The Board of Supervisors, at its June 7 meeting, approved a response to an April 4 Grand Jury report claiming that the Public Health Office was abandoned by the Board of Supervisors in the COVID-19 crisis, stating it “disagreed wholly” with most of the findings.
The Grand Jury report included six findings and six recommendations related to the information contained in its report. The Board wholly disagreed with four of the Grand Jury’s findings and partially disagreed with two.
Grand Jury Findings and County Responses
F1. On March 19, 2020, the Sacramento County Public Health Officer issued a Public Health Order. Lack of coordinated emergency response and direction from the County Executive and the Board of Supervisors shifted all oversight of the planning and implementation to the Public Health Officer and the Office of Emergency Services.
County Response: The Board of Supervisors disagrees wholly with the finding. The County proclaimed a local emergency, and a local public health emergency on March 5, 2020, which was ratified on March 10, 2020. The Emergency Operations Center (EOC) was activated and opened March 16, 2020.
Communication and coordination took place regularly between the EOC and the activated Department Operations Centers, including the Public Health Department Operations Center.
All County departments were provided regular direction on the process for identifying the need for related funding and FEMA Public Assistance projects to address their particular situation, and for requesting funding to cover those needs.
F2. In 2009, OPH experienced dramatic staffing and funding cutbacks, which have never been fully restored. As a result, OPH entered the 2020 pandemic with distinct deficits in areas, such as the field nursing unit, services for at-risk communities, and other programs that significantly impacted its ability to respond to the dynamic nature of the COVID-19 pandemic as it reached Sacramento in early 2020. These under-investments in Public Health presented significant challenges for OPH in meeting the immediate public health emergency response required in a pandemic.
County Response: The Board of Supervisors disagrees partially with the finding. As a result of the Great Recession, between 2008 and 2011, budget cuts were made County-wide, impacting all County departments including the Department of Health Services. Therefore, the Board agrees that Public Health experienced staffing reductions that were not fully restored by 2020.
As a result, the number of positions in Public Health was reduced from 278.6 in 2008 to 167.5 by 2011. By 2020, the number of Public Health positions had been restored to 221.2.
In response to the pandemic, staffing increases resulted in 280.6 total positions in Public Health by 2021.
The Board of Supervisors disagrees that the Public Health funding and staffing levels entering the pandemic represented distinct deficits or under-investments. As indicated by the numbers above, staffing restorations were made in Public Health as more funding became available, with needs in Public Health balanced against needs across the County, including in other critical safety net programs.
F3. Sacramento County administrators adhered to a traditional budget process and calendar in response to emergency funding requests from OPH, despite the availability of $181 million in CARES Act funding. That rigid process absolutely stymied appropriate and timely disbursal of emergency funds requested by OPH for needed equipment, staffing and services.
County Response: The Board of Supervisors wholly disagrees with this finding. On April 21, 2020, the Board adopted resolution 2020-0257, authorizing the County Executive to apply for, accept and draw down Federal or State funding related to the COVID-19 emergency.
As result of the Board’s delegated authority to the County Executive and in light of the urgent and evolving nature of the public health emergency and the limited time frame governments originally had to spend Coronavirus Relief Funds (CRF), the County implemented an expedited and real-time process to assess needs and make funding decisions.
All County departments were directed to identify needs and submit funding requests for the use of CRF revenue. All funding requests were promptly reviewed by staff from the Office of Budget and Debt Management for compliance with Treasury Guidance and then forwarded to a Review Committee comprised of senior County officials, which, after review, made funding recommendations to the County Executive.
The County Executive reviewed the departmental requests, the recommendations of the Review Committee and the Treasury Guidance and then made decisions on which requests to fund. The approved funding request then went to the County Finance Department, where staff further reviewed the requests on an expedited basis for compliance with federal rules and approved or denied funding for specific expenditures as appropriate.
F4. Despite the gravity of the COVID-19 pandemic and its impact on Sacramento County residents, the Board of Supervisors did not request pandemic response reports directly from its Public Health Officer for nearly five months after the issuance of the first COVID-19 Public Health Order.
Board of Supervisors Response: The Board of Supervisors disagrees partially with the finding. The Board agrees that there was not a formal request for reports from the Public Health Officer during a public meeting until August 19, 2020.
The Board disagrees with any suggestion that information was not regularly received. Staff provided regular reports and communication to the Board despite waiver of regular reporting requirements normally required by state law. During many Board meetings, Board members frequently requested additional information that augmented information provided regularly by staff.
Outside of these formal, public reports, 83 communications and early news releases were made to the Board with updates and information regarding COVID and COVID-related issues including changes in state orders and response activities within Sacramento County.
F5. The Board of Supervisors does not have its own “Continuity of Operation” plan in place for the Board of Supervisors to use in the case of any type of public emergency which would prevent or adversely impact critical Board of Supervisors governance activities and responsibilities.
County Response: The Board of Supervisors disagrees wholly with the finding. The Board of Supervisors has a Continuity of Operations Plan (COOP) and specific annex in place dated 2017 which had been in effect for two years at the start of the pandemic. Plans are updated within three- to five-year timeframes. The base COOP was updated in January 2021 with a portion of departments completing updates to their department annex the same year.
F6. Implementation of COVID-19 related Public Health Orders was hamstrung by a lack of enforcement support from the Sacramento County Board of Supervisors, the County Chief Executive, the County Sheriff and local law enforcement agencies.
County Response: The Board of Supervisors disagrees wholly with this finding. There was general agreement at the beginning of and throughout the pandemic – from law enforcement, Public Health, and the County – that an approach emphasizing education on the Public Health Order and the risks of COVID was preferable to strict enforcement.
- Follow-up actions were taken by Code Enforcement and others on many entities that consistently failed to comply with the Order after initial contacts and warnings.
- During the pandemic General Services, Security Services posted and enforced all County Public Health order requirements at 700 H Street and other County facilities.
- The Clerk’s office enforced requirements for public meetings and established accommodations for those who could not or would not comply with health orders.
- County 3-1-1 collected reports of violations to Public Health Orders and the Environmental Management Department (EMD) investigated 205 complaints received between March 2020 and 2022.
Grand Jury Recommendations and County Responses
R1. The County Executive, Board of Supervisors, and OPH should develop and adopt a public health emergency response plan which recognizes, and plans for the immediate requirements of OPH to implement public health orders to best ensure public safety. The Board of Supervisors should finalize and approve the response plan by December 2022.
County Response: The recommendation will not be implemented because it is not warranted. There are countywide as well as Department-specific plans in place that meet local, state, and federal requirements.
R2. The Board of Supervisors should immediately develop, formally approve and implement a direct and regular reporting process for the Public Health Officer. This process should require at least monthly reporting to the Board during public sessions. Whenever a community-wide public health order has been declared, the Board of Supervisors should augment regular reporting by OPH with detailed reporting on the response to the public health emergency, including recommendations for needed services, programs and funding. These policies and processes should be adopted by the Board of Supervisors no later than June 2022.
County Response: The Recommendation will not be implemented because it is not warranted. The Board of Supervisors has already established regularly scheduled meetings each month where the Public Health Officer provides reports on the status of the pandemic. Any additional reporting, beyond the normal Board approval process or what is already established under federal, state, or local laws will be established by the Board depending on the need at that time.
R3. Funding for OPH should be immediately reviewed and adequately increased to build and maintain a strong organizational infrastructure with sufficient staffing. Such funding is essential to ensure that OPH maintains the critical capacity to immediately implement all essential and emergency public health services. This funding assessment and increased funding levels should be included in the budget process for the 2022-2023 budget.
County Response: This recommendation will not be implemented because it is not warranted. The Department of Health Services already works with all of its divisions – including Public Health – to ensure that its operational needs are identified as part of the County’s budget process. These needs – including proposals for additional growth items - are prioritized, submitted in a full budget proposal to the County Executive’s Office, and fully discussed with County leadership as part of the budget development effort
R4. The County should develop and adopt a separate emergency budget allocation and approval process. This process would operate outside the regular fiscal year county budget process in order to expedite emergency funding requests from County departments. Such a process should include program staff training, as well as transparent allocation and expenditure reporting to the Board of Supervisors and County Executive staff. The Board of Supervisors should finalize and approve the emergency budget allocation process by December 2022.
County Response: The recommendation will not be implemented because it is not warranted. The County already has standard processes in place for making budget adjustments outside of the annual budget process and routinely recommends budget adjustments to the Board as a result of additional funding or unanticipated needs that occur during the fiscal year.
R5. The Board of Supervisors should develop and adopt its own “Continuity of Operation” plan, with periodic updating as appropriate. The Board of Supervisors should finalize its “Continuity of Operation” plan by December 2022.
County Response: The Recommendation has been implemented. The Board of Supervisors has a Continuity of Operations Plan (COOP) and specific annex (2017) in place which had been in effect for two years at the start of the pandemic. Plans are updated within three to five-year timeframes. The base COOP was updated in January 2021 with a portion of departments completing updates to their department annex the same year.
R6. The Board of Supervisors and OPH should immediately begin discussions with the County Sheriff and other County law enforcement entities. These discussions should result in a County ordinance directing local law enforcement to enforce public health emergency orders. The Board of Supervisors should enact this ordinance by December 2022.
County Response: The recommendation will not be implemented because it is not warranted or is not reasonable. The Board does not have legal authority to direct law enforcement officials to enforce public health emergency orders. It is beyond the Board’s authority to direct independently elected officials to exercise their discretionary powers in any particular manner.