In California, counties have been providing health care services for almost 150 years. With the exception of local Health Departments operated by the cities of Berkeley, Long Beach, and Pasadena, counties provide a wide variety of health services to all residents of the county, regardless of whether they reside in the unincorporated area or reside within city limits. In other words, the county Health Department is also the cities’ Health Department. A County Organized Health System (agency or department) is usually administered by an Administrative Director who is appointed by either the County Administrative Officer (CAO) and/or the Board of Supervisors and is responsible to them for all health related issues. The Board also appoints a Public Health Officer (physician) who serves as the chief medical officer for the county on public health issues. The type of organizational structure and programs offered can vary from county to county, as this is one of the most complex and diverse areas of county government and one which affects every county resident.

Office Responsibilities

Alcohol-Drug — Assures necessary substance abuse services are available to the public through a network of public operated and private contracted providers. Services typically include inpatient and outpatient care, residential recovery, detoxification, information, education, prevention, and early intervention.

Detention Facilities — Assures that necessary medical, dental, psychiatric, and substance abuse services are provided to adult and juvenile persons incarcerated in county facilities.

Environmental Health — Provides all health related approvals and permits relating to land development (well water permits, septic permits, and land use permits), consumer protection (food facility inspections/permits, public pools, small water systems, solid waste, and foodborne illness investigation), and hazardous materials (underground storage tanks, medical waste, Proposition 65 reporting, chemical spills, and incident response). (See separate description in this section.)

Emergency Medical Services (EMS) — If designated as the local EMS agency, responsibilities involve ambulance permitting and monitoring, Emergency Medical Technician certification, emergency medical dispatch approvals, and disaster planning.

Hospitals — Prior to the implementation of Federal Medicaid in 1964, 49 counties owned and operated 66 general acute care county hospitals. In 1994, 21 counties own and operate 28 county hospitals which serve as safety net providers of last resort to any person seeking medical care. Most of these hospitals are full service teaching hospitals affiliated with university medical schools. Services vary slightly from hospital to hospital but generally include medical, surgical, emergency, trauma, outpatient, and a wide variety of specialty services.

Indigent Medical Care — Provides medical care to indigent persons, including Medically Indigent Adults, in a variety of ways including operating a county hospital and/or primary care clinics, or using a wide variety of contracts with providers of care to fulfill their responsibilities.

Medically Indigent Adults (MIA) — Counties are separated into two categories in fulfilling state mandated medical and dental services to eligible persons. Those counties with a population over 300,000 in 1980 are referred to as Medically Indigent Services Program (MISP) counties and are required to administer their medical program. Those counties with a population under 300,000 in 1980 have an option of either contracting with the state to administer their MIA program as a County Medical Services Program (CMSP) or administering it themselves (MISP county). Most MISP counties are in the process of developing and implementing managed care plans.

Mental Health — Provides a wide range of psychiatric services to the public either directly or by contract with providers. Services typically include acute inpatient care for Welfare and Institutions Code Section 5150 persons (danger to themselves, others, or are gravely disabled), State Mental Hospital placements, long term care in institutes for mental disease, local crisis services, day treatment, outpatient care, and operation of a conditional release program for Penal Code offenders. Starting October 1, 1994, county mental health programs will provide managed care for hospitalized persons.

Public Health — Services include prevention, early intervention, education, and treatment through a wide range of specific programs and services which typically include adult health screening; HIV/AIDS testing and counseling; communicable and infectious disease control; immunizations; family planning; children’s services (CHDP, physical exams, medical, nutrition, etc.); sexually transmitted diseases; home nursing visits; tuberculosis; Women, Infants and Children (WIC) nutritional services; and vital statistics registration involving birth/death certificates and burial permits. Normally a public health laboratory is on-site to perform all tests required by the nursing functions of public health in addition to testing for rabies, water, food, lyme disease, parasites, bacteria, and microorganisms.