May 24, 2020
Mayor Terry Tornek
Vice Mayor Tyron Hampton
Members of the Pasadena City Council
Re: Report and Related Documents Addressing Pasadena’s COVID-19 Response in Its Long-term Care Facilities
Dear Mayor Tornek, Vice Mayor Hampton, and Councilmembers:
I am a longtime resident of Pasadena, an advocate for homeless neighbors in our community, a retired attorney after 31 years of state service, and a registered nurse (inactive). This letter addresses the following documents the City made public late last week related to Pasadena’s COVID-19 response for patients/residents and staff members residing or working in Pasadena’s long-term care facilities:
May 21, 2020 Letter from Brenda Klutz to City Manager Steve Mermell; Ms. Klutz’ chronology entitled “ Onset of COVID-19 and the City of Pasadena’s Public Health Response” (“Chronology”); and City Attorney Michele Beal Bagneris’ “Summary of Health Officer’s Authority Relating to Skilled Nursing Facilities.”
First, I want to thank you for authorizing the engagement of a consultant to consider Pasadena’s response to the COVID-19 pandemic as related to Pasadena’s long-term care facilities. According to the City’s COVID-19 dashboard, the numbers of COVID-19 cases and deaths related to long-term care facilities in Pasadena are very high: 71% of the total cases and 88.6% of the total deaths citywide. In contrast, Los Angeles County and Orange County report that COVID-19 deaths related to skilled nursing facilities are 52% and 38% of total COVID-19 deaths countywide, respectively.
The California Department of Veterans Affairs (CalVets) reports that, as of May 11, 2020, only two veterans (total) have died from COVID-19 in its eight CalVet Veterans Homes. Of significance, on March 15, 2020, CalVets began restricting all visitation to the homes except to those in hospice care. Prior to that, group events both on and off the campuses were postponed, communal dining for most residents was halted, every employee was screened before entering the home, and the department increased the cleaning and sanitizing of all spaces. (www.calvet.ca.gov/COVID19.)
Given these substantial jurisdictional differences in outcomes, I previously requested the City Council to thoroughly examine the imminent report to determine how this City might have better outcomes for our most vulnerable residents on a going forward basis. I urged the PPHD to reach out to other jurisdictions that have had better outcomes and to the California Public Health Department to determine whether additional measures needed to be adopted. Further, if state regulatory gaps were identified, I urged that those be addressed.
I have reviewed the three documents referenced above. Preliminarily, the Chronology raises a number of questions suggesting that further inquiry is warranted. Since I will be unable to ask those questions, I respectfully include those questions for your consideration in the Addendum attached to this letter, not to play “Monday morning quarterback,” but to, hopefully, elicit critical information that is missing or unclear that may be useful in protecting the patients/residents and staff in our long-term care facilities from the next wave of COVID-19 and beyond.
Ms. Klutz’s one-page report notes that she was asked “to review the City of Pasadena Public Health Department’s (PPHD) actions, orders, public health nurse logs of onsite visits and calls, emails and other documents or assistance related to the COVID-19 pandemic. This review included the information sent to the administrators, directors of nursing and infection control preventionists providing care to the residents of the City of Pasadena’s long-term care facilities.” Ms. Klutz concludes as follows: “As a result of my review, I found the PPHD to have responded in a timely and thorough manner to provide orders and technical assistance to prevent, detect and/or mitigate the spread of COVID-19 in long-term care facilities.”
I am unaware of Ms. Klutz’s expertise in epidemiology, infection control, pandemics, or public health. Assuming she is qualified to render the conclusions expressed in her report, the apparent scope of her assignment raises substantial concerns as Vice Mayor Hampton and Councilmember Gordo have already stated. Was she simply asked to review what PPHD did or, was she asked to evaluate why Pasadena’s numbers are so high as compared with other jurisdictions, whether there were possible measures that could have produced better outcomes, and whether there are gaps in regulations covering education, training, inspection and the like? The report itself does not suggest that she was tasked with providing guidance on how Pasadena may have better outcomes in the future by instituting additional protective measures in its long-term care facilities.
I am certain that Dr. Goh and her staff are working very hard during this crisis and I am grateful for that. But our COVID-19 case and death rates in our long-term care facilities should receive our City’s highest attention and most resources. Patients and residents in our long-term care facilities are among our most vulnerable residents and they have borne the brunt of COVID-19. While I agree with Dr. Goh’s statement “[t]here needs to be discussions at a national level on how these facilities are funded, staffed and regulated,” what is our City going to do in the meantime? Is the PPHD going to follow the same measures it did in “the first wave” of COVID-19 (since no shortcomings are identified) and yet expect better results?
Attorney Bagneris states in her memorandum as follows: “The City of Pasadena Public Health Department is a local health department with specific responsibilities and authorities for the protection of public health under the California Health and Safety Code. A city health department is independent of a county health department unless the city has elected to be included within the jurisdiction of the county health department.” (5/21/2020 Bagneris Memo. to City Council, citing Health & Safety Code section 101185.) It is unclear whether the city has elected to be included within the jurisdiction of the Los Angeles County Health Department. My review of this memorandum leads me to believe that is not the case, but I may be wrong. Attorney Bagneris also notes that “the California Department of Public Health may, in its discretion, opt to ‘control and regulate’ local health authorities, but has not elected to exercise that control at this time.” (Bagneris Memo., p. 1.) The statutory authority cited in the memorandum suggests that PPHD has a huge responsibility in protecting patients/residents and staff in our long-term care facilities.
On May 26, 2020, the Los Angeles County Board of Supervisors will be considering whether to approve a motion that provides for the appointment of an Inspector General to provide a report by August 1, 2020, “on the Oversight and Operations of Skilled Nursing Facilities in Los Angeles County (Report), with the Report to include an evaluation of SNFs within the County, and recommendations on operational and programmatic changes necessary to improve the County’s monitoring and oversight of these facilities, including legislative and regulatory recommendations aimed at improving operations within these facilities, given the role of State and Federal regulations impacting the operation of these facilities.” Since Pasadena has its own public health department, it is unclear how the motion applies to this City. I have reached out to Supervisor Barger’s Office for clarification. If the motion would not cover Pasadena’s long-term care facilities, I urge this Council to consider how Pasadena can adopt measures similar to those in the motion in order to provide accountability and best practices for the care and protection of our vulnerable patients/residents and staff members in our long-term care facilities in the future. I urge the Council to also examine the extent of PPHD’s regulatory authority over all of its long-term care facilities. If there are gaps in that authority, the Council should determine how to bridge those gaps.
Thank you for your consideration.
Sonja K. Berndt, R.N. (inactive), J.D.
Cc: Michele Beal Bagneris, City Attorney
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