HomeMy WebLinkAboutAgreement A-12-181-2 with Exodus Foundation, Inc.pdfFL-1 OO/UMC-BLDG#319
Exodus/DBH/5630(Adult CSC)
1 SECOND AMENDMENT TO FACILITY USE AGREEMENT
2 THIS SECOND AMENDMENT TO FACILITY USE AGREEMENT (AGT 12-181/FL-100)
3 (hereinafter "SECOND AMENDMENT") is made and entered into this day of
4 , 2015, by and between the COUNTY OF FRESNO, a political
5 subdivision of the State of California, 2220 Tulare Street, Suite 2100, Fresno, California
6 93721-2106, (hereinafter "LANDLORD") and EXODUS FOUNDATION, INC., a non-profit
7 Nevada corporation, with offices at 9808 Venice Boulevard, Suite 700, Culver City, California
8 90232-6824 (hereinafter "TENANT'). LANDLORD and TENANT may, hereinafter, be referred
9 to collectively as "Parties" or individually as "Party".
10 WITNESSETH:
11 WHEREAS, LANDLORD and TENANT are Parties to that certain Facility Use
12 Agreement #12-181/FL-100, dated April 24, 2012, and as amended by the First Amendment
13 (#12-181-1/FL-100), dated May 21,2013 (AGREEMENT); and
14 WHEREAS, TENANT uses the Premises as a Crisis Stabilization Center for adults as
15 described in Exhibit "B-1'' attached hereto and incorporated herein; and
16 WHEREAS, LANDLORD and TENANT desire to (1) increase the square footage of the
17 Building, and, (2) extend the existing term of the AGREEMENT; and
18 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of
19 which is hereby acknowledged, the Parties agree as follows:
20 1. Clause 1, PREMISES of the AGREEMENT is deleted and replaced with the
21 following:
22 "1. PREMISES -LANDLORD shall make available to TENANT
23 approximately seven thousand sixty {7,060) square feet of space at the location commonly
24 known as 4411 E. Kings Canyon, Fresno, California 93702 (Building 319) (hereinafter
25 "Building") as shown in Exhibit "A-1", attached hereto and by this reference incorporated
26 herein (hereinafter "Premises").
27 Upon completion of improvements to the Building in the year 2015, TENANT shall
28 occupy a total of seven thousand four hundred twenty {7,420) square feet in the Building as
COUNTY OF FRESNO
Fresno, California 1
FL-1 OO/UMC-BLDG#319
Exodus/DBH/5630(Adult CSC)
1 shown on Exhibit "A-1 ", attached hereto and by this reference incorporated herein, (hereinafter
2 "Premises")."
3 2. Clause 2, TERM AND TERMINATION of the Agreement is deleted and
4 replaced with the following~
5 "2. TERM AND TERMINATION-The initial term of this AGREEMENT shall
6 be effective the date of occupancy by TENANT through June 30, 2012. The date of
7 occupancy shall be confirmed in writing between the LANDLORD and TENANT. Effective July
8 1, 2012, this AGREEMENT shall renew for a maximum of four (4) one-year periods upon the
9 same terms and conditions herein set forth, unless either LANDLORD or TENANT provides
1 0 written notice of non-renewal to the other Party no later than sixty (60) days prior to June 30 of
11 each year. In no event shall the term of this AGREEMENT extend beyond June 30, 2016.
12 Notwithstanding anything to the contrary in this AGREEMENT
13 LANDLORD shall have the right to terminate this AGREEMENT immediately in the event that
14 Exodus Recovery, Inc. ceases to perform any of its obligations and provide any of the services
15 described in Clause 3, hereinbelow. TENANT acknowledges that Exodus Recovery, Inc. is an
16 affiliate of TENANT and, as such, Exodus Recovery, Inc.'s failure to perform any of its
17 obligations as described in Clause 3 hereinbelow shall be deemed TENANT's failure to
18 perform any of its obligations pursuant to the AGREEMENT. As to LANDLORD, the Director
19 of Internal Services/Chief Information Officer or the Director of the Department of Behavioral
20 Health, or one of their designees, may provide written notice of non-renewal or termination of
21 this AGREEMENT."
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COUNTY OF FRESNO
Fresno, California
3. Clause 3, CONSIDERATION of the AGREEMENT is changed
• By inserting the word "Tenant's" between the words "for" and "use" on page 2,
Line 15 of the AGREEMENT; and,
• By deleting the words "Exhibit "B" as shown on page two (2), Line 16 of the
AGREEMENT and inserting the words "Exhibit "B-1 "; and,
• By deleting Exhibit B of the AGREEMENT in its entirety and inserting Exhibit B-
1, attached hereto and by this reference incorporated herein.
2
FL-1 OO/UMC-BLDG#319
Exodus/DBH/5630(Adult CSC)
1 The Parties agree that this SECOND AMENDMENT is sufficient to amend the
2 AGREEMENT. The AGREEMENT is hereby amended, ratified and continued. It is the intent
3 of the Parties that all other provisions of the AGREEMENT shall remain unchanged. The
4 Parties agree that, upon execution of this SECOND AMENDMENT, the AGREEMENT, the
5 FIRST AMENDMENT, and this SECOND AMENDMENT shall together be considered the
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COUNTY OF FRESNO
Fresno, California
AGREEMENT.
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COUNTY OF FRESNO
Fresno, California
FL-100/UMC-BLDG#319
Exodus/DBH/5630(Adult CSC)
EXECUTED as of the date first herein specified .
LANDLORD :
COUNTY OF FRESNO
ATTEST: BERNICE E. SEIDEL , CLERK
BOARD OF SUPERVISORS
APPROVED AS TO LEGAL FORM :
DANIEL C . CEDERBORG , COUNTY COUNSEL
10---~·
By __ ~~~=-~-~~-----------------Deputy
APPROVED AS TO ACCOUNTING FORM :
VICKI CROW, C.P .A.
AUDITOR-CONTROLLER/TREASURER-
TAX COLLECTOR
Fund No . 0001
Subclass 1 0000
Org . No . 56302110
Acct. No . 7294
PropertyFL-1 OO/Exodus/DBH5630/2ndAmend
4
TENANT:
EXODUS FOUNDATION , INC .
By.~
LeeAnn Skorohod , CHC , CCEP
Senior Vice President
University Medical Center Campus Building 319 Exodus Adult Crisis Stabilization Center ..,"'m r::Jx •a.:::r ...... -· o)>Q: 03'": (1) -::J :p-a. ....... 3 = (1) ::J r+
ORGANIZATION:
ADDRESS:
SITE ADDRESS:
SERVICES:
PROJECT DIRECTOR:
Phone Number:
CONTRACT PERIOD:
ADULT CRISIS STABILIZATION CENTER
Scope of Work
Exodus Recovery, Inc.
9808 Venice Boulevard, Suite 700, Culver City, CA 90232
4411 E. Kings Canyon Road, Fresno, CA 93702
Adult Crisis Stabilization Services
Luana Murphy, MBA, PresidenUCEO
(559) 453-6271
March 7, 2012-May 31, 2012 (Ramp Up Period)
May 4, 2012-June 30, 2012 (Initial Operational Period)
Exhibit B-1
FL-100
Page 1 of9
Effective July 1, 2012, shall continue with an option for four (4) twelve (12) month
renewals (Operational Periods)
INITIAL CONTRACT AMOUNT:
(12 beds maximum)
$ 583,045
$ 656,434
$3,855,249
$3,967,741
3/7/2012 through 5/31/2012 (Ramp Up Period)
5/4/2012 through 6/30/2012 (Initial Operational Period)
FY 2012-13 (Operational Periods)
EXPANSION AMOUNT:
(additional 8 beds, for a
total of 20 beds maximum)
SCHEDULE OF SERVICES:
$ 48,448
$4,532,933
$6,418,893
FY 2013-14
3/10/2015 through 3/31/2015 (Second Ramp Up Period)
FY 2014-15 (Operational Periods)
FY 2015-16
CONTRACTOR shall operate the Adult Crisis Stabilization Center (Adult CSC) twenty-four (24) hours per day,
seven (7) days per week. The Adult CSC shall be located at the Kings Canyon Campus at 4411 E. Kings
Canyon Road, Fresno, California 93702 (Building 319), a COUNTY-owned building, pursuant to a separate
lease agreement (and any related amendments) between COUNTY and Exodus Foundation, Inc., an affiliate
of CONTRACTOR.
TARGET POPULATION:
The target population will include clients 18 years of age and older from Fresno County, who are exhibiting
acute psychiatric symptoms that have been placed on a Welfare and Institution Code (W&IC) 5150
designation or who request admittance to the Adult esc on a voluntary status. CONTRACTOR will provide
crisis stabilization services to adult clients with a twenty (20) bed maximum at any given time. However,
CONTRACTOR may be in the process of assessing or evaluating additional clients, as necessary.
CONTRACTOR will accept voluntary or involuntarily admitted clients regardless of source of payment;
clients will include Medi-Cal beneficiaries, Medicare and Medicare/Medi-Cal beneficiaries, privately insured
and indigent/uninsured clients who are referred by the Department of Behavioral Health (DBH), a contract
provider with the DBH, a hospital emergency room (aka emergency department), law enforcement, or
Emergency Medical Services (EMS). Clients may also be family or self-referred.
These services shall be performed pursuant to W&IC, sections 5704.5(b), 5704.6(c), and 5614(b)(3) and
program principles and the array of treatment options required under W&IC, sections 5600.2 to 5600.9
inclusive:
Exhibit B-1
FL-100
Page 2 of9
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid.
Federal statutes and regulations state that youth under age 21 who are enrolled in Medicaid are entitled to
EPSDT benefits and that States must cover a broad array of preventive and treatment services to include
crisis stabilization. The requirement is to maintain its funding for children's services at a level equal to or
more than the proportion expended for children's program services in FY 83-84. These requirements shall
apply to clients between the ages of 18 to 21 regarding services under this Agreement.
PROJECT DESCRIPTION:
CONTRACTOR shall be responsible to comply with the requirements of the Fresno County Mental Health Plan
(FCMHP) and must complete and submit supporting clinical and any other such documentation as may be
required by the COUNTY for every client served in the Adult CSC. The FCMHP will perform a utilization
review of all admissions to determine that the documentation demonstrates that medical necessity criteria as
defined by the California Department of Health Care Services (DHCS) was met for each duration of the
hospitalization, except for the episode of discharge.
CONTRACTOR shall be responsible to enter all Client Service Information, admission data and billing
information into the COUNTY data system (AVATAR) and will be responsible for any and all audit exceptions
pertaining to the delivery of services.
CONTRACTOR'S RESPONSIBILITIES:
A CONTRACTOR shall ensure that the Adult CSC provides the following services:
1. Management and alleviation of client's acute psychiatric symptoms through effective therapeutic
interventions and supportive services to avoid the need for a higher level of psychiatric care
when clinically appropriate.
2. A recovery/strength based clinical program which has appropriate professional staffing on a
twenty-four (24) hour, seven (7) day a week basis.
3. A safe, secure environment for clients that encourages wellness and recovery.
4. A comprehensive multi-disciplinary evaluation and client-centered treatment plan.
5. Dietary services through the availability of nourishment or snacks in accordance with Title 22,
Division 5, Chapter 9, Article 3, Section 77077.
6. Admission procedures for clients, who are not on involuntary holds in accordance with Welfare
and Institutions Code 5150 and also individuals placed on W&l 5150 involuntary holds.
7. Treatment Planning -Under the clinical direction of the mental health clinician, the multi-
disciplinary treatment team formed by the Crisis Stabilization staff shall provide the following
services:
a. Mental Status Examination
b. Medical Evaluation
c. Psycho-Social Assessment
d. Nursing Assessment
e. Multi-Disciplinary Milieu Treatment Program
f. Client Centered Treatment Planning
g. Aftercare Planning and Wellness Recovery Action Plan (WRAP)
8. Staffing
Exhibit B-1
FL-100
Page 3 of9
a. The staffing pattern for the crisis stabilization program shall meet all current State
licensing and regulatory requirements including medical staff standards, nursing staff
standards, social work and rehabilitation staff requirements pursuant to Title 9, Division 1,
Chapter 11, Article 3, Section 1840.348 of the California Code of Regulations (CCR) for
Crisis Stabilization services. All staff that require federal/state licensure or certification will
be required to be licensed or certified in the State of California and be in good standing
with the state licensing or certification board. CONTRACTOR shall remain up-to-date with
all current regulatory changes and adhere to all new and/or modified requirements.
b. All facility staff who provide direct client care or perform coding/billing functions must meet
the requirements of the FCMHP Compliance Program. This includes the screening for
excluded persons and entities by accessing or querying the applicable licensing board(s),
the National Practitioner Data Bank (NPDB), Office of Inspector General's List of Excluded
Individuals/Entities (LEIE), Excluded Parties List System (EPLS) and Medi-Cal Suspended
and Ineligible List prior to hire and annually thereafter. In addition, all
licensed/registered/waivered staff must complete a FCMHP Provider Application and be
credentialed by the FCMHP's Credentialing Committee. All of CONTRACTOR's staff who
have direct contact with the clients, shall have Department of Justice (DOJ), Federal
Bureau of Investigation (FBI), and Sheriff fingerprinting (Livescan) executed.
c. Peer and/or family support staff will be an active and key member of the multi-disciplinary
team to assist with treatment planning, mentoring, support and advocate with
clients/families during their time at the Adult CSC facility and will assist with discharge
planning and facilitate the client's transition to the appropriate lower level of care.
d. The staffing requirements defined by CCR, Title 9, Section 1840.348 for the Adult CSC is
as follows:
"(a) A physician shall be on call at all times for the provision of those Crisis Stabilization
Services that may only be provided by a physician.
(b) There shall be a minimum of one Registered Nurse, Psychiatric Technician, or
Licensed Vocational Nurse on site at all times beneficiaries are present.
(c) At a minimum there shall be a ratio of at least one licensed mental health or
waivered/registered professional on site for each four beneficiaries or other patients
receiving Crisis Stabilization at any given time.
(d) If the beneficiary is evaluated as needing service activities that can only be provided by
a specific type of licensed professional, such persons shall be available.
(e) Other persons may be utilized by the program, according to need.
(f) If Crisis Stabilization services are co-located with other specialty mental health
services, persons providing Crisis Stabilization must be separate and distinct from persons
providing other services.
(g) Persons included in required Crisis Stabilization ratios and minimums may not be
counted toward meeting ratios and minimums for other services."
9. Medical Records
Exhibit B-1
FL-100
Page 4 of9
a. The CONTRACTOR shall be responsible to enter all Client Service Information, admission
data and billing information into the COUNTY data system (AVATAR) and will be
responsible for any and all audit exceptions pertaining to the delivery of services.
b. The CONTRACTOR will be responsible for "release of information" requests for the Adult
esc facility and shall adhere to applicable federal and state regulations.
10. Clinical Staff -The clinical staff of CONTRACTOR shall be composed of all licensed mental
health or waivered/registered professionals as included in CCR, Title 9, Division 1, Chapter 11,
Article 3, Section 1840.348 (Crisis Stabilization Staffing Requirements).
11. Medical Staff -The medical staff shall include a physician and a registered nurse, psychiatric
technician or licensed vocational nurse and any other type of licensed professional needed to
address client needs, pursuant to CCR, Title 9, Division 1, Chapter 11, Article 3, Section
1840.348 (Crisis Stabilization Staffing Requirements).
12. Pharmaceutical Services -CONTRACTOR shall provide for medication services on an as
needed basis and the staffing must reflect this availability, pursuant to CCR, Title 9, Division 1,
Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site Requirements) and
all other applicable federal/state regulations.
13. Assessment of Physical Health and Medical Backup Services -Pursuant to CCR, Title 9,
Division 1, Chapter 11, Article 3, Section 1840.338 (Crisis Stabilization Contact and Site
Requirements), CONTRACTOR shall provide admission history and physical examination, and
maintain a written agreement for medical services with one or more general acute care hospitals.
14. Utilization Review, Billing and Cost Report:
a. CONTRACTOR shall notify the COUNTY of any admission of a COUNTY client within
twenty-four (24) hours or the next business day in a manner approved by the COUNTY.
The notification method shall be mutually acceptable by both COUNTY and
CONTRACTOR.
b. CONTRACTOR shall be responsible to insure that documentation in the client's medical
record meets medical necessity criteria for the hours of service submitted to COUNTY for
reimbursement by federal intermediaries, third-party payers and other responsible parties.
c. CONTRACTOR shall enter all mental health data and billing information into the COUNTY
data system and will be responsible for any and all audit exceptions pertaining to the
delivery of services.
d. CONTRACTOR shall submit a complete and accurate DHCS Short/Doyle Medi-Cal Cost
Report for each fiscal year ending June 301h affected by the proposed agreement within
ninety (90) days following the end of each fiscal year.
e. CONTRACTOR shall insure that cost reports are prepared in accordance with Generally
Accepted Accounting Principles and the standards set forth by the DHCS and the
COUNTY.
15. Patients' Rights and Certification Review Hearings:
Exhibit B-1
FL-100
Page 5 of9
a. CONTRACTOR shall adopt and post in a conspicuous place a written policy on patient
rights in accordance with section 70707 of Title 22 of the California Code of Regulations
and section 5325.1 of the California Welfare and Institutions Code and Title 42 Code of
Federal Regulations section 438.100.
b. CONTRACTOR shall allow access to COUNTY clients by the Patients' Rights Advocate
designated by the COUNTY.
16. Grievances and Incident Reports -CONTRACTOR shall log all grievances and the disposition of
all grievances received from a client or a client's family in accordance with FCMHP policies and
procedures as indicated within Exhibit H. CONTRACTOR shall provide a summary of the
grievance log entries concerning COUNTY-sponsored clients to the DBH Director, or designee,
at monthly intervals, by the fifteenth (15th) day of the following month, in a format that is mutually
agreed upon. CONTRACTOR shall post signs, provided by the COUNTY, informing clients of
their right to file a grievance and appeal.
CONTRACTOR shall notify COUNTY of all incidents or unusual occurrences reportable to state
licensing bodies that affect COUNTY clients within twenty-four (24) hours. The CONTRACTOR
shall use the Incident Report form as indicated within Exhibit I for such reporting.
Within fifteen (15) days after each grievance or incident affecting COUNTY-sponsored clients,
CONTRACTOR shall provide County with the complaint and CONTRACTOR's disposition of, or
corrective action taken to resolve the complaint or incident.
Within fifteen (15) days after CONTRACTOR submits a corrective action plan to a California
State licensing and/or accrediting body concerning any sentinel event, as the term is defined by
the licensing or accrediting agency, and within fifteen (15) days after CONTRACTOR receives a
corrective action order from a California State licensing and/or accrediting body to address a
sentinel event, CONTRACTOR shall provide a summary of such plans and orders to COUNTY.
17. Provide a safe and secure environment to provide for clinical and medical assessment,
diagnostic formulation, crisis intervention, medication management and clinical treatment for
mental health clients with acute psychiatric symptoms. This includes the manner in
which seclusion and restraint will be administered when necessary for the safety of the
clients, other clients in the program and staff.
18. CONTRACTOR shall utilize cost containment strategies for the provision of stock and
prescription medications to clients by contracting with a pharmaceutical benefits management
company, and provide the COUNTY with the type of formulary utilized by the program, and
provide the COUNTY with information regarding co-pays and/or generic substitutions.
19. Provide the appropriate type and level of staffing to provide for a clinical effective program
design that adheres to State staffing requirements.
20. Provide an intensive treatment program which has individualized treatment plans.
21. Stabilize the clients' acute psychiatric symptoms in the most expedient manner possible while
adhering to appropriate clinical care standards. This may include initiating a Treatment
Authorization Request (TAR) to the pharmacy and providing justification when psychotropic
medications are needed on an emergency basis.
22. Effectively partner with other programs in the COUNTY and community system (i.e. law
enforcement, local emergency departments, etc.) in accepting COUNTY clients for admission for
Crisis Stabilization services and also to work collaboratively in discharge planning to ensure
appropriate ongoing outpatient specialty mental health treatment services (COUNTY mental
health programs, community based organizations, etc.) are provided.
Exhibit B-1
FL-100
Page 6 of9
23. Identify COUNTY clients with frequent admissions during the fiscal year and develop
strategies with other COUNTY and community agencies to reduce readmissions and improve
clients' overall well-being through coordination of care.
24. Effectively interact with community agencies, other mental health programs and providers,
natural support systems and families to assist clients to be discharged to the appropriate
level of care.
25. Work effectively with the DBH Conservatorship Team as appropriate for clients
presenting to the Adult CSC as gravely disabled who may require consideration for a temporary
conservatorship.
26. Integrate mental health and substance use disorder services. The CONTRACTOR shall
perform the following:
a. Develop a formal written Continuous Quality Improvement (CQI) action plan to identify
measurable objectives toward the achievement of co-occurring disorders (COD) treatment
capability that will be addressed by the program during the contract period. These
objectives should be achievable and realistic for the program, based on a self-assessment
and the program priorities, but need to include attention to making progress on the
following issues, at minimum:
1. Welcoming policies, practices, and procedures related to the engagement of
individuals with co-occurring issues and disorders;
2. Removal or reduction of access barriers to admission based on co-occurring
diagnosis or medication;
3. Improvement in routine integrated screening, and identification in the data
system of how many clients served have co-occurring issues;
4. Developing the goal of basic co-occurring competency for all treatment and
support staff, regardless of licensure or certification, and
5. Documentation of coordination of care with collaborative mental health and/or
substance use disorder providers for each client.
B. Regarding cultural and linguistic competence requirements. CONTRACTOR shall:
1. Ensure compliance with Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45
C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial
assistance from discriminating against persons based on race, color, national origin, sex,
disability or religion. This is interpreted to mean that a limited English proficient (LEP) individual is
entitled to equal access and participation in federally funded programs through the provision of
comprehensive and quality bilingual services.
2. Create and maintain policies and procedures for ensuring access and appropriate use of trained
interpreters and material translation services for all LEP clients, including, but not limited to,
assessing the cultural and linguistic needs of its clients, training of staff on the policies and
procedures, and monitoring its language assistance program. The CONTRACTOR's procedures
must include ensuring compliance of any subcontracted providers with these requirements.
3. Ensure that minors shall not be used as interpreters.
4. Conduct and submit to COUNTY an annual cultural and linguistic needs assessment to promote
the provision and utilization of appropriate services for its diverse client population. The needs
Exhibit B-1
FL-100
Page 7 of 9
assessment report shall include findings and a plan outlining the proposed services to be
improved or implemented as a result of the assessment findings, with special attention to
addressing cultural and linguistic barriers and reducing racial, ethnic, language, abilities, gender,
and age disparities.
5. Develop internal systems to meet the cultural and linguistic needs of the CONTRACTOR's client
census including the incorporation of cultural competency in the CONTRACTOR's mission;
establishing and maintaining a process to evaluate and determine the need for special -
administrative, clinical, welcoming, billing, etc. -initiatives related to cultural competency.
6. Develop recruitment and retention initiatives to establish contracted program staffing that is
reflective and responsive to the needs of the program and target population.
7. Establish designated staff person to coordinate and facilitate the integration of cultural
competency guidelines and attend the COUNTY's DBH Cultural Competency Committee monthly
meetings. The designated person will provide an array of communication tools to distribute
information to staff relating to cultural competency issues.
8. Keep abreast of evidence-based and best practices in cultural competency in mental health care
and treatment to ensure that the CONTRACTOR maintains current information and an external
perspective in its policies. The CONTRACTOR shall evaluate the effectiveness of strategies and
programs in improving the health status of cultural-defined populations.
9. Ensure that an assessment of a client's sexual orientation is included in the bio-psychosocial
intake process. CONTRACTOR's staff shall assume that the population served may not be in
heterosexual relationships. Sensitivity to gender and sexual orientation must be covered in
annual training.
10. Utilize existing community supports, referrals to transgender support groups, etc., when
appropriate.
11. Attend annual Cultural Competence, Compliance, Health Insurance Portability and Accountability
Act (HIPAA), Billing, and Documentation training provided by COUNTY's DBH.
12. Report its efforts to evaluate cultural and linguistic activities as part of the CONTRACTOR's
ongoing quality improvement efforts in the monthly activities report. Reported information may
include clients' complaints and grievances, results from client satisfaction surveys, and utilization
and other clinical data that may reveal health disparities as a result of cultural and linguistic
barriers.
C. Regarding Conservatees, CONTRACTOR agrees to the following:
CONTRACTOR shall work with COUNTY's DBH Client Placement Team to find placement for
COUNTY conservatees that are discharged from the CONTRACTOR-operated Adult esc.
D. Regarding direct admissions to the Adult CSC from COUNTY's DBH programs or its contracted
providers. the CONTRACTOR agrees to the following:
1. To allow direct admits from COUNTY's DBH programs or its contracted providers when the Adult
esc has the capacity to accept clients for services.
2. Said direct admits shall not require medical clearance, if client would otherwise meet the
Emergency Medical Services 5150 Destination Policy requirements as mentioned hereinbelow in
Subsection F. However, in the event a referred client is known to possess a contagious medical
Exhibit B-1
FL-100
Page 8 of9
condition, said patient shall be medically cleared by a local hospital prior to admission to the Adult
CSC operated by CONTRACTOR.
E. Regarding the provision of court testimony related to Adult CSC clients. CONTRACTOR agrees to
the following:
CONTRACTOR's staff shall provide court testimony relevant to Adult CSC clients, when required.
F. Regarding the Emergency Medical Services (EMS) 5150 Destination Policy. CONTRACTOR
agrees to the following:
CONTRACTOR agrees to follow the then-current Emergency Medical Services 5150 Destination
Policy as identified in Revised Exhibit L, attached hereto and incorporated herein. Said policy
may be updated periodically throughout the term of this Agreement; CONTRACTOR must adhere
to the most recent policies designated by the EMS 5150 Destination Policy. References to the
Children's Crisis Assessment Intervention Resolution (CCAIR) Unit in Revised Exhibit L reflect
services to be performed by CONTRACTOR at the COUNTY's Youth CSC, beginning April 1,
2015. Upon commencement of services, the EMS 5150 Destination Policy will be updated
accordingly.
G. CONTRACTOR shall participate in the following meetings:
1. CONTRACTOR shall participate in periodic workgroup meetings scheduled by staff from
COUNTY's DBH Mental Health Contracted Services Unit. The meetings shall be held monthly, or
as needed, to discuss contract requirements, data reporting, outcomes measurement, training,
policies and procedures, and overall program operations.
2. CONTRACTOR's administrative level agency representative, who is duly authorized to act on
behalf of CONTRACTOR, shall attend regularly scheduled monthly Behavioral Health Board
meetings (upon commencement of the newly-enacted Board).
3. CONTRACTOR shall attend quarterly or periodic DBH Contractor/Provider Meetings, as
scheduled by staff from COUNTY's Mental Health Contracted Services Unit, when deemed
necessary by the DBH Director, or designee.
H. Regarding the development of policies and protocols:
CONTRACTOR and COUNTY's DBH shall collaborate on the development of specific policies
and protocols related to the daily operation of the Adult CSC. Such policies will include, but not
be limited to, the following: placement of adults in psychiatric health facilities or other inpatient
programs either locally or outside the county, facility limitations, and special client populations.
Such policies and protocols shall be mutually agreed upon between CONTRACTOR and
COUNTY's DBH Director, or designee. Any changes to such policies and protocols shall be
mutually agreed upon between CONTRACTOR and COUNTY's DBH Director, or designee.
COUNTY RESPONSIBILITIES:
COUNTY shall:
Exhibit B-1
FL-100
Page 9 of9
1. Perform a utilization review, annually at a minimum, (through its FCMHP) of ten percent (1 0%) of all
admissions to determine that the documentation demonstrates that medical necessity criteria as defined
by the DHCS were met throughout the duration of the crisis stabilization episode. The FCMHP will
maintain discretion regarding possible subsequent utilization review beyond ten percent (10%), as
necessary.
2. Provide oversight of the CONTRACTOR's Adult CSC program. In addition to contract monitoring of
program(s), oversight includes, but is not limited to, coordination with the DHCS in regard to program
administration and outcomes.
3. Assist the CONTRACTOR in making linkages to the appropriate level of care within the behavioral
health system of care to insure continuity of care. This will be accomplished through regularly
scheduled meetings as well as formal and informal consultation.
4. Participate in evaluating the progress of the overall program and the efficiency of collaboration with the
CONTRACTOR staff and will be available to the contractor for ongoing consultation.
5. Receive and analyze statistical outcome data from CONTRACTOR throughout the term of contract on a
monthly basis. DBH will notify the CONTRACTOR when additional participation is required. The
performance outcome measurement process will not be limited to survey instruments but will also
include, as appropriate, client and staff interviews, chart reviews, and other methods of obtaining
required information.
6. Recognize that cultural competence is a goal toward which professionals, agencies, and systems should
strive. Becoming culturally competent is a developmental process and incorporates at all levels the
importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that
result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to
meet culturally-unique needs. Offering those services in a manner that fails to achieve its intended
result due to cultural and linguistic barriers is not cost effective. To assist the CONTRACTOR's efforts
towards cultural and linguistic competency, DBH shall provide the following at no cost to
CONTRACTOR:
A Mandatory cultural competency training including sexual orientation and sensitivity training for
CONTRACTOR personnel, at minimum once per year. COUNTY will provide mandatory training
regarding the special needs of this diverse population and will be included in the cultural
competence training(s). Sexual orientation and sensitivity to gender differences is a basic cultural
competence principle and shall be included in the cultural competency training. Literature suggests
that the mental health needs of lesbian, gay, bisexual, transgender (LGBT) individuals may be at
increased risk for mental disorders and mental health problems due to exposure to societal
stressors such as stigmatization, prejudice and anti-gay violence. Social support may be critical for
this population. Access to care may be limited due to concerns about providers' sensitivity to
differences in sexual orientation.
B. Assistance to CONTRACTOR in locating appropriate providers who can translate behavioral health
and substance abuse services information into COUNTY's threshold languages (English, Spanish,
and Hmong). Translation services and costs associated will be the responsibility of the
CONTRACTOR
ExhibitH
To Scope of Work Exhibit B-1
FL-100
Page I of2
Fresno County Mental Health Plan
Grievances
The Fresno County Mental Health Plan (MHP) provides beneficiaries with a grievance
and appeal process and an expedited appeal process to resolve grievances and
disputes at the earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHP and its fee-for-
service providers to give verbal and written information to Medi-Cal beneficiaries
regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHP has developed a Consumer Guide, a beneficiary rights poster, a grievance
form, an appeal form, and Request for Change of Provider Form. All of these
beneficiary materials must be posted in prominent locations where Medi-Cal
beneficiaries receive outpatient specialty mental health services, including the waiting
rooms of providers' offices of service.
Please note that all fee-for-service providers and contract agencies are required to give
their clients copies of all current beneficiary information annually at the time their
treatment plans are updated and at intake.
Beneficiaries have the right to use the grievance and/or appeal process without any
penalty, change in mental health services, or any form of retaliation. All Medi-Cal
beneficiaries can file an appeal or state hearing.
Grievances and appeals forms and self-addressed envelopes must be available for
beneficiaries to pick up at all provider sites without having to make a verbal or written
request. Forms can be sent to the following address:
Fresno County Mental Health Plan
P.O. Box 45003
Fresno, CA 93718-9886
(800) 654-3937 (for more information)
(559) 488-3055 (TIY)
Provider Problem Resolution and Appeals Process
Exhibit H
To Scope of Work Exhibit B-1
FL-100
Page 2 of2
The MHP uses a simple, informal procedure in identifying and resolving provider
concerns and problems regarding payment authorization issues, other complaints and
concerns.
Informal provider problem resolution process -the provider may first speak to a
Provider Relations Specialist (PRS) regarding his or her complaint or concern.
The PRS will attempt to settle the complaint or concern with the provider. If the attempt
is unsuccessful and the provider chooses to forego the informal grievance process, the
provider will be advised to file a written complaint to the MHP address (listed above).
Formal provider appeal process-the provider has the right to access the provider
appeal process at any time before, during, or after the provider problem resolution
process has begun, when the complaint concerns a denied or modified request for MHP
payment authorization, or the process or payment of a provider's claim to the MHP.
Pavment authorization issues-the provider may appeal a denied or modified request
for payment authorization or a dispute with the MHP regarding the processing or
payment of a provider's claim to the MHP. The written appeal must be submitted to the
MHP within ninety (90) calendar days of the date of the receipt of the non-approval of
payment.
The MHP shall have sixty (60) calendar days from its receipt of the appeal to inform the
provider in writing of the decision, including a statement of the reasons for the decision
that addresses each issue raised by the provider, and any action required by the
provider to implement the decision.
If the appeal concerns a denial or modification of payment authorization request, the
MHP utilizes Managed Care staff who were not involved in the initial denial or
modification decision to determine the appeal decision.
If the Managed Care staff reverses the appealed decision, the provider will be asked to
submit a revised request for payment within thirty (30) calendar days of receipt of the
decision
Other complaints-if there are other issues or complaints, which are not related to
payment authorization issues, providers are encouraged to send a letter of complaint to
the MHP. The provider will receive a written response from the MHP within sixty (60)
calendar days of receipt of the complaint. The decision rendered buy the MHP is final.
Exhibit I
To Scope of Work Exhibit B-1
FL-100
Page 1 of2
FRESNO COUNTY MENTAL HEALTH PLAN
GRIEVANCES AND INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent -within 24 hours from the time of the incident
• Incident Report should be sent to:
DBH Program Supervisor
Exhibit I
To Scope of Work Exhibit B-1
FL-100
Page 2 of2
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) ______ Where did this happen?
Name/DMH #
1. Background information of the incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent IDI inconsequential D consequential D death D not applicable D unknown 0
4. Response: a) corrective action, b) Plan of Action, c) other
Com~e~dby~ri~nam~ --------------------------
Completed by (signature) Date completed
Reviewed by Supervisor (print name)
Supervisor Signature Date
c c ENTRAL ALIFORNIA Exhibit M
EMERGENCY MEDICAL SERVICES To Scope of Work Exhibit B-1
A Division ofthe Fresno County Department of Public Health FL-100
Manual Policy
Emergency Medical Services Number 547
Administrative Policies and Procedures
Page I of 10
Subject Patient Destination
References Title 13, Section 1106 of the California Code of Regulations Effective:
Title 22, Division 9, Chapter 7 of the California Code of Regulations 04/18/83
I. POLICY
Patients of the Prehospital EMS System shall be transported to an appropriately staffed and equipped hospital.
II. MEDICAL PATIENT DESTINATION
A. Medical Patients shall be transported to the appropriate destination in accordance with the following chart:
Non-emergent Patient's Choice
Life-threatening Closest Appropriate
Regional Medical
Acute current of injury Center or St. Agnes
(acute Ml) Medical Center
Stable Patient/Family Choice
RMC or Children's *** Unstable (Quickest travel time)
within Fresno
CCAIRor
5150-Children (<18 yrs) Patient/Family Choice
Kaiser (within Kaiser Kaiser designated
F
Veteran's Veteran's
Administration Administration
Patient's Choice
Closest Appropriate
Kaweah Delta Medical
Center or Regional
Medical Center
Patient/Family Choice
RMC or Children's ***
(Quickest travel time)
Patient/Family Choice
within Kings County
NIA
NIA
Patient's Choice
Closest Appropriate
Regional Medical
Center or St. Agnes
Medical Center
Patient/Family Choice
RMC or Children's ***
(Quickest travel time)
Patient/Family Choice
within Madera County
N/A
NIA
Patient's Choice
Closest Appropriate
Kaweah Delta Medical
Center or Regional
Medical Center
Patient/Family Choice
Kaweah Delta Medical
Center or
Sierra View District
Patient/Family Choice
within Tulare County
N/A
NIA
***If transport time is greater than 60 minutes, base hospital contact shall be made to determine appropriate destination.
Approved By Revision
Signatures on File at EMS Agency
EMS Division Manager 01/01/2015
Signature on File at EMS Agency
EMS Medical Director
Page 2 of 10
Subject:
Patient Destination
Policy
Number: 547
B. Medical Patient Destination -Considerations
1. In a non-emergent situation (as determined by the EMT or Paramedic at the scene and/or the Base Hospital
Physician/MICN giving medical direction), the patient will be taken to the receiving hospital of his/her
choice. If the patient is unable to determine this, the hospital designated by the private physician and/or
patient's family member will be utilized.
Paramedics and EMTs should determine where the patient normally receives their medical care and
encourage the patient to return to that hospital for medical care as long as the patient's medical condition
allows for such transport.
2. The Paramedic/EMT/MICN/BHP should only provide the patient with alternatives for destination of
patient choice. It is inappropriate for the Paramedic/EMT/MICN/BHP to endorse specific facilities or
provide personal opinion on the quality of local facilities.
3. Health Plans-If the patient is a member of a health plan with a preferred hospital, an attempt should be
made to transport the patient to a participating facility.
4. Closest Appropriate Hospital
a. The closest appropriate hospital is defined as the closest emergency department "equipped, staffed,
and prepared to administer care appropriate to the needs of the patient" (California Code of
Regulations, Title 13, Section 1106 (b) 2).
b. Closest is defined as the shortest travel time not necessarily the closest by distance.
c. The Base Hospital Physician will have the ultimate authority concerning patient destination.
d. The closest appropriate hospital does not mean that critically ill patients always go to the closest
"receiving" hospital. They go to the closest "appropriate" hospital. The following guidelines will
help to define "appropriate":
1) Due to short transport times, the appropriate receiving facility for a life-threatening
medical situation would be a hospital with a basic emergency service (holds a special
services permit from the California State Department of Health Services). Hospitals with
basic emergency services are:
a) Adventist Medical Center Hanford (AMC-H)
b) Children's Hospital Central California (Children's Hospital)
c) Clovis Community Medical Center (CCMC)
d) Kaiser Permanente Hospital (KPH)
e) Kaweah Delta Medical Center (KDMC)
f) Madera Community Hospital (MCH)
g) Saint Agnes Medical Center (SAM C)
h) Sierra View District Hospital (SVDH)
i) Tulare Regional Medical Center (TRMC)
j) Regional Medical Center (RMC)
2) Rural Areas -Due to prolonged travel times to the urban area, the appropriate receiving
hospital for a life-threatening medical situation would be a hospital with a standby
emergency service (holds a special services permit from the California State Department
of Health Services). Hospitals with stand-by emergency services that are approved to
receive ambulances are:
a) Adventist Medical Center Reedley (AMC-R)
b) Adventist Medical Center Selma (AMC-S)
Page 3 of 10
Subject:
Patient Destination
c) Coalinga Regional Medical Center (CRMC)
5. Acute Cardiac Emergency
Policy
Number: 547
In the event of an acute current of injury transport should be to a facility with interventional heart
catheterization capabilities. The following is a list of readings from various cardiac monitors:
• ***ACUTE MI *** (Zoll Monitor E Series)
• ***STEMI*** (Zoll Monitor X Series))
• ***ACUTE MI SUSPECTED*** (Physio-Control Monitor LifePak 12)
• ***MEETS ST ELEVATION MI CRITERIA*** (Physio-Control Monitor LifePak 15)
Transport should be either to:
• Regional Medical Center
• Kaweah Delta Medical Center
• Saint Agnes Medical Center;
whichever has the quickest transport time, if transport time is less than 60 minutes. If transport time is
greater than 60 minutes then transport to the closest appropriate facility or consider helicopter rendezvous.
Destination is determined by:
a. Interpretation of 12-lead ECG; or
b. Base Hospital consultation if required.
6. Patients who go directly to the closest appropriate receiving hospital:
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS airway).
Example: If the patient can be bagged via a BVM without an ET Tube or OPA, this is not an
unstable airway.
b. Any patient with CPR in progress.
c. Any critically ill or unstable patient when Base Hospital contact is not possible (i.e., Paramedic or
EMT must make the ultimate destination decision).
7. Patients who go to a non-receiving hospitals:
Patients may be transported to a non-receiving hospital only when the Base Hospital has contacted the
receiving doctor and received assurance of immediate acceptance ofthe patient. Such assurance should
then be documented on the Base Hospital run form.
8. Patients who go to a receiving hospital, which is not closest:
Unstable patients who request this hospital and, in the opinion of the Base Hospital Physician, the extra
travel time is not dangerous to the patient
Page 4 of 10
Subject:
Patient Destination
Policy
Number: 547
C. Fresno County 5150 Holds-Considerations
I. Fresno County 5150 patient criteria for transport Crisis Stabilization Center (CSC) and Children's Crisis
Assessment Intervention Resolution (CCAIR):
a. If the patient meets the following criteria, he/she shall be transported directly to Crisis Stabilization
Center (CSC) if age 18 or greater; or the Children's Crisis Assessment Intervention Resolution
(CCAIR) if under 18 years of age:
• No urgent medical complaint or evidence of acute medical/surgical/trauma problem requiring
urgent treatment prior to psychotic admission.
• No alteration in mental status due to dementia or delirium.
• Glasgow Coma Score 14 or 15.
• Complete vital signs within limits (HR, RR, BP, and GCS).
• Not febrile to palpation/measurement.
• Under the influence of alcohol or drugs, patient can walk without assistance and is able to
follow verbal commands (does not apply to CCAIR).
I) Adults:
a) Pulse: 50-120.
b) Systolic Blood Pressure: 100-180.
c) Diastolic Blood Pressure: less than 120.
d) Respiratory Rate: 12-30.
2) Pediatrics:
a) Vital signs appropriate for children (policy 530.32).
NOTE: Refer to the Criteria for Transporting a Fresno County 5150 Patient Directly to Crisis
Stabilization Center (CSC) or CCAIR Screening Form attached to this policy.
Patients that Crisis Stabilization Center (CSC) cannot accept:
• Patients with dementia or delirium
• Patients with ongoing medical care (i.e., patients who require continuous oxygen use,
catheters, wired devices, etc.)
• Patients in wheelchairs that cannot move independently
• Patients with any open wound, laceration, skin ulcer, or decubitus that requires anything
more that once daily dry gauze and tape dressing
b. All other patients on a 5150 hold in Fresno County not meeting the above criteria will be
transported to Patient/Family Choice within Fresno County.
c. Patients placed on a 5150 hold are to be transported to facilities within the county where the 5150
hold was initiated.
d. The 5150 destination policy does not apply to psychiatric patients who are voluntarily requesting
evaluation (not on a 5150 hold). If the patient is not on a 5150 hold, then transport will be to a
receiving facility of their choice, which includes CSC (Fresno County only) if patient meets
criteria within this policy.
e. Veteran's Administration
Page 5 of 10
Subject:
Patient Destination
Policy
Number: 547
2. The Veteran's Administration emergency department will accept all patients with a Veterans
Administration (VA) Identification Card or active duty Department of Defense (DOD) Card (Patient Name
Only, no dependant(s). Name of patient on card must be the patient requesting transport). No prior
approval or Base Hospital contact is necessary. If the patient requests transport to Veterans Administration
emergency department and does not have the identification noted above, contact the VA Emergency
Department directly for prior approval before the patient is transported. The complete name and the full
social security number will be required. Contact the Veteran's Administration on Med 6 or 241-3600.
3. Patients that cannot be transported directly to the Veteran's Administration are:
• Cardiac arrest due to trauma
• Pediatric cardiac arrest
• Trauma Center Triage Criteria
• OB patient in active labor
• Gynecological complaints and known obvious pregnancy with vaginal bleeding
• ST-segment elevation myocardial infarction (STEM!)
NOTE: INTERF ACILITY TRANSPORTS ARE NOT MANAGED THROUGH THIS PROCEDURE.
III. TRAUMA PATIENT DESTINATION
A. Trauma patients shall be transported to the appropriate destination in accordance with the following chart:
0 I
'
,
\..
TRAUMA DESTINATION CHART
Assess Physiological Criteria 1
• Systolic Blood Pressure: ' 0 Adults: < 90 mm Hg
0 Pediatrics: < 80 mm Hg with signs and
symptoms of shock (Refer to EMS Policy
530.32 for estimated weight formulas or
use Broselow Tape)
• Respiratory Rate:
0 Adults: < 10 or> 30
0 Children: < 20 if under age 1
w
Assess Loca I Criteria )
"""' • Glasgow Coma Score< 13 (or, in patients whose
normal GCS is less than 15, or a decrease oftwo
or more of the patients GCS score)
• Penetrating injury to the head
• Paraplegia
• Quadriplegia
• Any Burn (Air only)
~ w
Assess Anatomy of Injury I
• Penetrating injuries to neck or torso
• Flail chest
• Two or more proximal long-bone fractures
• Amputation proximal to wrist or ankle
"'
RMC orKDMC
(Consider air transport)
RMC
(Consider air transport)
RMC or KDMC
(Consider air transport)
Page 6 of 10
Subject:
Patient Destination
'" Assess Burns l
STABLE TRAUMA PATIENTS WITH:
• Partial/Full thickness burns> 10% TBSA
• Partial/Full thickness circumferential burns
• Partial/Full thickness burns to face, hands, feet,
major joints, perineum, or genitals
• Electrical burns with voltage > 120 volts
• Chemical burns> 10% TBSA
\..
H
Assess Mechanism of Injury ]
• Falls
0 Adults: >20ft. (one story= 10ft.)
0 Children: > 10ft. or 3 times height of the
child
~,
Assess Special Considerations ]
~
WITH A SIGNIFICANT COM PLAINT:
• Age greater than 55 years
• Anticoagulation or bleeding disorders
• Pregnancy greater than 20 weeks
• Auto vs. Pedestrian > 20 mph
• Motorcycle crash > 20 mph
..1 "' l
Paramedic/Flight Nurse Judgment ]
WITH A SIGNIFICANT COMPLAINT
,,
Transport According to Policy
""
~
Policy
Number: 547
RMC
(Consider air transport)
RMCor KDMC
(Consider air transport)
Consider transport to
RMC or KDMC
Consider RMC or KDMC
Base Hospital Consultation
SIGNIFICANT COMPLAINT
Perseveration
Deteriorating mental status
Severe chest pain
Severe shortness of breath
Severe abdominal pain
Sustained, overwhelming "Feeling of Doom"
Page 7 of 10
Subject:
Patient Destination
Policy
Number: 547
NOTE: If transport time is greater than 60 minutes for patients meeting trauma triage criteria, base hospital contact
shall be made to determine appropriate destination.
NOTE: If transport time is greater than 2 hours for patients meeting bum triage criteria, base hospital contact shall
be made to determine appropriate destination.
B. Triage Criteria
Triage criteria will determine if the patient will be transported to a trauma center or closest receiving hospital.
C. Trauma Patient Destination -Considerations
I. If the patient is in cardiac arrest from penetrating trauma in the greater Fresno or Visalia metropolitan area,
the patient should be transported to Regional Medical Center or Kaweah Delta Medical Center, bypassing a
closer receiving facility. However, if the transport time to Regional Medical Center or Kaweah Delta
Medical Center is greater than ten (I 0) minutes, then transport should be to the closest receiving facility
within ten minutes transport time (Refer to EMS Policy #550).
2. Trauma patients, meeting trauma center criteria, who have a transport time greater than 60 minutes to the
trauma center, will require base hospital contact for destination decision.
3. The following types of incidents should be consideration for transport to the designated Trauma Center,
based upon paramedic judgment:
a. Motorcycle Crash -Non-ambulatory with potential of significant injuries
b. Auto versus Pedestrian -Non-ambulatory with potential of significant injuries
NOTE: Paramedic judgment is based upon the paramedic's own knowledge and experience to determine if the
patient's condition would require transport to a designated Trauma Center due the mechanism of injury and
potential underlying injuries. The Paramedic may contact a Base Hospital for advice on destination.
4. Transport of Trauma Patients by Helicopter
A trauma patient should not be transported by helicopter unless they meet trauma triage criteria to be
transported to the Regional Trauma Center or the patient is inaccessible by ambulance (i.e., wilderness
transports). EXCEPTION: When the paramedic feels helicopter transport of the patient would be
beneficial to the outcome of the patient.
5. Bum Patients
a. The following patients should be transported directly to the Regional Bum Center (Regional
Medical Center) bypassing other hospitals if ETA to Regional Medical Center is within two hours.
I) Patients with 2° (partial thickness) or 3° (full thickness) bums that are more than IO% total
body surface area
2) Patients with 2° (partial thickness) or 3° (full thickness) circumferential bums of any body part
3) Patients with 2° (partial thickness) or 3° (full thickness) bums to face, hands, feet, major joints,
perineum, or genitals
4) Electrical bums with voltage greater than I20 volts
5) Patients with chemical bums greater than 10% total body surface area.
6. Carbon Monoxide Poisoning -Early call-ins to Regional Medical Center should be made for patients that
appear to have significant exposure to carbon monoxide poisoning (altered mental status, vomiting, and
headaches).
Page 8 of 10
Subject:
Patient Destination
7. Trauma patients who go directly to the closest appropriate receiving hospital:
Policy
Number: 547
a. Any unstable or unmanageable airway (this is defined as unable to maintain a BLS airway).
Example: If the patient can be bagged via a BVM without an ET Tube or OPA, this is not an
unstable airway.
b. Any patient with CPR in progress (refer to EMS Policy #550).
c. Any critically injured or unstable patient when Base Hospital contact is not possible (i.e.,
Paramedic or EMT must make the ultimate destination decision).
IV. PATIENTS WHO REFUSE TRANSPORT TO THE APPROPRIATE HOSPITAL
A Base Hospital shall be contacted for the purpose of physician consultation on patients who meet one or more of the triage
criteria and refuse transport to the appropriate hospital. This will usually not be a problem with the acutely ill patient.
However, some patients with normal mental status may wish to be transported to a different hospital than the one selected via
the triage criteria. These situations should be treated as "Refusal of Medical Care and/or Transportation" situation (refer to
EMS Policy #546). The Base Hospital Physician, after radio contact, may allow the patient to go to the destination of their
choice, have a "Refusal of Medical Care and/or Transportation" signed or insist on transport to the designated hospital.
V. PATIENTS WHO CAN GO DIRECTLY TO AN EMERGENCY DEPARTMENT WAITING ROOM
Prehospital personnel shall utilize the emergency department patient entrance at all receiving hospitals for non-emergent
patients. Delivery of patients to the appropriate area of the emergency department is based on severity of illness.
Patients who meet the following criteria can be taken directly to the emergency department walk-in waiting room, bypassing
the ambulance entrance used for serious or critically ill patients.
• Patients 18 years old or older or minors accompanied by a responsible adult.
• Patient has normal, age appropriate vital signs(± 5%).
• Patient can sit unassisted and has reasonable mobility.
• Patient does not meet criteria for ETA call-in.
• Patient does not have IV access started by EMS.
• Patient is not on a 5150 hold or in custody.
EMS personnel must give report to a hospital employee authorized to triage, or take possession of the patient, and obtain a
signature for transfer of patient care. If there is a difference of opinion as to the appropriate waiting area, or location of the
patient, the hospital representative will make the final decision as to the disposition of the patient and provide the turnover
signature.
Page 9 of 10
Subject:
Patient Destination
Policy
Number: 547
VI. SPECIAL CONSIDERATION FOR OBSTETRICS OR PREGNANT PATIENTS REQUESTING ADVENTIST MEDICAL
CENTER-HANFORD
While Central Valley General Hospital will not have an emergency department, the hospital will still be open as an in-patient
I out-patient facility for OB/GYN services. Ambulance patients may be taken directly to Central Valley General Hospital
under the following circumstances:
• Transfers from a physician's office when the physician requests that the patient be taken directly to Central Valley
General Hospital
• An interfacility transfer from another hospital (i.e., direct admit)
• Obstetrics or pregnancy related calls when directed by the Base Hospital (Adventist Medical Center-Hanford) to
transport directly to Central Valley General Hospital. A full standard call-in must be made to the Base Hospital on
all OB/GYN patients.
VII. SPECIAL CONSIDERATION FOR HEART HOSPTAL DESTINATION
While the Heart Hospital is a hospital within Central California EMS Region, it does not have an emergency
department and is not an approved facility for patient transports within EMS Policy and Procedures. Patients who are
requesting transport to the Heart Hospital from the prehospital setting will require Base Hospital contact to confirm
acceptance. Since the Heart Hospital is under the Community Medical Center organization, EMS personnel should contact
Regional Medical Center when requesting transport to the Heart Hospital. If attempts to contact Regional Medical Center
are unsuccessful, EMS personnel should contact another Base Hospital. Interfacility transfers involving the Heart Hospital
shall be in accordance with EMS Policy #553, "ALS Interfacility Transports".
Central California EMS Agency
Criteria for Transporting a Fresno County 51 50/Psychiatric Patient
Directly to CSC or CCAIR Screening Form
Patient's Name:------------------EMS#: ____________ _
Patient has urgent medical complaint or evidence of acute medical/surgical problem.
[ ] True-transport Patient/Family Choice [ ] False
Patient has alteration in mental status due to dementia or delirium.
[ ] True -transport Patient/Family Choice [] False
Patient has a Glasgow Coma Score 13 or less.
[ ] True-transport Patient/Family Choice [] False
There are lacerations with a gap of greater than 2 mm or fat/muscle visible in the wound (excludes any type of stab
wound).
[ ] True-transport Patient/Family Choice [] False
There are lacerations or wounds inflicted by others.
[] True-transport Patient/Family Choice [) False
Complete vital signs are within limits:
Adults:
Pulse outside range ofS0-120.
Systolic Blood Pressure outside range of 100-180.
Diastolic Blood Pressure greater than 120.
Respiratory Rate outside range of 12-30.
Pediatrics:
Vital signs inappropriate for children
(Policy 530.32)
Patient is febrile to palpation/measurement.
[] True-transport Patient/Family Choice [] False
Is patient under the influence of alcohol or drugs.
(]Yes []No
[) True-transport Patient/Family Choice
[] True-transport Patient/Family Choice
[] True-transport Patient/Family Choice
[ ] True-transport Patient/Family Choice
[ ] True-transport Patient/Family Choice
If yes, to under the influence of alcohol or drugs, does patient require assistance to walk.
[) True-transport Patient/Family Choice [ J False
If all ofthe above answers are False, patient may be transported to CSC/CCAIR. Otherwise transport is
Patient/Family Choice.
Patients that Crisis Stabilization Center (CSC) cannot accept:
•
[]False
[]False
[]False
[]False
[]False
Patients with dementia or delirium
Patients with ongoing medical care (i.e., patients who require continuous oxygen use, catheters, •
wired devices, etc.)
• Patients in wheelchairs that cdannl ot m~.ve i:~~~:~~=;t~ decubitus that requires anything more that
Patients with any open woun ' ace~a IOn, ,
once daily dry gauze and tape dressmg •