Local authorities didn't consider HACHR essential service but Dr. Frankovich and CDPH overruled them

The City of Eureka continues to receive questions, concerns and complaints regarding Shelter in Place Order compliance related to various business and organizations within our jurisdiction.  HACHR (Humboldt Area Center for Harm Reduction), a CDPH certified syringe exchange program in Eureka, is one of the organizations we received inquiries/complaints about.

Upon being made aware of this issue on Friday morning (March 27th), I contacted Sheriff Honsal to receive an opinion from the county as to whether or not HACHR’s operation was considered “essential” services under the County Health Officer’s Shelter in Place Order (SIP). I received a response from the Sheriff that passing out harm reduction is not essential services.

The City of Eureka’s current protocol regarding the SIP order is that Code Enforcement (Under the Public Works Department) will take the lead in education, compliance checks, complaint follow-up, and enforcement for violations as a last resort.  The Eureka Police Department will primarily focus on emergency services and our other priority law enforcement functions while acting in a support role for Code Enforcement as needed.  The City’s senior leadership team meets regularly to discuss, plan and act regarding our COVID-19 response and issues such as SIP compliance and exemptions for essential activities, services and businesses.

After briefing Director Gerving and City Manager Lotter on the Sheriff’s determination that HACHR it was not an essential business under the SIP order, Code Enforcement was tasked with following up with the notification to HACHR that they were not an essential service and needed to cease operations temporarily while the current SIP order was in effect.  This was based on our best information at the time and a decision I fully supported under the circumstances.  However, they were not open at their 3rd Street premises on Friday and this notification wasn’t made.

On Saturday, March 28th, I was included in an email sent by HACHR’s Executive Director, Jessica Smith, expressing concern about my statement on Facebook (in response to a concerned citizen’s inquiry) that HACHR was not consider an essential service under the SIP order.

In her email, Jessica wrote:
“We are taking necessary protocols to keep staff and consumers safe, including operating with a skeleton crew and not allowing people in the building. All supplies (besides syringes) are being pre packaged and handed out. We are in constant contact with CDPH, the National Harm Reduction Coalition and belong to several listservs that provide up to date information about safety for programs like ours. We hand out literature about COVID-19 to participants and have conversations about the need for social distancing and the shelter in place ordinance that is in effect. As far as the statewide ordinance goes, SEPs and Harm Reduction programs are considered essential services. Perhaps the folks at CDPH can speak more to this; I have a few of them cc'd here.”

I replied to Jessica’s email that based on the information we had received from the Sheriff regarding the County’s SIP order, HACHR was not considered an essential service and I directed her to cease operations. Later that day I received an email authored by the Humboldt County Health Officer, Dr. Teresa Frankovich, who stated: “It was not my intention to eliminate these services through my order and I was not part of the conversation referenced. We will be discussing this in our EOC meeting Monday.”

I also received an email from Matt Curtis, a Harm Reduction Specialist from the California Department of Public Health (CDPH), who wrote:

“Chief Watson – this is Matt Curtis from the California Department of Public Health (CDPH), Office of AIDS, which supports syringe services programs (SSPs) such as HACHR across California. As you may know, the statewide shelter-in-place order was issued by Dr. Sonia Angell, the state public health officer and CDPH’s director, pursuant to public health powers defined in state law. That order, referencing the ‘critical infrastructure’ sectors defined by the U.S. Department of Homeland Security, defines public health programs, including those operated by community-based organizations such as HACHR, as essential services for purposes of the shelter-in-place order. For more detail, please refer to the guidance pasted at the end of this email, which our office recently sent to the state’s 54 authorized SSPs.

CDPH has authorized HACHR to provide syringe services and provides state funding for HACHR to carry out its work. Like the SSP operated by the Humboldt County Department of Health and Human Services, HACHR provides vital care to people who may be especially vulnerable to COVID-19 as well as other infectious disease, overdose, and other health conditions. We would appreciate your cooperation supporting the operation of state-funded public health programs at this time of crisis.

Thank you, and please be in touch if you have questions in this matter,
Matt

CDPH Office of AIDS Guidance for SSPs:

Dear Harm Reduction Colleagues,

The California Department of Public Health, Office of AIDS Harm Reduction Unit has been in touch with most of the California syringe services programs over the last few days, and we appreciate people taking the time to update us on how you’re responding to COVID-19 and the statewide stay-at-home order. California’s SSPs are making complicated choices right now, and quickly.

The majority of California’s 54 authorized SSPs have modified their services and remain in operation. The March 19 order of the State Public Health Officer, Dr. Sonia Angell, exempts critical infrastructure sectors – which include privately operated public health programs – from the general stay-at-home directive.

The State Public Health Officer’s designated list of “Essential Critical Infrastructure Workers” (attached, and available on the California government COVID-19 website) includes: “Public health/community health workers…behavioral health workers (including mental and substance use disorder) responsible for coordination, outreach, engagement, and treatment to individuals in need of mental health and/or substance use disorder services…[and] workers who provide support to vulnerable populations to ensure their health and well-being.”

Please be in touch any time if our team hasn’t reached out to your SSP yet. From our conversations with California programs, we are compiling a list of practices SSPs are putting in place to safeguard staff, volunteers, and participants. Although a few have closed due to staff shortages, most SSPs have modified their services to maintain social distance, limit the handling of supplies, and temporarily discontinue services such as HIV and viral hepatitis testing that require interpersonal contact. Programs have also increased the amount of supplies they give to each person, lifted any 1:1 exchange restrictions, and increased their naloxone distribution efforts to ensure participants have needed supplies. Many SSPs have also added a home delivery option. The CASEP mailing list is a good place to find other ideas and resources from harm reductionists, and we’ll be sending out information through the CASEP list regularly.

Thank you for the work you’re doing in these complex and chaotic times – we appreciate all that you do to provide services to people who use drugs under these conditions.”

As a follow up to Dr. Frankovich’s email and the one from CDPH which contrasted from the information we had previously been given, I phoned Sheriff Honsal who confirmed his opinion. However, he agreed to follow-up with Dr. Frankovich on Monday.

On Monday afternoon, Sheriff Honsal and I spoke and he confirmed he had met and discussed the issue of syringe exchange/harm reduction programs with Dr. Frankovich.  He informed me Dr. Frankovich had confirmed her position aligned with that of the California Department of Public Health’s (CDHP) and that these programs were considered essential services (it should be noted SEPS are not referenced in the current Shelter in Place order which contributed to the difference of opinions and confusion).

Based on this updated information, and after consulting with counsel and senor leadership, the City will follow the County Health Officer’s and CDPH’s position that they consider HACHR an essential service under both the Governor’s Executive Order and the County Health Officer’s SIP order.

I spoke with Jessica Smith this afternoon and informed her of this change. Jessica outlined many of the safety practices they have implemented (including educational materials distributed to their clients and signs posted concerning social distancing requirements etc.).  I also asked Jessica to work with her staff to insure that their clients do not remain and congregate in the area after receiving their services.  (HACHR must continue to follow the spirit of the order which is to promote social isolation etc.).

I understand this is going to upset some people but the City really no choice based on the new information and direction we received from the authorities behind the orders upon which enforcement relies.

This is a long and detailed post but I offer it to you here in the spirit of full transparency of process and leadership.

EPD Chief Steve Watson