House panel to probe federal medical response capacity

As the most damaging hurricane season in U.S. history continues, a congressional panel is trying to understand how the federal government provides doctors, medicine and supplies to affected areas following a disaster.

The House Homeland Security Committee is slated to hold a hearing Thursday focusing on how the federal medical response to hurricanes Katrina and Rita reflect the government's readiness to respond to biological or nuclear terrorist attacks.

While Congress gropes for answers, an investigation by Government Executive has found that the medical response to Katrina in particular was hamstrung by confused lines of responsibility, a failure to adequately plan for a disaster and a failure to follow what sparse plans had been made. The results of that investigation will be published in the Nov. 1 issue of Government Executive.

In Alexandria, La., more than 200 members of the U.S. Public Health Service were directed to erect a temporary 1,000-bed hospital but never saw a patient, Government Executive found. In Meridian, Miss., 79 PHS officers set up a 480-bed hospital that handled fewer than 50 patients, according to the Health and Human Services Department, which oversees the service. In Baton Rouge, FEMA set up a massive temporary hospital on the Louisiana State University campus staffed by dozens of medical responders, which went mostly unused, according to responders present.

Meanwhile, sick and injured hurricane victims went for days without help. Flooded hospitals waited for supplies and evacuation teams. Injured residents who did not or could not flee the storm could not reach the PHS field hospitals, which were miles away from the devastated region. It took well over a week, and sometimes longer, for federal medical workers to reach those people.

Part of the trouble may have stemmed from confusion at the top. Statutes and presidential directives are unclear about how FEMA and HHS share medical response functions, and the two do not always coordinate well. As a result, it is not always clear how responders and supplies are deployed, or how they integrate with other response efforts.

What's more, the response effort on the ground and in Washington was tangled in confusion over how medical needs were assessed, reported and met.

Dr. Susan Briggs coordinated medical response teams in Louisiana as part of FEMA's National Disaster Medical Service. Although she is normally under the Homeland Security Department's directions, as a medical response asset she was under the direction of HHS during this emergency. At one point, Briggs' personnel and their patients were suffering from dehydration, and she needed Gatorade--quickly. "We tasked it through HHS," Briggs said in a recent interview. "We were told it's not a medical need; it's logistics." She said she was told that therefore the request had to come from the state--and go to FEMA.

Briggs said an HHS official told her that if she resubmitted her request asking for "oral rehydration" instead of "Gatorade," it could be considered a valid medical need and the department could fill it directly. "I've never seen such poor coordination between federal agencies," she said.

According to Dr. Elin Gursky, a bioterrorism and public health expert with the government-sponsored ANSER Institute, such episodes show how the government would respond to a flu outbreak or other major medical disaster. "We're no more prepared for a pandemic outbreak than we were for Katrina," she said.

The House hearing will not feature FEMA or HHS officials as witnesses, although it will include two doctors who participated in response efforts to Rita and Katrina.