Score: 0 (9/15/9)

San Diego County Grand Jury • 2017-2018

The San Diego Hepatitis a Epidemic:

Published: January 23, 2018 20 pages

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⚠️ Aviso de traducción: Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

Findings 7 findings

F01

An earlier declaration of a local public health emergency would have provided the authority to direct the implementation of more effective measures to deal with the epidemic. Fact: The Emergency Operations Plan for local public health emergencies does not define the separate and combined responsibilities of County and City agencies during an emergency. Fact: The Emergency Operations Plan lists multiple authorities, within different jurisdictions, that could potentially direct activities during a health emergency, rather than defining a single authority.

F02

The Emergency Operations Plan failed to establish an incident command structure in a health emergency which led to confusion and jurisdictional conflict. Fact: Prior to the declaration of a local public health emergency, County and City departments did not effectively cooperate and coordinate their activities. Fact: Prior to the declaration of a local public health emergency, handwashing stations, an effective tool in combatting disease transmission, had not been allowed on City property because permits had not been granted. Fact: Information provided by the County to the City regarding availability of handwashing stations was seen as inconsistent by City staff. Fact: Over 40 handwashing stations were installed in the City within a week after declaration of a local public health emergency.

F03

The lack of early cooperation between County and City resulted in unnecessary delays in installation of handwashing stations and other public health measures. Fact: The County Public Health Service is responsible for monitoring and managing public health activities within the county, including directing those activities within municipalities. Fact: Health and Safety Code §§101375-101380 defines a procedure by which a city may consent on an annual basis to the authority of the county health officer to enforce orders and statutes relating to public health.

F04

The City has not followed the procedures defined in Health and Safety Code §§101375-101380 to allow the county health officer to enforce orders relating to public health.

F05

City administrators and County health officers had different concerns in responding to the crisis and failed to appreciate each other’s perspectives.

F06

The City of San Diego does not have a staff member with medical expertise to evaluate and fully appreciate the significance of public health directives.

F07

The County has not designated a project manager with sufficient expertise to understand the administrative concerns of City staff in responding to public health directives. COMMENDATION The 2017/2018 San Diego County Grand Jury commends the San Diego County Department of Public Health Services and the nurses, law enforcement personnel, paramedics, and homeless service providers who created the special foot teams to provide vaccinations for unsheltered individuals living in difficult-to-reach areas. This method for ensuring the widest possible distribution of vaccinations to an at-risk population represented an innovative and effective procedure to help deal with an unprecedented health emergency. The tireless efforts of the foot team personnel, who hiked in to homeless encampments and persuaded residents to agree to vaccination, reflect their dedication to the task of providing health care to our citizens. This procedure will undoubtedly be considered as a best practice for other agencies if they face a similar public health threat.

Recommendations 7

18-06
Page 12

Declare a local public health emergency much sooner when confronted with
18-07
Page 12

Direct that the County Emergency Operations Plan be revised to establish a
18-08
Page 12

Clearly establish lines of authority to prevent misunderstandings regarding
18-09
Page 12

Designate a project manager who can communicate effectively with City
18-10
Page 12

That the City of San Diego adopt the procedures described in Health and
18-11
Page 12

That the City of San Diego designate a medical professional to report directly
18-12
Page 13

That the City of San Diego construct and maintain additional secure

Commendations 1

CM1

The 2017/2018 San Diego County Grand Jury commends the San Diego County Department of Public Health Services and the nurses, law enforcement personnel, paramedics, and homeless service providers who created the special foot teams to provide vaccinations for unsheltered individuals living in difficult-to-reach areas. This method for ensuring the widest possible distribution of vaccinations to an at-risk population represented an innovative and effective procedure to help deal with an unprecedented health emergency. The tireless efforts of the foot team personnel, who hiked in to homeless encampments and persuaded residents to agree to vaccination, reflect their dedication to the task of providing health care to our citizens. This procedure will undoubtedly be considered as a best practice for other agencies if they face a similar public health threat.

Agency Responses 6

Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.

County of San Diego

August 07, 2018 • 7 responses • Score: -3 (+0, 4, -3) View Details ▾

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7 responses to findings and recommendations

F01

Response: Disagree Score: -1

The County of San Diego Chief Administrative Officer disagrees with this finding. The Centers of Disease Control and Prevention has expressed, in a letter regarding the San Diego County hepatitis A outbreak1, that the most effective and demonstrated measure to stop the outbreak (one of the largest nationally to-date) was mass vaccinations. Despite public perception, the Public Health Officer's authority to direct the response, in particular the effort to vaccinate at-risk individuals, does not increase as a result of declaring a local health emergency. The County of San Diego (County) implemen...

F02

Response: Disagree Partially Score: 0

The County of San Diego Chief Administrative Officer disagrees partially with this finding. The County recognizes that communication is a vital component to the efficiency of a response to an emergency. When the outbreak was identified, communication lines were established with critical stakeholders. These included the health care community, the cities and service providers who serve the identified at-risk community. In addition, during this time, Public Health Services Page 1 of 12 put a command structure in place to work with stakeholders and respond to the outbreak. A forn1al incident conu...

F03

Response: Disagree Partially Score: 0

The County of San Diego Chief Administrative Officer disagrees partially with this finding. The County implemented a tlu·ee-pronged strategy to address the hepatitis A outbreak. The primary focus of responding to this outbreak was mass vaccinations, which is a demonstrated and effective way to stop the transmission of hepatitis A. The City and County were fully cooperative with vaccination and education 111easures to address the outbreak. Unfortunately, there is a perception that handwashing stations are a routine response to such an outbreak. However, deploying handwashing stations regionally...

F04

The City has not followed the procedures defined in Health and Safety Code §§101375-101380 to allow the county health officer to enforce orders relating to public health.

Response: Disagree Partially Score: 0

The San Diego County Probation Department disagrees partially with this finding. The Probation Depm1ment has already developed several programs designed to prevent and reduce violence among youth. including at East Mesa Jm·enile Detention Facility. which houses youth with the most extensive criminal justice histories. However, we will continue to develop and add to these programs. Probation is currently working with the Center for Juvenile Justice Reform at Georgetown University as part of their Youth in Custody Practice Model technical assistance program. This effort is aimed at adopting an a...

F05

City administrators and County health officers had different concerns in responding to the crisis and failed to appreciate each other’s perspectives.

Response: Disagree Partially Score: 0

The County of San Diego Chief Administrative Officer disagrees partially with this finding. As with any government entity, the County and the City had the same concern which was the protection of the public health and safety. This shared concern was e,·ident in the cooperation between both jurisdictions with vaccination and education measures to address the outbreak. Roles and responsibilities between County Public Health and other local municipalities are sometimes different during public health emergencies. Enhancements in conmmnication and a clarification of roles and responsibilities is re...

F06

The City of San Diego does not have a staff member with medical expertise to evaluate and fully appreciate the significance of public health directives.

Response: Disagree Score: -1

The County of San Diego Board of Supervisors and Chief Administrative Officer for the County of San Diego disagree with this finding. The County's Public Safety Group has no operational oversight over CLERE. The group's executive office provides only administrative support. The Public Safety Group is best suited to provide administrative support services to CLERE such as Human Resources and Finance because of the group's deep experience and knowledge in the subject areas addressed by CLERB. For example, Public Safety Group Human Resources staff members currently assist in the hiring of investi...

F07

Response: Disagree Score: -1

The County of San Diego Chief Administrative Officer disagrees with this finding, The County determined at the onset of this infectious disease outbreak that an appropriate representative to the City of San Diego was necessary. Thus, the County assigned the Deputy Public Health Officer as the primary liaison Page 2 of 12 to the City. This liaison continues to work collaboratively and regularly with City staff to coordinate cross-jurisdictional public health activities. The Deputy Public Health Officer and the City of San Diego began communicating in April 201 7 and had the first fonnal meetin...

San Diego City Council

November 14, 2018 • 11 pages • 7 responses • Score: 0 (+2, 3, -2) View Details ▾

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7 responses to findings and recommendations

F01

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding.

F02

Response: Disagree Partially Score: 0

the Mayor and City Council partially disagree with Finding 02.

F03

Response: Disagree Partially Score: 0

The Mayor and City Council partially disagree with the Grand Jury's finding. Page 1 of 6 "San Diego Community Review Board on Police Practices" On May 10, 2018, the Mayor issued a memo soliciting input from the City Council on appointees to the CRB. The Measure G implementing ordinance and CRB Standard Operating Procedures went into effect in August 2018 which allowed the Mayor to appoint, and the Council to confirm, appointees to the Board. In August 2018 the City Council approved 21 board members. The implementing ordinance eliminated the category of "prospective member" to streamline the a...

F04

The City has not followed the procedures defined in Health and Safety Code §§101375-101380 to allow the county health officer to enforce orders relating to public health.

Response: Disagree Partially Score: 0

the City partially disagrees with Finding 04.

F05

City administrators and County health officers had different concerns in responding to the crisis and failed to appreciate each other’s perspectives.

Response: Disagree Score: -1

disagree with Finding 05.

F06

The City of San Diego does not have a staff member with medical expertise to evaluate and fully appreciate the significance of public health directives.

Response: Disagree Score: -1

The Mayor and City Council disagree with the Grand Jury's finding. The presence of SDPD in closed session meetings of the CRB is intended to provide a resource to the Board as they deliberate on cases. The review model that the CRB uses affords the Board all information regarding an IA case and ensures civilian oversight through the entire IA process. This constant interaction between the CRB and IA allows for the Board to advise, question, consult, criticize, or commend IA during an investigation, with the aim of producing a better investigatory process from beginning to end. Additionally, th...

F07

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding. The CRB has the authority to control attendance at its closed session meetings. Per the CRB bylaws, the CRB has the authority to convene an Executive Session which is solely attended by the members of the CRB.

San Diego City Council

November 08, 2018 • 8 pages • 3 responses • Score: +1 (+1, 2, 0) View Details ▾

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3 responses to findings and recommendations

F01

Response: Disagree Partially Score: 0

The Mayor and City Council partially disagree with the Grand Jury's finding. Frequent 911 callers, who represent approximately one percent of the population (1,400+ individuals), typically generate 15% to 20% of the EMS call volume. Like other major EMS systems in the United States, the San Diego EMS system can manage this level of frequent use because system management is designed around call volume. However, an Page 2 of 3 City of San Diego Response to San Diego County Grand Jury Report Entitled "The Resource Access Program: A Successful Program Disbanded" ever-increasing call volume in the...

F02

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding.

F03

Response: Disagree Partially Score: 0

The Mayor and City Council partially disagree with the Grand Jury's finding. Most RAP functions, like coordination of services and navigation through the healthcare system, do not require an exemption from the California EMS Authority. However, certain specialized services provided by RAP paramedics do require a State exemption to operate in roles beyond the normal paramedic "scope of practice". This exemption enhances the program because it allows RAP paramedics to, for example, transport patients to non-hospital locations or to provide medications or treatment that 911 paramedics cannot. Leg...

San Diego City Council

November 08, 2018 • 43 pages • 6 responses • Score: -1 (+2, 1, -3) View Details ▾

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6 responses to findings and recommendations

F01

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding.

F02

Response: Disagree Score: -1

, selling stadium suites requires sales staff, expertise in negotiating suite sales agreements, knowledge of market contacts and relationships, and knowledge of industry standard suite rates, none of which the City's staff located at the stadium are qualified to do. Developing staff with this expertise would have Page 1 of 5 City Response to San Diego County Grand Jury Report Titled "San Diego Continues to Lose Money on Stadium Management" diverted resources away from the actual management of the stadium and booking revenueproducing events at the stadium. Finding 04: The City gave away revenu...

F03

Response: Disagree Partially Score: 0

The Mayor and City Council partially disagree with the Grand Jury's finding. Similar to the City's response to

F04

The City has not followed the procedures defined in Health and Safety Code §§101375-101380 to allow the county health officer to enforce orders relating to public health.

Response: Disagree Score: -1

The Mayor and City Council disagree with the Grand Jury's finding. This finding assumes that the City's existing staff, which lacks advertising and suite sales expertise, could have generated greater advertising and suite sales revenues than the professionals the City contracted with to perform this function.

F05

City administrators and County health officers had different concerns in responding to the crisis and failed to appreciate each other’s perspectives.

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding. Fox Sports did start work prior to the effective date of the contract. Their work consisted of developing an RFP and soliciting interest in the market. However, as no costs were incurred during this process and no commitments would have been binding or finalized without a fully executed contract in place, risk to the City was limited.

F06

The City of San Diego does not have a staff member with medical expertise to evaluate and fully appreciate the significance of public health directives.

Response: Disagree Score: -1

The Mayor and City Council disagree with the Grand Jury's finding. Suites were marketed prior to commencement of the agreement with the Bowl Association, however, no suites were sold prior to execution of the agreement.

San Diego City Council

November 08, 2018 • 9 pages • 7 responses • Score: +2 (+3, 2, -1) View Details ▾

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7 responses to findings and recommendations

F01

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding.

F02

Response: Disagree Partially Score: 0

The Mayor and City Council partially disagree with the Grand Jury's finding. The San Diego County auditors requested information on agreements that have been developed by CPD; and CPD provided the auditors a comprehensive list of marketing Page 1 of 4 City Response to San Diego County Grand Jury Report Titled "City of San Diego Corporate Partnership Development Program" partnership agreements (including those not directly labeled as such). In addition, the auditors were provided a revenue and in-kind tracking report for the last five years, from which they selected agreements to examine.

F03

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding. This requirement has been addressed in the revised Marketing Partnership Policy. CPD will be obtaining marketing partnership information from departments for agreements valued at $25,000 or greater and will be including such information in annual reports.

F04

The City has not followed the procedures defined in Health and Safety Code §§101375-101380 to allow the county health officer to enforce orders relating to public health.

Response: Agree Score: +1

The Mayor and City Council agree with the Grand Jury's finding. This requirement has been addressed in the revised Marketing Partnership Policy and updated Request for Sponsorship (RFS) form. RFSs will require disclosure of any conflicts of interest. If an RFS is not issued, marketing partnership agreements will address compliance with required disclosures.

F05

City administrators and County health officers had different concerns in responding to the crisis and failed to appreciate each other’s perspectives.

Response: Unknown Score: 0

Recommendation 18-36: Ensure that all City employees administering CPD agreements receive adequate training in contract administration. Response: The recommendation has been implemented. CPD has developed training for City personnel who administer partnership agreements and will provide such training for these employees on an as-needed basis. Page 4 of 4

F06

The City of San Diego does not have a staff member with medical expertise to evaluate and fully appreciate the significance of public health directives.

Response: Disagree Partially Score: 0

The Mayor and City Council partially disagree with the Grand Jury's finding. CPD maintains complete documentation for its agreements and does not believe its agreement files are inadequate. There is one exception for the Waxie agreement, for which the San Diego County auditors noted that there was not an executed agreement. This agreement was for a promotional event that occurred in both 2012 and 2013 (for a total City/public benefit of $4,000). The event that Waxie sponsored in 2012 and 2013 was the culmination of an Environmental Services Department/San Diego County Office of Page 2 of 4 Ci...

F07

Response: Disagree Score: -1

The Mayor and City Council disagree with the Grand Jury's finding. CPD does not enter into agreements that do not have an inherent net benefit to the City. Each agreement is unique, and the foundation of each partnership is the value to the City, which is carefully reviewed and negotiated by CPD. Additionally, marketing partnerships agreements are often reviewed and approved by the City Council, which also considers the value to the City. Partnership agreements include one or more of the following benefits: financial - e.g., Toyota partnership provides Lifeguard vehicles the City would otherwi...

San Diego City Council

November 08, 2018 • 10 pages • 4 responses • Score: +1 (+1, 3, 0) View Details ▾

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4 responses to findings and recommendations

F01

Response: Agree Score: +1

The Mayor, City Council, and City Attorney agree with the Grand Jury's finding. See Response to

F02

Response: Disagree Partially Score: 0

, the timing of preparing a § 9212 analysis may not synchronize with the City's elections laws and processes. Whether the new "model" of the Ballot Initiative Transparency Act or § 9212 would result in an "extended period" of review at a local level could depend on when a given initiative is submitted and qualified, and the timing of this in connection with the date of the next election. Finding 04: The City of San Diego may use public funds to educate the voters in an unbiased and informative way on issues raised by initiatives. Response: The Mayor, City Council, and City Attorney partially d...

F03

Response: Disagree Partially Score: 0

The Mayor, City Council, and City Attorney partially disagree with this finding. The City notes that the initiative provisions of the California Elections Code do not apply to Charter cities such as San Diego that have not adopted the California Elections Code as their governing elections law. Additionally, as alluded to in the response to

F04

The City has not followed the procedures defined in Health and Safety Code §§101375-101380 to allow the county health officer to enforce orders relating to public health.

Response: Disagree Partially Score: 0

The Mayor, City Council, and City Attorney partially disagree with the Grand Jury's finding. The City agrees that unbiased education of voters is critical and that California Government Code section 54964 allows public funds to be used for specific educational purposes. The section prohibits the use of public funds unless the exception below applies: (c) This section does not prohibit the expenditure of local agency funds to provide information to the public about the possible effects of a ballot measure on the activities, operations, or policies of the local agency, if both of the following c...

No Responses Found 2

Government entities assigned to respond to this report. No response documents have been linked in our database.

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