COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

 

DATE:

September 12, 2005

BOARD MEETING DATE:

September 20, 2005

SPECIAL NOTICE:

None

VOTE REQUIRED:

None

 

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

2004-05 Grand Jury Response

 

Recommendation

Accept this report containing the County’s responses to the following 2004-05 Grand Jury reports on Youth Gangs in San Mateo County, San Mateo County Indigent Health Care, and Adult Protective Services and Public Guardian.

Vision Alignment:

Commitment: Responsive, effective and collaborative government.

Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.

This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.

Discussion

The County is mandated to respond to the Grand Jury within 90 days from the date that reports are filed with the County Clerk and Elected Officials are mandated to respond within 60 days. It is also the County’s policy to provide periodic updates to the Board and the Grand Jury on the progress of past Grand Jury recommendations requiring ongoing or further action. To that end, attached is the County’s responses to the Grand Jury’s reports on Youth Gangs in San Mateo County issued on June 23, 2005, and San Mateo County Indigent Health Care and Adult Protective Services and Public Guardian issued June 29, 2005.

San Mateo County Indigent Health Care

Findings:

The County and San Mateo Medical Center (SMMC) have been working to continually improve operational efficiency. Even though SMMC is currently operating above the allocated budget, more patients have been served in every department, all cost of living increases and unfunded mandates haven been absorbed, and the 2005 fiscal year actual County contribution was $8M less than it was in fiscal year 2002. We agree that all efforts should be made to serve the un- and underinsured as efficiently and effectively as possible, but continued threats of closing the Medical Center have serious unintended consequences on recruitment and retention, attracting new patients and philanthropy.

Recommendations:

I. Public Health Care Alternatives

The Board of Supervisors should:

    1. Issue a request for proposal (RFP), within 90 days, to review public health care services provided by the county with particular emphasis on indigent care. Qualified proposals should demonstrate a high level of experience and active involvement with indigent care in California. The RFP should include but not be limited to a study of:

    Advantages and disadvantages of the payer model as compared to San Mateo County’s provider health care system and should include the fiscal, medical, and social effects of each.

    The effectiveness of the provider model currently employed.

    The sale or lease to a third party, (e.g. Stanford Medical Center, University of California San Francisco Medical Center), of the San Mateo Medical Center and clinics with the agreement it remain a provider of medical care to the indigent.

    Response: Disagree. It is premature to issue a request for proposal (RFP) until the County has the information needed to make decisions related to employing a payer vs. provider model. The County acknowledges that it needs to determine the best approach to providing and funding indigent healthcare to meet its obligation under Section 17000 of the California Welfare and Institutions Code. It has recently developed separate financial assistance policies for the medically indigent, charity care, and self-pay, and has begun a pilot process to conduct full screening and verification of uninsured persons applying for health care coverage.

    The data gathered during the pilot (October 2005 through March 2006) will be used to better define the medically indigent population and the County’s financial responsibility under Section 17000. It will also provide more information about the charity care population being served at SMMC. This type of information is needed by County staff or outside consultants to analyze the advantages and disadvantages of a payer vs. provider model.

    It should be noted that a similar proposal to examine a payer model was considered in 1993 when the construction funding for SMMC was being discussed. At that time, there was little interest on the part of the private community hospitals to assume responsibility for SMMC’s population, particularly the psychiatric and long-term care components, which comprise over half of SMMC’s current bed capacity. There is also limited capacity in the private sector for absorbing the large volume of SMMC outpatient clinic visits. The current SMMC leadership has more recently attempted to create affiliations with Sutter, Kaiser, CHW, UCSF, Stanford and Palo Alto Medical Foundation, with limited success.

II. Revenue Enhancement and Cost Reduction

    San Mateo Medical Center

    The Board of Supervisors should authorize the County Manager to direct the Director of the San Mateo Medical Center to:

    General Operations

    2. Require enrollees of the WELL program to pay the annual fee within three months of enrollment or commit to a more suitable payment plan.

    Response: Agree. Currently patients are asked for payment prior to or on the same day of the visit. Patients should expect to pay off the full amount of the annual fee in a timely manner. SMMC will explore shortening the timeframe in which a patient must pay the annual fee and what the penalty should be for non-compliance. This will be accomplished by the end of the fiscal year.

    3. Triage WELL and other uninsured patients requesting emergency room services. Those determined not to be in need of immediate care should be directed to clinics for follow-up care. Although triage may slightly increase the medical liability and add initially to the administrative burden of emergency personnel, it would dissuade patients from using emergency services for non-emergency needs.

    Response: Agree in principle but find it difficult to implement due to recently enacted federal legislation called the Emergency Medical Treatment and Labor Act (EMTALA). This act requires all patients to be medically stabilized in the emergency room by a physician prior to discharge. In addition, all patients seeking emergency room care must be seen and treated by a physician regardless of ability to pay or type of insurance coverage. It is doubtful that this type of change would ultimately lower the Medical Center’s costs since the patient, if referred later to a clinic, would be treated twice by a physician. However, Emergency Room management and Ambulatory Care management are currently looking at ways to reduce the number of patients being seen in the emergency room for non-urgent care. This includes educating patients on the alternatives for receiving non-urgent care outside of the emergency room.

    4. Instruct screeners to verbally verify patient eligibility with each hospital visit and annually confirm and document patient continued eligibility.

    Response: Agree. SMMC does annually confirm and document continued WELL eligibility and verify patient eligibility with each hospital visit. In the outpatient clinics, registrars verbally verify demographic and insurance information with each visit.

    5. Develop a formal indigent care policy that specifies the qualifications required to receive medical care. This policy should be posted and published, where appropriate and any individual seeking medical services should be required to formally acknowledge the qualifications established.

    Response: Agree. The Health Department, Human Services Agency, the County Manager’s Office and SMMC have recently developed four financial assistance policies, including a formal indigent care policy. They will be posted and published in conjunction with the expanded WELL eligibility pilot program. Patients will be required to acknowledge the qualifications established to be eligible to receive financial assistance.

    6. Transfer all accounts over 90 days past due and not eligible for the WELL program to the Revenue Services Collection Unit.

    Response: Agree. Currently any self-pay account greater than 30 days is assigned to the Revenue Services Collection Unit. As part of the new WELL Eligibility pilot program, this timeframe will be extended to any account greater than 90 days delinquent because SMMC will be forming an in-house self-pay team to collect on accounts that did not qualify for WELL or other coverage, including additional self-pay accounts that receive the new Health Care Discount option (charity care discount).

    7. Suspend the 50% cash discount option that is available to uninsured patients with resources. Initiate a study that establishes the profitability of offering this option.

    Response: Agree that a study should be established to review the profitability of offering this option, but do not concur on suspending the cash discount option for uninsured patients with resources. The compelling reasons for offering discounts to self-pay patients are threefold, 1) self-pay patients represent the only payer group that has no option but to pay full charges, while all other payers receive some sort of discount. It is difficult to justify not offering a discount without the appearance of exploitation and it has become a community standard among hospitals to offer a discount, 2) this discount still allows the Medical Center to recover its costs, and 3) offering a discount allows the Medical Center to resolve its outstanding bills sooner, which lowers days in accounts receivable and reduces bad debt write-offs. A study will be performed by the end of the fiscal year.

    8. Require non-critical patients to provide identification prior to receiving initial treatment and inform them that a subsequent visit will require a documentation and verification process.

    Response: Agree with the implementation of the new WELL Eligibility pilot program. All patients that present without insurance coverage will be screened for financial assistance through a formal documentation and verification process.

    Screening Operations

    9. Investigate the cost, advisability, and timeliness of outsourcing the entire screening process as it relates to indigent care across all programs.

    Response: Agree. Community Health Advocates from the SMMC and the Health Department, as well as community-based organizations, will be performing the screening function during the pilot process to conduct full screening and verification of uninsured applicants. The Human Services Agency will also be reviewing a portion of applications that are determined eligible for the WELL and Discounted Health Care (charity care) programs. Outsourcing of the screening process will be explored after the pilot has been completed and results evaluated at the end of the current fiscal year.

    10. Upgrade the enrollment process to identify those individuals who do not qualify for medical care programs because of residency, income, or asset criteria by making verification of qualifying criteria mandatory in all cases and creating a prescribed script for screeners to determine that all relevant issues are covered.

    Response: Agree. The County has initiated a pilot process to conduct full screening and verification of uninsured persons applying for health care coverage. Data collection will take place from October 2005 through March 2006 using a web-based screening tool called One-e-App. It is estimated that this effort will cost $950,000. This includes modifications to One-e-App, extra help staffing and increases to community-based provider contracts, equipment and supplies.

    11. Create or integrate a countywide, inter-departmental database to facilitate monitoring of program participants.

    Response: Agree. As part of its information technology strategic plan, SMMC, along with the County’s Information Services Department and other applicable departments has begun work on an unduplicated client database that will track health and social services provided to individuals by County departments including SMMC, the Health Department and Human Services Agency. The unduplicated client database will use a common client database across these three departments so that program data about common clients can facilitate better services for clients and for analytical and statistical reporting purposes. This is referred to as the “Applicable Client Record Store (ACRS) and this technology approach lays important groundwork for other County operations. ACRS allows County departments who share clients to identify client records in the same way. This process will allow better Countywide reporting to measure the effectiveness of services provided by the County and to determine unmet needs. Cost estimates are not available at this time, but there will be costs incurred by the County for these efforts.

    12. Combine all screening processes under one department to enhance operational control and consistent application of qualifying criteria.

    Response: Agree. Alternatives to performing the screening process will be explored after the screening and verification pilot process has been completed and evaluated at the end of the fiscal year. There will be consistent application of qualifying criteria during the pilot, given the features offered by the One-e-App screening tool, including eligibility calculation logics for all programs and the validation of all required data fields and verification documents.

    13. Redesign the WELL Program’s self-declarative form to impress upon applicants the seriousness of the process and that providing false or inaccurate information may have legal ramifications.

    Response: Agree. The WELL self-declaration process has been eliminated as part of the screening and verification pilot that is estimated to cost $950,000. The financial assistance policies, application forms, and brochures have been modified in order to emphasize the consequences of providing false or inaccurate information, including denial or dis-enrollment, and criminal charges for perjury.

    Private Pay Patients

    The San Mateo Board of Supervisors should require that San Mateo Medical Center:

    14. Build a for-fee parking structure and offer valet parking providing convenient facility access for those unable or unwilling to negotiate parking lot distances.

    Response: A study is currently underway to evaluate additional parking. We anticipate recommendations by the end of October. However, it is doubtful that the majority of patients and visitors to SMMC would be able to pay for parking.

    15. Initiate a publicity campaign describing hospital capabilities and desirability as a provider of health care services.

    Response: Agree. We agree that SMMC is more than a "County hospital" and that its new hospital, in addition to its clinics and its many key programs, offer County residents quality services that anyone should be proud to use. Unfortunately, because many people have not seen or heard from the Medical Center, public perception may not match this reality.

    As the Grand Jury report states, to date we have signed agreements that enable us to accommodate private-pay patients yet the hard work of attracting them remains. We will be working on this effort through targeted outreach and publicity campaigns that focus on service lines where we have capacity. It is important to note than most of the clinics are filled to capacity and some have waits as long as three months for non-urgent visits so we can therefore only market certain services unless we open additional capacity. As much of the Grand Jury report focuses on cost, it is also important to note that publicity campaigns will require an investment in order to generate goodwill and eventual growth in volume. For example, we are developing an outreach campaign for the Ron Robinson Senior Care Center, in order to tell the community about its services and most important, about the benefits that this Center offers to seniors and caregivers. We will be preparing a similar campaign for the new Keller Women and Children's Center, scheduled to open in 2006.

    16. Affiliate with other medical groups capable of referring doctors and patients.

    Response: Numerous conversations with private physicians and medical groups were unsuccessful in generating significant additional private patients. Most physicians are affiliated with a hospital and are not interested in the additional drive time to SMMC. We are considering opening a private primary care office near SMMC to increase capacity and access for private pay patients and increase ancillary and hospital volume.

    Indigent Care and Charity Care Cost Sharing

    17. The Board of Supervisors should research and explore methods to encourage the other non-profit hospitals to substantially increase their charity care.

    Response: Agree. Charity care is defined as free or discounted health and health-related services provided to persons who are uninsured and cannot afford to pay or who are not eligible for public programs. SMMC provides 95% of indigent in the county and a majority of the Medi-Cal or underinsured care. The County General Fund will contribute over $54 million in FY 2005-06 toward these costs. It is anticipated that these costs will rise given continued increases in costs related to providing healthcare.

    While most private hospitals have maintained their non-profit status by contributing to the community for the community’s benefit and or by providing care to the underinsured, they have not significantly contributed to costs directly related to indigent care. There have been efforts to highlight the need for other hospitals to contribute to costs incurred by SMMC for indigent patients. One of the recommendations from the Southern San Mateo County Task Force on New Hospital Construction in its June 2004 report was for the County to “create a vehicle that includes all hospitals in order to dialogue as a group and see how the charity care issue can be resolved.” The Hospital Consortium of San Mateo County, which includes SMMC, Mills-Peninsula Health Services, Sequoia Hospital and Seton Medical Center/Seton Coastside, has recently attempted to quantify each organization’s contribution to indigent/charity care and benefits provided to the community.

    The County is developing separate policies for medically indigent care, for which the County is financially responsible under its Section 17000 mandate, and charity care, in an attempt to further quantify costs incurred for charity care patients. The charity care policy was developed based on income and asset standards used by other community hospitals. The policies will be implemented during the eligibility screening and verification pilot that will start in late October. The results of the pilot will be used to further define the County’s obligation under Section 17000, which will not include charity care. Estimated costs for charity care will then be developed so that the Board can make decisions on how these costs should be funded by the County and other hospitals in the community.

    The County has also reviewed San Francisco’s charity care ordinance that requires annual publication and dissemination of charity care statistics for all hospitals in the City, and will explore recommending a similar ordinance after completion of the pilot at the end of the fiscal year.

Adult Protective Services and Public Guardian

Findings:

Since many of the findings are already standard practice within Aging and Adult Services (AAS), staff concurs with the majority of them with the exception of the one related to caregiver oversight and one related to transportation, which are explained within the recommendation responses.

Recommendations:

1.0 The Board of Supervisors should direct the Director of Health Services to:

    1.1 Identify the office of Public Guardian in its building and in directories to improve citizen awareness and access.

    Response: Agree. Staff agrees that separate listings for the Public Guardian could improve public access to the program. A sign will be posted to identify the office of the Public Guardian and other services provided by AAS. The Public Guardian program is currently listed in the government section of the SBC telephone directory under AAS. Staff will request that the Public Guardian be listed separately in the next publication of San Mateo County’s “County and City Telephone Directory.”

    1.2. Give proposed conservatees an explanation in person and in writing of their rights at the time of filing a petition to curtail or remove their personal and/or property rights.

    Response: Agree. Personal noticing of proposed conservatees and relatives is required by law. In addition to continuing the practice of verbally informing the proposed conservatee of his/her rights, a new one-page informational notice is being developed. This notice will inform proposed conservatees of their right to oppose the Conservatorship, to have an attorney appointed to represent them if they cannot afford to hire an attorney, to have a court trial, or to have a jury trial. This information is always reiterated by the Court Investigator, who personally visits each proposed conservatee.

    1.3. Issue specific written policies instructing the Deputy Public Guardians about Aging and Adult Services priorities, including maintaining the conservatees in their own home if possible, locating and consulting with all family, friends, and neighbors (against whom there is no evidence of abusive actions), and providing all needed assistance without delay.

    Response: Agree. AAS and the Public Guardian are publicly and explicitly committed to keeping people in their own homes as long as they are safe and can afford to remain there. AAS works according to its goal as stated in the Division’s informational brochure and on the AAS website: “Our goal is to ensure the delivery of client-centered, compassionate, and fiscally responsible services that foster self-determination, meet professional standards and ethics, and reflect the County’s statement of beliefs. We will accomplish this by offering services that provide a combination of protection, support, prevention and advocacy.” This principle of fostering self-determination and supporting the wishes of people to remain in their homes as long as possible is emphasized at staff meetings, unit meetings, case conferences, and individual supervision meetings. AAS will continue to emphasize this guiding principle, both in writing and verbally.

    The Probate Code and the Welfare and Institutions Code, which are the bodies of law that govern the actions of the Public Guardian, contain specific noticing requirements for all legal actions. The law requires the written noticing of all relatives within the second degree of relationship when legal actions are taken. There are specific confidentiality and privacy restrictions that prevent information being shared with non-relatives. In addition, the Health Insurance Portability and Accountability Act (HIPAA) requirements prevent the disclosure of private health information. The Public Guardian strives to gather all relevant information to support comprehensive and compassionate decision-making. The office maintains names, addresses, and phone numbers of all relatives and significant others, and contact is made whenever it is necessary. The Public Guardian, as addressed in its budget statements, considers, acknowledges and values family members as partners in the Conservatorship program.

    AAS, including Adult Protective Services (APS) and the Public Guardian program, will continue to provide assistance required by its vulnerable clients without delay. An AAS leadership sub-committee will be convened to recommend improvements to current policies and procedures. Written procedures will be distributed to staff by March 2006.

    1.4. Install a plan for regular agency oversight and consultation with the Deputy Public Guardians.

    Response: Agree. There are existing systems for providing regular and close agency oversight of and consultation with the Deputy Public Guardians. In AAS there are four units of Deputy Public Guardians; one unit comprised of three conservatorship investigators and three units comprised of 16 Deputy Public Guardians who are assigned the continuing conservatorships. Each unit is supervised by a knowledgeable and experienced supervisor who meets with the workers both individually and as a unit. Supervisors are available for immediate consultation as needed. In addition, the supervisors meet individually on a weekly basis with the program manager to review problems and resolve issues. There are frequent interdisciplinary case conferences and weekly meetings with supervisors, managers and County Counsel to review and consult regarding cases. There is a case review system to provide quality assurance and improvement oversight, and there are checks and balances within the accounting functions that provide fiscal support to the Public Guardian. In addition, all Conservatorship cases are reviewed by the Superior Court, and Probate cases receive review by the Probate Court Investigator.

    There is an annual audit performed by the County’s Auditor/Controller’s office on all cases receiving public benefits, and periodically the County Controller audits all of the work of the Public Guardian. AAS will continue to provide oversight and consultation for the Deputy Public Guardians following the above protocols.

    1.5. Eliminate any lag time between the time that all bank accounts are frozen and the time when provision is made for the proposed conservatee’s bills to be paid and supplies and services made available.

    Response: Agree. The APS program provides intervention activities directed toward safeguarding the well being of elders and dependent adults suffering from or at risk of abuse or neglect, including self-neglect. APS and the Public Guardian are committed to providing timely response to individuals’ needs. Not all bank accounts are frozen; however, there are times when it is necessary for APS to freeze an individual’s assets using Probate Code 2901, which allows for the freezing of bank accounts to prevent losses belonging to proposed conservatees and to prevent abusive dissipation. Usually one account remains available for the use of the proposed conservatee. Provision is made for payment of bills for essential services and supplies such as food and medications. APS has emergency funding available to ensure the individual’s safety during the conservatorship process. Funding is available for such services as attendant care, food, clothing, temporary shelter, medications, and other emergency expenses. The APS Supervisor and Deputy Public Guardian supervisor for investigations monitor these policies and procedures. These policies will continue to be followed.

    1.6. Document the oversight and upgrade the training of in-home service caregivers.

    Response: Disagree. There are two scenarios in which clients of AAS, including conservatees and individuals open to APS, receive in-home services by caregivers. The first is through home health agencies on contract with AAS. In this scenario, caregivers are supervised by the agencies that employ them. These agencies invoice AAS for services provided, and any questions of discrepancies are resolved prior to payment. For services provided through contracts, AAS staff is responsible for deciding the level of services needed by the client. The staff monitors the provision of those services and makes changes as necessary. It is the responsibility of the contracted agencies to provide training to their caregiver staff. In the future, AAS will require agencies to provide detailed information regarding training provided to their staff as a part of the Request For Proposals (RFP) and contractor selection process.

    The second scenario is through the In-Home Supportive Services (IHSS) program, where Medi-Cal eligible clients or conservatees are assisted in finding a caregiver through the IHSS Public Authority registry of caregivers or identifying a family member or friend to provide the in-home services. In this scenario, it is the client (or Public Guardian, if the client is a conservatee) who handles the hiring/firing of caregivers and is responsible for the oversight of that caregiver. The Deputy Public Guardians, in coordination with the IHSS case manager, determine the appropriate in-home care services to be provided to the conservatees and the number of hours of care necessary.

    The Public Authority currently provides six trainings per year for in-home caregivers supplied through the IHSS program. In addition, the Public Authority provides caregivers with information on additional training available through other agencies and schools, including referrals to Peninsula Works to identify other training opportunities. Each caregiver has available up to $150 per year to be used for training purposes as part of the IHSS provider union contract. The State of California does not require certification of IHSS caregivers, although the provider pool in San Mateo County does include some certified nursing assistants.

    1.7. Establish written policies for requests for proposals or contracts for in-home caregiver organizations, financial managers, real estate brokers, et al.

    Response: Agree. AAS follows the County of San Mateo’s written guidelines for RFPs and the Administrative Memorandum B-1 issued by the County Manager for issuing contracts. RFPs were issued on January 21, 2004 for in-home caregiver agencies, and on December 22, 2003 for contract caregiver services for the IHSS program. An RFP was issued on March 4, 2005 for real estate services for the Public Guardian, and five contracts were awarded. RFPs were issued on March 1, 2004 for financial management services and on August 9, 2004 for tax preparation services. AAS uses County Counsel for attorney services. These policies will continue to be followed.

    1.8. Visit conservatees living independently once a month at a minimum.

    Response: Agree. The Public Guardian has a written policy and procedure, last updated and revised in June of 2004, which requires monthly visits to all conservatees who are living independently. Adherence to this procedure is monitored by the Deputy Public Guardian Supervisors who review every visit report for individual conservatees. Additionally, the supervisors monitor monthly reports of all visits made and due to be made. This procedure will continue to be followed.

    1.9. Perform an annual audit of investment accounts of conservatees held by the Financial Manager to assure they are appropriately invested to meet the account goals and to clearly show the annual rate of return and commissions on transactions.

    Response: Agree. Annual audits are regularly performed at several different levels. A court accounting of each individual conservatee with investments is prepared and presented yearly for review and approval by the Court. The Court Investigator reviews each accounting and submits a report of findings to the Court. The Probate Judge reviews each report and accounting.

    Additionally, the Estate Manager meets with the Financial Advisor to review and re-balance each conservatee’s portfolio no less than once yearly. Securities America audits the Financial Advisor’s files and procedures on an annual basis. In addition, the Financial Advisor is subject to announced and unannounced audits by the Securities and Exchange Commission (SEC) and the Department of Corporations. Staff will meet with a representative of the County’s Auditor/ Controller to discuss other possible audit options to ensure that conservatees’ investments are appropriate and meet account goals. The annual rate of return is clearly identified on every quarterly and year-end report received from the Financial Advisor for each conservatee. There are no commissions paid by the Public Guardian or by the conservatees on any transactions, as the Financial Advisor contracted by the Public Guardian is an independent broker.

    1.10. Establish additional procedures that set rigorous “best practices” standards for calculation of fees and consider requiring that any billing method used not include cash or money market accounts as part of the total investment account, and determine whether there is additional compensation, such as commissions or partial commissions paid the Financial Manager as a result of his affiliation with the broker.

    Response: Agree. The process for calculation of fees currently in use by the Financial Advisor is the “best practice” standard as regulated by the SEC. Fees are calculated by Securities America (not the Financial Advisor) and are based on the monthly average, not daily or year-end averages which would result in a higher fee. This process includes charging a fee on funds in the money market account. However, that account is maintained at the lowest level possible. The money market account is purposefully set up for several reasons: funds are set aside in the money market account when it is known at the time of investment that a lump sum payment will be due shortly (such as a capital gains tax on the sale of a residence) and for the monthly management fee. An estimate for one year of fees is set aside every annual review to avoid periodic sales during the year and any associated fees. The Financial Advisor contracted by the Public Guardian is an independent broker; as such he receives no commissions as a result of any affiliation with a brokerage company.

    Staff will request that the Auditor/Controller’s office review the Division’s practices and procedures related to fee calculation, billing methods, and related areas and will request that office to make recommendations regarding best practices and standards to be followed.

2. The Grand Jury recommends that the Board of Supervisors fund Aging and Adult Services for additional transportation services for conservatees’ appointments for personal or medical care, or court appearances.

Response: Disagree. AAS has one Transportation Officer who provides transportation for Public Guardian clients to Court, medical appointments, and for shopping. When Deputy Public Guardians transport conservatees to medical appointments, this time spent allows for conferring with medical treatment care providers and for individual visiting time with the conservatees. This is valuable and necessary time spent developing relationships and assuring that necessary services are appropriately provided.

AAS will review current staff resources and allocations of funding for this function. Staff will convene a committee comprised of the Paratransit Council, Mental Health Services, and other community providers to address the overall transportation gaps and client needs, and will report back to the Board in January during the FY 2005-06 mid-year budget review.

Youth Gangs in San Mateo County

Findings:

Generally agree with the Grand Jury’s finding that the County lacks a centralized, comprehensive source for gang activity statistics. The San Mateo County Gang Action Team, which is made up of representatives from city police departments and County criminal justice departments, has been an effective resource for sharing information across jurisdictional boundaries. Additional work must be done to quantify, in a meaningful way, the level and type of gang-related activity occurring in the county.

Recommendations:

1.0 The Board of Supervisors and the Sheriff should:

    1.1 Provide a centralized clearing-house of gang-related programs and information. A confidential hot line for reporting suspected gang activity or membership is an essential component of this program.

    Response: Agree. The Sheriff has agreed to work with the Board of Supervisors and the San Mateo County Police Chiefs and Sheriff’s Association to study the feasibility of creating a centralized clearinghouse of gang-related programs and information, as well as a confidential hot line for reporting suspected gang activity. The study would include the cost of creating, maintaining and operating these systems and determine the level of interest among city and county criminal justice departments in sharing these costs and participating in the ongoing data gathering and input processes.

    1.2 Ensure that statistical information be collected on a countywide basis in order to measure the problem and the success or failure of the various efforts to curtail it.

    Response: Agree. This recommendation supports the objective of recommendation 1.1 above. For policy makers to make informed decisions on the success or failure of programs, the statistical information complied must be complete and accurate. This will require the cooperation of all criminal justice agencies in San Mateo County and uniform data collection and reporting practices.

    1.3 Promptly schedule a second meeting of the Youth Violence Prevention Workshop.

    Response: Agree. Supervisors Adrienne Tissier and Jerry Hill convened meetings of the Youth Violence Prevention Workshop on July 18 and August 15, 2005. The next meeting is scheduled for October 3, 2005. The Workshop’s focus is to reduce youth violence and crime through collaborative methods and programs involving law enforcement, education, parks and recreation agencies, and community-based organizations.