City, county officials blame each other for growing hepatitis A outbreak in San Diego

 In Health

SAN DIEGO — Finger-pointing started Monday over what appears to be a delayed response to the deadly hepatitis A outbreak ravaging San Diego County, as public records to and from city and county officials began to be released.

In one email from June, an officer at St. Vincent de Paul’s charity told county leaders that the city flatly refused to install portable toilets and sinks to help control the spread of the virus, which has infected nearly 450 people in recent months and killed 16.

“From my understanding, the city of San Diego has declined an opportunity to put portable toilets/wash stations around the city because it wasn’t so long ago they were fighting other kinds of outbreaks by virtue of the availability of portable toilets,” Ruth Bruland wrote June 30.

The city has a long history of warnings by the grand jury and others over the need for restrooms downtown, where a growing homeless population has had to use other means to relieve themselves — contributing to the current sanitation and health crisis. A concern that restrooms attract drugs and prostitution has been one impediment.

The St. Vincent de Paul email was released by county spokesman Michael Workman after The San Diego Union-Tribune asked him to respond to a batch of other emails released by the city under a California Public Records Act request.

Those communications, hundreds of exchanges to and from city and county public officials, show the two agencies discussing a multitude of responses to the public health threat and not implementing them broadly for months — even as the death toll mounted.

Bruland did not immediately respond to questions about her email to county officials. According to Workman, city officials early in the crisis did not act on certain matters as the preventable outbreak of the liver infection hepatitis A grew more deadly by the month.

Many of the measures proposed involved better hygiene to avoid spread of the disease, which can occur when tiny amounts of fecal matter are transmitted and ingested.

“May 4 we proposed the wash stations and city said no,” Workman said Monday. “Two weeks later we offered to pay for them, still no.”

“June 28 they said they’ll consider a permit process but want us to pilot first on our properties,” he said. “(We) placed one in July at Rosecrans,” where the county has offices for the Health and Human Services Agency.

Greg Block, a spokesman for Mayor Kevin Faulconer, said the city did not turn away wash stations.

“We never had any issues with the installation of hand washing stations, except they had to be self-contained and in compliance with (permits),” he said.

Block said the city deferred in responding to the outbreak because the county has public-health experience the city lacks.

“The county is our public health agency,” Block said. “They have the expertise on public health matters that the city does not. As a result, we take our direction on public health issues from them.”

Block said the city’s reluctance to embrace new bathrooms downtown and in other areas where the outbreak is most concentrated stems from previous experiences with public restrooms that have been well-documented.

“We have had issues with vandalism and illegal activities, causing complaints from residents and business owners, leading many of them to be removed,” Block said. “The restrooms we have installed recently all have 24 hour security.”

The city and county installed 40 or more temporary sinks in at-risk communities earlier this month. Records show discussion of the measure started as far back as June.

“We are waiting for the final description of what you envision the ‘handwashing’ stations will look like (e.g. specifications) and locations that you may want to utilize,” Stacey LoMedico, the city’s assistant chief operating officer, wrote to Deputy Public Health Officer Sayone Thihalolipavan in late June.

“I have our development services department staff on standby so they can provide us the requirements (e.g. permits) that may be needed to install in the public (right-of-way),” she added.

Thihalolipavan replied just 10 minutes later, saying the idea was still in development.

“It is only in planning phase right now and once we get with the contractor and get those details we can definitely pass them along of course,” the county public health official wrote back.

In another email exchange this spring, city officials were asked for information about suspected hepatitis A patients treated by San Diego Fire-Rescue teams but held off until the county could provide a list of specific names.

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