DATE: April 4, 2017
TO: Board of Supervisors
SUBMITTED BY: Dave Pomaville, Director, Department of Public Health
SUBJECT: Salary Resolution Amendment
RECOMMENDED ACTION(S):
TITLE
Approve Amendment to the Salary Resolution adding ten positions and deleting two positions to the Public Health Org 5620, effective April 10, 2017 as reflected on Appendix E.
REPORT
Approval of the recommended action will add ten new positions in the Department of Public Health, including one of each of the following: Public Health Nurse, Communicable Disease Specialist, Licensed Vocational Nurse, Program Technician, Staff Analyst, Office Assistant, Health Educator and Medical Social Worker as well as two Health Education Specialists to address increased caseloads. The addition of these positions will increase disease investigation and follow-up, meet existing grant requirements, promote compliance with State and Federal mandates, connect families with critical resources and facilitate relationships with community partners.
Approval of the recommended action will delete two vacant positions, a Public Health Physician and a Nutrition Education Coordinator. The increased cost for the added positions in FY 2016-17 is $160,077. The savings from the deleted positions for the same period is $65,071, for a total net increase of $95,006, funded with Health Realignment, grants, and fee revenues, with no increase in Net County Cost.
ALTERNATIVE ACTION(S):
Alternatives include approving a part of the requested positions. Should the requested positions not be approved, the Department would continue to have an inadequate number of staff handling an overwhelming number of serious health related cases. Existing delays include the reporting of animal bite cases to expedite investigations, meeting grant requirements and training to businesses and local emergency response agencies regarding accessing hazardous waste information during emergencies.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended Salary Resolution Amendment adds ten positions and deletes two positions. The estimated increased cost for salaries and benefits associated with the proposed ten positions in FY 2016-17 is $160,077. The savings from the deleted positions in FY 2016-17 is $65,071, for a total net increase of $95,006. The full year estimated cost is $698,405. The full year savings for the deleted positions is $283,291, for a total net increase of $415,114. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2016-17 Adopted Budget and will be included in future budget requests.
The increase for the requested positions will be funded in FY 2016-17 ($160,077) as follows:
• Health Realignment $60,340
• Grants $86,452
• Fees $13,285
The full year cost ($698,405) will be funded as follows:
• Health Realignment $263,252
• Grants $377,194
• Fees $57,959
DISCUSSION:
A Departmental assessment resulted in an established need for an increase in the total number of staff by ten. The positions would be assigned to the Department’s Community Health, Environmental Health, Office of Policy, Planning and Communication and Children’s Medical Services Divisions to address identified service delivery gaps.
• The six Community Health Division positions will address the increased tuberculosis (TB) caseload, syphilis data management, aid in agenda and policy preparation and address an identified need in the South East Asian community.
• The two Environmental Health Division positions will expedite dog bite investigations and allow more in-depth hazardous material education and training.
• The one Office of Policy, Planning and Communication Division position will oversee the implementation of nutrition program activities in six targeted rural communities.
• The one California Children’s Services Division position will provide added support to address the uncovered medical therapy clinics.
By adding these positions, the Department will be able to adjust job duties and responsibilities and delete a Public Health Physician and Nutrition Education Coordinator position, which have been hard to fill and are vacant.
The following is a summary of requested positions and justifications for each position categorized by divisions:
Community Health Division:
The following would be assigned to the Community Health Division:
• One (1) Staff Analyst I/II/III - Position will work closely with supervisors to develop clinical Policy & Procedure Guidelines for TB, Immunizations and sexually transmitted diseases. The position will also prepare board agenda items, contract development, budget monitoring, grant writing and reporting and assist in administrative needs.
• One (1) Health Education Specialist - Position will be assigned with the primary focus on infectious diseases impacting the Southeast Asian Community. The Department has identified the need to improve health messages directed to the Southeast Asian communities in the County. The position will assist with improving it's messaging to this community and help with building trust on important health issues that are impacting this population.
The responsibilities of this position include implementation of community outreach events geared towards assuring accurate information is disseminated to the target audience through meetings, television and radio interviews as well as social media. The position will also build relationships and trust with community and faith based organizations serving the target population. The Department foresees that this position will evolve into other aspects of public health geared towards the target population.
The following would be assigned to the TB Control Program:
• One (1) Public Health Nurse I/II - Position will help manage the overwhelming number of cases for existing nurses. Existing nurses have a caseload of 120 cases per, the added position will reduce the caseload to a more manageable 80 cases per. The position will provide case management to patients with active and suspected TB disease as well as provide nursing assessments for foreign-born individuals and contacts of TB cases. In addition, this position will assist in providing TB screening for a portion of the homeless population coming through the program.
• One (1) Communicable Disease Specialist I/II - Position will address increased workload, manage and re-evaluate identified close contact clients per California Department of Public Health’s recommendation. In 2013, the Department investigated 450 close contact cases. By 2016, cases nearly tripled to 1,299. In addition, the Department continues to regularly screen the homeless population; in 2016, 817 were screened for TB.
• One (1) Licensed Vocational Nurse I/II/III - Position will be assigned with a primary focus on case management of specialty cases. The cases include follow-up of foreign-born individuals immigrating to the County. In 2016, of the 153 cases in the program, 80 were foreign-born and identified by the Federal government. The County receives an average of 90 foreign-born cases per year. The position will be assigned to a recent successful pilot project administering a treatment regimen which resulted in an increase in the compliance rate from an estimated 60% to 90% in 2016.
• One (1) Program Technician I/II - Position will assist with the management of data and follow up directly with healthcare providers on treatment information related to syphilis and other reportable diseases. In 2015, there were 1,035 syphilis cases, of which 42 were congenital. In 2016, preliminary numbers indicate 1,765 cases, of which 53 were congenital. In the past, the California Department of Public Health has provided resources to cover these duties; however, the resources are no longer available but the workload is expected to remain steady or grow.
Environmental Health Division:
• One (1) Office Assistant I/II/III - Position will assist with the Rabies Control Program. Over 1,200 dog bite reports are submitted to the Department each year. This position will handle the collection and entry of the data needed to enter the reports. Once the reports are entered into the database, the Environmental Health Specialist staff can complete the investigation. Dog bite complaints require immediate investigation because if the quarantine of the animal is not observed in a timely manner, the next alternative for the bite victim is Post Exposure Prophylaxis or PEP. This position takes over the data processing component of these reports previously handled by the animal control vendor. An Extra-Help employee fulfilled interim responsibility for this role once the previous animal control vendor contract ended, but the employee continuously went over the 28-hour per week limitation because of the program demand. This position will also assist all County cities and the animal control vendor with collection and entry of the data required to complete dog bite reports.
• One (1) Health Education Specialist - Position will be assigned to the hazardous materials program, Certified Unified Program Agency (CUPA). The program is charged with regulating businesses that create, store and use hazardous materials. The CUPA Program has received monies from state wide settlements with large companies over the illegal disposal of hazardous waste. This money can only be spent to enhance and encourage compliance within this program. Approximately 5,000 businesses in the County are regulated by this program and are required to electronically report and maintain their hazardous materials plan. Because of the complexity of state and federal regulations, many businesses have trouble understanding and complying with these regulations. Many do not even know where to go to obtain assistance.
This position will manage an outreach and education program to assist facilities to become compliant with mandated reporting requirements. The HES will organize and implement educational and training opportunities that would benefit businesses that must comply with these laws. This position will facilitate the use of subject matter experts, such as Fresno County CUPA staff and hired consultants, to organize and implement educational workshops for business owners, assisting with electronic form completion and submission, use existing data sources to identify non-compliant businesses and direct those businesses toward compliance options. The responsibilities will also include overall promotion and education regarding the CUPA program, including the development of media campaigns and website content, such as the creation and addition of educational videos and documents on the Fresno County CUPA website. In addition, the position will coordinate training to local emergency response agencies to access the electronic inventory hazardous materials portal, which is critical for pre-emergency planning.
Office of Policy, Planning and Communication Division:
• One (1) Health Educator - Position will replace the vacant Nutrition Education Coordinator position. This new position will be funded by the Nutrition Education Obesity Prevention Program grant to oversee the implementation of community coordination activities in the following six targeted communities: Kerman, Lowell, Parlier, Reedley, Sanger, and West Fresno. The position will work on policy, systems, and environmental changes impacting all residents. The target communities, with population totaling 83,919, will be saturated with activities in retail, work sites, schools, and other community-based locations. Work will also be done supporting residents in resident-identified community improvements such as park improvements, community walkability, and increasing access to healthy food.
California Children’s Services (CCS) Division:
• One (1) Medical Social Worker I/II/III - Position will replace the vacant Public Health Physician position. This position will provide assistance to the general CCS child population as well as for those being seen at the Medical Therapy Program (MTP). There is inadequate support being provided currently as the sole existing Department Medical Social Worker (MSW) cannot meet the need to be available to address referrals from CCS nurses for general CCS children and also attend MTPs monthly patient clinics held at three different geographic locations. Each clinic involves eight to ten children and their families with a total of five to six clinic days per month. Due to the current staffing shortage, more direct services have been substituted by the mailing of pertinent and referral service information, which is not nearly as effective as the meeting with the MSW. The addition of this new position will allow for more adequate support of the children and families being served by the CCS Program.
With your Board’s approval of the recommended Salary Resolution Amendment, ten positions will be added to the Department of Public Health to address increased caseloads. The Amendment will also delete two vacant positions. The recommended Salary Resolution Amendment is effective April 10, 2017, and the Department of Human Resources concurs with the Resolution.
ATTACHMENTS INCLUDED AND/OR ON FILE:
Salary Resolution Amendment - Appendix E
CAO ANALYST:
Sonia De La Rosa