Administrative Committee Administrative Committee

Incompetence of employees which endangers the Department’s infrastructure and the public at large 2. Lack of experience among current administrators of DPH 3. Abrupt implementation of the Integration/Reorganization project ALLEGATION FINDINGS 1. Health and Safety Code Section 121361 prohibits a health facility, local detention facility, or state correctional institution from discharging a person known or reasonably believed to have tuberculosis before the discharge is approved and a treatment plan is reviewed by the local health officer. The SBC Medical Health Officer on Friday, August 1, 2008, was Dr. Manliguis. At 2:45 p.m. that day, the Human Resources Officer (HRO) required Dr. Manliguis to sign an interoffice memorandum issued by the Director of Public Health. This memorandum informed him that he was being “relieved of his normally assigned duties” and was being placed on paid administrative leave effective immediately. That interoffice memo specified Dr. Manliguis’ work hours as follows: “Your work hours are 8:00 a.m. to 5:00 p.m., Monday through Friday, excluding one (1) hour for lunch from 12:00 p.m. to 1:00 p.m. You are to report in each morning by 8:00 a.m. to [name] the Human Resources Officer at [number]. Any exception to this schedule must be cleared through [name]. While on paid administrative leave, you 2 2008-2009 San Bernardino County Grand Jury Final Report are to be available to report to work and be reachable by telephone by the Department.” The memo also stated that he could not have any contact and/or enter the County facility without first obtaining permission from the Human Resources Officer. In addition, at that time, the Human Resources Officer required Dr. Manliguis to surrender his ID Badge, Deputy Health Officer Badge, and his Blackberry. Not until Monday, August 4, 2008, at 3:24 p.m. was Dr. Ryan Zane designated as the Interim Health Officer. The interoffice memo that outlined Dr. Manliguis’ work hours failed specifically to direct him to be available outside the 8:00 a.m. to 5:00 p.m. work hours in order to fulfill his duties required by Health and Safety Code Section 121361. As a result of this omission, there was uncertainty within the DPH for approximately 72 hours as to who within the Department was designated to fulfill the duties mandated by statute.

According to the Health Officer Practice Guide for Communicable Disease Control in California, “Law enforcement agencies such as the Sheriff’s office or the local police department enforce Health Officer orders because Health Officers do not have Peace Officer status. Peace Officers have the broadest authority to effectuate an arrest, and are protected in their use of reasonable force to do so. Therefore, criminal enforcement requires local law enforcement involvement and may also include the District Attorney and Probation Department. Furthermore, the enforcement of civil orders for detention, isolation or quarantine of individuals will likely be conducted with the assistance from law enforcement.” An incident occurred in Needles, California, on August 30, 2008, Labor Day weekend, that required the coordination of effort between the Department of Public Health and the Sheriff’s Department. Despite repeated warnings by the DPH, a tuberculosis patient was disobeying a Department of Public Health order regarding his medication and quarantine. As a result, the Health Officer decided to enforce the order by transporting the patient to the Arrowhead Regional Medical Center for treatment and evaluation. Efforts by the Department of Public Health to obtain assistance from the Sheriff’s Department were hampered by poor communication and coordination by DPH. San Bernardino County has no policies or procedures manual in place for the enforcement of civil orders for detention, isolation, or quarantine of individuals.

The Grand Jury reviewed the educational and work experience of the current administrators within the DPH. These positions included the Director of Public Health, Assistant Director, Director of Nursing, and the Chief Medical Health Officer. None of the top DPH administrators had extensive experience in the field of Public Health. 3 2008-2009 San Bernardino County Grand Jury Final Report When he was hired, the Director had earned a Bachelor’s Degree in Economics and a Master’s Degree in Public Administration (MPA) from California State University, San Bernardino. He was the San Bernardino County’s Director of Purchasing for one year and had worked for one year as a legislative analyst for the Board of Supervisors. He had also been Director of Education at Barstow Community College and an adjunct instructor at a variety of colleges. Presently, he is working on his Doctorate in Public Administration. He had no experience in Public Health prior to his present position. The Assistant Director had earned an Associate of Science Degree in Respiratory Therapy from Crafton Hills Community College. She obtained her Bachelor of Science Degree in health care administration from Rochville University, a non- traditional program. Currently she is working on her second Bachelor’s Degree in organizational leadership from La Verne College. She had been the Director of Respiratory Services of Arrowhead Regional Medical Center for two years. The Director of Nursing has been a registered nurse since 1979. She moved to California in 1985. She earned a Bachelor’s Degree in nursing in 1998 and a Master’s Degree in nursing in 1999. Her Bachelor’s Degree included a Public Health Certificate, in addition to her nursing license. She is presently in a graduate program to obtain a degree in clinical psychology. The Chief Medical Officer has a medical degree, specializing in obstetrics/gynecology. He had some foreign experience with Africa World Health. Neighboring counties require that their Directors/Medical Officers have advanced education in the area of Public Health. When this investigation was started, San Bernardino County had no such qualifications for the Director/Medical Officer. (See Attachment B & C - San Bernardino County Job Description & Counties Comparisons) 4. Multi-funded grants provide a portion of the DPH’s clinical program budget. However, clinic staff was arbitrarily re-assigned with no regard to funding sources or required grant criteria. At one administrative meeting, the program directors decided how many and which nurses would be re-assigned. The following week, however, that agreed-upon arrangement was changed by administrators without notifying or consulting the staff. Program managers were concerned that grant criteria were not being respected in these changes, resulting in the possible loss of funding.

San Bernardino County policy requires that all employees be treated with respect and dignity in order to maintain and promote faith and confidence of the people in their government. A limited number of DPH employees involved in the reorganization and integration of the clinical departments described negative incidents involving the Director of 4 2008-2009 San Bernardino County Grand Jury Final Report Public Health. They felt intimidated and perceived some comments as a threat to their employment. This undermined employee morale and made staff reluctant to voice dissenting viewpoints. The Grand Jury made no determination whether or not such conduct was pervasive throughout the DPH.

Although change is inevitable in any new administration, the new Director of Public Health stated at one of his first staff meetings that he intended to “fix a broken department…I have been fixing organizations for 20 years and I am here to fix you." Testimony indicated that this director and other administrators were not willing to listen to the expertise and opinions of the DPH staff. Some staff members were threatened with termination. Several DPH employees reported comments and incidents involving upper administrators which ranged from veiled to overt hostility. OTHER FINDINGS 7. Human Resources Supervisor’s Guide requires that "work performance evaluations be completed by the immediate supervisor. No change shall be made except for appeals or by mutual consent of the parties.” On July 3, 2008, Dr. Manliguis, as immediate supervisor, evaluated Employee X. The evaluation was signed by both parties, a copy was given to the employee and the original was placed in the employee's personnel file. However, within one week, Employee X told Dr. Manliguis that his evaluation had been changed by someone else, and a new, less positive evaluation had been substituted in his file without Dr. Manligius' knowledge or approval. The employee hesitated to complain because he believed his job was in peril. Human Resources (HR) policy prohibits any changes after the employee has signed an evaluation, and no appeals process was initiated. This action is against San Bernardino County HR personnel rules.

The salary comparison between San Bernardino County and neighboring counties shows a significant discrepancy. (See Attachment B & C - San Bernardino County Job Description & Counties Comparisons) 9. The San Bernardino County Department of Public Health Mission Statement states that its institutional goal is "to satisfy our customers by providing community and preventive health services that promote and improve the health, safety, well being, and quality of life of San Bernardino County residents and visitors.” That mission statement is commendable because the County of San Bernardino covers an area of 20,052.50 square miles and has a population in excess of 2 million residents who depend on the DPH for services and protection. That institutional goal is shared by other non-profit organizations which also provide public health services within the County. The San Bernardino County Department of Public Health has worked diligently to provide better, more efficient health care with the institution of an "Integration" 5 2008-2009 San Bernardino County Grand Jury Final Report program throughout the County. This program provides the opportunity for a number of medical services to be available under one roof. The County’s Holt Clinic in Ontario is presently operating under the new program. A similar clinic, the H Street Clinic in the City of San Bernardino, is operated by a non-profit organization and has experience with the "Integration" approach the DPH is hoping to establish. Also, the H Street Clinic owns and operates the $6,000 fiber optic machine, the only colposcope instrument in the County. This instrument is used in anoscopy procedures. However, the DPH chooses to send its clients to a Palm Springs facility for that screening. During the investigation, the Grand Jury found a lack of dialogue and collaboration between DPH and the H Street Clinic. The leaders of DPH and the H Street Clinic were unable to agree on the issues which prevented a more collaborative relationship. Because the investigation was limited to only one non-profit organization, the Grand Jury did not determine whether or not the problems extend to relationships between DPH and other nonprofit organizations which provide health services. The Department of Public Health is in a position to expand the availability of health services to County residents by assisting other county health nonprofit organizations to improve their programs.