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Rubber Bullets, When Can Cops Use Them? Commission On Police Practices Gaining Support, Being Black And An Immigrant In The U.S. Right Now, And Removing Police From Homeless Outreach

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Rubber bullets have been touted as a non-lethal police tool, but they can maim, blind and kill. Plus, a proposed commission to investigate complaints of police misconduct is gaining support. Also, KPBS talks to immigrants from Africa on what it is like to black and an Immigrant in the U.S. right now. And, two San Diego City Council Members are proposing using social workers to do homeless outreach instead of police officers.

Speaker 1: 00:01 Are rubber bullets, really proper crowd control tools and San Diego's mayor joins in support of a new police review commission. I'm Maureen Kavanaugh with Alison st. John. This is Katie.

Speaker 2: 00:12 Yes, mid day edition.

Speaker 1: 00:24 It's Wednesday, June 3rd. Ulla Mesa woman is an intensive care this week after being struck in the face by a rubber bullet while she was peacefully protesting the death of George Floyd in front of the Lemmy. So police department over the weekend, her family is now calling for an investigation. They want the person who fired the bullet to be charged. Law enforcement used rubber bullets along with pepper spray to respond to protesters in San Diego. And Lamesa prompting outrage, citizens to question, what are the rules for when to use these nonlethal weapons? Joining us as lesiba has senior correspondent for Kaiser health news. Liz, thanks for joining us.

Speaker 3: 01:02 Happy to be here.

Speaker 1: 01:03 So now rubber bullets are called non-lethal, but you cite research though, of nearly 2000 people struck by rubber bullets that shows the natto is non-vital. What did they find?

Speaker 3: 01:14 That's right. They were originally called a non-lethal use of force. People provide that sometimes people call it less lethal or less than lethal, but there was a study looking at, uh, years and years of research that found three and every 100 people struck by a rubber bullet is actually killed and 15% are permanently injured. And sometimes those injuries are quite serious.

Speaker 1: 01:38 Talk a bit about the sorts of injuries they can cause.

Speaker 3: 01:41 Well, in some cases, this is, these can be quite serious. Uh, the bullets are flying out at, at, at really high force about 90 miles an hour, according to one site that I looked at, um, and they can fracture your skull. They can break bones. Um, they can cause traumatic brain injury. Um, they can blow out the globe of the eye, the actual eyeball. It can be exploded. Um, in the worst case scenario, it also causes tissue damage around the eye. Um, in that case, surgeons tell me they have to not only remove the eye, but a lot of the soft tissue and skin around it, which can be tremendously disfiguring you're, you're left with sort of a big gouge in your face. Um, these can also, um, if they were to, uh, hit a major blood vessel at your heart, that can be incredibly dangerous. There's just all sorts of major organs that can be damaged by these rubber bullets. And as I, as I said, they can be lethal in 3% of cases.

Speaker 1: 02:37 So what, what the law enforcement officials say about why they use rubber bullets?

Speaker 3: 02:43 Well, apparently there's an entire hierarchy of, of force. Um, I talked to law enforcement experts and they said that generally police will try to, to start with something that is much less dangerous. Um, something like pepper spray while intensely irritating at the time. Um, doesn't tend to cause any permanent damage. Uh, tear gas is, is much less dangerous. And experts told me that you only really escalate to rubber bullets. Um, if a crowd is extremely dangerous, um, so you've, you've tried everything else and, and this is pretty much, uh, one of your last resorts. Um, but every law enforcement official that I talked to said they should never ever be used on peaceful protesters. This, this is when there is a real danger of violence.

Speaker 1: 03:34 Did you speak with law enforcement? Were they willing to talk to you for your story?

Speaker 3: 03:37 You know, I, I didn't get any callbacks from actual police officers. I got an email, uh, from the Minneapolis police. Um, I had contacted them because a freelance photographer has been blinded by what she referred to on Twitter as a rubber bullet. Um, she actually lost an eye. And when I emailed them to ask about this, they said, we do not use rubber bullets. We use 40 millimeter, uh, marking foam, um, whatever it was though, this was an extremely dangerous projectile because it did blow out her eye.

Speaker 1: 04:13 We have a reporter from our NPR affiliate, KPCC Adolfo Guzman Lopez, who our listeners may have heard on our air. He's among several journalists who say they were injured by rubber bullets over the weekend. Adolfo was actually a hit in the throat and he's posted photographs of that. And it looks like a pretty, could have been a very serious injury. Um, does law enforcement training see where you're supposed to fire a rubber bullet and from how far away?

Speaker 3: 04:42 Yes. Um, people say that you should absolutely only aim for the legs if you fire a rubber bullet, um, which in some ways is a misnomer because many of them have a metal core. So it's a metal bullet wrapped in rubber in some cases, um, that you should aim for the legs. If you fire them at close range, uh, they have tremendous force and they can do a lot more damage. But if you fire them from far away, you lose accuracy. You could hit a target that you could hit something. That's not your target. You could hit a bystander, but everyone agrees. You should aim for the legs because what you want to do is hit someone so that they fell down so that they can't walk. Um, these are supposed to be used on a dangerous person or a dangerous crowd that's advancing on you. You want them to stop coming towards you. So you hit them in the legs and there are there, um, there's extensive training. Um, people say that should be used. Not every police officer should be using rubber bullets. They tell me you need special training. You need special guns.

Speaker 1: 05:40 W w what exactly do you know about the different kinds of rubber bullets? I mean, what are they, what are they, what are they made of?

Speaker 3: 05:48 Well, in some cases, it's a regular metal. Well, it's the metal bullet. That's surrounded in a rubber coating and other cases, they are rubber. Um, the Minneapolis police denied using rubber bullets. They say that they use these foam pellets. Um, but dr. Say a lot of these names are really euphemisms. Um, a rubber bullet sounds like it's a pencil eraser or a super ball. You know, these are very, very hard projectiles. Um, and these foam products, these foam projectiles, when you call them phone, it sort of sounds like a pool noodle or a, uh, shaving cream. These are very, very hard and whatever it was that was sprayed at this, uh, reporter in Minneapolis, she, she lost an eye. So, um, they, they can be quite hard. Sometimes people will shoot out tiny beanbag pellets from a specialized gun. Um, sometimes they'll shoot out pepper, spray balls, um, pepper spray balls can also be dangerous. Uh, Boston police use them on an unruly crowd in 2004 after the world serious. When, when crowds were getting a bit Rawkus in Boston, um, the pepper ball hit a 21 year old college student in the eye and killed her.

Speaker 1: 07:03 Now, is there any reporting on how often this form of non-lethal supposedly, um, weapons are used?

Speaker 3: 07:12 Unfortunately, no, there is no requirement that police document when and where, uh, they use, um, any of these projectiles. So we have no national numbers. We have absolutely no national numbers. They have certainly been used extensively in recent days. Uh, but there are no national numbers and there are no national standards. Every, every, uh, police jurisdiction has its own standards about when the leave used. Um, there there's really no national, um, set of guidelines for police to follow.

Speaker 1: 07:44 This is Liz Zebo of Kaiser health news. Congress is planning to hold hearings on the use of excessive force and the militarization of the nation's police force in coming weeks

Speaker 2: 07:58 [inaudible]

Speaker 4: 07:58 as part of the city of San Diego's response to questions about police use of force during protests and routine arrests. Mayor Kevin Faulkner has thrown his support behind a proposed November ballot measure that would create a commission on police practices. Advocates have struggled for years to get a strong, independent review commission in place to investigate complaints against police misconduct and influence policy. The measure of still needs to get approval from the city council to be placed on the ballot. Joining me is Andrea st. Julien she's attorney and co-chair of San Diego for justice, the group behind the proposed ballot measure. And Andrea, welcome to the program. Thank you efforts to get a similar measure on the ballot have failed in recent years. And now mayor Faulkner says, he's on board here. He is at a press conference earlier this week,

Speaker 1: 08:51 moving forward. It will be on the ballot. We've been having a lot of very good productive discussions with

Speaker 5: 08:56 our police officers association. And I look forward to giving it my full support.

Speaker 4: 09:00 The city of San Diego currently has a community review board on police practices. So Andrea, how would this commission differ from the board?

Speaker 6: 09:09 It's going to be quite different from the board. The first thing to note is that it is going to be a commission rather than a board, and that's more than just a name change. So with the commission, a commission can be truly independent. A board is merely an advisory body to the mayor. And when you have a board that is an advisory body, the current charter member amendment requires that the city attorney be the attorney for that board problem with that is the city attorney is also the attorney for the police department. So, um, that is, um, an important distinction. Another, the other distinctions are that the current review board is merely a review board. It looks at what the police department has done in terms of investigating complaints. The new commission is independent. It has the duty and the power to do independent investigations. It has the power to subpoena witnesses, gather evidence and make its own independent decisions. And of course, it's going to have its own independent attorney. So those are some of the key differences between the current board and what will we hope will be the future commission?

Speaker 4: 10:22 Why is it important that this new commission have its own attorney?

Speaker 6: 10:27 It's important that the commission habits own attorney, because we don't want to have any conflicts. How can a city attorney who is charged with the duty of protecting the police at the same time, appropriately advise a body whose job it is to root out any wrongdoing. That's a real conflict. The city attorney plays an incredibly important role in the life of the current CRB. And people feel very uncomfortable with that. Um, people don't feel that they, that they can trust what's going on with the CRB, because how can they trust that the city attorney can at one at the same time protect the police department. And at the same time properly advise a CRB on doing its duty of rooting out wrongdoing.

Speaker 4: 11:22 Now, the president of the San Diego police officer's association said yesterday on this program that the union has okayed. The police review measured to go on the ballot and they are not in opposition. This is a big change from the opposition they had when this was originally proposed. In fact, the POA was apparently part of the effort to keep a similar measure off the ballot two years ago. So what do you think is different now?

Speaker 6: 11:47 Yes. I let's be very clear. The, the, uh, police officers association has opposed this charter amendment, no matter how hard we worked to be fair and get input from the police officers association for the last six or seven years, they have fought it tooth and nail, and I'm happy to see that they have decided to look at it more favorably. I think obviously, and it has been an evolution for the past few months. They have not publicly opposed it, but they have opposed it in the meet and confer process that's that's taking place right now. So, uh, I can only say that they have now come to understand how much the public really wants robust community led oversight of police actions.

Speaker 4: 12:43 Law enforcement has traditionally been wary of review boards, feeling that their every move will be scrutinized by people who don't know anything about police work. So how do you avoid that

Speaker 6: 12:54 several ways? One, I want to step back and say it is woven into our culture to have citizen oversight of all professions. I, as an attorney, you know, any anyone that I work with can make a complaint against me, and then there's going to be a review of what I've done the same way with physicians, any professionals, particularly those who deal in life and death matter are subject to review. And particularly a community led review. So as a professional, the best professionals, police officers, shouldn't be exempted from that. So getting back to the point of, okay, well they need professionals really looking at what their con conduct and looking at their conduct. I would say that the commission totally answers that question. The current review board is made up purely of community members. There are no professionals that advise that board law enforcement professionals under the new commission, the commission has the power. And in fact, the duty to bring on professional investigators, most of whom will be ex ex police officers. If, if they follow the path at many other, um, uh, community led oversight organizations have undertaken. So the commission is going to give them the expertise in law enforcement that they need. So that's, that's a win for everybody.

Speaker 4: 14:23 Now, as you watch people take to the streets across the country in recent days, how do you see this proposal addressing issues, being raised by protesters like institutional racism and police violence?

Speaker 6: 14:37 I think it's absolutely crucial. It is. It is crucial. You can put was you can put regulations and policies into place, but if you don't have a method of sure those policies are followed, the policies are meaningless. And that's what a robust commission does. It finally gives a citizen led body, the tools it needs to really scrutinize whether police officers and the police department are following its own policies and the laws. So it's absolutely crucial.

Speaker 7: 15:14 I've been speaking with Andrea Saint Julian. She's an attorney and co-chair of San Diego runs for justice. And that's the group behind the proposed ballot measure. Andrea, thank you very much. Thank you.

Speaker 8: 15:38 [inaudible]

Speaker 7: 15:40 the black immigrant community in San Diego has been under intense stress over these last few weeks. As protests continue over the abuse of black people by police, the flagging economy has led the white house to propose even further restrictions on immigration KPBS, reporter max Rivlin, Nadler hosted a virtual round table with three black men from immigrant communities to hear their thoughts on this trying time.

Speaker 2: 16:09 [inaudible]

Speaker 9: 16:09 we connected through zoom to drink Motorola refugee advocates and community organizer,

Speaker 7: 16:17 activist, Mohamed ADI program coordinator at United women of East Africa.

Speaker 9: 16:23 We asked these three about what was different or not different about the video of George Floyd's death from other acts of police brutality and why it led to such widespread protests. For me, if it's like a

Speaker 7: 16:35 oblique execution, you know, it's really demonizing in a way that he shows how much you are, nothing you can do nothing. You know, I think, uh, black folks in this country are tired of, uh, being told how to go about, uh, dismantling their own oppression. And I think this is where it's, this was their way of, uh, letting America know enough is enough

Speaker 10: 16:57 officer's demeanor when he had that knee on, um, on, um, on the gentleman's neck. It was, you know, like he just did not care. It was so nonchalant. He had his hands in his pockets. Like, I feel like that just outraged. So many people, it just sent the message that this man's life doesn't even matter.

Speaker 9: 17:16 We asked about the demands of protesters this week. Police brutality got to stop.

Speaker 7: 17:21 People are so tired in 21st century to be treated that way, but also reforms need to be police reform needs to be put in place so that at least we can have a country that respect to human rights. You know, for me, that's beyond, uh, yeah. Uh, just police brutality. That's a human rights violation. We want to see the defunding of police departments. It is ridiculous that, um, this climate of our country, um, mayors like San Diego Marriott, Kevin Fulkert fucking her are asking the city council to increase the budget by 20 plus million dollars for San Diego police department. Um, it is just utterly crazy and ridiculous that we're spending more on policing than anything else in this in the city,

Speaker 10: 18:03 we have law enforcement always come into our communities saying that, you know, they want to build connection. They want to build bridges. Well, how, how, how can law enforcement possibly do that?

Speaker 7: 18:12 We asked about the duality of being both black and America and an immigrant. This is the issue of skin color. So before even a police, uh, uh, he is my accent or knows where I'm from. He sees my collar. And once this is my color, I'm profiled, once it is my color, I'm targeted. And that's the problem of the day today, a struggle of African immigrants, even refugees are living in this country. And this is really as double level, a level of a part of annoying and at being paranoid and scanners and hopelessness. My mom said it best like when she was living, um, you know, back in Somalia, like she didn't have to worry about, um, you know, my, her, her brothers or her cousins leaving the house, um, and have to think about their death, uh, or then possibly dying. Even though they were living during a time where people were being senselessly murdered, for whatever reason. Um, but today, uh, everyday I leave the house every day. My brothers lived the house every day. My dad leaves the house and we have to say, we love each other. We have to say, this might be our last goodbye.

Speaker 10: 19:12 Our community members come to America to seek a better life, but then they're being killed or they're watching other members or people they know be killed. That also leads them to not contact the law enforcement. They're not going to trust law enforcement. If crimes are being done to them in the community, those crimes will just continue because if they call on enforcement, there's that thought in the back of their mind that they might be killed calling law enforcement in our communities could lead to a death of a family member or the death of ourselves.

Speaker 7: 19:45 We asked about how white people can support immigrant and black communities. What I've been telling people or white folks to do is speak about it. No, it doesn't, it doesn't cost anything to say, this is wrong. Justice needs to be done. I post something on social media that shows that this is wrong and making sure that you voice his heart because, uh, some people in the workforce, in the white folks, sometimes they try to be quiet or, or neutral a lot of people trying to be neutral because they want to be a part of it. For me, that's just like a slap in the face, because if you need to, that means you're still, I guess, maybe because you can say anything going on

Speaker 10: 20:23 this entire time, all we've been doing was having, you know, dialogue, um, with no action behind it. People need to actually come and confront these biases, confront racism.

Speaker 7: 20:34 They should, uh, be on the front lines. They should be the people in the front who are locking them arms up and protecting, uh, the, uh, black and other POC, uh, protests are there. If you cannot attend a protest, that's fine. If you cannot financially contribute, that's fine.

Speaker 10: 20:48 Um, but what you can do for the movement is read a book. You can read an article, you can have discussions with your family members. And we asked them about the work they're doing in their community. We also provide a space where, you know, young men could come, they could, um, seek peer to peer support, even dropping support, um, you know, where they can build community. You know, it's one thing that there are black students are being expelled at much higher rates, but they're are also the victims of, um, you know, they're being gagged. You know, essentially they can't talk about their oppression. They can't voice, um, the harms that are being done to them. They're not allowed to express any of this stuff without the threat of being removed from the, uh, education setting that was Muhammad OBD-II program coordinator of United women of youth Africa. We also spoke with Cedric marula, a refugee advocate, a community organizer and student activists, a Modbar mood

Speaker 1: 21:38 to learn more about the organizations. These young men work with. You can visit kpbs.org

Speaker 10: 21:43 org.

Speaker 11: 21:49 [inaudible]

Speaker 1: 21:52 several local cities, including the city of Lamesa. Along with other unincorporated areas of San Diego County have been under curfews due to the recent demonstrations, elected officials and law enforcement agencies say the curfews help keep people safe and restore order, but others disagreed like the Southern California chapter of the American civil liberties union, which has asked the Los Angeles County to revise or rescind the curfew, their [inaudible] Mary Franklin Harvin reports.

Speaker 12: 22:21 According to the letters the ACLU sent mayor Garcetti and the LA board of supervisors. The current curfew orders violate Angelina's freedom of speech and assembly. The group is concerned that the orders give police too much discretion over who they arrest, but advocates say curfews help timbered the destructive aspects of protest activities, LA city council member. Paul Koretz represents the city's fifth district and talked about his constituents experiences in a recent city council meeting

Speaker 13: 22:51 mom and pop businesses in my district, many owned by immigrants, many owned by black and Brown individuals have all been lost,

Speaker 12: 23:01 correct says he's been criticized for focusing on property damage, but he also says it's more than that.

Speaker 13: 23:06 I would argue that, uh, it's not just property. We've devastated a lot of lives and we can't be expected to sit by and say that that's okay.

Speaker 12: 23:17 He's asked mayor Garcetti to make the city's curfew more expansive LAPD confirmed. It has arrested 2,700 demonstrators since the start of the protests, but only 200 of those arrests have been linked to robbery or vandalism. A Healon Arlen Anthem, senior counsel at ACLU. Soquel says these figures are just further support that

Speaker 10: 23:39 counties in Southern California are suppressing a huge amount of very important

Speaker 6: 23:45 peaceful in the name of stopping a small number of people who in a few places have engaged in polluting.

Speaker 12: 23:52 David Levine is a law professor at UC Hastings in San Francisco

Speaker 6: 23:56 with a curfew. The issue is, uh, whether it solves a problem or creates a problem in the sense that if the populous thing, so the government is coming down with too heavy, a hand, it might just enrage people and maybe even get more people out on the streets,

Speaker 12: 24:15 but consider the alternatives. Levine says,

Speaker 6: 24:17 and in contrast, for example, the president's threat to put the military on the streets, which I think by and large has been condemned by elected officials. So I think the perception is given the amount of damage that we've seen in Oakland, in Los Angeles. A curfew is a modest escalation in pressure to get people to peacefully protest and to comply with the law.

Speaker 12: 24:45 But it's not just protesters who are impacted by curfew orders. It's a lot of regular people who are considered exempt from them to says our Milan in them like a central workers.

Speaker 6: 24:55 If you are a essential worker, you have to believe that the color of your skin, I know what you're wearing and things like that are going to influence how safe do you feel in being able to assert this exemption when the police tried to stop you? And it's ironic because that is the underlying issue that the protests are about. And the government's response is just heightening the exact injustice that the protests we're trying to address in the first place.

Speaker 12: 25:24 In the meantime, counties and city statewide continue to confirm new and existing curfew orders. Some with end dates that lasts until further notice. I'm Mary Franklin Harvin

Speaker 2: 25:40 [inaudible],

Speaker 1: 25:43 as we continue to have over 5,000 people living on the streets and the city of San Diego, it's becoming increasingly obvious that responding with police officers may not be the best way to help the homeless. Several cities have tried to modify their approach to working with the homeless, by forming hot teams, homeless outreach teams that combined police with social workers, but now some San Diego city council members say it's time to change the approach altogether. Joining us a San Diego city council, president Georgette Gomez. Thanks for being with us. Thank you for having me. So why isn't the current system working so well, why do you think there's changes needed?

Speaker 14: 26:19 Well, I mean, I, when I first got elected, I was part of the special select committee on homelessness that, uh, at the time precedent vertical created, and one of the number one things that was highlighted and not even by us, but by somebody that came down from the housing, uh, commission from, from DC, from HUD, the one other observations was us saying, Hey, the way that you're doing outreach is not the best. And you really should consider, um, restructuring that PD, shouldn't be the ones offering assistance because the relationship is different. Um, and, uh, it really, and that really even led to when we just adopted the, the housing blueprint that we adopted unanimously by the council, it calls out for him for a different approach. So I think that it's time that we start really, uh, pivoting from, from what we have now to a different approach, just because we're seeing that that is not, not the, that's not the best resources that we have in utilizing it the way that we're doing.

Speaker 1: 27:27 You've actually spoken with some of those experiencing homelessness about this concern and got some personal

Speaker 14: 27:33 most definitely. I mean, I could tell you that I had a personal encounter. Um, as soon as we, we were opening up golden hall, the bottom floor, when we were trying to figure out and create, uh, a response to COVID and create, um, more additional beds for folks to come in. Um, I can tell you that when I was leaving city hall, I encounter this gentleman that was trying to get in. Unfortunately it wasn't a walk in process. So we were, I was trying along with my chief of staff, we were trying to help him out. And we were trying to get him to the shelter, the emergency shelter on 16th in Newton and Barrio, Logan are the one that alphabet utilized utilizes, but the only way he could get there was by a hot team, a PT coming in and getting him and driving him over there.

Speaker 14: 28:23 Now, when that happened and this guy saw that he walked away. Now, that's just a perfect example that I personally experienced and that didn't ask him why. And there wasn't because they were going to do anything to him, but it was just because he already had an experience that was not the best. So he was scarred. Um, and he just didn't want to take that risk. And this is not to speak on anything bad about PD, but he already does have that relationship, that interaction it previous times. So he, instead of in, he wanted it's just us. He wanted a bag. So he just decided to walk away and figure it out on his own. So that was very shameful and I just felt really bad. And that really was the, the tipping point for me.

Speaker 1: 29:11 So there is evidence already in city Heights and North park that that's shifting away from law enforcement for outreaches working. What do we learn from there? Almost done. Definitely.

Speaker 14: 29:22 I mean, I was able to partner with a council member, ward, the County, and we were able to identify private money to help us put together a program between North park, Hillcrest and city Heights, the mid city area, uh, to bring a long path. Um, they have a great program which has been extremely successful with no PD enforcement attached to it. They have over 47% rate success of, uh, of engaging clients. They have a pretty high placement percentage as well. And the, really the, the, what we find there is that it's a social worker. Um, he is based geographically. So he's placed there in that is his whole, his, his only purpose is to serve the community in the mid city area. So he goes there every single day. He's building relationships. He under he's understanding intimately understanding the client in the eventually there's there's trust that gets developed over, over that relationship.

Speaker 14: 30:30 And they, they really then that's when he starts figuring out, okay, what is the best program for you to be pleased to? And then he's doing all that process in mind, you, all these interactions that this person is having is not coupled with PD at all. And they do know that at times you need PT to come, but this program really proves that there is a better path. There is a better way in this better way. It's actually leading to higher rates of success, of placing people in the proper prop, a program that they need to be placed. So now I'm calling for money to be reallocated, to start pivoting or outreached to model this type of outreach.

Speaker 1: 31:13 Um, president Gomez. I just wanted to, I just wanted to ask you, um, so this change we're talking about would help make relating to the homeless more effective, but what about the shortage of actual housing to offer them? I know that there has been talk of buying whole motels to provide more housing for the homeless. Where do you stand on that?

Speaker 14: 31:31 Yeah, I mean, that, that, that idea, they come, um, early, um, a couple of weeks ago and the housing commission has been evaluating some of the potential sites. My, my only one when the idea was ran by me, I, I basically, I just wanted to make sure that we're doing our due diligence, that we're not placing people in the, in the space that is not habitable healthy to live in. And then the other question that I had was, okay, why are we leasing? Why not just acquire these parcels, these, these hotels, and strike the start, basically transforming them to single occupied types of rooms, uh, which is already a model that we have, and we know how to manage it. That makes sense to me. Um, I didn't want to go into this path of longterm leasing, and then we lose those units because we find that it's not worth buying, or we don't have the capital to buy it because then that's not permanent supportive housing.

Speaker 14: 32:32 That's just once again, another, another bandaid of temporary housing and mind you, it's critical. We all, we need all the tools in the toolbox to really address this, this critical issue. So I'm not against it, but I really do believe that we need to, to bring more units that are actual permanent supportive units. And if it means acquiring parse, uh, hotels. So be it, if it means having, uh, preventing the loss of single occupied, uh, units, and we currently have been Lucy, we need to make sure that we're not losing any more of those. If it means actually developing and supporting develop, developing new units that are permanent supportive housing, that's real also critical. Uh, so there's, there's all, all sorts of ways in which we can, we can achieve adding more units at the end of the day. It's adding more permanent supportive housing is critical to, to resolving the, the, the, this crisis. Well, I'd like to thank you very much for your time, president Gomez. Thank you. I really appreciate it.

Speaker 4: 33:37 Well, we've been speaking with San Diego city council, president Georgette Gomez.

Speaker 2: 33:56 [inaudible]

Speaker 4: 34:01 many San Diego doctors are busy with COVID-19 patients in our region, but some local physicians are also volunteering to advise doctors on the other side of the border. The collaboration launched by a UC San Diego health pulmonologist involves the San Diego County medical society and sharp Chula Vista infectious disease expert. Dr. Christian Ramers is one physician who lent his time to the effort. He tells KPBS health reporter, Taran mento about a recent visit to Tijuana general hospital.

Speaker 14: 34:33 What was your experience when you just visited? What did you see? What were you w what was going on?

Speaker 15: 34:39 It was a 24 bed ICU, almost all patients were on a ventilatory support, meaning they were on breathing machines. I think 22 out of the 24 were, uh, this was an area of the hospital that was not an ICU before it had just been sort of converted into an ICU. And we essentially paired up with the Mexican physicians and, um, you know, did our best to help around with them and, um, you know, share experiences with, um, uh, the critical care attendings on how to manage a respiratory failure. Some of this is uncharted territory. For example, there's a procedure called proning, which appears to be one of the interventions, which does help people with COVID-19 pneumonia and respiratory failure. Proning is the practice of taking a patient and flipping them face down. And for reasons that aren't fully understood, it actually improves the way the lungs function improves the, the match between respiration and air coming in and out, as well as the circulation in the lungs. And this is a new thing for many, the doctors and nurses down there. So working on, on protocols, I'm an infectious disease specialist, uh, and, uh, um, can speak Spanish. And so my role there was really to, to look at the, uh, infectious aspects of the, um, of the situation down there. Um, and as well as translating between some of the physicians and our team that was there,

Speaker 16: 35:55 you said going on rounds with these physicians there, can you recap to me, um, about the patients without giving too much detail that invades privacy, like an hour, what it was like going from room to room or, or what it, what the experience was for an audience that is, has no idea what, what it's like in an ICU wing in, in America let alone in Mexico?

Speaker 15: 36:19 Yeah, well, like I mentioned, you know, an ICU as a place where people are very, very ill and almost all the patients in this unit were sedated and intubated and on a breathing machine. Um, in order to do this technique called proning, most patients are also paralyzed, which means they're being given medication, so they can't move around and that's really to protect the breathing machine and the tube that's in the throat. Um, there were multiple patients per room, uh, sometimes two to a room, sometimes four to a room. And, uh, the infection control interventions that they've set up are excellent. And I would say, uh, probably akin, if not better than some of the infection control mechanisms being used in our own hospitals. And what I mean by that is that the personal protective equipment that's available to the doctors and nurses is at the standard of care worldwide, meaning that, and 95 masks were available to everybody.

Speaker 15: 37:14 I protection masks, uh, full body suits, uh, as well as very strict procedures on putting the material on the protective material, as well as taking it off. And that means that there was a separate entrance and an exit to the ICU. They do. What's called observed doffing, which means that a nurse is specifically assigned to watch you take off your protective equipment and ensure that you don't contaminate yourself. Uh, so in terms of infection control, I think very, very high standards and high, high quality really to avoid the healthcare workers themselves becoming infected. Um, we did hear some, some rumors and some stories in the media about, uh, healthcare workers becoming infected early on. Uh, some of those healthcare workers are out of, uh, of commission and out of work and now recovering at home. And then the Mexican government also had an intervention where they, uh, because older individuals are at higher risk of complications from COVID, any physician or nurse above age 60 was not allowed to work anymore.

Speaker 15: 38:14 And that's part of the trouble that they've had with staffing on the unit. Uh, so rounding with them, um, there were three, uh, physicians in the, in the unit and we basically kind of split up depending on our language abilities, uh, and divided the 24 patients up, um, uh, eventually sort of saw all of them and addressed, uh, most of the issues that were needed on the ventilator. I will say that, uh, you know, this is a different environment in, in Tijuana general, there are resource limitations that are very real. Um, for example, uh, you know, patients that need, uh, haemodialysis, which is when a patient, for example, might be in kidney failure, uh, that's not always automatically available. And it may be a situation where the patient's family is asked to pay for that service, um, in order for it to, to, um, to occur in terms of treatment for COVID pneumonia.

Speaker 15: 39:05 Uh, there are in our hospitals, in San Diego availability of medications, such as REM DESA veer, which is one of the antiviral medicines, another medicine called Tulsa, Olivia MAB, which is being studied for use in COBA pneumonia. Uh, and those were not available at Tijuana general hospital. Um, there are other things being studied in clinical trials, and there were not any clinical trials being conducted at the hospital. Um, one last thing I'll say just about the acuity is that all of these patients were incredibly ill. Um, many of the ICU attendings from UCLA said some, some of the patients were the sickest that they had seen in a long time. Uh, and I don't want to get too much into numbers out of respect for the patients, but there were several deaths really just during the weekend while we were rounding.

Speaker 16: 39:48 You also mentioned that some of the treatments that we have here in the U S and in San Diego Ram Dass severe, um, we're, we're also using, um, Kobe convalescent plasma to treat individuals here in San Diego. Um, is that being used there or what medications are actually being used?

Speaker 15: 40:06 So there are no medications being used because there really are none that are widespread and available and approved. Um, so really what they're offering is high quality supportive care. And I mentioned this earlier that we're in a state where we don't really have very, uh, directed treatments against this virus. And we are still just beginning to understand the inflammatory response to the virus, which in some cases is really what pushes people over into respiratory failure. So all we can do right now is offer the supportive care. And again, that's the, uh, the impetus behind this whole effort is to really allow a very high quality supportive care for those, with the most severe forms of the disease. And that involves techniques, uh, using the ventilators, um, the proning that I mentioned as well, uh, and then really allowing the body time to try to fight off the infection on its own. Again, this is just such an incredibly intense stress test for the body, uh, to try to get over this infection and try to fight it off using our natural immune defenses, developing antibodies, developing T-cell immunity to fight off the virus. Uh, and basically if someone is not in a good state of underlying health, uh, they may die, uh, during that process or before the immune system can fully fight off the virus.

Speaker 16: 41:24 Now there's a desire to assist medical professionals in Tijuana and Mexico, because they are our neighbors, but what is happening across the border, it does affect what happens here. Can you explain how the outbreak there creates challenges for us here in San Diego?

Speaker 15: 41:41 I sure can. So I I've talked about this a little bit in a, in an op ed to the union Tribune a little while ago, and, you know, infectious disease doctors know through our experience with HIV or with sexually transmitted diseases or tuberculosis, that infectious diseases do not respect international borders. And to try to manage an infectious disease outbreak by focusing only on one side of the border is a as sure strategy to fail. I think the County has learned through a lot of the work they've done with tuberculosis, that collaborating with our colleagues across the border is the way to do it. Uh, patients and people move across the border. We are basically a border town in San Diego, whether we like it or not, uh, thousands or tens of thousands of people cross the border every day in order to work in San Diego.

Speaker 15: 42:29 And so a lot of our essential workers, a lot of our, um, service industry workers live in, in Tijuana and our us citizens and crossover. Um, this is a virus with a five day on average of five days, silent incubation period. So someone can be feeling fine. They can be in their environment in Tijuana or Mexicali, and the disease can cross over in that human host. Uh, so overall we can't get through this unless we work with our colleagues on the other side of the border. Uh, tuberculosis has taught us that lesson. Um, and I, and it's very nice to see the collaboration starting to happen between the two regions, because our fate is essentially intertwined, uh, with respect to infectious diseases that don't respect these international borders.

Speaker 16: 43:10 That was dr. Christian Ramers of family health centers of San Diego speaking with KPBS health reporter, Taran mento.

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KPBS Midday Edition

KPBS Midday Edition is a daily talk show hosted by Maureen Cavanaugh and Jade Hindmon, keeping San Diegans in the know on everything from politics to the arts.