by an additional 6% and he added that other costs have been reduced or eliminated, particularly those associated with capital acquisition, maintenance, and replacement of critical infrastructure.
Sheriff Rupf commended his staff for an excellent effort to continue to serve with less personnel, aggressively seeking greater efficiency, significantly reducing the use of sick leave, and driving down liability exposure while successfully keeping up with increased 911 call demands. He said the department has recently implemented online reporting of many categories of criminal misbehavior, reduced the amount of supervision and administration, and continued the practice of civilianizing sworn positions where possible to allow for a higher percentage of officers in the front line functions while reducing the cost of those functions that remain.
The Sheriff expressed confidence in that Deputy Sheriff’s Association and other union organizations for being willing to seek some changes in the compensation and benefit packages and possible changes in the retirement system. He asked the Board to consider all the difficult decisions necessary such as the use of reserves, policy changes to amortize unfunded liabilities over longer periods of time, elimination of services more properly funded by other levels of government, contracting out certain services, and if it is necessary working with our labor organizations to restructure pay and benefit packages to make provision of vital services more affordable. He commended the County Administrator and his staff for their efforts in a very difficult time. The Sheriff said that all options must be considered and that he would support Dr. Walker in whatever manner he was able in the delivery of heath care services to inmates including contracting out the service. He noted that in the previous year, it was hoped to capture approximately $4 million dollars by doing so, but that support for the plan was not sufficient and it had been abandoned.
Supervisor Gioia said that while there is resistance to this idea, it should be considered because there is potential savings that could help with other areas of the budget. Supervisor Gioia further noted that if there is any possibility of county residents approving a ballot measure for a new revenue resource like a utility tax, it is important to demonstrate that all possible savings are being actively sought. He thanked the Sheriff for structuring his budget proposal in a way as to maximize public protection services in the unincorporated area.
Supervisor Uilkema asked about the status of a federal competitive grant for funding for patrol officers and if there is any estimate of the amount or the number of officer positions it might restore.
Sheriff Rupf assured the Board that the department has already submitted a grant application and is monitoring it closely.
Mr. Twa said the County could only speculate at this time but should the County receive a sum of $1 million it would equate to 7.5 officers and not be sufficient to replace all the positions slated for elimination.
Chair Bonilla asked if the number of layoffs proposed actually would actually mean the loss of that many deputies and other staff and what percentage of the Sheriff’s budget comprised Proposition 172 sales tax revenue.
The Sheriff explained that in practice, the department first eliminates vacant positions irrespective of classification. The number 56 is based on the cost of 56 deputy sheriffs. He said the eight recruit positions currently in the academy would be included along with a combination of deputy and clerical positions. He noted that it might require two clerical positions to equal the cost of one deputy, but he did anticipate that the estimation of 56 less officers was accurate. He said that historically, about 1/3 of the department revenue came from Proposition 172 funds which has a projected shortfall of $7.5 million dollars this year and an additional shortfall of $3 to $3.5 million next year.
Robert Kochly, District Attorney, echoed the comments of the Sheriff. He said that over that last few years, even while taxes were still increasing, they were buying less services resulting in the department building up a vacancy factor of $3.9 million, primarily in the ranks of support staff. The vacancy rate in the investigative services is slightly less because of the use of a number of more cost-effective temporary investigators that cost much less than benefited employees. He said the attorney staff vacancy rate is slightly below ten percent. Mr. Kochly noted the original targets called for a $4.1 million reduction in addition to the $3.9 million vacancy factor and said he has proposed fairly draconian cuts, all in attorney positions because the unit is down to the frontline service providers and any more reduction to other staff would leave the department unable to continue functioning. He noted that the reductions to be absorbed are down to about $1.9 million and thanked the Board and County Administrator for their efforts. He said that the reductions would necessitate the lay-off of six Deputy District Attorneys effective May 1, 2009, and 12 additional positions effective in December 2009 bringing the staff number down from 91 to 73. He said the following measures would also be implemented: effective May 1, 2009, a restructuring of felony operations will reduce staffing in the prosecution units to include sexual assault, domestic violence, homicides, and drugs; there will be more reliance on the pooling of cases and attorneys to achieve efficiency in handling high volumes of cases, standards in the filing of felony drug cases with be revised to reduce the caseloads; and as of May 1, 2009, new filings will commence on only core misdemeanors.
Mr. Kochly explained that his goal is to reduce the current misdemeanor filings by 45% to accommodate the proposed reduction in staffing. He said that Driving Under the Influence (DUI) cases would continue to be prosecuted and the Zero Tolerance for Domestic Violence program still has some funding to prosecute some domestic violence cases. He said that misdemeanor cases already filed will be prosecuted, and discussions with the courts will begin immediately to most efficiently schedule cases in the vastly spread out court locations. He said that the new limitations will be communicated to local law enforcement communities as soon as there are filings, and assured the Board that the department will continue to seek other revenues and cost-saving opportunities wherever possible. Mr. Kochly concluded his presentation, noting that due to Budget constraints the District Attorney’s Office can no longer maintain its previous level of service to the community.
Chair Bonilla said a letter had been received from the Deputy District Attorney Association questioning an apparent inequity in the number of reductions between the Public Defenders Office and the District Attorney’s Office.
Mr. Kochly said he had no knowledge of that other than the information contained in the proposed budget.
Mr. Twa said that the reductions to the Public Defender’s Office were proportionately similar to The District Attorney’s Office and a lot depends on the vacancy rates and operations in the respective departments.
Chair Bonilla opened the hearings and invited the public to comment. The following people spoke:
Regarding elimination of funding for Cooperative Extension:
Shelley Murdock, Director, UCCE (handout provided)
John Viano, Farm Bureau
Carla Moore, 4-H Youth Development Program & Nutrition
Kate Jewett, 4-H Youth Development Program participant
Marion Smith, 4-H Youth Development Program participant
Joe Kalinowski, 4-H Youth Development Program
Elisa Dowd, Past President of 4-H Council
Laurie Limrite, 4-H Youth Development Program
Chuck Waitman, 4-H Youth Development Program volunteer
Rebeca Suzanne, UCCE
Jim Frazier, Oakley City Councilman
Lisa Chrisman, resident of Pleasant Hill
Liz Rottger, UCCE Master Gardener
Pamela Trail, UCCE Master Gardener
Alison Kalinowski, 4-H Youth Development Program
Robert M. Whalen, 4-H Youth Development Program
Rita Mitchell, UC Davis, for Barbara Sutherland, Director of EFNEP
Regarding proposed cuts in health services to undocumented adults, the neurosurgical department and clinic at West County Detention Facility:
Lara Wright, MD, CC Health Services
Theresa Flores, CCISCO
Natasha Pinto, M.D., CCC Health Services
David Sulliman, M.D., CCC Health Services
Jan Diamond, M.D., resident of Richmond
Francisco Dorado, M.D.
Joanna Eveland, CCC Family Medicine Residency
Miriam Wong, Lucy Sanchez
Pablo Cardenas, CCISCO
Anne Snyder reading letter for Reverend Olman Solis,
Paulina Mavia for Reverend Jerry Brown
Antonio Medranos
Rose Cabrera, California Nurses Association
Yeh Ling-Ling, Alliance for a Sustainable USA
James A Roemer, resident of Rossmoor
Jane Garcia, La Clinica, and Community Clinic Consortium
Mary Ann Roemer, resident of Walnut Creek
Clyde Trombettas Public Environmental Health Advisory Board, Evelyn Launius, resident of Clayton
Isaac, undocumented resident
Marianne Moore, Contractors Alliance of Contra Costa County
MariaAlegria, on opportunities to partner with the community
Mary Rocha, resident of Antioch
Gina Perez Baron, resident of Contra Costa County
Maria, in support of Dr. Miller
Jim Bickert, Deputy Sheriff’s Association, in opposition tohealth care for undocumented residents
Regarding reductions in funding to AC5 Arts and Culture Commission:
Christine Callahan, AC5 Arts and Culture Commission;
Sarah Michael, AC5 Arts and Culture Commission;
Robin Moore, AC5 Arts and Culture Commission.
Other:
Rollie Katz, Pubic Employees’ Union Local One
Chris Jacuzzi, Library Adult Literacy Program
Alan Smith, District IV Representative of County Library Commission;
Joan Monroe, resident of Orinda, regarding the District Attorney budget (handout provided)
Beverly McAdams, Mothers Against Drunk Drivers (MADD)
Bob Britton, Local 21
Lois McKinney, SEIU 1021
Alison McKee, Contra Costa County Library
The following people provided written comments:
Shelley Murdock, Director, UCCE
David Ginsburg, MPH, Director UC Food Stamp Nutrition Education Program
Laura Campbell, TeenAge Program
Amilo Zaks, M.D., on basic health care for undocumented adults
Malaika Scott, M.D., on basic heath care for undocumented adults
Arwen Mohr, M.D, Contra Costa Regional Medical Center, on cuts in neurosurgery
Elizabeth Bierer, on cuts in health services
Bhakti Tantod, M.D., CCRMC Family Medicine Residency, reductions in services to the uninsured
Joanna Eveland, M.D., CCRMC Family Medicine Residency, reductions in services to undocumented
John C. Cope, Vice President Deputy D.A’s Association, ratio of cuts in proportion to other departments
Lavenia B., resident of Contra Costa County, on funding for UCCE
Eve Cominos, resident of Walnut Creek, health care budget cuts
Mary Rocha, resident of Antioch
Pringle Miller, M.D. Contra Costa Regional Medical Center
Evelyn Launius, resident of Clayton
Joan Monroe, resident of Orinda
RYSE Center
Jose Suarez
Lara Wright, M.D.
Sigmund Moskovitz
Maggie Ewing
Chair Bonilla returned the matter to the Board.
Supervisor Gioia said he had to leave for an appointment but provided the following recommendations for the Board's considertion:
1. To direct the County Administrator and Health Services Director to meet with community clinics and hospitals to explore a plan that would not result in a gap of healthcare coverage to those that would lose coverage;
2. To direct the County Administrator to meet with the U.C. Cooperative Extension to explore the minimum amount of funds required to keep the program running;
3. Determine the minimum funding required to retain state matching funds for the AC5 Arts and Culture Program.
Mr. Twa said that Dr. Walker has already arranged a meeting with the hospitals and clinics for March 23, 2009.
Chair Bonilla requested that Mr. Twa attend the meeting as well. She further requested that the County Administrator come back to the Board after examining options with all the community providers for a plan that addresses collaboration and partnership to cover the health care delivery challenges and components needed to realize that goal. She also requested that more information be provided on the number of chronically ill patients enrolled in the Basic Health Care program, the projected cost in the long run related to discontinuing primary care, and the what current levels of partnership are in place and the elevation of those that might be required.
Supervisor Glover offered to attend the health care meeting as well. He said he believes community partners are willing to assist the Cooperative Extension program in searching for matching funds to continue the 4-H program and said he would be pleased to help in that effort. He noted that care needs to be taken to make sure programs are sustainable over the long term.
Supervisor Uilkema asked if it would be necessary to act on the Beilenson notices today in the event that further efforts to locate funding were unsuccessful. She added doing so would have no effect other than starting the clock running.
Mr. Twa recommended closing the hearing with the exception of the list of items the Board requested be addressed at the March 31, 2009 hearing.
Supervisor Uilkema requested an update on the status of the federal grant funding for peace officers and a review of revenue-generating departments for assurance that there is a net revenue gain.
Chair Bonilla asked what status the County is in regarding stimulus monies.
Dr. Walker said it is expected that stimuls funds will be received in the form of increased federal participation in programs such as the Medi-Cal program. He said the final figures are not yet available, and whether the state’s trigger would be activated will be unknown until April 1, 2009.
Mr. Twa said it is very difficult to predict results at this time but said he anticipates returning to the Board at some point to make adjustments to the budget when accurate stimulus details are known.
Chair Bonilla asked about the expected impacts of labor negotiations.
Mr. Twa said that is very difficult to predict but should savings be realized or stimulus monies received, the Board could consider restoration of positions, funding of liabilities, and other options.
Chair Bonilla expressed a desire to see grant funding for the Arts and Culture Commission and stated that the Library Adult Literacy Program is a high priority in light of its return on investment to the County by assisting residents to be more employable. She further requested that the Library budget proposal that will be presented at the Board’s March 31, 2009 meeting contain more concrete data. She said it would be wise to have town hall meetings in all the Supervisorial districts to help residents understand the health care crisis.