AGA Today
County Aims
Anti-Terrorism Cash at Some Unusual Targets
By
Charles Ornstein, Times Staff Writer
March 6, 2006
Los Angeles County
has spent at least $2 million in taxpayer dollars intended to prepare
for bioterrorism on buffing up the health department's image, responding
to unrelated health scourges and buying questionable supplies and
services, a Times review has found.
When public health
officials couldn't round up enough volunteers to take part in a smallpox
vaccination drill, for instance, they turned to actors from an old
Hollywood standby: Central Casting.
To hire extras to
play the role of patients in the half-day drill, the county's Department
of Health Services in 2004 paid the aptly named firm $57,045. That's not
counting what the department ponied up to thank the paid actors and
volunteers: $10,000 for gift certificates, $13,600 for pens, digital
thermometers and bags to hold the gifts, and thousands more for food and
transportation.
The county has
spent most of the federal grant money to hire and train staff to respond
to emergencies, which generally is consistent with the purpose of such
funds. Yet at times, the spending has stretched the definition of
terrorism readiness, drawing concern even from the department's own
employees, according to spending requests and other documents.
"Unless we have a
compelling public message, this seems to be a big waste of taxpayer
funds," John Wallace, the department's director of external and
government relations, wrote in an August 2004 e-mail to department
leaders about a proposed $1-million contract for a media campaign.
"I am concerned
that it will appear that we are trying to spend grant dollars for the
sake of not having to return them, and that is not acceptable."
In fact, the
department has failed to spend one in six dollars granted by the federal
government for bioterrorism preparations from 2002 to 2004.
During those
years, the U.S. Centers for Disease Control and Prevention doled out
more than $2.7 billion to prepare states, counties and cities in the
event of a bioterrorism attack. L.A. County alone received $83 million,
of which $14 million went unspent. For the current grant year beginning
last summer, the county was given an additional $27.9 million.
The grants have
been a boon to an otherwise cash-starved health department, which faces
massive cutbacks to head off an expected $781-million shortfall within
three years.
Dr. Jonathan
Fielding, the county's public health director, defended his department's
spending, saying it is much better prepared than it was several years
ago to handle a disaster. For instance, the department has conducted
more than 130 drills to test the county's readiness and created a
surveillance system — working with hospitals, schools, laboratories and
the coroner — to track disease outbreaks.
Without a
bioterrorism attack, it isn't possible to say whether the county's
spending habits have impaired its preparedness.
But in some key
areas, such as building a new public health laboratory, the county
remains behind schedule as dollars flow to other projects or remain
unused.
Among the county's
other expenditures on bioterrorism, sometimes referred to as BT,
detailed in documents obtained by The Times under the California Public
Records Act:
•
More than $128,000 for tchotchkes
to be given away to the public, including letter openers, whistles,
magnets, mouse pads, flashlights, pens, travel toothbrushes and
emergency kits. The department spent $1,000 on nylon discs for Public
Health Week, emblazoned with the slogan "Nutrition and Physical
Activity: Keys to Health." And it spent $4,145 on clipboards, notepads
and stress balls to give away at a forensic epidemiology conference.
•
At least $170,000 to train
department staff on how to put together videos to be viewed online. Two
videos have been produced: one on the role of public health, the other
on home pool safety.
•
A $4,675 teleprompter so that
Fielding and others can "face the camera and be able to read a prepared
speech," plus nearly $450 in upgrades to the teleprompter, $2,187 for a
laptop to write scripts for the teleprompter and $3,392 for a "very
special portable microphone for excellent quality remote interviews and
scene descriptions," according to the expense reports.
Hundreds more went
to replace a podium that had been "damaged by rodents."
•
More than 70 high-end desk chairs
at about $600 each and about 800 computers, although only 171 staff
members are funded by the bioterrorism grant.
•
More than $18,000 to print fliers
and information cards about West Nile virus and to purchase cases of
mosquito repellent. An additional $4,629 for printer cartridges because
of an "increased amount of bite reports" related to West Nile.
The California
Department of Health Services — which funnels funding from the CDC to
the rest of California's counties — does not allow them to spend their
bioterrorism money on West Nile, said Betsey Lyman, the state's deputy
director for public health emergency preparedness.
•
Assorted inexpensive but puzzling
items such as motivational posters, a $46 mahogany tape dispenser and
four copies of the book "The leadership secrets of Santa Claus."
Fielding said the
spending fit federal guidelines. For instance, he said, CDC Director Dr.
Julie Gerberding personally approved the county's use of bioterrorism
money to combat West Nile. He said the computers are used by public
health employees who may be needed to respond to a disaster, the
promotional items direct people to the county's bioterrorism website,
and the teleprompter and webcasting training would help in an emergency.
The teleprompter
has been used at least three times for training purposes.
For the smallpox
drill, it was much cheaper to use paid actors than county employees,
Fielding said.
As for the gift
bags, "Even actors might need to know how to reach the BT website or
have the material available on how to prepare themselves — that was our
thinking," bioterrorism preparedness director Sharon Grigsby said.
Meanwhile, the
county's new public health laboratory, which was supposed to open in
November 2004 and is key to identifying harmful agents, won't be ready
to open until late spring. It is now projected to cost more than $15
million, compared with the $9 million originally predicted, partly
because of rainstorms and "unforeseen structural and infrastructure
problems," documents show.
In public health,
said Dr. Richard Jackson, California's former public health officer,
"you live and die on the quality and functioning of your laboratories."
Fielding said the
existing lab, although old and cramped, still could respond in a
disaster. Even so, he conceded, "we would have loved to see the lab
available earlier as well."
Each year, the CDC
issues general guidelines for the use of its bioterrorism grants, but
the agency does not dictate the particulars of what should be purchased.
It has put a premium on such things as disease surveillance, laboratory
capacity, a health alert network, risk communications and education.
Contacted by The
Times, a CDC official who oversees the emergency preparedness grants
said staff have identified numerous problems with spending requests from
Los Angeles County. As a result, they have put some restrictions on its
grants, requiring better justification for use of some funds.
"I would say they
have more issues than what we would normally see" compared with other
agencies, said Alison Johnson, director of CDC's division of state and
local readiness. "They definitely have more issues than average."
When told of The
Times' findings, she said, "You've raised some valid concerns."
A more senior CDC
official, Donna Knutson, later said she didn't view the county's
problems as excessive.
The CDC does not
have the time to scrutinize every expense, Johnson and Knutson said. The
agency expects grant recipients to commission outside audits.
One county
bioterrorism official, Phillip Moore, warned fellow employees of such a
possibility in a Feb. 2005 e-mail. "So far, no one has contacted us
wanting to do an audit of our finance or activities (keep our fingers
crossed!)" he wrote.
Fielding said his
agency is willing to open its books to auditors at any time. He said the
sentiment voiced by Moore was that audits are time-consuming and
distracting. Previous audits, Fielding said, have not uncovered major
problems.
Because of the
county's size and potential as a terrorist target, it, along with New
York City and Chicago, gets its money directly from the CDC. Allocations
for all other counties in California flow through the state Department
of Health Services.
Other
jurisdictions, including San Diego and San Francisco, have not asked to
spend their money for such items as smallpox drill actors, a
teleprompter or giveaway key chains and flashlights, said Lyman, the
state bioterrorism official.
Even with its many
expenses, at the end of the 2004 fiscal year, L.A. County had $14
million left over.
To avoid returning
all of it to the federal treasury, the county received permission from
the federal agency to roll some into future years. Fielding cited
trouble recruiting personnel, delays in purchasing and lengthy
negotiations with vendors.
Still, internal
correspondence at the county health department suggests that employees
were under great pressure to spend the federal money.
Grigsby, the
department's bioterrorism preparedness director, told her staff in May
2003 about a meeting to "emphasize the importance" of spending all the
grant money given to the county, according to an e-mail she wrote to
colleagues. At the time, the county worried that it wouldn't spend up to
$9.9 million of its grant.
"We have
repeatedly assured Dr. Fielding, and he the Board [of Supervisors], that
we will not forgo any of this money," Grigsby wrote. "Please be able to
demonstrate how we can make this happen."
Weeks later, the
department approved a $2,584 overhead projector for Fielding's office.
In February 2004,
Fielding ordered a brochure to be handed out during Public Health Week,
an event devoted to general health promotion. He "said to charge it to
BT (we'll include a bullet about making an emergency plan)," his chief
of staff, Anna Long, wrote in an e-mail at the time.
Some public health
experts who have worked with Los Angeles County say they are impressed
with its preparedness.
"The county is
better prepared than most counties in the United States to handle a
large-scale public health emergency," said Dr. Steven Rottman, director
of the UCLA Center for Public Health and Disasters, which has received
hundreds of thousands of dollars from the county to do training.
Some of the
expenses that may appear questionable are indeed related to emergency
preparedness, Rottman and others said. Tchotchkes, for instance, have
the health department's contact information or web address, so they
could be useful in an emergency.
Other experts say
the federal government is inviting problems by parceling out huge
amounts exclusively for emergency preparedness and not for general
public health infrastructure — in financially strapped Los Angeles
County and elsewhere.
"Rather than
building public health infrastructure in general, you sort of end up
with this gap that you need to backfill," said Beth Maldin, an associate
at the Center for Biosecurity of the University of Pittsburgh Medical
Center. "It's a real problem, this sort of disease du jour funding
rather than rebuilding public health infrastructure as a whole."
Dr. Tomás Aragón,
director of the Center for Infectious Disease Preparedness at the UC
Berkeley School of Public Health, said what matters overall is not
specific expenditures, but results.
"The big issue is:
Are they prepared?" Aragón said. "If something happens, you want to know
that they're going to be able to pull off a response and you're at less
risk."
