COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

September 18, 2002

BOARD MEETING DATE:

October 8, 2002

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director, Health Services

Gale Bataille, Director, Mental Health Services

SUBJECT:

Amendment to the Agreement with Lisa Nelson, M.D.

Recommendation

Adopt a resolution authorizing the President of the Board to execute an amendment to the agreement with Lisa Nelson, M.D.

Background

For the most part, Mental Health Services Division has been successful in its recruitment and retention of psychiatrists for permanent positions. There are, however, gaps in coverage of necessary psychiatric services. Contracting psychiatrists, who have the flexibility and availability to work part-time, fill these gaps.

Discussion

Physicians are exempt from Administrative Memorandum B-1, which governs the selection of independent contractors and requires a Request for Proposals process. However, Mental Health Services Division runs advertisements for specialty psychiatric services on a regular basis in the Northern California Psychiatric Newsletter and other venues as needed.

The current agreement with Dr. Nelson provides for child psychiatric services for the Community Counseling Center in East Palo Alto, South County Mental Health Center in Redwood City, and the Redwood Therapeutic Day School. Her duties include child and youth medication evaluation and treatment; diagnostic evaluation; psychotherapy; family consultation; treatment plan review; and case consultation. Dr. Nelson is highly skilled in treating emotionally disturbed youth and adolescents and her skills, knowledge, language abilities, and cultural sensitivity make her the best candidate for this position.

There is a serious shortage of child psychiatrists in California and the nation. As a result, Mental Health has found it difficult to impossible to fill child psychiatrist positions. In June 2002, your Board approved a new Child Psychiatrist ordinance classification that increases child psychiatrist salaries by 10%, allowing us to be more competitive in this challenging market. Two of our five current child psychiatrists, including Dr. Nelson, are contract physicians. It is critical to keep their compensation commensurate with ordinance child psychiatrists in order to retain them. This amendment will provide that 10% increase to this contractor.

Vision Alignment

This amended agreement keeps the commitment of ensuring basic health and safety for all and goal number 8: help vulnerable people-the aged, disabled, mentally ill, at risk youth, and others-achieve a better quality of life. The amended agreement contributes to this commitment and goal by providing psychiatric services and consultation for children and youth in San Mateo County.

Fiscal Impact

The term of the amended agreement remains the same, July 1, 2002 through June 30, 2003. The agreement has been reviewed and approved by Risk Management and County Counsel.

The amended contract total is $105,581 and has been included in the FY2002-03 Mental Health Services Division budget. State and federal Medi-Cal is expected to fund $52,791 of the cost and $31,674 is reimbursed under SB90 claims. The remaining $21,116 is funded by sales tax through realignment. There is no net County cost.