DATE: August 19, 2025
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Interim Director, Department of Public Health
Sanja Bugay, Director, Department of Social Services
Susan Holt, Director, Department of Behavioral Health
Raymond T. Hunter, Director, General Services Department
SUBJECT: Partnership with San Joaquin Valley Free Medical Clinic and Needle Exchange to Host Harm Reduction Program at Brix-Mercer Complex
RECOMMENDED ACTION(S):
TITLE
1. Receive presentation from the Department of Public Health on the two-year pilot project with the Departments of Public Health, Social Services, and Behavioral Health and the San Joaquin Valley Free Medical Clinic and Needle Exchange, a 501(c)3 non-profit organization, for the Whole Person Harm Reduction Program;
2. Make a determination that the use of county-owned office and medical space at 1221 Fulton Street, Fresno, CA, 93721 by San Joaquin Valley Free Medical Clinic and Needle Exchange, a 501(c)3 non-profit organization, to provide health care services and harm reduction treatment to residents of the County will serve public purposes, and is in the best interest of the County and the public, pursuant to Government Code, section 26227;
3. Approve and authorize the no cost Lease Agreement with San Joaquin Valley Free Medical Clinic and Needle Exchange for approximately 1,100 square feet of office and medical space in the Brix-Mercer Building Complex, located at 1221 Fulton Street, Fresno, CA 93721, to be used by San Joaquin Valley Free Medical Clinic and Needle Exchange to provide health care services and harm reduction treatment, effective upon execution for five years through August 31, 2030, with annual review of the program to ensure compliance and ability to issue a 30 day termination notice if required; and
4. Approve and authorize the Agreement with San Joaquin Valley Free Medical Clinic and Needle Exchange to collaborate on providing health care services and harm reduction treatment, effective upon execution for five years through August 31, 2030, with annual review of the program to ensure compliance and ability to issue a 30-day termination notice if required ($0).
REPORT
Receipt of recommended action one will provide the Board with an oral presentation on the data and information collected during the prior two-year pilot program.
Approval of recommended action two through four will authorize San Joaquin Valley Free Medical Clinic and Needle Exchange, a 501(c)3 non-profit organization (SJVFMCNE), to lease office and medical space at no cost ($0) in the county-owned building that operates at the Department of Public Health (DPH) headquarters, the Brix-Mercer Building Complex, for health care and harm reduction treatment services to clients who reside Countywide. Approval of the recommended actions authorizes the Departments of Behavioral Health, Public Health and Social Services to enter into an Agreement with SJVFMCNE to collaborate on providing health care and harm reduction treatment services. This item pertains to a location in District 3 but has an effect countywide.
ALTERNATIVE ACTION(S):
Your Board may not approve of the recommended actions. In this case, SJVFMCNE would not have an indoor site to service clients and would be unable to provide services at the County facility. Alternatively, your Board could make changes to the term length and/or requirements of this agreement.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. It is estimated that the total cost for the use of the facility would remain neutral as both utilities and solid and medical waste charges would remain consistent with non-use of the facility. Janitorial costs would be neutral as current janitorial services would be adjusted to accommodate the operating hours of this pilot project. The cost for security would increase approximately $2,450 monthly. Staffing costs for Department of Public Health would total approximately $1,900 per month. Program supplies would remain constant at $1,500 annually. Costs for Security, Staffing, and Supplies are offset through current State grant funding and anticipated grant funding received from the Future of Public Health.
The recommended lease agreement with SJVFMCNE would allow the utilization of approximately 1,100 square feet of office and medical space at no charge. Sufficient appropriations and estimated revenues will be proposed in DPH Org 5620 FY 2025-26 Recommended Budget and will be included in subsequent budget requests.
DISCUSSION:
The Fresno County Whole Person Harm Reduction Pilot Program, approved by the Board on September 9, 2023, provided for a two-year pilot program with the understanding this item would return to your board at the end of the two-year pilot. The pilot program has shown significant public health benefits with minimal financial impact on the County and minimal community impact. DPH has returned to provide an update presentation and recommend continuing the program with a new lease and service agreement.
Since 1994, the San Joaquin Valley Free Medical Clinic and Needle Exchange (SJVFMCNE) has provided free harm reduction services in the Fresno Metropolitan Area, including collecting used needles for proper disposal in exchange for clean needles, medical care, and referrals for social services. Since January 2024, SJVFMCNE has been operating within the DPH Building.
The SJVFMCNE provides the following services: medical care which includes on-site incision and drainage or wound care, overdose prevention, which includes the distribution of Narcan, addiction treatment services, which include medication-assisted treatment (MAT) and syringe exchange. All SJVFMCNE services are fully funded through their own grants, donations, and other sources, not by Fresno County. Since inception of this pilot program, the County of Fresno has not paid for any of these materials.
Key Findings and Challenges:
Pathways to Recovery & Integrated Care: Successfully enrolled 327 individuals in Medically Assisted Treatment (MAT) in 2024, a new service. Also connects clients to primary care (63 referred) and behavioral health (20 referred).
Community Concerns: DPH engaged contracts with the Downtown Fresno Partnership and Poverello House to determine the effects of the pilot program on the area in the area around DPH. This data shows no sustained increase in unsheltered population or tents, and police data shows a drop in 'homeless' loitering/trespassing calls.
Significant Taxpayer Savings and Cost Efficiency: Estimated 2024 savings total over $6.3 million, primarily from avoided emergency room visits, medical treatments and lifetime savings from MAT engagement. Direct costs for utilities, janitorial, security, labor, and materials offset or have minimal county expense resulting in $90,760.62 in costs in 2024. These costs were offset through Future of Public Health grant funding.
Comprehensive Social Support: DSS served 844 individuals, facilitating hundreds of applications for essential benefits (Medi-Cal, CalFresh, General Relief) and addressing over 700 case inquiries, primarily for unhoused individuals.
Persistent Chronic Homelessness: On average 52% of individuals utilizing the Whole Person Harm Reduction Program reported chronic homelessness, highlighting the need for continued broader systemic housing solutions.
Overall, the pilot program has been successful in continuing to assist and enhance the services for at-risk individuals by connecting them to mental health, public health, and social services through collaborations with the Departments of Behavioral Health (DBH), Social Services (DSS), and Public Health (DPH). This includes access to behavioral health and substance use treatment, Medi-Cal, CalFresh, CalWORKs benefits, and referrals for HIV/AIDS, Hepatitis C, and Tuberculosis and to our other programs including our Nurse Family Partnership and pre and perinatal programs.
The proposed five-year lease and service agreement will ensure stability and allow for continued service enhancements. The clinic will operate Saturday mornings (8:00 AM - 8:30 AM to allow for set up, 8:30 AM - 12:00 PM for client services, with medical and cleanup until 2:00 PM). An annual review with a 30-day termination option will ensure ongoing alignment with County goals. DPH, in collaboration with its partners, would evaluate operations and adjust as necessary due to special events and/or resources to maintain an efficient and effective harm reduction program every Saturday.
ATTACHMENTS INCLUDED AND/OR ON FILE:
Presentation
On file with Clerk - Lease Agreement with SJVFMCNE
On file with Clerk - Agreement with SJVFMCNE
CAO ANALYST:
Ron Alexander