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January 2018

Message From The Director

Reflections on My Career as Health Director

With my time as health director coming to a close within the next few months, I have begun to reflect on the many changes over the years that improved access to care, prevention, quality outcomes and health equity. I will use the next few issues of the Director's Report to share my experiences, what attracted me to Contra Costa Health Services (CCHS) and what kept me here all of these decades.

What Attracted me to Contra Costa Health Services

I started my career with CCHS on July 1, 1974 as a primary care physician. I was attracted to the department because of its commitment to family medicine with a quality teaching program, its practice of delivering outpatient care regionally in the communities and its own managed care plan for Medi-Cal beneficiaries, Contra Costa Health Plan (CCHP).

One of my first assignments was to work in a "temporary" building in Oakley with one bathroom and makeshift walls constructed with bedsheets. Six years later, we moved from this "temporary" site when funding was secured to lease a building in Brentwood. I learned from this experience that the community which was mostly agricultural at the time valued respectful, culturally sensitive care more than shiny walls. This is a lesson I have never forgotten and I found it most valuable in my role as medical director for CCHP.

I became the medical director in 1980 and worked with consultants to make CCHP the first publicly sponsored, managed care health plan in the nation to become federally qualified. This designation allowed the plan to eventually enroll not only Medi-Cal beneficiaries, but also Medicare members, small business employees, individuals and County employees. I valued the care and services that the plan provided enough to enroll my family as members and I remain a member today. Medi-Cal beneficiaries have choice today regarding where they seek their healthcare, and more than 80% choose to be members of CCHP. We do not take this statistic for granted, and strive daily to meet and exceed the expectations of our 200,000 members.

The cost of healthcare has grown tremendously from the time that CCHP was offered to County employees for one penny a month. I am proud to say that since those early days, CCHP has worked tirelessly under the leadership of several CEOs to improve access and quality for all of its members, including the addition of advice nurse services. I remember the day when after-hour advice was provided by me and several other physicians who had to keep a pocket full of dimes to respond to a page for advice by using a pay phone. We have come a long way with our state-of-the-art telephone systems and health information technology, and we are continuously making changes to improve access, including creating an online portal that allows patients to email their providers.

Thank You, Pat Godley

In 1983, after experiencing a $10 million deficit due to an accounting error, the positions of health director and county administrator suddenly became opened. I was appointed by the Board of Supervisors (BOS) as the interim health director along with several other job titles - medical director, county public health officer, mental health director, county physician and public guardian. Although, I didn't quite understand what all of these jobs entailed, I knew that I needed someone with public finance expertise to help me. This is when I hired Pat Godley as chief financial officer.

Pat helped the department overcome the deficit and created finance and accounting systems that allowed us to promise the BOS that we would never encounter another deficit due to an accounting error. Pat remains with us after 33 years, and is primarily responsible for the financial and operational success of our department despite the ups and downs of federal, state and local funding for safety-net healthcare.

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Many Roles within Department

A year after being appointed to so many positions simultaneously, someone figured out that I couldn't do this work alone. Mark Finucane was appointed health director and I was appointed medical director and health officer. In these roles, I had the responsibility of overseeing all physicians, with direct responsibility for Public Health, Environmental Health, Hazardous Materials and Emergency Medical Services.

My lasting memory of 1984 was how the entire staff of the department came together with passion and commitment to find ways to increase revenue, decrease expenses and operate more efficiently as we dug our way out of the $10 million deficit. It was inspiring and prepared us well for the struggle over the next decade on the question of rebuilding the hospital.

New Hospital Built

Mark and I were faced with whether to close or rebuild the aging County hospital that was not seismically safe. In the end, a deciding vote cast by then-Supervisor Mark DeSaulnier helped us to do what was in the best interest of the people living in Contra Costa County – build a state-of-the-art, seismically safe hospital, located geographically in the center of the county. Since Contra Costa Regional Medical Center opened 20 years ago in 1998, we have experienced what it is like to lose Los Medanos Hospital in East County and Doctor's Medical Center in West County. Can you imagine the impact if we didn't have CCRMC? Again, I am proud to have advocated for this valuable resource for our county and see the benefits and rewards of that decision today.

Addressed Community Health Issues

In the meantime, there were other community health issues to address, and Dr. Wendel Brunner, Public Health Director at the time, was victorious in the battle against Big Tobacco. Contra Costa County was one of the first in the nation to pass anti-smoking ordinances which were then adopted by all of our cities. This laid the ground work for the ensuing progression of ever more restrictive ordinances that continues today.

Being the home to several oil refineries, challenged us to address health hazards they posed to our communities. The Hazardous Materials Division assumed responsibility for all the multiple HazMat safety programs passed by the state Legislature during the 1980s and developed a superbly trained and competent HazMat emergency response team. In addition, we hired our own chemical engineers for the more complex refinery and chemical plant inspections which then allowed our Board of Supervisors to pass an Industrial Safety Ordinance in 1999. These ordinances and trained staff markedly reduced the number of facility fires and toxic releases that had been occurring on a regular basis.

County Trauma Center Designation

In 1985, I recognized the need for a county-wide trauma center and convened a process to designate a facility. John Muir Medical Center in Walnut Creek successfully won the designation and serves us well to this day. We also developed the first Bi-County Trauma Audit Committee, overseeing all the trauma care in the four trauma centers serving Alameda and Contra Costa.

Looking Back and the Work Ahead

Since my appointment to health director in 1995, I have been involved with many, many policy and procedural changes that I have not mentioned in this message. The passage of the Affordable Care Act has been the most impactful in that it not only significantly reduced the uninsured rate in the county, but it also funded prevention and health outcomes. It requires providers of healthcare to show improvements in the health of their patients, including addressing the social determinants of health.

It is exciting to leave the leadership role in the organization at a time when so many of the protections that I have supported and advocated for are in place. I know there are many threats to the great strides we have made, and still much work ahead to address health inequities. I am very optimistic that we will continue this path to health for all who live and work in Contra Costa County.

As I shared with you in the previous issue of the Director's Report, job candidates are being interviewed and I expect a new health director will be selected in the next few weeks. In the meantime, I will continue to work hard with you and for the residents we serve.


Going the Extra Mile:

These CCHS Employees are GEMs

Click here to find out how the people named below went the extra mile.

Yesenia Bermudez
Ashley Cramer
Eliza Virata, RN
Melissa Carofanello
Arlene Lozada
Jo-Anne Linares
Cheryl Shipley
Shelly Watling
Gina Maglasang, RN
Hanna Nash, RN
Harpreet Chatha, RN
Jena Villena, RN
Josephine Nwosu, RN
Kaitlin Thomas, RN
Kaneisha Griffin, RN
Krystle Placheta, RN
Lynn Soloway, RN
Michelle Lim, RN
Rachele Roberds, RN
Robert Torres, RN
Robin Bevard, RN
Sharon Rini, RN
Ashley Walkup, RN
EMS Branch and Division Staff
Diana Canate-Blount
Carlo Barlaan
Monique Barrett
Kimberly Thai
Cynthia Choi
Tammy Stoicich
James Baird-Kerr
Dennis Richards
Oleg Andreev
Jim Liu
Latashia Randle
Lisa Smith-Johnston, RN
Nula Lakha-Jackson
Christine Conner
Kathreen Reece, LVN
Sharon Holder, LVN
Belaynesh Biwota, RN
Jessica Venson
Kimberly Possible
Gregory Wilson
Aurora Pelayo
Jessica Venzon
Cha’vonne Tatum

Nilwin Papa
Araceli Puentes
Jose Reyes
Amanda Dold
Peter Ordaz
Catherine Frances, MD
Karen Glover
Laneisha Terrell
Kristine Miller
Alycia Rubio
Sonja Bailey
Andrea Blair
Liza Butorac
Rebecca Campagna
Teresa Cochran
Craig Coffman
Christina Connolly
Cherie Decker
Debbie Dorsey
Isa Garcia
Todd Gilloon
Katy Gilman
Allyn Glosser
George Huntington
Shirlee Johnson
Taasha Jones Reyes
Erin Jordan
Christianna McCarty
Nancy McLafferty
Nora Meadows
Mark Olson
Kathy Overholser
Deborah Price
Nicole Sevier
Diane Shouse
Sharon Singh
Natalya Sturtz
D’Anne White
Carla Wilson
Maricar Fontanilla, LVN
Brian Blaisch, MD
Grace Munene
Eslit Torres
Gerie Barry
Pittsburg Health Center Healthy Start Staff


Communicable Disease

Flu Season Gets Off to Early and Deadly Start

The flu season has gotten off to an earlier-than-usual start, and sick patients are flooding hospital emergency rooms around California and the Bay Area, including Contra Costa Regional Medical Center (CCRMC).

Our Emergency Medical Services (EMS) and Public Health divisions have activated their operations centers at a virtual level in response to the high flu activity in the area. Earlier this month, EMS reported delays in ambulance patient offload times and CCRMC's ER saw a significant increase in wait times because of the high volume of flu-related cases.

In California, 42 deaths had been reported from flu-related causes for persons under the age of 65 by mid-January. Most of the people who died didn't get their flu vaccines, according to state officials. In Contra Costa County, there already have been six flu-related deaths of people under 65 years of age, compared to four deaths for the entire flu season last year.

The predominant influenza strain so far, H3N2, can cause more severe symptoms, especially among children and the elderly. Communicable Disease Chief Paul Leung and other public health officials are reminding people that getting vaccinated remains the best protection available. A vaccinated person may still get sick, Paul said, but the vaccine will likely prevent severe disease and possibly death.


Contra Costa Health Plan

CCHP Introduces New Palliative Care Benefit

Starting on Jan. 1, Contra Costa Health Plan (CCHP) and other Medi-Cal managed care providers began offering a new palliative care benefit for seriously ill members who need assistance with decision-making when their advanced illness continues to decline and they are not yet eligible for hospice.

Palliative care consists of patient- and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering. The new benefit provides eligible members visits with palliative care physicians, nurses and social workers for symptom control, advanced care planning and care coordination.

In order to qualify for the benefit, members must have a chronic and advanced life-limiting illness with either congestive heart failure, chronic obstructive pulmonary disease, cancer or liver disease – to a level of severity that death within a year is plausible.

"CCHP hopes this new benefit will assist members and their families with support in making personal quality-of-life decisions in the later stages of life; to reduce suffering and worry in terminal care situations, and to ensure our members' end of life journey is as peaceful as possible," said CCHP Chief Executive Officer Patricia Tanquary. "CCHP has contracted with two community palliative care providers, as well as CCRMC's outpatient palliative care clinic, to ensure our members have access to these services."


Alcohol and Other Drugs Services

AODS Effort Eliminates Long Waits for Treatment in Contra Costa

Contra Costa Medi-Cal patients referred to substance use disorder (SUD) treatment no longer need to wait for the services they need, thanks to the county's newly implemented Drug Medi-Cal Organized Delivery System (DMC-ODS).

Wait lists for residential SUD treatment previously extended for months in Contra Costa, and prospective clients even had to call every week in order to keep their place in the wait list. But the DMC-ODS, funded through the Medi-Cal 2020 Waiver, has dramatically improved the way capacity is managed and the range of services available.

Led by the Alcohol & Other Drugs Services Program (AODS), part of the Behavioral Health Services Division (BHS), Contra Costa's DMC-ODS has rapidly ramped up services since last July, when the Board of Supervisors approved an agreement with the state to secure funding for the expansion.

The previous backlog of patients waiting for SUD services, about 200, has effectively dissipated, meaning patients no longer experience long delays between referral to services and placement, according to AODS Program Chief Fatima Matal Sol.

DMC-ODS allows our Medi-Cal patients to access to comprehensive SUD therapy, including residential treatment, withdrawal management, recovery support services, case management, outpatient and intensive outpatient services, and medication assisted treatment.

BHS, Contra Costa Health Plan and many other partners worked for two years on an expansion plan to accommodate an estimated 7,000 new SUD patients in our system of care.


Contra Costa Regional Medical Center

Hospital Cafeteria Re-Opens

The cafeteria at Contra Costa Regional Medical Center (CCRMC) re-opened January 10 after undergoing an extensive renovation that began two years ago.

The upgraded cafeteria, called Contra Costa Café, features improved signage and nicer furnishings. There is also a wider variety of food options to choose from, as well as Starbucks Coffee. For the first time, cafeteria patrons will now be able to pay with their credit or debit cards.

What hasn't changed: Employees still get a 20% discount and meal tickets will still be honored.

An open house with free snacks and drinks was held on January 9 to show off the new space and thank staff for their patience while the cafeteria was closed for repairs.


Information Technology

New CoCoHealth App Connects People to Community Resources

Contra Costa Health Services, in partnership with Health Leads USA, released a new mobile app in December that helps people to identify social-needs resources in the community. Using Health Leads' "Reach" database, the CoCoHealth connects people with resources for healthcare, jobs, food, housing, child care and other needs that can impact health.

Users can search hundreds of listings in Contra Costa County and quickly identify the best food pantries, heating assistance programs, bill-payment support or housing options in their area. The service listings even explain who is eligible for support and how to apply.

The CoCoHealth app is available for Android and iOS (Apple) devices. The plan is to add more information about services offered by Contra Costa Health Services in future updates to the app.


Hospital & Health Centers

One-Stop Clinics Reduce Surgical Cancellations

Thanks to one-stop perioperative clinics launched 18 months ago, fewer patients have to cancel surgical procedures at Contra Costa Regional Medical Center (CCRMC) at the last minute.

A couple of years ago, patients who needed surgeries at CCRMC would have to make four to five separate preparatory visits before their operations. This often resulted in confusion and many patients had procedures canceled the day they were scheduled to happen because of non-medical problems such as financial clearance, lack of transportation, as well as lab work issues and incomplete charts.

Three perioperative clinics started in July 2016 to improve care coordination and make the system less confusing. Patients can now handle all their pre-surgical screening requirements in just one visit to these clinics.

More than a year later, the data shows the one-stop clinics are having an impact: Only 2.6% of cases are being canceled on the day of surgery, as opposed to the previous 8% cancellation rate. Surveys show patients like the new one-stop service, which also produces cost savings to the system by avoiding unnecessary tests and preventing duplication of efforts.

For more information, contact Specialty Care Director Dr. Gabriela Sullivan at Gabriela.Sullivan@hsd.cccounty.us.


Tobacco Prevention

Contra Costa County Begins Enforcing New Tobacco Sales Laws

New laws to protect youth from tobacco influences went into effect this month and local health officials are enforcing the new regulations, which include prohibiting the sale of flavored tobacco products (such as menthol cigarettes and flavored e-liquids) within 1,000 feet of schools, parks, playgrounds, and libraries in unincorporated parts of the county.

The sale of cigars in pack sizes under 10 is also prohibited in unincorporated areas of the county, with cigars selling for $5 each excluded from the regulations.

The Contra Costa Board of Supervisors passed new rules last summer, and retailers were given a period of time to prepare. Our Tobacco Prevention Program has been doing education and outreach to all tobacco retailers in recent months to help ensure compliance with the new youth protections.

Another provision adopted by the Board of Supervisors that bans sales of tobacco products in pharmacies won't take effect until July 2018 after their tobacco retailer licenses expire.

Retailers not complying with the new rules can be fined up to $500 for each day they are in violation and may face suspension or revocation of their tobacco retailer license.

For more information about the County's new tobacco regulations, please visit cchealth.org/tobacco.


Homeless Services

More than 150 Volunteers Join H3 for Annual Homeless Count

The Division of Health, Housing and Homeless Services (H3), along with numerous community organizations and more than 150 volunteers, will conduct its annual survey of Contra Costa residents who are experiencing homelessness from Jan. 23-25.

The point-in-time count documents both sheltered and unsheltered community members and helps government, service providers and community advocates develop effective responses to the challenges facing local people who need permanent housing.

The count will take place in many locations across the county, from outdoor encampments to sites where homeless services are offered. Residents will also be able to participate in the survey by calling 211 from Contra Costa County during the count.

During the 2017 count, 1,607 people were identified as homeless in Contra Costa County. For more information about the count and homeless services in the county, visit cchealth.org/homeless.


Regional Health Foundation

Save the Date: Foundation Hosting Event on April 26

The Contra Costa Regional Health Foundation, which supports and raises awareness of the work being done by CCHS, will celebrate its 15th anniversary on April 26 at the Pleasant Hill Community Center.

The $50 event will highlight programs supported by the Foundation through the years. Light appetizers, wine and dessert will be served.

For more information, contact CCRFH board member Rhonda Smith at Rhonda.Smith@hsd.cccounty.us.


Whole Person Care

CommunityConnect is Up and Running!

With over 38,000 telephone calls made, 3,000 home visits completed, and 14,400 patients enrolled, CommunityConnect (CMCT) is making waves in the needs of its patients.

CommunityConnect is CCHS' pilot Whole Person Care program. It features a multidisciplinary staff that includes public health nurses, mental health specialists, social workers, community health workers, and substance abuse counselors.

Social Workers from the Employment and Human Services Department recently joined the team in November and Homeless Services specialists will be joining the teams soon to better assist our homeless clients and people at risk of becoming homeless. The program recently completed a pilot with Bay Area Legal Aid making free legal services available to all CMCT patients. Partnerships with the LifeLong and La Clinica clinics are in process to provide case management services to eligible patients cared for by their healthcare systems.

CMCT has also been working to implement new technology to support care coordination and data accessibility throughout CCHS's system of care. All CMCT documentation is completed within our electronic health record, ccLink, allowing all CCHS users to view case management notes, assessments and interventions.



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MILESTONES

Thanks to these employees who have given us long years of service:

30 Years

Marie C. Servantes, Cynthia L. Cook-Yoell, Tanya Gutierrez

25 Years

Juliette K. Moore, Daniel M. Lively, Rebecca S. Aguilar

20 Years

Walter R. Gorski, Kimberlee S. Cox, Margaret Pytlak, Laura E. Reynolds, Christopher E. Dodd, Anissa Y. Carter, Mary T. Vessy, Denise L. Whittle, Roya Iranpour, Ma Linda H. Siat, Aggie Houshmandi, Ma Isabel Ongkingco, Lorena C. Ruano, Rosalia C. Gonzalez

15 Years

Jessica D. Davison, Elizabeth R. Diaz, Laurianda S. Abenda, Erin M. Crowley, Perry O. O'Brien, Gretchen M. Eger, Venet H.M. Cremona-Thompson, Jennifer R. Gonzaga, Maria Perpetua H. Macaraig, Cynthia P. O'Brien, Clintonia Walker

10 Years

Andrea F. Bivens, Matthew J. Camarena, Catherine I. Nwosu, Jennifer C. Milne, Emelyn E. Tepace, Steven E. Blum, Gary P. Zimpel, Paolo S. Gargantiel, Juliana M. Mijares, Eslit P. Torres, Dianne E. Rohde, Andrea T. Mostella, Inas A. Moussa, Teresa G. DeVera, Saunaz Sarvi, Pamela R. Perez, Annette K. Ramirez, Irma J. Contreras


Send feedback and story ideas to editor Will Harper at will.harper@hsd.cccounty.us