DATE: September 5, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
Sanja Bugay, Director, Department of Social Services
Susan Holt, Director, Department of Behavioral Health
Robert W. Bash, Director of Internal Services/Chief Information Officer
SUBJECT: Pilot 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. 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;
2. Approve and authorize the Director of Internal Services to execute, upon review and approval by County Counsel as to legal form and the Auditor-Controller/Treasurer-Tax Collector as to accounting form, the no cost Lease Agreement, in the same form as the draft lease agreement included with this item, 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 through August 31, 2025 ($0); and
3. Approve and authorize the Director of Public Health to execute, upon review and approval by County Counsel as to legal form and the Auditor-Controller/Treasurer-Tax Collector as to accounting form, the agreement, in the same form as the draft agreement included with this item, with San Joaquin Valley Free Medical Clinic and Needle Exchange to collaborate in a pilot program on providing health care services and harm reduction treatment, effective upon execution through August 31, 2025 ($0).
REPORT
Approval of the recommended actions 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 in the county-owned building that operates as 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 also authorizes the Departments of Behavioral Health, Public Health and Social Services to enter into an Agreement with SJVFMCNE to collaborate in a pilot program on providing health care and harm reduction treatment services. The lease and pilot program will be effective for approximately two-years starting upon execution. This item pertains to a location in District 3.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, SJVFMCNE would not have an indoor site to service clients and would continue to operate at its current location on a side street near Roeding Park in Fresno.
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 slightly increase as both utilities and solid and medical waste charges would go up minimally. 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 $2,100 monthly and is completely offset through funding received from the Future of Public Health funding previously approved by your Board.
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 the Department’s Org 5620 FY 2023-24 Recommended Budget and will be included in subsequent budget requests.
DISCUSSION:
SJVFMCNE has been operating in the Fresno Metropolitan Area since 1994, providing free harm reduction services, including collecting used needles for proper disposal in exchange for clean needles, medical care, and referrals for social services. SJVFMCNE currently provides these services out of a mobile van on a side street near Roeding Park on every Saturday afternoon. Close to 20,000 syringes are exchanged each Saturday afternoon. From July 2022 to June 2023, SJVFMCNE exchanged 790,000 syringes and served 4,000 unique participants. More recently, SJVFMCNE has been providing pipes as an alternative route of drug ingestion to reduce use of needles, which in turn reduces the risk of blood-borne pathogens such as Hepatitis B, C and HIV/AIDS and soft tissue infections. These services are effective harm reduction strategies because they reduce the number of used needles improperly disposed of in our community.
SJVFMCNE also provides condoms as a harm reduction strategy that can reduce transmission of sexually transmitted diseases (STDs), as well as basic medical assistance and treatment by a qualified medically licensed physician, particularly for infections, abscesses, and wound care related to injection drug use. From April 2022 to April 2023, there were 304 medical clients who were treated by physicians in the clinic, 57 of whom required incision and drainages being performed onsite. Had these services not been available, these client needs likely would have resulted in the emergency room visitations and services, causing a strain on the local medical system. Based on our own survey of clients, approximately 35% of the individuals who received the medical treatment services are unhoused or uninsured, further suggesting that these program services have provided a relief to the countywide medical system.
Finally, SJVFMCNE provides linkages to drug treatment, mental health, social services, and other harm reduction methods including distribution of naloxone, the opioid overdose reversal medication commonly known as Narcan®. In 2022, SJVFMCNE provided 8,000 doses of Narcan and reported 1,295 overdose reversals from their efforts. The linkages work includes offering Medicated Assisted Treatment (MAT), in person and through the telehealth option, along with wrap-around support from a nurse and a community health worker to clients by prescribing enough buprenorphine (Suboxone) to support home induction coupled with follow-up at an Opioid Treatment Program.
The proposed operation hours for the clinic would be from 12:00pm to 4:00pm every Saturday. This time corresponds with SJVFMCNE’s current program hours. 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.
Because the individuals served by the SJVFMCNE are at high risk for encountering barriers related to other social determinants of health, the Departments of Behavioral Health (DBH) and Social Services (DSS) will participate in helping develop more holistic strategies that connect individuals to available services. DPH staff and partners from the contracted community health workers network would provide services that include access and referral to behavioral health and substance use treatment through DBH, and accessing or maintaining Medi-Cal, CalFresh, or CalWORKs benefits through DSS. DPH also proposes expanding the range of public health services offered to this population to include screening and treatment options for STDs and HIV/AIDS, as well as linkages to pre-natal or perinatal services.
In order to ensure that the pilot program is working, several metrics will be tracked to measure success and they include:
• Identifying and tracking resources to which program participants were provided linkages,
• Monitoring participant trust in harm reduction or medical clinics,
• Tracking the number of health professionals receiving training in the field through this program,
• Tracking the number of unique clients served,
• Increased encounters with DPH, DBH, and DSS staff addressing identified health and social service needs, and
• Tracking the number of medical services provided by the program that otherwise may have been provided at a local Emergency Department.
REFERENCE MATERIAL:
BBR - Pilot Partnership with San Joaquin Valley Free Medical Clinic and Needle Exchange to Host Harm Reduction Program at Brix-Mercer Complex - August 14, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Lease Agreement with SJVFMCNE
On file with Clerk - Agreement with SJVFMCNE
CAO ANALYST:
Ron Alexander