Figure 1

Figure 1 shows the following six public health regions in San Diego County:

1. The North Coastal Region is surrounded by the Pacific Ocean to the west, Orange County to the northwest, Riverside County to the north, the North Inland Region to the east, and the North Central Region to the south.
2. The North Inland Region is surrounded by the North Coastal Region to the west, Riverside County to the north, Imperial County to the east, the East Region to the south, and the North Central Region to the southwest.
3. The North Central Region is surrounded by the Pacific Ocean to the west, the North Coastal Region to the northwest, the North Inland Region to the northeast, the East Region to the east, and the South and Central regions to the south.
4. The East Region is surrounded by the North Central, Central, and South regions to the west, the North Inland Region to the north, Imperial County to the east, and Baja California, Mexico to the south.
5. The Central Region is surrounded by the North Central Region to the northwest, the East Region to the east, and the South Region to the south.
6. The South Region is surrounded by the Pacific Ocean to the west, the Central Region to the north, the East Region to the east, and Baja California, Mexico to the south.

Figure 2

Figure 2 shows the following divisions, regions, and branches of the Health Agency, from top to bottom and left to right:

1. Health Agency Director is at the top.
2. Within the Medical Care Services Division, the Chief Medical Officer oversees the Chief Nursing Officer.1 of 2 PHN positions were filled in the CNO office.
   
   Regions
3. The North Coastal and North Inland Regional Director oversees the North Coastal region, where 11 of 16 PHN vacancies were filled, and the North Inland region, where all 16 PHN positions were filled. Together, 27 of 32 PHN positions were filled.
4. The North Central and East Regional Director oversees the North Central region, where 14 of 16 PHN positions were filled, and the East region, where 15 of 22 PHN positions were filled. Together, 29 of 38 PHN positions were filled.
5. The Central and South Regional Director. Oversees the Central region, where 15 of 20 PHN positions were filled, and the South Region, where 13 of 15 PHN positions were filled. Together, 28 of 35 PHN positions were filled. Altogether in the six regions, 84 of 105 PHN positions were filled.
   
   Programmatic departments and branches
6. The Public Health Services Director oversees the Maternal, Child, and Family Health Services Branch, where 10 of 11 PHN positions were filled; the California Children’s Services Branch, where 25 of 25 PHN positions were filled; the Tuberculosis and Refugee Health Branch, where 17 of 17 PHN positions were filled; the Epidemiology and Immunization Services Branch, where 10 of 10 PHN positions were filled; the Public Health Preparedness and Response Branch, where 3 of 6 PHN positions were filled; and the HIV, STD, and Hepatitis Branch, where 2 of 2 PHN positions were filled. Altogether in Public Health Services, 67 of 71 PHN positions were filled.
7. Aging and Independence Services Director. Oversees the Aging and Independence Services Administration branch, where 0 of 1 PHN positions were filled; the Adult Protective Services Branch, where 5 of 6 PHN positions were filled; the In-Home Supportive Services Branch, where 3 of 4 PHN positions were filled; and the Multi-Purpose Senior Services Branch, where 3 of 3 PHN positions were filled. Altogether in Aging and Independence Services 11 of 14 PHN positions were filled.

Figure 3

Figure 3 illustrates that:

1. In November 2016, there were 2 new hepatitis A cases in San Diego County. These were the first cases of the 2017 outbreak.
2. In December 2016, there were 4 new hepatitis A cases in San Diego County.
3. In January 2017, there was 1 new hepatitis A case in San Diego County.
4. In February 2017, there were 7 new hepatitis A cases in San Diego County.
5. In March 2017, there were 28 new hepatitis A cases in San Diego County. The Health Agency identified the unusual number of hepatitis A cases as an outbreak and began to vaccinate at-risk populations.
6. In April 2017, there were 51 new hepatitis A cases in San Diego County.
7. In May 2017, there were 87 new hepatitis A cases in San Diego County. The Health Agency piloted foot teams to vaccinate additional at-risk populations.
8. In June 2017, there were 73 new hepatitis A cases in San Diego County.
9. In July 2017, there were 86 new hepatitis A cases in San Diego County. The County issued requests for quotation to hire temporary nurses to assist with vaccinations.
10. In August 2017, there were 95 new hepatitis A cases in San Diego County.
11. In September 2017, there were 80 new hepatitis A cases in San Diego County. On September 1, the county declared a local public health emergency.
12. In October 2017, there were 34 new hepatitis A cases in San Diego County. On October 13, the Governor declared a statewide public health emergency.
13. In November 2017, there were 21 new hepatitis A cases in San Diego County.
14. In December 2017, there were 8 new hepatitis A cases in San Diego County.
15. In January 2018, there were 5 new hepatitis A cases in San Diego County. On January 23, the county lifted its public health emergency.

Figure 4

Figure 4 is a bar chart showing that the Health Agency’s PHNs' average caseloads exceeded state benchmarks for both the Foster Care and Children’s Services programs for all three years we reviewed. For Foster Care PHNs, the state caseload benchmark is 200, while the Health Agency's average caseloads on July 1 of each year were 276 in 2015, 258 in 2016, and 255 in 2017. For Children’s Services PHNs, the state caseload benchmark is 400, while the Health Agency's average caseloads on July 1 of each year were 859 in 2015, 764 in 2016, and 735 in 2017.

Figure 5

Figure 5 is a bar chart showing the Health Agency's average caseloads for Foster Care PHNs on July 1, 2017 by region and number of PHNs. The state caseload benchmark is 200 cases per PHN.

1. The South region had 2 Foster Care PHNs with an average caseload of 197.
2. The North Coastal region had 1.5 Foster Care PHNs with an average caseload of 229.
3. The North Central region had 3 Foster Care PHNs with an average caseload of 245.
4. The North Inland region had 1.5 Foster Care PHNs with an average caseload of 248.
5. The Central region had 4 Foster Care PHNs with an average caseload of 256.
6. The East region had 1 Foster Care PHN with an average caseload of 295.

Figure 6

Figure 6 is a bar chart showing the average number of days authorized PHN positions remained vacant by region and fiscal year.

For fiscal year 2014-15, the average number of days that authorized PHN positions remained vacant was 77 days in the Central region, 76 days in the East region, 138 days in the North Central region, 84 days in the North Coastal region, 71 days in the North Inland region, and 103 days in the South region.

For fiscal year 2015-16, the average number of days that authorized PHN positions remained vacant was 161 days in the Central region, 128 days in the East region, 178 days in the North Central region, 140 days in the North Coastal region, 22 days in the North Inland region, and 195 days in the South region.

For fiscal year 2016-17, the average number of days that authorized PHN positions remained vacant was 229 days in the Central region, 109 days in the East region, 83 days in the North Central region, 148 days in the North Coastal region, 46 days in the North Inland region, and 61 days in the South region.