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State Audit Slams San Diego Response To Hepatitis A Outbreak

A mobile San Diego Fire-Rescue hepatitis A vaccination truck shown in this undated photo.
Matt Hoffman / KPBS
A mobile San Diego Fire-Rescue hepatitis A vaccination truck shown in this undated photo.
State Audit Slams San Diego Response To Hepatitis A Outbreak
State Audit Slams San Diego Response To Hepatitis A Outbreak | GUEST: Assemblyman Todd Gloria, D-San Diego Subscribe to the Midday Edition podcast on iTunes, Google Play or your favorite podcatcher.

San Diego city and county have already issued after action reports on their response to the hepatitis outbreak in 2017. Now the state has taken a look and that new report finds that if San Diego had acted more quickly it may have reduced the spread of the disease. The findings of the state auditor point to a weak and uncoordinated response by the city and county. The report outlines steps that should be taken in any future health crisis. Joining me is state assembly member Todd Gloria and Todd welcome to the program. Thank you for having me. Now you requested this audit of the response to the hepatitis C outbreak. Why did you want the state auditor to take a look at it. Because I didn't want the lives that were lost to be forgotten. I didn't want this issue swept under the rug. And I think too often when the about vulnerable populations like our homeless that's a strong temptation. I think we had a sense that not all was right in this situation. It required a independent nonpartisan review. That's exactly what the state auditor did nearly 50 page report. That really spells out as you mentioned the failings that really contributed or were complicit in more people becoming sick and sadly more people dying. This report means that those that will not go unnoticed are those lives will not have been lost in vain. Can you run down a few of the major points for us in this report. There are so many more and I hope that your listeners will look at it because I do think this hepatitis A outbreak has been a true stain on R R R R R community. You know it's a lack of vigor in the response that was necessary despite knowing that more was necessary. The report spells out very clearly that the people involved knew in March and April that this was serious that this could have been historic and that an aggressive response was necessary. And yet that aggressive response didn't happen until late August early September. Those months in between when you see skyrocketing infection rates hospitalizations and deaths and what the report details is that whether it was the county failing to alert cities to their responsibilities in their roles to the counties slow use of procurement of nurses to administer vaccines. All of this conspiring to create a situation that seemingly was made a lot worse not just because of the disease but because of the response watching the outbreak unfold in real time. It looked like there was confusion about which entity this city of San Diego in particular or the county should take the lead on the response is that one of the things that the auditor found that that level of confusion. Yes. And it's it's pretty damning when you read about it in part that the the the convening of stakeholders were fairly limited to a small group inside the county rather than the full county and the full of municipalities involved that you have a public health service that didn't feel comfortable mandating other jurisdictions to take specific actions although when those jurisdictions got the full understanding of the situation they acted swiftly and so it was kind of a comedy of errors that resulted again in this becoming much bigger than anyone anticipated more than was seen in any other community during this outbreak. And something that really we should reflect upon and take action on. Now this didn't spring out of nowhere really this city and county were warned by about the lack of sanitary conditions with people living on the streets by the county grand jury back in 2010. You were on the San Diego city council then. Why was there very little response to that warning. Well we did provide a response to the grand jury agreeing with some of those findings disagreeing with others. I think this is a lesson learned in that regard. You know public restrooms are often thought of as nuisances as crime attractors people often don't want them in their community. I've been in many community meetings where that has been the voice of the neighborhood. But we sometimes forget about the basic functions that people need to take care of and the deadly results that can happen if they don't have action. So while that's not a focus of this particular audit this is certainly a component of it as is our housing affordability crisis. I don't want people to get confused that this is anything other than a symptom of our housing crisis. These folks are living outdoors and unsheltered and while those of us who are fortunate have to be sheltered may think that this doesn't affect us but certainly hepatitis A showed that a number of sheltered people got infected because these people are living amongst us. They are part of our community and we need to do better by them. Tom glorie what was your reaction as you were reading through the findings of the state auditor's report. Well I have to confess I was pretty emotional meeting because you're seen spelled out very clearly what the inaction resulted in which is a lot of people getting sick and some people dying and that you know there the report is numerous references to people asking for a different approach for a more robust approach and that just simply not happening. I think a flaw of this audit is that doesn't ASAE spell out why a lack of urgency amongst those involved. We don't know what their motivations were. But to the extent that some tried to suggest otherwise. Now the historic record will tell very clearly that there was that lack of urgency that lack of forward thinking planning and it's a challenge to all of us to make sure it never ever happens again based on what you're reading and what you know. Do you think that this lack of urgency was because the county was not taking this outbreak seriously enough or was just being overwhelmed by it. I think more the former than the latter. I mean you have evidence here references to you know information from the University of California saying that this could be a major medical director claiming this is going to be big. They there were. Notice to folks involved that this was a big deal why that wasn't responded to in kind. Not at least until September. I can't really tell you you don't know. We know motivations of people are but I think this is a part of a system and a practice that has generally shown a lack of interest or concern real concern in the most vulnerable in our community. We've seen stories of low utilization rates of food stamps other kinds of public programs where the response and the focus hasn't been there and it has probably been more acute when you're talking about the homeless in our community. Well then do you think the county is taking this state report seriously enough. They are going to have to. There are findings in here that they've agreed to make implementation of and with deadlines. So we'll be watching that. There's your call for state legislation. And I will be acting upon that. But being here today right now with you is a way of making sure that no one ignores what's in this report. Can you tell us a little bit more about what state legislation that you're thinking about. Well there's two recommendations from the auditor and she spells out one is making clear that public health officers have the ability to direct other jurisdictions. Part of the concern apparently was the concern of ruffling feathers and maybe bothering someone outside of your chain of command. But when lives are on the line I think that should be clear and so making sure that authority that responsibility is spelt out and then importantly it is pretty clear that the city had a slow response that was because they weren't necessarily fully aware of the situation. So making sure that counties have to tell municipalities about exactly what's going on. Geographic data which was held back when the city became constructively informed their response was much swifter than the counties and we have to make sure that the local municipalities are notified and that the counties have that responsibility spelled out for them. This report from the state is now out there available for anyone who wants to read it. And I've been speaking with state assembly member Todd Gloria. Todd thank you.

The city and county of San Diego failed to quickly control a hepatitis A outbreak last year that grew to be among the largest seen in the U.S. in decades, according to a state audit released Thursday.

The county lacked a concrete hepatitis A prevention plan that led to a delay in getting the most vulnerable residents vaccinated, and mass vaccinations did not happen until after a health emergency had been declared, according to the audit conducted by the state auditor at the request of lawmakers.

The disease killed 20 people, most of them homeless. More than 580 were infected and nearly 400 people were hospitalized.


The city was also slow to respond, according to the audit. Six months into the outbreak, the city began power-washing streets and installing hand-washing stations and public restrooms downtown, where streets were lined with tents of homeless people.

Hepatitis A is a highly contagious liver disease spread through dirty hands and other contact.

The county did not share sufficient information with the city when the outbreak was detected in March 2017, causing the city to not fully recognize the seriousness of what was happening and delaying its response, the audit found.

If the county had administered mass vaccinations sooner, the outbreak might not have grown to as large as it did, the audit found.

The number of new cases tripled to about 20 cases per week from May through September 2017, compared to six new cases per week during March 2017.


More vaccinations were administered in September 2017 than in the previous six months combined and the effort led to a decline in new cases, the audit found. The county declared the outbreak over in October after 100 days passed with no new cases.

The auditor said lawmakers should enact legislation requiring local health officers to promptly notify local public entities within their jurisdictions about outbreaks that may affect them and provide the locations of where cases are concentrated, the number of residents affected, and the measures that should be taken.

The California Department of Public Health also should amend its disease outbreak response plan to include asking jurisdictions to set vaccination targets, establish dates to meet those targets, and determine needed resources, the report said.

San Diego city government officials "agree with the recommendations, particularly that the city and county should strengthen their relationship as it relates to responding to regional emergencies," said city chief operating officer Kris Michell.

San Diego County's Health and Human Services Agency said in a statement that the findings were consistent with the results of a county review and that county officials "reiterate our commitment to making the recommended improvements so that as a region we are better prepared to respond to any future health emergency."

Democrat Todd Gloria, a state lawmaker representing San Diego, said in a statement that he plans to "propose solutions to ensure this never, ever happens again."

He declined to provide specifics until after he evaluates the report but said "one thing is clear: Lives could have been saved."

VIDEO: State Audit Slams San Diego Response To Hepatitis A Outbreak