HomeMy WebLinkAboutPD 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such cases, County shall notify City of the name of the individual whose status has been
revoked.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.