DATE: June 20, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Waiver of Extra-Help Maximum Hour Limitation
RECOMMENDED ACTION(S):
TITLE
Authorize a waiver of the 28 hours per week and 960 hours per calendar year maximum hours limitation for the Extra-Help positions listed on Attachment A in the Department of Public Health, Org 5620, pursuant to the provisions set forth in Salary Resolution, section 1100 and Personnel Rules 2040 and 4240.
REPORT
There is no additional Net County Cost associated with the recommended action. Approval of the recommended action will ensure the Department’s Community Health, and Epidemiology Surveillance and Data Management Divisions have adequate staffing to continue to complete COVID-19 and vaccine related tasks, as well as data clean up. Approval will also ensure that the Environmental Health Division has adequate staffing to complete necessary water well inspections. This item is countywide
ALTERNATIVE ACTION(S):
There is no viable alternative action due to the number of projects stemming from the increase of emergent communicable diseases, the need for continued COVID-19 test processing and the demand for well permit applications and recreational health facility inspections. Should your Board not approve this request, there will be delays in vaccine transportation and clinic preparations; processing COVID-19 testing; and issuing well permits and recreational health facility inspections
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. Sufficient funding exists within the Epidemiology and Laboratory Capacity (ELC) grant for the Extra-Help Program Technician (PT) and Laboratory Intern positions. The Extra-Help Medical Assistant (MA) will be funded by 56201654 Realignment cost savings from the vacant Office Assistant (OA) position. The salary of the Extra-Help Medical Assistant and the budgeted Office Assistant II position that has been vacant since March of 2022 are both $36,764. The Extra-Help Environmental Health Aide (EHA) position ($40,535) will be financed by the generation of permit fees collected by Public Health, Environmental Health Division from vendors conducting businesses requiring mandated inspections in Fresno County. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2022-2023 Adopted Budget.
DISCUSSION:
On January 13, 2015, and June 7, 2016, your Board reiterated County policy that the use of Extra-Help employees should:
• be of limited duration;
• not be used as a first response to staffing requirements;
• not supplant work regularly performed by permanent employees; and
• only be used to meet the critical, seasonal, or temporary work needs of departments on a limited basis.
On June 7, 2016, the Board approved Salary Resolution Amendments that provided departments with the requested flexibility, while limiting the use of most Extra-Help employees. As provided in those Amendments, County Counsel is recommending a waiver of the 28-hours per week maximum hours limitation for the positions listed on Attachment A due to the staffing needs.
The Department is requesting a waiver for one (1) extra-help Program Technician (PT), one (1) extra-help Medical Assistant (MA), one (1) extra-help Environmental Health Aide (EHA) and two (2) extra-help Laboratory Interns.
Due to the current workload of staff, COVID vaccine and other vaccine work is beyond what permanent employees can manage. During 2020-2022, resources were redirected to help with COVID response, which adversely impacted and delayed work in other programs. Approval of this item would allow for Extra-Help staff to support the reconstruction of these delayed projects.
The PT will be assigned the following job duties:
• Assist with COVID Vaccine pick up and drop off (0-5 days/week)
• Assist with transport of non-COVID vaccine as needed (0-2x/week task, as needed)
• Assist with prepping ancillary supplies for COVID Vaccine pickups (0-5 days/week)
• Assist with managing vaccine transport equipment (including ensuring cooler panels are correctly conditioned, temperature devices are stored properly and have current calibration) (0-5 days/week)
• Assist with off-site pop-up clinics (including COVID vaccine clinics, Flu Clinics, and Flu/COVID clinics) (roughly 15-20 clinics expected in Fall 2023)
• Assist with inventory management for general vaccine supplies and equipment stored throughout the building (daily task)
• Assist with checking patients in/out for vaccine appointments at Brix (as needed)
• Scanning vaccine medical records into Laserfiche (4-15 hours/week)
Metrics:
• 70-100% COVID Vaccine related work
• 0-30% Vaccines work that isn’t COVID vaccine
• Expected hours: 28-35 hours/week; expected to fluctuate
The workload assigned to this PT position is not consistently at 40 hours/week. Additionally, the funding of COVID vaccine itself is expected to change over the next year, resulting in an unclear outlook in workload need. The funding for this position that is specific to COVID Vaccine support is not projected to last longer than two years.
The Department continues to have high vacancy rates in the OA classification, despite multiple recruitments, several rounds of referring qualified candidates and conducting interviews. Many applicants have declined interviews citing that they have already taken jobs elsewhere, applicants have not showed their interviews, and other applicants accepted the position but ultimately took a position with a different entity citing higher pay.
The MA would provide improved support for IZ Clinic:
• OA’s frequently receive calls that need to be fielded to nursing staff as they are related to vaccine recommendations and health questions outside the scope of an OA. Having an MA actively answering phones could both decrease client wait time and decrease the demand on nurses’ time. The staff will also be supporting the clinic through scheduling appointments, checking patients in and out for appointments, and ensuring medical records and billing are up to date.
A permanent MA position is being pursued via Salary Resolution. The need of the program is 40 hours per week to better provide phone coverage and assistance with checking patients in and out for appointments.
The recent drought has substantially impacted the Department’s water well program to the point that current staffing resources are inadequate to meet program demands. To maintain clean, pure water, it is important to ensure new water wells are sealed with cement or another approved sealing material. This is the primary barrier to keep surface contamination from entering into the ground water and contaminating it. The Environmental Health Division inspects to ensure these seals are installed in an approved manner to protect current ground water supplies. The number of well permits and well inspections conducted has rapidly increase in recent years. Additionally, the Governor’s executive order has added complexity to our ability to evaluate permits. The utilization of an extra help Environmental Health Aide (EHA) as field staff will keep our existing permit review staff from needing to cover field inspections and stay focused on reviewing new permits.
Calendar Year # of Permits Permits/Month
2023 (to date) 212 71
2022 946 79
2021 1081 90
2020 673 56
2019 556 46
2018 886 74
The primary focus for this EHA has been, and will continue to be, working in the water well program. The incumbent extra-help EHA is needed approximately 32-40 hours per week. Additionally, if well inspection demand decreases, the EHA can assist with other Environmental Health programs where staffing is also limited, such as trash complaints, CUPA program scouting, housing complaints, public pool inspections, etc.
The Epidemiology Surveillance Data Management Division’s Extra-Help Laboratory Interns typically work under the supervision of experienced microbiologists in laboratory settings. The specific duties and responsibilities can vary depending on the current need and the focus of the microbiology work being conducted. Some common tasks that Laboratory Interns may be perform are:
• Laboratory Techniques: Laboratory Interns often assist in performing various laboratory techniques related to microbiology research. This can include preparing and sterilizing culture media, handling microbial cultures, performing aseptic techniques, and using laboratory equipment such as microscopes and centrifuges.
• Sample Collection and Processing: Laboratory Interns may be involved in the collection and processing of samples, such as environmental samples, clinical specimens, or food samples. They may learn to handle and transport samples properly, perform sample preparation techniques, and maintain accurate records of sample information.
• Data Collection and Analysis: Laboratory Interns may assist in collecting and organizing data from experiments or research studies. This can involve recording observations, analyzing microbial growth patterns, performing data entry, and using basic statistical analysis techniques.
• Assisting with Experiments: Laboratory Interns may support ongoing experiments by setting up equipment, carrying out specific protocols, monitoring experiments, and recording results. They may also assist in troubleshooting issues that arise during experiments and ensure proper documentation of experimental procedures.
• Lab Safety and Quality Control: Laboratory Interns are typically trained in laboratory safety protocols and may be responsible for maintaining a clean and safe work environment. They may assist in implementing quality control measures, calibrating equipment, and ensuring compliance with standard operating procedures.
• Literature Review and Research Support: Interns may be involved in literature reviews, gathering relevant research articles, and assisting with background research for ongoing projects. They may also participate in team meetings, discussions, and contribute to scientific presentations or reports.
The Department will utilize Extra-Help staff for specific project-based work or initiatives that have a defined timeline and do not provide funding for permanent positions. The duration for which Extra-Help staff will be utilized depends on the specific assay that is in demand. It will align with the critical, seasonal, or temporary work that is assigned and allow for flexibility in staffing levels. The Department will return to your Board if it is necessary to extend these Extra-Help staff past December of 2023.
REFERENCE MATERIAL:
BAI #49 - October 25, 2022
BAI #72 - June 21, 2022
BAI #46 - November 16, 2021
BAI #37 - June 7, 2016
BAI #19 - January 13, 2015
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Attachment A
CAO ANALYST:
Ron Alexander