Hopkins says Sonoma County should take control of coronavirus vaccination appointments

Sonoma County should take control over the fragmented campaign to administer coronavirus vaccinations to its half-million residents, Board of Supervisors Chair Lynda Hopkins declared Tuesday, proposing an executive order that would allow the county to direct immunizations underway at private medical providers like Kaiser Permanente, Sutter Health and St. Joseph Health.

The proposal emerged as the county unveiled an $8.1 million plan Tuesday to implement its vaccination strategy, which has been tripped up by conflicting messages that have led to widespread public confusion and anxiety over eligibility and access to the vaccine.

At the heart of the chaos is the county's decision to withhold vaccinations for members of the general public under the age of 75, preserving scarce doses for high-risk elders while putting the county at odds with a Jan. 13 recommendation by Gov. Gavin Newsom that granted eligibility to everyone over the age of 65.

The turmoil grew Tuesday as websites used to schedule vaccinations at clinics in Rohnert Park, Oakmont and Sonoma continued to allow people under the age of 75 to book appointments, prompting many to question the effectiveness of the vaccine rollout and whether the eligibility rules were being applied fairly and consistently.

OptumServe, the company managing the Rohnert Park clinic, worked to restore appointments it had canceled Sunday and Monday for residents 75 and older in the rush to rectify a flaw on its website that allowed people aged 65-74 to book vaccinations. People under the age of 75 who received their first shot at the clinic are also promised appointments for their second doses.

OptumServe’s sign-in page now clearly states that Sonoma County appointments are open only to those 75 and up. But one week after a county official approved a mock-up design for the website, it appeared to contain the same defect that allowed people under the age of 75 to book a vaccination, even though users are required to enter their birth date before receiving confirmation of the appointment. The glitch has forced site managers to turn away people at the clinic’s doors and left some appointments unfilled, slowing down the immunization campaign at a critical moment during the deadliest period of the pandemic.

Hopkins believes the messy situation calls for the county to take a more central role, including the ability to require hospitals to vaccinate people outside their networks and release the associated data.

“I would hope that we can, if we need to, strong-arm with a public health order,” she said Tuesday during the Board of Supervisors’ meeting. “Not only getting the data that we need, but also mandating that they actually provide the services to the community.”

Despite the county’s inability to prevent the problem with the OptumServe website and the chaos that resulted from the mass cancellations, Hopkins said the experience called for more oversight, not less.

“We need to take a stronger lead role because of the snafu,” she said in an interview. “Desperation for vaccine access is what caused the crash of the OptumServe site. And part of the problem, I think, was our indirect control. We have the responsibility but not the authority.”

Giving county health Officer Dr. Sundari Mase the power to centralize vaccination authority with a health order, Hopkins believes, would increase the county’s ability to ensure the right people have access to vaccine doses, and could establish standard eligibility requirements among all health providers even when the county and state are at odds, as they are now.

Hopkins directed county staff to investigate the scope of the health officer’s power, but said her initial research — at 3:30 a.m. during a recent bout of insomnia — was promising.

“The language is extraordinarily empowering for our public health officer,” Hopkins said. “We’re obviously using it to delve into the realm of emergency paid sick leave and tenant protections, in the interest of public health. So why can’t we use a public health order to ensure that people actually get a vaccine that will save them from potentially dying or experiencing severe complications of COVID-19?”

Hopkins’ idea met with varying degrees of enthusiasm from the other supervisors. All were interested in learning more about the county’s scope of authority over hospital partners, but some had reservations.

Supervisor Chris Coursey wondered whether county staff could take on additional workload when they are already overtaxed, and was eager to give representatives of Kaiser Permanente, Sutter Health, Santa Rosa Memorial and Petaluma Valley hospitals a chance to respond.

“I do believe if we’re talking about working more closely with health care partners, we actually need to treat them as partners and get them involved in the conversation,” Coursey said.

Supervisor Susan Gorin argued that no shift in planning or coordination will be successful if it isn’t accompanied by better communication from the county, noting the anxiety that still reigns among many local seniors.

“I’m all for the county taking charge and asking for a plan,” Gorin said. “But I want to look at outcomes. What will that achieve?”

Hopkins did not offer great detail on what her proposal would look like in action. Much of what she described came back to creating a central hub for vaccination sign-ups in the county, a process she believes would avoid debacles such as the OptumServe experience. That would mean subjecting the big hospitals to direction from the county.

Under the current configuration, those health providers receive vaccine doses independently and have been handling their own appointment scheduling. Hopkins’ plan, if executed, would allow the county to guide who receives those appointments.

For Hopkins, it’s a question of equity. Many of the people who crashed the OptumServe system by flooding it with appointments are affiliated with one of the major health providers, she said. If the county is vaccinating their members, she wonders, why shouldn’t the providers be offering doses to county residents outside their systems.

“It’s crazy when you see the $8 million price tag on the agenda today, and think of how much private companies are investing in this,” she said. “And we’re giving them the facilities for free. They can come and occupy the fairgrounds or the Sonoma Veterans Building. Which they totally should be doing. But where’s our end of the bargain? They make quite a bit of money.”

Without a written plan to respond to, the hospital groups were leery of offering detailed assessments.

A Kaiser Permanente representative said the company is already offering vaccinations to nonmembers. He said they can obtain an appointment, if available, and a medical record number by calling 866-454-8855.

A St. Joseph Health spokeswoman provided a link explaining that her company is reaching out to eligible recipients regarding appointments.

“If the idea expressed by Supervisor Hopkins takes specific form, we will evaluate it at that time,” the company said in release. “Regardless, our focus will continue to be on doing what we can to vaccinate our caregivers and members of the community as effectively as possible, and doing so in partnership with the County and in accordance with the guidelines being provided by public health.”

Sutter Health did not provide comment.

The vaccine plan unveiled Tuesday provides money for the county to expand the number of local vaccinators, conduct stakeholder outreach, direct information to the public and fulfill other services through June 30. Current FEMA funding will cover 75% of the $8.1 million. Sources of the other 25% are undetermined.

Since the program began Dec. 15, more than 38,000 people have received vaccinations in Sonoma County, including more than 9,000 who have received both of the two required doses. That does not include residents and staff of long-term elder care facilities serviced by CVS and Walgreens.

The county’s vaccination effort, which put about 1,785 doses into arms each day over the past week, got a boost Tuesday when it was announced that the CVS pharmacy in Sonoma is one of 100 in California selected to administer shots to eligible recipients beginning Feb. 11. Those doses — the number was not disclosed — will come directly from a federal partnership and will not be subtracted from Sonoma County’s allotment.

But even as the vaccination campaign expands, there is still widespread confusion over who can get a shot.

Word spread Tuesday that people under 75 were able to book appointments at a drive-thru site at Sonoma Valley High School to be run by Sonoma Valley Hospital this weekend, though the instructions stated otherwise. And some Oakmont Village residents received notice that they should cancel their appointments for Thursday, Friday and Monday if they are younger than 75. At least 520 of the 800 slots that had been filled for a clinic run by Safeway there were taken by people in the 65-74 range.

“By having those people who are under 75 cancel their appointments, we can avoid the potential of having all appointments canceled, and requiring people over 75 to reschedule,” managers of the retirement community wrote in an email to residents.

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.