A new report released Thursday by the San Diego County Grand Jury delivers the toughest critique so far of local efforts to end last year’s hepatitis A outbreak.
Starting with its title, which includes the phrase “(Mis)handling a public health crisis,” the 20-page document doles out pointed criticism, and also some praise, for the very-public fight waged against the hepatitis A outbreak that killed 20 and sickened nearly 600 largely homeless and drug-using residents throughout the region last year.
Though many of its recommendations are similar to those made in the county’s own after-action report, which was released last week, the grand jury did criticize the timing of a key health emergency declaration and also the festering sanitation problems present in many downtown San Diego homeless camps.
After examining a trove of documents, from media reports to internal emails, and conducting its own interviews, the grand jury assembled its own outbreak timeline which it used to conclude that the county health department could have declared a local health emergency much more quickly than it did.
It also determined the city could have taken broader action on sanitation efforts, such as street washing, and better access to bathrooms and hand-washing stations in areas where large numbers of homeless residents congregate.
Such measures, the report notes, have been recommended in previous grand jury reports dating back to 2005.
Just as the county’s report did, the grand jury’s review calls for a better emergency action plan that is set up to get elected leaders and top staffers in county and city governments working as one team more quickly than occurred during the outbreak.
A clearer command structure surely would have helped all involved make quicker decisions about an unprecedented health threat, said Randy Sandstrom, the grand jury’s deputy foreperson.
“They just didn’t have a playbook to follow because this kind of a situation had never happened before,” Sandstrom said. “The takeaway we would like the government agencies to have is that a little more refinement of their policies and procedures to make sure we learn from this experience.”
By law, all public agencies mentioned in a civil grand jury report must respond to recommendations within 90 days. Citing this legal requirement, public health officials with the county were not made available to address the report’s findings Thursday.
However, county Supervisor Ron Roberts, asked about the grand jury report during a press conference held by the Regional Task Force on the Homeless, said he thought collaboration between the city and the county was better than billed.
“There was cooperation,” Roberts said. “The mayor and I met numerous times early on. When I discovered that we could do street washing and mentioned it to him, he got right on it.”
Mayor Kevin Faulconer acknowledged in a statement that collaboration was less robust early on.
“It’s clear there needed to be better coordination and communication when the outbreak was first identified and there were a lot of lessons that will help us going forward,” Faulconer said.
Though it doesn’t have the power to put people in jail, the grand jury’s reviews nonetheless carry significant weight in the community. Just Wednesday, state Auditor Elaine Howle said during a hearing in Sacramento that her investigators will review the grand jury’s report and the county’s before they begin their work conducting a formal audit of the local hepatitis response. The audit, requested by Assembly Todd Gloria of San Diego, is expected to take five months to complete.
The grand jury’s assessment wasn’t all criticism.
The panel of 19 retired professionals drawn from throughout the region commended the county for its innovative use of vaccination foot teams, which continue to be sent out into remote areas embedded with law enforcement homeless outreach teams to vaccinate those who may be reluctant to get a shot in a more traditional clinic setting.
This effort started with a pilot project in May and exemplified the positive efforts that were taken throughout the outbreak, Sandstrom said. Vaccinating more than 100,000 people, he said, was an impressive feat.
“The county did not hold back a penny in addressing this crisis, and they went out and bought all of the vaccine they could as fast as they could. It was vaccination that ultimately ended this thing,” Sandstrom said.
But the grand jury, drawing on documents such as internal emails and interviews with leaders at the city, county and in law enforcement, found that it took far too long for a formal emergency to be called on Sept. 1, 2017.
“Analyses of email records revealed that the city and county discussed a number of possible responses to the crisis, but did not implement them for several months as the disease spread and the number of deaths continued to climb … By the time a local public health emergency was declared, the epidemic had peaked and the number of new cases was declining,” the report states.
Jurors point squarely at the county’s Emergency Operations Plan, which specifies five different officials, from the County Administration Officer to the county Public Health Officer, who had authority to activate the section of the larger plan that pertains to public health.
“The numerical ranks in this list do not represent an order of precedence. The presumptive leader is not defined, which leads to uncertainty and delays when leadership and action is needed,” the report continues, calling for a plan update that would put one official clearly in charge and able to act quickly using their own judgment of the situation on the ground.
“We are coming from the standpoint that things could have been done a lot more quickly and, if they had been, then perhaps the outbreak could have been identified and dealt with sooner,” Sandstrom said.
But Roberts wasn’t so sure that it was possible to cut through the fog of war that was present as local experts scrambled to identify and react to the threat, consulting with experts at the U.S. Centers for Disease Control and Prevention in Atlanta.
“There were a lot of good things happening, especially marshalling the resources we had. A lot of things became clear as we were working our way through an epidemic nobody had experienced before,” Roberts said.
Regardless of whether things could have moved faster, Faulconer noted that the hepatitis outbreak has broken the sad inertia of inaction on homelessness across the region.
“The biggest lesson is that our community can’t put off difficult decisions on homelessness because it makes the problem worse,” Faulconer said. “We must take action, and we are, with the largest expansion of homeless services in our city’s history over the past nine months.”
Other specific recommendations in the grand jury report include:
- Establishing clear lines of authority for health emergencies to prevent misunderstandings,
- Designating a project manager during health crises to communicate more effectively with city officials and medical personnel,
- Reinforcing the county health officer’s authority according to state law,
- Designating a medical professional to report directly to the San Diego Mayor,
- Constructing and maintaining more secure restrooms and hand-washing stations in areas within the City of San Diego where the homeless congregate as suggested in three previous Grand Jury reports dating back to the 2004-2005 budget year.
Correction: A previous version of this story indicated that five different individuals could declare a local health emergency. These five executives can activate the public health section of the county’s emergency operations plan, but it is the responsibility of the county public health officer to find that an emergency is necessary.
May 17, 2018
The San Diego Union-Tribune
By Paul Sisson
No comments:
Post a Comment