La County Supervisor Molina Motion Re Jail Medical Care 2012
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AGN. NO. MOTION BY SUPERVISOR GLORIA MOLINA July 24, 2012 The Los Angeles County Sheriff’s Department Medical Services Bureau (MSB) provides medical care at nine locations throughout the County including Men’s Central Jail, Pitchess Detention Center, Twin Towers and Century Regional Detention Center (CTC). Each year, MSB medically screens approximately 144,000 inmates. Sixty percent of these inmates receive additional medical services including intensive specialty care services and/or inpatient care at the LAC+USC jail ward. Historically, specialty care for jail patients has created challenges for care coordination and timeliness of patient care. Additionally, the logistical challenge of transporting patients from MSB to the jail clinic at LAC+USC is associated with high personnel, transportation, and security costs. Finally, given the recent implementation of AB109, the size and structure of the LAC+USC jail clinic appears to be insufficiently sized to accommodate the growing volume of jail patients transferred for specialty care. Consistent with the Board’s ongoing commitment to high quality, patient-focused medical care delivered in the most efficient and cost effective manner, the Board directed the Department of Health Services (DHS) to collaborate with the Sheriff’s Department to review current specialty care delivery and propose a plan to improve care coordination and timeliness of care. DHS and the Sheriff’s Department have jointly prepared a plan that will improve MOTION Molina ____________________________ Ridley-Thomas ____________________________ Knabe ____________________________ Antonovich ____________________________ Yaroslavsky ____________________________ access, quality, and coordination of specialty care between DHS and MSB, focusing on the highest risk and highest demand specialties including obstetrics and gynecology, orthopedic surgery, ear-nose-throat surgery, general surgery, oral-maxillary-facial surgery, cardiology and gastroenterology among others. The specialty care initiative, as recommended by the DHS Director in his June 28, 2012 Board letter, includes additional specialty care providers deployed to the MSB, enhancement of existing MSB diagnostic capabilities, a Specialty Care Leadership team for proper care coordination and quality assurance, and utilization of eConsult to increase specialty care access and decrease wait times. On-site jail medical staff at MSB will also work at LAC+USC’s jail clinic in order to improve continuity of care. DHS has further identified various cost saving mechanisms to help fund the estimated $5.8M in first year costs and estimated $5.2M in ongoing annual costs, including securing 340b prescription pricing for medications provided to jail patients; shifting MSB laboratory services to a DHS lab as opposed to a private vendor; and reduction in transportation costs between Sheriff’s Department clinics and LAC+USC. I, THEREFORE, MOVE THAT the Board of Supervisors direct the Department of Health Services (DHS) to work with the Sheriff’s Department to implement the initiative to provide on-site specialty care to jail patients and to implement the cost savings proposals to fund the collaborative specialty care initiative. I, FURTHER, MOVE THAT the Board of Supervisors request that DHS and the Sheriff’s Department report back within 45 days with a Memorandum of Understanding (MOU) between the Departments that outlines the scope of responsibilities between the Departments with respect to the operation and administration of the specialty care initiative. The MOU should stipulate a process by which a review of current year expenses informs the allocation of monies into the specialty care budget for the coming fiscal year. I, FURTHER, MOVE THAT the Board of Supervisors direct the Chief Executive Office and the Auditor-Controller to work with the Sheriff’s Department to establish the required accounts and/or budget to track and uniquely identify Medical Services Bureau/DHS Specialty Care costs within the Sheriff Department’s Custody Division budget and to provide at least $5.8M for this service within the Los Angeles County Sheriff’s Department Custody Division Budget—which in FY2010-11 included $185.9M for Medical Services Bureau costs—to fund the first year implementation of the specialty care initiative. Each year thereafter, funds will be identified within the Sheriff’s Department Custody Division Budget for the Medical Services Bureau/DHS Specialty Care budget unit in an amount sufficient for ongoing operation and administrative costs of the specialty care initiative. Additionally, the CEO and the Sheriff’s Department shall ensure that all costsavings generated over and above the costs to operate and administer this specialty care initiative be included in the Medical Services Bureau/DHS Specialty Care budget unit for use in expanding the scope of specialty care. I, FURTHER, MOVE THAT the Board of Supervisors request that DHS and the Sheriff’s Department submit a joint status report to the Board every four (4) months on its implementation of the MSB specialty care initiative and cost-savings proposals. The report back shall also include, but not be limited to, an evaluation of staff workload efficiencies, number of patient visits, time-to-care statistics, the effect on LAC+USC Medical Center jail clinic utilization and the impact of specialty care coordination efforts.