[House Report 107-766]
[From the U.S. Government Publishing Office]
107th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 107-766
_______________________________________________________________________
Union Calendar No. 481
HOW CAN THE FEDERAL GOVERNMENT BETTER ASSIST STATE AND LOCAL
GOVERNMENTS IN PREPARING FOR A BIOLOGICAL, CHEMICAL OR NUCLEAR ATTACK?
__________
FIFTH REPORT
by the
COMMITTEE ON GOVERNMENT REFORM
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
October 24, 2002.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
ILEANA ROS-LEHTINEN, Florida EDOLPHUS TOWNS, New York
JOHN M. McHUGH, New York PAUL E. KANJORSKI, Pennsylvania
STEPHEN HORN, California PATSY T. MINK, Hawaii
JOHN L. MICA, Florida CAROLYN B. MALONEY, New York
THOMAS M. DAVIS, Virginia ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
BOB BARR, Georgia DENNIS J. KUCINICH, Ohio
DAN MILLER, Florida ROD R. BLAGOJEVICH, Illinois
DOUG OSE, California DANNY K. DAVIS, Illinois
RON LEWIS, Kentucky JOHN F. TIERNEY, Massachusetts
JO ANN DAVIS, Virginia JIM TURNER, Texas
TODD RUSSELL PLATTS, Pennsylvania THOMAS H. ALLEN, Maine
DAVE WELDON, Florida JANICE D. SCHAKOWSKY, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
ADAM H. PUTNAM, Florida DIANE E. WATSON, California
C.L. ``BUTCH'' OTTER, Idaho STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia ------
JOHN J. DUNCAN, Jr., Tennessee BERNARD SANDERS, Vermont
JOHN SULLIVAN, Oklahoma (Independent)
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
James C. Wilson, Chief Counsel
Robert A. Briggs, Chief Clerk
Phil Schiliro, Minority Staff Director
Subcommittee on Government Efficiency, Financial Management and
Intergovernmental Relations
STEPHEN HORN, California, Chairman
RON LEWIS, Kentucky JANICE D. SCHAKOWSKY, Illinois
DOUG OSE, California MAJOR R. OWENS, New York
ADAM H. PUTNAM, Florida PAUL E. KANJORSKI, Pennsylvania
JOHN SULLIVAN, Oklahoma CAROLYN B. MALONEY, New York
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Bonnie L. Heald, Staff Director
Henry A. Wray, Senior Counsel
Chris Barkley, Clerk
David McMillen, Minority Professional Staff Member
LETTER OF TRANSMITTAL
----------
House of Representatives,
Washington, DC, October 24, 2002.
Hon. J. Dennis Hastert,
Speaker of the House of Representatives,
Washington, DC.
Dear Mr. Speaker: By direction of the Committee on
Government Reform, I submit herewith the committee's fifth
report to the 107th Congress. The committee's report is based
on a study conducted by its Subcommittee on Government
Efficiency, Financial Management and Intergovernmental
Relations.
Dan Burton,
Chairman.
(iii)
C O N T E N T S
Page
I. Summary of Oversight Findings and Recommendations................1
A. Introduction............................................ 1
B. Findings................................................ 3
1. Incompatible communications systems impede 3
interagency coordination efforts.
2. The Nation's health care infrastructure has limited 5
capacity.
3. Intelligence sharing among law enforcement agencies 8
is improving.
4. National emergency management guidelines, standards 9
and best practices are needed.
5. Federal funding structure need greater flexibility 9
and a single point of contact.
C. Recommendations......................................... 12
APPENDIXES
Appendix A.--List of field hearings.............................. 13
Appendix B.--Index of witnesses.................................. 14
(v)
Union Calendar No. 481
107th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 107-766
======================================================================
HOW CAN THE FEDERAL GOVERNMENT BETTER ASSIST STATE AND LOCAL
GOVERNMENTS IN PREPARING FOR A BIOLOGICAL, CHEMICAL OR NUCLEAR ATTACK?
_______
October 24, 2002.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Burton, from the Committee on Government Reform submitted the
following
FIFTH REPORT
On October 9, 2002, the Committee on Government Reform
approved and adopted a report entitled ``How Can the Federal
Government Better Assist State and Local Governments in
Preparing for a Biological, Chemical or Nuclear Attack?'' The
chairman was directed to transmit a copy to the Speaker of the
House.
I. Summary of Oversight Findings and Recommendations
A. INTRODUCTION
The Committee on Government Reform (the ``committee'') has
legislative jurisdiction with respect to the ``overall economy,
efficiency, and management of government operations and
activities.'' \1\ The committee also has the general oversight
responsibility:
---------------------------------------------------------------------------
\1\ Clause 1(h)(6) rule X of the Rules of the House of
Representatives, 107th Congress.
[T]o determine whether laws and programs addressing
subjects within the jurisdiction of [the] committee are
being implemented and carried out in accordance with
the intent of Congress and whether they should be
continued, curtailed, or eliminated. Each standing
committee (other than the Committee on Appropriations)
shall review and study on a continuing basis the
application, administration, execution, and
effectiveness of laws and programs addressing subjects
within its jurisdiction. [The committee shall review
and study] any condition or circumstances that may
indicate the necessity or desirability of enacting new
or additional legislation addressing subjects within
its jurisdiction.\2\ Moreover, the committee has the
special oversight function to ``review and study on a
continuing basis the operation of Government activities
at all levels with a view to determining their economy
and efficiency.'' \3\
---------------------------------------------------------------------------
\2\ Ibid., Clause 2(b)(1) (A) and (C).
\3\ Ibid., Clause 3(e).
---------------------------------------------------------------------------
The Subcommittee on Government Efficiency, Financial
Management and Intergovernmental Relations (the
``subcommittee'') has legislative jurisdiction with respect to
all matters relating to the handling of Government efficiency
and intergovernmental relations.
Pursuant to this authority, the Committee on Government
Reform's Subcommittee on Government Efficiency, Financial
Management and Intergovernmental Relations (the
``subcommittee'') convened 11 oversight hearings to explore:
The Federal Government's role in helping State and
local government agencies prepare for the possibility of a
terrorist attack using a biological, chemical or nuclear agent.
How the Federal Government can improve its
assistance to State, local and regional entities in responding
to a biological, chemical or nuclear attack.
The ability of the Nation's public health system to
handle the large influx of victims that could result from a
biological, chemical or nuclear attack.
On September 11, 2001, the world witnessed the most
devastating attacks ever committed on United States soil.
Despite the damage and enormous loss of life, the attacks
failed to cripple this Nation. To the contrary, Americans have
never been more united in their fundamental belief in freedom
and their willingness to protect that freedom. Nonetheless, the
diabolical nature of those attacks and the subsequent anthrax
attacks sent a loud and clear message to all Americans: We must
be prepared for the unexpected. The mechanisms must be in place
to protect the Nation and its people in the event that another
attack occurs. The aftermath of September 11, 2001, clearly
demonstrated the need for reliable communications systems and
the rapid deployment of well-trained, well-equipped emergency
personnel. Yet despite billions of dollars in Federal spending
toward that goal, there remain serious doubts as to whether the
Nation is adequately prepared to withstand a massive chemical,
biological or nuclear attack.
To gain a better understanding of the efficiency and
effectiveness of Federal emergency management efforts in
assisting State and local governments in their preparation for
a major disaster, the Government Reform Committee's
Subcommittee on Government Efficiency, Financial Management,
and Intergovernmental Relations conducted a series of 11 field
hearings in U.S. cities of varying size and demographics.
Between March 1, 2002, and August 23, 2002, the subcommittee
visited Nashville, TN; Tempe, AZ; Albuquerque, NM; Los Angeles
and San Francisco, CA; Milwaukee, WI; Chicago, IL; Omaha, NE;
Abilene, KS; Iowa City, IA; and Golden, CO. Witnesses at each
hearing included representatives from local, regional and State
agencies involved with emergency management. In addition, the
subcommittee interviewed private-sector witnesses responsible
for health care and others who are responsible for key
infrastructures, including water and power.
The hearings primarily focused on the first responders to
an emergency--the firefighters, police officers, medical
personnel and local emergency management officials who are
responsible for protecting the health and well-being of the
citizens in their community. Witnesses also included
representatives from the Federal Bureau of Investigation [FBI]
and the Federal Emergency Management Agency [FEMA], two of the
more than 40 Federal agencies that have a role in the Nation's
homeland security efforts. In addition, the U.S. General
Accounting Office, which is evaluating the Nation's overall
preparedness to respond to a terrorist attack, testified at
each subcommittee hearing.
B. FINDINGS
Although many issues were discussed throughout the field
hearings, first responders highlighted several significant
concerns. They included: (1) the lack of interoperable
communications systems; (2) the inability of the health care
system to handle a massive influx of victims; (3) the need for
fast, reliable intelligence sharing; and (4) the need for
Federal emergency planning guidelines, standards and best
practices.
In addition, first responders said the Federal Government
could provide more effective assistance if: (1) Federal funding
programs had greater flexibility; (2) the Federal Government
had a single point of contact to apply for Federal grants,
awards and training programs; and (3) the Federal Government
encouraged more fully a regional, all-hazards approach to
emergency preparedness.
1. Incompatible communications systems impede interagency coordination
efforts.
Communications interoperability emerged as one of the
leading concerns of local officials throughout the subcommittee
hearings. During the subcommittee's first field hearing in
Nashville, local witnesses discussed a serious communications
shortfall, in which a civilian helicopter and a National Guard
helicopter were responding to the same incident but were unable
to communicate with each other. At a subsequent hearing in
Albuquerque, witness Thomas L. English, Cabinet Secretary for
the New Mexico Department of Public Safety, explained that
existing regulations require the National Guard to operate on a
separate set of frequencies. ``A complete re-look at this is
absolutely essential to our ability to have a unified
response,'' he said.
The problem is an interagency issue as well as
intergovernmental. In Albuquerque, for example, the city and
Bernalillo County, which includes Albuquerque, use compatible
800-megahertz systems. However, neighboring cities operate on
much lower frequencies. Thus, a significant part of the region
is left out of the communications loop.
In Nashville, Dr. William Schaffner of Vanderbilt
University School of Medicine stressed the need for a multi-
faceted communications network that ties together a
communitywide response. It should also include hospitals, he
said. ``Our community has the communications capacity, however,
it is institution specific. Something substantially more
sophisticated is needed that could tie all the elements of the
response mechanism together.'' Los Angeles County Sheriff Lee
Baca agreed, saying, ``We need to coordinate with the medical
group as to what goes on when firefighters and police officers
get out on the scene of a disaster or terrorist attack.''
Local officials in Omaha are hoping to upgrade to an
interoperable system, said Omaha Fire Chief Paul Wagner.
Douglas County, which includes Omaha, is planning to move to an
800-megahertz system that would allow regional communications.
But the proposal is still being worked out, he said. ``So we
are looking at a number of years down the road before we would
even be able to do that.''
Having an 800-megahertz system does not necessarily resolve
the communications problem, however. Mario H. Trevino, Director
of the San Francisco Fire Department, said that San Francisco
uses an 800-megahertz system, but during emergencies, the
system becomes overloaded and shuts down. Better systems exist,
but they are too expensive for most city budgets, he said,
noting that one system costs $50,000 per radio unit.
``It's more than just a problem of procuring radios,'' said
Lucien Canton, who heads up the San Francisco Mayor's Office of
Emergency Services. ``There are no national standards on how we
should use these radios; no set frequencies that are all on a
common band.'' Mr. Canton said that the Federal Government
should take a leadership role in developing national standards
for emergency responders.
Additional concerns were raised over the Federal
Communications Commission's proposed sale of frequencies within
the 700-megahertz spectrum for commercial use. The concern
involves potential voice interference between commercial users
on the 700-megahertz spectrum and the 800-megahertz public
safety spectrum. ``To put it simply, there is a level of over-
speak between the two systems that is problematic,'' said
Phoenix Mayor Skip Rimsza. Noting the devastating
communications breakdown in New York City on September 11,
2001, Mr. Rimsza said, ``One of the reasons we are all looking
to 800 megahertz is to avoid that kind of loss.'' Mr. Rimsza is
especially concerned because Phoenix voters just approved a
$120 million referendum to purchase a new 800-megahertz
communications system. Jack Harris, assistant chief of the
Phoenix Police Department, is equally concerned about potential
disruptions, saying, ``when you get into that group of bands,
it is not that there is not enough bands for public safety and
for the private sector; it is how they are arranged . . . When
they are not arranged appropriately, you can get cross-talk
between the bands, and it stops the communication.''
Los Angeles County Sheriff Lee Baca reiterated the
importance of interoperability, saying, ``first responders need
to talk to each other at command sites of incidents. We can't
do that now, and I don't think it is being done in too many
places in the Nation. Therefore, what we need is the Federal
Communications Commission to be a participant in ensuring that
the radio frequency spectrum, which is so valued in this
Nation, is not just given to the private sector on any request
that the private sector has,'' he said. ``The public safety
systems of our Nation depend on radio communication.''
Phoenix Mayor Rimsza summed up this concern, saying, ``All
we are asking is: Solve the problem before we sell those radio
frequencies so that our officers do not get blocked from
critical communications when they are most important.''
2. The Nation's health care infrastructure has limited capacity.
The terrorist attacks of September 11, 2001, and the
ensuing anthrax attacks focused long overdue attention on the
ability of the Nation's health infrastructure to respond to
major emergencies involving a large number of victims. This
concern was discussed at each of the subcommittee's 11 field
hearings.
During the subcommittee's Los Angeles field hearing,
witnesses representing the Centers for Disease Control and
Prevention [CDC] and California's Department of Health Services
pointed out that September 11, 2001, demonstrated the fragility
of the public health system. In addition, witnesses raised
serious concerns that private-sector hospitals no longer have
the capacity to treat the potential influx of victims that
would result from a biological, chemical or nuclear incident.
Throughout the hearings, witnesses said that hospitals have
essentially eliminated their excess capacity, called surge
capacity, in order to cut overhead costs.
In Nashville, Dr. Schaffner said, ``Given the structure and
financing of health care in the United States today, there is
only minimal surge capacity in the health care system.'' Dr.
Ian Jones of Vanderbilt University Medical Center concurred,
saying, ``The No. 1 problem that we are facing today is
emergency department overcrowding.''
As an example, Dr. Jones said that a recent, relatively
mild outbreak of influenza temporarily shut down a number of
hospital emergency rooms throughout the Nashville area. In
other areas, he said, there have been reports of citywide
emergency room shutdowns. ``When that happens, there is really
nowhere for the EMS service, who may be carrying critically ill
patients, to take them,'' he said. ``It does not take a lot of
imagination to understand what might happen if 1,000 critically
ill patients requiring ICU care were dumped on the system at
the same time, as might happen in a bioterrorism event.''
Dr. Philip Smith, Chief of Infectious Diseases at the
University of Nebraska confirmed that overcrowded emergency
rooms is also a problem in Omaha, where, on occasion, patients
have had to be shuttled to hospitals as far away as Kansas City
and Des Moines.
Dr. Jones said that emergency room overcrowding is a result
of several factors. In large part, hospital emergency rooms are
serving as a source of primary care for uninsured patients. In
addition, the population is aging and is sicker and, in
general, there has been a breakdown in the mental health
system, he said.
In Albuquerque, witnesses Dr. Paul Roth, Dean of the
University of New Mexico School of Medicine and Dr. Mack
Sewell, State Epidemiologist at the New Mexico Department of
Health reaffirmed that emergency room overcrowding is
nationwide problem.
During the subcommittee's hearing in Abilene, Raymond
Williams, president and chief executive officer of the Sumner
Regional Center suggested yet another cause of declining
hospital capacity. ``Over the last 10 years we have watched the
Medicare reimbursement go lower and lower to the point that,
today, we find almost every hospital in Kansas getting paid
below its cost,'' he said. ``If we had any cash reserves set
aside to buy equipment, to provide training, those funds are no
longer there.''
States are looking at various ways to create additional
patient beds. In Nebraska, health officials are working on a
plan to set up field hospitals, which would create an
additional 500 beds in the event of a catastrophe, said Dr.
Smith of the University of Nebraska. However, Vanderbilt's Dr.
Schaffner urged caution in relying on such temporary
facilities. ``The medical capacity we would need in a
bioterrorist event would not be satisfied simply by housing
patients somewhere else with minimal care. Neither the medical
community nor the public would find that sufficient today,'' he
said.
In California, State health officials are working closely
with the Department of Veterans Affairs [VA] to use VA
facilities during a major emergency, said Diana Bonta, director
of the California Department of Health and Human Services. ``We
have had coordination at a local level and at a statewide
level, and we will continue to have that as well with the
Federal facilities. It is very crucial for us to be able to
work closely with them,'' she said.
During the subcommittee hearing in Tempe, Robert Spencer,
the director of Maricopa County Department of Emergency
Management, suggested that the Federal Government consider
developing 12 regional mobile field hospitals, which could
respond effectively to a disaster in any part of the country.
Metro Medical Response Systems [MMRS], composed of law
enforcement, public health and hospital personnel, have been
established in most of the cities the subcommittee visited. In
Omaha, Lieutenant Tim Conohan, emergency preparedness
coordinator for the Omaha Police Department, credited this
regional program for Omaha's overall planning for emergencies.
Emergency managers are eager to embrace the program, however,
they are concerned about the Federal Government's willingness
provide sustaining funding for it. Dr. Frances Winslow,
Director of Emergency Services for the city of San Jose, said,
``We received training, equipment and supplies. However, at
this point, we have no promise of sustainment of these efforts
that we bought at such great cost.''
MEDICAL LABORATORIES NEED BOLSTERING
Along with other public health efforts, the Nation needs to
have a robust network of medical laboratories capable of
testing for unique biological, chemical and nuclear agents.
That concern was raised at many of the subcommittee's field
hearings. Chicago physician, Dr. Quentin Young said, ``Our
national, State and local health agencies are under-funded and
poorly coordinated. Elementary modern capabilities in computer
information systems, round the clock personnel in place,
laboratories of a uniform high quality and speedy
accessibility, a full public health professional work force--
are all deficient in various degrees across our country and our
State.''
Omaha's police Lt. Tim Conohan agreed, saying, ``The
Government must examine the status of the Nation's medical
laboratories. These labs need to be a high priority. Public
safety departments cannot formulate a response plan until they
know exactly what they are dealing with, and time is critical
during these types of incidents.''
In Iowa City, Dr. Mary Gilchrist, director of the
University of Iowa Hygienic Laboratory told the subcommittee
that the anthrax threat in 2001 taxed her laboratory beyond its
limitations, and she described the result. Dr. Gilchrist's lab
is part of the Center for Disease Control and Prevention's
[CDC] Laboratory Response Network. Yet despite the lab's
capabilities, its limited resources required that specimens be
initially evaluated at local facilities to rule out powders
that did not appear to constitute a credible Anthrax threat.
``Some powders were not tested at all,'' she said. ``While not
a real health threat, it caused panic and the shutdown of
assembly lines at a cost of hundreds of thousands of dollars.
We were lucky that our wake-up call involved few who were truly
ill, and we managed to minimize fear and panic.'' Dr. Gilchrist
said there is a significant need to train and equip local
laboratories to enable them to test for chemical and nuclear
agents as well as biological agents. ``The capacity for
detection and identification of the three types of agents
should be present in each lab,'' she said. In addition, Dr.
Gilchrist said the CDC should expand the Laboratory Response
Network to include food and other specialized laboratories.
Dr. Steven Hinrichs who heads up the Nebraska Public Health
Laboratory is also concerned about the Nation's laboratory
network. ``Continued support of public health efforts over
several years is needed to facilitate the rebuilding of
national capacity and the overall national laboratory system.
The recruitment and training of new personnel to fill the need
of expert scientists will take many years,'' he said. In
addition, Dr. Hinrichs is concerned that the CDC-sponsored
Laboratory Response Network does not include the private
sector. ``We believe that the private sector is really on the
front lines. So our efforts have been to connect to the front
lines those private laboratories in order to prepare them. That
is an extremely important issue,'' he said.
Dr. Hinrichs also pointed out the need to utilize
universities and colleges more effectively for training first
responders and volunteer service providers, and educating the
public on the threats stemming from biological, nuclear and
chemical agents.
Kirkwood Community College near Iowa City provided an
excellent example of how colleges can assist in the Nation's
homeland security effort. Kirkwood's Director of Environmental
Training Programs, Douglas A. Feil, discussed the college's
training program for first responders. Kirkwood provides
hazardous materials training through the Hazardous Materials
Training and Research Institute, he said. Since 1987, the
institute, which includes Kirkwood and 80 partner colleges, has
trained more than 120,000 workers. In addition, Kirkwood has
developed a partnership with city and county governments, and
local industry to build and operate a multi-use community
training and response center. The center will provide an
emergency operations center for Linn County's Emergency
Management Agency and will house a CDC-funded national mass
fatalities institute.
As well as partnering with colleges and universities, Dr.
Hinrichs said, ``The national need exists for a reserve force
of expert laboratory scientists capable of responding to
national emergencies. These reserve scientists could be
deployed during non-crisis times to provide training to front-
line laboratories throughout each State. The CDC has begun
exploring mechanisms to meet this need.''
California's health director, Diana Bonta, said that
California is considering compiling an inventory of infectious
disease specialists who might be available in time of
emergency. The State is also considering adding education
courses on bioterrorism-related issues for health care
professionals.
``Training and coordinating physicians, both in the
hospital and in the community, to recognize unusual infections
and to respond appropriately is a task that has begun, but more
needs to be done,'' said Vanderbilt's Dr. Shaffner.
Dr. Philip Smith of the University of Nebraska summed up
his concerns and the concerns of many others saying, ``The key
role of the Federal Government here is to not only to foster,
but to insist on multi-agency collaboration to minimize the
chance that we are going to have duplication and do the best
job of protecting the public in the future.''
3. Intelligence sharing among law enforcement agencies is improving.
Shortly after September 11, 2001, the subcommittee held its
initial hearing on the Nation's ability to respond to
biological or chemical attack in Washington, DC. During that
hearing police chiefs from Philadelphia and Baltimore told the
subcommittee that they were not getting adequate or timely
intelligence from the Federal Bureau of Investigation [FBI]
regarding suspects in the terrorist attacks. Following the
hearing, FBI Director Robert Mueller pledged that the Bureau
would be more forthcoming with detailed, timely information for
local law enforcement officials. In addition, the director
began extending the offer of security clearances to local law
enforcement department heads who qualify for them. This issue
was discussed extensively at the subcommittee's field hearings.
Witnesses from the FBI discussed their efforts to improve
intelligence sharing through the Bureau's expanded Joint
Terrorism Task Force [JTTF] structure. The JTTFs and the
Bureau's effort to give local police chiefs and sheriffs access
to classified information have clearly enhanced the
intelligence sharing process, especially among JTTF
participants.
Some States, such as Colorado, are also working to improve
intelligence sharing. Suzanne Mencer, executive director of
Colorado's Department of Public Safety, described a statewide
system that is being developed in Colorado for the secure
dissemination of intelligence information. Once completed, she
said, the State will be able to disseminate FBI bulletins to
State and local law enforcement officials and will be able to
share data generated by these agencies with the FBI.
Overall, most law enforcement witnesses said they were
satisfied with the progress the FBI has made in providing more
detailed and timely information. However, a few non-law
enforcement witnesses described their ongoing frustration in
obtaining timely threat information. Mr. Canton, who directs
the San Francisco Mayor's Office of Emergency Services said,
``There is very little intelligence that actually reaches us
through the emergency management community.'' Several other
witnesses agreed, saying that their most timely information
still comes from the media via CNN. Similarly, representatives
from water and power utilities said they needed more
information on potential threats to their facilities.
4. National emergency management guidelines and best practices are
needed.
At each of the hearings, witnesses, including the General
Accounting Office, stressed the need to establish national
standards for preparedness. They noted that such standards
would assist State and local entities in determining their
successes and weaknesses, and in their long-term planning. In
addition, performance standards could be used as a basis for
assessing the effectiveness of Federal programs.
Lt. Tim Conohan of the Omaha Police Department said, ``We
would like to see the Federal Government assist us with a best
practices manual. There needs to be consistency throughout the
country when dealing with these events. Regional training for
standardized response goes hand in hand with the completion of
a best practice manual. State and local public safety agencies
need the Federal Government's expertise in the field to assist
us with training our people so there is a standardized response
to these types of incidents.'' That sentiment was reiterated at
all of the subcommittee's field hearings.
In California, Los Angeles County Sheriff Lee Baca said,
``We look forward to the Office of National Preparedness, under
FEMA, to get some guidelines out so that we can start doing
what we need to do to further our ability to provide first
responder services. And so we wait. The whole idea of homeland
security when you boil it down is how well local fire and
police and medical service are going to be able to perform.''
Mr. Canton from San Francisco summed it up, saying, ``We
really do need some national priorities. What do you expect us
to be able to do at the local level? What should we be focusing
on? What is important?''
5. Federal funding structure needs greater flexibility and a single
point of contact.
Federal funding and the mechanisms for distributing those
funds were also discussed during this series of hearings.
Although State and local officials are appreciative of the
increased Federal dollars they are receiving in response to the
September 11, 2001, attacks, they encouraged greater
flexibility in spending those dollars and a single source of
the revenue.
In general, some of the larger Federal homeland security-
related grants require that States distribute approximately 75
percent of the dollars they receive to local governments.
Predictably, local agencies would prefer that those Federal
dollars be given directly to them. San Francisco's Fire Chief
Mario Trevino said, ``It is essential that the process is done
so without any redirection of those funds so that as much of
the money as possible comes to the aid of the emergency
agencies that will be responding. The first responders that you
see represented here today will be alone working the disaster
until other assistance arrives, and that could be anywhere from
hours to days,'' he said. In addition, Mr. Canton from San
Francisco's Emergency Management Service said that first
responders need a block grant from a single source. ``We are
more than happy to be held accountable for funds that are
provided to us. We've been doing that for years. That's part of
our job. What we would like to see are those requirements
reduced to the point where they are manageable, and we can give
you some concrete evidence of what we've done,'' he said.
State agencies see it differently, saying that in order to
have an organized, comprehensive statewide emergency response,
the funding must be distributed to State agencies.
Milwaukee's Mayor John Norquist believes the best solution
is somewhere in between. The mayor said, ``To make sure that
funds are expended efficiently, I am not sure that any level of
government should be getting 100 percent funding from the
Federal Government. I do not completely agree with the U.S.
Conference of Mayors, which wants to have an unrestricted block
grant in this area, and I would not agree that States ought to
just be able to have money to throw around . . . My plea to you
would be to have the money follow where it is going to be the
most effective. That takes a thoughtful approach by the Federal
Government, not just making State governments happy or local
governments happy, but figuring out how things will work
effectively in Wisconsin or California.''
Throughout the hearings, first responders expressed their
frustration over the lack of coordination among the Federal
agencies that issue grants. ``There are training and education
opportunities from many, many Federal agencies that can be
applied at the local level,'' said. Fire Chief James Reardon of
Northbrook, IL. ``We appreciate that, but there is no single
coordination point. What that means is that we are missing
opportunities to send people to the right training,'' he said.
``We need a single point of coordination with all the Federal
agencies and the Federal training programs.''
Dennis Nilsson, commander of field operations for the
Evanston Police Department, agreed, saying, ``We need to know
what resources are out there and available to us.''
Dallas Jones, who heads up the Governor's Office of
Emergency Services in California, said the Government needs to
compile a directory of Federal training programs. ``That would
be very helpful in sorting through some of the maze of
identifying some of these programs for local governments,'' he
said.
NEED FOR BETTER EQUIPMENT
Overall, fire and police chiefs of small and mid-sized
cities said they need more equipment and training. They said
their departments lack basic equipment such as personal
protective gear. In larger, better equipped cities, officials
noted that many types protective equipment have a shelf life.
They are concerned that Federal funding might not be available
to replace those items. In addition, several witnesses said
that the Federal Government should provide better guidance in
purchasing equipment and do a better job of sharing new
technology.
In general, local fire departments are better equipped to
respond to a hazardous incident than police departments, many
of which lack personal protection equipment. Police officers
have been called ``blue canaries,'' said Lt. Tim Conohan of the
Omaha Police Department. ``We respond, and we determine that we
have a hazardous situation by falling to the ground and
dying,'' he said, explaining that the police department is
generally called to a hazardous incident before the fire
department. ``So, we do need a minimal amount of personal
protective equipment,'' he said.
Lt. Roger Hoffner of the Arapahoe County Officer of
Emergency Management in Colorado obtained a Federal grant to
buy some quick masks for his police officers whose protective
equipment consisted of out-dated military gas masks which, he
said, gave the officers a false sense of security. ``They had
nothing,'' he said. He asked Federal officials to recommend the
best type of mask to purchase. Their response: ``Well, now, we
could give you a list of things, but we can't tell you which
one because that would be a conflict of interest,'' Lt. Hoffner
said, adding, ``I found that very frustrating.''
Fire Chief Reardon of Northbrook, IL, also would like
Federal guidance on his equipment purchases, he said. ``Vendors
are selling products that I am calling snake oil out there. We
need to have those validated through a single source so that if
we respond to an incident in California or Florida, or they
come here, we are all using similar equipment.''
Larger agencies with more sophisticated equipment have an
additional concern. Omaha's Fire Chief Wagner said that Federal
grant programs have been extremely beneficial, however, he
said, ``there is a shelf-life on some of these products, and
there is no program in effect to offer replacement without
using city funds,'' which, he noted, are extremely limited.
In addition, nearly all first responders said they need
more flexibility in the Federal grant programs. Summing up this
concern, Chief Wagner said, ``As a fire chief, we respond
locally first and regionally second, but that can obviously
change very quickly. We want to be able to provide the best
equipment, the best training and the best offer to save lives
that we can.''
Dallas Jones, who heads up California's homeland security
effort, also said, ``Technology transfers from Federal agencies
in the military to local and State government would be very
helpful.'' Mr. Jones had learned about a technology that could
quickly detect chemical and biological agents, but the
technology is not available to State and local agencies, he
said. ``We even asked the question, `Could we buy it for the
State or local government?' And the answer basically is `no.'
''
Throughout the subcommittee field hearings, witnesses from
State, local and regional agencies stressed the importance of a
comprehensive, flexible, all-hazards approach to emergency
management planning. In earthquake-prone San Francisco Mr.
Trevino said, ``Any capability we develop must be able to be
used for multi-hazard planning.''
C. Recommendations
Based on the foregoing findings, the committee recommends
the following:
The Federal Government must take a leadership role
in resolving the communications interoperability problem.
Congress must insist that sufficient radio frequencies remain
in the public domain to ensure that the Nation's emergency
responders have access to reliable communications systems. In
addition, Congress must provide adequate funding for research
and development of radio technologies that would allow local,
State and Federal emergency responders to communicate.
The Federal Government must re-examine ways to
bolster the Nation's public health system.
The Federal Government should establish a single
point of contact in the Federal system for homeland security
grants, training programs and other related funding.
The Federal Government should insist on working
agreements among local governments, health officials, the
Department of Defense, and the Department of Veterans Affairs
to provide additional medical facilities in catastrophic
situations.
The Federal Government needs to assist local and
State governments in procuring new technologies that enhance
the detection of, and protection against, biological, chemical
or nuclear agents; and technologies designed to enhance
communications interoperability.
Working with State and local governments, the
Federal Government must move quickly to provide national
guidance standards and best practices for emergency management
responders.
APPENDIXES
------
Appendix A.--List of Field Hearings
``How Effectively is the Federal Government Assisting State
and Local Governments in Preparing for a Biological, Chemical
or Nuclear Attack?''
------------------------------------------------------------------------
City and State Hearing was
Date of Hearing Held
------------------------------------------------------------------------
March 1, 2002............................. Nashville, Tennessee
March 22, 2002............................ Tempe, Arizona
March 25, 2002............................ Albuquerque, New Mexico
March 28, 2002............................ Los Angeles, California
April 2, 2002............................. San Francisco, California
July 1, 2002.............................. Milwaukee, Wisconsin
July 2, 2002.............................. Chicago, Illinois
July 3, 2002.............................. Omaha, Nebraska
August 20, 2002........................... Abilene, Kansas
August 22, 2002........................... Iowa City, Iowa
August 23, 2002........................... Golden, Colorado
------------------------------------------------------------------------
Appendix B.--Index of Witnesses
ARREDONDO, P. Ben, city councilman, Phoenix, AZ, March 22,
2002.
ATCHINSON, Christopher G., associate dean for public health
practice, College of Public Health, University of Iowa, Iowa
City, IA, August 22, 2002.
AUSTIN, Michael P., director, Arizona Division of Emergency
Management, Phoenix, AZ, March 22, 2002.
BACA, Lee, sheriff, Los Angeles County, Los Angeles, CA,
April 2, 2002.
BAKAS, Nick, chief of public safety, Office of Public
Safety, City of Albuquerque, Albuquerque, NM, March 25, 2002.
BAKERSKY, Peter, Director, Office of National Preparedness,
Region 8, Federal Emergency Management Agency, Denver, CO,
August 23, 2002.
BEASLEY, Colonel Norman, assistant director, criminal
investigations division, Arizona Department of Public Safety,
Phoenix, AZ, March 22, 2002.
BERKIN, Jeffrey J., Assistant Special Agent in Charge,
Milwaukee Division, Federal Bureau of Investigation, Milwaukee,
WI, July 1, 2002.
BICE, Dr. Steven, Director, National Pharmaceutical
Stockpile, Center for Disease Control and Prevention, San
Francisco, CA, April 2, 2002.
BOGNER, James F., Special Agent in Charge, Omaha Division,
Federal Bureau of Investigation, Omaha, NE, July 3, 2002; Iowa
City, IA, August 22, 2002.
BONTA, Dr. Diana, director, California Department of Health
Services, State of California, Los Angeles, CA, April 2, 2002.
BROWN, Dr. John, medical director, San Francisco EMS System
and Emergency Department, San Francisco, CA, April 2, 2002.
BUIKEMA, Edward G., Regional Director, Region 5, Federal
Emergency Management Agency, Milwaukee, WI, July 1, 2002;
Chicago, IL, July 2, 2002.
BURRIS, Kenneth, Regional Director, Federal Emergency
Management Agency, Nashville, TN, March 1, 2002.
BURTON, Dr. Richard, associate director, California
Department of Health Services, San Francisco, CA, April 2,
2002.
BUSBOOM, Stanley L., division leader, security and
safeguards division, Los Alamos National Laboratory,
Albuquerque, NM, March 25, 2002.
CANTON, Lucien G., director, Mayor's Office of Emergency
Services, city of San Francisco, San Francisco, CA, April 2,
2002.
CARBALLIDO, Raul E., Acting Special Agent in Charge,
Federal Bureau of Investigation, Denver, CO, August 23, 2002.
CARVER, James E., director, Tennessee Valley Authority
Police, Nashville, TN, March 1, 2002.
CASTLEMAN, Ron, Regional Director, Region 6, Federal
Emergency Management Agency, Phoenix, AZ, March 22, 2002;
Albuquerque, NM, March 25, 2002; Los Angeles, CA, March 28,
2002; San Francisco, CA, April 2, 2002.
CHAPIN, John D., administrator, Department of Public
Health, State of Wisconsin, Milwaukee, WI, July 1, 2002.
CHEL, Casey, disaster preparedness manager, city of Long
Beach, Los Angeles, CA, March 28, 2002.
CHERRY, Janet, associate, the Cadmus Group, San Francisco,
CA, April 2, 2002.
CHURAY, Ray P., Assistant Special Agent In Charge, Phoenix
Field Office Federal Bureau of Investigation, Phoenix, AZ,
March 22, 2002.
CLARKE, David, sheriff, Milwaukee County Sheriff's
Department, Milwaukee, WI, July 1, 2002.
COCHRAN, Ronald W., executive director, Lawrence Livermore
National Laboratory, San Francisco, CA, April 2, 2002.
CONOHAN, Lt. Tim, emergency preparedness coordinator, Omaha
Police Department, Omaha, NE, July 3, 2002.
COPELAND, Stanley H., director, planning and training,
Tennessee Emergency Management Agency, Nashville, TN, March 1,
2002.
CRAIG, Dr. Allen, State epidemiologist, director of
Communicable and Environmental Disease Services, Nashville, TN,
March 1, 2002.
DALTON, Patricia A., Director, Strategic Issues, U.S.
General Accounting Office, Los Angeles, CA, March 28, 2002; San
Francisco, CA, April 2, 2002; Abilene, KS, August 20, 2002.
DALY, Patrick J., Administrative Assistant Special Agent in
Charge, Chicago Division, Federal Bureau of Investigation,
Chicago, IL, July 2, 2002.
DEAN, Steven M., Assistant Special in Charge, Albuquerque
Field Office, Federal Bureau of Investigation, Albuquerque, NM,
March 25, 2002.
DEVRIES, Commander Mark R., Commanding Officer, Marine
Safety Office Milwaukee, U.S. Coast Guard, Milwaukee, WI, July
1, 2002.
DIAZ, Dr. Pamela S., director, emergency preparedness and
infectious disease control, Chicago Department of Public
Health, Chicago, IL, July 2, 2002.
EDEN, Catherine R., director, Arizona Department of Health
Services, Phoenix, AZ, March 22, 2002.
ENGLISH, Thomas, secretary, New Mexico Department of Public
Safety, Albuquerque, NM, March 25, 2002.
ERICKSON, Keith, director, Linn County Department of Public
Health, Iowa City, IA, August 22, 2002.
FEIL, Douglas A., director, environmental training
programs, Kirkwood Community College, Iowa City, IA, August 22,
2002.
FOLDY, Dr. Seth, commissioner of health, city of Milwaukee,
Milwaukee, WI, July 1, 2002.
GALLIER, Tom, general manager, Tempe Water Utilities
Department, Phoenix, AZ, March 22, 2002.
GARDNER, Larry, fire chief, Milwaukee Fire Department,
Milwaukee, WI, July 1, 2002.
GARDNER, Major General Gregory, Kansas adjutant general,
State of Kansas, Abilene, KS, August 20, 2002.
GATES, W. Gary, vice president, nuclear division, Omaha
Public Power District, Omaha, NE, July 3, 2002.
GILBERT, Wendall H., Tennessee Department of Veterans
Affairs, Deputy to the Governor for Homeland Security,
Nashville, TN, March 1, 2002.
GILCHRIST, Dr. Mary J.R., director, University of Iowa
Hygienic Laboratory, University of Iowa, Iowa City, IA, August
22, 2002.
GLEASON, Edward J., administrator, Wisconsin Emergency
Management, Milwaukee, WI, July 1, 2002.
GORDON, Ellen M., administrator, emergency management
division, State of Iowa, Iowa City, IA, August 22, 2002.
HAINJE, Richard, Regional Director, Region 7, Federal
Emergency Management Agency, Omaha, NE, July 3, 2002; Abilene,
KS, August 20, 2002; Iowa City, IA, August 22, 2002.
HALFORD, Stephen D., director and chief, Nashville Fire
Department, Nashville, TN, March 1, 2002.
HARBOR, Terry L., chief, Long Beach Fire Department, Los
Angeles, CA, March 28, 2002.
HARRIS, Jack, assistant chief, Phoenix Police Department,
Phoenix, AZ, March 22, 2002.
HARTLEY, Captain Scott E., Commanding Officer, National
Strike Force Coordinating Center, U.S. Coast Guard, Milwaukee,
WI, July 1, 2002.
HAVLIK, Stephen C., fire chief, Cedar Rapids Fire
Department, Iowa City, IA, August 22, 2002.
HECKER, JayEtta Z., Director, Physical Infrastructure
Issues, U.S. General Accounting Office, Nashville, TN, March 1,
2002; Milwaukee, WI, July 1, 2002; Chicago, IL, July 2, 2002;
Omaha, NE, July 3, 2002.
HEINEMAN, David, Lt. Governor, State of Nebraska, Omaha,
NE, July 3, 2002.
HINRICHS, Dr. Steven, director of Nebraska health
laboratory, director of microbiology and virology, Department
of Pathology/ Microbiology, University of Nebraska Medical
Center, Omaha, NE, July 3, 2002.
HOFFNER, Lt. Roger E., Arapahoe County officer of Emergency
Management, Denver, CO, August 23, 2002.
IDEN, Ronald, L., Assistant Director in Charge, Los Angeles
Division, Federal Bureau of Investigation, Los Angeles, CA,
March 28, 2002.
JAAX, Dr. Jerry P., associate vice provost for research
compliance, university veterinarian, Kansas State University,
Abilene, KS, August 20, 2002.
JONES, Dallas, director, Governor's Office Of Emergency
Services, State of California, Los Angeles, CA, March 28, 2002.
JONES, Ian David, Vanderbilt University Medical Center,
Nashville, TN, March 1, 2002.
KELLER, Larry, executive director, Port of Los Angeles, Los
Angeles, CA, March 28, 2002.
KNOWLES, Terry L., deputy director, Kansas Bureau of
Investigation, Abilene, KS, August 20, 2002.
KRAFT, David A., director, Nuclear Energy Information
Services, Chicago, IL, July 2, 2002.
KULESZ, Jim, program manager, systems engineering and
technology, Oak Ridge National Laboratory, Nashville, TN, March
1, 2002.
KULISCH, Commander Gail, Commanding Officer Atlantic Area
Strike Team, U.S. Coast Guard, Chicago, IL, July 2, 2002.
LACY, Bruce, nuclear business assets manager for Alliant
Energy, Duane Arnold Energy Center, Iowa City, IA, August 22,
2002.
LANE, James L., undersheriff, Ford County Sheriff's Office,
Abilene, KS, August 20, 2002.
LEE, Steve, director, Douglas County Emergency Management
Agency, Douglas County Health Department, Omaha, NE, July 3,
2002.
LUMPKIN, Dr. John R., Director, Illinois Department of
Public Health, Chicago, IL, July 2, 2002.
MAYNARD, Otto, president and chief executive officer, Wolf
Creek Nuclear Operating Corp., Abilene, KS, August 20, 2002.
MCCUE, Kerry G., director, Ellis County Emergency Medical
Service, Abilene, KS, August 20, 2002.
MEFFORD, Larry A., Associate Special Agent in Charge, San
Francisco Field Office, Federal Bureau of Investigation, San
Francisco, CA, April 2, 2002.
MENCER, Suzanne, executive director, Department of Public
Safety, State of Colorado, Denver, CO, August 23, 2002.
MILLER, Dr. Lisa A., State epidemiologist for bioterrorism,
Colorado Department of Public Health and Environment, Denver,
CO, August 23, 2002.
MISRA, Dr. Majit, director, seed sciences, Iowa State
University, Iowa City, IA, August 22, 2002.
MOSER, Dr. Michael, director, Kansas Department of Health
and Environment, Division of Health, Abilene, KS, August 20,
2002.
NEDDO, Pete, manager of safety and security, Metropolitan
Utilities District, Omaha, NE, July 3, 2002.
NILLSON, Commander Dennis, field operations division,
Evanston Police Department, Chicago, IL, July 2, 2002.
NOKES, K. David, director, Systems Research Organization,
Sandia National Laboratory, Albuquerque, NM, March 25, 2002.
NORQUIST, John O., mayor, city of Milwaukee, Milwaukee, WI,
July 1, 2002.
OLAV-JOHNSEN, John, chairman, DOE/NNSA Biosafety Working
Group, Albuquerque, NM, March 25, 2002.
PATE, Paul D., mayor, Cedar Rapids, Iowa City, IA, August
22, 2002.
POSNER, Paul L., Managing Director, Federal Budget Issues,
Strategic Issues, U.S. General Accounting Office, Tempe,
Phoenix, March 22, 2002; Iowa City, IA, August 22, 2002;
Denver, CO, August 23, 2002.
PURCELL, Bill, mayor, city of Nashville, Nashville, TN,
March 1, 2002.
RAYMOND, Dr. Richard A., chief medical officer, State of
Nebraska, Omaha, NE, July 3, 2002.
RESNICK, I. Gary, program manager, biothreat reduction
programs, Los Alamos National Laboratory, Albuquerque, NM,
March 25, 2002.
RIMSZA, Skip, mayor, Phoenix, AZ, March 22, 2002.
RIORDAN, Ray, emergency preparedness officer, East Bay
Municipal Utility District, San Francisco, CA, April 2, 2002.
ROTH, Dr. Paul B., associate vice president for clinical
affairs and dean, school of medicine, University of New Mexico
Health Sciences Center, Albuquerque, NM, March 25, 2002.
SANDERS, Prentice, assistant chief, San Francisco Police
Department, San Francisco, CA, April 2, 2002.
SCHAFFNER, Dr. William, chairman, Department of
Preventative Medicine, professor of infectious diseases,
Vanderbilt University School of Medicine, Nashville, TN, March
1, 2002.
SCHIFALACQUA, Mariano A., commissioner, Department of
Public Works, city of Milwaukee, Milwaukee, WI, July 1, 2002.
SCHNEIDER, Dr. Arthur, professor of medicine, chief,
endocrinology section, University of Illinois, Chicago, IL,
July 2, 2002.
SEEBALD, Captain Raymond E., Captain, Port of Chicago, U.S.
Coast Guard, Chicago, IL, July 2, 2002.
SEWELL, Dr. Mac, director of epidemiology, New Mexico
Department of Health, State of New Mexico, Albuquerque, NM,
March 25, 2002.
SMITH, Dr. Philip W., chief, section of infectious disease,
Department of Internal Medicine, University of Nebraska Medical
Center, Omaha, NE, July 3, 2002.
SPENCER, Robert, director, Maricopa County Department of
Emergency Management, Phoenix, AZ, March 22, 2002.
STAFFORD, Kevin L., Special Agent in Charge, Kansas City
Field Office, Federal Bureau of Investigation, Abilene, KS,
August 20, 2002.
STANLEY, Ellis, Emergency Management Services, city of Los
Angeles, Los Angeles, CA, March 28, 2002.
STEWART, Roy, president, Stewart Electric & Communications,
Phoenix, AZ, March 22, 2002.
STORMENT, Steve, assistant chief, Phoenix Fire Department,
Phoenix, AZ, March 22, 2002.
SULLIVAN, David B., acting director, Office of Emergency
Management, city of Denver, Denver, CO, August 23, 2002.
TAIT, Joseph, E., executive vice president and chief,
operating officer, Metropolitan Water District, Los Angeles,
CA, March 28, 2002.
TEAGARDEN, George A., livestock commissioner, Kansas Animal
Health Department, State of Kansas, Abilene, KS, August 20,
2002.
THACKER, James E., director, Mayor's Office of Emergency
Management, city of Nashville, Nashville, TN, March 1, 2002.
THOMAS, Philip, Special Agent in Charge, Memphis Field
Office, Federal Bureau of Investigation, Nashville, TN, March
1, 2002.
TREVINO, Mario H., chief, San Francisco Fire Department,
San Francisco, CA, April 2, 2002.
TURNER, Emmett H., chief, Nashville Police Department,
Nashville, TN, March 1, 2002.
VARNER, Dr. Kevin P., area veterinarian in charge, U.S.
Department of Agriculture, Animal and Plant Health Inspection
Services, Veterinary Services, State of Kansas, Abilene, KS,
August 20, 2002.
WAGNER, Paul R., chief, Omaha Fire Department, Omaha, NE,
July 3, 2002.
WALL, Larry H., president, Colorado Health and Hospital
Association, Denver, CO, August 23, 2002.
WHITNEY, Major General Mason C., adjutant general, State of
Colorado, Denver, CO, August 23, 2002.
WIKES, Lieutenant Byron D., Office of Safety Services,
Police Division, city of Englewood, Denver, CO, August 23,
2002.
WILHELM, Dr. John, commisioner, Chicago Department of
Public Health, Chicago, IL, July 2, 2002.
WILKINSON, John, chief, Fire and Life Safety Services, city
of Evanston, Chicago, IL, July 2, 2002.
WILLIAMS III, Raymond, president, chief executive officer,
Sumner Regional Medical Center, Abilene, KS, August 20, 2002.
WILSON, Bernie, chief, Los Angeles International Airport
Police Department, Los Angeles, CA, March 28, 2002.
WINSLOW, Dr. Frances, director of Emergency Services, city
of San Jose, San Francisco, CA, April 2, 2002.
WOOD, Major General Jackie, adjutant general, Tennessee
National Guard, Nashville, TN, March 1, 2002.
WRIGHT, Ned, director, Linn County Management Agency, Iowa
City, IA, August 22, 2002.
YESKEY, Kevin, Director, Bioterrorism Response Program,
Centers for Disease Control and Prevention, Los Angeles, CA,
March 28, 2002.
YIM, Randall, Managing Director, National Preparedness,
U.S. General Accounting Office, Albuquerque, NM, March 25,
2002.
YOUNG, Quentin, M.D., chair, Health and Medicine Policy
Research Group, Hyde Park Associates in Medicine, Chicago, IL,
July 2, 2002.