Los Angeles County has spent at least $2 million in taxpayer dollars intended to prepare for bioterrorism on buffing up the health department’s image, responding to unrelated health scourges and buying questionable supplies and services, a Times review has found.
When public health officials couldn’t round up enough volunteers to take part in a smallpox vaccination drill, for instance, they turned to actors from an old Hollywood standby: Central Casting.
To hire extras to play the role of patients in the half-day drill, the county’s Department of Health Services in 2004 paid the aptly named firm $57,045. That’s not counting what the department ponied up to thank the paid actors and volunteers: $10,000 for gift certificates, $13,600 for pens, digital thermometers and bags to hold the gifts, and thousands more for food and transportation.
The county has spent most of the federal grant money to hire and train staff to respond to emergencies, which generally is consistent with the purpose of such funds. Yet at times, the spending has stretched the definition of terrorism readiness, drawing concern even from the department’s own employees, according to spending requests and other documents.
“Unless we have a compelling public message, this seems to be a big waste of taxpayer funds,” John Wallace, the department’s director of external and government relations, wrote in an August 2004 e-mail to department leaders about a proposed $1-million contract for a media campaign.
“I am concerned that it will appear that we are trying to spend grant dollars for the sake of not having to return them, and that is not acceptable.”
In fact, the department has failed to spend one in six dollars granted by the federal government for bioterrorism preparations from 2002 to 2004.
During those years, the U.S. Centers for Disease Control and Prevention doled out more than $2.7 billion to prepare states, counties and cities in the event of a bioterrorism attack. L.A. County alone received $83 million, of which $14 million went unspent. For the current grant year beginning last summer, the county was given an additional $27.9 million.
The grants have been a boon to an otherwise cash-starved health department, which faces massive cutbacks to head off an expected $781-million shortfall within three years.
Dr. Jonathan Fielding, the county’s public health director, defended his department’s spending, saying it is much better prepared than it was several years ago to handle a disaster. For instance, the department has conducted more than 130 drills to test the county’s readiness and created a surveillance system – working with hospitals, schools, laboratories and the coroner – to track disease outbreaks.
Without a bioterrorism attack, it isn’t possible to say whether the county’s spending habits have impaired its preparedness.
But in some key areas, such as building a new public health laboratory, the county remains behind schedule as dollars flow to other projects or remain unused.
Among the county’s other expenditures on bioterrorism, sometimes referred to as BT, detailed in documents obtained by The Times under the California Public Records Act:
* More than $128,000 for tchotchkes to be given away to the public, including letter openers, whistles, magnets, mouse pads, flashlights, pens, travel toothbrushes and emergency kits. The department spent $1,000 on nylon discs for Public Health Week, emblazoned with the slogan “Nutrition and Physical Activity: Keys to Health.” And it spent $4,145 on clipboards, notepads and stress balls to give away at a forensic epidemiology conference.
* At least $170,000 to train department staff on how to put together videos to be viewed online. Two videos have been produced: one on the role of public health, the other on home pool safety.
* A $4,675 teleprompter so that Fielding and others can “face the camera and be able to read a prepared speech,” plus nearly $450 in upgrades to the teleprompter, $2,187 for a laptop to write scripts for the teleprompter and $3,392 for a “very special portable microphone for excellent quality remote interviews and scene descriptions,” according to the expense reports.
Hundreds more went to replace a podium that had been “damaged by rodents.”
* More than 70 high-end desk chairs at about $600 each and about 800 computers, although only 171 staff members are funded by the bioterrorism grant.
* More than $18,000 to print fliers and information cards about West Nile virus and to purchase cases of mosquito repellent. An additional $4,629 for printer cartridges because of an “increased amount of bite reports” related to West Nile.
The California Department of Health Services – which funnels funding from the CDC to the rest of California’s counties – does not allow them to spend their bioterrorism money on West Nile, said Betsey Lyman, the state’s deputy director for public health emergency preparedness.
* Assorted inexpensive but puzzling items such as motivational posters, a $46 mahogany tape dispenser and four copies of the book “The leadership secrets of Santa Claus.”
Fielding said the spending fit federal guidelines. For instance, he said, CDC Director Dr. Julie Gerberding personally approved the county’s use of bioterrorism money to combat West Nile. He said the computers are used by public health employees who may be needed to respond to a disaster, the promotional items direct people to the county’s bioterrorism website, and the teleprompter and webcasting training would help in an emergency.
The teleprompter has been used at least three times for training purposes.
For the smallpox drill, it was much cheaper to use paid actors than county employees, Fielding said.
As for the gift bags, “Even actors might need to know how to reach the BT website or have the material available on how to prepare themselves – that was our thinking,” bioterrorism preparedness director Sharon Grigsby said.
Meanwhile, the county’s new public health laboratory, which was supposed to open in November 2004 and is key to identifying harmful agents, won’t be ready to open until late spring. It is now projected to cost more than $15 million, compared with the $9 million originally predicted, partly because of rainstorms and “unforeseen structural and infrastructure problems,” documents show.
In public health, said Dr. Richard Jackson, California’s former public health officer, “you live and die on the quality and functioning of your laboratories.”
Fielding said the existing lab, although old and cramped, still could respond in a disaster. Even so, he conceded, “we would have loved to see the lab available earlier as well.”
Each year, the CDC issues general guidelines for the use of its bioterrorism grants, but the agency does not dictate the particulars of what should be purchased. It has put a premium on such things as disease surveillance, laboratory capacity, a health alert network, risk communications and education.
Contacted by The Times, a CDC official who oversees the emergency preparedness grants said staff have identified numerous problems with spending requests from Los Angeles County. As a result, they have put some restrictions on its grants, requiring better justification for use of some funds.
“I would say they have more issues than what we would normally see” compared with other agencies, said Alison Johnson, director of CDC’s division of state and local readiness. “They definitely have more issues than average.”
When told of The Times’ findings, she said, “You’ve raised some valid concerns.”
A more senior CDC official, Donna Knutson, later said she didn’t view the county’s problems as excessive.
The CDC does not have the time to scrutinize every expense, Johnson and Knutson said. The agency expects grant recipients to commission outside audits.
One county bioterrorism official, Phillip Moore, warned fellow employees of such a possibility in a Feb. 2005 e-mail. “So far, no one has contacted us wanting to do an audit of our finance or activities (keep our fingers crossed!)” he wrote.
Fielding said his agency is willing to open its books to auditors at any time. He said the sentiment voiced by Moore was that audits are time-consuming and distracting. Previous audits, Fielding said, have not uncovered major problems.
Because of the county’s size and potential as a terrorist target, it, along with New York City and Chicago, gets its money directly from the CDC. Allocations for all other counties in California flow through the state Department of Health Services.
Other jurisdictions, including San Diego and San Francisco, have not asked to spend their money for such items as smallpox drill actors, a teleprompter or giveaway key chains and flashlights, said Lyman, the state bioterrorism official.
Even with its many expenses, at the end of the 2004 fiscal year, L.A. County had $14 million left over.
To avoid returning all of it to the federal treasury, the county received permission from the federal agency to roll some into future years. Fielding cited trouble recruiting personnel, delays in purchasing and lengthy negotiations with vendors.
Still, internal correspondence at the county health department suggests that employees were under great pressure to spend the federal money.
Grigsby, the department’s bioterrorism preparedness director, told her staff in May 2003 about a meeting to “emphasize the importance” of spending all the grant money given to the county, according to an e-mail she wrote to colleagues. At the time, the county worried that it wouldn’t spend up to $9.9 million of its grant.
“We have repeatedly assured Dr. Fielding, and he the Board [of Supervisors], that we will not forgo any of this money,” Grigsby wrote. “Please be able to demonstrate how we can make this happen.”
Weeks later, the department approved a $2,584 overhead projector for Fielding’s office.
In February 2004, Fielding ordered a brochure to be handed out during Public Health Week, an event devoted to general health promotion. He “said to charge it to BT (we’ll include a bullet about making an emergency plan),” his chief of staff, Anna Long, wrote in an e-mail at the time.
Some public health experts who have worked with Los Angeles County say they are impressed with its preparedness.
“The county is better prepared than most counties in the United States to handle a large-scale public health emergency,” said Dr. Steven Rottman, director of the UCLA Center for Public Health and Disasters, which has received hundreds of thousands of dollars from the county to do training.
Some of the expenses that may appear questionable are indeed related to emergency preparedness, Rottman and others said. Tchotchkes, for instance, have the health department’s contact information or web address, so they could be useful in an emergency.
Other experts say the federal government is inviting problems by parceling out huge amounts exclusively for emergency preparedness and not for general public health infrastructure – in financially strapped Los Angeles County and elsewhere.
“Rather than building public health infrastructure in general, you sort of end up with this gap that you need to backfill,” said Beth Maldin, an associate at the Center for Biosecurity of the University of Pittsburgh Medical Center. “It’s a real problem, this sort of disease du jour funding rather than rebuilding public health infrastructure as a whole.”
Dr. Tomas Aragon, director of the Center for Infectious Disease Preparedness at the UC Berkeley School of Public Health, said what matters overall is not specific expenditures, but results.
“The big issue is: Are they prepared?” Aragon said. “If something happens, you want to know that they’re going to be able to pull off a response and you’re at less risk.”
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Giveaway items
Using federal grants, Los Angeles County health officials have spent more than $128,000 on giveaway items touting public health and bioterrorism preparedness. Below are some of the items purchased:
Collapsible nylon disc: $1,060.85 for 1,000 items
Pocket whistle with key light: $3,918.65 for 3,000* items
*Three separate purchases of 1,000 each.
Radio with light: $6,685.70 for 4,000 items
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Source: Requests for procurement of supplies or services, Los Angeles County Department of Health Services
Los Angeles Times
