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

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Ridley-Thomas ____________________________
Knabe

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Antonovich

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Yaroslavsky

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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.