THE SENATE COMMITTEE ON HEALTH
ON CALIFORNIA'S PUBLIC HEALTH
INFRASTRUCTURE AND CAPACITY.
AND I WANT --
TO WELCOME EVERYONE.
WHO'S HERE TODAY --
TODAY IS A BUSY SESSION DAY SO
THERE ARE MULTIPLE HEARINGS
GOING ABOUT.
AND THAT YOU'LL SPICY MEMBERS
COMING IN AND OUT OF HERE BUT
REST ASSURED --
THAT -- THAT
COMMITTEE MEMBER STAFF FULL --
FOR FOLLOWS VERY WILL BE
FOLLOWING THIS HEARING --
AND INFORMING THEIR MEMBERS SO I
WILL POINT OUT TO JUST IN TERMS
OF WHAT'S GOING ON FOR EXAMPLE.
I WAS VERY PLEASED TO BE ABLE TO
ATTEND THE VERY BEGINNING OF
CENTER HOLLY MITCHELL'S SELECT
COMMITTEE HEARING ON SOCIAL
TERMS OF CHILDREN'S WELL BEING
ALSO A OF THE HEALTH COMMITTEE
BUT HER OWN SELECT COMMITTEE IS.
VERY MUCH ATTUNED TO THE TOUGH
TOPICS WILL BE TALKING ABOUT
HERE IS I AM TO WHAT'S GOING ON
IN HER SELECT COMMITTEE EVEN
THOUGH I WILL NOT BE PHYSICALLY
PRESENT AT HER SORT COMMITTEE --
BUT BUT YOU CAN SEE IS ACTUALLY.
CONSIDER WILL INTEREST IN.
SHE IS A PUBLIC HEALTH --
THINKING ABOUT THAT'S LIKE
COMPETE THE DRESSING SOCIAL
DETERMINANTS OF HEALTH BUT HERE
TODAY WE'RE GOING TO TALK ABOUT
CALIFORNIA'S PUBLIC HEALTH
INFRASTRUCTURE.
AND I KNOW THAT --
THERE'S A LOT OF INTEREST IN
HEALTH.
RIGHT NOW IN OUR COUNTRY AND IN
OUR STATE.
IN THIS LAST ELECTION WHEN ARE
YOU HEALTH IS ONE OF THE TOP CARE COVERAGE.
BUT IT'S ALSO IMPORTANT THAT WE
NOT FORGET THAT WE NEED TO HAVE
A PUBLIC HEALTH INFRASTRUCTURE.
TO SUPPORT --
THE VERY THESE ARE TO KEEP US
SAFE AND HEALTHY AND THAT
ACTUALLY PREVENTS PEOPLE FROM
ACTUALLY HAVING TO ACCESS TO
HEALTH CARE SYSTEM IS OFTEN.
THE PUBLIC HEALTH INFRASTRUCTURE
IS SOMETHING THAT WORKS HAND IN
HAND IN FACT ACTUALLY IS ONE THE
MOST COST EFFECTIVE MEANS OF
KEEPING OUR COMMITTEES HEALTHY.
AND IN FACT --
WE THINK ABOUT A YOU WAS A
FORMER --
COMMISSIONED OFFICER IN THE US
PUBLIC HEALTH SERVICE.
THAT WAS ONE THE EARLIEST THINGS
OUR COUNTRY DID WAS ESTABLISH A
PUBLIC HEALTH SERVICE BECAUSE
THEY RECOGNIZE WE'RE GOING TO
KEEP OUR COMMUNITIES HEALTHY WE
NEED TO HAVE.
A A A GOVERNMENT ROLE IN TRY TO
PREVENT THE SPREAD OF DISEASE.
TO BE SURE THAT PEOPLE OF ACCESS --
TO TO THE CLEAN AIR AND WATER
AND OTHER TYPES OF THINGS THAT
WE NEED.
TO BE SURE THAT WE HAVE THAT
INFRASTRUCTURE THERE AND SO
THAT'S BEEN A CONTINUING ROLE
AND GOVERNMENT HERE IN UNITED
STATES PRACTICALLY SINCE OUR
FOUNDING OUT ALSO POINT OUT THAT --
GEORGE WASHINGTON WHEN HE WAS
COMMANDED REVOLUTIONARY ARMY
ACTUALLY MANDATED INOCULATION
WITH SMALLPOX TO ENSURE THAT HIS
ARMY DIDN'T DIE OF DISEASE
BEFORE THE BRITISH --
THE MET THE BRITISH ON THE
BATTLEFIELD AND SO CLEARLY
PUBLIC HEALTH IS PLAYED
EXTREMELY IMPORTANT ROLE --
FROM THE BEGINNING OF OUR
COUNTRY THROUGH --
MORE TALK ABOUT THE CIVIL WAR WE
CAN TALK ABOUT THE FLU PANDEMIC
THAT AFTER WILDER ONE WHICH BY
THE WAY KILLED MORE PEOPLE THAN
ALL THE SOLDIERS SAILORS AND
AIRMEN THAT SERVED ON BOTH SIDES
OF THE WAR --
TO THE INNOVATIONS THAT WE'VE
DEVELOPED.
IN THE PAST CENTURY AFTER --
WORLD WAR TWO TO TRY TO KEEP
PEOPLE HEALTHY.
SO -- WITH
THAT LET'S TALK ABOUT WHAT'S
HAPPENING HERE IN CALIFORNIA OF
WATER ALL THE COMPONENTS OF THAT
WE OFTEN TAKE TOO MUCH FOR
GRANTED OVER PUBLIC HEALTH
INFRASTRUCTURE.
AND WHAT WE NEED TO DO TO BE
SURE THAT A STRONG AND THAT
AIN'T THIS A VERY VITAL PART OF
OUR OUR HEALTH INFRASTRUCTURE
AND A GOVERNMENT.
SO I'M VERY PLEASED THAT WE'RE
GONNA HAVE HAVE --
HERE TODAY WE HAVE SEVERAL
PANELS ONE WILL START OFF AT THE
STATE LEVEL OVERVIEW THAT WE
TALK ABOUT THE EXTREMELY
IMPORTANT.
ROLE OF THE LOCAL HEALTH.
DEPARTMENTS AND THEN --
ALSO FOCUS ON SOME PARTICULAR
DISEASES ARE CONDITIONS THAT --
WE'RE ALSO TRYING TO THE ADDRESS
THROUGH OUR PUBLIC HEALTH
INFRASTRUCTURE.
AND ALSO DO WANTING KNOWLEDGE
THE IMPORTANT ROLE THAT THE AND
ALSO TALKING ABOUT POTENTIAL
SOLUTIONS AS WELL BUT ALSO
ACKNOWLEDGE THE IMPORTANT ROLE.
OF THE FEDERAL GOVERNMENT AS
WELL AND HOW THEY ALL WORK IN
CONCERT --
CERTAINLY IS CHAIR OF THE BUDGET
SUBCOMMITTEE HEALTH AND HUMAN
SERVICES YOU KNOW WE ACTUALLY
JUST HAD A HEARING ON THE
CALIFORNIA FOR PUBLIC HEALTH AND
RECORD BILLION DOLLAR BUDGET OF
THE CALIFORNIA BAR PUBLIC HEALTH
ACTUALLY COMES IN FEDERAL GRANTS.
IN FEDERAL FUNDS SO THIS IS A
PARTNERSHIP THAT HAS TO WORK
ACROSS ALL THESE LAYERS AND ALSO
I POINT OUT THAT MANY DISEASES
THEY DON'T PAY ATTENTION TO
POLITICAL BOUNDARIES.
THEY DON'T CARE ABOUT POLITICAL
BOUNDARIES DAY --
SO -- SO
THAT'S WHY WE ALL NEED TO WORK
TOGETHER AND EVEN WITH THE WORLD --
AS WELL THE REST OF THE REST OF
THE WORLD.
SO WITH THAT LET'S GO AHEAD
BEGIN AND I'M A UNIFIED UPPER
STATE LEVEL OVERVIEW OF VERY
PLEASED TO HAVE OUR STATE PUBLIC
HEALTH OFFICER AND DIRECTOR OF
THE CALIFORNIA BAR PUBLIC HEALTH
DOCTOR TERENCE SMITH.
WE ALSO HAVE DOCTOR DEAL SHOP
THIS IS DIFFIE DIRECTOR OF AT
THE CENTER AND OF THE CENTER F
TEXAS DISEASE AT THE PART F
PUBLIC HEALTH.
AND SUSAN --
FINELLI.
IS ALSO CHIEF DEPUTY DIRECTOR OF
POLICY PROGRAMS THAT APARTMENT
PUBLIC HEALTH.
AND THEY'RE GONNA GIVE AN
OVERVIEW OF BASICALLY THE
DEPARTMENT VEHICLE DISEASES AND
EMERGENCY PREPAREDNESS --
AND INFRASTRUCTURE ALSO AN
OVERVIEW OF THE CENTER FOR FAXES
THESE ROLL.
ROLE PARTICULARLY FOCUSING ON
SOME OTHER COMMUNICABLE DISEASE
LIKE STDS AND T. B. AND THEN OF
COURSE --
OUR ABILITY TO RESPOND TO
DISASTERS IN EPIDEMICS AS WELL
AT THE TO SERVING UP LIKE THE
CAMPFIRE SO WELCOME AND THANK
YOU SO MUCH FOR BEING HERE.
THANK YOU --
MISTER TURNER AND I AM A DOCTOR
KAREN SMITH I'M THE CD PH
DIRECTOR AND THE STATE PUBLIC
HEALTH OFFICER.
AND I'VE ASKED TO BE ADDED TO
PROVIDE A VERY BRIEF OVERVIEW OF
THE DEPARTMENT AND TO SHARE WITH
YOU -- A
CONCERN THAT I HAVE REGARDING
PUBLIC HEALTH INFRASTRUCTURE. TO
CITY PAGES FUNDAMENTAL
RESPONSIBILITIES ARE EXTREMELY
BROAD AND COMPREHENSIVE ARE KEY
ACTIVITIES IN SERVICE SERVICES
INCLUDE EVERYTHING FROM
PROTECTING PEOPLE FROM THE
THREAT OF PREVENTABLE INFECTIOUS
DISEASES. TO PROVIDING A GOOD
RELIABLE LOCK AND PUBLIC HEALTH
LABORATORY SERVICES AND
INFORMATION ON HEALTH THREATS WE
ALSO PROVIDE NUTRITIONAL SUPPORT
TO LOW INCOME WOMEN INFANTS AND
CHILDREN --
WE SCREEN NEWBORNS IN PREGNANT
WOMEN FOR GENETIC DISEASES AND
WE ALSO WORK TO ENSURE THE
SAFETY OF FOOD AND BOTTLED WATER
IN THE STATE OF CALIFORNIA.
WE ALSO HELP REDUCE RISK FACTORS
FOR CHRONIC DISEASES LIKE
SMOKING AND DIABETES AND A AND
OBESITY AND THEN TO PREVENT THE
DISEASE'S THEMSELVES.
WE ALSO PROTECT PATIENT SAFETY
AND HOSPITALS AS YOU KNOW AND
SKILLED NURSING FACILITIES
MAINTAIN VITAL RECORDS FOR THE
STATE AND RESPOND PUBLIC HEALTH
EMERGENCIES AMONG OTHER
MISCELLANEOUS ACTIVITIES --
SIOUX CITY PITCH IS A KEY
COMPONENT OF THE GOVERNMENTAL
PUBLIC HEALTH INFRASTRUCTURE IN
CALIFORNIA BUT WE'RE NOT THE
ONLY COMPONENT.
OF THE PUBLIC HEALTH STRUCTURE
IN CALIFORNIA GOVERNMENTAL
PUBLIC HEALTH STRUCTURE
PARTICULARLY ENCOMPASSES BOTH.
THE STATE AND LOCAL HEALTH
DEPARTMENTS AND WE WORK VERY
CLOSELY DEPARTMENT TOGETHER.
CITY PH RELIES ON LOCAL HEALTH
DEPARTMENTS TO ACTUALLY CARRY
OUT AT THE LOCAL LEVEL THE
MAJORITY OF THE ACTIVITIES THAT
OCCUR AT THAT LEVEL --
EACH COMMUNITY IN CALIFORNIA IS
UNIQUE AND THE LOCAL HEALTH
DEPARTMENTS ARE THE ONES HAVE
THE BEST UNDERSTANDING OF THEIR
COMMUNITIES WHAT THEY'RE
CHALLENGES ARE AND HOW TO
ADDRESS THEM.
WANT TO TAKE JUST A MOMENT TO
TALK ABOUT THE INFRASTRUCTURE
THAT'S NECESSARY FOR THE WORK OF
GOVERNMENTAL PUBLIC HEALTH.
AS I SAID WE HAVE WE DO MANY
THINGS IN IN PUBLIC HEALTH BUT
THERE ARE CERTAIN CORE FUNCTIONS --
OF GOVERNMENTAL PUBLIC HEALTH IN
PARTICULAR THE PUBLIC HEALTH
SYSTEMS VERY LARGE INCLUDES
OTHER PARTNERS BUT FOR
GOVERNMENTAL PUBLIC HEALTH AS
YOU POINTED OUT MISTER CHAIR.
THIS WAS IN THIS IS A
FUNDAMENTAL.
RESPONSIBILITY OF GOVERNMENT TO
PROTECT HEALTH.
WE HAVE A WE HAVE A LANGUAGE
THAT WE USE OF THE FOUNDATIONAL
PUBLIC HEALTH SERVICES THIS IS A
SET OF SERVICES THAT WAS FIRST
ENVISIONED BY THE INSTITUTE OF
MEDICINE AND IN A REPORT A FEW
YEARS AGO CALLED --
INVESTING IN A HEALTHIER FUTURE.
THIS IS ESSENTIALLY THE MINIMUM
PACKAGE OF SERVICES THAT MUST BE
AVAILABLE AT STATE AND LOCAL
PUBLIC HEALTH DEPARTMENTS
EVERYWHERE FOR THE HEALTH SYSTEM
TO WORK ANYWHERE.
ANDTHEY INCLUDE COMMUNICABLE
DISEASE CONTROL ENVIRONMENTAL
PUBLIC HEALTH MATERNAL CHILD AND
FAMILY HEALTH AND WORKING WITH
THE HEALTH CARE SYSTEM TO ASSESS
AND CREATE HAVE LINKAGES TO
CLINICAL CARE.
BUT IMPORTANTLY EACH OF THESE.
IS A FOUNDATIONAL SERVICES
REQUIRE CERTAIN CAPABILITIES AND
THOSE INCLUDE THINGS LIKE
GATHERING ANALYZING PRIORITIZING
REPORTING OUT ON DATA AROUND
HEALTH RISKS.
THIS IS STAINED ABILITY AND
CAPACITY TROLL DISASTERS AND
EMERGENCIES. TO SERVE AS A
PRIMARY AND EXPERT RESOURCE FOR
PUBLIC HEALTH POLICY
RECOMMENDATIONS.
THE ABILITY TO MAINTAIN ONGOING
RELATIONSHIPS WITH MEDIA AND THE
PUBLIC TO PROVIDE RISK
COMMUNICATIONS.
AND THE ABILITY TO CONVENE
COMMUNITY STAKEHOLDERS IN AN
AUTHENTIC FASHION TO TOGETHER
WORK TOWARD HER PROTECTING
HEALTH IN THE COMMUNITIES.
AS WELL AS THE BASIC
ADMINISTRATIVE CAPABILITIES.
EACH OF THESE CAPABILITIES IS
ESSENTIAL FOR EVERY SINGLE
SOLITARY HEALTH DEPARTMENT AND
THEY HAVE THEY NEED THOSE TO
CARRY OUT THOSE FOUNDATIONAL
SERVICES.
AS WELL AS TO ADAPT TO THE EVER
CHANGING ENVIRONMENT THAT PUBLIC
HEALTH FINDS ITSELF IN.
AND THESE CAPABILITIES.
RESIDE IN THE STAFF WHO WORK IN
PUBLIC HEALTH IN THEIR EXPERTISE
AND THEIR EXPERIENCE.
BUT IT'S THIS VERY
INFRASTRUCTURE OF TRAINED
SKILLED PEOPLE.
THAT HAS BEEN SIGNIFICANTLY
ERODED OVER THE PAST DECADE YES
WE ALSO NEED OUR DATA SYSTEMS
THE OTHER HARD CORE BUT THE
REALLY AT THE HEART OF PUBLIC
HEALTH.
ARE THE PEOPLE WHO DO THAT WORK
AND I REMEMBER VERY CLEARLY MY
IN WHEN I WAS A LOCAL HEALTH
OFFICER.
DURING THE RECESSION IN THREE
YEARS WE HAD FOURTEEN ROUNDS OF
BUDGET CUTS AND IT DIDN'T TAKE
MANY ROUNDS TO GET DOWN TO THE
ACTUAL PEOPLE.
AND THOSE THAT FUNDING AND MANY
OF THOSE PEOPLE NEVER CAME BACK.
AND SO I BELIEVE THAT THE LOSS
OF OUR EXPERIENCE PUBLIC HEALTH
WORKFORCE AT THE LOCAL LEVEL
ACTUALLY REPRESENTS A VERY REAL
THREAT TO THE HEALTH OF
CALIFORNIA.
AND THERE'S NO READY SUPPLY OF
TRAINED PUBLIC HEALTH NURSES ARE
EPIDEMIOLOGISTS OR COMMUNICATE
DISEASE INVESTIGATORS SITTING
AROUND WAITING FOR US TO CALL ON
THEM IN THE CASE OF A CRISIS.
AND IN FACT WE ARE IN A CRISIS
OUR SURPLUS RATES AS YOU KNOW.
OUR THE AT THE HIGHEST THEY'VE
BEEN IN TWENTY THE LOCAL HEALTH
DEPARTMENTS HAVE THE CAPACITY TO
ONLY INVESTIGATE A TINY FRACTION
OF THOSE CASES AND CONTACT
INVESTIGATIONS.
ARE HIGHLY LIMITED BUT WE KNOW
THAT THOSE ARE THE THINGS THAT
ARE ACTUALLY NECESSARY TO STOP
THE RISING CASES. TO TO MAINTAIN
THE CAPABILITY IS NECESSARY TO
PROVIDE THIS THE SERVICES THAT
EVERY COMMUNITY NEEDS AND
DESERVES.
REQUIRES A SUSTAINABLE FUNDING
SOURCE THAT CAN BE INVESTED OVER
TIME.
IN AN EXPERIENCED WORK FORCE
THAT CAN NOT ONLY RESPOND TO
WHAT'S HAPPENING TODAY BUT CAN
ALSO WORK INTO THE FUTURE THANK
YOU.
ASK QUESTIONS AT THE END OKAY GO
UP GOOD AFTERNOON DOCTOR PAN AND
MEMBERS OF THE COMMITTEE.
MY NAME IS DR GIL CHAVEZ I'M
DEPUTY DIRECTOR FOR INFECTIOUS
DISEASES.
I AM I AM THANKFUL FOR THE
OPPORTUNITY TO SHARE WITH YOU
SOME THOUGHTS ON THE STATE'S
CAPACITY TO ADDRESS INFECTIOUS
DISEASE THREATS.
LET ME START BY SAYING THAT
INFECTIOUS DISEASES ARE A MAJOR
COST OF AN OF ILLNESS AND DEATH
IN CALIFORNIA AND THROUGHOUT THE
WORLD.
THE VAST MAJORITY OF
MICROORGANISMS IN OUR ECOSYSTEM
WITH A KEEN ABILITY TO EVOLVE
AND ADAPT.
IN CALIFORNIA'S CRITICAL ROLE IN
INTERNATIONAL COMMERCE AND
TRAVEL.
CREATE ONGOING AND NEVER ENDING
THREATS TO OUR HEALTH AND
CONTINUOUSLY TEST AND CHALLENGE.
OUR ABILITY TO PREVENT AND
CONTROL DISEASE.
THE NUMBER OF CASES OF
INFECTIOUS DISEASES REPORTED TO
THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH BY HEALTHCARE
PROVIDERS.
HOUSE INCREASED NEARLY 45% OVER
THE LAST DECADE.
EVERY YEAR HEALTHCARE PROVIDERS
REPORT NEARLY FOUR HUNDRED
THOUSAND CASES OF NOTIFIABLE
INFECTIONS IN CALIFORNIA.
THIS EQUATES TO ABOUT ONE CASE
PER ONE HUNDRED PERSONS RESIDING
IN CALIFORNIA.
NOTIFY WILL INFECTIOUS DISEASES
ARE JUST THE TIP OF THE ICEBERG.
MANY INFECTIOUS DISEASES THAT
ARE NOT REPORTABLE ARE ALSO
AFFECTING CALIFORNIANS AND
REQUIRE PUBLIC HEALTH
INTERVENTIONS.
OUR SIXTY ONE LOCAL HEALTH
DEPARTMENTS ARE AT THE FOREFRONT
OF REVIEWING AND RESPONDING TO
ALL OF THESE THIS IS THREATS.
MANY OF THE INFECTIOUS DISEASES
WE ARE CONCERNED ABOUT IN PUBLIC
HEALTH ARE RARE.
BUT HAVE VERY SERIOUS
CONSEQUENCES.
OTHERS HOWEVER.
ARE MORE COMMON IN ACCOUNT FOR
SIGNIFICANT ONGOING BURDEN OF
THE SEAS.
THE MOST COMMON TYPES OF
INFECTIONS REPORTER IN
CALIFORNIA ARE SEXUALLY
TRANSMITTED DISEASES WHICH
INCLUDE SYPHILIS GONORRHEA AND
CHLAMYDIA.
FOLLOWED BY BY --
HEPATITIS.
RESTAURANT TESTING ALL
INFECTIONS AND VACCINE
PREVENTABLE DISEASES.
VECTOR BORNE DISEASES SUCH AS
WEST NILE VIRUS INFECTION.
FUNGAL INFECTIONS SUCH AS THE
VALLEY FEVER.
AND INFECTIONS TRANSMITTED BY
BODY FLUIDS SUCH AS HIV AIDS ARE
ALSO SIGNIFICANT CAUSES OF
MORBIDITY IN THE STATE
[inaudible]
SEASONAL INFLUENZA.
CAN COSTS YEARLY WAVES OF
INFECTIONS AND IS RESPONSIBLE
FOR UP 27% OF ALL
HOSPITALIZATIONS.
DURING THE PEAK OF THE SEASON IN
HOSPITAL VOLUNTARY REPORTING TO
SEE THE PH.
NOROVIRUS CAUSES AN ESTIMATED
58% OF ALL GASTROINTESTINAL
ILLNESSES IN THE STATE.
ALL OF THESE THESE PIECES
BECAUSE A GREAT DEAL OF
SUFFERING AND DEATH.
AND IMPOSE SIGNIFICANT FINANCIAL
BURDENS TO THE STATE PRIVATE AND
PUBLIC SECTORS.
NOW LET ME BRIEFLY DESCRIBE SOME
OF THE WORK WE DO IN PUBLIC
HEALTH.
AT THE CORE OF OUR DAILY
ACTIVITIES HE'S OUR BELIEF THAT
WE EXIST TO PROTECT THE PEOPLE
OF CALIFORNIA.
FROM THE THREAT OF REVENTABLE
INFECTIOUS DISEASES.
THE DELIVERY OF PUBLIC HEALTH
SERVICES IN CALIFORNIA INCLUDING
INFECTIOUS DISEASE PREVENTION
AND CONTROL.
HE'S ACCOMPLISHED THROUGH A
SOLID PARTNERSHIP OF FEDERAL
STATE AND LOCAL AGENCIES.
THROUGHOUT CALIFORNIA LOCAL
PUBLIC HEALTH DEPARTMENTS WITH
SUPPORT FROM CV PH.
HAVE PRIMARY RESPONSIBILITY FOR
INFECTIOUS DISEASE PREVENTION
AND CONTROL INCLUDING RESPONDING
TO POT BREAKS IN THEIR
JURISDICTIONS. ONE OF OUR JOINT
KEY ACTIVITIES ENOUGH FOUNDATION
TO ALL WE DO IS TO COLLECT AND
ANALYZE DATA FROM LABORATORIES.
AND HEALTH CARE PROVIDERS ON
EIGHTY SIX INFECTIOUS DISEASE AS
A PUBLIC HEALTH SIGNIFICANCE.
THESE SURVEILLANCE FUNCTION IS
ESSENTIAL.
BY GIVING US INTELLIGENCE FOR
THE EARLY DETECTION OF
INFECTIOUS DISEASE THREATS.
WE ROUTINELY PREPARE AND RESPOND
TO SUSPECT CASES OF BIO
TERRORISM AND OTHER EMERGES
EMERGING INFECTIOUS DISEASES A
PUBLIC HEALTH SIGNIFICANT AN
EMERGENCE AS OVER THE PAST
SEVERAL YEARS.
PUBLIC HEALTH AGENCIES IN
CALIFORNIA HAVE INVESTIGATED AND
BROUGHT UNDER CONTROL AN ALMOST
CONTINUOUS SUCCESSION OF
HUNDREDS OF INFECTIOUS DISEASE
OUTBREAKS.
IN TWO THOUSAND SIXTEEN ALONE.
CV PH RESPONDED TO MORE THAN A
HUNDRED AND FORTY OUTBREAKS.
MANY HUNDREDS MORE WERE
INVESTIGATED AND ADDRESS LOCALLY
WITHOUT SEE THE PH SUPPORT.
THESE OUTBREAKS VARY IN SIZE
FROM A HANDFUL OF INDIVIDUALS TO
HUNDREDS OF PEOPLE.
IN VARIOUS SEVERITY FROM MILD TO
VERY SEVERE.
IN EVERY INSTANCE SWIFT PUBLIC
HEALTH ACTION PROVED TO BE
EXTREMELY IMPORTANT FOR
CONTAINMENT [inaudible]
OFTEN.
PUBLIC HEALTH AGENCIES MUST PULL
STUFF FROM ONGOING COMMUNICABLE
DISEASE ACTIVITIES.
SUCH AS TASTY THE CONTROL AND
PROMOTION OF THE MANY SESSIONS
TO ADDRESS PUBLIC HEALTH
EMERGENCIES.
THUS THE ADDED WORKLOAD OF
EMERGENCY RESPONSE HAS RESULTED
IN SIGNIFICANT STRESS.
ON ALL COMMUNICABLE DISEASE
CONTROL EFFORTS.
MAINTAINING AN EXPANDED THE
CAPABILITIES TO PREVENT
INFECTIOUS DISEASES IS BOTH
ESSENTIAL IN CHALLENGING.
AS A LOCAL HEALTH DEPARTMENTS
AND SEE THE PH FACE AN
INCREASING NUMBER OF INFECTIOUS
DISEASES.
AT THE INDIVIDUAL LEVEL AN
OUTBREAK SO THE COMMUNITY LEVEL
WE FIND OURSELVES CONSTANTLY
CHALLENGED TO RESPONDING CARRY
OUT OUR IMPORTANT PUBLIC HEALTH
WORK.
I AM CONFIDENT THAT WE CAN
SUCCESSFULLY INITIATE A RESPONSE
TO ANY SINGLE INFECTIOUS DISEASE
THREAT.
HOWEVER HANDLING MULTIPLE
THREATS AT THE SAME TIME OR
SUSTAINING A VERY LENGTHY AND
PROTRACTED RESPONSE WITHOUT
AFFECTING.
OUR DAILY WORK WE CONTINUE TO
PRESENT SIGNIFICANT CHALLENGES.
THANK YOU ONCE AGAIN FOR THE
OPPORTUNITY TO TESTIFY.
GOOD AFTERNOON MISTER CHAIR AND
MEMBERS MY NAME IS SUSAN VALLEY
I'M THE CHIEF DEPUTY OF POLICY
AND PROGRAMS IN OUR DEPARTMENT.
I THANK YOU FOR THE OPPORTUNITY
TO SHARE INFORMATION ABOUT THEM --
PREPAREDNESS AND EMERGENCY THAT
BREAKS SEE PAGE HAS RESPONDED TO
AN INCREASING NUMBER AND
SEVERITY OF OUTBREAKS --
OF DISASTERS SUCH AS WILDFIRES
FLOODS EXTREME HEAT EVENTS
EARTHQUAKES --
DROUGHT POWER OUTAGES YOU NAME
IT -- AND
MANY INFECTIOUS DISEASES FROM
EBOLA EBOLA TO SEEK OUT THE H.
ONE AND ONE AND HEPATITIS A
UNDER THE STATE EMERGENCY PLAN
THE DEPARTMENT PUBLIC HEALTH IN
PARTNERSHIP WITH EMSA SERVES AS
A CO LEAD FOR EMERGENCY FUNCTION
EIGHT PUBLIC HEALTH A MEDICAL.
IN THIS ROLE WE WORK WITH THAT --
GOVERNOR'S OFFICE OF EMERGENCY
SERVICES TO COORDINATE PUBLIC
HEALTH AND MEDICAL PREPAREDNESS
AND RESPONSE DURING AN EMERGENCY.
I WE WORK WITH OTHER DEPARTMENTS
WITHIN OUR HEALTH AND HUMAN
SERVICES AGENCY AND WE CERTAINLY
WORK WITH OUR LOCAL PARTNERS.
ALL OF THESE ACTIVITIES ARE
ORGANIZED UNDER OUR PUBLIC
HEALTH AND MEDICAL RESPONSE
STRUCTURE AND MATT AND ON IS
ACKNOWLEDGED IN THE EMERGENCY
PLAN.
THE PURPOSE OF PUBLIC HEALTH AND
MEDICAL RESPONSE SYSTEM IS TO
BUILD A COP COMMON OPERATIONAL
FRAMEWORK TO SUPPORT EFFECTIVE
INFORMATION FLOW BETWEEN LOCAL
REGIONAL AND STATE PARTNERS AND
TO SUPPORT EFFICIENT RESPONSE
WHEN ADDITIONAL RESOURCES ARE
NEEDED.
THAT EXCEED THE LOCAL RESPONSE
CAPABILITIES INCLUDING
COORDINATION OF MUTUAL AID
ACROSS JURISDICTIONS.
THE PILLARS OF THIS RESPONSE
SYSTEM ARE THE LOCAL MEDICAL AND
HEALTH OPERATIONAL AREA
COORDINATOR.
LOVINGLY CALLED THE MOHAWK
PROGRAM WHICH HAS SEVENTEEN
PUBLIC HEALTH AND MEDICAL
FUNCTIONS UNDER STATUTE.
THE REGIONAL DISASTER MEDICAL
AND HEALTH SPECIALIST CO SUPPORT
IT BY -- IN
EACH MUTUAL AID READ MS AGENCY
AND THE STATE.
AND THE STATE MEDICAL HELP
COORDINATION CENTER AND OUR
CENTERS AND PROGRAMS THIS
STRUCTURE EXPANDS AND CONTRACTS
BASED ON THE NEEDS OF THE IMPACT
IT LOCAL JURISDICTION OR
JURISDICTIONS.
IN ORDER TO DESCRIBE THE STATE
LOCAL ROLE I THOUGHT I WOULD
GIVE YOU JUST A FEW EXAMPLES OF
HOW WE WORK TOGETHER IN EACH ONE
AND ONE THE PANDEMIC INFLUENZA
AND IN THE RECENT CAMPFIRE.
AB SO IN EACH ONE AND ONE ONCE A
PANDEMIC INFLUENZA IS VIRUSES
IDENTIFIED SEE THE PAGE AND
LOCAL JURISDICTIONS COORDINATE
ON HAND AND ENHANCED.
LABORATORY SURVEILLANCE
ACTIVITIES ON LABORATORYTESTING --
CD PAGE WORKS WITH LOCAL
JURISDICTIONS TO DEVELOP A
VACCINE ALLOCATION AND
DISTRIBUTION PLAN BASED ON THE
EPIDEMIOLOGY AND DISTRIBUTION OF
THAT THE DISEASE WITH IN
CALIFORNIA.
AND WE WORK TOGETHER TO
EFFECTIVELY DISTRIBUTE AND
SUBSEQUENTLY REDISTRIBUTE BACK
SCENE BASED ON ABILITY.
AVAILABILITY AND NEED --
SEE PAGE AND LOCAL JURISDICTIONS
WORK TOGETHER TO IMPLEMENT
VACCINATION CAMPAIGNS TO MAKE
SURE PEOPLE UNDERSTAND THE NEED
FOR VACCINATION.
SEE THE PAGE AND LOCAL
JURISDICTIONS WORK TOGETHER TO
ASSESS AND RECOMMEND THE NEED
AND TIMING FOR NON FORMER
SUITABLE INTERVENTIONS SUCH AS
SCHOOL CLOSURES CANCELING MASS
GATHERINGS AND SO MANY OF THOSE
THINGS THAT WE DID DURING H. ONE
ON ONE IN THE RECENT CAMPFIRE.
WE WORK TOGETHER AND WE
ACTIVATED OUR MEDICAL HEALTH AND
COORDINATION CENTER TO
COORDINATE PUBLIC HEALTH AND
MEDICAL RESPONSE ACROSS
DEPARTMENTS AND WITH OUR LOCAL --
PARTNERS CREATING A COMMON
OPERATING PICTURE WITH A DAILY
SITUATION REPORT THAT INCLUDES
ALL THE ACTIVITIES BOTH STATE
AND LOCAL AND SHARE THAT OUT.
WE MONITOR AND TRACK THE IMPACT
TO HEALTHCARE FACILITIES AND
THAT INCLUDES OUR OWN FACILITIES
THAT WE LICENSE AS WELL AS
AGGREGATING AND MAPPING ALL OF
THE FILM FACILITIES THAT HAVE
OVERSIGHT UNDER OUR HEALTH AND
HUMAN SERVICES AGENCY.
WE ASSIST THEM HEALTHCARE
FACILITIES CAN YOU. TO HELP THEM
TO CONTINUE THEIR OPERATIONS AND
TO EVACUATE PATIENTS AND THAT IS
A JOINT RESPONSIBILITY AT THE
STATE AND LOCAL LEVEL.
I'M AND WE CONTINUE TO PROVIDE
THAT INFORMATION TO OUR LOCAL
PARTNERS.
WE ALSO --
PROVIDE GUIDANCE TO OUR LOCAL
HEALTH JURISDICTIONS AND OFTEN
INVOLVE THEM IN AND DEVELOPING
THE GUIDANCE SUCH AS AIR QUALITY
THE USE OF AN NINETY FIVE
RESPIRATORS DEBRIS REMOVAL AND
HEALTH OFFICER EMERGENCY POWERS --
WE ALSO PROVIDE --
EPIDEMIOLOGIC SUPPORT EXPERTISE
TO THE LOCAL HEALTH DEPARTMENT
STAFF TO ASSIST IN TRACKING
THINGS LIKE THE NOROVIRUS
OUTBREAK IN --
BE COUNTY SHELTERS AND IN SOME
CASES WHERE THERE'S LIMITED
STAFF AND THE STAFF ARE IMPACTED
AT THE LOCAL LEVEL BY THE M.
EMERGENCY WE IN THE CASE OF
BUTTE COUNTY ALSO RE DIRECT AT
SOME OF OUR STAFF.
FROM OTHER PROGRAMS TO DEPLOY A
INFECTION CONTROL TEAMS TO MANY
SHELTERS IN BUTTE COUNTY --
IN PRIOR FIRES ARE BILL HAS
REALLY BEEN MORE OF TECHNICAL
ASSISTANCE ON INFECTION CONTROL
BUT WE NOW RECOGNIZE THAT PRETTY
CANYON SMALL COUNTIES HERE MAY
BE A NEED.
FOR THE EARLIER WE GOT AND INTO
THE SHELTERS THE BETTER WE WILL
BE ABLE TO CONTROL INFECTION.
I WE ALSO PROVIDE FACTSHEETS ON
NOR OF SHELTER INTAKE KINDS OF
THINGS SO AS I'VE TRIED TO
DEMONSTRATE CRITICAL TO
EFFECTIVE AND TIMELY RESPONSE IS
THE EXPERTISE AND ACTIONS OF
BOTH LOCAL AND STATE STAFF.
AND THE INFRASTRUCTURE THAT WE
BUILT WORKING TOGETHER WITHIN
THE OVERALL PUBLICHEALTH AND
MEDICAL RESPONSE STRUCTURE IN
ORDER TO MEET THE NEEDS OF THOSE
IMPACTED JURISDICTIONS SO THANK
YOU FOR THE OPPORTUNITY. TO
TESTIFY TODAY THANK YOU THANK
YOU ALL FOR YOUR PRESENTATIONS --
QUESTIONS.
OKAY.
ALL RIGHT.
SO --
BLACKSMITH BLACKSMITH --
SO -- I MADE
REFERENCE IN MY REMARKS ABOUT
THE THE CURRENT PUBLIC HEALTH
BUDGETS.
YOU TALK ABOUT THE CORE
FUNCTIONS OF PUBLIC HEALTH --
AND IN THE PARTS OF THE SERVICE
STAFF CAPACITY SO I GUESS ONE OF
THE QUESTIONS I HAVE FOR YOU IS
GIVEN THE FACT THAT ONLY A SMALL
FRACTION OF THE BUDGET IS
ACTUALLY FROM STATE FUNDS
[inaudible]
OR TO WHAT DEGREE ARE YOU
DEPENDENT ON THE STATE FUNDS TO
MAINTAIN THE STATUS OF BECAUSE
THE FEDERAL FUNDS AND CENTER
FROM GRANTS FOR A SPECIFIC
PURPOSE IS NOT JUST LIKE THE
FEDERAL GOVERNMENT WROTE A BIG
CHECK AND SAID HERE USES FOR
PUBLIC HEALTH THEY HAVE.
THEIR IT IT'S FOR VERY SPECIFIC
THINGS.
SO.
CAN YOU SPEAK TO THE ROLE OF THE
STATE GENERAL FUND IN TERMS OF%
MAINTAINING THAT CORE
INFRASTRUCTURE PIECE THAT YOU
TALKED ABOUT THAT CORPS STAFF.
I MEAN --
ONLY JUST POSING AS A RELATED
QUESTION THAT MAYBE CAN A PUBLIC
HEALTH EMERGENCY YOU HAVE PEOPLE
WHO ARE BEING PAID FOR FEDERAL
FUNDS TO DO VERY SPECIFIC THINGS.
WHAT THREE CAN YOU PULL PEOPLE
WHO ARE BEING PAID TO DO TASKS
FOR THE FEDERAL GET THAT THAT
THAT FEDERAL FUNDS ARE PAYING
FOR AND PULL THEM OUT OF THE
THAT WORK AND SAY NO WE GOT WORK
ON THIS STATE HEALTH EMERGENCY
THAT WE HAVE?
AND YANK THEM OUT OF AND HOW
DOES THAT AND AND DOES THE
FEDERAL GOVERNMENT GO WELL GEE.
THEY'RE NOT DOING THE WORK THAT
WE'RE PAYING FOR THE FOR WHY WE
STILL PAYING THEM RIGHT NOW SO A
BABY THEY COULD SPEAK ABOUT HOW
THE FUNDING STRUCTURE AFFECTS
YOUR ABILITY TO BUILD THE KIND
OF STAFF CAPACITY.
YOU SAY THE STATE NEEDS.
YEAH THANK YOU FOR THE QUESTION
YOU'RE YOU'RE ABSOLUTELY RIGHT
THE FEDERAL MONEY IS
OVERWHELMINGLY THE MONEY THAT WE
USE PARTICULARLY FOR THE
FUNCTIONS THAT WE SHARE WITH
LOCAL PUBLIC HEALTH --
AND IT IS IN FACT QUITE SILOS BY
DISEASE TYPE IT CETERA THERE ARE
A COUPLE OF FUNDING STREAMS FROM
FEDERAL GOVERNMENT THAT ALLOWS
US A LITTLE MORE LATITUDE
PARTICULARLY FOR INFRASTRUCTURE
ONE OF THOSE IS THE PREVENTION
PUBLIC HEALTH FUND.
WHICH IS A TYPE OF BLOCK GRANT --
IT'S ONE OF THE THINGS THAT WE
WATCH MOST CAREFULLY IN CONGRESS
BECAUSE IT'S BEEN UNDER ATTACK
SINCE IT WAS FIRST CREATED AND
SO THAT'S NOT A VERY RELIABLE
SOURCE BUT WE USE THAT ALONG
WITH FUNDING THAT WE HAVE THAT
ALLOWS US --
TO BUILD AND MAINTAIN OUR DATA
SYSTEMS FOR EXAMPLE AND OUR
EPIDEMIOLOGY CAPACITY SO THAT WE
CAN TRAIN PEOPLE ACROSS SERVICES.
THE ISSUE OF REDIRECTING STAFF
THE FEDERAL GOVERNMENT DIDN'T
THIS WAS PART OF A CONVERSATION
ACTUALLY WITH LOCAL AND AND
STATE PUBLIC HEALTH OFFICERS --
AFTER EACH ONE AND ONE AND
AROUND THE THE PANDEMIC AND ALL
HAZARDS PREPAREDNESS.
FUND WAS AROUND.
THERE ARE A THE YOU TO RE DIRECT
STAFF PAID FOR WITH FEDERAL
FUNDS UP 25% OF THEIR TIME.
SO AS SOON DOCTOR CHAVEZ POINTED
OUT POINTED OUT WE'RE VERY GOOD
AT SMALL SHORT TERM THINGS WE
BEGIN TO STRUGGLE WHEN IT
REQUIRES A LONGER TERM.
REDIRECTION OF STAFF AND WHAT
ENDS UP HAPPENING IS THE OTHER
WORKED SIMPLY DOESN'T GET DONE.
AND AND OR WHAT EVERYONE WHO IS --
NOT ON AN HOURLY SCHEDULE
MANAGERS AT CENTER I WORKED VERY
VERY LONG HOURS TO TRY TO MAKE
IT WORK --
I'M VERY PROUD OF THE WORK THAT
WE DO BUT IT IS A CONSTANT
STRUGGLE AND I WILL SAY THAT
THAT VERY SAME STRUGGLE PLACE
OUT.
AT THE LOCAL JURISDICTION I
WOULD ALSO POINT OUT THAT MUCH
OF THE GENERAL FUND THAT WE
RECEIVE.
ALMOST ALL OF IT IS ACTUALLY
ALSO SIDELOAD LESS THAN 4% OF
OUR BUDGET IS ACTUALLY FLEXIBLE
ME[inaudible]
OKAY.
AND WHEN YOU SPOKE ABOUT THE THE
I GUESS THE BLACK IS IT
BASICALLY STAFF EXPERTISE WHY I
MEAN BY THAT IS IS THAT IT'S NOT
THE EXPERTISE OF PEOPLE
CURRENTLY THERE BUT JUST BE IT'S
IT'S THE NUMBER OF PEOPLE YOU
HAVE TO HAVE THE EXPERTISE RIGHT
IT'S NOT.
I GUESS WE DON'T WE DON'T HAVE
WE DON'T WE DON'T HAVE.
WE'RE NOT PAYING EPIDEMIOLOGISTS
AND PUBLIC HEALTH NURSES TO SIT
AROUND WITH THE ALARM THAT GOES
OFF WHEN IT RIGHT THERE THEY'RE
DOING EXISTING TASKS.
WHICH WE COULD ALL RIGHT THIS IS
A HAS THERE BEEN ASSESSMENT DONE
IS TO SO WHAT IS THE SHORTFALL I
MEAN I REALIZE THERE'S OBVIOUSLY
SOME JUDGMENT TO BE MADE WHAT
WHAT HOW MANY WHAT IS THE WHAT
WHAT WOULD BE THE GOAL NUMBER
BUT IT WHEN YOU SAY WE SO.
WHEN YOU'RE TRYING TO HIRE
PEOPLE OR WHEN THERE'S --
EVENTS THAT HAPPENED --
CAN R. V. LIKE A LITTLE SHORTER
A LOT SHORTER --
WHAT FOR SALE LIKE WE COULD USE
TWICE AS MANY AS WE HAVE NOW OR
SOME SOME?
ANALYSTS SAY THAT I DON'T THE I
THINK THAT FOR SPEAKING FOR CPAS.
I DON'T THINK THAT OUR SHORTFALL
IS PARTICULARLY DRAMATIC AYE OUR
CHALLENGE IS NOT SO MUCH THE
TOTAL AMOUNT OF FUNDING AS THE
WAY THE FUNDING COMES TO US. TO
DO VERY VERY VERY CREATIVE IN
ORDER TO SEARCH PARTICULAR
ACTIVITIES WE'VE BEEN VERY
SUCCESSFUL FOR THAT --
I WORRY ABOUT THE PANDEMIC THAT
TAKES TWO YEARS --
WE WILL WE WILL BURN OUT WE HAVE
NOT DONE A FORMAL ASSESSMENT OF
WHAT THAT WOULD LOOK LIKE FULLY
FLESHED OUT WHERE IT BECOMES
CRITICAL REALLY IS AT THE LOCAL
LEVEL AND I'M SURE YOU'LL HEAR
ABOUT THAT WHEN YOU HAVE. ONE OR
TWO PUBLIC HEALTH NURSES IT TOOK
US TWO YEARS TO HIGHER WHEN I
WAS IN AFFECT PUBLIC HEALTH
OFFICER TOOK US TWO YEARS TO
HIRE COMMUNICABLE DISEASE PUBLIC
HEALTH NURSE.
BECAUSE THERE ARE SO FEW OF THEM
OUT THERE --
AND BECAUSE THEY CAN MAKE MUCH
MORE MONEY OBVIOUSLY IN THE
PRIVATE SECTOR.
SO KEEPING THE PEOPLE THAT
YOU'VE INVESTED IN THAT YOU'VE
TRAINED IT IS NOT EASY TO DO A
CONTACT INVESTIGATION WHETHER
IT'S FOR TUBERCULOSIS OR
NOROVIRUS WARS MEASLES.
AND TO EXPECT US TO BE ABLE TO
SORT OF JUST GO OUT AND HIRE NEW
PEOPLE -- IS
REALLY TAKES ABOUT TWO YEARS TO
BECOME REALLY PROFICIENT AND
THAT'S WHY WHAT WE HAVE FOCUSED
ON DOING IS TRYING TO PROVIDE
THAT TECHNICAL EXPERTISE.
AND SUPPORT AS LOCAL HEALTH
JURISDICTIONS TRY TO TO HANDLE
THESE ISSUES.
THE OTHER DISTURBING AYE
ANECDOTALLY OF THERE COUNTIES
WHEN DISCUSSING YOU KNOW WHERE
THEY'RE GOING TO CUT GENERAL
FUND USUALLY COMMUNICABLE
DISEASES BECAUSE IT IS LARGELY
FUNDED AT THE LOCAL LEVEL BY
COUNTY GENERAL FUND --
SAY WELL IT'S OKAY BECAUSE IF
YOU CAN'T RESPOND THE THE STATE
WILL COME WE DON'T HAVE A A
WORKFORCE THAT DOES BOOTS ON THE
GROUND --
ANSWER THAT JUST HAVING TO DO
THAT THE SHELTERS FOR A SHORT
PERIOD OF TIME WHERE TO PULL
FROM MULTIPLE DIFFERENT PARTS OF
THE DEPARTMENT. TO IMAGINE THAT
WE WOULD BE ABLE TO MOBILIZE A
WORK FORCE TO GO IN AND DO A
CONTACT AN INVESTIGATION AND IT
COMMUNITY THAT WE DON'T KNOW.
IS IT'S JUST NOT REALISTIC AND
SO -- WE
REALLY DO NEED THAT LOCAL
INFRASTRUCTURE TO BE ROBUST
ENOUGH TO MAINTAIN.
SO YOU YOU SERVE ANTICIPATE WHAT
MY NEXT QUESTION WAS WHICH IS
GOING TO BE IS THAT WHAT WHAT
HAPPENS IF YOU HAVE A LOCALITY.
THAT HAS INSUFFICIENT PUBLIC
HEALTH STAFF TO DEAL WITH A
PUBLIC HEALTH EMERGENCY AN
OUTBREAK --
WELL WHAT DO IT WHAT DO YOU DO.
ONE THING THAT HAS HAPPENED --
AND THAT THE THE BOTH --
THE CALIFORNIA COMFORTS OF LOCAL
HEALTH OFFICERS AND HEALTH
OFFICERS ASSOCIATION CHECK HAVE
BEEN REALLY GOOD ABOUT REACHING
OUT TO OTHER COUNTIES THE PUBLIC
HEALTH OFFICER BY THE WAY IS
MOSTLY ALWAYS ONE PERSON IN A
SMALL COUNTY AND IT'S EXHAUSTING
THAT SOMETIMES THEY'RE WORKING
FOR A MILTON YOU'RE.
GOING TO HEAR FROM YOU COUNTY
ABOUT THEIR EXPERIENCE AND SO
OTHER HEALTH OFFICERS WE SHIPS
FOR THEM WORK FOR SEVERAL DAYS
IN A ROW AND HELP OUT.
I'M THAT KIND OF MUTUAL AID IS
AT THIS POINT RELATIVELY
INFORMAL.
BUT IN A IN A LARGE EVIDENT
WE'RE WE'RE PRETTY ROBUST IN
TERMS OF EPIDEMIOLOGY CAPACITY
AT THE DEPARTMENT.
SO I DON'T FORESEE A
CIRCUMSTANCE --
WHERE WE'RE NOT GONNA BE ABLE TO
PROVIDE THAT KIND OF TECHNICAL
ASSISTANCE BUT BOOTS ON THE
GROUND IT'S GOING TO BE
BORROWING FROM EACH OTHER AND
POTENTIALLY AS HAS HAPPENED IN
NATURAL DISASTERS BORROWING FROM
OTHER STATES?
PEOPLE WHO ACTUALLY KNOW HOW TO
DO THE TECHNICAL PARTS
PARTICULAR COMMUNICABLE DISEASE
CONTROL AND I WOULD HATE TO SEE
THIS HAVE TO DO THAT FRANKLY.
AS SERVER SO
YES PLEASE PLEASE YES ASSEMBLY.
SO COULD YOU GO BACK TO WHAT YOU
SAID ABOUT IT'S NOT THE FUNDING
IT'S THE WAY YOU RECEIVE IT.
RIGHT SO I'M SPEAKING OUT FOR
THE DEPARTMENT OF PUBLIC HEALTH
OKAY LEVEL WE GOT WE HAVE OVER
TWO HUNDRED SEPARATE FUNDING
STREAMS ALMOST EVERY ONE OF THEM
IS DISEASE OR CONDITION SPECIFIC.
AND SO IF YOU HAVE TO DIABETES
FUNDING YOU MAY HAVE AN
EPIDEMIOLOGIST TO DO THAT.
BUT THAT'S ALL THAT PERSON CAN
WORK ON EXCEPT FOR THAT
FEDERALLY ALLOWABLE 5% FOR
EMERGENCIES OR DISASTERS.
SO HOW DO YOU SUGGEST WE MAKE
THAT BETTER FOR YOU.
IT BUT I LIKE I WAS GOING
CONVERSATION OKAY FEDERAL
GOVERNMENT ON FRANKLY OKAY I I
ALSO I DO THINK THOUGH THAT
THERE IS A ROLE --
FOR FOR STATE FUNDING TO KIND OF
BRIDGE GAPS --
POTENTIAL A BUT THAT'S NOT
SOMETHING WE LOOKED INTO AND AT
ANY ANY IN ANY DETAIL.
IF YOU COMPARE THE DEGREE OF LOW
IT GOES INTO LOCAL HEALTH
DEPARTMENTS WITH THE AMOUNT OF
STATE GENERAL FUND THAT COMES.
TO THE STATE HEALTH DEPARTMENT
YOU'LL SEE THEY'RE VERY
DIFFERENT.
THANK YOU THANK YOU MISTER US
CHAIR -- SO
ACTUALLY THE IT.
I ALSO WANT TO SO IN TERMS SO
ACTUALLY THIS IS THERE BEEN SOME
CONVERSATIONS --
AND AND WE SERVE HAVE YOUR
SEPARATE PANELS AND I'M VERY
MUCH LOOKING FORWARD TO HEARING
FROM THE LOCAL HEALTH
DEPARTMENTS.
TO THAT IS YOUR BEEN SOME
CONVERSATION ABOUT A MUTUAL AID
SYSTEM LIKE THE FIRE DEPARTMENTS
HAVE --
WHERE WE TRY TO FIGURE OUT HOW
WE -- BUILD
UP SOME.
I REALIZE THAT REQUIRES SOME
RESOURCES BUT BUILD UP SOME
BASICALLY SOME EXTRA CAPACITY
AND CERTAIN LOCALITIES TO TRY.
TO TAKE THAT ONE OKAY HEARD OF
US ABOUT HOW THE MEDICAL
RESPONSE STRUCTURE AND IN FACT
WE DO HAVE A AND RIVERSIDE
COUNTIES HERE AND I KNOW THAT
THEY ARE ONE OF THE COUNTIES
THAT REALLY JUMPS AND THAT WITH
MUTUAL AID --
ASSISTANCE AND SO.
PART OF THE SYSTEM THAT WE'VE
BUILT IS TO ALLOW WITHIN EACH
REGION COUNTIES TO WORK TOGETHER
TO USE EACH OTHER'S RESOURCES
AND AND SOME --
REGIONS WE'VE AND DO HAVE
AGREEMENT SOMEHOW THEY WILL PAY
ONE ANOTHER WHEN THEY COME IN
BUT IT IS.
A FOR FOR A LONGER EVENT IT DOES
REQUIRE DOLLARS BETWEEN.
SO I I GUESS MY NEXT QUESTION IS
FIFTH TALKED ABOUT THE NEED TO
SHORE UP THE MUTUAL AID SYSTEM
BECAUSE THE QUESTION IS HOW MUCH
EXCESS COULD PASS.
RIGHT NOT THE RIGHT WORD RIGHT
BUT I MEAN HOW MUCH CAPACITY IS
THERE.
YOU CAN HAVE A MUTUAL AID SYSTEM
THAT IS OF VERY LITTLE CAPACITY
TO MOVE AROUND I MEAN IT HELPS A
LITTLE BIT YEAH SO HOW MUCH SO
ANSWERS ESTIMATE ABOUT HOW MUCH.
CAPACITY THAT V. L. OBVIOUS YEAH
WE WE ALSO SAY I DON'T KNOW WHAT
OUTBREAK WILL HAPPEN EVERY YEAR
BUT THIS YOU KNOW BETTER AND I I
CAN ALWAYS COUNT ON AT LEAST ONE
OR TWO THAT SIGNIFICANT ONES
NEARBY Là SMALLER ONES AS AS AS
AS AS PRESENTED EARLIER BUT I WE
SHOULD.
BE THINKING ABOUT WHAT LEVEL OF
THE PASSAGE WE HAVE OUT THERE
THAT PERHAPS.
YOU KNOW THAT COULD BE
DISTRIBUTED ACROSS DIFFERENT
COUNTIES FOR YOU TO TO TO TO BE
SURE TO USE THAT VOTE WHAT
BASICALLY WHAT THE MINIMUM
CAPACITY WE SHOULD HAVE TO OUR
MUTUAL AID SAYS. SEVEN SOME
ASSESSMENT OF THAT.
THERE HASN'T FORMALLY THERE IS
THERE A COUPLE OF AREAS WHERE
THEY'RE ACTUALLY HAVE BEEN.
WELL WHEN AREA WHERE WE'VE
ACTUALLY MADE A FAIR AMOUNT OF
PROGRESS AND THAT'S THE
LABORATORY CAPACITY BECAUSE IN
OUTBREAKS THOSE HAVE TO SEARCH.
AND IN HISTORICALLY IT WAS ONE
ONE COUNTY ONE LABORATORY AND
THAT'S JUST IT'S WITH NEW
LABORATORY TECHNOLOGY NOT
FEASIBLE --
AND SO THERE ARE SEVERAL
DIFFERENT MODELS OF REGIONAL
LABORATORIES IN CALIFORNIA AND
SOME OF WHICH ARE VERY --
VERY SUCCESSFUL TYPES OF SUMMER
GPA IS SOME ARE --
CONTRACT IS AND ONE THAT'S A
THAT'S ACTUALLYWE'VE BEEN.
LOOKING AT THOUGHT MORE
CONSISTENTLY TO SEE BECAUSE OURS
COUNTIES DETERMINED THAT.
IT MAY NOT BE FEASIBLE FOR THEM
TO MAINTAIN THEIR PUBLIC HEALTH
ARE THEY DO HAVE CERTAIN
CAPACITIES THAT THEY MUST
MAINTAIN.
HOW DO WE MAKE THAT POSSIBLE AND
SO THAT'S AN AREA THAT WE HAVE
HAD CONVERSATIONS INTERMITTENTLY
IN THE PAST AROUND?
COULD WE DO SOMETHING SIMILAR
WITH EPIDEMIOLOGY CAPACITY
REGIONAL AS IT WE EVERY TIME
THAT WE'VE HAD STARTED THOSE
CONVERSATIONS I HAVE NOT BEEN AT
THE STATE DURING THAT
CONVERSATION BUT AS A LOCAL --
WE RUN INTO CHALLENGES WITH HOW
IS IT PAID FOR BECAUSE THE
FUNDING. FOR MANY OF THOSE
ACTIVITIES COMES FROM FEDERAL
GOVERNMENT GOES DOWN FROM US TO
COUNTIES WE HAVEN'T WE NEED TO
BE MORE CREATIVE AND IN HOW WE
CAN FIND AN ENTITY THAT DOESN'T
ACTUALLY LEGALLY EXIST LIKE A
COLLABORATIVE.
AND SO THAT I THINK IS BUT I
ALSO THINK THERE'S AN APPETITE
FOR THOSE CONVERSATIONS OVER
TIME.
SO DO YOU A THE CITY HAVEN'T
PERFORMED ANY SUCH ASSESSMENT IS
THAT SOMETHING THAT THE
DEPARTMENT MIGHT WANT TO
CONSIDER DOING.
I THINK THAT I AT THE VERY LEAST
WE SHOULD TALK ABOUT WHAT WHAT
WOULD --
WHAT ARE THE CAPACITIES WERE
TALKING ABOUT THAT WE WOULD WANT
TO MAKE SURE WERE PRESENT IN A
CERTAIN RIGHT THE PAST YOU FOR
PARTICULAR SPECIFICALLY FOR
RESPONSE --
TO AN EVENT.
AND I THINK THAT MULTIPLE.
MULTIPLE IS YES WHICH IS TO OUR
OUR NEW NORM ACTUALLY SO --
THAT IS ACTUALLY THAT SOMETHING
I CAN TAKE BACK TO THE CAL FOR
COMFORT OF LOCAL HEALTH OFFICERS
WHICH IS OUR ADVISORY BODY ON
THESE ISSUES AND SEE IF THEY
WOULD LIKE TO HAVE THAT
CONVERSATION --
OUT WHAT ARE THE PARAMETERS AND
THEN -- WHAT
THAT WOULD LOOK LIKE BUT I THINK
THAT IT'S IT IS A DURABLE
CONVERSATION WELL I I WOULD TO
AND WILL HAVE THE LOCAL HEALTH
AUSTRALIA MAY INNER CITY THE
AUDIENCE RIGHT NOW I WOULD
SUGGEST THAT MIGHT BE SOMETHING
TO HAVE A CONVERSATION ABOUT TO
NOT ONLY A CONVERSATION?
SO THIS WAY CERTAINLY HERE AT
THE LEGISLATURE WE DEPEND ON
YOUR EXPERTISE YOU KNOW YOUR
EXPERTISE AT THE STATE
DEPARTMENT THE EXPERTISE OF THE
LOCAL HEALTH DEPARTMENTS.
WE NEED YOU TO COME TO US AND
SAY THIS IS WHAT WE NEED. TO
KEEP PEOPLE SAFE.
I CAN TRY TO GUESS I CAN TRY SAY
I WANT TO OFFER SOMETHING BUT
AND I KNOW IT'S NOT THIS REALLY
EASY BUT WE NEED YOU TO TELL US
WHAT YOU NEED.
YEAH WE GOT THE BALLOT SET OFF
AGAINST A LOT OF OTHER THINGS
BUT IF I DON'T HAVE SOMETHING IN
FRONT OF ME TO SAY WELL THIS IS
WHAT OUR HEALTH OFFICER SAID.
THIS IS WHAT WE NEED THIS IS
WHAT WE CAN BE ABLE TO DO WITH
THAT RESOURCE WE HAVE THIS IS
WHAT HAPPENED WE DON'T HAVE THEM.
IT'S HARD FOR ME TO HELP YOU
HELP ME OUT THAT YOU NEED I NEED
YOU TO HELP ME HELP YOU SO WE
CAN HELP THE PEOPLE CALIFORNIA
SO I WOULD SUGGEST HAVING A
CONVERSATION ABOUT WHAT.
YOU NEED.
SO THAT WE CAN --
THE BILL TO DO OUR JOBS 8% AT
THE END THE LEGISLATURE --
CAN DO THAT.
THANK YOU ALL RIGHT I APPRECIATE
THAT I I APPRECIATE YOU PERCENT
ABOUT H. ONE AND ONE BECAUSE IN
OUT A ROOMMATE THAT YOU THAT WAS
WHICH HERE AGAIN WAS THAT.
THE NINE TWO THOUSAND AND NINE
AND I A REMEMBER --
AT THAT THE WHO'S HERE SECOND
OKAY AT THE TIME I WAS NOT THE
LEGISLATURE I WAS VERY INVOLVED
IN THAT MEDICAL ASSOCIATION AND
I REMEMBER HAVING A CONVERSATION
WITH THE THEN PUBLIC HEALTH
OFFICER.
I DON'T WILL GET ANYBODY IN
TROUBLE THE FOR THE ALL THE
OFFICER WHO TOLD ME --
THAT.
BASICALLY --
THAT WAS DURING THE GREAT
RECESSION.
AND TOLD AND ACTUALLY WHEN THE
OUTBREAK WAS HAPPENING.
THAT -- THE
ONLY REASON SHE WAS ABLE TO
MOBILIZE PEOPLE SHE COULD AT THE
COUNTY.
WAS A BECAUSE THAT HAPPENED THAT
THAT THE EVENT TO THE H. ONE N.
ONE THE ISSUE THAT WAS HAPPENING
RIGHT BEFORE.
THOSE PEOPLE WHO SHE NEEDED TO
USE WERE LAID OFF THEY ARE HAVE
THE PINK SLIPS.
JERRY HAD THEIR PINK SLIPS THEY
WERE ON THEIR WAY OUT BUT THEY
STILL HADN'T LEFT YET AND SO SHE
SAID SHE WAS ACTUALLY ABLE TO
MOBILIZE A RESPONSE AND REACH
OUT TO ALL THE SCHOOLS WRITERS
Là READ SCHOOS THAT WERE
INVOLVED AND SO FORTH.
AND THAT IS THAT IS THAT THIS IT
HAPPENED JUST A COUPLE MONTHS
LATER.
DO YOU KNOW IF YOU DO.
I GUESS YOU A CALLED YOU UP AND
SAID -- LOOK
AT ALL THE PEOPLE YOU HAVE
SITTING AROUND RIGHT.
RIGHT.
RIGHT AND THAT'S AN ANYTHING
THAT BECAUSE THAT'S THAT'S THE
CLASS WAS ASKING THE QUESTION
ABOUT I APPRECIATE YOU YOU
DRESSED UP LIKE.
IT IT THERE AREN'T LIKE IT WE
DON'T HAVE A WHOLE PEOPLE
SITTING AROUND WAITING FOR THE
NEXT THING TO HAPPEN AND THEY'RE
BUSY DOING OTHER STUFF AND WEAK
AND THE ACTORS IN THIS ARMY OF
PEOPLE AT THE STATE WHO CAN STEP
IN WHEN.
THE LOCAL GOVERNMENTS HAVE CUT
THEIR PUBLIC HEALTH STAFF RIGHT
AND AND THAT'S A PARTICULARLY
APT -- ISSUE
BECAUSE I CAN REMEMBER AS A
LOCAL HEALTH OFFICER SEC HAVING
TO ARGUE TO KEEP MY MINIMAL IN
MUSICIANS STAFF WHEN THE
ARGUMENT AS WELL THEY CAN GET IT
PEOPLE CAN GET THEIR
IMMUNIZATIONS AT HEALTHCARE
FACILITIES PRIMARY CARE CLINICS
FQHCS.
BUT FQHCS WORK AND WORK AT A
MAXIMUM CAPACITY THEY HAVE NO
SURGE CAPACITY IF WE LOSE PUBLIC
HEALTH'S ABILITY TO SEARCH.
THEN WE ARE REALLY GOING TO HAVE
A PROBLEM IF WE NEED TO
VACCINATE PEOPLE OR DISTRIBUTE
PILLS OR YOU KNOW WHATEVER IT
COMES.
TO THERE ARE WAYS TO WORK AROUND
BUT WE DON'T WANT TO BE MAKING
IT UP AT THE LAST MINUTE.
SALINAS IS OPPOSED BECAUSE YOU
MENTIONED THAT PEOPLE SAID WELL
YOU CAN THEY CAN GET IN OTHER
PLACES SO WHAT IS THIS.
WE TALK ABOUT SERGIO PASS THE I
KNOW WE MAINLY TALK ABOUT
GOVERNMENTAL ENTITY STATE LOCAL
FEDERAL BUT WHAT IS IT MEAN TO
WHAT DEGREE.
THE DOES THE PRIVATE SECTOR
RULES AND CLINIC.
AND SO WHAT BETWEEN IT AND THE
PUBLIC HEALTH SIDE BETWEEN.
HEALTH DEPARTMENTS AND PRIVATE
ENTITIES ESSENTIALLY AND THEIR
ROLE AND AND HELPING OUT WITH
SURGERY OTHER TYPES OF THINGS.
SO WE WE DO HAVE A ROOM A
VOLUNTEER SYSTEM AND WE HAVE A
SERIES OF MEDICAL RESERVE COURSE
AT THE LOCAL LEVEL ON WHO CAN
STEP AND THEY TRAIN BUT IT'S
ALSO WE'RE THEY ALL HAVE JOBS.
TO RIGHT AND SO IF IT'S A
SITUATION WHERE THE MEDICAL SIDE
IS ALSO IMPACT IT WHERE THEY'RE
GOING TO BE NEEDED IN THEIR
HOSPITALS OR THEIR CLINICS YOUR
WORK SORT OF ROBBING PETER TO
PAY PAUL --
AND SO ALTHOUGH WE DO TRAIN
PEOPLE AND FOR SMALLER AMOUNTS
AND SHORTER EVENTS I THINK YOU
KNOW LIKE AT THE BUTTE COUNTY --
SHELTERS WHERE MANY.
PEOPLE DID VOLUNTEER NOT ONLY
THEM ARE SEES BUT HEALTHCARE
INDUSTRY BROUGHT PEOPLE TO THE
TABLE IN A SMALL OF AN TO SHORT
TERM EVENT THAT IS THERE AND CAN
BE HELPFUL.
BUT I THINK WHEN LAST AND IF
YOU'RE TALKING ABOUT BRINGING
PEOPLE INTO HEALTHCARE AND
SURGING THERE IT'S DIFFICULT
WITH A LOT OF RULES ABOUT WHO
CAN AND CAN'T COME INTO
HEALTHCARE FACILITIES DO YOU.
PRACTICE BUT IT'S PRETTY LIKELY
THAT IN ANY EVENT LIKE PAN BIKE
A PANDEMIC THE HEALTH CARE
INDUSTRY IS NOT GOING TO HAVE A
LOT OF BAND WITH BECAUSE THEY'RE
GOING TO BE TAKING CARE OF THEIR
OWN PATIENTS.
THERE IS SINCE EACH ONE AND WHEN
THERE'S A NEW PHENOMENON WELL
NEW AS OF THAT IF YOU'VE BEEN
AROUND AS LONG AS I HAVE WHICH
IS THERE ARE PRIVATE COMPANIES
THAT DO SPECIFICALLY MASS
VACCINATION SO THEY HAVE LARGE
CADRES OF NURSES WHO WORK FOR
THEM THAT CAN GO ANYWHERE.
IN THE STATE THE THING IS YOU
HAVE TO HAVE THE RESOURCES TO TO
HIRE THEM TO COME IN.
BUT I HAVE DON'T HAVE ANY
EXPERIENCE WITH ACTUALLY.
OKAY.
AND ACTUALLY --
AT OUR CHAVEZ AID --
DID YOU TALK ABOUT THE
INCREASING NUMBER OF REPORTS
INFECTIONS I MEAN 45% --
HAS YOUR STAFF INCREASED BY 45% --
TO TAKE ALL THESE REPORTS ARE.
HOW HOW'S THAT GOING --
ACTUALLY.
YES THEY SAID YOU KNOW FIRST
THOSE REPORTS FIRST COME TO THE
LOCAL HEALTH DEPARTMENT RIGHT
THEY DO HAVE TO REVIEW EVERYONE
OF THEM AND FREQUENTLY RESPOND
TO WHAT THEY FIND.
AND NOT HAVE THEY JUST NOT HADAN INCREASE BUT AS YOU HEARD
ALMOST EVERYONE OF THEM HAS HAD
A DECREASING PERSONNEL SO.
I FREQUENTLY THAT TASK TAKES A
BIG PART OF THEIR STOPPING JUST
MAINTAINING WITH THE INCREASING
NUMBER OF OF REPORT A WE SING A
LAGAN RESPONSES THIS IS GOING ON
WITH.
THERE WERE REPORTS AND FEWER
PEOPLE ANYWHERE HAVING DELAYS
THAT WE ARE DOING THAT I THINK
IT'S BEEN HELPFUL HIS IS
LEVERAGING IT TECHNOLOGIES SO
THAT WE CAN AUTOMATE AS MUCH OF
THAT US AS WE POSSIBLY CAN.
SO NOW WE HAVE A YOU KNOW AND
ELECTRONICAL OVER ANOTHER TWENTY
CLUB REPORTING SYSTEM --
FOR A REPORT FROM LABORATORIES
TO COME ELECTRONIC GREEN TO OUR
SURVEILLANCE SYSTEM SO THAT WE
DON'T HAVE TO MANUALLY.
ENTER AND PROCESS THAT
INFORMATION.
I AND WE'RE MOVING ACTUALLY
TOWARDS DOING THE SAME THING
WITH ELECTRONIC CASE REPORTING
SO THAT WE CAN MIND ELECTRONIC
HEALTH RECORDS SIMPLE SOME OF
THAT INFORMATION OUT.
INSTEAD OF HAVING TO HAVE PEOPLE
FILL OUT SPECIFIC FORMS SO WE
TRIED TO BE SMART TO USING NEW
TECHNOLOGY SO THAT WE CAN
COMPENSATE FOR THE OR THE LACK
OF RESOURCES AND AT THE SAME
TIME WE CAN ACTUALLY EXPEDITE
THE PROCESS.
AND CAN YOU SPEAK YOU MENTION
TECHNOLOGY YOUR ABILITY TO YOUR
DATA CAPACITY ABILITY TO
INTERFACE WITH LIKE EHRS AND
OTHER PRIVATE --
YOU KNOW LEAD DATA SETS --
TO HELP YOU ADDRESS ANY WHAT
WHERE DID THE THE NEEDS TO FOR
FOR THE STATE DEPARTMENT PUBLIC
HEALTH TO BE ABLE.
TO ACCOMPLISH THIS TASK SO OUR
FIRST -- A
PLAN TO GET TO THE POINT WHERE
WE HAVE A STATEWIDE HEALTH
SURVEILLANCE SYSTEM THAT'S NOT
SPECIFIC TO ANY GIVEN DISEASE
BUT ACCESS CAPABILITY TO AS AS
DOCTOR CHAVIS SAYS.
REACH INTO EMR SIMPLE BECAUSE
PASSIVE REPORTING OF THAT TIME
IS MUCH MORE EFFECTIVE THAN
EXPECTING PHYSICIANS ENTER DATA.
RIGHT NOW WE'RE BUILDING THE COR
CAPACITY FOR THAT AND WE'RE
BUILDING IN OUR OPERABILITY
WITHIN OUR MANY DISEASE
REGISTRIES BECAUSE SOME OF
THAT'S ALREADY HAPPENING IN
PUTTING GOING INTO THESE
LEGACIES.
WE ARE CURRENTLY LEVERAGING --
OPIOID MONEY FROM THE FEDERAL
GOVERNMENT TO TRY --
TO ADVANCE THAT IT REQUIRES
ENTERING INTO DO USE AGREEMENTS
WITH A VARIETY OF ENTITIES.
AND WE'RE JUST BEGINNING THAT
PROCESS I THINK WE HAVE A VERY
REALISTIC PLAN I'M CONCERNED
THOUGH --
THE NEW AT THIS WE JUST GOT THE
ANNOUNCEMENT FOR THE NEW OPIATE
GRANT IS IT'S BEEN DECREASED-SUBSTANTIALLY --
SO IT'S AGAIN IT'S AN ISSUE OF
SUSTAINED FUNDING I THINK THAT
DOT THAT KIND OF INFORMATION
PARTICULARLY WITH THE ADVANCED
ANALYTICS CAPABILITY THAT WE'VE
ALSO BUILT IN.
IS ACTUALLY GOING TO BE VERY
HELPFUL AND US FIGURING OUT
EXACTLY WHAT YOU'RE ASKING IS
WHAT CAPACITY DO WE ACTUALLY
NEED --
BECAUSE RIGHT NOW WE DON'T HAVE
A GOOD OVER VIEW --
OF THE THE BIGGER PICTURE
FRANKLY.
AND I SHOULD ACT SERVICE I KNOW
THAT YOU WERE VERY INVOLVED IN
THE TWENTY FIFTEEN MEASLES
OUTBREAK --
KEY PERHAPS SPEAK THE AS AN
EXAMPLE --
TO WHAT EXTENT PEOPLE GOT PULLED
OFF OF RIGHT WHAT TASKS GOT.
NAKED I'VE NEGLECTED MIGHT NOT
BE THE RIGHT WORD BUT BASICALLY --
BECAUSE PEOPLE WERE PULLED TO
TRUST THAT OUTBREAK --
WE KNOW THAT OVER A HUNDRED
NINETEEN HUNDRED THIRTY SIX
PEOPLE DIED FACT ABOUT HOW MANY
PEOPLE ACTUALLY HAD TO TOUCH IN
ORDER TO CONTAIN THAT OUTBREAK
AND DO YOU HAVE A ROUGH ESTIMATE
I KNOW WE'VE TALKED ABOUT THE
SALUTE FOR BUT OF HOW MUCH THAT.
ENDED UP COSTING THE STATE JUST
RESPONDED THAT ONE OUTBREAK --
DICKEY KIKI WRAPS.
AS AS A CASE EXAMPLE OF A I
GUESS THAT WOULD BE WHAT AND A
AND A LARGER MEDIUM SIZED --
EVENTS.
US ACTUALLY A FAIRLY SMALL EVENT
OKAY THAT'S A SMALL IT'S A HOW
MUCH OF THAT INVOLVED OKAY IT'S
A SMALL THAT BALANCE THAT
INVOLVED AND HOW MANY PEOPLE HOW
MUCH MONEY ALL THAT KIND OF
STUFF ON THE LAST.
AS YOU KNOW MEASLES BEING ONE OF
THE MOST A CONTAGIOSUM
AFFECTIONS --
IT'S A VERY IMPORTANT TO RESPOND
QUICKLY TO IDENTIFY CASES AND TO
PREVENT SUBSEQUENT CASE AND AND
WHAT HAPPENED DURING THE MEASLES
OUTBREAK.
IN ORANGE COUNTY PARTICULARLY IS
THAT.
YOU KNOW FOR EVERYONE CASE THAT
WE IDENTIFIED WE IDENTIFIED
DOZENS AND DOZENS OF INDIVIDUALS
THAT WERE EXPOSED THAT AND HOW
TO BE INTERRED FOUND AN
INTERVIEW --
AND AND PROFIT LOCKED AND VERY
QUICKLY JUST ARE JUST GOING INTO.
A HUNDREDS AND HUNDREDS OF
PEOPLE WE HAD ONE SITUATION JUST
TO ILLUSTRATE THE COMPLEXITY OF
DOING DAYS WHERE WE HAD --
IN A NEONATE NEONATAL INTENSIVE
CARE UNIT --
THERE WAS --
THE DATA ONE OF THE MOMS WHO
CAME TO VISIT THE GRANDSON.
AND HE HAD MEASLES AS PART OF
THE OUTBREAK --
AND SO THEN WE HAVE A NO NO JUST
THE DODD BUTTON ENTIRE AN ICY
YOU'LL BABIES --
EXPOSED AND AS YOU IMAGINE
THEY'RE VERY HIGH RISK RIGHT OUR
AND SO HE REALLY REQUIRED ALL
HANDS ON DECK FROM THE COUNTY
HEALTH DEPARTMENT PERSPECTIVE
AND THANKFULLY WE HAD. ZERO
ADDITIONAL CASES FROM THAT
EXPOSURE.
BUT THAT MEANS THAT THE COUNTY
BASICALLY HOW TO STOP EVERYTHING
THEY WERE DOING --
BUT ON DAY TO DAY BASIS TO BE
ABLE TO RESPOND --
I KNOW WE'VE HAD THIS
CONVERSATION --
IN TERMS OF US NEEDING TO BE
BETTER UP ACCOUNTING. FOR
RESOURCES ARE SPENT ON THESE
OUTBREAKS ARE PARTICULARLY
TRYING TO DO A PRO PROSPECTIVELY
SO THAT WE CAN BETTER ACCOUNT
AND WE WE'VE BEEN WORKING ON ON
THAT FOR FUTURE OUTBREAKS.
YOUR THROAT AND A ROUGH NUMBER
FOR HOW MUCH THAT MEASLES
OUTBREAK COST I THINK SOMEONE.
YOU KNOW IT DEPENDS ALSO FROM
WHAT ANGLE YOU SEE IT I MEAN THE
COSTS ARE AMONG THE STATE.
AND LOCAL HEALTH YEAH I THINK
THAT LOW YET COST FOR LOCAL HELP
THE OTHER PUBLIC HEALTH PARTS OF
STATE HEALTH DEPARTMENT LOCAL
HEALTH DEPARTMENTS NOT THE COST
FOR HOSPITALIZATION FOR PEOPLE
WHO GOT SICK AND SO FORTH JUST
JUST THAT THE PUBLIC HEALTH COST
I THINK I DON'T HAVE IF.
YOU'RE A NEW BUT I KNOW WE'VE
DONE SOME ESTIMATES OF WHAT THE
LOCAL YOU KNOW WHAT.
GIVE ME A NUMBER A ROUGH NUMBER
NOW I MEAN WE'RE TALKING
MILLIONS OR HUNDREDS OF
THOUSANDS MILLIONS SO MILLIONS
WERE TALKING OF MILLIONS OF
DOLLARS FOR THIS.
SMALL USED TO SAID WITH A SMALL
DENT.
OKAY MILLIONS ALL RIGHT ALAMEDA
COUNTY WHICH WAS NOT THE
EPICENTER OUTBREAK ESTIMATED
THAT IT COSTS THEM ON THE ORDER
FOUR MILLION DOLLARS IN STAFF
TIME. TO RESTORE MILLION IN ONE
COUNTY THAT'S TRUE.
WILD WRONG I WILL MAKE SURE THAT
OKAY BUT THAT'S THE NUMBER THE
STICKS IN MY MIND BECAUSE I GIVE
A TALK ON THAT VERY THE VERY
FACT HOW DESTRUCTIVE THE SET
EPIDEMIC RIGHT ARE.
BUT ALSO THINKING ADD THIS EVENT
IN THE NICK YOU --
YOU SAID EVERYTHING STOPPED SO
FOR EXAMPLE WE'RE TALKING ABOUT
S. T. D. ONGOING A CD PROBLEMS
THAT MEAN PEOPLE GOT PULLED AWAY
FROM DOING A CD WORK IN THAT
COUNTY WHILE THIS MEASLES
OUTBREAK HAPPENED.
SO I MEAN THERE IS ONE RIGHT AND
THAT'S WHY I'M SAYING THAT THESE
THINGS ARE INTERLINKED RIGHT WE
HAVE AND YOU KNOW WE'RE TALKING
ABOUT I MEAN THAT'S NOT THE
THING THAT'S NECESSARY ON THE
NEWS ALL THE TIME IT'S BEEN IN
THE NEWS BUT YOU KNOW IT'S ON
GOING.
STD THING GOING ON THE PROBLEM
GOING ON SO THAT MEANS PEOPLE
GOT PULLED AWAY. TO TAKE CARE OF
THIS THING PEOPLE GOT PULLED
AWAY FROM OTHER TYPES OF NOLLIE
DISEASE OUTBREAKS PROBABLY
CHRONIC THAT.
ENDING A GAP SO EVERYONE EVER
GOT PULLED INTO BECAUSE
OBVIOUSLY YOU DON'T GET ON TOP
OF THIS LIKE A FIRE RIGHT IF YOU
DON'T JUMP ON TOP OF IT IT'S
GOING.
TO CONTINUE XCELERATED SPREAD.
AND BUT MEANTIME THAT MEANS WERE
NEGLECTING.
NEGLECT IS NOT QUITE THE RIGHT
WORD BUT AND YET PRIORITIZE BUT
WHAT HAPPENS IS THAT MEANT THAT.
WE HAD THE MORE VIDEO WE'RE NOT
TAKING CARE OF OUR CITIES WERE
NOT TAKEN CARE OF MAYBE SOME NON
VISITING PROGRAMS THAT PROVIDE
OTHER TYPES OF PREVENTION
PROGRAMS [inaudible]
OKAY WELL.
SLIDE TO OKAY.
ALL RIGHT ANY OTHER QUESTIONS.
ALL RIGHT WELL THANK YOU SO VERY
MUCH THANK YOU.
THANK YOU [inaudible]
ALL RIGHT.
SO OUR NEXT PANEL IS OUR LOCAL
HEALTH DEPARTMENT ROLE
INFRASTRUCTURE CHALLENGES IN
ADDRESSING OUTBREAKS AND WE'VE
OF COURSE HAVE HEARD ABOUT THE
VERY IMPORTANT.
NOT JUST VERY IMPORTANT
ESSENTIAL ROLLER LOCAL HEALTH
DEPARTMENTS PLAY.
AND SO WE HAVE --
SEVERAL MEMBERS OF OUR PANEL WE
HAVE ROB TOLD HIM HIS THE FASTER
COUNTY HEALTH OFFICER PUBLIC
HEALTH DIRECTOR HIS GOING TO
HIGHLIGHT THE ROLE LOOK.
VASE PUBLIC HEALTH
RESPONSIBILITIES LOCAL HEALTH
DEPARTMENTS --
ADMINISTER AND HOW TO CONTRAST
WITH THE STATE ROLE WE HAVE I
KIM.
SIR -- WITH
HARLEY'S HELP THE PRONOUNCE THAT
CORRECTLY OKAY THANK YOU THE
RIVERSIDE COUNTY PUBLIC HEALTH
DIRECTOR WHO'S GONNA BE TALK
ABOUT MERGERS HE PREPAREDNESS.
AND I ALSO RECOGNIZE THAT EACH
OF YOU DO ALL THIS STUFF BY
HAVING EACH OF YOU FOCUS ON
PARTICULAR THINGS.
WE HAVE ANY MILLARD THE BUTTE
COUNTY HEALTH OFFICER THANK YOU
VERY MUCH HE'S GOT TALK ABOUT
THE EXPERIENCE WITH THE WILD
FIRES AND SO WITH THE TIMER TO
SEE AND THEN --
DOCTOR SHERRIN --
BALZER FROM THE LOS ANGELES
APART PUBLIC HEALTH DIRECTOR OF
THE VISION COMMUNICABLE DISEASE
CONTROL TALKING ABOUT HEPATITIS
A WHICH OF COURSE HAS BEEN A THE
ISSUE -- AS
WELL SO --
WHAT WE GO AHEAD AND START OFF
WITH DOCTOR OLDHAM TO GIVE A
CERTAIN THE OVERVIEW ON THE
LOCAL HEALTH DEPARTMENTS IF YOU
LOOK?
AT THANK YOU CHAIRMAN PAN
MEMBERS MY NAME IS DOCTOR ROB
OLDHAM AND I'M THE HEALTH
OFFICER AND DIRECTOR OF PUBLIC
HEALTH FOR PLASTER COUNTY.
AND ALSO THE PRESIDENT OF THE
CALIFORNIA CONFERENCE OF LOCAL
HEALTH OFFICERS ARE C. SEELEY
JOE AND I'VE BEEN ASKED TO
DESCRIBE THE ROLES AND
RESPONSIBILITIES TO LOCAL HEALTH
DEPARTMENTS.
THERE'S A LOCAL HEALTH
DEPARTMENT FOR EVERY COUNTING
KLAY LONG BEACH IN PASADENA.
EACH LOCAL HEALTH DEPARTMENT HAS
THE PRIMARY RESPONSIBILITY FOR
ASSURING THE SUCCESSFUL LOCAL
IMPLEMENTATION OF CORE PUBLIC
HEALTH FUNCTIONS AND ESSENTIAL
SERVICES.
WHAT ARE SOME VARIATION BETWEEN
JURISDICTIONS AS TO HOW WE
FULFILL THIS RESPONSIBILITY IN
ALMOST EVERY LOCAL HEALTH
DEPARTMENT YOU'LL FIND SOME OF
THE SAME QUIRK PUBLIC HEALTH
PROGRAMS?
SO FOR EXAMPLE OF ITS WAS
DESCRIBED EARLIER --
COMMUNITY DISEASE CONTROL AND
PREVENTION PROGRAMS CAN TO
CONDUCT SURVEILLANCE FOR AN
INVESTIGATION OF INFECTIOUS
DISEASE CASES AND OUTBREAKS SO
IN PLASTER COUNTY.
OUR TEAM OF ONLY A HANDFUL OF
COMMUNITY THESE STAFF RECEIVE
NEARLY FOUR THOUSAND CASE
REPORTS EVERY YEAR.
IDEALLY WE INTERVIEW EVERY
PERSON SUSPECTED OF HAVING THE
COMMUNITY DISEASE CONFIRM THE
DIAGNOSIS IDENTIFY LIKELY
SOURCES OF EXPOSURE TO THE
ILLNESS AND OTHER PEOPLE EXPOSED
THAT WE CAN RECOMMEND
APPROPRIATE TREATMENT.
ANOTHER OUTBREAK CONTROL
MEASURES HOWEVER DUE TO LIMITED
RESOURCES WE'RE OFTEN NOT ABLE
TO DO AS IN DEPTH AND AND THAT
INVESTIGATIONS WOULD LIKE.
THIS IS ESPECIALLY TRUE AS WAS
MENTIONED BY DOCTOR CHAVEZ
BEFORE ABOUT --
SIX ACTUALLY TRANSMITTED
INFECTIONS WE'VE SEEN DRAMATIC
INCREASES AND THE RATES OF CASES
IN RECENT YEARS.
SOME OTHER PROGRAMS --
IMMUNIZATION PROGRAMS PROVIDE
LEADERSHIP AND SUPPORT TO LOCAL
HEALTH CARE PROVIDERS SCHOOLS
AND OTHERS IN OUR COMMUNITY TO
MAINTAIN AN ADEQUATE SUPPLY OF
SAFE AND AFFORDABLE VACCINES AND
TO IMPROVE IMMUNIZATION RATES.
PUBLIC HEALTH EMERGENCY
PREPAREDNESS AND RESPONSE
PROGRAMS PREPARE FOR AND RESPOND
TO EMERGENCIES THROUGH THE
DEVELOPMENT IMPLEMENTATION OF
PARTNERSHIPS PLANS TRAININGS
DRILLS AND EXERCISES.
BUY RECORDS REGISTERS ALL BIRTH
MATERNAL CHILD ADOLESCENT HEALTH
PROGRAMS PROVIDE SUPPORT SUCH AS
HOMEOWNERS HOME VISITS CASE
MANAGEMENT AND SERVICE LINKAGES.
TO AT RISK FAMILIES.
CRIME DISEASE PREVENTION
PROGRAMS WORK TO REDUCE THE
BURDEN OF DISEASES LIKE DIABETES
HEART LUNG DISEASE AND OBESITY
BY PROMOTING MORE HEALTHFUL
LIFESTYLES AND COMMUNITY
ENVIRONMENTS.
THE CALIFORNIA CHILDREN'S
SERVICES PROGRAM PROVIDES
DIAGNOSTIC AND TREATMENT
SERVICES MEDICAL CASE MANAGEMENT
AND PHYSICAL AND OCCUPATIONAL
THERAPY TO CHILDREN WITH
ELIGIBLE MELT MEDICAL CONDITIONS.
THIS PROGRAM PROGRAM IS A
GODSEND TO MANY FAMILIES WITH
SPECIAL NEEDS.
THE CHILD HEALTH DISABILITY
PREVENTION PROGRAM DELIVERS
PERIODIC HEALTH ASSESSMENTS CARE
COORDINATION OTHER SERVICES TO
ASSIST CHILDREN FAMILIES WITH
THINGS LIKE MEDICAL APPOINTMENT
SCHEDULING AND TRANSPORTATION.
THE HEALTH CARE PROGRAM FOR
CHILDREN IN FOSTER CARE PROVIDES
PUBLIC HEALTH NURSE EXPERTISE IN
MEETING MEDICAL DENTAL MENTAL
HEALTH AND DEVELOPMENT
DEVELOPMENTAL NEEDS OF CHILDREN
AND YOUTH IN FOSTER CARE --
SO THESE ARE JUST A FEW OF THE
PUBLIC HEALTH PROGRAMS THAT
YOU'LL FIND IN ALMOST EVERY
LOCAL HEALTH DEPARTMENT.
MANY LOCAL HEALTH DEPARTMENTS
ALSO OVERSEE ENVIRONMENTAL
HEALTH WERE ACTIVITIES RANGE
FROM FOOD INSPECTIONS TO
HAZARDOUS MATERIALS AND WASTE
MANAGEMENT.
SOME LOCAL HEALTH DEPARTMENT
ALSO OPERATOR OVERSEE PUBLIC
HEALTH LABS ANIMAL CONTROL
SHELTERS PUBLIC HOSPITALS
MEDICAL CLINICS JAIL MEDICAL
SERVICES HOMELESSNESS SERVICES
AND SUBSTANCE USE DISORDER
PREVENTION PROGRAMS.
AND WHILE I KNOW YOU'LL BE
HEARING FROM TO MY COLLEAGUES
ABOUT FUNDING CHALLENGES LATER
IN TODAY'S MEETING IT'S
IMPORTANT AS A SAID BEFORE TO
NOTE THAT MUCH OF THIS WORK IS
DONE WITH LIMITED AND
RESTRICTIVE CATEGORICAL FUNDING.
THAT OFTEN IS NOT COVER THE FULL
COST OF RUNNING MANY OF THESE
PROGRAMS IS OFTEN NOT ENOUGH TO
MEET THE UNIQUE AND RAPIDLY
CHANGING NEEDS LOCAL.
PUBLIC HEALTH NEEDS.
OUR WORK REQUIRES A STRONG
PARTNERSHIP WITH CITY PH --
HOWEVER THE ULTIMATELY UP TO THE
LOCAL HEALTH DEPARTMENT TO MEET
THE PUBLIC HEALTH NEEDS OF OUR
COMMUNITIES FOR EXAMPLE --
C. PH HAS A FABULOUS CENTER FOR
INFECTIOUS DISEASES THE DOCTOR
CHAVEZ LEADS --
THEY PROVIDE A LOCAL HEALTH
DEPARTMENTS WITH EXPERT GUIDANCE
AND CONSULTATION ON SOME OF OUR
MOST CHALLENGING CASES SUCH AS
CASES OF MULTI DRUG RESISTANT
TUBERCULOSIS.
HOWEVER REMAINS UP TO THE LOCAL
HEALTH DEPARTMENT TO WORK
DIRECTLY WITH THE PERSON THE TV.
OFTEN THAT MEANS LITERALLY GOING
THE PERSON FOR WORK TO ENSURE
THAT THEY'RE TAKING THEIR
MEDICATIONS AS PRESCRIBED NOT
HAVING ANY ANY SIDE EFFECTS.
IN A SIMILAR WAY --
C. PH HAS AN OUTSTANDING CENTER
FOR HEALTH STATISTICS AND
INFORMATICS THAT HAS SPEARHEADED
THE CREATION OF A CUTTING EDGE
SYSTEM FOR BIRTH AND DEATH
REGISTRATION.
HOWEVER IT'S UP TO THE LOCAL
HEALTH DEPARTMENT TO ACTUALLY
INTERACT WITH OUR LOCAL PARENTS
FUNERAL HOME DIRECTORS HOSPITALS
AND DOCTORS OFFICES TO MAKE SURE
THE CORRECT INFORMATION IS
ACTUALLY ENTERED IN THIS NEWS
NEW SYSTEM.
AND THESE RECORDS ARE THEN
PROVIDED TO OUR RESIDENTS IN A
TIMELY FASHION.
SO IN SUMMARY OUR LOCAL HEALTH
DEPARTMENT SURVEY CRITICAL
FUNCTION FOR THE RESIDENTS OF
THE STATE.
THERE'S NO REPLACEMENT FOR LOCAL
HEALTH DEPARTMENTS NOBODY ELSE
REALLY DOES WHAT WE DO.
THINGS ARE GOING WELL OUR WORK
S LARGELY IN THE BACKGROUND TOO
MANY PEOPLE IN OUR COMMUNITIES.
BUT WE OFTEN SERVE SOME OF OUR
NEEDIEST RESIDENTS OUR ENTIRE
COMMUNITY BENEFITS FROM A STRONG
LOCAL PUBLIC HEALTH SYSTEM.
ADDITIONAL INVESTMENTS ARE
NECESSARY TO ENSURE THAT OUR
COMMUNITIES RETAIN THESE VITAL
PUBLIC HEALTH SERVICES AND
PROTECTIONS.
ON EXPRESS MY APPRECIATION OF
THE COMMITTEE FOR CONVENING THIS
HEARING ON OUR PUBLIC HEALTH
INFRASTRUCTURE IN FOR THE
OPPORTUNITY TO TESTIFY AND I'M
AVAILABLE TO ANSWER ANY
QUESTIONS THAT YOU HAVE THANKS
[inaudible]
THANK.
HAVE TO OF THAT RIGHT NOW.
YEP THERE WE GO OKAY THANK YOU.
GOOD AFTERNOON MISTER CHAIR
SENATOR LEYVA MY NAME IS KIM
SORRY WHAT SORRY AND I'M THE
DIRECTOR OF PUBLIC HEALTH FOR
RIVERSIDE COUNTY.
I SPENT MOST OF MY CAREER
FOCUSING ON EMERGENCY
PREPAREDNESS AND I HELPED
ESTABLISH AND LEAD THE EMERGENCY
MANAGEMENT DEPARTMENT AND
RIVERSIDE COUNTY.
THANK YOU FOR THE OPPORTUNITY TO
SPEAK TO YOU ABOUT THE ROLE OF
THE LOCAL HEALTH DEPARTMENT AND
ADDRESSING OUTBREAKS IN
PREPARING FOR EMERGENCIES.
WHEN YOU CONSIDER OUR GLOBAL
SOCIETY AND THE ABILITY OF
DISEASES TO SPREAD WORLDWIDE IN
A MATTER OF DAYS PREPAREDNESS IS
CRITICALLY IMPORTANT?
SINCE NINE ELEVEN AND THE
ANTHRAX ATTACKS OF TWO THOUSAND
ONE LOCAL HEALTH DEPARTMENTS
ACROSS THE UNITED STATES HAVE
WORKED TO DEVELOP THE CAPACITY
TO RESPOND TO BIOTERRORISM.
LARGE SCALE INFECTIOUS DISEASE
OUTBREAKS AND NATURAL DISASTERS
IN CALIFORNIA WE'VE DEVELOPED A
STATEWIDE OPERATIONAL FRAMEWORK
FOR RESPONDING TO PUBLIC HEALTH
EMERGENCIES.
YOUR LOCAL HEALTH DEPARTMENT TO
THE LYNCH PIN OF THE SYSTEM AND
OUR PUBLIC HEALTH OFFICERS HAVE
THE LEGAL AUTHORITY TO TAKE
ACTION TO PROTECT THE PUBLIC'S
HEALTH.
WE SPENT SIGNIFICANT TIME
WRITING RESPONSE PLANS TRAINING
STAFF AND PRACTICING HOW TO
RESPOND TO LARGE SCALE DISASTERS.
WITH THAT SAID AS YOU'VE HEARD
BEFORE.
THE MOST CRITICAL COMPONENT OF
THE SYSTEM OF THE PUBLIC HEALTH
STAFF.
INCLUDING WELL TRAINED DOCTORS
NURSES EPIDEMIOLOGIST LABORATORY
ENDS DISEASE INVESTIGATORS AND
OTHERS BECAUSE THEY'RE THE ONES
WHO MAKE THE SYSTEM WORK.
FUNDING SHORTAGES OF COST
REDUCTIONS IN STAFFING LEVELS IN
MANY AREAS WELL THIS IS HAMPERED
OUR DAILY CAPACITY TO PROVIDE
SERVICES IT'S EVEN MORE CRITICAL
WHEN YOU CONSIDER THE IMPACTS OF
PANDEMICS.
NATURAL DISASTERS OR OTHER
EMERGENCIES AND RIVERSIDE COUNTY
LIKE IN MANY OTHER COUNTIES
EVERYONE OF OUR HOSPITALS HAS A
CACHE OF DISASTERS SUPPLIES THAT
HAVE BEEN PURCHASED WITH GRANT
FUNDS.
WE MAINTAIN A STOCKPILE OF
ANTIBIOTICS AND ANTI BY RULES
FOR FIRST RESPONDERS.
WE HAVE PERSONAL PROTECTIVE
EQUIPMENT GENERATORS VENTILATORS
AND SUPPLIES FOR MEDICAL
FACILITIES TO BE ABLE TO SEARCH
TO MEET INCREASED DEMAND FOR
PATIENTS.
ALL THIS IN ABOUT A TWENTY TWO
THOUSAND SQUARE FOOT WAREHOUSE.
WE HAVE AN EMERGENCY OPERATIONS
CENTER TO COORDINATE ALL OF OUR
PUBLIC HEALTH AND MEDICAL
ACTIVITIES.
BUT THE SYSTEM IS REALLY IN
PLACE TO HANDLE SMALL TO MEDIUM
SIZED INCIDENTS THAT ARE
RELATIVELY SHORT IN DURATION.
FOR EXAMPLE IN DECEMBER OF TWO
THOUSAND THIRTEEN OUR PUBLIC
HEALTH OFFICER ORDERED ONE
THOUSAND EIGHT HUNDRED STUDENTS
AND STAFF BE TESTED --
AT A LOCAL HIGH SCHOOL AFTER
MULTIPLE STUDENTS AND BEEN
EXPOSED TO TUBERCULOSIS.
SO WE USE THE INCIDENT COMMAND
SYSTEM STRUCTURE AND EMERGENCY
OPERATIONS CENTER TO COORDINATE
RESOURCES AND THE TESTING WAS
SUCCESSFULLY COMPLETED IN JUST
TWO DAYS.
WELL TRAINED PEOPLE CAN RESPOND
TO ANY INCIDENT THE GIVEN THE
LIMITATIONS ON THE NUMBER OF
STAFF THE LONGER THE DURATION OF
THE INCIDENT.
THE MORE DIFFICULT IT WILL BE TO
HAVE A SUSTAINED AND EFFECTIVE
RESPONSE.
YOU ALWAYS HEAR FROM PEOPLE LIKE
MYSELF THAT WE NEED MORE MONEY
FOR ADDITIONAL PERSONNEL TO
IMPROVE OUR DAY TO DAY
OPERATIONS.
WELL THIS IS TRUE THE REAL
BENEFIT IS THAT THE PERSONNEL
CAN BE TRAINED TO RESPOND TO
SIGNIFICANT EMERGENCIES THAT
STRETCH BEYOND THE CAPACITY OF
OUR EXISTING STAFF.
PUBLIC HEALTH STAFF WILL BE
CALLED TO OPERATE BACKS NATION
SITES.
SUPPORT LOCATIONS FOR MEDICAL
CARE CONDUCTED SPECIMENS AND
MAKE RECOMMENDATIONS TO SLOW THE
SPREAD OF DISEASE.
EVEN WITH ALL OF OUR RESPONSE
PLANS ARE TRAINING IN OUR
PRACTICE EXERCISES WE CANNOT
PREDICT THE NEXT EMERGING
DISEASE THAT WILL PRESENT NEW
CHALLENGES AND INCREASE OUR
WORKLOAD.
DISEASE CONTROL STAFF SPENT
COUNTLESS HOURS PREPARING FOR
THE POTENTIALLY DEVASTATING
EFFECTS OF DISEASES LIKE SECA
ANY BOLEH AND THE RE EMERGENCE
OF DISEASES LIKE MEASLES.
OUR LOCAL HEALTH DEPARTMENTS
PREPARED.
YES THEY ARE PREPARED TO RESPOND
WE HAVE THE KNOWLEDGE TRAINING
AND PASSION TO DO THE WORK.
DO THEY HAVE THE CAPABILITY TO
RESPOND TO A LARGE SCALE LONG
TERM PUBLIC HEALTH EMERGENCY NO
NOT WITH OUR CURRENT
INFRASTRUCTURE.
AND THIS IS WHY CRITICAL ONGOING
INVESTMENT INTO OUR PUBLIC
HEALTH INFRASTRUCTURE VITAL AND
WE URGE YOUR CONSIDERATION OF
STRENGTHENING THAT CAPACITY THE
LOCAL LEVEL.
THANK YOU [inaudible]
GOOD AFTERNOON.
MISTER CHAIR AND AND COMMITTEE
MEMBERS MY NAME IS ANDY MILLER
ON THE PUBLIC HEALTH OFFICER FOR
BUTTE COUNTY.
I WAS INVITED HERE TO DESCRIBE
OF THE LOCAL HEALTH DEPARTMENTS
RESPONSIBILITIES WHEN IT COMES
TO DISASTERS --
AND I'M GONNA USE THE EXPERIENCE
WE'VE HAD IN THE NOVEMBER EIGHT
CAMPFIRE TO TRIED. TO SEDATE
THOSE RESPONSIBILITIES.
I REALIZE THAT OUR COUNTY IS
DIFFERENT THAN OTHERS --
AND DO THAT CAPACITIES MAY BE
DIFFERENT AND IF ANYBODY WANTS A
MORE EXHAUSTIVE LOOK INTO IT
THERE ARE A GREAT DOCUMENTS OUT
THERE.
I THINK THE COMMITTEE HAS A ONE
PAGE DOCUMENT FROM THE M ACT
WHICH IS THE MEDICAL HELP
OPERATIONAL AREA COORDINATOR.
DANIEL THAT DESCRIBES THE
SEVENTEEN ESSENTIAL FUNCTIONS OF
THE MARK AND JUST TO OVER
SIMPLIFY YOU CAN PROBABLY JUST
SAY THOSE ARE THE
RESPONSIBILITIES MOSTLY THE
LOCAL PUBLIC HEALTH DEPARTMENT
OVER YOU SEE.
SOME OTHER ENTITIES INVOLVED SO
I'M GONNA TALK QUICKLY ABOUT --
PUBLIC HEALTH IN DISASTER
PREPAREDNESS DISASTER RESPONSE
AND DISASTER RECOVERY WITH MOST
OF THAT BEING IN RESPONSE.
DISASTER PREPAREDNESS WHICH
WOULD WARRANT AT ABOUT --
I'M NOT GONNA TAKE THE TIME TO
TO GO IN GREAT DEPTH BUT OUR
ABILITY TO PROVIDE RESPONSES
LARGELY DICTATED BY THE PLANS
AND THE RELATIONSHIPS.
AND THE CREATIVE THINKING THAT
TAKES PLACE DURING PREPAREDNESS
PREPAREDNESS IS REALLY THE ONLY
THING THAT WE RECEIVE FUNDING.
FOR NOT FOR RESPONSE AS YOU
PROBABLY KNOW.
SO IN DISASTER RESPONSE I'M
GONNA GO QUICKLY THROUGH.
OUR RESPONSIBILITIES IN
EVACUATION SHELTERING INFECTION
CONTROL ANIMAL SHELTERING AND
SOME OTHER HEALTH RELATED ISSUES --
SO START WITH EVACUATION ON
NOVEMBER EIGHT THAT --
AT EIGHT OO SEVEN IN THE MORNING.
I RECEIVED A PHONE CALL FROM THE
ORIGINAL DISASTER MEDICAL HEALTH
SPECIALIST ASKING FOR FIVE
AMBULANCE STRIKE TEAMS TO COME
INTO OUR COUNTY TO EVACUATE AND
VETS ADVENTIST FOR THE RIVER
HOSPITAL.
THAT'S TWENTY FIVE AMBULANCES
EACH STRIKE TEAM HAS.
FIVE THAT WAS QUICKLY APPROVED
AND THE DISCUSSION THROUGHOUT
THE DAY BROUGHT IN AIR
AMBULANCES AND A NUMBER OF OTHER.
RESOURCES INTO THE COUNTY I
BRING THAT UP BECAUSE IT IS THE
RESPONSIBILITY OF THE MALL ACT
IN THE PUBLIC HEALTH DEPARTMENT
ESSENTIALLY. TO REQUEST OUT OF
STICTION WHEN IT COMES --
TO EVACUATION.
OUR PUBLIC HEALTH DEPARTMENT I
ASSISTED A GREAT DEAL IN HELPING
LONG TERM CARE FACILITIES AND
SNAPS NOW LEGALLY IT'S THEIR
RESPONSIBILITY TO HAVE A PLAN
AND TO EVACUATE.
BUT WE KNOW FROM PREVIOUS FIRES
ESPECIALLY PREVIOUS FIRES IN THE
TOWN OF PARADISE.
THAT THAT WAS GOING TO BE AN
ISSUE SO VERY QUICKLY THAT
MORNING.
WE CONTACTED ARE MAPPED.
AND TOOK THE STATUS OF ALL OF
THOSE FACILITIES AND ULTIMATELY --
SENT AMBLIN STRIKE TEAMS TO SIX
OF THEM AND FORTUNATELY THROUGH
THOSE EFFORTS AND A NUMBER OF
OTHER EFFORTS--
NO LIVES WERE LOST IN LONG TERM
CARE FACILITIES ARE SNIFFS IN
THE TOWN OF PARADISE WHICH IS
OUR ONE OF THE FEW SILVER
LININGS.
ADDITIONALLY WE GET INVOLVED IN
THE EVACUATION OF ANIMALS WE
HAVE TRAINED STAFF PEOPLE NOT
LEAVE WITHOUT THEIR ANIMALS.
SO WE'VE LEARNED WE NEED TO HAVE
STRAINED TRAINED STAFF THAT ARE
BEHIND.
LAW ENFORCEMENT LINES AND FIRE
LINE SOMETIMES WELL TRAINED IN
ORDER TO REMOVE ANIMALS FROM THE
AREA NEXT YEAR IS SHELTERING.
ARE IN SHELTERS IS THE
RESPONSIBILITY OF PUBLIC HEALTH
IN CONCERT WITH THE RED CROSS TO
PROVIDE MEDICAL SUPPORT.
AT THE AT KIND OF THE XENA IN
FIVE OF FISH I'M SORRY TWO
THOUSAND PEOPLE IN FIVE OFFICIAL
SHELTERS AND MANY MORE PEOPLE IN
UNOFFICIAL SHELTERS.
WE ESSENTIALLY PROVIDED STAFFING
THAT WAS PHYSICIANS.
NURSES AND LOGISTICS PEOPLE ARE
FOR ALL OF THOSE SHELTERS TWENTY
FOUR HOURS A DAY FOR THREE
MONTHS.
I THAT INCLUDED PUBLIC HEALTH
STAFF INITIALLY LOCAL VOLUNTEERS
LOCAL DOCTORS COMING FROM ALL
OVER PEOPLE WE KNEW FRIENDS WE
KNEW CALLING THEM --
OTHER LOCAL VOLUNTEERS ARE
ULTIMATELY MANY OUTSIDE
VOLUNTEER ORGANIZATIONS AND MANY
OF OUR STATE AND FEDERAL
PARTNERS AS YOU HEARD EARLIER.
ADDITIONALLY FOR THOSE SHELTERS
WE ARE SUPPLYING THEM AS IF WE
ARE THEIR HOSPITAL SUPPLIER.
WITH HELP BRINGING AN OXYGEN
RESPIRATORY MEDICATIONS MET
MEDICATIONS LOS DURABLE METAL
MEDICAL EQUIPMENT WHEELCHAIRS
WALKERS.
AND JUST EVERYTHING YOU NEED IN
A HOSPITAL OR A CLINIC HOW IS
SENSUALLY STAFFED AND SUPPLIED A
GROUP OF TWENTY FOUR HOUR URGENT
CARE CLINICS FOR ABOUT THREE
MONTHS.
WE ARE ALSO RESPONSIBLE FOR
FEEDING AND HOUSING ALL THOSE
PEOPLE THAT COME IN TO HELP US.
WHICH SHOWS WHEN YOU DON'T HAVE
ANY HOUSING IN YOUR COMMUNITY
BECAUSE IT'S TAKEN BY FIRE AND
AND OTHER HELPERS IS HARD.
ANOTHER AREAS INFECTION CONTROL
YOU'VE HEARD ABOUT NOROVIRUS
THIS ALSO REQUIRE SHELTERING
DURING THE INFLUENZA SEASON.
LOTS OF WORK WAS DONE BY LOCAL
AND STATE AND SOME FEDERAL
RESOURCES TO TRY TO CONTROL
THOSE WE HAD STAFF VISITING EACH
SHELTER UPON ITS OPENING.
AND PRETTY MUCH DAILY THEREAFTER
TO HELP ENFORCE AND REINFORCE
INFECTION CONTROL MESSER
MEASURES WITH SOME STATE HELP
[inaudible]
I THE NEXT IS ANIMAL SHELTER
SHELTERING IN BI COUNTY
ANIMAL CONTROL IS HOUSED IN THE
PUBLIC HEALTH DEPARTMENT AT ITS
ZENITH WE WERE HELPING TEN
THOUSAND ANIMALS. SIX THOUSAND
OF THEM WERE SHELTERED IN PLACE
IN FIRE AREAS FOUR THOUSAND IN
SHELTERS WE HAD SIX HUNDRED
VOLUNTEERS EACH DAY HELPING TO
SUPPORT THOSE.
ANIMALS TWENTY TONS OF ANIMAL
FEED EACH DAY SEVENTY FIVE TEAMS
IN THE FIELD FIFTY TEAMS WORKING
IN SHELTERS REALIZE THAT OUR
LOCAL ANIMAL CONTROL STAFF IS.
TWELVE AND MANY OF THEM LOST
THEIR HOMES.
SO THERE'S SOME OTHER HEALTH
RELATED RESPONSE ACTIVITIES AIR
QUALITY OF PUTTING OUT
ADVISORIES WATER QUALITY TOXIC
EXPOSURES AND GIVING ADVISORIES
AS PEOPLE ARE MOVING BACK INTO
BURN SCAR AREAS.
SO NOW MOVES THE LAST IS
DISASTER RECOVERY WHICH WERE
STILL LEARNING ABOUT REALLY IN
ALL HONESTY --
DEBRIS CLEANUP AS REQUIRED MORE
AND MORE OF PUBLIC HEALTH AND
ENVIRONMENTAL HEALTH --
INVOLVEMENT AS THE RENTS HAVE
GOTTEN LARGER AND AS A DIFFERENT
REGULATORY.
DEVELOPMENTS HAVE OCCURRED ONE
IS THAT CALORIE ASSN FEMA HAVE A
LEGAL REQUIREMENT TO BRING CLEAN
UP CREWS IN AND TO PAY FOR THAT
FOR THERE TO BE DECLARATIONS OF
PUBLIC HEALTH EMERGENCIES.
ARE AND ADVISORIES AND THAT ALL
DISASTERS ARE ESSENTIALLY LOCAL
AND THAT PEOPLE COME IN AND HELP
BUT IT'S REALLY THE
RESPONSIBILITY OF OUR
ENVIRONMENTAL HEALTH DEPARTMENT
TO GIVE FINAL APPROVAL.
ON REBUILDING ON A LOT AND WE
HAVE EIGHTEEN THOUSAND OF THEM.
I AND TO GET LEGAL RIGHT OF
ENTRY FORMS AND WE HAVE ELEVEN
OUT THOUSAND OF THEM SO FAR THEY
HAVE BEEN PROCESSED.
THE LAST IS HEALTHCARE
INFRASTRUCTURE WHICH AGAIN WE
ARE ONLY STARTING TO DEAL WITH
WE LOST A HOSPITAL WE LOST MOST
OF THE DOCTORS IN THE THAT WERE
WORKING IN THAT HOSPITAL.
WE LOST OUR ABOUT FOUR HUNDRED
SKILLED NURSING FACILITY IN LONG
TERM CARE FACILITY BEDS WE ARE
NOT A LARGE COMMUNITY WE DON'T
HAVE THOSE BETS.
ARE THE HOSPITALS ARE HOLDING ON
TO PATIENTS --
FOR ABOUT THIRTY DAYS TO TRY TO
FIND PLACEMENT OFTEN IN SOUTHERN
CALIFORNIA.
SO WHAT I'VE TRIED TO DO IS GIVE
KIND OF A HIGH LEVEL OF
UNDERSTANDING OF THE LOCAL
PUBLIC HEALTH ACTIVITIES DURING
A DISASTER --
IT'S IMPORTANT TO NOTE THAT ALL
THIS RESPONSE AND RECOVERY WORK
IS DONE WITHOUT SPECIFIC
BUDGETARY RESOURCE ALL ROUTINE
PUBLIC HEALTH FUNCTIONS SUFFER
FROM AN ATTENTION AS YOU'VE
HEARD.
DURING THESE EVENTS.
THERE'S REALLY NO CHOICE I IN
OUR COUNTY WE HAD TWO PEOPLE
DEDICATED TO EMERGE EMERGENCY
PREPAREDNESS ONE OF WHOM LOST
THEIR HOM.
AND WAS MOVED OUT OF THE AREA
AND WAS NEVER INVOLVED IN THE
RESPONSE WE ESSENTIALLY HAD ONE
PERSON. TO TRY TO DO THAT
OBVIOUSLY THAT'S NOT POSSIBLE SO
IS EVERYBODY.
THANK YOU FOR YOUR TIME.
YOU THANK YOU.
IN FACT ABOUT I THANK YOU MY
NAME IS DOCTOR SHARON FALTER I
AM THE DIRECTOR OF THE DIVISION
OF COMMUNICABLE DISEASE CONTROL
AND PREVENTION.
AT THE LA COUNTY DEPARTMENT OF
PUBLIC HEALTH.
THANK YOU FOR INVITING ME TO
SHARE THE LESSONS THAT WE
LEARNED FROM THE RECENT
HEPATITIS A OUTBREAK AMONG
PERSONS EXPERIENCING
HOMELESSNESS IN LOS ANGELES
COUNTY.
I'D LIKE TO START BY SAYING THAT
THINGS TO THE EXTRAORDINARY WORK
OF OUR STAFF WE WERE SUCCESSFUL
IN STOPPING THIS OUTBREAK.
BUT OUR RESPONSE SHOWED AREAS OF
VULNERABILITY.
IN JULY OF TWO THOUSAND AND
SEVENTEEN WITH HUNDREDS OF CASES
OF HEPATITIS A IN SAN DIEGO AND
AN OUTBREAK IN SANTA CRUZ AND
FIFTY EIGHT THOUSAND HOMELESS
PERSONS IN OUR COUNTY.
DPH WAS ACUTELY AWARE THAT WE
WERE AT SERIOUS RISK OF AN
OUTBREAK.
HEPATITIS A IS A HIGHLY
CONTAGIOUS VIRUS OF THE LIVER.
IT SPREAD FROM PERSON TO PERSON
THROUGH THE FECAL ORAL ROUTE.
THE VIRUS CAN LIVE ON
ENVIRONMENTAL SURFACES FOR NEXT
SPEND AN EXTENDED PERIOD OF TIME
HOWEVER IT IS PREVENTABLE WITH
GOOD SANITATION AND VACCINATION.
PERSONS LIVING IN HOMELESS
ENCAMPMENTS ARE PARTICULARLY
SUSCEPTIBLE TO HEPATITIS C.
OUTBREAKS BECAUSE OF THE LACK OF
TOILETS IN HAND WASHING
FACILITIES.
RESIDENTS LIVE IN CLOSE QUARTERS
AND RESPECT YOURS FOR
EXPERIENCING HOMELESSNESS SUCH
AS DRUG USE CAN ALSO CONTRIBUTE
TO THE SPREAD OF HEPATITIS SAY.
PRISONS EXPERIENCING
HOMELESSNESS CAN ALSO BE VERY
DIFFICULT TO REACH AND PROTECT.
OUR IN PART BECAUSE THEY HAVE
OTHER MEDICAL AND PSYCHOSOCIAL
STRESSORS THE PREVENT THEM FROM
SEEKING PREVENTIVE CARE WERE
DELAY CARE WHEN THEY BECOME ILL.
IN LA COUNTY WE BENEFITED FROM
THE EARLY LESSONS IN SAN DIEGO
AND SANTA CRUZ.
EFFORTS TO QUICKLY IDENTIFY AND
RESPOND IMPORTED TO THE COUNTY
MAY HAVE BEEN KEY IN PREVENTING
A SIGNIFICANT OUTBREAK.
WE ALSO PARTNERED WITH COMMUNITY
OUTREACH ORGANIZATIONS AND
WORKING WITH THESE PARTNERS
DISTRIBUTED THIRTY SIX THOUSAND
VACCINES.
AND WORK TO IMPROVE THESE A
SANITARY CONDITIONS IN THE
ENCAMPMENTS WHICH MANAGED TO
KEEP CASES TO A MINIMUM THIS
TIME.
THE OUTBREAK WHICH INCLUDED MORE
THAN SEVEN HUNDRED CASES IN
TWENTY ONE THE STATE WIDE
HOWEVER ILLUSTRATES THE CRITICAL
NEED FOR FUNDING. TO SUPPORT
BASIC HUMAN NEEDS ADEQUATE
HOUSING AND SANITATION.
AMONG OUR HOMELESS CITIZENS
THERE'S ALSO A NEED FOR MENTAL
HEALTH SUBSTANCE USE AND SOCIAL
SUPPORT SERVICES.
AT POINTS WE DID NOT HAVE
ADEQUATE FACILITIES FOR RECOUP
PART OF CARE FOR OUR PATIENTS
WHO WERE SOMETIMES DISCHARGED
WHILE INFECTIOUS BACK TO
ENCAMPMENTS WHICH POTENTIALLY
FURTHER THE SPREAD OF INFECTION.
OUR DEPARTMENT MOUNTED AN
AGGRESSIVE RESPONSES PEOPLE HAVE
DESCRIBED ELSEWHERE BY MOVING
STAFF FROM THEIR REGULAR
POSITIONS TO EMERGENCY WORK FROM
JULY OF TWO THOUSAND AND
SEVENTEEN THROUGH MARCH OF TWO
THOUSAND AND EIGHTEEN DURING
THIS TIME NON AS THE WORK SLOWED
OR STOPPED ALL TOGETHER.
A VERY SIGNIFICANT CONSEQUENCE
WAS A DELAY IN BASIC PROCUREMENT
WHICH LED TO SHORTAGES IN
LABORATORY AND CLINICAL SUPPLIES
LATER IN THE YEAR.
THERE WAS AN EXTREME TOLL ON OUR
WORKFORCE WHO WORKED OVERTIME
FOR MANY MANY WEEKS IF WE'D HAD
ANOTHER OUTBREAK AT THE SAME
TIME WE WOULD HAVE BEEN VERY
VULNERABLE. ONE OF THE STRONGEST
TOOLS IN ADDRESSING AN EPIDEMIC
IS THE PUBLIC HEALTH LABORATORY
WE FOUND TO DURING OUR HEPATITIS
A RESPONSE THAT SOME HOSPITALS
WERE BATCHING OR SENDING OUT.
TESTS WHICH DELAYED CRITICAL
DIAGNOSTICS SO OUR PUBLIC HEALTH
LABORATORY STEPPED IN TO PROVIDE
REAL TIME TESTING FOR THESE
FACILITIES. FOR SOME DISEASES
SUCH AS BOTULISM EBOLA ONLY THE
PUBLIC HEALTH LABORATORY CAN DO
THE TESTING.
THE US PUBLIC HEALTH LABS MUST
BE SUPPORTED WITH ADEQUATE
FUNDING.
ADDITIONALLY IN THE TWENTY FIRST
CENTURY DIGITAL INFRASTRUCTURE
IS PARAMOUNT AND THERE WAS A
DISCUSSION OF ELECTRONIC
LABORATORY REPORTING EARLIER AND
IT'S CRITICAL FOR THE CONTROL OF
INFECTIOUS DISEASES.
HOWEVER DURING THE HEPATITIS A
OUTBREAK OCCASIONS THE ENTIRE
AEO OUR SYSTEM WENT DOWN AND WE
DIDN'T GET IT.
FOR SOME HOSPITALS WHICH AREN'T
ON THE ELECTRONIC WEB REPORTING
SYSTEM --
DELAYED THERE REPORTING FROM
WHICH CRITICALLY DELAYED A
RESPONSE IN CERTAIN CASES.
SO AS THE WORLD MOVES FASTER AND
FASTER AND WE FACE EVER MORE
EMERGING INFECTIOUS DISEASE
THREATS WE NEED MORE OF A STABLE
FUNDING FOR PUBLIC HEALTH DATA
SECT SYSTEMS.
AND INFORMATICS I'M URGENTLY IN
CALIFORNIA AND THESE NEEDS AR
ONLY GOING TO BECOME MORE
COMPLEX AS WE GO FORWARD.
A STRONG PUBLIC HEALTH
INFRASTRUCTURE MEANS ADEQUATE
EXPERT STAFFING AND RESOURCES TO
ADDRESS COMMUNICABLE DISEASES IN
CALIFORNIA WE CAN DETERMINE OUR
OWN HEALTH BY INVESTING IN
PUBLIC HEALTH INFRASTRUCTURE AND
STRENGTHENING OUR EXISTING
SYSTEMS.
SANITATION VACCINATION
ELECTRONIC DISEASE IN CASE
REPORTING LABORATORY CAPACITY
AND PUBLIC HEALTH STAFF WHO ARE
EXPERT IN RESPONDING TO ALL
EMERGENCIES EVEN THE ONES WE
HAVEN'T IMAGINED YET
[inaudible]
THANK YOU.
THANK YOU THANK YOU ALL
QUESTIONS.
OKAY.
SO ACTUALLY LET ME START WITH
THE DOCTOR BALTER SO YOU'RE IS
YOU'RE TALKING ABOUT HEPATITIS A
YOU SAID YOU AT THE POLE PEOPLE --
YOU SAID NONESSENTIAL BUT I MY
GUESS IS THAT WE SEE
NONESSENTIAL NOT URGENT PRICE
MORE ACCURATE --
THEN -- YOUR
LA COUNTY THE BIGGEST COUNTY IN
THE WHOLE STATE YOUR COUNTIES
LARGER IN MANY STATES.
CORRECT WE ARE LARGER THAN I
THINK FORTY TWO AND AND HOW MANY
CASES OF HEPATITIS A HAPPENED IN
LA YOU ARE ACTUALLY ABLE WE THAT
WE BELIEVE ARE RELATED TO THE
OPERATOR.
FIND RATE.
WE WERE ABLE TO KEEP IT TO ABOUT
EIGHTEEN BUT IT IT REQUIRED AN
ALL OUT EFFORT BY EVERYONE
BECAUSE YOU KNOW WE DON'T.
WE'RE NOT ORDINARILY WORKING YOU
KNOW TO TRACK DOWN PEOPLE IN
THIS AGGRESSIVE WAY --
AND NOT REQUIRES A LOT A LOT OF
PEOPLE SO SO SO I JUST.
I MEAN I I GUESS I REALLY WANT
TO POINT OUT SO WE HAD EIGHTEEN
CASES TURN THOSE OLD ONLY
EIGHTEEN CASES BUT THERE'S ONLY
EIGHTEEN CASES BECAUSE YOU WORK
SO HARD.
RIGHT AT THAT RATE THAT MEANS
THAT WE ALL RIGHT WHERE THEY ARE
YEAH YOU'LL YOU'LL LEARN YOU'RE
ABLE TO LEARN FROM YOU KNOW THAT
THIS IS NOT.
A YOU KNOW AGAIN SAN DIEGO SANTA
CRUZ WHO ACTUALLY UNFORTUNATELY
HAD TO LEARN THE LESSONS FIRST.
RIGHT [inaudible]
BUT EVEN LA COUNTY AS LARGE AS
YOU ARE HAD TO PULL SO MANY
STAFF THAT YOU COULD YOU ADD
SLOWED THAT YOU WEREN'T ABLE TO
GET TO OTHER THINGS SO THE
ABSTAINED IT STOP IT AN
IMPENDING OUTBREAK.
AND THE AND SUCCESSFULLY LIMITED
ONLY EIGHTEEN CASES.
YEAH BUT HE DID IT HAD A HUGE
IMPACT ON US AND I'D SAY
CONTINUING OUT INTO THE YEAR WE
HAD SHORTAGES OF LAB SUPPLIES
CLINIC RIGHT WHY IS IT WAS IT.
IT HAD TO BE AYE OKAY I THAT.
OKAY JUST.
BECAUSE I THINK LA SO BIG.
YOU GOT EVERYTHING OKAY ALL
RIGHT WE HAVE A LOT OF PEOPLE DO
YEAH OKAY --
SO [inaudible]
ACTUALLY.
I GOLDEN SINCERE THAT.
ALSO THAT THE THANK YOU CHAIR
PRESENT THE SEED I SO I YOU
HEARD ME ASK FOR THE OUR STATE
PUBLIC HEALTH OFFICER --
ABOUT.
DOING AN ASSESSMENT OF CAPACITY
OBVIOUSLY THAT'S NOT JUST STATE
THAT ALSO LOCAL IS THAT
SOMETHING THAT YOU THINK YOUR
ORGANIZATION DE INTERESTED IN
PURSUING --
AS I MENTIONED BEFORE.
I NEED YOUR EXPERTISE TO TELL ME
WHAT YOU NEED.
YEAH ABSOLUTELY AND I KNOW THE
SEALY JOE AND SHE ACT OR HAVE WE
HAVE.
PASSED AND ASK FOR ACTUALLY
SPECIFIC TO COMMUNICATE DISEASE
CONTROL WHAT THAT MIGHT LOOK
LIKE AT LEAST TO BEGIN TO FILL
SOME OF THOSE GAPS PARTICULARLY
WITH --
DECREASES IN REALIGNMENT
ETCETERA --
WELL I THINK WE'RE WE'RE MEETING
LATER I THINK THAT THAT'S IN THE
WORKS FOR SURE --
BUT ALSO KIND OF DOING OUT FULL
ASSESSMENT OF I THINK OFTEN THAT
WE HAVE ARE VICTIMS OF LEARNED
HELPLESSNESS AND SO --
THAT WE THINK WELL WE'LL GET BY
BUT LOCALLY I KNOW I MEAN I I
MENTIONED AT THE A SEXUALLY
TRANSMITTED INFECTIONS AND SO
IT'S WE WE WE ARE REALLY GOOD
WITH.
YEAH IT'S A DOCTOR SAYS THAT
WE'RE REALLY GONNA GOING THROUGH
BUDGET CUTS AND FIGURE IN
PRIORITIZING AND SO IN SOME WAYS
IT'S SOMETHING THAT WE NEED TO
THINK DIFFERENTLY ABOUT WELL
WHAT.
YOU KNOW WHAT SHOULD WE BE DOING
WHAT AT WHAT ARE THE REALLY COR
THINGS AND ABSOLUTELY WHAT THINK
WE HAVE SOME --
GENERAL ESTIMATES OF WHAT IT
WOULD COST I MEAN JUST TO GET US
BACK TO WHERE WE WERE TEN YEARS
AGO RIGHT AND THAT'S AN EASY.
OF A RELATIVELY EASY CALCULUS
BUT TO LOOK AT AS DOCTOR SMITH
THE SAME WHAT ARE THE CORE
THINGS THAT EVERY HEALTH
DEPARTMENT SHOULD BE DOING AND
WOULD BE VERY INTERESTED IN IN
DOING THIS AS A THE CUT TOGETHER
WITH THE PH.
I APPRECIATE THAT THE WOULD MAKE
NOTE SINCE I ALSO A MASTERS IN
PUBLIC HEALTH MYSELF.
THAT SOMETIMES THE PEOPLE PUBLIC
HEALTH WE'RE GOOD NUMBERS PEOPLE
BUT SOMETIMES I THINK --
I WILL TELL YOU TIMING WISE --
BECAUSE I KNOW YOU'RE VERY
THOROUGH AND BUT URGENCY IS ALSO
THERE SO THE LONGER I EIGHT YOU
WAIT TO GET US THE INFORMATION.
THE LONGER IT TAKES FOR THEN
THAT MEANS THAT WE CAN'T GET TO
IT SO I WOULD.
I HOPE I HOPE THAT --
THAT WE CAN WE CAN HEAR FROM YOU
SEE --
SOONER THAN LATER SO WE CAN TRY
TO HELP NOW --
ACTUALLY --
THE SERVER TO PAR YOU TALKED
ABOUT NUMBERS APPEAR AS WE AYE
AYE AT THAT BECAUSE I KNOW A LOT
OF THIS OVERLAPS --
IT SEARCH CAPACITY SO --
WHICH WE DO THAT THIS IS THERE
HOW IS A MENTIONED LIKE FIRE
DEPARTMENTS HAVE STE NOW THEY'VE
HAVE MUTUAL AID RIGHT --
IS THE DEED WHAT DO YOU THINK
ARE THE OPPORTUNITIES AND
ACTUALLY THIS COULD BE AS FOR
ANYBODY HERE --
SINCE YOU GOT YOUR OWN
EXPERIENCE YOUR OWN COUNTIES --
AND AND SO.
WE WE CURRENTLY HAVE SORT OF A
SYSTEM --
AND BUT IS THE TO RE CREATE A
MORE FORMAL SYSTEM SHOULD WE DO
MORE OF MORE FORMAL SUSPEND AND
TERMS OF NEW.
PUBLIC HEALTH NURSES AND
EPIDEMIOLOGISTS YOU KNOW AND
SITTING AROUND IN THE WAR ROOM
JUST WAITING FOR SOMETHING TO
HAPPEN BUT THERE'S ALWAYS
SOMETHING HAPPENING BY THE
WEIGHT BUT AS YOU KNOW --
BUT BUT BASICALLY SAYING LOOK
MAYBE THE WAY WE SHOULD APPROACH
THIS IS IS THAT WE ACTUALLY HAVE
A LITTLE EXTRA CAPACITY THAT IS
FUNDED TO SPREAD AROUND
DIFFERENT PLACES THERE'S
CERTAINLY PLENTY OF WORK TO DO
BUT THEN --
INTO IT AND EVENTS --
WE'RE NOT SO THE THE DEPEND NOW
PULLING PEOPLE OFF FROM THERE --
LESS URGENT ACTIVITIES AS MUCH
THAT WE HAVE PEOPLE WHO ACTUALLY
CAN HELP OUT WITH ON GOING
ACTIVITIES BUT THEN --
WOULD BE MORE AVAILABLE --
AND NOT HAVE TO STRESS THAT
EXISTING ACTIVITIES SOME
THOUGHTS ON THAT.
ABSOLUTELY I THINK ALL OF YOU OF
YOUR THOUGHTS ON THAT SO SO IF
YOU EXPLAINED IT EXACTLY RIGHT
BUT WE REALLY NEED IS TO BUILD
CAPACITY AT THE LOCAL.
LEVEL TO TO DO A VARIETY OF
THINGS AND IF WORD SUCCESS WITH
OUR IMMUNIZATION EFFORTS AN STD
CONTROL IN GENERAL DISEASE
CONTROL THOSE STAFF CAN BE
REDIRECTED DURING AN EMERGENCY.
AND WE'LL HAVE MORE ABILITY TO
CONTINUE TO DO THOSE ESSENTIAL
SERVICES WHILE RESPONDING TO THE
SEARCH THAT'S NEEDED.
IN TERMS OF THE OFFICIAL SYSTEM --
IS SIMILAR TO FIRE SO FOR HOW WE
REQUEST RESOURCES FROM OTHER TO
OTHER JURISDICTIONS --
SO THAT THE SYSTEM IS THERE TO
MAKE THOSE REQUESTS LARGER
JURISDICTIONS WOULD BE ABLE TO
PROVIDE SOME RESOURCES THAT I
CAN SPEAK FOR RIVERSIDE COUNTY
WE'VE WE TRY.
TO PROVIDE RESOURCES WHENEVER WE
CAN TO HELP OUR PARTNERS BECAUSE
THEN HOPEFULLY THEY'LL BE THERE
FOR US WHEN WE NEED THEM --
AT AND THEIR OPPORTUNITIES --
FOR AMMO USED TO BE IN PLACE FOR
EXAMPLE IN --
REGION SIX WERE RIVERSIDE IS SO
RIVERSIDE SALMON DINO INYO MONO
SAN DIEGO --
AN IMPERIAL COUNTIES WE'VE
SIGNED AN AGREEMENT TO SHARE
STAFF AND RESOURCES DURING AN
EMERGENCY AND SO WE'VE ALREADY
OUTLINED THE TERMS OF
REIMBURSEMENT AND AND THOSE
TYPES OF THINGS SO SO I THINK
THAT THE INFRASTRUCTURE FOR
SHARING RESOURCES IS THERE --
IT'S JUST A MATTER OF HAVING THE
RESOURCES TO BE ABLE TO SHARE
AND THERE'S QUITE A DISPARITY
BEING ABLE TO DO THAT BUT YOU
KNOW FOR EXAMPLE.
THAT THE STATE WILL PAY FOR SOME
FIRE TRUCKS THAT COULD BE USED
STRAIGHT AND THINGS LIKE SO WE
WENT WITH THINK ABOUT.
THIS WE TRIED OF ALL OF THAT --
HOW DO SAID DISAGREEMENTS ALSO
WHERE SOME THE THINGS THAT
SAMPLE YOU'LL SHOULD STATE
PIGEON SOME RESOURCES RIGHT --
THAT THAT THAT THAT BE AVAILABLE --
DOCTOR MILLER MY THANK YOU SO
MUCH FOR YOUR AND YOUR TEAMS
REALLY HARD WORK AND AND AND AND
AND THEN THAT ACTUALLY. FORTY
FOR PUBLIC HEALTH IS IS THAT
YOUR SUCCESS IS MEASURED BY
THINGS THAT DON'T HAPPEN.
RIGHT AND THAT THAT DOESN'T TEND
TO MAKE THE NEWS AS MUCH --
BUT MAYBE IT'S OKAY.
TO ANSWER AND UP YOU TELL ME
LIKE HOUSE OF BUTTE COUNTY HOW
HOW BIG WAS YOUR DEPARTMENT
BEFORE.
THE FIRES CAME HOW WOULD YOU
START WITH THAT THE DEPARTMENT
IS ABOUT A HUNDRED AND TWENTY
PEOPLE TOTAL --
AND THAT INCLUDES EVERYBODY
THERE ARE PEOPLE DOING ALL KINDS
OF DIFFERENT PROGRAMS SO THAT'S
THAT'S THE SIZE.
AND YOU KNOW WE WE GHOST UP
THROUGH THE HIERARCHY THAT WAS
JUST DESCRIBED AND ASK WITHIN
OUR REGION I YOU KNOW EITHER
FORTUNATELY UNFORTUNATELY FOR US
WE'RE IN A PRETTY RURAL AREA SO
THERE AREN'T MANY RESOURCES WE
TEND TO BE.
THE THE COUNTY IN THE AREA THAT
SO WITHIN OUR REGION YOU KNOW WE
NEED TO FOLLOW THAT HIERARCHY
WHICH WE DO --
WE DID RECEIVE.
HELP FROM FOLKS IN THE BAY AREA --
THERE WE RECEIVED FOR FOLKS FROM
FROM ALL OVER AND STILL IT WAS
DIFFICULT AND AND I'LL SAY THAT
BECAUSE DISASTERS ARE LOCAL AND
THERE'S OVERSIGHT THAT'S
REQUIRED TO BE DONE LOCALLY.
EVEN WITH ALL THAT HELP
SOMETIMES JUST I CAN MANAGING
ALL OF THAT HELP CAN BE AN ISSUE
AND OF MY ANIMAL CONTROL
DIRECTOR WE'RE HERE HE COULD
TELL YOUR GREAT STORIES ABOUT
PEOPLE COME IN AND WANT TO HELP
ANIMALS.
BUT REALLYMUDDYING THE WATERS
SIGNIFICANTLY IN CAUSING ALMOST
AS MANY PROBLEMS AS THEY HELPED
TO TAKE CARE OF BUT YEAH SO FOR
US REGIONALLY THERE'S NOT THAT
MUCH HELP BUT BUT STATEWIDE AND
YOU KNOW THEY'RE THEY'RE
DEFINITELY SPACE.
FOR MORE AGREEMENTS AHEAD OF
TIME AND I THINK IN ALL HONESTY
WE ALL HAVE TO FOSTER A AN ETHIC
OF RESPONSE WHICH WE HAVE NOT
REALLY HAD TO DO AS OF YET --
AND THAT'S AND AT EVERY LEVEL AT
THE LOCAL LEVEL AT EVERY LEVEL
AND REALIZE THAT WE ARE A PART
OF THE RESPONSE BECAUSE WITHOUT
THAT ETHIC IT'S EASY TO JUST
HOPE IT DOESN'T HAPPEN TO YOU.
AND CONTINUE YOUR DAY.
AND I GUESS THE OF ONE OTHER
QUESTION ACTUALLY.
EACH OF YOU TO THINK ABOUT SO.
WE TALK ABOUT FUNDING OR TALK
ABOUT CAPACITY SO FOR A YEAR.
WELL YOU'RE ALL COUNTY HEALTH
OFFICERS --
SO WHAT IS THE PROCESS BY WHICH
YOUR COUNTY DECIDES HOW MUCH
RECENT HOW MANY RESOURCES YET SO --
CAN CAN YOU PERHAPS SPEAK SPEAK
TO THAT.
YES FUNNY YOU SHOULD ASK BECAUSE
WE'RE JUST GOING TO THAT BUDGET
PROCESS RIGHT NOW --
FOR YEAH THE NEXT FISCAL YEAR --
WELL.
IT'S ACTUALLY STARTS CATEGORICAL
OF FUNDING OFTEN WE CAN LOOK AT
WILL WHAT AT THE FUNDING SOURCES
THAT WE KNOW WE HAVE COMING AND
WHAT HOW WE YOU KNOW PROJECT
DOING PROJECTIONS AND FIGURE OUT
WHAT WE SPENDING RIGHT NOW HOW'S
THAT GOING THIS YEAR WHAT ARE WE
LOOKING AT FOR NEXT.
YEAR AND THEN USING SOME OF
THESE VERY LIMITED SOURCES OF
DISCRETIONARY FUNDING TO KIND OF
FILL IN THE GAPS AND RIGHT NOW I
MEAN FOR PLASTER ITS IT'S
NINETEEN NINETY ONE REALIGNMENT
AND OF COUNTY GENERAL FUND MANY
COUNTIES --
PUT IN YOU KNOW THEY'RE THERE
DON'T KNOW REALLY --
PUT A LOT OF COUNTY GENERAL FUND
IN THE PUBLIC HEALTH RIGHT --
I'M --
INVESTMENTS BECAUSE OF OUR
WANING NINETEEN NINETY ONE
REALIGNMENT DOLLARS GOING HEALTH
REALIGNMENT --
HAS GONE DOWN JUST IN THE TIME
I'VE BEEN THERE --
SIGNIFICANTLY AND IT'S CONTINUE
TO GO DOWN SO --
SO EACH YEAR WE HAVE TO GO BACK
AND ASK FOR MORE IT EITHER PULL
MONEY FROM OTHER LIKE SOCIAL
SERVICES REALIGNMENT FOR MORE
MONEY FROM GENERAL FUND OR QUITE
FRANKLY.
LOOK AT AND WE JUST --
CLOSED OUR PUBLIC HEALTH LAB IN
LAST YEAR --
AND HAD A CONTRACT WITH THE
SURROUNDING COUNTY WE CLOSE OUR
MEDICAL CLINIC SO THAT IN
UNFORTUNATELY SOMETHING WORLD
TOO GOOD AT IS FIGURING OUT WE
DON'T KNOW HOW WE CAN GET MORE
OFFICIAL CONTRACTING OUT.
MUCH OF OUR TV WORK NOW TO THOSE
THE DECISIONS THAT ARE WHERE
WE'VE MADE YEAR AFTER YEAR AFTER
YEAR AND WE CONTINUE TO DO THAT
BUT FELT THAT AT THIS POINT
WE'RE DOWN --
TO REALLY THE BARE BONES.
IN RIVERSIDE COUNTY WE ALSO ARE
GOING TO THE BUDGET PROCESS
RIGHT NOW --
AT AND WE HAVE CONSISTENTLY LOST
COUNTY GENERAL FUND DOLLARS --
IN THE MILLIONS OF DOLLARS OVER
THE LAST DECADE.
NOT BECAUSE THE BOARD OF
SUPERVISORS ISN'T SUPPORTIVE OF
PUBLIC HEALTH BECAUSE BUT
BECAUSE OF ALL THE COMPETING
PRIORITIES --
AND SO.
WHAT HAPPENS IS THEN WERE FORCED
TO MAKE DECISIONS ABOUT WHAT WE
CAN CONTINUE TO FUND BECAUSE OUR
GENERAL FUND DOLLARS ARE REALLY
WHAT PROVIDE US WITH THE
FLEXIBILITY? TO ADDRESS NEW
RULES FOR PUBLIC HEALTH AND
BUILD UP OUR CORE FUNCTIONS SO --
IT'S IT'S DEFINITELY BEEN A
CHALLENGE WHERE.
WE HAVE BEEN KEPT FLAT SAID NO
ADDITIONAL FUNDING FROM THE
COUNTY FOR THE LAST SEVERAL
YEARS.
AND LOOKS LIKE IT WILL STAY THAT
WAY IN THE FORESEEABLEFUTURE SO
IT'S REALLY A CHALLENGE.
THEY ACTUALLY HOW MUCH CARE
THAT'S A LAST YEAR HOW MUCH
GENERAL FUND COUNTY GENERAL FUND
MONEY DID YOUR DEPARTMENT GET DO
YOU KNOW ABOUT --
YEAH ABOUT TWO MILLION DOLLARS
OF WE HAVE ABOUT A TWENTY
MILLION DOLLAR --
DEPARTMENTS TWO MILLION INVOICE
POPULATION PLASTER COUNTY FOUR
HUNDRED THOUSAND AND TWO
THOUSAND OKAY YOUR COUNTY SO ARE
COUNTY POPULATIONS ABOUT TWO
POINT FOUR MILLION.
OUR PUBLIC HEALTH BUDGETS ABOUT
A HUNDRED MILLION AND WE GET
ABOUT. ELEVEN TWELVE MILLION
DOLLARS GENERAL FUND OKAY
[inaudible]
AM.
DOCTOR MILLER YEAH DO I TELL ME
ABOUT IT I REALIZE YOU'RE IN THE
MIDDLE OF SO I DON'T KNOW WHAT
THE PROCESS IS RIGHT NOW.
ACTUALLY --
DON'T HAVE THAT INFORMATION
WHERE I CAN TELL YOU HOUSE
LARGER COUNTY IS BUT I DON'T
KNOW HOW MUCH GENERAL FUND.
MONIES ARE BROUGHT INTO THE
DEPARTMENT.
I DID IT OUT OF YOU KNOW FOR LA
THESE ARE NOT YET THE DIRECTOR
BUT I WILL SAY WE'RE GOING
THROUGH THAT PROCESS NOW AND IT
HAS BEEN MADE CLEAR TO US THAT
IN THE PAST APPARENTLY THERE WAS.
MORE MONEY BUT AS YOU KNOW AS
TIME HAS GONE ON THE COST OF
LIVING IN LA IT'S SKYROCKETED
THE STAFF.
YOU KNOW SALARIES WHO HAD TO
INCREASED COMMENSURATELY BUT THE
FUNDING HASN'T INCREASED EITHER
FROM.
THE COUNTY OR THAT THE FEDERAL
GOVERNMENT ALSO A LOT OF OUR
FUNDING COMES FROM THE FEDERAL
GOVERNMENT.
AND THAT DOES IMPACT I MEAN THE
DIRECTORS BEEN CLEAR SHE
UNDERSTANDS THAT WHAT YOU CAN DO
WITH YOUR STAFF IS LESS.
THANK YOU I QUESTIONS FROM
COMMITTEE MEMBERS.
BUT WELL THANK YOU VERY MUCH FOR
BEING HERE AND FOR TESTIFYING
AND REALLY PRE ACTUALLY NOW
WE'RE GOING TO MOVE INTO.
SECTION OF OUR PANEL UNDER
TREATED DISEASES.
AND WE HAVE --
FOR THIS PANEL [inaudible]
NICHOLAS OF WE HAVE A DOCTOR --
LAURA DALTON AS CHIEF MEDICAL
OFFICER FOR PLANNED PARENTHOOD
MAYOR MANTE HIS GOING TO ADDRESS
THE ISSUE OF S. T. D.'S HARRIS
TI'S.
WE ARE SEVENTIES AND HE SAID
DAVIS --
DOCTOR NEED TO DAVIS --
THE HEALTH OFFICER FOR CITY OF
LONG BEACH IS ALSO THE ADDRESS.
THE ISSUE OF AS THE EYES AS WELL
SO WE SERVE A AT PRIVATE SECTOR
AND THE PUBLIC SECTOR.
QUESTION ABOUT THIS.
WE HAVE DOCTOR LOUISE MAGNET
COUNTRY COST --
COMMUNICABLE DISEASE CONTROL IS
GOING TO TALK ABOUT AND DEPUTY
HEALTH OPTIONS ARE ABOUT TO
BURKE ELEUSIS.
KAMALA KANNAN THIS FROM THE
CURRENT PUBLIC COUNTY PUBLIC
HEALTH SERVICES.
DEPARTMENT ASSISTED DIVISION
DIRECTOR OF HEALTH SERVICES
TALKING OF VALLEY FEVER AND ALSO
HAVE MENACE MONTEREY COUNTY
HEALTH DIRECTOR TO ADDRESS OF A
CHRONIC DISEASE.
AND WHAT WE'RE DOING CRIED
DISEASE SO WELCOME EACH OF YOU
AND THAT WILL GO HEAD START WITH
DOCTOR DALTON.
THANK YOU WELCOME.
DOCTOR PAN AND GOOD AFTERNOON MY
NAME IS DOCTOR LAURA DALTON I AM
THE CHIEF MEDICAL OFFICER FOR
PLANNED PARENTHOOD MORE MANTE
THE LARGEST PLANNED PARENTHOOD
AFFILIATE IN THE STATE OF
CALIFORNIA AND THE COUNTRY.
I AM THE CHAIR OF THE MEDICAL
DIRECTORS FOR THE PLANNED
PARENTHOOD AFFILIATES OF
CALIFORNIA OR P. PACK AND SERVE
AS A CLINICAL VOICE FOR
STATEWIDE SEXUALLY TRANSMITTED
INFECTIONS ARE STI WORKGROUP.
IN TWO THOUSAND SEVENTEEN THE
RATE OF CHLAMYDIA AND THE STATE
OF CALIFORNIA INCREASED 9% FROM
TWO THOUSAND SIXTEEN AND WAS THE
HIGHEST NUMBER SINCE REPORTING
BEGAN IN.
NINETEEN NINETY THE CALIFORNIA
RATES OF GONORRHEA INCREASE 16%
FROM TWO THOUSAND SIXTEEN AND
WAS THE HIGHEST NUMBER SINCE.
NINETEEN EIGHTY EIGHT THE
CALIFORNIA RATES OF SYPHILIS
INCREASED BY OVER 21% COMPARED
TO TWO THOUSAND SIXTEEN THIS IS
THE HIGHEST NUMBER SINCE.
NINETEEN EIGHTY SEVEN IN TWO
THOUSAND SEVENTEEN THE RATE OF
CONGENITAL SYPHILIS INCREASE FOR
THE FIFTH CONSECUTIVE YEAR.
CONGENITAL SYPHILIS IS SUPPOSE
THAT IS TRANSMITTED FROM A
PREGNANT INDIVIDUAL TO A FETUS
AND SUBSEQUENTLY ANYMORE NEWBORN
BABY.
AND IT IS 1100% PREVENTABLE.
CONGENITAL SYPHILIS CAN CAUSE
SEVERE ILLNESS AND BABIES
INCLUDING PREMATURE BIRTH.
LOW BIRTH WEIGHT.
BIRTH DEFECTS BLINDNESS AND
HEARING LOSS.
IT CAN ALSO LEAD TO STILLBIRTH
AN INFANT DEATH.
THERE WERE THIRTY STILLBIRTH IN
TWO THOUSAND SEVENTEEN THREE
TIMES THE NUMBER IN.
TWO THOUSAND SIXTEEN
APPROXIMATELY ONE THIRD OF
INDIVIDUALS WHO DELIVERED A BABY
WITH CONGENITAL SYPHILIS DID NOT
RECEIVE PRENATAL CARE.
IN RESPONSE THE CALIFORNIA
PLANNED PARENTHOOD AFFILIATES
HAVE BEEN ENCOURAGING CIVIL
SCREENING FOR ALL INDIVIDUALS AT
RISK FOR PREGNANCY.
WE HAD A 58% INCREASE AND
TESTING.
ADDITIONALLY THE CALIFORNIA
PLANNED PARENTHOOD AFFILIATES
HAVE STARTED ENCOURAGING
COMPREHENSIVE STI SCREENING FOR
ALL INDIVIDUALS WITH A POSITIVE
PREGNANCY TEST.
COLLECTIVELY WE HAVE SEEN AN
EIGHT FOLD INCREASE AND TESTING
OF THESE PATIENTS.
WE'VE ALSO SEEN AN ALMOST 20%
INCREASE IN THE NUMBER OF
PATIENTS WE ARE TREATING FOR
SYPHILIS.
IT IS IMPORTANT TO NOTE THAT THE
RISE IN OPIATE USE COINCIDES
WITH INCREASING RATES OF THESE
S. T. EYES.
PUBLIC HEALTH EXPERTS HAVE
ESTABLISHED A LINK BETWEEN
OPIOID USERS TRANSITIONING TO
METHAMPHETAMINE USE AND
SUBSEQUENT RISKY SEXUAL
BEHAVIOURS.
WE CAN THEORIZE THAT THESE
INDIVIDUALS MAY BE FEARFUL TO
OBTAIN HEALTH CARE INCLUDING
PRENATAL CARE.
DUE TO FEAR OF LOSING RIGHTS OR
CUSTODY OF THEIR CHILD.
WE UNDERSTAND THE IMPORTANCE OF
CRITICAL RELATIONSHIPS WITH OUR
PUBLIC HEALTH PARTNERS AND THE
NEED FOR PLANNED PARENTHOOD.
AS ONE OF THE LARGEST PROVIDERS
OF STI TESTING AND TREATMENT AND
EDUCATION IN THE STATE OF
CALIFORNIA. TO CREATE PILOTS
INVOLVING NEW TESTING AND TO
IMPROVE AND UPDATE MESSAGING AND
EDUCATION FOR OUR STAFF AND OUR
COMMUNITIES.
TITLE TEN FUNDING IN CALIFORNIA
CURRENTLY SUPPORTS OVER ONE
MILLION LOW INCOME PATIENTS
IMPROVING ACCESS TO FAMILY
PLANNING PREVENTIVE AND
EDUCATION SERVICES.
THE FEDERAL GOVERNMENT'S NEW
REGULATION PROJECT MANY
PROVIDERS FROM THIS PROGRAM
INCLUDING PLANNED PARENTHOOD.
THE LHASA TITLE TEN SUPPORT WILL
REDUCE ACCESS TO PREVENTIVE CARE
AND THAT'S EXACERBATING STI
CRISIS.
AS PROVIDERS WE KNOW THAT WITH
THE RIGHT RESOURCES AND FUNDING
PLANNED PARENTHOOD CAN DO MORE
PREVENTION AND EDUCATION WHICH
WILL LEAD TO HELP YOUR OUTCOMES
ACROSS THE BOARD.
IT IS IMPORTANT TO RECOGNIZE
THAT MATERNAL AND INFANT
MORTALITY CONGENITAL SYPHILIS
PREVENTION AND EDUCATION.
AND TITLE TEN ARE INTERRELATED.
ACCESS TO COMPREHENSIVE SEXUAL
AND REPRODUCTIVE HEALTH SERVICES
IS AMUST IF WE'RE GOING TO
REDUCE STI RATES [inaudible]
THANK YOU.
A DAVIS --
I'M DARK THEM ANYTHING DAVIS THE
HEALTH OFFICER IN AS TO THE
CONTROLLER FOR THE LONG BEACH
DEPARTMENT OF HEALTH AND HUMAN
SERVICES.
AND I'VE BEEN ASKED TO DISCUSS
THE ROLE OF THE LOCAL HEALTH
DEPARTMENT --
IN ADDRESSING SEXUALLY
TRANSMITTED DISEASES I ACTUALLY
HAVE SOME SLIDES AND I DON'T
KNOW.
HOW TO MAKE THEM [inaudible] ONE
THANK YOU.
THANK YOU THANK YOU FOR ASKED ME
TO SPEAK --
SEE.
A DOCTOR DALTON HAS ARTICULATED
THE MAGNITUDE OF THE S. T. D.
EPIDEMIC NATIONALLY AND IN
CALIFORNIA.
IN THE CITY OF LONG BEACH WE
HAVE THE SECOND HIGHEST RATE OF
CHLAMYDIA AND GONORRHEA AND WE
HAVE THE THIRD HIGHEST RATES OF
SYPHILIS REPORTED IN THE STATE.
SHE ALSO HAS GONE OVER OUR
CONCERNS AROUND CONGENITAL
SYPHILIS --
IN LONG BEACH WE'VE ALSO SEEN A
DRAMATIC INCREASE.
IN.
THE NUMBER OF BABIES BORN WITH
THIS PREVENTABLE TRAGIC DISEASE.
LOCAL HEALTH DEPARTMENTS
THROUGHOUT CALIFORNIA PROVIDE
THE BACKBONE OF STD PREVENTION
TREATMENT AND CONTROL WE HAVE
THE LEGAL MANDATE TO PREVENT THE
SPREAD OF STDS IN OUR
COMMUNITIES.
WE INSURE THE PATIENTS ARE
TREATED THAT THEIR PARTNERS ARE
TESTED AND THAT HEALTH CARE
PROVIDERS HAVE THE TRAINING AND
THE SUPPORT THEY NEED TO PROVIDE
GOOD CARE.
THIS IS EASIER SAID THAN DONE.
PREVENTING ONE CASE OF
CONGENITAL SYPHILIS REQUIRES A
LOT OF BOOTS ON THE GROUND WORK --
HOMELESSNESS SUBSTANCE USE AND
MENTAL HEALTH CONDITIONS ARE
SIGNIFICANT BARRIERS FOR MANY
WOMEN WITH SYPHILIS --
JUST RECENTLY WE HAD A PREGNANT
WOMAN WHO IS EXPERIENCING
HOMELESSNESS AND USES
METHAMPHETAMINES.
SHE WENT TO HER LOCAL HOSPITAL --
AND DELIVERED TWIN BE
PREMATURELY.
THE MOM WAS DISCHARGED TO THE
STREETS --
STILL NEEDING MORE TREATMENT.
SO WE'VE HAD TO SEARCH FOR HER
CONTACTING THE POLICE AND
HOMELESS SERVICE PROVIDERS
CHECKING DMV A MEDIC COW RECORDS
AND EVEN GOING DOOR TO DOOR INTO
HOMELESS ENCAMPMENTS TO TRY TO
LOCATOR.
WE ALSO MAY NEED TO PROVIDE --
TRANSPORTATION TO GET HER TO OUR
THE LOCAL HEALTH DEPARTMENT AS
TO THE CLINIC TO FINISH HER
TREATMENT.
WE WILL NEED TO INTERVIEW HER TO
FIND OUT TO OUR PARTNERS ARE AND
THEN TRY TO TRACK THEM DOWN SO
THAT THEY CAN --
AND TO LET THEM KNOW THAT
THEY'VE BEEN EXPOSED TO AN STD
AND AND COORDINATE GETTING THEM
TESTED.
AND THEN WILL NEED TO OFF ALSO
OFFER SUPPORT TO HER FOR HER
SUBSTANCE USE AND HOMELESSNESS.
HOUSING SITUATION.
THE BABIES ARE STILL IN THE NICK
YOU.
AND COULD FACE ANY NUMBER OF
DEVASTATING BIRTH DEFECTS FROM
CONGENITAL SYPHILIS WILL MAKE
SURE THAT THE BABIES ARE TREATED
PROPERLY.
AND WE'LL ALSO PROVIDE CASE
MANAGEMENT SUPPORT THROUGHOUT
THEIR LIFE.
CASE INVESTIGATION SUCH AS THESE
ARE THE GOLD STANDARD OF STD
CONTROL IN THEIR VERY LABOR
INTENSIVE.
IN ADDITION TO CASE
INVESTIGATIONS LOCAL HEALTH
DEPARTMENTS PERFORM ANY OTHER
PIVOTAL ACTIVITIES. TO COMBAT
STDS.
THE TSTING DIAGNOSIS AND
TREATMENT OF SYPHILIS IS A
COMPLEX ISSUE AND MANY HEALTH
CARE PROVIDERS HAVEN'T SEEN
SYPHILIS BEFORE.
LOCAL HEALTH DEPARTMENTS PROVIDE
SUBJECT MATTER EXPERTISE TO
COMMUNITY PROVIDERS.
IF THIS PREGNANT PATIENT HAD HAD
PRENATAL CARE AND SHE BEEN
DIAGNOSED EARLIER THERE'S A HIGH
LIKELIHOOD THAT WE WOULD HAVE
BEEN CALLED TO HELP GUIDE
TREATMENT AND FOLLOW UP THE NEXT
STEPS.
SEVERAL COMMUNITY PROVIDERS ALSO
DON'T CARRY THE REQUIRED
MEDICATION TO TREAT SYPHILIS AND
IN THAT CASE OUR HEALTH
DEPARTMENT STD CLINIC WILL TREAT
THESE PATIENTS.
IN THE MANY CALIFORNIA'S
JURISDICTIONS THE DON'T HAVE STD
CLINICS THIS IS NOT EVEN AN
OPTION.
WE'VE HAD TO DO ALL.
WE'VE HAD TO DO ALL OF THIS WITH
VERY LITTLE STAFF AND WE'VE HAD
TO MAKE SOME HARD CHOICES.
FEDERAL FUNDING FOR STD CONTROL
EFFORTS DECREASED BY TWENTY ONE
MILLION DOLLARS BETWEEN TWO
THOUSAND THREE IN.
TWO THOUSAND SIXTEEN THIS IS A
QUITE TO A 40% REDUCTION IN
PURCHASING POWER WHEN ADJUSTED
FOR INFLATION.
SO WHILE THE RATES OF STDS ARE
AT ALL TIME HIGHS THE FUNDING IS
AT ALL TIME LOWS.
IN LONG BEACH ALTHOUGH WE HAVE
SOME OF THE HIGHEST RATES IN THE
STATE WE ONLY HAVE ENOUGH
FUNDING FOR ONE PERSON DEDICATED
TO S. T. D. INVESTIGATION.
BECAUSE OF THIS AND LONG BEACH
AS WELL AS THROUGHOUT THE STATE
HEALTH DEPARTMENTS HAVE HAD TO
FOCUS THEIR ATTENTION AND
RESOURCES ON PREVENTING
CONGENITAL SYPHILIS.
AND IT'S STILL NOT ENOUGH.
INVESTIGATING SYPHILIS CASES IN
HETEROSEXUAL MEN AND MEN WHO
HAVE SEX WITH MEN HAS SUFFERED.
AND INVESTIGATING CHLAMYDIA AND
MOST GONORRHEA CASES IS
IMPOSSIBLE.
WE'VE HAD TO REDIRECT STAFF FROM
OTHER PROGRAMS JUST TO STAY
BARELY AHEAD OF THE MOST
IMPORTANT STD CASES NOT REALLY
MAKING A DENT IN THE OVERALL
LEVEL OF DISEASE.
GETTING AHEAD OF THIS
UNPRECEDENTED INCREASE AND STDS
IS POSSIBLE.
IT WILL REQUIRE SUSTAINED
FUNDING GOING TO LOCAL HEALTH
DEPARTMENTS IN ORDER TO STAFF
TRAIN AND RETAIN A DEDICATED AND
EXPERIENCED WORKFORCE.
WITH ADDITIONAL RESOURCES WE CAN
STOP BABIES FROM BEING BORN WITH
DEVASTATING BIRTH DEFECTS AND WE
CAN TURN THE TIDE AGAINST STDS.
THANK YOU FOR YOUR TIME.
HAPPY TO ANSWER QUESTIONS.
THANK YOU WILL TAKE QUESTIONS AT
THE END OF THE PANEL THANK YOU
SO MUCH ADEQUATE DID
[inaudible]
OKAY [inaudible]
HI [inaudible]
THIS WORKING [inaudible]
BUT ON CUT NO --
GOOD AFTERNOON CHAIRMAN PAN AND
COMMITTEE MEMBERS THANK YOU FOR
ALLOWING ME TO COME AND TESTIFY
TODAY MY NAME IS LOUISE MAGNET I
AM NOT CAMINO COOL DISEASE AND
TRIBULUS CONTROLLER FOR CONTRA
COSTA COUNTY.
AND I'LL BE TALKING ABOUT
TUBERCULOSIS TODAY.
SO TUBERCULOSIS IS THE NUMBER
ONE INFECTIOUS DISEASE KILLER IT
WORLD WIDE AND IT CONTINUES TO
BE A PROBLEM THROUGHOUT THE U.
S. --
ESPECIALLY IN CALIFORNIA.
IN TWENTY SEVENTEEN OVER 20% OF
THE TOTAL NUMBER F PEOPLE
DIAGNOSED WITH TV IN THE ENTIRE
US WERE CALIFORNIANS.
THESE TWO THOUSAND FIFTY SEVEN
RESIDENTS OF OUR STATE OUT
NUMBER THE TOTAL NUMBER OF
PEOPLE DIAGNOSED WITH TB IN NEW
YORK AND TEXAS COMBINED.
THE TWO STATES WITH THE SECOND
AND THIRD HIGHEST NUMBER OF
CASES.
TPS SKEWS ME TV IS A DISEASE
THAT IS PASSED FROM PERSON TO
PERSON THROUGH THE AIR.
SO IF SOMEONE IS SICK WITH
TUBERCULOSIS IN THEIR LUNGS WHEN
THEY COUGH TALK LAUGHS SAYING
THEY RELEASE TB BACTERIA IN THE
AIR AND THE PEOPLE.
WHO SPEND A LOT OF TIME WITH
THEM AND CLOSE THIRTY BACTERIA
INTO THEIR BODY --
MOST PEOPLE WHO BREATHE IN THE
BACTERIA WILL NOT GET --
SICK RIGHT AWAY BUT SOME PEOPLE
WILL GET A LEAD IN FORM OF THE
INFECTION THAT WE CALLED.
THE IN TB INFECTION AND PEOPLE
CAN HARPER.
TB INFECTION FOR YEARS TO
DECADES --
AND THEN WILL BECOME SICK LATER
ON AND AND THEIR LIVES --
MOST PATIENTS DIAGNOSED WITH TV
AND CALIFORNIA ARE MEMBERS OF
MARGINALIZED GROUPS --
IMMIGRANTS PEOPLE OF COLOR.
PEOPLE EXPERIENCING HOMELESSNESS
PEOPLE WHO SUFFER FROM ALCOHOL
AND DRUG OR DRUG ABUSE PEOPLE
WHO ARE INCARCERATED OR LIVING
WITH HIV AIDS.
OFTEN FOR PEOPLE IN THESE
SITUATIONS TB IS NOT THE MOST
PRESSING PROBLEM.
SINCE OFTEN HAVE CONCERNS ABOUT
KEEPING A JOB WELL HAVING TO
TAKE TIME OFF TIME OFF TO THEIR
DUE TO THEIR ILLNESS.
CONCERNED ABOUT OTHER CHRONIC
DISEASES CONCERNED ABOUT HOW
HAVING TO ACCESS HEALTH CARE
SERVICES MIGHT AFFECT THEIR
IMMIGRATION STATUS.
CONCERNS ABOUT HIGHS HOUSING
TRANSPORTATION CHILD CARE OR
EVEN JUST FEEDING THEMSELVES AND
THEIR FAMILIES.
ALL THIS IN THE FACE OF HAVING
AN ELSE ILLNESS THAT OFTEN
REQUIRES BEING ISOLATED IN THE
HOSPITAL OR AT HOME FOR WEEKS TO
MONTHS.
TAKING MULTIPLE MEDICATIONS
WHICH MAY CAUSE SIDE EFFECTS WHO
SERIOUSNESS CAN RANGE FROM MILD.
TO DEADLY.
TAKING THESE MEDICATIONS DAILY
FOR AT LEAST SIX TO NINE MONTHS
ALONG WITH REGULAR VISITS THE
DOCTOR FOR EXAMS.
LAB TESTS AND TESTS X. RAYS HOW
MANY OF US HAVE SUCCESSFULLY
CLIP COMPLETED A USUAL COURSE OF
ANTIBIOTICS AT LAST SEVEN TO TEN
DAYS.
LET ALONE SIX TO NINE MONTHS --
OF MORE INTENSIVE TREATMENT.
THIS IS ONE OF THE REASONS WHY
TV CONTROL REQUIRE SUSTAINED AND
PERSISTENT EFFORT.
TB CONTROL PROGRAM STAFF AND
LOCAL HEALTH DEPARTMENTS MONITOR
TREATMENT OF EVERY SINGLE PERSON
DIAGNOSED WITH TB IN THEIR
JURISDICTIONS.
ENSURING THAT PATIENTS TAKE
EVERY DOSE OF THEIR TV
MEDICATION EVERY DAY FOR THE SIX
MIND. SIX TO NINE MONTHS IT
TAKES TO COMPLETE TREATMENT.
ENSURE THAT PATIENTS HAVE ACCESS
TO MEDICAL CARE AND THAT THEY
CAN MAKE IT TO THE DOCTOR'S
APPOINTMENTS.
THAT ANYTHING THAT MIGHT PREVENT
THEM FROM COMPLETING TREATMENT
AS ADDRESSED SOMETIMES THIS
MEANS HELPING THEM FIND
TRANSPORTATION.
HOUSING CHILD CARE A JOB TO
HEALTH SERVICES.
EVEN IN ONE INSTANCE THAT I KNOW
OF PROVIDING A TEMPORARY HOME
FOR PATIENTS PAT.
TV PROGRAM STAFF ARE ALSO
RESPONSIBLE FOR COMPLETING A
CONTACT INVESTIGATION FOR EVERY
PATIENT WHO MIGHT BE INFECTIOUS.
THIS INVOLVES IDENTIFYING ANYONE
WHO MIGHT HAVE BEEN EXPOSED TO
THE PATIENT WITH TB AND ENSURING
THAT THEY GET APPROPRIATE
EVALUATION AND TREATMENT
AND TWENTY EIGHTEEN CONTRA COSTA
COUNTY TV PROGRAM PROVIDEDCARE
TO SIXTY SEVEN PATIENTS WITH
ACTIVE TB.
THIS IS CONSIDERED A MODERATE
NUMBER OF CASES BY CALIFORNIA
STANDARDS BUT COMPELS IN
COMPARISON. TO JURISDICTIONS
LIKE LA THAT HAVE FIVE TO SIX
HUNDRED CASES.
AND OTHER COUNTIES IN THE BAY
AREA SUCH AS SAN FRANCISCO
ALAMEDA AND SANTA CLARA THAT
HAVE ONE TO TWO HUNDRED CASES
PER YEAR.
PROVIDING CARE TO THE SIX SIXTY
SEVEN RESIDENTS ARE COUNTY TO
ENSURE THEY COMPLETED TREATMENT
AND THAT TB TRANSMISSION WAS
STOPPED.
REQUIRED NINE HUNDRED AND THIRTY
FOUR HOME VISITS TO PATIENTS AND
THEIR FAMILIES.
MONITORING OF THREE THOUSAND
THREE HUNDRED AND SIX SIXTY FIVE
AND JUSTIN'S OF TV MEDICATIONS.
AND ENSURING THAT THREE HUNDRED
AND SIXTY NINE PEOPLE WITH
POSSIBLE TV EXPOSURE WERE TESTED
FOR TB AND TECH INFECTION AND
TREATED APPROPRIATELY.
IF THAT WEREN'T ENOUGH TV
CONTROL PROGRAMS ARE ALSO
RESPONSIBLE FOR ENSURING THAT
PEOPLE WHO ARE APPLYING FOR US
CITIZENSHIP COMPLETE THE
REQUIRED TO BE MEDICAL
EVALUATION.
DUE TO CHANGES AT THE FEDERAL
LEVEL THAT OCCURRED LAST FALL
THIS GROUP HAS EXPANDED TO
INCLUDE NEW CAT CLASSES OF
IMMIGRANTS.
PRELIMINARY DATA FROM MY COUNTY
SHOWS THAT THE NUMBER OF
IMMIGRANTS ENTERING OUR COUNTY
NEEDING PUBLIC HEALTH FOLLOW UP
ONE CREASE BY 3250% IN THE
COMING YEAR.
RESULTING IN ONE TO TWO
REFERRALS TO OUR PROGRAM EACH
DAY.
WHAT ARE PROGRAM NEEDS IN ORDER
TO IMPROVE TB PREVENTION EFFORTS
IN OUR COMMUNITY IS MORE STAFF?
MORE STAFF TO REACH OUT TO
PROVIDERS IN THE COMMUNITY TO
EDUCATE THEM ON HOW TO
APPROPRIATELY EVALUATE AND TREAT
PATIENTS WITH TB INFECTION
BEFORE THEY GET SICK WITH ACTIVE.
ACTIVE DISEASE.
MORE STAFF TO ACT AS DISEASE
DETECTIVES TO FIND PEOPLE.
WHO HAVE BEEN EXPOSED TO TB AND
GET THEM INTO TREATMENT?
AND MORE STEP TO FOLLOW UP WITH
IMMIGRANTS WHO ARE MOST AT RISK
OF BECOMING SICK WITH TB.
AS LONG AS TV CONTINUES TO BE A
THREAT GLOBALLY LOCAL PUBLIC
HEALTH DEPARTMENTS IN CALIFORNIA
WILL HAVE TO CONTINUE THESE TIME
INTENSIVE ACTIVITIES IN ORDER TO
PREVENT TB TRANSMISSION AND OUR
COMMUNITIES [inaudible]
THANK YOU.
THANK YOU WITH THIS HERNANDEZ
[inaudible]
OKAY.
GOOD AFTERNOON AND THANK YOU FOR
ON ALLOWING US TO COME SPEAK
BEFORE YOU MY NAME'S CAN REALLY
HERNANDEZ I AM THE ASSISTANT
DIVISION DIRECTOR OF HEALTH
SERVICES AT THE PUBLIC HEALTH
DEPARTMENT IN KERN COUNTY.
I'VE BEEN ASKED TO SPEAK JUST
FOR A MOMENT ABOUT VALLEY FEVER --
MANY OF YOU ALREADY KNOW WHAT
VALLEY FEVER IS BUT IF YOU DON'T
I'M GONNA GIVE YOU A LITTLE BIT
OF VALLEY FEVER ONE A ONE IT'S
KNOWN AS CUT VIDEO TO MYCOSIS IN
THE MEDICAL COMMUNITY --
IN THE PUBLIC SECTOR A LOT OF
PEOPLE OF COLOR **** E. FOR
SHORT.
BUT VALLEY FEVER IS AN
INFECTIOUS DISEASE I GUESS THAT
GROWS ON OUR SOIL.
WHEN THE SOIL IS TO STORE THAT
FUNGAL SPORES CAN BE INHALED AND
THEY CAN INFECT THE LUNGS?
YOU CAN DEVELOP A FEVER A COUGH
A RASH OR A VARIETY OF OTHER
SYMPTOMS.
IN RARE CASES THE FUNGUS CAN
SPREAD OUTSIDE OF YOUR LUNGS AND
IN FACT OTHER ORGAN SYSTEMS
INCLUDING YOUR BONES AND YOUR
BRAIN. ONE MEDICATION THERE ARE
MEDICATIONS TO TREAT VALLEY
FEVER AND SEVERE CASES MAY
REQUIRE LIFELONG TREATMENT.
PEOPLE CAN AND DO DIA VALLEY
FEVER EACH YEAR.
IT'S IMPORTANT TO KNOW THAT MOST
PEOPLE WHO ARE INFECTED WITH A
HIGH FEVER NEVER KNOW IT THEY
WILL HAVE VERY MILD SYMPTOMS OR
MAYBE NO SYMPTOMS AT ALL.
BUT BETWEEN TWO THOUSAND AND
TWELVE AND TWO THOUSAND AND
SEVENTEEN TWENTY SIX THOUSAND
PEOPLE IN THE STATE OF
CALIFORNIA WERE SICK ENOUGH TO
GO TO THE DOCTOR AND TO BE
DIAGNOSED WITH VALLEY FEVER --
TWO THOUSAND SEVENTEEN SAW THE
HIGHEST NUMBER OF CASES ABOUT A
FEVER IN THE STATE OF CALIFORNIA
IN THE HISTORY OF VALLEY FEVER
AND THE PRELIMINARY DATA FOR TWO
THOUSAND AND EIGHTEEN SUGGEST.
THAT THE NUMBER IS GOING TO BE
AS HIGH OR EVEN HIGHER. 40% OF
CALIFORNIANS DIAGNOSE OF VALUE
RELIVING KERN COUNTY.
IT AFFECTS MY COMMUNITY MORE
THAN ANY OTHER COMMUNITY IN THE
STATE BUT EFFECTS SO MANY PEOPLE
IN CALIFORNIA.
THERE'S ONE BIG TOWN WHEN IT
COMES TO VALLEY FEVER AND IT
THAT'S IT'S A REGIONAL DISEASE.
ON THE FUNGUS IS FOUND MAINLY IN
THE SOUTHWESTERN UNITED STATES
INCLUDING MANY PARTS OF
CALIFORNIA.
BUT IF YOU HAVEN'T LIVED HERE
LONG OR IF YOU'RE A MEDICAL
PROVIDER WHO WASN'T TRAINED IN
THIS AREA YOU MAY HAVE NEVER
HEARD OF IT AND YOUR KNOWLEDGE
OF THE DISEASE MAY BE VERY
LIMITED.
VALUE HAS VERY COMMON SYMPTOMS
YOU CAN TALK ABOUT A FEVER A
COUGH SHORTNESS OF BREATH
TIREDNESS.
ALONE OR IN COMBINATION THAT
COULD BE A MILLION DIFFERENT
DISEASES.
SO MANY OF US AS PATIENTS AS
PEOPLE WE WAIT TO GO TO THE
DOCTOR --
SOME OF US WAIT SO LONG THAT WE
END UP IN THE EMERGENCY
DEPARTMENT OR WE HAVE TO BE
HOSPITALIZED.
WE MISS ANYWHERE FROM A WEEK OF
WORK TO SIX WEEKS OF WORK ON
AVERAGE.
AND WE AS PATIENTS CAN BE OUR
OWN WORST ENEMY IN REGARDS TO
THE LIKE THE ROOM.
EVEN PEOPLE WHO LIVE IN AREAS
LIKE KERN COUNTY WERE VALLEY
FEVER IS VERY COMMON AND CAN BE
MISINFORMED ABOUT THE DISEASE
AND ABOUT THEIR RISK.
SO ALL OF US WOULD BENEFIT FROM
WHERE EDUCATION.
AND THEN OF COURSE ONCE WE
DECIDE WERE SICK ENOUGH TO GO TO
THE DOCTOR --
WE DEPEND ON OUR DOCTOR TO KNOW
ABOUT VALLEY FEVER AND TO TEST.
FOR A STUDY THAT WAS IN ABOUT
TEN YEARS AGO --
FOUND THAT IT TOOK AN AVERAGE OF
TWENTY THREE DAYS FROM THE TIME
THE PATIENT FIRST THOUGHT HEALTH
CARE TO BE DIAGNOSED WITH VALLEY
FEVER. 60% OF PEOPLE OR
PRESCRIBE ANTIBIOTICS THAT THEY
DIDN'T NEED AND WOULDN'T HELP
THEIR INFECTION OF VALLEY FEVER.
IN KERN COUNTY WERE ALMOST EVERY
COMMUNITY IN ART EIGHT THOUSAND
SQUARE MILES IS A FEDERALLY
DESIGNATED HEALTH CARE PROVIDER
SHORTAGE AREA.
WE GET A LOT OF HEALTH CARE
PROVIDERS I COME FROM FAR AWAY.
YOU KNOW WHEN WE THINK ABOUT WHO
WOULD WANT TO COME TO THE STATE
OF CALIFORNIA RIGHT --
BUT UNFORTUNATELY WHAT THAT
MEANS IS THEY OFTEN WEREN'T
TRAINED ABOUT VALLEY FEVER THEY
DON'T KNOW THAT THIS IS A
CONCERN IN OUR COMMUNITY --
AND THEY DON'T KNOW WHAT TO DO
ABOUT IT.
YOU KNOW THIS.
IS HOW CURATORS ARE WONDERFUL
WE'RE GLAD THEY'RE HERE TO SERVE
OUR COMMUNITY --
BUT WE WISH THAT THERE WAS A
MECHANISM.
TO BETTER EDUCATE THEM OR ENSURE
THAT THEY WERE EDUCATED ABOUT
VALLEY FEVER --
IT CAN BE DIAGNOSED OR RULED.
WHAT WE HOPE FOR IS THAT ALL THE
PATIENTS EVERYONE IN OUR
COMMUNITY --
IS AFFORDED THE SAME LEVEL OF
CARE -- IN
PARTICULAR FOR DISEASE LIKE
VALLEY FEVER THAT ARE JUST UNDER
AN NOT WELL KNOWN --
OUTSIDE OF THE AREAS WHERE IT'S
PUBLIC.
I'M AS MENTIONED VALLEY FEVER IS
JUST ONE OF MORE THAN EIGHTY
CONDITIONS THAT ARE REQUIRED TO
REPORT THE HEALTH DEPARTMENT.
AND IN MOST COUNTIES INCLUDING
MINE THE PEOPLE WHO ARE
RESPONSIBLE FOR INVESTIGATING BY
FEVER ARE ALSO RESPONSIBLE FOR
DOZENS OF OTHER DISEASES.
AND AS VALLEY FEARS HAVE AS LIKE
YOUR CASES OF CONTINUE TO RISE.
I COUNTY AFTER COUNTY HAS FOUND
THAT THEY DO NOT HAVE THE
RESOURCES TO FULLY INVESTIGATE
THEM.
BEGINNING JANUARY ONE OF THIS
YEAR WE AS A STATE MOVED TO A
CASE DEFINITION THAT DOES NOT
REQUIRE --
CASE PATIENT INTERVIEWS OR TO
REVIEW MEDICAL RECORDS.
AND THIS DECISION WAS MADE TO
REDUCE THE BURDEN ON COUNTY
HEALTH DEPARTMENTS AND TO CREATE
A UNIFORM A DEFINITION ACROSS
THE STATE.
BUT IN DOING SO WE KNOW THAT WE
WILL NO LONGER HAVE ACCESS TO
DETAILS ABOUT A PATIENT LIKE
THEIR OCCUPATION THEIR SEVERITY
OF ILLNESS WHETHER OR NOT THEY
WERE HOSPITALIZED.
WE KNOW THAT THIS WILL REDUCE
OUR ABILITY TO DETECT OUTBREAKS
OR DETERMINE IF EXPOSURES HAPPEN
OUTSIDE OF THE COUNTY RESIDENTS.
BUT COUNTY THROUGHOUT THE STATE
FELT UNABLE TO KEEP UP WITH THE
NUMBER OF CASES AND WE AS A
STATE DECIDED THAT IT WAS MORE
IMPORTANT TO ACCURATELY CAPTURE
THE NUMBER OF CASES.
IN TO KNOW EVERY DETAIL.
IN AN IDEAL WORLD OF PUBLIC
HEALTH WOOD WE INVESTIGATE
EVERYONE OF THE NEARLY THREE
THOUSAND CASES OF THE LIKE THE
RING KERN COUNTY.
ABSOLUTELY.
THERE'S STILL SO MUCH WE HAVE TO
LEARN ABOUT THIS DISEASE AND WHO
TO FAX.
I WANT TO KNOW WHAT WHAT
PREDICTS A GOOD YEAR OR A BAD
YEAR FOR VALLEY FEVER.
I WANT TO BE ABLE TO BETTER
EDUCATE PEOPLE SO THAT THEY KNOW
HOW THEY CAN REDUCE THEIR RISKS.
AND SO THEY KNOW THEY CAN SEEK
MEDICAL CARE AND THAT WHEN THEY
DO SEEK MEDICAL CARE THAT THEIR
PROVIDER WILL TAKE CARE OF THEM.
I WANT TO KNOW IF THERE'S A
CLUSTER OF CASES SOMEWHERE SO WE
CAN DETERMINE THE SOURCE OF
EXPOSURE AND TAKES STEPS TO KEEP
MORE.
BEING INFECTED.
BUT IN OUR CURRENT SITUATION I
NEED MY LIMITED STAFF LIKE ALL
THE OTHER HEALTH DEPARTMENTS. TO
CONTINUE THEIR INVESTIGATIONS
AND INTERVENTIONS IN OTHER
DISEASES.
WE ALL DO THE BEST WE CAN WITH
THE RESOURCES WE HAVE SO I URGE
YOU TO CONSIDER PUBLIC HEALTH AS
YOU LIKE US SEEK TO SERVE THE
COMMUNITY.
WE ALL KNOW THAT WITHOUT HEALTH
THERE'S NOT MUCH ELSE THAT
MATTERS.
THANK YOU ALL FOR YOUR TIME.
THANK YOU THANKS FOR MUCH MISS
VENICE WELCOME GOOD AFTERNOON
CHAIR AND MEMBERS MY NAME IS
ALSO HUMANNESS AND I'M THE
MONTEREY COUNTY HEALTH DIRECTOR.
I'M HERE TO DISCUSS CHRONIC
DISEASES AND OUR CAPACITY AT THE
LOCAL LEVEL TO ADDRESS THE
PREVALENCE OF THEM IN OUR
COMMUNITIES.
DESPITE CALIFORNIA'S EFFORTS IN
EXPANDING OUR HEALTH CARE SYSTEM
CHRONIC DISEASES WHICH ARE
PREVENTABLE STILL ACCOUNT 475%
OF DEATHS IN CALIFORNIA. ONE
THIRD OF CALIFORNIA'S CHILDREN
ARE OVERWEIGHT. 46% OF ADULTS IN
OUR STATE ARE DIAGNOSED WITH PRE
DIABETES.
THE BURDEN OF CHRONIC DISEASE IS
DISTRIBUTED UNFAIRLY AND
DISPROPORTIONATELY IMPACTS LOW
INCOME AND PEOPLE OF COLOR IN
OUR COMMUNITIES.
IN TWO THOUSAND SEVENTEEN AND
MONTEREY COUNTY 9% OF OUR ADULT
POPULATION HAD DIABETES. TWENTY
POINT 6% WAS OBESE AND TEN POINT
THREE HAD HEART DISEASE.
ALTHOUGH THE PERCENTAGE OF
MONTEREY COUNTY RED EIGHTIES WAS
SLIGHTLY LOWER THAN THE STATE.
THE RATE OF MONTEREY COUNTY
RESIDENTS HOSPITALIZED WITH
PREVENTABLE LONG TERM
COMPLICATIONS WAS GREATER THAN
THE STATE RATE.
THE PERCENTAGE OF MONTEREY
COUNTY ADULT LATINOS DIAGNOSED
WITH DIABETES IS TWO TIMES MORE
COMPARED TO WHITES.
AND ONE IN FOUR MONTEREY COUNTY
ADULT LATINOS ARBY'S COMPARED TO
SIXTEEN POINT 1% OF WHITES.
LOW INCOME LATINOS EXPERIENCED
THE HIGHEST HEALTH INEQUITIES
DUE TO A LACK OF ACCESS TO
STABLE HOUSING.
HEALTHY FOODS OPPORTUNITIES FOR
ACTIVE LIVING SAFE COMMUNITIES
AND PRIMARY CARE MONTEREY COUNTY
HAS A HIGH NUMBER OF
UNDOCUMENTED INDIVIDUALS WHO
LACK ACCESS TO BASIC SERVICES.
LOCAL HEALTH DEPARTMENTS ARE
MANDATED TO ADDRESS CHRONIC
DISEASES WE UTILIZE DATA TO
INFORM US OF THE HEALTH STATUS
OF OUR COMMUNITIES.
AND BEST PRACTICES AND EVIDENCE
BASED DREADED USED TO HELP US
ADVANCE HEALTHEQUITY TO CREATE
HEALTHIER COMMUNITIES.
LOCAL HEALTH DEPARTMENTS CAN
SUCCEED OF COMMUNITY RESIDENTS
ARE INFORMING THE WORK AND OF
PUBLIC PRIVATE PARTNERSHIPS ARE
FORMED.
I WILL HIGHLIGHT JUST A COUPLE
OF EXAMPLES FROM MY COMMUNITY.
OUR HEALTH DEPARTMENT THROUGH
OUR NUTRITION EDUCATION OF THE
CITY PREVENTION PROGRAM HAS
PARTNERED WITH WAKE AND
EVERYONE'S HARVEST TO FACILITATE
THE ISSUANCE OF VOUCHERS. FOR
FRESH FRUITS AND VEGETABLES AT
FARMERS MARKETS LOCATED ARE WHAT
CLINICS AND WE PARTNER WITH
SCHOOLS TO PROMOTE HEALTHY
EATING AN ACTIVE LIVING.
OUR HEALTH DEPARTMENT AND THE
TRANSPORTATION AGENCY OF
MONTEREY COUNTY SECURED FUNDING
FOR CREATING SAFE STREETS AND
WALKABLE ENVIRONMENTS.
INFRASTRUCTURE IMPROVEMENTS AND
SAFE ROUTES TO SCHOOL
PROGRAMMING SUCH AS WALKING
SCHOOL BUSES ARE BEING
IMPLEMENTED.
COMMUNITY WIDE PHYSICAL ACTIVITY
EVENTS SUCH AS OPEN STREETS AND
BIKE RODEOS HAVE BEEN HELD.
SOME OF OUR HOME VISITATION
PROGRAMS FOCUS ON ADDRESSING
SOCIAL DETERMINANTS OF HEALTH
FOR INDIVIDUALS EXPERIENCING
CHRONIC DISEASES.
AND WE'RE IMPLEMENTING EARLY
SCREENING FOR JUST A TIONAL
DIABETES TO HELP PREVENT OR
MITIGATE CONSEQUENCES.
THE ABSENCE OF FLEXIBLE
SUSTAINABLE REVENUE AND
CATEGORICAL GRANT FUNDING LIMITS
OUR ABILITY TO IMPLEMENT
COMPREHENSIVE PREVENTION
STRATEGIES.
MOST GRANTS REQUIRE SPECIFIC
STRATEGIES TO BE IMPLEMENTED
PREVENTING LOCAL HEALTH
DEPARTMENTS FROM SELECTING
STRATEGIES THAT MAY WORK ACROSS
MULTIPLE CHRONIC DISEASES AN
INJURY AREAS.
THE SILOS ARE WORK IN ADDRESSING
COMMON RISK FACTORS AND
INDIVIDUALS AND ACROSS
POPULATIONS.
COMMUNITY MEMBERS OFTEN HAVE
MORE THAN ONE RISK FACTOR AND
FRAGMENTED APPROACHES ARE NOT AS
EFFECTIVE. FOR EXAMPLE WE KNOW
THAT THE LEADING CAUSES OF
CHRONIC DISEASES.
ARE TOBACCO USE POOR NUTRITION
AND PHYSICAL AND ACTIVITY.
PROPOSITION FIFTY SIX FUNDING
MAY ONLY BE TOBACCO.
ACCESSING USE.
LIMITING OUR ABILITY TO
COMPREHENSIVELY PREVENT CHRONIC
DISEASES FURTHER WITH THE
LEGALIZATION OF CANNABIS AND
LACK OF FUNDING TO LOCAL HEALTH
DEPARTMENTS TO ADDRESS.
CANNABIS PREVENTION SURVEILLANCE
EDUCATION AND ENFORCEMENT
EFFORTS AND THE INABILITY TO USE
PROP FIFTY FIFTH PROP FIFTY SIX
FUNDING TO ADDRESS THE SUBSTANCE.
LOCAL HEALTH DEPARTMENTS ARE
CHALLENGED IN IMPLEMENTING TRACK
STRATEGIES TO REDUCE ACCESS AN
EARLY INITIATION BY OUR YOUTH.
WITH LIMITED RESOURCES BOTH AND
DOLLARS AND STAFFING OTHER LOCAL
HEALTH DEPARTMENT MANDATE SUCH
AS DISEASE OUTBREAKS TAKE
PRESIDENT PRECEDENCE.
AND SHIFT THE ATTENTION AWAY
FROM UPSTREAM APPROACHES PUBLIC
HEALTH NURSES ARE BE DIRECTED AS
YOU'VE HEARD EARLIER FROM THEIR
DAY TO DAY FUNCTIONS.
AND AN M. C. H. WHOLE PERSON
CARE CHRONIC DISEASE PREVENTION.
TO ADDRESS THESE DISEASE
OUTBREAKS AT MONTEREY COUNTY
HEALTH DEPARTMENT WE HAVE ABOUT
TEN NURSES DEDICATED TO THESE
PREVENTION EFFORTS AND WITH OUR
RECENT OUTBREAK OF HEPATITIS SAY.
THE THE STAFF MEMBERS WERE BE
DIRECTED TO CONDUCT EDUCATION A
VACCINATION SERVICES FOR AS MANY
HOMELESS RESIDENTS AS WE COULD
AND WE WERE ABLE TO VACCINATE
ABOUT A THIRD OF OUR HOMELESS
POPULATION.
THUS KEEPING OUR OUTBREAK TO A
TOTAL OF ELEVEN PREVENTION
EFFORTS PARTICULAR THOSE FOCUSED
ON POLICY SYSTEMS AND
ENVIRONMENT CHANGE.
DON'T RESULT IN INSTANT SUCCESS
BUT CREATE THE OPPORTUNITIES
COMMUNITIES NEED TO THRIVE
ACROSS GENERATIONS FOR EXAMPLE.
INJURIES RESULTING FROM VEHICLE
CRASHES DID NOT DECREASE UNTIL
LAWS MANDATING RESTRAINTS WERE
PASSED SIMILARLY CALIFORNIA HAS
EXPERIENCED A HUGE DECREASE IN
TOBACCO USE AND EXPOSURE.
BUT IT HAS TAKEN TWENTY PLUS
YEARS TO GET WHERE WE ARE THESE
EFFORTS CAN'T BE SCORED AS QUICK
SAVINGS.
SHOULD YOU WISH TO BUILD THE
INFRASTRUCTURE AT THE LOCAL
LEVEL TO PREVENT CHRONIC
DISEASES CONSIDERATION OF THE
FOLLOWING SHOULD BE GIVEN.
SUSTAINABLE FLEXIBLE FINDING
DEDICATED TO AGGRESSIVE ADDRESS
CHRONIC DISEASES WILL ALLOW
LOCAL HEALTH DEPARTMENTS TO
TAILOR STRATEGIES TO MEET THEIR
UNIQUE LOCAL NEEDS. FOR EXAMPLE
AN ONGOING ALLOCATION OF GFC
COMMITMENT OR ESTABLISHMENT OF A
WHILE THE STRESS WILL PROVIDE
THE FLEXIBILITY NEEDED TO BUILD
HEALTHIER COMMUNITIES.
SUPPORT FOR ADVANCING HEALTH
ADVANCING HEALTHEQUITY THROUGH A
FOCUS ON HEALTH AND ALL POLICIES
RIGHT MARK.
OUR FOCUS SHOULD BE COMMUNITY
EMPOWERMENT INVOLVEMENT THROUGH
DEVELOPMENT OF GENERAL PLAN
HEALTH ELEMENTS ADOPTION OF
MULTI UNIT HOUSING SMOKE FREE
TOBACCO FREE POLICIES AND
TOBACCO RETAILER LE LET ME TELL
LICENSE IN.
I'M MORE INTENTIONAL FOCUS ON
ADDRESSING SOCIAL DETERMINANTS
OF HEALTH SUCH AS EXPAND IN
EARLY CHILDHOOD EDUCATION
SUPPORT AND EXPANSION OF NURSE
FAMILY PARTNERSHIP.
AND OF COURSE COMMUNICABLE
DISEASE INVESTIGATE.
SO THAT WE HAVE THE BASIC
INFRASTRUCTURE NOT TO ONLY MEET
DAY TO DAY NEEDS BUT IF WE WERE
TO HAVE A BIG OUTBREAK.
AND LASTLY AND THE KNOWLEDGE A
KNOWLEDGE MEANT THAT INVESTING
IN PREVENTION IS CRITICAL AND
HELPS TO AVOID HEALTH CARE COSTS
IN THE FUTURE.
INVESTING AND HELP YOUR
COMMUNITIES IS THE SMARTEST WAY
TO FUNDAMENTALLY RESHAPED THE
HEALTH OF CALIFORNIA.
THE BENEFITS OF INVESTING IN
BUILDING HEALTHIER COMMUNITIES
CAN PREVENT ILLNESS INJURY AND
AN EQUITABLE HEALTH CONDITIONS
AND FAR OUTWEIGHED THE BENEFITS
OF ACCESSING HEALTH CARE
SERVICES ALONE.
INVESTING TEN DOLLARS PER PERSON
AND PREVENTION WITH TOTAL ABOUT
FOUR HUNDRED MILLION DOLLARS
THAT'S LESS THAN ONE ONE
THOUSANDTH OF WHAT WE SPEND ON
HEALTHCARE IN CALIFORNIA
ANNUALLY.
I WANT TO THANK YOU VERY MUCH
FOR YOUR TIME AND FOR YOUR
INTEREST IN PUBLIC HEALTH.
THANK YOU THANK YOU ALL
QUESTIONS A CENTER MONEY.
THANK YOU MISTER CHAIR I WANT TO
THANK YOU AND YOUR STAFF.
FOR THE FOCUS OF TODAY'S HEARING
IN.
PREVENTION AND INFRASTRUCTURE
AND FOR THOSE ON THE PANL ON
THE OTHER PANELS THANK YOU FOR
YOUR WORK EVERY DAY HIM FOR
BEING HERE TODAY. ONE OFFER A
SPECIAL WELCOME TO OUR MONTEREY
COUNTY.
COUNTY HEALTH OFFICER.
MISSY MENACE THANK YOU FOR
JOINING US.
THE COMMON THREAD AMONG ALL OF
THESE IS PREVENTION AND
PREVENTABLE --
IN SOME OF THE SOLUTIONS I THINK
ALL OF THEM.
INVOLVE MORE RESOURCES MORE
STAFFING.
THE PROBLEM IS I SEE IT IS THAT.
THERE'S NO PROFIT IN PREVENTION.
AND WE HAVE A MEDICAL SYSTEM.
THAT -- IS
INVESTMENT.
IS PLACE WHERE THERE CAN BE
DERIVED PROFIT.
SO LEAVES GOVERNMENT TO BE THE
FIFTEEN IT --
IN THE WORK THAT YOU DO --
WITH GOVERNMENT SUPPORT IN OUR
LIMITED BUDGETS --
IF I MIGHT MISS HIM MINUTES YOUR
FOCUS ON PREVENTABLE TYPE TWO
DIABETES.
IT AFFECTS OUR ENTIRE STATE.
THE TRANS KEEP GOING UP IF WE
HAD A BETTER WAY OF INVESTING
[inaudible]
IN PREVENTION.
WE WOULD SAVE OURSELVES WHAT'S
BEEN DESCRIBED AS A PUBLIC
HEALTH EPIDEMIC NOT BY
POLITICIANS THAT BYE.
BY DOCTORS AND MEDICAL
SCIENTISTS.
SO -- MISSY
MENACING YOUR WORK IN MONTEREY
COUNTY -- IN
LOOKING AT SOME OF THE THE AREAS
OF FOCUS ON TERMS OF NUTRITION.
EXERCISE LIFESTYLE --
THE RAW SUGAR SWEETENED
BEVERAGES IN BEING ONE OF THE
LEADING SOURCES OF INCREASED.
BAD CALORIC INTAKE FOR CHILDREN
AND FAMILIES.
HUNDREDS OF MILLIONS OF DOLLARS
SPENT EVERY YEAR IN ADVERTISING.
IN TARGETING THE AT RISK
COMMUNITIES THAT YOU DESCRIBED.
WHAT IS MARIN COUNTY DOING IN
WHAT ARE YOU DOING IN
PARTNERSHIP WITH OTHER PUBLIC
HEALTH OFFICERS TO TRY?
TO OFFSET THAT IMBALANCE.
SOME OF THE STRATEGIES THAT I
MENTIONED IS --
INCLUDE HAVING SOME OF OUR STAFF
GOING TO THE SCHOOL SETTINGS AND
OTHER SETTINGS TO EDUCATE
CHILDREN AT AN EARLY AGE ABOUT.
MAKING THE HEALTHIER CHOICE I
WE'VE DONE SOME WORK AS WELL
WITH OUR HIGH SCHOOLS TO LOOK AT
YOU KNOW THAT.
WHETHER OR NOT THEY HAVE SODA
VENDING MACHINES AND WE WORK
WITH THEM TO GET THOSE OUT OF
THEIR SCHOOLS.
AS WELL AS MAKING SURE THAT
WATER FOUNTAINS ARE IN WORKING
CONDITION AND ATTRACTIVE TO KIDS --
IT'S WE'VE IMPLEMENTED RETHINK
YOUR DRINK CAMPAIGN AGAIN
FOCUSING ON KIDS HOPEFULLY
SELECTING OUT WATER OVER ANY
OTHER BEVERAGE AND SO WE'RE
WORKING WITH THE SYSTEMS THAT
THEY RESIDE AND TO HOPEFULLY
HELP THOSE OPPORTUNITIES.
BE MORE READILY AVAILABLE FOR
THE USE START EARLY ON AND KIDS
ARE FIRST EXPOSED TO
ALTERNATIVES.
THAT THEY TEND TO GO FOR THE
APPLE VERSES THE COOKIE IT'S
IT'S ONCE THEY'VE BEEN
INTRODUCED AND HAVE GAINED THAT
APPETITE FOR THE SUGAR.
THAT IT'S REALLY HARD TO TWO
TERMS SO AGAIN AND TESTING EARLY
ON IN TRYING TO CREATE --
THE CHILDREN THAT WE NEED SO
THAT THEY CAN ACTUALLY MAKE THE
HEALTHIER CHOICE.
THANK YOU AGAIN.
SO MUCH OF THIS PARTICULAR IN
THIS SERENE OF THE SUGAR
SWEETENED BEVERAGES IT'S DAVID
VERSUS GOLIATH AND WHILE WE'VE.
BANNED THE SALE OF SODAS IN
PUBLIC SCHOOLS --
THE CAMOUFLAGE OF SUGAR LOADED
DURING SENT TO ENERGY DRINKS
SPORTS TEAMS THAT CENTERS HOW
THEY'VE.
GOTTEN AROUND --
SOME OF THOSE YOU ALSO MENTION
SUCCESSES IN REDUCING.
TOBACCO ADDICTION IN YET --
WE'RE SEEING A HUGE INCREASE IN
THE VAPING --
HOW ARE YOU APPROACHING THAT IS
A PUBLIC HEALTH OFFICER --
I ASSUME IN COMBINATION WITH THE
SCHOOLS BUT IN TALK TO SOME OF
OUR SCHOOL LEADERS AROUND THE
STATE --
IT'S IT'S REALLY OUT OF CONTROL.
IT IS DEFINITELY A REALLY BIG
PROBLEM ACROSS CALIFORNIA
PROBABLY ACROSS THE STATE --
WE ARE USING WHAT WE CAN WITH
RESPECT TO OUR TOBACCO LIMITED
TOBACCO FUNDING. TO BE ABLE TO
WORK WITH COMMUNITY SINCE I'M
GOING INTO THE SCHOOLS AND
EDUCATING THE TEENS ABOUT THE
HARMS OF TOBACCO USE ABOUT FAITH
BEING.
ABOUT REALLY UNDERSTANDING
WHAT'S WHAT THEIR PURCHASING
MANY KIDS DON'T EVEN KNOW WHAT
THEIR PURCHASE SCENE --
WE'VE HAD A FEW INSTANCE
INCIDENCES WHERE.
KIDS HAVE --
BEEN EXPOSED TO AND OVERDOSED ON
CANNABIS AND HAD TO BE TAKEN TO
THE EMERGENCY DEPARTMENT.
SO WE ARE WORKING IN TERMS OF
DOING EDUCATION WITH THOSE WITH
THE STUDENTS AND ALSO WITH THE
ADMINISTRATORS AND HOPEFULLY WE
CAN MOVE TOWARDS --
WORKING WITH AND I'M
IMPLEMENTING SOME POLICIES.
SO THAT THERE'S OF RESTRICTIONS
IN TERMS OF WHAT THEY CAN BRING
ON CAMPUS BECAUSE MY
UNDERSTANDING IS THAT RIGHT NOW
THEY CAN PRETTY MUCH.
HIDE BRING IT IN.
THEY'RE SELLING IT AND AND SO WE
REALLY NEED TO WORK ON ON ON ON
DEVELOPING A POLICY AND THEN AND
FORCING IT TO ENSURE THAT THAT
KIDS AREN'T ABLE TO DO THAT ON
CAMPUS THANK YOU.
NINE AM APPRECIATE THAT YOU
MENTION THE CANNABIS ISSUE IN
YOUR EARLIERTESTIMONY AND THEN
AGAIN WITH RESPECT TO THE VAPING
PRODUCTS BECAUSE THAT'S AN
INTERSECTION.
WE HAD A RECENT HEARING ASIAN OF
CANNIBAL [inaudible]
IN IT'S THE LEFT AFTER WE HIT
CERTAIN TARGETS. FOR LAW
ENFORCEMENT AND OTHERS.
THERE'S CAN OF THE FINAL --
BUCKET IF THERE'S MONEY THERE IS
FOR EDUCATION AND PREVENTION AND
IT JUST SEEMS LIKE IT SHOULD BE
ONE OF THE BUILT IN --
REQUIRED DIRECTIONS --
ON THE SO MISTER CHAIR JUST IF I
COULD MAYBE YES ONE MORE
QUESTION --
THANK YOU MISS HIM IN THIS FOR
YOUR WORK --
IN THE STI --
CHALLENGE AGAIN.
THE COST ONCE SOMEBODY'S
INFECTED YOU GAVE THE EXAMPLE OF
THE MOTHER WITH.
DRUG ADDICTION IN.
GIVING BIRTH PREMATURELY TO THE
TWINS.
WHAT'S THIS IF YOU HAD THE MAGIC
WAND HOW DO WE GET ON THE FRONT
END OF BETTER --
PREVENTION OF THE THE IT'S A
COMMUNICABLE DISEASE HAVE.
EDUCATION BUT OFTEN WERE
RETIREMENT ASSETS AT RISK
COMMUNITIES.
THE TRENDS ARE GOING UP WHAT
ONLY.
WHAT WE NEED TO DO TO REVERSE
THE TRENDS?
OF BOTH PROVIDERS AND COMMUNITY
MEMBERS SO PROVIDERS ABOUT THE
SEXUALLY TRANSMITTED INFECTIONS
HOW TO TREAT THEM HOW OFTEN YOU
SHOULD BE SCREENING HOW TO TAKE
A BASIC SEXUAL HISTORY FOR
PATIENTS --
SO I THINK THAT WOULD BE HELPFUL
AND THEN I THINK THE COMMUNITY
MEMBERS AS WELL --
A LOT OF SIX SAID DOESN'T HAPPEN
ANYMORE IN SCHOOLS SO KIND OF
REINSTITUTING THAT AND BEING
REALLY OPEN AND FRANK ABOUT
SEXUAL PRACTICES AND HARM
REDUCTION AND AND MAKING BETTER
CHOICES --
AND THEN HAVING ACCESS TESTING
AND TREATMENT FACILITIES IS ALSO
REALLY IMPORTANT.
A LOT OF FOLKS THAT ARE GETTING
SEXUALLY TRANSMITTED INFECTIONS
HAVE -- ARE
EXPERIENCING HOMELESSNESS AND
HAVE POOR EDUCATIONAL
OPPORTUNITIES AND JOBS --
AND SO I THINK LOOKING AT THAT
IS ALSO VERY IMPORTANT --
AND HAVING REALLY GOOD REFERRAL
SYSTEMS IN PLACE WHEN YOU ARE
CHALLENGED WITH THOSE THINGS
WILL BE IF THERE ARE WERE READY --
TO DEAL WITH THEIR THEIR
SUBSTANCE USE FOR INSTANCE
HAVING SOMEWHERE RIGHT NOW THAT
WE COULD --
GET THEM TO I THINK THOSE ARE
THE THINGS HAVING HOUSING RIGHT
NOW THAT WE COULD HELP THEM WITH
I THINK WOULD BE HELPFUL.
THANK YOU IN.
ON THINK PLANNED PARENTHOOD FOR
THE ROLE YOU PLAYING IN YOUR
TEAMS AROUND THE STATE --
WITH.
PART OF THE PREVENTION AND
TREATMENT --%
FOR ANY OF YOU YOU PAUL
MENTIONED AT RISK POPULATIONS
HAS INCLUDING IMMIGRANT
POPULATIONS.
IN THE GIVEN THE CURRENT
ATMOSPHERE OF THE CURRENT
ADMINISTRATION THE FEDERAL
GOVERNMENT --
IN TARGETING IMMIGRANTS HAVE YOU
SEEN A DECLINE IN PEOPLE
ACCESSING.
PROGRAMS FOR WHICH THEY ARE
ELIGIBLE.
BUT BECAUSE OF FEAR OF AN
IMMIGRATION CONSEQUENCE AREN'T --
TAKING ADVANTAGE OF A DECLINE IN
IN ELIGIBLE.
IMMIGRANT COMMUNITY NOT
ACCESSING HEALTHCARE SERVICES
ANY OF YOU.
WE'VE WE'VE SEEN --
PEOPLE WHO ARE IMMIGRATING HERE --
UP TO BECOME MEET TO BECOME
PERMANENT RESIDENTS ARE WITH
SCENES THEY'VE BEEN MORE
HESITANT ABOUT GOING TO GET
THERE FOLLOW UP TO BE
EVALUATIONS BECAUSE THEY'RE
WORRIED THAT IF THE YOU SERVICES
AT MY AFFECT THEIR ABILITY. TO
APPLY FOR CITIZENSHIP LATER ON
SO WE HAVE SEEN THAT HAPPEN --
AND PEOPLE AND OTHER KIND OF NON
STEVE HERE WITH VARIOUS
DIFFERENT TYPES OF VISAS BEING
RELUCTANT ACCESS HEALTH CARE --
OR BEING RELUCTANT TO APPLY FOR
FOR MEDICAL BENEFITS.
THANK YOU I MEAN FROM A PUBLIC
HEALTH POINT OF VIEW.
GERMS IN INFECTIOUS DISEASE TO
NOT CHECK GREEN CARDS OR
IMMIGRATION STATUS SO.
REGARDLESS OF ANYBODY STATUS IN.
MULTI GENERATIONAL CITIZENS ARE
COMMUNITIES ENJOY BETTER HEALTH
[inaudible]
WHEN?
EVERYONE IN OUR COMMUNITIES HAS
ACCESS AND I KNOW I'M PREACHING
TO THE CHOIR HERE BUT I THINK.
FROM A GOVERNMENT POINT OF VIEW --
WE NEED TO TAKE CONSCIOUS STEPS
TO OFFSET SOME OF THOSE FEARS
AND MYTHS TO PROVIDE REASSURANCE --
FOR FAMILY MEMBERS TO TO SEEK.
CARE AND TREATMENT THAT IS
AVAILABLE TO THEM --
AGAIN I JUST APPLAUD THE WORK
YOU'RE.
IT'S OFTEN SAID ABOUT OUR
BUDGETS THAT WERE PENNY WISE AND
POUND FOOLISH WE CAN RARELY GET
I SHARE THIS FRUSTRATION WITH
OUR CHAIR WE WE WE COMMISERATE
OFTEN THAT WHEN WE ASK.
OUR FINANCE DEPARTMENT FOLKS OR
LEGISLATIVE ANALYST'S FOLKS WHAT
IS THE CONSEQUENCE OF NOT MAKING
A PARTICULAR INVESTMENT IN OUR
BUDGET.
AND THEY CAN RARELY TELLIS OUT
YEARS HOW MUCH MORE WE'RE GONNA
HAVE TO PAY IN IN ITS IN THIS
ARENA ESPECIALLY.
THAT OUR FAILURE TO INVEST
ADEQUATELY.
IN PREVENTION WE CAN GUARANTEE
WE'RE GONNA SPEND MORE DOWN THE
ROAD WITH.
WITH TREATMENT BUT AGAIN I
APPLAUD THE WORK YOU'RE DOING
THANK YOU MISTER CHAIR.
THANK YOU CENTER MONEY YES --
WHEN WE DO OUR BUDGETS --
SINCE AS A TO THE BUDGET
SUBCOMMITTEE --
THOUGH HE'S HAPPY TO TELL US HOW
MUCH AN INTERVENTION WOULD COST
THEY DON'T.
THEY DON'T FIGURE OUT HOW MUCH
IT WOULD COST WITHOUT THAT
INTERVENTION RIGHT AND I THINK
THAT'S SOMETHING I APPRECIATE
CENTER MONEY BRINGING UP.
AND ALSO LIKE SHE ACTUALLY --
JUST TO FOLLOW UP AND QUESTIONS
FOR CEREMONY AND FOR DOC HURT
PEOPLE BEING RELUCTANT TO SIGN
UP FOR HEALTH CARE SERVICES LIKE.
YOU KNOW MEDI CAL OR OTHER TYPES
OF THINGS BUT YOUR TD CONTROL
OFFICER SO YOU'RE GOING SAY YOU
GOT TV AND WE'RE GOING TO COME
BY YOUR HOUSE OR YOU COME TO OUR
CLINIC -- SO
WE CAN BE SURE YOU TAKE YOUR
MEDICATION.
HAVE YOU RUN INTO THAT PROBLEM
FOR PEOPLE INTERFACE WITH THE
WELL BUT YOU'RE A GOVERNMENT
SERVICE SO I'M ANYWAY WE ARE WE
HAVING PROBLEMS WHERE PEOPLE ARE
TRYING TO AVOID ACTUALLY SEEN.
PUBLIC HEALTH BECAUSE THEY'RE
AFRAID THAT THE GOVERNMENT
SERVICE AND THEY WOULD --
AND AND THAT THAT MIGHT AFFECT
THE ONLY.
YEAH I'D I DON'T THINK I'VE SEEN
NOT SUCH OKAY AND BECAUSE WHAT
WE DO ESPECIALLY WITH PEOPLE WHO
WERE RECENTLY ARRIVING TO THE U.
S. OR WHO ARE APPLYING FOR
CITIZENSHIP.
IS -- THEY
HAVE TO GO THROUGH --
AN EVALUATION THAT'S PRESCRIBED
BY THE CDC AND SO THEY'LL SAY
WELL I DON'T I DON'T.
I DON'T WANT TO GO SEE A DOCTOR
I DON'T WANT TO GET INSURANCE TO
PAY FOR IT.
SO EITHER THEY SAY YOU KNOW DO I
REALLY HAVE TO DO IT OR THEY'LL
TRY -- SEE
IF THEY CAN AFFORD TO PAY FOR IT --
OUT OF POCKET OKAY SO WHAT IS SO
SO BASICALLY I'M JUST WRAPPING
UP BECAUSE OF THE ONE IS THAT.
IT BE KIND OF SCARY THAT THEY'RE
ACTUALLY YEAH YOU KNOW YOU'RE
DOING THIS BECAUSE WE'RE TRYING.
TO PREVENT OTHER PEOPLE FROM
CATCHING TB SO WE DON'T WANT
PEOPLE TRYING TO AVOID.
THE PUBLIC HEALTH OFFICE I MEAN
WE KNOW THERE'S TO BECAUSE
YOU'RE WORRIED THAT THE OF A
PUBLIC CHARGE --
ALSO SOUNDS LIKE BECAUSE WE'RE
ABOUT PUBLIC CHARGE --
WE KNOW THAT YOU KNOW WE THEM IN
SOUTH DEPARTMENT ISN'T ALSO
TRIED RIGHT EVERY HEALTHCARE
SERVICE AVAILABLE RIGHT SO WE'RE
DEPENDENT ON HEALTHY PEOPLE WILL
GET COVERAGE AND BE ABLE TO GET --
BUT THEY CAN THE BASIC THAT'S
AUSSIE SHIFTING MORE ACTIVITY.
TO PUBLIC HEALTH BUDGETS WHERE
IS MAYBE A CLINICA DE TAKING
CARE OF SOME OF THIS --
SO THAT YOU YEAH --
IT'S IF THEY WERE ACTUALLY GOT
HEALTH CARE COVERAGE VERSUS NOW
SAYING WELL BUT I DON'T WANT TO
GO TO A CLINIC BECAUSE I'M
AFRAID IT'S GONNA BE PUBLIC
SHARDS OF NOW.
MORE CLINICAL ACTIVITIES GET
SHIFTED ON TO PUBLIC HEALTH
DEPARTMENTS IS THAT SOMETHING
THAT YOU'RE DEAD TO BE CONCERNED
ABOUT.
YEAH WE ARE COUNTY IS A LITTLE
BIT.
UNIQUE IN THAT WE WELL WE DON'T
REALLY HAVE A A WE DON'T HAVE A
TV CLINIC THAT'S ON BY PUBLIC
HEALTH --
BUT I COULD DEFINITELY SEE AND
COUNTIES WHERE YOU KNOW IF YOU
DON'T HAVE YOUR PROVIDER YOU GO
TO PUBLIC HEALTH I COULD
DEFINITELY SEE THAT HAPPEN OKAY.
ALL RIGHT.
AND ACTUALLY --
SPENT AS AN IT ANSWER FIVE AND
CENTER MONEY YOU KNOW YOU
MENTIONED 46% HAVE PRE DIABETES
SO -- SO
WHAT PERCENTAGE OF THOSE PEOPLE
EVENTUALLY BECOME DIABETIC.
MAYBE I CAN ASK MY HEALTH OFFICE
OKAY **** ALL RIGHT I THINK IT'S
ONE IN FOUR I I KNOW TO ASK YOU
THE QUESTION I KNOW THE ANSWER.
TO SO SO SO SO THAT'S THAT'S
VERY EXPENSIVE RIGHT AND WE KNOW
THERE'S INTERVENTIONS LIKE THE
DIABETES PREVENTION PROGRAM
WHERE WE HAVE THEM SEE --
DIETITIANS --
THAT CAN ACTUALLY REDUCE THAT BY
ABOUT HALF --
SO EIGHT EIGHT EIGHT AGAIN AND-AND THE OTHER I THINK I REALLY
APPRECIATE THAT WHAT YOU SAID IS
IS THAT WHEN IT COMES.
TO CHRONIC DISEASES LIKE OKAY
CHRONIC DISEASES --
MAN THAT NOT AS URGENT WE TALK
ABOUT WHEN I SAY NOT ESSENTIAL
IS IT NOT AS URGENT AS PERHAPS
AN OUTBREAK GOING ON AND SO WE I
HEARD THAT VENTURE NURSES --
OF THE HEPATITIS A OUTBREAK WE
HEARD FROM THE LA.
I COUNTY AS WELL THAT HAPPENED --
BUT THAT DOESN'T MEAN THE
CHRONIC CONDITIONS STOP WENT
AWAY IT JUST MEANS THAT PEOPLE
ARE GETTING HELP AND I WOULD
POINT OUT WE HAD A PREVIOUS
HEARING WE TALKED ABOUT THE FACT
THAT 40% OF CALIFORNIANS AT
LEAST ONE CRY CONDITION THAT
7280% OF OUR HEALTH.
CARE COSTS.
RIGHT SO WE'RE SPENDING WHAT
PERCENTAGE OF PUBLIC HEALTH AND
WE'RE SPENDING 70%. 7280% ON A
HEALTHCARE SPENDING ON THE
CONSEQUENCE OF THAT NOT DOING
THE PREVENTION RIGHT RIGHT SO --
WHEN WE START TALKING ABOUT
BUDGETS AND TALKING ABOUT THINGS
WHAT HAPPENS WE DON'T DO THINGS --
AND IT WOULD IT HELP IF I MAY
IT'S GOING TO TAKE INVESTMENT ON
BOTH ENDS RIGHT OBVIOUSLY WE
HAVE INDIVIDUALS THAT ARE
EXPERIENCING CHRONIC CONDITIONS
NOW THAT WE STILL HAVE TO CARE.
FOR SO WE STILL HAVE TO KEEP
INVESTING IN THAT LINE BUT WE
ALSO NEED TO INVEST IN THE
PREVENTION MORE HEAVILY SO THAT
HOPEFULLY.
YEARS FROM NOW.
IT'S MORE BALANCED AND WE ARE
ACTUALLY GETTING PEOPLE.
TO IT LIVING COMMUNITIES THAT
ACTUALLY PROMOTE WELL BEING AND
THAT ACTUALLY ENCOURAGE THEM TO
WALK FROM HOME TO SCHOOL BECAUSE
THEY LIVE IN A SAFE COMMUNITY
AND AND WE'RE GOING TO HAVE TO
INVEST HEAVILY ON THAT
PREVENTION SIDE IF I OR ELSE
WE'RE GOING TO CONTINUE TO
EXPERIENCE THE HIGH.
RATES OF CHRONIC CONDITIONS THAT
WE HAVE NOW [inaudible]
S. CI [inaudible]
SURPLUS.
I THINK MOST PEOPLE THINK THAT
WHEN WE WITH THE VICTORIAN ERA.
RIGHT NOW WE HAVE A MULTI DRUG
RESISTANT GONORRHEA.
BY THE WAY YOU JUST TOLD ME THAT
BECAUSE THE SURPLUS YOU DON'T
HAVE PEOPLE TO TRACK ON A RE
ANYMORE.
THEY REALLY DO SURPLUS.
AND I WILL SAY YES TO ANSWER ONE
OF THE QUESTIONS YOU ASK BEFORE --
THAT STD CONTROL BRANCH I
BELIEVE --
WAS THE LEAD BUT THEY'VE DONE
AROUND STD --
WORK FOR SO I CAN'T TELL YOU.
FOR THE CITY OF LONG BEACH WE
SHOULD HAVE FIVE DISEASE
INVESTIGATORS --
AND WE NEED ANOTHER DOCTOR AND
WE NEED A SUPERVISOR DATA
ANALYST SO AND YOU HAVE THAT.
OKAY.
SO THE LADY AT THE END AND AND I
KNOW ES DE ACTUALLY.
WE HAVE ONE WE HAVE ACTUALLY ONE
PROVIDER PLANNED PARENTHOOD
YEARLY OF PERCEIVED PUBLIC
HEALTH BUT REALLY I MEAN IT IS
THIS INTERFACE TO WRITE AS I LAY
ASK IF ANY PLANNED PARENTHOOD WE
HAVE.
WE HAVE THE NEW THE TRUMP
ADMINISTRATION TRYING TO CUT OUT
CUT PLANNED PARENTHOOD BY THE
KNEES.
I CERTAINLY I THINK YOU'RE IN
THE STATE WILL WE WON'T ALLOW
THEM TO HAVE TO CLOSE ALL THE
CLINICS BUT IF.
THAT CAPACITY ONE AWAY WHAT
WOULD HAPPEN THAT. TO YOUR
HEATH DEPARTMENT IF SUDDENLY
ALL THE ALL THE CAPACITY OF
PLANNED PARENTHOOD SAID WHAT
SORRY WE DON'T HAVE THE MONEY
WE'RE WE'RE WE'RE THAT WE'RE
WE'RE SHUTTING THAT OFF.
WHAT WHAT WHAT WOULD HAPPEN --
FOR LONG BEACH OUR RELATIONSHIP
WITH PLANNED PARENTHOOD IFTHEY
SEE ON MANY OF THE PATIENTS AND
THEN -- IF
THEY'RE POSITIVE AND THEY GET
SENT TO THE HOME.
SO I THINK THEY WOULD JUST COME
DIRECTLY TO THE HEALTH
DEPARTMENT PROBABLY --
I OFFEND PEOPLE FOR THAT RIGHT
IT WOULD BE.
IT WOULD BE DIFFICULT I I THINK
WE ALL HEALTH DEPARTMENTS ARE
ABLE TO HAVE AN ISSUE THE CLINIC
IT IS VERY EXPENSIVE AND IT'S
VERY DIFFICULT TO FIND --
BUT IT IS I THINK YOU KNOW KIND
OF A CORNERSTONE OF STD CONTROL --
TO BE ABLE TO GET PATIENTS IN
WHEN THEY DON'T HAVE ANYWHERE
ELSE TO GO SO ANY FUNDING CUT OF
ANY SORT WHETHER ITS TITLE --
TEN MEDICARE HOW WHICH IS
ANOTHER BIG UNDER --
IS IS --
MAKING --
ALREADY KINDA TENUOUS SITUATION
KIND OF FALL OFF THE CLIFF
[inaudible]
AND WHEN YOU TALKED ABOUT WHAT'S
DRIVING THE STI.
A BREAK RIGHT.
IT'S IT'S NOT JUST THAT --
SO AND I ACTUALLY WORKED IN A
CLINIC WHERE THEY DID THEY THEY
WERE THE ESSENTIALLY THE STI ARM
FOR THE CITY HEALTH DEPARTMENT
THAT WASN'T HERE IN CALIFORNIA
BUT THAT --
WELL IT IS NOT JUST ABOUT OKAY
WELL WE DIAGNOSE YOU AN STI
HERE'S THE TREATMENT NEAR THE
ANTIBIOTIC AND TELL US WHO YOU
CONTACTS ARE WE'VE GO AND TRY TO
FIND THEM AND STUCK THEM AS WELL.
WHAT'S DRIVING IT OR THINGS LIKE
YOU KNOW --
SUBSTANCE USE POVERTY.
OTHER TYPES OF MENTAL HEALTH
ISSUES AND SO FORTH AND OUR TO
RATIONS ARE SERRATION RIGHT SO
ARE YOU ABLE TO PROVIDE ALL THE
SERVICES IN THE AT THE COUNTY
HEALTH DEPARTMENT.
NO WE'RE NOT SO WE'RE ONE OF THE
CITY HEALTH DEPRIVE CITY HOW THE
PRICE IT'S A YEAH YOU'RE CITY
EYES ARE --
NO AND I THINK NO ONE IS ABLE --
TO BUT I THINK WE ONE OF THE
BENEFITS OF WORKING AND I DON'T
DEPARTMENT AS WE HAVE HOMELESS
SERVICES --
RIGHT NOW WE HAVE COMMUNITY
HEALTH WITH THE PUBLIC HEALTH
NURSES WE HAVE CHRONIC JOURNEYS
PREVENTION AND SO WE CAN ALL
WORK TOGETHER AND WE BRING IN
THE POLICE WE BRING IN YOU KNOW.
THE FIRE DEPARTMENT HAS A HEART
TEAM WHICH WORKS IN HOMES
COMMUNITIES SO WE DO EVERYTHING
WE CAN TO REALLY ESTABLISH
RELATIONSHIPS AND TO TRIGGER
PEOPLE AND TO TRY TO DON'T HAVE
THAT.
THAT THING TO GIVE THEM BREAK
THAT.
FIX THEIR ISSUE RIGHT SO --
DR DALTON. TO PLANNED PARENTHOOD.
I KNOW YOU DO MUCH MORE INDUSTRY
STI IS SO CAN YOU TO SPEAK A
LITTLE BIT PERHAPS THE ROLE OF
PLANNED PARENTHOOD ACTUALLY
COMPLAIN IN TERMS OF THESE THE
THE THE THE THINGS DRIVING STI
SO ASIDE FROM JUST.
TREATING PEOPLE AS TI IS I MEAN
WHY WOULD THE L. WIRES ON THE
THINGS THAT YOU DO THAT HAVE
PEOPLE COME IN RELATION TO BILL
THE PATIENTS AND ALSO OTHER
SERVICES YOU PROVIDE REFERRALS
THAT YOU PROVIDE THAT HELP
ADDRESS THIS.
THANK YOU ABSOLUTELY I THINK --
IT'S REALLY IMPORTANT TO COMMENT
ALSO ON THE PREVIOUS QUESTION --
REGARDING --
THE LOCAL HEALTH DEPARTMENTS AND
THEIR ABILITY TO TREAT FOR
SYPHILIS SO WE HAVE SEVERAL
COUNTIES WITH AND KIND HEARTED
MARMITE TASTES REGION.
ON THAT DOES NOT BUT DO NOT HAVE
THE CAPACITY TO TREAT INVERSE OF
US AREN'T RELY ON OUR PLANNED
PARENTHOOD HEALTH CENTERS
PROVIDE THAT --
AT TEN PART AMANTE WE OFFER A
COMPREHENSIVE PRIMARY CARE
SERVICES SO WE TREAT NEWBORNS
TWO HUNDRED PLUS.
WE OFFER BEHAVIORAL HEALTH THAT
IS INTEGRATED INTO OUR PRIMARY
CARE MODEL --
GENDER AFFIRMING CARE SERVICES
PRENATAL CARE SERVICES --
AFFECTED ME SERVICES --
AND THEN REFERRALS AS NEEDED TO
OUR COMMUNITY --
RESOURCES FOR HOUSING AND FOOD
NEEDS.
I THINK --
SOMETHING THAT'S REALLY
IMPORTANT TO NOTE IS THAT AS ONE
OF THE EXPERTS AND SEXUAL
REPRODUCTIVE HEALTH ON THE
GROUND.
WE HAVE THE CAPACITY TO COLLECT
A LARGE AMOUNT OF DATA --
WHEN WE ARE FACING EPIDEMICS
SUCH AS THE?
AND IT WAS THE INFORMAL
RELATIONSHIP WITH THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH AND
COMPARED AMANTE THAT REALLY
STARTED THE WORK.
OF US CHANGING --
SCREENING OF PATIENTS FOR
SYPHILIS.
AND I THINK THAT THAT'S
SOMETHING THAT WE SHOULD THINK
ABOUT MORE --
AND IF THERE IS AN OPTION FOR US
TO BE MORE INNOVATIVE AND
FORMALIZE THOSE RELATIONSHIPS --
BECAUSE WE SEE THE PATIENTS WE
HAVE THE DATA --
AND CAN WE NEED TO KIND OF WORK
MORE FORMALLY WITH OUR LOCAL AND
STATE PUBLIC HEALTH DEPARTMENTS
TO MAKE AN IMPACT BECAUSE I
THINK.
IN SOME OF THESE AREAS LIKE
CONGENITAL SYPHILIS --
AN EPIDEMIC WE DON'T ALWAYS
UNDERSTAND EXACTLY WHAT IS
CAUSING IT WE CAN DERIVE ALL
THESE ISSUES WITH HOMELESSNESS --
AND DRUG USE BUT IT'S ALSO ABOUT
COLLECTING DATA TO SAY WHAT'S
WHAT'S NOT WORKING WITH OUR
CURRENT --
SCREENING GUIDELINES THEN USING
THAT DATA SO WE GET YES --
THE STATE ACTUALLY HE HAS HAVE
SOME EXPANDED SCREENING
GUIDELINES THAT ARE IN DRAFT
FORM SO HOPEFULLY LATER THIS
YEAR THEY'LL BE ADDRESSING SOME
OF THESE THINGS THAT.
SHE'S DISCUSSING --
MAKING YOU KNOW TESTING MORE
PEOPLE IN EMERGENCY ROOMS MAKE
SURE YOU HAVE PREGNANCY STATUS
WHEN YOUR BEING SEEN.
SO I MADE A I THINK ONE OF THE
THINGS THAT --
IS DESERVE THIS --
THE RELATIONSHIP BETWEEN.
HEALTH DEPARTMENTS AND SERVE THE
REST OF THE THE SERVER THE
HEALTH CARE DELIVERY SYSTEM.
AND DIFFERENT --
THE DIFFERENT ORGANIZATIONS
WITHIN THAT AND SO WE WE TALKED
A LOT ABOUT DISASTER
PREPAREDNESS WHAT DEGREE CAN YOU --
AND IT'S IT'S GREAT WHEN PEOPLE
CIVIL VOLUNTEER AND HELP YOU
STILL NEED SOMEBODY ON THE
HEALTH STAFF TO COORDINATE ALL
THE VOLUNTEERS VOLUNTEERS OUT
COORDINATE ARE USING.
NOW TO CREATE CAN BE MORE
CONFUSION ANYTHING ELSE IF WE
DON'T HAVE THAT KIND OF
DIRECTION AND BUT ALSO ON THE
ONGOING PEACE RIGHT WHERE THEY
WERE TALKING STI IS --
TV CRACKED DISEASE AND ACTUALLY
VALLEY FEVER AS WELL.
AC WE CAN AYE --
TRENT HERNANDEZ ABOUT THE VALLEY
FEVER YOU TALKED A BIT ABOUT THE
CONDITION AND AND THE THINGS WE
NEED TO DO BUT HE'S TALKED A
LITTLE BIT ABOUT WHAT THE HEALTH
DEPARTMENT'S DOING WITH THE
PROVIDERS TO YOU MENTIONED MANY
OF THEM.
NEVER HEARD OF VALLEY FEVER
LOCAL DISEASE --
AND YOU KNOW I TRAINED ON THESE
BECAUSE THERE WAS A VALLEY FEVER
AND IT'S FOR TRANSYLVANIA TO
MEDICAL SCHOOL IN BOSTON RIGHT
IN MY RESIDENCY TRAINING SO.
WHAT DO YOU SEE IS THE ROLE OF?
OF OF THE YOU KNOW OF PUBLIC
HEALTH YOUR HEALTH DEPARTMENT IN
TERMS OF EDUCATING BUT ALSO A
TWO TYPES OF DIRECTION YOU GIVE
TO YOUR ORDER --
TO TO YOUR LOCAL.
DECISIONS AND OTHER HEALTH
PROVIDERS TO BE SURE THAT YOU
HAVE THE INFORMATION YOU NEED ON
VALLEY FEVER TO WORK WITH THEM
TO BE SURE THAT THEY'RE MAKING
ACCURATE DIAGNOSIS YOU'RE ABLE.
TO CONTACT OUR EVER TRACE KEEP
TRACK OF THIS THE PURPOSE THE
TEST TAKES I KNOW WE CHANGE THE
DEFINITION IT CETERA BUT THE
COLLABORATIONS THAT COULD HAVE
HAPPENED A KERN COUNTY --
WITH WITH THE PROVIDERS IN TERMS
OF TRYING TO KEEP YOUR PUBLIC
HEALTH GOALS AROUND VALLEY FEVER --
IN KERN COUNTY WE WERE WE'RE
LUCKY THAT MANY OF OUR PROVIDERS
IT YOU KNOW DO NO VALUE FOR A
WHILE AND WE HAVE SOME REALLY
GOOD INFECTIOUS DISEASE DOCTORS --
WHO HELP SUPPORT THIS EDUCATION --
A LOT OF AYE FEVER IS DIAGNOSED
IN PRICE IN PRIMARY CARE AND SO
A LOT OF IT IS --
REACHING NEW PHYSICIANS --
WE WE HAVE A DEDICATED VALLEY
FEVER WEBSITE IN KERN COUNTY AND
THAT SPEAKS TO THE DATA TO THE
DISEASE --
OUR PUBLIC HEALTH LABORATORY --
WE'RE VERY LUCKY THEIR PUBLIC
HEALTH LABORATORY DOES CLINICAL
TESTING FOR VALLEY FEVER IN THE
IN MY OPINION ARE THE BEST --
LAB VALLEY FEVER --
YOU KNOW IN THE NATION BUT THEY
WE WE STRUGGLE IN REACHING A LOT
OF PROVIDERS BECAUSE THEIR NEW --
AND WE DO HAVE SOME SYSTEMS OF
WE USED A HAND TO SEND UP
PROVIDER ALERTS TO REMIND THEM
ABOUT THE LIFE HERE TO TALK TO
THEM ABOUT PREVENTION --
BUT IT'S HARD --
WE HAVE THE LIKE YOUR INSTITUTE
AT COMMERICAL AND THAT WAS YOU
KNOW IT HAS RECENTLY COME INTO
FRUITION THEY ACTUALLY HOLDING A
SYMPOSIUM --
FOR HEALTHCARE PROVIDERS I AM IN
A REACH OUT TO OUR HEALTH CARE
PROVIDERS AND YOU KNOW INCLUDING.
DOCTORS TO PRACTITIONERS ANY
KIND OF PROVIDER AND TO TELL
ABOUT THE IF YOU WERE GIVEN THE
OPPORTUNITY ASK QUESTIONS TO
KIND OF CREATE THAT RESOURCE
BASE SO THAT --
IF THEY NEED TO DISCUSS
TREATMENTS --
THAT THEY HAVE A POSITION TO
HELP THEM WITH THAT --
AND SO IT'S IT'S KIND OF A LONG
TIME COMING AND WE'RE WE'RE GLAD
THAT THIS IS THE RELATIONSHIP IS
DEVELOPING AND SO WE HOPE TO
CONTINUE TO REACH THEM.
AND YOU KNOW THE THE TRICKIEST
PART IS THAT WE DON'T CONTROL
THE PRIZE THAT COME IN --
AND IF THEY ARE IN LARGE CLINIC
GROUPS USUALLY THERE'S KIND OF
THAT SUPPORT SYSTEM TO HELP THEM
BUT WHEN THEY COME IN AS A
PRIVATE PROVIDER OPEN THEIR NEW
PRACTICE --
IF THEY DON'T KNOW ABOUT IT THEY
DON'T KNOW ABOUT IT.
WE OBVIOUSLY DON'T HAVE THE
CAPACITY TO GO OUT ONE ON ONE TO
EDUCATE PROVIDERS --
WE DO A BIT OF EDUCATION AS WE
ARE RECEIVE THE LABORATORY
RESULTS TO KIND OF TALK THROUGH
I KNOW WHAT THAT MEANS WE GET A
LOT OF QUESTIONS SOMETIMES ABOUT
WHAT THIS MEANS ABOUT A
PATIENT'S DIAGNOSIS IF THEY NEED
TREATMENT OR NOT --
AND USUALLY HAS TO GET REFERRED
TO A MEDICAL DOCTOR --
TO HELP THEM.
TALK THROUGH IT SO THERE IS WE
KNOW THAT THERE'S A NEED FOR
BETTER EDUCATION --
AND AND WE KNOW THAT THERE'S A
NUMBER OF CLINICAL STUDIES
CLINICAL TRIALS THAT ARE GOING
ON AND THROUGH THAT YOUR
INSTITUTE IN ORDER TO HELP
PROVIDE BETTER --
CLINICAL GUIDANCE ABOUT
TREATMENT AND I'M ONE OF THEM IS
IMPAIR TREATMENT --
OF VALLEY FEVER YOU KNOW WHEN
YOU SUSPECT MANY PEOPLE ARE
MISDIAGNOSIS BACTERIAL PNEUMONIA
GIVEN ANTIBIOTICS THEN THEY EVEN
TAKE ONE OR TWO COURSES
SOMETIMES ANTIBIOTICS BEFORE IT
BACK YEARS CONSIDERED --
VERSES IF WE KID CHIEF AMONG YOU
KNOW STARTING WITH THE ANTI
FUNGAL SLICKLY OUR TURNAROUND
TIME IN KERN COUNTY IS VERY
QUICK THAT IF THEY DON'T NEED WE
TAKE THAT UP TAKE IT.
TAKE THEM OFF OF IT RELATIVELY
QUICKLY VERSES IF THEY DO NEED
IT THEY'LL BE ON IT TWO WEEKS
FASTER --
THAN IF THEY HAD STARTED
EMPIRICALLY OKAY.
SO -- YEAH
LAST YEAR WE PUT INTO THE STATE
BUDGET THANKS TO CENTER FULLER --
FUNDING FOR THE VALLEY FEVER
INSTITUTE BUT I WHEN THAT THE
ITEM CAME TO OUR THE BUDGET
SUBCOMMITTEE A I DID ASK LIKE
WHAT DOES THE HEALTH DEPARTMENT
NEED RIGHT AND SO HE SAID YOU
DON'T HAVE THE RESOURCES TO BE
ABLE.
TO DO SOME ONE ON ONE EDUCATION.
OKAY AS A WELL WHAT ELL ME WHAT
YOU NEED.
I CAN'T PROMISE YOU ANYTHING BUT
YOU KNOW THAT WE WANT TO BE SURE
THE HEALTH DEPARTMENT HAS THE
CAPACITY TO TRY TO ADDRESS.
THAT ISSUE AS WELL AS YOU KNOW
IT'S GREAT THAT WE HAVE.
AND NOW MORE DOCTORS YOU CAN AT
AT AT THE MEDICAL CENTER TO DO
THAT AND MORE RESEARCHERS AND
LENA CAME FROM ACADEMIC HEALTH
CENTERS SO I'D LIKE RESEARCH --
BUT WE ALSO WANTED TO BE SURE
THAT CITY AS WELL.
I DON'T THINK IT PIECE OF THAT
IF I MAY IS --
LEARNING MORE ABOUT VALLEY FEVER
ITSELF YOU KNOW WE HAVE THE
CLINICAL TRIALS THAT TALK ABOUT
TREATMENT OF PATIENTS BUT WE'RE
REALLY MISSING A BIG PIECE OF
THE PREVENTION OF VALLEY FEVER
AS A COMMUNITY --
I KNOW THAT YOU KNOW FROM
OCCUPATIONAL HEALTH STANDPOINT A
LOT YOU KNOW CAL OSHA HAS PUT
OUT SOME GUIDANCE --
AND A LOT OF EMPLOYERS CALL OUR
OFFICE AND SAY YOU KNOW WHAT CAN
I DO YOU KNOW TO PROTECT MY
WORKERS.
AND WE UNFORTUNATELY HONESTLY
DON'T HAVE GOOD ANSWERS WE HAVE
KIND OF COMMON SENSE ANSWERS
THAT SAY IF IT'S WINDY --
THEN YOU SHOULD MOVE YOUR
WORKERS INDOORS OR STOP WORK BUT
THEN THEY ASK HOW INDIA'S WINDY
AND WE HONESTLY DON'T KNOW AT
THIS POINT IF IT'S FIVE MILES AN
HOUR THAT PUT YOU AT RISK OR
THIRTY MILES AN HOUR.
AND SO THERE'S THERE'S A NEED --
FOR A COMMUNITY TYPE OF RESEARCH
FOR US TO BE ABLE TO GUIDE
PEOPLE BETTER --
AND THAT THAT'S YOU KNOW THE
BIGGER PIECE OF IT OKAY WE HOPE
TO SOMEDAY BE HOPE TO GET OUT
AND I I THINK IT'S AN EXCELLENT
POINT A THAT I TALKED CENTER
GROWTH WHO WHO REPRESENTS THE
AREA AND THE CHALLENGES WITHOUT
THE ANSWERS WHAT HAPPENS IS THAT
THEN YOU.
HAVE TO BE VERY CONSERVATIVE
RIGHT WELL IT'S WINDY WELL
THERE'S ANYWAY AND WHAT LIMIT
PEOPLE NEED TO WORK WE NEED TO
GET THINGS DONE IT'S AT IT SO.
I HAVING THAT DATA SO WE CAN
BETTER TAILOR MORE SPECIFIC
RECOMMENDATIONS AND AND ALSO
KNOW WHAT REALLY IS AS I THINK
OF IMPORTANT --
FOR FOR CERTAINLY --
AREAS AFFECTED BY VALLEY FEVER
APPRECIATE THAT.
BOTH HELLO THANK ALL OF YOU SO
MUCH FOR BEING HERE AND FOR
TESTIFYING AND FOR SHARING WITH --
THE HEALTH COMMITTEE --
YOUR YOUR INSIGHTS THANK YOU SO
MUCH.
ALL RIGHT WE'RE MOVING ON TO OUR
LAST PANEL WHICH IS BUT A VERY
IMPORTANT ONE SO WE CAN TALK
ABOUT WE'VE HEARD A LOT ABOUT
PROBLEMS --
WE TALKED A LITTLE BIT ABOUT
DIFFERENT IDEAS BUT THIS IS THE
POTENTIAL SOLUTIONS IN
INVESTMENTS.
SO -- WE
HAVE --
TRUDY RIMANDO FROM THE SAN BIRD
ITO ASSEMBLY --
COUNTY PUBLIC HEALTH DIRECTOR --
IS GONNA BE TALKING ABOUT FUND I
SEE HIS FOR THAT LAKE COUNTY
DEPARTMENT PUBLIC HEALTH --
HIS EMERGENCY PREPAREDNESS
PUBLIC HEALTH NURSE AND SCA USE
SEVEN TWO ONE TALK ABOUT
WORKFORCE INVESTMENTS --
DR -- MEGAN
CRUMPLER FROM THE ARCH COUNTY
PUBLIC HEALTH LABORATORY AT
DIRECTOR SCOTT TALK ABOUT LAB
CAPACITY AND HAITI THAT A DOCTOR
HAITI DEBRETT'S YOLO COUNTY OF
THE DVL JUST.
TALKING ABOUT IN INFORMATION
DATA AND INFORMATION TECHNOLOGY
SO WELCOME --
WHEN WE START WITH THAT AS THE
DIRECTOR ROMAN?
RIMANDO WELCOME.
GOOD AFTERNOON CHAIRED MEMBERS
UP MY NAME IS TUTOR MONDO AND
THE DIRECTOR OF PUBLIC HEALTH
FOR SALMON DINO COUNTY.
AND THE IMMEDIATE PAST PRESIDENT
OF THE CALIFORNIA HEALTH
EXECUTIVES ASSOCIATION OF
CALIFORNIA.
AND I'M HERE TODAY TO DESCRIBE
SOME OF THE FUNDING CHALLENGES
THAT LOCAL HEALTH DEPARTMENTS
HAVE INDOOR TO DATE --
BUT ALSO HIGHLIGHT SOME KEY
CONSIDERATIONS THAT YOU MIGHT
WANT TO CONSIDER.
AS YOU LOOK TO BOLSTER PUBLIC
HEALTH INFRASTRUCTURE.
LOCAL HEALTH DEPARTMENTS RECEIVE
FUNDING FROM A VARIETY OF
SOURCES.
WHETHER THEY BE FEDERAL STATE
AND LOCAL THE MAJORITY OF THESE
FUNDS ACTUALLY COME FROM EITHER
THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH OR THROUGH
NINETEEN NINETY ONE HEALTH
REALIGNMENT.
A REAL SORT OF RECENTLY THE
CALIFORNIA HEALTH EXECUTIVES
ASSOCIATION COMPARED LOCAL
ASSISTANCE FUNDING MADE
AVAILABLE TO LOCAL HEALTH
DEPARTMENTS. TO AS FAR BACK AS
200-072-0008. TO CURRENT TO
EIGHTEEN TO NINETEEN WE CHOSE TO
USE THE200-072-0008 AS A BASS
LINE BECAUSE IT REPRESENTS THE
TIME IMMEDIATELY PRIOR TO THE
GREAT RECESSION.
AND I THINK WHAT YOU WILL SOON
SEE AS UP THE FUNDING FOR LOCAL
HEALTH DEPARTMENT SINCE THAT
TIME HAS NEVER TRULY RECOVERED.
IN TWO THOUSAND EIGHTEEN
NINETEEN LOCAL HEALTH
DEPARTMENTS WERE BUDGETED TO
RECEIVE ROUGHLY ONE HUNDRED AND
SEVENTY SEVEN MILLION IN TOTAL
FUNDS LESS.
THAN OUR TWO THOUSAND TWO
THOUSAND EIGHT BUDGETS.
IT SHOULD BE NOTED THOUGH THAT
THIS NOT AMOUNT ACTUALLY
INCLUDES INCREASES AND FEDERAL
AND SPECIAL FUNDS SO ULTIMATELY
THE NET DECREASE IS THE RESULT
OF A TOTAL DECREASE OF STATE
GENERAL FUNDING.
IN THE AMOUNT OF NINETY MILLION
DOLLARS. FOR THE PURPOSES OF
THIS HEARING I'D LIKE TO
HIGHLIGHT THREE KEY AREAS OF
FUNDING.
AT THE FIRST IS AROUND
INFECTIOUS DISEASE CONTROL WHICH
WE'VE TALKED ABOUT.
INFECTIOUS DISEASE CONTROL IS
BUDGETED TO RECEIVE THIRTY EIGHT
MILLION MORE.
IN FUNDING BUT WHEN YOU EXCLUDE
THE CATEGORICAL FUNDING AS WE'VE
TALKED ABOUT RELATED TO HIV AND
AIDS.
THE ACTUAL FUNDING THAT LOCAL
HEALTH DEPARTMENTS WILL GET.
WILL BE EIGHT AND A HALF MILLION
DOLLARS LESS THAN WHAT THEY
RECEIVED IN 200-072-0008.
CHRONIC DISEASE PREVENTION IS
BUDGETED TO RECEIVE TWENTY SIX
POINT FOUR MILLION MORE.
ULTIMATELY THOUGH WHEN YOU
REMOVE THE DRAMATIC CURRENT
INCREASES AND TOBACCO FUNDING.
LOCAL HEALTH DEPARTMENTS WILL
RECEIVE FIFTEEN POINT FOUR
MILLION DOLLARS LESS THAN WHAT
THEY RECEIVED IN 200-072-0008.
AND FOR EMERGENCY PREPAREDNESS
LOCAL HEALTH DEPARTMENTS ARE
BUDGETED TO RECEIVE TEN POINT
SEVEN MILLION LESS THAN WHAT
THEY RECEIVED IN 200-072-0008.
I THINK AS YOU HEARD OF MUCH OF
THE FUNDING THAT WE RECEIVE AT
THE LOCAL LEVEL IS CATEGORICAL
FUNDING --
AND ULTIMATELY IS INFLEXIBLE AND
CANNOT BE SHIFTED FOR OTHER
PURPOSES.
SO THOUGH IN MANY INSTANCES WHAT
YOU MAY SEE ARE ACTUALLY LOCAL
HEALTH DEPARTMENT BUDGETS IN
TOTAL INCREASING THAT'S THE
RESULT OF CATEGORICAL FUNDING.
OFTEN THE FUNDING IS ALSO SO
PRESCRIPTIVE IN NATURE THAT IT
DOES NOT ALLOW US TO EITHER
SUPPORT OR EXPAND OUR ABILITY TO
PERFORM ANY OF OUR CORE
FUNCTIONS.
NOR DOES IT ALLOW US TO SUPPORT
ANY OF OUR CORE INFRASTRUCTURE.
ALTERNATIVELY HOWEVER NINETEEN
NINETY ONE HEALTH REALIGNMENT IS
SEEN BY LOCAL HEALTH DEPARTMENT
AT THAT FLEXIBLE SOURCE.
AND CONSEQUENTLY ENDS UP BEING
EITHER THE PRIMARY OR SOLE
SOURCE OF FUNDING FOR US TO
PERFORM MANY OF OUR CORE
UNCTIONS ARE SUPPORT OUR
INFRASTRUCTURE.
YET IN COMPARISON WITH ALL OF
THE DRAMATIC INCREASES YOU'VE
SEEN IN CATEGORICAL FUNDING.
CURRENT NINETEEN NINETY ONE
HEALTH REALIGNMENT FUNDING IS
OVER ONE HUNDRED MILLION DOLLARS
LESS THAN IT WAS IN 200-072-0008.
AND LASTLY.
IT CERTAINLY IN RECENT YEARS
NINETEEN NINETY ONE HEALTH
REALIGNMENT FUNDING HAS SEEN A
LOT OF DIVERSIONS TO HELP FUND
OTHER PRIORITY AREAS. FOR
EXAMPLE IN SAMBHAR DINO COUNTY
WHERE I'M FROM.
OUR TOTAL NINETY ONE REALIGNMENT
DOLLARS FOR SEVENTEEN EIGHTEEN
WAS ROUGHLY FIVE MILLION LESS
THAN WHAT RECEIVE WHAT WE
RECEIVED IN 200-072-0008.
AND I KNOW OVERALL THOUGH THAT
MAY NOT SEEM LIKE A VERY LARGE
NUMBER.
OF THAT ACTUALLY REPRESENTS 9%
OF OUR TOTAL.
CONVERSELY OUR POPULATION
INCREASED BY 7% DURING THAT SAME
TIME PERIOD.
ULTIMATELY THE INVESTMENT OF
STATE DOLLARS TOWARDS BROAD
COMMUNICABLE DISEASE CONTROL HAS
DRAMATICALLY DIMINISHED.
WITH VERY LITTLE **** FUNDING
COMING FROM THE STATE.
LOCAL HEALTH DEPARTMENTS LIKE
MINE HAVE LOOKED TO HEALTH
REALIGNMENT TO HELP.
BACK FILL ALL OF THOSE NEEDS.
HOWEVER OUR ABILITY TO CONTINUE
TO DO SO HAS BEEN STYMIED BY THE
FUNDS JUST ABSOLUTE INABILITY TO
RECOVER FROM THE RECESSION --
AND IS EVEN MORE SO BECAUSE OF
THE CURRENT DIVERSIONS OF HEALTH
REALIGNMENT.
AND AS OF LATE THE COMMUNICATIVE
THESE ISSUES THAT WE'VE BEEN
TALKING ABOUT.
HAVE BEEN COMPOUNDED BY OTHER
SOCIAL ISSUES THAT ALSO REQUIRE
RESOURCES LIKE TO HAVE A BY A
BREAK IN OUR HOMELESS
POPULATIONS.
FINALLY AND I'D BE REMISS IF I
DIDN'T EXPRESS SOME APPRECIATION
FOR THE INCREMENTAL FUNNY THAT
WE'VE SEEN.
AS OF LATE.
AND CERTAINLY WE WILL --
BUT ULTIMATELY WHAT WE NEED IS
FUNDING THAT IS ONGOING
SUSTAINABLE.
AND FLEXIBLE THE ONE TIME
ALLOCATIONS OF FUNDING
ULTIMATELY JUST ALLOW US TO DO
ONE TIME ACTIVITIES.
IT ALLOWED US TO PURCHASE A SOME
ADDITIONAL SUPPLIES AND TO DO
SOME EXPANDED OUTREACH AND
EDUCATION BUT AGAIN IT WAS
LIMITED AND FUNDING WHAT IT DID
NOT ALLOW ME TO DO WHAT HIGHER
CRITICAL STAFFING THAT I NEEDED.
TO SCREEN TO TEST TO INVESTIGATE
AND TO TREAT THE RISING
CASELOADS WHAT I SEE ON MY DESK
EVERY DAY.
AND IT CERTAINLY ISN'T DOING
ANYTHING TO HELP SUPPORT OUR
INFRASTRUCTURE NOR IS IT HELPING
US TO SUPPORT --
AND IT FROM AN INFRASTRUCTURE
THAT COULD ADEQUATELY ADDRESS.
ANY OF THE EMERGENT INFECTIOUS
DISEASES THAT WE'RE SEEING TODAY.
SO I WANT TO EXPRESS MY
APPRECIATION FOR EXAMINING THE
PUBLIC HEALTH INFRASTRUCTURE
TODAY.
AND HOPING HOPE THAT YOU'LL
CONSIDER ONGOING A FLEXIBLE
INVESTMENTS IN THE PUBLIC HEALTH.
I TRULY BELIEVE THAT IT'S ONLY
THREE SUSTAINED ONGOING
INFLEXIBLE FUNDING THAT AT THE
LOCAL LEVEL WILL BE ABLE TO
REBUILD OUR LOCAL CAPACITIES.
AND STRENGTHEN OUR LOCAL
INFRASTRUCTURE THANK YOU
[inaudible]
THANK YOU --
SAUCY WELCOME.
THANK YOU FOR THE OPPORTUNITY.
MY NAME IS JAMAICA AUSSIE
ELEMENT EMERGENCY PREPAREDNESS
PUBLIC HEALTH NURSE FOR THE
COUNTY OF LOS ANGELES.
LOS ANGELES COUNTY DEPARTMENT OF
PUBLIC HEALTH HAS A MULTI
DISCIPLINARY WORKFORCE AROUND
FOUR THOUSAND PUBLIC HEALTH
INVESTIGATORS.
ANALYSTS PROGRAM PLANNERS.
HEALTH EDUCATORS COMMUNITY
HEALTH WORKERS CLINIC STAFF
LICENSED VOCATIONAL NURSES
EPIDEMIOLOGISTS LAB TECHNICIANS
CASE MANAGERS AND PUBLIC HEALTH
NURSES WHO WORK TO PROTECT AND
IMPROVE THE HEALTH AND WELL
BEING OF THE POPULATION SIZE OF
OVER TEN MILLION.
THE LARGEST COUNTY IN THE UNITED
STATES.
MY COLLEAGUES AND I ARE THE
FRONT LINES OF ANY POSSIBLE
PUBLIC HEALTH CRISIS WHETHER IT
IS A NATURAL DISASTER.
PANDEMIC OR INFECTIOUS DISEASE
OUTBREAK.
AS A PUBLIC HEALTH NURSE I HAVE
THE JOB I'VE ALWAYS DREAMED OF
DOING.
YOU SEE I'M A SECOND GENERATION
PUBLIC HEALTH NURSE.
AND I WAS INSPIRED TO ENTER THE
FIELD BY MY MOTHER FREE ALLOWED
A MORE.
WHO WORKED FOR THE COUNTY OF LOS
ANGELES?
FOR AS A PUBLIC HEALTH NURSE.
AS A GIRL I WOULD HEAR STORIES
OF THE EXCITING WORK SHE DID AS
A PUBLIC HEALTH NURSE IN THE
FIELD.
AS ALWAYS KNEW I DIDN'T WANT TO
WORK IN AN ACUTE CARE NURSE
FACILITY AT THE BAD SIDE.
BUT INSTEAD MY CALLING WAS TO
LEAVE A LASTING IMPACT ON MY
COMMUNITY AS A PUBLIC HEALTH
NURSE.
IT WAS WITH THIS CALLING THAT I
WORK TO GET SPECIALIZED
EDUCATION AND TRAINING NEEDED TO
BECOME A PUBLIC HEALTH NURSE.
FIRST GETTING MY BACHELORS
BACHELOR'S OF SCIENCE DEGREE IN
NURSING AND THEN MY PUBLIC
HEALTH NURSING CERTIFICATION.
IN ADDITION TO MY EDUCATION I
HAVE BENEFITTED TREMENDOUSLY
FROM THE ADDITIONAL ON THE JOB
TRAINING I'VE GOTTEN THROUGH THE
COUNTY OF LOS ANGELES.
AS A PUBLIC HEALTH NURSE WITH
THE COUNTY I'VE HELD VARIOUS
ROLES.
I STARTED MY CAREER AT THE
DISTRICT PUBLIC HEALTH NURSE
RESPONSIBLE FOR OUR REACH AND
RESPONSE FOR PREGNANT WOMEN WHO
TESTED POSITIVE OR SEXUALLY
TRANSMITTED INFECTIONS.
FOLLOWING UP TO ENSURE THEY AND
THEIR PARTNERS TOOK APPROPRIATE
PRECAUTIONS TO PREVENT THE
SPREAD TO OTHERS AND TO SUPPORT
HEALTHY DELIVERY FOR THEIR MOMS
AND THEIR BABIES.
IN MY CURRENT ROLE.
I AM PRIMARILY FOCUSED ON
BUILDING OUT THE FIRST EVER
COMMUNITY EMERGENCY RESPONSE
TEAM PROGRAM AND THE WHAT'S
COMMUNITY.
BUT I WE'RE VARIETY OF HATS FOR
EXAMPLE.
I WORK EACH YEAR AS AN INFLUENCE
THE COORDINATOR TO BRING FLU
CLINICS TO WORKING COMMUNITIES
WHO OTHERWISE WOULD FIND IT HARD
TO GET OFF WORK.
THEY MIGHT LOSE PAY.
OR THEY MAY NOT BE ABLE TO GET A
MANAGER'S PERMISSION TO LEAVE
WORK.
SO THESE WORKING COMMUNITIES
HAVE COM. TO RELY ON ANNUAL FREE
EVENTS OFTEN HELD ON THE
WEEKENDS A COMMUNITY GATHERINGS
AND HOUSES OF WORSHIP.
MY PROUDEST ACCOMPLISHMENT TODAY
CAME IN MY CURRENT ROLE AS AN
EMERGENCY PREPAREDNESS PUBLIC
HEALTH NURSE.
COLLABORATING WITH COMMUNITY
BASED ORGANIZATIONS FAITH GROUPS
LOCAL BUSINESSES AND GOVERNMENT
AGENCIES AND EFFORTS ENGAGING
HIGH RISK COMMUNITIES AND
EMERGENCY AND DISASTER
PREPAREDNESS EDUCATION AND
TRAINING.
AS A RESULT I WAS INVITED TO THE
WHITE HOUSE BY THE OBAMA
ADMINISTRATION THREE TIMES.
200-013-2000 FIFTEEN IN TWO
THOUSAND SEVENTEEN AS IN A
WARRANTY AND FOR VARIOUS
RECOGNITION EVENT.
BUT THAT IS JUST MY SPECIFIC
WORK.
AS PUBLIC HEALTH NURSES AT A
MOMENT'S NOTICE MY COLLEAGUES
AND I ARE CALLED OUT TO SUPPORT
THE CORE WORK OF THE DEPARTMENT
ACUTE.
COMMUNICABLE DISEASE CONTROL OR
AC DC PROGRAM WHICH PROVIDES
AROUND THE CLOCK DISEASE
SURVEILLANCE AND RESPONSE TO
ENSURE THE PUBLIC SAFETY.
AT THE DROP OF A HAT A CDC
EPIDEMIOLOGIST AND INVESTIGATORS
AND CLINICIANS PROVIDE RAPID
RESPONSE. TO ACTIVE AND
EMERGENCY EVENTS.
EXAMPLES INCLUDE A SUSPECTED
FOOD BORNE ILLNESS OUTBREAK AN
AREA HOTEL HOSTING A CONFERENCE.
ASSESSING A FALSE ALARM ON A BIO
HAZARD BREACH.
OR HOSPITAL RELATED INFECTION
ALARM OR EAT CALL OUTBREAK.
PUBLIC HEALTH NURSE AT ACTIVELY
SET UP TO SUPPORT THIS RAPID
RESPONSE BY HELPING TO CONTAIN
AN OUTBREAK.
AND PREVENT A CRISES.
BE IT AN EPIDEMIC.
BE IT AN EPISODIC EVENT.
OR INCREASE PER VALENCE OF
MENINGITIS TYPHUS WHOOPING COUGH
OR TUBERCULOSIS.
CALIFORNIA NEEDS TO BE
CONSIDERABLY MORE TO NEEDS TO DO
CONSIDERABLY MORE TO INVEST IN
AND SUPPORT THE TRAINING AND
DEVELOPMENT OF A DIVERSE.
PUBLIC HEALTH NURSING WORKFORCE
AS WE ARE LINED WITH AND SUPPORT
SO MANY OF THE LEGISLATURE'S
PRIORITIES.
WE ARE OFTEN OVERLOOKED IN THE
BROADER HEALTH CARE WORKFORCE
INVESTMENT CONVERSATION.
DESPITE THE FACT THAT WE ARE
FACING A CRISIS LEVEL SHORTAGE
OF TRAINED EXPERIENCED PUBLIC
HEALTH WORKERS. FOR EXAMPLE A
RECENT STUDY FOR FOR HIS PUBLIC
HEALTH WORKFORCE IS EXPECTED TO
RETIRE IN THE NEXT FIVE YEARS.
ANY HEALTHCARE WORKER WORKFORCE
INVESTMENT EFFORTS OVER LET THE
PUBLIC HEALTH WORKFORCE ENTIRELY.
THAT WAS NOT THE CASE WITH THE
RECENTLY RELEASED REPORT FROM
THE FUTURE HEALTH WORKFORCE
COMMISSION WHICH CALLED OUT THE
NEED TO INVEST IN OUR PUBLIC
HEALTH WORKFORCE.
ALTHOUGH INVESTING IN THE PUBLIC
HEALTH DID NOT TAKE IT MAKE IT
I'M SORRY TO INTO THE
COMMISSION'S TOP TEN PRIORITY
FOCUS AREA.
THE PUBLIC HEALTH WORKFORCE
PIPELINE SIMPLY ISN'T THERE. ONE
OF THE BIG ISSUES FACING THE
PUBLIC HEALTH NURSING WORKFORCE
IS THAT PRIVATE SECTOR AND ACUTE
CARE NURSING JOBS PAY SO MUCH
BETTER.
EVEN THOUGH OUR NURSES AND STAFF
OFTEN HAVE TO TAKE ON MORE
STUDENT AT THE SPECIALIZED AND
PUBLIC HEALTH.
AND TO TOP IT OFF WERE CHARGED
HIGHER LICENSING FEES BY THE
BOARD OF RESTAURANT REGISTERED
NURSING.
AND OUR ROLES AS PUBLIC HEALTH
NURSES ARE SPECIALIZED AND
GENERALLY SPEAKING REGISTRIES
DOWN STAFF PUBLIC HEALTH NURSES.
CALIFORNIA NEEDS TO CONSIDER ITS
INVESTMENT IN OUR PUBLIC HEALTH
WORKFORCE AS PART OF ITS PLAN TO
ADDRESS THE START DISPARITIES
AND HEALTH STATUS THROUGHOUT THE
STATE.
AND TO PREPARE FOR THE NEXT
PANDEMIC THAT CAN SERIOUSLY
COMPROMISE THE HEALTH AND WELL
BEING OF CALIFORNIANS THANK YOU.
THANK YOU SO WHILE THE
COMMISSION MAY NOT HAVE MADE IT
A PRIORITY I THINK IT'S MORE
IMPORTANT THAT THIS COMMITTEE
WANTS TO MAKE IT A PRIORITY.
THANK YOU.
THANK YOU SO MUCH --
DOCTOR COBBLER WELCOME.
GOOD AFTERNOON SENATOR PAN AND
COMMITTEE MEMBERS I AM MAKING
CRUMPLER PUBLIC HEALTH
LABORATORY DIRECTOR FOR ORANGE
COUNTY.
REPRESENTING THE CALIFORNIA
ASSOCIATION OF PUBLIC HEALTH
LABORATORY DIRECTORS A NETWORK
OF THIRTY ONE PUBLIC HEALTH
LABORATORIES LOCATED THROUGHOUT
THE STATE.
OUR LABORATORIES PLAY AN
ESSENTIAL AN IRREPLACEABLE ROLE
IN PUBLIC SAFETY BY PROTECTING
THE HEALTH OF CALIFORNIA'S
RESIDENTS AND VISITORS.
THEY WERE ESTABLISHED A HUNDRED
YEARS AGO BY FORWARD LOOKING
COMMUNITY LEADERS AND RESPONSE
TO OUTBREAKS OF TYPE.
TYPHOID SMALLPOX AND IF THE AREA
WHICH ARE FOR NOW CONSIDER
DISEASES OF THE PAST.
TODAY THEY CONTINUE TO PLAY A
CENTRAL ROLE IN COMMUNICABLE
DISEASE DETECTION AND
SURVEILLANCE.
THE CALIFORNIA PUBLIC HEALTH
LABORATORY NETWORK IS COMPRISED
OF A VARIETY OF LABS TAILORED TO
MEET THE UNIQUE NEEDS OF THEIR
COMMUNITY AND REGION AS WELL AS
PROVIDING SURGE CAPACITY TO
ENSURE.
CONTINUITY OF OPERATIONS
STATEWIDE.
TOGETHER AS A NETWORK THE SYSTEM
IS STRONGER IN ABLE TO PROVIDE A
TIMELY AND COMPREHENSIVE
RESPONSE EMERGING THREATS WHICH
ARE NOT JUST LIMITED TO
INFLUENZA.
MEASLES PROTEST THIS ZECA EBOLA
AND BIOLOGICAL AND CHEMICAL
TERRORISM EVENTS.
AS AN EXAMPLE DURING THIS EAGER
RESPONSE OF TWENTY SIXTEEN OUR
LABS FOR TESTING FOR ZEKE ON
PATIENTS WITHIN SEVERAL WEEKS OF
RECEIVING TEST KITS FROM THE CDC.
IN COMPARISON IT TOOK CLINICAL
LABS NEARLY A YEAR TO DEVELOP A
AS HE COULD TESTING CAPABILITIES.
THIS RAPID RESPONSE WAS DUE TO A
WELL ORCHESTRATED COORDINATION
BETWEEN THE CDC AND THE NETWORK
OF FOURTEEN LOCAL LABS THAT ARE
ALSO APPROVED MEMBERS OF THE
NATIONAL LABORATORY RESPONSE
NETWORK.
KNOWN AS THE ALR AN EACH COLOR
AND LAB HAS TWENTY FOUR SEVEN
THREE SIXTY FIVE RESPONSE
CAPACITY FOR RAPID DETECTION OF
AGENTS CAUSING DISEASES SUCH AS
PLAGUE.
ANTHRAX AND TOXINS SUCH AS RICE
AND THE L. AROUND LABS RECEIVE
AND TEST WHITE POWDERS LETTERS
AND PACKAGES THAT ARE SENT TO
MEMBERS OF OUR COMMUNITY.
SUCH AS POLITICAL LEADERS AND
LAW.
FOR CLINICAL LABS ALSO PLAY A
ROLE HERE FOR SUSPECTED BIO
THREAT IS ISOLATED FROM ONE OF
THEIR PATIENTS BUT THEY DO NOT
HAVE THE FACILITIES FOR TRAINING.
OF AVAILABLE TO PERFORM
CONFIRMATIONS ON THE SUSPECT
ISOLATES ONLY THE ELLER AND LABS
OF THIS UNIQUE CAPABILITY.
IN ADDITION TO RESPONSE EFFORTS
ARE LAB FOR FOR MANDATED
SURVEILLANCE IN THE BACKGROUND
UNBEKNOWNST TO MANY FOR DISEASES
SUCH AS RABIES SALMONELLA
ENTERED THE REGULAR BASIS.
MAYBE IF SENIOR FAVORITE
RESTAURANT TEMPORARILY CLOSED
DUE TO FOOD BORNE ILLNESS
INVESTIGATION ARE SKILLED
NURSING FACILITY CLOSE BECAUSE
THEY ARE VULNERABLE RESIDENTS
ARE EXPERIENCE A DISEASE
OUTBREAK.
DURING THESE EXAMPLE EVENTS.
STAFF AT OUR LABS WORK AROUND
THE CLOCK IF NECESSARY. TO
ISOLATE THE CAUSE OF THE
OUTBREAK AND TO REDUCE ANY
FURTHER SUFFERING BY PATRONS AND
RESIDENTS.
STAFF MAY EVEN GO OUTSIDE THE
LAB TO PERFORM AND FIRE MENTAL
TESTING TO ENSURE CONTAMINATED
AREAS ARE NOW SAFE.
LABS LOCAL LABS ARE IN CLOSE
pCOMMUNITY WHICH ALLOWS FOR QUICK
AND LESS COSTLY TRANSPORT OF
SAMPLES TO OUR LABS FOR TESTING.
FOR SOME OUTBREAKS SUCH AS
MEASLES A QUICKLY REPORTED
RESULT HAS A MAJOR IMPACT ON
HEALTH THE HEALTH DEPARTMENT'S
RESPONSE AND ULTIMATE STOPPING
OF DISEASE SPREAD.
OR THE RAPID RESPONSE THE
TESTING A åENTIALLY
ANIMAL THAT BIT A RESIDENT CAN
pPATIENT AND REDUCE DEADLY COST
RICK REDUCE COSTS OF THIS DEADLY
DISEASE.
IN THE LAST TEN YEARS TEN LOCAL
LABS CLOSED DUE TO COST CUTTING
ACTIONS OF THEIR LOCAL
DEPARTMENTS OR SHORTAGE OF
QUALIFIED INDIVIDUALS MAINLY
LABORATORY DIRECTORS. TO PUT
THIS IN CONTEXT TEN YEARS AGO
THERE WERE FORTY LABS IN
CALIFORNIA WAS NOT PREPARED TO
HANDLE THE TWO THOUSAND AND NINE
H. ONE AND ONE FLU PANDEMIC.
OUR LABORATORIES HAVE BEEN
AFFECTED BY REDUCTIONS IN LOCAL
STATE AND NATIONAL FUNDING.
SUCH AS HEALTH REALIGNMENT FAB
AND COMMUNICABLE DISEASE FUNDING
IT WE ARE FACING INCREASING COST
CONTINUED BUDGET REDUCTIONS
ENCLOSURE OF LOCAL LABORATORIES
WILL REDUCE OVERALL CAPACITY. TO
RESPOND TO DISEASE OUTBREAKS IN
A TIMELY MANNER AND EVIDENTLY
CAUSING HIGHER MORBIDITY AND
MORTALITY RATES AMONG CALIFORNIA
CITIZENS.
PRIVATE CLINICAL LABORATORIES
CANNOT REPLACE PUBLIC HEALTH
LABORATORIES THEY PERFORM
DIFFERENT TESTS FOR DIFFERENT
FUNCTIONS.
CLINICAL LABS ASSESS ONE PATIENT
AT A TIME WE ASSESS THE ENTIRE
COMMUNITY. FOR EXAMPLE THE
CLINICAL LAB TESTED PATIENTS
SPECIMEN FOR SALMONELLA.
SO THAT THE HEALTH CARE PROVIDER
CAN TREAT THE PAY SPECIMEN IF
POSITIVE FOR SALMONELLA.
IS SENT TO THE PUBLIC HEALTH
LABORATORY FOR HIGHLY
SPECIALIZED MOLECULAR TESTS TO
DETERMINE IF THAT PARTICULAR
SALMON ALLAH.
IS SIMILAR TO OTHER STRAINS THAT
ARE CAUSING LOCAL REGIONAL AND
NATIONWIDE OUTBREAKS WE CAN ALSO
TEST THE FOOD TO DETERMINE THE
SOURCE OF THE OUTBREAK AS WELL
AS CLEARING EMPLOYEES SO THEY
CAN RETURN BACK TO WORK.
COMPREHENSIVE TESTING SUCH AS
THIS IS NOT PERFORMED IN
CLINICAL LABS THEY HAVE NEITHER
THE HIGHLY IT NEITHER THE
EQUIPMENT OR HIGHLY TRAINED
PUBLIC HEALTH MICROBIOLOGISTS
YOU CAN DO THIS TYPE OF
SURVEILLANCE TESTING.
OUR LABS ALSO PERFORM INFLUENZA
SURVEILLANCE FOR THE DETECTION
OF NOVEL FLU STRAINS BY
PROVIDING DATA AND SPECIMENS OF
THE WHL AND CDC TO HELP PREDICT.
WHICH INFLUENZA STRAIN TO
INCLUDE AND THE VACCINE FOR NEXT
FLU SEASON.
IN CLOSING TESTING PROVIDED BY
PUBLIC HEALTH LABORATORIES ARE
NOT MERELY JUST A SERVICE BUT
ACT AS A MECHANISM TO ASSESS THE
HEALTH STATUS OF A COMMUNITY.
IN THAT VIEW THE LOCAL PUBLIC
HEALTH LABORATORIES MISSION IS
TODAY AS IT WAS ONE HUNDRED
YEARS AGO PUBLIC SAFETY.
THANK YOU THANKS VERY MUCH YOU
KNOW MAYBE WE SHOULD HAVE A TV
SHOW ABOUT PUBLIC HEALTH LAB
LIKE WE OFFER CSI.
OKAY DOCTOR DIRECTS WELCOME.
THANK YOU FOR HEART AND BY DOING
TO SPEAK TODAY MY NAME'S HAITI
DAY BRICKS I'M NOT ONLY THE YOLO
COUNTY EPIDEMIOLOGIST BUT I'M
ALSO PRESIDENT OF THE CALIFORNIA
CONFERENCE OF LOCAL HEALTH DATA
MANAGES AND EPIDEMIOLOGISTS.
EMAIL SENATE CCLI STEAMY WHERE
AN AFFILIATE OF THE CALIFORNIA
CONFERENCE LOCAL HELP OFFICES.
I'VE BEEN WORKING IN PUBLIC
HEALTH SINCE TWO THOUSAND SIX
AND IT YOLO COUNTY FOR THE PAST
SIX YEARS.
DURING THAT TIME THAT BEEN GREAT
ADVANCES IN INFORMATION
TECHNOLOGY FOR LOCAL HEALTH
DEPARTMENTS.
IN LATE TWENTY TEN THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH IMPLEMENTED THE STATE
WIDE ELECTRONIC REPORTING SYSTEM
CALLED CAL READY.
WHERE MANDATED REPORTABLE
COMMUNICORP DISEASES AND
CONDITIONS ARE SUBMITTED AND
THAT'S ACCORDING TO TITLE
SEVENTEEN OF THE CALIFORNIA CODE
REGULATIONS?
WITH THE PASSAGE OF A HIGH TECH
ACT CALL HEALTH ACT IN TWO
THOUSAND NINE HEALTH SYSTEMS
WERE INCENTIVIZE TO OUGHT. TO
ADOPT ELECTRONIC HEALTH RECORDS
SO USING EHR ENABLES HEALTH
SYSTEMS TO COMMUNICATE MORE
EFFECTIVELY WITH THEIR PATIENTS
AND IN THEORY MAKES IT EASIER TO
COME FOR THEM TO COMPLY WITH
THEM MANDATED REPORTING
REQUIREMENTS TO PUBLIC HEALTH.
IN PRACTICE PROVIDERS ARE STILL
RE ENTERING DATA FROM THEIR
ELECT CHRONIC HEALTH RECORD INTO
CAL READY FOR THE REPORTABLE
CONDITIONS.
AND ABOUT HALF OF THE
COMMUNICABLE DISEASE REPORTS
THAT WE RECEIVE ARE SUBMITTED TO
THE ARE SUBMITTED VIA FAX IN
PAPER FORMAT STILL TODAY.
THIS YEAR THE CALIFORNIA PALM
PUBLIC HEALTH IS IN FINDING THE
PILOT STAGE OF FOR A DOCTOR SHIP
AS MENTIONED IS KNOWN AS
ELECTRONIC CASE REPORTING OR ECR.
WITH THE UC DAVIS HEALTH SYSTEM.
THIS EFFORT IS PART OF A
NATIONWIDE DIGITAL BRIDGE TO
STREAMLINE COMMUNICABLEDISEASE
REPORTING AND MEET THE
REQUIREMENTS OF PROMOTING INTER
OPERABILITY ALSO KNOWN AS
MEANINGFUL USE.
VISIONS OF THE HIGH TECH ACT.
SO THE OTHER TWO STATES PILOTING
THIS ALL TEXAS IN UTAH.
SO ELECTRONIC CASE REPORTING
WILL AUTOMATICALLY EXTRACT THE
INFORMATION FROM THE ELECTRONIC
HEALTH RECORD WHEN A REPORTER
CALLED CONDITION LET'S SAY
SYPHILIS IS RECORDED BY THE
DOCTOR IN THAT PATIENTS RECORD.
THAT DATE WOULD BE A SENT
ELECTRONICALLY TO CAL READY AND
THENCE TO THE LOCAL HEALTH
DEPARTMENT.
THUS IT WOULD SAVE HUGE AMOUNTS
OF TIME ON THE PROVIDER SIDE AS
WELL AS ON THE HEALTH DEPARTMENT
SIDE NOT HAVING TO RE ENTER ALL
THAT.
THAT PATIENT INFORMATION.
IT WILL ALSO IMPROVE THE SPEED
COMPLETENESS AND QUALITY OF DATA
REPORTING --
OF THE LOCAL HEALTH POINT WHERE
I WORK JUST FOR CHLAMYDIA AND
GONORRHEA SPENDS ABOUT ONE STAFF
DAY PER MONTH TO REQUEST
COMMUNICABLE DISEASE REPORTS
FROM PROVIDE IS.
BASICALLY WE GET ABOUT 60% OF
OUR CANADIAN GONORRHEA REPORTS
ARE RECEIVED FROM THE PROVIDE
WITHOUT AN ASK BUT THE REST OF
THEM WE HAVE TO REQUEST THAT WAS
ALMOST FIVE HUNDRED FAXES
ELECTRONIC FAXES IT WAS SENT IN.
TWENTY EIGHTEEN ELECTRONIC CASE
REPORTING WOULD ELIMINATE ALL
THAT WORK.
IT TAKES SIGNIFICANT I. T.
INVESTMENT FOR A STATE HEALTH
DEPARTMENT AND OUR HEALTH
SYSTEMS. TO IMPLEMENT MAJOR
CHANGES LIKE LIKE.
HEALTH SYSTEMS WILL NEED TO
PURCHASE EXTRA SOFTWARE MODULES
FOR THEIR EHRS THEY'LL HAVE TO
TRAIN IT STAFF AND THEY'LL HAVE
TO INTEGRATE THOSE MODELS INTO
THEIR EHR SYSTEMS.
THE OTHER ISSUE OUR LOCAL HEALTH
DEPARTMENTS GRAPPLE WITH IS
SYNDROMIC SURVEILLANCE WHICH IS
A COLLECTION OF DISEASE DATA
FROM HOSPITAL EMERGENCY
DEPARTMENTS IN REAL TIME.
SYNDROMIC SURVEILLANCE ENABLES
LOCAL HEALTH DEPARTMENTS TO
OBTAIN DE IDENTIFIED EMERGENCY
DEPARTMENT DATA FROM HOSPITALS
IN THAT JURISDICTION'S AND
QUICKLY DETECT AND RESPOND TO
LOCAL DISEASE OUTBREAKS.
CDC HAS MADE AVAILABLE PROGRAM
CALLED BIO SINCE TO ANALYZE
THESE DATA AND PROVIDES TRAINING
FOR LOCAL STAFF TO ON BOARD.
NOW MOST STATES NATIONWIDE
IMPLEMENTED BY A STATE BY A
SENSE AT THE STATE LEVEL IN
CALIFORNIA IS THE RESPONSIBILITY
OF THE COUNTY OR LOCAL
JURISDICTIONS OFTEN.
AN ONBOARDING TAKES THREE TO
FOUR MONTHS AND REQUIRES A
FAIRLY SUBSTANTIAL AMOUNT OF
STAFF TIME.
AND TRAINING MOST OF THOSE WHO
WOULD BE COUNTY WE CURRENTLY IN
CALIFORNIA HAVE SIXTY ONE HEALTH
JURISDICTIONS AS YOU HEARD EARLY
ON ELEVEN OF THEM ARE CURRENTLY
ON BY A SENSE.
AND MOST OF THOSE WHO WOULD BE
INTERESTED IN JOINING SIMPLY
DON'T HAVE THE STAFF TIME TO
SPARE.
WE ENCOURAGE ADDITIONAL
INVESTMENTS INTO TECHNOLOGY
SYSTEMS TO SUPPORT THE WORK OF
LOCAL HEALTH DEPARTMENTS HAVE A
COUPLE WITH THAT WE ENCOURAGE
INVESTMENTS IN HUMAN CAPITAL
NEEDED TO SUPPORT THOSE SYSTEMS.
THIS INCLUDES STRENGTHENING
STAFFING AT THE LOCAL LEVEL AS
YOU'VE HEARD MANY TIMES TODAY
AND PROVIDING FUNDING FOR ON
GOING TRAINING AND TECHNICAL
SYSTEM ASSISTANCE FOR STAFF.
DATA IS A CRUCIAL ELEMENT TO THE
WORK WE DO AND AS YOU CONSIDER
BUILDING AND INVESTING INTO THE
PUBLIC HEALTH INFRASTRUCTURE.
ACCESS TO TECHNOLOGY MUST BE
INCLUDED IN THE DISCUSSION.
YOU FOR THAT YOUR TIME.
RIGHT WELL THANK YOU THANK YOU
OFFER YOUR PRESENTATIONS --
ACTUALLY --
MR WINDOW WITH IF YOU HAVE A
COPY OF YOUR REMARKS WE'D LIKE
TO BE SURE CAPTURE ALL THE
NUMBERS YOU RATTLED OFF.
THE FUNDING SO --
APPRECIATE THAT --
IN TERMS OF THE I. T. --
WORK --
ACTUALLY --
BUT IF YOU BE IMPORTANT TO
CERTAIN SAME WAY ASKED ABOUT.
THE ASSESSING CAPACITY AND AND
AND THAT'S NOT LEAST WORKFORCE
BUT ALSO OTHER THINGS BUT THE
ABOUT LIKE.
WHAT KIND OF I. T. PROPOSALS
WOULD YOU BE ABLE TO BRING TO US
SO THAT WE CAN LOOK AT THAT AND
THAT PERHAPS THE --
C. PH COULD HELP FIGURE OUT A
AND WITH THE LOCAL HELP THERE'S
AB THE A IN I. T. PACKAGE RIGHT
I THINK THAT'S SOMETHING THEY'VE
BEEN LOOKING AT BUT I KNOW WE
LEAVING THERE'S LOTS OF IT
PROJECTS THAT FLEW AROUND OUR
BUDGET SUB COMMITTEES BUT I
THINK IT'D BE.
GOOD TO THINK ABOUT WHAT KIND OF
MAKE MORE EFFICIENT USE OF OUR
PERSONNEL --
ALSO I MEAN THAT'S WE TALK ABOUT
WORKFORCE THAT AND CERTAINLY I
THE DATA SYSTEMS WILL REPLACE
YOU KNOW THE BUT I CAN CERTAINLY
HELP IMPROVE EFFICIENCY THERE
RIGHT I COULD DEFINITELY MAKE US
DO MORE WORK FASTER YEAH.
AND DINO TERMS OF OUR WORK FORCE
EIGHT EIGHT THE ONE OF THE
THINGS THAT'S COME OUT FROM BOTH
THIS PANEL IN THE LAST PANEL --
IT AS I AND THEN MAYBE PERHAPS --
THERE'S ALSO YOU CAN SPEAK TO
THIS IS THAT I NEED TO IT.
IS IT'S GOT LIKE --
COMMITTEE POLICE WORK RIGHT I
MEAN IT'S BOOTS ON THE GROUND
TALKING TO PEOPLE --
IT DELAYED AND AND AND AND
BUILDING THAT RELATIONSHIP WITH
PEOPLE SO THEY'LL SHARE WITH YOU
PRETTY SENSITIVE INFORMATION --
ABOUT THEMSELVES ABOUT OTHER
PEOPLE THEY KNOW IN THE
COMMUNITY HAVING THAT TRUST.
AND SO FORTH AND AND AND REALLY
THE GROUND THERE AND THE US
SPEAK TO THAT I MEAN YOUR SECOND
GENERATION --
SHOE LEATHER --
PUBLIC HEALTH --
YOU KNOW ABIGAIL WORKER SO YEAH.
DEFINITELY --
EXTENSIVE COMMUNITY ENGAGEMENT --
IT TAKES TIME TO BUILD RAPPORT
WITH THE COMMUNITY --
THAT TRUST --
FOR SOME COMMUNITY MEMBERS IT
TAKES TIME AND SO WHAT WE KNOW
AS PUBLIC HEALTH NURSES IS YOU
KNOW THE FACT THAT OUR
RELATIONSHIPS WITH THE COMMUNITY.
HELPS -- TO
DELIVER THAT MISSION THAT WE'RE
TRYING TO DELIVER AND SO REALLY
BEING OUT --
ENGAGING WITH THE COMMUNITY ON A
REGULAR BASIS BEING VISIBLE --
IN EL.
BEING COMPETENT.
AND WHAT WE DO OUR OUR NURSES
ARE EXPERIENCE WE HAVE A LOT OF
FEES THE NURSES THAT WE WANNA
RETAIN IN THE DEPARTMENT.
AND SO DEFINITELY --
SOMETHING THAT WE VALUE IN OUR
DEPARTMENT.
THANK YOU AND A VOICE SAID THAT --
YOU CAN HAVE DIFFERENT PEOPLE
WITH THE QUOTE SAME CREDENTIALS
DEGREES WHATEVER ELSE BUT THAT
RELATIONSHIP HAS VALUE AND SO
THE PEOPLE ARE JUST LIKE WHICH
IS THAT CAN BE INTERCHANGED JUST
BECAUSE YOU HAVE SOME OF THIS
EVEN.
SO WE CERTAINLY NEED TO BUILD A
PIPELINE AND PEOPLE AND THERE IN
THE YOU KNOW IT IN THE COMMUNITY
IT'S NOT LIKE YOU TO SWITCH
PEOPLE OUT.
WITH EACH OTHER RIGHT AT THE ANY
TAKES.
IT'S NOT JUST THE SKILL LEVEL
IT'S ALSO THE RELATIONSHIPS AND
RELATIONSHIPS MATTERED AND AND
AND HEALTHCARE.
LABS I DISS SO TELL ME WHAT'S SO
WE HAVE.
CAN BE -- SO
TELL ME WHAT THE LAB STRUCTURE
ME YOU HAVE WE HAVE STATE THE
ACCOUNT IS SO.
WHAT'S RELATIONS BETWEEN THAT A
COUNTIES AND THE STATE REGARDING
LABORATORY SERVICES AND ALSO
BETWEEN DIFFERENT COUNTIES ANY
THE THE IT'S LIKE BECAUSE A
QUESTION --
IS IT EFFICIENT FOR WELL LET'S
SEE. EIGHT IT DOESN'T SOUND VERY
EFFICIENT FOR EVERY COUNTY TO
HAVE DROWNED LAB RIGHT NOT THAT
THAT'S ACTUALLY WHAT'S HAPPENING
BUT WE SHOULD TO SHOULD BE
TALKING ABOUT MORE
REGIONALIZATION WE WANT TO BE
SURE IT'S CLOSE ENOUGH SO WE CAN
GET SAMPLES TOO QUICKLY OR EIGHT
BUT WE DO HAVE.
VARIOUS MODES OF TRANSPORTATION --
BUT THE ONLY TALK ABOUT RARE
CONDITIONS IN ACTUALLY GIVE YOU
MORE CAPACITY SO CAN YOU JUST
SPEAK TO THE WAY WE CURRENTLY
HAVE STRUCTURED THE OUR PUBLIC
HEALTH LABORATORIES AND AND
SHOULD BE THINKING ABOUT.
THAT I I DON'T KNOW IT WAS THE
THE THE LEVEL WE HAVE
REGIONALIZATION MORE RECENTLY
SOME LESS REGIONALIZATION.
THE YOUR SO WE EACH COUNTY
OPERATES IN THE INDEPENDENTLY OF
EACH OTHER SO WE ARE ALL
SEPARATED FISCALLY HOWEVER WE DO --
HAVE STATEWIDE NETWORKS THAT WE
PARTICIPATE IN SO WE HAVE THE
STATE.
THE CALIFORNIA STATE LABS --
THERE SEVERAL NETWORKS --
WHERE COUNTY LABS DO TESTING FOR
THINGS LIKE INFLUENZA NOROVIRUS
BECAUSE THERE'S LIMITED CAPACITY
AT THE STATE AND WE TEST AT OUR
AT OUR LOCAL LEVELS --
THERE ARE SOME WE DO HAVE SOME
GREAT --
EXAMPLES OF LABS THAT HAVE.
REGIONAL LABS --
WELL COUNTIES --
WHERE WE START TO SEE SOME --
SOME --
DROPS AND COVERAGE --
ARE IS AN R. L. OVER OUR ELLER
EN PROGRAM SO RIGHT NOW WE HAVE
ONE LABORATORY THAT SUPPORTING --
NINE NINE JURISDICTIONS --
BECAUSE OF SOME LABORATORY
CLOSURES AND SO THIS AND FOR
THOSE TYPES OF EVENTS WHERE YOU
NEED ANSWERS IMMEDIATELY THERE
ARE LARGE DISTANCES TO TRAVEL BY.
A CAREER YOU KNOW TO GET THERE
SO IT DEFINITELY SIGNIFICANTLY
DELAYS THE RESPONSE FOR FOR
THOSE KIND OF FOR THOSE KIND OF
EVENTS --
BUT I I DEFINITELY THINK IT'S
SOMETHING THAT WE HAVE BEEN --
WE'VE BEEN TALKING ABOUT AND
WE'VE BEEN DISCUSSING AND
LOOKING OUT BUT YOU KNOW OVER
ALWAYS SERVE FORTY MILLION
PEOPLE SON ORANGE COUNTY A SURF
THREE POINT FOUR MILLION PEOPLE.
OF AND WE HAVE A LAB OF FIFTY
STAFF THOUSAND TEST --
SO IT REALLY IS DEPENDENT ON THE
LOCATION THAT GEOGRAPHY --
THE POPULATION OF THE THE REGION
OR THE AREA THAT IS SERVED.
THANK YOU.
DON'T WONDER WHETHER YOU GET
DRUNK DELIVERIES FOR CERTAIN
DISTANCE AND IT HAS BEEN
DISCUSSED THAT ENDING QUEST TO
STARTING TO DO THAT.
AND I THINK IT'S ALSO APPRECIATE
YOUR YOUR YOUR COMMENTS ABOUT
THE DIFFERENCE BETWEEN WHAT
PUBLIC HEALTH LABS TO AND WHAT.
CITY COMMERCIAL LABS TO COMMIT --
SO.
LIKE SOMETIMES PEOPLE THINK OH
WELL YOU KNOW WE HAVE
LABORATORIES AND HOSPITALS IN
LABORATORIES AND OTHER PLACES
AND SO FORTH.
WHILE I THANK YOU ALL SO MUCH
FOR TAKING YOUR TIME IN AND
PRESENTING AND AND THEN GIVE ME
AS YOUR PERSPECTIVE --
AND DO EXPERIENCES OF ALL OF US
THANK YOU EXTRA MUCH.
RIGHT SO --
NEXT WE'RE GONNA TAKE A PUBLIC
COMMENTS --
SO PEOPLE IN A LINE UP BY THE
MICROPHONE.
WE ASK YOU CAN TRY TO KEEP YOUR
PUBLIC COMMENT TO TWO MINUTES OR
LESS.
THAT'S ACTUALLY NICE ARE USUALLY
SET ONE MINUTES I'M GOING --
TO THEN --
AND SO THE SO WHAT I JUST SAY
YOUR NAME YOUR ORGANIZATION AND
AND YOUR COMMENTS THAT WELCOME
EXECUTIVES ASSOCIATION OF
CALIFORNIA WE REPRESENT LOCAL
HEALTH DEPARTMENTS THROUGHOUT
THE STATE AND WE ARE REALLY
PLEASED TO HAVE HAD THIS HEARING
TODAY AND WE APPRECIATE YOUR
ATTENTION TO THE PUBLIC HEALTH.
INFRASTRUCTURE IN A LOT OF THE
CHALLENGES THAT WE REYES TODAY.
I'M IN TERMS OF YOUR QUESTION
THAT YOU ASKED EARLIER ABOUT
WHAT WE NEED AND WE HAVE A
BUDGET US THAT IS JOINTLY.
SPONSORED BY BOTH JACK AND HOW
ACT AND IT'S ASKING FOR FIFTY
MILLION DOLLARS I HAD TO PUT
INTO THE PUBLIC HEALTH
INFRASTRUCTURE AND WHILE WE KNOW
GIVEN THAT THE FUNDING GAPS THAT
MR MONDO HAS RAISED TO YOU WHAT
WE KNOW THAT'S NOT GOING TO
COVER ALL OF THEM.
IT IS THE START OF A
CONVERSATION IT'S THE STARTING
POINT THAT WE NEED RIGHT NOW ALL
AND THEN WE ARE MORE THAN OPEN
TO KIND OF PUTTING TOGETHER A
WORK GROUP --
OR FIGURING OUT A WAY TO ADDRESS
AND TO DETERMINE WHAT THE
CAPACITY IS AT THE LOCAL LEVEL
SO WE THANK YOU FOR YOUR TIME
AND ATTENTION OF THE THINKING.
OKAY THANK YOU.
WELCOME HI RISHI A JURY WERE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES ON A START BY THANKING
YOU FOR CONVENING THIS
INFORMATIONAL HEARING --
AS THE PANELS HAVE DEMONSTRATED
THERE'S A VAST RANGE OF DUTIES
THAT LOCAL HEALTH DEPARTMENTS
COMPLETE --
IN MOST OF TIME THEY GO
UNNOTICED UNTIL THEY'RE THRUST
INTO THE SPOTLIGHT WHAT WE WOULD
LIKE TO SEE IS THAT THERE'S A
CONTINUE FINANCIAL INVESTMENT
FROM THE STATE. TO FIND THOSE
LOCAL DEPARTMENTS AS WELL
SUPPORT THEM THANK YOU.
THANK YOU.
WELCOME.
GOOD AFTERNOON DOCTOR LOOKED.
THIRTY LYNN SILVER FROM THE
CALIFORNIA LINES FOR PREVENTION
FUNDING CULTURE --
WE APPRECIATE THE CONVENING
TODAY A CAP IS AN ALLIANCE OF
NINETEEN CALIFORNIA
ORGANIZATIONS INCLUDING THE
COUNTY HEALTH EXECUTIVES GEAC
KOVAC -- THE
AMERICAN HEART ASSOCIATION THE
CLINICS A BUNCH OF OTHER GROUPS
THAT HAVE BEEN WORKING TOGETHER
TO DEVELOP A HIGH LEVEL PROPOSAL
FOR CALIFORNIA WELLNESS TRUST.
AND WE BRING THIS BEFORE YOU
TODAY FOR YOUR IN FOR THE BILLS
FOR THIS YEAR.
WE'LL BE PROVIDING COPIES AT
LEAST THREE STATES HAVE CREATED
THESE TYPES OF SYSTEMS --
FOR COMMUNITY BASED PREVENTION
AND WE HOPE THAT CALIFORNIA WILL
BE NEXT A DIRECTOR JIMENEZ
OUTLINED THE CHALLENGE PERFECTLY --
SO I WON'T REPEAT HER WORDSBUT
WE ASK THAT THE COMMITTEE
REFLECT DEEPLY ON HOW TO
COMPLEMENT.
OUR HEALTH INVESTMENT PORTFOLIO
AN EXPANSION OF HEALTH CARE
ACCESS WITH GREATER AND
SUSTAINED INVESTMENTS IN
PREVENTION AND HEALTH EQUITY.
ON NOT YEAR BY YEAR BUT IN A IN
A SUSTAINED FASHION --
WE THINK WE NEED TO BE WITH
THEIR CITIZENS IN SICKNESS AND
IN HEALTH AND WE LOOK TO YOU FOR
LEADERSHIP FOR THAT CHANGE THANK
YOU.
THANK YOU.
WELCOME.
GOOD AFTERNOON DAVID
SURVEILLANCE PUBLIC HEALTH
DIRECTOR FROM ORANGE COUNTY
CALIFORNIA THANKS GOOD TO SEE
YOU AGAIN AND I SEE A BUNCH OF
FUTURE PUBLIC HEALTH WORKERS IN
THE BACKGROUND THERE SOME
EXCITED --
WILL DISCERN RECRUITMENT --
TO HERE SHORTLY APPRECIATE YOUR
LEADERSHIP AND THAT THE
COMMITTEES LEADERSHIP ON ON
THESE ISSUES ALSO REALLY WANNA.
SAY INTERPRETATION OF THANKS FOR
THE CALIFORNIA DEPARTMENT PUBLIC
HEALTH LEADERSHIP DOCTOR SMITH
DR CHAVEZ AND SUSAN FINALITY TO
BEEN GREAT PARTNERS THEIR TEAMS
ARE AMAZING --
TO WORK WITH AND WE'RE WE'RE
BLESSED TO HAVE AT THAT COULD
STATE AT LOCAL PARTNERSHIP HERE
IN.
IN CALIFORNIA --
THIS DOCTOR TRAVIS SAID MULTIPLE
THREATS DISNEYLAND MEASLES --
RESPONSE IT PASSED US
SIGNIFICANTLY.
WE STILL HAD FOOD ARE BORN
OUTBREAKS OCCURRING WHEN THAT
HAPPENED WE STILL HAD OTHER.
OUTBREAK SITUATIONS WE STILL HAD
STD CLINICS TO RUN --
SO WHEN WE GET WHEN WE GET
STRETCHED OUT ON IT IT'S A
STRUGGLE AND WE TALKED A LITTLE
BIT ABOUT THE RECESSION AND THE
IMPACTS THAT THAT'S HAD AN
ORANGE COUNTY WE LOST ABOUT --
TWO HUNDRED POSITIONS --
DURING THE ECONOMIC DOWNTURN
THOSE HAVEN'T COME BACK SO A LOT
OF THAT FLEXIBILITY AND CAPACITY
THAT WE HAD BEFORE WE NO LONGER
HAVE.
CHALLENGE FOR PUBLIC HEALTH IS
THAT WE'RE WE ARE BY AND LARGE
AT A BUSINESS WEEK OPERATION ANY
TO FIVE OPERATION BUT EXPECTED
TO BE A TWENTY FOUR SEVEN
RESPONSE SO YOU THINK ABOUT FIRE.
FIRE IS STRUCTURED TO WAIT FOR
THE FIRE TO OCCUR AND THEN
RESPOND.
WERE EXPECTED TO DO THAT BUT
WITH AN EIGHT TO FIVE STAFF AND
SO --
CONTINUING TO RETHINK THE MODELS
FOR PUBLIC HEALTH AND RESPONSE
AND SEARCH CAPACITY AND WORKING
ACROSS OUR JURISDICTIONS CAN BE
CRITICAL AND REALLY APPRECIATE
YOUR SUPPORT IN THAT THANK YOU.
THANK YOU.
WELCOME AFTERNOON LOCAL DOLPHY
WITH THE ALZHEIMER'S ASSOCIATION
JUST YESTERDAY WE RELEASED OUR
TWO THOUSAND NINETEEN FACTS AND
FIGURES REPORT ONCE AGAIN AT
NUMBERS IN CALIFORNIA ARE ON THE
RISE.
WE ARE JUST THE STATE LEGISLATOR.
TO EXPAND PUBLIC HEALTH
INFRASTRUCTURE TO INCORPORATE
ALZHEIMER'S AND RELATED
DEMENTIAS.
AB THREE EIGHT EIGHT AND ARE TEN
MILLION DOLLAR ONE TIME BUDGET
REQUEST ARE STEPS IN THE RIGHT
DIRECTION THANK YOU.
THANK YOU [inaudible]
WELCOME.
THANK YOU MY NAME IS MELISSA
PERISH I AM FROM ITS WOLLEMI
COUNTY I'M THE DIRECTOR OF
PUBLIC HEALTH NURSING IN THE
PUBLIC HEALTH ADMINISTRATOR.
I'M HERE IN SACRAMENTO AS PART
OF OUR AND BI ANNUAL --
DIRECTOR OF PUBLIC HEALTH NURSES
MEETING AND I JUST WANT TO ECHO
AND ALL OF THE INFORMATION THAT
YOU'VE HEARD TODAY AND REALLY
URGE YOU TO CONSIDER.
THAT HOUSE FOR PUBLIC HEALTH
INFRASTRUCTURE FUNDING --
SUSTAINABILITY AND MOST OF ALL --
FLEXIBILITY THAT IS DIRECTED TO
PUBLIC HEALTH TO STAY WITHIN
PUBLIC HEALTH WE ARE VERY ROLE
COUNTY AS YOU KNOW.
YOU SEE ME AS A PART OF OUR
COUNTY FIFTY THOUSAND PEOPLE I
HAVE SIX PUBLIC HEALTH NURSES
ONE OF WHICH IS MYSELF.
OF THOSE SIX PUBLIC HEALTH
NURSES.
ONLY ONE IS UNDER THE AGE OF
FIFTY FIVE AND SO.
FUTURISTIC.
THAT'S GOING TO BE ANOTHER ISSUE
AND I'D LIKE TO ECHO ALSO WHAT
MISS ALL THREE SAID FROM.
LOS ANGELES COUNTY THE THANK YOU.
THANK YOU.
WE NEED TO FREE MORE PEOPLE.
OKAY SO I WENT.
I WOULD THINK ALL EVERYONE WHO
CAME UP FOR PUBLIC COMMENT AS
WELL AND I PARTICULARLY THINKER.
A SPEAKERS TODAY --
WHO'VE --
SHARED VERY IMPORTANT
INFORMATION --
I THINK WE NEED TO THINK ABOUT
HOW YOU KNOW HOW DO WE FUND
PUBLIC HEALTH IS A SAID EARLIER --
WE ALSO NEED TO THINK ABOUT WHAT
WE'RE PAYING WE DON'T AS WELL
AND CERTAINLY IF THERE'S
ANYTHING THAT TALK ABOUT
PREVENTION IT'S PUBLIC HEALTH.
AND ALSO THE CHALLENGE OF
TELLING PEOPLE REMINDING PEOPLE
THAT SUCCESS IS WHEN NOTHING
HAPPENS RIGHT.
BECAUSE YOU'RE PREVENTING VERY
BAD THINGS SO DON'T SEE BAD
THINGS HAPPENING SO THESE PEOPLE
DON'T REALLY WELL NOTHING THAT
HAPPENED RIGHT ONLY EIGHTEEN
CASES AN ALLEY WITH THE APTIVA
SE SO WHAT'S THE BIG DEAL.
THAT WAS A BIG DEAL BECAUSE ONLY
EIGHTEEN CASES RIGHT.
AND I THINK WE NEED TO REMIND
PEOPLE THAT SO I REALLY
APPRECIATE AGAIN ALL THE
PRESENTATIONS AND IT WILL
CERTAINLY LOOK AT THAT WE'RE
LOOKING AT THEM AND THINK ABOUT
WHAT POLICIES AND ALSO FINANCIAL --
STEPS WE NEED TO TAKE AND I
THINK I THREW A FEW CHALLENGES
AS WELL --
SO WE'RE HOPING TO SEE SOME
RESULTS FROM THAT AND WITH THAT
I JUST --
WE'RE GONNA TURN THIS A SENATE
COMMITTEE ON HEALTH THE HEARING
ON THE CALIFORNIA'S PUBLIC
HEALTH INFRASTRUCTURE CAPACITY
THANK YOU VERY MUCH