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Grand jury report hammers Sonoma County Department of Health Services

For the third time in six years, a Sonoma County Civil grand jury blasted the county’s Department of Health Services.

This time, the subject was the department’s pandemic response.

In a section titled “Dedication Overcame Dysfunction,” the report, published in May, describes what jury members called “a long-term pattern of poor communication, lack of collaboration, staffing challenges, and low employee morale that predated COVID” at the department.

Among other specific flaws, it calls DHS unprepared for the budding health emergency because of staff vacancies, including the director of nursing position. It notes a power struggle between the DHS and Office of Emergency Services leadership teams early in the pandemic as well, and cites DHS’s failure to adhere to FEMA financial requirements.

The report also alludes to a lack of responsiveness by the department’s Human Resources office.

These shortcomings affected more than staff well-being. They “disrupted the emergency response to COVID,” the grand jury wrote.

DHS Director Tina Rivera addressed the report briefly on Thursday, pushing back against its characterization of her management style. She pointed out that she’s been director of health services only since March.

She joined the county health department in January 2020 as assistant director and stepped in as interim director in May 2021, after then-director Barbie Robinson quit for a job in Houston.

“I have built my entire career on collaboration and partnership, and I have an open door,” Rivera said. “It is always open. I was really disappointed in some of the things I read.”

This grand jury report arrived just as DHS was formulating its plan for reduced COVID services. And while that strategy may be warranted by the coronavirus’ shift to an endemic phase, it, too, brought complaints of poor communication.

Previous grand juries documented similar problems at the department.

The 2016-17 and 2017-18 juries both cast an eye to DHS and reached harsh conclusions about the department. The 2017-18 report stated that “ … professional communication was stifled by a culture of retribution and neglect which impacted the free flow of information. This led to an egregious lack of transparency.”

A highlighted excerpt from a Sonoma County Civil Grand Jury report scrutinizing the county’s Department of Health Services.
A highlighted excerpt from a Sonoma County Civil Grand Jury report scrutinizing the county’s Department of Health Services.

This fiscal year’s examination was prompted by a citizen’s complaint asking the grand jury to investigate the county’s COVID-19 emergency response, and the overall leadership and organizational climate within DHS. The jury conducted at least 24 interviews with county officials, past and present DHS employees, and other county staff who assisted with the COVID response, while also reviewing hundreds of public and private documents.

The jury members found much to like in the overall COVID program. They commended the county’s Emergency Operations Center for its quick response to the pandemic, noted the collaborative approach of county Health Officer Dr. Sundari Mase (who reports to Rivera but has some powers that transcend the traditional work structure) and lavished praise on rank-and-file workers.

“We found an abundance of dedicated County employees who performed admirably and heroically,” the report reads. “ … A number of individuals contributed at an extraordinary level, working countless hours, sometimes without any additional compensation, and with minimal public recognition.”

DHS leadership didn’t fare as well.

“From our interviews, a common theme emerged of a top-down leadership style characterized by what one interviewee termed a ‘my way or the highway’ approach,” the grand jury report states. “Many interviewees said that top DHS leadership only wanted managers who agreed with them, and that there was a fear of retribution if they did not. … Interviewees used adjectives such as ‘toxic,’ ‘hostile,’ ‘chaotic,’ ‘dysfunctional,’ ‘desperate,’ and ‘fearful’ to characterize the resulting organizational climate.”

One soon-to-be-former DHS contract worker agreed with that assessment.

“There is such a vacuum of leadership,” said the displaced worker, who requested anonymity for fear of retribution as they pursue new employment.

A highlighted excerpt from a Sonoma County Civil Grand Jury report scrutinizing the county’s Department of Health Services.
A highlighted excerpt from a Sonoma County Civil Grand Jury report scrutinizing the county’s Department of Health Services.

One particular disruption cited by the grand jury was an early-pandemic power struggle between Robinson and the county’s Emergency Operations Center. The rift led to a decision by the county to have co-leaders in the overall COVID response, the report stated. After two months, the strategy shifted again and DHS was given ultimate authority.

Rivera argued that the grand jury missed an important point — that Sonoma was far from the only county to shift from traditional disaster response to a health-based response as the pandemic unfolded.

“And the data speaks for itself,” Rivera said. “What this department, what this staff, what our health officers, what our leadership, what our partners, stakeholders, our disaster service workers have done has saved lives in this community. And we can put our data against any county in California and across this nation.”

About 83% of eligible Sonoma County residents are fully vaccinated, a figure that ranks ninth among California’s 58 counties, according to state data.

Beyond that, Rivera said, the county would be responding to the report through the process established by state law.

Several county supervisors defended Rivera’s overall leadership, arguing that many of the issues raised by the grand jury report stem from years of structural and institutional problems within the department.

“Tina is taking an organization that has been frayed,” Gore said. “With eyes wide open she is in a leadership position to reform and stabilize that organization.”

Gore said the county’s health services department “has been hammered by the pandemic,” with many of its flaws being exposed. But he said that he’s confident in Rivera’s ability to improve the department, adding that “I got her back.”

District 3 Supervisor Chris Coursey said he had deep concerns about the grand jury report, but also said problems with the department date back several years and that no one person is to blame.

“It's clear to me that management problems are structural, maybe cultural, and go beyond the person at the top,” Coursey said. “I think that the Board of Supervisors has to take some responsibility here, too. The grand jury points that out, that we’re the five-headed boss, and that may not be consistent in its direction.”

District 2 Supervisor David Rabbitt also remains committed to Rivera’s leadership.

“Tina has my 100% support,” Rabbitt said. “If anything, we have to make sure she has the resources they need to carry out what’s in front of them. Anything less than that is scapegoating.”

He also suggested some of the negative comments from DHS employees might have been aimed at Rivera’s predecessor, Robinson.

“Barbie was hired as a change agent,” Rabbitt said. “By their nature, they will ruffle people’s feathers. Some of those exit interviews might have been holdovers.”

Any complaints about Rivera and DHS must be weighed in the context of a once-in-a-century pandemic that presented uncharted challenges for every local jurisdiction, Rabbitt said. Those sentiments were echoed by District 1 Supervisor Susan Gorin.

“The COVID pandemic and now endemic has been extraordinarily challenging for the County — and every jurisdiction across the planet,” Gorin texted. “It required an immediate mobilization of resources and organization on an unprecedented scale. Working together, all departments, the Board of Supervisors and all of our partners collaborated in crisis mode together and performed well.”

Moving forward, Gabriel Kaplan — director of the county’s Public Health Division, who spoke to The Press Democrat in a joint interview with Rivera — acknowledged there will be a “period of adjustment” as COVID support services begin to migrate out of Department of Health Services. But, he added, two-thirds of staff are staying over. DHS will retain contract leaders, will still be working with Fox Home Health and will still have access to state nursing partners.

“Operationally, I think we probably won’t experience a lot of hiccups,” Kaplan said. “I think what may require some adjustment is people’s perspectives in the community as to what they were able to count on in the past, and what’s going to be available in the future.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post. You can reach Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.

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