COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

DATE:

October 2, 2002

BOARD MEETING DATE:

October 22, 2002

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director, Health Services

Gale Bataille, Director, Mental Health Services

SUBJECT:

Amendment to the Agreement with Rashmi Garg, M.D.

Recommendation

Adopt a resolution authorizing the President of the Board to execute an amendment to the agreement with Rashmi Garg, 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. On September 11, 2001, your Board approved an agreement with Rashmi Garg, M.D., for the provision of child psychiatric services for the Receiving Home and children and youth served under SB 933. Her duties include: child and youth medication evaluation and treatment; psychotherapy and family consultation; case consultation to staff; and other duties as assigned.

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. Dr. Garg was selected from candidates who responded to those advertisements.

Discussion

There is a shortage of child psychiatrists in California and in 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%. Currently, two of our five child psychiatrists are contract doctors. In order to retain them it is critical to keep their compensation commensurate with ordinance child psychiatrists. This amendment will provide a 10% increase to Dr. Garg, allowing Mental Health to be competitive in this challenging market.

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, 2001 through June 30, 2003. The 10% increase is effective July 1, 2002. This amendment has been reviewed and approved by Risk Management and County Counsel.

The new contract maximum is $240,548 and includes an increase of $11,776. The agreement maximum for FY 2001-02 was $111,053. The new agreement maximum of $129,495 has been included in the FY 2002-03 Mental Health Services Division budget. That maximum includes a 6% COLA for FY 2002-03. State and Federal Medi-Cal is expected to fund $64,748 of the cost. A total of $38,848 is reimbursed under SB90 claims and $18,111 is funded through Human Service Agency's out-of-home placement fund, a Children's System of Care match. The remaining $7,788 is funded from sales tax through realignment. There is no net county cost.