COPING WITH TWIN DISASTERS:

HHS RESPONSE TO THE 1989

HURRICANE AND EARTHQUAKE

'ERVICES. 
ItYd3a 
OFFICE OF INSPECTOR GENERAL 
OFFICE OF EVALUATION AND INSPECTIONS 
DECEMBER 1990  COPING WITH TWIN DISASTERS:

HHS RESPONSE TO THE 1989

HURRICANE AND EARTHQUAKE

Klcnaro r. l\usserow 
INSPECTOR GENERAL 
OEI-09-90-01040  DECEMBER 1990
 EXECUTIVE SUMMARY 
PURPOSE 
This inspection evaluated the Deparent of Health and Human Services ' (HS) response to 
Hurrcane Hugo and the Lorna Preta earhquake and identified ways to improve response 
effons to futur disasters. 
BACKGROUND 
In 1989, HHS provided disaster recovery assistace and some emergency relief after 
(a) Hurcane Hugo devastated pars of Pueno Rico, the Virgin Islands and Nonh and South 
Carolina, and (b) the Lorna Preta earquake caused massive destrction in Nonhern 
California. These combined disasters were the most destrctive and costly this centur. 
The Federal Government always provides financial assistace for recovery when the 
dict 
President declares a major disaster but only assists with  relief when State and local 
capabilties ar overwhelmed. The HHS provides both imedate response and long term 
recovery assistace under the diection of the Federal Emergency Management Agency 
(FMA), which coordinates the entie Federal response. 
We interviewed 68 Federal, State and local offcias who had fist hand experience with the 
relief and reovery effons in the affected areas. We reviewed situation repons and other 
documents descrbing the disasters and the response. We did not study Nonh Carolina 
experiences. 
FINDINGS 
The Department responded promptly and appropriately to the earthquake and hurrcane to 
restore program operatons ant! provide direct disaster relief. 
progr 
Managers in HHS took all necessar steps to restore  operations promptly and to 
provide immedate relief and reovery assistace. The effects of the disasters, and hence the 
responses, were different in Pueno Rico, the Vlfgi Islands, South Carlina and California. 
Government services broke down in St. Croix, Vlfgin Islands, but not in the other areas. 
Although some Head Sta and other HHS program centers were closed, most were restored 
within a few days. A few in the Vlfgin Islands were still closed at the time we issued our draft 
repon. Social Securty Admnistrtion (SSA) facilties were daaged, but all were restored in 
The Public Health Service 
a week or less. Social Securty benefits were not interrpted. 
(PHS) provided some immediate disaster response in the Vlfgin Islands and Pueno Rico, and 
the PHS National Institute for Menta Health provided the fundig mechanisms for counseling 
to disaster victims in each affected area.  The Department experienced internal communicaton problems as well as both 
communicatn and coordinaton problems with FEMA. 
Some HHS managers, parcularly at the regional level, were confused about which agency 
within the Deparent is responsible for coordinating the disaster response. This confusion 
had not been resolved by the Januar 1990 trsfer of primar disaster authority from the 
Offce of the Secretar to PHS. Both HHS and State officials had problems communicating 
and coordinatig with FEMA. Some of these problems caused delays in transportng needed 
supplies and personnel that could result in deaths in a catastrophic disaster. 
Arrangements for funding disaster response activitis are inaequate. 
Few discretionar or formula grant funds are available within the Deparent for use in 
disaster relief to fill gaps not covere by FEMA or other federa agencies. Curnt accounting 
systems used by all components to pay trvel and personnel expenses for disaster relief are 
inadequate and result in delays in charging payments to the proper accounts. 
The Departent laks clearly defined, up-to-dae plans for restoring programs in future 
disasters. 
Regional and national plans for program restoration and long term disaster recovery contan 
outdated information and rely too heavily on telephone systems. In contrast, the HHS plans 
for emergency medcal relief are much more thorough and useful, parcularly preparedess 
plans for a California earquake. Most HHS managers said they need plans that are simple, 
flexible, updated and practiced fruently. 
RECOMMENDATIONS 
The Office of the Secretary (OS) and the PHS Offce of the Assistant Secretary for Health 
(DASH) should clarify HHS disaster recovery roles and responsibilities. 
The OS and OASH should (a) defme precisely how they will implement the Januar 1990 
delegation of authority and (b) clarfy the disaster relief and reovery responsibilties of PHS, 
other operating divisions (OPDIVs), regional diectors and regional OPDIVs. 
The DASH should issue guidelines to improve diaster planning. 
The guidelines should mandate simple, flexible plans and fruent 
practice of these plans. 
sta 
The plans of each operating and  division should spell out lines of communication with 
each other and should intermesh with the overal HHS disaster plan. The disaster plan should 
specify headquarrs and regional lines of communication with FEMA, which should then be 
reflected in OPDIV plans. Each plan should be updated periodcally.  The DASH should establish backup communicaton systems and regional command posts. 
The backup system could include cellular telephones and radio communication utilizing the 
frequency aleady set aside for HHS. To faciltate better communication, the OASH should 
mandate that each region establish a regional command post. 
The DASH should improve procedures to pay for disaster relief expenditures. 
The OASH, working with the HHS Offce of the Assistat Secreta for Management and 
Budget, should (a) set up a system to identify existing HHS discretionar and formula grant 
funds that could be used to supplement FEMA funding for disaster relief, (b) establish an 
improved system, including a common accountig number, to account for disaster payments 
and (c) develop procedurs to ensur that the suppon agrment with FEMA for each declared 
disaster provides appropriate reimbursement. 
AGENCY COMMENTS 
The PHS, SSA and Offce of Human Development Services concured with the 
recommendations. The Health Car Financing Admistration had no comments. The PHS is 
takng steps to clarfy the emergency preparess and disaster reovery roles and 
ditors, 
responsibilties of the regional  regional health adnistrtors and others. The PHS 
is also revising and simplifying emergency planning and response guidace for OPDIVS and 
Staf Divisions, improving internal emergency communication systems and developing 
procedurs with FEMA to assur prompt reimbursement for HHS operations in disasters 
declared by the President. 
We also solicite comments from FEMA. While agreeing with the repon s recommendations, 
FEMA generally considere its actions in the disasters to be appropriate, citing (a) limits on 
the Federal role durng disasters, (b) the less than catastrophic natue of the earquake and (c) 
the necessity for quick action in a disaster allowing litte time for trainig or screening of 
non-FEMA personnel. While we did not undenae a comprehensive review ofFEMA' 
actions in the dual disasters, we disagree with FEMA' s premise that the nee for quick action 
in disaster response precludes carful planning which would optimize the use of HHS 
personnel. 
The complete texts of the comments are contaed in Appendix A.  .................................................................................................
. . . . . ..  ..  ..  ...   ....    ....    ....    ....    ....    ....
. . . . . .....  ....... . ...... . .......  ........ .  ........   ........ .  . ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ..  ..  ..  ..  ..  . . . . 
TABLE OF CONTENTS 
EXECUTIVE SUMMARY 
INTRODUCTION 
FINDI NGS 

The Department responded promptly and 
appropriately to the earthquake and hurricane to 
. restore program operations and provide direct 
disaster relief. 

The Department experienced internal communication 
problems as well as both communication and

coordination problems with FEMA. ............................

Arrangements for funding disaster response activities 
are inadequate. 

The Department lacks clearly defined, up-to-date

plans for restoring programs in future disasters. . . 

RECOMMENDATIONS 
. . . . . . . . . . . . A - 1
APPENDIX.  INTRODUCTION

This inspection evaluated the Deparent of Health and Human Services ' (HS) response to 
Hurcane Hugo and Calfornia s earhquake and identified ways to improve futue disaster 
response effons. These combined disasters were the most destrctive and costly this centu. 
In September 1989, Hurcane Hugo devastated pars of Puert Rico, the Vlfgin Islands and 
Nonh and South Carolina. Less than a month later, the Lorna Preta earquake caused 
Nonhern California. Both affecte HHS because they (a) 
widespread death and destrction in 
durg 
trggered emergency health and other assistace  the immediate recovery periods and 
(b) daaged office buildings and temporarly disrupte some program operations. 
The Federa Government always provides financial assistace in the recovery stage when the 
President declares a major disaster, but only assists with diect disaster relief when State and 
local governments ar unable to do so. When a disaster occurs, local authorities within 
damaged areas use all available resoures. If local resources ar inadequate or exhausted, 
assistace is requested fIrst from State agencies and then from the Federal government. 
Federal effons are coordiated by the Federal Emergency Management Agency (FMA) 
which also provides financial assistace to individuals and businesses for repais, physical 
rehabiltation and economic reconstrction. 
When a disaster stres, HHS offcials have two major responsibilties: (a) to restore HHS 
progr operations as quickly as possible and (b) to provide emergency medcal and public 
health services when a State or local government is overwhelmed by the disaster. Executive 
Order 12656, issued in November 1988, diects HHS to mobilze the health industr in 
mecal 
national securty emergencies to provide  servces and to assist State and local 
governments in providing huma servces, including lodgig, foo, clothing and social 
services. In major disasters, the Public Health Service (PHS) is the lead agency to provide 
emergency medcal and health services under the overal diection of FEMA. Within PHS, the 
Offce of the Assistat Secreta for Health (OASH) manages the National Disaster Medical 
System, and the Centers for Disease Control (CDC) mae public health expertse avaiable to 
the disaster area. Each HHS operating division is responsible for developing adequate 
preparg 
emergency plans for its progrs. The HHS regional diectors ar responsible for 
and dissemiating regional emergency plans and for coordinating the regional office response. 
METHODOLOGY 
We interviewed 68 offcials from HHS, FEMA, other Fedra agencies and State and local 
governments who had fist hand information about the relief and recovery efforts in Pueno 
Rico, the Vlfgin Islands, South Caolina and California. We did not study Nonh Carolina 
experiences. We reviewed arcles, news clippings, situation reports, disaster plans and other 
perting 
documents  to the disasters and the governments' responses.  FINDINGS 
The Department responded promptly and appropriately to the earthquake and hurrcane to 
restore program operations and provid direct disaster relief. 
Following Hurcane Hugo and the Lorn Preta earquake, HHS was responsible primaly 
progr  dict 
for restorig normal  operations. The only signifcant  relief required in these 
two emergencies occurd though PHS medcal services in the Vlfgin Islands. The Offce of 
Human Development Services (OHDS) and the Famly Suppon Admnistrtion (FSA) 
provided relief funding to each afected ara. 
The effects of the disasters, and hence the nee for relief, were dierent in Pueno Rico, the 
Virgin Islands, South Carolina and California. In St. Croix, 90 percent of homes, the island' 
main hospital and most programs and services were destroyed and disrupted. Law and order 
broke down, and local government was not able to cope with the situation. In the rest of the 
dage 
Virgi Islands, in Pueno Rico and in South Carolina, Hurcane Hugo  was severe, 
but State and local governments were able to deal with most emergency medcal nees. The 
Lorn Preta earquake caused 66 deaths and extensive daage to propeny, bridges and 
highways, but State and local governments were also able to provide neeed emergency 
medical services. 
. Offcials quickly restored HHS programs after the disater. 
Managers in HHS acted immedately to ensur employee safety and restore program 
operations. They used initiative without awaiting instrctions. Following the earquake and 
the hurcane, most HHS maagers attempted to reach al their employees to ensur that they 
were safe. Although all employees eventualy were trcked, the process took a few days 
because telephone lies fruently were jamed or out of order, and may managers did not 
have complete lists of employees ' home phone numbers. 
Social Securty Admnistration (SSA) field offces in all four afected aras were closed for up 
to a week, but benefits contiued without interrption. In San Francisco, however, some 
Social Securty recipients would not have received their checks except for the prompt action 
of SSA sta. Although the genera delivery window of the daaged post offce building was 
closed, the SSA sta worked with the U.S. Posta Servce to get notices out and develop 
delialvternaetive rwayys to  deliver the checks. In South Carolina, the regional and field offces 
worked together to assure that Supplementa Securty Income benefits were paid on time
Sta 
problems.  also requested ban drts from headquarers in case 
despite mail 

they neeed to make emergency payments. 
The PHS sent architects and engieers to help FEMA and the terrtorial agencies in Pueno 
Rico and the Virgin Islands assess health facilty daage and provided funding for repais 
PHS-supported clinics. Health Care Financing Admnistrtion (HCFA) regional offces 
dage 
contacted State health agencies, which in tur determned the extent of facilty  and the  effects on hospita and nursing home patients. In Region IV, HCFA gave the South Carolina 
Deparent of Health and Environmenta Control permssion to suspend surey reviews of 
damaged nursing homes and hospitals for a couple of weeks and asked the Peer Review 
durg 
Organization to be reasonable in their expetations and demads  the hardship period. 
prily 
In all disaster areas, however, the HCFA role was  to gather informtion from State 
agencies. In Pueno Rico, one of the two HCFA fiscal intermedares maaged to reimburse 
hospitas by using an old manual  flashlight. Loal bans were then notied 
tyewrter and a 
that these checks were valid and asked not to bounce them. 
Head Star and other OHDS programs were disrupted in all areas. Although most programs 
closed only for a few days, some Vlfgin Islands program were disrupted up to 6 weeks and a 
drt 
few were still closed at the tie we issued our  repon. Several senior centers and 
daged, 
developmenta disabilty facilties also were  but were quickly restored. When the 
disasters closed Head Sta facilties, grante sta worked with famlies and children in their 
homes. Several Head Star centers were used as emergency shelters, and their staf worked at 
FEMA disaster assistace centers. Grantes also encourged their famlies to go to these 
centers to obtan financial assistace. The OHDS sta obtaned daage assessments from 
grantees, mae funds avaiable for repai and worked with grantees to secure FEMA 
drt 
assistace for facilty  report a few facilties on St. 
restoration. At the time we issued our 
Croix also had not been restored beause of disagreements with FEMA about funding. 
The earquake daaged the San Francisco HHS regional offce. Workig with the General 
Services Admnistrtion, HHS offcials were able to make repai and restore operations 
promptly. Although the building was closed for a week to most employees, the closure did not 
progr 
seriously interrpt HHS  operations. 
Departmental programs provided limited direct emergency assistance. 
daged. 
In the Vlfgin Islands, much of the health care delivery system was  The St. Croix 
hospita remans closed beause of water daage. It had ben decertfied even before the 
hurcane. In St. John, the hospita was 85 percent destroyed and took 
daged 
5 months to restore. In St. Thomas, the hospita was  but remained operational. 
Hospitas located on the eastern side of Pueno Rico were closed due to lack of utilities and 
diesel fuel for emergency generators. In both Calfornia and South Carolina, hospitals were 
able to car for their regular patients as well as disaster victims without strning the facilties. 
Nursing home patients were moved from baner islands to an inland facilty for about 10 days, 
but services were not denied. Severa community health centers were daaged, but were 
restored to full service within a week. 
The PHS provided medical sta to both Pueno Rico and the Vlfgin Islands and sent St. Croix 
a disaster medcal assistace team includig vector control staf. Ths team staed the 
emergency rom, clinic and inpatient car facilty. Pueno 
evacuation hospita and operated an 
Rico did not need diect medcal assistace, although PHS staf worked with Commonwealth  health officials to place patients evacuated from the Virgin Islands. In South Carolina, CDC 
provided several staff for mosquito abatement, the only PHS direct assistance in that region. 
Both PHS and FEMA officials stated that emergency medical relief services were ready in all 
affected areas in California, even though they were not needed because the State and local 
governments had the situation under control. Immediately following the earquake, PHS had 
medical teams set up west of the Mississippi, alen and ready to go if needed. A PHS official 
stated, "All the buttons were there waiting to be pressed to send a lot of people into action. 
California let PHS know early, however, that little direct Federal medical assistance was 
needed. County governments were able to handle the immediate emergency and did not have 
to turn to the State, let alone to the Federal government. 
The Food and Drug Administration (FDA) and the National Institutes of Mental Health 
(NIMH) also provided direct relief in all the affected areas. Staff from FDA removed 
contaminated food and monitored damage to pharaceutical manufacturing plants. All 59 
FDA employees stationed in Pueno Rico were assigned to work with the Commonwealth food 
drg 
and  agency. The FDA staff faced danger from the public while disposing of 
contaminated food because people wanted to consume it. Accordig to the FDA manager for 
the San Juan distrct, "We had to call in the police to get rid of food at dump sites and keep 
people away. People were fighting us off, tearng off our shins, to get at the perishable, 
already spoiled food." Overal, there were no repons of ilness because of spoiled food in 
Pueno Rico or the Virgin Islands, and eventually an emergency food distrbution system was 
set up by local governments. 
The FDA regional manager in San Francisco reponed that his staff completed emergency 
inspection work even though the damaged office and laboratory were closed for a week. The 
SSA provided FDA with temporar offce space and supplies. The FDA manager said, " 
did without some fies. We used our laboratory people to supplement our investigations staff 
and we shipped lab samples to our Los Angeles laboratory. 
The Department experienced internal communication problems as well as both 
communication and coordination problems with FEMA. 
HHS experienced problems with FEMA. 
Both HHS and State offcials had problems coordinating and communicating with FEMA. 
Some of these problems caused delays that could have resulted in deaths in a more 
catastrophic disaster. For example, FEMA gave a low priority to HHS requests for 
transponation to the Virgin Islands, and key equipment and personnel did not arve when they 
should. An HHS official in Puerto Rico could not get FEMA to help fly an employee to the 
Virgin Islands. He finally aranged transponation through the Customs Service. A local 
agency director in the Virgin Islands had to go to several locations to request FEMA' 
assistance, but could not locate the correct site. On the other hand, SSA reported good 
communication with FEMA in the Virgin Islands because FEMA operated out of the SSA  , "
offce in St. Thomas. A FEMA manager commended PHS staf for their wilingness to accept 
assignments in the Vlfgin Islands and Pueno Rico and to coordinate with other agencies. 
Some significant interagency coordination and communication problems occured when 
FEMA asked for HHS Region IX volunteers to work in disaster assistace centers following 
the earquake. Initially, FEMA requested 250 HHS sta. About 40 HHS staf showed 
for training on the Saturday following the earquake, but several hundred FEMA and State 
employees also came. The FEMA traiing was disorganiz. As a result, HHS staff were left 
. with unclear assignments. underassignments or no assignments. The FEMA also used 
untrained California Conservation Corps sta when skiled case and eligibilty workers were 
available. The FEMA brought people frm distat communities and paid them per diem when 
sta 
many traied Federa sta were available localy. Most HHS  said that FEMA needs to 
have better deployment procedures. According to an FSA sta person  FEMA would not 
even let HHS people go out and conduct outreach, something that the HHS people are used to 
and goo at." Region IX HHS officials also had problems getting reimbursement for salares 
and expenses of staf detaled to the disaster assistace centers. 
The FEMA sent confusing messages about what level of disaster response HHS should 
provide. A diective issued immediately following the earquake did not clearly say whether 
Federal catastrophic earquake proedures would be invoked. The FEMA took 2 days to 
clarfy its policy that the earquake did not meet the catastrophic crteria. Because of this 
confusion, regional PHS sta were concerned that they may have given the wrong signals to 
others durg the flfst 48 hour following the earquake. One PHS manager said, "It was not 
clear when or if FEMA would cal on us. There cenaly was fuzziness when we tred to cal 
FEMA that fIrst night. There is no goo way to access FEMA in its regional offce or 
headquarrs. " Although FEMA was ambiguous, State disaster officials clearly declared 
within hour after the earquake that Federal emergency medcal assistace would not be 
needed. 
Telephone problems were widespread. 
Telephone systems in the disaster aras often were inoperative or jamed, and HHS staf 
frm 
lacked adequate backup communication equipment. It took  severa days to severa 
weeks to establish contact with pars of Pueno Rico and the Vlfgin Islands. Telephone 
communication was absent for more than a month in St. Croix and for 
10 days in St. Thomas. A local official in the Vlfgi Islands had to (a) use a radio to 
communicate or (b) drve from place to place to deliver messages. One office in Region II 
could not get though to Puerto Rico because the regular phone lines were busy and fmally 
used the separate electronic mail line. Following the earquake, all Region IX telephones 
were inoperative except for a few old-fashioned .dial phones. Region IV offcials had to wait 
for phone servce to retur before contactig South Carolina program dictors about the level 
of damage and nee for assistace.  The HHS lacked any kind of systematic emergency rado communication system to replace 
inoperative telephones. A dedcate radio fruency set aside for the Secretar has been 
sittig idle fer many year. Even when telephone service retured, some Region IX managers 
did not have curnt telephone numbers for sta. This hampered effons to ensur that 
In one office, employee home phone numbers were 
employees were accounted for and safe. 
locked in the offce vault and were inaccessible after the earquake. Regional staf utilized 
several ad hoc, alternative communication methods to replace lost telephone service. The 
regional inspector general. for investigations in San Fracisco had a cellular phone in a 
s actig regional diector set up a commd center in one of 
government car. San Fracisco 
the few offces in the daaged regional offce building with a workig telephone. The smal 
collocate to that offce said that the command center 
group of regional maagers who 
surounte many communication problems. 
Internal HHS coordination problems caused delays. 
Some HHS officials said that delays and duplication of effon resulted from the lack of 
headquarrs and regional coordination. They were not sure who was supposed to coordiate 
the overall HHS response and criticize the lack of clear procedurs in how to work with other 
agencies. Region II maagers expressed the most concern about communication and 
Region IV managers. For example, effons to contact 
coordiation problems, followed by 
HHS employees and fmd out whether they were safe were accomplished by individual agency 
components, not as a coordinate regional effort. Region n HCFA sta reported that 
duplication resulted frm failur to coordinate PHS and HCFA efforts to restore daaged 
health facilties in Pueno Rico and the Vlfgi Islads. Region n HCFA sta did not 
understand how coordiation was to be achieved The regional diector s offce in Atlanta 
cited the need for clear policy  ' role. 
guidace on headquarers
Prmar responsibility for HHS emergency preparedess and response has changed since the 
Secta 
hurcane and earquake. In Januar 1990,  Sullvan transferred primar authority 
Secta 
to the Offce of the Assistat  Under the delegation, OASH
for Health  (DASH). 
provides policy guidace and monitors the performance of all HHS offcials. 
Regional diectors and regional health admnistrtors do not understad their respective 
dict 
responsibilties following the trsfer of authority. They do not know how much 
authority OASH or the regional health adnistrtors have over HCFA, SSA and other 
components or what the working relationship is between the regional health admnistrtor and 
ditors 
CDC. They also wonder whether regional  are sti the priar HHS contact with 
State and local officials or whether this function also has been trsferred to OASH. The 
OASH has not yet issued policy guidace on roles and responsibilties to implement the 
delegation of disaster authority.  Arrangements for funding disaster response activitis are inadquate. 
Using FEMA funding, NIMH provided -grts to the States for menta health counseling. All 
areas reponed that this program is useful and effective, but some complained that funding 
delays for second-phase longer term grts slowed the provision of neeed counseling. In 
fact, NIMH was overloaded with applications for grants from State and local menta health 
agencies. The NIM is working with FEMA to spee up the application review and approval 
process. 
Both OHDS and FSA provided discretionar grant funds for Hurcane Hugo relief. The 
OHDS Admistration on Aging (AOA) has a small grt program for disaster relief, and FSA 
provided funds to the Vlfgin Islands for projects FEMA could not fund to provide jobs to 
rebuild senior housing. However, OHDS and FSA did not provide simiar discretionar grant 
grt 
funds immediately after the earquake. The AOA mae a disaster  to California later, in 
Februar 1990. Some San Fracisco regional officials said this was because of ting--the 
occur 
hurrcane  at the end of one fiscal year and the earquake at the beginning of another. 
These officials also felt that the HHS operating divisions (OPDIVS) gave a lower priority to 
the earhquake than to Hurcane Hugo. 
progr  grt 
Regional  staf stated that few discretionar or formula  funds ar avaiable 
within the Deparent for use in disaster relief to fil gaps not covered by FEMA or other 
Federal agencies. Discretionar funds are usualy encumbered for other 
puroses, and no 
tracking system exists to identify them. Formula grant funds are diffcult to use for disaster 
relief because they often  authorization. 
reuire speial 
The OASH disaster relief sta reponed that curnt HHS accountig systems used by all 
components to pay trvel and personnel expenses for disaster relief ar inadequate and result 
sta 
in delays in charging payments to the proper accounts. Severa regional program 
reponed that no agrments or proedures exist within the Deparent or between the 
Deparent and FEMA for reimburement for salar and expenses of sta detaled outside 
HHS for disaster relief activities. Furermore, no clear HHS guidelines exist to document 
to HHS 
disaster-related costs. This creates diffculties trcking and reimbursing costs 
and sta divisions (STAFIVs).
OPDNs 
The Department laks clearly defined, up-to-dae plans for restoring programs in future 
disasters. 
While HHS .has many plans spelling out general roles for restoring program following a 
disaster, most ar obsolete, ineffective or overly detaled. In Region IX, for example, at least 
seven national and regional earquake and genera disaster maagement plans were in place 
earquake. Yet few people knew about them. Each of the affected regions lacked 
prior to the 
simple reportng rosters and diectories showing where to reach people at work and home. 
One San Fracisco offce had no paper copies of the emergency telephone lists; the 
computerized list was unavailable because the power was out. A regional manager said that 
the national PHS response plan is wrtten as if PHS were all "within the Washington, D.  , "

beltway" and that the plan does not spell out regional responsibilties sufficiently. Most of the 
plans depend on telephones, yet the phone lines to disaster areas were all disrupted. 

Many respondents said that the general management plans were irrelevant to the actual 
hurrcane and earhquake responses. Program restoration steps which regional managers took 
were based on logic and reason and not on a disaster management plan that listed emergency 
actions. A South Carolina manager said that every SSA office is required to have a security 
action plan, but the plan does not address disasters the magnitude of Hurrcane Hugo. One 
PHS manager said that they have a plan for program restoration, but it has been so long since

. they updated it, he does not know if it would be effective. Managers said the plans need to be

briefer and more flexible; detailed plans are not helpful. Some State and terrtorial plans were

equally ineffective. According to the Virgin Islands health diector  We stared to use our 
plans and then discovered problems. Communications were wiped out. We could not contact 
St. Croix for a full day. The key to the plans is getting in touch with key people, and we could 
not get in touch. 
In contrast, emergency medical plans are more thorough and useful, especially in California. 
These plans are intended primarly for disaster specialists who wil be deployed in medical 
relief activities, and many have been updated recently. 
Region IX has been the lead region for earhquake and general disaster planning, serving as a 
model for the other regions. For example, "Response ' 89," a 2-day training exercise designed 
to simulate a catastrophic earhquake was held by FEMA in California in August 1989 for 
Federal and State officials. This training proved useful when the Lorna Preta earthquake 
strck 2 months later. The HHS Region IX earhquake plan is more complete than any other 
HHS disaster relief plan. Accordig to FEMA offcials, however, even the Region IX plan 
needs to be coordinated better with its national plan. 
Officials in HHS suggest that disaster plans be practiced more regularly. A Region IX PHS 
offcial suggested, "Plans should be simple loose-leaf reference manuals, involve all staff and 
not just emergency specialists, be practiced regularly and be kept up to date. " According to 
the deparmental coordinator, FEMA is planning a major training exercise for 1992 to 
replicate "Response ' 89" in other pars of the countr. Although the greatest attention has 
been given to California, the possibilty for a big disaster exists everywhere.  RECOMMENDATIONS

The OS and the DASH should clafy HHS disaster recovery roles and responsibilities. 
They should define clearly how they wil implement the Januar 1990 delegation of authority 
for disaster relief and clarfy the disaster relief and reovery responsibilties of PHS, other 
operating divisions, regional ditors and regional OPDIVs. 
Regional diectors and regional health adnistrtors do not understad their respective roles 
in disaster response activities. This is still not sort out under the delegation of authority to 
OASH. Duplication of effort and delays in providing disaster relief can be reduced if roles 
and responsibilties for each component ar defied clearly. 
The DASH should issue guidelines to improve diaster planning. 
sta 
The OASH should (a) issue overal planning guidace to al operating divisions and 
divisions based on the reent disaster experience; (b) diect each operating division, regional 
office and field instalation to develop a simple, clear, concise and flexible set of procedures 
for dealng with emergency contingencies; (c) mandate that each plan spell out lines of 
communication within HHS and between HHS and FEMA; (d) ensure that individual 
component plans ar compatible with the overal deparenta plan and ar reviewed and 
updated periodcally; and (e) conduct fruent, brief traiing sessions at both national and 
regional levels. 
The Deparent has an overabundance of obsolete, ineffective and overly detaled disaster 
plans for restoring progrs. Pror to the 1989 disasters, few sta knew about the plans or 
about their roles and responsibilties in disaster reovery. Clear and frequently practiced plans 
wil allow a prompt and effective HHS disaster response. 
The DASH should establish backup communicaton systems and regional command posts. 
This backup communication system could include cellular telephones and radio 
communication utilzing the frequency aleady set aside for HHS. The OASH also should 
mandate that each region establish a command post. 
prima 
Curently HHS lacks adequate backup communication systems to use when  systems, 
occur 
such as telephones, are out of service. Communication breakdowns  in both the 
Secta 
hurcane and the earquake. A rado frequency set aside for the  has not been used. 
Adequate backup systems would ensure that vita communication links are maintaed 
between disaster areas and response agencies. Collocatig sta in a command post would 
faciltate emergency communication.  The DASH should improve procedures to pay for disaster relief expendiures. 
The OASH, working with the Offce of the Assistat Secreta for Management and Budget, 
should (a) set up a system to identify existing HHS discrtionar and formula grant funds that 
could be used to supplement FEMA fundig for disaster relief, 
(b) establish an improved system, including a common accounting number, to account for 
disaster payments and (c) develop procedures to ensur that the suppon agreement with 
FEMA for each declared disaster provides appropriate reimbursement 
An improved accounting and funds trcking system would enable HHS to respond more 
rapidly and effectively to disasters and ensure that each HHS component is fully reimbursed 
for disaster relief expenses. 
AGENCY COMMENTS 
The PHS, SSA, and OHDS concured with the reommendations. The HCFA had no 
tang 
comments. The PHS is  steps to clarfy the emergency preparedess and disaster 
ditors, 
recovery roles and responsibilties of the regional  regional health admnistrators and 
others. The PHS is also revising and simpliing emergency planning and response guidance 
for OPDIVS and Staf Divisions, improvig internal emergency communication systems and 
developing procedurs with FEMA to assur prompt reimbursement for HHS operations in 
disasters declared by the Prsident. 
We also solicite commnts from FEMA. While agreeing with the repon s recommendations, 
FEMA generally considere its actions in the disasters to be appropriate, citing (a) limits on 
the Federal role durng disasters, (b) the less than catastrphic natue of the earquake and (c) 
the necessity for quick action in a disaster allowing litte time for trainig or screening of 
non-FEMA personnel. While we did not undenae a comprehensive review of FEMA' 
actions in the dual disasters, we disagree with FEMA' s premise that the nee for quick action 
in disaster response preludes carful planning which would optimize the use of HHS 
personnel. 
The complete texts of the comments are contaed in Appendix A.  APPENDIX A

Agency Comments
 :. .,
..  .." &.  :,..  -.. ;-;,  ....
DEPARTMENT OF HEATH  HUMA SERVICES  Public Healt Serice 
Memorandum 
.t""no (; 
SEP '1 199

Date 
Assistant Secretary for Health 
From 
Subjec  oth I eG  D1 r9 a8f9t  HR ue rpr 0i cra tn "e C aonpd i  nE ga rWtiht qhu aT kwei n,  "D  Oi Es Ia -s 0t 9e -r 9s0: -R0H1 0S4 R0e
 s p 0 n se  t 0

Inspector General, OS

At t a c h e d are the c 0 mm e n t s 0 f the Pub 1 i c He a 1 t h S e r v ice 0 n  th e

draft report. Though we agree that the HHS disaster 
subj ect 
the Loma Prieta earthquake was

response to Hurricane Hugo and 
improved
prompt and appropriate, we are supportive of

Departmental capabilities to respond to emergencies and 
disasters. 
We concur wi t h the re port s re co mmenda t ions and have taken 0 r
are taking action to implement hem. 
(), /k
Mason, M.  , Dr.

Attachment 
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EX SEC  V; 
DATE  q I/
 THE PUBLIC HETH SERVICE ON TH OFFICE OF 
COMMENTS OF 
INSPECTOR  GENERA' S DRAT REPORT " COPING WITH TWIN 
HUICAE 
DISASTERS: HHS RESPONSE TO THE 1989  AND EATHQUAKE" 
OEI-09-90-01040, JULY 31, 1990 
OIG Recommendation

1) --
The Office of the Secretary (OS) and the Office of the
Assistant Secretary for Health 
(OASH) should clarify 
responsibilities. 
HHS disaster recovery roles and 
PHS Cornen 
We concur. OASH has taken the lead in this area by hosting a

meeting, chaired by the Deputy Assistant Secretary for Health 
(DASH), that was held on June 29 with headquarters Operating
At that 
Divi'  (OPDIV) emergency preparedness officials. 
sion 
time, implications of the Secretary s January 8 delegation of 
authori ty were discussed. Plans for updating and revising the 
Maual and the 
Departmen t Emergency Planning and Operations 
was requested 
Disaster Response Guides were discussed and input 
from the Social Securi ty Admnistration, Heal th Care Financing
Admnistration, Office of Human Development Services, and
Famly Support Admnistration. 
OASH, through the Office of Emergency Preparedness (OEP), is

fostering continuing dialogue between the HHS Regional

Adnistrators 
Directors 
(RDs) and the PHS Regional Health 
(RH). A statement clarifying the respective emergencyRH 
has
preparedness roles and responsibilities of the RDs aRndH  
been prepared. This statement was approved by the  and, on 
August 1, was forwarded by the DASH to the Deputy Under 
Commssions 
Secretary for Intergovernental Affairs, Boards and 
for his review and that of the RDs. On August 10, OASH staff 
met with the RDs to discuss this draft statement and other

concerns. 
emergency preparednes s  This meeting resolved many of 
the RDs' concerns. OASH is awaiting comments on the draft 
Intergovernental 
statement from the Deputy Under Secretary for 
Affairs, Boards and Commssions. Following approval of a 
forml delegations of 
statement of roles and reRspoHns wibiillli ties, 
authori ty to the RDs and  be prepared, approved, and 
Federal Reqister

published in the 

OASH Office of Emergency Preparedness (OEP) staff participated

in a series of meetings with PHS regional emergency

the 
preparedness officials that were held in conjunction with 
9, in

National Disaster Medical System Conference, August 6-
Memphis, Tennessee. These meetingsR hHelsp.e d to reinforce the

roles and responsibilities on the  To further 
coordination on emergency preparedness matters, OEP staff meet

RHs during their 
with the  regular quarterly meetings and

needed.

participate in regional conference calls as  Page 2. 
OIG Recommendation 
2) --
The OASH should issues guidelines to improve disaster
planning. 
PHS Comment

We concur.  updating, and 
OASH OEP has undertaken the revis  ion, 
simplification of emergency planning and response guidance for 
OPDIVs, Staff Divisions, and Agencies at Headquarters and 
Regional levels. It is expected that draft guidance will be 
1, 1990. In 
available for review and comment by October 
addition, OASH OEP will coordinate the development of HHS 
Disaster Response Guides, which will outline the types 
emergency assistance provided by the Departent, and the 
assistance. 
primary and supporting agencies for providing such 
The target date for completion of these guides is October 1990. 
OIG Recommendation

3) -- systems 
The OASH should establish backup communications 
and regional commnd posts. 
PHS Comment

We concur. OASH is currently analyzing the need for, and

resource implications of emergency communications systems for

regional command post operations during emergencies and
disasters. 
Also, OASH is analyzing the need to enhance 
headquarters emergency communications systems and provide 
deployment to 
improved emergency communications capability for 
areas affected by major disasters or emergencies.

OIG Recommendation

4) --
The OASH should Lmprove procedures to pay for disaster 
relief expenditures. 
PHS Comment

We concur. OASH is working with appropriate Federal Emergency 
Management Agency (FEM) officials to simplify FEM tasking and 
reimursement 
mission assignment procedures to assure prompt 
declared 
for HHS operations associated with a Presidentially-
disaster or emergency. The FEMA mission assignent contains 
reimurse  tasks. 
commi tments for FEM to  HHS for specific  ge 3. 
Staff from OEP and the OASH Division of Financial Maagement 
have discussed the need for clear gudance and procedures for 
includiq the
tracking disaster related expenditures, 
assignent of  Numer (CA) to 
a Common Accountinq  each disaster
operation. Such CAs were assigned followinq Huricane 
Huqo 
and the Loma Prieta Earthquake. Improved trackiq procedures 
Aqencies, other 
will be developed in coordination with the PHS 
OPDIVs and the Assistant Secretary for Maagement and Budget 
(ASMB) . OASH will work with ASMB to establish a system to 
identify existing HHS discretionary and for.ula grant funds 
FEM disaster 
that might be used to supplement  relief fundinq.  ';; 
- .-. 
Cd /K.  "". (" 
I Y/J  Social Seu-curity Adminisfratiuo nt;":
PEPARTMENT OF HEALTH &. HUMAN SERVICES
 Anr
Refer to: 
SEP 24 199

Date: 
From: 
securi ty 
Off' e of Inspe  Disasters: 
Subject:  r General Draft Report, "Coping with 
Eartquake"
Response to the 1989 Hurricane and 
I-09-90-01040) --INFORMTION 
To: 
Mr. Richard P. KUsserow

Inspector General

Aftutarceherd  is the response to your draft report. If we can be of

assistance, please let us know. 
Attachment: 
SSA response

moo
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V1 :: :: 

...- j- VJ5  rc::
  - .
. .
COMMNTS OF THE SOCIAL SECUITY ADMINISTRTION ON TH OFFICE OF 
INSPECTOR GENERAL DRAFT REPORT, "COPING WITH TWIN DISASTERS: HHS 
RESPONSE - TO TH 1989 HUICAN AND EARTHOUAKE" (OEI-09-90-01040) 
Office of Inspector General (OIG) Recommendation 
The Office of the Secretary and the Office of the Assistant
Secretary for Health 
(OASH) should clarify the Health and Human
Services 
(HHS) disaster recovery roles and responsibilities. 
SSA Response 
We concur with this recommendation. We believe that coordination 
preparedness. 
at the regional office level will improve emergency 
OIG Recommendation 
planning. 
The OASH should issue guidelines to improve disaster 
SSA Response 
We concur with this recommendation. SSA field offices are 
includes 
required to possess both an office security plan which 
physical and systems security and an Occupant Emergency Plan 
which addresses safeguarding lives and property, including in the
event of huricanes 
and eartquakes. Each region has been 
directed to review and update its Emergency Operating Plan and 
office. 
forward appropriate portions to central 
OIG Recommendation 
The OASH should establish backup communication systems and

regional command posts.

SSA Response

We concur with this recommendation. We agree that adequate 
backup systems would assure that vital communication links are 
agencies. 
maintained between disaster areas and response 
OIG Recommendation 
relief 
The OASH should improve procedures to pay for disaster 
expenditures . 
SSA Response

We concur with this recommendation. An improved accounting and

funds tracking system would enable HHS to respond more rapidly

component 
and effectively to disasters and ensure that each 
within the departent is fully reimbursed for disaster relief

expenses.  ;. 	
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!t,,,VIC, . 
,Jt.(/(.,?1 
REm  HUN  Offce of 
DEPARTMT OF  SEVICE 
Human Development Services 
Asistant Secretar 
41a  Washington DC 20201-0001 
,Jw 
C" ':

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..
TO:	 Richard P. Kusserow  . ri f" 
Inspector General 
FROM:  Assistant Secretary 
for Human Development Services 
SUBJECT:	 OIG Draft Report: "Coping with Twin Disasters: 
HHS Response to the 1989 Hurricane and Earthquake,
OEI-09-90-0l040 
We agree with the findings of the subject draft report.
The 
report accurately describes the assistance given and the 
inadequac ies in federal emergency procedures. 
We wish to emphasize in particular our concurrence with the
recommendations that seek to clarify HHS disaster recovery roles
and respons ibili ties, 
provide guidelines to improve disaster
planning, establish backup communication 
systems, and improve
procedures to pay for disaster relief expenditures. 
Thank you for this opportuni  : review t

Gall 
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ent Agency
Federal Emergency 
 C. 20472 DIG

Washington, D.
DIG-I 
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OCT 2 5 
!990 
SE!IT
Mr. Richard P. Kusserow 
Inspector Genera 
Services 
Department of Health & Human 
Office of InspeCct.o r General 
20201 
Washington, D.
09- 01040 
Dear Mr. Kusserow: 
'It;  , r 
ry ' 
This is in response to your letter of July 31, 1990, to Mr. J 
diit 
D. Jennings, Deputy Director, Federal Emergency Management Agency 

i(nFEsMpAe) c,t iionn  wrheipcoh ryt oeun rteiqtlueedst e"dc orpeivnige wW aintdh  Tcowmmine nDt isona sttheer s: 
HHS 
Response to the 1989 Hurricane and Earthquake.

better 
general  coordination 
agree in  regardiongn t hdei snaesedte fro rre sponse plans 
between FEMA and HHS  and 
ities. 
report
responsibi  Most of the problems cited in the draft 
in-depth
are valid, but the report does not always communicate an 

understanding of the real issues, systems and tphreoc dediusraess teutrisl.i zed
by FEM and other agencies in responding' to  The 
subj ecti ve rather than being a mechanism for 
report appears too 
I suggest changing
fact finding and subsequent problem correction. 
Descr 
on of the Problem
the format of the report to include (1) 
followed by  Pro  osal for Solution. Using this format, we offer

(2)  improved

the following suggestions to better serve as the basis for 
procedures in the fu ture .

ISSUE 1: Amb:iity Reaardj.nCf the Neeq. for Me  Ass  stance (Pace

governents are responsible for

The system, under which local 
local disaster  which local

situations and under 
responding to 
information

governments must request assistance from and provide 
governent' 
s ability to

to state governments, limits the Federa event. 
Federal agencies
be the most knowledgeable of a disaster 

must become familiar with the system and their responsibilities in

expectations. Under the "Plan for Federal

order to reduce false 
"Plan  ), the Public

Response to a Catastrophic Eartquake" (the 
h.as the 
Health service  responsibility to coordinate with the 

need. for supp  emental Federal

State medical counterpart regardinq 
assistance and to provide information on medical requirements to

FEM . 
Since Hurricane Hugo and the Loma Prieta earthquake, FEMA thhaes

been reviewing the concept of operations as developed in 

Plan. Though the Plan was not formally activated in either of

Plan, grouping essential
these disasters, the structure of the 
and

activities such as transportation, communications, and health 
 - .'
medical services under Emergency Support Functions (ESFs) was 
Plan is
utilized successfully in the Loma Prieta response. The 
IIFederal Natural Disaster
being extensively rewritten as the 

Response Plan" to better address any disaster situation which

requires Federal response.

individuals 
The revised Plan focuses particularly on the need for 
to deploy as part of an interagency response team in order 
state. 
establish early liaison both with F  1A and the affected 
operational
This team will also be the nucleus of the ESP 
tie? to 
acti vi  follow. We believe that based on our experience 
are better 
Hurricane Hugo and the Lama Prieta eartquake, we 
governent in 
prepared to utilize the resources of the Federal 
disaster. 
providing timely assistance to a state affected by a 
ISSUE :2: Leve+ of Dj aster Response (page ,.6) - The "Planlf was 
eartquake of 
unprecedented 
originally based on a catastrophic 
and 
proportions in which the State would be quickly overwhelmed 
imediate  protection 
Federal assistance to provide lifesavinq and 
A severe but ,less than catastrophic 
of life would be required. 
eartquake, did result in 
disaster, such as the Loma Prieta  some 
FEM headquarters to the 
unclear information ceinq provided by 
Federal coordinating Officer and from the Federal coordinatinq

e Federal agencies as to whether or not

officer and staff to 

the Plan was ceinq activated and to what extent it would 

problem, lEM
o correct this 
utilized to conduct the response. 

eveloped an operational concept using a response and

has  any

recovery organization which will address the requirements of 
incorporated

disaster situation. This concept is also being 
into the revised Plan-

cation (page 6)  The Reqion IX Interagency 
ISSUE 3: Ear 
steering Committee had not completed the notification and

earthquake. This

activation procedures before the Loma Prieta 
resul ted in lack of timely and appropriate communication between 
and the other Federal agencies. The Region IX steering

Committee meets monthly to develop and refine procedures for a

catastrophic disaster. The Fiscal Year 1990 work plan included

developing the regional notification, deployment, and disaster

eartquake occued 
field office procedures. 
As the Loma Prieta 
before these procedures were fully developed, there were limited 
notification and activation procedures utilized durinq the 
supplements will 
disaster. By the end of Fiscal Year 1990 interim 
be developed and the notification procedures will be drilled and 
continuing 
activated. The Fiscal Year 1991 work plan includes 
involve all 
development of these detailed procedures and will 
agencies under the Plan.  IS UE  . ina Was Disor anized a e 6  In view of the 
: FEMA Tr 
urgency of the situation, and the requirement for the entire 
Federal government to respond quickly to a disaster of the
magnitud  of the Lama Prieta Eartquake, it was necessary to
requirements
train personnel as rapidly as possible in the basic

for the positions they were to assume. since the Disaster 
Application Centers (DACs) were to be opened within sevefraacli ldiatiyess  
s declaration, and since these 
following the President'
operation, the 
were the initial focal point of the response 
effort. The

immediate staffing of the DACs became a critical 
to be

training was considered by most of those receiving it 

fourtdations for their assiqnments to the

adequate to provide the  inadequate.
DACs, although the physical traininq environment was  prior

ApproximatelY 300 personnel were DgAivCens . oInned idvaiyd uoafl  tarnadi nini-nd
 epth
to their assignment to specific 
 was

circustances, and it 
training wasf unrotte pro ssible under the 
clear that  training would have to be accomplished on the 
c effectively

job. We  numer of staff  event,.
do, however, recognize the requirement  for such an 
and efficiently train a large 

and we are enhancing our current traininq capability withfuture

additional resources to better address this situation in
form, and

disasters - We are revising our basic D1A9C9 r1e.q istration

This development
are also proceeding to automate it in  staff

will result in the need for only minimal fturnacitnioinng. of DAC

before they will be able to perform the 

th Unclear Assianments

(paae 6).  There was not
UISSUnE 5d: iejS rStaafsf Wserie  Lenft m
 ents or No Assianments  situation, for
sufficient time allowed, due to the urgency of the 

this 
detailed personnel screening to determine the best person for the

staff, an 
best job. The initial requirement was for DAC  the

was the aim of the training and was the basis for much of 

Some HHS personnel were assigned different

initial assignments. 
duties; however , without the opportunity tsop ecconifdiucc ta sas idgentaeinltesd 

time. 
The effort was 
analysis of the initial staffing charts 
HHS personnel cannot be provided at this

assignments, and to make such

made to continuously review  additional

reassignments as was necessary in the light of 

information on personnel capabilities.

, FEMA used California conservation

Amonq resources available
inqual assistance

corps 
(CCC) personnel in the DACs to provide bi
other CCC staff were

to the applicants and the DAC staff.  erie  and 
atrsasiignniend gt.o  various duties consistent with their e r tra  ng,
Some of these personnel, because of thceontrol. 
data entry and document 

were assigned duties in  . . .
I trust these comments will be helpf  in developing your final

report . 
nt C. Peterson

Associate Director

State and Local Proqr

and support