As San Diego officials scramble to stop a deadly hepatitis A outbreak linked to a lack of downtown public restrooms, they can’t say they weren’t warned.

A U-T Watchdog review of public records found that since 2000, four grand jury reports attempted to steer attention to the risks posed by human waste on city streets and a shortage of toilets available for use by the city’s growing homeless population.

One such report, filed in 2010, explicitly warned that an outbreak of illness caused by such unsanitary conditions “could result in liability to the city.”


Each of the reports called on the city to either add more all-hours, publicly available restrooms or bolster its street cleaning regimen to ensure the public would not be exposed to human waste.

Health officials say such exposure helped fuel San Diego’s growing outbreak, which has left 16 people dead and more than 300 who required hospitalization. Since November, San Diego has seen 444 hepatitis A cases — as many as the combined total reported by California, Texas and New York in all of 2015, the most recent year for which statewide data is available.

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This month, San Diego undertook both grand jury-recommended steps in earnest — new bathrooms and street cleaning — after the outbreak garnered international media attention. Adding two new restrooms brought downtown San Diego to a new total of 21.


The 19-member grand jury is a civil watchdog panel that investigates certain aspects of local government and citizen complaints. It does not do criminal investigations.

City responses to two past jury reports, filed in 2005 and 2015, both cited security concerns and budget constraints among the hurdles posed by building new restrooms. New toilets, officials said, can be a magnet for criminal activity. They estimated the cost to install restrooms at $250,000, with annual operating cost estimates ranging from $65,000 to $400,000.

In 2005, the grand jury made a recommendation that the city “provide more public restrooms in the downtown area.”

The city responded, “The recommendation will not be implemented at this time due to the financial challenges of the city. The city does not have the resources to execute a project of this magnitude.”


Ronne Froman, city manager at the time, told grand jurors that corporate sponsorships were explored, but “corporations interested in spending these types of dollars with the city are not keen on the idea of associating their brand identity with toilets.”

Signage recommended by grand jurors to make restrooms more accessible was also rejected. Froman said advertising public toilets could not be done without amending city rules limiting signs placed in the public realm.

A spokeswoman said the city has since added some signs to mark the way to existing restrooms.


City Council members in 2015 said they needed more time to analyze a grand jury recommendation that asked the city to come up with a budget and a plan for adding 24-hour toilets.

They partially disagreed with jurors’ determination that existing restrooms were often unsanitary and hard to find, and emphasized potentially expensive and time-consuming challenges to building new ones.

“There are several challenges that require further analysis to providing additional 24-hour accessible public restrooms in downtown San Diego,” the mayor and council members wrote in a response signed by then-Council President Sherri Lightner. “First, various types of projects, including public restrooms, compete for limited capital funding. There are also challenges to finding suitable locations where public restrooms can be installed from both an engineering and public safety perspective.

“From an engineering perspective, installation of a public restroom requires access to adequate capacity of existing water, sewer and utility lines. If public restrooms are not adequately secured, they can become sites of criminal activity, and therefore require additional police oversight.”


Officials this past March — the same month the county determined hepatitis A had reached outbreak proportions — declined to further analyze the grand jury’s 2015 call for a plan to add toilets. A response to the recommendation presented by David Graham, the city’s deputy chief operating officer, said the city already has community plans that include public restrooms. The response goes on to say that Civic San Diego, the city-owned nonprofit planning agency, encourages efforts to provide public restrooms “when there are opportunities to work with private developers.”

Officials said efforts to build the costly facilities were hamstrung by the loss of downtown development-generated tax dollars once collected by the city’s redevelopment agency. That agency disappeared, alongside 400 others, under a 2012 state law that banished all of California’s former blight-fighting agencies.

The U-T in January reported that since the shutdown of the agency, some $68.6 million former redevelopment dollars had made their way into San Diego’s general fund. That’s enough to add and maintain 104 new restrooms under the city’s own top-end cost estimates — or roughly five times the number of of public restrooms currently available downtown.

Today, officials say money is no object in facing the crisis surrounding hepatitis A, which is spread when when people ingest even tiny amounts of contaminated fecal matter. Last week, they announced the addition of the two new bathroom sites and expanded hours at 14 Balboa Park restrooms.


Critics say the city should have acted sooner to try and prevent the outbreak.

“Anybody working with the homeless could’ve told you this was going to happen,” said Anne Rios, executive director of San Diego homeless advocacy group Think Dignity and a longtime advocate for adding more downtown restrooms.“I think part of it is the city doesn’t want to acknowledge that our homeless problem is as bad as it is.”

Mayor Kevin Faulconer served on the City Council from January 2006 to March 2014, when he was sworn in as mayor. For much of his council tenure, his district included downtown San Diego. Approached after a Tuesday morning news conference, Mayor Kevin Faulconer did not directly answer questions about San Diego’s earlier inaction.

He said the city had worked closely with county officials to open the restrooms announced last week. The two-term mayor said joint efforts to add the toilets started “primarily” after the county directed the city, in an Aug. 31 memo, to immediately expand access to public restrooms and wash stations within city limits.


“I think we’ve always had public restrooms,” he said. “We’ve had numerous public restrooms.”

Stacey LoMedico, the city’s assistant chief operating officer and the point person charged with rolling out the city’s new restrooms, said the city did not need the county’s directive to move forward with the additional facilities.

In retrospect, she said, it’s possible she could have done more to add long-sought downtown bathrooms prior to the hepatitis outbreak.

“I can sit here and say ‘shoulda, coulda,woulda,’” LoMedico added, “but I’m looking forward.”


LoMedico said she didn’t know off-hand how many public restrooms the city had built since grand jurors’ first published their concerns about the issue in 2005.

That 12-year-old report picked up on concerns published one year earlier, when grand jurors said San Diego had too long ignored the fact that its streets were being used as toilets.

The jurors’ latest report, published in 2015, reviewed calls for new restrooms downtown dating back to October 2000, when a City Council advisory committee asked the city to immediately start work on a program to install public toilets throughout downtown, “as has been done by many other U.S. and European cities.”

The 2015 report echoed that recommendation, before lamenting that it took five years for city officials to add two public restrooms first funded in 2010. Both of those facilities, known as Portland Loos, were plagued by cost overruns. The first was removed in July 2015, less than a year after it was installed, amid crime and vandalism concerns.


Spokeswoman Katie Keach said the city has added, and kept, four other downtown bathroom sites since 2010. She said four other sites, largely located in parks planned for downtown and the East Village, are expected to open by 2020.

Dr. Nick Yphantides, the county’s chief medical officer, predicted at a Tuesday news conference that San Diego’s hepatitis outbreak would risk more lives and last another six months, or perhaps longer.

Timeline

October 2000 : The East Village Redevelopment Homeless Advisory committee -- a temporary panel of dozens of downtown homeless advocates and business leaders -- found only two public restrooms available for the use of street people downtown. The committee, created to advise the city on homeless displacement issues, said that has “inevitably resulted in urination and defecation in public areas.”

: The East Village Redevelopment Homeless Advisory committee -- a temporary panel of dozens of downtown homeless advocates and business leaders -- found only two public restrooms available for the use of street people downtown. The committee, created to advise the city on homeless displacement issues, said that has “inevitably resulted in urination and defecation in public areas.” June 2004 : Members of a San Diego County grand jury seek additional street cleaning efforts, pointing to sidewalks “littered with human and animal waste, dirt, and refuse.”

: Members of a San Diego County grand jury seek additional street cleaning efforts, pointing to sidewalks “littered with human and animal waste, dirt, and refuse.” September 2005 : Grand jurors, at a previous grand jury’s request, urge the city to add public toilets, citing the “inconvenient locations and less-than-attractive conditions of the two existing 24-hour public toilets.”

: Grand jurors, at a previous grand jury’s request, urge the city to add public toilets, citing the “inconvenient locations and less-than-attractive conditions of the two existing 24-hour public toilets.” May 2010 : Grand jurors add to calls for cleaner streets and more bathrooms, in part to reduce “fecal deposits and urine odors in the downtown and East Village.”

: Grand jurors add to calls for cleaner streets and more bathrooms, in part to reduce “fecal deposits and urine odors in the downtown and East Village.” May 2015: A grand jury report finds San Diego’s need for public restrooms has been an issue “for more than decade.”

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