Report 2018-116 Recommendation 7 Responses

Report 2018-116: San Diego's Hepatitis A Outbreak: By Acting More Quickly, the County and City of San Diego Might Have Reduced the Spread of the Disease (Release Date: December 2018)

Recommendation #7 To: San Diego, City of

To identify and address any unresolved issues that may have contributed to delays in implementing sanitation measures before the county health officer's September 2017 declaration of a local health emergency, the city should, by March 31, 2019, examine its actions related to the hepatitis A outbreak before the emergency declaration, identify any such issues, and use the results of that examination to develop a corrective action plan to address them.

1-Year Agency Response

In the initial update on February 15, 2019, the City anticipated to complete this recommendation by April 30, 2019. Staff completed the final draft of a Process Narrative (PN) which provides clear definitions of roles, responsibilities, and processes for City employees who may be contacted by local, state or federal official regarding public health issues.

Approval of the Process Narrative (PN) was subsequently placed on hold pending formal passage of a Memorandum of Agreement (MOA) between the City and County detailing communication and service protocols between the two agencies. The hold ensured that the PN and MOA would be consistent and avoid any future missteps in communication procedures. The MOA was approved by the City Council on December 9 and approved by the County Board of Supervisors on December 10. The City's Process Narrative was approved and published on December 9.

Establishment of the PN and MOA ensure that moving forward, the City has adequate procedures in place for internal and external communications to address local health emergencies in a timely and effective manner.

Supporting documents will be emailed directly to audit staff as a part of this response. First Full Month of Implementation will be January 2020.

California State Auditor's Assessment of 1-Year Status: Resolved

Based on the documents provided by the City of San Diego, we assess this recommendation as resolved.

6-Month Agency Response

In the initial update on February 15, 2019, the City anticipated to complete this recommendation by April 30, 2019. Staff has completed the final draft of a Process Narrative (PN) which provides clear definitions of roles, responsibilities, and processes for City employees who may be contacted by local, state or federal official regarding public health issues. In addition, the PN contains processes for notifying City elected officials of public health concerns.

It is anticipated the PN will be approved within 30 days. Once it is complete, it will immediately be transmitted to the State for review.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

Staff met to discuss the recommendation and have identified a need for clear definitions of roles and responsibilities for city employees who may be contacted by a local, state, or federal official regarding a public health issues, such as an outbreak. To assist in this, a Process Narrative (PN) will be developed to clearly define the steps related to such a contact, in addition to having a robust city contractual arrangement with medical experts. It is the intent to have the initial review completed by March 31, 2019.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2018-116

Agency responses received are posted verbatim.