By Cody Dulaney and Jill Castellano | inewsource
San Diego County awarded a $30 million contract for operating COVID-19 hotels to an unqualified company with poorly trained staff, who forced residents to suffer through long delays for much-needed medication and who allowed for gaps in services that may have led to overdoses and suicide.
Those are among the findings outlined in a 154-page report released Tuesday from San Diego State University.
The school’s Institute for Public Health evaluated the county’s COVID-19 hotel sheltering program, which was meant to isolate people with the virus who had nowhere else to go.
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The County Board of Supervisors ordered the review of the program in early March, eight days after an inewsource investigation uncovered poor care and oversight issues at the Crowne Plaza in Mission Valley — the main hotel used in the program.
Employees and hotel guests told SDSU that the county’s contractor, Equus Workforce Solutions, is mismanaging the program, and staff aren’t trained to work with many of those who are isolating — people who are homeless and might be struggling with mental illness or substance use disorders.
The report includes more than 40 confidential interviews with county employees, hotel program staff and guests. Most of the guests who responded to a survey had positive comments, but some describe harrowing experiences during SDSU interviews.
“Employees treat us like animals, without any compassion,” a pregnant woman with two kids wrote in a complaint after leaving the program, according to the report.
“I don’t want any family to go through what I went through, it’s all inhumane,” she added.
More key findings from the report include:
- Equus didn’t have the credentials to operate this program, employed staff with no experience in social services and didn’t provide necessary training.
- The company responsible for mental health services, Telecare Corp., isn’t equipped to meet guests’ acute, complex or severe mental health needs.
- Nurses and mental health specialists are not available 24 hours a day, even though guests are under a public health order to stay in their rooms while many suffer from COVID-19 symptoms.
- Some guests went hungry because they were repeatedly given meals they were allergic to or couldn’t eat, and they were told their needs couldn’t be met.
The county’s contract with Equus is set to expire at the end of this year, but SDSU’s report comes as COVID-19 cases surge across the region and officials urge the public to take more precautions.
The county agreed in April to pay SDSU $140,000 to review the strengths and weaknesses of the COVID-19 hotels, as well as offer recommendations.
County spokesperson Michael Workman defended the sheltering program, saying it “stood up in response to an unprecedented pandemic.”
“This Public Health program was designed to mitigate community spread of COVID-19 among residents who needed isolation shelter,” Workman said. “Either because they had tested positive or were in a high-risk environment. It was not intended to be a shelter or a hospital.”
Nathan Fletcher, chair of the county board of supervisors, could not be reached for comment by publication time.
The final report commends county and contract employees for their dedication to the program, for moving quickly to get the program started and for adapting under constantly changing circumstances. It lists 10 strengths, including that the vast majority of people completed their isolation and quarantine period. The program likely prevented the spread of COVID-19 across the county, SDSU said.
But the review also confirms much of inewsource’s previous reporting about poor care and gaps in services for people in isolation. The SDSU authors found that no county employee is responsible for overseeing all aspects of the program, and they couldn’t determine if anyone has ultimate decision-making authority.
“Staff at all levels report confusion about who is responsible for various aspects of the program,” the report said. “Clear answers about program operations and program data were difficult for the evaluation team to obtain.”
SDSU offered nine recommendations to improve the program, one of which included 14 changes that could be made right away to address concerns raised by staff and guests. They include staffing nurses and mental health specialists around the clock, ensuring medications are delivered on time and assessing guests for mental health needs when they arrive at the hotel.
In March 2020, San Diego County started using the Crowne Plaza and other hotels to house people who had nowhere else to isolate from the coronavirus. That included first responders who needed to be away from family as well as people without housing.
The stated goal of the hotel sheltering program was twofold: to isolate people who test positive or come in contact with the virus and to protect people who are at-risk for developing severe illness. In a six-month period, the program served more than 5,500 people.
The at-risk hotels are available to people who are medically compromised or experiencing homelessness, and while they were not included in the report, SDSU recommended they be evaluated as well.
SDSU found that the program was up and running within a week, and to keep it operating, county employees continue to make many personal and professional sacrifices. But the program has been plagued with problems from the start.
In an email inewsource obtained last spring, one county employee told colleagues she was “pushing and begging and pleading for additional staff” to help provide adequate support.
Within a week, county officials changed an existing $13 million contract it had with Telecare, which had been providing mental health services to San Diegans in the legal system, to also help people in isolation.
But multiple people told SDSU that Telecare wasn’t equipped to work with people isolating in the hotels.
“Telecare is behavioral health lite,” one county employee said. “It is not for acute care. It can’t be used for crisis stabilization.”
Not long after Telecare became involved, 28-year-old Jose Angel Gomez-Camacho died by suicide at the Crowne Plaza. The death wasn’t discovered for five days.
Telecare would not comment for this story.
Gomez-Camacho’s autopsy report said he had checked out of the hotel but was somehow able to gain reentry before his death. The SDSU review explains that keeping track of guests has been a recurring problem for the program: Staff have trouble tracking who’s supposed to arrive at the hotel, where they’re coming from and who has already checked in.
Two months after inewsource uncovered the suicide death, county officials hired Equus to take over the hotel sheltering program.
The report found Equus was able to provide lodging services within one month. But that was the staffing agency’s main focus. Equus wasn’t prepared to handle other parts of the job, such as working with homeless and mentally ill people.
Hiring Equus was like fitting “a square peg in a round hole,” one employee said.
An Equus representative did not respond to a request for comment.
Multiple people told SDSU that any contractor running the program needed to have extensive experience offering around-the-clock care, with “a team of medical folks, mental health experts and residential experts in place,” the report said.
But county staff members disagreed about the type of program that was needed. Some said the goal was simply to house people and reduce community spread, while others recognized it would become a shelter serving primarily vulnerable people with complex needs.
“Equus had good intentions, but they were not prepared to do behavioral health or social services work,” one person told SDSU.
A lack of experience and training among Equus staff played a big role, the report found.
Equus’ medical director had no experience in infectious disease or public health, the report said, and was hired because of his background administering over-the-counter medications.
Each Equus employee interviewed by SDSU said they had only received on-the-job training and a large binder of operating procedures they were expected to review on their own. No one received formal training on behavioral health, trauma-informed care or de-escalation techniques. One staff member said the person in Human Resources who hired him couldn’t even describe the job duties. Frontline employees weren’t given the tools to help those in need.
“I have no background or training in social support. My manager told me my experience with multitasking would be enough,” one Equus employee said.
Gaps in Care
According to their contracts with the county, Equus and Telecare are supposed to provide case management and wraparound services to meet people’s unique needs. That covers everything from cash assistance and housing navigation, to mental health and substance use disorders.
SDSU found some case management has happened. The majority of people experiencing homelessness before entering the program returned to another shelter setting, while 22 people moved into permanent supportive housing, which was considered “an impressive accomplishment,” the report said.
But no single person is assigned to a guest to oversee all aspects of their care. Instead, the services are provided piecemeal and responsibilities are divided among multiple staff members.
“These gaps in care coordination may have led to both overdoses and suicide,” one county staff member said.
Suicide prevention help
If you are having thoughts of suicide, you can call the National Suicide Prevention Lifeline at (800) 273-8255 or the San Diego Access and Crisis Line at (888) 724-7240.Other resources are available here.
Employees also had difficulty managing guests with substance use disorders. County staff acknowledged that drug activity has been a concern, and one guest described “rampant drug use” and drugs being smuggled in through food delivery bags that went unsearched.
“This is a terrible place if you are in recovery — there are people actively using all around you,” a county staff member said.
SDSU recommended investigating whether it is possible to limit deliveries and start searching belongings.
Calls to San Diego police about problems at these hotels have continued flooding in ever since the program started, records show. About 1 in 10 of the calls were related to mental health, including suicide attempts and threats, according to a recent analysis.
But even when violence, drug use and suicide attempts occur in the hotels, San Diego police are reluctant to intervene, the report said.
Once a person has keys to a hotel room, according to county staff, it is then considered their property and police can only enter under extreme circumstances.
One employee described a traumatic experience with a guest experiencing suicidal ideation and psychosis, where law enforcement refused to do anything unless staff observed an attempt being made.
“They are following the rule book,” a county employee said of San Diego police, “but the rule book doesn’t work in a crisis like this.”
‘They’re Trying to Fix it’
The SDSU review corroborated stories from employees and guests who have exposed neglect and wrongdoing in the sheltering program in inewsource reporting over the past year and a half.
A former Equus employee, Turquoise Teagle, in interviews with inewsource criticized the county for not closely monitoring the program on site, instead relying on daily video calls with staff. She also described guests waiting days for medication and not receiving adequate food — all of which have been supported by the new report.
“I had diarrhea and was vomiting, but I had to wait for medication,” one guest told SDSU. Another said he started feeling sick after the program’s nurse left work and couldn’t get help until the next day.
“I thought it would be more intense medical care because we had COVID,” someone else in the program said. “I was worried I was going to die. If I had a choice I would have stayed home where I felt safer.”
According to the report, many guests complained they were hungry, food portion sizes were too small, staff wouldn’t provide snacks and they limited the amount of water each person could have. One person said they were repeatedly given meat even though they don’t have molars. Another said they were provided ham sandwiches even though they don’t eat pork.
SDSU’s review brought up another frequently cited issue among those in the sheltering program — AllState Security guards.
While some guests said they had no issues with security, others recounted waking up to the sounds of guards screaming in the middle of the night. One heard a guard yelling at a guest that they “need to shut up and get in (their) room,” and another witnessed a violent altercation between two guards.
Equus acknowledged that ensuring adequate, respectful security has been problematic, the report says.
A representative with AllState Security Service did not respond to an interview request.
William Morris, who went to the Crowne Plaza last November after his wife tested positive for COVID-19, said he has faced harassment and physical violence from security guards. A dispute about his service dog escalated to a guard attempting to hit him with a chair, he told inewsource in February. Records show he also reported the incident to Equus.
But ever since inewsource reported these issues earlier this year, he said his experience in the program has greatly improved.
“Thank God somebody, somewhere started talking, having meetings and it’s a lot better, it really is,” Morris said in an interview last week.
Morris was living in a gold Mitsubishi Outlander with his wife and 11-year-old Havanese service dog named Mini-Me. But they’ve been staying in one of the at-risk hotels managed by Equus in Old Town since January.
“It got out of hand and now they’re trying to fix it,” Morris said, later adding that “these people are doing a wonderful job.
“You have a lot of people who care,” he added, “and you can see it the way they speak to people, you can see it the way they look at people, you can see it the way they walk away from people.”
Moving forward, SDSU recommended that the county increase oversight of future programs, contract with qualified service providers with extensive experience and focus on medical and behavioral health services.
County officials have not announced when the report will be reviewed at a public board meeting or what it will mean for the future of services provided at the hotels.
Workman, the county spokesperson, said SDSU’s review shows the county’s commitment to continually improving its services. He added that the county has worked with its contractors to adapt to quickly changing situations over the course of the pandemic.
“We look forward to working with our partners, contracted and otherwise to strengthen our response to health and other emergencies now and in the future,” Workman said, “and this report will be taken into account in those next steps.”