FINAL_Grandy_Jury_Report_HSS-Lab-Systems-Review.pdf

2023-2024

PUBLIC HEALTH LABORATORY SYSTEMS REVIEW

(NAPA-SOLANO-YOLO-MARIN-MENDOCINO COUNTY)

June 21, 2024

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PUBLIC HEALTH LABORATORY SYSTEMS REVIEW

(NAPA-SOLANO-YOLO-MARIN-MENDOCINO COUNTY)

Solano County Civil Grand Jury 2023-2024

I. SUMMARY

The Solano County Civil Grand Jury elected to review the Health and Social Services Laboratory systems. The official name of the laboratory is The Napa-Solano-Yolo-Marin-Mendocino County Public Health Laboratory. The last Grand Jury report on the Laboratory was completed in 2012-13 and several problems were noted including inadequacies in the billing system and personnel shortages. Therefore, a follow-up investigation was deemed appropriate.

II. INTRODUCTION

The Public Health Laboratory (PHL) is located at 2201 Courage Drive, Fairfield, California. The main functions of the laboratory are to perform routine public health laboratory testing (assays) for tuberculosis, rabies, communicable diseases as well as drinking and beach water quality tests.

The Lab performs testing not covered by hospitals or insurance. It also provides testing for other counties in the assigned Joint Exercise of Powers Agreements (JEPA). The chart below shows the number of assays and tests performed by PHL for each county during 2022.

III. STATEMENT OF FACTS:

The Public Health Laboratory is a regional laboratory. Through a Joint Exercise Powers of Agreement (JEPA) it serves: Napa, Solano, Yolo, Marin and Mendocino counties. Laboratory staff stated that an agreement with Sonoma County may be added in the future. The JEPA is negotiated with each county for three years with an option for a two-year continuation. The JEPA is currently using variable agreements with each county based on usage. Meetings of member counties are held quarterly.

The Public Health Laboratory is currently fully staffed. It has 15 full-time personnel and occasionally one or two part-time employees. It has two full-time clerical staff. The Laboratory

FINAL 240621 H&SS Laboratory Systems Review - 3 -staff are acquired through the Solano County personnel system. The PHL has a full-time Director and a full-time Public Health Assistant Laboratory Director. Professional staff are recruited through State and National registries and through networking. Laboratory staff stated they have had difficulties recruiting microbiologists due to California certification requirements. However, the State recently agreed to the County changing its requirements allowing non-certified microbiologists to work for at least three years if they meet licensing requirements within that timeframe. The following chart shows current personnel positions based on the requirements of JEPA members.

PHL uses two computer software systems: Billing and Transfers (BAT) and Orchard software.

BAT is used for accounting and runs on an Excel program. No electronic funds transfers (EFT) or credit card payments can be completed on-line. The current billing system does not meet existing security requirements. This was a finding from the Grand Jury of 2012-13. As of this report date, this finding has not been resolved. PHL has submitted a request to the Solano County Department of Information Technology (DOIT) to acquire a new accounting system that will meet commonly accepted industry standards for security. A completion date has not been identified.

Orchard software is used to run the lab information management system and does meet current security needs. The Orchard system has an annual usage fee of $67,000. PHL is working to implement the cloud-based back-up feature of Orchard. When the cloud-based feature is implemented, the annual fee will be $140,000. A date has not yet been established to complete the update.

The overall PHL budget exceeded $3 million during the COVID pandemic. It was increased temporarily by one-time monies for COVID requirements. The annual operating budget is now

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$2 million. This budget cannot be exceeded without going back to JEPA partners. The County Auditor-Controller reviews the PHL budget annually. The last two county audits from 2021 and 2022 found no discrepancies.

PHL averages approximately 30,000 tests per year. During the Covid pandemic the annual tests exceeded 100,000.

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During the Covid pandemic, conflicting information was published. Lab staff stated that public information from agencies such as CDC (Centers for Disease Control), NIH (National Institute of Health), and WHO (World Health Organization) were misleading. It was also stated that the general public lost trust and confidence in these agencies.

IV. FINDINGS AND RECOMMENDATIONS

FINDING 1 – The Public Health Laboratory has an antiquated billing system that is not secure and cannot process billing with credit cards and electronically, which may lead to security breaches as well as delays in payment processing.

RECOMMENDATION 1 – Purchase a new secure system which can process billings through credit cards or EFT. This Recommendation was noted in the 2012-13 Civil Grand Jury Report and has still not been completed. Establish a completion date and finalize the acquisition of the upgrade no later than June 30, 2025.

FINDING 2 – The accuracy of health information provided by CDC, NIH, WHO and Solano County Public Health Department to the general public greatly diminished community trust due to inaccurate information distributed by government agencies during the Covid pandemic.

RECOMMENDATION 2 – Re-establish public trust within the community regarding the accuracy of health information and their contribution to public health. The Solano County Public Health Department establish more aggressive displays of its services and functions through public outreach programs. Participate in activities such as regional television and radio networks, county newspapers, local churches, school programs, civic organizations, local markets and festivals, and public access channels.

COMMENTS

Since the release of the 2012-13 report, the Public Health Lab has made several improvements.

The facility is fully staffed due to changes in hiring practices. The billing process has improved with the addition of a billing assistant. The Lab appears very clean and well managed by the Public Health Laboratory Director.

REQUIRED RESPONSES

Solano County Board of Supervisors (Findings 1 and 2) Health & Social Services Director (Findings 1 and 2) Director, Public Health (Findings 1 and 2) Department of Information Technology (Finding 1)

COURTESY COPIES

Public Health Laboratory Director.

V. METHODOLOGY

The Solano County Civil Grand Jury:

• Interviewed County Public Health Staff.

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• Reviewed all Joint Exercise of Power Agreements.

• Reviewed fiscal year 2023-24 Laboratory Budget.

• Reviewed the last two Auditor-Controller’s Laboratory Revenue Reports.

• Reviewed summary of laboratory tests performed for fiscal year 2022-2023.