Home
Grand Jury final report and responses
To link to this object, paste this link in email, IM or document
To embed this object, paste this HTML in website
Grand Jury final report and responses
|
small (250x250 max)
medium (500x500 max)
large ( > 500x500)
Full Resolution
|
|
Santa Cruz County
Grand Jury
2004- 2005
Final Report
June 2005
Greetings Citizens of Santa Cruz County,
It is with great pride that we present the 2004 – 2005 final report. The Grand Jury is
charged by state law with review and oversight of county agencies and their contractors.
It is our hope that the issues raised, the problems found and the information extracted will
contribute to more responsive, more accessible and more responsible government. We
also hope that this report will aid in your understanding of the Santa Cruz County
government.
This report is a compilation of information provided by your public officials and the
insights we gained during those interviews. Our charge is to get the facts straight and get
the information to you with no bias. We have done that here, and it is our great hope that
much good comes from our efforts.
Our current budget picture is bleak, and we must all do our part to ensure we make the
most of our limited funds. We all have a responsibility to ensure we have the best, most
efficient government possible.
We would like to thank the various entities and employees that took the time to educate
us and answer our questions. I would also like to thank the other eighteen jurors who
have given generously of their most precious commodity, their own time. We are anxious
for your response.
Sincerely,
Earl Kieser, Foreperson
2004 – 2005 Santa Cruz County Grand Jury
i
Santa Cruz County Grand Jury
2004- 2005 Final Report
Table of Contents
Introduction to the Santa Cruz Grand Jury
Grand Jurors
Section 1: Audit and Finance Committee Reports
Counting Your Dollars: Contracting for the Services of an Independent Auditor of
County Finances
1 - 1
The Welfare of Child Welfare: A Comparison of Budgets
1 - 7
Section 2: Cities and County Committee Report
No report included
Section 3: Criminal Justice Committee Reports
Santa Cruz County Jails Review 3 - 1
California Public Records Act, Compliance by Local Police Agencies
3 - 17
Section 4: Health and Human Services Committee Reports
Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility 4 - 1
Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 and
Proposition 10 Funds in Santa Cruz County 4 – 15
Section 5: Schools and Libraries Committee Report
Ready to Check Out? Santa Cruz City- County Library System
5 - 1
Section 6: Special Districts Committee Reports
Santa Cruz County Port District Boat Slip Waiting List 6 - 1
Water Planning in Santa Cruz County 6 - 7
Section 7: Instructions for Respondents 7 - 1
ii
This page left intentionally blank.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Introduction to the Santa Cruz County
Grand Jury
Two Types of Grand Juries in Santa Cruz County
As with many California counties, Santa Cruz County has two types of Grand Juries. The
regular, or civil, Grand Jury is an investigative body that serves for one year. There are
19 members on the jury. The civil Grand Jury does not deal with trials but rather serves
as a watchdog over local government and other tax- supported entities.
The other Grand Jury is a criminal Grand Jury that deals with issuing indictments
( charging a person with a criminal or public offense). This jury is called up on a case- by-case
basis.
Duties and Powers of the Civil Grand Jury
The Civil Grand Jury has three primary functions:
• To randomly audit local governmental agencies and officials
• To publish its investigative findings and recommendations toward improving
those governmental operations in the interest of the community being served
• To investigate citizens' complaints
The Civil Grand Jury investigates local government agencies and officials to evaluate if
they are acting properly. If a Grand Jury determines that they are not, it has various
options. The most frequently used option is the presentation of a report outlining the
Grand Jury's findings and recommendations in the matter. Such reports are public and
sometimes attract media attention. Agencies or elected officials discussed in the report
must respond specifically to the report's findings and recommendations.
Citizens may file complaints with the Grand Jury to request that it investigate what they
perceive as wrongdoing by a public agency, such as a school district or a police
department. The Jury will decide if the complaint has merit and is not obligated to pursue
the complaint. County complaint forms are available from the following address:
Santa Cruz County Grand Jury
701 Ocean Street, Room 318- I
Santa Cruz, CA 95060
( 831) 454- 2099
FAX ( 831) 454- 3387
grandjury@ co. santa- cruz. ca. us
www. co. santa- cruz. ca. us/ grandjury
2004 – 2005 Santa Cruz County Grand Jury Final Report
This page left intentionally blank.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Grand Jurors
2004- 2005
Earl Kieser, Foreperson
Paula Berman
Diana Cunningham
Lisette Darst
Kimberly Kildsig- DiBiasi
Mike Eynon
Mark Glasser
Katherine Gleaton
Jane Kearney
Kathy Kreiger
Edith P. Lenz
Mike McManus
Maxine McNamara
Karen Rogers
Tisha Scurich
Barbara Smith
Patricia A. Talbert
Nancy Talley
Katherine Wadhams
2004 – 2005 Santa Cruz County Grand Jury Final Report
This page intentionally left blank.
Santa Cruz County
Grand Jury
Final Report:
Section 1
Audit and Finance Committee Reports
2004 – 2005 Santa Cruz County Grand Jury Report
Counting Your Dollars: Page 1 - 1
Contracting for the Services of an
Independent Auditor of County Finances
Counting Your Dollars:
Contracting for the Services of an Independent Auditor
of County Finances
Synopsis
“ The purpose of an independent audit is to protect the equity of the entity audited with
tests that determine if the assets are properly protected.” 1 This report covers the bid
process for securing the services of an independent auditor for the County of Santa Cruz.
It has been the practice of the county to go out to bid for external independent audit
services every three to four years. However, the current external independent auditing
firm has been retained for the past seven years. The bid process was used to select a new
external independent auditor for the County of Santa Cruz.
Background
The Grand Jury, as required by law, is responsible for performing an independent audit of
county offices and investigating spending by city and county governments. The
investigations may be conducted on a selective basis each year but shall not duplicate
examination or financial statements that have been performed by or for the Board of
Supervisors. 2 In earlier years, the Grand Jury budget included funds to employ an outside
independent auditor to fulfill these duties. Subsequently, while retaining oversight of this
task, the Grand Jury transferred to the County of Santa Cruz the responsibility for
contracting with an external independent auditor for these services, along with the budget
item to cover this expense. To fulfill both the county and Grand Jury responsibilities to
conduct audits of county records, a County Audit Committee was formed. This
committee is comprised of Santa Cruz County Administrative Officer/ Representative,
County Auditor- Controller, County Treasurer/ Tax Collector/ Recorder/ Clerk and two
members of the Santa Cruz County Grand Jury. In addition, two members of the
Treasurer Oversight Committee have been added to the County Audit Committee
membership.
Scope
The County of Santa Cruz contracts with an outside audit firm to furnish independent
audit and compilation services of county accounts. These services are obtained through a
Request for Proposal ( RFP) bid process. Two members of the Santa Cruz County Grand
Jury, one from the Audit and Finance Committee and one from the Grand Jury
membership at large, followed the bid process from the Invitation to Bid to the
Recommendation of Acceptance of the best contract.
1 Rudolph Vargas, Vargas and Company, Minutes Audit Committee Meeting, August 25, 2004.
2 Penal Code § 925 and Government Code § 25250.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 1 - 2 Counting Your Dollars:
Contracting for the Services of an
Independent Auditor of County Finances
Sources
Meetings:
County of Santa Cruz Audit Committee:
• August 25, 2004.
• February 14, 2005.
• May 9, 2005.
• June 6, 2005.
Bidders’ Conference, December 10, 2004.
Analysis of Bids, February 14, 2005.
Entrance Conference, June 6, 2005.
Reviewed:
Bidders’ List.
Comprehensive Annual Financial Report, Fiscal Year 2003.
County Analysis for Award of Contract.
Government Code § 25250.
Grand Jury Reports:
• 1990- 1991.
• 1997- 1998.
• 1999- 2000.
• 2000- 2001.
• 2001- 2002.
Management Letter, Fiscal Year 2003.
Management Letter, Fiscal Year 2004.
Penal Code § 925.
Request for Proposal.
Single Audit Report, Fiscal Year 2003.
Findings
1. It has been the practice of the county to request proposals for independent audit
services every three or four years.
2. The current independent audit firm has provided services for seven years.
3. The 2001- 2002 Santa Cruz County Grand Jury Final Report recommended that
retention of an independent auditor should be reviewed every three years and changed
at least every six years.
4. This Request for Proposal process was to select an independent auditor to prepare an
annual audit for the County of Santa Cruz beginning with the fiscal year ending June
30, 2005. The contract would be awarded for one to three years, whichever would be
the most cost effective for the county.
2004 – 2005 Santa Cruz County Grand Jury Report
Counting Your Dollars: Page 1 - 3
Contracting for the Services of an
Independent Auditor of County Finances
5. The independent audit firm provides various reports to the Santa Cruz County Audit
Committee throughout the year. These reports require County Audit Committee
review.
6. The Request for Proposal process began with preparation of the bid documents that:
• outlined the requirements of the county;
• described the basis on which the bids would be judged; and
• requested the qualifications of the bidders.
Invitations to Bid were sent to 44 qualifying accounting firms, locally and throughout
northern and central California. Four bidders attended the bidders’ conference on
December 10, 2004. Proposals were received on January 14, 2005 from all four firms
present at the bidders’ conference. The proposals were evaluated according to the
criteria established in the bid documents as outlined in Appendix A. Using this
comprehensive criteria, the County Audit Committee recommended awarding the
contract to the firm that best met the county’s needs: Bartig, Basler, and Ray.
7. Two members of the Santa Cruz County Grand Jury are active members of the
County Audit Committee.
Conclusions
1. Response to Santa Cruz County’s request for proposals was minimal.
2. The County Audit Committee did not follow the recommendation of the 2001- 2002
Santa Cruz County Grand Jury stating that independent audit services should be
reviewed every three years with no one firm providing services for more than two
consecutive three- year contracts. Good accounting practices and procedures dictate a
change of auditing firms.
3. Criteria used to evaluate bids was comprehensive.
4. Grand Jury membership on Santa Cruz County Audit Committee fulfills the Grand
Jury’s mandated responsibilities as outlined in Penal Code § 925. The County Audit
Committee met four times during fiscal year 2004- 2005.
Recommendations
1. The County of Santa Cruz Auditor should continue to actively seek and qualify new
bidders for future invitations for proposals and should update the current list.
2. Review of the contract for independent audit services or invitation to bid should be
scheduled every three years with no one firm providing services for more than two
consecutive three- year contracts.
3. The County of Santa Cruz should continue to notify the Grand Jury of County Audit
Committee activities.
4. The County Audit Committee should continue to meet at least twice each year, more
frequently if needed.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 1 - 4 Counting Your Dollars:
Contracting for the Services of an
Independent Auditor of County Finances
Responses Required
Entity Findings Recommendations Respond Within
Santa Cruz County
Board of
Supervisors
1, 2, 3 1, 2, 4 60 Days
August 30, 2005
Santa Cruz County
Auditor- Controller
3 1, 2, 3, 4 90 Days
September 30, 2005
Santa Cruz County
Audit Committee
3, 7 2, 4 90 Days
September 30, 2005
2004 – 2005 Santa Cruz County Grand Jury Report
Counting Your Dollars: Page 1 - 5
Contracting for the Services of an
Independent Auditor of County Finances
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 1 - 6 Counting Your Dollars:
Contracting for the Services of an
Independent Auditor of County Finances
2004 – 2005 Santa Cruz County Grand Jury Final Report
The Welfare of Child Welfare: Page 1 - 7
Comparison of Budgets
The Welfare of Child Welfare:
Comparison of Budgets
Synopsis
This report compares the Child Welfare Services ( CWS) budget of Santa Cruz County to
those of four other counties considered demographically similar to Santa Cruz County.
Three of the four other counties spent more than twice as much per child as Santa Cruz
County.
Definitions
Active Cases: all children who had an open investigation in the Emergency Response
category, or an open case in the remaining three categories of Family Maintenance,
Family Reunification or Permanency Planning. Active cases do not include children who
were referred but whose situation did not meet the criteria for investigation. In other
words, they were “ evaluated out.” Emergency Response, Family Maintenance, Family
Reunification and Permanency Planning are industry- standard categories set up by the
State of California. All children served by Child Welfare Services fall into one of these
categories.
Overmatch: the portion of the total CWS budget for any county contributed solely by
that county that is above 30 percent of the minimum total CWS budget established for
that county by the State of California
Background
In Santa Cruz County, Child Welfare Services ( CWS) is a division of the Human
Resources Agency. Child Welfare Services, more commonly known as Child Protective
Services, investigates and intervenes when necessary when child abuse or neglect is
reported.
The Santa Cruz County CWS budget, like that of other counties, has suffered because of
funding shortages. This investigation examined how Santa Cruz County’s CWS budget
compared to those of comparison counties. To fulfill its mandate to protect children from
neglect or abuse, CWS must have funds available.
The Grand Jury requested data from seven counties whose demographics are considered
to be similar to those of Santa Cruz County. Of those seven counties, four replied with
data in the format that allowed us to compare it to that of Santa Cruz County. The Grand
Jury would like to express its appreciation to the seven counties for their assistance in
providing information for this report.
2004 – 2005 Santa Cruz Grand Jury Final Report
Page 1 - 8 The Welfare of Child Welfare:
Comparison of Budgets
Scope
This investigation examined five aspects of the Santa Cruz County budget for Child
Welfare Services ( CWS):
• the annual total budget for Santa Cruz County CWS
• the county share of the annual budget for Santa Cruz County CWS
• the number of active cases per year for Santa Cruz County CWS
• how the total budget dollars compare to those of other counties
• how the county share budget dollars compare to those of other counties
Sources
Interviewed:
CASA of Santa Cruz County.
Marin County Adult and Children’s Social Services.
Monterey County Family and Child Services.
Napa County Children’s Behavioral Health.
San Mateo County Health Services Agency.
Santa Clara County Family and Children’s Services.
Santa Cruz County Human Resources Agency personnel.
Santa Cruz County Personnel Department.
Solano County Child Welfare Services.
Sonoma County Human Services Department.
Reviewed:
California Quick Facts, from U. S. Census Bureau web site,
http:// quickfacts. census. gov.
Child Welfare Services Reports for California, from University of California at
Berkeley Center for Social Services Research web site,
http:// cssr. berkeley. edu/ CWSCMSreports/.
Child Welfare Services, Self- Assessment, Santa Cruz County, 2004.
Child Welfare Services, System Improvement Plan, 2004.
2004 – 2005 Santa Cruz County Grand Jury Final Report
The Welfare of Child Welfare: Page 1 - 9
Comparison of Budgets
Findings
1. The State of California determines a minimum total CWS budget for each county.
Some factors that influence the total minimum budget are:
• number of children served;
• cost to employ qualified social workers ( as determined by the state); and
• state ratios for number of social workers to children in need of services.
Of this minimum required budget, the state contributes 70 percent and mandates that
counties contribute 30 percent as a county share of the total CWS budget. Monies
contributed by counties to their CWS budgets above the minimum required share are
supplemented by other monies from state and federal sources. The resulting increased
budget may not reflect the 70: 30 budget contribution ratio.
2. Some counties supplement their CWS budget with additional state, federal and other
monies. Santa Cruz County CWS has been able to access some of these funds.
3. In 2002- 2003, Santa Cruz County overmatched the required minimum share of the
CWS budget by $ 696,152. In 2003- 2004, Santa Cruz County overmatched the
required share of the minimum CWS budget by $ 718,541.
4. CWS budgets, county shares of these budgets, number of active cases and budget- to-child
ratios vary from county to county.
Fiscal Year 2002-
2003
Fiscal Year 2003-
2004
Santa Cruz
County
Population: 251,584
Number of Active Cases 687 809
Total CWS Budget $ 8,246,650 $ 9,002,816
County Share Budget $ 1,538,957 $ 1,497,975
Total Budget Per Child $ 12,004 $ 11,128
County Share Budget Per Child $ 2,240 $ 1,852
2004 – 2005 Santa Cruz Grand Jury Final Report
Page 1 - 10 The Welfare of Child Welfare:
Comparison of Budgets
County A
Population: 246, 073
Number of Active Cases 470 391
Total CWS Budget $ 3,917,501 $ 4,778,564
County Share Budget $ 701,473 $ 967,956
Total Budget Per Child $ 8,335 $ 12,221
County Share Budget Per Child $ 1,493 $ 2,476
County B
Population: 1,678,421
Number of Active Cases 5,638 5,242
Total CWS Budget $ 202,603,417 $ 214,665,827
County Share Budget $ 56,017,081 $ 52,586,883
Total Budget Per Child $ 35,936 $ 40,951
County Share Budget Per Child $ 9,936 $ 10,032
County C
Population: 697,456
Number of Active Cases 1,175 1,216
Total CWS Budget $ 29,555,012 $ 31,736,859
County Share Budget $ 5,346,921 $ 7,453,884
Total Budget Per Child $ 25,153 $ 26,099
County Share Budget Per Child $ 4,551 $ 6,130
2004 – 2005 Santa Cruz County Grand Jury Final Report
The Welfare of Child Welfare: Page 1 - 11
Comparison of Budgets
County D
Population: 131,607
Number of Active Cases 251 227
Total CWS Budget $ 8,523,987 $ 8,275,200
County Share Budget $ 779,255 $ 820,399
Total Budget Per Child $ 33,960 $ 36,455
County Share Budget Per Child $ 3,105 $ 3,614
Note: The total CWS budget number includes the 30 percent county share of the minimum budget, the 70 percent state
share of the minimum budget and all additional county, state, federal and other dollars contributed to the CWS budget
regardless of source.
The populations of each county are 2003 US Census Bureau estimates. 1
Table 1: Child Welfare Services Dollars Per Child Comparison.
5. The Grand Jury also researched information from the UC Berkeley “ Point in Time”
studies found on the UC Berkeley web site. This information, although very thorough
in reporting data by children’s ages, caseloads of social workers and numbers of
children in each category, is derived from the data of a single given day for each
quarter. 2
Conclusions
1. The County of Santa Cruz has contributed more than the required county share to the
CWS budget for fiscal years 2002- 2003 and 2003- 2004, resulting in additional total
CWS budget dollars.
2. For fiscal year 2002- 2003, Santa Cruz County CWS had significantly less total
money budgeted than three of the four counties studied and more budgeted than the
fourth county in comparison to the number of active cases.
3. For fiscal year 2003- 2004, Santa Cruz County CWS had less total money budgeted
than the four counties in comparison to the number of active cases.
4. For fiscal year 2002- 2003, Santa Cruz County CWS had less county share money
budgeted than three of the four counties studied and more budgeted than the fourth
county in comparison to the number of active cases.
5. For fiscal year 2003- 2004, Santa Cruz County CWS had less county share money
budgeted than the four counties in comparison to the number of active cases.
1 California Quick Facts, from US Census Bureau web site, http:// quickfacts. census. gov.
2 Child Welfare Services Reports for California, from University of California at Berkeley Center for
Social Services Research web site, http:// cssr. berkeley. edu/ CWSCMSreports/.
2004 – 2005 Santa Cruz Grand Jury Final Report
Page 1 - 12 The Welfare of Child Welfare:
Comparison of Budgets
6. Compared to other counties, Santa Cruz County CWS has less funds available to
serve an increasing number of active cases.
7. The UC Berkeley “ Point in Time” studies do not reflect an annualized number of
children served which the Grand Jury believes were needed for this budget analysis.
Recommendations
1. Santa Cruz County Human Resources Agency personnel, along with the Board of
Supervisors, should be commended for overmatching the required share of the
County of Santa Cruz CWS budget.
2. The County of Santa Cruz should explore other options for obtaining additional
money to supplement Child Welfare Services funds.
Responses Required
Entity Findings Recommendations Respond Within
Santa Cruz County
Board of Supervisors
1- 4 1, 2 60 Days
( August 30, 2005)
Santa Cruz County
Human Resources
Agency
1- 4 1, 2 90 Days
( September 30, 2005)
Santa Cruz County
Grand Jury
Final Report:
Section 2
Cities and County Committee Report
2004 – 2005 Santa Cruz County Grand Jury Final Report
Committee on Cities and County Page 2 - 1
No report submitted.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 2 - 2 Committee on Cities and County
This page intentionally left blank.
Santa Cruz County
Grand Jury
Final Report:
Section 3
Criminal Justice Committee Reports
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 1
Santa Cruz County
Jails Review
Definitions
Electronic monitoring: a program run by the Probation Department in which the
offender is fitted with an ankle bracelet that is programmed to apprise the
Probation Department of his/ her whereabouts
Exit plan: a written plan that staff members and inmates work on together in hopes of
preparing inmates for successful re- entry into the community
Infirmary: an area within a healthcare unit set up and operated for the purpose of caring
for patients who need skilled nursing care but are not in need of hospitalization or
placement in a licensed nursing facility, and whose care cannot be managed safely
in an outpatient setting. It is not the area itself, but the scope of care provided that
makes the bed an infirmary bed.
Medium security: inmates whose crime and criminal history do not pose a high security
risk. They are housed in a locked facility, but often in a dorm- like setting, rather
than individual cells.
Minimum security: inmates whose crime and criminal history pose very little security
risk. They are housed in an unlocked facility and can easily walk away from the
jail.
Misdemeanor Promise to Appear: a citation that any peace officer can write. The
promise to appear is a legal instrument that allows a person to be arrested for a
misdemeanor crime but not be book into jail. This helps with jail overcrowding
but starts the criminal complaint process.
“ O” unit: The observation unit includes rooms within the medical unit, where inmates
who are physically or mentally ill are monitored both by video and medical staff.
Parole hold: a prisoner/ inmate is placed in custody at the local county jail level by
his/ her Supervising Parole Agent for having violated the conditions of parole or
for committing a new crime. There is a hearing held while the prisoner is in
custody ( Morrissey Hearing) to determine the disposition of the case.
Plastic boats: used by the Sheriff’s Department to sleep inmates when the population
surpasses the maximum capacity. The boat- shaped plastic bed sits directly on the
floor within a cell block.
Rated capacity: California Board of Corrections minimum standards for detention
facilities, contained in Title 15 of the California Code of Regulations. It includes
the number of inmates each detention facility was built to hold ( rated capacity)
and the number of inmates that can safely be housed in the facility ( maximum
capacity).
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 2 Santa Cruz County Jails Review
Rubber room: an isolation room in which the walls and floors are covered in a rubber
material. Inmates who present a serious danger to themselves can be housed in
this room, which is monitored by staff every 15 minutes.
S. A. F. E.: Safe and Free Environment program which is derived from the RSAT
( Residential Substance Abuse Treatment) grant. This program is in operation at
the Rountree Medium Security facility.
Ward: an offender who is under the age of eighteen years and has been sentenced by the
Juvenile Court
Background
The Santa Cruz County jail system is comprised of six facilities:
1. Main Jail
2. Rountree ( Medium)
3. Rountree ( Minimum)
4. Blaine Street
5. Juvenile Hall
6. California Youth Authority
Each facility has its own operating budget, and the first five facilities comprise 50 percent
of the Sheriff’s budget. The California Youth Authority is a state- funded institution.
The Santa Cruz Main Jail
The Santa Cruz Main Jail is located at 259 Water Street in the city of Santa Cruz. The
Main Jail was constructed in 1981. The California Board of Corrections sets both the
rated capacity and the maximum capacity. The rated capacity is 311, and the maximum
capacity is 400. The Main Jail is the booking center for all of Santa Cruz County ( adult
offenders). It holds both sentenced and unsentenced inmates, both male and female. Most
females there are un- sentenced. Sentenced females are housed at Blaine Street Jail unless
they are violent or have medical problems that cannot be managed by that facility. If they
are violent, they are housed in a segregated section of the Main Jail.
All law enforcement agencies within Santa Cruz County bring their arrestees to the Main
Jail. Booking fees of $ 168 per arrestee are paid by each city. The cities are subsequently
reimbursed by the State of California. According to detention personnel, the Board of
Supervisors is considering cutting next year’s booking fees in half.
Rountree Jail
Rountree Jail consists of two jail facilities located conjointly at 90 Rountree Lane
( medium security) and 100 Rountree Lane ( minimum security) in Watsonville. These
jails were originally built in 1970. The medium facility has a rated capacity of 96 and a
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 3
maximum of 110. The minimum facility has a rated capacity of 162 and maximum
capacity is 250. Both jails hold sentenced prisoners.
Blaine Street Jail
This jail is located at 144 Blaine Street in Santa Cruz. It has been in operation since 1984.
It has a rated capacity of 32 with a maximum capacity of 42. It houses sentenced female
inmates who can be housed in a minimum security setting.
Juvenile Hall
Juvenile Hall is located at 3650 Graham Hill Road in Felton. It was established in 1968.
It houses sentenced and un- sentenced juvenile offenders ( male and female) between the
ages of 12 and 18. The rated capacity is 42. It also houses Juvenile Court with one
Superior Court Judge assigned to preside over all cases.
California Youth Authority
The California Youth Authority was located at 13575 Empire Grade Road in Santa Cruz,
and operated as a Youth Conservation Camp, from 1947 until 2005. The California
Department of Corrections decided to close the facility to youthful offenders. The wards
who had not completed their sentences were moved to other California Youth Authority
camps or institutions. When the Grand Jury toured the facility, it was in operation as a
Fire Conservation Camp.
The Department of Corrections plans to move in 100 adult prison inmates. The last ward
was moved out of the facility in April of 2005. The adult population is slated to move in
June 1, 2005. The fire camp will continue to operate as before, but with adult inmates
instead of juvenile wards.
Scope
The Grand Jury is charged with inspecting of conditions and management of the jail
facilities within the county under Penal Code § 919 ( b). In order to meet these
requirements, the Criminal Justice Committee of the Grand Jury:
• toured each facility at least once with attention to the conditions;
• interviewed staff and inmates of various facilities;
• reviewed previous Grand Jury reports and responses in regard to
detention/ facilities;
• made telephone calls and exchanged e- mails with jail commanders;
• reviewed California Code of Regulations pertaining to jail/ detention facilities;
• reviewed the Santa Cruz County jail budget;
• reviewed web sites, at the state and county levels, pertaining to detention
facilities; and
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 4 Santa Cruz County Jails Review
• reviewed numerous newspaper articles in the Santa Cruz Sentinel and the San
Jose Mercury News.
The Board of Corrections performs reviews of each penal institution within the county to
ensure compliance with mandatory state standards. It also audits the financial
management of each jail facility.
Main Jail Findings
1. On May 3, 2005, the inmate population was 384 in a facility with a rated capacity of
311. According to detention personnel, the Main Jail population fluctuates but is
routinely over the rated capacity.
2. General housekeeping and cleanliness were observed to be very good by the touring
Grand Jury members. It was pointed out that painting the interior of the jail is a
continuous process, beginning at one end and starting over once it is completed.
3. On May 3, 2005, the inmate population was:
• 87.8 percent male;
• 12.2 percent female.
Of those,
• 5.5 percent had mental health issues;
• 25.8 percent had committed crimes against person;
• 14.8 percent were parole holds; and
• 23 percent had committed drug related offenses.
Detention personnel report that records of repeat offenders are not available, but
experience and anecdote indicate the percentage is significant.
4. Data on jail population was collected from June through November 2004. It indicated
21.2 percent of detainees were released on a Misdemeanor Promise to Appear, which
helps with overcrowding. Over 16 percent were released under PC § 849( b) in which
no court action was taken.
5. A grievance procedure is in place in which several levels of detention staff review the
grievances and respond to the inmates’ complaints, both verbally and in writing.
6. Inmates are given access to:
• educational programs;
• religious services;
• counseling;
• parenting classes;
• domestic violence classes;
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 5
• drug and alcohol awareness;
• gang awareness; and
• classes to earn or study for a G. E. D. ( General Equivalency Diploma).
7. The booking process includes:
• sobering ( when necessary);
• placement in a restraint chair for combative detainees;
• fingerprinting and photo;
• recording and retention of inmates’ personal effects;
• strip search with visual inspection for weapons, drugs or any noted injuries;
• showering and decontamination;
• issuing of jail clothing; and
• health screening by deputies.
8. After the booking procedure, each prisoner is classified by strict criteria prior to
receiving a housing assignment. The deputies in the booking area review:
• criminal sophistication;
• age;
• gender/ transgender;
• need for protective custody;
• gang affiliation;
• charges;
• physical, medical and mental status;
• escape risk; and
• level of violence, from and to others and self.
9. Since the last Grand Jury report of June 30, 2004, there has been one death by suicide
on November 23, 2004.
10. Since the last Grand Jury report of June 30, 2004, there have been no escapes from
the Main Jail.
11. Because of jail overcrowding, some inmates sleep in plastic “ boats” that are placed on
the floor within the units. In May 2005, four inmates were sleeping in plastic boats.
12. The Correctional Officers and Sheriff Deputies involved in running the jails are
required to attend state- mandated courses designed to keep them abreast of changes in
the field and new tactics in dealing with inmates. Forty hours of POST ( Peace Officer
Standards and Training) must be completed each year to remain employed.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 6 Santa Cruz County Jails Review
Medical Unit
13. The Medical Unit at the Main Jail is staffed by:
• one part- time physician;
• one part- time psychiatrist;
• a minimum of one, usually two, registered nurses per shift;
• one community health worker;
• two medical assistants; and
• two licensed therapists.
14. In addition to serving inmates at the Main Jail, the medical staff also provides
medical care for Rountree, Blaine Street and Juvenile Hall.
15. The medical facility at the Main Jail is not licensed as an infirmary. Under the current
license, the medical staff can provide clinic care, administer first aid, take blood
sugars, change dressings and administer medications.
16. The clinic staff is available to see patients Monday through Friday in the mornings.
Inmates are charged $ 2.00 per visit. The money is taken from the Inmate Welfare
Fund, which is also used for personal care items, commissary needs and telephone
calls. The money is put in the Inmate Welfare Fund by the prisoners’ families. The
inmates are issued a “ debit” card to pay for expenses.
17. The nursing staff is on site 24 hours a day, seven days a week. There are two
registered nurses on the day shift and one on the night shift. There is also an on- call
medical doctor available by telephone when there is no physician on site.
18. In addition to their clinic work, the jail nurses also handle medical screening upon
booking.
19. The medical staff is supplemented by nursing students from Cabrillo College. Many
of these students are put on the extra- help list after graduating, but so far none have
sought full- time employment in detention nursing.
20. Some of the inmate medical problems cannot be treated at the Main Jail’s medical
facility. These conditions include, but are not limited to:
• stroke;
• cancer;
• serious heart disease; and
• broken bones.
21. Inmates who require treatment outside the scope of the Main Jail Medical facility are
taken to Dominican Hospital, Doctors on Duty or the County Health Clinic.
22. Inmates are transported via ambulance or in a patrol car with a Transportation
Deputy. The deputy’s maximum hourly rate is $ 48.85. If a lower level of security is
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 7
appropriate, a private security company can be used for $ 18.08 per hour. The
Sheriff’s Department has a contract for services.
‘ O’ unit
23. There are twelve rooms in the “ O” unit. Seven of the rooms are on video monitoring.
The patients ( inmates) are individually allowed out of their rooms for one hour each
day. They are in a room adjoining the nurses’ station so they can be fully monitored.
Healthcare workers also monitor some inmates on a one- to- one basis, however, they
are not allowed to distribute medication. The staff in the “ O” unit is able to handle
medical and psychiatric problems that would be cost prohibitive if the Sheriff’s staff
had to transport the inmates outside the facility for treatment.
24. Detention nurses’ pay scale is lower than in the private sector. The pay scale range is
from $ 31.82 per hour to $ 40.44 per hour, depending on their employment status with
Santa Cruz County. Private sector nurses earn between $ 50 per hour and $ 60 per hour
depending on their training.
25. The “ Rubber Room,” room 13 of the “ O” unit, is used for mental health patients who
are considered to be a danger to themselves or others. They are monitored every 15
minutes.
26. The nursing staff at the Main Jail often uses extra help staff, or even administrators
from Health Services Agency, to provide mandated coverage.
Pharmaceutical
27. Pharmaceutical costs are a major problem in the jail/ medical environment. If an
inmate is prescribed medication, he or she uses it only while in custody. If the
prisoner is released or escapes, the medication must be discarded. Recently, the
County of Santa Cruz, through the Health Services Agency, has contracted with a
company that provides “ bubble” packaging that allows unused medication to be
returned to the pharmaceutical company or prescribed / used for another inmate.
Currently, Rountree and Juvenile Hall are using this system. It is expected that the
Main Jail will adopt this program.
Conclusions
1. The staff is professional and well trained in the day- to- day functioning of the
institution.
2. The facility, though old, is well maintained, clean and well managed by the staff.
3. The number of nurses on staff is inadequate for the current jail population.
4. The present method of dispensing medication is not cost effective.
5. The Main Jail continues to face overcrowding.
6. The grievance procedure allows inmates the opportunity to express their concerns,
and the staff responds in a timely fashion.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 8 Santa Cruz County Jails Review
Recommendations
1. The Sheriff’s Department and the Santa Cruz County Board of Supervisors should
continue to work on solutions to address jail overcrowding.
2. The Board of Supervisors should take action to increase the pay scale for the
detention nursing staff.
3. The Board of Supervisors should work to re- open the medical clinic at the Rountree
facility to reduce the workload of the nursing staff and to cut transportation costs of
bringing inmates to the Main Jail for treatment.
4. The Main Jail should adopt “ bubble” packaging for dispensing medication to save
money.
5. Jail administrators and staff should be commended for the care and integrity they
apply toward the running of this institution.
6. The Main Jail should continue to conduct the inmate grievance procedure in the fair
and well- documented manner they currently employ.
Rountree Medium Security Findings
28. On December 3, 2005, the population was 55, well within the rated capacity of 96.
29. The S. A. F. E. program, a drug rehabilitation program, had 27 participants on
December 3, 2005.
30. The on- site nursing position was eliminated in February of 2004 due to budget cuts.
As a result, the facility cannot house any inmates requiring daily medical injections or
psychotropic drug dosing. Other types of prescription drugs are dispensed by a nurse
from the Main Jail seven days a week for two hours in the morning. Detention staff
estimated that 25- 30 inmates on psychotropic drugs could be housed at Rountree if
the medical facility were staffed by a full- time, on- site nurse. This would alleviate
Main Jail overcrowding.
31. Non- urgent medical issues are handled by transporting inmates to the Main Jail
medical facility or, on occasion, to Doctors on Duty by officer- driven vehicle.
Emergency medical issues are handled by transporting inmates to the Watsonville
Community Hospital by either ambulance or officer- driven vehicle.
32. An established and documented grievance procedure, dated May 4, 1996, is in place
to respond to issues relating to conditions of confinement.
33. General housekeeping/ cleanliness of the medium security facility was observed to be
very good by the touring Grand Jury members.
Rountree Minimum Security Facility Findings
34. On December 3, 2005, the population was 115, well within the rated capacity of 162.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 9
35. There have been 13 escapes ( walkaways) since the seating of the 2004- 2005 Grand
Jury, up from seven during the term of the 2003- 2004 Grand Jury.
36. There are ample opportunities for inmates to participate in numerous programs during
incarceration. A partial list follows.
• Education:
• English as a Second Language ( ESL)
• General Equivalency Diploma ( GED)/ ESL
• GED Testing
• Self Improvement:
• Alcoholics Anonymous
• Narcotics Anonymous
• Bible study/ church
• AIDS awareness class/ testing
• Substance abuse
• Tobacco cessation
• Vocational:
• Auto body and paint
• Computer skills
• Building maintenance and landscaping
37. A designated area outside the facility is maintained for family visits.
38. An established and documented grievance procedure, dated May 4, 1994, is in place
to deal with issues relating to conditions of confinement.
Conclusions
7. Rountree is a well- run facility.
8. Rountree inmates can benefit from a variety of programs and educational
opportunities.
9. The grievance procedures are due for a review and possible update.
10. The staff at Rountree performs its duties in a professional manner.
11. Closing the medical facility resulted in otherwise eligible inmates being housed in the
Main Jail facility because of prescription drug needs.
Recommendations
7. The Rountree staff should continue to run the facility in a professional manner.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 10 Santa Cruz County Jails Review
8. Rountree should continue to offer numerous programs and encourage all inmates to
participate.
9. A study should be undertaken to assess what impact the re- opening of the medical
facility would have on Main Jail overcrowding.
10. The grievance procedures of both the medium and minimum security facilities should
be reviewed and updated, if appropriate.
Blaine Street Jail ( Women’s Minimum Security Facilities)
Findings
39. The Board of Corrections’ rated capacity is 42 inmates. As of May 4, 2005, the
facility had 22 inmates.
40. There have been six escapes ( walkaways) in the past year.
41. There have been no deaths in the past year.
42. Fire drills are held monthly.
43. There are 25 rooms, five of which do not house inmates. These are used for storage or
office space. The inmates’ rooms house up to two inmates per room.
44. Meals are prepared by inmates from menus provided by the county dietitian.
45. There are two classrooms in the facility. Attendance at these classes is voluntary. The
classes offered are:
• GED ( General Equivalency Degree);
• job skills;
• Pajaro Valley Substance Abuse Prevention and Student Assistance;
• exit plans;
• computers;
• crocheting and knitting;
• parenting skills;
• communication skills;
• women’s health;
• Narcotics Anonymous;
• Alcoholics Anonymous; and
• Bible study, various church groups.
46. Grievances are handled through a grievance form. An inmate can request this form
from a staff member. If the grievance concerns a staff member, the grievance is
handled with that staff member and the director. If the grievance concerns other areas,
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 11
it is discussed with the director. Grievances are usually handled upon receipt of the
form.
47. Each inmate is given a set behavior rules. If there is a violation of these rules, the
following steps are taken:
• a verbal warning is issued;
• a written warning is issued;
• privileges are lost;
• extra work detail is assigned;
• counseling is scheduled with the director; and
• if there are too many infractions, the inmate is sent to the Main Jail.
48. Both the interior and exterior of the building are clean and neatly maintained. The
outside area is in a garden setting and used by inmates for activities such as reading
and socializing and is also used for family visits.
49. There is one officer on duty for all shifts, 24 hours a day.
Conclusions
12. The Blaine Street Jail buildings and grounds are attractive and well maintained.
13. The facility is well staffed, and staff appears to be attuned to the needs of the inmates.
14. There is a variety of useful activities available to the inmates.
Recommendations
11. The Blaine Street Jail staff should continue to operate the facility in the same caring
and efficient manner that it does at present.
12. The staff should be commended for their attractive and well- run facility.
Juvenile Hall Findings
50. This facility has a State Board of Corrections rating of 42 detainees. It has an average
daily population of 24.7 ( fiscal year).
51. This facility has passed inspection by the State Board of Corrections, the local Fire
Department and Nutritional Health.
52. The County Board of Education provides school programs for Juvenile Hall wards.
53. The average length of stay in Juvenile Hall is between nine and 11 days.
54. Counseling and substance abuse treatment are part of the Juvenile Probation process.
Juvenile Hall is not a treatment program but has a drug counselor on staff 20 hours
per week. Mental health services are provided 80 hours per week.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 12 Santa Cruz County Jails Review
55. Juveniles are housed in two units. One of the units houses boys who are more
“ criminally sophisticated.” The other unit houses girls and less “ criminally
sophisticated” boys.
56. Juveniles are given an orientation to the facility upon intake. They are given a list of
the rules and consequences which they must acknowledge and sign.
57. Rules and grievance procedures are posted, and a box is provided to receive the
grievance forms. The box is checked twice daily.
58. Juveniles are assigned to a housing unit based on a classification system that includes
consideration of:
• age;
• gender; and
• type of crime.
59. Parents are charged $ 24 per day while their child is in Juvenile Hall.
60. Juvenile Probation has a Home Electronic Monitoring Program which allows for
early release. Two counselors make daily visits to wards released on this program.
61. This facility houses juveniles between the ages of 12 and 18. Children under the age
of 12 are the responsibility of Child Protective Services and are not housed at
Juvenile Hall.
62. This facility does not have a covered gymnasium.
63. The detainees’ rooms are small, and they contain:
• a bed;
• a sink;
• a drinking fountain; and
• a toilet.
64. Juvenile Hall does not have adequate heating, ventilation or air conditioning. The
walls of the detainees’ rooms are made of cement blocks. They retain extreme
temperatures. Juvenile Hall staff report that the inadequacy of the heating and air
conditioning is not compatible with good public health.
65. There are electronic doors entering the facility and the courtyard, but other areas do
not have electronic doors. Staff reported that electronic doors throughout the facility
would improve the response time in an emergency.
Conclusions
15. Juvenile Hall is well managed with a caring and diverse staff.
16. The Juvenile Hall buildings and grounds are well maintained.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 13
17. Construction of a closed gymnasium would allow for adequate physical activity
during poor weather.
18. The Home Electronic Monitoring program reduces the Juvenile Hall population.
19. For security and safety reasons, electronic doors need to be installed throughout the
facility.
20. The heating and ventilation system in Juvenile Hall is inadequate.
Recommendations
13. The Home Electronic Monitoring Program should be continued as it reduces the
facility population.
14. The Board of Supervisors should budget money to upgrade the security system to
include security cameras and electronic doors.
15. The Board of Supervisors should give higher priority to funding the construction of
an enclosed gymnasium.
16. The Board of Supervisors should budget to upgrade the heating and ventilation
system in Juvenile Hall.
17. The staff is to be commended for its efforts to maintain a safe and secure environment
and help juveniles under their care.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 14 Santa Cruz County Jails Review
California Youth Authority Findings
66. This facility had a State Board of Corrections rated capacity of 85. Prior to closure, its
average daily population was approximately 46.
67. The wards were all at least 18 years old and sentenced to the California Youth
Authority, where they would stay until they were 25 years old or had completed their
sentences.
68. The wards had already served a portion of their sentences in a locked California
Department of Corrections Youth Authority facility before being moved to the Fire
Camp.
69. This facility provided a full high school program.
70. This facility employed seven counselors to work with the wards to address any
emotional problems they may have had and to prepare them for release back into the
community.
71. Many of the wards were trained to work on a fire crew, which could prepare them for
employment upon their release.
72. The grievance procedure was well defined and taken seriously by the staff. Both
written and verbal responses were provided to the wards.
73. There had never been a suicide or suicide attempt at this facility.
74. This was a minimal security facility and the wards slept in a dorm setting with shared
showers and toilet facilities. The heating system was old and unable to heat the
facility adequately.
75. Meals were shared in a central dining area and the food served was plentiful and well
prepared.
76. There were 22 escapes during the past year. All were “ walkaways” from job sites.
Conclusions
21. The California Youth Authority Camp facility was well managed by a professional
and well- trained staff.
22. The California Youth Authority Fire Camp provided a community service to Santa
Cruz County.
23. The support provided to the CDF by the CYA wards was a beneficial service to our
community.
24. The wards once housed there have lost an enriching opportunity to learn an
employment skill, which might have kept them from returning to a life of crime.
Recommendations
18. There are no recommendations as the facility is closed.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Santa Cruz County Jails Review Page 3 - 15
Responses Required
Entity Findings Recommendations Respond
Within
Santa Cruz
County Board of
Supervisors
1, 22, 25, 30,
39- 49, 64, 65
1- 3, 9, 11, 12, 14, 15 60 Days
( August 30, 2005)
Santa Cruz
County Sheriff
1, 4, 27, 30, 31,
39- 49
1, 4, 6, 9- 12, 14, 15 60 Days
( August 30, 2005)
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 16 Santa Cruz County Jails Review
This page left intentionally blank.
2004 – 2005 Santa Cruz County Grand Jury Final Report
California Public Records Act Page 3 - 17
Compliance by Local Police Agencies
California Public Records Act
Compliance by Local Police Agencies
“ In enacting this chapter, the legislature, mindful of the right of individuals to
privacy, finds and declares that access to information concerning the conduct
of the people’s business is a fundamental and necessary right of every person
in this state.”
The California Public Records Act
California Government Code § 6250
Synopsis
Police agencies are required to comply with the California Public Records Act ( the act) as
codified in California Government Code § 6250- 6270. The act allows the public to access
and review the “ police blotter” ( list of times and circumstances of all calls to police,
names and details of arrests, warrants, charges and hearing dates) that is compiled daily
by police agencies. This investigation found that the Scotts Valley Police Department is
in full compliance with the act. The Capitola Police Department, the Santa Cruz County
Sheriff’s Department, the Santa Cruz Police Department and the Watsonville Police
Department provide only limited information and are not in compliance with the act.
Definitions
Arrest log: abbreviated version of the incident log ( police blotter) made available to the
press and public upon request
Local agencies: includes counties; cities, whether general law or charter; school districts;
municipal corporations; special districts; political subdivisions; any board,
commission or agency; other local public agencies; or entities that are legislative
bodies of a local agency pursuant to subdivisions
Media release log: abbreviated version of the incident log ( police blotter) made available
to the press and public upon request
Member of the public: person who is not a member, agent, officer or employee of a
federal, state or local agency acting within the scope of his or her membership,
agency, office or employment
Police blotter: an incident log that contains a list of times and circumstances of all calls
to the police, names and details of arrests, warrants, charges and hearing dates,
that is compiled daily by police agencies
Public agency: any federal, state, regional or local agency
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 18 California Public Records Act
Compliance by Local Police Agencies
Public records: information relating to the conduct of the public’s business prepared,
owned, used or retained by any state, regional or local agency regardless of physical
form or characteristics
Sources
Interviewed:
Capitola Police Department.
Livermore Police Department.
Santa Cruz County Sheriff’s Department.
Santa Cruz Police Department.
Scotts Valley Police Department.
Watsonville Police Department.
911 Dispatch.
Reviewed:
All Santa Cruz County police departments’ policies and procedures in regard to
access to public information.
California Penal Code § 11075, 11105, 11105.1.
First Amendment Project site, www. thefirstamendment. org. ca- html.
Contra Costa Times, “ Half of Police Agencies Withhold Incident Logs,” July 25,
2004.
Public Records Act Government Code § 6250- 6270.
Background
California Government Code § 6254 ( f)( 2) requires the following information in police
blotters:
“ the time, substance, and location of all complaints or requests for assistance received
by agency and the time and nature of the response including the extent the
information regarding crimes alleged or committed or any other incident investigated
is recorded, the time, date and location of the occurrence, the time and date of the
report, the name and age of the victim, the factual circumstances surrounding the
crime or incident, and a general description of any injuries, property or weapons
involved.”
Information in the “ police blotter” ( time and circumstances of calls to police, names and
details of arrests, warrants, charges and hearing dates) MUST be disclosed unless such
disclosure would endanger an investigation or the life of an investigator. Additional
information that may not be disclosed without a court order includes the name( s) of
2004 – 2005 Santa Cruz County Grand Jury Final Report
California Public Records Act Page 3 - 19
Compliance by Local Police Agencies
suspects under investigation, juveniles’ identities, names of victims of domestic violence
and the names of the victims of child abuse or molestation. On July 25, 2004, the Contra
Costa Times reported that one- half of the 36 police agencies contacted were in violation
of the State Public Records Act for failure to produce their incident logs. At least one
agency ( the Oakland Police Department) allowed only a review of an “ abridged incident
report” and others issued vague referrals to other locations. The Livermore Police
Department was cited as one of the police agencies in full compliance with the act.
Members of the Grand Jury visited the five police agencies in the county as private
citizens to request information. In only one case did they have to identify themselves as
Grand Jurors to obtain information. They also visited the Livermore Police Department
as a comparison to the local agencies. This department readily provided all information of
police activity as requested by private citizens.
In addition to the California State Highway Patrol, there are five police agencies within
Santa Cruz County:
• Capitola Police Department
• Santa Cruz Police Department
• Santa Cruz County Sheriff’s Department
• Scotts Valley Police Department
• Watsonville Police Department
Scope
This report examined whether local police agencies comply with the California Access to
Public Records Act. It also looked at whether they comply with their own policies and
procedures and whether those policies and procedures are consistent with the act.
Findings
Capitola Police Department
1. The department does not provide a complete police blotter but provides information
in the form of a media release log.
2. The department’s access to public records policy is in accordance with the California
Access to Public Records Act.
3. When Grand Jury members, without identifying themselves as such, requested
information in regard to police activity, copies of the log were provided.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 20 California Public Records Act
Compliance by Local Police Agencies
Santa Cruz County Sheriff’s Department
1. The department does not provide a complete police blotter but provides information
in the form of an arrest log.
2. When the access to public records policy was requested from the Sheriff’s
Department, a copy of the California Public Records Act [ Law Enforcement Records
Exempt Records – 6254 ( f)] was provided.
3. The arrest log was not made available when requested by public citizens.
4. The arrest log was made available when citizens identified themselves as members of
the Grand Jury.
5. Copies of the arrest log could only be made by hand.
Santa Cruz Police Department
1. The department does not provide a complete police blotter but provides information
in the form of a media release log.
2. The department’s access to public information policy is in accordance with the
California Access to Public Records Act.
3. When members of the Grand Jury, without identifying themselves as such, requested
information regarding police activity, it was provided in the form of a media release
log.
4. The media release log could be read at the department, but information could only be
copied by hand.
Scotts Valley Police Department
1. The department issues an event history ( police blotter) that contains all the
information that the public is entitled to.
2. The department also issues a media log which is a synopsis of the event history.
3. The department’s access to public information policy is in accordance with the
California Access to Public Records Act.
4. When members of the Grand Jury, without identifying themselves as such, requested
information regarding police activity, both the event history and the media log were
provided and copies were allowed to be made.
Watsonville Police Department
1. The department does not provide a complete police blotter but provides information
in the form of a media release log.
2. The department’s access to public records policy is in accordance with the California
Access to Public Records Act.
2004 – 2005 Santa Cruz County Grand Jury Final Report
California Public Records Act Page 3 - 21
Compliance by Local Police Agencies
3. When Grand Jury members, without identifying themselves as such, requested
information regarding police activity, copies of the media release log were provided.
Conclusions
Capitola Police Department
1. The information of police activity provided in the media release log is not in
compliance with the California Access to Public Records Act.
2. The information provided in the media release log is not in compliance with the
department’s own policies and procedures.
3. The staff was courteous when providing information to unidentified Grand Jurors.
Santa Cruz County Sheriff’s Department
1. The information provided in the arrest log is not in compliance with the California
Access to Public Records Act.
2. The information provided in the arrest log is not in compliance with the department’s
own policies and procedures.
3. The staff was neither courteous nor helpful when Grand Jury members requested
information, whether as private citizens or as Grand Jury members.
Santa Cruz Police Department
1. The information provided in the media release log is not in compliance with the
California Access to Public Records Act.
2. The information provided in the media release log is not in compliance with the
department’s own policies and procedures.
3. The staff was courteous when providing information to unidentified Grand Jurors.
Scotts Valley Police Department
1. The Scotts Valley Police Department complies with the California Public Records
Act.
2. It provides information to the public in compliance with department’s own policy and
procedures manual.
3. The staff was courteous and friendly when visited by unidentified Grand Jurors.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 22 California Public Records Act
Compliance by Local Police Agencies
Watsonville Police Department
1. The information provided in the media release log is not in compliance with the
California Access to Public Records Act.
2. The information provided the media release log is not in compliance with
department’s own policies and procedures.
3. The staff was courteous to the public in providing information to unidentified Grand
Jurors.
Recommendations
Capitola Police Department
1. The Capitola Police Department should create a police blotter that is in compliance
with the California Access to Public Records Act and with its own policy in regard to
public access to information.
2. The staff should be educated in its own internal policies and procedures and trained to
handle requests for information by the public.
3. The staff should be commended for its courtesy in response to public requests for
information.
Santa Cruz County Sheriff’s Department
1. The Santa Cruz County Sheriff’s Department should create a police blotter that is in
compliance with the California Access to Public Records Act and with its own policy
in regard to public access to information.
2. The staff should be educated in its own internal policies and procedures and trained to
handle requests for information by the public.
3. The staff should make information in the arrest log readily available to the public in a
courteous and efficient manner.
Santa Cruz Police Department
1. The Santa Cruz Police Department should create a police blotter that complies with
the California Access to Public Records Act and with its own policy in regard to
public access to information.
2. The staff should be educated in its own internal policies and procedures and trained to
handle requests for information by the public.
3. The staff should be commended for its courtesy in response to public requests for
information.
2004 – 2005 Santa Cruz County Grand Jury Final Report
California Public Records Act Page 3 - 23
Compliance by Local Police Agencies
Scotts Valley Police Department
1. The Scotts Valley Police Department should be commended for its compliance to the
California Access to Public Records Act.
2. The staff should be commended for its courtesy to the public.
Watsonville Police Department
1. The Watsonville Police Department should create a police blotter that is in
compliance with the California Access to Public Records Act and with its own policy
in regard to public access to information.
2. The staff should be commended for its courtesy in response to public requests for
information.
Responses Required
Entity Findings Recommendations Respond
Within
Capitola Police
Department
All in
pertinent
section
All in pertinent section 90 Days
September 30, 2005
Santa Cruz County
Sheriff’s
Department
All in
pertinent
section
All in pertinent section 60 Days
August 30, 2005
Santa Cruz Police
Department
All in
pertinent
section
All in pertinent section 90 Days
September 30, 2005
Scotts Valley Police
Department
All in
pertinent
section
All in pertinent section 90 Days
September 30, 2005
Watsonville Police
Department
All in
pertinent
section
All in pertinent section 90 Days
September 30, 2005
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 3 - 24 California Public Records Act
Compliance by Local Police Agencies
This page left intentionally blank.
Santa Cruz County
Grand Jury
Final Report:
Section 4
Health and Human Services Committee Reports
2004- 2005 Santa Cruz County Grand Jury Final Report
Shades of Gray: Page 4 - 1
Dominican Santa Cruz Hospital/ Jail Medical Facility
Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
Synopsis
Providing care to chronic inebriates through a hospital emergency room is costly,
particularly if they are medically indigent. Dominican Hospital and Santa Cruz County
detention staff are in agreement that treating these alcohol and substance abusers is staff
intensive. These patients often exhibit behavior problems, are homeless and have
underlying medical conditions. The use of the Emergency Department at Dominican
Hospital increases the cost of medical care, extends waiting time and diverts ambulances
from other types of emergencies. Opinions differ, however, about who pays for patients
not yet booked into jail. Dominican Hospital is required by federal law to provide
emergency care regardless of a patient’s ability to pay. The county is responsible for
medical care for prisoners under arrest, often serial inebriates or “ frequent flyers.” When
a detainee is in custody but not yet booked, Dominican Hospital often ends up delivering
services and not receiving reimbursement within this “ gray area.” Detention staff is
exploring ways to decrease the cost of caring for serial inebriates, including establishing
rehabilitation programs and a sobering facility and restructuring policies. Several other
communities have started cost- effective, non- medical programs to divert inebriates from
emergency rooms.
Definitions
Booking: the process by which an arrestee is registered into the detention system
CHIP: California Health Care for the Indigent Program
Detainee: a person in custody
DUI: driving under the influence of intoxicating substances
ED: Emergency Department
EMTALA: Emergency Medical Treatment and Labor Act
ETOH: chemical or medical notation for ethyl alcohol
Frequent Flyers: persons who are frequently inebriated and brought to jail or the
Emergency Department by law enforcement officers
Inebriate: one using alcohol or drugs to the point of intoxication
In custody: detained by law enforcement officers
LVN: Licensed Vocational Nurse
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 2 Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
Medi- Cruz: a county- operated health care program that helps low- income residents of
Santa Cruz County without health insurance to get the health care services they need
Netcom: Santa Cruz County’s computer- aided dispatch center
Proposition 36: The Substance Abuse and Crime Prevention Act of 2000 offers adults
convicted of nonviolent drug possession offenses the opportunity for substance abuse
treatment instead of incarceration.
RN: Registered Nurse
Safety chair: a restraining device in the Main Jail booking area for inmates with
behavioral problems
Sallyport: a system of security doors in which the first door opens, then must be closed
and locked before the second door will open
Triage: the process for evaluating casualties and assigning priority of treatment
Background
According to detention personnel, the biggest drain on the jail’s medical budget is serial
inebriates. These people are arrested for “ Drunk in Public,” PC § 647( f) and can be
brought to jail repeatedly.
When a person is arrested and taken to the county jail, he or she is first admitted through
the booking sallyport1 to a processing area. If arrestees are inebriated to the point of being
unable to stand unassisted, they are taken to Dominican Hospital for medical evaluation.
The jail nurse will not accept an injured arrestee because the jail does not have the
necessary equipment and staff to treat the injuries. If the arrestee is not booked and taken
to the hospital, he or she is responsible for the bill.
Dominican Hospital provides medical care to “ county- responsible patients” under a
Hospital Services Agreement with Santa Cruz County. 2 Persons under arrest by the Santa
Cruz County Sheriff’s Department or incarcerated in the county jail are the responsibility
of the county. Care of these often uninsured detainees increases the cost of medical care,
extends waiting times in the Dominican Hospital Emergency Department ( ED) and
diverts ambulances from other types of emergencies.
Patients referred to the hospital from the jail sallyport prior to booking are treated as
private pay patients. Many of these people are uninsured and also do not have Medi- Cal
or Medi- Cruz. Their treatment, therefore, becomes a write- off for the hospital and the
physicians who treat them. The bad debt ( write- off) in the Emergency Department is
significant. According to the Access to Medical Care Agreement ( AMCA) between
Dominican Hospital and Santa Cruz County, Dominican Hospital agrees to spend seven
1 See Definitions.
2 County of Santa Cruz and Dominican Santa Cruz Hospital, Hospital Services Agreement.
2004- 2005 Santa Cruz County Grand Jury Final Report
Shades of Gray: Page 4 - 3
Dominican Santa Cruz Hospital/ Jail Medical Facility
percent of the hospital’s net operating expenses on uncompensated care, which include
charity care and bad debts.
Once a person has been cleared for booking and accepted into the jail, any subsequent
medical treatment the jail cannot provide is performed at the hospital. Santa Cruz County
is responsible for the bill.
Hospitals in other counties and cities share the problem of uncompensated medical care.
For example, Stanford University Medical Center sued the city of East Palo Alto and San
Mateo County, accusing them of not paying for medical costs incurred by injured
suspects brought in by East Palo Alto police. Stanford has a contract with the county to
provide medical care to injured suspects.
San Diego, Portland, Phoenix, Seattle, Las Vegas and San Joaquin County have programs
diverting public inebriates from emergency rooms. They have non- medical alternative
placements for sobering up. Most use a combination of a sobering facility and local jails.
The most cost- effective programs use vans to pick up public inebriates and bring them to
the sobering programs.
Scope
This investigation began as a review of ways to improve medical care and to save money
at the county’s main jail medical facility. In the course of the investigation, the issue of
uncompensated care for detained but unbooked patients in county hospital emergency
rooms emerged. Although Watsonville Community Hospital may also have this problem,
we chose to focus on Dominican Hospital.
Sources
Interviewed:
Dominican Santa Cruz Hospital personnel.
Santa Cruz County Health Services Agency personnel.
Santa Cruz County Main Jail medical personnel.
Santa Cruz County Sheriff’s Department personnel.
Reviewed:
Memoranda/ Reports
2003- 2004 Santa Cruz Grand Jury Final Report, “ Hospitals and Charity Care in Santa
Cruz County.”
Application for California Healthcare for Indigents Program Funding for Fiscal Year
2004- 5, May 4, 2005.
Board of Supervisors Meeting Minutes, January 4, 2005.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 4 Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
County of Santa Cruz and Dominican Santa Cruz Hospital, Hospital Services
Agreement, [ Article 2, § 2.1, ( d)], signed in 1994, amendment signed in 1997.
Dominican Hospital Response, December 31, 2004.
Health Services Agency, Sheriff’s Department, Public Inebriate Summary, March
2003, EMS “ Snapshot” with Estimated Annual Impacts.
Rama Khalsa, HSA Director, Mark Tracy, former Sheriff, Report Back on
Emergency Room Issues Related to Criminal Justice and Public Inebriates, April
14, 2003.
Health Services Agency personnel, Follow- up Questions, May 4, 2005.
Steve Robbins, Sheriff – Coroner, Memo regarding study of inebriates at local
hospital emergency rooms, April 27, 2005.
Newspaper/ Magazine Articles
San Jose Mercury News, “ Hospital sues for cost of treating suspects,” 2005.
Santa Cruz Sentinel, “ County will offer drunks treatment,” July 27, 2004.
The Valley Post, “ New Program Helping to Keep Inebriates Out of Emergency
Rooms,” San Lorenzo Valley, February 15, 2005- March 14, 2005.
Web sites
City of San Diego, “ Federal Government Lauds Local Efforts to End Chronic
Homelessness,” September 4, 2004,
http:// www. sandiego. gov/ press/ 040914. shtml.
Centers for Medicare and Medicaid Services web site,
http:// www. cms. hhs. gov/ providers/ emtala/ default. asp.
Santa Cruz County Personnel Department web site, http:// sccounty01. co. santa-cruz.
ca. us/ personnel/ salsched/ salsched. asp.
Findings
1. In 1986, Congress enacted the Emergency Treatment and Labor Act ( EMTALA) to
ensure public access to emergency medical services regardless of ability to pay.
Medicare- participating hospitals that offer emergency services must provide a
medical screening examination when a request is made for examination or treatment
for an emergency medical condition. Hospitals are required to provide stabilizing
treatment for patients with emergency medical conditions [ USC 42 § 1395( dd)]. 3
2. Increased use of services is a key driver of rising hospital costs. While costs have
continued to increase, reimbursements from government and many private health
insurers have not kept pace. Increased use of Emergency Department services by
patients not requiring this level of hospital care strains an already fragile emergency
medical care system and may result in increased waiting times and ambulance
3 Centers for Medicare and Medicaid Services Web site,
http:// www. cms. hhs. gov/ providers/ emtala/ default. asp.
2004- 2005 Santa Cruz County Grand Jury Final Report
Shades of Gray: Page 4 - 5
Dominican Santa Cruz Hospital/ Jail Medical Facility
diversion. Public inebriates consume hospital resources and could be better managed
in alternative settings. Medically indigent inebriates further tax the system because
they are uninsured.
3. According to HSA personnel, emergency- room visits can be costly. At Dominican
Hospital, it costs about $ 350,000 to $ 500,000 annually to treat indigent drunks. 4
4. A person can be booked “ in absentia.” This happens if an arrestee has an immediate
and serious medical condition that requires emergency medical treatment before
going to jail. Santa Cruz County is responsible for medical care because the person
under arrest is too injured to go to jail.
5. In regard to medical clearance of an arrestee prior to booking, the jail nurse on duty
triages5 the arrestee at the door. If arrestees cannot stand on their own, they are taken
to Dominican Hospital by the arresting agency for medical clearance. The cost of the
medical care while at Dominican Hospital falls on the individual. If the individual
cannot pay, Dominican Hospital assumes the cost. If an inmate needs hospitalization
or treatment after booking, the financial responsibility belongs to the Sheriff’s budget.
6. The safety room at the Main Jail ( drunk tank) is not often used. Confining a detainee
in the safety room requires frequent observation of the detainee. Another restraining
device, the safety chair, can be used for a few hours at a time until the detainee
“ settles down.”
7. Detention personnel said the biggest drain on the jail’s medical budget is “ serial
drunks.” These are people are arrested repeatedly for PC § 647( f) ( Drunk in Public), a
misdemeanor.
8. Ambulances in California must bring patients to emergency rooms unless the patients
have adequate mental capacity to refuse treatment and have no obvious injuries.
9. Detention personnel say that handling inebriates is staff intensive. They often exhibit
behavioral problems, are homeless and can have underlying medical problems. Some
“ frequent flyers” are recognized by detention nurses upon arrival as having chronic
medical problems. Those needing treatment must be taken to the hospital Emergency
Department. According to Detention personnel, the target group in Santa Cruz
County is about 10 people who are routinely picked up for drunkenness. 6
10. According to Dominican Hospital personnel, in- custody patients who had used the
Emergency Department while in custody sometimes return on their own to use it as a
source of narcotics and as an alternative to “ street- acquired” medications.
11. Detainees do not have a large effect on staffing in the Emergency Department but can
affect patient flow through the department. Having to perform Driving Under the
4 Santa Cruz Sentinel, “ County will offer drunks treatment,” July 27, 2004.
5 See Definitions.
6 Santa Cruz Sentinel, “ County will offer drunks treatment,” July 27, 2004.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 6 Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
Influence ( DUI) blood draws may affect staffing because medical technicians are
taken away from caring for other patients.
12. When an officer picks up an inebriate in public, the inebriate is sometimes given the
choice of going to jail or going to the hospital. According to Emergency Department
personnel, the inebriate often chooses the hospital.
13. Weekend and overnight shifts are more impacted by inebriates and drug users
because they come in during those shifts more often. Staffing levels are lower during
the night shift. If inebriates are medically stable, they may occupy a bed for eight to
10 hours to sober up. It usually takes at least four hours for a patient to sober up and
be ready to discharge. Typically, an officer does not stay with them. For many of
these patients, the reason they were detained is no longer applicable ( i. e., public
intoxication), and they are released without being charged.
14. Inebriates are often brought to the hospital by ambulance. There are a total of 13
ambulances in service in the County of Santa Cruz ( in and out of service at different
times). If they are tied up on calls for inebriates, they cannot answer calls for other
emergency situations.
15. Detainees can be a factor in overwhelming an emergency room because frequently
they arrive unannounced, especially if they are coming in a police car directly from
being arrested. With an ambulance, the emergency room gets a few minutes’ warning.
The emergency room could use that time to get a bed ready. If someone just “ shows
up,” there is more pressure to move people around.
16. If inebriates come in off the street ( for example, they were in a bar fight), they are
evaluated by a physician to determine if they are sufficiently medically stable to go to
jail. Those patients may arrive in an ambulance or a police car.
Funding
17. In 1994, Dominican Hospital and Santa Cruz County signed a contract that specifies,
“ persons under arrest by the County Sheriff’s Department or incarcerated in the
County jail” are county- responsible patients. The county is responsible for the cost of
their health care. 7
18. Dominican Hospital accepts reimbursement for services from Santa Cruz County at a
negotiated and agreed- upon rate.
19. Dominican Hospital personnel say that early this year Detention administration
implemented a new policy requiring that a triage nurse at the sallyport fill out the
Medical Triage/ Sallyport Refusal form and send it to the hospital with the officer and
inebriate. Once individuals have been treated at the hospital and medically cleared,
they are taken to jail for booking. All medical services provided prior to booking are
now the financial responsibility of the individual. Despite the lack of health
7 County of Santa Cruz and Dominican Hospital Services Agreement, 1994.
2004- 2005 Santa Cruz County Grand Jury Final Report
Shades of Gray: Page 4 - 7
Dominican Santa Cruz Hospital/ Jail Medical Facility
insurance/ financial resources for many of these patients, the hospital is required by
law to provide services but is not guaranteed any reimbursement. In addition, this
new procedure requires that a new form must accompany the bill in order to secure
payment for inmates transported to the hospital from county detention facilities.
Dominican Hospital personnel say that this new procedure was put into effect without
adequate communication about the changes to either Dominican Hospital or to law
enforcement, creating much confusion.
20. According to Dominican Hospital personnel, the approved patient payment is based
on a hospital services agreement reimbursement contract. Reimbursement for
outpatient care covers the cost of services. However, reimbursement for inpatient
services does not cover total costs.
21. According to Dominican Hospital personnel, patients in custody may require
Emergency Department and other hospital services. Hospital personnel say that the
costs of providing care should not be the responsibility of the hospital. Sometimes the
hospital has no way to ascertain the booking status of a patient before providing
services.
22. HSA personnel said that whether the county is legally responsible for emergency
room care for detainees who have not been formally booked is a “ gray area.”
23. There is a distinction between eligiblity for Medi- Cal and Medi- Cruz in Santa Cruz
County. Medi- Cal recipients must meet certain criteria including income, citizenship,
children and disabilities. Medi- Cal is a federal program administered by the state.
24. Medi- Cruz is the county’s response to CA Government Code § 17000. It applies to
people in the county who have no other resources, i. e., homeless, indigent,
undocumented aliens or older people without children.
25. Services available to Medi- Cruz recipients are:
• primary health care in clinics;
• X- rays;
• pharmaceuticals;
• emergency care; and
• hospital ( in- patient) care.
26. Medi- Cruz does not cover jailed inmates. The medical costs for incarcerated patients
come from the Detention Jail budget. Even if they are active Medi- Cruz patients,
services cease after they are booked according to HSA personnel.
27. According to Dominican Hospital personnel, there is a staff member at Dominican
Hospital to assist people to sign up for Medi- Cruz and Medi- Cal. This position is not
staffed 24 hours a day.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 8 Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
28. Patients determined eligible for Medi- Cruz services can have treatment paid for
retroactively. However, it is up to the client to cooperate and follow through with the
paperwork for this to be accomplished.
29. The medical budget for detention facilities is $ 3 million. The three largest
components of the detention medical budget are:
• nursing/ medical care ( salaries) within the jail;
• services delivered at the county health clinics ( X- rays, pharmacy and
laboratory are the largest intra- agency cost); and
• outside medical care ( Doctors On Duty or dental care).
30. CHIP funds may not be used to support health services provided to persons detained
in a county or city jail or other correctional facility ( W& I Code Section 16995). 8
31. HSA personnel believed that claims for indigent detainees might be partially covered
by CHIP money. The amount of funding the county receives from CHIP doesn’t
allow for 100 percent reimbursement of all of those claims. The total 2004- 2005
CHIP allocation for Santa Cruz County is $ 77,214.
32. According to HSA personnel, there is disagreement over who is financially
responsible for blood draws and Breathalyzer tests done on detainees to determine
drug and alcohol levels. The law is not specific, and it is an area of contention.
33. The jail does not do Breathalyzer tests or blood draws on arrested subjects. Law
enforcement officers perform Breathalyzer tests. The hospital does not have
Breathalyzer equipment. Nurses at the Main Jail do not take blood alcohol levels.
They cannot collect evidence.
34. Hospital personnel must perform blood draws. As a result, this takes away from staff
time to collect samples. Hospital staff is often called to testify in court regarding
collection of such samples as evidence. Staff are not reimbursed for court
appearances.
Procedural Alternatives
35. A Santa Cruz County elected official says that legislation should be changed. People
who are eligible for state medical benefits should not lose those benefits when
incarcerated.
36. According to a Dominican Hospital medical staff member, patients could be better
handled at the jail if there were an infirmary on site. Once they are cleared medically,
they should be able to be monitored on site at the jail.
8 Application for California Healthcare for Indigents Program Funding for Fiscal Year 2004- 5, May 4,
2005.
2004- 2005 Santa Cruz County Grand Jury Final Report
Shades of Gray: Page 4 - 9
Dominican Santa Cruz Hospital/ Jail Medical Facility
37. Detention Health Services intends to clarify in writing the criteria for transporting
individuals to emergency departments for medical clearance prior to bringing them to
jail. It appears that many people being brought to emergency departments could be
brought to the jail directly by police officers. Training for police also appears
necessary so that individuals are brought to the appropriate location. 9
38. Detention Medical staff is also evaluating current staffing patterns and hours to better
serve this population in a cost- effective and clinically appropriate manner. Additional
staffing may be required on Friday and Saturday nights for medical direction of these
cases. This is a peak time for cases with alcohol and drug involvement. 10
39. Dominican Hospital staff has suggested that the jail medical facility should be
sufficient to take care of inebriates if patients could receive intravenous treatment.
40. Netcom staff is currently developing management reports based upon computer-aided-
dispatch data to help determine when and how ambulances are dispatched for
serial inebriates, as well as the involvement of law enforcement from different
jurisdictions. Because of the law forbidding alternate destinations, 11 the best way to
reduce emergency room use for this purpose is to not have law enforcement call for
an ambulance solely for public inebriates. Once Netcom is contacted to dispatch an
ambulance, national medical procedures do not give them broad latitude in these
areas.
41. According to Dominican Hospital personnel, the Main Jail could decrease use of the
Emergency Department by providing the following services:
• more advanced nursing assessment and triage at the medical triage/ sallyport to
decrease refusals;
• observation and sobering;
• wound evaluation and care; and
• Breathalyzer and blood or urine alcohol testing.
42. According to Dominican Hospital personnel, law enforcement manipulates the system
by not arresting the client under the influence or only citing after sobering, thereby
avoiding a booking fee/ court appearance.
43. According to Detention personnel and Dominican Hospital personnel, a previous
sobering center in the county was closed due to a patient/ inmate escaping and
creating problems in the neighborhood.
9 HSA Director, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and
Public Inebriates, April 14, 2003.
10 HSA Director, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and
Public Inebriates, April 14, 2003.
11 See Finding 1.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 10 Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
44. The Sheriff’s Department, Netcom and AMR, a local ambulance service, will be
further analyzing local data and processes that lead to emergency room use.
Alternatives in Santa Cruz County
45. Project Connect, a new program of the county’s Homeless Person’s Health Project, is
a grant program administered through the Health Services Agency, designed to
reduce misuse of emergency services such as ambulance, emergency rooms and fire
services.
46. Project Connect seeks out individuals who have had five or more ER visits in one
year and enrolls them in an intensive case management process. Project Connect is
funded by a $ 300,000 grant from the California Healthcare Foundation and The
California Endowment. The funds pay primarily for staff who connect participants
with outside agencies providing many services.
47. In its first year of operation, Project Connect has seen a 43 percent decrease in
emergency room visits, a 35 percent decrease in jail bookings and a 25 percent
decrease in ambulance transports by its participants. Project Connect takes a holistic
approach, helping people access primary health care but also supporting constructive
life changes.
48. In November of 2004, Santa Cruz County started a Serial Inebriate Program in hopes
of decreasing the jail population and beginning some meaningful rehabilitation. This
program is funded by a grant through HSA and involves the Probation Department,
the District Attorney’s Office, the Public Defender’s Office and the Sheriff’s
Department.
49. In the Serial Inebriate Program, sentenced inmates can choose to serve their time at a
sobering facility in Santa Cruz, located on 7th Avenue, in lieu of jail. For instance,
they might have a choice of a specified jail sentence or serving the same amount of
time in the rehabilitation program. According to detention personnel, the program is
working well; although sometimes inmates have two or three failures before they
commit to treatment.
50. Under the Serial Inebriate Program, inebriates who are arrested three times go to
detoxification or jail.
Serial Inebriate Program in San Diego County
51. Started in January 2000, the Serial Inebriate Program is an innovative effort involving
the City and County of San Diego, the San Diego Police and Sheriff's Departments,
San Diego County Superior Courts, San Diego County Health and Human Services
and Mental Health Systems, Inc. A number of agencies and treatment partners work
in tandem with SIP. This collaborative effort provides a less expensive and more
appropriate alternative to emergency departments and jails for treatment of homeless
chronic inebriates. This program has had a dramatic effect on San Diego emergency
2004- 2005 Santa Cruz County Grand Jury Final Report
Shades of Gray: Page 4 - 11
Dominican Santa Cruz Hospital/ Jail Medical Facility
departments. 12 In San Diego, the first year of the program saw 144 people enter the
program. A year later, 58 percent had had no contact with police since leaving
treatment.
52. The goals of the Serial Inebriate Program ( SIP) are to:
• slow or stop the revolving door cycle of chronic alcoholics going in and out of
detoxification centers, county jail and emergency rooms;
• divert this population off the street and into county- funded treatment
programs;
• significantly reduce the uncompensated costs, time constraints and manpower
burdens to San Diego County's healthcare, law enforcement and judicial
infrastructure caused by homeless, chronic alcoholics; and
• give people who routinely live on the street an opportunity to create a stable
mainstream lifestyle.
53. The program strategy offers treatment in a joint City/ County- funded program in lieu
of custody time resulting from a guilty verdict for public intoxication. Once in
treatment, clients are provided with wraparound services designed to help their
recovery from alcoholism and begin moving them toward re- entering society as a
sober community member. 13
Conclusions
1. Providing medical care for serial inebriates, especially if they are medically indigent,
raises Dominican Hospital’s operating expenses significantly. Those costs are
absorbed by the consumer.
2. Providing services to serial inebriates negatively impacts Emergency Department
operations.
3. Dominican Hospital and county personnel have different understandings of who is
responsible for paying for medical care for patients who have been placed in custody
but not booked.
4. Dominican Hospital could improve its reimbursement rate by expanding the hours of
staff who assist patients with the Medi- Cal and Medi- Cruz process.
5. Since taxpayers and medical consumers ultimately cover uncompensated medical
expenses, a cost- effective alternative to using the Emergency Department to treat
inebriates would be a sobering center in the county. This would reduce the financial
and workload burden on Dominican Hospital and Detention staff.
12 HSA Director, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and
Public Inebriates, April 14, 2003.
13 City of San Diego, “ Federal Government Lauds Local Efforts to End Chronic Homelessness,” September
4, 2004, http:// www. sandiego. gov/ press/ 040914. shtml.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 12 Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
6. Alternative programs in Santa Cruz County have been successful in reducing the
number of frequent Emergency Department users. These programs depend on
continued funding from Santa Cruz County or the State of California.
7. Alternative programs in other cities and counties have been successful in reducing the
number of serial inebriates. Drawing from the experience of these programs could
prove beneficial to Santa Cruz County.
Recommendations
1. The Health Services Agency should clarify procedures for reimbursement of medical
costs for those in custody who have not been booked and communicate those
procedures to Dominican Hospital.
2. Law enforcement officers should continue to receive training in policies and
procedures for transporting serial inebriates to the emergency room.
3. Detention staff and HSA should explore the possibility of establishing a sobering
facility in Santa Cruz County.
4. Project Connect is to be commended for its success in reducing Emergency
Department visits, jail bookings and ambulance transports.
5. County officials should join in efforts to maintain funding for promising programs
that assist serial inebriates in creating stable lifestyles for themselves.
6. HSA and Detention staff should stay in communication with other cities and counties
that have successful programs for serial inebriates and incorporate some of these
ideas into Santa Cruz County programs.
7. Santa Cruz County should investigate creative solutions to involve Dominican
Hospital in solving the problem of frequent use of the Emergency Room by serial
inebriates. The Access to Medical Care Agreement may provide the avenue to
encourage collaboration.
2004- 2005 Santa Cruz County Grand Jury Final Report
Shades of Gray: Page 4 - 13
Dominican Santa Cruz Hospital/ Jail Medical Facility
Responses Required
Entity Findings Recommendations Respond
Within
Santa Cruz County
Board of Supervisors
1- 53 1- 7 60 Days
( August 30, 2005)
Santa Cruz County
Health Services
Agency
1- 53 1- 7 90 Days
( September 30, 2005)
Santa Cruz County
Sheriff
1- 53 1- 7 60 Days
( August 30, 2005)
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 14 Shades of Gray:
Dominican Santa Cruz Hospital/ Jail Medical Facility
This page left intentionally blank.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 – 15
Expenditure of Proposition 99 and
Proposition 10 Funds in Santa Cruz County
Where There’s Smoke, There’s Funding:
Expenditure of Proposition 99 and Proposition 10 Funds
in Santa Cruz County
Synopsis
This report looked at how tobacco tax funds received by Santa Cruz County are spent,
specifically funds from:
• Proposition 99 ( passed in 1988); and
• Proposition 10 ( passed in 1998).
The county has had success with tobacco education, prevention and cessation programs,
and providing indigent medical care using Proposition 99 funds. Proposition 10 monies
have established and funded healthcare for young children, high- risk infant intervention,
drug and alcohol treatment for parents of young children and early childhood education
programs. We applaud the successes of these programs.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 16 Where There’s Smoke, There’s Funding:
Expenditure of Proposition 99 Funds
in Santa Cruz County
Expenditure of Proposition 99 Funds in
Santa Cruz County
Definitions
CDHS: California Department of Health Services
CHIP: California Healthcare for the Indigent Program
LLA: Local Lead Agency
Medically indigent: a person who cannot afford medical care and for whom payment
will not be made by any private coverage or federal program
Medi- Cruz: a county- operated healthcare program that helps low- income residents of
Santa Cruz County without health insurance get the healthcare services they need
TCS: Tobacco Control Section
Background
In November 1988, California voters approved Proposition 99, also known as the
California Tobacco Tax and Health Promotion Act of 1988. This act increased the state
surtax on cigarettes by 25 cents per pack and added an equivalent amount on other
tobacco products. The two main uses of this tobacco tax revenue are to fund:
• tobacco- related health education programs and disease research; and
• medical and hospital care for medically indigent patients.
At the state level, money is deposited in Health Education, Hospital Services and
Physician Services accounts, then dispersed to county and city health departments. The
money deposited in the Health Education Account goes for health education efforts to
prevent and reduce tobacco use. One- third of these health education funds go to the
California Department of Education and two- thirds go to the California Department of
Health Services ( CDHS).
The state funds numerous health and tobacco- related programs with Proposition 99
revenue. The only funds that come directly into Santa Cruz County accounts, however,
go to the Tobacco Education Program and the California Healthcare for Indigents
Program ( CHIP).
Tobacco Education Program
The state’s health services department was charged with reducing tobacco use through
statewide media campaigns, tobacco control programs in local health departments and
competitively selected state, regional and community- based projects. It was also charged
with conducting extensive, ongoing evaluations of the entire tobacco education
campaign. The department created a Tobacco Control Section ( TCS) to implement these
2004- 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 - 17
Expenditure of Proposition 99 Funds
in Santa Cruz County
programs, following a mandate set forth in California Health and Safety Code, Chapter
1.2, beginning with § 104350.
The mission of the statewide Tobacco Control Section is to work toward a tobacco- free
California and reduce illness and premature deaths due to tobacco use. This is
accomplished through programs to reduce tobacco use and exposure to secondhand
tobacco smoke. The state’s Tobacco Control Section funds county, community, regional
and statewide projects.
Each of the state’s 58 county and three city health departments are designated as Local
Lead Agencies ( LLA). In Santa Cruz County, the lead tobacco control agency is the
County of Santa Cruz Health Services Agency, Community Health and Prevention
Programs. It is responsible for coordinating information, referrals, outreach and education
activities within its health jurisdiction. LLAs are legislatively mandated to periodically
submit a comprehensive tobacco control plan to CDHS. They oversee community
coalitions to help develop this plan and engage in community activities that promote
social changes, educate the public about health issues related to tobacco use and tobacco
industry strategies that promote tobacco use. Local Lead Agencies develop local
community policy, support enforcement of tobacco control laws and provide local
tobacco cessation services.
California Healthcare for Indigents Program ( CHIP)
In 1989, the Legislature established the California Healthcare for Indigents Program
( CHIP) and the Rural Health Services Program to allocate Proposition 99 funds to
participating counties. These funds reimburse providers for uncompensated services for
individuals who cannot afford care and for whom no other source of payment is
available. Santa Cruz County is one of 23 California counties to receive CHIP funds and
to do so has agreed to:
• maintain a financial level of effort in the delivery of services;
• report expenditure and utilization data to the department; and
• provide medically necessary follow- up treatment to eligible children.
In Santa Cruz County, Proposition 99 funds come through the Health Services Agency
and go to the Tobacco Education Program and the California Health Care for the Indigent
Program ( CHIP). The CHIP monies go to Dominican Santa Cruz Hospital and
Watsonville Community Hospital and physicians.
Statewide, Proposition 99 funds have been decreasing and continued to decrease for
fiscal year 2004- 05 due to reduced tobacco product purchases, changes in revenue
estimates and state redirection of resources to programs outside the Department of Health
Services. 1
1 Department of Health Services, State of California, 2004- 05 Budget Act Highlights, August 13, 2004.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 18 Where There’s Smoke, There’s Funding:
Expenditure of Proposition 99 Funds
in Santa Cruz County
Scope
This investigation examines Proposition 99 tobacco tax spending in Santa Cruz County.
Sources
Interviewed:
County administrative personnel.
County health officials.
Reviewed:
Application for California Healthcare for Indigents Program Funding for Fiscal Year
2004- 05, provided by Health Services Agency, Santa Cruz County.
“ California Healthcare for Indigents Program and Rural Health Services Program
( Proposition 99),” http:// www. dhs. ca. gov/ hisp/ ochs/ chsu/ index. htm.
California Healthcare for Indigents Program, CHIP Funding History, provided by
Santa Cruz County Health Services Agency, May 4, 2005.
Community Assessment Project, Comprehensive Report, 2004.
Department of Health Services, State of California:
2004- 05 Budget Act Highlights, August 13, 2004.
“ Local Lead Agency Guidelines for a 2004- 2007 Comprehensive Tobacco
Control Plan, Issued January 6, 2004.”
http:// www. appliedsurveyresearch. org/ products/ CAP10_ Health. pdf.
“ Local Programs,” http:// www. ldhs. ca. gov/ tobacco/.
News Release: “ California Smoking Rates Drop 33 Percent Since State’s Anti-
Tobacco Program Began,” February 2005,
http:// www. dhs. ca. gov. santacruzhealth. org.
Santa Cruz County administrative personnel, memo.
Santa Cruz County Health Services Agency personnel, memo.
Santa Cruz County Health Services Agency, Tobacco Education Program:
“ Administrative/ Collaborative Activities,” http:// catob. esp. fsu. edu.
“ Coalition Membership.”
“ Scope of Work: Overview and Intervention Activities, 7/ 1/ 2004 – 6/ 30/ 2007.”
State Board of Equalization, “ Cigarette and Tobacco Products Taxes,” June 2004,
Publication No. 93.
“ Tobacco Control Section” ( TCS), http:// www. dhs. ca. gov/ tobacco/.
“ Tobacco Education Coalition,”
http:// www. santacruzhealth. org/ phealth/ healthed/ 3tobacco. htm.
Tobacco Education Coalition, 2003 Year- in- Review.
Tobacco Education Program, Budget Justification for Santa Cruz County Health
Services Agency.
2004- 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 - 19
Expenditure of Proposition 99 Funds
in Santa Cruz County
Findings
Tobacco Education Program
1. The Santa Cruz County Health Services Agency, Community Health and Prevention
Programs, acting as the Local Lead Agency ( LLA), receives Proposition 99 funds in
three- year funding cycles. In the present funding cycle for Fiscal Years 2004- 05,
2005- 06 and 2006- 07, a total of $ 450,000, or $ 150,000 per year, is projected. This
amount is based on population, with $ 150,000 being the smallest amount a county
could receive.
2. The budget for the present three- year funding cycle is outlined as follows: 2
Budget Section FY 04- 05 FY 05- 06 FY 06- 07 Total
Personnel Costs $ 75,622 $ 89,336 $ 90,859 $ 255,817
Fringe Benefits @ 35- 42% $ 30,249 $ 35,734 $ 35,435 $ 101,418
Operating Expenses $ 2,000 $ 1,500 $ 500 $ 4,000
Equipment Expenses $ 2,700 $ 0 $ 0 $ 2,700
Travel/ Per Diem and Training $ 4,000 $ 2,169 $ 3,900 $ 10,069
Subcontracts and Consultants $ 12,000 $ 1,000 $ 0 $ 13,000
Other Costs $ 5,762 $ 1,500 $ 362 $ 7,624
Indirect Expenses @ 14- 15% $ 17,667 $ 18,761 $ 18,944 $ 55,372
Total Expenses $ 150,000 $ 150,000 $ 150,000 $ 450,000
Table 1. Budget for Fiscal Year 2004- 05 through Fiscal Year 2006- 07 for the
Tobacco Education Program.
3. The California Department of Health Service’s document titled “ Local Lead Agency
Guidelines for a 2004- 2007 Comprehensive Tobacco Control Plan, January 6, 2004”
sets forth strict operating, program and budget guidelines for LLAs. 3
4. The Tobacco Education Program in Santa Cruz County must follow the state’s strict
budget and spending guidelines in order to receive funding and be reimbursed for
expenditures. Any tobacco education activity funded by Proposition 99 must be
approved in advance by the state. The LLA then sends a cost report to the state for
2 Tobacco Education Program, Budget Justification for Santa Cruz County Health Services Agency.
3 California Department of Health Services, Tobacco Control Section, “ Local Lead Agency Guidelines for
a 2004- 2007 Comprehensive Tobacco Control Plan, Issued January 6, 2004.”
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 20 Where There’s Smoke, There’s Funding:
Expenditure of Proposition 99 Funds
in Santa Cruz County
reimbursement. The state oversees spending of the funds, which must be spent on
required objectives.
5. Santa Cruz County has not been formally audited for its expenditures of Tobacco
Education Proposition 99 monies.
6. The “ Scope of Work” of the Santa Cruz Tobacco Education Program for the term
7/ 1/ 04 to 6/ 30/ 2007 includes well- defined activities, start and end dates for each
activity, responsible parties for each activity and tracking measures. Its objectives are
to:
• reduce exposure to secondhand smoke in public places;
• reduce retail availability of tobacco;
• review the extent to which LLA and TCS- funded projects address specific
objectives of cultural or ethnic/ minority communities or populations; and
• counter pro- tobacco influences such as tobacco sponsorships of public, private
and sporting events; tobacco company contributions to education, research,
public health, cultural and intellectual activities.
7. The Tobacco Education Program is the repository for tobacco information for the
community, and it:
• recruits, maintains and organizes the Tobacco Education Coalition. The
Coalition takes action on tobacco industry activities in the community,
proposes legislation and advocates for Proposition 10 monies to be spent on
tobacco- related issues. The Tobacco Education Coalition meets monthly.
• stays current on local and statewide tobacco- related events. The Tobacco
Education Program makes public statements and answers questions and
concerns from the public, media and other agencies regarding tobacco issues.
• fields calls from the public, sends materials, maintains a list of current
cessation services in the county, stays current with tobacco- related laws or
policies in the five jurisdictions and creates anti- tobacco curriculum ideas for
teachers.
8. The Tobacco Education Coalition, formed in 1985, is an advocacy group that
promotes a tobacco- free lifestyle and environment. The Tobacco Education Coalition
membership includes the following government and community non- profit agencies: 4
American Cancer Society
American Heart Association
American Lung Association
Cabrillo College Student Health Center
4 Santa Cruz County Health Services Agency, Tobacco Education Program, “ Coalition Membership.”
2004- 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 - 21
Expenditure of Proposition 99 Funds
in Santa Cruz County
Central Coast Alliance for Health
Children and Families First
City of Santa Cruz Parks and Recreation
City of Santa Cruz Police Department
Community Connections
ETR Associates
Front Street, Inc.
Individual community members at large ( 10 members)
Katz Cancer Resource Center
Medical Works
Mental Health Client Action Network
Mountain Community Resources
Pajaro Valley Prevention and Student Assistance ( three members)
Planned Parenthood
Salud Para la Gente
San Lorenzo Valley Unified School District
Santa Cruz City Schools District ( two members)
Santa Cruz County Medical Society
Santa Cruz County Office of Education
Santa Cruz County Parks and Recreation
Santa Cruz County Sheriff’s Department ( two members)
Substance Abuse Prevention Program
Tobacco Education Clearinghouse of California
Tobacco Education Program ( three members)
University of California, Santa Cruz Alcohol and Other Drug Prevention Program
9. Some of the recent accomplishments of the Tobacco Education Coalition are:
• promoting compliance with smoke- free workplace laws;
• working with the Seaside Company to make the Santa Cruz Beach Boardwalk
a smoke- free environment;
• conducting surveillance of local newspapers for print tobacco advertisements
and writing letters, when appropriate, to ask each organization to adopt a
smoke- free advertising policy;
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 22 Where There’s Smoke, There’s Funding:
Expenditure of Proposition 99 Funds
in Santa Cruz County
• conducting media campaigns about smoke- free playgrounds, cigarette sales to
minors and other tobacco issues;
• supporting Pajaro Valley Prevention and Student Assistance efforts to create
100 percent smoke- free parks in Watsonville via letters to the editor and
letters to Watsonville City Council members;
• working with local jurisdictions on smoking ordinances;
• writing letters to various agencies to discourage acceptance of tobacco
industry grant monies;
• reducing the number of stores that sell tobacco to minors and providing
education materials to discourage self- service tobacco displays. In 2002, the
Coalition supported a self- service tobacco display ban that was adopted in the
City of Capitola; and
• surveying Santa Cruz County bars regarding compliance with smoking
ordinances.
10. California’s adult smoking rate dropped to a historic low of 15.4 percent in 2004,
compared to 22.8 percent in 1988 ( a 32.5 percent decrease) when California voters
passed Proposition 99.5
11. Comprehensive local and school- based tobacco education programs have been
credited as key factors in statewide smoking reductions. 6
12. From 1994 to 2002, student tobacco use has decreased in Santa Cruz County as
illustrated in the following table: 7
Year
Percentage of Age Group Stating That They
Have Used Tobacco
9th Graders 11th Graders
1994 65% 64%
2002 31% 40%
Table 2. Percentages of Santa Cruz County 9th and 11th Graders Stating
That They Have Used Tobacco.
13. Surveys done in 2002 and 2003 show adult smoking rates continue to decrease in
Santa Cruz County. 8
5 News Release: “ California Smoking Rates Drop 33 Percent Since State’s Anti- Tobacco Program Began,”
February 2005, http:// www. dhs. ca. gov.
6 News Release: “ California Smoking Rates Drop 33 Percent Since State’s Anti- Tobacco Program Began,”
February 2005, http:// www. dhs. ca. gov.
7Community Assessment Project, Comprehensive Report, 2004,
http:// www. appliedsurveyresearch. org/ products/ CAP10_ Health. pdf.
2004- 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 - 23
Expenditure of Proposition 99 Funds
in Santa Cruz County
Do you now smoke cigarettes every day, some days or not at all?
Everyday Some Days Not At All
2002 19.5% 6.9% 73.6%
2003 18.9% 6.2% 74.8%
Table 3. Adult Cigarette Smoking Rates, Santa Cruz County.
CHIP Funds
14. In order to receive California Healthcare for the Indigent Program ( CHIP) funds from
the state, Santa Cruz County must submit an application to the California Department
of Health Services and agree to abide by strict state guidelines.
15. In 1998- 99, Santa Cruz County Health Services Agency received over $ 1.1 million in
Proposition 99 monies that went to CHIP. By 2002- 03, that amount had dwindled to
$ 314,111, then dropped to $ 68,933 in 2003- 04.
16. CHIP funds received by Santa Cruz County from Fiscal Year 2001- 02 to Fiscal Year
2003- 04 are summarized as follows: 9
Fiscal Year Allocation
CHIP Account 2001- 02 2002- 03 2003- 04
Total Hospital $ 363,822 $ 233,984 $ 64,500
Total Physician $ 14,624 0 0
Total Other $ 56,970 $ 80,127 $ 4,433
Total CHIP $ 435,416 $ 314,111 $ 68,933
Table 4. CHIP Allocations for Santa Cruz County for Fiscal Year 2001- 02
through Fiscal Year 2003- 04.
17. For Fiscal Year 2004- 05, the CHIP allocation from Proposition 99 for Santa Cruz
County was $ 77,214. These funds were appropriated in April 2005 and were not
anticipated in the current year’s budget.
18. According to health services personnel, due to the strict, cumbersome and staff-intensive
state reporting requirements, receiving a CHIP allocation of less than
$ 35,000 would not be cost effective for the county.
8 Community Assessment Project, Comprehensive Report, 2004,
http:// www. appliedsurveyresearch. org/ products/ CAP10_ Health. pdf.
9 California Healthcare for Indigents Program, CHIP Funding History, provided by Santa Cruz County
Health Services Agency, May 4, 2005.
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 24 Where There’s Smoke, There’s Funding:
Expenditure of Proposition 99 Funds
in Santa Cruz County
19. The State of California deposits money into county revenue accounts and/ or trust
funds. When claims are made, the money is pulled from the trust fund accounts, goes
into the general fund, then is paid out. Charges are made before money comes out of
the trust fund.
20. The Medi- Cruz Program within the Health Services Agency pays for indigent care,
and CHIP money is expended from that division’s budget. The Health Services
Agency receives claims from the hospitals and physicians for indigent care. Available
CHIP funds are used to help pay the claims until the funds are exhausted.
21. CHIP funds going to Dominican Santa Cruz Hospital and Watsonville Community
Hospital and physicians involve contracts. Some contracts are blended and may
contain some Proposition 99 money as well as other funding sources.
22. The current budget for the Medi- Cruz program is $ 4.5 million. Although the current
$ 77,214 CHIP allocation is a small part of that budget, county health officials felt it
would still be beneficial to receive the money.
23. Despite the continuing decrease in CHIP allocation, Santa Cruz County has used
county overmatch and realignment funds to keep the Medi- Cruz program viable.
Approximately 8,000 to 9,000 patients annually receive care paid by Medi- Cruz
funds.
Conclusions
1. Santa Cruz County is spending its Proposition 99 monies according to the guidelines
set forth by the State of California.
2. The Tobacco Education Program and Tobacco Education Coalition have mounted
successful programs in Santa Cruz County to reduce smoking rates in adults and
students.
3. The Tobacco Education Program and Tobacco Education Coalition have successfully
worked with local jurisdictions and businesses to reduce second- hand smoke
exposure.
4. Since CHIP funds have decreased dramatically since 1998- 99, Santa Cruz County has
less money for indigent medical care. Eventually, Proposition 99 funding could drop
so low that accepting it would not be cost- effective for the county.
Recommendations
1. Santa Cruz County’s Tobacco Education Program is to be commended for its success
in reducing tobacco use and lessening exposure to secondhand smoke.
2. Santa Cruz County is to be commended for successfully using Proposition 99 funds
for indigent medical care and for its efforts to keep the Medi- Cruz program intact.
2004- 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 - 25
Expenditure of Proposition 99 Funds
in Santa Cruz County
Responses Required
Entity Findings Recommendations Respond
Within
Santa Cruz County
Board of Supervisors
1- 23 1, 2 60 Days
( August 30, 2005)
Santa Cruz County
Health Services
Agency
1- 23 1, 2 90 Days
( September 30, 2005)
2004- 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 26 Where There’s Smoke, There’s Funding:
Expenditure of Proposition 99 Funds
in Santa Cruz County
This page left intentionally blank.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 - 27
Expenditure of Proposition 10 Funds
in Santa Cruz County, First Five Santa Cruz
Expenditure of Proposition 10 Funds in
Santa Cruz County
First Five Santa Cruz County
Definitions
ASR ( Applied Survey Research): an independent, non- profit research organization
which completed program evaluations for the year 2004
First Five Santa Cruz County ( First Five SCC): the commission in Santa Cruz County
that administers local revenues from Children and Families First Act
First Five Partners: community agencies that receive grants from First Five Santa Cruz
County
Our Children Large Community Grants: grants given in amounts over $ 20,000
Our Children Community Mini- grants: grants that are given in amounts less than
$ 10,000
The Santa Cruz County Service Unifying Network ( SCC SUN): database used by
First Five Partners for collection of program information and client referral
WIC ( Women Infants and Children): an income- qualified federal program which
provides subsidies and nutrition education to pregnant women, nursing mothers and
children five and under
Background
In November of 1998, California voters passed a statewide initiative, Proposition 10,
known as the Children and Families First Act. Proposition 10 added a 50- cent- per- pack
tax on cigarettes and other tobacco products. It was passed “ for the purposes of
promoting, supporting and improving the early development of children from the prenatal
stage to five years of age.” 1 The law states that revenue may be used to fund child
immunizations, vision and hearing tests, prenatal care and drug and alcohol- abuse
treatment for parents of children five and under.
Twenty percent of the revenues are allocated to the State First Five Commission for
statewide expenditures as mandated by law. This includes a public education campaign,
educational materials and training, technical support for local county commissions,
education and training of child- care providers and research and development. Of the 20
percent, only one percent is to be used for administrative functions of the state
commission.
1 Text of state law, Proposition 10, Children and Families First Act.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Page 4 - 28 Where There’s Smoke, There’s Funding:
Expenditure of Proposition 10 Funds
in Santa Cruz County, First Five Santa Cruz
The remaining 80 percent of revenues are allocated to local commissions that are
established in all 58 California counties, as required by law. Allocations to each county
are based upon the number of births in the mother’s county of residence.
These revenues are to be spent on programs determined by members of each local First
Five Commission that best support optimal early childhood development. Nine
commission members are appointed based upon experience or employment in fields of
child welfare such as social services, medicine and education. In addition, all county
commissions must develop strategic plans based on extensive public input before
disbursing any funds. 2 Since 1999, California counties have received more than $ 3.2
billion dollars for early childhood education programs called First Five.
Santa Cruz County’s First Five Commission ( hereafter known as First Five Santa Cruz
County or First Five SCC) was established in January 1999 with the selection of the first
commission members by the Santa Cruz County Board of Supervisors. The initial
meeting of First Five Santa Cruz County was held in March of 1999, and the commission
was expanded to nine members in May 1999. Santa Cruz County’s First Five
Commission has received over $ 13 million since its inception.
In 2004, a state audit was requested of some of the First Five Commissions by California
State Senator Dean Flores after he charged that Kern County Proposition 10 monies were
being misused. This audit led to the discovery that appropriate procedures were not being
followed for distribution of some grant monies. In addition, some grant distributions were
not sufficiently documented. First Five Santa Cruz County was not included in the state’s
audit. Since that time, the legislature has considered two bills, Senate Bill 34 and
Assembly Bill 109, intended to create more accountability for the funds spent by all local
commissions.
Scope
This investigation examines how First Five Santa Cruz County spends Proposition 10 tax
revenues.
Sources
Interviewed:
First Five Santa Cruz County personnel.
Health Services Agency personnel.
Santa Cruz County Audit personnel.
Meetings attended:
First Five Santa Cruz County Commission Meetings, February and March 2005.
2 Text of state law, Proposition 10, Children and Families First Act.
2004 – 2005 Santa Cruz County Grand Jury Final Report
Where There’s Smoke, There’s Funding: Page 4 - 29
Expenditure of Proposition 10 Funds
in Santa Cruz County, First Five Santa Cruz
Reviewed:
Newspaper/ Magazine Articles:
Click tabs to swap between content that is broken into logical sections.
Description
| Rating | |
| Title | Grand Jury final report and responses |
| Subject | California. Grand Jury (Santa Cruz County)--Periodicals.; Santa Cruz County (Calif.)--Politics and government--Periodicals. |
| Description | Description based on: 2003/2004; title from opening screen of HTML index page.; Harvested from the web on 2/21/07 |
| Creator | California. Grand Jury (Santa Cruz County) |
| Publisher | Santa Cruz County Grand Jury] |
| Type | Text |
| Identifier | http://digitalarchive.oclc.org/request?id%3Doclcnum%3A144635200; http://www.co.santa-cruz.ca.us/grandjury/index.htm |
| Language | eng |
| Title-Alternative | Santa Cruz County Grand Jury report |
| Format-Extent | 1 web site : digital, HTML, PDF files. |
| Relation-Requires | Mode of access: Internet.; System requirements: Adobe Acrobat Reader. |
| Transcript | Santa Cruz County Grand Jury 2004- 2005 Final Report June 2005 Greetings Citizens of Santa Cruz County, It is with great pride that we present the 2004 – 2005 final report. The Grand Jury is charged by state law with review and oversight of county agencies and their contractors. It is our hope that the issues raised, the problems found and the information extracted will contribute to more responsive, more accessible and more responsible government. We also hope that this report will aid in your understanding of the Santa Cruz County government. This report is a compilation of information provided by your public officials and the insights we gained during those interviews. Our charge is to get the facts straight and get the information to you with no bias. We have done that here, and it is our great hope that much good comes from our efforts. Our current budget picture is bleak, and we must all do our part to ensure we make the most of our limited funds. We all have a responsibility to ensure we have the best, most efficient government possible. We would like to thank the various entities and employees that took the time to educate us and answer our questions. I would also like to thank the other eighteen jurors who have given generously of their most precious commodity, their own time. We are anxious for your response. Sincerely, Earl Kieser, Foreperson 2004 – 2005 Santa Cruz County Grand Jury i Santa Cruz County Grand Jury 2004- 2005 Final Report Table of Contents Introduction to the Santa Cruz Grand Jury Grand Jurors Section 1: Audit and Finance Committee Reports Counting Your Dollars: Contracting for the Services of an Independent Auditor of County Finances 1 - 1 The Welfare of Child Welfare: A Comparison of Budgets 1 - 7 Section 2: Cities and County Committee Report No report included Section 3: Criminal Justice Committee Reports Santa Cruz County Jails Review 3 - 1 California Public Records Act, Compliance by Local Police Agencies 3 - 17 Section 4: Health and Human Services Committee Reports Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility 4 - 1 Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 and Proposition 10 Funds in Santa Cruz County 4 – 15 Section 5: Schools and Libraries Committee Report Ready to Check Out? Santa Cruz City- County Library System 5 - 1 Section 6: Special Districts Committee Reports Santa Cruz County Port District Boat Slip Waiting List 6 - 1 Water Planning in Santa Cruz County 6 - 7 Section 7: Instructions for Respondents 7 - 1 ii This page left intentionally blank. 2004 – 2005 Santa Cruz County Grand Jury Final Report Introduction to the Santa Cruz County Grand Jury Two Types of Grand Juries in Santa Cruz County As with many California counties, Santa Cruz County has two types of Grand Juries. The regular, or civil, Grand Jury is an investigative body that serves for one year. There are 19 members on the jury. The civil Grand Jury does not deal with trials but rather serves as a watchdog over local government and other tax- supported entities. The other Grand Jury is a criminal Grand Jury that deals with issuing indictments ( charging a person with a criminal or public offense). This jury is called up on a case- by-case basis. Duties and Powers of the Civil Grand Jury The Civil Grand Jury has three primary functions: • To randomly audit local governmental agencies and officials • To publish its investigative findings and recommendations toward improving those governmental operations in the interest of the community being served • To investigate citizens' complaints The Civil Grand Jury investigates local government agencies and officials to evaluate if they are acting properly. If a Grand Jury determines that they are not, it has various options. The most frequently used option is the presentation of a report outlining the Grand Jury's findings and recommendations in the matter. Such reports are public and sometimes attract media attention. Agencies or elected officials discussed in the report must respond specifically to the report's findings and recommendations. Citizens may file complaints with the Grand Jury to request that it investigate what they perceive as wrongdoing by a public agency, such as a school district or a police department. The Jury will decide if the complaint has merit and is not obligated to pursue the complaint. County complaint forms are available from the following address: Santa Cruz County Grand Jury 701 Ocean Street, Room 318- I Santa Cruz, CA 95060 ( 831) 454- 2099 FAX ( 831) 454- 3387 grandjury@ co. santa- cruz. ca. us www. co. santa- cruz. ca. us/ grandjury 2004 – 2005 Santa Cruz County Grand Jury Final Report This page left intentionally blank. 2004 – 2005 Santa Cruz County Grand Jury Final Report Grand Jurors 2004- 2005 Earl Kieser, Foreperson Paula Berman Diana Cunningham Lisette Darst Kimberly Kildsig- DiBiasi Mike Eynon Mark Glasser Katherine Gleaton Jane Kearney Kathy Kreiger Edith P. Lenz Mike McManus Maxine McNamara Karen Rogers Tisha Scurich Barbara Smith Patricia A. Talbert Nancy Talley Katherine Wadhams 2004 – 2005 Santa Cruz County Grand Jury Final Report This page intentionally left blank. Santa Cruz County Grand Jury Final Report: Section 1 Audit and Finance Committee Reports 2004 – 2005 Santa Cruz County Grand Jury Report Counting Your Dollars: Page 1 - 1 Contracting for the Services of an Independent Auditor of County Finances Counting Your Dollars: Contracting for the Services of an Independent Auditor of County Finances Synopsis “ The purpose of an independent audit is to protect the equity of the entity audited with tests that determine if the assets are properly protected.” 1 This report covers the bid process for securing the services of an independent auditor for the County of Santa Cruz. It has been the practice of the county to go out to bid for external independent audit services every three to four years. However, the current external independent auditing firm has been retained for the past seven years. The bid process was used to select a new external independent auditor for the County of Santa Cruz. Background The Grand Jury, as required by law, is responsible for performing an independent audit of county offices and investigating spending by city and county governments. The investigations may be conducted on a selective basis each year but shall not duplicate examination or financial statements that have been performed by or for the Board of Supervisors. 2 In earlier years, the Grand Jury budget included funds to employ an outside independent auditor to fulfill these duties. Subsequently, while retaining oversight of this task, the Grand Jury transferred to the County of Santa Cruz the responsibility for contracting with an external independent auditor for these services, along with the budget item to cover this expense. To fulfill both the county and Grand Jury responsibilities to conduct audits of county records, a County Audit Committee was formed. This committee is comprised of Santa Cruz County Administrative Officer/ Representative, County Auditor- Controller, County Treasurer/ Tax Collector/ Recorder/ Clerk and two members of the Santa Cruz County Grand Jury. In addition, two members of the Treasurer Oversight Committee have been added to the County Audit Committee membership. Scope The County of Santa Cruz contracts with an outside audit firm to furnish independent audit and compilation services of county accounts. These services are obtained through a Request for Proposal ( RFP) bid process. Two members of the Santa Cruz County Grand Jury, one from the Audit and Finance Committee and one from the Grand Jury membership at large, followed the bid process from the Invitation to Bid to the Recommendation of Acceptance of the best contract. 1 Rudolph Vargas, Vargas and Company, Minutes Audit Committee Meeting, August 25, 2004. 2 Penal Code § 925 and Government Code § 25250. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 1 - 2 Counting Your Dollars: Contracting for the Services of an Independent Auditor of County Finances Sources Meetings: County of Santa Cruz Audit Committee: • August 25, 2004. • February 14, 2005. • May 9, 2005. • June 6, 2005. Bidders’ Conference, December 10, 2004. Analysis of Bids, February 14, 2005. Entrance Conference, June 6, 2005. Reviewed: Bidders’ List. Comprehensive Annual Financial Report, Fiscal Year 2003. County Analysis for Award of Contract. Government Code § 25250. Grand Jury Reports: • 1990- 1991. • 1997- 1998. • 1999- 2000. • 2000- 2001. • 2001- 2002. Management Letter, Fiscal Year 2003. Management Letter, Fiscal Year 2004. Penal Code § 925. Request for Proposal. Single Audit Report, Fiscal Year 2003. Findings 1. It has been the practice of the county to request proposals for independent audit services every three or four years. 2. The current independent audit firm has provided services for seven years. 3. The 2001- 2002 Santa Cruz County Grand Jury Final Report recommended that retention of an independent auditor should be reviewed every three years and changed at least every six years. 4. This Request for Proposal process was to select an independent auditor to prepare an annual audit for the County of Santa Cruz beginning with the fiscal year ending June 30, 2005. The contract would be awarded for one to three years, whichever would be the most cost effective for the county. 2004 – 2005 Santa Cruz County Grand Jury Report Counting Your Dollars: Page 1 - 3 Contracting for the Services of an Independent Auditor of County Finances 5. The independent audit firm provides various reports to the Santa Cruz County Audit Committee throughout the year. These reports require County Audit Committee review. 6. The Request for Proposal process began with preparation of the bid documents that: • outlined the requirements of the county; • described the basis on which the bids would be judged; and • requested the qualifications of the bidders. Invitations to Bid were sent to 44 qualifying accounting firms, locally and throughout northern and central California. Four bidders attended the bidders’ conference on December 10, 2004. Proposals were received on January 14, 2005 from all four firms present at the bidders’ conference. The proposals were evaluated according to the criteria established in the bid documents as outlined in Appendix A. Using this comprehensive criteria, the County Audit Committee recommended awarding the contract to the firm that best met the county’s needs: Bartig, Basler, and Ray. 7. Two members of the Santa Cruz County Grand Jury are active members of the County Audit Committee. Conclusions 1. Response to Santa Cruz County’s request for proposals was minimal. 2. The County Audit Committee did not follow the recommendation of the 2001- 2002 Santa Cruz County Grand Jury stating that independent audit services should be reviewed every three years with no one firm providing services for more than two consecutive three- year contracts. Good accounting practices and procedures dictate a change of auditing firms. 3. Criteria used to evaluate bids was comprehensive. 4. Grand Jury membership on Santa Cruz County Audit Committee fulfills the Grand Jury’s mandated responsibilities as outlined in Penal Code § 925. The County Audit Committee met four times during fiscal year 2004- 2005. Recommendations 1. The County of Santa Cruz Auditor should continue to actively seek and qualify new bidders for future invitations for proposals and should update the current list. 2. Review of the contract for independent audit services or invitation to bid should be scheduled every three years with no one firm providing services for more than two consecutive three- year contracts. 3. The County of Santa Cruz should continue to notify the Grand Jury of County Audit Committee activities. 4. The County Audit Committee should continue to meet at least twice each year, more frequently if needed. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 1 - 4 Counting Your Dollars: Contracting for the Services of an Independent Auditor of County Finances Responses Required Entity Findings Recommendations Respond Within Santa Cruz County Board of Supervisors 1, 2, 3 1, 2, 4 60 Days August 30, 2005 Santa Cruz County Auditor- Controller 3 1, 2, 3, 4 90 Days September 30, 2005 Santa Cruz County Audit Committee 3, 7 2, 4 90 Days September 30, 2005 2004 – 2005 Santa Cruz County Grand Jury Report Counting Your Dollars: Page 1 - 5 Contracting for the Services of an Independent Auditor of County Finances 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 1 - 6 Counting Your Dollars: Contracting for the Services of an Independent Auditor of County Finances 2004 – 2005 Santa Cruz County Grand Jury Final Report The Welfare of Child Welfare: Page 1 - 7 Comparison of Budgets The Welfare of Child Welfare: Comparison of Budgets Synopsis This report compares the Child Welfare Services ( CWS) budget of Santa Cruz County to those of four other counties considered demographically similar to Santa Cruz County. Three of the four other counties spent more than twice as much per child as Santa Cruz County. Definitions Active Cases: all children who had an open investigation in the Emergency Response category, or an open case in the remaining three categories of Family Maintenance, Family Reunification or Permanency Planning. Active cases do not include children who were referred but whose situation did not meet the criteria for investigation. In other words, they were “ evaluated out.” Emergency Response, Family Maintenance, Family Reunification and Permanency Planning are industry- standard categories set up by the State of California. All children served by Child Welfare Services fall into one of these categories. Overmatch: the portion of the total CWS budget for any county contributed solely by that county that is above 30 percent of the minimum total CWS budget established for that county by the State of California Background In Santa Cruz County, Child Welfare Services ( CWS) is a division of the Human Resources Agency. Child Welfare Services, more commonly known as Child Protective Services, investigates and intervenes when necessary when child abuse or neglect is reported. The Santa Cruz County CWS budget, like that of other counties, has suffered because of funding shortages. This investigation examined how Santa Cruz County’s CWS budget compared to those of comparison counties. To fulfill its mandate to protect children from neglect or abuse, CWS must have funds available. The Grand Jury requested data from seven counties whose demographics are considered to be similar to those of Santa Cruz County. Of those seven counties, four replied with data in the format that allowed us to compare it to that of Santa Cruz County. The Grand Jury would like to express its appreciation to the seven counties for their assistance in providing information for this report. 2004 – 2005 Santa Cruz Grand Jury Final Report Page 1 - 8 The Welfare of Child Welfare: Comparison of Budgets Scope This investigation examined five aspects of the Santa Cruz County budget for Child Welfare Services ( CWS): • the annual total budget for Santa Cruz County CWS • the county share of the annual budget for Santa Cruz County CWS • the number of active cases per year for Santa Cruz County CWS • how the total budget dollars compare to those of other counties • how the county share budget dollars compare to those of other counties Sources Interviewed: CASA of Santa Cruz County. Marin County Adult and Children’s Social Services. Monterey County Family and Child Services. Napa County Children’s Behavioral Health. San Mateo County Health Services Agency. Santa Clara County Family and Children’s Services. Santa Cruz County Human Resources Agency personnel. Santa Cruz County Personnel Department. Solano County Child Welfare Services. Sonoma County Human Services Department. Reviewed: California Quick Facts, from U. S. Census Bureau web site, http:// quickfacts. census. gov. Child Welfare Services Reports for California, from University of California at Berkeley Center for Social Services Research web site, http:// cssr. berkeley. edu/ CWSCMSreports/. Child Welfare Services, Self- Assessment, Santa Cruz County, 2004. Child Welfare Services, System Improvement Plan, 2004. 2004 – 2005 Santa Cruz County Grand Jury Final Report The Welfare of Child Welfare: Page 1 - 9 Comparison of Budgets Findings 1. The State of California determines a minimum total CWS budget for each county. Some factors that influence the total minimum budget are: • number of children served; • cost to employ qualified social workers ( as determined by the state); and • state ratios for number of social workers to children in need of services. Of this minimum required budget, the state contributes 70 percent and mandates that counties contribute 30 percent as a county share of the total CWS budget. Monies contributed by counties to their CWS budgets above the minimum required share are supplemented by other monies from state and federal sources. The resulting increased budget may not reflect the 70: 30 budget contribution ratio. 2. Some counties supplement their CWS budget with additional state, federal and other monies. Santa Cruz County CWS has been able to access some of these funds. 3. In 2002- 2003, Santa Cruz County overmatched the required minimum share of the CWS budget by $ 696,152. In 2003- 2004, Santa Cruz County overmatched the required share of the minimum CWS budget by $ 718,541. 4. CWS budgets, county shares of these budgets, number of active cases and budget- to-child ratios vary from county to county. Fiscal Year 2002- 2003 Fiscal Year 2003- 2004 Santa Cruz County Population: 251,584 Number of Active Cases 687 809 Total CWS Budget $ 8,246,650 $ 9,002,816 County Share Budget $ 1,538,957 $ 1,497,975 Total Budget Per Child $ 12,004 $ 11,128 County Share Budget Per Child $ 2,240 $ 1,852 2004 – 2005 Santa Cruz Grand Jury Final Report Page 1 - 10 The Welfare of Child Welfare: Comparison of Budgets County A Population: 246, 073 Number of Active Cases 470 391 Total CWS Budget $ 3,917,501 $ 4,778,564 County Share Budget $ 701,473 $ 967,956 Total Budget Per Child $ 8,335 $ 12,221 County Share Budget Per Child $ 1,493 $ 2,476 County B Population: 1,678,421 Number of Active Cases 5,638 5,242 Total CWS Budget $ 202,603,417 $ 214,665,827 County Share Budget $ 56,017,081 $ 52,586,883 Total Budget Per Child $ 35,936 $ 40,951 County Share Budget Per Child $ 9,936 $ 10,032 County C Population: 697,456 Number of Active Cases 1,175 1,216 Total CWS Budget $ 29,555,012 $ 31,736,859 County Share Budget $ 5,346,921 $ 7,453,884 Total Budget Per Child $ 25,153 $ 26,099 County Share Budget Per Child $ 4,551 $ 6,130 2004 – 2005 Santa Cruz County Grand Jury Final Report The Welfare of Child Welfare: Page 1 - 11 Comparison of Budgets County D Population: 131,607 Number of Active Cases 251 227 Total CWS Budget $ 8,523,987 $ 8,275,200 County Share Budget $ 779,255 $ 820,399 Total Budget Per Child $ 33,960 $ 36,455 County Share Budget Per Child $ 3,105 $ 3,614 Note: The total CWS budget number includes the 30 percent county share of the minimum budget, the 70 percent state share of the minimum budget and all additional county, state, federal and other dollars contributed to the CWS budget regardless of source. The populations of each county are 2003 US Census Bureau estimates. 1 Table 1: Child Welfare Services Dollars Per Child Comparison. 5. The Grand Jury also researched information from the UC Berkeley “ Point in Time” studies found on the UC Berkeley web site. This information, although very thorough in reporting data by children’s ages, caseloads of social workers and numbers of children in each category, is derived from the data of a single given day for each quarter. 2 Conclusions 1. The County of Santa Cruz has contributed more than the required county share to the CWS budget for fiscal years 2002- 2003 and 2003- 2004, resulting in additional total CWS budget dollars. 2. For fiscal year 2002- 2003, Santa Cruz County CWS had significantly less total money budgeted than three of the four counties studied and more budgeted than the fourth county in comparison to the number of active cases. 3. For fiscal year 2003- 2004, Santa Cruz County CWS had less total money budgeted than the four counties in comparison to the number of active cases. 4. For fiscal year 2002- 2003, Santa Cruz County CWS had less county share money budgeted than three of the four counties studied and more budgeted than the fourth county in comparison to the number of active cases. 5. For fiscal year 2003- 2004, Santa Cruz County CWS had less county share money budgeted than the four counties in comparison to the number of active cases. 1 California Quick Facts, from US Census Bureau web site, http:// quickfacts. census. gov. 2 Child Welfare Services Reports for California, from University of California at Berkeley Center for Social Services Research web site, http:// cssr. berkeley. edu/ CWSCMSreports/. 2004 – 2005 Santa Cruz Grand Jury Final Report Page 1 - 12 The Welfare of Child Welfare: Comparison of Budgets 6. Compared to other counties, Santa Cruz County CWS has less funds available to serve an increasing number of active cases. 7. The UC Berkeley “ Point in Time” studies do not reflect an annualized number of children served which the Grand Jury believes were needed for this budget analysis. Recommendations 1. Santa Cruz County Human Resources Agency personnel, along with the Board of Supervisors, should be commended for overmatching the required share of the County of Santa Cruz CWS budget. 2. The County of Santa Cruz should explore other options for obtaining additional money to supplement Child Welfare Services funds. Responses Required Entity Findings Recommendations Respond Within Santa Cruz County Board of Supervisors 1- 4 1, 2 60 Days ( August 30, 2005) Santa Cruz County Human Resources Agency 1- 4 1, 2 90 Days ( September 30, 2005) Santa Cruz County Grand Jury Final Report: Section 2 Cities and County Committee Report 2004 – 2005 Santa Cruz County Grand Jury Final Report Committee on Cities and County Page 2 - 1 No report submitted. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 2 - 2 Committee on Cities and County This page intentionally left blank. Santa Cruz County Grand Jury Final Report: Section 3 Criminal Justice Committee Reports 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 1 Santa Cruz County Jails Review Definitions Electronic monitoring: a program run by the Probation Department in which the offender is fitted with an ankle bracelet that is programmed to apprise the Probation Department of his/ her whereabouts Exit plan: a written plan that staff members and inmates work on together in hopes of preparing inmates for successful re- entry into the community Infirmary: an area within a healthcare unit set up and operated for the purpose of caring for patients who need skilled nursing care but are not in need of hospitalization or placement in a licensed nursing facility, and whose care cannot be managed safely in an outpatient setting. It is not the area itself, but the scope of care provided that makes the bed an infirmary bed. Medium security: inmates whose crime and criminal history do not pose a high security risk. They are housed in a locked facility, but often in a dorm- like setting, rather than individual cells. Minimum security: inmates whose crime and criminal history pose very little security risk. They are housed in an unlocked facility and can easily walk away from the jail. Misdemeanor Promise to Appear: a citation that any peace officer can write. The promise to appear is a legal instrument that allows a person to be arrested for a misdemeanor crime but not be book into jail. This helps with jail overcrowding but starts the criminal complaint process. “ O” unit: The observation unit includes rooms within the medical unit, where inmates who are physically or mentally ill are monitored both by video and medical staff. Parole hold: a prisoner/ inmate is placed in custody at the local county jail level by his/ her Supervising Parole Agent for having violated the conditions of parole or for committing a new crime. There is a hearing held while the prisoner is in custody ( Morrissey Hearing) to determine the disposition of the case. Plastic boats: used by the Sheriff’s Department to sleep inmates when the population surpasses the maximum capacity. The boat- shaped plastic bed sits directly on the floor within a cell block. Rated capacity: California Board of Corrections minimum standards for detention facilities, contained in Title 15 of the California Code of Regulations. It includes the number of inmates each detention facility was built to hold ( rated capacity) and the number of inmates that can safely be housed in the facility ( maximum capacity). 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 2 Santa Cruz County Jails Review Rubber room: an isolation room in which the walls and floors are covered in a rubber material. Inmates who present a serious danger to themselves can be housed in this room, which is monitored by staff every 15 minutes. S. A. F. E.: Safe and Free Environment program which is derived from the RSAT ( Residential Substance Abuse Treatment) grant. This program is in operation at the Rountree Medium Security facility. Ward: an offender who is under the age of eighteen years and has been sentenced by the Juvenile Court Background The Santa Cruz County jail system is comprised of six facilities: 1. Main Jail 2. Rountree ( Medium) 3. Rountree ( Minimum) 4. Blaine Street 5. Juvenile Hall 6. California Youth Authority Each facility has its own operating budget, and the first five facilities comprise 50 percent of the Sheriff’s budget. The California Youth Authority is a state- funded institution. The Santa Cruz Main Jail The Santa Cruz Main Jail is located at 259 Water Street in the city of Santa Cruz. The Main Jail was constructed in 1981. The California Board of Corrections sets both the rated capacity and the maximum capacity. The rated capacity is 311, and the maximum capacity is 400. The Main Jail is the booking center for all of Santa Cruz County ( adult offenders). It holds both sentenced and unsentenced inmates, both male and female. Most females there are un- sentenced. Sentenced females are housed at Blaine Street Jail unless they are violent or have medical problems that cannot be managed by that facility. If they are violent, they are housed in a segregated section of the Main Jail. All law enforcement agencies within Santa Cruz County bring their arrestees to the Main Jail. Booking fees of $ 168 per arrestee are paid by each city. The cities are subsequently reimbursed by the State of California. According to detention personnel, the Board of Supervisors is considering cutting next year’s booking fees in half. Rountree Jail Rountree Jail consists of two jail facilities located conjointly at 90 Rountree Lane ( medium security) and 100 Rountree Lane ( minimum security) in Watsonville. These jails were originally built in 1970. The medium facility has a rated capacity of 96 and a 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 3 maximum of 110. The minimum facility has a rated capacity of 162 and maximum capacity is 250. Both jails hold sentenced prisoners. Blaine Street Jail This jail is located at 144 Blaine Street in Santa Cruz. It has been in operation since 1984. It has a rated capacity of 32 with a maximum capacity of 42. It houses sentenced female inmates who can be housed in a minimum security setting. Juvenile Hall Juvenile Hall is located at 3650 Graham Hill Road in Felton. It was established in 1968. It houses sentenced and un- sentenced juvenile offenders ( male and female) between the ages of 12 and 18. The rated capacity is 42. It also houses Juvenile Court with one Superior Court Judge assigned to preside over all cases. California Youth Authority The California Youth Authority was located at 13575 Empire Grade Road in Santa Cruz, and operated as a Youth Conservation Camp, from 1947 until 2005. The California Department of Corrections decided to close the facility to youthful offenders. The wards who had not completed their sentences were moved to other California Youth Authority camps or institutions. When the Grand Jury toured the facility, it was in operation as a Fire Conservation Camp. The Department of Corrections plans to move in 100 adult prison inmates. The last ward was moved out of the facility in April of 2005. The adult population is slated to move in June 1, 2005. The fire camp will continue to operate as before, but with adult inmates instead of juvenile wards. Scope The Grand Jury is charged with inspecting of conditions and management of the jail facilities within the county under Penal Code § 919 ( b). In order to meet these requirements, the Criminal Justice Committee of the Grand Jury: • toured each facility at least once with attention to the conditions; • interviewed staff and inmates of various facilities; • reviewed previous Grand Jury reports and responses in regard to detention/ facilities; • made telephone calls and exchanged e- mails with jail commanders; • reviewed California Code of Regulations pertaining to jail/ detention facilities; • reviewed the Santa Cruz County jail budget; • reviewed web sites, at the state and county levels, pertaining to detention facilities; and 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 4 Santa Cruz County Jails Review • reviewed numerous newspaper articles in the Santa Cruz Sentinel and the San Jose Mercury News. The Board of Corrections performs reviews of each penal institution within the county to ensure compliance with mandatory state standards. It also audits the financial management of each jail facility. Main Jail Findings 1. On May 3, 2005, the inmate population was 384 in a facility with a rated capacity of 311. According to detention personnel, the Main Jail population fluctuates but is routinely over the rated capacity. 2. General housekeeping and cleanliness were observed to be very good by the touring Grand Jury members. It was pointed out that painting the interior of the jail is a continuous process, beginning at one end and starting over once it is completed. 3. On May 3, 2005, the inmate population was: • 87.8 percent male; • 12.2 percent female. Of those, • 5.5 percent had mental health issues; • 25.8 percent had committed crimes against person; • 14.8 percent were parole holds; and • 23 percent had committed drug related offenses. Detention personnel report that records of repeat offenders are not available, but experience and anecdote indicate the percentage is significant. 4. Data on jail population was collected from June through November 2004. It indicated 21.2 percent of detainees were released on a Misdemeanor Promise to Appear, which helps with overcrowding. Over 16 percent were released under PC § 849( b) in which no court action was taken. 5. A grievance procedure is in place in which several levels of detention staff review the grievances and respond to the inmates’ complaints, both verbally and in writing. 6. Inmates are given access to: • educational programs; • religious services; • counseling; • parenting classes; • domestic violence classes; 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 5 • drug and alcohol awareness; • gang awareness; and • classes to earn or study for a G. E. D. ( General Equivalency Diploma). 7. The booking process includes: • sobering ( when necessary); • placement in a restraint chair for combative detainees; • fingerprinting and photo; • recording and retention of inmates’ personal effects; • strip search with visual inspection for weapons, drugs or any noted injuries; • showering and decontamination; • issuing of jail clothing; and • health screening by deputies. 8. After the booking procedure, each prisoner is classified by strict criteria prior to receiving a housing assignment. The deputies in the booking area review: • criminal sophistication; • age; • gender/ transgender; • need for protective custody; • gang affiliation; • charges; • physical, medical and mental status; • escape risk; and • level of violence, from and to others and self. 9. Since the last Grand Jury report of June 30, 2004, there has been one death by suicide on November 23, 2004. 10. Since the last Grand Jury report of June 30, 2004, there have been no escapes from the Main Jail. 11. Because of jail overcrowding, some inmates sleep in plastic “ boats” that are placed on the floor within the units. In May 2005, four inmates were sleeping in plastic boats. 12. The Correctional Officers and Sheriff Deputies involved in running the jails are required to attend state- mandated courses designed to keep them abreast of changes in the field and new tactics in dealing with inmates. Forty hours of POST ( Peace Officer Standards and Training) must be completed each year to remain employed. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 6 Santa Cruz County Jails Review Medical Unit 13. The Medical Unit at the Main Jail is staffed by: • one part- time physician; • one part- time psychiatrist; • a minimum of one, usually two, registered nurses per shift; • one community health worker; • two medical assistants; and • two licensed therapists. 14. In addition to serving inmates at the Main Jail, the medical staff also provides medical care for Rountree, Blaine Street and Juvenile Hall. 15. The medical facility at the Main Jail is not licensed as an infirmary. Under the current license, the medical staff can provide clinic care, administer first aid, take blood sugars, change dressings and administer medications. 16. The clinic staff is available to see patients Monday through Friday in the mornings. Inmates are charged $ 2.00 per visit. The money is taken from the Inmate Welfare Fund, which is also used for personal care items, commissary needs and telephone calls. The money is put in the Inmate Welfare Fund by the prisoners’ families. The inmates are issued a “ debit” card to pay for expenses. 17. The nursing staff is on site 24 hours a day, seven days a week. There are two registered nurses on the day shift and one on the night shift. There is also an on- call medical doctor available by telephone when there is no physician on site. 18. In addition to their clinic work, the jail nurses also handle medical screening upon booking. 19. The medical staff is supplemented by nursing students from Cabrillo College. Many of these students are put on the extra- help list after graduating, but so far none have sought full- time employment in detention nursing. 20. Some of the inmate medical problems cannot be treated at the Main Jail’s medical facility. These conditions include, but are not limited to: • stroke; • cancer; • serious heart disease; and • broken bones. 21. Inmates who require treatment outside the scope of the Main Jail Medical facility are taken to Dominican Hospital, Doctors on Duty or the County Health Clinic. 22. Inmates are transported via ambulance or in a patrol car with a Transportation Deputy. The deputy’s maximum hourly rate is $ 48.85. If a lower level of security is 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 7 appropriate, a private security company can be used for $ 18.08 per hour. The Sheriff’s Department has a contract for services. ‘ O’ unit 23. There are twelve rooms in the “ O” unit. Seven of the rooms are on video monitoring. The patients ( inmates) are individually allowed out of their rooms for one hour each day. They are in a room adjoining the nurses’ station so they can be fully monitored. Healthcare workers also monitor some inmates on a one- to- one basis, however, they are not allowed to distribute medication. The staff in the “ O” unit is able to handle medical and psychiatric problems that would be cost prohibitive if the Sheriff’s staff had to transport the inmates outside the facility for treatment. 24. Detention nurses’ pay scale is lower than in the private sector. The pay scale range is from $ 31.82 per hour to $ 40.44 per hour, depending on their employment status with Santa Cruz County. Private sector nurses earn between $ 50 per hour and $ 60 per hour depending on their training. 25. The “ Rubber Room,” room 13 of the “ O” unit, is used for mental health patients who are considered to be a danger to themselves or others. They are monitored every 15 minutes. 26. The nursing staff at the Main Jail often uses extra help staff, or even administrators from Health Services Agency, to provide mandated coverage. Pharmaceutical 27. Pharmaceutical costs are a major problem in the jail/ medical environment. If an inmate is prescribed medication, he or she uses it only while in custody. If the prisoner is released or escapes, the medication must be discarded. Recently, the County of Santa Cruz, through the Health Services Agency, has contracted with a company that provides “ bubble” packaging that allows unused medication to be returned to the pharmaceutical company or prescribed / used for another inmate. Currently, Rountree and Juvenile Hall are using this system. It is expected that the Main Jail will adopt this program. Conclusions 1. The staff is professional and well trained in the day- to- day functioning of the institution. 2. The facility, though old, is well maintained, clean and well managed by the staff. 3. The number of nurses on staff is inadequate for the current jail population. 4. The present method of dispensing medication is not cost effective. 5. The Main Jail continues to face overcrowding. 6. The grievance procedure allows inmates the opportunity to express their concerns, and the staff responds in a timely fashion. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 8 Santa Cruz County Jails Review Recommendations 1. The Sheriff’s Department and the Santa Cruz County Board of Supervisors should continue to work on solutions to address jail overcrowding. 2. The Board of Supervisors should take action to increase the pay scale for the detention nursing staff. 3. The Board of Supervisors should work to re- open the medical clinic at the Rountree facility to reduce the workload of the nursing staff and to cut transportation costs of bringing inmates to the Main Jail for treatment. 4. The Main Jail should adopt “ bubble” packaging for dispensing medication to save money. 5. Jail administrators and staff should be commended for the care and integrity they apply toward the running of this institution. 6. The Main Jail should continue to conduct the inmate grievance procedure in the fair and well- documented manner they currently employ. Rountree Medium Security Findings 28. On December 3, 2005, the population was 55, well within the rated capacity of 96. 29. The S. A. F. E. program, a drug rehabilitation program, had 27 participants on December 3, 2005. 30. The on- site nursing position was eliminated in February of 2004 due to budget cuts. As a result, the facility cannot house any inmates requiring daily medical injections or psychotropic drug dosing. Other types of prescription drugs are dispensed by a nurse from the Main Jail seven days a week for two hours in the morning. Detention staff estimated that 25- 30 inmates on psychotropic drugs could be housed at Rountree if the medical facility were staffed by a full- time, on- site nurse. This would alleviate Main Jail overcrowding. 31. Non- urgent medical issues are handled by transporting inmates to the Main Jail medical facility or, on occasion, to Doctors on Duty by officer- driven vehicle. Emergency medical issues are handled by transporting inmates to the Watsonville Community Hospital by either ambulance or officer- driven vehicle. 32. An established and documented grievance procedure, dated May 4, 1996, is in place to respond to issues relating to conditions of confinement. 33. General housekeeping/ cleanliness of the medium security facility was observed to be very good by the touring Grand Jury members. Rountree Minimum Security Facility Findings 34. On December 3, 2005, the population was 115, well within the rated capacity of 162. 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 9 35. There have been 13 escapes ( walkaways) since the seating of the 2004- 2005 Grand Jury, up from seven during the term of the 2003- 2004 Grand Jury. 36. There are ample opportunities for inmates to participate in numerous programs during incarceration. A partial list follows. • Education: • English as a Second Language ( ESL) • General Equivalency Diploma ( GED)/ ESL • GED Testing • Self Improvement: • Alcoholics Anonymous • Narcotics Anonymous • Bible study/ church • AIDS awareness class/ testing • Substance abuse • Tobacco cessation • Vocational: • Auto body and paint • Computer skills • Building maintenance and landscaping 37. A designated area outside the facility is maintained for family visits. 38. An established and documented grievance procedure, dated May 4, 1994, is in place to deal with issues relating to conditions of confinement. Conclusions 7. Rountree is a well- run facility. 8. Rountree inmates can benefit from a variety of programs and educational opportunities. 9. The grievance procedures are due for a review and possible update. 10. The staff at Rountree performs its duties in a professional manner. 11. Closing the medical facility resulted in otherwise eligible inmates being housed in the Main Jail facility because of prescription drug needs. Recommendations 7. The Rountree staff should continue to run the facility in a professional manner. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 10 Santa Cruz County Jails Review 8. Rountree should continue to offer numerous programs and encourage all inmates to participate. 9. A study should be undertaken to assess what impact the re- opening of the medical facility would have on Main Jail overcrowding. 10. The grievance procedures of both the medium and minimum security facilities should be reviewed and updated, if appropriate. Blaine Street Jail ( Women’s Minimum Security Facilities) Findings 39. The Board of Corrections’ rated capacity is 42 inmates. As of May 4, 2005, the facility had 22 inmates. 40. There have been six escapes ( walkaways) in the past year. 41. There have been no deaths in the past year. 42. Fire drills are held monthly. 43. There are 25 rooms, five of which do not house inmates. These are used for storage or office space. The inmates’ rooms house up to two inmates per room. 44. Meals are prepared by inmates from menus provided by the county dietitian. 45. There are two classrooms in the facility. Attendance at these classes is voluntary. The classes offered are: • GED ( General Equivalency Degree); • job skills; • Pajaro Valley Substance Abuse Prevention and Student Assistance; • exit plans; • computers; • crocheting and knitting; • parenting skills; • communication skills; • women’s health; • Narcotics Anonymous; • Alcoholics Anonymous; and • Bible study, various church groups. 46. Grievances are handled through a grievance form. An inmate can request this form from a staff member. If the grievance concerns a staff member, the grievance is handled with that staff member and the director. If the grievance concerns other areas, 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 11 it is discussed with the director. Grievances are usually handled upon receipt of the form. 47. Each inmate is given a set behavior rules. If there is a violation of these rules, the following steps are taken: • a verbal warning is issued; • a written warning is issued; • privileges are lost; • extra work detail is assigned; • counseling is scheduled with the director; and • if there are too many infractions, the inmate is sent to the Main Jail. 48. Both the interior and exterior of the building are clean and neatly maintained. The outside area is in a garden setting and used by inmates for activities such as reading and socializing and is also used for family visits. 49. There is one officer on duty for all shifts, 24 hours a day. Conclusions 12. The Blaine Street Jail buildings and grounds are attractive and well maintained. 13. The facility is well staffed, and staff appears to be attuned to the needs of the inmates. 14. There is a variety of useful activities available to the inmates. Recommendations 11. The Blaine Street Jail staff should continue to operate the facility in the same caring and efficient manner that it does at present. 12. The staff should be commended for their attractive and well- run facility. Juvenile Hall Findings 50. This facility has a State Board of Corrections rating of 42 detainees. It has an average daily population of 24.7 ( fiscal year). 51. This facility has passed inspection by the State Board of Corrections, the local Fire Department and Nutritional Health. 52. The County Board of Education provides school programs for Juvenile Hall wards. 53. The average length of stay in Juvenile Hall is between nine and 11 days. 54. Counseling and substance abuse treatment are part of the Juvenile Probation process. Juvenile Hall is not a treatment program but has a drug counselor on staff 20 hours per week. Mental health services are provided 80 hours per week. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 12 Santa Cruz County Jails Review 55. Juveniles are housed in two units. One of the units houses boys who are more “ criminally sophisticated.” The other unit houses girls and less “ criminally sophisticated” boys. 56. Juveniles are given an orientation to the facility upon intake. They are given a list of the rules and consequences which they must acknowledge and sign. 57. Rules and grievance procedures are posted, and a box is provided to receive the grievance forms. The box is checked twice daily. 58. Juveniles are assigned to a housing unit based on a classification system that includes consideration of: • age; • gender; and • type of crime. 59. Parents are charged $ 24 per day while their child is in Juvenile Hall. 60. Juvenile Probation has a Home Electronic Monitoring Program which allows for early release. Two counselors make daily visits to wards released on this program. 61. This facility houses juveniles between the ages of 12 and 18. Children under the age of 12 are the responsibility of Child Protective Services and are not housed at Juvenile Hall. 62. This facility does not have a covered gymnasium. 63. The detainees’ rooms are small, and they contain: • a bed; • a sink; • a drinking fountain; and • a toilet. 64. Juvenile Hall does not have adequate heating, ventilation or air conditioning. The walls of the detainees’ rooms are made of cement blocks. They retain extreme temperatures. Juvenile Hall staff report that the inadequacy of the heating and air conditioning is not compatible with good public health. 65. There are electronic doors entering the facility and the courtyard, but other areas do not have electronic doors. Staff reported that electronic doors throughout the facility would improve the response time in an emergency. Conclusions 15. Juvenile Hall is well managed with a caring and diverse staff. 16. The Juvenile Hall buildings and grounds are well maintained. 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 13 17. Construction of a closed gymnasium would allow for adequate physical activity during poor weather. 18. The Home Electronic Monitoring program reduces the Juvenile Hall population. 19. For security and safety reasons, electronic doors need to be installed throughout the facility. 20. The heating and ventilation system in Juvenile Hall is inadequate. Recommendations 13. The Home Electronic Monitoring Program should be continued as it reduces the facility population. 14. The Board of Supervisors should budget money to upgrade the security system to include security cameras and electronic doors. 15. The Board of Supervisors should give higher priority to funding the construction of an enclosed gymnasium. 16. The Board of Supervisors should budget to upgrade the heating and ventilation system in Juvenile Hall. 17. The staff is to be commended for its efforts to maintain a safe and secure environment and help juveniles under their care. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 14 Santa Cruz County Jails Review California Youth Authority Findings 66. This facility had a State Board of Corrections rated capacity of 85. Prior to closure, its average daily population was approximately 46. 67. The wards were all at least 18 years old and sentenced to the California Youth Authority, where they would stay until they were 25 years old or had completed their sentences. 68. The wards had already served a portion of their sentences in a locked California Department of Corrections Youth Authority facility before being moved to the Fire Camp. 69. This facility provided a full high school program. 70. This facility employed seven counselors to work with the wards to address any emotional problems they may have had and to prepare them for release back into the community. 71. Many of the wards were trained to work on a fire crew, which could prepare them for employment upon their release. 72. The grievance procedure was well defined and taken seriously by the staff. Both written and verbal responses were provided to the wards. 73. There had never been a suicide or suicide attempt at this facility. 74. This was a minimal security facility and the wards slept in a dorm setting with shared showers and toilet facilities. The heating system was old and unable to heat the facility adequately. 75. Meals were shared in a central dining area and the food served was plentiful and well prepared. 76. There were 22 escapes during the past year. All were “ walkaways” from job sites. Conclusions 21. The California Youth Authority Camp facility was well managed by a professional and well- trained staff. 22. The California Youth Authority Fire Camp provided a community service to Santa Cruz County. 23. The support provided to the CDF by the CYA wards was a beneficial service to our community. 24. The wards once housed there have lost an enriching opportunity to learn an employment skill, which might have kept them from returning to a life of crime. Recommendations 18. There are no recommendations as the facility is closed. 2004 – 2005 Santa Cruz County Grand Jury Final Report Santa Cruz County Jails Review Page 3 - 15 Responses Required Entity Findings Recommendations Respond Within Santa Cruz County Board of Supervisors 1, 22, 25, 30, 39- 49, 64, 65 1- 3, 9, 11, 12, 14, 15 60 Days ( August 30, 2005) Santa Cruz County Sheriff 1, 4, 27, 30, 31, 39- 49 1, 4, 6, 9- 12, 14, 15 60 Days ( August 30, 2005) 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 16 Santa Cruz County Jails Review This page left intentionally blank. 2004 – 2005 Santa Cruz County Grand Jury Final Report California Public Records Act Page 3 - 17 Compliance by Local Police Agencies California Public Records Act Compliance by Local Police Agencies “ In enacting this chapter, the legislature, mindful of the right of individuals to privacy, finds and declares that access to information concerning the conduct of the people’s business is a fundamental and necessary right of every person in this state.” The California Public Records Act California Government Code § 6250 Synopsis Police agencies are required to comply with the California Public Records Act ( the act) as codified in California Government Code § 6250- 6270. The act allows the public to access and review the “ police blotter” ( list of times and circumstances of all calls to police, names and details of arrests, warrants, charges and hearing dates) that is compiled daily by police agencies. This investigation found that the Scotts Valley Police Department is in full compliance with the act. The Capitola Police Department, the Santa Cruz County Sheriff’s Department, the Santa Cruz Police Department and the Watsonville Police Department provide only limited information and are not in compliance with the act. Definitions Arrest log: abbreviated version of the incident log ( police blotter) made available to the press and public upon request Local agencies: includes counties; cities, whether general law or charter; school districts; municipal corporations; special districts; political subdivisions; any board, commission or agency; other local public agencies; or entities that are legislative bodies of a local agency pursuant to subdivisions Media release log: abbreviated version of the incident log ( police blotter) made available to the press and public upon request Member of the public: person who is not a member, agent, officer or employee of a federal, state or local agency acting within the scope of his or her membership, agency, office or employment Police blotter: an incident log that contains a list of times and circumstances of all calls to the police, names and details of arrests, warrants, charges and hearing dates, that is compiled daily by police agencies Public agency: any federal, state, regional or local agency 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 18 California Public Records Act Compliance by Local Police Agencies Public records: information relating to the conduct of the public’s business prepared, owned, used or retained by any state, regional or local agency regardless of physical form or characteristics Sources Interviewed: Capitola Police Department. Livermore Police Department. Santa Cruz County Sheriff’s Department. Santa Cruz Police Department. Scotts Valley Police Department. Watsonville Police Department. 911 Dispatch. Reviewed: All Santa Cruz County police departments’ policies and procedures in regard to access to public information. California Penal Code § 11075, 11105, 11105.1. First Amendment Project site, www. thefirstamendment. org. ca- html. Contra Costa Times, “ Half of Police Agencies Withhold Incident Logs,” July 25, 2004. Public Records Act Government Code § 6250- 6270. Background California Government Code § 6254 ( f)( 2) requires the following information in police blotters: “ the time, substance, and location of all complaints or requests for assistance received by agency and the time and nature of the response including the extent the information regarding crimes alleged or committed or any other incident investigated is recorded, the time, date and location of the occurrence, the time and date of the report, the name and age of the victim, the factual circumstances surrounding the crime or incident, and a general description of any injuries, property or weapons involved.” Information in the “ police blotter” ( time and circumstances of calls to police, names and details of arrests, warrants, charges and hearing dates) MUST be disclosed unless such disclosure would endanger an investigation or the life of an investigator. Additional information that may not be disclosed without a court order includes the name( s) of 2004 – 2005 Santa Cruz County Grand Jury Final Report California Public Records Act Page 3 - 19 Compliance by Local Police Agencies suspects under investigation, juveniles’ identities, names of victims of domestic violence and the names of the victims of child abuse or molestation. On July 25, 2004, the Contra Costa Times reported that one- half of the 36 police agencies contacted were in violation of the State Public Records Act for failure to produce their incident logs. At least one agency ( the Oakland Police Department) allowed only a review of an “ abridged incident report” and others issued vague referrals to other locations. The Livermore Police Department was cited as one of the police agencies in full compliance with the act. Members of the Grand Jury visited the five police agencies in the county as private citizens to request information. In only one case did they have to identify themselves as Grand Jurors to obtain information. They also visited the Livermore Police Department as a comparison to the local agencies. This department readily provided all information of police activity as requested by private citizens. In addition to the California State Highway Patrol, there are five police agencies within Santa Cruz County: • Capitola Police Department • Santa Cruz Police Department • Santa Cruz County Sheriff’s Department • Scotts Valley Police Department • Watsonville Police Department Scope This report examined whether local police agencies comply with the California Access to Public Records Act. It also looked at whether they comply with their own policies and procedures and whether those policies and procedures are consistent with the act. Findings Capitola Police Department 1. The department does not provide a complete police blotter but provides information in the form of a media release log. 2. The department’s access to public records policy is in accordance with the California Access to Public Records Act. 3. When Grand Jury members, without identifying themselves as such, requested information in regard to police activity, copies of the log were provided. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 20 California Public Records Act Compliance by Local Police Agencies Santa Cruz County Sheriff’s Department 1. The department does not provide a complete police blotter but provides information in the form of an arrest log. 2. When the access to public records policy was requested from the Sheriff’s Department, a copy of the California Public Records Act [ Law Enforcement Records Exempt Records – 6254 ( f)] was provided. 3. The arrest log was not made available when requested by public citizens. 4. The arrest log was made available when citizens identified themselves as members of the Grand Jury. 5. Copies of the arrest log could only be made by hand. Santa Cruz Police Department 1. The department does not provide a complete police blotter but provides information in the form of a media release log. 2. The department’s access to public information policy is in accordance with the California Access to Public Records Act. 3. When members of the Grand Jury, without identifying themselves as such, requested information regarding police activity, it was provided in the form of a media release log. 4. The media release log could be read at the department, but information could only be copied by hand. Scotts Valley Police Department 1. The department issues an event history ( police blotter) that contains all the information that the public is entitled to. 2. The department also issues a media log which is a synopsis of the event history. 3. The department’s access to public information policy is in accordance with the California Access to Public Records Act. 4. When members of the Grand Jury, without identifying themselves as such, requested information regarding police activity, both the event history and the media log were provided and copies were allowed to be made. Watsonville Police Department 1. The department does not provide a complete police blotter but provides information in the form of a media release log. 2. The department’s access to public records policy is in accordance with the California Access to Public Records Act. 2004 – 2005 Santa Cruz County Grand Jury Final Report California Public Records Act Page 3 - 21 Compliance by Local Police Agencies 3. When Grand Jury members, without identifying themselves as such, requested information regarding police activity, copies of the media release log were provided. Conclusions Capitola Police Department 1. The information of police activity provided in the media release log is not in compliance with the California Access to Public Records Act. 2. The information provided in the media release log is not in compliance with the department’s own policies and procedures. 3. The staff was courteous when providing information to unidentified Grand Jurors. Santa Cruz County Sheriff’s Department 1. The information provided in the arrest log is not in compliance with the California Access to Public Records Act. 2. The information provided in the arrest log is not in compliance with the department’s own policies and procedures. 3. The staff was neither courteous nor helpful when Grand Jury members requested information, whether as private citizens or as Grand Jury members. Santa Cruz Police Department 1. The information provided in the media release log is not in compliance with the California Access to Public Records Act. 2. The information provided in the media release log is not in compliance with the department’s own policies and procedures. 3. The staff was courteous when providing information to unidentified Grand Jurors. Scotts Valley Police Department 1. The Scotts Valley Police Department complies with the California Public Records Act. 2. It provides information to the public in compliance with department’s own policy and procedures manual. 3. The staff was courteous and friendly when visited by unidentified Grand Jurors. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 22 California Public Records Act Compliance by Local Police Agencies Watsonville Police Department 1. The information provided in the media release log is not in compliance with the California Access to Public Records Act. 2. The information provided the media release log is not in compliance with department’s own policies and procedures. 3. The staff was courteous to the public in providing information to unidentified Grand Jurors. Recommendations Capitola Police Department 1. The Capitola Police Department should create a police blotter that is in compliance with the California Access to Public Records Act and with its own policy in regard to public access to information. 2. The staff should be educated in its own internal policies and procedures and trained to handle requests for information by the public. 3. The staff should be commended for its courtesy in response to public requests for information. Santa Cruz County Sheriff’s Department 1. The Santa Cruz County Sheriff’s Department should create a police blotter that is in compliance with the California Access to Public Records Act and with its own policy in regard to public access to information. 2. The staff should be educated in its own internal policies and procedures and trained to handle requests for information by the public. 3. The staff should make information in the arrest log readily available to the public in a courteous and efficient manner. Santa Cruz Police Department 1. The Santa Cruz Police Department should create a police blotter that complies with the California Access to Public Records Act and with its own policy in regard to public access to information. 2. The staff should be educated in its own internal policies and procedures and trained to handle requests for information by the public. 3. The staff should be commended for its courtesy in response to public requests for information. 2004 – 2005 Santa Cruz County Grand Jury Final Report California Public Records Act Page 3 - 23 Compliance by Local Police Agencies Scotts Valley Police Department 1. The Scotts Valley Police Department should be commended for its compliance to the California Access to Public Records Act. 2. The staff should be commended for its courtesy to the public. Watsonville Police Department 1. The Watsonville Police Department should create a police blotter that is in compliance with the California Access to Public Records Act and with its own policy in regard to public access to information. 2. The staff should be commended for its courtesy in response to public requests for information. Responses Required Entity Findings Recommendations Respond Within Capitola Police Department All in pertinent section All in pertinent section 90 Days September 30, 2005 Santa Cruz County Sheriff’s Department All in pertinent section All in pertinent section 60 Days August 30, 2005 Santa Cruz Police Department All in pertinent section All in pertinent section 90 Days September 30, 2005 Scotts Valley Police Department All in pertinent section All in pertinent section 90 Days September 30, 2005 Watsonville Police Department All in pertinent section All in pertinent section 90 Days September 30, 2005 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 3 - 24 California Public Records Act Compliance by Local Police Agencies This page left intentionally blank. Santa Cruz County Grand Jury Final Report: Section 4 Health and Human Services Committee Reports 2004- 2005 Santa Cruz County Grand Jury Final Report Shades of Gray: Page 4 - 1 Dominican Santa Cruz Hospital/ Jail Medical Facility Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility Synopsis Providing care to chronic inebriates through a hospital emergency room is costly, particularly if they are medically indigent. Dominican Hospital and Santa Cruz County detention staff are in agreement that treating these alcohol and substance abusers is staff intensive. These patients often exhibit behavior problems, are homeless and have underlying medical conditions. The use of the Emergency Department at Dominican Hospital increases the cost of medical care, extends waiting time and diverts ambulances from other types of emergencies. Opinions differ, however, about who pays for patients not yet booked into jail. Dominican Hospital is required by federal law to provide emergency care regardless of a patient’s ability to pay. The county is responsible for medical care for prisoners under arrest, often serial inebriates or “ frequent flyers.” When a detainee is in custody but not yet booked, Dominican Hospital often ends up delivering services and not receiving reimbursement within this “ gray area.” Detention staff is exploring ways to decrease the cost of caring for serial inebriates, including establishing rehabilitation programs and a sobering facility and restructuring policies. Several other communities have started cost- effective, non- medical programs to divert inebriates from emergency rooms. Definitions Booking: the process by which an arrestee is registered into the detention system CHIP: California Health Care for the Indigent Program Detainee: a person in custody DUI: driving under the influence of intoxicating substances ED: Emergency Department EMTALA: Emergency Medical Treatment and Labor Act ETOH: chemical or medical notation for ethyl alcohol Frequent Flyers: persons who are frequently inebriated and brought to jail or the Emergency Department by law enforcement officers Inebriate: one using alcohol or drugs to the point of intoxication In custody: detained by law enforcement officers LVN: Licensed Vocational Nurse 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 2 Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility Medi- Cruz: a county- operated health care program that helps low- income residents of Santa Cruz County without health insurance to get the health care services they need Netcom: Santa Cruz County’s computer- aided dispatch center Proposition 36: The Substance Abuse and Crime Prevention Act of 2000 offers adults convicted of nonviolent drug possession offenses the opportunity for substance abuse treatment instead of incarceration. RN: Registered Nurse Safety chair: a restraining device in the Main Jail booking area for inmates with behavioral problems Sallyport: a system of security doors in which the first door opens, then must be closed and locked before the second door will open Triage: the process for evaluating casualties and assigning priority of treatment Background According to detention personnel, the biggest drain on the jail’s medical budget is serial inebriates. These people are arrested for “ Drunk in Public,” PC § 647( f) and can be brought to jail repeatedly. When a person is arrested and taken to the county jail, he or she is first admitted through the booking sallyport1 to a processing area. If arrestees are inebriated to the point of being unable to stand unassisted, they are taken to Dominican Hospital for medical evaluation. The jail nurse will not accept an injured arrestee because the jail does not have the necessary equipment and staff to treat the injuries. If the arrestee is not booked and taken to the hospital, he or she is responsible for the bill. Dominican Hospital provides medical care to “ county- responsible patients” under a Hospital Services Agreement with Santa Cruz County. 2 Persons under arrest by the Santa Cruz County Sheriff’s Department or incarcerated in the county jail are the responsibility of the county. Care of these often uninsured detainees increases the cost of medical care, extends waiting times in the Dominican Hospital Emergency Department ( ED) and diverts ambulances from other types of emergencies. Patients referred to the hospital from the jail sallyport prior to booking are treated as private pay patients. Many of these people are uninsured and also do not have Medi- Cal or Medi- Cruz. Their treatment, therefore, becomes a write- off for the hospital and the physicians who treat them. The bad debt ( write- off) in the Emergency Department is significant. According to the Access to Medical Care Agreement ( AMCA) between Dominican Hospital and Santa Cruz County, Dominican Hospital agrees to spend seven 1 See Definitions. 2 County of Santa Cruz and Dominican Santa Cruz Hospital, Hospital Services Agreement. 2004- 2005 Santa Cruz County Grand Jury Final Report Shades of Gray: Page 4 - 3 Dominican Santa Cruz Hospital/ Jail Medical Facility percent of the hospital’s net operating expenses on uncompensated care, which include charity care and bad debts. Once a person has been cleared for booking and accepted into the jail, any subsequent medical treatment the jail cannot provide is performed at the hospital. Santa Cruz County is responsible for the bill. Hospitals in other counties and cities share the problem of uncompensated medical care. For example, Stanford University Medical Center sued the city of East Palo Alto and San Mateo County, accusing them of not paying for medical costs incurred by injured suspects brought in by East Palo Alto police. Stanford has a contract with the county to provide medical care to injured suspects. San Diego, Portland, Phoenix, Seattle, Las Vegas and San Joaquin County have programs diverting public inebriates from emergency rooms. They have non- medical alternative placements for sobering up. Most use a combination of a sobering facility and local jails. The most cost- effective programs use vans to pick up public inebriates and bring them to the sobering programs. Scope This investigation began as a review of ways to improve medical care and to save money at the county’s main jail medical facility. In the course of the investigation, the issue of uncompensated care for detained but unbooked patients in county hospital emergency rooms emerged. Although Watsonville Community Hospital may also have this problem, we chose to focus on Dominican Hospital. Sources Interviewed: Dominican Santa Cruz Hospital personnel. Santa Cruz County Health Services Agency personnel. Santa Cruz County Main Jail medical personnel. Santa Cruz County Sheriff’s Department personnel. Reviewed: Memoranda/ Reports 2003- 2004 Santa Cruz Grand Jury Final Report, “ Hospitals and Charity Care in Santa Cruz County.” Application for California Healthcare for Indigents Program Funding for Fiscal Year 2004- 5, May 4, 2005. Board of Supervisors Meeting Minutes, January 4, 2005. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 4 Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility County of Santa Cruz and Dominican Santa Cruz Hospital, Hospital Services Agreement, [ Article 2, § 2.1, ( d)], signed in 1994, amendment signed in 1997. Dominican Hospital Response, December 31, 2004. Health Services Agency, Sheriff’s Department, Public Inebriate Summary, March 2003, EMS “ Snapshot” with Estimated Annual Impacts. Rama Khalsa, HSA Director, Mark Tracy, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and Public Inebriates, April 14, 2003. Health Services Agency personnel, Follow- up Questions, May 4, 2005. Steve Robbins, Sheriff – Coroner, Memo regarding study of inebriates at local hospital emergency rooms, April 27, 2005. Newspaper/ Magazine Articles San Jose Mercury News, “ Hospital sues for cost of treating suspects,” 2005. Santa Cruz Sentinel, “ County will offer drunks treatment,” July 27, 2004. The Valley Post, “ New Program Helping to Keep Inebriates Out of Emergency Rooms,” San Lorenzo Valley, February 15, 2005- March 14, 2005. Web sites City of San Diego, “ Federal Government Lauds Local Efforts to End Chronic Homelessness,” September 4, 2004, http:// www. sandiego. gov/ press/ 040914. shtml. Centers for Medicare and Medicaid Services web site, http:// www. cms. hhs. gov/ providers/ emtala/ default. asp. Santa Cruz County Personnel Department web site, http:// sccounty01. co. santa-cruz. ca. us/ personnel/ salsched/ salsched. asp. Findings 1. In 1986, Congress enacted the Emergency Treatment and Labor Act ( EMTALA) to ensure public access to emergency medical services regardless of ability to pay. Medicare- participating hospitals that offer emergency services must provide a medical screening examination when a request is made for examination or treatment for an emergency medical condition. Hospitals are required to provide stabilizing treatment for patients with emergency medical conditions [ USC 42 § 1395( dd)]. 3 2. Increased use of services is a key driver of rising hospital costs. While costs have continued to increase, reimbursements from government and many private health insurers have not kept pace. Increased use of Emergency Department services by patients not requiring this level of hospital care strains an already fragile emergency medical care system and may result in increased waiting times and ambulance 3 Centers for Medicare and Medicaid Services Web site, http:// www. cms. hhs. gov/ providers/ emtala/ default. asp. 2004- 2005 Santa Cruz County Grand Jury Final Report Shades of Gray: Page 4 - 5 Dominican Santa Cruz Hospital/ Jail Medical Facility diversion. Public inebriates consume hospital resources and could be better managed in alternative settings. Medically indigent inebriates further tax the system because they are uninsured. 3. According to HSA personnel, emergency- room visits can be costly. At Dominican Hospital, it costs about $ 350,000 to $ 500,000 annually to treat indigent drunks. 4 4. A person can be booked “ in absentia.” This happens if an arrestee has an immediate and serious medical condition that requires emergency medical treatment before going to jail. Santa Cruz County is responsible for medical care because the person under arrest is too injured to go to jail. 5. In regard to medical clearance of an arrestee prior to booking, the jail nurse on duty triages5 the arrestee at the door. If arrestees cannot stand on their own, they are taken to Dominican Hospital by the arresting agency for medical clearance. The cost of the medical care while at Dominican Hospital falls on the individual. If the individual cannot pay, Dominican Hospital assumes the cost. If an inmate needs hospitalization or treatment after booking, the financial responsibility belongs to the Sheriff’s budget. 6. The safety room at the Main Jail ( drunk tank) is not often used. Confining a detainee in the safety room requires frequent observation of the detainee. Another restraining device, the safety chair, can be used for a few hours at a time until the detainee “ settles down.” 7. Detention personnel said the biggest drain on the jail’s medical budget is “ serial drunks.” These are people are arrested repeatedly for PC § 647( f) ( Drunk in Public), a misdemeanor. 8. Ambulances in California must bring patients to emergency rooms unless the patients have adequate mental capacity to refuse treatment and have no obvious injuries. 9. Detention personnel say that handling inebriates is staff intensive. They often exhibit behavioral problems, are homeless and can have underlying medical problems. Some “ frequent flyers” are recognized by detention nurses upon arrival as having chronic medical problems. Those needing treatment must be taken to the hospital Emergency Department. According to Detention personnel, the target group in Santa Cruz County is about 10 people who are routinely picked up for drunkenness. 6 10. According to Dominican Hospital personnel, in- custody patients who had used the Emergency Department while in custody sometimes return on their own to use it as a source of narcotics and as an alternative to “ street- acquired” medications. 11. Detainees do not have a large effect on staffing in the Emergency Department but can affect patient flow through the department. Having to perform Driving Under the 4 Santa Cruz Sentinel, “ County will offer drunks treatment,” July 27, 2004. 5 See Definitions. 6 Santa Cruz Sentinel, “ County will offer drunks treatment,” July 27, 2004. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 6 Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility Influence ( DUI) blood draws may affect staffing because medical technicians are taken away from caring for other patients. 12. When an officer picks up an inebriate in public, the inebriate is sometimes given the choice of going to jail or going to the hospital. According to Emergency Department personnel, the inebriate often chooses the hospital. 13. Weekend and overnight shifts are more impacted by inebriates and drug users because they come in during those shifts more often. Staffing levels are lower during the night shift. If inebriates are medically stable, they may occupy a bed for eight to 10 hours to sober up. It usually takes at least four hours for a patient to sober up and be ready to discharge. Typically, an officer does not stay with them. For many of these patients, the reason they were detained is no longer applicable ( i. e., public intoxication), and they are released without being charged. 14. Inebriates are often brought to the hospital by ambulance. There are a total of 13 ambulances in service in the County of Santa Cruz ( in and out of service at different times). If they are tied up on calls for inebriates, they cannot answer calls for other emergency situations. 15. Detainees can be a factor in overwhelming an emergency room because frequently they arrive unannounced, especially if they are coming in a police car directly from being arrested. With an ambulance, the emergency room gets a few minutes’ warning. The emergency room could use that time to get a bed ready. If someone just “ shows up,” there is more pressure to move people around. 16. If inebriates come in off the street ( for example, they were in a bar fight), they are evaluated by a physician to determine if they are sufficiently medically stable to go to jail. Those patients may arrive in an ambulance or a police car. Funding 17. In 1994, Dominican Hospital and Santa Cruz County signed a contract that specifies, “ persons under arrest by the County Sheriff’s Department or incarcerated in the County jail” are county- responsible patients. The county is responsible for the cost of their health care. 7 18. Dominican Hospital accepts reimbursement for services from Santa Cruz County at a negotiated and agreed- upon rate. 19. Dominican Hospital personnel say that early this year Detention administration implemented a new policy requiring that a triage nurse at the sallyport fill out the Medical Triage/ Sallyport Refusal form and send it to the hospital with the officer and inebriate. Once individuals have been treated at the hospital and medically cleared, they are taken to jail for booking. All medical services provided prior to booking are now the financial responsibility of the individual. Despite the lack of health 7 County of Santa Cruz and Dominican Hospital Services Agreement, 1994. 2004- 2005 Santa Cruz County Grand Jury Final Report Shades of Gray: Page 4 - 7 Dominican Santa Cruz Hospital/ Jail Medical Facility insurance/ financial resources for many of these patients, the hospital is required by law to provide services but is not guaranteed any reimbursement. In addition, this new procedure requires that a new form must accompany the bill in order to secure payment for inmates transported to the hospital from county detention facilities. Dominican Hospital personnel say that this new procedure was put into effect without adequate communication about the changes to either Dominican Hospital or to law enforcement, creating much confusion. 20. According to Dominican Hospital personnel, the approved patient payment is based on a hospital services agreement reimbursement contract. Reimbursement for outpatient care covers the cost of services. However, reimbursement for inpatient services does not cover total costs. 21. According to Dominican Hospital personnel, patients in custody may require Emergency Department and other hospital services. Hospital personnel say that the costs of providing care should not be the responsibility of the hospital. Sometimes the hospital has no way to ascertain the booking status of a patient before providing services. 22. HSA personnel said that whether the county is legally responsible for emergency room care for detainees who have not been formally booked is a “ gray area.” 23. There is a distinction between eligiblity for Medi- Cal and Medi- Cruz in Santa Cruz County. Medi- Cal recipients must meet certain criteria including income, citizenship, children and disabilities. Medi- Cal is a federal program administered by the state. 24. Medi- Cruz is the county’s response to CA Government Code § 17000. It applies to people in the county who have no other resources, i. e., homeless, indigent, undocumented aliens or older people without children. 25. Services available to Medi- Cruz recipients are: • primary health care in clinics; • X- rays; • pharmaceuticals; • emergency care; and • hospital ( in- patient) care. 26. Medi- Cruz does not cover jailed inmates. The medical costs for incarcerated patients come from the Detention Jail budget. Even if they are active Medi- Cruz patients, services cease after they are booked according to HSA personnel. 27. According to Dominican Hospital personnel, there is a staff member at Dominican Hospital to assist people to sign up for Medi- Cruz and Medi- Cal. This position is not staffed 24 hours a day. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 8 Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility 28. Patients determined eligible for Medi- Cruz services can have treatment paid for retroactively. However, it is up to the client to cooperate and follow through with the paperwork for this to be accomplished. 29. The medical budget for detention facilities is $ 3 million. The three largest components of the detention medical budget are: • nursing/ medical care ( salaries) within the jail; • services delivered at the county health clinics ( X- rays, pharmacy and laboratory are the largest intra- agency cost); and • outside medical care ( Doctors On Duty or dental care). 30. CHIP funds may not be used to support health services provided to persons detained in a county or city jail or other correctional facility ( W& I Code Section 16995). 8 31. HSA personnel believed that claims for indigent detainees might be partially covered by CHIP money. The amount of funding the county receives from CHIP doesn’t allow for 100 percent reimbursement of all of those claims. The total 2004- 2005 CHIP allocation for Santa Cruz County is $ 77,214. 32. According to HSA personnel, there is disagreement over who is financially responsible for blood draws and Breathalyzer tests done on detainees to determine drug and alcohol levels. The law is not specific, and it is an area of contention. 33. The jail does not do Breathalyzer tests or blood draws on arrested subjects. Law enforcement officers perform Breathalyzer tests. The hospital does not have Breathalyzer equipment. Nurses at the Main Jail do not take blood alcohol levels. They cannot collect evidence. 34. Hospital personnel must perform blood draws. As a result, this takes away from staff time to collect samples. Hospital staff is often called to testify in court regarding collection of such samples as evidence. Staff are not reimbursed for court appearances. Procedural Alternatives 35. A Santa Cruz County elected official says that legislation should be changed. People who are eligible for state medical benefits should not lose those benefits when incarcerated. 36. According to a Dominican Hospital medical staff member, patients could be better handled at the jail if there were an infirmary on site. Once they are cleared medically, they should be able to be monitored on site at the jail. 8 Application for California Healthcare for Indigents Program Funding for Fiscal Year 2004- 5, May 4, 2005. 2004- 2005 Santa Cruz County Grand Jury Final Report Shades of Gray: Page 4 - 9 Dominican Santa Cruz Hospital/ Jail Medical Facility 37. Detention Health Services intends to clarify in writing the criteria for transporting individuals to emergency departments for medical clearance prior to bringing them to jail. It appears that many people being brought to emergency departments could be brought to the jail directly by police officers. Training for police also appears necessary so that individuals are brought to the appropriate location. 9 38. Detention Medical staff is also evaluating current staffing patterns and hours to better serve this population in a cost- effective and clinically appropriate manner. Additional staffing may be required on Friday and Saturday nights for medical direction of these cases. This is a peak time for cases with alcohol and drug involvement. 10 39. Dominican Hospital staff has suggested that the jail medical facility should be sufficient to take care of inebriates if patients could receive intravenous treatment. 40. Netcom staff is currently developing management reports based upon computer-aided- dispatch data to help determine when and how ambulances are dispatched for serial inebriates, as well as the involvement of law enforcement from different jurisdictions. Because of the law forbidding alternate destinations, 11 the best way to reduce emergency room use for this purpose is to not have law enforcement call for an ambulance solely for public inebriates. Once Netcom is contacted to dispatch an ambulance, national medical procedures do not give them broad latitude in these areas. 41. According to Dominican Hospital personnel, the Main Jail could decrease use of the Emergency Department by providing the following services: • more advanced nursing assessment and triage at the medical triage/ sallyport to decrease refusals; • observation and sobering; • wound evaluation and care; and • Breathalyzer and blood or urine alcohol testing. 42. According to Dominican Hospital personnel, law enforcement manipulates the system by not arresting the client under the influence or only citing after sobering, thereby avoiding a booking fee/ court appearance. 43. According to Detention personnel and Dominican Hospital personnel, a previous sobering center in the county was closed due to a patient/ inmate escaping and creating problems in the neighborhood. 9 HSA Director, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and Public Inebriates, April 14, 2003. 10 HSA Director, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and Public Inebriates, April 14, 2003. 11 See Finding 1. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 10 Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility 44. The Sheriff’s Department, Netcom and AMR, a local ambulance service, will be further analyzing local data and processes that lead to emergency room use. Alternatives in Santa Cruz County 45. Project Connect, a new program of the county’s Homeless Person’s Health Project, is a grant program administered through the Health Services Agency, designed to reduce misuse of emergency services such as ambulance, emergency rooms and fire services. 46. Project Connect seeks out individuals who have had five or more ER visits in one year and enrolls them in an intensive case management process. Project Connect is funded by a $ 300,000 grant from the California Healthcare Foundation and The California Endowment. The funds pay primarily for staff who connect participants with outside agencies providing many services. 47. In its first year of operation, Project Connect has seen a 43 percent decrease in emergency room visits, a 35 percent decrease in jail bookings and a 25 percent decrease in ambulance transports by its participants. Project Connect takes a holistic approach, helping people access primary health care but also supporting constructive life changes. 48. In November of 2004, Santa Cruz County started a Serial Inebriate Program in hopes of decreasing the jail population and beginning some meaningful rehabilitation. This program is funded by a grant through HSA and involves the Probation Department, the District Attorney’s Office, the Public Defender’s Office and the Sheriff’s Department. 49. In the Serial Inebriate Program, sentenced inmates can choose to serve their time at a sobering facility in Santa Cruz, located on 7th Avenue, in lieu of jail. For instance, they might have a choice of a specified jail sentence or serving the same amount of time in the rehabilitation program. According to detention personnel, the program is working well; although sometimes inmates have two or three failures before they commit to treatment. 50. Under the Serial Inebriate Program, inebriates who are arrested three times go to detoxification or jail. Serial Inebriate Program in San Diego County 51. Started in January 2000, the Serial Inebriate Program is an innovative effort involving the City and County of San Diego, the San Diego Police and Sheriff's Departments, San Diego County Superior Courts, San Diego County Health and Human Services and Mental Health Systems, Inc. A number of agencies and treatment partners work in tandem with SIP. This collaborative effort provides a less expensive and more appropriate alternative to emergency departments and jails for treatment of homeless chronic inebriates. This program has had a dramatic effect on San Diego emergency 2004- 2005 Santa Cruz County Grand Jury Final Report Shades of Gray: Page 4 - 11 Dominican Santa Cruz Hospital/ Jail Medical Facility departments. 12 In San Diego, the first year of the program saw 144 people enter the program. A year later, 58 percent had had no contact with police since leaving treatment. 52. The goals of the Serial Inebriate Program ( SIP) are to: • slow or stop the revolving door cycle of chronic alcoholics going in and out of detoxification centers, county jail and emergency rooms; • divert this population off the street and into county- funded treatment programs; • significantly reduce the uncompensated costs, time constraints and manpower burdens to San Diego County's healthcare, law enforcement and judicial infrastructure caused by homeless, chronic alcoholics; and • give people who routinely live on the street an opportunity to create a stable mainstream lifestyle. 53. The program strategy offers treatment in a joint City/ County- funded program in lieu of custody time resulting from a guilty verdict for public intoxication. Once in treatment, clients are provided with wraparound services designed to help their recovery from alcoholism and begin moving them toward re- entering society as a sober community member. 13 Conclusions 1. Providing medical care for serial inebriates, especially if they are medically indigent, raises Dominican Hospital’s operating expenses significantly. Those costs are absorbed by the consumer. 2. Providing services to serial inebriates negatively impacts Emergency Department operations. 3. Dominican Hospital and county personnel have different understandings of who is responsible for paying for medical care for patients who have been placed in custody but not booked. 4. Dominican Hospital could improve its reimbursement rate by expanding the hours of staff who assist patients with the Medi- Cal and Medi- Cruz process. 5. Since taxpayers and medical consumers ultimately cover uncompensated medical expenses, a cost- effective alternative to using the Emergency Department to treat inebriates would be a sobering center in the county. This would reduce the financial and workload burden on Dominican Hospital and Detention staff. 12 HSA Director, former Sheriff, Report Back on Emergency Room Issues Related to Criminal Justice and Public Inebriates, April 14, 2003. 13 City of San Diego, “ Federal Government Lauds Local Efforts to End Chronic Homelessness,” September 4, 2004, http:// www. sandiego. gov/ press/ 040914. shtml. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 12 Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility 6. Alternative programs in Santa Cruz County have been successful in reducing the number of frequent Emergency Department users. These programs depend on continued funding from Santa Cruz County or the State of California. 7. Alternative programs in other cities and counties have been successful in reducing the number of serial inebriates. Drawing from the experience of these programs could prove beneficial to Santa Cruz County. Recommendations 1. The Health Services Agency should clarify procedures for reimbursement of medical costs for those in custody who have not been booked and communicate those procedures to Dominican Hospital. 2. Law enforcement officers should continue to receive training in policies and procedures for transporting serial inebriates to the emergency room. 3. Detention staff and HSA should explore the possibility of establishing a sobering facility in Santa Cruz County. 4. Project Connect is to be commended for its success in reducing Emergency Department visits, jail bookings and ambulance transports. 5. County officials should join in efforts to maintain funding for promising programs that assist serial inebriates in creating stable lifestyles for themselves. 6. HSA and Detention staff should stay in communication with other cities and counties that have successful programs for serial inebriates and incorporate some of these ideas into Santa Cruz County programs. 7. Santa Cruz County should investigate creative solutions to involve Dominican Hospital in solving the problem of frequent use of the Emergency Room by serial inebriates. The Access to Medical Care Agreement may provide the avenue to encourage collaboration. 2004- 2005 Santa Cruz County Grand Jury Final Report Shades of Gray: Page 4 - 13 Dominican Santa Cruz Hospital/ Jail Medical Facility Responses Required Entity Findings Recommendations Respond Within Santa Cruz County Board of Supervisors 1- 53 1- 7 60 Days ( August 30, 2005) Santa Cruz County Health Services Agency 1- 53 1- 7 90 Days ( September 30, 2005) Santa Cruz County Sheriff 1- 53 1- 7 60 Days ( August 30, 2005) 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 14 Shades of Gray: Dominican Santa Cruz Hospital/ Jail Medical Facility This page left intentionally blank. 2004 – 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 – 15 Expenditure of Proposition 99 and Proposition 10 Funds in Santa Cruz County Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 and Proposition 10 Funds in Santa Cruz County Synopsis This report looked at how tobacco tax funds received by Santa Cruz County are spent, specifically funds from: • Proposition 99 ( passed in 1988); and • Proposition 10 ( passed in 1998). The county has had success with tobacco education, prevention and cessation programs, and providing indigent medical care using Proposition 99 funds. Proposition 10 monies have established and funded healthcare for young children, high- risk infant intervention, drug and alcohol treatment for parents of young children and early childhood education programs. We applaud the successes of these programs. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 16 Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 Funds in Santa Cruz County Expenditure of Proposition 99 Funds in Santa Cruz County Definitions CDHS: California Department of Health Services CHIP: California Healthcare for the Indigent Program LLA: Local Lead Agency Medically indigent: a person who cannot afford medical care and for whom payment will not be made by any private coverage or federal program Medi- Cruz: a county- operated healthcare program that helps low- income residents of Santa Cruz County without health insurance get the healthcare services they need TCS: Tobacco Control Section Background In November 1988, California voters approved Proposition 99, also known as the California Tobacco Tax and Health Promotion Act of 1988. This act increased the state surtax on cigarettes by 25 cents per pack and added an equivalent amount on other tobacco products. The two main uses of this tobacco tax revenue are to fund: • tobacco- related health education programs and disease research; and • medical and hospital care for medically indigent patients. At the state level, money is deposited in Health Education, Hospital Services and Physician Services accounts, then dispersed to county and city health departments. The money deposited in the Health Education Account goes for health education efforts to prevent and reduce tobacco use. One- third of these health education funds go to the California Department of Education and two- thirds go to the California Department of Health Services ( CDHS). The state funds numerous health and tobacco- related programs with Proposition 99 revenue. The only funds that come directly into Santa Cruz County accounts, however, go to the Tobacco Education Program and the California Healthcare for Indigents Program ( CHIP). Tobacco Education Program The state’s health services department was charged with reducing tobacco use through statewide media campaigns, tobacco control programs in local health departments and competitively selected state, regional and community- based projects. It was also charged with conducting extensive, ongoing evaluations of the entire tobacco education campaign. The department created a Tobacco Control Section ( TCS) to implement these 2004- 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 - 17 Expenditure of Proposition 99 Funds in Santa Cruz County programs, following a mandate set forth in California Health and Safety Code, Chapter 1.2, beginning with § 104350. The mission of the statewide Tobacco Control Section is to work toward a tobacco- free California and reduce illness and premature deaths due to tobacco use. This is accomplished through programs to reduce tobacco use and exposure to secondhand tobacco smoke. The state’s Tobacco Control Section funds county, community, regional and statewide projects. Each of the state’s 58 county and three city health departments are designated as Local Lead Agencies ( LLA). In Santa Cruz County, the lead tobacco control agency is the County of Santa Cruz Health Services Agency, Community Health and Prevention Programs. It is responsible for coordinating information, referrals, outreach and education activities within its health jurisdiction. LLAs are legislatively mandated to periodically submit a comprehensive tobacco control plan to CDHS. They oversee community coalitions to help develop this plan and engage in community activities that promote social changes, educate the public about health issues related to tobacco use and tobacco industry strategies that promote tobacco use. Local Lead Agencies develop local community policy, support enforcement of tobacco control laws and provide local tobacco cessation services. California Healthcare for Indigents Program ( CHIP) In 1989, the Legislature established the California Healthcare for Indigents Program ( CHIP) and the Rural Health Services Program to allocate Proposition 99 funds to participating counties. These funds reimburse providers for uncompensated services for individuals who cannot afford care and for whom no other source of payment is available. Santa Cruz County is one of 23 California counties to receive CHIP funds and to do so has agreed to: • maintain a financial level of effort in the delivery of services; • report expenditure and utilization data to the department; and • provide medically necessary follow- up treatment to eligible children. In Santa Cruz County, Proposition 99 funds come through the Health Services Agency and go to the Tobacco Education Program and the California Health Care for the Indigent Program ( CHIP). The CHIP monies go to Dominican Santa Cruz Hospital and Watsonville Community Hospital and physicians. Statewide, Proposition 99 funds have been decreasing and continued to decrease for fiscal year 2004- 05 due to reduced tobacco product purchases, changes in revenue estimates and state redirection of resources to programs outside the Department of Health Services. 1 1 Department of Health Services, State of California, 2004- 05 Budget Act Highlights, August 13, 2004. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 18 Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 Funds in Santa Cruz County Scope This investigation examines Proposition 99 tobacco tax spending in Santa Cruz County. Sources Interviewed: County administrative personnel. County health officials. Reviewed: Application for California Healthcare for Indigents Program Funding for Fiscal Year 2004- 05, provided by Health Services Agency, Santa Cruz County. “ California Healthcare for Indigents Program and Rural Health Services Program ( Proposition 99),” http:// www. dhs. ca. gov/ hisp/ ochs/ chsu/ index. htm. California Healthcare for Indigents Program, CHIP Funding History, provided by Santa Cruz County Health Services Agency, May 4, 2005. Community Assessment Project, Comprehensive Report, 2004. Department of Health Services, State of California: 2004- 05 Budget Act Highlights, August 13, 2004. “ Local Lead Agency Guidelines for a 2004- 2007 Comprehensive Tobacco Control Plan, Issued January 6, 2004.” http:// www. appliedsurveyresearch. org/ products/ CAP10_ Health. pdf. “ Local Programs,” http:// www. ldhs. ca. gov/ tobacco/. News Release: “ California Smoking Rates Drop 33 Percent Since State’s Anti- Tobacco Program Began,” February 2005, http:// www. dhs. ca. gov. santacruzhealth. org. Santa Cruz County administrative personnel, memo. Santa Cruz County Health Services Agency personnel, memo. Santa Cruz County Health Services Agency, Tobacco Education Program: “ Administrative/ Collaborative Activities,” http:// catob. esp. fsu. edu. “ Coalition Membership.” “ Scope of Work: Overview and Intervention Activities, 7/ 1/ 2004 – 6/ 30/ 2007.” State Board of Equalization, “ Cigarette and Tobacco Products Taxes,” June 2004, Publication No. 93. “ Tobacco Control Section” ( TCS), http:// www. dhs. ca. gov/ tobacco/. “ Tobacco Education Coalition,” http:// www. santacruzhealth. org/ phealth/ healthed/ 3tobacco. htm. Tobacco Education Coalition, 2003 Year- in- Review. Tobacco Education Program, Budget Justification for Santa Cruz County Health Services Agency. 2004- 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 - 19 Expenditure of Proposition 99 Funds in Santa Cruz County Findings Tobacco Education Program 1. The Santa Cruz County Health Services Agency, Community Health and Prevention Programs, acting as the Local Lead Agency ( LLA), receives Proposition 99 funds in three- year funding cycles. In the present funding cycle for Fiscal Years 2004- 05, 2005- 06 and 2006- 07, a total of $ 450,000, or $ 150,000 per year, is projected. This amount is based on population, with $ 150,000 being the smallest amount a county could receive. 2. The budget for the present three- year funding cycle is outlined as follows: 2 Budget Section FY 04- 05 FY 05- 06 FY 06- 07 Total Personnel Costs $ 75,622 $ 89,336 $ 90,859 $ 255,817 Fringe Benefits @ 35- 42% $ 30,249 $ 35,734 $ 35,435 $ 101,418 Operating Expenses $ 2,000 $ 1,500 $ 500 $ 4,000 Equipment Expenses $ 2,700 $ 0 $ 0 $ 2,700 Travel/ Per Diem and Training $ 4,000 $ 2,169 $ 3,900 $ 10,069 Subcontracts and Consultants $ 12,000 $ 1,000 $ 0 $ 13,000 Other Costs $ 5,762 $ 1,500 $ 362 $ 7,624 Indirect Expenses @ 14- 15% $ 17,667 $ 18,761 $ 18,944 $ 55,372 Total Expenses $ 150,000 $ 150,000 $ 150,000 $ 450,000 Table 1. Budget for Fiscal Year 2004- 05 through Fiscal Year 2006- 07 for the Tobacco Education Program. 3. The California Department of Health Service’s document titled “ Local Lead Agency Guidelines for a 2004- 2007 Comprehensive Tobacco Control Plan, January 6, 2004” sets forth strict operating, program and budget guidelines for LLAs. 3 4. The Tobacco Education Program in Santa Cruz County must follow the state’s strict budget and spending guidelines in order to receive funding and be reimbursed for expenditures. Any tobacco education activity funded by Proposition 99 must be approved in advance by the state. The LLA then sends a cost report to the state for 2 Tobacco Education Program, Budget Justification for Santa Cruz County Health Services Agency. 3 California Department of Health Services, Tobacco Control Section, “ Local Lead Agency Guidelines for a 2004- 2007 Comprehensive Tobacco Control Plan, Issued January 6, 2004.” 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 20 Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 Funds in Santa Cruz County reimbursement. The state oversees spending of the funds, which must be spent on required objectives. 5. Santa Cruz County has not been formally audited for its expenditures of Tobacco Education Proposition 99 monies. 6. The “ Scope of Work” of the Santa Cruz Tobacco Education Program for the term 7/ 1/ 04 to 6/ 30/ 2007 includes well- defined activities, start and end dates for each activity, responsible parties for each activity and tracking measures. Its objectives are to: • reduce exposure to secondhand smoke in public places; • reduce retail availability of tobacco; • review the extent to which LLA and TCS- funded projects address specific objectives of cultural or ethnic/ minority communities or populations; and • counter pro- tobacco influences such as tobacco sponsorships of public, private and sporting events; tobacco company contributions to education, research, public health, cultural and intellectual activities. 7. The Tobacco Education Program is the repository for tobacco information for the community, and it: • recruits, maintains and organizes the Tobacco Education Coalition. The Coalition takes action on tobacco industry activities in the community, proposes legislation and advocates for Proposition 10 monies to be spent on tobacco- related issues. The Tobacco Education Coalition meets monthly. • stays current on local and statewide tobacco- related events. The Tobacco Education Program makes public statements and answers questions and concerns from the public, media and other agencies regarding tobacco issues. • fields calls from the public, sends materials, maintains a list of current cessation services in the county, stays current with tobacco- related laws or policies in the five jurisdictions and creates anti- tobacco curriculum ideas for teachers. 8. The Tobacco Education Coalition, formed in 1985, is an advocacy group that promotes a tobacco- free lifestyle and environment. The Tobacco Education Coalition membership includes the following government and community non- profit agencies: 4 American Cancer Society American Heart Association American Lung Association Cabrillo College Student Health Center 4 Santa Cruz County Health Services Agency, Tobacco Education Program, “ Coalition Membership.” 2004- 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 - 21 Expenditure of Proposition 99 Funds in Santa Cruz County Central Coast Alliance for Health Children and Families First City of Santa Cruz Parks and Recreation City of Santa Cruz Police Department Community Connections ETR Associates Front Street, Inc. Individual community members at large ( 10 members) Katz Cancer Resource Center Medical Works Mental Health Client Action Network Mountain Community Resources Pajaro Valley Prevention and Student Assistance ( three members) Planned Parenthood Salud Para la Gente San Lorenzo Valley Unified School District Santa Cruz City Schools District ( two members) Santa Cruz County Medical Society Santa Cruz County Office of Education Santa Cruz County Parks and Recreation Santa Cruz County Sheriff’s Department ( two members) Substance Abuse Prevention Program Tobacco Education Clearinghouse of California Tobacco Education Program ( three members) University of California, Santa Cruz Alcohol and Other Drug Prevention Program 9. Some of the recent accomplishments of the Tobacco Education Coalition are: • promoting compliance with smoke- free workplace laws; • working with the Seaside Company to make the Santa Cruz Beach Boardwalk a smoke- free environment; • conducting surveillance of local newspapers for print tobacco advertisements and writing letters, when appropriate, to ask each organization to adopt a smoke- free advertising policy; 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 22 Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 Funds in Santa Cruz County • conducting media campaigns about smoke- free playgrounds, cigarette sales to minors and other tobacco issues; • supporting Pajaro Valley Prevention and Student Assistance efforts to create 100 percent smoke- free parks in Watsonville via letters to the editor and letters to Watsonville City Council members; • working with local jurisdictions on smoking ordinances; • writing letters to various agencies to discourage acceptance of tobacco industry grant monies; • reducing the number of stores that sell tobacco to minors and providing education materials to discourage self- service tobacco displays. In 2002, the Coalition supported a self- service tobacco display ban that was adopted in the City of Capitola; and • surveying Santa Cruz County bars regarding compliance with smoking ordinances. 10. California’s adult smoking rate dropped to a historic low of 15.4 percent in 2004, compared to 22.8 percent in 1988 ( a 32.5 percent decrease) when California voters passed Proposition 99.5 11. Comprehensive local and school- based tobacco education programs have been credited as key factors in statewide smoking reductions. 6 12. From 1994 to 2002, student tobacco use has decreased in Santa Cruz County as illustrated in the following table: 7 Year Percentage of Age Group Stating That They Have Used Tobacco 9th Graders 11th Graders 1994 65% 64% 2002 31% 40% Table 2. Percentages of Santa Cruz County 9th and 11th Graders Stating That They Have Used Tobacco. 13. Surveys done in 2002 and 2003 show adult smoking rates continue to decrease in Santa Cruz County. 8 5 News Release: “ California Smoking Rates Drop 33 Percent Since State’s Anti- Tobacco Program Began,” February 2005, http:// www. dhs. ca. gov. 6 News Release: “ California Smoking Rates Drop 33 Percent Since State’s Anti- Tobacco Program Began,” February 2005, http:// www. dhs. ca. gov. 7Community Assessment Project, Comprehensive Report, 2004, http:// www. appliedsurveyresearch. org/ products/ CAP10_ Health. pdf. 2004- 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 - 23 Expenditure of Proposition 99 Funds in Santa Cruz County Do you now smoke cigarettes every day, some days or not at all? Everyday Some Days Not At All 2002 19.5% 6.9% 73.6% 2003 18.9% 6.2% 74.8% Table 3. Adult Cigarette Smoking Rates, Santa Cruz County. CHIP Funds 14. In order to receive California Healthcare for the Indigent Program ( CHIP) funds from the state, Santa Cruz County must submit an application to the California Department of Health Services and agree to abide by strict state guidelines. 15. In 1998- 99, Santa Cruz County Health Services Agency received over $ 1.1 million in Proposition 99 monies that went to CHIP. By 2002- 03, that amount had dwindled to $ 314,111, then dropped to $ 68,933 in 2003- 04. 16. CHIP funds received by Santa Cruz County from Fiscal Year 2001- 02 to Fiscal Year 2003- 04 are summarized as follows: 9 Fiscal Year Allocation CHIP Account 2001- 02 2002- 03 2003- 04 Total Hospital $ 363,822 $ 233,984 $ 64,500 Total Physician $ 14,624 0 0 Total Other $ 56,970 $ 80,127 $ 4,433 Total CHIP $ 435,416 $ 314,111 $ 68,933 Table 4. CHIP Allocations for Santa Cruz County for Fiscal Year 2001- 02 through Fiscal Year 2003- 04. 17. For Fiscal Year 2004- 05, the CHIP allocation from Proposition 99 for Santa Cruz County was $ 77,214. These funds were appropriated in April 2005 and were not anticipated in the current year’s budget. 18. According to health services personnel, due to the strict, cumbersome and staff-intensive state reporting requirements, receiving a CHIP allocation of less than $ 35,000 would not be cost effective for the county. 8 Community Assessment Project, Comprehensive Report, 2004, http:// www. appliedsurveyresearch. org/ products/ CAP10_ Health. pdf. 9 California Healthcare for Indigents Program, CHIP Funding History, provided by Santa Cruz County Health Services Agency, May 4, 2005. 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 24 Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 Funds in Santa Cruz County 19. The State of California deposits money into county revenue accounts and/ or trust funds. When claims are made, the money is pulled from the trust fund accounts, goes into the general fund, then is paid out. Charges are made before money comes out of the trust fund. 20. The Medi- Cruz Program within the Health Services Agency pays for indigent care, and CHIP money is expended from that division’s budget. The Health Services Agency receives claims from the hospitals and physicians for indigent care. Available CHIP funds are used to help pay the claims until the funds are exhausted. 21. CHIP funds going to Dominican Santa Cruz Hospital and Watsonville Community Hospital and physicians involve contracts. Some contracts are blended and may contain some Proposition 99 money as well as other funding sources. 22. The current budget for the Medi- Cruz program is $ 4.5 million. Although the current $ 77,214 CHIP allocation is a small part of that budget, county health officials felt it would still be beneficial to receive the money. 23. Despite the continuing decrease in CHIP allocation, Santa Cruz County has used county overmatch and realignment funds to keep the Medi- Cruz program viable. Approximately 8,000 to 9,000 patients annually receive care paid by Medi- Cruz funds. Conclusions 1. Santa Cruz County is spending its Proposition 99 monies according to the guidelines set forth by the State of California. 2. The Tobacco Education Program and Tobacco Education Coalition have mounted successful programs in Santa Cruz County to reduce smoking rates in adults and students. 3. The Tobacco Education Program and Tobacco Education Coalition have successfully worked with local jurisdictions and businesses to reduce second- hand smoke exposure. 4. Since CHIP funds have decreased dramatically since 1998- 99, Santa Cruz County has less money for indigent medical care. Eventually, Proposition 99 funding could drop so low that accepting it would not be cost- effective for the county. Recommendations 1. Santa Cruz County’s Tobacco Education Program is to be commended for its success in reducing tobacco use and lessening exposure to secondhand smoke. 2. Santa Cruz County is to be commended for successfully using Proposition 99 funds for indigent medical care and for its efforts to keep the Medi- Cruz program intact. 2004- 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 - 25 Expenditure of Proposition 99 Funds in Santa Cruz County Responses Required Entity Findings Recommendations Respond Within Santa Cruz County Board of Supervisors 1- 23 1, 2 60 Days ( August 30, 2005) Santa Cruz County Health Services Agency 1- 23 1, 2 90 Days ( September 30, 2005) 2004- 2005 Santa Cruz County Grand Jury Final Report Page 4 - 26 Where There’s Smoke, There’s Funding: Expenditure of Proposition 99 Funds in Santa Cruz County This page left intentionally blank. 2004 – 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 - 27 Expenditure of Proposition 10 Funds in Santa Cruz County, First Five Santa Cruz Expenditure of Proposition 10 Funds in Santa Cruz County First Five Santa Cruz County Definitions ASR ( Applied Survey Research): an independent, non- profit research organization which completed program evaluations for the year 2004 First Five Santa Cruz County ( First Five SCC): the commission in Santa Cruz County that administers local revenues from Children and Families First Act First Five Partners: community agencies that receive grants from First Five Santa Cruz County Our Children Large Community Grants: grants given in amounts over $ 20,000 Our Children Community Mini- grants: grants that are given in amounts less than $ 10,000 The Santa Cruz County Service Unifying Network ( SCC SUN): database used by First Five Partners for collection of program information and client referral WIC ( Women Infants and Children): an income- qualified federal program which provides subsidies and nutrition education to pregnant women, nursing mothers and children five and under Background In November of 1998, California voters passed a statewide initiative, Proposition 10, known as the Children and Families First Act. Proposition 10 added a 50- cent- per- pack tax on cigarettes and other tobacco products. It was passed “ for the purposes of promoting, supporting and improving the early development of children from the prenatal stage to five years of age.” 1 The law states that revenue may be used to fund child immunizations, vision and hearing tests, prenatal care and drug and alcohol- abuse treatment for parents of children five and under. Twenty percent of the revenues are allocated to the State First Five Commission for statewide expenditures as mandated by law. This includes a public education campaign, educational materials and training, technical support for local county commissions, education and training of child- care providers and research and development. Of the 20 percent, only one percent is to be used for administrative functions of the state commission. 1 Text of state law, Proposition 10, Children and Families First Act. 2004 – 2005 Santa Cruz County Grand Jury Final Report Page 4 - 28 Where There’s Smoke, There’s Funding: Expenditure of Proposition 10 Funds in Santa Cruz County, First Five Santa Cruz The remaining 80 percent of revenues are allocated to local commissions that are established in all 58 California counties, as required by law. Allocations to each county are based upon the number of births in the mother’s county of residence. These revenues are to be spent on programs determined by members of each local First Five Commission that best support optimal early childhood development. Nine commission members are appointed based upon experience or employment in fields of child welfare such as social services, medicine and education. In addition, all county commissions must develop strategic plans based on extensive public input before disbursing any funds. 2 Since 1999, California counties have received more than $ 3.2 billion dollars for early childhood education programs called First Five. Santa Cruz County’s First Five Commission ( hereafter known as First Five Santa Cruz County or First Five SCC) was established in January 1999 with the selection of the first commission members by the Santa Cruz County Board of Supervisors. The initial meeting of First Five Santa Cruz County was held in March of 1999, and the commission was expanded to nine members in May 1999. Santa Cruz County’s First Five Commission has received over $ 13 million since its inception. In 2004, a state audit was requested of some of the First Five Commissions by California State Senator Dean Flores after he charged that Kern County Proposition 10 monies were being misused. This audit led to the discovery that appropriate procedures were not being followed for distribution of some grant monies. In addition, some grant distributions were not sufficiently documented. First Five Santa Cruz County was not included in the state’s audit. Since that time, the legislature has considered two bills, Senate Bill 34 and Assembly Bill 109, intended to create more accountability for the funds spent by all local commissions. Scope This investigation examines how First Five Santa Cruz County spends Proposition 10 tax revenues. Sources Interviewed: First Five Santa Cruz County personnel. Health Services Agency personnel. Santa Cruz County Audit personnel. Meetings attended: First Five Santa Cruz County Commission Meetings, February and March 2005. 2 Text of state law, Proposition 10, Children and Families First Act. 2004 – 2005 Santa Cruz County Grand Jury Final Report Where There’s Smoke, There’s Funding: Page 4 - 29 Expenditure of Proposition 10 Funds in Santa Cruz County, First Five Santa Cruz Reviewed: Newspaper/ Magazine Articles: |
| PDI.Date | 2005 |
| PDI.Date.Issued | 2005 |
| PDI.Title | Final Report. 2004-2005. |
| OCLC number | 144635200 |
Tags
Comments
Post a Comment for Grand Jury final report and responses
Your rating was saved.
you wish to report:
Your comment:
Your Name:
|
|
...