Category Archives: Health

State Auditor slams lack of transparency of DOH admin

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The auditor just dropped their report on the contract tracing efforts of the State Department of Health.

I haven’t had a chance to read through it yet, but the auditor’s comments that preface the report are devastating.

Auditor’s Comment

Transparency and Accountability – Now More Than Ever

We recognize that the Department of Health had myriad responsibilities when it did not respond to our request for information on its contact tracing efforts; however, it is precisely during times of crisis when the public needs and deserves clear, concise, and transparent communication from its government.

As Hawai‘i has watched its total number of COVID-19 cases more than double since the end of July, a growing sense of urgency has intensified scrutiny of the Department of Health’s (DOH) contact tracing program. Leadership of the department’s contact tracing efforts has been heavily criticized by the public and government officials, including the Lieutenant Governor and a member of the Hawai‘i Congressional delegation.

We intended to report on DOH’s contact tracing process, primarily to filter through the varying, confusing, and often conflicting information and to provide a clearer, objective, and up-to-date understanding of the department’s efforts. However, instead of cooperation and assistance, we encountered barriers, delays, and ultimately were denied access to those responsible for leading the department’s contact tracing: the Disease Outbreak Control Division (DOCD) Chief and the Disease Investigation Branch (DIB) Chief, who recently took over that task. While the Health Director spoke with us, failing to respond to numerous requests until a few hours before the interview, he repeatedly directed us to speak with the DOCD Chief for answers to specific questions about the department’s contact tracing process. At the end of our discussion, the Director said he would ask the DOCD Chief to talk to us and would provide us with documents we had requested in multiple letters to him, including the department’s policies and procedures relating to contact tracing. However, the DOCD Chief did not contact us, and the Health Director did not provide the requested documents.

The Deputy Director for Health Resources provided us with a time when the DIB Chief was available to speak with us. In her email, the Deputy Director instructed us to include the Attorney General on future communication and that the Attorney General would participate in our meeting with the DIB Chief. However, on the day of our scheduled meeting, the DIB Chief informed us that the Deputy Director, her boss, was mistaken about her availability and said she was too busy to speak with us. The Governor’s Chief of Staff subsequently contacted us to repeat that the DIB Chief was unavailable.

While we understand DOH staff are busy, especially those working to improve the department’s contact tracing approach, we expected the department’s full and timely cooperation. We did not expect the Attorney General or the Governor’s office to involve themselves in our attempt to report about DOH’s approach to contact tracing. We are not a political office. We are an office established by the State Constitution to provide objective, unbiased assessments of government operations. We can only do our job with unimpeded and complete access to an agency’s program.

Now, more than ever, DOH must be transparent and accountable. The lack of cooperation we received is, frankly, inexcusable. Public confidence in the department, specifically in its ability to perform timely contact tracing of the growing number of positive cases, has been eroded. The community now has many questions about the process that DOH has, for months, represented as under control. For DOH to effectively protect public health and reduce the spread of the novel coronavirus so we can begin re-starting our economy, it is critical the department rebuild public trust. This health emergency demands DOH ensure that its response is transparent by providing the public with complete, timely, and accurate information.

We hope the department will fully and promptly cooperate with future requests.

Leslie H. Kondo State Auditor

Civil Beat: Covid-19 order “flips health experts’ advice on its head”

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Remember the Talivans of 2002? You should. Unhinged Covid-19 enforcement brings back memories of the thankfully short-lived effort to reduce speeding through the use of automated cameras in mobile vans.

I’ll get back to the Talivans in a moment. First, thanks to Civil Beat and reporter Christina Jedra for soliciting the opinions of public health experts concerning the latest iteration of Honolulu’s Covid-19 rules (“Beaches, Parks, Trails Closed? Honolulu Mayor’s COVID-19 Rules Defy Science, Experts Say“).

Jedra spoke with several prominent epidemiologists who agreed that denying public access to outdoor spaces is not consistent with what is known about the spread of this virus, and has the effect of driving people indoors, where they are more likely to be exposed to the disease.

There’s also an equity issue, according to Julia Marcus of Harvard Medical School.

While free outdoor spaces are closed, open-air operations that require an entrance fee are open, including the city zoo, the Wet ‘n’ Wild Hawaii water park, the Aloha Stadium swap meet, golf courses, Kualoa Ranch and Waimea Valley.

“You’re depriving more economically disadvantaged people of outdoor space where they can recreate, socialize safely, exercise, enjoy their lives,” she said.

Mayor Caldwell has said officials are trying to establish a “bright line” to make the rules against large gatherings easier to enforce.

But we’ve tried and rejected that approach to law enforcement before. Remember back in 2002 when Hawaii implemented the automated system that was supposed to catch and cite speeding drivers, and therefore make the roads safer for everyone? These camera-equipped vehicles became known as “Talivans,” and became the focus of widespread public anger.

The problem was summarized in a Honolulu Star-Bulletin editorial in April 2002.

The program failed because its focus extended beyond dangerously aggressive drivers, outraging motorists who have become accustomed to traveling slightly — and, under normal conditions, safely — faster than the speed limit.

While police continued to recognize normal driving habits, operators of what motorists derisively called “Talivans” applied another standard for criminality — correctly dismissed by judges as “deminimis,” Latin legalese for what one TV reporter accurately translated into Hawaiian as manini. The Department of Transportation foolishly brought charges against driving behavior that is both customary and tolerable.

And now Mayor Caldwell’s orders have police issuing citations to people just out for a walk in the open air, even if they are far from any other people and, therefore, posing no possible danger to others. And giving thousands of such citations undeniably draws attention away from the real gatherings that do pose health risks, while also causing the same kind of public backlash that greeted the Talivans.

That doesn’t have to mean the rules change, it just requires the normal, everyday judgement and discretion that causes police officers to ignore those driving 36 mph in a 35 mph zone, so that they are ready to grab those careening past at high and dangerous speeds.

Taken together with UH Professor Karl Kim’s recent critique, today’s Civil Beat story should prompt a reappraisal of official policies sooner rather than later.

“This is a crisis of data….”

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That’s how Karl Kim, a UH professor of Urban and Regional Planning, and an expert in disaster preparedness, summarized the failure of Hawaii’s Covid-19 responses in a Star-Advertiser op-ed this week (“Column: Poor data management worsens Hawaii’s COVID-19 crisis“).

Kim, who among other things is director of the National Disaster Preparedness Training Center, said a basic need in any disaster is data.

“We need reliable, accurate, timely, comprehensive, actionable information on who has the disease, how they caught it, and how it is spreading in our community,” Kim wrote.

And that’s a key area in which Hawaii has failed.

Kim put it rather bluntly: “The management, sharing and communications of data on the disease have been deplorable.”

It’s no surprise that the public has been confused, since there has been little or no attention paid to explaining the rationale behind the various restrictions established by the governor and mayors.

The connection between policy and data has been noticeably absent, Kim argues.

Where are the analyses to support decisions to shutter businesses or force schools to go online? Where is the evidence that closing beaches and parks will reduce the disease? Why aren’t data on the bad behavior of super spreaders or risky events shared with us? Why do we have to piece this together from limited media and social media posts or aggregate statistics lumped together at the zip code level?

In watching daily press conferences, the same tired information is repeated with little connection to protective action. General slogans such as wear a mask or wash your hands are offered rather than targeted identification and actions to curtail the disease.

Why haven’t high-risk locations and activities been systematically identified? Why were gatherings of 10 or more targeted, only to be changed to five or more? Why haven’t the interactions and behaviors extracted from contact tracing been shared, analyzed and presented to motivate positive collective, corrective actions?

Stigmatization of the disease is a real problem. Yet, we need to bring it out in the open so that families and communities can work to contain it and protect those likely to be harmed. We need open, transparent data to take the necessary precautions as to avoiding physical contact and exposure and making informed choices as to work, school, church and social activities.

Where is the state’s Board of Health when we really, really need it?

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Last year the legislature, in its infinite wisdom, decided to do away with the Board of Health, which had been around for more than a century.

HB898 SD1 (2019) abolished the Board of Health, which had been established to advise the health director on any matters within the department’s jurisdiction.

The bill was introduced by Rep. Della Au Belatti, House Majority Leader, and Health Committee Chair John Mizuno. An identical measure was introduced in the Senate by Stanley Chang (“by request”).

The only testimony on the measure over the course of public hearings before three different committees was a one-page sheet of written testimony submitted on behalf of the Department of Health. The testimony does not indicate whether it was delivered in person, and two of the three committees stamped it “Late,” meaning it was received after the hearing deadline.

No testimony was received from any health providers, health care or community organizations, public health experts, or concerned individuals.

Here’s how the legislators justified the move.

The legislature finds that the board of health was originally intended to serve as an advisory panel to the director of health. However, given the current breadth and complexity of public health issues and prominent guidance from federal programs, the legislature, and the private sector, the board of health has been rendered obsolete and no longer adds value to department of health operations.

The legislature further finds that the board of health has been historically difficult to fill and currently has no members. Abolishing the board of health would more accurately reflect the reality of decision making at the department of health and would reduce the administrative burden on the department.

One thing apparently forgotten along the way. A public board at the top of a department may become the primary access point for concerned members of the community, and a critical avenue for holding a complex agency accountable to the public.

That was the point made by two people who testified on the Senate version of the bill.

“Eliminating the Board of Health will lead to less transparency of the Department of Health and less accountability,” one person noted in opposing the bill.

A second person wrote:

“To have the department of health decisions made by one or two people is leaving grande decision making in a vacume of thought. The department of health needs a sounding board and a committee to keep as a voice of reason and understanding of complex issues.”

In hindsight, their concerns appear spot-on. When the current pandemic brought us face-to-face with a real public health crisis, it’s been the lack of transparency and accountability that have finally become the real story behind the department’s chronic ineptness.

Even before passage of HB898 SD1 eliminated the Board of Health, it had been gradually starved and allowed to wither away. Vacancies on the board were not filled, until eventually it became a ghost board on the top of the Health Department’s organizational chart.

This was the list of members that appeared in recent editions of the standard publication produced by the Legislative Reference Bureau, “Guide to Government in Hawaii.”

Board of health members none