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PD Mental Health Services Designated EmployeeMEMORANDUM OF UNDERSTANDING BETWEEN THE COUNTY OF MARIN, DEPARTMENT OF HEALTH AND HUMAN SERVICES, DIVISION OF MENTAL HEALTH AND SUBSTANCE USE AND THE CITY OF SAN RAFAEL REGARDING DESIGNATED PROFESSIONAL PERSONS This Memorandum of Understanding (MOU) is made and entered into this --- day of R Pa i L , 2016 by and between the CITY OF SAN RAFAEL (hereinafter "City"), and the COUNTY OF MARIN (hereinafter "County"). Purpose: The purpose of this MOU is to establish the requirements and procedures by which the City can request the County's Mental Health Director to designate specific City employees as professional persons authorized to initiate an "Application for 72 -Hour Detention for Evaluation and Treatment" (Application) pursuant to Welfare and Institutions Code § 5150. Terms of Agreement: Revocation of Designated Professional Person Status: Should City wish to terminate the Designated Professional Person status of an individual designated pursuant to this MOU, City shall provide written notice of this intention to the County Mental Health Director at the earliest possible date. County shall have the right and sole authority to revoke the Designated Professional Person status of any individual so designated pursuant to this MOU at any time and for any reason. In such cases, County shall notify City of the name of the individual whose status has been revoked. This notice of revocation is effective immediately. Duration of MOU: This MOU shall be effective as of the date it is approved by both the City Council and the County Board of Supervisors and shall continue for a period of one year thereafter. The parties may extend this MOU for additional one year terms upon mutual written consent. Notwithstanding the foregoing, this MOU may be terminated by either party immediately upon written notice to the other party. Certificates of insurance must be current on the day the MOU commences and if scheduled to lapse prior to termination date, must be updated before any such lapse occurs. Insurance: The City shall maintain a commercial general liability insurance policy or provide proof of self- insurance as authorized by Government Code section 990, in the amount of $1,000,000 ($2,000,000 aggregate). The County shall be named as an additional insured on the commercial general liability policy. Where services to be provided under this MOU involve or require the use of any type of vehicle by City, or any of City's agents or employees, City shall provide comprehensive business or commercial automobile liability coverage, including non -owned and hired automobile liability, or proof of self-insurance, in the amount of $1,000,000. Attachment I City acknowledges that the State of California requires every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of the Labor Code. If City has employees, a copy of the certificate evidencing such insurance, a letter of self-insurance, or a copy of the Certificate of Consent to Self -Insure shall be provided to the County prior to commencement of work. All policies shall remain in force through the life of this MOU and shall be payable on a "per occurrence" basis unless County specifically consents to a "claims made" basis. City shall supply County adequate proof of insurance and/or a certificate of insurance evidencing coverage and limits prior to commencement of work. Should any of the required insurance policies in this MOU be cancelled or non -renewed, it is the City's duty to notify the County immediately upon receipt of the notice of cancellation or non -renewal. Indemnification: City agrees to indemnify, defend, and hold County, its employees, officers, and agents, harmless from any and all liabilities including, but not limited to, litigation costs and attorney's fees arising from any and all claims and losses to anyone who may be injured or damaged by reason of City's negligence, recklessness or willful misconduct in the performance of this MOU. Indevendent Agencies: The parties to this MOU are independent agencies. Nothing herein contained shall be construed as creating the relationship of employer and employee, or principal and agent, between the parties or any of their agents or employees. Division of Responsibilities: City: 1. To request that a City employee be granted status as a Designated Professional Person, City shall submit a request in writing to the County Mental Health Director. The request shall include all the following information for each individual for which designation is being sought: a. The name of the individual applying for designation; b. Evidence of employment with the City; c. A resume of relevant past clinical experience; d. Evidence of any and all of the individual's current California licensure(s); and e. The individual's Certificate of Completion of the Marin County 5150 Training Program. 2. City hereby agrees that it shall abide by County's 5150 Policy and Procedure, attached hereto as Exhibit A. 3. City shall maintain written policies and procedures, approved by the County Mental Health Director, consistent with the County's 5150 Policy and Procedure and with the terms and condition of this MOU. 4. City agrees to abide by all state and federal laws relating to Involuntary Psychiatric Detention. 5. City agrees to participate with County, on a quarterly basis, in a quality assurance process to review those Involuntary Psychiatric Detentions initiated by Designated 2 Professional Persons so designated pursuant to this MOU. Such quality assurance process will consist of, at a minimum, an in-person meeting between the County Mental Health Director or his/her designee and the individual Designated Professional Persons, during which meeting the County Mental Health Director or his/her designee may review, as appropriate, any and all of the Designated Professional Persons' Applications. This process shall comply with all applicable state and federal laws and any accreditation standards to ensure the confidentiality of any Patient Health Information, including but not limited to such information as protected under (1) the Confidentiality of Medical Information Act (CMIA) codified at California Civil Code § 56 et al. and its applicable successor provisions, as may be amended form time to time; (2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA) codified at 45 CFR Parts 160 and subparts A and E of Part 164, and its applicable successor provisions, as may be amended from time to time; (3) the LIPS Act codified at Welfare and Institutions Code § 5328 et seq.; and (4) federal law specially protecting substance abuse records codified at 42 CFR § 2 et seq. Coun . 1. All credentials and information submitted to the County pursuant to this MOU shall be maintained and available for review in the office of the County Mental Health Director or his/her designee. 2. County shall notify City in writing, within thirty days of City's submission of the information set forth in Paragraph 1 of City's Responsibilities enumerated above, whether or not the individual has been granted Designated Professional Person status. 3. County shall establish and maintain a current roster of the names of all Designated Professional Persons so designated pursuant to this MOU. IN WITNESS WHEREOF, the parties have executed this Agreement as of this day, month and year first above written. CI OF SA F L JI SC UTZ, City an er ATTEST: e- - ge,,-, ESTHER C. BEIRNE, City Clerk Cg.UWIY OF MA I Steve Kinsey, President Marin County Board of Supervisors APPROVED AS TO FORM: r—E7– ROBERT F. EPSTEIN, Oity Atto�n�LL 3 County of Marin Mental Health & Substance Use Services (MHSUS) POLICY: AUTHORITY TO INITIATE 5150 INVOLUNTARY DETENTION SUPERCEDES — PP210-08 & PP208-14 Exhibit A POLICY NO. NMSUS-PES-03 Review Date: February, 2019 Date Approved: February 9, 2016 Date Reviewed/Approved: Suzanne 'I avano, PhD Mental Health Director POLICY: AUTHORITY TO ]INITIATE 5150 INVOLUNTARY DETENTION I. PURPOSE: Section 5150 of the California Welfare and Institutions Code (5150) provides for the involuntary detention of any person who, "... as a result of a mental disorder, is a danger to others, or himself or herself, or [is] gravely disabled." The purpose of this policy is to provide guidance regarding the authority of specified Marin County employees to initiate 5150 involuntary detentions. II. REFERENCES: Lanteiman-Petris-Short Act (LPS), Welfare and Institutions Code §§5000, et seq. Children's Civil Corrunitment and Mental Health Treatment Act of 1988, Welfare and Institutions Code §§5585 et seq. DHCS 1801 (07/2014) Application for Assessment, Evaluation and Crisis Intervention or Placement for Evaluation and Treatment. CA Penal Code, Sections 830.1, 830.2 and 830. 8. MHSUS 5150 Training Manual (December 2015) and test III. POLICY: Only those individuals identified in W&I Code 5150 may initiate a 5150 detention. Such involuntary holds must comply with all laws governing mental health services arid care. Some individuals, like peace officers, have the authority to initiate 5150 holds pursuant to the plain language of the statute. Other individuals, such as professional persons designated by the Director of MIISUS, may also initiate 5150 detentions, but only once they have specifically had such authority delegated to them. The Director of MHSUS, and/or his/her designees, may only exercise their authority to initiate a 5150 detention within the boundaries of the County of Marin and in the course of their official duties. LAUTHORITY TO INMATE 5150 INVOLUNTARY DETENTION - I Page 1 of 3 County of Marin Mental Health & Substance Use Services (MHSUS) POLICY: AUTHORITY TO INITIATE 5150 INVOLUNTARY DETENTION SUPERCEDES — PP210-08 & PP208-14 POLICY NO. MHSUS-PES-03 Review Date: February, 2019 Date Approved: February 9, 2016 Date Reviewed/Revised: The LPS Act typically does not authorize the provision of medical treatment without the client's consent. Similarly, refusal of medical attention is not a basis for initiation of a 5150 hold, unless such refusal has created a situation in which the client has become a danger to himself or herself as defined in the LPS Act. For other information pertinent to this process, and to 5150 detentions, please refer to MHSUS' 5150 Training Manual and PowerPoint Presentation) IV. AUT1lORITY/RESPONSIBILITY: The following employee groups/categories are responsible for the dissemination, training, implementation and monitoring of this policy and its procedures: MHSUS Director MHSUS Medical Director MHSUS Quality Manager MHSUS Crisis Continuum Program Manager V. PROCEDURE: A. Individuals Authorized to Sign Form DHCS 1801 Application for Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment, thereby initiating a 72 -hour involuntary hold are: (a) Peace Officers, as defined by Sections 830.1, 830,2 and 830. 8 of the California Penal Code, (b) The professional person in charge of a facility designated by Marin County for evaluation and treatment, (c) Members of the attending staff, as defined by regulation, of a facility designated by Marin County for evaluation and treatment, (d) Designated members of a mobile crisis team, (e) Designated Marin County employees, and (f) All other professional persons as designated by the Director of MHSUS. B. Individuals eligible for designation by the Director of MHSUS are: (a) Licensed Physicians (b) Licensed Psychologists (c) Nurse Practitioners https://www.marinhhs. orgtsitesldefaultlflles/fileslservicepagesl2015_08/civil_versus_criminal_evaluation_5150_po werpoint.pdf AUTHORITY TO INITIATE 5150 INVOLUNTARY DETENTION Page 2 of 3 County of Marin Mental Health & Substance Use Services (MHSUS) POLICY: AUTHORITY TO INITIATE 5150 INVOLUNTARY DETENTION SUPERCEDES — PP210-08 & PP208-14 POLICY NO. NASUS -PES -03 Review Date: February, 2019 Date Approved: February 9, 2016 Date Reviewed/Revised: (d) Licensed Clinical Social Workers (e) Licensed Professional Clinical Counselors (f) Licensed Marriage Family Therapists (g) Licensed Registered Nurses (h) Licensed Psychiatric Technicians (i) Licensed Medical and Psychiatric Residents 0) All other professional persons as designated by the Director of MHS US. Students/interns are not eligible for authorization to write an application Form (DIICS 1801). Professional persons who are not currently employed by Marin County may not receive a 5150 designation from the Director of MHSUS unless they or their agency/employcr have entered in to a specific, written agreement concerning designation of professional persons with Marin County. C. Requirements for individuals who have been designated by the Director of NUISUS: (a) No less frequently than annually, attend training related to 5150 authorization that has been approved by the Director of MHSUS. (b) Upon completion of training and successfiil completion of the post training. test, the eligible individual's name will be added to the list of individuals designated :to initiate 5150 detentions. The list will be maintained by the Director of MHSUS or his/her designee. (c) The individual will be issued a 5150 Authorization Card by MHSUS indicating: (i) Authorization to write 5150 applications. (ii) Individual's name and signature. (iii)Signed by Marin County MHSUS Director. (iv)Expiration date of no longer than 3 years. The card may be renewed for another 3 years if the holder successfully attends another 5150 training session discussed in subsection (a) above. (d) The card will be issued and updated by the Director of MHSUS or his/her designee. (e) The card is to be carried with the individual if off site and made available to peace officers, upon request. (f) When an employee separates from Marin County employment, or is no longer employed by Marin County in a role that requires the 5150 Authorization Card, the card shall be returned to the employee's supervisor.. LAUTHORITY TO INITIATE 5150 INVOLUNTARY DETENTION Page 3 of 3 a DEPARTMENT OF HEALTH AND H MA SERVICE COUNTY OF MARIN `� Promoting and pra-ecting health, well-being, self-sufficiency, and safely of all in Marin County. M A R I N HEALTH & HUMAN SERVICES April 18, 2016 Grant Nash Colfax. MD DIRECTOR Esther Beirne City Clerk 20 North San Pedro Road City of San Rafael Suite 2002 1400 Fifth Avenue San Rafael, CA 94903 San Rafael, California 94901 415 473 3696 T 415 473 3791 F Re: MOU between City of San Rafael and County of Marin Department of Health and 415 473 3344 TTY Human Services, Division of Mental Health and Substance Use Services www.marincounty.orgAhs Dear Ms. Beirne, Enclosed please find an executed copy of the MOU between our two entities regarding designating professional persons authorized to initiate an "Application for 72 -Hour Detention for Evaluation and Treatment" pursuant to Welfare and Institutions Code Section 5150. Mr Schutz requested it be returned to your attention. Thank you very much. Sincerely, Karen Wuopio Public Health Division Director PROFESSIONAL SERVICES AGREEMENT/CONTRACT COMPLETION CHECKLIST AND ROUTING SLIP Below is the process for getting your professional services agreements/contracts finalized and executed. Please attach this "Completion Checklist and Routing Slip" to the front of your contract as you circulate it for review and signatures. Please use this form for all professional services aureements/contracts (not just those requiring City Council approval). This process should occur in the order presented below. Step Responsible Description Completion Department Date 1 City Attorney Review, revise, and comment on draft agreement. 3% /A 2 Contracting Department Forward final agreement to contractor for their signature. Obtain at least two signed originals from contractor. 3 Contracting Department Agendize contractor -signed agreement for Council approval, if Council approval necessary (as defined by City Attorney/City Ordinance*). 4 City Attorney Review and approve form of agreement; bonds, and insurance certificates and endorsements. 5 City Manager / Mayor / or Agreement executed by Council authorized Department Head official. 6 City Clerk City Clerk attests signatures, retains original agreement and forwards copies to the U 1� contracting department. �- To be completed by Contracting Department: Project Manager: A�� ( Project Name: S Agendized for City Council Meeting of (if necessary): 3 J FPPC: ❑ , check if required If you have questions on this process, please contact the City Attorney's Office at 485-3080. * Council approval is required if contract is over $20,000 on a cumulative basis.