CEO Letter to Board re Jail Health Consolidation & Office of Diversion, LA County, 2015
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October 06, 2015 The Honorable Board of Supervisors County of Los Angeles 383 Kenneth Hahn Hall of Administration 500 West Temple Street Los Angeles, California 90012 Dear Supervisors: COUNTYWIDE CLASSIFICATION ACTIONS TO FACILITATE JAIL HEALTH CONSOLIDATION AND THE OFFICE OF DIVERSION AND RE-ENTRY (ALL DISTRICTS - 3 VOTES) SUBJECT This letter and accompanying ordinance will update the tables of classes of positions and the departmental staffing provisions by adding new classifications and positions, and by reclassifying positions in the Sheriff Department to facilitate the implementation of the Jail Health Consolidation Plan and the new Office of Diversion and Re-entry. IT IS RECOMMENDED THAT THE BOARD: Approve the accompanying ordinance amending Title 6, Salaries, of the County Code to add five (5) new classifications and positions in the Department of Health Services (DHS) and to reclassify three (3) positions, currently in the Sheriff Department, to facilitate the Jail Health Consolidation Plan and establishing the Office of Diversion and Re-entry. PURPOSE/JUSTIFICATION OF RECOMMENDED ACTION Your Board of Supervisors (Board) has requested submission of classification letters on a periodic basis throughout the year to facilitate consideration of classification and compensation recommended actions in a timely manner. Approval of the recommendation will provide the ordinance authority for the Departments of Health Services (DHS) and Sheriff to implement the classification recommendations in this letter. The Honorable Board of Supervisors 10/6/2015 Page 2 The recommendations will ensure the proper classification and compensation of positions based upon the duties and responsibilities assigned to these jobs as performed by incumbents (Attachments A and B). This is a primary goal of the County¶s classification and compensation system. We are recommending these actions based upon generally accepted principles of classification and compensation. Furthermore, these actions are important in implementing high-priority Board initiatives. The proper classification and compensation of positions facilitates good business operations and can reduce the number of costly personnel-related problems. New Classifications ±Department of Health Services On June 9, 2015, your Board approved the proposed Jail Health Services Structure and the related implementation plan. For the first six months we are in Phase Zero which includes the establishment, recruitment, and hiring of new leadership positions and the proper alignment of the rest of the management team. This letter recommends all the classification actions that will facilitate the achievement of this goal in a timely matter. Specifically, we are creating four (4) new, highly-specialized leadership classifications (Attachment A). The Correctional Health Director (UC) will be an unclassified position which, under the direction of a DHS Deputy Director and an Assistant Sheriff, will have responsibility for the management of all healthcare services within the Los Angeles County jails. This position is the sole authority on health care within the County jails. The Director, Substance Use Disorder Treatments, will be responsible for developing, implementing, and administering a comprehensive, coordinated and integrated continuum of care for substance use disorder treatment in the County correctional health care system, linking in-custody services with out-of-custody services. The Director, Care Transitions, will be responsible for ensuring that an integrated, efficient and comprehensive care team model is in place to strengthen effective discharge planning and linkage to community health care and other services. And finally, the Program Director, Jail Mental Health, will work with the Chief, Psychiatrist to develop, implement, and administer all mental health aspects of the integrated jail health services. We are also creating a new class Director, Office of Diversion and Re-entry (UC), which will report to the same Deputy Director as the Correctional Health Director. This position will direct and oversee the County¶s jail diversion efforts, which are dedicated to preventing or reducing the needless incarceration of individuals with mental illness and/or substance use disorders. The position has full responsibility for guiding the strategic, operational, and administrative alignment of diversion activities and decisions with the goal of reducing the incarceration and recidivism of mentally ill and/or severely addicted residents of Los Angeles County. Reclassifications ±Sheriff Department We are reclassing three (3) positions (Attachment B) currently in the Medical Services Bureau of the Sheriff Department, which will be moving to DHS within Phase One. All three (3) positions are being reclassed based on their new and expanded duties and responsibilities as part of the new DHS leadership team for integrated jail health care. Implementation of Strategic Plan Goals Your Board¶s approval of the accompanying ordinance is consistent with the County Strategic Plan Goal 1 - Operational Effectiveness. The new leadership team established by these actions will develop a transformative, integrated health care system throughout the County¶s correctional The Honorable Board of Supervisors 10/6/2015 Page 3 facilities, and will help prevent or reduce the needless incarceration of individuals with mental illness and/or substance use disorders. FISCAL IMPACT/FINANCING The projected budgeted annual cost associated with filling the five (5) new leadership positions is estimated to total $1,030,420 and the projected budgeted annual cost resulting from the reclassifications recommended is estimated to total $175,207. The cost increases for the Jail Health Services (JHS) related items are expected to be fully covered by the integrated JHS budgets across the four impacted departments. The Chief Executive Office (CEO) will continue to work with DHS and the impacted departments to evaluate the integrated budget as the consolidated JHS program is transferred in phases to DHS. The CEO will notify your Board of any additional funding needs to ensure DHS has sufficient funding to cover the total cost of the integrated JHS program. The cost of the Director of the Office of Diversion and Re-entry will be covered by funding included in the new Diversion and Re-entry budget unit that was created as part of the Fiscal Year 2015-16 Supplemental Budget changes. There is no net County cost associated with this action at this time. FACTS AND PROVISIONS/LEGAL REQUIREMENTS The County Charter authorizes the establishment and maintenance of ³a classification plan and the classification of all positions.´This responsibility is further delineated in Civil Service Rule 5. The accompanying ordinance implementing amendments to Title 6, Salaries, of the County Code has been approved as to form by County Counsel. IMPACT ON CURRENT SERVICES (OR PROJECTS) Your approval of these classification recommendations will provide for a leadership team that will greatly enhance the health care received by inmates throughout the County¶s correctional system, as well as other individuals with mental illness and/or substance use disorders. The Honorable Board of Supervisors 10/6/2015 Page 4 Respectfully submitted, SACHI A. HAMAI Interim Chief Executive Officer SAH:RM:SJM AE:KP:mmg Enclosures c: Executive Office, Board of Supervisors County Counsel Auditor-Controller Human Resources Sheriff Department Attachment A CLASSIFICATIONS RECOMMENDED FOR ADDITION Proposed Savings! Cafeteria Benefit Plan Item No. Title Salary Schedule & Level Savings! Megaflex 4554 Correctional Health Director (UC) N23 R19* Savings! Megaflex 4562 Director, Care Transitions N23 S13 Savings! Megaflex 4583 Director, Office of Diversion and Re-entry (UC) N23 R19 Savings! Megaflex 4561 Director, Substance Use Disorder Treatments N23 S13 Savings! 4584 Program Director, Jail Mental Health N23 S17 Megaflex * If the incumoent is ‘icensed to practice medicine in the State of California or is a registered nurse in the State of California, a provision in the County Code creates an extended range that is 7.5 % higher at the top. Attachment B SHERIFF DEPARTMENT No of Pos. 1 — MEDICAL SERVICES BUREAU Present Classification Chief Physician Ill Item No. 5459A-55 N42 Non-Represented No of Pos. I Classification Findings Medical Director I Item No. 5463A N42 E24 Non-Represented I Clinical Nursing Director III Item No. 5300A N23S16 Non-Represented I Chief Nursing Officer II Item No. 5308A N23S17 Non-Represented I Staff Analyst, Health Item No. 4593A NM98F Non-Represented 1 Senior Staff Analyst, Health Item No. 4594A NMIO5G Non-Represented Medical Director I As part of the leadership team, directly reporting to the Correctional Health Director (CHD), the Medical Director I is the top ranking physician leader in the jail. The Medical Director is responsible for the clinical care program on the front line including intake within the inmate reception center at both the men’s and women’s facility; the primary care clinics scattered across all Sheriff custody institutions; the specialty care throughout all of the Sheriff custody institutions; the urgent care program at Twin Towers; the Correctional Treatment Center which is a 150 bed skilled nursing facility and the coordination with the 24-bed LAC+USC jail ward. The Medical Director has ultimate responsibility over the clinical program, the staffing of clinicians in these areas, the interactions of clinicians with other disciplines such as pharmacy and laboratory, death review and peer review and ultimately the Quality Improvement (QI) program at the jail. Many of these functions closely interact with the CHD but they ultimately are the responsibility of the jail medical director. These increased responsibilities are in line with the Medical Director I classification, which states that the position “acts as the head of the medical department in one of the smaller County hospitals or a medically-related program for DHS.” Therefore, we recommend upward reclassification to Medical Director I. HOA.1221151.1 Attachment B SHERIFF DEPARTMENT — MEDICAL SERVICES BUREAU (Continued) Chief Nursing Officer II As part of the leadership team, reporting directly to the Correctional Health Director, the Chief Nursing Officer II (CNO II) is responsible for nearly 1300 nursing staff, covering five (5) different Sheriff facilities and many clinical areas. The CNO II must manage two (2) areas that operate on a 24/7 basis as well as a number of clinical areas which operate seven (7) days a week approximately ten (10) hours per day. The responsibilities include: (a) creating and maintaining nursing protocols, (b) managing a complex “sick call” system; (c) augmenting the physician led Quality Improvement infrastructure at the jail by organizing the data analytics functions for jail health services; (d) managing the daily operations of the 150 bed Correctional Treatment Center; (e) recruitment and hiring for the jail nursing structure; (f) working directly with medical and mental health providers to ensure timely provision of care and prescribed medications; and (g) developing a nursing leadership and training program to ensure jail health service nursing staff remain current with their skills and knowledge. These expanded duties are in line with the classification CNO II which states as follows: “directs the nursing services of an autonomous County acute or rehabilitative medical center with responsibility for 501 to 2500 full-time equivalent subordinate positions.” Therefore, we recommend upward reclassification to Chief Nursing Officer II. Senior Staff Analyst, Health The Senior Staff Analyst, Health reports to a Captain and is responsible for directing, through two (2) subordinate supervisors, multiple units comprised of budget, personnel operations, contract, procurement and other administrative services. Duties include serving as project manager for the Bureau’s Electronic Medical Record project; reviewing reimbursement rates annually for payments to thirty-three (33) contracted hospitals; collaborating with the Auditor-Controller’s Office on a new patient accounting system; and coordinating audits related to budget and staffing. The duties and responsibilities meet the classification standards for Senior Staff Analyst, Health, a class responsible for supervising professional employees in the research, analysis, and preparation of recommendations regarding the use and deployment of resources and the implementation and improvement of operations and programs having department-wide impact. Therefore, we recommend upward reclassification to Senior Staff Analyst, Health. HOA. 1221151.1