SPECIAL REPORT: Inside a San Benito County vaccine investigation

HOLLISTER, Calif. (KION)

From late January to early March, San Benito County's largest COVID-19 vaccine provider was on the outside looking in. The County's Health and Human Services department paused vaccine allocation to non-profit San Benito Health Foundation (SBHF) as they investigated claims the foundation administered the vaccine to people not eligible at the time, most notably to family, friends and patients. Since the investigation was announced, SBHF has denied any wrongdoing.

The county finished their investigation on March 2, telling the foundation President in a letter that they found the SBHF's intentions "well meaning," but "evidence clearly documents that individuals were vaccinated by the SBHF outside of the eligible allowances in effect at that time." A week later, county officials and the foundation came to an agreement to begin reallocating doses.

Start of the investigation:

A California Public Records Act request by KION uncovered a letter sent by the health agency to the California Department of Public Health on January 22nd, asking for relief, guidance and further investigation into the San Benito Health Foundation. The letter includes claims the foundation was prioritizing their own patients, "friends of friends," and people in lower eligibility phases (including food and agricultural workers and people ages 65 and older), writing that San Benito County is still making their way through Phase 1A (healthcare workers and people 75 and older).

“Any vaccine that goes to someone that isn’t in the tier yet means that somebody else doesn’t get that vaccine and it is a risk of serious illness or death,” San Benito County Health Officer Dr. David Ghilarducci tells KION.

The county sent letters to the foundation on January 28th and January 29th, first warning them of the investigation and then going into detail about their concern, a pause on vaccine allocation and what needs to happen for doses to return to SBHF.

"We don’t know who accused us. We can speak about the allegations we know about, but we don’t really know what the county’s process was," San Benito County Health Foundation Board member Dr. Laura Stampleman tells KION.

Largest concern: 

The county health department is largely upset over a significant amount of "orphan," or unused and punctured, doses that must be used before they expire.

In the March 2nd letter notifying the foundation of the investigation's conclusion, Health and Human Services Director Tracey Belton writes, "your prior statements to the effect that all or most individuals who were vaccinated out of tier by the SBHF received "orphan doses" is not common or an acceptable practice given that leftover doses should occur infrequently and in low numbers and not in the volume of ineligible vaccinated claimed by SBHF."

Records obtain by KION show "orphan doses" accounted for nine percent of the foundation's total in January, which KION is told is higher than any other provider. The county also says other vaccine providers were better able to use orphan doses for people on a county-list of eligible people.

“To me this suggests very poor planning or it was intentional to have orphan doses," Ghilarducci said. “It is not who you know or how you are connected. That doesn’t determine whether you get vaccinated. It is whether you fit into tier or not.” 

SBHF blames orphan doses on a variety of factors - no-shows, people on the county list not wanting the vaccine, a storm and the logistical challenges of running a large vaccine program while maintaining operations as a fully-functional health center. As for who got those doses, foundation President and CEO Rosa Vivian Fernandez describes their definition of "friends of friends" as a pipeline of at-risk people who could be hard to reach for the vaccine without a personal connection.

The San Benito Health Foundation plays a key role in the local vaccine effort with an expansive list of low-income and Latino clients.

“(They are) not reached by internet, and website, and 'sign up and wait for your turn,' that’s not how we engage this population. It is through people that they trust that have been there for them in the past,” Fernandez said.

Rotary Club:

But the complaint to CDPH also mentions the foundation vaccinating members of the San Juan Bautista Rotary club. Fernandez is a past rotary President. The Rotary's current President is on the Health Foundation's Board, as is their Executive Secretary Art Testani.

“They had been partners and volunteers within the San Benito Health Foundation since the beginning of this pandemic,” Fernandez said.

The foundation says the Rotary members were eligible for the vaccine in January because of a recommendation from the CDC that lists essential healthcare workers as, "all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials. This includes persons not directly involved in patient care, but potentially exposed to infectious agents while working in a healthcare setting."

Testani tells KION the rotary members provided "volunteer work, distribution work, fundraising, providing PPE to people that don’t have it.” 

KION emailed CDPH: "if members of a local community organization volunteered with a health/vaccine provider for local outreach and food drives... would they be considered Phase 1A eligible?" A CDPH spokesperson responded: "they are community health workers at that point and become eligible (though not guaranteed) a vaccine.”

Separate priorities?

At the time, the county was still working through Phase 1A healthcare workers and gave SBHF a list of in-home supportive services (IHSS) workers eligible for the vaccine. An email on January 11 from the county to the foundation writes that some IHSS workers were told by the foundation not to schedule the vaccine through them, but to go through the county. SBHF responded that wasn't the case.

Emails obtained by KION show the county was asking the foundation to vaccinate all 642 IHSS workers. Records show between January 4 and 26, the foundation vaccinated 243, 31 percent of their total. However, 119 doses went to people in the 65-74 age group and 249 to food and agricultural workers. Neither of those groups were eligible in San Benito County until January 25, when officials opened up eligibility to Phase 1B. All but 20 total doses were administered on the 22nd or earlier.

"(Food and ag) is a deserving group. You can maybe split some hairs over who is more deserving, but the allocation guidelines were pretty clear,” Ghilarducci said.

The foundation doesn't deny they vaccinated these groups and published the information themselves. They, disputably, claim many people on the county IHSS list were not interested or did not answer. They ignored county guidelines and say they took directives from a January 14th memo from the CDPH, that says based on "available supply" you can prioritize and target outreach efforts with Phase 1B workers.

Fernandez, talking about how COVID-19 spreads in the community, discussed multi-generational households. "We have many 10 people in that house, or even more, and it is not the grandma or grandpa that are staying home. It is all the other individuals."

But through the end of March, it is the counties who determine vaccine eligibility. Many, like San Benito, have been "micro targeting" due to limited supply. The county was targeting people aged 75 and older to limit the number of people dying from COVID-19. The foundation says that is the same reason why targeted their patients, specifically the Latino population, who have also been overrepresented in the number of local COVID-10 deaths.

Moving forward, the county says there is a "zero tolerance policy" for SBHF. If there is any documented vaccine allocation out of tier, and determined true through investigation, the county is going to halt vaccine doses again. A second documented incident, and they will notify federal authorities who have legal oversight of federally qualified health centers.