2018-116 Audit Scope and Objectives

City and County of San Diego— Management of the Hepatitis A Virus Outbreak

The audit by the California State Auditor will provide independently developed and verified information related to how the county of San Diego (county) and the city of San Diego (city) identified, contained, and treated the recent hepatitis A virus outbreak. The audit's scope will include, but not be limited to, the following objectives:

  1. Review and evaluate the laws, rules, and regulations significant to the audit objectives.
  2. Evaluate the county's response to the hepatitis A outbreak by determining the following:
    1. Which criteria the county used to determine that the increased number of hepatitis A cases was, in fact, an outbreak and an emergency and whether the county identified, contained, and treated the hepatitis A outbreak in accordance with legal requirements and established protocols.
    2. Whether the county's efforts to identify, contain, and treat the hepatitis A outbreak before the county officially declared a public health emergency in September 2017 were consistent with legal requirements and established protocols for managing an infectious disease outbreak, including the release of location data and communication between the medical directors of local municipalities.
    3. What steps the county has taken to prevent another infectious disease outbreak and how those steps may be helpful for other jurisdictions.
  3. Evaluate the city's response to the hepatitis A outbreak by determining the following:
    1. Which criteria the city used to determine that the increased number of hepatitis A cases was, in fact, an outbreak and an emergency and whether the city identified, contained, and treated the hepatitis A outbreak in accordance with legal requirements and established protocols.
    2. Whether the city's efforts to identify, contain, and treat the hepatitis A outbreak before the county officially declared a public health emergency in September 2017 were consistent with legal requirements and established protocols for managing an infectious disease outbreak, including the release of location data and communication between the medical directors of local municipalities.
    3. What steps the city has taken to prevent another infectious disease outbreak and how those steps may be helpful for other jurisdictions.
  4. Determine whether the county or city was aware of the potential for an infectious disease outbreak among a particular population before March 2017 and, if so, whether they had the resources to prevent an infectious disease outbreak of this magnitude.
  5. Determine whether the city's policy for approving public works contracts in response to declared emergencies differs between contracts awarded any other time and whether the city approved contracts related to the hepatitis A emergency in accordance with applicable legal requirements and its own policy.
  6. Review and assess any other issues that are significant to the audit.

California State Auditor's Office
5/8/2018