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6/21/2004

Poison Control Centers' Basic Funding Should Be Federal, IOM Says

Cheryl A. Thompson

The most effective approach to ensuring that the nation's 63 regional poison control centers do not struggle each year to stay afloat is for the federal government to pay for their core activities, an Institute of Medicine (IOM) committee recommended in late April.

For about $100 million a year, the committee stated, the federal government can ensure that all the centers

  • Manage telephone calls about poison exposure and information,
  • Prepare and respond to "all-hazards" emergency needs, especially those arising from biological or chemical terrorism,
  • Capture, analyze, and report data on poison exposures,
  • Train personnel, including specialists in and providers of poison information,
  • Perform continuous quality improvement, and
  • Integrate the centers' services into the public health system.

Services beyond the core ones should be continued, the committee stated, but with funds from sources other than the federal government.

IOM studied the long-term support of poison prevention and control services at the request of the Maternal and Child Health Bureau, part of the Health Resources and Services Administration (HRSA).

"Our philosophy was," said Andy Stergachis, the only pharmacist on the IOM committee, "if any one of the current funding sources fell short, it would be a very precarious situation for our poison centers."

Stergachis is professor of epidemiology and affiliate professor of pharmacy at the Northwest Center for Public Health Practice, University of Washington School of Public Health and Community Medicine in Seattle. He resigned from the Washington Poison Center board of directors to accept IOM's committee appointment.

"There is a societal value to the functions performed by poison control centers," Stergachis said, but that is not enough to sustain them. "There's no fewer than 30 different funding sources out there. A lot of the funding presently comes from states, and we all know the current issues with state budgets. And there are poison centers threatened every year for closure by virtue of state funds not being sufficient to fund essential services."

Oregon Health and Sciences University in Portland, for example, had planned to close its poison control center a year ago because of decreased revenue from the state and Medicaid, the Associated Press reported on June 28, 2003. A state legislator had proposed funding the Oregon Poison Center, which costs the university $1.35 million a year to run, with a portion of the 75-cent-per-month telephone-service surcharge that supports the 911 program.

But the legislation did not pass. Oregon Poison Center remains open, at least through June 2005, because a budget bill was amended to send the center $1.4 million over two years from the Criminal Fine and Assessment Public Safety Fund.

History of federal funding. The Maternal and Child Health Bureau manages the funds that Congress set aside through the Poison Control Center Enhancement and Awareness Act. Enacted in February 2000, the legislation called for $25 million in grants each year to stabilize the centers' funding structure. At that time, there were 72 centers.

Highlights of the Poison Control Center Act

The Poison Control Center Enhancement and Awareness Act Amendments of 2003 authorizes

  • $2 million annually through fiscal year 2009 for a nationwide toll-free telephone number (800-222-1222) that automatically routes calls from U.S. residents to the regional poison control center serving their area,
  • $600,000 annually through fiscal year 2005 for a media campaign to educate the public and health care providers about poisoning prevention and the availability of poisoning control resources in local communities and to advertise the nationwide toll-free number, and
  • $25 million annually through fiscal year 2004 and $27.5 million annually in fiscal years 2005–09 for grants to certified regional poison control centers to help them achieve financial stability, provide treatment recommendations for poisonings, develop standardized poisoning-prevention and -control promotion programs, develop standard patient management guidelines for commonly encountered toxic exposures, improve and expand the poisoning-control data-collection systems, improve national toxic exposure surveillance, expand the toxicological expertise in poison-control centers, and improve the capacity of poison control centers to answer high volumes of calls during times of national crisis.

Annual appropriations related to the grants have never reached $24 million. For fiscal year 2005, which starts October 1, the Bush administration has requested $23.7 million for grants to poison control centers—the same amount as for fiscal year 2004. The Poison Control Center Enhancement and Awareness Act Amendments of 2003 calls for $27.5 million annually through fiscal year 2009 (see sidebar).

This more recent act formalized an additional purpose for poison control centers: answer high volumes of calls during times of national crisis involving biological, chemical, or nuclear toxins.

Nine centers have closed since the federal government first agreed to help stabilize the funding structure.

Input sought from stakeholder groups. "ASHP is very supportive of the findings of the Institute of Medicine," said Daniel J. Cobaugh, the Society's representative to HRSA's poison control centers stakeholders' group, which has met at least annually since February 2000. "A stabilized poison control system within the United States is critical to many of the priorities of ASHP," he said, particularly patient safety.

ASHP, he said, also supports the IOM committee's recommendations for the government to have an expert panel develop a definition of poisoning for use in surveillance activities and to ask the World Health Organization to improve the International Classification of Diseases codes for poisoning. In addition, ASHP is pleased that the explanation for one recommendation calls for a subset of poison control centers, through clinical toxicology fellowships, to help prepare pharmacists for managerial positions at the centers.

Before working at ASHP, where he directs the Section of Home, Ambulatory, and Chronic Care Practitioners, Cobaugh, a board-certified toxicologist, worked at the American Association of Poison Control Centers.

ASHP is the only pharmacists organization participating in the stakeholder group, he said.

HRSA will hold a two-day "special session" for the group's representatives at the end of June, Cobaugh said. Not only will the IOM report be discussed, he said, but also the evaluation by Battelle of the poison control center grant program.

"The Battelle report is really the first structured evaluation of the HRSA grant program for poison centers, and the IOM report has sweeping recommendations to stabilize poison control services in the country," he said.

IOM recommendations. The IOM committee, in its report Forging a Poison Prevention and Control System, made 12 recommendations to HRSA.

In addition to those on funding, core activities, and terminology, the committee recommended that the Department of Health and Human Services and the states establish a poison prevention and control system in which poison control centers are integrated with public health agencies.

Stergachis explained that poisoning-prevention efforts by the centers can be more effective if they collaborate with other programs, such as those in state and local public health agencies. "There's an entire field of injury prevention and control, also funded in part from the federal government and state governments, that focuses on one of the leading causes of morbidity and mortality," he said. "And they're really not very well connected with the poison centers, and vice versa."

Other recommendations pertain to having poison control centers certified by a group that does not also serve as their professional organization. Also, the government should promote broader access to poisoning-exposure data and inform health care providers how they can obtain consultations from poison control centers without violating federal privacy regulations.

The IOM report is available at www.nap.edu/books/0309091942/html.

ASHP Executive Vice President Henri R. Manasse Jr. was one of several independent reviewers of the drafts of the report.