2005 Gulf Coast Hurricanes: The Public Health and Medical Response

Congressional research reportJan 20, 2006

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Order Code RL33096

CRS Report for Congress

Received through the CRS Web

2005 Gulf Coast Hurricanes:

The Public Health and Medical Response

Updated January 20, 2006

name redacted

Specialist in Public Health and Epidemiology

Domestic Social Policy Division

Congressional Research Service ˜ The Library of Congress

2005 Gulf Coast Hurricanes:

The Public Health and Medical Response

Summary

Hurricane Katrina struck the Gulf Coast in late August 2005, causing

catastrophic wind damage and flooding in several states, and a massive dislocation

of victims across the country. The storm was one of the worst natural disasters in the

nation’s history. Estimates are that more than 1,200 people were killed and about 2

million displaced. Hurricane Rita, which made landfall along the Gulf Coast in late

September 2005, was ultimately less lethal than Katrina, but prompted aggressive

preparedness efforts by governments and citizens shaken by the devastation of the

earlier storm.

In response to a series of disasters and terrorist attacks over the past decade, in

particular the terror attacks of 2001, Congress, the Administration, state and local

governments and the private sector have made investments to improve disaster

preparedness and response. New federal authorities and programs to strengthen the

nation’s public health system were introduced in comprehensive legislation in 2002.

Congress also created the Department of Homeland Security (DHS) in 2002 to

provide national leadership for coordinated preparedness and response planning. A

new National Response Plan (NRP), launched by DHS in December 2004, met its

first major test in the response to Hurricane Katrina.

According to the NRP, the Department of Health and Human Services (HHS)

is tasked with coordinating the response of the public health and medical sectors

following a disaster. HHS works with several other agencies to accomplish this

mission, which includes assuring the safety of food, water and environments, treating

the ranks of the ill and injured, and identifying the dead. HHS activities are

coordinated with those of other lead agencies under the overall leadership of DHS.

Congress and others will review the response to Hurricanes Katrina and Rita

with an eye toward assessing how well the NRP worked as an instrument for

coordinated national response, and how well various agencies at the federal, state and

local levels carried out their missions under the plan. Hurricane Katrina dealt some

familiar blows in emergency response. The failure of communication systems, and

subsequent difficulties in coordination, challenged response efforts in this disaster

as with others before it. Hurricane Katrina also pushed some response elements,

such as surge capacity in the healthcare workforce, to their limits. The response to

Hurricane Katrina has also called attention to the matter of disaster planning in

healthcare facilities, and the potential role of health information technology in

expediting the care of displaced persons. Policymakers will no doubt study these

elements of the Katrina response and seek options for continued improvement in

national disaster preparedness and response.

This report discusses the NRP and its components for public health and medical

response, provides information on key response activities carried out by agencies in

HHS and DHS, and discusses certain issues in public health and medical

preparedness that have been raised by the response to the 2005 Gulf Coast hurricanes.

This report will be updated as circumstances warrant.

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Federal Authorities and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

The Stafford Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

The National Response Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Declarations of Public Health Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . 5

The Public Health Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Public Health Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Selected HHS Agency Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

HHS Office of the Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Agency for Toxic Substances and Disease Registry . . . . . . . . . . . . . . . 9

Centers for Disease Control and Prevention . . . . . . . . . . . . . . . . . . . . . 9

Food and Drug Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

The Medical Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Medical and Healthcare Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Selected HHS Agency Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Centers for Medicare and Medicaid Services . . . . . . . . . . . . . . . . . . . 12

Health Resources and Services Administration . . . . . . . . . . . . . . . . . . 12

National Institutes of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Substance Abuse and Mental Health Services Administration . . . . . . 13

Department of Homeland Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

National Disaster Medical System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Department of Defense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Department of Veterans Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Issues for Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

All-Hazards Preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Coordinated Needs Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Disaster Planning in Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Regulation of Institutions and Services . . . . . . . . . . . . . . . . . . . . . . . . 20

Community-based Disaster Planning . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Promising Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Options for Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

National Disaster Medical System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Volunteer Health Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Health Information Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Additional CRS Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

2005 Gulf Coast Hurricanes:

The Public Health and Medical Response

Introduction

Hurricane Katrina struck the Gulf Coast in late August 2005, causing extensive

wind damage and catastrophic flooding, and leading to Presidential disaster

declarations for Alabama, Florida, Louisiana and Mississippi. The storm was one of

the worst natural disasters in the nation’s history. Hurricane Rita, which made

landfall along the Gulf Coast in late September 2005, was somewhat less severe than

Katrina when it hit. But a few days earlier in the Gulf it had been a powerful

category five hurricane. Government officials and citizens shaken by the devastation

of the earlier storm mounted aggressive preparedness efforts in anticipation of

Hurricane Rita, drawing on lessons learned from Katrina just weeks earlier.

Hurricane Katrina is estimated to have killed more than 1,200 people, and

displaced about 2 million. The death toll continues to be revised, as bodies continue

to be found, and investigations into the causes of death of others continue.1 More

than 4,000 persons are still reported missing. The Federal Emergency Management

Agency (FEMA) recently increased its estimate of the number of persons displaced

by Hurricanes Katrina and Rita to about 2 million.2

The logistical hurdles posed by Hurricane Katrina were formidable.

Communications were knocked out in hard-hit areas, which compromised the process

of assessing and prioritizing needs. Physical access was blocked in some areas, and

civil disorder was a problem in some others. Each kept responders from delivering

aid. In some cases, victims were isolated without water and medicines, and hospitals

that had not been evacuated before the hurricane were unable to sustain operations.

Each circumstance required the emergency evacuation of critically ill patients to a

triage center, which then itself became overwhelmed. Federal, state, and local

governments, businesses and corporations, the faith community and other volunteers

all pitched in to speed relief to Katrina’s victims, but keeping all of it coordinated

was a challenge.

Responding to a catastrophe of the scope of Hurricane Katrina requires that a

variety of public health and medical activities be carried out and coordinated. Public

health activities are those that identify, address or prevent health problems in

National Oceanic and Atmospheric Administration, National Weather Service, National

Hurricane Center, “ Tropical Cyclone Report, Hurricane Katrina,” Dec. 20, 2005, p. 10 ff.,

at [http://www.nhc.noaa.gov/pdf/TCR-AL122005_Katrina.pdf].

Spencer S. Hsu, “2 Million Displaced by Storms,” Washington Post, Jan. 13, 2006

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populations. Examples include assuring the safety of food and water, preventing the

spread of disease in shelters, evaluating the safety of neighborhoods for rehabitation,

and assuring the health and safety of responders. Medical activities are those that

deliver healthcare services to individuals. Examples include treatment of injuries,

continuity of care for those with chronic illnesses, mental health counseling, and

cause-of-death investigation.

The medical response to Hurricane Katrina may have posed the greater

challenge. The public health response required the coordination of variety of

agencies, community-based organizations, and private parties at different levels of

government, though these entities had generally worked together in the past. The

medical response, in contrast, required the coordination of a broader mix of federal,

state and local government agencies, private parties and others, with no comparable

recent precedent or experience in such an effort on this scale.

Over the past decade, in response to the Oklahoma City bombing, the terror

attacks of 2001 and several serious natural disasters, Congress and the

Administration created new authorities, structures and plans to assure that

government at all levels can respond well to disasters like Hurricane Katrina. Local

and state governments are to be the first responders in a disaster. When their

resources are overwhelmed, federal assistance is provided under the Robert T.

Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act) and other

authorities. A new National Response Plan (NRP) places the Secretary of Homeland

Security in charge of coordinating the overall federal response. The Secretary of

Health and Human Services (HHS) is in charge of coordinating the federal public

health and medical response during a disaster.

In the wake of Hurricanes Katrina and Rita, Congress is likely to review

response efforts, recent public health preparedness laws and the NRP. While even

the best plan and response may be overwhelmed in a disaster of the scope of

Hurricane Katrina, Congress may nonetheless find opportunities to revisit

management structures, programs and goals in order that national response capability

can be steadily improved.

This report will discuss relevant authorities and response plans that guided the

public health and medical response to the 2005 hurricanes. Given its catastrophic

scope, the response to Hurricane Katrina will be the primary focus of this report, with

reference to the Hurricane Rita response when relevant. The roles and response

activities of selected agencies in HHS and DHS will be discussed. Finally, a number

of policy issues will be discussed. This report will be updated as circumstances

warrant. For a broader discussion of all-hazards public health and medical

preparedness, see CRS Report RL31719, An Overview of the U.S. Public Health

System in the Context of Emergency Preparedness.

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Federal Authorities and Responsibilities

The Stafford Act

The Stafford Act authorizes the President to issue major disaster and emergency

declarations, whereupon federal agencies are authorized to provide assistance to

affected states.3 Through executive orders, the President has delegated to the Federal

Emergency Management Agency (FEMA), within DHS, responsibility for

administering the major provisions of the Stafford Act. In calendar year 2005,

President Bush issued 48 major disaster declarations, including those for Alabama,

Florida, Louisiana, and Mississippi for Hurricane Katrina, and for Texas and

Louisiana for Hurricane Rita.4

Activities undertaken under authority of the Stafford Act are provided through

funds appropriated to the Disaster Relief Fund (DRF). Federal assistance supported

by DRF money is used by states, localities, and certain non-profit organizations to

provide mass feeding and shelter, restore damaged or destroyed facilities, clear

debris, and aid individuals and families with uninsured needs, among other activities.

Federal agencies that receive mission assignments from DHS and provide assistance

pursuant to the NRP are also reimbursed through funds appropriated to the DRF. In

addition to the FEMA assistance authorized by the Stafford Act, a wide range of aid

is provided by other federal agencies under their general statutory authority.

The National Response Plan

The National Response Plan (NRP) is the framework under which federal and

voluntary agencies are instructed to operate when a disaster occurs.5 The NRP was

released by DHS in December 2004, replacing the previous Federal Response Plan.

The NRP is an administrative plan and does not establish new federal authorities. In

general, federal responsibilities in the plan are intended to assist state and local

authorities, not to replace them.

According to the NRP, which is under the overall coordination of the Secretary

of Homeland Security, the Secretary of HHS is tasked with Emergency Support

Function (ESF) #8, the coordination of public health and medical services, as laid out

in the plan’s ESF#8 annex.6 HHS is responsible for coordinating the following

42 U.S.C. §5121 et seq, available at [http://www.fema.gov/library/stafact.shtm]. Also see

CRS Report RL33053, Federal Stafford Act Disaster Assistance: Presidential Declarations,

Eligible Activities, and Funding, by (name redacted).

For a list of federal disaster declarations, see [http://www.fema.gov/news/disasters.fema].

See CRS Report RL32803, The National Preparedness System: Issues in the 109th

Congress, by (name redacted).

Department of Homeland Security, National Response Plan, Dec. 2004, (hereafter called

the NRP), Annex ESF#8, at [http://www.dhs.gov/interweb/assetlibrary/NRP_FullText.pdf].

See also HHS, “HHS Maintains Lead Federal Role for Emergency Public Health and

Medical Response,” press release, Jan. 6, 2005.

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activities under ESF#8, and may request assistance from 14 designated support

agencies and the American Red Cross as needed:

Assessment of public health and medical needs;

Health surveillance;

Medical care personnel;

Health and medical equipment and supplies;

Patient evacuation;

Patient care;

Safety and security of human drugs, biologics, and medical devices,

veterinary drugs, and other HHS-regulated products;

Blood and blood products;

Food safety and security;

Agriculture safety and security (principally with regard to foodproducing animals and animal feeds and drugs);

Worker health and safety;

All-hazard public health and medical consultation, technical

assistance and support;

Behavioral health care;

Public health and medical information;

Vector control (e.g., control of disease-carrying insects and rodents);

Potable water, wastewater and solid waste disposal;

Victim identification and mortuary services; and

Protection of animal health (principally with regard to HHSregulated animal feeds and drugs).

The HHS Concept of Operations Plan (CONOPS) for Public Health and

Medical Emergencies outlines how HHS plans to implements its emergency

preparedness and response authorities and establishes the department’s policies for

emergency preparedness and response.7 The CONOPS plan designates the Secretary

of HHS as the official responsible for the overall response to public health

emergencies. The Assistant Secretary for Public Health Emergency Preparedness

(ASPHEP) is to act on behalf of the Secretary to direct and coordinate the

department’s efforts, including on-scene operations and liaison with the DHS and

other federal agencies. The plan lays out additional responsibilities of HHS offices

and agencies during an emergency.8

HHS does not bear primary responsibility for mass care, which is the

coordination of non-medical services such as shelter, feeding, emergency first aid,

and efforts to reunite displaced family members. Mass care is the responsibility of

DHS and is carried out by FEMA and the American Red Cross according to ESF#6.

HHS is also not responsible for urban search and rescue, which is also the

HHS, “Concept of Operations Plan (CONOPS) for Public Health and Medical

Emergencies,” Mar. 2004, at [http://www.hhs.gov/nvpo/pandemicplan/hhs_conops.pdf].

For more information, see [http://www.hhs.gov/ophep/index.html]. The role of the

ASPHEP is further explained in HHS, “Office of Public Health Emergency Preparedness

Statement of Organization, Functions, and Delegations of Authority,” 70 Federal Register

5183, Feb. 1, 2005.

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responsibility of DHS and FEMA pursuant to ESF#9. Furthermore, HHS may

depend on numerous other agencies to carry out certain of their ESF activities (e.g.,

public safety, road clearing and power restoration) before some ESF#8 activities can

commence.

Many of HHS’s responsibilities under ESF#8 are within the department’s

primary control. An important exception is the National Disaster Medical System

(NDMS), which comprises teams of medical professionals who are pretrained to

deploy and provide medical services in the immediate aftermath of a disaster before

other federal assets arrive. NDMS, which previously operated under the Public

Health Service in HHS, was transferred to DHS in the Homeland Security Act of

2002 (P.L. 107-296), and now operates under FEMA. NDMS will be discussed in

greater depth in subsequent sections of this report. Certain other critical components

of the medical response are housed in the Departments of Defense and Veterans

Affairs, and the private sector.

Declarations of Public Health Emergencies

Absent an emergency, most public health authority, such as mandatory disease

reporting, licensing of healthcare providers and facilities, and quarantine authority,

rests with states as an exercise of their police powers. Most states have considerable

powers in responding to public health events, and most can also declare public health

emergencies to expand their powers further when needed.9 The federal role is largely

assistive through the provision of funding, additional personnel, and specialized

services such as laboratory testing and surveillance. This model does not change

substantially in emergencies, though there are statutory provisions for some specific

emergency expansions of federal public health authority.

Section 319 of the Public Health Service Act provides broad authority for the

Secretary of HHS to declare a public health emergency at the federal level.

Following the 2001 terror attacks, Congress updated this authority in the Public

Health Security and Bioterrorism Preparedness and Response Act of 2002 (P.L. 107188). One provision in the bioterrorism act allows the Secretary, during a public

health emergency, to waive certain requirements for provider participation in serving

individuals enrolled in Medicare, Medicaid and the State Children’s Health Insurance

Program (SCHIP.)10 Otherwise, the statutory authority for a federal declaration of a

public health emergency rests in broad language, as follows:

If the Secretary determines, after consultation with such public health officials

as may be necessary, that —

A listing of legal authorities invoked by Hurricane Katrina-affected states is provided by

the American Health Lawyers Association at

[http://www.healthlawyers.org/Content/NavigationMenu/News_Center/Disaster_Relief_

Resources.htm]. For a discussion of the exercise of federal and state authorities in response

to recent shortages of influenza vaccine, see CRS Report RL32655, Influenza Vaccine

Shortages and Implications, by (name redacted).

42 U.S.C. §1320b-5. This waiver authority also requires a concurrent Presidential

declaration of a major disaster or emergency pursuant to the Stafford Act.

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(1) a disease or disorder presents a public health emergency; or

(2) a public health emergency, including significant outbreaks of infectious

diseases or bioterrorist attacks, otherwise exists,

the Secretary may take such action as may be appropriate to respond to the public

health emergency, including making grants, providing awards for expenses, and

entering into contracts and conducting and supporting investigations into the

cause, treatment, or prevention of a disease or disorder as described in

paragraphs (1) and (2).11

The declaration expires upon the Secretary’s determination that an emergency no

longer exists, or in 90 days, whichever comes first, but is renewable upon the

Secretary’s finding that an emergency persists.

In response to Hurricane Katrina, the HHS Secretary Michael Leavitt declared

public health emergencies in Alabama, Florida, Louisiana and Mississippi on August

31, 2005, two days after the storm made landfall along the Gulf Coast. On

September 4, as thousands of evacuees from the devastated city of New Orleans

began arriving in Texas, the Secretary declared a public health emergency in that host

state. The additional host states of Arkansas, Colorado, Georgia, North Carolina,

Oklahoma, Tennessee, West Virginia, and Utah were declared by the Secretary on

September 7. On December 31, HHS Secretary Leavitt renewed the determinations

of public health emergency for all Katrina-affected states through January 31, 2006.12

On September 23, in anticipation of Hurricane Rita’s landfall the following day, the

Secretary declared public health emergencies in Texas and Louisiana. These

declarations have since expired.13 Prior to Hurricane Katrina, the only recent incident

for which a federal public health emergency had been declared was the terror attack

of September 11, 2001. That declaration applied to all states.

There is no additional statute or regulation that clarifies this authority with

regard to stipulating thresholds or conditions of the determination. The decision to

declare emergencies in certain host states in response to Hurricane Katrina, but not

in all states, appears to be an exercise of the Secretary’s discretion. There is also no

precedent for this authority to be used to supercede or assume public health

authorities that are generally reserved to states, though the Secretary does have

specific emergency authorities elsewhere in statute, such as the authority to impose

domestic quarantine restrictions when warranted.14

42 U.S.C. §247d.

HHS public health emergency declarations in response to Hurricane Katrina are found at

[http://www.hhs.gov/katrina/emergency.html].

HHS public health emergency declarations in response to Hurricane Rita are found at

[http://www.hhs.gov/emergency/ritadeclaration.html].

A listing of HHS emergency authorities is found in Table 2 of CRS Report RL33064,

Organization and Mission of the Emergency Preparedness and Response Directorate:

Issues and Options for the 109th Congress, by (name redacted). See also CRS Report RL33201,

Federal and State Quarantine and Isolation Authority, by (name redacted) and

(name redacted).

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The Public Health Response

Overview

Federal leadership for public health emergency response rests with the Secretary

of HHS, with important responsibilities in the Office of Public Health Emergency

Preparedness (OPHEP) and the Centers for Disease Control and Prevention (CDC).

Much of the support provided by HHS to affected states and communities could

normally be provided in the absence of federal or state declarations of public health

emergencies or disasters, through assistance mechanisms that are used regularly in

response to public health threats such as outbreaks of foodborne disease. Because

there has been a presidentially-declared disaster and HHS has received mission

assignments from DHS in the wake of Hurricanes Katrina and Rita, the costs of HHS

response activities will generally be reimbursed through the DRF administered by

FEMA.15

Given the scope of the public health disaster caused by Hurricane Katrina,

virtually all agencies and offices in HHS were engaged in the response.16 Key public

health challenges and response efforts are described below. A number of HHS

agencies have medical response roles as well, which are discussed in a subsequent

section.

Public Health Challenges

Many of the public health challenges posed by Hurricane Katrina were familiar

and anticipated, based on experience with other hurricanes and floods. Flooding

compromises the safety of water supplies and the integrity of sewage disposal,

leading to threats of food and waterborne illness. Power line damage and power

outages increase the risk of foodborne illness and electrocution. Hurricane wind

damage may cause primary traumatic injury, while also setting the stage for

subsequent chain saw injuries, punctures, and other wounds. Bites from dogs,

venomous snakes, and insects are also seen. Hurricanes and floods also carry in their

wake some predictable causes of death, including drowning, automobile crashes,

carbon monoxide poisoning, and chronic conditions exacerbated by the loss of access

to the healthcare system. 17

For more information, see CRS Report RL33053, Federal Stafford Act Disaster

Assistance: Presidential Declarations, Eligible Activities, and Funding, by (name redacted).

For more information on specific agency activities see HHS, “What HHS Agencies Are

Doing,” at [http://www.hhs.gov/katrina/hhsagencies.html].

CDC has prepared a list of public health reports on several recent floods, hurricanes, and

the 2004 Asian tsunami at [http://www.bt.cdc.gov/disasters/hurricanes/mmwr.asp].

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CDC notes that before 1990, the majority of hurricane-related deaths in the

United States resulted from drowning caused by storm surges.18 With more attention

to early warning and evacuation since then, indirect causes of death such as

electrocution, carbon monoxide poisoning and injury associated with cleanup have

predominated. But despite warnings of the advancing storm, the majority of deaths

from Hurricane Katrina resulted from coastal storm surges and from flooding in New

Orleans.

The catastrophic scope of Hurricane Katrina presented some unusual public

health threats. News reports suggested that deaths may have resulted from

dehydration and heat stress, especially in situations in which fresh water was scarce

and where victims were crowded into poorly ventilated areas, especially where they

had pre-existing medical conditions. There were also reports of homicide, suicide

and euthanasia.

Selected HHS Agency Actions

HHS Office of the Secretary. The HHS Office of the Secretary is the point

of coordination for all ESF#8 public health and medical support functions under the

NRP. HHS set up a website cataloging departmental and agency actions and other

information regarding Hurricanes Katrina and Rita.19 As noted above, the HHS

Secretary declared federal public health emergencies in several states. The Office of

the Surgeon General and the OPHEP sought to identify and mobilize healthcare

professionals and relief personnel to assist in relief efforts. In addition, more than

2,000 Commissioned Corps officers were deployed to the Gulf region before, during,

and after Hurricanes Katrina and Rita, to assist in a number of public health and

medical activities.20

One immediate element of HHS response was the activation of Emergency

Operations Centers (EOCs) at HHS headquarters in Washington, DC and at

numerous HHS agencies. When activated, the EOCs are staffed round-the-clock, are

electronically connected with each other, and are also connected with the Homeland

Security Operations Center (HSOC) at DHS, which in turn receives inputs from other

Cabinet departments. This system of continuous communication and coordination

is an example of the changes that have been made in national public health response

capability in the aftermath of the September 11 and anthrax attacks of 2001, though

there is still work to be done in assuring that all relevant state agencies have

continuous EOC communication with those at the federal level.21

CDC, “Public Health Response to Hurricanes Katrina and Rita — Louisiana, 2005,”

MMWR, vol. 55(2), pp. 29-30, Jan. 20, 2006.

See [http://www.hhs.gov/emergency/hurricane.html].

HHS, “New Initiative Announced to Transform the U.S. Public Health Service

Commissioned Corps,” press release, Jan. 18, 2006.

A listing of federal coordinating mechanisms in emergencies is found in Table 3 in CRS

Report RL33064, Organization and Mission of the Emergency Preparedness and Response

Directorate: Issues and Options for the 109th Congress, by (name redacted).

CRS-9

Agency for Toxic Substances and Disease Registry. The Agency for

Toxic Substances and Disease Registry (ATSDR), which is administratively under

the Centers for Disease Control and Prevention (CDC), is directed by congressional

mandate to perform specific functions concerning the effect on public health of

exposure to hazardous substances in the environment.22 These functions include

public health assessments of hazardous waste sites, health consultations concerning

specific hazardous substances, health surveillance and registries, response to

emergency releases of hazardous substances, applied research in support of public

health assessments, information development and dissemination, and education and

training concerning hazardous substances. ATSDR has conducted health hazard

assessments following a large oil spill in St. Bernard Parish, LA, that resulted from

Hurricane Katrina.23

Centers for Disease Control and Prevention. The CDC launched a

website to provide public health information in the aftermath of Hurricane Katrina.24

The site includes a variety of fact sheets and other information for health

professionals, response and cleanup workers, evacuation center staff, school officials,

state grantees and the general public. In addition, the site provided regular updates

from the CDC Director’s EOC through October 7.25 Once activated, the EOC was

the point of contact for state health departments, other CDC grantees, and other

interested parties to request assistance or to provide the agency with new or updated

information about public health concerns on the ground.

CDC deployed several hundred of its staff to affected states, including

individuals in the following specialties: medicine, epidemiology, sanitation,

environmental health, assessment, disease surveillance, public information and health

risk communication. In addition, the agency deployed more than 600 staff to its EOC

response. The agency also deployed the Strategic National Stockpile of drugs and

medical supplies to affected states. Among the specific supplies delivered for this

disaster were: 1) many thousands of doses of vaccines for tetanus/diphtheria, and

hepatitis A and B; 2) vials of insulin; 3) prescription pain medications; and 4)

ventilator kits.

The agency also made numerous public health recommendations to address the

anticipated and atypical threats posed by Hurricane Katrina and its aftermath. CDC

made several specific recommendations for infectious disease control, including the

immunization of emergency responders, relief workers and evacuees. The agency

expressed particular concern about the risks of tetanus from wounds, and of

ATSDR is required to conduct various activities under the Comprehensive Environmental

Response, Compensation, and Liability Act of 1980 (CERCLA or “Superfund”) and

subsequent amendments, and the Resource Conservation and Recovery Act of 1976. See

[http://www.atsdr.cdc.gov/congress.html] and CRS Report RL31154, Superfund: A

Summary of the Law, by (name redacted).

See ATSDR, “Health Consultation: Murphy Oil Spill,” Dec. 9, 2005, at

[http://www.bt.cdc.gov/disasters/hurricanes/].

See [http://www.bt.cdc.gov/disasters/hurricanes/index.asp].

See [http://www.cdc.gov/od/katrina/].

CRS-10

influenza, measles, chickenpox and hepatitis A in crowded conditions, especially if

some children may not have had current immunizations.26 CDC also alerted health

officials and others to cases of Vibrio infection in hurricane victims, which caused

22 illnesses, five of them fatal.27 Vibrio, a bacterial pathogen found in salty and

brackish waters, can cause foodborne illness or severe wound infection. CDC made

an effort to alert health workers to this unusual hazard because Vibrio infections are

especially severe, leading to loss of an affected limb or death within a matter of days,

sometimes despite aggressive treatment.

On September 17, CDC and the Environmental Protection Agency (EPA) issued

a joint report of their initial assessment of environmental health and infrastructure

hazards in New Orleans, to assist state and local officials in planning for

reoccupation of the city.28 FEMA requested CDC assistance in evaluating any

potential health effects of housing displaced persons in trailers sited on former

agricultural fields. The agency has also evaluated the potential health threat posed

by exposure to mold,29 and provided assistance in the federal environmental cleanup

effort.30

Responders may be at increased risk from certain hazards in the aftermath of

disasters. CDC’s National Institute for Occupational Safety and Health (NIOSH)

developed resources for occupational safety and health for responders, and in

hospitals, health departments, and shelters involved in the response to Hurricane

Katrina.31

Food and Drug Administration. In the aftermath of Hurricane Katrina, the

Food and Drug Administration (FDA) issued numerous recommendations regarding

the handling of drugs, biologics and medical devices that may have been harmed by

exposure to floodwaters or loss of refrigeration. The agency also issued guidance in

ensuring the safety of food, and participated in evaluations of the safety of fish and

shellfish in affected Gulf Coast waters.32

See CDC, “Immunization Information for Hurricane

[http://www.bt.cdc.gov/disasters/hurricanes/immunizations.asp].

Katrina,”

CDC, “Vibrio Illnesses After Hurricane Katrina — Multiple States, August-September

2005,” MMWR, vol. 54/(37), p. 928-931, Sept. 23, 2005.

CDC and EPA, “Hurricane Katrina: Environmental Health Needs & Habitability

Assessment,” Sept. 17, 2005, at

[http://www.bt.cdc.gov/disasters/hurricanes/katrina/envassessment.asp].

See CDC, “Environmental Concerns after Hurricane

[http://www.bt.cdc.gov/disasters/hurricanes/environmental.asp].

Katrina,”

See CRS Report RL33115, Cleanup after Hurricane Katrina: Environmental

Considerations, by (name redacted), Linda Jo Schierow, (name redacted), and (name

redacted).

See CDC NIOSH, [http://www.cdc.gov/niosh/topics/flood/#new].

See [http://www.fda.gov/oc/opacom/hottopics/hurricane.html].

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The Medical Response

Overview

The medical response to a disaster may be more challenging than the public

health response. Most public health activities are inherently governmental and

involve agencies that work together regularly, though often at different levels of

government. Medical response capabilities, in contrast, span a wide array of sectors,

both public and private, and involve more non-traditional partnerings such as the

coordination of DHS and Department of Defense (DOD) activities by HHS. A

successful medical response to a disaster requires the coordination of six elements:

patients in need; a site where care is provided; the needed drugs, supplies and

equipment; a provider workforce; a system of record keeping; and a financing

mechanism.

Though national disaster planning has long anticipated the need to respond to

a mass casualty incident, such a situation, with overwhelming numbers of non-fatal

illness and injury victims, has not happened recently in the United States. While

certain recent events (e.g., the September 11, 2001 attack and some jetliner crashes)

have tested the national system for mass fatality management, Hurricane Katrina is

the only event in recent times that has caused non-fatal mass casualties of a scope

that could not easily be absorbed into the existing healthcare system. Scrutiny of the

response to this challenge is ongoing.

As discussed earlier, federal leadership for medical emergency response is based

in HHS per its coordinating responsibility under NRP ESF#8. Numerous medical

response programs and activities reside in HHS agencies within the Public Health

Service (PHS). In addition, the Commissioned Corps of the PHS, headed by the

Surgeon General, is composed of many healthcare professionals who are expected

to maintain current skills and deploy to support emergency responses when needed.33

Another critical medical response asset, the National Disaster Medical System

(NDMS) was transferred from HHS to DHS in March 2003. Additional critical

assets such as personnel, bed capacity, equipment and patient transport capability are

based in the Departments of Defense and Veterans Affairs, as well as the private

sector.

Medical and Healthcare Challenges

Hurricane Katrina posed a number of challenges to the healthcare system, many

without recent precedent. Physical access to healthcare facilities was hampered

across the Gulf Coast following the storm, and many facilities sustained primary

damage. Several facilities that did not evacuate prior to the storm found their

patients in dire circumstances when rising floodwaters made it progressively more

difficult to maintain standards of care. Individuals with pre-existing health

conditions worsened as they were cut off from access to essential medications and

See the HHS Office of the Surgeon General at [http://www.surgeongeneral.gov/] and the

U.S. Public Health Service Office of Force Readiness and Deployment at

[http://oep.osophs.dhhs.gov/ccrf/].

CRS-12

treatments such as oxygen, insulin, or kidney dialysis. In some flooded areas, access

to fresh water was so scarce that victims and their caregivers suffered from

dehydration. In the wake of large-scale evacuations of New Orleans beginning on

September 1, victims from shelters and from failing healthcare facilities were

evacuated to a temporary field hospital at the New Orleans airport, where medical

response teams, initially overwhelmed, conducted triage and prioritized victims for

airlift to available healthcare facilities outside the flood zone. Meanwhile, medical

workers continued their efforts to reach numerous isolated communities along the

Mississippi and Louisiana coast. Morgues were set up in Louisiana and Mississippi

to house and identify the dead.

In the wake of the catastrophe, victims were sent for treatment to numerous

permanent and temporary healthcare facilities across a wide area of the south central

United States, often becoming separated from their loved ones and important

medications and medical records along the way. Public health emergencies were

declared in nine states that did not suffer primary impacts from Hurricane Katrina but

that became hosts to large numbers of evacuees needing care. Healthcare facilities

sought assistance in covering the costs of care for those who were previously or

newly uninsured.

The short-and long-term mental health needs of victims and responders had to

be assessed. Immediate problems such as Post-Traumatic Stress Disorder receive

considerable popular attention, but some evidence shows that victims of catastrophic

disasters may continue to suffer from major depression and other disorders for

several years. Mental health services following disasters must also account for preexisting mental health and substance abuse problems in some victims.

Selected HHS Agency Actions

Centers for Medicare and Medicaid Services. The Centers for Medicare

and Medicaid Services (CMS), which administers the Medicare, Medicaid and

SCHIP programs, took several actions to streamline access to healthcare for those

displaced by Hurricanes Katrina and Rita. Many evacuees crossed state lines without

proper documentation of program eligibility. HHS Secretary Leavitt exercised

certain authorities under Sections 1115 and 1135 of the Social Security Act and

waived several program requirements, in order to assist displaced victims and their

providers.34

Health Resources and Services Administration. The Health Resources

and Services Administration (HRSA) provides grants to Federally Qualified Health

Centers, Ryan White HIV/AIDS outpatient providers and some other providers and

clinics that offer health services to underserved populations. HRSA administers

several relevant programs in emergency preparedness. One is a grant program for

state and local hospital preparedness for public health emergencies, which is meant

to help states identify and coordinate hospital bed capacity, personnel and medical

supplies in an emergency. Another is a program for the advance registration of

See CRS Report RL33083 , Hurricane Katrina: Medicaid Issues, by Evelyne Baumrucker,

(name redacted), (name redacted), Elicia Herz,

ame redacted),

(name redacted), and (name redacted).

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volunteer health professionals.35 The latter program is discussed in a subsequent

section on Issues for Congress.

HRSA undertook a number of response efforts following Hurricane Katrina,

including staff deployments.36 On September 9, HHS Secretary Leavitt announced

that HRSA would advance approximately $2.3 million in FY2005 funds to establish

26 new health center sites in areas impacted by Hurricane Katrina.37 The agency

issued a notice clarifying that providers who normally provided services under the

liability protections of federal employment in certain HRSA-supported health centers

would continue to receive protection while serving at temporary locations established

in response to the hurricane. In addition, in affected areas, the agency offered

expedited procedures for designating Health Professions Shortage Areas, and for

reviewing loan repayment applications for National Health Service Corps personnel.

National Institutes of Health. The National Institutes of Health (NIH) set

up a phone-based medical consultation service for providers treating victims or

evacuees from the Hurricane Katrina disaster, which it operated through September

2005. The agency also identified hospital bed capacity within its medical system,

among other activities.38 The National Institute of Environmental Health Sciences

developed an interactive Geographic Information System (GIS) for Texas, Louisiana

and Mississippi to help model the movement of contaminants and identify sources

of human exposure.39

Substance Abuse and Mental Health Services Administration.40 The

Substance Abuse and Mental Health Services Administration (SAMHSA) has as its

mission to build resilience and facilitate recovery for people with or at risk for

substance abuse and mental illness. SAMHSA’s Center for Mental Health Services

(CMHS) focused on providing resources to aid in the recovery process following

Hurricanes Katrina and Rita, and established a toll-free hotline for people in crisis in

the aftermath of this disaster.41

For more information, see CRS Report RL31719, An Overview of the U.S. Public Health

System in the Context of Emergency Preparedness, by (name redacted), and

[http://www.hrsa.gov/bioterrorism/index.htm].

See HRSA, “Hurricane Katrina Relief and Recovery,” at [http://www.hrsa.gov/katrina/].

HHS, “Secretary Leavitt Announces Advance of Health Center Funds to Hurry Services

to Hurricane-Affected Areas,” press release, Sept. 9, 2005.

See [http://www.nih.gov/about/director/hurricanekatrina/index.htm].

See [http://www-apps.niehs.nih.gov/katrina/].

For further information see CRS Report RS22292, Hurricanes Katrina & Rita:

Addressing the Victims’ Mental Health and Substance Abuse Treatment Needs, by (name r

edacted)

See SAMHSA, “Hurricane Katrina and Disaster Relief Information,” at

[http://www.mentalhealth.samhsa.gov/cmhs/katrina/], and HHS, “HHS Awards $600,000

in Emergency Mental Health Grants to Four States Devastated by Hurricane Katrina,” news

release, Sept. 13, 2005.

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SAMHSA has three main mechanisms to provide funding to address disaster

victims’ mental health needs: 1) the Crisis Counseling Assistance and Training

program (CCP), 2) SAMHSA Emergency Response Grants (SERG), and 3)

supplemental appropriations. The CCP is administered by SAMHSA through an

interagency agreement with FEMA. Eligible entities (state mental health agencies

and tribal authorities) work with SAMHSA to apply for and receive grants for

counseling outreach and training local crisis counselors to provide assistance after

federal relief workers leave the area. SERG are available when local resources are

overwhelmed and other resources are unavailable. SAMHSA may provide SERG for

crisis mental health and substance abuse services in accordance with SAMHSA’s

Mental Health and Substance Abuse Emergency Response Criteria.42 Supplemental

appropriations may be used by SAMHSA for emergency mental health and substance

abuse counseling and related services not addressed by the CCP, the SERG, or other

existing funding. These may include, for example, substance abuse and mental

health treatment services, psychotropic medication expenses, methadone treatment,

suicide prevention programs, and major administrative expenses for mental health

and substance abuse resulting from the disaster.

Department of Homeland Security

National Disaster Medical System. The National Disaster Medical System

(NDMS) was established in HHS in 1984 to provide medical and ancillary services

when a disaster overwhelms local emergency services.43 NDMS was most recently

reauthorized through 2006 in the Public Health Security and Bioterrorism

Preparedness and Response Act (P.L. 107-188),44 and was transferred to DHS in the

Homeland Security Act (P.L. 107-296) effective in March 2003.45 NDMS is

administered by FEMA and is a partnership of HHS, DHS, the Departments of

Defense and Veterans Affairs, state and local governments, and the private sector.

NDMS consists of a number of response teams that can deploy to a scene

rapidly and set up field operations that are self-sustaining for up to 72 hours, until

additional federal support arrives. NDMS also provides for transportation of large

numbers of casualties from an impacted site to distant locations for care. There are

several types of NDMS teams, which are typically comprised of 20-35 individuals.

Team members train as a group between deployments, under a defined team

commander, and are versed in incident command and other emergency management

protocols in addition to their disaster medicine skills. NDMS teams can be requested

by the Secretary of HHS pursuant to NRP ESF#8. Medical professionals on the

teams must be licensed to practice in at least one U.S. jurisdiction and are not

generally federal employees unless deployed, at which time they are considered

federalized for liability and compensation purposes. On September 9, 2005, FEMA

See [http://www.fema.gov/library/stafact.shtm#sec416], and 66 FR 51873, Oct. 11, 2001.

See the NDMS home page at [http://www.ndms.dhhs.gov/], and Jerry L. Mothershead et

al., “Bioterrorism Preparedness III: State and Federal Programs and Response,” Emergency

Medicine Clinics of North America, vol. 20, 2002, pp. 477-500.

42 U.S.C. §300hh.

6 U.S.C §312 et seq.

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reported that it had deployed more than 87 NDMS teams in response to Hurricane

Katrina. Information about specific deployment activities follows.

Disaster Medical Assistance Teams (DMATs) are teams of physicians, nurses

and other medical professionals who provide medical care. FEMA reported that it

deployed all of the nation’s more than 50 DMATs in the initial response to Hurricane

Katrina. At least one team was predeployed to the New Orleans Superdome shelter.46

The Louis Armstrong International Airport outside New Orleans served as a

temporary field hospital for hurricane victims as they were evacuated from the city.

DMAT members from a dozen teams deployed at the airport reported overwhelming

numbers of patients, some of whom could not be saved under the austere conditions

they faced. Teams fanned out across the affected Gulf Coast, doing what they could

to accommodate victims of the hurricane which, by some reports, also robbed the

region of 6,000 hospital beds.47

Disaster Mortuary Operational Response Teams (DMORTs) are composed of

medical examiners, coroners, pathologists, forensic dentists, radiologists, mental

health counselors, funeral directors and support personnel. Teams typically consist

of 26 members. They assist in handling the dead and conducting two types of

investigations in mass fatality incidents: disaster victim identification (DVI) and

death investigation. DVI involves the identification of victims, in order that their

loved ones can have documentation of their deaths, claim the remains, and carry out

funeral rites. It is considered an essential responsibility of governments in assisting

survivors in their recovery. Death investigation involves establishing the cause, time

and other circumstances of death. These investigations are conducted under the

authority of state or local medical examiners, with assistance from DMORT

personnel and federal funding through FEMA. DMORT sites were set up in Gabriel,

Louisiana, and Gulfport, Mississippi, each site with four DMORT teams and one

portable morgue.48

Veterinary Medical Assistance Teams (VMATs) are composed of veterinarians,

technicians and support personnel who provide animal rescues, health assessments

and other services during a disaster. Following Hurricane Katrina, all four VMAT

teams were deployed to the Gulf Coast to provide care for displaced companion

animals and support for damaged or destroyed veterinary practices.49

Jeff Jones, “N.M. Team Has Praise for Superdome: Medical Staff Says Stadium Saved

Katrina Victims’ Lives,” Albuquerque Journal, Sept. 8, 2005.

Anne Jungen, “DMAT Member: New Orleans Airport Was Like ‘Third World,’” Erie

Times-News, Pa. Knight Ridder/Tribune Business News, Sept. 9, 2005; and Ceci Connolly,

“Improvising to Replace Services for Many Thousands,” Washington Post, Sept. 6, 2005.

FEMA, “Medical Assistance and Supplies Flow into Hurricane-Hit Areas,” press release

number HQ-05-205, Sept. 5, 2005; Alan Levin, “Morgue Units Preparing as Katrina’s Dead

Uncovered,” USA Today, Sept. 8, 2005; and Darryl E. Owens, “Katrina’s Aftermath,

Helping the Dead Reclaim Identity,” Orlando Sentinel, Sept. 9, 2005.

See Susan C. Kahler and R. Scott Nolen, “AVMA Mounts Preparedness, Response to

Katrina,” Journal of the American Veterinary Medical Association, Sept. 13, 2005, at

[http://www.avma.org/onlnews/javma/oct05/x051001b.asp], and VMAT Team situation

(continued...)

CRS-16

NDMS also supports National Pharmacy Response Teams of pharmacists,

pharmacy technicians, and students of pharmacy who assist in mass-dispensing of

medications during disasters, and National Nurse Response Teams to assist if a

disaster such as a bioterrorism event were to require a mass prophylaxis or mass

vaccination campaign, or if the healthcare workforce is otherwise overwhelmed.

Federal Coordinating Centers (FCCs) are based in the Departments of Defense

(DOD) and Veterans Affairs (VA), where they identify available nationwide hospital

bed capacity in civilian and military hospitals, and coordinate planning and

distribution of patients evacuated from a disaster area.50

Since NDMS deploys in situations other than disasters (e.g., National Special

Security Events such as political conventions) and much of its work is, therefore, not

eligible for reimbursement from the DRF, the program has a regular annual

appropriation. NDMS is funded through the Public Health Programs account under

the DHS Preparedness and Response title, and received $34 million in FY2005 and

in FY2006.51 On September 8, the President signed the second emergency

supplemental appropriation for Hurricane Katrina relief (P.L. 109-62), which

authorized the transfer of up to $100 million from the DRF to maintain Katrinarelated NDMS response operations. In its weekly report to Congress on Hurricane

Katrina expenditures, FEMA reported that it had transferred the entire amount.52

Department of Defense

During a presidentially-declared disaster and pursuant to the NRP, the DOD

assists the Secretary of HHS with numerous ESF#8 responsibilities. These include

evacuating patients, locating or providing hospital beds, additional personnel and

supplies, and providing specialized laboratory testing and other technical assistance.53

On September 13, DHS reported that DOD had: 1) 789 beds available in field

hospitals at Louis Armstrong New Orleans International Airport in New Orleans, the

14th Combat Support Hospital, and aboard USS Bataan, USS Iwo Jima, USS Tortuga

and USS Shreveport; and 2) 20 Navy ships on station in the region to provide

medical support, humanitarian relief, and transportation.54

(...continued)

reports at [http://www.avma.org/disaster/situation_reports/default.asp].

See NDMS FCC page at [http://ndms.dhhs.gov/fcc.html].

See Table 8 in CRS Report RL32863, Homeland Security Department: FY2006

Appropriations, by (name redacted) and (name redacted).

DHS/ FEMA, Weekly Report on Hurricane Katrina Allocations, Commitments, and

Obligations, Sept. 22, 2005.

See NRP ESF Annex #8, Public Health and Medical Services, p. 9.

See DHS, “What Government Is Doing,” press release, Sept. 13, 2005; and DOD website

on Katrina relief efforts at [http://www.dod.mil/home/features/2005/katrina/news/].

CRS-17

Department of Veterans Affairs

During a presidentially-declared disaster and pursuant to the NRP, the

Department of Veterans Affairs (VA) assists the Secretary of HHS with numerous

ESF#8 responsibilities. These include coordinating available hospital beds,

additional personnel and supplies, and providing technical assistance.55

The VA evacuated veterans from two of its own medical centers impacted by

Hurricane Katrina, one in Biloxi, Mississippi, which was evacuated prior to landfall

and demolished by the storm, and the other in New Orleans, which was evacuated

after the city was flooded. The VA also activated 17 of its NDMS Federal

Coordinating Centers to coordinate the relocation of evacuated veterans, as well as

of civilian patients who were evacuated from permanent and temporary hospitals in

storm-ravaged areas56

Issues for Congress

All-Hazards Preparedness

In the aftermath of Hurricane Katrina there were concerns that federal readiness

for the disaster had been hampered by an overemphasis on planning for terrorism at

the expense of planning for natural disasters. A similar debate exists for public

health preparedness, namely how the balance should be struck between all-hazards

preparedness versus readiness for specific threats such as a cyanide attack or

pandemic influenza. In comprehensive bioterrorism preparedness legislation after

the 2001 terror attacks, Congress authorized grants to states to “address the following

hazards in the following priority: (i) Bioterrorism or acute outbreaks of infectious

diseases (and) (ii) Other public health threats and emergencies.”57 Discussions have

followed about whether a focus on terrorism (e.g., the civilian smallpox vaccination

program) has hampered preparedness for other threats, or, on the other hand, whether

flexible all-hazards grant guidance has failed to assure state preparedness for some

specific threats (e.g., a cyanide or plague attack).58

Some reports suggest that the public health response to Hurricane Katrina was

streamlined by some all-hazards improvements made since 2001. For example,

when the Louisiana state public health laboratory in New Orleans was disabled by the

storm, operations were quickly diverted to branch public health laboratories in

See NRP ESF Annex #8, Public Health and Medical Services, p. 12.

VA Under Secretary for Health Jonathan B. Perlin, briefing to congressional staff on

Hurricane Katrina response, Sept. 8, 2005. See also CRS Report RS22279, Hurricane

Katrina and Veterans, by (name redacted).

42 U.S.C. §247d-3a.

For further discussion, see CRS Report RL31719, An Overview of the U.S. Public Health

System in the Context of Emergency Preparedness, by (name redacted), section on “Issues

for Congress: Overview.”

CRS-18

Shreveport, Lake Charles and Amite, or to other states as needed.59 The swift

response was facilitated by inter-state electronic communications systems and

relationships that had been established since 2001.

Upon completing their missions, disaster response personnel are typically

required to report to supervisors on their activities. These after-action reports are

expected to be prepared and submitted to a variety of agencies involved in the

response to Hurricane Katrina. As after-action reports become available, Congress

may review the public health and medical response to Hurricane Katrina to determine

how well it met the goals Congress laid out for achieving a flexible, efficient national

system for response to health emergencies. Part of this review may be the

consideration of the process of developing standards for federal, state and local

public health preparedness, a process which has proven difficult in the past.

Coordinated Needs Assessments

Needs assessments are considered critical in the response to catastrophic

disasters. When it is likely that response assets will be overwhelmed, lives may be

saved by prioritizing the response as effectively as possible (e.g., matching the

deployment of NDMS teams as well as possible to defined areas of medical need).

However, the response to public health and medical needs may have to be delayed

until response has been made to other problems such as civil disorder or a lack of

physical access. Therefore, coordinating the assessments across all sectors is

essential.

Following a disaster, the NRP calls for the early deployment of Emergency

Response Teams for Assessment (ERT-A), which are FEMA-led teams that work

with state Emergency Operations Centers (EOCs) and others to conduct initial and

ongoing impact assessments. Early assessments define the extent of problems such

as flooding, the integrity of roads and bridges, and damage to the electricity grid.

Representatives from selected ESF support agencies are to be included in ERT-A

deployments. The ERT-A teams are to report back to an Interagency Incident

Management Group (IIMG), which is tasked to report to the Secretary of DHS with

recommendations for those areas in most critical need of response assets and

activities.60

The CDC manages a program in Disaster Epidemiology and Assessment, which

includes development of a disaster rapid needs assessment tool designed to quickly

provide emergency managers with reliable information about potential public health

threats.61 The CDC has conducted these assessments for several domestic and

Announcement from the Louisiana Office of Public Health, “Public Health Laboratory

Capacity in Louisiana After Hurricanes Katrina and Rita,” updated Oct. 17, 2005, at

[http://www.bt.cdc.gov/disasters/hurricanes/katrina/lalabcapacity.asp].

NRP, p. 40.

See CDC Disaster Epidemiology and Assessment

[http://www.cdc.gov/nceh/hsb/disaster/surveillance.htm].

home

page

CRS-19

foreign disasters, including Hurricane Katrina.62 The tool is not designed for the

rapid assessment of medical or mental health needs. CDC has reported on longerterm assessments of medical and mental health needs in areas affected by Hurricanes

Katrina and Rita, and on surveillance systems, set up in evacuee shelters, that

allowed for the measurement of the burden of certain chronic diseases such as

diabetes and mental illness.63 Further review of this information will inform efforts

to improve the tools used for needs assessment, though it is not know whether there

are efforts underway to develop a process specifically for the rapid assessment of

medical and mental health needs in the immediate aftermath of a disaster.

Policy issues may include the performance of the FEMA ERT-A process in

supporting the more specific goals of assessing public health, medical and mental

health needs following Hurricane Katrina, and, indeed, whether an effective process

of medical and mental health needs assessment exists. In particular, are the federal

mechanisms to support rapid public health, medical and mental health needs

assessments in place and adequate to support a capable national response? Also, are

these processes integrated well within the larger FEMA-led process of overall

assessment, in order that appropriate public health, medical and mental health

responses can reach their targets quickly and efficiently?

Disaster Planning in Healthcare

Overview. Following Hurricane Katrina, there were numerous reports of

problems experienced by fragile or medically needy persons. These problems

included 1) drownings and dehydration in facilities that did not evacuate and were

flooded by the hurricane storm surge; 2) emergency evacuations of deteriorating

patients from hospitals that were unable to care for patients after power, water and

food had been cut off for several days; and, 3) chronic conditions exacerbated by the

loss of access to needed care such as insulin, oxygen therapy or kidney dialysis. In

preparing for Hurricane Rita, authorities in many communities on the Texas and

Louisiana coast paid particular attention to identifying and helping those with special

health needs, providing public transportation to support the evacuation of nursing

homes and those receiving other health services.

Hurricane Katrina also exposed a number of problems that healthcare facilities

experienced as a result of the scope of the disaster. The failure of communications

systems across the Gulf Coast made it difficult for facilities to seek assistance, or for

emergency responders to know that a facility was in need. In addition, since all

facilities were simultaneously affected, the use of shared resources (“doublecounting”) led to problems. For example, single ambulance companies had

contracted to evacuate multiple facilities. This arrangement, which would work well

if facilities had been affected in isolation, was untenable in a wide scale disaster.

CDC, “Hurricane Katrina Response and Guidance for Health-Care Providers, Relief

Workers, and Shelter Operators,” MMWR, 54(35), p. 877, Sept. 9, 2005.

CDC: “Assessment of Health-Related Needs After Hurricanes Katrina and Rita —

Orleans and Jefferson Parishes, New Orleans Area, Louisiana, October 17-22, 2005,”

MMWR, vol. 55(2), pp. 38-41; and, “Surveillance in Hurricane Evacuation Centers —

Louisiana, September - October 2005,” MMWR, vol. 55(2), pp. 32-35, Jan. 20, 2006.

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Following the hurricanes, experts have stressed the need for coordinated disaster

planning in healthcare. They note that in addition to assuring that facilities are well

prepared on their own, they must be integrated into community-wide emergency

management activities. Further, identifying vulnerable non-institutionalized

populations and assuring their care before, during and after a disaster also requires

a community-wide coordinated approach.

Regulation of Institutions and Services. Healthcare facilities (e.g.,

hospitals and nursing homes) are regulated by state and local authorities, with varying

degrees of federal involvement. Regulations provide an opportunity for oversight of

two critical disaster planning functions: evacuation and continuity of operations. (In

this context, continuity of operations, the ability to sustain life-saving operations in

the absence of power, water and other external supplies, could also be considered

sheltering in place.) Given the nature of their business, hospitals are generally able

to continue operations in the face of power outages, at least temporarily, because they

employ generators to maintain critical life-support functions in an emergency.

Furthermore, it is difficult to evacuate hospital or nursing home patients as their

special needs may require special transport and host facilities. This may motivate

better preparedness for continuity of operation as a more feasible option than

evacuation. Healthcare facilities should be able to do both, though, as different types

of disasters would require one or the other response. Hospitals in New Orleans that

initially chose to continue operations ultimately had to evacuate.

Evacuation policies and regulations for healthcare facilities have long focused

on fire safety, for which the need to evacuate is evident, and for which drills are

regularly conducted by local fire safety authorities. Evacuation planning for a

predicted threat such as a hurricane may be more challenging. The decision to

evacuate or not may hinge on emergency management rather than healthcare

expertise, and may be guided by local officials rather than facility managers. For

example, the mandatory evacuation order issued by the city of New Orleans on

August 28 excluded “essential personnel of hospitals and their patients,” but did not

exempt other types of healthcare facilities.64 In preparing for Hurricane Charley in

Florida in 2004, one county issued a countywide mandatory evacuation order, while

a neighboring county issued a mandatory order for nursing homes only.65

While healthcare facilities are licensed and regulated by state and local

authorities, there is a role for federal oversight of their disaster preparedness and

response capabilities through standards developed by the Occupational Safety and

Health Administration (OSHA) and the Joint Commission on Accreditation of

Healthcare Organizations (JCAHO), as well as through conditions of participation

(CoPs) for Medicare and Medicaid.66 Following Hurricane Katrina, a JCAHO

Civil District Court for the Parish of New Orleans, State of Louisiana, City of New

Orleans, “Promulgation of Emergency Orders,” undated document, at

[http://www2a.cdc.gov/phlp/docs/NewOrleansEmergencyOrders.pdf].

CDC, “Epidemiologic Assessment of the Impact of Four Hurricanes — Florida, 2004,”

MMWR, 54(28), pp. 693-697, July 22, 2005.

See “Evacuation Strategies for Disaster Planning,” Healthcare Hazard Management

(continued...)

CRS-21

witness testified that the commission certifies 85% of U.S. hospitals encompassing

96% of hospital beds.67 JCAHO-certified hospitals are deemed by federal law as

meeting the conditions of participation for Medicare and Medicaid reimbursement.

The commission’s 2005 accreditation manual for hospitals includes standards

regarding emergency management, in addition to standards addressing certain

specific threats such as fire and hazardous materials.68 The Government

Accountability Office (GAO) has reported concerns regarding enforcement of

JCAHO certification standards.69

While JCAHO has certification programs for other types of healthcare

institutions besides hospitals, some of the programs are voluntary or do not cover a

majority of the relevant industry. Conditions of participation for Medicare and

Medicaid reimbursement for other institutions, as well as for various non-institutional

services (e.g., home-based care), vary in the degree to which disaster planning is

addressed. The role of state and local authorities in assuring disaster preparedness

for these facilities and services appears to dominate.

Community-based Disaster Planning. In Congressional testimony

following Hurricane Katrina, a JCAHO witness stressed the need for hospitals to

prepare for disasters within a community-wide structure, not in isolation.70 The

commission’s 2005 emergency management standards include a requirement that

hospitals conduct a “hazard vulnerability analysis” to determine the types of hazards

the facility is likely to face. There are also several standards requiring that hospitals

have and test emergency backup systems for electricity and other utilities. Careful

planning of this type could prevent planning errors such as the placement of back-up

generators in the basement of a flood-prone facility. In addition, hospitals are

required to coordinate various planning tasks with local emergency management

authorities.

Problems in delivering care to the chronically ill after hurricanes were described

in reports following four hurricanes in Florida in 2004.71 The emphasis of disaster

(...continued)

Monitor, vol. 15, no. 8, Apr. 2002; and 42 C.F.R. §482 through §485.

Testimony of Joseph Cappiello for JCAHO, hearing before the House Committee on

Energy and Commerce, Subcommittees on Health and on Oversight and Investigations, on

“Assessing Public Health and the Delivery of Care in the Wake of Hurricane Katrina,” Sept.

22, 2005, 109th Congress, 1st sess., Washington, D.C., hereafter called JCAHO testimony.

JCAHO, “Management of the Environment of Care,” Comprehensive Accreditation

Manual for Hospitals, 2005.

GAO, “CMS Needs Additional Authority to Adequately Oversee Patient Safety in

Hospitals,” GAO-04-850, July 2004.

JCAHO testimony.

See, for example: CDC, “Epidemiologic Assessment of the Impact of Four Hurricanes —

Florida, 2004,” MMWR 54(28), pp. 693-697, July 22, 2005; and CDC, “Rapid Assessment

of the Needs and Health Status of Older Adults After Hurricane Charley — Charlotte,

DeSoto, and Hardee Counties, Florida, August 27 — 31, 2004,” MMWR 53(36), pp.

(continued...)

CRS-22

planning for non-institutional services is based on assuring continuity of care during

and after a disaster. Some communities have developed programs to identify

vulnerable individuals and assure continuity of care. The massive dislocation of the

victims of Hurricane Katrina demonstrates how challenging this task can be.

Following the terror attacks in 2001, Congress created a national program of

grants to states to improve the ability of communities to respond to emergencies that

cause mass casualties.72 The National Bioterrorism Hospital Preparedness Program

is administered by the Health Resources and Services Administration (HRSA).73

Grants are awarded to state health officials to develop coordinated state and regional

mass casualty plans. Though grant guidance directs that a majority of funds be

passed through to healthcare institutions, the program is not designed to assure

preparedness for each facility or service in a state. It could be a means, however, for

states to develop reliable communications systems between hospitals and emergency

management authorities, or to address other aspects of coordination. There is limited

publicly available information on how states have used hospital preparedness grant

funds.

Promising Practices. Some states and communities with disaster experience

have come up with approaches to address problems of disaster planning in

healthcare.74 For example, Florida has a requirement (in statute and regulation) that

home health agencies include in patients’ records individual disaster plans (e.g., an

individual evacuation plan) that have been discussed with the patient and the

patient’s caregivers.75 Florida also established Special Needs Shelters for vulnerable

persons during the 2004 hurricanes. The state facilitated evacuation to the shelters

of individuals who were pre-identified by county health departments. This

arrangement facilitated care of those whose needs were not so great that they required

hospitalization, but that nonetheless exceeded the expertise available in Red Cross

and other community shelters.76

In New York City, the Office of Emergency Management serves as the focal

point of coordination for the Department of Aging and other city agencies to identify

and plan for the care of special-needs populations during a disaster. Individuals are

pre-identified from certain databases such as home-delivered and group meals

(...continued)

837-840, Sept. 17, 2004.

42 U.S.C. 247d-3a.

For more information, see CRS Report RL31719, An Overview of the U.S. Public Health

System in the Context of Emergency Preparedness, by (name redacted).

See Senate Committee on Aging, hearing on “Preparing Early, Acting Quickly: Meeting

the Needs of Older Americans During a Disaster,” Oct. 5, 2005, 109th Congress, 1st sess.,

Washington, D.C.

State of Florida, “Provision of Services During an Emergency,” State Health Care Law

400.492.

Association of State and Territorial Health Officials, “Special Needs Shelters Are Key

Component of the Public Health Response to the 2004 Hurricanes,” fact sheet, undated, at

[http://www.astho.org/pubs/SpecialNeeds.pdf].

CRS-23

programs and the electric utility’s list of clients who are on life support equipment.

The Greater New York Hospital Association has testified on the value of redundant

communications systems that were established in city hospitals and the Office of

Emergency Management prior to the northeast blackout in 2003.77

Options for Congress. Congress could decide to look specifically at

whether the federal requirements for facility disaster and evacuation plans are

adequate, and adequately enforced. If it did so, it might consider options to improve

general emergency preparedness in healthcare facilities, including the elements of

planning, staffing, training, stockpiling of supplies, evacuation procedures, and

coordination with emergency management authorities. In addition, the role of the

HRSA hospital preparedness grant program as a mechanism for coordinated disaster

planning in healthcare could be examined.

National Disaster Medical System

As previously discussed, the NDMS was created in the 1980s under the U.S.

Public Health Service in HHS, and was transferred to DHS under FEMA in the 2003.

The cited intent of this transfer, proposed by the Administration, was to assure a

coordinated federal response to terrorism and other disasters. The Government

Accountability Office (GAO) supported the transfer.78 But since then, a review of

DHS medical response capabilities, conducted at the request of then-Secretary Tom

Ridge in 2004, found “... that the nation’s medical leadership works in isolation, its

medical response capability is fragmented and ill-prepared to deal with a mass

casualty event and that DHS lacks an adequate medical support capability for its field

operating units.”79 Further, some NDMS team members have complained that the

program has not received adequate administrative support under FEMA.80 Two

organizational issues may be relevant to this concern.

First, some NDMS team members have stated that their mission — to provide

direct medical services — is not understood by FEMA management.81 The Lowell

report had recommended the appointment of a DHS Assistant Secretary for Medical

Testimony of the Greater New York Hospital Association before the New York City

Council, Committee on Health, regarding “New York City Hospitals in the Blackout of

2003: Lessons Learned,” Sept. 29, 2003, at [http://www.gnyha.org/testimony/].

Government Accountability Office, Homeland Security: New Department Could Improve

Coordination but Transferring Control of Certain Public Health Programs Raises

Concerns, GAO-02-954T, July 16, 2002. At the time of publication, the agency was called

the General Accounting Office.

Jeffrey A. Lowell, “Medical Readiness Responsibilities and Capabilities: A Strategy for

Realigning and Strengthening the Federal Medical Response,” report to DHS Secretary Tom

Ridge, Jan. 3, 2005, hereafter called the Lowell report, at

[http://www.democrats.reform.house.gov/Documents/20051209101159-27028.pdf].

Star Lawrence, “Culture Shock,” Homeland Protection Professional, Apr. 2005.

Ibid. This concern had been repeated in the aftermath of Hurricane Katrina. See, for

example, Richard Knox, “New Orleans Airport as Field Hospital,” Morning Edition,

National Public Radio, Sept. 14, 2005.

CRS-24

Readiness to address this concern.82 In July 2005, DHS Secretary Michael Chertoff

announced his proposal to reorganize DHS following a comprehensive review, which

became known as the “Second Stage Review” or 2SR.83 Chertoff announced that he

proposed to split the existing Emergency Preparedness and Response Directorate

(which housed FEMA and NDMS) into two separate directorates, for distinct

activities in preparedness and response, respectively. He announced the appointment

of a chief medical officer (CMO), a position that had not previously existed in DHS,

within the proposed preparedness directorate, as follows:

...as part of our consolidated preparedness team, I will appoint a chief medical

officer within the preparedness directorate. This position will be filled by an

outstanding physician who will be my principal advisor on medical preparedness

and a high-level DHS representative to coordinate with our partners at the

Department of Health and Human Services, the Department of Agriculture and

state governments.

The chief medical officer and his team will have primary responsibility for

working with HHS, Agriculture and other departments in completing

comprehensive plans for executing our responsibilities to prevent and mitigate

biologically-based attacks on human health or on our food supply.84

The following day, Chertoff announced the appointment of Dr. Jeffrey Runge to the

post.85

Under the new structure, NDMS remains within FEMA, while the CMO is

within the new Directorate for Preparedness. While NDMS is logically a response

asset, some critics say the proposed structure may blunt the benefit that NDMS might

have received from leadership provided by the new CMO position, since that

individual would be in a different directorate.

A second organizational concern with the transfer of NDMS to DHS is that

NDMS and FEMA take different temporal approaches to deployment in response to

a disaster. Historically, DMAT teams trained to be able to deploy rapidly and set up

self-supporting field hospitals in austere conditions, without external water or power

sources, within the first 72 hours after a disaster, before other federal assets arrive.86

FEMA has historically operated under the planning assumption that while it would

Lowell report, p. ii.

See CRS Report RL33064, Organization and Mission of the Emergency Preparedness and

Response Directorate: Issues and Options for the 109th Congress, by (name redacted); and CRS

Report RL33042, Department of Homeland Security Reorganization: The 2SR Initiative, by

(name redacted) and (name redacted).

DHS, “Secretary Michael Chertoff, U.S. Department of Homeland Security Second Stage

Review Remarks,” Ronald Reagan Building, Washington, DC, July 13, 2005, at

[http://www.dhs.gov/dhspublic/display?theme=44&content=4597&print=true].

DHS, “Secretary Michael Chertoff Announces the New Chief Medical Officer for the

Department of Homeland Security,” press release, July 14, 2005.

See comments of Kevin Yeskey, then chief executive officer of NDMS, in Paula Hartman

Cohen, “The Three Faces of NDMS,” Homeland Protection Professional, Aug. 2003.

CRS-25

mount a response as soon as possible, state and local officials were responsible for

emergency response in the first 72 hours following a disaster.87 After Hurricane

Katrina, a DMAT team member stated that FEMA was unable to support the

historical rapid-deployment capability of NDMS.88

NDMS teams are required to submit after-action reports following deployment,

in order that response planners can benefit from lessons learned in disaster response.

Some analyses of the NDMS response to Hurricane Katrina response have become

available, and more are expected, including one from DHS.89 Policymakers likely

will review the mission of NDMS and its alignment with national goals for terrorism

and disaster response. NDMS program authority expires at the end of FY2006.

Congress may decide to review the mission of NDMS and the role of DHS and

FEMA in supporting it, in general, and specifically in response to Hurricane Katrina,

as it considers reauthorization of the program.

Volunteer Health Professionals

Despite the deployment of all FEMA DMAT teams in the wake of Hurricane

Katrina, there were reports of overwhelmed field hospitals and triage centers, and

urgent calls from hospitals for more medical personnel. On September 3, HHS

issued a call for more volunteer health professionals (VHPs) to deploy, as federalized

employees, to the affected areas. All officers of the U.S. Public Health Service were

also put on alert for possible deployment.90 The NDMS, which was transferred from

HHS to the DHS in 2002, remains authorized within the Public Health Service Act,

where it is stated that the Secretary of HHS can augment emergency response

personnel by deploying volunteers as intermittent disaster response personnel under

NDMS.91 Volunteers could also potentially be deployed as temporary volunteers in

the Public Health Service, or as temporary federal employees.92 By September 19,

the call for additional personnel had been lifted.

See, for example, FEMA, “Can You Go It Alone For Three Days?” press release number:

1354-41, Jan. 31, 2001, at [http://www.fema.gov/news/newsrelease.fema?id=7591].

Richard Knox, “New Orleans Airport as Field Hospital,” Morning Edition, National

Public Radio, Sept. 14, 2005.

See “The Decline of the National Disaster Medical System,” Committee on Government

Reform, Minority Staff, Special Investigations Division, Dec. 2005, at

[http://www.democrats.reform.house.gov/]; and Mimi Hall, “‘Significant Gaps’ Reported

in Disaster Medical System,” USA Today, Jan. 18, 2006.

HHS, “HHS Releases Website and Toll Free Number for Deployment by Health Care

Professionals,” press release, Sept. 3, 2005, and website at [https://volunteer.ccrf.hhs.gov/].

42 U.S.C. §300hh-11.

For a discussion of the three legal mechanisms, see James G. Hodge, Jr., et al., “Hurricane

Katrina Response, Legal Protections for Federalized Volunteer Health Personnel under a

Federal Declaration of Public Health Emergency,” The Center for Law and the Public’s

Health at Georgetown and Johns Hopkins Universities, memorandum, Sept. 15, 2005, at

[http://www.publichealthlaw.net/Research/Katrina.htm].

CRS-26

The licensing of medical professionals is the responsibility of state authorities.

Federalized VHPs must hold a current license in at least one U.S. jurisdiction, and

the federal agency responsible for deployment bears the burden of verifying

credentials. Federalized VHPs are considered to be federal employees for purposes

of liability and compensation. VHPs can also deploy at the request of affected states,

as long as their state’s licensure and certification are recognized by the requesting

state. A number of legal mechanisms govern reciprocity in order to assure that VHPs

are protected from liability in the requesting state.93 One of the more challenging

aspects of accepting mutual aid is the ability to verify an individual’s qualifications.

The Health Resources and Services Administration (HRSA) notes:

According to reports, hospital administrators involved in responding to the

World Trade Center tragedy reported that they were unable to use medical

volunteers when they were unable to verify the volunteer’s basic identity,

licensing, credentials (training, skills, and competencies), and employment. In

effect, this precious, needed health workforce surge capacity could not be used.94

Following the terrorist attacks of 2001, Congress established a program to

develop a national database for verifying the licensure and credentials of VHPs

during emergencies.95 The Emergency System for Advance Registration of Volunteer

Health Professionals (ESAR-VHP), administered by HRSA, is designed to assist

state and local authorities in verifying the status of volunteer healthcare workers by

developing standards for a nationwide database and providing funding and technical

assistance to states in linking to it. The program is in its early stages, with pilots

beginning in several states, and was not ready for use in response to Hurricane

Katrina. The program was funded at $8 million in FY2005. The Administration

requested $8 million for FY2006, and Congress provided $4 million in final

appropriations. Senate appropriators had commented that states could use their

hospital preparedness grant funds to support this activity. Authority for the ESARVHP program expires at the end of FY2006.

While Congress has explicitly tasked HHS, through HRSA, with a federal role

in creating a nationwide system for health professionals volunteers, the DHS Chief

Medical Officer (CMO) has also voiced an interest in coordinating this activity.96

DHS is expected to publish, in the Federal Register, a notice of delegation of

authority to the CMO. Until such time, comprehensive information on the scope of

the responsibilities and activities of this office, and how the CMO will coordinate

efforts with HHS, is not publicly available.

See CRS Report RS22255, Emergency Response: Civil Liability of Volunteer Health

Professionals, by Kathleen Swendiman and (name redacted).

See HRSA, Emergency System for Advance Registration of Volunteer Health

Professionals, background, at [http://www.hrsa.gov/bioterrorism/esarvhp/].

42 U.S.C. § 247d-7b.

Comments of Jeffrey Runge, Chief Medical Officer, Department of Homeland Security,

before the House Committee on Homeland Security, Subcommittee on Management,

Integration, and Oversight, hearing on “The Department of Homeland Security

Second-Stage Review: The Role of the Chief Medical Officer,” Oct. 27, 2005, 109th

Congress, 1st sess., Washington, D.C., CQ Transcriptions.

CRS-27

The federal role in assisting states with licensure verification and other matters

involved in using VHPs during an emergency has been of interest to Congress.

Relevant legislation introduced following Hurricane Katrina includes S. 1638, which

would establish a National Emergency Health Professionals Volunteer Corps under

the Secretary of HHS, among other provisions, and H.R. 3736, which would provide

Hurricane Katrina volunteers, including health workers, immunity from liability. The

latter bill has passed the House and been referred to the Senate Judiciary Committee.

Health Information Technology

In response to Hurricane Katrina, the HHS Office of the National Coordinator

for Health Information Technology, working in collaboration with more than 150

public and private healthcare organizations, established an online service for

authorized health professionals to gain electronic access to prescription medication

records for evacuees. Medication data from a variety of government and commercial

sources — Medicaid, the Veteran’s Health Administration, private insurers, and

pharmacy benefit managers — was indexed and made accessible through a single

Internet portal (www.katrinahealth.org) to any licensed physician or retail pharmacist.

Comparable efforts made the immunization records of children who evacuated from

Louisiana available to public health officials in host states, and, through the use of

Medicaid billing records, allowed the reconstruction of rudimentary health records

for some of those who were displaced.97

HHS Secretary Leavitt noted that the disaster had made the case for a national

system of electronic health records (EHR), and that such a system could be useful in

general as well as for other emergencies such as pandemic influenza. The VA, which

uses a system of electronic health records for its beneficiaries, was able to provide

uninterrupted care to several hundred veterans who were evacuated from its medical

centers in Biloxi, Mississippi, and New Orleans, Louisiana, due to the hurricane.

Congress has taken several steps in recent years to implement a nationwide

health information technology (health IT) infrastructure.98 Several bills have been

introduced in the 109th Congress to boost federal investment and leadership in health

IT and provide incentives both for EHR adoption and for the creation of regional

health information networks, which are seen as an important step towards the goal

of interconnecting the health care system nationwide. (Examples include H.R. 2334,

S. 1262 and S. 1355.) On November 18, 2005, the Senate passed a bipartisan health

IT bill, S. 1418, which has been referred to the House for further consideration.

See Jennifer Jones and Bob Brewin, “Dodged the Storm but not the Crisis; Diaspora

Dispatches,” Federal Computer Week, Nov. 14, 2005; and CRS Report RS22310, Hurricane

Katrina: HIPAA Privacy and Electronic Health Records of Evacuees, by Gina Marie

Stevens.

See CRS Report RL32858, Health Information Technology: Promoting Electronic

Connectivity in Healthcare, by (name redacted).

CRS-28

Additional CRS Reports

CRS Report RS22292, Hurricanes Katrina & Rita: Addressing the Victims’ Mental

Health and Substance Abuse Treatment Needs, by (name redacted).

CRS Report RS22279, Hurricane Katrina and Veterans, by (name redacted

CRS Report RL33083, Hurricane Katrina: Medicaid Issues, by Evelyne

Baumrucker, (name redacted), (name redacted),

licia Herz,

E (name redacted), (name redacted),

and (name redacted).

CRS Report RS22254, The Americans with Disabilities Act and Emergency

Preparedness and Response, by (name redacted).

CRS Report RS22255, Emergency Response: Civil Liability of Volunteer Health

Professionals, by Kathleen Swendiman and (name redacted).

CRS Report RS22252, Older Americans Act: Disaster Assistance for Older Persons

After Hurricane Katrina, by Carol O’Shaughnessy.

CRS Report RS22235, Disaster Evacuation and Displacement Policy: Issues for

Congress, by (name redacted).

CRS Report RL32803, The National Preparedness System: Issues in the 109th

Congress, by (name redacted).

CRS Report RL32858, Health Information Technology: Promoting Electronic

Connectivity in Healthcare, by (name redacted).

CRS Report RS22310, Hurricane Katrina: HIPAA Privacy and Electronic Health

Records of Evacuees, by Gina Marie Stevens.

CRS Report RL31719, An Overview of the U.S. Public Health System in the Context

of Emergency Preparedness, by (name redacted).

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