Public restrooms in an East Village park have been mostly locked for months, even while a hepatitis A outbreak fueled in part by lacking hygiene has plagued homeless San Diegans.

Pinnacle International developed two high-rises bordering Fault Line Park, agreeing years ago to build and maintain the park and restrooms in exchange for perks including the right to build more apartments in the towers and a garage underneath the park.

The restrooms have been a problem since they opened, as inewsource reported last year. Homeless people have settled at the edge of the park, and city officials, Pinnacle staff and owners of the restaurant that houses the bathrooms have described near-constant safety hazards, including a stabbing that some restaurant workers witnessed.

“They basically got used all the time for drug use and prostitution and crime,” said John Long, whose restaurant Stella Public House oversees the restrooms for the developer.

Long, the city and the developer said they decided last fall to ensure safety by locking the restroom doors and requiring visitors to walk into the restaurant to get a key. The restaurant had previously just kept them closed.

In the months since, homeless people who visit or regularly settle at Fault Line Park say they’ve gotten the message the restrooms still aren’t open to them. The number of people gathering at the park between J Street and Island Avenue has grown, and more homeless children spend time there. One afternoon last month, several young children roamed or sat with their parents, belongings in tow, paces away from the locked restrooms.


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Meanwhile, a countywide hepatitis A outbreak has exploded. Nearly a dozen people have died and more than 230 have been hospitalized, many of them homeless. It’s the biggest hepatitis A outbreak in the state in 20 years.

Public health officials say the virus is passed through person-to-person contact, and basic hygiene could help mitigate further spreading. The county’s encouraged those who might be at risk to take extra care to wash their hands before eating or after using the bathroom – seemingly simple tips that can be more difficult for homeless people without easy access to restrooms.

Two homeless mothers who regularly visit the park with their infants told VOSD they’ve assumed the restrooms are closed. There aren’t signs to let them know they are open to those who ask for a key.

“It seems like they don’t care,” said Alexis Leftridge, who has an infant son and now spends her nights at nearby Father Joe’s Villages.

The other young mother, whose 2-year-old and infant sons were with her at the park earlier this month, also expressed frustration. She admitted, eyes widening, that she hadn’t been aware of the hepatitis A outbreak until I told her about it and planned to double-check that her older son had received the hepatitis A vaccine. She asked that I not share her name to protect her privacy.

Her biggest concern, she said, was where she could find a clean restroom or take her sons to wash their hands.

After VOSD asked about the bathroom policy, city spokeswoman Katie Keach said city workers would install temporary signage at the Fault Line bathroom next week to clarify that visitors can access the bathrooms if they get a key from the restaurant. Permanent signs will go up in about a month, Keach said.

“The key system works to ensure those using the restroom must check in with someone,” Keach wrote in an email. “While we understand that it may seem like a hurdle to use the restroom, this extra step can deter those who use the restroom for illicit activities which have been problematic at this public bathroom.”

But Danielle, a 33-year-old who lived at Fault Line Park until she was hospitalized with hepatitis A more than a month ago, said she and others have asked for the key in recent months only to be told the restrooms are closed.

“They say it before you can get the sentence out and they won’t let you use the (other bathroom) inside unless you’re a paying customer and it doesn’t count if you buy a soda,” said Danielle, who asked that I not print her last name to protect her privacy.

Keach said the city would follow up with Stella Public House, which has taken on the management of the bathrooms, to ensure workers provide restroom keys to those who ask to use the bathroom.

“The goal is to have a public restroom for all,” Keach said. “There may be times when the key is refused if the individual poses a threat to threat to health and safety; at those times (the San Diego Police Department) is contacted.”

Long, the Stella Public House co-owner, said he would also clarify that protocol with restaurant staff.

Dennis La Salle, the San Diego-based development manager for Pinnacle International, did not return calls and emails from VOSD.

Danielle doesn’t believe she contracted hepatitis A because of curtailed bathroom access at Fault Line Park. She said she regularly used hand wipes, a tool public health experts have noted isn’t as effective as hand-washing, and other restrooms in the area.

But state and county health officials have said hepatitis A – which is marked by flu-like symptoms, jaundice and nausea – has predominantly been spread in San Diego County through ingestion of fecal matter from those who already have the virus. Homeless people, who often lack easy access to restrooms, can face particular hygiene challenges that make them more susceptible to the virus.

“Unfortunately, because hepatitis A is transmitted by the fecal-oral route and homeless people do not typically have ready access to clean toilets and hand-washing facilities, there is likely to be more person-to-person transmission than outbreaks in other populations with better access to these types of facilities,” a spokesperson for the state Department of Public Health wrote in a statement. Kathleen Harriman, an epidemiologist with the department, said she’s regularly been in touch with San Diego officials.

Danielle and others who have stayed at Fault Line Park were more concerned with the daily impacts of the locked bathrooms. Many criticized the city for not enforcing the developer’s contract with Civic San Diego that requires the developer to operate the bathrooms.

Homeless people in the area instead rely on restrooms at the Central Library and a nearby grocery store that are open during the day. When necessary, they’ll venture to facilities at Park Boulevard and Market Street and Father Joe’s Villages, which they describe as dirtier and busier.

But they say the lack of easy bathroom access can be problematic and sometimes even painful.

Some describe waiting for hours for a clean, open bathroom where they can relieve themselves, trying to hide in the bushes when they can’t wait or walk any longer, or urinating in large gas station to-go cups in the middle of the night.

Danielle and her friend Debbie, a 60-year-old woman with irritable bowel syndrome, recalled an accident the she had a few months ago when a nearby grocery store restroom was closed.

Debbie soiled her clothes. She was mortified.

Danielle said she reluctantly approached Stella Public House and asked if they’d let her friend clean up in their restroom.

Danielle said restaurant staff initially said that the bathrooms were closed.

“I had to almost beg them, ‘This isn’t a joke. She seriously needs to use the restrooms,’” Danielle recalled. “They’re sitting there, just locked.”

Eventually, she said, a restaurant worker let the two women into one of the public restrooms to get cleaned up.

    This article relates to: Government, Homelessness, Must Reads, Nonprofits/Community

    Written by Lisa Halverstadt

    Lisa writes about San Diego city and county governments. She welcomes story tips and questions. Contact her directly at lisa@vosd.org or 619.325.0528.

    7 comments
    lorisaldana
    lorisaldana subscriber

    After three more deaths in one week. #SanDiego #hepatitis death count is now at 14, and the mortality rate is now 4%.


    On the bright side: the restrooms at this park were unlocked and available on Aug. 23.

    Still- this is a horrifying healthcare crisis. In 2015 a total of 67 people died of #HepA in the entire US. San Diego is now on track to have over 25% of the nation's total deaths.


    Source and weekly updates of local illnesses: http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/Hepatitis_A.html

    joe coneglio
    joe coneglio

    They shouldn't be allowed to live on the streets or parks of San Diego. 

    Just another reason to set up camps for the homeless.

    Jim Lovell
    Jim Lovell

    Talk about a behavior with deadly consequences! The city has continually worked against resolving the public health issue of places for poor people to use public restrooms and clean handwashing facilities for decades. Just look into the 24-hour public restrooms at third and C. to my understanding the city only created those once they were sued. And I don't know any homeless individuals who believe that a private establishment is just going to open their bathroom doors when anyone asks. Talk about a Trust issue… As far as crime goes, is the kind of crime that had it closed in the first place similar to the crime purportedly being committed at the Portland Loo by the library? If I remember right the rumors of crime turned out to be untrue in the end after the Loo was removed.


    And what happened to the city's promise of four such Portland Loos? Isn't that why the porta pottys by God's Extended Hand were taken out? In the 14 years that I have worked with people who do not have homes the single biggest problem from the community at large has been about homeless people urinating and defecating in public. Why would the city then work against itself or the community either for that matter? Unless that's not the real underlying issue for them.


    Thank you Lisa for clear and honest reporting.


    lorisaldana
    lorisaldana subscriber

    To put San Diego's 11 hepatitis-related deaths into context: 

    In 2015, a total of 67 people died of hepatitis in the entire United States. 


    This means, at the current rate, San Diego may see nearly 1/3 of total annual hepatitis deaths for the entire nation by the end of the year.  Yet- according to the Center for Disease Control- Hepatitis A cases have been steadily declining in the US since 2000.  (see: https://www.cdc.gov/hepatitis/statistics/2015surveillance/index.htm)


    Moreover, while hepatitis A is one of the most obvious and potentially deadly health problems related to the lack of public restrooms, hand washing stations, and sanitary eating conditions, homeless people (especially women and older adults) are also more likely to develop urinary tract infections when they do not have access to restrooms. These UTIs can become kidney infections without early treatment- also a serious and potentially deadly condition. 


    The combination of UTIs, kidney disease and other infections contribute to declining health and early death in the homeless population when left untreated. They may also be why so many HepA infections are resulting in the need for hospitalization, intensive treatment, and- without those interventions- death. 


    For weekly updates on the local deaths from hepatitis see: http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/Hepatitis_A.html

    Nathan Wollmann
    Nathan Wollmann

    Public Health needs to be doing outreach to get people inoculated. There is a Hep A vaccine. This is the more effective way to deal with an outbreak. Hand washing well enough to kill all pathogens is actually pretty hard. But then, County Nurses are being lost at an alarming rate. The conditions they work under are unmanageable. The County is stretching their resources too thin, and do not pay enough to attract quality nurses to fill these positions.

    lorisaldana
    lorisaldana subscriber

    @Nathan Wollmann agree vaccinations will help, but getting them to the thousands of homeless San Diegans who have been pushed underground by policing/criminalization will be a challenge. 


    Also- There is a lack of trust that makes some avoid social workers/healthcare providers. And as you mention, working conditions for county nurses are also bad and may result in a strike.


    Finally- the County is treating symptoms, and still not addressing the underlying cause of this outbreak: lack of secure housing and basic sanitation.  These are needed, along with vaccinations, to prevent additional infections/deaths.

    Nathan Wollmann
    Nathan Wollmann

    Agree. Just noting that, strictly from a public health standpoint, now is the time to get people vaccinated. The root of the problem is certainly lack of housing for homeless. Also, I think it is government and nonprofit responsibility to address the lack of trust you mention. I think they have good reason for that lack of trust at this point.