Department of Health and Human Services


OFFICE OF 

INSPECTOR GENERAL 

THE COMMISSIONED CORPS’


RESPONSE TO HURRICANES 


KATRINA AND RITA


Daniel R. Levinson


Inspector General 


February 2007


OEI-09-06-00030

Office of Inspector General 
 http://oig.hhs.gov 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, 

as amended, is to protect the integrity of the Department of Health and Human Services 

(HHS) programs, as well as the health and welfare of beneficiaries served by those 

programs. This statutory mission is carried out through a nationwide network of audits, 

investigations, and inspections conducted by the following operating components: 

Office of Audit Services 

The Office of Audit Services (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors 

in carrying out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations. These assessments help reduce waste, 

abuse, and mismanagement and promote economy and efficiency throughout HHS. 

Office of Evaluation and Inspections 

The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide 

HHS, Congress, and the public with timely, useful, and reliable information on 

significant issues. Specifically, these evaluations focus on preventing fraud, waste, or 

abuse and promoting economy, efficiency, and effectiveness in departmental programs. 

To promote impact, the reports also present practical recommendations for improving 

program operations. 

Office of Investigations 

The Office of Investigations (OI) conducts criminal, civil, and administrative 

investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries 

and of unjust enrichment by providers. The investigative efforts of OI lead to criminal 

convictions, administrative sanctions, or civil monetary penalties. 

Office of Counsel to the Inspector General 

The Office of Counsel to the Inspector General (OCIG) provides general legal services to 

OIG, rendering advice and opinions on HHS programs and operations and providing all 

legal support in OIG's internal operations. OCIG imposes program exclusions and civil 

monetary penalties on health care providers and litigates those actions within HHS. 

OCIG also represents OIG in the global settlement of cases arising under the Civil False 

Claims Act, develops and monitors corporate integrity agreements, develops compliance 

program guidances, renders advisory opinions on OIG sanctions to the health care 

community, and issues fraud alerts and other industry guidance. 
Δ EXECUTIVE SUMMAR Y 

OBJECTIVE 

1. To evaluate the U.S. Public Health Service Commissioned Corps’ 

(the Corps) response to Hurricanes Katrina and Rita. 

2. To identify whether and how the Corps could improve its response to 

public health emergencies. 

BACKGROUND 

The U.S. Public Health Service Commissioned Corps, one of seven U.S. 

uniformed services, is made up entirely of officers commissioned on the 

basis of their health-related training. Agencies within and outside the 

Department of Health and Human Services (the Department) employ 

Corps officers to provide health care and related services in health 

professional shortage areas. In addition, the Secretary of the 

Department has the authority to deploy the Corps in response to public 

health emergencies. Hence, Corps officers must simultaneously fulfill 

their responsibilities to their employer agency and to the Corps. 

In August and September 2005, respectively, Hurricanes Katrina and 

Rita struck the Gulf Coast. In response to health care and public health 

needs in the affected areas, the Corps carried out the largest 

deployment in its 207-year history. More than 2,100 officers worked 

with State, local, and private agencies in response to the hurricanes. 

Since 2003, the Corps has been engaged in a continuous effort to 

improve its response capacity. On January 18, 2006, the Secretary 

announced the latest phase in this effort, in which the Corps will 

increase the number of officers by 10 percent, create a team-oriented 

deployment process, and improve the recruitment process. 

For this evaluation, we: (1) surveyed a stratified random sample of 

350 Corps officers; (2) analyzed Corps administrative databases; 

(3) interviewed and collected documentation from Corps field 

commanders, Corps management components, and the Office of the 

Assistant Secretary for Preparedness and Response (ASPR, then known 

as the Office of Public Health Emergency Preparedness); (4) interviewed 

State health officials; and (5) interviewed seven agencies that employ 

Corps officers. 

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EXE CUTIVE S U MMAR Y

FINDINGS 

Commissioned Corps officers deployed in response to Hurricanes 

Katrina and Rita provided valuable services, but the Corps could 

improve its response to public health emergencies. The 

Commissioned Corps provided valuable support to States, but more 

officers—especially nurses, mental health professionals, and dentists— 

were needed. While most deployed officers met Corps readiness 

standards, many lacked experience, effective training, and familiarity 

with response plans. Agencies were unwilling or unable to allow some 

officers to deploy, while logistical difficulties delayed others’ arrival in 

the field. Confusion surrounded some officers’ arrival, but most field 

assignments were appropriate and officers felt safe at their locations. 

Most officers were equipped adequately, but some lacked working 

communications devices and other basic tools. Many officers personally 

incurred mission-related expenses and some were not reimbursed 

promptly, which could affect their ability to deploy to future public 

health emergencies. 

RECOMMENDATIONS 

Although the transformation of the Corps may alleviate many of the 

issues it experienced in responding to Hurricanes Katrina and Rita, the 

Corps also should take the following actions to improve its effectiveness 

and efficiency: 

Institute more effective training for Corps officers. The Corps should 

implement more hands-on, focused training and seek funding to allow 

Corps officers to be paid for time spent in training. 

Improve the system used to contact officers for deployment. The 

Corps should develop a system to quickly and reliably contact officers 

for deployment. 

Work with the Office of the Assistant Secretary for Preparedness 

and Response to streamline deployment-related travel. The Corps 

should work with the Office of the Assistant Secretary for Preparedness 

and Response to establish a system for rapid deployment. 

Stagger deployments to ensure continuity of operations. The Corps 

should stagger deployments to mitigate the loss of experience as officers 

end their tours, especially during lengthy responses. 

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EXE CUTIVE S U MMAR Y 

Improve its ability to coordinate mission assignments and 

communications in the field. The Corps should work with the Office of 

the Assistant Secretary for Preparedness and Response to develop more 

effective systems to ensure that officers arrive when and where they are 

needed with a clear understanding of their assignments and to increase 

the variety of communications equipment available to officers. 

Ensure that all deployable officers have Federal Government travel 

credit cards. All deployable officers should have official Government 

travel credit cards with which to make mission-related purchases so 

they do not use personal accounts. The Corps should work with the 

Office of the Assistant Secretary for Preparedness and Response to 

review the procedures used to reimburse officers for mission-related 

expenses. 

AGENCY COMMENTS 

The Assistant Secretary for Health agreed with the Office of Inspector 

General’s (OIG) recommendations for improving the Corps’ response to 

public health emergencies. As part of the Corps’ comprehensive 

transformation process and its efforts to improve the Office of Force 

Readiness and Deployment’s practices, the Corps is currently 

addressing OIG’s recommendations. 

This evaluation was conducted in conjunction with the President’s 

Council on Integrity and Efficiency (PCIE) as part of its examination of 

relief efforts provided by the Federal Government in the aftermath of 

Hurricanes Katrina and Rita. As such, a copy of the report has been 

forwarded to the PCIE Homeland Security Working Group, which is 

coordinating Inspectors General reviews of this important subject. 

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Δ T ABLE OF CONTENTS 

EXECUTIVE SUMMARY .................................... i

INTR O D U C T I ON ........................................... 1

FINDI NG ................................................. 8

 Response valuable, but some shortcomings ....................... 8

RECOM M E NDATI O NS ..................................... 14

 Agency Comments ......................................... 15

APPENDIXES ............................................. 17

 A: Commissioned Corps Employer Agencies

 and Professional Categories ............................... 17

 B: Commissioned Corps Management Structure ................. 18

 C: Commissioned Corps Standards of Readiness ................. 19

 D: Emergency Support Function #8 ........................... 20

 E: Statistical Confidence Intervals ........................... 21

 F: Agency Comments....................................... 23

ACKN O W LEDGMENTS ..................................... 24
Δ INTRODU C TION 

OBJECTIVES 

1. To evaluate the U.S. Public Health Service Commissioned Corps’ 

(the Corps) response to Hurricanes Katrina and Rita. 

2. To identify whether and how the Corps could improve its response to 

public health emergencies. 

BACKGROUND 

The U.S. Public Health Service Commissioned Corps is one of seven 

U.S. uniformed services. The Corps is made up entirely of officers who 

were commissioned on the basis of their health-related training. A 

primary purpose of the Corps is to provide health care and related 

services to health professional shortage areas.1 The Secretary of the 

Department of Health and Human Services (the Secretary) has the 

authority to deploy the Corps in response to public health emergencies,

2 

and the President may utilize the Corps in time of war or emergency.3 

Although the Corps recruits officers, those officers actually are 

employed by other agencies within and outside the Department. Hence, 

Corps officers must simultaneously fulfill their responsibilities to their 

employer agency and the Corps. Officers provide a variety of 

professional skills to their employer agencies, including clinical, 

environmental health, and engineering services. (See Appendix A for a 

complete list of Department and external agencies that employ Corps 

officers and the professional categories of skills that Corps officers 

provide.) 

2003 Transformation 

In 2003, the Corps developed a transformation plan that reorganized its 

management structure, revised its officers’ standards of readiness, and 

created a new mission statement. The Corps implemented the 

1 As defined by 42 U.S.C. § 254e(a), the term “health professional shortage area” means 

“(A) an area in an urban or rural area (which need not conform to the geographic 

boundaries of a political subdivision and which is a rational area for the delivery of health 

services) which the Secretary determines has a health manpower shortage and which is not 

reasonably accessible to an adequately served area, (B) a population group which the 

Secretary determines has such a shortage, or (C) a public or nonprofit private medical 

facility or other public facility which the Secretary determines has such a shortage.” 

2 42 U.S.C. § 247d(a). 

3 42 U.S.C. § 217. 

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INTROD UCT ION 

transformation plan before Hurricanes Katrina and Rita struck. The 

Corps is structured as follows. 

The Corps’ management structure. The Assistant Secretary for Health 

administers the Public Health Service4 within the Office of Public 

Health and Science. Pursuant to Title 42 of the United States Code 

(U.S.C.) § 204, the Corps is a component of the Public Health Service.5 

Within the Office of Public Health and Science, the Office of 

Commissioned Corps Force Management and the Office of the Surgeon 

General form the broad management structure of the Corps. The Office 

of Commissioned Corps Force Management establishes performance 

standards and measurements for the Corps, while two offices in the 

Office of the Surgeon General handle most other Corps functions. 

Within the Office of the Surgeon General, the Office of Commissioned 

Corps Operations (OCCO) administers the Corps’ day-to-day operational 

functions, including general training, career development, and other 

personnel functions. The Office of Force Readiness and Deployment 

(OFRD) administers deployment training and readiness, contacts 

officers for deployments, and assembles deployment rosters. The Office 

of the Assistant Secretary for Preparedness and Response (ASPR, then 

known as the Office of Public Health Emergency Preparedness), located 

in the Office of the Secretary, handles travel and other logistics for 

deployed officers. (See Appendix B for more details on Corps 

management.) 

The Corps’ standards of readiness. Unless Corps officers are exempted, 

they are required to meet certain standards of readiness prior to being 

placed on an OFRD deployment roster. The Corps’ standards of 

readiness consist of health and safety requirements (such as 

immunizations), physical readiness, and training and competency 

standards. According to former Surgeon General Richard Carmona, 

72 percent of Corps officers met the standards of readiness as of October 

2005, up from the 23 percent who met the standards in January 2003.6 

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4 42 U.S.C. § 202.

5 For a historical description of the U.S. Public Health Service Commissioned Corps visit 

U.S. Public Health Service Commissioned Corps, “The History of the Commissioned Corps.” 

Available online at http://www.usphs.gov/html/history.html. 

6 Letter from former Surgeon General Richard Carmona to all commissioned officers, 

October 3, 2005. Available online at 

http://dcp.psc.gov/PDF_docs/SGLetterreadinessOct305.htm. Accessed December 12, 2005. 

T HE C O MMI S S I O N E D C O R P S ’ RESP O N SE T O HURR I CANE S KAT R I N A AND RI TA 2 
INTROD UCT ION 

(See Appendix C for the standards of readiness as of October 2005.7) 

The Corps’ mission statement. At the time of Hurricanes Katrina and 

Rita, the Corps’ mission statement was as follows: “Protecting, 

promoting, and advancing the health and safety of the Nation. As 

America’s uniformed service of public health professionals, the 

Commissioned Corps achieves this mission through: 

• Rapid and effective response to public health needs, 

• Leadership and excellence in public health practices, and 

• The advancement of public health science.” 

Deploying the Commissioned Corps 

The Department’s Concept of Operations Plan (CONOPS)8 establishes 

the framework for managing and coordinating its response to public 

health and medical emergencies. The CONOPS is coordinated with 

other emergency response plans, such as the National Response Plan.9 

Under the National Response Plan, Emergency Support 

Function #8 (ESF #8) provides the mechanism for coordinated Federal 

assistance to supplement State, local, and tribal resources in response 

to public health care needs. To request resources such as Corps officers 

or supplies during a public health emergency, State health officials are 

required to submit an action request form to the Federal Emergency 

Management Agency (FEMA), which generally will be collocated with 

other Federal, State, and local agencies in a temporary joint field office. 

Once FEMA approves the request, it will issue a mission assignment to 

the Department, which will mobilize the requested resources. (See 

Appendix D for a flowchart depicting this process.) 

Once the Secretary authorizes the Corps to deploy, the Assistant 

Secretary for Health establishes the scope, size, and duration of the 

deployment. At the request of the Assistant Secretary for Health, the 

Surgeon General deploys the Corps and manages day-to-day operations 

in cooperation with the ASPR. These two officials are charged with 

ensuring that Corps officers with the appropriate skills are deployed 

when necessary. Within the Surgeon General’s office, OFRD contacts 

 OE I-09-06-00 030 

7 “MANUAL CIRCULAR – COMMISSIONED CORPS PERSONNEL PHS NO. 377.” 

Available online at http://dcp.psc.gov/PDF_docs/Man_circ_377.pdf. Accessed 

December 12, 2005. 

8 U.S. Department of Health and Human Services, “Concept of Operations Plan (CONOPS)

for Public Health and Medical Emergencies,” June 2006. 

9 U.S. Department of Homeland Security, “National Response Plan,” December 2004. 

T HE C O MMI S S I O N E D C O R P S ’ RESP O N SE T O HURR I CANE S KAT R I N A AND RI TA 3 
INTROD UCT ION 

Corps officers and their employer agencies to request the mobilization. 

If an officer is able to deploy and his or her agency supervisor approves 

the deployment, OFRD places the officer on a deployment roster. ASPR 

receives the deployment rosters from OFRD and makes the officers’ 

travel arrangements through a contractor. 

The Corps’ Response to Hurricanes Katrina and Rita 

In late summer and early fall 2005, Hurricanes Katrina and Rita 

devastated the Gulf Coast. On August 29, Hurricane Katrina made 

landfall in Louisiana as a Category 3 storm, causing an estimated 

$81 billion in damage and 1,833 deaths.10 On September 24, Hurricane 

Rita made landfall between Texas and Louisiana, also as a Category 

3 storm, causing estimated total damage of $10 billion and at least 

62 deaths.11 

In response to health care and public health needs in the areas affected 

by the hurricanes, the Corps carried out the largest deployment in its 

207-year history. According to Corps administrative data, 2,119 of the 

6,122 Corps officers (35 percent) on active duty between August 26 and 

November 7, 2005, deployed at least once in 

response to Hurricanes Katrina or Rita. These 

officers served a total of 2,372 missions (some 

officers deployed more than once). The Corps 

itself deployed officers for 1,777 of these missions 

(75 percent), while agencies that employed Corps 

officers deployed the remainder. As shown in 

Table 1, officers deployed by the Corps served 

mainly in States directly affected by the 

hurricanes—Louisiana, Mississippi, and Texas— 

though a significant number filled roles in 

Source: Office of Inspector General analysis of Corps national and regional headquarters.12 Of officers 

administrative data, 2006. deployed to the Gulf Coast, 81 percent served on 

Table 1: Corps Deployment Locations 

Mission location Number Percentage 

Louisiana 814 45.8% 

Mississippi 453 25.5% 

Washington, DC/Maryland 283 15.9% 

Texas 184 10.4% 

Georgia 43 2.4% 

Total 1,777 100.0% 

10 National Hurricane Center. “Tropical Cyclone Report, Hurricane Katrina, 

23-30 August 2005.” December 20, 2005, updated August 10, 2006. Available online at 

http://www.nhc.noaa.gov/pdf/TCR-AL122005_Katrina.pdf. Accessed August 12, 2006. 

11 National Hurricane Center. “Tropical Cyclone Report, Hurricane Rita, 

18-26 September 2005.” March 17, 2006, updated August 14, 2006. Available online at 

http://www.nhc.noaa.gov/pdf/TCR-AL182005_Rita.pdf. Accessed August 14, 2006. 

12 Federal disasters were declared in Alabama, Florida, Louisiana, and Mississippi for 

Hurricane Katrina and in Louisiana and Texas for Hurricane Rita. However, Alabama and 

Florida did not request assistance that resulted in Corps deployments. 

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INTROD UCT ION 

teams that rendered direct services to affected communities and 

19 percent served on the Secretary’s Emergency Response Teams or at 

local operations centers, such as Camp Phoenix in Baton Rouge. 

Corps 2006 Transformation 

On January 18, 2006, the Secretary announced that the Corps’ 

transformation would continue into its next phase, which would enable 

it to address public health challenges more quickly and efficiently. 

From February through March 2006, the Corps developed strategies to 

increase its size and improve its ability to respond quickly to urgent 

public health needs by: 

• Increasing the number of officers by 10 percent, to a total of 

6,600; 

• Improving response operations and team-oriented deployment 

processes; and 

• Changing the recruitment process so that it includes stronger 

personal incentive programs and a better approach for assigning 

officers.13 

Rapid Deployment Force and Health and Medical Response Team. In response 

to recommendations 57c and 60 of the White House report, “The Federal 

Response to Hurricane Katrina: Lessons Learned,”14 in 2006 the Corps 

commenced implementing a tiered response plan, which will include a 

Rapid Deployment Force (RDF).15 The Corps also is developing plans for a 

Public Health Service Health and Medical Response (HAMR)16 team. 

The Corps’ response plan will consist of four response tiers: 

• Tier one will constitute the RDF. The RDF will be strategically 

located in multiple locations and staffed for rapid deployment 

across the Nation. Tier one will be expected to report to a point 

of departure within 12 hours of notification. 

13 U.S. Department of Health and Human Services news release, “New Initiative 

Announced to Transform the US Public Health Service Commissioned Corps,” 

January 18, 2006. Available online at 

http://www.os.dhhs.gov/news/press/2006pres/20060118.html. Accessed January 18, 2006. 

14 Frances Fragos Townsend, “The Federal Response to Hurricane Katrina: Lessons

Learned,” February 2006. 

15 Letter from RADM John Babb, U.S. Public Health Service Commissioned Corps, to Corps 

officers, April 28, 2006. 

16 “Transformation Working Group on Readiness,” February 2006. 

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INTROD UCT ION 

• Tier two also will be strategically located for rapid deployment 

across the Nation and staffed with applied public health and 

mental health teams. However, tier two will be expected to 

report to a point of departure within 36 hours of notification. 

• Tier three will consist of officers not placed in tier one or two. 

Tier three will be expected to report to a point of departure 

within 72 hours of notification. 

• Tier four will consist of officers in the Corps’ inactive reserve. 

There is no specific time requirement for reporting to a point of 

departure upon notification. 

Under the HAMR team concept, the Corps would create and maintain a 

cadre of full-time, equipped teams dedicated to training for and 

responding to public health emergencies. 

METHODOLOGY 

For this evaluation, we: (1) surveyed a stratified random sample of 

200 deployed Corps officers and 150 Corps officers who did not deploy; 

(2) analyzed Corps administrative databases; (3) interviewed and 

collected documentation from Corps field commanders, Corps 

management components, and ASPR officials; (4) interviewed State 

health officials; and (5) interviewed selected agencies that employ Corps 

officers. 

Corps officer surveys. To obtain perspectives about the Corps’ emergency 

response operations, we surveyed a stratified random sample of Corps 

officers. We administered two surveys: one 

to 200 officers who deployed in response to 

Hurricanes Katrina and/or Rita between 

August 26 and November 7, 2005; and one 

to 150 officers who did not deploy during 

that period.17 Our sampling method allowed 

us to project the results of the survey to the 

population of all officers who were on the 

Corps roster during that time. Appendix E 

contains statistical confidence intervals for 

all projected survey figures presented in this report. We received 

Table 2: Corps Officer Survey Characteristics 

Stratum Population 

Count 

Sample 

Count 

Response 

Count 

Deployed 2,173 200 197 

Nondeployed 3,949 150 133 

Total 6,122 350 330 

Source: Office of Inspector General, 2005. 

17 We selected this time period to obtain information about the initial experiences that 

officers encountered during Hurricanes Katrina and Rita. 

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INTROD UCT ION 

197 responses from deployed officers and 133 responses from 

nondeployed officers, for an overall response rate of 94 percent. Ten 

officers whom we selected as part of the deployed sample indicated in 

the survey that they had not deployed, and nine selected as part of the 

nondeployed sample indicated that they had deployed. Hence, our 

analysis refers to 196 deployed and 134 nondeployed officers. 

Table 2 (previous page) shows population, sample, and response counts 

for the officer survey. 

Corps administrative databases. At the time of our evaluation, the Corps 

maintained several databases with personnel, readiness, and historical 

deployment information for all of its officers (it has since combined 

those separate databases into a single system). We used information 

from these databases to identify our universe of deployed and 

nondeployed officers and to analyze officers’ deployment history and the 

extent to which they met the standards of readiness. We did not 

validate the information contained in these databases. 

Field commanders and Corps’ management components. To gain insight into 

Corps field operations, we interviewed and obtained documentation from the 

seven field commanders who managed Corps emergency response operations 

throughout Louisiana, Mississippi, and Texas. We also interviewed and 

obtained documentation about the Corps’ responses to Hurricanes Katrina 

and Rita from each of the Corps management components. 

State health officials. To gather stakeholder perspectives on the Corps’ 

responses to Hurricanes Katrina and Rita, we interviewed State health 

officials in Louisiana, Mississippi, and Texas. 

Agencies that employ Corps officers. To understand the viewpoint of 

agencies that employ Corps officers, we interviewed officials at seven 

agencies that together employed 87 percent of the officers in our sample.18 

These included both Department and external agencies. 

Standards 

This study was conducted in accordance with the “Quality Standards for 

Inspections” issued by the President’s Council on Integrity and 

Efficiency and the Executive Council on Integrity and Efficiency. 

18 These agencies were the Indian Health Service, the Centers for Disease Control and 

Prevention, the Food and Drug Administration, the Health Resources and Services 

Administration, the Bureau of Prisons, the National Institutes of Health, and the 

Department of Homeland Security. 

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Δ FINDING 

Commissioned Corps officers deployed in 

response to Hurricanes Katrina and Rita provided 

valuable services, but the Corps could improve its 

response to public health emergencies 

The Corps provided valuable 

assistance in response to the 

public health threats triggered by 

Hurricanes Katrina and Rita and 

addressed the health care needs 

of those affected. Officers provided critical clinical and environmental 

health and engineering services to affected communities and valuable 

support to State health officials. However, the Corps was not able to 

meet some State needs. Furthermore, deficiencies in officer 

preparation, deployment logistics, field operations, and officer 

reimbursement diminished the effectiveness and efficiency of the 

response. 

Corps officers provided valuable support to States but could not meet 

some needs 

Corps officers in Joint Field Offices worked side-by-side with State 

officials, and both partners generally reported very positive working 

relationships. According to State health officials, these officers 

integrated “seamlessly” into emergency operations centers in the early 

days of the response. Perhaps most important to State health officials, 

Corps officers helped the States identify and understand the Federal 

assets available for their use. They also helped States understand the 

situation on the ground in affected areas. One State health official 

reported, “There were some lessons learned, but overall we got what we 

needed. They were extremely beneficial.” 

Overall, approximately 67 percent of officers deployed by the Corps 

served on teams that provided health care and public health services in 

hurricane-affected areas. State health officials credited these officers 

with saving many lives. Officers employed their clinical skills to 

provide a variety of services, including primary and emergent care, 

pharmacy, and veterinary medicine. Meanwhile, Corps environmental 

health officers and engineers helped assess and counter public health 

threats caused by the hurricanes and subsequent flooding. 

Although State health officials generally were satisfied with the relief 

services the Corps provided, some needs were not met, especially in the 

nursing, mental health, and dental areas. Corps officers and field 

commanders also identified the need for more nursing and mental 

health professionals, the latter for both hurricane victims and response 

personnel. One State health official noted that a small number of Corps 

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F I NDING

officers lacked adequate skills in administering immunizations and 

providing primary, acute, and emergent care. 

Although most deployed Corps officers met readiness standards, many 

lacked experience, effective training, and familiarity with response plans 

Readiness. According to our survey, 96 percent of the officers who 

deployed in response to Hurricanes Katrina and Rita met the Corps’ 

readiness standards.19 This preparation helped the Corps better 

respond to the hurricanes: 70 percent of deployed officers said that 

meeting the standards helped improve their performance in the field. 

Officers deployed to hurricane-affected areas were significantly more 

likely than those deployed to national or regional command centers to 

state that meeting the standards improved their performance. 

Although this level of readiness is valuable, attaining it exacts a cost. 

As agency employees, officers must negotiate with their supervisors for 

time to maintain their readiness. If they cannot obtain sufficient time 

during working hours, officers must use personal time to meet the 

standards. According to our survey, 28 percent of officers spend more 

than 15 hours of personal time each month keeping up with the 

standards. Approximately 12 percent of officers, mainly those who 

reported having young children or a regular workweek that greatly 

exceeded 40 hours, stated that maintaining their readiness status 

creates a significant hardship for them. 

Experience. Fifty-two percent of the Corps officers deployed in response 

to the hurricanes had no previous deployment experience, which 

hindered the Corps’ overall effectiveness. Field commanders reported 

that inexperienced officers were unfamiliar with response protocols and 

that more experienced personnel had to spend time training and 

orienting the new officers in the field. Furthermore, the Corps’ 

standard 2-week deployment meant that these inexperienced officers 

often left the relief operation soon after they had become comfortable in 

their roles. To counter this, some officers voluntarily extended their 

tours; nevertheless, 80 percent of deployments lasted 15 or fewer days. 

Although all interview respondents noted the lack of experience as a 

problem, the Corps did not use many of its experienced officers in the 

response. Of all officers deployed by the Corps or their employer 

19 Corps administrative data show that approximately 85 percent of deployed Corps officers 

met the readiness standards at the time of deployment. 

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F I NDING 

agencies, only 57 percent of the experienced officers on the Corps’ active 

duty roster deployed for hurricane relief operations. 

The number of inexperienced officers increased as the response to 

Hurricane Katrina continued and Hurricane Rita arrived. Field 

commanders and State health officials noted that while the initial wave 

of officers was relatively experienced, officers deployed later were less 

experienced. Corps administrative data support this perception, 

showing that the proportion of officers with previous deployment 

experience steadily declined as the response continued. (See 

Table 3 below.) One field commander stated, “ . . . [The] Corps threw 

everything into Katrina—[we] didn’t have the resources to reload for 

Rita.” 

Table 3: Previous Experience of Deployed Officers, by Week, in 2005 

Week Starting 

22-Aug 29-Aug 5-Sep 12-Sep 19-Sep 26-Sep 3-Oct 10-Oct 17-Oct 24-Oct 

Number of 48 541 224 125 307 134 102 54 46 officers 

Percentage with 69% 54% 57% 50% 44% 37% 36% 35% 35% 24%

experience 

Source: Office of Inspector General analysis of the Corps’ administrative data, 2006. 

Training. Certain respondents viewed Corps training prior to the 

hurricanes as ineffectual in some respects. Thirty-six percent of 

deployed officers stated that their Corps training did not adequately 

prepare them for field operations; some field commanders agreed. Most 

commonly, officers said that the Corps’ computerized training modules 

were overly broad and did little to prepare them for the conditions and 

situations they encountered during the response. Officers called for 

more hands-on practical training. About 24 percent of the surveyed 

officers volunteered that team-based training, as outlined in the Corps 

2006 transformation, would have been beneficial.20 Some officers, about 

13 percent of those surveyed, expressed concern that their agency 

workloads limited their opportunity to undergo Corps training. This 

20 We did not solicit input on particular ways to enhance Corps’ training but instead asked 

generally how Corps training and emergency response could be improved. 

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42 
F I NDING

situation, they said, could be improved by providing Corps funding and 

dedicated time for training courses and exercises. 

Familiarity with response plans. Many deployed officers were unfamiliar 

with the framework for public health emergency response—only 

37 percent were familiar with the CONOPS and 61 percent with 

ESF #8. As the primary guides to the responsibilities of the 

Department in response to a terrorist attack or natural disaster, these 

documents are an important part of the incident command structure. 

The field commanders we interviewed all agreed that deployed officers 

should be familiar with ESF #8, but some believed that it was less 

important that officers be familiar with CONOPS. 

Agencies were unwilling or unable to allow some officers to deploy; 

logistical difficulties delayed others’ arrival in the field 

Agency release. According to our survey of Corps officers, 17 percent of 

the officers who did not participate in the Corps’ response to the 

hurricanes received requests to deploy that they could not fulfill. 

Agency responsibilities prevented 56 percent of this group from 

deploying, generally because the officers could not obtain supervisory 

approval. For example, one officer related that his agency supervisor 

stated that the officer’s priority was the agency rather than hurricane 

relief. Agencies could not spare others because the officers’ primary 

work locations already were understaffed or because the agencies 

needed them for their own response operations. 

Logistical difficulties. Delays in notification and travel challenges meant 

that Corps officers were not always available when and where they 

were expected. Although the first wave of Corps officers arrived 

quickly, replacements arrived 2 to 3 days after the State’s request. 

Several Corps field commanders and State health officials reported that 

delays led to difficulties in the field. For example, one State health 

official stated that beyond the first cadre of officers, “by the time 

they . . . arrived, our needs had changed.” 

Many Corps officers did not receive the requests to deploy until well 

after they were made, which delayed their travel significantly. 

Forty-six percent of officers who were requested to deploy received the 

requests more than 12 hours after they were sent, and 13 percent 

received them after a delay of more than 72 hours. More than half of 

the officers (55 percent) contacted for Hurricanes Katrina and Rita said 

the contact method used by the Corps was not ideal. For example, 

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F I NDING

28 percent of officers told us that the best way to contact them was via 

personal cell phone, but only 9 percent were contacted that way. 

Once officers received notifications, the travel system used for 

deployments presented further challenges. One-half of deployed Corps 

officers departed more than 48 hours after receiving the initial requests, 

and 29 percent left more than 72 hours afterward. The most frequently 

cited problem was obtaining approved travel orders for flights, ground 

transportation, and lodging. Our interview respondents attributed this 

to difficulties with the travel coordinator contracted for the response as 

well as to the impact of the hurricanes on flight schedules and other 

travel components. 

Confusion surrounded some Corps officers’ arrival in the field, but most 

field assignments were appropriate and officers felt safe at their locations 

According to our survey, 37 percent of officers did not receive clear 

direction on their assignments during field operations. Because they 

were unsure what to do, 10 percent of officers were unable to 

immediately begin relief operations upon arriving in the field. 

Furthermore, 15 percent of officers were initially sent to the wrong 

locations or to locations where their skills were not needed, meaning 

that they could not start rendering services until their situations were 

resolved. Although incoming travel delays and local transportation 

deficiencies contributed to the problem, poor communication and the 

lack of a formal system to track officers’ movements were major factors 

according to our respondents. 

Once they commenced field operations, most Corps officers were 

satisfied with their assigned duties. Approximately 87 percent of 

deployed Corps officers reported that their field assignments made 

appropriate use of their professional skills. Some, though, were not 

used effectively. For example, one State health official used a team of 

surgeons to assess special needs shelters, which he conceded was 

“probably a misuse of their skills.” Several survey respondents noted 

that their professional skills went unused—for example, one dentist was 

assigned as a supply officer—but few believed the assignments were 

inappropriate in the context of the overall response. 

Deployed officers generally viewed their personal security and that of 

supplies as adequate. According to our survey, about 82 percent of 

officers believed that both they and the medical and other supplies at 

their locations were safe. A few reported that supplies, especially 

pharmaceuticals, were not secured adequately and “disappeared” on 

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F I NDING

occasion. Several others indicated that the behavior of patients and 

their families caused them to feel unsafe because of insufficient security 

personnel at their sites. 

Most officers were equipped adequately, but some lacked working 

communications devices and other basic tools 

Deployed Corps officers generally had the tools they needed to do their 

jobs but sometimes lacked certain equipment or supplies. Although 

78 percent of officers believed that they had been issued necessary 

equipment, some officers and field commanders reported that they had 

not had functioning communications equipment or had been forced to 

use their personal cell phones (at their own expense) to communicate. 

Having a greater variety of redundant communications equipment, such 

as satellite phones and walkie-talkies in addition to cell phones, would 

have helped when one mode was inoperable. Other needs that survey 

respondents mentioned included pharmaceuticals, medical reference 

texts, additional food and water, and beds that could accommodate 

obese patients. Several officers stated that if they and their colleagues 

had not brought personal medical devices, such as blood pressure cuffs 

and stethoscopes, these basic tools would not have been available onsite. 

Many officers personally incurred mission-related expenses and some were 

not reimbursed promptly, which could affect future deployments 

During the response to Hurricanes Katrina and Rita, just 62 percent of 

deployed officers had Federal Government travel credit cards, and 

56 percent of the officers reported that they personally paid for 

mission-related expenses. The most common items included food, cell 

phone bills, ground transportation, and supplies, with the amounts 

ranging from $10 to almost $2,700. Many expenses were not 

reimbursed promptly—29 percent of officers were repaid more than 

3 months after they submitted vouchers for the expenses, and, at the 

time of our survey, 16 percent said they had not been repaid. Half the 

officers in our survey said that not being reimbursed for mission-related 

expenses would create a significant barrier to deployment. Agency 

representatives agreed that the failure to promptly reimburse officers 

could affect their ability to deploy to future public health emergencies. 

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Δ RECOMME NDA TIONS 

The Corps currently is undergoing a substantial transformation that 

may address many of the issues it encountered in response to 

Hurricanes Katrina and Rita. In so doing, the Corps should address 

and resolve the problems identified in this report. We recommend that 

the Commissioned Corps: 

Institute More Effective Training for Corps Officers 

Improved training is a major focus of the Corps’ transformation efforts. 

As the Corps develops its training program, it should implement more 

hands-on focused training and rely less on computer-based modules. 

The Corps should seek funding that would be used to grant officers time 

away from their agency jobs to train for public health response. 

Improve the System Used To Contact Officers for Deployment 

Although the Corps maintains a variety of contact information for its 

officers, many requests to deploy were received significantly after they 

were made. More than half of the officers contacted for Hurricanes 

Katrina and Rita said that the methods used to contact them were not 

ideal. The Corps should develop a system to quickly and reliably 

contact officers for deployment. 

Work With the Office of the Assistant Secretary for Preparedness and 

Response To Streamline Deployment-Related Travel 

Corps officers, leadership, and agency representatives believe that the 

travel system used during the hurricanes caused delays in reaching the 

field for numerous officers. The Corps should work with ASPR to 

improve the current system, or acquire a new one, so that officers can be 

deployed efficiently and rapidly. 

Stagger Deployments To Ensure Continuity of Operations 

Numerous respondents reported that the Corps had difficulty keeping 

experienced officers in the field. The Corps’ standard 2-week 

deployment contributed to this problem. To counter this, some officers 

voluntarily extended their tours, but a more systematic approach is 

needed for long deployments. The Corps should consider staggering 

deployments to mitigate the loss of experience as officers end their 

tours. 

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R E C O MMENDA T I O N S 

Improve Its Ability To Coordinate Mission Assignments and 

Communications in the Field 

Confusion over mission assignments led to less than optimal response in 

some instances. Although poor travel logistics contributed to the 

problem, Corps management and ASPR also lacked an effective means 

to position and track officers in the field. The Corps should work with 

ASPR to develop more effective systems to ensure that officers arrive 

when and where they are needed with a clear understanding of their 

responsibilities. The systems should be flexible enough to respond as 

needs change. The Corps also should work with ASPR to expand the 

variety of communications equipment issued to Corps officers to ensure 

that they can effectively communicate with leadership. 

Ensure That All Deployable Officers Have Federal Government Travel 

Credit Cards 

According to our survey, 38 percent of the officers deployed in response 

to Hurricanes Katrina and Rita did not have Federal Government travel 

credit cards21 and more than half personally incurred mission-related 

expenses. All deployable officers should have official Government travel 

credit cards with which to make mission-related purchases. The Corps 

should work with ASPR to review procedures for reimbursing officers 

for mission-related expenses incurred during deployments to ensure 

that appropriate and prompt reimbursements are made. 

AGENCY COMMENTS 

The Assistant Secretary for Health agreed with the Office of Inspector 

General’s (OIG) recommendations for improving the Corps’ response to 

public health emergencies. As part of the Corps’ comprehensive 

transformation process and its efforts to improve OFRD’s practices, the 

Corps is currently addressing OIG’s recommendations. 

21 Government-issued travel credit cards are issued and billed to Government employees for 

authorized official business expenses associated with temporary duty travel, including cash 

travel advances. Use of the Government-issued travel credit card is governed by General 

Services Administration (GSA) travel regulations and accompanying travel policies issued 

by the respective Government employer agency. GSA offers courses on the proper use of 

Government-issued travel credit cards. Government-issued travel credit cards differ from 

International Merchant Purchase Authorization Cards (IMPAC). An IMPAC is used by 

cardholders to procure items for their respective components. However, the cardholder is 

not personally billed. Use of an IMPAC is governed by Federal Acquisition Regulations and 

accompanying policies issued by the respective Government employer agencies. 

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R E C O MMENDA T I O N S 

Specifically the Corps is developing more effective deployment-related 

training programs for officers, improving contact and communication 

mechanisms for officer deployments, and revamping its travel systems 

in support of deployments. The Assistant Secretary for Health stated 

that the OIG’s recommendations will assist his office, working in 

collaboration with ASPR, in its efforts to continuously improve the 

Department’s response to public health emergencies. The Assistant 

Secretary for Health’s comments are included in their entirety in 

Appendix F. 

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ΔAPP E N D I X A APPENDIX ~ B APPENDIX ~ A 

Commissioned Corps Employer Agencies and Professional 

Categories 

Corps Officer Employers 

 Department of Health and Human Services 

Office of the Secretary 

Agency for Healthcare Research and Quality 

Agency for Toxic Substance and Disease Registry 

Centers for Disease Control and Prevention 

Centers for Medicare & Medicaid Services 

Food and Drug Administration 

Health Resources and Services Administration 

Indian Health Service 

National Institutes of Health 

Substance Abuse and Mental Health Services Administration 

Office of Public Health and Science 

Program Support Center 

External Agencies 

Federal Bureau of Prisons 

District of Columbia Commission on Mental Health Services 

Environmental Protection Agency 

U.S. Citizenship and Immigration Services 

National Oceanic and Atmospheric Administration 

National Park Service 

U.S. Coast Guard 

U.S. Marshals Service 

U.S. Department of Agriculture 

Corps Professional Categories 

Dentist 

Dietitian 

Engineer 

Environmental Health 

Health Services 

Nurse 

Pharmacist 

Physician 

Scientist 

Therapist 

Veterinarian 

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Δ APPENDIX ~ B 

Commisioned Corps Management Structure 

Office of Commissioned Corps Force Management 

The Office of Commissioned Corps Force Management reports directly to 

the Assistant Secretary for Health.22 The office became operational on 

April 18, 2004.23 It establishes performance standards and measurements 

for the Commissioned Corps’ (Corps) operations. 

Office of the Surgeon General 

The Office of the Surgeon General reports to the Assistant Secretary for 

Health with respect to the administration of Corps operations. The 

Surgeon General provides leadership and management oversight for the 

Corps’ involvement in Department of Health and Human Services 

emergency preparedness and response activities.24 

• Office of Commissioned Corps Operations 

The Office of Commissioned Corps Operations (OCCO) carries 

out the day-to-day management and administration of major 

Corps operational functions. The OCCO recruits Corps 

personnel, oversees Corps personnel matters, and advises the 

Assistant Secretary for Health and the Surgeon General on 

matters related to Corps operations.

25 

• Office of Force Readiness and Deployment 

The Office of Force Readiness and Deployment (OFRD) is also 

located within the Office of the Surgeon General. The OFRD 

administers deployments to a variety of situations, including 

public health challenges that exceed the capabilities of local, 

State, or operating division resources; public health requirements 

under the national response plan;26 or declared emergencies.27 

22 “Office of Commissioned Corps Force Management.” Available online at 

http://dcp.psc.gov/OCCFM.asp. Accessed December 9, 2005. 

23 Ibid. Accessed December 27, 2005. 

24 U.S. Department of Health and Human Services, “About the Office of the Surgeon

General.” Available online at http://www.surgeongeneral.gov/aboutoffice.html. Accessed 

December 9, 2005. 

25 “Office of Commissioned Corps Operations.” Available online at 

http://dcp.psc.gov/occo.asp. Accessed December 9, 2005. 

26 “National Response Plan,” U.S. Department of Homeland Security. Available online at 

http://www.dhs.gov/dhspublic/interapp/editorial/editorial_0566.xml. Accessed 

December 9, 2005. 

27 Office of Force Readiness and Deployment, “Essentials.” Available online at 

http://oep.osophs.dhhs.gov/ccrf/ccrf_essentials.htm#BACKGROUND. Accessed 

December 12, 2005. 

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Δ APPENDIX ~ C 

Commissioned Corps Standards of Readiness as of October 2005 

A. Health and Safety Standards 

i. Physical examination and medical history 

ii. Immunizations 

iii. Height and weight reporting 

B. Physical Readiness Standards 

 i. Physical fitness standards 

ii. Annual physical fitness tests 

C. Training and Professional Competency Standards 

 i. PHS Commissioned Corps Readiness Training Modules (12) 

ii. Basic Life Support 

iii. Professional Competency 

 iv. Uniforms 

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Δ APPENDIX ~ D 

ESF #8 Medical Action Request Process (ARF)

Identify need 

ESF #8/PHS 

does not 

generate an 

State liaison to ESF #8 State local EOC or ARF 

for personnel health official 

ESF #8 State LNO 

Assign State # (different from 

JFO and ARF#) and create State E Team E team resource request 1. Research & discuss with State authorities & 

ESF #8 

2. Match requests with available resources 

3. Create ARF; forward to DHH ARF signed by approved State

4. Communicate with ESF #8 authority only

5. Request State E-Team copy & file 

JFO FEMA approves FEMA Processes ARF FEMA 

disapproves 

EOC State authority 

Sent to SOC for 

action 

Communicate with

ESF #8 finance/admin ESF #8 State liaison 

tasked by Ops 

Signed/reviewed/ 

ESF #8 finance & 

admin (constant and 

ongoing) 

Source: CAPT (S) Debra Scott, United States Public Health Service Commissioned Corps, September 2005. Used with permission. 

NOTES: 

“EOC” refers to “Emergency Operations Center” 

“LNO” refers to “State Liaison Officer.” 

“JFO” refers to “Joint Field Office” 

“SOC” refers to “Secretary’s Operational Center” 

“State E Team” refers to “State Emergency Team” 

Director DHH 

OE I-09-06-00 030 T HE C O MMI S S I O N E D C O R P S ’ RESP O N SE T O HURR I CANE S KAT R I N A AND RI TA 20 
Δ APPENDIX ~ E 

Statistical Confidence Intervals 

Corps Officer Characteristic n Point Estimate 95% Confidence Interval 

Deployed officers who met readiness requirements 196 95.6% 93.0% to 98.3% 

Deployed officers who stated that meeting readiness requirements 

improved performance 196 70.2% 63.7% to 76.6% 

Officers who spend more than 15 hours per month meeting readiness 

requirements 330 27.6% 22.5% to 32.7% 

Officers for whom meeting readiness requirements creates a significant 

hardship 330 12.4% 8.46% to 16.3% 

Deployed officers who said training was not adequate 196 36.1% 29.4% to 42.8% 

Deployed officers who were familiar with CONOPS 196 37.2% 30.2% to 44.1% 

Deployed officers who were familiar with ESF #8 196 60.2% 53.3% to 67.1% 

Nondeployed officers who received deployment requests 330 17.4% 11.0% to 23.7% 

Nondeployed officers who couldn’t respond because of agency 

responsibilities 134 55.9% 36.5% to 75.4% 

Officers who received the requests to deploy more than 12 hours after 

they were sent 330 46.0% 38.6% to 53.4% 

Officers who received the requests to deploy more than 72 hours after 

they were sent 

330 12.7% 7.27% to 18.2% 

Officers who received the requests to deploy by other than optimal means 330 54.5% 47.7% to 61.4% 

Officers for whom the personal cell phone would have been the optimal 

means of contact 330 28.3% 22.1% to 34.5% 

Officers contacted by personal cell phone 330 8.68% 4.92% to 12.4% 

 OE I-09-06-00 030 T HE C O MMI S S I O N E D C O R P S ’ RESP O N SE T O HURR I CANE S KAT R I N A AND RI TA 21 
ΔA P PEND IX E

 APPENDIX ~ E 

Statistical Confidence Intervals (continued) 

Corps Officer Characteristic n Point Estimate 95% Confidence Interval 

Deployed officers who left more than 48 hours after receiving the requests 

to deploy 

196 49.5% 42.4% to 56.6% 

Deployed officers who left more than 72 hours after receiving the requests 

to deploy 

196 29.2% 22.4% to 36.1% 

Officers deployed to the Gulf Coast who said their assignments were not 

clearly communicated 164 37.0% 29.5% to 44.5% 

Officers deployed to the Gulf Coast who said they could not immediately 

begin work because of confusion over assignments 164 9.67% 5.46% to 13.9% 

Officers deployed to the Gulf Coast who said they were initially sent to the 

wrong locations 164 15.4% 10.2% to 20.5% 

Deployed officers who said their assignments were appropriate 196 86.9% 81.9% to 91.9% 

Deployed officers who said they were satisfied with the security of 

themselves and of supplies 196 81.8% 76.7% to 87.1% 

Deployed officers who said they were adequately equipped 196 78.1% 72.6% to 83.6% 

Officers who said the lack of reimbursement would significantly affect their 

ability to deploy 330 50.2% 43.2% to 57.2% 

Deployed officers who paid for mission-related expenses from personal 

accounts 196 56.2% 49.2% to 63.2% 

Deployed officers who had Government travel credit cards 196 62.4% 55.5% to 69.3% 

Deployed officers reimbursed more than 3 months after they incurred the 

expenses 

196 28.8% 19.8% to 37.7% 

Deployed officers who had not been repaid at the time of the survey 196 15.8% 9.18% to 22.5% 

 OE I-09-06-00 030 T HE C O MMI S S I O N E D C O R P S ’ RESP O N SE T O HURR I CANE S KAT R I N A AND RI TA 22 
.. A P PEN 0 x F

Agency Comments

(A.-'t.. ~.~~~

:.....ia (J

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office Of the Secretary

Assistant Secretary tor Heàlth

Office of Public Health and Scienc.e

Washington D,C. 20201

JAN 3 0 2007

TO: Inspector General, Deparent of Health and Human Services

FROM: Assistat Secret' fOi" Health

SUBJECT: Inspector General's Report (OEI-09-06-00030) -INFOllATION

I am writig to express my appreciation for your repqrt entitled ''Te Commissioned

Corps' Response to Hurcanes Katrna and Rita" (OEI-09'06-00030). The evaluation

conducted by your sta included interiews with a strtified random sampling of offcers,

review of our databases, and interiews with members of our Deparent and those state

heath officials we served durg the response. From the design as well as the findings

and conclusions, it is evident that much careful and thoughtf consideraton was given

thoughout the evaluation. I concur with the fidigs and the recommendaions as to how

the Commissioned Corps of the U.S. Pulic Health Serce (Corps) can improve its

futUe responses to public health emergencies.

The recommendations. of the report mirror many of the prepardness and response areas

we are addressing as par of the business practice improvements with the Offce of

Force Readiness and Deploymentand our comprehensive Trafonnation effort. We are

developing more effective deployment-related trainng program for our offcers,

improving contact/communcation mechansms with offcers when deployments are

necessar, and revamping our travel systems in support of deployments. Our Corps'

Trasfonnation will greatly enhance our ability to respond effectively to public health

emergencies by developing a tota force managenient approach to officer selections,

training, readiness and assignents. The tranfonned Corps wil be better able to deploy

offcers with the appropriate skill sèts required to respond to the wide aray of public

health emergencies our Nation will face.

The recommendations contained withn your report will assist us, workig in

collaboration with the Assistat Secretay for Preparèdess and Response, in our goal of .

continuously improving our Deparent's response to public health eiergencies and

assurng that the Corps remains the Deparent's premier and primary deployable asset.

Than you for your Offce's dilgence and timeliness in the preparation of this report.

.~-

-= - John O. Agwobi -

U.S. Public Health Service

OE 1-09-06-00030 THE COMMISSIONED CORPS' RESPONSE TO HURRICANES KATRINA AND RITA 23
ΔAPP E N D I X E~ A 

 ACKNOWLEDGMENTS 

This report was prepared under the direction of Paul A. Gottlober, 

Regional Inspector General for Evaluation and Inspections in the San 

Francisco regional office, and Deborah W. Harvey, Assistant Regional 

Inspector General. Other principal Office of Evaluation and Inspections 

staff who contributed include: 

Michael Henry, Project Leader 

Scott Hutchison, Program Analyst 

Rob Gibbons, Program Analyst 

Mark Richardson, Program Specialist 

Ayana Everett, Program Specialist 

Elise Stein, Director, Public Health and Human Services Branch 

Barbara Tedesco, Mathematical Statistician 

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