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Funding Cuts Could Expose States to Terrorist Attacks

Donna Young

Without federal bioterrorism-response and preparedness funds, Kentucky public health workers and hospital staff may not have had the capabilities to quickly and efficiently respond to a smallpox scare on May 19, said state Department for Public Health Commissioner Rice C. Leach.

An emergency room patient at Marymount Medical Center, an 89-bed facility in London, a small town that sits on the edge of the Daniel Boone National Forest, was suspected of having smallpox after a nurse noticed that the man—a Georgia truck driver—had unusual skin lesions and a fever of 104 °F, Leach said.

The hospital notified Leach, other public health officials, and the Centers for Disease Control and Prevention (CDC) to seek guidance.

But by 9:30 p.m., a few hours after the truck driver had entered Marymount's emergency room, CDC had determined that the patient did not have smallpox, Leach said.

Because the hospital and public health workers had held disaster drills and prepared for bioterrorism events, he said, patients, health care workers, and the general public were spared a potential widespread panic.

"This is a perfect example of how [federal grants] have got Kentucky better prepared than we were three years ago to respond in some of the smaller communities to this kind of surprise," Leach said.

But on the same day of Kentucky's smallpox scare, Department of Health and Human Services (HHS) Secretary Tommy G. Thompson wrote to the House and Senate Appropriations health care subcommittees asking to take back nearly $55 million in CDC bioterrorism-preparedness funds awarded to states and redirect it to 21 large cities and other federal programs.

Thompson plans to use $39 million of the redirected funds for HHS's Cities Readiness Initiative, a pilot program that includes training U.S. Postal Service workers to deliver emergency antiinfectives and other supplies from the Strategic National Stockpile (SNS)a national cache of drugs, vaccines, and supplies that can be deployed to areas struck by disasters, including bioterrorism.

The remaining $15.9 million in redirected funds will be used to expand CDC's quarantine station capacity and for a disease-surveillance system.

Each state is losing $1.085 million and territories are out $108,500 of CDC funds allocated by Congress for 2004.

Both chairs of the Appropriations subcommittees on health care who approved Thompson's request in early JuneSenator Arlen Specter (R-Pennsylvania) and Representative Ralph Regula (R-Ohio)have cities in their states that are gaining the redirected CDC funds.

In fact, Pennsylvania, which is receiving $1.35 million for Philadelphia and $690,000 for Pittsburgh, is gaining an extra $955,000 in reallocated funds.

California has three cities on the list to receive funds under the Cities Readiness Initiative: Los Angeles, $2.67 million; San Diego, $1.22 million; and San Francisco, $940,000.

Baltimore, Maryland, which has one of the nation's major ports of entry, was left off the list of 21 cities.

Cleveland, in Regula's state of Ohio, is receiving $770,000 from the redirected funds.

Terrorists can strike anywhere. Most states, including Kentucky, do not have cities among the 21 selected for the Cities Readiness Initiative, Leach noted.

He argued that the potential for a bioterrorism attack is just as great in a small community as a large metropolitan city.

"There are lots of ways that people who don't like us can disrupt our country," Leach said.

Terrorists could set off hoaxes in large cities to cause a panic, while simultaneously targeting small, unprotected communities with a real bioterrorism attack, he warned.

"The whole point of terrorism is to scare the daylights out of people and create dysfunction in society," he said.

Preparedness is vital for all. Critical programs crucial to protecting Americans are vulnerable at all levelsnational, state, and local, said Shelley A. Hearne, executive director of Trust for America's Health, a nonprofit, nonpartisan organization.

"While we can't be sure when or how a terrorist may strike, we do know that by shifting money around rather than properly investing in strong bioterror defense across the board, we are leaving huge areas unprotected and vulnerable," she asserted in a statement.

The states with the smallest populations, including Wyoming, Idaho, Vermont, West Virginia, Iowa, and Alaska, will be hurt the most by the loss of the CDC funds because the $1.085 million is being redirected from the $5 million base portion of each state's CDC grant awarded for 2004 and not from the additional population-based portion of the grants.

Jim McCameron, Wyoming's bioterrorism program manager, said his state is losing about 18% of its total CDC bioterrorism grant.

Because of the cut in CDC funding, he said, Wyoming might be unable to fill vital bioterrorism-preparedness-program jobs, including nine vacant all-hazards response coordinator positions.

"We're not fully staffed now," he said.

One unfilled pharmacist job that McCameron expects to be fully funded is the state's SNS coordinator position.

Even though Wyoming has fewer than 500,000 residents, McCameron noted, it is home to two of the nation's most popular tourist destinationsGrand Teton and Yellowstone National Parks, which could be targeted by terrorists.

Kimberly Fetty, public information officer for West Virginia's Division of Threat Preparedness, said that while her state is uncertain of the full impact from the loss of CDC funds, officials are concerned that the ability of the state to prepare for a bioterrorism event or public health emergency could be severely limited.

"Specifically, we will be unable to develop our new lab facilities for testing of biological and chemical agents," she said. "We will be unable to maintain the level of technology we have achieved in our developing threat-preparedness capabilities across our counties and regions."

While the federal government has increased its demands for states to be prepared for a bioterrorism attack, Fetty added, "they are decreasing funding."

Steve Marshall, director of Wisconsin's Public Health Preparedness Program, said that the loss of the CDC funds could cause his state to slash some bioterrorism-preparedness programs, filled and future jobs, staff training, and planned purchases of equipment.

"We're currently trying to figure out exactly what will have to be cut," he said.

Helene Nelson, secretary of Wisconsin's Department of Health and Family Services, warned in a May 26 letter to Wisconsin Representative David R. Obey (D) that without the full appropriated CDC funding, it would be impossible to completely maintain statewide disease surveillance systems and training programs.

"Although additional funding would be welcomed to further prepare our country's most populated cities, this funding should not come at the expense of programs already in place," she declared.

HHS's decision to redirect CDC funds will force many states to postpone or discontinue some bioterrorism-preparedness programs, said Paula A. Steib, spokesperson for the Association of State and Territorial Health Officials (ASTHO).

ASTHO Executive Director George E. Hardy Jr, in a May 21 statement, contended that if HHS's Cities Readiness Initiative is worthy of implementation, "it should be worthy of new funding."

On the bright side. Although states are losing CDC funds for bioterrorism preparedness, HHS announced on May 24 the availability of $498 million in Health Resources and Services Administration (HRSA) grants for states, territories, and four metropolitan communities to strengthen the ability of hospitals and other health care facilities to respond to bioterrorism attacks, outbreaks of infectious diseases, and natural disasters.

Gladys H. Cornn, Marymount's infection control director, said that her hospital was well prepared to handle the suspected smallpox case because of HRSA grants awarded in 2002 and 2003, which helped the hospital provide training, equipment, and other resources.

To help develop and maintain its plan for HRSA funding and for dispersing funds to the state's more than 120 hospitals, Kentucky contracted with its state hospital association, Leach said.

The state is scheduled to receive $7.15 million in HRSA funding for 2004.

HRSA funds are not automatically awarded to states and hospitals, Cornn noted.

"It wasn't just given to us; we had to show progress and work extensively with the state on upgrading our plans," she said. "It's not just like, well, here's this money; go do what you want to with it. You really have to show progress, and we do. We have a passion for improving the quality of health care in this region."

Merit A. Thomas, Wyoming's HRSA bioterrorism hospital preparedness coordinator, said that her state has 25 hospitals that range in size from less than 25 to about 200 beds.

Because the state's hospitals are spread out among several large, rural counties, and the 75 ambulance services in Wyoming are "90%" staffed with volunteers, the state is using some of the HRSA funds as incentives for ambulance services to complete transfer agreements with hospitals in neighboring counties, she said.

Each ambulance service that completes transfer agreements is awarded $5000, Thomas said.

One project Thomas has planned for the HRSA funds is to survey hospital pharmacies about existing and needed emergency pharmaceutical caches and space availability for storing medications and supplies.

With the HRSA funding, Wyoming was able to purchase protective equipment and decontamination tents for hospitals last year, and Thomas plans to use grant money this year to provide the equipment to emergency medical services and other first responders.

The state is also using HRSA dollars for training mental health agency workers in emergency preparedness, she noted.

Mental health workers, Thomas said, are frequently the first people called to respond during disasters or other crises, and their training in emergency skills is often overlooked.

Wyoming, which does not have a burn care center, is also using HRSA funds for training hospital staff in burn care, Thomas added.

The state is scheduled to receive $1.74 million in HRSA funding for 2004.

Without the HRSA grants, said Dennis J. Tomczyk, Wisconsin's director of hospital bioterrorism preparedness, hospitals, which are often "strapped for funds," would have little ability to invest in emergency preparedness.

John Carter, Iowa's hospital bioterrorism coordinator, said that while hospitals are critical to a community's disaster response, emergency preparedness often takes a "back burner" to other health-system activities that must be addressed, including Medicare reimbursement, Health Insurance Portability and Accountability Act education, and activities associated with the Emergency Medical Treatment and Active Labor Act.

"With the limited staff and funding available, choices must be made," he said.

But the HRSA funding, Carter declared, has allowed hospitals to better prepare for disasters.

"Stable funding is a must for a strong threat-preparedness program," said West Virginia's Fetty.