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- SUP. MOLINA, CHAIR
- DR. BRUCE CHERNOFF
- SUP. ANTONOVICH
- C.A.O. JANSSEN
- DR. THOMAS GARTHWAITE
- SUP. YAROSLAVSKY
SUP. MOLINA, CHAIR: THANK YOU, MR... WARREN WILLIAMS: ...MILLION A WEEK. SUP. MOLINA, CHAIR: THANK YOU, MR. WILLIAMS. THANK YOU VERY MUCH. THAT COMPLETES THE TESTIMONY ON THIS ITEM. ARE THERE ANY OTHER QUESTIONS OR COMMENTS? WE HAVE A MOTION THAT HAS BEEN INTRODUCED BY SUPERVISOR ANTONOVICH. I THINK IT WAS SECONDED BY SUPERVISOR YAROSLAVSKY AND WE HAVE A MOTION THAT'S BEEN INTRODUCED, ALSO. I THINK THAT WE'RE HAND IN HAND WITH EACH OTHER BY SUPERVISOR YAROSLAVSKY, IT WAS SECONDED BY SUPERVISOR ANTONOVICH. ALL RIGHT. SO WE HAVE THOSE TWO MOTIONS. IS THERE ANY QUESTION OR COMMENT ON THESE ITEMS? IS THERE ANY OBJECTION TO THESE ITEMS? IF NOT, SO ORDERED ON THE TWO MOTIONS. THANK YOU SO MUCH. NEXT WE HAVE S-1. SO IF I COULD HAVE MARV SOUTHARD AS WELL AS-- I DON'T KNOW IF IT-- OKAY, DR. CHERNOFF, YOU'RE GOING TO BE THE PRESENTER ON IT. MARVIN SOUTHARD: MADAM CHAIR, MEMBERS OF THE BOARD, I'M MARVIN SOUTHARD, DIRECTOR OF THE DEPARTMENT OF MENTAL HEALTH. I'D LIKE TO BEGIN BY THANKING THE DEPARTMENT OF HEALTH SERVICES, THE BOARD AND THE BOARD STAFF FOR THE ASSISTANCE THAT WE HAVE-- WE HAVE HAD IN PUTTING TOGETHER WHAT I THINK IS A GOOD PLAN FOR DEALING WITH THE ISSUES OF OVERCROWDING IN THE EMERGENCY ROOMS AT THE FOUR COUNTY HOSPITALS. I THOUGHT, AS A PART OF THE DEMONSTRATION OF THE WAY THAT THE DEPARTMENTS ARE WORKING TOGETHER TO SOLVE THIS ISSUE, THAT I WOULD PRESENT THE POINTS THAT ARE PRESENTED IN THE DEPARTMENT OF HEALTH SERVICES LETTERHEAD, JOINT LETTER THAT WAS SUBMITTED ON APRIL THE 6TH AND ASK DR. CHERNOFF TO MAKE THE PRESENTATION ON THE APRIL THE 18TH AUGMENTATION OF THAT LETTER. BETWEEN THE TWO REPORTS, I THINK THAT THEY REPRESENT A COMPREHENSIVE APPROACH TO THIS ISSUE. ON APRIL THE 6TH, WE REPORTED TO YOUR BOARD THAT WE INTENDED TO EXPAND DIVERSION OF PARTICULARLY INDIGENT PSYCHIATRIC EMERGENCY PATIENTS WHO CURRENTLY NOW GO-- WHO CURRENTLY PRIMARILY NOW GO TO THE FOUR COUNTY FACILITIES, TO OTHER L.P.S. DESIGNATED FACILITIES. AND THE METHODOLOGY WE PLAN TO USE TO DO THAT IS TO BEGIN DIVERTING WHEN THE COUNTY HOSPITALS ARE ON AN OVERCROWDED SITUATION, THE P.M.R.T. TEAM REFERRALS TO THIS NETWORK OF OTHER COUNTY HOSPITALS AND PAYING FOR THOSE BEDS AS WE USE THEM. AN ADDITIONAL THING THAT WE PLAN TO DEVELOP IS THE DEVELOPMENT OF MORE PSYCHIATRIC URGENT CARES. YOUR BOARD TODAY APPROVED THE CREATION OF A PSYCHIATRIC URGENT CARE AT OLIVE VIEW AND OUR HOPE WOULD BE TO HAVE THESE URGENT CARE CENTERS DESIGNATED AS L.P.S. RECEIVING FACILITIES SO THAT SOME SUBSET OF THE 5150S WHO DO NOT NEED A MEDICAL INTERVENTION MIGHT RECEIVE THEIR EVALUATION AT THESE PSYCHIATRIC URGENT CARE CENTERS THAT WE ARE DEVELOPING. ADDITIONALLY, WE HAVE-- WE HAVE ALREADY CONTRACTED FOR 12 ADDITIONAL ADOLESCENT AND CHILD INPATIENT BEDS FOR INDIGENTS ON THE PRIVATE SECTOR. YOUR BOARD APPROVED THAT CONTRACT ON APRIL THE 19TH. AND WE ARE IN THE-- WE ARE IN THE PROCESS OF NEGOTIATING 10 ADDITIONAL ADULT INDIGENT PSYCHIATRIC BEDS AT WHITE MEMORIAL HOSPITAL AND WE HAVE INCREASED OUR CONTRACTS WITH KEDRIN AND GATEWAYS TO PROVIDE ADDITIONAL PSYCHIATRIC INPATIENT BEDS AVAILABLE. SO THOSE NEW ADDITIONAL RESOURCES ALLOW US TO HAVE MORE PLACES BEFORE-- BESIDES THE FOUR COUNTY HOSPITALS TO WHICH WE MIGHT BRING INDIGENT, MENTALLY ILL CLIENTS. WITH THAT, I WILL ASK DR. SCHUNHOFF TO SPEAK TO THE ADDITIONAL ITEMS THAT WE HAVE AGREED AND BEGUN TO IMPLEMENT BEYOND THE MATTERS THAT WERE INCLUDED IN YOUR-- IN OUR MEMO TO YOU OF APRIL THE 6TH. SUP. MOLINA, CHAIR: THANK YOU. DR. CHERNOFF? DR. BRUCE CHERNOFF: SUPERVISORS, MY NAME IS DR. BRUCE CHERNOFF AND, ON BEHALF OF THE DEPARTMENT OF HEALTH SERVICES, I REALLY WANT TO SECOND WHAT DR. SOUTHARD HAS ALREADY SAID. I THINK THAT THE DEPARTMENTS HAVE MADE TREMENDOUS PROGRESS LOOKING FOR WAYS TO RATIONALIZE AND STABILIZE WHERE THE COUNTY PSYCHIATRIC EMERGENCY ROOMS FIT WITHIN THE SERVICES DELIVERED WITHIN THE DEPARTMENT OF HEALTH SERVICES AND WITHIN THE LARGER SCOPE OF SERVICES DELIVERED FOR FOLKS WITH MENTAL HEALTH PROBLEMS. ON TOP OF THE INPUT ISSUES, WHICH MARV HAS JUST DESCRIBED, DR. SOUTHARD HAS JUST DESCRIBED AND WE BELIEVE ARE REALLY IMPORTANT TO BE ABLE TO RATIONALLY FIND OTHER PLACES TO PROVIDE STABLE, EFFECTIVE SERVICES, TO WORK COLLABORATIVELY WITH THE PRIVATE SECTOR AND OTHER KINDS OF DELIVERY SITES LIKE URGENT CARES IS INCREDIBLY IMPORTANT AND WILL HELP US MANAGE THE INFLUX IN A MORE EFFICIENT FASHION. THE OTHER CRITICAL PIECE IN THIS IS THE OUTPUT, THE ABILITY TO MOVE PATIENTS FROM A PSYCHIATRIC EMERGENCY ROOM INTO ACUTE BEDS AND/OR OTHER APPROPRIATE LEVELS OF CARE, WHICH MAY NOT NECESSARILY BE AN ACUTE BED. THE DEPARTMENT OF MENTAL HEALTH HAS WORKED VERY HARD TO INCREASE THE BED STOCK OF LOCKED BEDS. I THINK BOTH DEPARTMENTS AGREE FUNDAMENTALLY THAT THE LONG-TERM IMPACT OF THE MENTAL HEALTH SERVICES ACT WILL PROVIDE A VARIETY OF COMMUNITY-BASED SERVICES AND WE SUPPORT THE EFFORTS TO DELIVER THOSE SERVICES. IN THE INTERIM, THOUGH, WE DO NEED TO HAVE A PLACE TO CARE FOR THOSE WHO ARE MENTALLY ILL AND THE BED STOCK OF I.M.D. AND OTHER LOCKED BEDS IS AN IMPORTANT TRANSITIONAL PIECE UNTIL SOME OF THESE NEWER RESOURCES COME ON LINE. D.M.H. HAS COMMITTED TO IDENTIFYING 30 I.M.D. BEDS, WHICH WILL BE A NEW SUBSET OF BEDS AVAILABLE TO OUR DEPARTMENT. THEY'VE COMMITTED TO IDENTIFYING 20 NEW BEDS FOR THE DEPARTMENT. THEY'RE GOING TO BE BRINGING ON 38 NEW RESIDENTIAL NON-LOCKED BEDS ON THE GROUNDS OF METRO, STATE HOSPITALS, 48 NEW SECURE BUT UNLOCKED BEDS IN THE SAN GABRIEL VALLEY AND PART OF WHY THESE TWO ELEMENTS ARE VERY IMPORTANT IS THAT THE DEPARTMENT OF MENTAL HEALTH HAS AGREED TO START BY LOOKING AT THE I.M.D. BEDS THAT ARE CLOGGED UP AND UNCLOGGING THEM AS A WAY OF STARTING TO MOVE TRAFFIC THROUGHOUT THE DELIVERY SYSTEM, GETTING PATIENTS TO A LOWER AND MORE ACCESSIBLE LEVEL OF CARE MORE QUICKLY BUT ALSO HELPING US DEAL WITH THE TRANSITION FROM OUR ACUTE HOSPITALS BACK INTO THE COMMUNITY. THERE'S A VARIETY OF OTHER BEDS THAT D.M.H. HAS AGREED TO, INCLUDING SOME BEDS AT WHITE MEMORIAL THAT THEY'RE LOOKING TO CONTRACT FOR, SOME ACUTE BEDS AT KEDRIN COMMUNITY HEALTH CENTER, 12 ADOLESCENT BEDS THAT YOUR BOARD HAS PREVIOUSLY APPROVED. THIS BRINGS A TOTAL OF 191 NEW BEDS INTO THE SYSTEM AT A VARIETY OF LEVEL OF CARE. WE BELIEVE THESE 191 NEW BEDS MAKE A SIGNIFICANT COMMITMENT TOWARDS PROVIDING A SPECTRUM OF SERVICES AND ALLOWING US TO FLOW PATIENTS THROUGH THE SYSTEM MORE EFFICIENTLY. IN SUMMARY, I THINK THE DEPARTMENT VIEWS BOTH THE EFFORTS TO MITIGATE INPUT AND FIND OTHER POINTS OF INPUT, THE EFFORTS TO MITIGATE OUTPUT CLOGS, FIND OTHER SOURCES OF CARE FOR OUR PATIENTS, TRANSITION THEM MORE SMOOTHLY IS A GREAT STEP TOWARDS WHAT THE MENTAL HEALTH SERVICES ACT WILL EVENTUALLY BRING TO US IN TERMS OF A WIDER SPECTRUM OF CARE. THANK YOU. SUP. MOLINA, CHAIR: WELL, WE APPRECIATE THE IMPROVEMENTS THAT BOTH DEPARTMENTS HAVE MADE AND I PARTICULARLY APPRECIATE THE COOPERATION IN TRYING TO FIND A WAY TO WORK TOGETHER BECAUSE IT'S A SOLUTION THAT'S BASED IN BOTH DEPARTMENTS, IT'S NOT ONE OR THE OTHER. BUT, DR. CHERNOFF, I AM CONCERNED ABOUT THE TRACKING SYSTEM. ARE YOU GOING TO PUT IN PLACE WHICH ARE-- MORE EFFECTIVE SYSTEM OF TRYING TO MAKE SURE HOW WE'RE TREATING EVERY PATIENT, DOING AN ANALYSIS, WHETHER MONTHLY OR HOWEVER, QUARTERLY? I'M-- I WAS DISTRESSED TO HEAR ABOUT THIS INITIALLY AND I WAS EVEN MORE DISTRESSED WHEN IT DIDN'T LOOK LIKE WE WERE DOING AN ANALYSIS TO FIND OUT HOW TO RESOLVE SOME OF THE OVERCROWDING SITUATION. I APPRECIATE THE WORK THAT YOU'VE DONE, I THINK THIS GOES A LONG WAY TO ASSIST US BUT I THINK IT'S ONLY GOING TO BE AN ESCALATION OF THESE KINDS OF SITUATIONS. AND SO, CONSEQUENTLY, IT WOULD BE WORTHWHILE TO DO AN ANALYSIS OF, YOU KNOW, HOW MANY PEOPLE ARE COMING IN, HOW MANY PEOPLE ARE LEAVING EACH DAY, WHAT KIND OF MEDICATION, IF THEY'RE GETTING MEDICATION, WHAT KIND OF TREATMENT, WHAT KIND OF-- WHERE ARE THEY BEING DISCHARGED TO? ALL OF THIS WILL ASSIST US IN THE KIND OF FUTURE PLANNING THAT WE NEED TO DO AND TO MEASURE WHETHER, IN FACT, WE'RE GOING TO BE ABLE TO ATTACH DOLLARS, WHICH IS WHAT, YOU KNOW, ONE OF THE OPPORTUNITIES THAT WE HAVE IS WITH THE NEW DOLLARS THAT WILL BE COMING INTO THE SYSTEM AND WE'VE GOT TO MAKE THOSE DOLLARS WORK, PARTICULARLY FOR THE PEOPLE WHO ARE IN-- THE MOST NEEDY AND THAT IS THOSE THAT ARE ENDING UP IN OUR PSYCH E.R., WHICH IS A FAIRLY DANGEROUS SITUATION. SO I DO HOPE YOU'LL PUT A TRACKING SYSTEM IN. DR. BRUCE CHERNOFF: WE'RE IN THE PROCESS OF DEVELOPING ONE, SUPERVISOR. SUP. MOLINA, CHAIR: AND HOW LONG DO YOU THINK IT WILL TAKE TO PUT TOGETHER? DR. BRUCE CHERNOFF: I BELIEVE WE'LL HAVE IT DEVELOPED AND TESTED IN ALL THE FACILITIES WITHIN THE NEXT, PROBABLY, TWO TO FOUR WEEKS AND THEN IMPLEMENTED AFTER THAT. SUP. MOLINA, CHAIR: ALL RIGHT. DR. BRUCE CHERNOFF: WE'RE GOING TO BE DOING THIS IN CONJUNCTION WITH THE DEPARTMENT OF MENTAL HEALTH AND WE WANT TO GIVE THEM THE OPPORTUNITY TO HELP US DEVELOP THE SYSTEM. SUP. MOLINA, CHAIR: AND, IN CONJUNCTION WITH THAT, ONE OF THE QUESTIONS THAT AT LEAST DR. SOUTHARD HAD WHEN I WAS IN THOSE MEETINGS WAS ABOUT DISCHARGE POLICY AND THE CRITERIA FOR DISCHARGE. ARE YOU IN THE PROCESS OF RESOLVING THOSE ISSUES OR HAVE THEY BEEN RESOLVED? DR. BRUCE CHERNOFF: I THINK WE'VE MADE A LOT OF PROGRESS. I THINK ONE OF THE PLACES WHERE WE'VE AGREED TO START TO WORK TOGETHER IS TO DEVELOP SOME SHARED DISCHARGE POLICIES, REALLY TRANSITION OF CARE POLICIES, STARTING WITH I.M.D. BEDS, BECAUSE THEY ARE SUCH A CRITICAL, SCARCE RESOURCE IN THE SYSTEM. ALSO, AGAIN, TRYING TO MAKE SURE THAT ALL OF OUR PATIENTS GO TO THE MOST UN-- YOU KNOW, MOST FREE LEVEL OF CARE THAT IS SAFE AND APPROPRIATE FOR THEM, SO THE MOST AUTONOMOUS LEVEL OF CARE. SUP. MOLINA, CHAIR: SO WILL YOU TRACK THAT AS WELL? BECAUSE I KNOW THAT, WELL, DR. SOUTHARD WOULD-- I MEAN, DOESN'T NEED THE ADDED EXPENSE OR DEBT BECAUSE HE'S HAVING TO PAY FOR THESE BEDS BUT, AT THE SAME TIME, WE HAVE TO HONOR WHAT DOCTORS ARE TELLING US AS FAR AS WHATEVER THE OUTCOME IS OR WHATEVER THE REMEDY IS OR THE TREATMENT SHOULD BE. BUT. AT THE SAME TIME, I THINK IT HAS TO BE-- YOU HAVE TO WORK IN CONJUNCTION WITH EACH OTHER, SO THERE'S A RESPECT AND UNDERSTANDING OF HOW WE GET IT ACCOMPLISHED AND I DIDN'T SEE THAT KIND OF THING GOING ON. SO, HOPEFULLY, THAT WILL ALSO BE PART OF THE TRACKING. ALL RIGHT. ANY OTHER-- MR. ANTONOVICH. SUP. ANTONOVICH: DR. SOUTHARD, WHAT IS THE STATUS OF DEVELOPING THE STATUS TO PERMIT THE L.P.S. DESIGNATION OF SPECIFIC PRIVATE PSYCHIATRIC CARE FACILITIES? MARVIN J. SOUTHARD: THE L.P.S. DESIGNATION OF NON-HOSPITAL PRIVATE FACILITIES? THE L.P.S. DESIGNATION, SUPERVISOR, IS, BY STATUTE, THE PREROGATIVE OF YOUR BOARD. YOU'VE DELEGATED THAT TO ME, AS MENTAL HEALTH DIRECTOR, AND SO WHAT WE ARE CURRENTLY DOING IS LOOKING AT COUNTY COUNSEL'S OPINION OF OUR ABILITY TO DESIGNATE NON-HOSPITAL FACILITIES. THE STATE DEPARTMENT OF MENTAL HEALTH, WHOM I'VE CONTACTED ON THIS MATTER, HAS NO PROBLEM WITH US DOING THAT. IT TURNS OUT THAT THE REAL ISSUE, SUPERVISOR, IS PROBABLY ONE OF LIABILITY AND, FOR THAT REASON, WE'RE HAVING COUNSEL TAKE A CLOSE LOOK AT IT. SUP. ANTONOVICH: ARE THERE EXISTING URGENT CARE CENTERS OR SIMILAR FACILITIES WITHIN OUR STATE THAT EVALUATE INDIVIDUALS WHO ARE A DANGER TO THEMSELVES THAT MAKE ASSESSMENTS OF PSYCHIATRIC EMERGENCY CARE? MARVIN J. SOUTHARD: SUPERVISOR, THERE ARE NO EXACT MODELS LIKE THE ONE WE'RE PROPOSING TO IMPLEMENT AND THE REASON FOR THAT IS THAT ONE OF THE KEY COMPONENTS THAT WE HOPE TO PUT IN OUR URGENT CARE CENTERS IS ATTENTION TO THE SUBSTANCE ABUSE ISSUES THAT OUR PATIENTS FACE BUT THERE ARE MANY COUNTIES WHO HAVE NON-HOSPITAL-BASED FACILITIES THAT ARE RECEIVING FACILITIES FOR 5150, SO THAT COMPONENT DOES EXIST IN OTHER PLACES IN THE STATE. SUP. ANTONOVICH: MR. JANSSEN, WHAT-- OR WHEN WILL THE BOARD RECEIVE THE DEPARTMENT OF HEALTH SERVICES AND MENTAL HEALTH RECOMMENDATIONS OF A FUNDING SOURCE FOR ANY RESTRUCTURING OF THE PSYCHIATRIC WARDS IN OUR COUNTY HOSPITALS? C.A.O. JANSSEN: SUPERVISOR, DURING BUDGET DELIBERATIONS. SUP. ANTONOVICH: BUDGET DELIBERATIONS? C.A.O. JANSSEN: THEY'RE FUNDED FOR WHAT THEY'RE PROPOSING RIGHT NOW. NEXT YEAR IS WHAT WE NEED TO TALK ABOUT. WE'LL HAVE IT IN JUNE. WE'LL HAVE IT IN MID-JUNE. SUP. ANTONOVICH: OKAY. DR. GARTHWAITE, WHAT TYPE OF REVIEW TAKES PLACE TO ENSURE THE ADEQUACY OF THE PHYSICAL FACILITIES ALLOCATED TO PSYCHIATRIC ASSESSMENT AND TREATMENT OF PATIENTS IN OUR EMERGENCY DEPARTMENTS WITHIN OUR COUNTY FACILITIES? DR. THOMAS GARTHWAITE: I CAN'T REALLY... [ LARYNGITIS - INAUDIBLE ] DR. BRUCE CHERNOFF: THE SPACE DEVOTED TO THE PSYCHIATRIC EMERGENCY ROOM SERVICES ARE-- THEY'RE A DESIGNATED SPACE IN EACH OF OUR FACILITIES. THE FUNCTION OF THAT SPACE, ITS EFFICIENCY, IS, IN PART, VOLUME- DRIVEN AND, IN PART, SPACE DRIVEN. SO, IF YOU HAVE THE ABILITY TO MOVE PATIENTS THROUGH THE SYSTEM QUICKLY THE SPACE IS MUCH MORE EFFICIENT. BECAUSE WE HAVE CHALLENGES ON INPUT AND A LOT OF CHALLENGES GETTING FOLKS FROM THE PSYCHIATRIC EMERGENCY ROOM INTO A BED, THAT ACTUALLY DECREASES THE EFFICIENCY OF THE FACILITIES. HISTORICALLY, THE FOOTPRINT IN EACH OF THE HOSPITALS IS ONE THAT WAS DESIGNATED IN THE ORIGINAL DEVELOPMENT OF THE FACILITIES, THE ONE EXCEPTION BEING U.S.C., WHERE WE'VE HAD SERVICES COMPRESSED INTO THE REMAINING BUILDING AFTER PREVIOUS EARTHQUAKE DAMAGE. SUP. ANTONOVICH: ARE BOTH THE MENTAL HEALTH AND FOR HEALTH DEPARTMENT, IS THE EXISTING HEALTH DEPARTMENT'S POLICIES AND PROCEDURES WHICH ADDRESS THE PROPER DOCUMENTATION RELATED TO MEDI-CAL MEDICAL NECESSITY CRITERIA GUIDELINES FOR SELECTION, OF POST-DISCHARGE, RESIDENTIAL CARE FACILITIES, AND APPROPRIATE COORDINATION WITH POST-DISCHARGE SUBSTANCE ABUSE SERVICES DONE IN COLLABORATION WITH THE DEPARTMENT OF MENTAL HEALTH? MARVIN J. SOUTHARD: SUPERVISOR, THOSE ARE POLICIES THAT HAVE NOT BEEN JOINTLY DEVELOPED IN THE PAST. THOSE ARE THINGS WE ARE CURRENTLY IN THE PROCESS OF WORKING TOGETHER TO DEVELOP SO THAT WE CAN HAVE MORE SUCCESSFUL OUTCOMES. AS SUPERVISOR MOLINA POINTED OUT, THESE ARE ISSUES THAT ARE JOINT RESPONSIBILITIES OF BOTH DEPARTMENTS IN FINDING THE RIGHT DISCHARGE PLAN SO THAT PATIENTS CAN BE SUCCESSFUL AND NOT BE A PART OF THE REVOLVING DOOR. AND THAT'S WHAT WE'RE TRYING TO DO IS TO FIND THE BALANCE. SUP. ANTONOVICH: WHAT IS THE TIMELINE FOR THOSE PROTOCOLS? MARVIN J. SOUTHARD: THE FIRST HIT ON THOSE POLICIES, THE FIRST DRAFT SHOULD BE RELATIVELY QUICK. SOME PIECES OF IT WILL PROBABLY BE MORE COMPLEX BECAUSE THEY REPRESENT UNCHARTED POLICY AREAS. FOR EXAMPLE, THE LINKAGE TO SUBSTANCE ABUSE WHEN THERE ARE NOT ENOUGH SUBSTANCE ABUSE TREATMENT FACILITIES IN THE COMMUNITY IS AN UNCHARTERED AREA THAT WILL TAKE A LONGER TIME TO DEVELOP. SOME OF THE ISSUES RELATED TO DISCHARGES THAT REFLECT PATIENT SAFETY I THINK WE'RE ON PROBABLY A MUCH CLOSER IMPLEMENTATION TIMELINE. IS THAT CORRECT, DOCTOR? DR. BRUCE CHERNOFF: YOU KNOW, I THINK THAT, DR. SOUTHARD, THERE ARE A WHOLE RANGE OF ISSUES WHERE DISCHARGE PLANNING IS GOING TO BE DIFFICULT BECAUSE THERE'S A WHOLE VARIETY OF COMMUNITY-BASED RESOURCES THAT DON'T EVEN EXIST YET. SO I THINK THAT, FOR THE CORE ISSUES, TRANSITION OUT OF AN ACUTE CARE FACILITY CERTAINLY INTO LOCKED FACILITIES AND THEN INTO A ARRAY OF COMMUNITY-BASED FACILITIES, THOSE ARE THE THINGS THAT WE CAN DEVELOP REASONABLY QUICKLY. IT'S THE FINER POINTS THAT WILL BE MORE OF A CHALLENGE. SUP. ANTONOVICH: SO IT'S A BASICALLY A PROCEDURAL PROCESS, NOT A FINANCIAL... DR. BRUCE CHERNOFF: IT'S A MIXTURE OF BOTH. I MEAN, I THINK ONE OF THE THINGS THAT'S IMPORTANT TO PUT ON THE TABLE IS ALL OF THE FACILITIES HAVE COMPREHENSIVE DISCHARGE PLANNING POLICIES IN PLACE. THEY ALWAYS HAVE HAD THEM. THEY'RE A J.C.H.L. REQUIREMENT. SO WHAT WE'RE TALKING ABOUT IS EVOLVING THOSE POLICIES, WHICH HAVE ALWAYS WORKED WELL FOR THE HOSPITALS TO REFLECT SOME SHARED KNOWLEDGE AND UNDERSTANDING WITH THE DEPARTMENT OF MENTAL HEALTH AND TO REFLECT THE KINDS OF RESOURCES THAT ARE CURRENTLY AVAILABLE AND THEN WE'LL EVOLVE OVER TIME WITH OTHER KINDS OF FUNDING LIKE THE MENTAL HEALTH SERVICES ACT COMING IN. SUP. ANTONOVICH: SO WE'RE LOOKING AT HAVING AN AGREEMENT TO THOSE ESTABLISHED PROTOCOLS PRIOR TO THE ADOPTION OF OUR '05/'06 BUDGET? DR. BRUCE CHERNOFF: I THINK THE INITIAL FRAMEWORK, YES. SUP. ANTONOVICH: WHAT IS YOUR CURRENT ANALYSIS OF THE PSYCHIATRIC EMERGENCY SERVICES SYSTEM, INCLUDING PSYCHIATRIC PATIENT ENTRY AND EXIT POINTS, NATURE AND RESULTS OF CLINICAL ASSESSMENTS AND TREATMENTS, THE REFERRAL SOURCES AND DISPOSITIONS, COMPARISONS WITH OTHER RECOGNIZED STATE-OF-THE-ART MODELS AND EXISTING AND PROJECTED UTILIZATION OF REFERRAL CATEGORIES? MARVIN J. SOUTHARD: SUPERVISOR, I THINK I WOULD BEGIN BY SAYING THAT WE HAVE BEEN TAKING A LOOK SPECIFICALLY ABOUT THAT FLOW-THROUGH PATTERN BECAUSE IT IDENTIFIES THE ISSUES AND PROBLEMS THAT OUR SYSTEMS HAVE BUT THE UNDERLYING ISSUE I THINK THAT OUGHT TO BE RECOGNIZED IS THAT BOTH DEPARTMENTS ARE RADICALLY UNDERFUNDED TO BE ABLE TO PROVIDE INDIGENT CARE, WHICH IS REALLY THE KEY ISSUE HERE. SO INDIGENT CARE FOR PERSONS WHO SUFFER FROM MENTAL ILLNESS AS WELL AS OTHER HEALTH CONDITIONS IS SHORT. SO IT'S UNLIKELY THAT, HOWEVER WELL THE TWO DEPARTMENTS WORK TOGETHER, THAT WE WILL HAVE A PROBLEM-FREE FLOW-THROUGH OF PATIENTS FOR A SYSTEM THAT JUST DOESN'T HAVE ENOUGH CAPACITY TO DEAL WITH ALL THE PROBLEMS IT FACES. DR. BRUCE CHERNOFF: AND TO ADD TO THAT, I THINK THAT, FOR THE DEPARTMENT OF HEALTH, ONE OF OUR CHALLENGES IS THAT WE ARE REALLY A VENDOR, IN MANY WAYS, TO THE DEPARTMENT OF MENTAL HEALTH. DEPARTMENT OF MENTAL HEALTH BUYS AN ARRAY OF SERVICES FROM A WHOLE VARIETY OF PROVIDERS AND WE'RE ONE OF THEM. WE PROVIDE PREDOMINANTLY EMERGENCY ROOM AND ACUTE INPATIENT SERVICES. THAT'S A FEW LITTLE EXCEPTIONS ON THE EDGES BUT THAT'S THE CORE SET OF SERVICES THAT WE PROVIDE. SO WE'RE NOT REALLY IN CONTROL OF A FULL SCOPE OF INPUTS THAT D.M.H. HAS AVAILABLE TO THEM OR THAT THEY CHOOSE TO CONTRACT WITH, NOR ARE WE NECESSARILY PART OF EVERY SINGLE OUTPUT. WE ARE COLLEAGUES IN THIS AND SO WE'RE DEFINITELY LOOKING TO WORK TOGETHER BUT IT'S A BROAD SYSTEM OF WHICH WE ARE KIND OF RIGHT IN THE CENTER BUT NOT REALLY AT THE EDGES. SUP. ANTONOVICH: WHEN DO YOU ANTICIPATE OR WHAT'S THE TIME LINE OF THE DEVELOPING OF YOUR METHODOLOGY FOR SETTLING COST ISSUES THAT EXIST BETWEEN MENTAL HEALTH AND HEALTH SERVICES RELATED TO PSYCHIATRIC EMERGENCY SERVICES? MARVIN J. SOUTHARD: SUPERVISOR, I BELIEVE THAT'S THE KEY ISSUE FOR OUR BUDGET DELIBERATIONS. I THINK THE TWO DEPARTMENTS HAVE A CLEAR UNDERSTANDING OF WHAT WE WOULD HAVE AS A FAIR APPROACH TO INPATIENT CHARGES BUT THE ISSUES OF WHAT COUNTS FOR EMERGENCY ROOM USE AND WHAT THE PROPER CHARGES ARE, ARE WHAT THE TWO DEPARTMENTS WILL BE WORKING WITH THE C.A.O. TO NEGOTIATE. SUP. ANTONOVICH: SO, MR. JANSSEN, YOU'LL BE PART OF THE PROCESS TO DEVELOP THAT...? C.A.O. JANSSEN: YES, SUPERVISOR. SUP. ANTONOVICH: AND WILL THE METHODOLOGY OF COST FOR PSYCHIATRIC EMERGENCY SERVICES TAKE INTO ACCOUNT THE HEALTH SERVICES' RESPONSIBILITY FOR THE COSTS OF ALCOHOL AND OTHER DRUG-RELATED CARE AND IDENTIFY OTHER COSTS NOT DIRECTLY CONNECTED WITH MENTAL HEALTH SERVICES? C.A.O. JANSSEN: THAT'S THE INTENT. SUP. ANTONOVICH: OKAY. SUPERVISOR MOLINA, I HAVE A MOTION, JOINT MOTION. PSYCHIATRIC EMERGENCY SERVICES IN ALL OUR COUNTY HOSPITALS HAS INCREASINGLY BEEN CHALLENGED WITH OVERCROWDED CONDITIONS. THE SITUATION IS COMPOUNDED BY THE FACT THAT APPROXIMATELY 60% OF INDIVIDUALS IN NEED OF EMERGENCY PSYCHIATRIC SERVICES ARE INDIGENT, HOMELESS OR AT RISK OF HOMELESSNESS. WITHOUT ADEQUATE SOCIAL SUPPORT SYSTEM AND OFTEN SUFFERING FROM CO-OCCURRING SUBSTANCE AND ABUSE DISORDERS, THE DIRECTOR OF THE DEPARTMENT OF HEALTH SERVICES AND MENTAL HEALTH HAVE IMPLEMENTED A VARIETY OF MEASURES TO ADDRESS THIS CRISIS BUT FURTHER ACTIONS ARE NEEDED TO ENSURE OUR SYSTEM HAS THE SUPPORT FOR THE INDIVIDUALS CURRENTLY USING THE PSYCHIATRIC EMERGENCY SERVICES AS PROVIDED. SO WE THEREFORE MOVE THAT THE BOARD DIRECT THE C.A.O., IN COLLABORATION WITH COUNTY COUNSEL, THE DEPARTMENT OF HEALTH SERVICES AND THE DIRECTOR OF MENTAL HEALTH, TO DEVELOP A STRATEGY TO PERMIT L.P.S. DESIGNATION OF SPECIFIC PSYCHIATRIC EMERGENCY CARE FACILITIES, INCLUDING URGENT CARE CENTERS FOR EVALUATION OF INDIVIDUALS TRANSPORTED INVOLUNTARILY FOR PSYCHIATRIC EMERGENCY ASSESSMENT. (2) REVIEW THE ADEQUACY OF THE PHYSICAL FACILITIES ALLOCATED TO PSYCHIATRIC ASSESSMENT AND TREATMENT OF PATIENTS IN THE EMERGENCY DEPARTMENTS OF THE COUNTY HOSPITALS AND RECOMMEND A FUNDING SOURCE FOR ANY RESTRUCTURING NEEDS. (3) DEVELOP COORDINATED CLINICAL DOCUMENTATION CLAIMING A DISCHARGE POLICIES AND PROCEDURES THAT FACILITATE ACCURATE CLAIMING AND REIMBURSEMENT, APPROPRIATE DISCHARGES AND SECURE LINKAGES TO COMMUNITY RESOURCES FOR ALL PSYCHIATRIC PATIENTS. THESE POLICIES AND PROCEDURES SHOULD ADDRESS THE PROPER DOCUMENTATION RELATED TO MEDI-CAL, MEDICAL NECESSITY CRITERIA, GUIDELINES FOR SELECTION OF POST-DISCHARGE RESIDENTIAL CARE FACILITIES, SUCH AS INSTITUTIONS FOR MENTAL DISEASE AND APPROPRIATE COORDINATION WITH POST-DISCHARGE SUBSTANCE ABUSE SERVICES. (4) COMPLETE AN ANALYSIS OF THE PSYCHIATRIC EMERGENCY SERVICES SYSTEM, INCLUDING BUT NOT LIMITED TO PSYCHIATRIC PATIENT ENTRY AND EXIT POINTS, NATURE AND RESULTS OF CLINICAL ASSESSMENTS AND TREATMENTS, REFERRAL SOURCES AND DISPOSITIONS, COMPARISONS AND OTHER RECOGNIZED STATE-OF-THE-ART MODELS AND EXISTING AND PROJECTED UTILIZATION BY REFERRING CATEGORIES. AND (5) DEVELOP A METHODOLOGY FOR SETTLING COST ISSUES THAT EXIST BETWEEN THE REFERRAL CATEGORIES-- EXCUSE ME, DEVELOP A METHODOLOGY FOR SETTLING COST ISSUES THAT EXIST BETWEEN THE DEPARTMENT OF HEALTH SERVICES AND MENTAL HEALTH RELATED TO PSYCHIATRIC EMERGENCY SERVICES, CARE. THE METHODOLOGY SHALL TAKE INTO ACCOUNT THE DEPARTMENT OF HEALTH SERVICES' RESPONSIBILITY FOR THE COSTS OF ALCOHOL AND OTHER DRUG-RELATED CARE AND IDENTIFY OTHER COSTS NOT DIRECTLY CONNECTED WITH MENTAL HEALTH SERVICES. SUP. YAROSLAVSKY: MADAM CHAIR? SUP. ANTONOVICH: THIS WAS ON THE GREEN SHEET BY SUPERVISOR MOLINA AND MYSELF. SUP. MOLINA, CHAIR: ALL RIGHT. SO THAT MOTION IS BEFORE US. SUPERVISOR YAROSLAVSKY. SUP. YAROSLAVSKY: HOW MANY-- YOU DESCRIBE THE NUMBER OF BEDS. THERE'S 190 BEDS COUNTYWIDE? DR. BRUCE CHERNOFF: THESE ARE 190... SUP. YAROSLAVSKY: THAT THIS PLAN WILL PUT FORWARD? DR. BRUCE CHERNOFF: WHAT THIS WILL BRING ON, SUPERVISOR, IS 191 NEW OR REDIRECTED BEDS THAT WILL BE AVAILABLE TO THE DEPARTMENT OF HEALTH SERVICES. SUP. YAROSLAVSKY: HOW MANY WILL BE NEW? MARVIN J. SOUTHARD: 161. SUP. YAROSLAVSKY: OKAY. AND, OF THE 161 NEW BEDS, WHERE WILL THEY BE LOCATED? WHAT PART OF THE COUNTY WILL THEY BE LOCATED IN? MARVIN J. SOUTHARD: THEY ARE ALL OVER THE COUNTY, SUPERVISOR. SUP. YAROSLAVSKY: HOW MANY ARE IN THE SAN FERNANDO AND THE ANTELOPE VALLEY? HOW MANY OF THOSE BEDS OF THE 161 NEW ONES? MARVIN J. SOUTHARD: I DON'T KNOW, SUPERVISOR. I'D HAVE TO DO AN ANALYSIS OF IT. SUP. YAROSLAVSKY: CAN YOU GIVE ME KIND OF A GUESS? MARVIN J. SOUTHARD: 25. SUP. YAROSLAVSKY: HOW DOES 12 SOUND? THAT'S MY UNDERSTANDING, IS THAT IT'S 12 NEW BEDS AND IT'S PART OF A DEAL THAT WAS APPROVED ON THE OTHER ITEM, ON OLIVE VIEW, AND THAT THE REST OF THE PLAN HAS, OTHER THAN THESE 12 FOR ADULTS, HAS NO PEDIATRIC PSYCH BEDS AND NO OTHER ADULT PSYCH BEDS, EITHER IN THE ANTELOPE, SANTA CLARITA OR SAN FERNANDO VALLEY OF 161 NEW BEDS. I'M JUST TRYING TO UNDERSTAND HOW THIS-- HOW YOU CAME ABOUT THE DECISION AS TO WHERE THE INVESTMENT WOULD BE MADE. IS THERE NO NEED IN THE ANTELOPE AND SAN FERNANDO VALLEYS? MARVIN J. SOUTHARD: SUPERVISOR, I'M NOT SURE WHERE THE ADDITIONAL I.M.D. BEDS ARE. THERE ARE I.M.D. BEDS IN THE SAN FERNANDO VALLEY THAT MAY NOT HAVE BEEN INCLUDED IN YOUR ANALYSIS, SO THERE ARE-- AMONG THE GROUP OF THINGS THAT WE'RE TALKING ABOUT ARE 50 ADDITIONAL I.M.D. BEDS, THERE ARE I.M.D.S IN THE VALLEY. I ASSUME SOME OF THOSE WOULD BE BUT I DON'T KNOW WHICH PARTICULAR FACILITIES WE'RE TALKING ABOUT. BUT, AS YOU KNOW, THERE HAVE BEEN ISSUES RELATED TO THOSE I.M.D.S IN THE VALLEY. WHAT WE DID IN THIS PLAN, SUPERVISOR, IS TRY TO PURSUE ALL AVAILABLE BEDS WHEREVER WE COULD FIND THEM. AND SO ONE OF THE KEY AREAS OF CONCERN IS THAT WE HAVE NOT HAD INDIGENT RESOURCES AVAILABLE FOR CHILDREN AND ADOLESCENTS IN THE VALLEY AND WE HAVE PURSUED CONTRACTS WITH SEVERAL HOSPITALS IN THE VALLEY TO SEE IF THEY MIGHT BE INTERESTED IN STARTING A CHILD AND ADOLESCENT WARD THAT WOULD TAKE INDIGENTS. AND OUR NEGOTIATIONS, TO THIS POINT, HAVE BEEN FRUITLESS. I WENT THROUGH MY MAIL THIS MORNING AND NOTED THAT YOU HAD SENT A LETTER TO A HOSPITAL IN THE VALLEY ASKING THEM TO LOOK AT THE POSSIBILITY OF OPENING SUCH A WARD. WE WOULD WELCOME THAT AND WE WOULD CONTRACT WITH THEM SHOULD THEY DO THAT BUT, TO THIS POINT IN TIME, WE HAVEN'T FOUND HOSPITALS THAT HAVE BEEN WILLING TO DO THAT. 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