Issue | Background | Findings | Conclusions | Recommendations | Responses | Attachments

Summary of
Pandemic Influenza Preparedness at the San
Mateo County’s Women’s Correctional Facility
Unprepared for Flu Outbreak
Issue
Have Correctional Health Services and the Sheriff’s Department developed a coordinated
plan providing for ongoing services at the Women’s Correctional Facility should an avian
flu pandemic arise in the County?

Summary
The potential for a widespread outbreak of avian influenza (strain H5N1) among the
general population in the near future is a subject of global concern. News reports indicate
that at least 140 people worldwide have been killed since this virus began ravaging Asian
poultry stocks in late 2003. An estimated 1.9 million Americans could die and almost 10
million could be hospitalized during a pandemic that may take a year or more to evolve.
Although the timing, nature and severity of the next pandemic cannot be predicted with
certainty, preparedness planning is imperative to lessen the impact. Measures to prevent
and control the spread of this disease may include quarantine and isolation where
feasible, limiting public gatherings and closing schools and businesses. “Social
distancing” strategies (i.e., the act of separating oneself from others as much as possible)
will be encouraged as a containment strategy. Many of these measures are not feasible
with a jailed population.
Lack of capacity with concomitant overcrowding is one of the Women’s Correctional
Facility’s (Women’s Facility) most serious deficiencies. The Women’s Facility
(described in the San Mateo Jails portion of prior San Mateo County Civil Grand Jury
Reports) has open-bay style dormitory living conditions and centralized toilet and shower
facilities that prevent isolating inmates and limiting physical interactions between them
and the staff or visitors. The problems are made worse by the chronic overcrowding, the
staff shortages within the Sheriff’s Department and the limited number of Correctional

1

Health nurses. Although staffing seems to operate satisfactorily during normal times, the
Women’s Facility is not designed or staffed to deal with a pandemic flu outbreak.
The San Mateo County Grand Jury recommends that the San Mateo Board of
Supervisors: (1) give priority to adequate staffing of the Women’s Facility; (2) continue
to develop a plan with deadlines for dealing with a pandemic flu disaster in this facility;
and (3) direct that the needs assessment report for the new Women’s Facility address
space planning and logistics for any contagious disease outbreak.

2

Pandemic Influenza Preparedness at the San
Mateo County’s Women’s Correctional Facility
Unprepared for Flu Outbreak
Issue
Have Correctional Health Services and the Sheriff’s Department developed a coordinated
plan providing for ongoing services at the Women’s Correctional Facility should an avian
flu pandemic arise in the County?

Background
The potential for a widespread outbreak of avian influenza (strain H5N1) among the
general population in the near future is a subject of global concern. To date, at least 140
people worldwide have died of this virus since it began ravaging Asian poultry stocks in
late 2003.1 An influenza pandemic could cause more death and illness than any other
public health threat. If a pandemic influenza virus with similar virulence to the 1918
“Spanish Flu” strain (20 million deaths worldwide) emerged today, in the absence of
intervention, it is estimated that 1.9 million Americans could die and almost 10 million
could be hospitalized as the pandemic evolves over a period of a year or more. Although
the timing, nature and severity of the next pandemic cannot be predicted with any
certainty, preparedness planning is imperative to lessen the impact. 2
The Centers for Disease Control and Prevention (CDC) have developed estimates of the
impact that pandemic influenza can have on a population. The following table uses those
estimates to quantify the impacts that pandemic influenza may have on the populations of
California and San Mateo County.3 Note that the hospitalization rate and mortality rate
1

The Wall Street Journal, August 21, 2006
U.S. Department of Health and Human Services: Pandemic Influenza Plan, Executive Summary,
November 2005, pp 4-11.
3
The San Mateo County Health Department’s “Pandemic Flu Preparedness and Response Plan: Phase 1”
that can be found at: http://www.smhealth.org.smc/department/printable/0,,1954_109395.
2

3

in the table below refer to the percentages of those infected and of those hospitalized,
respectively.
CDC Estimates of Percent of
Population Affected by the Next
Pandemic (Avian Flu Rates)
Population
Influenza Infection Rate
Patients Requiring Hospitalization
Mortality Rate

Rate

California

San Mateo
County

35%
3.8%
50%

33,000,000
11,550,000
440,000
220,000

750,000
262,500
10,000
5,000

Influenza is a highly contagious viral disease that is usually transmitted by coughing,
sneezing, or by touching people or objects. Measures to prevent and control the spread of
this disease may include quarantine and isolation where feasible, limiting public
gatherings and the closing of schools and businesses. “Social distancing” strategies (i.e.,
the act of separating oneself from others as much as possible) will be encouraged as a
containment strategy.
The usual measures for containing the spread of influenza would be difficult in a jail
under the best of circumstances, and the San Mateo County Women’s Correctional
Facility (Women’s Facility) is certainly not the best of circumstances. It has a number of
deficiencies; the most serious is the lack of capacity that produces serious overcrowding.
The San Mateo Jails portion of the 2004-2005 and 2005-2006 San Mateo County Civil
Grand Jury Reports4 describe the open-bay style dormitory living conditions wherein
upwards of 40 inmates may be housed in one room at the Women’s Facility.

Investigation
Members of the Grand Jury toured the Women’s Facility, interviewed staff members of
the Sheriff’s Department and the County Health Department, including staff of
Correctional Health Services, and reviewed selected documents, some of which are cited
in the footnotes to this report.

Findings
The Women’s Facility is overcrowded. The facility is currently configured for 158 beds
in a building with capacity for 84 beds, according to the State Department of Corrections
and Rehabilitation. Most toilet and shower facilities are centralized and for group use.
There are no isolation facilities at the Women’s Facility; if needed, female inmates are
transported to the Maguire Facility, which has only a limited number of isolation rooms.

4

The 2004-2005 Grand Jury report on San Mateo County Jails: available at http://www.sanmateocourt.org/
grandjury/2004/reports/Jailsvisit_31_final.pdf and the 2005-2006 Grand Jury report available at:
http://www.sanmateocourt.org/grandjury/2005/reports/JailsF.pdf.

4

A consulting firm, DMJM H&N5, has been retained to conduct a needs assessment for a
new Women’s Facility.
Historically, the initial health screening, TB testing and staff vigilance has limited the
spread of communicable diseases at the Women’s Facility. Correctional Health Services
has begun to stockpile appropriate protective masks and anti-viral medication to be used
by staff and inmates should they have to combat an avian flu outbreak.
Annually, 16,000 to 18,000 inmates are booked through the County’s correctional
system. The medical needs of this population are served by 60 employees of
Correctional Health, 30 of whom are nurses rotating through assignments. A nurse from
Correctional Health Services is on-site about 12 hours per day at the Women’s Facility
(as compared to the Maguire Correctional Facility with 24-hour nursing care). Afterhours emergency medical care for a female inmate is provided at a hospital or the
Maguire Facility.
Staffing shortages exist in both the Sheriff’s Department and Correctional Health
Services. Of the approximately 200 employees in the Sheriff’s Department, 25% may be
unavailable at any given time due to vacancies, illness, vacations, training, etc.
Permanent staffing by the Sheriff’s Department at the Women’s Facility is below the
authorized level of four officers per shift. Vacancies are filled temporarily by overtime
work. Nurses in Correctional Health Services must pass a background check and work
well in a detention environment. Attraction and retention of qualified nursing personnel
is difficult. Although “hard numbers” are not available, correctional officers and medical
staff will not be immune if the flu spreads through the County. Staff shortages will be
exacerbated.

Conclusions
Many people come in contact with the inmates in the Women’s Facility (new inmates,
Sheriff and probation staff, visitors, attorneys, agency volunteers and counselors), so this
“confined” population is unlikely to escape exposure to a pandemic flu outbreak. The
sheer number of inmates cycling though this facility almost guarantees exposure.
Furthermore, chronic overcrowding, open-bay style dormitories and the centralized toilet
and shower facilities of the Women’s Facility prevent isolation, or even the limitation of
physical contact among inmates, staff and visitors. This facility is woefully inadequate to
deal with a pandemic flu outbreak. All these problems are made worse by the staff
shortage in the Sheriff’s Department and the limited number of Correctional Health
nurses. While the staffing seems to operate satisfactorily during normal times, the
Women’s Facility could not deal with a pandemic flu outbreak.

5

DMJM H&N - San Francisco, 405 Howard Street (Suite 400), San Francisco, CA 94105.

5

Recommendations
The Grand Jury recommends that the Sheriff’s Department:
1.1 Give priority to staffing the Women’s Correctional Facility at the authorized
level so that it can more effectively deal with critical situations.
1.2 Continue its planning sessions with the Health Department, employees of other
state and county correctional facilities and the courts to establish a detailed plan
for dealing with a pandemic flu outbreak.
The Grand Jury recommends that the Board of Supervisors:
2.1 Ensure that the needs assessment report for the new Women’s Facility to be
prepared by the consulting firm, DMJM H&N, adequately addresses the logistics
and space planning needed to combat a contagious disease outbreak.
2.2 Support and participate in the planning sessions among the Sheriff’s Department,
Health Department and the Court; establish timelines with realistic deadlines for
formalizing a detailed plan for dealing with a pandemic flu outbreak.
2.3 Revisit the 2006-2007 preliminary budget allocation for the Sheriff’s Department
and Correctional Health Services to consider (a) whether it can support the hiring
of additional nurses to reduce the need to transport inmates to the Maguire
Facility/hospital or (b) whether the salaries of additional personnel can be offset
by a savings in transportation costs and overtime expenses.

6

COUNTY OF SAN MATEO
Inter-Departmental Correspondence
County Manager’s Office
DATE:
BOARD MEETING DATE:
SPECIAL NOTICE:
VOTE REQUIRED:
TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

2006-07 Grand Jury Response

December 22, 2006
January 9, 2007
None
None

Recommendation
Accept this report containing the County’s responses to the following 2006-07 Grand
Jury reports: Pandemic Influenza Preparedness at the San Mateo County Women’s
Correctional Facility and Badge Control at the San Mateo County Hall of Justice.
VISION ALIGNMENT:
Commitment: Responsive, effective and collaborative government.
Goal 20: Government decisions are based on careful consideration of future impact,
rather than temporary relief or immediate gain.
This activity contributes to the goal by ensuring that all Grand Jury findings and
recommendations are thoroughly reviewed by the appropriate County departments
and that, when appropriate, process improvements are made to improve the quality
and efficiency of services provided to the public and other agencies.
Discussion
The County is mandated to respond to the Grand Jury within 90 days from the date
that reports are filed with the County Clerk and Elected Officials are mandated to
respond within 60 days. It is also the County’s policy to provide periodic updates to
the Board and the Grand Jury on the progress of past Grand Jury recommendations
requiring ongoing or further action. To that end, attached is the County’s response to
the Grand Jury reports on Pandemic Influenza Preparedness at the San Mateo
County Women’s Correctional Facility and Badge Control at the San Mateo County
Hall of Justice issued October 12, 2006.

Pandemic Influenza Preparedness at the San Mateo County
Women’s Correctional Facility
Findings:
Staff is in general agreement with the Grand Jury’s findings.
Recommendations:
The Board of Supervisors should:
2.1 Ensure that the needs assessment report for the new Women’s Facility to
be prepared by the consulting firm, DMJM H&N, adequately addresses the
logistics and space planning needed to combat a contagious disease
outbreak.
R e s p o n s e : Concur. The needs assessment for the new Women’s
Correctional Facility will include consideration of pandemic flu preparedness
requirements.
2.2 Support and participate in the planning sessions among the Sheriff’s
Department, Health Department and the Court; establish timelines with
realistic deadlines for formalizing a detailed plan for dealing with a pandemic
flu outbreak.
Response: Concur. The Sheriff’s Office, Health Department, and the Court
have held a series of meetings to prepare a planned Pandemic Flu response,
including a potential outbreak occurring in one of the Sheriff’s secure
facilities. A draft plan has been prepared. The team is currently developing a
final plan that is due to be completed in March 2007. A Pandemic Flu
exercise is being planned for May 2007, so that the plans of the County and
other community partners can be rehearsed and assessed to identify any
gaps in coverage.
2.3 Revisit the 2006-07 preliminary budget allocation for the Sheriff’s
Department and Correctional Health Services to consider (a) whether it can
support the hiring of additional nurses to reduce the need to transport
inmates to the Maguire Facility/hospital or (b) whether the salaries of
additional personnel can be offset by savings in transportation costs and
overtime expenses.
Response: Concur. Nurse staffing levels at the Women’s Correctional
Facility will be reviewed as part of the FY 2007-08 budget development for
the Sheriff’s Office and Correctional Services Division of the Health
Department.

Badge Control at the San Mateo County Hall of Justice
Findings:
Staff is in general agreement with the Grand Jury’s findings, however, there are
some minor clarifications that should be noted, as follows:
•

•

•

In the first sentence of the Background, it reads, “Upon entering the Hall of
Justice, the general public and their belongings are processed through
a metal detector and then further scrutinized by security.” It should be
noted that any carry-in items such as handbags, brief cases, boxes, etc. are
screened through an x-ray machine.
The first sentence of the Investigation reads, “The Grand Jury interviewed
representatives of the BSWG (Building Security Work Group) and was
provided a copy of the County Administrative Memorandum B-20,
Building Security Policy and Court Security Plan, which has not yet
been approved by the County or the Court.” Administrative Memorandum
B-20 was formally adopted on August 12, 1998; however, it is currently out of
date and needs to be updated.
The second sentence of the Findings, under sub-header Attorneys reads,
“Attorneys from other counties appearing before the courts in the Hall
of Justice may also obtain badges, which may have active status for
years even if they are not used.” Only attorneys in good standing with the
San Mateo County Bar Association for a period of at least two years may be
issued badges. It is true that on one occasion visiting attorneys for a highprofile case were issued cardkeys, but those cardkeys were terminated
immediately following completion of the trial.

Recommendations:
The Board of Supervisors should:
1. Adopt procedures to insure that occasional and unannounced spot checks
are conducted at all badge controlled access points to verify that each badge
belongs to the user of that badge.
Response: Concur. The Sheriff’s Countywide Security Unit will be tasked
with the responsibility of conducting spot checks by the un-intrusive use of
cardkey computer monitors. The results of these spot checks will be
documented and forwarded to the Captain of Courts, Custody and Security
Services and will be shared with the BSWG in order to identify and address
security concerns in the future.
2. Adopt procedures to insure that the badge of every terminated employee is
returned to the County and deactivated immediately upon termination.

Response: Concur. If an employee is terminated for cause, ISD or the San
Mateo Medical Center (depending on the employee’s assignment) will
deactivate the employee’s cardkey and notify the Sheriff’s Countywide
Security Unit. Routine resignations are handled through a termination report,
which is generated after each payroll. The report is sent to the County’s
Cardkey Administrator at ISD. The cardkeys are deactivated for all employees
on the termination report. The Medical Center’s Cardkey Administrator is
notified by e-mail from the various Unit Managers that an employee has
terminated and immediately deactivates that employee’s cardkey. The result
is that the cardkeys, cancelled electronically, will no longer activate the door
mechanisms. These processes have been in place for some time but need to
be formally adopted in County Administrative Memorandum B-20.
The issue of the employees returning their cardkeys is a more complicated
issue, as some employees feel that the cardkey is their personal property and
fail to return them upon termination. The Sheriff’s Office will work with the
BSWG to develop a countywide procedure that will ensure that every effort is
made to retrieve employee cardkeys upon termination from County service.
3. Re-examine the policies of issuing badges that are valid for more than
twelve months and of allowing unused badges to remain valid.
Response: Disagree. Setting annual termination dates for County
employees and members of the Bar Association would create an undue
burden on cardkey administration and could have significant impacts on
building operations. This past year the County initiated a process whereby
departments are required to review a report of all their employees that have
cardkey access to the Hall of Justice and verify that the employees are still
employed by the County and that their level of access is appropriate. The
County’s Health Department has already completed such a review and a
review by the Human Services Agency is currently underway. The plan is that
all departments would perform a comprehensive review at least once a year.
Though in place, this process still needs to be formally adopted in County
Administrative Memorandum B-20. The BSWG will also approach the Bar
Association about conducting a review of all member attorneys who possess
active cardkeys.
4. Re-examine the policy of allowing work crews access to the Hall of Justice
without vetting each member of the crew.
Response: Disagree. It would cause significant workload to do backgrounds
on all contract workers. Also, the policy would effectively eliminate the
County’s use of contractors that provide rehabilitation services, such as
Delancey Street Movers. It should be noted that Public Works and/or County
department staff are required to have at least one employee on hand when
vendors/contractors are accessing any County building after hours to ensure
that workers remain in the authorized areas.

5. Formalize and adopt County Administrative Memorandum B-20, Building
Security and Court Security Plan.
Response: Concur. Although County Administrative Memorandum B-20 was
formally adopted in 1998, it needs to be updated. An interdepartmental work
group will be established in early 2007 to begin a comprehensive review and
update of all County Administrative Memoranda. Administrative Memorandum
B-20 will be a high priority item. The County will notify the Grand Jury once B20 has been updated and adopted.

December 4, 2006

Honorable John L. Grandsaert
Judge of the Superior Court
Hall of Justice
400 County Center, 2nd Floor
Redwood City, CA 94063-1655
Re: Grand Jury Report: Pandemic Influenza Preparedness at the San Mateo County’s
Women’s Correctional Facility
Dear Judge Grandsaert:
Summary:
The potential for a widespread outbreak of avian influenza (strain H5N1) among the general
population in the near future is a subject of global concern. News reports indicate that at least
140 people worldwide have been killed since this virus began ravaging Asian poultry stocks in
late 2003. An estimated 1.9 million Americans could die and almost 10 million could be
hospitalized during a pandemic that may take a year or more to evolve. Although the timing,
nature and severity of the next pandemic cannot be predicted with certainty, preparedness
planning is imperative to lessen the impact. Measures to prevent and control the spread of this
disease may include quarantine and isolation where feasible, limiting public gatherings and
closing schools and businesses. “Social distancing” strategies (i.e., the act of separating oneself
from others as much as possible) will be encouraged as a containment strategy. Many of these
measures are not feasible with a jailed population.
Lack of capacity with concomitant overcrowding is one of the Women’s Correctional Facility’s
(Women’s Facility) most serious deficiencies. The Women’s Facility (described in the San
Mateo Jails portion of prior San Mateo County Civil Grand Jury Reports) has open-bay style
dormitory living conditions and centralized toilet and shower facilities that prevent isolating
inmates and limiting physical interactions between them and the staff or visitors. The problems
are made worse by the chronic overcrowding, the staff shortages within the Sheriff’s Department
and the limited number of Correctional Health nurses. Although staffing seems to operate
satisfactorily during normal times, the Women’s Facility is not designed or staffed to deal with a
pandemic flu outbreak.

The San Mateo County Grand Jury recommends that the San Mateo Board of Supervisors: (1)
give priority to adequate staffing of the Women’s Facility; (2) continue to develop a plan with
deadlines for dealing with a pandemic flu disaster in this facility; and (3) direct that the needs
assessment report for the new Women’s Facility address space planning and logistics for any
contagious disease outbreak.
Findings
The Women’s Facility is overcrowded. The facility is currently configured for 158 beds in a
building with capacity for 84 beds, according to the State Department of Corrections and
Rehabilitation. Most toilet and shower facilities are centralized and for group use. There are no
isolation facilities at the Women’s Facility; if needed, female inmates are transported to the
Maguire Facility, which has only a limited number of isolation rooms.
Conclusions
Many people come in contact with the inmates in the Women’s Facility (new inmates, Sheriff
and probation staff, visitors, attorneys, agency volunteers and counselors), so this “confined”
population is unlikely to escape exposure to a pandemic flu outbreak. The sheer number of
inmates cycling though this facility almost guarantees exposure. Furthermore, chronic
overcrowding, open-bay style dormitories and the centralized toilet and shower facilities of the
Women’s Facility prevent isolation, or even the limitation of physical contact among inmates,
staff and visitors. This facility is woefully inadequate to deal with a pandemic flu outbreak. All
these problems are made worse by the staff shortage in the Sheriff’s Department and the limited
number of Correctional Health nurses. While the staffing seems to operate satisfactorily during
normal times, the Women’s Facility could not deal with a pandemic flu outbreak
Recommendations
The Grand Jury recommends that the Sheriff’s Department:
1.1 Give priority to staffing the Women’s Correctional Facility at the authorized level so that
it can more effectively deal with critical situations.
Response:
Concur. The administrative staff of the Maguire Correctional Facility and the Women’s
Correctional Center has developed a staffing plan that provides immediate relief to the
Women’s Correctional Center; this however is only a short term solution. The County
has provided us with four additional positions to provide a full shift complement at the
Women’s Correctional Center, this only underscores the greater issue staffing
throughout the Sheriff’s Office.
In recent months the Sheriff’s Office has conducted a staffing study and found that as
an organization we are severely understaffed. We believe that this is a result of many
years of budget cuts, restricting our ability to operate 24 hours a day, seven days a
week. It is important to understand that once positions are approved it takes a period of
eighteen months to recruit, hire and train an employee before they are able to stand
alone in an assignment. We are actively engaged in the process of recruitment, as well
as temporarily filling positions with the assistance of staff from other divisions within
the Sheriff’s Office.

2

We are currently meeting with the County Manager’s Office on an ongoing basis to
resolve this issue and to work on the establishment of a relief staff pool. This will allow
us to provide staff support in those areas where assistance is needed during our regular
course of business.
1.2 Continue its planning sessions with the Health Department, employees of other state and
county correctional facilities and the courts to establish a detailed plan for dealing with a
pandemic flu outbreak.
Response:
Partially agrees with recommendation. .It is essential to continue planning sessions with
the Health Department and other county departments and courts regarding a pandemic
flu. It is unlikely that state and other county correctional facilities will be in a position to
assist this county. Any plan that is developed has to be able to stand alone.
The Sheriff’s Office, has been developing internal plans for responding to a pandemic
flu over the last six months. This planning task is now been expanded to interface with
other county departments. This will ensure the operational continuity of the criminal
justice system as well as the continuance of county government service.
Pandemic flu concerns will also be a consideration in further discussions as we move
forward in the planning process for new correctional facilities, currently with DMJM
H&N.
The Grand Jury recommends that the Board of Supervisors:
2.1 Ensure that the needs assessment report for the new Women’s Facility to be prepared by
the consulting firm, DMJM H&N, adequately addresses the logistics and space planning
needed to combat a contagious disease outbreak.
2.2 Support and participate in the planning sessions among the Sheriff’s Department, Health
Department and the Court; establish timelines with realistic deadlines for formalizing a
detailed plan for dealing with a pandemic flu outbreak.
2.3 Revisit the 2006-2007 preliminary budget allocation for the Sheriff’s Department and
Correctional Health Services to consider (a) whether it can support the hiring of
additional nurses to reduce the need to transport inmates to the Maguire
Facility/hospital or (b) whether the salaries of additional personnel can be offset by a
savings in transportation costs and overtime expenses.
Sincerely,

Don Horsley, Sheriff
cc: The Honorable Board of Supervisors
Grand Jury website

3