[0:05] this is a test.
[0:05] >> good afternoon.
[0:11] I'm going to call the May 15
[0:15] budget workshop to order.
[0:19] please call the roll.
[0:22] >> supervisor kniss, cortese,
[0:25] wassermann, vice
[0:27] President Yeager, President
[0:28] Shirakawa, you have a quorum.
[0:31] >> ladies and gentlemen please
[0:34] stand and join in the
[0:35] pledge of allegiance.
[0:35] >> I pledge of allegiance, to
[0:36] the flag of the united
[0:36] states of america and to the
[0:37] republic for which stands, one
[0:38] nation under God, indivisible,
[0:40] with liberty and justice for
[0:49] all.
[0:51] >> thank you item three is
[0:51] public comment.
[0:57] I have two speakers at this
[0:57] time.
[1:00] linda kincaid and richard
[1:02] calhoun come on up please.
[1:08] Give you a couple minutes to
[1:09] speak.
[1:10] Good afternoon.
[1:14] Hold on a second, is the mic on?
[1:17] Let's make sure the mic is on.
[1:21] >> thank you, my name is linda
[1:23] kincaid.
[1:30] I'm speaking on behalf of
[1:33] jazell. Notice of rights and
[1:34] file states unless the court
[1:39] has limited or taken the right
[1:41] of way, the conservative keeps
[1:43] right to receive personal
[1:44] mail.
[1:46] The court has not taken away
[1:49] her right to visitation.
[1:52] However, the public guardian
[1:56] has violated that right
[1:58] since becoming conservator in
[1:58] 2010.
[2:00] She was allowed to visit her
[2:02] son marcus for less than 2
[2:03] hours in the past two years.
[2:05] She is not allowed visitors
[2:06] from the community.
[2:08] She is not allowed phone calls
[2:09] and her mail is
[2:10] intercepted. She lost about a
[2:13] third of her body weight
[2:16] under the care of a public
[2:17] guardian.
[2:19] She needs new eye glasses.
[2:25] she is rarely allowed access to
[2:26] hearing aid.
[2:29] Her world is dark, silent and
[2:30] very lonely.
[2:32] She pray every night that God
[2:32] take her.
[2:37] I pray santa clara county will
[2:38] protect the public
[2:42] guardian.
[2:48] >> thank you richard calhoun.
[2:49] >> good afternoon.
[2:50] The public guardian spent about
[2:53] 45 minutes on the phone
[2:56] with me regarding my
[2:58] mother-in-law elder abuse case
[2:58] in
[2:58] southern california.
[3:01] They assured me that abuse will
[3:02] not happen here in
[3:03] santa clara county.
[3:05] it's happening under his direct
[3:07] control at that time of
[3:08] the conversation.
[3:09] That abuse happening in this
[3:12] county is worse.
[3:15] The county despite selling our
[3:16] house for $350,000
[3:21] recently -- she has to use
[3:22] toilet paper.
[3:26] she has to use toilet paper.
[3:27] Kleenex is not that expensive.
[3:30] We walked across the street and
[3:31] bought three boxes.
[3:37] There's something wrong.
[3:38] The pastor of westgate church
[3:39] should be able to walk
[3:40] over and visit.
[3:41] He was denied.
[3:42] I was denied visits.
[3:44] Everybody has the right to
[3:51] visits, even prisoners have
[3:53] rights to visits.
[3:55] But yet the guardian is not
[3:58] letting me visit her.
[3:59] That takes time in southern
[4:02] california, we got no
[4:06] citation approved for months.
[4:12] then you probably heard about
[4:13] it, there was conviction
[4:14] of bribery down there.
[4:16] We already have four about
[4:17] dozen investigations under
[4:18] way.
[4:20] There's probably about five or
[4:21] six here in santa clara
[4:23] county happening under your
[4:24] public guardian and you guys
[4:27] need to wake up and pay
[4:28] attention and find out we
[4:28] cannot
[4:29] visit our elders when they're
[4:31] under the care of guardian.
[4:32] That is wrong and it's abusive
[4:33] and it's a human right
[4:36] the violation and we should not
[4:37] tolerate it in this county.
[4:40] Thank you for your time.
[4:42] >> be richard, we mentioned
[4:43] before.
[4:45] We cannot engage on issues on
[4:46] this agenda.
[4:47] I don't want to gauge back and
[4:47] forth.
[4:50] for the record, our public
[4:52] guardian office does great
[4:54] work protecting those most
[4:54] vulnerable in our community.
[4:56] I understand there's issues out
[4:58] there in some of those
[4:58] homes.
[4:59] We're on top of it.
[5:01] >> I will say, we brought this
[5:03] to your attention two
[5:05] weeks ago and nobody
[5:06] communicated in any shape or
[5:07] form.
[5:09] I did hear from Mr. Cortese and
[5:11] therefore it's not
[5:13] happening. I'm sorry,
[5:15] vacations doesn't take priority
[5:15] on
[5:16] someone personal right.
[5:17] >> I understand richard, you
[5:18] will be contacted by
[5:20] staff.
[5:21] Thank you.
[5:22] Next item -- anyone else want
[5:24] to address the board?
[5:26] I have cards on other issues.
[5:30] On this item on the opening
[5:30] session.
[5:31] i see none in the room.
[5:35] Moving on to item four, vivre
[5:37] view and county executive
[5:38] fy '13 budget.
[5:38] >> Mr. President, members of
[5:39] the board.
[5:43] I like to give a little
[5:45] introduction to the proposed
[5:51] budget that we are starting to
[5:56] evaluate today.
[6:07] First slide.
[6:09] We've been discussing a
[6:11] maintenance budget for a number
[6:14] of months now and I would like
[6:16] to clarify maintenance budget
[6:18] does not mean status quo.
[6:21] What we focused on in this
[6:23] budget as we've developed
[6:26] it, is trying to not only
[6:27] maintain the services that we
[6:29] are
[6:31] providing but also change the
[6:32] style and process with which
[6:35] we provide those in order to
[6:37] reduce the cost for unit
[6:39] service.
[6:40] Then fundamentally rebuild our
[6:41] foundation which
[6:43] includes rebuilding both the
[6:44] physical and financial
[6:46] infrastructure of the county so
[6:47] that we can prepare for the
[6:48] future.
[6:51] We know that this year's
[6:52] budget, fiscal year '13, will
[6:55] give us a bit of a break from
[6:58] the more than a decade of
[6:59] reduction that the board has
[7:05] been asked to take.
[7:08] However, that brief relief will
[7:10] not last forever.
[7:11] We're preparing the
[7:12] organization for the future.
[7:16] i like to point out that
[7:18] concessions from labor had an
[7:20] enormous part in helping to
[7:21] balance this budget.
[7:24] As you remember, last year, we
[7:26] asked labor for
[7:29] concessions in the general fund
[7:31] amounting to $75 million.
[7:33] They were very difficult
[7:34] negotiations but successful.
[7:37] our partners in labor and our
[7:38] employees take great
[7:41] credit or should take credit in
[7:45] great part for this budget.
[7:47] You'll notice as you go through
[7:48] the budget, you won't
[7:50] see a line item that says $75
[7:50] million.
[7:54] All of those concessions have
[7:58] been successful and
[8:00] they're built into the object
[8:03] one cost of each department.
[8:06] As we look forward, we're
[8:07] looking at a new normal.
[8:09] There's been a lot of talk
[8:12] about in the economy lately.
[8:14] But not a new normal just
[8:17] because we don't see an
[8:18] amazing number of jobs
[8:20] returning to the nation but
[8:21] because
[8:24] at a county level, we can no
[8:26] longer rely upon state and
[8:27] federal revenue to keep pace
[8:32] with the need for services.
[8:35] Also, with healthcare reform
[8:41] changes, our hospital and
[8:47] clinic system, santa clara
[8:48] valley medical system, where we
[8:55] can no longer rely on lump sum
[8:58] supplemental payments.
[8:58] Next slide.
[9:04] we do have a bit of respite
[9:07] from deficits because in
[9:10] 2012 this board took the very
[9:11] thoughtful approach of only
[9:14] using one time moneys to solve
[9:17] one time problems and not
[9:18] putting them into ongoing
[9:21] deficits.
[9:22] That has stabilized our budget
[9:24] to great extent and
[9:26] we've also noticed some
[9:28] stabilization of the economy
[9:28] around
[9:30] us with some slight up tick in
[9:31] revenues.
[9:35] However those revenues are
[9:37] typically related to public
[9:38] safety realignment.
[9:41] we've had relief from
[9:42] reductions this year.
[9:46] As a matter of fact, you'll see
[9:46] in this proposed
[9:49] budget, we're actually adding
[9:49] positions.
[9:51] Total over 300 positions.
[9:52] I will point out many of those
[9:54] positions are funded
[9:56] from other sources than the
[9:59] general fund we've looked at
[10:02] each one closelily to make sure
[10:04] that next year, fiscal year
[10:07] '14, will not be faced with a
[10:09] situation of reducing those
[10:12] positions that we're now adding.
[10:14] We think they're all justified,
[10:16] we think they are all
[10:16] critical.
[10:24] we have utilized them to try to
[10:28] rebuild our foundation.
[10:29] However this brief respite will
[10:30] give us time to refocus
[10:31] our attention in the county on
[10:34] what our core mission and
[10:34] values are.
[10:39] The board of supervisors
[10:41] adopted this mission and value
[10:45] statement over two years ago.
[10:48] We have an opportunity now to
[10:49] make sure that it spreads
[10:51] throughout the organization and
[10:52] refocus the organization on
[10:59] the values that are critical to
[11:00] our future success.
[11:06] as I mentioned in the last
[11:09] decade, we have deferred
[11:10] many capital projects and much
[11:12] maintenance in order to
[11:13] continue provide services.
[11:15] This year we have the
[11:17] opportunity as the economy
[11:21] stabilizes to begin to rebuild
[11:22] and some of recommended
[11:24] budget invest in four key
[11:25] issues.
[11:28] Number one is the retiree
[11:32] medical benefits also called
[11:32] opeb.
[11:36] Gary will give you more
[11:38] detailed discussion on this
[11:40] budget.
[11:41] We also rebuilding our
[11:42] inspection technology systems
[11:45] putting some money into a few
[11:46] of the capital projects that
[11:49] have been on hold for a long
[11:51] time.
[11:53] We're recommending some
[11:55] reserves because of the
[11:56] question marks at the state
[12:00] level that have only gotten
[12:02] larger in the last day because
[12:08] of the May revise.
[12:09] Briefly, as I mentioned gary
[12:12] will give you more details
[12:14] later, but in recent years --
[12:16] >> President Shirakawa, can I
[12:18] ask a quick information
[12:20] question?
[12:24] Where you listed epic and the
[12:25] funding sources how they
[12:28] will be spent, within there
[12:29] somewhere is an incentive bonus.
[12:35] Are you going to mention that
[12:36] at some point?
[12:40] >> yes, we will mention that.
[12:43] >> is that another time?
[12:47] >> we'll get there.
[12:49] with regard to the retiree
[12:50] medical benefits, this is a
[12:54] very significant problem.
[12:59] A decade ago, this county was
[13:03] very forward-thinking and
[13:05] unfunded the light retiree
[13:06] health.
[13:08] over the decade of cuts of
[13:12] funding to that system has
[13:13] decreased.
[13:14] At this point we're
[13:19] recommending in this budget 75%
[13:23] funding to the normal cost for
[13:23] retiree health with a
[13:29] commitment to go up to 100%.
[13:32] Normal cost is a word used to
[13:34] describe essentially what
[13:36] would be equivalent to minimum
[13:39] payment on your credit card
[13:42] not really adequate to actually
[13:44] fund the unfunded liability
[13:45] in the long run.
[13:47] But certainly a minimum and we
[13:49] think you should commit
[13:50] to that.
[13:52] We need to develop further
[13:57] strategies in the future to
[13:57] deal with that.
[13:59] Information technology, we are
[14:01] recommending some
[14:02] significant investments in
[14:05] technology and as supervisor
[14:07] kniss pointed out, with regard
[14:09] to epic, one of the
[14:12] advantages that we have is that
[14:14] we are anticipating money
[14:15] from meaningful so called
[14:17] meaningful use which is federal
[14:22] money that will help defray the
[14:26] cost of revamping the entire
[14:28] core health information system.
[14:33] we have decided to issue debt,
[14:34] technology bond for
[14:34] $100 million.
[14:36] This is not a bond that needs
[14:38] to go to the voters, this
[14:43] is a bond we paid for based
[14:46] commitment from the meaningful
[14:47] use money.
[14:50] $70 million of that will go
[14:52] towards epic.
[14:54] $20 million will go towards
[14:55] general fund I.T. Project.
[15:01] $10 million for the cost of
[15:02] issuance and contingency
[15:02] fund.
[15:04] You can see that the total cost
[15:07] of epic that's budgeted
[15:11] at $68 million, most of that
[15:13] will be from bond proceeds.
[15:17] There also be will money from
[15:19] mental health services
[15:20] act.
[15:23] These are the list of the
[15:24] general fund I.T. Projects
[15:26] that we are recommending that
[15:28] you fund.
[15:31] You'll see that all of them are
[15:32] critical function.
[15:34] on the left are the ones we
[15:38] think we can fund with the
[15:38] bond proceeds.
[15:40] They are basic enterprise
[15:41] functions that are required
[15:43] for us to move forward.
[15:48] Things like public safety
[15:50] radios, sheriff's mobile
[15:52] computers, enterprise system
[15:56] called clarinet and our
[15:57] voiceover internet protocol
[15:58] system which helps with
[15:59] communications.
[16:02] We did not add all the I.T.
[16:07] System in here.
[16:11] These are just the ones that
[16:12] are absolutely necessary.
[16:12] Additional I.T. Projects which
[16:16] will not be funded
[16:22] through the bonds include the
[16:25] assessor system, modifications
[16:29] to kronus which is our time
[16:30] sheet keeping mechanism the
[16:32] cloud system and you can see
[16:39] also public safety radios.
[16:41] The next category that we're
[16:43] recommending for
[16:43] additional foundational
[16:45] investment is capital programs.
[16:48] I won't go through all of these
[16:49] capital programs.
[16:51] Again, these are actually small
[16:55] number of the programs
[16:57] -- projects that we need to
[16:57] accomplish.
[16:58] These are the most critical
[17:04] ones and totals up to
[17:07] $13.7 million.
[17:13] Terms of budgetary reserves, as
[17:14] always, your reserve
[17:15] we're keeping at 5% general
[17:16] fund revenues.
[17:20] We're recommending a funding
[17:22] $10 million for economic
[17:24] uncertainties from the state
[17:25] and fed.
[17:27] As I mentioned, the state
[17:30] proposal particularly the
[17:31] recent May revise has a lot of
[17:33] questions associated with it.
[17:36] At this point, we're doing
[17:37] analysis to try to decide
[17:39] exactly effect it will have on
[17:39] us.
[17:42] There are cuts recommended to
[17:45] medi-cal and safety net
[17:46] hospitals.
[17:47] Actually, it looks like to the
[17:50] best of our analysis at
[17:55] this point, those cuts will not
[17:56] have an effect upon us this
[17:58] year but it certainly will have
[18:01] effect upon us next fiscal
[18:01] year.
[18:03] However, don't hold me to that
[18:05] because there's still
[18:06] details we need to straighten
[18:07] out.
[18:11] As you watch the federal budget
[18:12] process, you remember
[18:12] that there automatic trigger
[18:17] cuts that are built into the
[18:20] federal process from last year
[18:22] so we're very concerned if
[18:24] congress and President Don't
[18:27] move ahead with effective
[18:29] budget or spending plan, we
[18:32] will end up with automatic
[18:34] reductions.
[18:38] We're also recommending a small
[18:39] set aside reserve for
[18:39] cash.
[18:41] This is not money we anticipate
[18:42] spending but this will
[18:44] actually help us with our cash
[18:46] flow issues which has been
[18:50] for the last two years, an
[18:51] issue.
[18:52] >> jeff, real quick.
[18:54] Last year we had extensive
[18:56] discussion on the
[18:56] contingency reserve.
[18:59] It's not all cash.
[19:01] just take 30 seconds to remind
[19:03] us again that the
[19:06] $96 million is not all cash.
[19:07] >> yes.
[19:09] >> we don't have to have the
[19:11] discussion again.
[19:14] >> the contingency is cash.
[19:17] It's an unspent allocation or
[19:18] appropriation.
[19:19] >> assets though?
[19:23] >> no, it's a budgeted
[19:24] allocation.
[19:27] It is equivalent to cash.
[19:28] >> what you're talking about is
[19:29] that we get the revenue
[19:31] over a period of time.
[19:32] We've allocated at the
[19:33] beginning of the year so we
[19:37] don't have a big lump sum
[19:38] instantaneously sitting there.
[19:41] >> how it was described to me --
[19:44] >> it's like buying on time.
[19:47] >> right, we also had some
[19:49] assets included in there.
[19:52] We had discussions about not
[19:52] being actual liquidable
[19:53] cash.
[19:56] I just want do make it clear
[19:57] because it's a different
[20:02] what we had last year.
[20:06] >> the fund balance is part of
[20:09] a fund balance.
[20:11] It's not 100% cash but it's
[20:12] tied into other assets
[20:13] which will convert to cash over
[20:18] a period of time.
[20:18] >> right.
[20:20] I guess that was my point.
[20:21] >> that's it.
[20:25] >> when you said asset, I was
[20:25] thinking you were talking
[20:30] about tangible assets as
[20:32] opposed to assets like
[20:33] receivable.
[20:37] >> the basic bottom line,
[20:38] there's not a lot of cash
[20:39] around.
[20:40] >> we had a long discussion
[20:41] last week.
[20:45] >> thank you Mr. President.
[20:47] May I ask one question page 7.
[20:56] On page 7, the debt issuance, I
[20:57] see the $70 million,
[20:59] the $20 million and $10
[21:00] million,ed needs for
[21:00] replacement of
[21:03] that debt, how is that
[21:04] happening?
[21:06] >> technology bond comes from
[21:08] the meaningful use money
[21:11] and it's also the general fund
[21:12] is committed to pay it back
[21:14] also.
[21:18] But it will come out of the 921
[21:19] budget.
[21:21] >> the $10 million jeff, where
[21:22] it says cost of
[21:27] issuance, I understand cost of
[21:27] issuance and contingency.
[21:29] What does that mean by
[21:30] contingency?
[21:33] >> it means basically that we
[21:35] have anticipated the cost
[21:40] of the infrastructure programs
[21:42] in a very rough way.
[21:45] We're not 100% sure those
[21:46] numbers are completely
[21:47] accurate.
[21:49] >> construction project, you
[21:50] got 10% contingency built
[21:51] in.
[21:54] Could end up with those moneys.
[21:55] Okay thank you.
[21:59] >> going back to page 11, a
[22:01] little bit about valley
[22:02] medical center and you'll hear
[22:06] a whole lot more later on in
[22:07] the day.
[22:09] You'll remember from mid-year,
[22:11] this year, this fiscal
[22:14] year, we anticipated about a
[22:16] $60 million current deficit.
[22:20] We look like we're on track to
[22:21] solve that deficit
[22:23] problem as was mentioned in
[22:27] health and hospital last week.
[22:29] We also had to commit $30
[22:30] million from the general fund
[22:34] in order to deal with that.
[22:36] Now, as we've known and
[22:41] mentioned many times in the
[22:42] past, the 921 fund, the
[22:44] enterprise fund is a very
[22:45] difficult
[22:51] fund to project because it's
[22:58] contingent revenue.
[22:59] Contingent on visits and mix of
[23:01] patients and lot of
[23:01] other issue.
[23:04] We have many billing problems
[23:05] associated with that.
[23:08] even though we look like we're
[23:11] solving this problem, we
[23:13] do expect some bounces back and
[23:16] forth over the next couple
[23:17] of months.
[23:20] You might see in the financial
[23:21] things going up and down
[23:23] but we think that in the end,
[23:28] we'll end up balancing.
[23:31] the recommended budget for this
[23:33] coming year, for 2013,
[23:35] we looked at very carefully.
[23:38] You'll notice that it does
[23:41] include significant
[23:44] projections of new revenue.
[23:46] The county execs office and I
[23:47] know the board has been
[23:50] concerned about the past about
[23:54] projecting new revenue.
[23:54] However, it is a revenue
[23:55] generating enterprise fund and
[23:58] that's a critical component of
[24:00] the -- patient care revenue
[24:03] is a critical component for the
[24:04] overall picture.
[24:05] We had to project something.
[24:10] we looked very carefully trying
[24:14] to come up conservative
[24:15] projections based on experience
[24:15] in 2012.
[24:17] We think they are justifiable
[24:18] and reasonable and we
[24:20] think they will be obtained.
[24:23] We also focused on work
[24:24] process changes, schedule
[24:25] changes and patient access
[24:26] changes
[24:29] in order to increase revenue.
[24:33] then the final comment, if the
[24:37] projections end up not
[24:38] being accurate, we will have a
[24:42] plan b to you which will
[24:45] actually decrease expenditures
[24:46] significantly.
[24:49] We plan this year on watching
[24:51] the revenue in the county
[24:55] execs office on a monthly basis.
[24:58] We will keep close track of
[24:59] those revenues and any
[25:05] projections that look off, we
[25:08] will address immediately.
[25:10] Again, to reemphasize the risks
[25:15] that are associated
[25:17] with this budget, there are
[25:18] always risks associated with
[25:18] any
[25:19] budget.
[25:21] The budget is really projected
[25:22] spending plan and
[25:22] revenue plan.
[25:25] The projections are based on
[25:26] assumptions.
[25:27] Those assumptions can change.
[25:30] We need to let you know what
[25:31] the risks are.
[25:33] In terms of healthcare reform,
[25:33] you know that the
[25:37] supreme court is in the process
[25:39] of reviewing healthcare
[25:39] reform act.
[25:41] It's pretty much anybody's
[25:44] guess what they'll do if
[25:49] they were to reverse the act
[25:51] significantly, that would
[25:53] definitely cause chaos and make
[25:54] funding really unpredictable
[25:55] at the local level.
[25:57] We also have our own local
[26:01] problems, which I just went
[26:03] through at vmc that essentially
[26:05] boils down to turning the
[26:08] entire organization into a
[26:08] competitive organization
[26:08] compared
[26:12] to what has been in the past
[26:15] which relied upon lump sum
[26:16] revenues.
[26:19] Other local risks, I mentioned
[26:19] earlier on, the
[26:21] $35 million that's built into
[26:23] this budget for labor
[26:23] concession.
[26:26] Remember that this coming year,
[26:29] 2013, is when the
[26:32] nurses, dsa and the district
[26:34] attorney investigators
[26:37] contracts open up and we
[26:41] programmed into this budget the
[26:42] expected concessions from those
[26:44] unions.
[26:47] If we are not successful in
[26:48] obtaining those concessions
[26:49] that will be a problem we would
[26:55] have to address with more
[26:58] reductions.
[26:59] We also are expecting increase
[27:02] retirement cost this
[27:03] coming year 2013.
[27:07] These retirement costs will
[27:07] come out of our general
[27:07] fund.
[27:09] We will not ask the employees
[27:12] to contribute to any of
[27:13] that.
[27:15] We will also have the risk of
[27:16] the retiree health which
[27:17] will be discussed in a little
[27:18] bit.
[27:21] I think I talked about state
[27:21] and federal issues enough
[27:26] so we can move on to the next
[27:27] page.
[27:28] >> supervisor kniss had a
[27:28] question.
[27:35] >> on this one in particular
[27:36] jeff, because, ken and i
[27:39] said on health and hospital.
[27:41] We spent substantial amount of
[27:43] time especially with
[27:43] washington consultants
[27:44] discussing the supreme court
[27:47] decision.
[27:48] You referenced chaos.
[27:50] I think more than chaos will
[27:50] ensue.
[27:54] I'm not sure that we need to do
[27:55] this right away.
[28:02] i think we should at least be
[28:03] very technical term,
[28:04] noodling what happens.
[28:05] It's a three part decision
[28:07] they're making.
[28:09] The first one would essentially
[28:10] not require states to
[28:13] have health insurance.
[28:18] That begins to alter the entire
[28:18] thing.
[28:20] That's one of the thing that we
[28:22] have been the most
[28:22] concerned about.
[28:25] Then as you know, the question
[28:27] will secondly be, can
[28:29] they separate different parts
[28:33] of the law and maintain other
[28:35] parts.
[28:37] I think you're right.
[28:39] It's a toss up at this point.
[28:40] It's probably up to one,
[28:43] believe it or not, probably up
[28:44] to one justice which is quite
[28:45] significant.
[28:48] I don't want us to lose the
[28:51] importance of that and that
[28:54] decision being made and also
[28:57] that there is a saying this is
[28:58] correctly as I can.
[29:01] There is a group in washington
[29:03] who very much had it as
[29:07] their goal to eliminate the new
[29:10] healthcare law should the
[29:11] administration change starting
[29:12] next year.
[29:16] Again, we can't be aware and
[29:21] ready for all
[29:21] contingencies.
[29:23] but at least, because I know
[29:26] that folks like gary are
[29:27] very good of kind of thinking
[29:29] ahead on this kind of issue.
[29:31] I hope that we're keeping that
[29:32] in mind.
[29:36] That will be a rather dramatic
[29:36] alteration for where we
[29:37] have been heading.
[29:40] It wipes out that meaningful
[29:41] use and dsrip whatever we
[29:45] will use for it.
[29:46] It's considerably alters that
[29:47] for the future
[29:49] >> yes, you're right.
[29:52] We have been noodling on it.
[29:57] Sort of standard logic in state
[30:00] of california has been
[30:03] that whatever the supreme court
[30:04] does, they won't invalidate
[30:06] the waiver and the waiver has
[30:09] been structured as a bridge to
[30:10] reform.
[30:13] However, we're seeing with the
[30:15] governor's proposal this
[30:17] year in the May revise, there's
[30:21] actually local effort to
[30:22] change the waiver.
[30:27] if the federal law changed,
[30:29] it's quite possible the
[30:30] state might change its mind too.
[30:32] >> as long as we're not caught
[30:33] off guard.
[30:34] I know you won't be.
[30:36] I think it's also important for
[30:37] us to say that in
[30:38] public and on the record that
[30:41] we are very aware of what
[30:44] those just what you call them
[30:49] risks and threats are that are
[30:51] out here.
[30:53] Cause us all kinds of heartache
[30:57] as a county.
[31:02] Of course, the $16 billion
[31:02] surprise I think it's
[31:05] sobering for all of us.
[31:06] Thanks george.
[31:09] >> okay.
[31:11] Page 13.
[31:16] We talked about restoration of
[31:18] personnel.
[31:21] There are issues having to do
[31:22] with bit rebuilding and
[31:23] financial infrastructure.
[31:25] You will see there are
[31:25] additions back to fleet and
[31:28] facility to deal with our
[31:29] increasing space.
[31:30] Additions back to employee
[31:32] services to deal with many
[31:35] of our workload issues and
[31:36] additions back to social
[31:38] services
[31:40] to deal with inhome supportive
[31:42] services and senior
[31:43] nutrition, which have not been
[31:44] performing as well as we
[31:50] would like without those
[31:50] resources.
[31:52] This is a summary of our one
[31:53] time funds.
[31:55] I won't go into it in detail
[31:59] but you can see basically
[32:02] that we're committing again to
[32:02] the 5% contingency.
[32:06] We have built in there the
[32:08] commitment to -- the
[32:10] repayment of loan from retiree
[32:12] health that was utilized to
[32:14] purchase the downtown clinic
[32:15] site.
[32:19] We built in here the sale of
[32:22] the children's shelter and
[32:25] we're spending that money on
[32:26] issues related to children.
[32:33] that will be on your agenda
[32:33] later on today.
[32:35] We'll give you much more detail
[32:37] about public safety
[32:38] realignment during the entire
[32:40] process but, I wanted to point
[32:42] out that santa clara county has
[32:45] been recognized across the
[32:47] state developing the most
[32:49] innovative ab109 plan available.
[32:51] we've been very successful in
[32:56] it at this point with
[32:56] reduced recidivism.
[32:58] We have not seen a dramatic
[33:00] increase, even significant
[33:03] increase in our jail population.
[33:05] Although there are mixed
[33:06] population and the population
[33:08] is changing a bit towards the
[33:09] more serious offenders.
[33:11] This budget assumes that our
[33:12] allocation will
[33:14] effectively be doubled.
[33:17] The formula has been in the
[33:18] works with negotiations
[33:21] between c sac and the state.
[33:22] We're seeing preliminary
[33:23] numbers which suggest that it
[33:30] will be at least doubled and
[33:32] we're therefore planning to
[33:35] spend on probation and public
[33:38] safety services commensurate
[33:38] with that.
[33:41] We're going to have a new
[33:42] population.
[33:43] We expect the state will
[33:45] continue with its commitment
[33:49] to fund our services to this
[33:50] new population.
[33:52] It is true that there is no
[33:53] guarantee at this point
[33:56] that this funding will come
[34:01] through without some more
[34:02] attached requirements.
[34:05] I wanted to highlight one part
[34:07] of the budget that we
[34:08] have relied upon for the last
[34:10] two years now.
[34:13] That is the center for
[34:15] leadership and transformation.
[34:16] We've focused on trying to
[34:18] change the way that we
[34:20] actually do business and we've
[34:21] had great success with
[34:22] empowering our employees to
[34:25] look at their jobs differently,
[34:30] to improve performance, to
[34:31] focus on customers and
[34:32] transforming the workforce so
[34:34] that people can lead from the
[34:38] middle as they say.
[34:39] So far, there are 39 teens
[34:40] currently working on
[34:42] projects which have saved us
[34:45] well over millions of dollars.
[34:47] You'll even see in your budget
[34:51] book, break out of all
[34:52] of those teams.
[34:54] these are the milestone dates
[34:58] for this budget process.
[35:00] We're currently starting the
[35:02] budget workshop.
[35:04] Last day for submission
[35:06] budgetary items will be the
[35:08] 29th.
[35:10] We're starting our hearings on
[35:11] the 7th.
[35:13] We expect to be done by the 5th
[35:17] and then our final
[35:19] meeting after that to approve
[35:21] the entire process.
[35:26] I'm open to any questions that
[35:30] you might have.
[35:32] >> so, just on this one jeff,
[35:37] the center for leadership
[35:43] and transformation is
[35:44] transformative.
[35:46] I wonder if we have looked yet
[35:47] at finding ways.
[35:50] I know I seen it mentioned
[35:51] occasionally but finding
[35:55] ways to let the public know the
[35:57] kinds of differences we have
[35:57] made.
[35:59] some of you know, I was in
[36:02] pittsburgh at the end of
[36:04] last week and it was a
[36:08] conference put on in order to
[36:08] talk
[36:09] about transformation.
[36:12] It happen to concentrate on
[36:13] pittsburgh where we were.
[36:16] Pittsburgh as in pennsylvania
[36:17] and not california.
[36:18] the transformation that has
[36:20] taken place there and I
[36:24] never been there before, they
[36:25] certainly showed a great demo
[36:29] of what it used to look like.
[36:31] Many of you remember in the
[36:33] past, the three rivers
[36:35] there will catch on fire for
[36:36] the incredible amount of
[36:36] pollution.
[36:37] Transformation is so powerful
[36:39] that it really turning
[36:41] that city around.
[36:43] I think you can make an
[36:45] argument for this in this
[36:48] county and let our employees as
[36:50] well as those live in the
[36:55] county know that we have done
[36:58] this because, if I'm going to
[37:00] accept all that you say as
[37:03] gospel and so forth, it would
[37:03] be
[37:07] great to see a series in the
[37:09] murk that talks about what were
[37:11] the differences that came about.
[37:12] We made substantial investment
[37:13] in this.
[37:16] We involved stanford at a very
[37:17] high level and I think
[37:21] it's a wonderful opportunity to
[37:24] show how we use county money
[37:26] in different way to save a good
[37:30] deal of money and also to
[37:32] motivate and transform some of
[37:34] our employees.
[37:37] Just a thought.
[37:40] >> well, in this year's budget
[37:42] message, pages 9-18,
[37:44] we've gone through all of the
[37:45] current projects that are in
[37:46] place.
[37:47] You're right, it hasn't gotten
[37:48] out as much to the
[37:54] public as we would like.
[37:57] We had a couple comments in the
[37:58] newspaper but and we
[38:01] put out a number of press
[38:04] releases that don't typically
[38:04] get
[38:05] picked up.
[38:08] We have this on our website
[38:09] both our internal website
[38:11] and our external website.
[38:12] This year, will give us a
[38:16] chance to refocus on getting
[38:17] the message out.
[38:21] >> a series was highlighted in
[38:21] some departments.
[38:25] some person putting a face on
[38:28] it, can be very
[38:29] influential.
[38:31] Whenever I travel, there always
[38:32] certain counties that
[38:35] stick out including yours.
[38:40] Fun to do that.
[38:46] >> perfect.
[38:48] >> supervisor cortese.
[38:52] >> page 11 of the slides, you
[38:54] went through this, that
[38:56] page closes talking about a
[38:59] plan b under development and
[39:04] possibly revenue materialize as
[39:06] planned.
[39:06] Under development, can you
[39:10] expand on that a little bit
[39:11] more?
[39:13] I don't know where is it at and
[39:15] when will we hear more
[39:15] about it?
[39:20] Presumably if we were going to
[39:21] have a contingency plan,
[39:23] woe would have it ready before
[39:25] the project develop and not
[39:26] after.
[39:27] I'm just wondering when is that
[39:27] going to be
[39:32] forthcoming.
[39:34] I'm also wondering if any of
[39:35] the thinking this board
[39:37] asked to have looked at in
[39:38] terms of areas where there can
[39:39] be
[39:42] a firewall between the general
[39:44] fund and the enterprise fund.
[39:46] i know we received some legal
[39:47] advice as to where we
[39:50] can't do that but we haven't
[39:53] seen anything come forward
[39:54] trying to make suggestions in
[39:57] the areas where we can do
[39:58] that.
[40:00] >> let me try to take those two
[40:02] questions one at a
[40:02] time.
[40:06] Number one, in terms of
[40:10] developing a plan b, we don't
[40:11] have that plan to the point
[40:12] where we would be prepared to
[40:16] put it out in the public.
[40:20] The only other approach to
[40:23] unrealized revenue is to
[40:23] reduce expenditures.
[40:25] There are a number of programs
[40:26] in the health and
[40:29] hospital system which are not
[40:30] absolutely mandated.
[40:32] Certainly not mandated to the
[40:36] level that we provide
[40:37] them.
[40:39] If indeed we were unable to
[40:41] meet revenues, we'd have to
[40:48] start looking at those services.
[40:51] They typically are specialty
[40:53] type services and other
[40:56] support services. That will be
[40:57] in significant reductions.
[40:58] Obviously, none of us want to
[40:59] do that.
[41:01] Therefore, we trying to project
[41:04] a budget here we think
[41:05] is very conservative and
[41:05] rational.
[41:08] In the midst of healthcare
[41:10] reform, it is not the time
[41:13] to be reducing services but as
[41:14] you well know, the budget has
[41:21] to balance one way or the other.
[41:25] We are in contingency planning.
[41:26] We will bring that forward when
[41:28] we feel like it's ready
[41:29] to be public.
[41:33] in terms of the second answer
[41:36] or second question about
[41:39] a firewall, as you know, the
[41:43] board does have constitutional
[41:46] obligations under 17,000 to
[41:47] provide healthcare for
[41:47] medically
[41:49] injured in the county.
[41:56] we provide far more than that.
[41:59] But, there is no legal
[42:01] structural way to actually
[42:03] prevent the expenditure of
[42:04] money on that program.
[42:10] It really boils down to setting
[42:11] up systems -- policy
[42:15] and commitments in the board
[42:16] policy area that will restrict
[42:18] how much money gets moved from
[42:20] the general fund.
[42:22] At this point, I know that
[42:23] county council has been
[42:29] working on some of those ideas.
[42:32] we are targeting in this budget
[42:36] trying to keep the
[42:38] general fund subsidy below the
[42:41] 10% range of the entire
[42:42] expenditure.
[42:44] I think you'll see that we are
[42:45] successful in that with
[42:48] some leeway.
[42:50] When I started 2.5 years ago,s
[42:53] general fund subsidy was
[42:54] about $220 million.
[42:57] This budget envisions it to be
[43:00] about $85.5 million.
[43:01] That's a significant reduction
[43:03] without significant
[43:05] reduction in services.
[43:08] I obviously can't take the
[43:08] credit for that.
[43:10] The hospital should take the
[43:11] credit for that.
[43:15] they done a fabulous job of
[43:18] improving their efficiency
[43:20] and effectiveness.
[43:24] That's a good step forward
[43:27] indicating that we are
[43:28] making significant progress.
[43:31] >> if you measure that by board
[43:33] presidency, we've all
[43:35] done well, President Shirakawa
[43:37] you just have $85 million
[43:38] more to go.
[43:43] [Laughter] I want to get this
[43:45] clear so it doesn't get
[43:46] -- probably will anyway --
[43:49] perhaps it doesn't get
[43:49] misprinted
[43:51] somewhere by some opinion
[43:52] maker. I'm not suggesting nor
[43:52] do
[43:56] i hear the board suggest that
[43:57] we do anything other than
[44:00] guarantee the 17,000
[44:00] commitments.
[44:04] When you present it to us last
[44:06] year, what the hospital
[44:07] system was spending money on,
[44:14] that piece of it is a less
[44:16] than 10% of the total hospital
[44:16] budget.
[44:18] It seem to me we can guarantee
[44:20] that piece and still
[44:23] have awful lot of attitude in
[44:28] term of where we prohibit
[44:28] ourselves moving money back and
[44:29] forth.
[44:31] I'm only suggesting under this
[44:32] plan b scenario.
[44:34] I'm coming into this process
[44:35] more than willing to
[44:41] support this plan at this point
[44:45] of half revenue solution and
[44:47] half subsidy solutions.
[44:51] Currently plan b -- we all have
[44:53] concern to have in
[44:54] place.
[44:58] i'm actually thanking you for
[44:59] that.
[45:04] >> you're correct on both parts.
[45:05] We do have more flexibility
[45:06] without reducing services
[45:10] to reduce our costs.
[45:12] We can actually increase
[45:16] services and reduce our cost.
[45:18] we're making progress there and
[45:19] that will be our
[45:20] directive.
[45:23] Like you say, if we can't meet
[45:25] it, we will then have to
[45:26] start thinking about what we
[45:27] can do without.
[45:31] >> to the chair, again, not to
[45:34] be misunderstood, I was
[45:36] joking with regard to the
[45:37] credit with the board President.
[45:39] i do agree that employees are
[45:41] the ones who have done
[45:42] this.
[45:43] There's no way five supervisors
[45:45] or senior staff can go
[45:47] out and manage an operation and
[45:52] bring numbers into alignment
[45:57] like that.
[45:57] That's understood.
[45:58] thank you.
[46:03] >> anyone else on this section?
[46:04] Thank you jeff.
[46:05] Item five is overview of
[46:07] funding status of the county
[46:11] retiree medical benefit program.
[46:13] >> george I'm taking my share
[46:13] of time this year.
[46:19] this is my last year.
[46:20] I get special privileges.
[46:22] I'm sitting here thinking that
[46:26] when I first got here in
[46:27] 2001, the budget was quite
[46:30] robust.
[46:31] You remember gary, believe it
[46:35] or not, they were called
[46:38] funds supervisors had to offer
[46:40] to their own district.
[46:43] The next year that wasn't the
[46:44] case.
[46:46] By 2003 it was dismal.
[46:47] It has been dismal for at least
[46:48] nine or ten years.
[46:50] It is amazing to be doing a
[46:53] budget where we're not
[46:54] discussing how awful it will
[46:55] be, how terrible the year will
[46:58] be, how many test we'll have to
[46:58] make.
[47:04] i think you're both to be
[47:08] commended.
[47:12] It seemed kind of jerky at
[47:12] times.
[47:14] Hard word, kind of a stop and
[47:15] start.
[47:18] Think we've gotten to an
[47:20] unusually good spot given
[47:24] where many other counties are.
[47:26] Where much of california
[47:27] doesn't enjoy the privilege
[47:30] we're having this year of
[47:31] looking at a budget that
[47:32] doesn't
[47:34] have as many challenges that it
[47:35] has before.
[47:37] I just don't -- it would not be
[47:38] there if we didn't call
[47:41] that out and say, good job.
[47:45] i can look back over 11.5 years
[47:45] at this point.
[47:50] It's been a lot of those times
[47:50] very rocky.
[47:52] I thank you and I'm sure whole
[47:54] board joins me in that.
[47:54] >> thank you.
[47:56] >> you better keep up the good
[47:57] work.
[47:59] >> well, we will.
[48:00] It's only because of fabulous
[48:03] employees and mary and
[48:05] leslie and gary and department
[48:10] heads who and all of their
[48:12] finance people who do yohman's
[48:13] job and they're here late
[48:15] nights and making sure
[48:16] everything adds up.
[48:16] Thank you for recognizing that.
[48:19] >> by the way, we are waiting
[48:20] until January for
[48:26] reinstated some of those funds
[48:34] from the districts.
[48:35] >> thank you Mr. President.
[48:38] We wanted to provide you with
[48:43] an overview of the issue
[49:05] of the opeb retiree benefit.
[49:09] First slide.
[49:10] The second slide -- I'm going
[49:11] to go through this
[49:19] quickly because there's a lot of
[49:19] contextual information.
[49:21] The important thing about this
[49:22] slide it outlines the
[49:24] benefit we provide employees by
[49:28] no means it's all retiree
[49:30] medical benefit, the most
[49:31] generous and no way that's the
[49:31] case.
[49:34] We only provide the benefit if
[49:39] you retire from the
[49:40] county, if you've met five up
[49:41] to ten year continue of
[49:42] service in order to get the
[49:43] benefit.
[49:47] also we only pay equal to the
[49:47] geyser premium.
[49:50] At the same time, that being
[49:55] said, this is an expensive
[49:55] benefit.
[49:56] Next slide provide you with
[49:57] some perspectives in terms
[50:02] of how things have changed.
[50:04] To give you some perspective,
[50:07] the county began
[50:11] prefunding this benefit in 1984.
[50:14] We wanted very few organizes
[50:15] that did studies to
[50:16] determine what we needed to put
[50:18] into this program in order
[50:20] to fully fund it.
[50:25] Since that time, there has been
[50:27] a variety of changes.
[50:29] 2008, new requirements,
[50:34] required the reporting of the
[50:41] unfunded actuarial liability.
[50:44] It requires dedicated assets to
[50:46] be placed in
[50:48] irrevokable trust.
[50:53] The county did open a trust in
[50:56] cal pers in indicate
[50:58] 2008.
[51:02] The board approved those
[51:04] funding. We ended up
[51:05] suspended contributions in 2010
[51:08] when we were really dealing
[51:10] with our cash flow crisis.
[51:13] That's the reason why in this
[51:16] year, we are recommending
[51:18] to increase our contribution to
[51:19] this benefit program.
[51:21] Also it's important to point
[51:26] out that beginning in
[51:29] 2012, we did negotiate, some of
[51:30] the employees contributing
[51:35] directly to the cost of retiree
[51:35] health.
[51:39] Next slide provide you with
[51:39] some definitions that might
[51:41] be helpful for you in terms of
[51:43] identifying how retiree
[51:44] medical benefits are funded and
[51:46] it gives a little
[51:49] description, pay as you go.
[51:51] Really only covers the current
[51:56] period cost for current
[51:57] retirees. The normal cost is
[51:59] pay as you go.
[52:00] Plus we're funding the cost of
[52:02] benefits for future
[52:03] retirees.
[52:07] This is referred tos a partial
[52:08] refunding, the arc,
[52:10] which is the annual required
[52:12] contribution is a normal cost
[52:16] plus we're also making payments
[52:17] on the unfunded liability.
[52:20] This is substantial amount of
[52:20] payments that ideally we
[52:22] can reach but when you see the
[52:25] figures, you can see what a
[52:27] challenge that will be.
[52:30] the next slide is a graphic
[52:33] representation of the value
[52:35] of these funding methodologies
[52:39] and as you can see, the arc
[52:43] currently is in the range of
[52:43] around $170 million, which is
[52:47] way above what we're currently
[52:47] funding.
[52:48] To the extent to which we do
[52:51] not pay for the unfunded
[52:53] liability, as you can see the
[52:55] trend will increase over time.
[52:59] These are annual costs.
[53:01] The next slide gives you a
[53:02] summary of where we are in
[53:05] the funding of this program.
[53:08] The amount that we have
[53:11] contributed to the irrevokable
[53:13] trust is $252 million opinion
[53:17] we are still retaining in our
[53:18] county funds $163 million.
[53:20] These are funds that were
[53:23] originally anticipated to be
[53:24] transferred to their
[53:24] irrevokable trust.
[53:26] We've hold on to them base on
[53:27] our concerns around cash
[53:29] flow.
[53:31] The retiree health trust fund
[53:32] is a major source.
[53:36] i think if you recall, we have
[53:37] about $250 million worth
[53:38] of play.
[53:42] I got amount of 160 is retiree
[53:44] health trust fund.
[53:46] During the 2009, '10 time frame
[53:50] when the economy was in
[53:51] a chaotic state, we felt it was
[53:54] very important to maintain
[53:57] that flexibility in cash as was
[53:58] discussed with the board.
[54:03] As time has moved on, we're
[54:04] feeling little more
[54:06] comfortable in starting to
[54:10] transfer funds out of the
[54:10] retiree
[54:11] health trust fund and that's
[54:12] went recommendations we're
[54:14] making in the current year.
[54:16] Now the number that's startling
[54:18] and of concern to us is
[54:23] in fact our actuarial accrued
[54:24] liability which is now
[54:25] exceeding $2 billion.
[54:33] Believe it or not, in 1999, the
[54:33] actuarial accrueded
[54:35] liability was $69 million.
[54:36] So it increased substantially
[54:37] based on a variety of
[54:40] factors that I will touch on.
[54:44] Again, the next slide gives you
[54:50] a since of how the
[54:50] unfunded actuarial accrueded
[54:53] liability has changed over the
[54:53] last 12 years.
[54:55] That growth has been
[54:56] significant as our
[54:57] contributions
[55:00] really have been limited again.
[55:02] We did that in order to really
[55:03] protect our services.
[55:04] It's a decision that was
[55:07] difficult but one that I think
[55:09] we stand behind because
[55:12] clearly, our mission is to
[55:12] provide
[55:13] service.
[55:15] I think looking back, it was
[55:16] the right thing to do.
[55:21] The next slide provides you
[55:23] with some more recent
[55:25] information about our
[55:26] contributions.
[55:29] In 2008 and 2009, we
[55:31] contributed 100% of our arc.
[55:32] That was possible because we
[55:33] utilized the retiree
[55:34] health trust fund in addition
[55:37] to what we budgeted to meet
[55:39] 100% of those costs.
[55:41] As our deficits grew and we had
[55:42] fewer and fewer
[55:46] options, we made the decision
[55:47] to reduce those expenditures
[55:52] and as you can see, the amount
[55:53] we contributed declined.
[55:55] So, at this point in time, one
[55:57] of the things that we're
[55:59] recommending is to increase our
[56:02] contribution in terms of our
[56:04] ongoing funds from 50% of the
[56:07] normal cost to 75% and then
[56:10] make up that difference to get
[56:11] to 100% gi beginning to
[56:14] transfer from the retiree
[56:17] health trust fun to the
[56:17] irrevokable trust.
[56:19] We begin drawing down reducing
[56:22] the amount in the
[56:25] retiree health trust fund by
[56:26] relatively small amount.
[56:29] We obviously will not go too
[56:31] far too fast because we're
[56:32] not 100% confident in the
[56:33] economy.
[56:37] The next slide provides you
[56:39] with again, a graphical
[56:41] representation about the
[56:42] estimated future unfunded
[56:43] liability
[56:45] based on the three funding
[56:46] mechanisms.
[56:49] Our goal is to again, reach
[56:50] that 100% of normal cost
[56:52] and then as possible, try to
[56:55] begin paying some of that
[57:00] unfunded liability depending on
[57:01] circumstances.
[57:03] the next slide provides some
[57:06] information regarding why
[57:09] the unfunded liability has
[57:11] grown so quickly. Retiree
[57:11] health
[57:14] is very sensitive to rise in
[57:14] health insurance premiums.
[57:17] That's a problem we face not
[57:18] only here but of course in our
[57:19] regular health premiums.
[57:21] We see substantial growth and
[57:23] even though they are not
[57:24] in the double didn't range as
[57:26] they had been in prior years,
[57:29] they are still growing
[57:29] significantly.
[57:31] The increase number of
[57:33] employees in retirees when we
[57:40] look at this from a actuarial
[57:41] perspective, has an impact on
[57:43] that.
[57:45] the funding strategy as I
[57:48] mentioned, the more we put
[57:51] into it, the limits the growth
[57:52] of unfunded liability and
[57:53] also the investment return rate.
[57:56] All of those things have been
[57:57] challenged by the economy
[58:02] over the last several years.
[58:05] the next slide provides some of
[58:07] the things -- some of
[58:09] the strategies that we're
[58:10] thinking about and certainly
[58:10] it's
[58:13] important to note that these
[58:14] are all subject to labor
[58:15] contract negotiations.
[58:17] These are not things that we
[58:19] would implement.
[58:21] Unilaterally but they will be
[58:23] part of our contract
[58:24] negotiations.
[58:25] things that we can do for
[58:27] instance would be to cap
[58:28] county contributions.
[58:32] We could reduce benefit
[58:33] coverage levels.
[58:38] Introduce a health saving
[58:38] account option.
[58:40] And on and on.
[58:43] There are ways in which we can
[58:47] address this obviously,
[58:52] mistakes obvious --
[58:54] this is something we have to
[58:55] address.
[58:58] The next step on the last
[59:00] slide, what we are suggesting
[59:02] we do is to create an
[59:03] administrative steering
[59:04] committee for
[59:08] the retiree health benefit to
[59:10] study best practices and to
[59:12] develop options for
[59:15] presentation to the board.
[59:18] Obviously we want to obtain
[59:20] input from our county and
[59:22] labor organizations.
[59:24] So that we can provide
[59:26] information and get feedback in
[59:29] terms of what this all means
[59:31] and how best to proceed.
[59:36] Our time frame is to study this
[59:39] in the upcoming fiscal
[59:41] year 2013 and to discuss with
[59:43] the board probably through the
[59:44] finance committee and the full
[59:47] board as we look at the
[59:48] budget for fiscal year 2014.
[59:50] Once again, we're making a very
[59:52] positive step this year
[59:55] in terms of getting to 100%
[59:56] normal cost.
[59:58] Our goal will be to try to put
[1:00:01] together a plan in terms
[1:00:03] of how we can address and
[1:00:05] approach these funding issues
[1:00:05] as
[1:00:06] we move forward.
[1:00:10] with that, I would be happy to
[1:00:11] answer any questions.
[1:00:13] >> supervisor cortese and then
[1:00:14] wasserman.
[1:00:17] >> first of all, thank you very
[1:00:19] much for including this
[1:00:21] as a major component of the
[1:00:23] study session.
[1:00:24] It's helpful and it's probably
[1:00:27] been on a lot of our
[1:00:28] minds wherever we sit here in
[1:00:32] the county in terms of roles
[1:00:33] given the conversation that's
[1:00:35] going on externally over the
[1:00:35] years.
[1:00:44] I know we were all aware of
[1:00:44] abstaining the funding
[1:00:45] effort.
[1:00:49] one of the questions I have is
[1:00:52] probably in the a real
[1:00:52] question per se.
[1:00:56] In the list of things that
[1:00:59] could be negotiated, there
[1:00:59] could be ideas.
[1:01:03] To what extent can we as a
[1:01:06] county given our capacities
[1:01:07] connected to the healthcare
[1:01:07] system?
[1:01:10] at least attempt to bargain to
[1:01:14] bring people into our
[1:01:18] own health plans in order to
[1:01:23] sort of mitigate what I would
[1:01:25] call a victimization of local
[1:01:26] governments by big insurance
[1:01:27] companies that we have no
[1:01:28] control over.
[1:01:32] i'm wondering if it's worth
[1:01:32] discussing?
[1:01:33] I'm not trying to bargain from
[1:01:34] here.
[1:01:37] I need to see it up there as a
[1:01:37] bullet point.
[1:01:39] I didn't know if that's because
[1:01:41] there's not much gained
[1:01:42] or because it's a collective
[1:01:44] bargaining issue.
[1:01:46] >> I would speak -- one thing I
[1:01:50] would say is there are
[1:01:51] limitations.
[1:01:53] i think that this is something
[1:01:54] that's been looked at
[1:01:55] before.
[1:01:57] In fact, was challenged and so
[1:01:59] there are limitations in
[1:02:03] terms of to what extent we can
[1:02:04] do that.
[1:02:05] I think that's about all I
[1:02:06] would say on it.
[1:02:09] >> I would add a little bit.
[1:02:12] last year we went forward with
[1:02:16] trying to make our
[1:02:18] internal system, vhp more
[1:02:20] attractive by expanding the
[1:02:23] network and making it a more
[1:02:24] attractive product for our
[1:02:25] employee.
[1:02:26] There's still we need to do in
[1:02:27] that respect.
[1:02:29] Gary is right, we can't really
[1:02:30] mandate that employees
[1:02:32] take one system or another but
[1:02:36] we can make it more
[1:02:37] attractive.
[1:02:39] We have seen significant
[1:02:39] transfer.
[1:02:43] I think it's up to 700 or 800
[1:02:48] or something like that.
[1:02:48] 1100.
[1:02:54] 1100 of people transferred over.
[1:02:54] That makes fairly significant
[1:02:56] dent.
[1:02:59] That helps us a lot because
[1:03:01] every dollar that we pay
[1:03:04] for health premiums it goes to
[1:03:04] vhp.
[1:03:08] Stays within the county system
[1:03:10] and allows us to have
[1:03:13] the flexibility to improve our
[1:03:14] health system, delivery
[1:03:14] system.
[1:03:16] Whereas, every dollar that goes
[1:03:18] to kaiser or health net
[1:03:19] goes outside of the county and
[1:03:20] helps them develop their
[1:03:22] system.
[1:03:26] >> it seems like that alone
[1:03:35] would be in a dialogue, an
[1:03:36] incentive or interest beyond
[1:03:39] just the product itself.
[1:03:43] In other words, if that's an
[1:03:46] organization, it helps us
[1:03:47] bring down accrued liability
[1:03:50] that end up impacting employees
[1:03:52] anyway. Trying to want if I
[1:03:54] that a little bit more.
[1:03:55] we're not asking people to take
[1:03:58] a hit for the team so
[1:04:00] to speak.
[1:04:01] But to the extent that people
[1:04:02] are attracted by the idea
[1:04:04] that we can reach a certain
[1:04:08] critical mass, it saves jobs,
[1:04:08] it
[1:04:11] freeze up dollars and wages and
[1:04:13] other things.
[1:04:14] I understand the collective
[1:04:14] bargaining session.
[1:04:24] i take note and other important
[1:04:27] thing is willingness
[1:04:31] convene early.
[1:04:34] My experience has been in other
[1:04:36] places, especially
[1:04:41] prior to coming here, that the
[1:04:45] lack or unwillingness of
[1:04:47] management elected officials
[1:04:49] and others to do that, really
[1:04:54] help lead to a lot of conflict.
[1:04:56] Like anything else, just like
[1:04:57] any balanced discussion
[1:05:00] with budget, there's a lot of
[1:05:01] questions whether accrued
[1:05:03] liability numbers are real.
[1:05:05] Are those numbers really where
[1:05:06] they should be.
[1:05:07] I don't dispute them but people
[1:05:08] need to understand that
[1:05:14] before they make commitments
[1:05:16] and secondly, what is the --
[1:05:18] how sharp does the trajectory
[1:05:20] need to be to get there from
[1:05:21] here?
[1:05:25] How much can we defer until we
[1:05:26] see how the macro
[1:05:28] economy changes and how
[1:05:29] healthcare reform May change
[1:05:29] things.
[1:05:32] I think those discussions are
[1:05:33] invaluable and maybe it's
[1:05:35] during those discussions when a
[1:05:37] little more sharing about
[1:05:41] how internal -- how vhp and how
[1:05:43] mechanisms internally might
[1:05:47] be able to help the problem.
[1:05:49] Sound like you're doing that?
[1:05:50] >> absolutely.
[1:05:56] The board action a few weeks
[1:05:58] ago to direct this to look
[1:06:00] carefully at a unified
[1:06:00] healthcare strategy is
[1:06:01] important
[1:06:03] component of this.
[1:06:06] It involves having a strategy
[1:06:08] to expand the commercial
[1:06:10] capacities of our local health
[1:06:13] systems so that we can make a
[1:06:14] much more attractive product
[1:06:16] for employees and for that
[1:06:20] matter, for employees of other
[1:06:22] organizations.
[1:06:22] >> supervisor wassermann.
[1:06:26] >> I wanted to thank staff and
[1:06:28] all of employees for
[1:06:30] being direct, being
[1:06:30] transparent, being
[1:06:31] collaborative.
[1:06:32] We're all working on this
[1:06:32] problem together.
[1:06:34] What I wanted to state here
[1:06:39] with something I stated in
[1:06:41] ledge committee,ly say it again
[1:06:45] now, at some point, I think
[1:06:46] somebody somewhere organization
[1:06:48] some individual needs to
[1:06:51] hold the medical industry
[1:06:52] accountable.
[1:06:53] When cost, supervisor cortese
[1:06:54] mentioned cost of
[1:06:59] insurance going up and up, they
[1:07:00] talk about premiums going up
[1:07:03] because the cost of the medical
[1:07:06] care is going up and up.
[1:07:08] I know I seen premiums.
[1:07:12] I seen in medical care.
[1:07:14] I'm just hoping somewhere
[1:07:14] washington, sacramento,
[1:07:17] somewhere somebody says why is
[1:07:19] medical costs going up 10
[1:07:23] times the cpi when we as
[1:07:24] employees are happy here when
[1:07:25] our
[1:07:27] salaries don't go down.
[1:07:30] The comcast go up couple 3%
[1:07:32] each year.
[1:07:38] The medical cost goes up 10 time
[1:07:40] s cip.
[1:07:43] it was double digit increases.
[1:07:46] When your cost of medical care
[1:07:49] or coverage insurance or
[1:07:52] whatever is estimating 10 and
[1:07:55] 20 percent and we're
[1:07:57] scrambling to try and find to
[1:07:58] be more efficient so we can
[1:08:01] set aside for money to pay for
[1:08:02] the insurance coverage of
[1:08:05] retiring employees, you got to
[1:08:07] ask at some point, why these
[1:08:09] costs are going this way?
[1:08:11] I appreciate the respect and
[1:08:11] collaborative efforts and
[1:08:14] between the administration and
[1:08:15] employees to figure out how
[1:08:19] we will pay for these expenses.
[1:08:25] sooner or later, we got to say
[1:08:27] these expenses are
[1:08:27] wrong.
[1:08:29] I don't know if we can throw
[1:08:29] out for further
[1:08:30] discussion.
[1:08:34] Gary if we have the right for
[1:08:35] justification of
[1:08:35] insurance premiums.
[1:08:38] I know there's a state
[1:08:39] insurance commissioner.
[1:08:42] I don't know who regulates the
[1:08:42] cost and what they
[1:08:44] charge for medical care.
[1:08:46] it's hard to be playing catchup
[1:08:47] all the time and you
[1:08:50] got this run away horse and
[1:08:52] somehow pull the reigns back.
[1:08:54] No matter what we do no matter
[1:08:59] with the epic, no matter
[1:09:01] with more efficient methods, we
[1:09:03] cannot keep up with
[1:09:07] escalating medical cost and
[1:09:10] premiums that are double digit
[1:09:10] each year.
[1:09:13] It's not a question of if or
[1:09:15] when.
[1:09:19] >> I think jeff and I can maybe
[1:09:20] both reflect on this.
[1:09:22] There was a time when medicine
[1:09:23] was not a business.
[1:09:26] it was looked at quite
[1:09:27] differently.
[1:09:31] It was a -- I don't mean to get
[1:09:32] carried away -- it was
[1:09:33] a laudable calling.
[1:09:37] Most of you know I have a
[1:09:37] nursing background.
[1:09:40] At that time, when people went
[1:09:41] into the hospital, there
[1:09:43] was insurance coverage but
[1:09:47] medicine was not the business
[1:09:47] it
[1:09:48] is today.
[1:09:49] There are, learning about this
[1:09:50] in pittsburgh, there are
[1:09:52] whole cities in the south that
[1:09:53] are devoted to healthcare.
[1:09:55] That's how people make their
[1:09:55] living.
[1:09:58] There's one city devoted just
[1:09:59] to dialysis.
[1:10:02] Dialysis is a very lucrative
[1:10:04] business.
[1:10:05] I hesitate saying things out
[1:10:06] loud but the more
[1:10:08] developed we have become in the
[1:10:09] healthcare field, the more
[1:10:13] ways there are to save people,
[1:10:17] to maintain them sometimes
[1:10:19] long after the quality has
[1:10:22] disappeared, the more expensive
[1:10:22] it becomes.
[1:10:26] That is one of the reasons in
[1:10:28] the aca there was a
[1:10:31] discussion initially which had
[1:10:33] a great dealed feedback about
[1:10:36] it about the dreaded word, what
[1:10:38] do I call that word instead
[1:10:41] of what it is.
[1:10:41] Call it options.
[1:10:44] Whether or not you discuss with
[1:10:45] people what they want
[1:10:46] the quality of life to be for
[1:10:51] them or for their family.
[1:10:57] I realize, I'm opining somewhat
[1:10:58] on this.
[1:11:00] We have become a very
[1:11:03] complicated country as far as
[1:11:04] healthcare goes.
[1:11:06] As we used to say, still do, no
[1:11:07] one every dies in
[1:11:08] surgery.
[1:11:11] they only die later because
[1:11:15] there is no way you can do
[1:11:18] that.
[1:11:20] Again, I am so sympathetic for
[1:11:22] families who lost
[1:11:23] someone who had that grief.
[1:11:25] There's also grief in families
[1:11:27] where someone lives far
[1:11:30] longer and as one of the women
[1:11:30] said earlier today, somebody
[1:11:32] who goes to bed praying,
[1:11:34] they'll be dead in the morning
[1:11:36] because it is so hard to
[1:11:37] maintain your life.
[1:11:41] It's a long answer mike but I
[1:11:42] really think the
[1:11:43] transformation that has taken
[1:11:46] place in healthcare and the
[1:11:48] time I reserved it is pretty
[1:11:48] dramatic.
[1:11:51] Probably why the aca did pass
[1:11:52] and even though it has
[1:11:53] its fault.
[1:11:55] I think there are a number of
[1:11:57] really good provisions in
[1:11:58] it.
[1:11:59] Longer answer than you you
[1:12:03] wanted but it has troubled
[1:12:05] me for years how insurance
[1:12:10] company have become such big
[1:12:11] business.
[1:12:14] their executives are paid
[1:12:15] extremely well and from time
[1:12:17] to time the system is misused.
[1:12:19] I don't know if you want to
[1:12:20] comment jeff or not.
[1:12:25] We have one nurse and one
[1:12:28] doctor on a board throughout
[1:12:28] california.
[1:12:31] Jeff you maybe the only
[1:12:36] physician ceo.
[1:12:37] I did carry on didn't I?
[1:12:42] >> I guess the question was who
[1:12:42] regulates this and
[1:12:45] there is some regulatory
[1:12:46] capacity that the insurance
[1:12:48] commissioner has but not
[1:12:48] complete.
[1:12:52] There also is regulatory
[1:12:54] capacity that the department
[1:12:56] of managed healthcare has.
[1:12:57] Again, not complete.
[1:13:01] I guess the fundamental issue
[1:13:03] is as supervisor kniss
[1:13:07] pointed out that in a for
[1:13:08] profit structure, somebody has
[1:13:08] to
[1:13:15] win and somebody has to lose.
[1:13:19] That's the way it no, our
[1:13:23] country today.
[1:13:27] >> to be perfectly clear so I'm
[1:13:29] not misunderstood or
[1:13:31] misquoted, I'm perfectly happy
[1:13:33] with each and every
[1:13:34] individual and organization
[1:13:36] making profitings. I don't
[1:13:39] begrudge that and it's the
[1:13:42] american dream.
[1:13:44] What I'm saying, I'm not just
[1:13:45] lobbying for government
[1:13:46] here.
[1:13:46] How government employees
[1:13:48] suppose to keep up with the
[1:13:50] cost.
[1:13:51] Private sector too.
[1:13:52] I was self-employed for 30
[1:13:53] years.
[1:13:54] Can't keep up with the
[1:13:55] escalating cost.
[1:13:56] We're in government now.
[1:13:58] I'm in government now, we're
[1:13:59] all in government, can't
[1:14:11] keep up with the cost.
[1:14:15] Something got to move more in
[1:14:15] parallel.
[1:14:18] i hope something somewhere
[1:14:19] happens at some point.
[1:14:20] Last couple years has been
[1:14:22] great.
[1:14:24] You brought that $220 million
[1:14:25] down to $80 million or
[1:14:27] whatever the number is, that's
[1:14:28] all great.
[1:14:33] But if cost go like this, and
[1:14:34] revenues go like this,
[1:14:39] like I said, it's a question
[1:14:39] when you break.
[1:14:42] Z
[1:14:42] break
[1:14:45] >> thank you supervisors.
[1:14:46] Anything else?
[1:14:47] Thank you gary and jeff.
[1:14:52] Item six is a recommendation
[1:14:57] relating to the sale of
[1:14:57] real property.
[1:14:59] Jeff I have one speaker.
[1:15:01] I think it's a question.
[1:15:06] Let me have her ask the
[1:15:12] question.
[1:15:14] Why don't you ask the question
[1:15:18] as presentation goes on.
[1:15:23] >> good afternoon lynn bradley
[1:15:24] from seiu.
[1:15:28] It talked about the shelter or
[1:15:29] receiving center where
[1:15:32] children will go.
[1:15:34] We have never been told in
[1:15:36] social services agency.
[1:15:38] we're curious where it will be
[1:15:39] moving one.
[1:15:39] >> staff?
[1:15:41] >> thank you Mr. President,
[1:15:43] members of the board.
[1:15:46] With me today, this is a
[1:15:47] familiar face, he's the
[1:15:48] interim acting director of the
[1:15:49] social services agency and
[1:15:52] responsible for the operation
[1:15:53] of a relocation assessment and
[1:15:56] intake assessment center.
[1:16:03] david and nancy weiner who is
[1:16:05] the founding and director
[1:16:06] of the silicone valley children
[1:16:08] fund.
[1:16:13] In the audience we have sharon
[1:16:15] pick assistant business
[1:16:18] manager for harker school.
[1:16:20] in conforming with the
[1:16:21] government code following
[1:16:25] direction on January 24th when
[1:16:26] you adopt resolution for
[1:16:28] offering to sale the former
[1:16:30] children's shelter.
[1:16:32] We subsequently opening sealed
[1:16:32] written bids on
[1:16:33] March 1st.
[1:16:36] We received four written bids,
[1:16:37] three at the minimum
[1:16:38] qualifying requirements.
[1:16:40] there was a subsequent oral
[1:16:44] bidding process at the
[1:16:46] closed of which harker school
[1:16:49] made the highest remaining bid
[1:16:56] of $25,505,000.
[1:16:57] Before recommend action to
[1:17:00] adopt the resolution accept
[1:17:01] highest bid approving purchase
[1:17:03] of sale agreement.
[1:17:05] It provides for 150 day due
[1:17:08] diligence period and a
[1:17:10] 30-day close escrow period.
[1:17:11] Following a successful close of
[1:17:14] escrow, the county
[1:17:16] would realize one time proceeds
[1:17:18] of $10.7 million and in the
[1:17:21] proposed budget there'sal a one
[1:17:23] time allocation of
[1:17:25] $3.5 million toward relocation
[1:17:27] of the intake and assessment
[1:17:28] center.
[1:17:32] But I think that those are the
[1:17:35] stark details.
[1:17:37] This really is a 20 year
[1:17:38] collaboration.
[1:17:51] there's been much cash --
[1:17:58] cachet.
[1:18:01] What we now see is prospect of
[1:18:02] beautiful facility
[1:18:06] entering new phase devoted to
[1:18:06] children.
[1:18:11] This partnership started out as
[1:18:15] a 50/50 joint venture
[1:18:19] between the private sector and
[1:18:21] the county and it ended up
[1:18:24] with 50% of the proceeds from
[1:18:28] the sale with the property
[1:18:32] being satisfied. Proceeds are
[1:18:35] split 50/50 with silicone
[1:18:36] valley children's fund.
[1:18:38] This afternoon I was also
[1:18:39] informed that city council of
[1:18:42] san jose played their part and
[1:18:45] took action to provide a
[1:18:48] process for lifting the
[1:18:49] affordable housing restrictions
[1:18:49] that
[1:18:50] were placed on the property at
[1:18:56] the beginning of the project.
[1:18:58] With that, Mr. Mavis.
[1:19:02] Anything you like to say on
[1:19:04] behalf of the fund?
[1:19:06] >> we would like to thank mike
[1:19:07] wasserman and his staff
[1:19:09] and also bruce for helping us
[1:19:12] navigate through this process.
[1:19:18] We're looking forward to
[1:19:22] wrapping it up.
[1:19:29] so thank you.
[1:19:31] >> I appreciate the opportunity
[1:19:32] to just make a few
[1:19:34] comments to all of you.
[1:19:36] Some of the familiar faces.
[1:19:38] I only want to correct one
[1:19:40] thing that bruce said.
[1:19:42] I was actually a 39 year
[1:19:44] employee of santa clara county
[1:19:46] and it was in that capacity
[1:19:49] that we formed the fund and
[1:19:50] developed this very unique
[1:19:51] partnership.
[1:19:54] Many of you know it was a model
[1:19:57] throughout the state
[1:20:01] for its community participation
[1:20:11] and for thed the model it set.
[1:20:12] I had opportunity to create
[1:20:12] this partnership.
[1:20:19] This gives me a chance to say a
[1:20:21] special thanks to
[1:20:22] supervisor diane mckenna who
[1:20:25] really did an amazing job
[1:20:27] with the cheerleader of this
[1:20:27] project.
[1:20:30] i think we ought to take a
[1:20:33] moment and thank the staff
[1:20:38] and our county supervisors and
[1:20:39] our county administration for
[1:20:40] the tremendous work that was
[1:20:41] done at the children shelter
[1:20:44] during all of these years.
[1:20:46] I am particularly appreciative
[1:20:48] of the very thoughtful
[1:20:52] process that has gone on at
[1:20:54] this point in time.
[1:20:57] I greatly appreciate the fact
[1:20:58] that bruce has been able
[1:21:01] and the county executive has
[1:21:02] been able to spearhead this
[1:21:08] project to place it in the
[1:21:09] good hands of harker who by the
[1:21:11] way contributed to this project.
[1:21:13] A group of kids from harker.
[1:21:16] That's a fun thing to note.
[1:21:17] I'm particularly appreciative
[1:21:19] that the fund will be
[1:21:22] able to use the donations that
[1:21:25] were given to this project to
[1:21:28] further the work because the
[1:21:29] real focus these continue to be
[1:21:31] to support and help the abused
[1:21:33] and neglected children of our
[1:21:33] county.
[1:21:35] I am very grateful for that and
[1:21:37] I thank all of you for
[1:21:38] the work you've done.
[1:21:41] I thank bruce for the work that
[1:21:43] he's done in carrying
[1:21:43] that forward.
[1:21:45] Thank you.
[1:21:46] >> thank you.
[1:21:50] >> Mr. President, I like to
[1:21:51] respond to lynn bradley's
[1:21:52] comment and question about what
[1:21:57] is the future of the center
[1:21:58] for social services agency.
[1:22:01] Comment that the employees have
[1:22:03] not been informed.
[1:22:09] I think the new shelter sale,
[1:22:10] pending sale is common
[1:22:11] knowledge as has been reported
[1:22:12] in the paper.
[1:22:15] The agencies continue to be
[1:22:16] seeking for alternate
[1:22:23] location for their scaled down
[1:22:24] operation.
[1:22:25] They received children for no
[1:22:28] more than 24 hours. We
[1:22:30] are in the process of looking
[1:22:34] for possibilities and we will
[1:22:37] definitely confer and consult
[1:22:38] our employee organization in
[1:22:39] the future of where the
[1:22:41] location is.
[1:22:44] There are other county partners
[1:22:45] whether it's pediatric
[1:22:47] center of vmc and mental health
[1:22:48] department and other
[1:22:49] department of social services
[1:22:52] agency that we will be
[1:22:59] consulting and conferring for
[1:23:02] either temporary location
[1:23:04] >> thank you, anything else?
[1:23:07] Thank you to all of you.
[1:23:09] Let me recognize supervisor
[1:23:09] yeager.
[1:23:14] >> I know all of this,
[1:23:15] appreciate all the work
[1:23:17] everybody has done to make this
[1:23:17] happen.
[1:23:20] For those of us following this
[1:23:22] very closely like I was.
[1:23:23] There was no guarantee we were
[1:23:26] going to be where we are
[1:23:29] this afternoon with everybody
[1:23:30] saying thank you.
[1:23:32] Having an agreement that works
[1:23:33] for everybody.
[1:23:37] this was very complicated from
[1:23:38] the very beginning.
[1:23:54] It took a lot of excellently of
[1:23:55] -- flexibility.
[1:23:56] i was excited that harker was
[1:23:57] the top bidder.
[1:23:59] It's going to fit very well
[1:24:04] with the surrounding
[1:24:04] neighborhoods.
[1:24:06] If I had to sort of choose
[1:24:07] where I would want public
[1:24:09] land to be used for school
[1:24:11] would certainly be at the top
[1:24:11] of
[1:24:11] my list.
[1:24:17] it was good to hear little bit
[1:24:17] about the history.
[1:24:19] We did have an obligation to
[1:24:20] make sure some of the
[1:24:25] proceeds did go to abused and
[1:24:26] neglected children.
[1:24:28] Nancy appreciate you giving a
[1:24:28] little bit of history and
[1:24:31] all the people involved in that.
[1:24:33] It was a magnificent project.
[1:24:35] When it started it look a lot
[1:24:36] of collaboration and lot
[1:24:37] of support and dollars and
[1:24:41] leadership to make it happen.
[1:24:45] Times changed and we all need
[1:24:47] to change with them.
[1:24:50] We did all of that obligation
[1:24:52] to the children that
[1:24:54] using that property to begin
[1:24:54] with.
[1:24:57] with thatly make a motion that
[1:24:59] we adopt this
[1:25:02] resolution.
[1:25:05] >> motion by yeager and
[1:25:05] seconded by wassermann.
[1:25:09] Supervisor yeager thank you for
[1:25:10] your work.
[1:25:11] Bruce of course you and your
[1:25:12] staff.
[1:25:16] Anything else on this board?
[1:25:22] please vote by light.
[1:25:25] That carries unanimously.
[1:25:28] Thank you everyone,
[1:25:28] congratulations.
[1:25:31] I think there's nothing before
[1:25:31] us for this item.
[1:25:34] We will move on to item seven.
[1:25:35] Supervisor cortese we are
[1:25:36] starting children family
[1:25:38] seniors committee.
[1:25:40] As a chair, I want to afford
[1:25:41] opportunities, if you want
[1:25:46] to say any word before we start
[1:25:48] with the child support
[1:25:49] services. Did want to say
[1:25:51] anything prior?
[1:25:54] >> only that we've taken a
[1:25:58] preliminary look at the
[1:26:00] committee.
[1:26:03] The budget items -- still
[1:26:06] opportunity for that to
[1:26:07] happen.
[1:26:09] Looking forward to the
[1:26:18] engagement of the full board on
[1:26:18] respite process.
[1:26:21] >> item seven is review of the
[1:26:25] department of child
[1:26:27] services.
[1:26:28] >> good afternoon.
[1:26:29] Adele hunter with the
[1:26:31] department of child support
[1:26:33] services filling in for ralph
[1:26:34] miller who has family
[1:26:34] emergency.
[1:26:41] i want to give you update of
[1:26:42] these department budgets
[1:26:43] since the recommended budget
[1:26:45] was published. Yesterday on
[1:26:46] the conference call from the
[1:26:50] state department of the child
[1:26:53] support services, it was
[1:26:54] announced there will be a
[1:26:55] reduction.
[1:26:57] At this point, the state is
[1:26:59] looking at options for ways
[1:27:03] to reduce that funding.
[1:27:04] We have no additional
[1:27:06] information and what the impact
[1:27:07] would be on santa clara county
[1:27:11] at this time is unknown.
[1:27:14] Once impact is known, and what
[1:27:15] our reductions are, we
[1:27:18] will be working oba to
[1:27:20] determine how to balance our
[1:27:20] budget
[1:27:23] and during the budget process,
[1:27:26] we will have more information
[1:27:27] for the board of supervisors.
[1:27:30] I'm available for any questions
[1:27:33] >> questions from the board?
[1:27:35] >> when you talk about the
[1:27:37] call, you referring to the
[1:27:38] May revise?
[1:27:40] There was a conference call
[1:27:41] dealing with the may
[1:27:42] revise.
[1:27:43] I just wanted to understand
[1:27:46] whether or not these are
[1:27:46] just additional proposals or
[1:27:47] something cemented?
[1:27:49] >> these are results of the May
[1:27:49] revise.
[1:27:51] >> so it's still up in the air
[1:27:52] at least.
[1:27:56] >> all right, thank you.
[1:27:57] >> anyone else?
[1:28:01] Jeff any other comments?
[1:28:04] thank you, appreciate it.
[1:28:08] Item number ability is inhome
[1:28:11] support services.
[1:28:14] Luke?
[1:28:21] Item eight now, ihss.
[1:28:25] >> sorry Mr. President, I was
[1:28:25] providing further
[1:28:27] explanation to --
[1:28:33] >> I know you were working.
[1:28:38] >> this is a my ihss support
[1:28:39] services.
[1:28:40] If you can confer with me, this
[1:28:41] is transferring the
[1:28:48] function to social services on
[1:28:49] the administrative portion?
[1:28:50] >> the transfer tax and
[1:28:51] responsibility will be
[1:28:57] transferred to social services
[1:28:58] on an administrative level.
[1:29:02] >> this has been historically
[1:29:03] been administered under
[1:29:04] the county executive office
[1:29:12] ever since the public authority
[1:29:15] was formed.
[1:29:21] >> questions from the board?
[1:29:26] >> I'll just point out that the
[1:29:27] governors May revise
[1:29:28] suggest more cuts when we know
[1:29:30] what's going on with that, we
[1:29:32] will come back to the board
[1:29:35] with modifications.
[1:29:38] >> okay.
[1:29:40] I'm thinking, it was difference
[1:29:42] you spoke of 11 years
[1:29:44] ago today and last years today
[1:29:46] it's a little different.
[1:29:48] I'm sorry I'm shell shocked and
[1:29:50] we had more discussions
[1:29:52] on some items.
[1:29:53] >> [Inaudible]
[1:29:54] >> thank you supervisor.
[1:29:55] Thank you luke.
[1:29:58] We will move on to item number
[1:30:01] nine.
[1:30:08] item nine is review of custody
[1:30:09] health services.
[1:30:13] >> I'll just make some very
[1:30:16] brief momentos keep with
[1:30:18] tradition, I guess.
[1:30:19] Thank you Mr. President
[1:30:21] shirakawa and honorable
[1:30:23] supervisors.
[1:30:27] at both Dr. Smith and gary
[1:30:28] described, the proposed
[1:30:29] budget for our health and
[1:30:32] hospital system fiscal year
[1:30:32] 2013
[1:30:37] reflects the direction to stay
[1:30:39] with maintenance level.
[1:30:42] It reconfirms commitment from
[1:30:47] the county mission.
[1:30:50] it continues and some cases
[1:30:51] accelerates the necessary
[1:30:53] changes to respond to the
[1:30:54] increasing challenges.
[1:30:58] As many of you noted, earlier
[1:30:58] discussion related to
[1:31:01] healthcare reform as well as
[1:31:02] the economic uncertainties.
[1:31:04] It's that purpose and with the
[1:31:06] county mission as well
[1:31:09] as our values in mind our
[1:31:11] executive leadership for
[1:31:11] adopting
[1:31:12] the following five major
[1:31:13] strategic priorities.
[1:31:15] First and foremost as you know,
[1:31:17] since this has been
[1:31:20] part of the strategic framework
[1:31:23] from the a&m work.
[1:31:24] The culture of accountability
[1:31:25] is very important for us.
[1:31:30] we can happens the monitoring
[1:31:32] of our system and also
[1:31:34] the manage performance of our
[1:31:35] health and particularly
[1:31:36] hospital system.
[1:31:37] System integration important
[1:31:40] for us as well in term of
[1:31:44] delivering better quality care
[1:31:47] and lowering cost.
[1:31:49] Position alignment is better
[1:31:52] for provision of care and
[1:31:54] strategic and decision-making
[1:31:55] process.
[1:31:58] Unified managed care in terms
[1:31:59] of happening reliability
[1:32:02] of safety net in more
[1:32:03] competitive marketplace as well
[1:32:03] as
[1:32:05] deliver the better and still
[1:32:05] support the critical functions
[1:32:09] of our health system.
[1:32:13] we added a tiff which is
[1:32:14] transforming communities.
[1:32:17] It's a challenge but also even
[1:32:19] more important to be
[1:32:21] within participations of both
[1:32:22] patients as well as community
[1:32:28] so we can continuously continue
[1:32:30] the health status.
[1:32:32] we think combining all of these
[1:32:33] five major strategic
[1:32:34] priority will position
[1:32:35] ourselves in a much better
[1:32:36] place in
[1:32:38] terms of reform.
[1:32:39] As you mentioned, our employees
[1:32:40] have done tremendous in
[1:32:46] terms of day in and day out,
[1:32:49] 7/24, 365 days out of year.
[1:32:51] Doing what we need to do to
[1:32:53] fulfill our mission.
[1:32:55] We want to make sure that we
[1:32:56] continue to protect and
[1:32:58] promote the health of residents
[1:33:00] in our communities.
[1:33:01] That includes all 1.8 million
[1:33:03] residents, that's part of
[1:33:04] our public health
[1:33:04] responsibility.
[1:33:06] Mental health will continue to
[1:33:08] treat and care the
[1:33:10] seriously mental ill in our
[1:33:12] communities on behalf of all of
[1:33:12] us.
[1:33:17] Custody health will serve
[1:33:18] incarcerated adult or youth.
[1:33:20] Drug and alcohol services
[1:33:21] department, will continue to
[1:33:24] serve youth and adults
[1:33:24] afflicted by addiction.
[1:33:26] Our community health services
[1:33:28] will continue to treat
[1:33:31] people with illnesses, that are
[1:33:38] risk to themselves as well
[1:33:41] as others. Certainly our santa
[1:33:42] clara valley medical center,
[1:33:45] we continue to provide care and
[1:33:47] treatment at your hospitals
[1:33:47] and clinics.
[1:33:49] Each of our department heads
[1:33:50] will now present very
[1:33:52] briefly the major highlights
[1:33:54] offer budget proposals and I
[1:34:02] will turn it over to mary yan.
[1:34:02] Maryann.
[1:34:04] >> let me recognize the chair.
[1:34:07] Let the chair say a couple
[1:34:10] words.
[1:34:16] >> just to say in general,
[1:34:18] welcome renee first of all.
[1:34:22] It's good to have you.
[1:34:26] Secondly, I'm not always sure
[1:34:28] that everyone understands
[1:34:29] what it takes to upgrade the
[1:34:32] health system in this county.
[1:34:35] Unless I'm wrong, we're usually
[1:34:35] running about
[1:34:36] $1.5 billion.
[1:34:42] Have we changed any this year?
[1:34:44] We upped it to 1.7.
[1:34:48] That is a third overall as we
[1:34:49] look at our $4 billion
[1:34:50] budget. It's very important
[1:34:52] service that we provide.
[1:34:56] i truly believe and I often say
[1:34:57] to people, this county
[1:34:59] has universal healthcare
[1:34:59] regardless what you might have
[1:35:00] in '
[1:35:00] county.
[1:35:03] We really do have that.
[1:35:06] There is absolutely no way that
[1:35:07] you could not get
[1:35:08] service in this county if you
[1:35:09] wish to get it.
[1:35:14] You can go to one of our
[1:35:16] clinics or partnership clinic.
[1:35:18] You can access our urgent care.
[1:35:19] You can access -- there are
[1:35:21] number of ways that you can
[1:35:24] get treatment in this county.
[1:35:26] We have had support from that
[1:35:27] from the public for a
[1:35:30] very long period of time.
[1:35:32] Right now, we're under way with
[1:35:34] a new building which I
[1:35:37] think still is on target for
[1:35:38] 2013, which is going to be
[1:35:40] certainly state of the art.
[1:35:43] Having said all of that, we
[1:35:45] really have struggled over
[1:35:50] the last few years, ken equal
[1:35:52] credit and I, to really put
[1:35:55] the hospital on a different
[1:35:55] track.
[1:35:59] because just as mike mentioned
[1:36:01] earlier that the rise in
[1:36:02] healthcare is phenomenal.
[1:36:04] It is also difficult when we
[1:36:09] now have so many issues so
[1:36:11] many new diagnostic test.
[1:36:13] So much is new particularly for
[1:36:14] patients not ask for
[1:36:14] those.
[1:36:16] If you go in with broken leg
[1:36:19] now rather than simply
[1:36:20] have an x-ray, someone will say
[1:36:24] you need an mri and ct scan.
[1:36:25] There's a lot of explanation
[1:36:29] that must go on between
[1:36:30] the provider and the user.
[1:36:32] It's become a far more
[1:36:34] complicated system that we use
[1:36:36] in order to provide healthcare.
[1:36:38] one that I think we have to be
[1:36:39] explaining to the public
[1:36:41] a great deal of time.
[1:36:43] Having said that, we still got
[1:36:46] great support in '08 for
[1:36:48] the bond putting up the new
[1:36:50] building. When we have gone
[1:36:51] out
[1:36:53] for public support particularly
[1:36:54] for kids areas, trauma and
[1:36:57] so forth, we've gotten that as
[1:36:58] well.
[1:37:00] i think the public truly does
[1:37:05] value this service that
[1:37:13] we provide in exemplary way in
[1:37:13] this county.
[1:37:17] This is not a whole new area
[1:37:19] for you but a different
[1:37:21] way to deliver healthcare.
[1:37:25] I really like to say thanks to
[1:37:27] ken because this is --
[1:37:29] these are long meetings that we
[1:37:30] have.
[1:37:32] We've spend a great deal of
[1:37:34] time.
[1:37:37] I spend a lot of time talking
[1:37:39] to jeff and linda
[1:37:42] particularly with gays and cfo.
[1:37:44] We are working with diligence
[1:37:48] to try to keep the cost
[1:37:50] down of that most expensive of
[1:37:52] our department.
[1:37:53] I really want the public as
[1:37:55] well as employees know
[1:38:03] that, I think we have had a
[1:38:05] concentrate effort in order to
[1:38:06] understand more completely
[1:38:07] exactly how the healthcare
[1:38:08] dollar
[1:38:08] is spent.
[1:38:11] I think we're making some
[1:38:12] progress.
[1:38:14] I'm going to turn this over to
[1:38:16] ken next year and lord
[1:38:18] knows he May save a whole lot
[1:38:20] more than we've been able to
[1:38:21] together.
[1:38:22] i really do want to show
[1:38:24] everyone that we have worked
[1:38:24] hard on this.
[1:38:28] It good to see you renee.
[1:38:30] You will be over seeing our
[1:38:32] umbrella of healthcare
[1:38:32] services.
[1:38:38] For all the other thing that we
[1:38:39] provide, we deliver
[1:38:40] kind of a sober message.
[1:38:42] if you don't have your
[1:38:44] healthcare and you don't have a
[1:38:46] way to get healthcare to help
[1:38:50] you through the problem to
[1:38:54] hopefully get better, there's
[1:38:57] no other option.
[1:39:02] many other things we can do
[1:39:03] without.
[1:39:05] When one's health is
[1:39:06] threatened, it changes your
[1:39:07] whole
[1:39:08] life.
[1:39:10] We're in a life saving business
[1:39:11] and hopefully we're
[1:39:13] also in a prevention business,
[1:39:16] which has been one of the
[1:39:18] areas that both ken and I have
[1:39:19] concentrated on through
[1:39:22] public health as we look at our
[1:39:29] great great grants come in.
[1:39:32] A rather long speech but I feel
[1:39:35] fairly passionately
[1:39:38] about this whole area and it
[1:39:40] certainly has been a
[1:39:42] challenging but very rewarding
[1:39:43] area to work with while I've
[1:39:48] been here at the county.
[1:39:49] Thanks.
[1:39:50] >> thank you very much
[1:39:51] supervisor kniss.
[1:39:52] You did ask a question in there
[1:39:54] that I feel compelled
[1:39:55] to answer.
[1:39:59] >> I'm trying to think where I
[1:40:01] asked the question
[1:40:01] [Laughter].
[1:40:02] >> you asked whether we're
[1:40:03] still on schedule for that
[1:40:04] building.
[1:40:05] the answer to that is no.
[1:40:12] With changes in terms of our
[1:40:18] interaction with osh pod
[1:40:26] as well as we modify our
[1:40:27] strategic planning.
[1:40:29] In addition, there's some
[1:40:30] issues around the design
[1:40:33] build and the relationship with
[1:40:34] the contractor.
[1:40:36] We are behind schedule and at
[1:40:38] this point, I can't give
[1:40:40] you an exact number but it's
[1:40:44] probably in the year range.
[1:40:49] i would not expect to be ready
[1:40:52] to open in 2013.
[1:40:54] >> heading at least to 2014?
[1:40:56] >> with our fingers crossed.
[1:41:00] >> one other thing I would say
[1:41:01] george, I think we've
[1:41:04] become much more realistic in
[1:41:05] our prediction of numbers.
[1:41:09] you're going to see that in
[1:41:09] here.
[1:41:12] Ken and I both follow an daily
[1:41:14] basis what the consensus
[1:41:17] is on the hospital.
[1:41:18] Almost no stone has been
[1:41:19] unturned if we track this.
[1:41:24] As you look at this here, you
[1:41:25] have noticed we have
[1:41:27] become far more realistic in
[1:41:28] our prediction which allow us
[1:41:29] to become much more realistic
[1:41:33] as we go through our budgeting
[1:41:35] session.
[1:41:41] That -- we haven't hit our
[1:41:42] target.
[1:41:45] I think it's more realistic and
[1:41:48] i think we have seen a
[1:41:49] number of improvements lately
[1:41:54] as far as getting toward that
[1:41:57] those actual numbers we
[1:41:58] allocated last year.
[1:42:00] >> thank you supervisor. Jeff
[1:42:01] anything else?
[1:42:05] Thank you renee and let's go to
[1:42:06] the unit form 14 grant.
[1:42:08] it was a long way to get to you.
[1:42:11] >> I'm happy to wait.
[1:42:12] Custody health services. From
[1:42:13] the highlights
[1:42:15] identified above, just like to
[1:42:19] quickly point out two of the
[1:42:20] highlights.
[1:42:22] The first the second bullet
[1:42:24] where we finalized
[1:42:27] agreement with the social
[1:42:30] security administration.
[1:42:34] This is really a critical
[1:42:35] piece, success reentry
[1:42:38] efforts for inmates back into
[1:42:40] our community I'm sure board
[1:42:43] members are aware May lose
[1:42:43] benefits upon incarceration and
[1:42:45] when they are released from the
[1:42:47] jail, it takes them three,
[1:42:49] six and more months to obtain
[1:42:51] benefits. This agreement will
[1:42:55] allow us to start the process
[1:42:56] three months prior to the
[1:42:58] release and the benefits will
[1:42:59] be available to them hopefully
[1:43:01] on the day of their release.
[1:43:04] We will be able to provide
[1:43:05] appropriate housing and
[1:43:10] other benefits for them.
[1:43:11] The last bullet I will point
[1:43:15] out 62% of our inmates
[1:43:18] receive medicare and equates
[1:43:19] about 2200 inmates. 22%
[1:43:21] receive mental health services
[1:43:27] and approximately a thousand
[1:43:29] inmates. As far as our request
[1:43:32] for funding, for fiscal
[1:43:34] year, the request is six
[1:43:35] positions.
[1:43:37] These positions are direct
[1:43:50] service care providers.
[1:43:53] i would be happy to answer any
[1:43:53] questions you might have
[1:43:58] >> maybe question and comment.
[1:44:03] We had discussions with
[1:44:06] possibly medical and that whole
[1:44:09] model.
[1:44:15] i think it was on page 463, the
[1:44:16] four positions and it
[1:44:19] mentions focus of care will be
[1:44:24] on primary prevention and
[1:44:25] chronic disease management.
[1:44:27] Certainly a good plan that
[1:44:30] rotate maybe one out of the
[1:44:30] six doctors and ga the
[1:44:33] community to do that treatment
[1:44:37] possibly and I've always
[1:44:39] advocated that the -- can you
[1:44:40] talk
[1:44:42] about discussions?
[1:44:46] >> the plan is that setting and
[1:44:49] primary care clinic at
[1:44:51] the reentry center.
[1:44:58] we want it to be a transition
[1:44:58] al center.
[1:45:01] We will be providing services
[1:45:03] until we can get them
[1:45:04] reestablished within the
[1:45:06] community with their primary
[1:45:06] care
[1:45:07] provider.
[1:45:10] >> we'll hear that five year
[1:45:10] plan.
[1:45:13] I'm sure you'll be there too.
[1:45:17] other questions from the
[1:45:22] committee?
[1:45:24] >> on page 460, on the right
[1:45:28] hand side three down, it
[1:45:32] says unfunded codes.
[1:45:35] i understand it cost center and
[1:45:37] it list 24 ftes.
[1:45:38] Can you explain what those are?
[1:45:40] Are they in the body of this
[1:45:44] and I didn't see it?
[1:45:46] >> the unfunded codes
[1:45:50] historically had a number up
[1:45:51] funded codes as I believe
[1:45:53] valley medical center had
[1:45:54] unfunded
[1:45:56] codes.
[1:45:57] Primary focus of those codes is
[1:45:59] they are all clinical
[1:46:01] positions. For-instances, we
[1:46:07] have clinical nurse position,
[1:46:09] nurse practitioner.
[1:46:11] They are used on individuals on
[1:46:12] a long term leave
[1:46:16] >> those are sort of like
[1:46:18] temporary health help?
[1:46:22] >> they are not temporary help.
[1:46:24] >> temporary contracts maybe?
[1:46:25] >> they would be.
[1:46:32] If we fill the position, it
[1:46:34] will be a coded position.
[1:46:37] it's a vacant position but it's
[1:46:38] unfunded.
[1:46:42] Funding will come from the
[1:46:43] position that -- let me see
[1:46:48] if I can back up.
[1:46:50] I can't remember when we last
[1:46:51] use them.
[1:46:53] We use it on in situations
[1:46:55] where we have a critical
[1:46:56] position within the
[1:46:58] organization to provide
[1:46:59] clinical care
[1:47:02] and we don't have the capacity
[1:47:05] to fill the position because
[1:47:06] people are on long term
[1:47:07] extended leave and we need to
[1:47:09] continue to provide the service.
[1:47:12] We would seek permission to use
[1:47:15] unfunded code.
[1:47:17] Let's say a nurse practitioner,
[1:47:18] we will seek
[1:47:20] opportunity to use unfunded
[1:47:22] code, hire someone under the
[1:47:24] code and they will be a coded
[1:47:25] employee.
[1:47:29] >> what jure saying, these are
[1:47:32] sort of your kinds of
[1:47:32] provided codes?
[1:47:35] You seldom use them but you
[1:47:39] need them in a just in case
[1:47:39] situation?
[1:47:40] >> that it correct.
[1:47:42] >> you you're saying you seldom
[1:47:44] use them?
[1:47:46] >> very seldom.
[1:47:48] I have to check with finance.
[1:47:53] I know we haven't used them in
[1:48:00] many years.
[1:48:04] >> employees on long term
[1:48:08] leave, we do not need
[1:48:09] unfunded codes. Historically,
[1:48:11] the unfunded codes in custody
[1:48:15] health as well as elsewhere in
[1:48:17] the hospital as mentioned are
[1:48:20] clinical positions.
[1:48:22] They mostly for the patient
[1:48:22] census.
[1:48:27] We build to the number of
[1:48:28] positions that maximumly
[1:48:31] going to be used. At times, we
[1:48:32] look at those unfunded codes
[1:48:35] to see if we continue to
[1:48:38] reflect that in the budget.
[1:48:41] >> anything else on that?
[1:48:47] >> I think you can understand
[1:48:49] why I was somewhat
[1:48:51] puzzled by those.
[1:48:53] I almost call them extremist if
[1:48:54] you need to pull on
[1:48:54] those.
[1:48:57] It's just a lot of codes.
[1:48:59] That what seemed unusual.
[1:49:04] thanks george.
[1:49:04] >> supervisor cortese?
[1:49:06] >> this is kind of a general
[1:49:09] question about the fte
[1:49:10] that will be seen throughout
[1:49:13] the budget in terms of ab109
[1:49:15] and the add ons.
[1:49:17] I'm not really clear.
[1:49:21] I didn't catch it in the
[1:49:23] overview or anything yet, as
[1:49:26] to what the bigger picture is.
[1:49:28] Obviously, the reentry program
[1:49:29] started in this current
[1:49:30] fiscal year.
[1:49:34] It started in prior calendar
[1:49:35] year.
[1:49:38] I don't recall how we factored
[1:49:42] in covering the cost of
[1:49:42] that.
[1:49:43] Obviously reimburses from the
[1:49:45] state.
[1:49:48] How we factored in terms of fte.
[1:49:50] How we getting by.
[1:49:52] There must be some strategy
[1:49:55] beneath all of this is is
[1:49:59] ramping up with the program to
[1:49:59] add fte.
[1:50:01] I do see the revenue coming in
[1:50:02] the documents I don't
[1:50:08] know what the methods to to
[1:50:10] the madness is.
[1:50:12] The way we receive it it's
[1:50:19] pieced in unit byunit.
[1:50:20] Maybe for the benefit for the
[1:50:22] rest of us, you can tell
[1:50:25] us how does that ramping
[1:50:25] working?
[1:50:27] I didn't really want to put
[1:50:28] that on one unit here.
[1:50:32] >> in the front of the
[1:50:36] document, there's a section on
[1:50:55] ab109 that 109 attempts.
[1:50:57] The department created a plan
[1:50:58] to how we approach this.
[1:51:02] The key factor is to recognize
[1:51:03] the fact since this was
[1:51:07] a major change, a change in a
[1:51:08] that we recognized there would
[1:51:13] be things happening where we
[1:51:13] have to adjust.
[1:51:14] It's a flexible plan.
[1:51:15] Over the course since October
[1:51:17] 1, we come back to the
[1:51:19] board on two different
[1:51:21] occasions to make modifications
[1:51:24] already to the plan.
[1:51:26] we attempting to -- what we
[1:51:27] seeing we given forecast.
[1:51:31] As we implement the programs we
[1:51:33] are adjusting based on
[1:51:34] the actual experience.
[1:51:36] It's not as if it's a hard and
[1:51:38] fast plan because we're
[1:51:40] trying to be flexible.
[1:51:42] As jeff mentioned in the
[1:51:44] introduction, we plan for
[1:51:48] basic. Getting a doubling of
[1:51:49] our resource and so what's in
[1:51:52] front of you in terms of the
[1:51:53] recommended budget, reflects
[1:51:53] that.
[1:51:57] There are an impact in terms of
[1:52:02] ftes in each the
[1:52:04] area, collection, probation and
[1:52:05] custody health.
[1:52:06] There's impacts more service
[1:52:07] and contract related drug
[1:52:09] and alcohol and mental health
[1:52:11] type of services. It's a
[1:52:11] combination.
[1:52:14] What we're trying to reflect is
[1:52:16] our actual experience
[1:52:17] in the area that is
[1:52:19] particularly clear to us as
[1:52:19] probation.
[1:52:22] We trying to keep a 1 to 30
[1:52:25] case load to make sure the
[1:52:28] over sight is very intense.
[1:52:29] Corrections is a little bit
[1:52:30] more difficult because
[1:52:39] we're changing the nature of
[1:52:42] our collection system.
[1:52:42] Previously, we rarely had
[1:52:43] people here only a year.
[1:52:45] We have to look at how we're
[1:52:47] going to manage that
[1:52:48] change in the geopopulation.
[1:52:51] >> is it fair to say we're
[1:52:52] extrapolating growth based
[1:52:54] on our immediate past
[1:52:55] experience, which only been
[1:52:57] about 6
[1:52:59] offer 8 months?
[1:53:02] In the formula over all seems
[1:53:06] to be a doubling of
[1:53:08] resources?
[1:53:10] sounds like there's nuances in
[1:53:11] each unit?
[1:53:14] >> their ramping up as we see
[1:53:14] more individuals coming
[1:53:16] out of state prison, we become
[1:53:20] more responsible for in terms
[1:53:20] of parole/probation.
[1:53:22] We also seeing increase in the
[1:53:24] number of individuals
[1:53:25] coming into our local jail
[1:53:27] system.
[1:53:29] these are known the 117hs that
[1:53:30] would have gone to
[1:53:30] state prison.
[1:53:32] You end up with this increase
[1:53:33] and then people start to
[1:53:37] be released and you end up with
[1:53:38] sort of a plateau effect.
[1:53:40] We have projections from the
[1:53:41] state in terms of the
[1:53:43] numbers of people we're getting
[1:53:44] out of the state prison
[1:53:48] system that would have normally
[1:53:49] gone to state parole.
[1:53:53] we know the individual that are
[1:53:53] being sentenced.
[1:54:00] I'm getting more detail here.
[1:54:01] There's changes in the way
[1:54:02] inmates are sentenced. Some
[1:54:05] are sentenced without any
[1:54:07] probation and some are split
[1:54:07] sentences.
[1:54:10] we have to take all of those
[1:54:13] factors into account to
[1:54:14] determine what's the
[1:54:16] appropriate level.
[1:54:18] We have the spillover in terms
[1:54:19] of custody health as
[1:54:21] more people are sicker and
[1:54:24] trying to manage all of that in
[1:54:27] terms of how we're allocating
[1:54:27] our resources.
[1:54:29] The other focus is making sure
[1:54:30] these people have the
[1:54:37] services that they need to avoid
[1:54:39] recidivating
[1:54:42] >> that's been a helpful
[1:54:45] overview.
[1:54:47] I heard bits and pieces
[1:54:53] depending on who office I was
[1:54:56] sitting on.
[1:54:57] I understand all that was put
[1:54:58] together by the teams
[1:54:59] that have been working on this
[1:55:03] and you brought it back down
[1:55:04] unit by unit.
[1:55:05] The board of supervisors
[1:55:09] ultimate question is, having
[1:55:10] done that, you then match those
[1:55:13] unit numbers up with the
[1:55:14] revenue.
[1:55:18] I don't want to call it new
[1:55:20] money.
[1:55:21] There's in general fund
[1:55:21] encroachment.
[1:55:22] I don't what keep asking that
[1:55:23] question.
[1:55:24] That's what I'm really after
[1:55:25] here.
[1:55:29] I need it understand the
[1:55:39] process, any time we see these
[1:55:41] ab109 ft es ramping up, that's
[1:55:44] going to come from the unit
[1:55:44] of that state.
[1:55:45] It's a wash.
[1:55:48] >> the dollars allocated for
[1:55:50] the ab109 expenses are
[1:55:52] 100% coming from the state.
[1:55:58] we tie them directly.
[1:55:59] There's no discretionary
[1:56:00] general fund impact.
[1:56:02] So far.
[1:56:07] >> thank you very much.
[1:56:11] That was one of the concerns
[1:56:16] that part $15 billion
[1:56:17] balancing act might pull the
[1:56:19] rug out from under us.
[1:56:20] I appreciate the explanation.
[1:56:24] I was just worried that these
[1:56:26] fte May not have been
[1:56:29] unit by unit balance against
[1:56:29] the revenue.
[1:56:31] If I was in the unit, I would
[1:56:47] say this is what I need.
[1:56:49] >> we're really managing the
[1:56:51] funding allocations from
[1:56:52] the county executive's office
[1:56:56] working closely with the ccp.
[1:56:58] The thing that is really
[1:57:01] interesting is that -- one of
[1:57:02] the things we will be talking
[1:57:04] about is that the preliminary
[1:57:05] formula or funding allocation
[1:57:08] looks like it's going to
[1:57:12] allocate more than we assumed.
[1:57:14] Recognizing the concerns that
[1:57:15] everyone rightly has with
[1:57:16] the state deficit increasing, I
[1:57:19] think it's going to give us
[1:57:21] an opportunity to reserve
[1:57:22] significant portion and hold it
[1:57:26] until we have more confidence
[1:57:27] that those allocations are
[1:57:28] going to be stable.
[1:57:30] Of course, one of the issues is
[1:57:31] going to be what
[1:57:31] happens in November.
[1:57:32] There is a funding guarantee
[1:57:35] that will be on the ballot
[1:57:39] for the ab109, the public
[1:57:40] safety realignment.
[1:57:43] >> we'll talk more about that
[1:57:44] on thursday.
[1:57:45] Supervisor wassermann.
[1:57:47] >> very quickly, I really
[1:57:50] appreciate the point
[1:57:51] supervisor cortese brought up.
[1:57:52] President Shirakawa you made
[1:57:55] about the rug coming out
[1:57:56] from under us.
[1:58:03] the reason if hasn't happened,
[1:58:04] they jumped to three
[1:58:04] days ago.
[1:58:07] The question I had was on page
[1:58:08] four, talking about
[1:58:11] custody health services
[1:58:13] highlight to fiscal year '12.
[1:58:17] it talks about two out of three
[1:58:19] inmate receive medical
[1:58:20] services daily.
[1:58:21] That's an astounding number to
[1:58:22] me.
[1:58:24] I learn more every single day
[1:58:29] while I'm in office.
[1:58:31] With the transitions taking
[1:58:31] place with those being
[1:58:33] transferred from the state to
[1:58:36] county, I imagine it's about
[1:58:36] the same.
[1:58:38] because of the nature of the
[1:58:40] individuals that were the
[1:58:44] state prison, I understand
[1:58:49] there's severity seriousness of
[1:58:51] crimes committed are the
[1:58:52] make-up the prisoners?
[1:58:57] I think it changes over time.
[1:58:59] will the medical needs increase
[1:59:00] greater still with
[1:59:02] those being transferred over?
[1:59:05] >> let me make a point of
[1:59:06] clarification, the inmate who
[1:59:10] within the jail system, the
[1:59:14] ab109 inmates, we are familiar
[1:59:16] with them because they've been
[1:59:17] incarcerated and gone through
[1:59:18] trial and they are sentenced.
[1:59:20] we believe in providing care to
[1:59:21] them.
[1:59:25] They now just in a new bucket.
[1:59:28] Now they are ab109 inmay notes.
[1:59:29] The inmates from the prison
[1:59:31] system who being released
[1:59:33] from the prison, we do not
[1:59:36] provide services to them within
[1:59:37] the jail.
[1:59:42] >> they're all probationary?
[1:59:45] >> yes.
[1:59:46] We would establish primary
[1:59:50] clinic center. We would
[1:59:54] have the doors open to them.
[1:59:55] >> thank you for that
[1:59:56] clarification.
[1:59:58] >> with respect do we
[1:59:59] anticipate that the healthcare
[2:00:00] needs essentially going to
[2:00:06] change this population, we do.
[2:00:08] In the past, although many May
[2:00:09] stay with us many years
[2:00:13] while they going through their
[2:00:15] trial, generally, period of
[2:00:18] time within the jail maybe 150
[2:00:20] average length of stay.
[2:00:23] we didn't necessarily need to
[2:00:24] provide services.
[2:00:27] For instance someone had a
[2:00:29] minor hernia, we would not
[2:00:31] support having that hernia
[2:00:33] repaired while they were in
[2:00:33] custody.
[2:00:36] It would be taken care when
[2:00:36] they were released.
[2:00:38] Now that they are going to be
[2:00:40] sentenced to the jail, we
[2:00:41] need to provide those services
[2:00:42] for them.
[2:00:48] In fact, we need to provide
[2:00:49] preventive healthcare
[2:00:50] services because they are going
[2:00:51] to be with us year after
[2:00:52] year.
[2:00:55] We do anticipate there will be
[2:00:56] very significant
[2:00:56] changes.
[2:00:59] >> I like to expand on that a
[2:01:00] little bit.
[2:01:05] it is also true that the
[2:01:06] inmates who classically are in
[2:01:10] prison or has been in prison
[2:01:14] tend to be less healthy than
[2:01:15] what has classically been in
[2:01:15] jail.
[2:01:18] That has to do with a lot of
[2:01:21] factors but when you
[2:01:22] figure that the vast majority
[2:01:24] of the crimes that are
[2:01:25] committed that result in people
[2:01:28] being in jail are drug
[2:01:30] related and violence related
[2:01:32] and people typically also
[2:01:37] taking their own drugs.
[2:01:39] We are much more able to keep
[2:01:41] people alive for longer
[2:01:42] periods of time.
[2:01:46] lots of people with chronic
[2:01:48] heart disease, chronic lung
[2:01:49] disease, chronic kidney
[2:01:53] disease, diabetes, all kinds of
[2:01:54] other issues infection, tb, hiv
[2:01:58] and various sort of things.
[2:02:00] As maryann brings out, now that
[2:02:01] we're going to be
[2:02:02] responsible for these people
[2:02:06] for a longer period of time,
[2:02:08] we're going to be responsible
[2:02:12] for things like transplants,
[2:02:15] dialysis, lots of very
[2:02:16] expensive procedures.
[2:02:18] >> you're saying they let
[2:02:20] health insurance lapse?
[2:02:24] >> we don't --
[2:02:25] >> I'm kidding.
[2:02:26] >> the question you are getting
[2:02:28] at, they're going to
[2:02:31] get more extensive and the
[2:02:35] answer is question yes, lot
[2:02:58] more.
[2:03:04] >> I wanted to ask board of
[2:03:07] supervisors so extend
[2:03:10] services to juvenile hall.
[2:03:15] They get visit one day a week.
[2:03:20] With 60% of the kids, have
[2:03:21] serious dental issues.
[2:03:25] It was also noted in the last
[2:03:25] juvenile justice report
[2:03:29] several grievances were filed
[2:03:32] by you because dental payments
[2:03:33] were delayed.
[2:03:35] We all know how much dental
[2:03:36] pain interferes with your
[2:03:42] ability to learn and behave.
[2:03:45] I know san diego is a much
[2:03:47] larger system but they have
[2:03:47] two full time dentist.
[2:03:51] We need to figure out how to do
[2:03:52] this because these kids
[2:03:56] -- they have so many issues
[2:03:59] with them.
[2:03:59] Thank you.
[2:04:02] >> any other questions on this
[2:04:04] unit?
[2:04:10] i see none, thank you.
[2:04:32] next unit is 417.
[2:04:34] >> good afternoon President And
[2:04:37] board members.
[2:04:38] I'm bruce copeley.
[2:04:41] I'm here to review our
[2:04:42] recommended budget.
[2:04:46] I would draw your attention to
[2:04:47] two elements.
[2:04:52] the first is a recommendation
[2:04:56] for authorization for
[2:04:58] $311,000 for two psychiatric
[2:05:00] social workers and a
[2:05:02] replacement of dollars lost for
[2:05:03] half time psychiatric social
[2:05:04] worker.
[2:05:07] These are individuals that are
[2:05:10] working at the park and
[2:05:13] adopted at the clinic to
[2:05:14] provide additional medical
[2:05:14] services.
[2:05:17] They will be providing
[2:05:19] screenings, consultation to the
[2:05:21] primary care doctors and
[2:05:23] treatment.
[2:05:30] The second is $401,000 that is
[2:05:32] for augmentation and
[2:05:33] enrollment of clients into the
[2:05:34] valley care.
[2:05:36] These are fees previously
[2:05:36] collected both from the
[2:05:38] county department as well as
[2:05:41] from our contract agencies.
[2:05:43] With enrollment of valley care
[2:05:44] that is eliminated to
[2:05:45] continue the capacity necessary
[2:05:47] to serve these individuals
[2:05:55] and to bring in enrollment in
[2:05:56] anticipation medi-cal
[2:05:57] qualification.
[2:05:58] We're recommending these
[2:05:59] dollars be added.
[2:06:02] The final good news is,
[2:06:03] approximately $2 million of
[2:06:05] additional 109 moneys that are
[2:06:07] recommended to be brought
[2:06:09] into the department to stand
[2:06:11] both outpatient services and
[2:06:11] residential services.
[2:06:15] currently we have a waiting
[2:06:16] list from ab109.
[2:06:18] It will substantially reduce
[2:06:19] that waiting list and
[2:06:20] allow us to serve the
[2:06:24] individuals that are now coming
[2:06:24] for
[2:06:25] into ab109 process.
[2:06:27] With that I'll take any
[2:06:28] questions or clarifications you
[2:06:32] would like from me.
[2:06:35] >> let me just start by saying
[2:06:37] thank you.
[2:06:40] Last year we talked about the
[2:06:41] gateway program.
[2:06:44] We all know people are ready to
[2:06:46] make that change and so
[2:06:48] appreciate that effort.
[2:06:49] You mentioned the $2 million.
[2:06:52] Hopefully it will free up this
[2:06:54] $2 million more services
[2:06:56] for others.
[2:06:57] That's a good thing.
[2:06:58] Supervisor wassermann?
[2:07:00] >> just a quick question, one
[2:07:01] way or another, how long
[2:07:03] have you been with the county?
[2:07:08] >> 24 years in another month.
[2:07:11] 14 years with dad and 10 years
[2:07:11] with mental health.
[2:07:14] >> it's probably a good time to
[2:07:16] think about, I know
[2:07:21] folks have talked previewed
[2:07:24] some kind of behavior health
[2:07:26] department from a dads merger.
[2:07:29] I know others out there talked
[2:07:30] about it.
[2:07:34] I'm just throwing that out
[2:07:36] there as a comment.
[2:07:38] >> I know that the issue has
[2:07:41] been discussed.
[2:07:43] I just met this morning with
[2:07:44] bruce.
[2:07:45] He's getting up to speed.
[2:07:49] We're looking at all of our
[2:07:52] options at to point and
[2:07:53] pluses and minuses to no matter
[2:07:55] what you do and nothing will
[2:07:57] be done without stakeholderrer
[2:07:58] input.
[2:07:59] >> it doesn't hurt to have the
[2:08:00] discussion for sure.
[2:08:02] That's all I'm saying.
[2:08:03] >> I understand.
[2:08:06] >> I don't have any other
[2:08:06] lights on thank you.
[2:08:11] We'll move on to the next
[2:08:15] section, unit 418, community
[2:08:25] health services.
[2:08:31] >> dave wright, directors of
[2:08:32] ambulatory care services.
[2:08:35] Our community health services
[2:08:41] is composed of two
[2:08:44] community health clinics.
[2:08:48] They also receive the unit and
[2:08:49] diversity award by the
[2:08:53] board of supervisors.
[2:08:59] our tb clinic and refugee
[2:09:03] clinic, they have the liest
[2:09:05] numbers coming from iran,
[2:09:07] burma, iraq and china.
[2:09:14] No budget changes are proposed
[2:09:22] for fy '13.
[2:09:24] >> I don't have any lights on.
[2:09:27] You're off the hook.
[2:09:30] Good job dave.
[2:09:35] Item 12, unit 725.
[2:09:40] valley health plan.
[2:09:45] >> hello.
[2:09:45] Greg price.
[2:09:47] Valley health plan has a
[2:09:48] commercial plan.
[2:09:50] We had a very successful year
[2:09:52] this year.
[2:09:53] We approach being 15,000
[2:09:55] commercial members.
[2:09:58] We also manage medi-cal,
[2:10:00] healthy kids healthy families
[2:10:01] for valley medical center.
[2:10:03] We're getting on to about
[2:10:06] 90,000 new lives and we're
[2:10:07] forecasting about 184 million
[2:10:08] next year in revenue.
[2:10:14] All of our positions for fy '12
[2:10:15] were paid for.
[2:10:17] We're in the asking for any new
[2:10:18] money.
[2:10:19] any questions about the budget?
[2:10:22] >> I don't have any lights.
[2:10:22] No, thank you.
[2:10:27] >> always a pleasure.
[2:10:31] Thanks.
[2:10:32] >> we still --
[2:10:33] >> we should mention at health
[2:10:34] and hospital committee,
[2:10:37] we discussed all of these.
[2:10:39] >> as a case with all the
[2:10:41] sections and committees
[2:10:44] either have or will have
[2:10:45] detailed discussions.
[2:10:45] Thank you.
[2:10:46] Supervisor wassermann.
[2:10:49] >> I want to mention that it's
[2:10:52] a pleasure spending
[2:10:54] hours going over these binders
[2:10:55] with staff and discussing and
[2:10:58] at the end hearing no new
[2:10:59] changes, status quo that kind
[2:10:59] of
[2:11:00] thing.
[2:11:02] Think you're all doing great
[2:11:05] work.
[2:11:06] >> thank you.
[2:11:07] Item 410.
[2:11:09] >> we'll start by going through
[2:11:14] our highlights for the
[2:11:14] year.
[2:11:18] Really a huge thanks to our
[2:11:18] board of supervisors for
[2:11:22] being progressive in adopting a
[2:11:23] number of health related
[2:11:24] policies. Just a quick
[2:11:26] refresher over this list.
[2:11:27] We adopted a comprehensive food
[2:11:27] and nutritional
[2:11:31] policies which a lot of folks
[2:11:31] worked on.
[2:11:34] Both the city and county passed
[2:11:37] a number of outdoor
[2:11:40] smoke prevention policy
[2:11:45] including tobacco retail
[2:11:45] licensing.
[2:11:47] We're in the line of to do the
[2:11:49] latino health assessment
[2:11:57] in the fall of 2012.
[2:11:58] The vietnamese community it in
[2:11:58] the bay area and become
[2:12:00] state and nationally recognized.
[2:12:02] as you will recall this time
[2:12:05] ast year, we were talking
[2:12:07] about a potential new vendor
[2:12:10] for our ems system.
[2:12:12] I'm pleased metro has been
[2:12:13] performing good or better
[2:12:14] than prior vendor.
[2:12:16] The response time is slightly
[2:12:16] better.
[2:12:18] All in all slight improvement
[2:12:22] in the system and kept
[2:12:23] the system affordable.
[2:12:24] now budget highlights.
[2:12:27] Much like my other colleagues
[2:12:28] our budget is essentially
[2:12:30] level budget for this next
[2:12:31] fiscal year.
[2:12:33] No additional county general
[2:12:34] fund augmentation request.
[2:12:35] I will quickly run you through
[2:12:37] where we're moving some
[2:12:39] money.
[2:12:45] we're moving essentially
[2:12:46] $247,000 from federal fund.
[2:12:49] I will start with accreditation.
[2:12:50] As I mentioned before,
[2:12:51] accreditation is a additional
[2:12:52] public health effort.
[2:12:55] We're going to be moving about
[2:12:56] $95,000 into that
[2:12:57] particular effort.
[2:12:58] The latino health assessment
[2:13:03] actually will cost us
[2:13:04] around $250,000 to $300,000.
[2:13:08] we need to move additional
[2:13:08] $75,000 essentially out of
[2:13:09] the administration in other
[2:13:12] areas and back fill that.
[2:13:14] Incidentally, we went out for
[2:13:16] bids to do the community
[2:13:18] neighborhood assessment for the
[2:13:18] latino health assessment.
[2:13:20] We got quotes as high as a
[2:13:21] million dollars.
[2:13:22] The fact that we're actually
[2:13:27] able to deliver hopefully,
[2:13:28] deliver an assessment during
[2:13:29] financial health week, it's
[2:13:30] quite an accomplishment for the
[2:13:31] amount of money we're
[2:13:31] working with.
[2:13:37] We like to propose to move about
[2:13:43] $30,000 into help
[2:13:44] promotion media.
[2:13:47] we were fortunate to have a
[2:13:48] full time position.
[2:13:52] We don't have a single dollar
[2:13:53] behind her code this is
[2:13:54] to recognize a small amount of
[2:13:58] money for that type of work.
[2:14:00] Public health preparedded, is
[2:14:01] an interesting idea.
[2:14:04] We never had any dedicated
[2:14:07] staff.
[2:14:07] This amount money coming from
[2:14:09] internal resources which
[2:14:10] fund a half time code.
[2:14:12] We'd initially hope to work
[2:14:15] with oes and faf to fund a
[2:14:16] full time position and we could
[2:14:17] have contributed half of
[2:14:17] that.
[2:14:23] We were not able to do this in
[2:14:26] this budget cycle.
[2:14:29] we have roughly $4 million in
[2:14:30] inventory in the
[2:14:30] warehouse.
[2:14:33] By the time full lease payment
[2:14:35] will be made, the county
[2:14:36] well invested well over $10
[2:14:37] million.
[2:14:38] This particular code and the
[2:14:39] reason I'm talking a
[2:14:41] little bit more about this one,
[2:14:42] is that this would be the
[2:14:45] one and only individual
[2:14:46] dedicated to nation sure that
[2:14:49] warehouse is on a ready-go
[2:14:50] status at all time.
[2:14:53] It's able to both receive and
[2:14:54] deploy goods in rain out
[2:14:56] of the warehouse in a disaster
[2:14:58] situation.
[2:15:01] The next item is interesting
[2:15:01] one immunization clinic
[2:15:04] staffing.
[2:15:06] We have 1.5 vacant codes in
[2:15:09] that particular code and we
[2:15:15] will be adding 1.5 1.5 vacant
[2:15:15] code.
[2:15:18] We're going to be deleting a
[2:15:23] vacant office specialist
[2:15:26] and a vacant clinical nurse and
[2:15:31] adding a full time office
[2:15:32] specialist specializing in data
[2:15:33] entry.
[2:15:34] Then the childhood led poison
[2:15:37] program, we are losing a
[2:15:40] state grant of just under
[2:15:41] $94,000.
[2:15:45] Therefore we're going to let
[2:15:47] go of a vacant position.
[2:15:49] This is cleanup from last
[2:15:51] budget year.
[2:15:55] We had lost grant last budget
[2:15:55] cycle.
[2:15:56] This is actually a cleanup that
[2:15:58] is to say that the
[2:15:59] services have not been provided
[2:16:01] for the full fiscal year.
[2:16:04] The child, health and
[2:16:04] disability prevention, we're
[2:16:09] going to be deleting a vacant
[2:16:12] public health nurse three
[2:16:12] code.
[2:16:16] That's due to the fact we're
[2:16:17] losing $110,000 state
[2:16:18] grant.
[2:16:20] That particular line item
[2:16:28] allows us to move $22,000 to
[2:16:30] general fund.
[2:16:33] we ask pharmacy to be very
[2:16:33] aggressive on object two
[2:16:34] cost.
[2:16:38] Really bringing down the cost
[2:16:39] of pharmaceuticals, we're
[2:16:42] able to move about $2000 of
[2:16:47] what's county general fund.
[2:16:50] Any questions?
[2:16:51] >> supervisor kniss?
[2:16:54] >> just some comments and a
[2:16:54] couple questions.
[2:16:57] One of the thing I like to call
[2:16:59] out is that with all of
[2:17:02] our employees, we happen to
[2:17:06] work particularly closely with
[2:17:08] dan peddycord.
[2:17:11] We came to me the other night
[2:17:11] with comprehensive plan.
[2:17:15] it was a challenging meeting.
[2:17:21] He handled it well.
[2:17:26] I want to call out that also on
[2:17:26] a national level, we
[2:17:29] have nose who play a major role
[2:17:33] and dan you're one of those.
[2:17:37] That would lead me into talking
[2:17:37] about the prevention
[2:17:42] fund which is part of the aca.
[2:17:46] One that naco and c-sac worked
[2:17:47] hard to protect.
[2:17:50] I had the health steering
[2:17:50] committee for naco.
[2:17:53] that is one of our top
[2:17:54] priorities.
[2:17:55] The reason that's so important
[2:17:58] that is where we have
[2:18:00] applied some time grants do
[2:18:02] come from other places. That
[2:18:02] is
[2:18:05] place where we can get grants.
[2:18:07] That is where some money can
[2:18:08] come in for just the kind
[2:18:11] of thing we talk about, led
[2:18:12] poisoning and so forth.
[2:18:13] There are issues that are
[2:18:14] looking for thousands of
[2:18:16] dollars and not for millions.
[2:18:19] They make a big difference in
[2:18:19] counties.
[2:18:23] It is a fund that is constantly
[2:18:24] in jeopardy that
[2:18:27] congress looks at it like it's
[2:18:29] a flush fund.
[2:18:31] Prevention doesn't have any
[2:18:33] great payback as far as
[2:18:34] they are concerned.
[2:18:38] It's a lot easier also if we
[2:18:38] put money into acute care
[2:18:40] and than it is to put into
[2:18:41] expression.
[2:18:44] It's one of areas public health
[2:18:46] keeps working hard.
[2:18:47] Marty is part of the national
[2:18:48] group as well.
[2:18:51] I just want to say out loud
[2:18:54] both marty and for dan, i
[2:18:56] so appreciate your service
[2:18:59] because we do get heard around
[2:18:59] the country.
[2:19:02] We are recognized being a
[2:19:05] county that really does do
[2:19:07] excellent work in the
[2:19:07] healthcare field.
[2:19:11] >> thank you very much
[2:19:12] supervisor kniss.
[2:19:14] By 2014 that fund is suppose to
[2:19:15] be about $2 billion on
[2:19:16] a national level.
[2:19:17] It represents the first time
[2:19:19] the federal government put
[2:19:20] some real financial backbone
[2:19:21] into prevention.
[2:19:23] We were the fortunate
[2:19:25] recipients through the
[2:19:26] community
[2:19:27] prevention work money for
[2:19:29] obesity that is reflected this
[2:19:31] that fund.
[2:19:34] Those funds seeming to come to
[2:19:36] an end here in our
[2:19:36] county.
[2:19:38] >> thank you having said that,
[2:19:41] we have a couple
[2:19:42] questions.
[2:19:45] We just talked about emergency
[2:19:46] warehouse position.
[2:19:47] Do we have any other department
[2:19:51] in the county that has
[2:19:54] any role in that warehouse?
[2:19:57] i only visited it once.
[2:19:59] >> we have a small presence
[2:20:00] there.
[2:20:01] The sheriff's office has a
[2:20:02] small presence there.
[2:20:04] We try to work with those
[2:20:06] partners to fill out the
[2:20:08] other half of the fte that full
[2:20:11] time code was justified for
[2:20:14] the amount of assets in that
[2:20:15] warehouse.
[2:20:17] they were not able to fund that
[2:20:18] particular request.
[2:20:19] Our proposal was to go forward
[2:20:20] at least with the half
[2:20:20] time code.
[2:20:23] >> thank you, I appreciate that.
[2:20:25] The other one regards the
[2:20:28] ongoing money for the phd
[2:20:29] accreditation, prep and
[2:20:29] application.
[2:20:32] Does it need to be ongoing
[2:20:32] situation?
[2:20:39] is that one to be a downside to
[2:20:39] one time money?
[2:20:41] >> we're looking at that level
[2:20:42] of commitment on ongoing
[2:20:43] basis.
[2:20:44] Once we reached point of
[2:20:48] applying, we will need to send
[2:20:49] in about $55,000 check. This
[2:20:51] that's good for five years.
[2:20:53] However, most department of our
[2:20:57] size are looking a the
[2:20:59] staffing 1-3 fte full time
[2:21:02] dedicated accreditation.
[2:21:03] What accreditation is
[2:21:05] instilling high level of
[2:21:06] quality
[2:21:06] insurance performance
[2:21:07] improvement across an entire
[2:21:08] organization.
[2:21:10] That takes small investment of
[2:21:11] human resources.
[2:21:13] >> so, I guess my question
[2:21:15] would be, because once we've
[2:21:17] gotten into ongoing, we tend to
[2:21:21] not look at it again as you
[2:21:21] know.
[2:21:25] You feel that's justified and
[2:21:26] something that we should
[2:21:27] include over the next several
[2:21:29] years?
[2:21:32] >> yes, I would very much
[2:21:33] supervisor kniss.
[2:21:38] We are moving other fte within
[2:21:39] the department to back
[2:21:39] our resource need.
[2:21:41] Rather than coming to you and
[2:21:44] asking for a financial
[2:21:46] augmentation for fte, we felt
[2:21:50] $95,000 if it stays relatively
[2:21:53] level should afford reasonable
[2:21:55] level of resource to sustain
[2:21:56] journey to accreditation.
[2:21:58] >> okay, thanks.
[2:21:58] >> besides supervisor the
[2:22:01] president announced on the
[2:22:02] state of the county.
[2:22:04] >> you know, george, you said
[2:22:05] it.
[2:22:06] It's got to be true.
[2:22:22] >> dan, just a couple things.
[2:22:23] When it comes to trauma and
[2:22:25] violence and injury and all
[2:22:26] of those issues, you guys are
[2:22:27] the experts I'm not.
[2:22:32] I can tell you, you come from a
[2:22:33] community of me -- I
[2:22:36] don't need to study, I don't
[2:22:37] need experts tell us the impact
[2:22:38] it has.
[2:22:45] we all know the impact of those
[2:22:50] -- obviously smoking
[2:22:50] thing.
[2:22:50] Interinterrelated.
[2:22:52] I want to thank you for your
[2:22:53] work and I know the
[2:22:57] committee will continue to have
[2:22:58] discussions.
[2:23:01] I think it was a one man
[2:23:02] discussion last time.
[2:23:04] I appreciate your efforts for
[2:23:06] sure and you can expect
[2:23:09] memo from supervisor kniss and
[2:23:10] I here shortly.
[2:23:13] Certainly finding someone to
[2:23:15] help coordinate some of
[2:23:24] those efforts.
[2:23:26] I just want to say that and
[2:23:29] thank you at this time and
[2:23:31] of course, some of the staff
[2:23:32] offline will ask you a few
[2:23:34] things to bring back in the
[2:23:34] future.
[2:23:38] Anything else on this item
[2:23:38] before the board?
[2:23:42] See none, thank you again.
[2:23:46] we're down to our last, before
[2:23:52] we recess, last unit,
[2:23:54] 412, mental health department.
[2:24:06] i see Dr. Pena making a way up.
[2:24:08] >> good afternoon.
[2:24:09] President Shirakawa and board
[2:24:10] of supervisors, nancy
[2:24:12] pena, mental health director.
[2:24:16] I am going to briefly talk
[2:24:18] about our highlights from
[2:24:19] this past year.
[2:24:22] We've been extremely busy.
[2:24:24] Thanks to really the support of
[2:24:26] the full board, mental
[2:24:29] health has been extremely busy
[2:24:33] and a very happy with our
[2:24:35] activities.
[2:24:36] School link services
[2:24:38] initiative, we are getting for
[2:24:38] the
[2:24:41] launch in fiscal year '13.
[2:24:43] Our older adult summit is also
[2:24:44] creating some
[2:24:45] implementation planning that we
[2:24:46] will also bring forward as
[2:24:49] we go into the next year.
[2:24:51] Certainly our partnership with
[2:24:53] ab109 and the ccp and
[2:24:55] all of the county departments
[2:24:57] that are participating in that
[2:24:58] has been extremely rewarding
[2:25:01] and we really look forward to
[2:25:04] the next year as we go forward.
[2:25:06] then as we do continue our work
[2:25:09] with the mental health
[2:25:11] services act and our interface
[2:25:13] with various innovations
[2:25:15] projects as well as
[2:25:18] partnership, we're extremely
[2:25:18] busy right
[2:25:18] now.
[2:25:21] One of the things I did want to
[2:25:23] note that isn't on the
[2:25:25] slides, it relates to the
[2:25:25] mental health services acts.
[2:25:28] This is an item that will be
[2:25:29] coming forward to the
[2:25:30] board.
[2:25:33] Probably in August once you
[2:25:33] return from the break.
[2:25:35] That's just because the timing
[2:25:38] for the mental health
[2:25:40] services act annual report and
[2:25:41] 30 day posting that to the
[2:25:43] public and then the hearing
[2:25:44] that we have to have through
[2:25:45] our
[2:25:46] mental health board won't
[2:25:48] happen until July probably.
[2:25:51] That means that we now have to
[2:25:52] come forward to you with
[2:25:55] our full plan for the mental
[2:25:57] health services act in August.
[2:25:59] There will be some items on
[2:26:02] there that we will be
[2:26:05] requesting in terms of ftes or
[2:26:07] funding for programs that
[2:26:08] you will see at that time.
[2:26:10] I just wanted to make sure that
[2:26:12] are aware of that.
[2:26:15] We are expecting with mental
[2:26:16] health services act to
[2:26:22] have about a 20% increase for
[2:26:22] fiscal year '13.
[2:26:23] That will pretty much pay for
[2:26:25] most of the items that we
[2:26:28] have funded with one time funds.
[2:26:29] we'll be bringing that forward
[2:26:32] and our budget for the
[2:26:33] mental health services act next
[2:26:36] year will be approximately
[2:26:37] $53 million.
[2:26:38] So it's a significant amount in
[2:26:39] the mental health
[2:26:39] department.
[2:26:42] Going on to the items that we
[2:26:46] have.
[2:26:48] The first item should be in the
[2:26:50] emerging issues.
[2:26:53] We are exploring the
[2:26:54] possibility of operating our
[2:26:58] emergency site services as a
[2:27:00] separate distinct stabilization
[2:27:00] program.
[2:27:04] You can operate these programs,
[2:27:05] these emergency psychs
[2:27:07] in two different ways.
[2:27:10] one is attached to a hospitals
[2:27:12] a an psych er the other
[2:27:15] one is a free standing crisis
[2:27:17] stabilization service.
[2:27:20] Both of them would be locked
[2:27:21] and contained and pretty
[2:27:23] much in compliance with title 9.
[2:27:27] We are really in the
[2:27:28] exploratory phases.
[2:27:34] we determine whether or not we
[2:27:34] will be feasible.
[2:27:37] If it is feasible, we will come
[2:27:38] back to you later in
[2:27:42] the fall with a proposal.
[2:27:47] I wanted to make sure people
[2:27:52] are seeing that we are
[2:27:54] operating off the vmc license.
[2:27:55] That is in the next fiscal
[2:27:56] year, we'll be coming
[2:27:58] forward with some plan about
[2:28:01] that or at least some reports
[2:28:02] on it.
[2:28:06] The second item relates to
[2:28:10] changes in the lives relates
[2:28:11] to special education.
[2:28:12] As aware the responsibility
[2:28:13] that the mental health
[2:28:16] department had and the counties
[2:28:19] had has changed this fiscal
[2:28:21] year.
[2:28:23] This fiscal year '12 to fiscal
[2:28:24] year '13 when the
[2:28:27] schools will be solely
[2:28:38] responsible for providing iep
[2:28:38] related
[2:28:39] service.
[2:28:43] We will continue to be involved
[2:28:46] as medi-cal
[2:28:51] beneficiaries are served
[2:28:52] through the health system he
[2:28:53] will
[2:28:54] no longer be the administrator
[2:28:55] of the program.
[2:28:58] Basically what this item, we're
[2:28:59] downsizing somewhat the
[2:29:00] budget that we have dedicated
[2:29:03] to that in general fund.
[2:29:07] Actually what we gend to do is
[2:29:09] redirect equivalent
[2:29:13] amount of two schooling
[2:29:16] services to help support our
[2:29:17] new
[2:29:18] schooling services effort.
[2:29:22] The next item really relates,
[2:29:23] we talked to you about
[2:29:25] this a little bit in this
[2:29:26] fiscal year, programs were
[2:29:29] transferred from dads to mental
[2:29:33] health.
[2:29:40] for the calworks treatment
[2:29:41] services. This basically
[2:29:42] moving the three administrative
[2:29:45] staff who are connected to
[2:29:46] those services from dads into
[2:29:48] the mental health department.
[2:29:51] The next item really is a no
[2:29:53] cost item but it does
[2:29:55] relate to priority of the board
[2:29:56] and certainly the county
[2:29:59] exec that we take a look at the
[2:30:02] high users in our county
[2:30:03] across departmentally.
[2:30:08] Particularly those who are
[2:30:09] homeless and chronically
[2:30:09] homeless as well as those who
[2:30:13] are involved in the criminal
[2:30:15] justice system and the health
[2:30:16] system.
[2:30:18] Those we consider most frequent
[2:30:20] users.
[2:30:21] And really looking at
[2:30:23] assessment of that population
[2:30:23] to
[2:30:25] see what we can do improve the
[2:30:26] services that we offer as a
[2:30:29] safety net for these
[2:30:30] populations.
[2:30:32] We also had some grant
[2:30:33] terminations ending of grants.
[2:30:37] we are picking those up in our
[2:30:40] medi-cal program or
[2:30:43] lihp, low income program.
[2:30:50] We do have 4.5ftes that we
[2:30:59] requested through the ab
[2:31:07] ab109 program.
[2:31:10] We also have a proposal here
[2:31:12] that really is done in
[2:31:13] collaboration with dads
[2:31:15] regarding the low income health
[2:31:15] plan
[2:31:19] and our continuing to move
[2:31:22] towards an expanded medi-cal
[2:31:25] program and benefits beginning
[2:31:27] in 2014.
[2:31:30] In will add some qi staff and
[2:31:31] health services
[2:31:32] representative staff to mental
[2:31:35] health that will be dedicated
[2:31:36] to dads.
[2:31:39] for the development more of a
[2:31:40] managed care
[2:31:41] infrastructure, getting ready
[2:31:44] for the future when there will
[2:31:46] be more individuals with
[2:31:50] medi-cal benefit who will be
[2:31:50] entitled to substance abuse
[2:31:53] treatment as well as mental
[2:31:55] health benefits.
[2:31:57] Finally, the last item is three
[2:31:59] contract staff.
[2:32:01] These would all be be paid
[2:32:04] through funding.
[2:32:07] We came to you earlier through
[2:32:08] the mental health
[2:32:09] hospital for these positions.
[2:32:12] These positions are desperately
[2:32:14] needed a we move into
[2:32:19] really processing close to 500
[2:32:22] either contract, rfps,
[2:32:24] mous we expect many for coming
[2:32:27] with school link services
[2:32:29] as we enter into agreements and
[2:32:31] our provides across the
[2:32:32] county to articulate services
[2:32:34] that we'll be delivering.
[2:32:36] These three staff are basic in
[2:32:38] our contract units to
[2:32:41] support the contracting process.
[2:32:45] With that, I will welcome any
[2:32:48] questions.
[2:32:49] >> any questions.
[2:32:56] I have one speaker.
[2:33:01] sparky, good afternoon.
[2:33:02] >> good afternoon.
[2:33:08] I wasn't sure if this belonged
[2:33:11] to you but it has to do
[2:33:12] with my concern with rap
[2:33:13] services.
[2:33:20] the reduction of services that
[2:33:21] emq and rebecca would
[2:33:21] have.
[2:33:24] If you've going to change
[2:33:24] providers, that's fine with
[2:33:27] me but I'm really concerned as
[2:33:29] you're putting this stuff out
[2:33:31] to bid, how you're going to
[2:33:31] transfer clients over?
[2:33:35] I know when I lost a grant that
[2:33:37] we had for 25 years
[2:33:39] with iop independent living
[2:33:40] program, the kids were suppose
[2:33:42] to transfer over and they did
[2:33:43] not.
[2:33:44] Because it was so tied to
[2:33:45] provider, they really did not
[2:33:48] want to transfer over to a new
[2:33:48] provider.
[2:33:50] Even though we tried really
[2:33:52] hard to do that.
[2:33:54] So my concern is that you
[2:33:57] really look at how those
[2:34:00] clients are going to transfer
[2:34:02] over sense they are most
[2:34:05] serious mentally ill clients
[2:34:06] and look attrition fund to give
[2:34:09] them time to transition out of
[2:34:10] emq.
[2:34:11] Another thought I have is
[2:34:13] something I know county
[2:34:15] department, how about
[2:34:16] encouraging new providers to
[2:34:17] hire
[2:34:17] those people that will be laid
[2:34:18] off.
[2:34:20] I can tell you right now what's
[2:34:20] happening.
[2:34:24] there's a lot of movement in
[2:34:25] nonprofit sector with
[2:34:27] everybody is changing jobs.
[2:34:32] We're all getting new contracts.
[2:34:37] We're all hiring each other
[2:34:52] staff.
[2:34:53] >> any questions from the board
[2:34:57] before we recess to
[2:34:58] 6:30?
[2:34:58] Jeff?
[2:35:01] Members of the boards, we will
[2:35:04] recess until 6:30
[2:35:04] exactly.
[2:59:41] >> we have our hands full at
[2:59:45] this time we do not have the
[2:59:46] financial expertise to handle
[2:59:50] these tasks at this time.
[2:59:52] Nor do we feel that the cross
[2:59:55] training is sustainable in the
[2:59:56] long run.
[3:00:07] And this will also relate to
[3:00:09] policies and procedures for the
[3:00:10] tasks.
[3:00:12] Thank you for your time, only
[3:00:14] financial experts can provide
[3:00:15] financial expertise.
[3:00:23] >> thank you.
[3:00:27] >> I am brett russell, and an
[3:00:28] am state administrator, and I
[3:00:31] have been worked in the office
[3:00:34] for 25 years and came in as an
[3:00:35] entry level position.
[3:00:39] I have worked myself up to the
[3:00:40] state administrator position.
[3:00:46] I was hired shortly after the
[3:00:48] grand injury admin strargz that
[3:00:51] held for the model was
[3:00:52] insufficient to protect our
[3:01:00] clients and the county
[3:06:28] incompetence and waste.
[3:06:36] >> good evening.
[3:06:40] So first highlights from fiscal
[3:06:41] year 12.
[3:06:44] We have increased hours of
[3:06:46] service at valley health center.
[3:06:50] we have reduced our diversion
[3:06:51] hours by 60%.
[3:06:55] Meaning that we are open to
[3:06:56] more ambulances arriving
[3:06:58] serving our community.
[3:07:03] We achieved our disrepresent
[3:07:05] milestones for the year, and
[3:07:07] collecting all revenue we could.
[3:07:10] And we have begun installation
[3:07:12] of the electronic record and
[3:07:16] scheduled to go live on that.
[3:07:19] We have formed a partnership
[3:07:23] for fciu to help in health care
[3:07:23] reform.
[3:07:25] We have seen increase in
[3:07:27] satisfaction over the last
[3:07:29] three quarters.
[3:07:31] And finally credited by the
[3:07:32] american college surgeons for
[3:07:33] burn care.
[3:07:35] Those are the highlights of our
[3:07:39] current fiscal year.
[3:07:45] We have 15 budget proposals for
[3:07:46] next fiscal year.
[3:07:51] We started with a deficit of 84
[3:07:52] million, once we based our
[3:07:54] revenue and the experience of
[3:08:01] the current fiscal year.
[3:08:03] The item that genders the most
[3:08:06] conversation is the clinic care
[3:08:06] volume.
[3:08:08] Some comments about where we
[3:08:14] are with that in this year.
[3:08:16] The projection for next fiscal
[3:08:24] year is a 15% -- 14% drop from
[3:08:30] the kurpt -- current year.
[3:08:33] we believe this is an
[3:08:35] achievable number.
[3:08:38] This is a sustainable number.
[3:08:40] We reduced our unused
[3:08:41] appointment slots.
[3:08:45] We have in our current clinic
[3:08:47] scheduling system the capacity
[3:08:50] to achieve this number.
[3:08:54] and it's managed to fill every
[3:08:55] appointment slot.
[3:08:57] Which we have many strategies
[3:08:58] to do.
[3:09:00] The inpatient volume increase
[3:09:03] is a result of down stream
[3:09:05] revenue from increased primary
[3:09:07] care volume.
[3:09:10] And increase enrollment in our
[3:09:11] low-income health plan that is
[3:09:15] a later budget proposal.
[3:09:18] It's simply a calculation.
[3:09:19] Revenue cycle redesign.
[3:09:21] We have four strategies to
[3:09:25] bring in that additional $21
[3:09:26] million.
[3:09:29] And as the board is aware that
[3:09:31] we brought in revenue
[3:09:32] collection.
[3:09:36] we are renegotiating some of
[3:09:40] our surance -- insurance
[3:09:42] contracts and working on
[3:09:47] collections of lab and dialysis
[3:09:47] centers.
[3:09:50] Reduction of vacant positions,
[3:09:51] these are positions that are
[3:09:53] not currently filled.
[3:09:57] that we don't intend to fill,
[3:10:03] for which we are not use are
[3:10:06] over time or extra help to get
[3:10:08] the work done and believe we
[3:10:13] can do without those 33
[3:10:14] positions.
[3:10:17] icpp-10 was delayed by cms by
[3:10:18] one year.
[3:10:20] But for the preparation of
[3:10:21] implementation, we will have
[3:10:25] some costs in the next fiscal
[3:10:35] year, approximately 2.8 million.
[3:10:38] Our core project for the
[3:10:40] medical record, we figure
[3:10:42] that's about 68 million, and I
[3:10:44] believe that jeff covered that
[3:10:46] earlier in the budget.
[3:10:47] Covered by technology.
[3:10:49] Is that correct?
[3:10:50] Okay.
[3:10:51] The cms incentive program.
[3:10:54] As I mentioned earlier, one of
[3:10:55] our highlights this fiscal year
[3:10:57] is that we achieved all of
[3:10:59] those revenues and goals as
[3:11:01] required in that program.
[3:11:04] We went back and looked at the
[3:11:06] possibility for next year.
[3:11:11] And we believe there is an
[3:11:12] additional $5 million we can go
[3:11:14] after and achieve.
[3:11:19] our managed care contract this
[3:11:22] is a renegotiation between
[3:11:30] santa clara health care.
[3:11:34] We have a different way of
[3:11:36] calculating valley health plan
[3:11:39] with transferring risk over to
[3:11:42] them that dmc has had in the
[3:11:42] past.
[3:11:44] But had no control of that risk.
[3:11:48] So this is more of an
[3:11:49] accounting transaction to move
[3:11:51] the revenue and expense to the
[3:11:55] appropriate place in valley
[3:12:02] health plan.
[3:12:05] Cap conversion.
[3:12:06] In the health plan, we started
[3:12:11] the year with 8,000 enrollies.
[3:12:14] And have a goal of 12,000
[3:12:16] enrollies by the end of the
[3:12:20] fiscal year, we are rapidly
[3:12:20] approaching 10,000.
[3:12:22] we believe this is achievable
[3:12:28] to bump that enrollment up.
[3:12:30] And our managed care contract
[3:12:32] featured service.
[3:12:34] A renegotiation of our future
[3:12:35] service, santa clara health
[3:12:36] plan contract.
[3:12:42] and thal bring -- that will
[3:12:54] bring an additional 7 million.
[3:13:03] we are currently in
[3:13:06] negotiations and we May be
[3:13:10] reforced to reduce our
[3:13:15] enicologists by 3.5 ftes.
[3:13:15] The contract position budget,
[3:13:20] in the past we used an outside
[3:13:30] firm care and we brought our
[3:13:33] physicians in and putting ftes
[3:13:37] back in the budget and this is
[3:13:48] cost neutral.
[3:13:50] We have assistance in opening
[3:13:51] the downtown location.
[3:14:05] they did not get guarantee this
[3:14:05] amount.
[3:14:13] We are bringing this next area
[3:14:17] in the custody health
[3:14:17] discussion.
[3:14:28] so questions?
[3:14:30] >> with information about
[3:14:32] gardener, I know at the hcc
[3:14:34] meeting I asked questions and
[3:14:36] didn't quite get clarification.
[3:14:38] I knew we had given the 550,000
[3:14:42] that we thought would cover the
[3:14:43] expense.
[3:14:47] but because they didn't get the
[3:14:48] additional dollars.
[3:14:49] Therefore we are covering it
[3:14:52] and it wasn't covered by the
[3:14:53] 550,000?
[3:14:58] >> I see that gary is reaching
[3:15:00] for the microphone phone.
[3:15:01] >> gardener's projection is
[3:15:03] that in the first year of
[3:15:06] operation, they require a
[3:15:07] 550,000 subsidy.
[3:15:10] The second year of the
[3:15:13] contract, they require a
[3:15:14] $300,000 subsidy.
[3:15:15] What happened here, we are
[3:15:18] being a little conservative.
[3:15:19] Because the original plan was
[3:15:21] for gardener to open earlier.
[3:15:23] So really what is happening,
[3:15:25] right now we are hoping that
[3:15:27] the downtown clinic will open
[3:15:28] on June 1.
[3:15:30] If we look at this on a
[3:15:31] calendar basis.
[3:15:39] Basically we are allocating
[3:15:46] 330,000 that is the amount for
[3:15:47] 2013 to 2014.
[3:15:48] The timing is a little skewed.
[3:15:52] But at this point in time the
[3:15:53] expectation is that what we
[3:15:57] were funding is a two-year
[3:15:59] program effect.
[3:16:02] And so the 550 is the first
[3:16:03] year and 300 for the second
[3:16:04] year.
[3:16:11] over two years it's a title of
[3:16:15] 850,000 subdiddys are --
[3:16:18] subsidy because they weren't
[3:16:20] able to acquire the federal
[3:16:20] funds.
[3:16:24] >> but we anticipated that they
[3:16:27] would and added that extra.
[3:16:30] >> adding the 850,000, our hope
[3:16:32] is that the amount they needed
[3:16:39] to open -- operate on a
[3:16:40] break-even basis.
[3:16:42] And with the clients and
[3:16:46] expenses results in a need for
[3:16:47] a 550,000 requirement in the
[3:16:48] first year.
[3:16:51] And because of a ramping up and
[3:16:54] seeing more clients, that
[3:16:56] requirement will decline to
[3:16:56] 300,000.
[3:16:57] Again this is based on forecast
[3:16:59] and we will be working with
[3:17:01] closely with them to see what
[3:17:02] their needs are.
[3:17:06] That at this point is what is
[3:17:07] funded.
[3:17:09] by allocating this 300,000, we
[3:17:11] will have funded them for two
[3:17:11] years.
[3:17:15] >> and we are anticipating
[3:17:17] gardener not receiving other
[3:17:18] grants that they were expecting
[3:17:20] and we would have to cover?
[3:17:22] >> at this point this is the
[3:17:24] maximum we expect to have to
[3:17:24] fund.
[3:17:27] >> okay, and also at our
[3:17:28] meeting, I had asked a couple
[3:17:31] of questions about the unused
[3:17:32] appointment rate.
[3:17:34] And maybe get a little more
[3:17:35] understanding about that.
[3:17:41] I know that the no-shows and
[3:17:42] the unused appointment rate.
[3:17:44] And maybe if you can talk a
[3:17:45] little about both of those.
[3:17:48] Where we have, I know we are
[3:17:50] trying to increase the number
[3:17:54] of patients that the dollars
[3:17:55] -- doctors see.
[3:17:58] And I assume that's the unused
[3:18:00] appointment rate, trying to get
[3:18:01] more patients in.
[3:18:04] And making sure, in a way you
[3:18:06] overbook, just in case you have
[3:18:07] the no-show.
[3:18:08] And can you talk about that.
[3:18:11] and as we look at that and
[3:18:13] reduce that, is that savings or
[3:18:15] additional revenue and how that
[3:18:17] will help the overall budget?
[3:18:19] >> sure.
[3:18:21] The unused appointment rate
[3:18:27] that we used in the budget is
[3:18:27] 6.25%.
[3:18:30] That's [Inaudible] Class is
[3:18:31] zero.
[3:18:33] There are physician practices
[3:18:40] out there that fill every
[3:18:41] appointment everyday.
[3:18:47] And we get an unused
[3:18:48] appointment rate daily.
[3:18:56] and since we have studied
[3:19:01] that, reduced our appointments.
[3:19:03] And appointments go unused for
[3:19:07] a variety of reasons.
[3:19:13] we don't include the no-snow
[3:19:15] -- no-show rate in the report.
[3:19:20] That's a different piece of it.
[3:19:22] An unused appointment is an
[3:19:24] appointment where the patient
[3:19:31] canceled in less than 24
[3:19:32] hours and we weren't able to
[3:19:33] fill that.
[3:19:36] Or it's a case where the
[3:19:38] patient demand wasn't there.
[3:19:40] Or the appointments we had
[3:19:42] availability for patient demand
[3:19:45] didn't match the type that the
[3:19:46] patient needed.
[3:19:50] Maybe we had three return
[3:19:50] appointment slots available.
[3:19:52] And this was a new patient.
[3:19:55] and we didn't have an
[3:19:57] appointment slot for them that
[3:19:57] day.
[3:20:04] So there is a tremendous
[3:20:07] science between managing of the
[3:20:08] appointment schedule system so
[3:20:10] every slot is filled.
[3:20:12] What I can tell about the
[3:20:15] budget, as compared to prior
[3:20:21] years, this year's clinic
[3:20:23] volume is based on what is in
[3:20:24] the scheduling system.
[3:20:27] We have a means electronically
[3:20:30] and by schedule to achieve it.
[3:20:34] And now it's as much about
[3:20:37] massaging the types of
[3:20:37] appointments.
[3:20:40] And you know making sure that
[3:20:42] there are very few unused
[3:20:45] appointment slots on a daily
[3:20:45] basis.
[3:20:47] >> yeah, I know this is a one
[3:20:49] part of a big puzzle we are
[3:20:51] trying to work with, trying to
[3:20:52] coordinate so many things in
[3:20:54] the hospital that we haven't
[3:20:56] been doing in the past.
[3:20:58] And my congratulations to focus
[3:21:00] in on that.
[3:21:02] And because so much revenue May
[3:21:04] be earned in addition, I am
[3:21:05] glad that everyone is focusing
[3:21:06] on that.
[3:21:08] And trying to tweak that
[3:21:12] schedule as ach -- as much as
[3:21:13] they can.
[3:21:15] >> thank you for the report.
[3:21:17] on your first page of
[3:21:19] highlights, I enjoyed seeing
[3:21:19] that.
[3:21:22] Second bullet from the end
[3:21:25] talked about patients
[3:21:27] increasing what would recommend
[3:21:29] the facility to friends and
[3:21:29] family.
[3:21:35] A couple of weeks ago I saw
[3:21:37] several graphs that recommend
[3:21:40] them to noise at night and
[3:21:40] cleanliness.
[3:21:42] And not thrilled where it
[3:21:43] showed that.
[3:21:48] But I am thrilled improvement
[3:21:51] of something, and when months
[3:21:54] go by and when you have
[3:21:55] measurements.
[3:21:59] i would appreciate receiving a
[3:22:00] copy of that.
[3:22:02] And where we are with our peers.
[3:22:08] I did this last year and I will
[3:22:10] continue it this year, thank
[3:22:14] you for taking a look at that
[3:22:15] funded vacant positions, and
[3:22:17] how necessary to keep them on
[3:22:19] the books.
[3:22:23] You eliminated 33 pots --
[3:22:26] spots and that equated to 43
[3:22:26] million.
[3:22:27] Thank you for looking at that.
[3:22:28] I don't know what the numbers
[3:22:32] are, still in the 700 range of
[3:22:33] funded vacant positions
[3:22:34] throughout the county.
[3:22:37] For a variety of reasons, some
[3:22:42] are brand-new and summon --
[3:22:45] someone leaves and retires.
[3:22:49] But when a department head
[3:22:55] takes a hot -- shot at this
[3:23:02] and it's instant savings to the
[3:23:02] country.
[3:23:11] >> probably the fluctuating
[3:23:14] to the department and this is
[3:23:16] an hour by hour science that
[3:23:18] goes on at the hospitals and
[3:23:19] clinics.
[3:23:24] >> siappreciate -- I
[3:23:25] appreciate that and every bit
[3:23:27] helpss and that's a big thing,
[3:23:28] thank you for that.
[3:23:31] >> thank you.
[3:23:32] Supervisor kniss.
[3:23:35] >> so I thought perhaps I would
[3:23:38] get a lot less grandular, even
[3:23:44] those are the things that made
[3:23:45] enormous difference.
[3:23:48] And I agree with ken asking
[3:23:49] about the clinics and unfunded
[3:23:50] positions.
[3:23:51] Those are what make the
[3:23:54] differences over the long run.
[3:23:55] But jeff, because I talked
[3:23:57] about this a little this
[3:23:57] afternoon.
[3:24:00] I thought maybe this time you
[3:24:01] could restate this.
[3:24:05] But I think in three years,
[3:24:07] while we haven't solved the
[3:24:08] problem, we have at least
[3:24:10] identified it.
[3:24:12] We have worked pretty
[3:24:17] successfully I think with the
[3:24:19] anm group that came in.
[3:24:21] And so I want to talk a little
[3:24:25] about what I think are some
[3:24:28] really good strides we made.
[3:24:30] And one might be far less
[3:24:31] subsidy than we have done in
[3:24:32] the past.
[3:24:34] And another might be far more
[3:24:36] attention to the numbers.
[3:24:38] As I mentioned before, I get
[3:24:40] the daily flash, I know what
[3:24:42] the numbers are all over the
[3:24:43] place.
[3:24:44] Which really helps.
[3:24:47] And you know, I think maybe you
[3:24:51] could toot your horn for a
[3:24:52] minute.
[3:24:53] It wouldn't be all bad.
[3:24:55] >> not my horn.
[3:24:58] >> it's been a tough two years
[3:25:01] to come in and make major
[3:25:02] changes in the health care
[3:25:02] system.
[3:25:06] >> it's not my horn.
[3:25:10] >> you can do gabrielle it is
[3:25:12] or anyonacy, just a horn.
[3:25:14] >> just like any other health
[3:25:18] system in the nation, vmc was
[3:25:20] faced with a total
[3:25:22] transformation in a short
[3:25:23] period of time.
[3:25:28] Going from a system that relied
[3:25:31] on med cal funding, that is one
[3:25:34] way of funding a system, to a
[3:25:37] system in the future that will
[3:25:40] rely on performance payment.
[3:25:44] and that's an enormous change
[3:25:45] in infrastructure and cultural
[3:25:46] approach.
[3:25:48] It means a lot of changes.
[3:25:50] And the team has done a
[3:25:52] fabulous job in the last years.
[3:25:54] Working towards that change.
[3:25:55] It's very difficult
[3:25:57] particularly at the same time
[3:26:00] that they are preparing for
[3:26:02] health care reform.
[3:26:09] and dealing with lip and
[3:26:10] medical expansion, everyone has
[3:26:13] a lot on their plate at vmc and
[3:26:14] health and hospital.
[3:26:18] And it's true, that in the
[3:26:21] past, we've removed little too
[3:26:24] much from the administratorive
[3:26:24] support.
[3:26:27] people are running around from
[3:26:28] one crisis to another at same
[3:26:33] time they are planning a
[3:26:34] long-term strategy.
[3:26:36] It makes it difficult to do and
[3:26:39] they have done an excellent job.
[3:26:41] The clinicians and nurses and
[3:26:44] doctors and technicians and
[3:26:47] everyone continue to do very
[3:26:48] high-quality work.
[3:26:49] And they are very proud of the
[3:26:52] work they do.
[3:26:55] And our job and the systems job
[3:26:58] is to get patients connected
[3:27:00] with the clinicians.
[3:27:02] In the riept time, in the right
[3:27:04] place and the right level of
[3:27:06] service and the right type of
[3:27:06] care.
[3:27:08] And we have proven that can be
[3:27:09] done and we are doing a good
[3:27:12] job of it.
[3:27:13] That all being sides.
[3:27:15] >> you still have a way to go.
[3:27:16] >> we have a ways to go.
[3:27:20] You don't change an
[3:27:23] organization of this size in a
[3:27:26] rapid period of time.
[3:27:29] particularly when the risk of
[3:27:32] rapid change is life and
[3:27:34] welfare of patients.
[3:27:37] You know, at any time it's
[3:27:38] certainly the highest priority
[3:27:41] to make sure that the patients
[3:27:44] are safe and cared for
[3:27:45] appropriately.
[3:27:48] and so change is not super
[3:27:48] rapid.
[3:27:49] But it's happening.
[3:27:52] And I am very proud of the team.
[3:27:58] And they are doing a great job.
[3:28:00] And individuals and the
[3:28:02] employees in the health and
[3:28:04] hospital system and the
[3:28:06] hospital system are truly
[3:28:08] committed to make sure they
[3:28:09] provide the best care possible.
[3:28:11] And they are all struggling
[3:28:12] with change.
[3:28:13] But they are doing a good job
[3:28:15] of it.
[3:28:16] >> I appreciate saying that.
[3:28:19] Because I think going from one
[3:28:21] system to another, as you said,
[3:28:23] from the dish and the system
[3:28:28] where money was really given to
[3:28:29] us.
[3:28:31] Without any measurable outcomes
[3:28:31] required.
[3:28:34] And that's a huge difference
[3:28:35] now.
[3:28:36] As measurable outcomes are
[3:28:37] required.
[3:28:38] And without them you will not
[3:28:39] get your money.
[3:28:42] And we will not get our money.
[3:28:44] We will not be able to continue
[3:28:45] to provide those services.
[3:28:48] And the one thing you didn't
[3:28:49] mention, jeff, the substantial
[3:28:52] decrease in the amount of
[3:28:55] essentially subsidy or general
[3:28:57] fund money we are using.
[3:29:00] It's down depending on how you
[3:29:02] look at it.
[3:29:03] Certainly 50% or more.
[3:29:05] And that's making a big
[3:29:06] difference as well.
[3:29:09] I think it's important, you
[3:29:17] know, we usually are saying far
[3:29:18] more inquisittive types of
[3:29:20] things, but it's good to hear
[3:29:22] that we are making good
[3:29:22] progress.
[3:29:25] And that we are not only doing
[3:29:29] that but paying great attention
[3:29:31] to how that progress can be
[3:29:32] made and reach those
[3:29:33] measurements.
[3:29:34] So far, so good.
[3:29:34] Thanks.
[3:29:37] >> thank you.
[3:29:38] Any other supervisors?
[3:29:40] I see none.
[3:29:44] >> thank you, Mr. President.
[3:29:47] >>> jeff, anything?
[3:29:47] Okay.
[3:29:50] Board we will recess until
[3:29:53] tomorrow afternoon at 1:30.