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SR 01-26-2016 3G City Council Report City Council Regular and Special Joint Meeting: January 26, 2016 Agenda Item: 3.G 1 of 7 To: Mayor and City Council From: Jacqueline Seabrooks, Police Chief, Police Department Subject: Medical Services for Arrestees Recommended Action Staff recommends that the City Council take the following actions: 1) Authorize the City Manager to negotiate and execute a professional service agreement with Vital Medical Services, LLC, a California-based company, for in- house medical service provisions for arrestees. This is a contract in an amount not to exceed $150,000 with future year funding contingent on Council budget approval. 2) Authorize the City Manager to negotiate and execute a professional service agreement with UCLA Santa Monica Hospital and Palm Drive Medical Group, a California-based company, to provide emergency room medical services to arrestees. This is a contract in an amount not to exceed $50,000 with future year funding contingent on Council budget approval. Executive Summary Staff recommends that the City enter into a Professional Services Agreement with Vital Medical Services, LLC (Vital) to provide in-house medical services for SMPD arrestees and inmates at a one year cost not to exceed $150,000. Medical services covered under the agreement would include pre-booking medical clearances provided to arrestees who exhibit or complain of medical conditions that police personnel are unable or unqualified to administer treatment for, and blood draws taken from persons arrested for driving under the influence (DUI). Under the proposed agreement, all medical services would be administered by experienced, licensed medical personnel under the supervision of a licensed emergency care physician. Secondly, SMPD is seeking authorization to enter into a Professional Services Agreement with UCLA Medical Center, Santa Monica (UCLA SM) and Palm Drive Emergency Physicians Medical Group (Palm Drive), which is the billing name for UCLA SM, at a one year cost not to exceed $50,000. Medical services covered under this agreement would include emergency room treatment, which would be any medical treatment , such as medical needs requiring x-rays, which cannot be provided under the in-house treatment services offered by Vital in the SMPD Jail Facility. Under this proposed agreement, all medical services would be administered by UCLA Santa Monica Hospital medical personnel. Background 2 of 7 SMPD is required by state and federal law to provide medical services to arrestees known to have or declaring medical issues or injuries prior to booking and housing in the SMPD Jail. Additionally, the Department routinely requires medical services in the form of blood draws for those arrested for DUI or being under the influence of a controlled substance. Currently, arrestees requiring pre-booking medical clearance, medical care, or blood draws are transported by police officers to local hospitals. The cost of the emergency room visits, physician services, and any ancillary tests or medical services are borne by the Department. Based on data from FY 2008 to FY 2014, the average number of patients requiring medical treatment was 287 per year, with the lowest year’s treatment numbers being 199 arrestees and the highest being 437. Costs paid for those medical services averaged $71,643 per year, with the span of costs ranging from $38,000 to $110,000. These averages do not include the costs associated with the amount of time officer(s) spent in the emergency room and the cost impacts of the resulting patrol shortages. Every medical clearance requires one or two sworn police officers (based on the nature of the arrest) to transport the arrestee to the medical facility, to wait for available medical personnel, to standby during the necessary treatment and tests, and to transport the arrestee back to the SMPD Jail Facility. Arrestees may also require follow-up medical treatments for wound care or the dispersal of medicine; these activities require additional police transports. These activities place an additional burden on the Department’s patrol personnel and create additional potential safety risks, while also taking away valuable time from responding to the community’s public safety needs. The Police Department and UCLA SM/Palm Drive have had an ongoing relationship for more than twenty years. The most recent Council meeting regarding the use of UCLA-Santa Monica Hospital/Palm Drive (under their previous name “Janzen, Johnston, and Rockwell”) for Emergency Room Treatment of Prisoners dates back to February 10, 1998. Medical services covered under this agreement would include emergency room treatment, which would be any medical treatment, such as medical needs requiring x-rays, which cannot be provided under the in-house treatment services offered by Vital in the SMPD Jail Facility. Discussion Vital Medical Services, LLC 3 of 7 Medical services covered by Vital would include pre-booking medical clearances provided to arrestees who exhibit or complain of medical conditions that police personnel are unable or unqualified to administer treatment for, and blood draws taken from persons arrested for driving under the influence (DUI). Earlier in 2015, the Police Department and Vital conducted a nine day pilot program to evaluate the feasibility of Vital’s services in a practical application. The nine days included two weekends when Vital’s medical personnel were on-site at the City Jail facility. Vital’s staff worked evenings and were available on an on-call basis, 24 hours per day with a guaranteed response time of within 30 minutes during the entire nine day period. During this time frame, 23 medical treatments were provided and the Police Department found the service to be timely, responsive, efficient and professional. Services included conducting arrestee assessments to determine the arrestee’s medical suitability for housing in the City Jail; thereby enabling the arrestee to be booked directly into the City Jail without the requirement of being transported to the SM UCLA Hospital’s Emergency Room. During the pilot period, only one incident occurred wherein the arrestee had to be transported to the Emergency Room to be seen for treatment. Vital’s staff may recommend calling paramedic services to transport an arrestee to the hospital; however, there were no such cases during the pilot. The average response time when Vital’s personnel were not already on -site was 13 minutes. During the pilot program, approximately 60.72 patrol hours were saved. These service hours were based on the Department’s statistics which indicate that it takes an average of 2.64 officer hours to transport an arrestee to the hospital, maintain custody of the arrestee in the emergency room while medical clearances and/or a blood draw are being performed, and to transport the arrestee back to the City Jail. The 23 arrestees who received medical services from Vital during the pilot program would otherwise have required medical treatment or booking clearance at an area hospital. Given the fully-benefitted hourly compensation rate for a police officer ($90.82), the estimated savings in personnel time for the nine-day pilot totaled $5,514.59. In addition, other cost savings resulted from V ital’s lower cost-per-arrestee charges; Vital charges a maximum of $250 per occurrence versus the $300 per occurrence charged by UCLA SM/ Palm Drive. The proposed initial, one-year agreement with Vital, affords the Department an opportunity to assess and evaluate the efficacy of providing medical services within the SMPD Jail. 4 of 7 Services would include treatment for up to 600 arrestees annually (an average of 50 per month) on-site in the Jail Facility. The agreement would enable SMPD to exceed this annual estimation by 20% (for a total of 720 arrestees) at no additional charge. Vital would notify the Department when 75% of the agreed upon services have been delivered; this notification serves as an early warning in the event the Department was on track to ex ceed the service estimations ahead of the 12-month contract timeline. While this level of service provision is higher than the average number of arrestees requiring medical treatment in years past, data collected during a pilot program with Vital in 2015 indicated this level of service is appropriate based on current bookings in the SMPD Jail Facility. Vital's Medical Director, Dr. Angelique Campen, MD, FACEP, MBA, is the Director of Saint Joseph's Emergency Department and a clinical instructor of Emergency Medicine and practicing physician at UCLA's Department of Emergency Medicine. Dr. Campen would be responsible for oversight of all Vital's medical services and licensed personnel. Dr. Campen and Vital's emergency room physicians possess relevant experience and have current histories of providing medical services to arrestees at local area hospitals, including level one trauma centers. These board certified emergency room physicians would provide 24/7 on-call support for the Physician Assistants (PA) and Nurse Practitioners (NP) assigned to provide services to the Police Department. Vital’s personnel would provide pre-booking medical clearance evaluations and select minor medical treatments to the Police Department’s arrestees utilizing appropriately vetted and licensed PAs and/or NPs. Examples of medical services that could be performed include minor wound care and treatment of nausea. Absent specific evidentiary kits required by County of Los Angeles crime laboratories, Vital would provide the necessary equipment and supplies to perform the medical services in a private room located within the City Jail; the City Jail’s Room B1114 meets all medical and Board of Corrections requirements for these types of services. Providing such medical services in the Jail complies with current standards and regulations of the California Board of Corrections. The City Jail facility requires no modifications to accommodate this program. It is projected that the proposed agreement with Vital would significantly reduce the need to transport arrestees to the hospital. Not having arrestees in the emergency room (ER) 5 of 7 prevents the general public and community from having to seek treatment in the ER along with uncooperative, potentially combative, arrestees. It is also an officer safety enhancement in not having to transport uncooperative, potentially combative, prisoners to and from the City Jail. Finally, the Hospital’s ER saves time by not having to spend time treating minor arrestee health issues better addressed by Vital’s personnel in the City Jail facility. Based on Dr. Campen's experience with arrestee pre-booking medical clearances for local police agencies, it is anticipated that approximately 95% of arrestees requiring pre- booking medical clearance would be able to be approved without a hospital visit. Furthermore, police staff time spent transporting and securing those remaining 5% of arrestees requiring hospital treatment due to more severe medical issues would be reduced, as Vital’s staff at the City Jail would alert the hospital ER’s staff before the arrestee arrives at the ER, a circumstance which has the potential to expedite the treatment to be received. Vital’s staff would also be available to evaluate any current jail inmate’s medical health needs, provide treatment, and/or make any recommendations for additional medical care. The proposed agreement commits Vital to providing 16 hours of on-site medical services per week and to provide medically certified personnel on an on-call basis 24-hours a day, 365 days a year. After being called by the Police Department’s personnel, on-call Vital staff members would respond to the City Jail within 30 minutes. In addition to providing medical assessments and treatments, Vital would also perform blood draws on DUI (driving under the influence) arrestees who elect a blood draw over a breathalyzer test under California's implied consent law. Based on an analysis of data from the past five fiscal years, staff projects that by utilizing Vital’s services, an average savings of 486 police officer service hours annual would be realized. These service hour estimates are based on Departmental statistics which indicate it takes an average of 2.64 hours each to transport an arrestee to the hospital, maintain custody of the arrestee in the emergency room while medical clearances and/or a blood draw are being performed, and return the arrestee to the City Jail. Based on a police officer’s hourly rate of $90.82, which includes benefits, the total estimated annual cost saving, in terms of personnel, approximates $44,138.52. Given that medical treatment transports are often a two-officer assignment, the total cost savings is likely to be higher 6 of 7 than these estimates. UCLA Medical Center, Santa Monica Hospital and Palm Drive The UCLA Medical Center and Santa Monica Emergency Center Director, Dr. Whalid Ghurabi, is Board Certified in emergency medicine. He has extensive experience in the field of EMS, and has served as the Santa Monica Fire Department Medical Director for the past 15 years. In the event an arrestee requires emergency room services, he/she would be transported to the UCLA Medical Center, Santa Monica Emergency Room for treatment. The proposed one-year agreement with UCLA SM/Palm Drive, at a cost of $300 per visit, would meet the medical needs of those arrestees who have medical needs requiring ongoing, emergent care and cannot be treated in-house by Vital. In the event that an arrestee requires emergency room treatment, one or two sworn police officers (based on the nature of the arrest) will transport the arrestee to the UCLA SM Hospital Emergency Room, wait with the arrestee for available medical personnel, standby during the necessary treatment and tests, and then transport the arrestee back to the SMPD Jail Facility. Examples of situations requiring emergency room treatment include any injury needing an x-ray or an MRI since that equipment is not available to Vital Medical in the SMPD Jail. Vendor/Consultant Selection Staff recommends Vital Medical Services furnish and provide in-house medical services in the City’s Jail facility. Vital approached Santa Monica in 2014 and after research staff determined that Vital is the only service in existence delivering facility-based medical support to municipal law enforcement agencies. In the past year, similar agreements were launched with the Glendale Police Department and the Hawthorne Police Department; the results have proved beneficial in terms of staff time and cost savings. The alternatives to providing in-house City Jail medical services would require SMPD to hire medical staff as City employees at a significantly higher cost or to continue existing practices. 7 of 7 In terms of those arrestees who require immediate, emergency medical care, staff recommends UCLA SM/Palm Drive to provide emergency room services to the Police Department’s arrestees. Staff has confirmed that there are no similar emergency room and billing services pairing provided at local hospitals. Financial Impacts and Budget Actions The agreement to be awarded to Vital Medical Services, LLC is for an amount not to exceed $150,000. Funds are available in the FY 2015-16 budget in the Police Department. The agreement would be charged to account 01306.555250. The agreement to be awarded to Palm Drive Emergency Physicians Medical Group is for an amount not to exceed $50,000. Funds are available in the FY 2015 -16 budget in the Police Department. The agreement would be charged to account 01306.555250. Prepared By: Nicole Bustamante, Senior Administrative Analyst Approved Forwarded to Council Attachments: A. Staff Report - February 10, 1998 (Web Link) Reference:    Agreement No.  10241   (CCS)  &  Agreement No. 10242  (CCS)