The San Diego Hepatitis a Epidemic: (Mis) Handling a Public Health Crisis*

The lack of early cooperation between the County and the City resulted in unnecessary delays in installation of handwashing and other public health measures. Response: Partially Disagree While the City agrees there were delays in the initial deployment of the handwashing stations, the City disagrees it was caused by a lack of cooperation between the City and County. The deploying of the handwashing stations throughout the city was unprecedented. After the initial 40 were deployed in early September, there were no delays with the balance of the 42 installations within the city limits.

The City has not followed the procedures defined in the Health and Safety Code 101375-101380 to allow the county health officer to enforce orders and statutes relating to public health City of San Diego Response to San Diego County Grand Jury Report Entitled "The San Diego Hepatitis A Epidemic: (Mis) Handling A Public Health Crisis" Response: Disagree. The City of San Diego complied with the California Health and Safety Code.

City administrators and County health officials had different concerns in responding to the crisis and failed to appreciate each other's perspectives. Response: Partially Disagree As the County expressed in their response to the report, the City and the County have a shared concern for the protection of the public's health and safety. In a public health emergency, the City takes direction from the County Public Health Director. The County Public Health Director issued a directive to the City on August 31 and the City immediately took steps to address the issues within the issued Directive. In addition, the City and County collaborated throughout the outbreak on outreach and vaccination measures.

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. San Diego Fire-Rescue's EMS Division is an integral part of both the healthcare delivery system and the public safety net. EMS is required to addresse all possible types of injuries and illnesses, among all ages, regardless of the circumstances or events leading to the injury or illness. For this reason, the EMS Division is staffed by a multidisciplinary team of healthcare providers and responders with diverse clinical, pre-hospital, and community-based experience. Current members of the EMS Division include Paramedics, Registered Nurses, community outreach liaisons, and public safety responders. These healthcare providers work under the guidance of the medical directors. Dr. Chris Kahn and Dr. J. Joelle Donofrio. Dr. Chris Kahn is a practicing emergency room physician at UCSD Medical Center. In his position, he receives real time notifications of public health directives both locally and nationally. He holds a Master of Public Health degree and is a member of multiple San Diego county committees and boards that ensure his understanding and involvement in these issues. Dr. Donofrio is a practicing pediatric emergency room physician and is the pediatric physician's representative to San Diego County EMS. In that position, similar to Dr. Kahn, she is a member of multiple committees focused on public health issues related to the pediatric population. These two physicians, in collaboration with the field experience of the EMS Staff, position the EMS department to monitor the community for medical patterns and collaborate with public health initiatives. However, some medical conditions, such as Hepatitis A, have non-specific signs and symptoms requiring in-hospital diagnosis and retrospective analysis. In these cases, the ability for EMS to participate in public health efforts is dependent on the willingness of hospitals and public health oversight agencies to collaborate and share data. In addition, state law places City EMS under City of San Diego Response to San Diego County Grand Jury Report Entitled "The San Diego Hepatitis A Epidemic: (Mis) Handling A Public Health Crisis" the authority of the County of San Diego Emergency Medical Services and efforts outside of traditional 911 response are permitted at the discretion of the County or the County's efforts to obtain permission from the state.