United States General Accounting Office 

GAO Testimony 

Before the Committee on Government 

Reform, House of Representatives 

For Release on Delivery 

Expected at 1:30 p.m. EDT 

Thursday, October 23, 2003 U.S. POSTAL SERVICE 

Clear Communication with 

Employees Needed before 

Reopening the Brentwood 

Facility 

Statement of 


Bernard L. Ungar, Director 


Physical Infrastructure 


Keith Rhodes, Chief Technologist 


Center for Technology and Engineering, Applied Research 


and Methods 


GAO-04-205T 

Highlights of GAO-04-205T, a testimony 

before the Committee on Government 

Reform, House of Representatives 

On October 21, 2001, the U.S. 

Postal Service closed its 

Brentwood mail processing facility 

after the Centers for Disease 

Control and Prevention (CDC) 

confirmed that an employee there 

had contracted inhalation anthrax, 

an often-fatal form of the disease. 

On October 21 and 22, two other 

Brentwood employees died of 

inhalation anthrax. The 

contamination was linked to a 

letter that passed through the 

facility on or about October 12, 

before being opened in the office of 

Senator Daschle (see fig.) in the 

Hart Senate Office Building on 

October 15. The Hart Building was 

closed the next day. The 

Brentwood facility has since been 

decontaminated and will soon 

reopen. This testimony, which is 

based on ongoing work, provides 

GAO’s preliminary observations on 

the decisions made in closing the 

facility and problems experienced 

in communicating with employees, 

as well as lessons learned from the 

experience. 

Because the Postal Service agreed 

to inform Brentwood employees 

before the facility is reopened that 

it could not guarantee that the 

facility is completely risk free, GAO 

is making no recommendations at 

this time. 

www.gao.gov/cgi-bin/getrpt?GAO-04-205T. 

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Bernard L. 

Ungar at (202) 512-2834 or ungarb@gao.gov. 

October 23, 2003 

U.S. POSTAL SERVICE 

Clear Communication with Employees 

Needed before Reopening the Brentwood 

Facility 

The Postal Service’s decision to wait to close the Brentwood facility and 

refer employees for medical treatment until CDC confirmed that a postal 

employee had contracted inhalation anthrax was consistent with the advice 

the Postal Service received from public health advisers and the information 

about health risk available at the time. However, because circumstances 

differed at Brentwood and the Hart Building—an observed spill at the Hart 

Building and no observable incident at Brentwood—the Postal Service’s 

response differed from the response at Capitol Hill, leading some Brentwood 

employees to question whether the Postal Service was taking adequate steps 

to protect their health. 

The Postal Service communicated information to its Brentwood employees 

during the anthrax incident, but some of the health risk information changed 

over time, exacerbating employees’ concerns about the measures being 

taken to protect them. Notably, employees later learned that their risk of 

contracting the disease was greater than originally stated. Other factors, 

including difficulties in communicating the uncertainty associated with 

health recommendations and employees’ distrust of postal managers, also 

challenged efforts to communicate effectively. Recently, the Postal Service 

informed employees that Brentwood, which has been tested and certified as 

safe for occupancy, is “100 percent free of anthrax contamination.” 

However, in discussions with GAO, the Service agreed to revise future 

communications to acknowledge that although any remaining risk at the 

facility is likely to be low, complete freedom from risk cannot be guaranteed. 

The Postal Service and others have learned since the 2001 anthrax incidents 

that (1) the risk of contracting anthrax through the mail is greater than was 

previously believed and more caution is needed to respond to that greater 

risk and (2) clear, accurate communication is critical to managing the 

response to an incident and its aftermath. The Postal Service is revising its 

guidance to respond more quickly and to communicate more effectively to 

employees and the public in the event of a future incident. 

Anthrax-Contaminated Letter Opened in Hart Building on October 15, 2001 
Mr. Chairman and Members of the Committee: 

We are pleased to be here to discuss issues related to the U. S. Postal 

Service’s response to the anthrax1

 contamination at the Washington D.C. 

Processing and Distribution Center, or Brentwood, as it was commonly 

known.2

 As you know, the facility was renamed the Joseph Curseen Jr. and 

Thomas Morris Jr. Processing and Distribution Center in memory of the 

two Brentwood employees who died of inhalation anthrax on October 21 

and 22, 2001. Inhalation anthrax is the most lethal form of the disease. The 

facility is about to reopen after being closed 2 years ago this week for 

decontamination and renovation. My testimony today will focus on the (1) 

decisions made by the Postal Service in closing the Brentwood facility and 

(2) problems the Postal Service experienced in communicating to its 

employees as well as (3) lessons that can be learned from the experience. 

While you also asked us to address the effectiveness of the facility’s 

decontamination, we are unable to do so because this issue is outside the 

scope of work that we have under way. However, we will relay our 

observations about communication issues associated with the facility’s 

decontamination. 

My testimony today is based largely on our ongoing work addressing the 

treatment of postal employees at several postal facilities, including the 

Brentwood facility, that were contaminated with anthrax spores in late 

2001. This work, which we expect to complete within the next several 

months, is being done at the request of Senator Joseph I. Lieberman and 

Representatives Christopher H. Smith and Eleanor Holmes Norton. Our 

work thus far has involved interviews with individuals involved in the 

response to the contamination, including representatives from the Postal 

Service, the Department of Defense, the Centers for Disease Control and 

Prevention (CDC), and state and local public health agencies and postal 

unions as well as reviews of relevant documents and literature related to 

the anthrax response. We are also drawing from our completed work 

addressing anthrax contamination at a postal facility in Connecticut,3 

1

Technically, the term “anthrax” refers to the disease caused by Bacillus anthracis and not 

the bacterium or its spores. In this report, we use the term “anthrax” for ease of reading 

and to reflect terminology commonly used in the media and by the general public. 

2

In this report, we refer to the facility as Brentwood. 

3

U.S. General Accounting Office, U.S. Postal Service: Better Guidance Is Needed to 

Improve Communication Should Anthrax Contamination Occur in the Future, 

GAO-03-316 (Washington, D.C.: Apr. 7, 2003). 

Page 1 GAO-04-205T Reopening the Brentwood Postal Facility 
issues related to the testing for anthrax in that facility,4

 and the public 

health response to the 2001 anthrax incidents.5

 Our work is being 

performed in accordance with generally accepted government auditing 

standards. The observations that we are making are based on our ongoing 

work and should be viewed as preliminary. 

Before I discuss the decisions made in closing the Brentwood facility, let 

me briefly place these decisions in context. When the Postal Service 

learned that a letter contaminated with anthrax spores had been sent 

through the mail and opened in the office of Senator Daschle within the 

Hart Senate Office Building (Hart Building) on October 15, 2001, the Postal 

Service reports that it immediately understood that the letter passed 

through its Brentwood facility. However, at that point, the risk of 

contamination and its consequences at the facility were uncertain. The 

Postal Service sought advice and guidance from CDC and the District of 

Columbia (D.C.) Department of Health, provided information to its 

employees, arranged for environmental tests of the facility, and provided 

some protective equipment, but it did not close the facility or refer the 

facility’s employees for medical treatment until October 21, when CDC 

confirmed that a Brentwood employee had inhalation anthrax. The Postal 

Service’s actions contrasted with those taken by the Attending Physician 

for the U.S. Capitol—the individual responsible for the health of public 

officials and other congressional employees on Capitol Hill. The Attending 

Physician decided to make antibiotics available to the most directly 

exposed congressional employees on the same day the contaminated letter 

was opened and advised closure of the Hart Building the following day. 

In summary: 

The Postal Service’s decision to wait for CDC’s confirmation of a case of 

inhalation anthrax before closing Brentwood and referring its employees 

for medical treatment was consistent with the advice it received from CDC 

and the D.C. Department of Health as well as the information about health 

risk available at the time. However, the decision raised questions among 

Brentwood employees about whether their health was being adequately 

protected. At the time, CDC advised waiting for such confirmation before 

4

U.S. General Accounting Office, U.S. Postal Service: Issues Associated with Anthrax 

Testing at the Wallingford Facility, GAO-03-787T (Washington, D.C.: May 19, 2003). 

5

U.S. General Accounting Office, Bioterrorism: Public Health Response to Anthrax 

Incidents of 2001, GAO-04-152 (Washington, D.C.: Oct. 15, 2003). 

Page 2 GAO-04-205T Reopening the Brentwood Postal Facility 
recommending closing a facility or recommending medical treatment 

because CDC and local public health authorities believed it unlikely that 

postal employees could contract inhalation anthrax from exposure to 

contaminated mail. The Postal Service’s decision differed from the 

decision to close the Hart Building, in large part, because there was an 

observable incident of anthrax contamination there—which was 

immediately recognized as a potentially high-risk situation—whereas there 

was no observable incident at Brentwood. However, even before CDC 

confirmed the first case of inhalation anthrax at Brentwood, some Postal 

Service employees questioned whether the Postal Service’s actions 

adequately protected their health. 

The Postal Service communicated health risk and other information to its 

Brentwood employees during the anthrax incident, but some of the 

information it initially provided changed as public health knowledge 

evolved—exacerbating employees’ concerns about the adequacy of the 

measures being taken to protect them. Most significantly, employees later 

learned that their risk of contracting the disease was greater than 

originally stated. Other factors, including difficulties in communicating the 

uncertainty associated with health recommendations, the appearance of 

disparate treatment between Brentwood and congressional employees, 

and employees’ long-standing distrust of postal managers, also challenged 

efforts to communicate effectively. According to postal managers, the 

Postal Service has made additional efforts to communicate with 

Brentwood employees since the facility’s closure, but challenges remain, 

including before the facility opens to clearly communicate the 

impossibility of eliminating all risk of contamination from the 

environment. Recently, for example, the Postal Service informed 

employees that Brentwood, which has been tested and certified as safe for 

occupancy, is “100 percent free of anthrax contamination.” However, 

following discussions with us about the impossibility of eliminating all risk 

of contamination, the Postal Service agreed to revise future 

communications to acknowledge that although any remaining risk at the 

facility is likely to be low, complete freedom from risk cannot be 

guaranteed. 

The Postal Service, CDC, and others have learned a great deal from the 

2001 anthrax incidents and have taken various steps to address the 

problems that occurred and to enhance their preparedness for any future 

incidents. One of the lessons learned is that the risk of employees 

contracting anthrax through the mail is greater than was previously 

believed and more caution is needed to respond to that greater risk. 

Another important lesson learned is that clear and accurate 

Page 3 GAO-04-205T Reopening the Brentwood Postal Facility 
communication to employees is critical to managing the response to an 

incident and its aftermath. The Postal Service, CDC, and others have taken 

steps to revise their guidance to respond more quickly in the event of a 

future anthrax incident and to communicate more effectively about such 

an incident with employees and the public. The Postal Service told us that 

it would inform Brentwood employees prior to opening the Brentwood 

facility that while the facility is safe for occupancy, it is impossible to 

guarantee that it is risk free. 

Background 	 Anthrax is an acute infectious disease caused by the spore-forming 

bacterium called Bacillus anthracis. The bacterium is commonly found in 

the soil and forms spores (like seeds) that can remain dormant for many 

years. Although anthrax can infect humans, it occurs most commonly in 

plant-eating animals. 

Human anthrax infections are rare in the United States and have normally 

resulted from occupational exposure to infected animals or contaminated 

animal products, such as wool, hides, or hair. Infection can occur in three 

forms, two of which are relevant to this testimony. They are (1) cutaneous, 

which usually occurs through a cut or abrasion6

 and (2) inhalation, which 

results from breathing aerosolized anthrax spores into the lungs.7 

Aerosolization occurs when anthrax spores become airborne, thus 

enabling a person to inhale the spores into the lungs. After the spores 

enter the body, they can germinate into bacteria, which then multiply and 

secrete toxins that can produce local swelling and tissue death. The 

symptoms are different for each form of infection and are thought to 

appear within about 7 days of exposure, although individuals have 

contracted inhalation anthrax as long as 43 days after exposure. 

Depending on the extent of exposure and its form, a person can be 

exposed to anthrax without developing an infection. Before the 2001 

incidents, the fatality rate for inhalation anthrax was approximately 75 

percent, even with appropriate antimicrobial medications.8

 People coming 

in contact with anthrax in its natural environment have generally not been 

6

Cutaneous means of, relating, to or affecting the skin. Cutaneous anthrax is characterized 

by lesions on the skin. 

7

The third form of anthrax infection is gastrointestinal, which results from ingesting 

undercooked contaminated meat. 

8

An antimicrobial medication either kills or slows the growth of microbes. Antibiotics are 

an example of antimicrobial medications. 

Page 4 GAO-04-205T Reopening the Brentwood Postal Facility 
at risk for inhalation anthrax, and before 2001, no cases of inhalation 

anthrax had been reported in the United States since 1976, although 224 

cases of cutaneous anthrax were diagnosed between 1944 and 1994.9 

Fatalities are rare for cutaneous anthrax. 

Because so few instances of inhalation anthrax have occurred, scientific 

understanding about the number of spores needed to cause the disease is 

still evolving. Before the 2001 incidents, it was estimated that a person 

would need to inhale thousands of spores to develop inhalation anthrax. 

However, based on the cases that occurred during the fall of 2001, experts 

now believe that the number of spores needed to cause inhalation anthrax 

could be very small, depending on a person’s health status and the 

aerosolization capacity of the anthrax spores. 

In total, the contaminated letters caused 22 illnesses and resulted in 5 

deaths from inhalation anthrax. Numerous postal facilities were also 

contaminated. The first two cases of disease involved media employees in 

Florida. The employees—one of whom died—contracted inhalation 

anthrax and were thought to have contracted the disease through 

proximity to opened letters containing anthrax spores. Media employees 

also developed anthrax in New York—the second location known to be 

affected. The initial cases in New York were all cutaneous and were also 

thought to have been associated with opened envelopes containing 

anthrax spores. The initial cases at the next site—New Jersey—involved 

postal employees with cutaneous anthrax. The postal employees were 

believed to have contracted the disease through handling the mail—as 

opposed to opening or being exposed to opened letters containing anthrax 

spores. Unlike the incidents at other locations, which began when cases of 

anthrax were detected, the incident at the Hart Building—the fourth 

location—began with the opening of a letter containing anthrax spores 

and the resulting exposure to the contamination. The discovery of 

inhalation anthrax in the first postal worker from Brentwood revealed that 

even individuals who had been exposed only to taped and sealed 

envelopes containing anthrax could contract the inhalation form of the 

disease. Subsequent inhalation cases in Washington, D.C.; New Jersey; 

New York; and Connecticut—the sixth location affected—underscored 

that finding and also demonstrated that exposure and illness could result 

9

Journal of American Medical Association, Anthrax as a Biological Weapon: Medical and 

Public Health Management, May 12, 1999. Volume 281, No. 18. 

Page 5 GAO-04-205T Reopening the Brentwood Postal Facility 
from cross contamination of mail.10 (See app. I for a time line of selected 

events related to the anthrax incident in the fall of 2001.) 

On or about October 9, 2001, at least two letters containing anthrax spores 

entered the U.S. mail stream—one was addressed to Senator Thomas 

Daschle, the other to Senator Patrick Leahy. The letters were mailed in 

Trenton, New Jersey, and forwarded to the Brentwood facility in 

Washington, D.C., where they were processed on high-speed mail sorting 

machines and further processed in the facility’s government mail section 

before delivery.11 On October 15, a staff member in Senator Daschle’s 

office opened the contaminated envelope. The envelope contained a 

powdery substance, which the accompanying letter identified as anthrax, 

that was released in a burst of dust when the envelope was opened. The 

U.S. Capitol Police were notified, and the substance was quickly tested 

and confirmed to be anthrax. Brentwood managers analyzed the path of 

the letter through the facility. Although the machine that processed the 

letter was reportedly shut off—at least for a period of time—the facility 

itself was not closed or evacuated at that time. Within days, a Brentwood 

employee was suspected of having contracted inhalation anthrax. The 

Postal Service closed the facility on October 21, 2001, after CDC confirmed 

that the employee had the disease. Thereafter, two other Brentwood 

employees, Mr. Curseen, Jr., and Mr. Morris, Jr., died. Both were 

subsequently found to have died of inhalation anthrax. 

The Brentwood facility is a large 2-story facility that operated 24 hours a 

day, 7 days a week. About 2,500 employees worked at Brentwood, 

processing mail on one of three shifts. Brentwood processed all the mail 

delivered to addresses on Capitol Hill, including the Hart Building. 

Brentwood was the second processing and distribution center closed for 

an extended period because of anthrax contamination. The Postal Service 

reported that it plans to reopen the facility in phases; by late November 

administrative personnel will begin working in the facility and limited mail 

processing operations will begin shortly after that. Brentwood is expected 

to be fully operational by spring 2004. The other facility—the Trenton 

Processing and Distribution Center—located in Hamilton, New Jersey, was 

closed 3 days before Brentwood on October 18, 2001, after CDC confirmed 

10Cross contamination occurs when other pieces of mail or equipment come in contact with 

the original source of the anthrax. 

11The letter addressed to Senator Leahy was never delivered. Instead, it was recovered in 

November 2001 in mail that had been quarantined on Capitol Hill on October 17, 2001. 

Page 6 GAO-04-205T Reopening the Brentwood Postal Facility 
Brentwood 

Employees 

Questioned Whether 

the Decision to Wait 

for Confirmation of 

Inhalation Anthrax 

Adequately Protected 

Their Health 

that a New Jersey postal employee had cutaneous anthrax. It is in the 

process of being decontaminated. 

The Postal Service’s decision to wait for CDC’s confirmation of a case of 

inhalation anthrax before closing Brentwood and referring the facilities’ 

employees for medical treatment was consistent with the public health 

advice the Postal Service received and the health risk information 

available at the time. However, the Postal Service’s decision contrasted 

with the more immediate decision to close the Hart Building after anthrax 

contamination occurred. As a result, postal employees questioned whether 

the Postal Service’s decision adequately protected their health. 

The Postal Service’s 

Decision Was Based on 

CDC’s Advice and 

Available Health Risk 

Information 

The Postal Service’s decision to wait for CDC’s confirmation of a case of 

inhalation anthrax before closing Brentwood and referring its employees 

for medical treatment was consistent with the advice provided by CDC 

and the D.C. Department of Health, as well as the available health risk 

information. CDC called for such confirmation before closing a facility or 

recommending medical treatment because, at the time, public health 

authorities believed postal employees were unlikely to contract inhalation 

anthrax from exposure to contaminated mail. Postal officials reported that 

they consulted CDC and the D.C. Department of Health about the possible 

health risks to Brentwood employees after learning that Senator Daschle’s 

letter—opened on October 15, 2001—contained anthrax. Even though the 

letter would have passed through Brentwood, the public health authorities 

said that they did not consider the facility’s employees at risk, given the 

results of ongoing investigations of anthrax incidents in Florida and New 

York and the scientific understanding at that time. Specifically, as 

discussed, no postal employees were known to have developed symptoms 

of anthrax after contaminated letters had passed through the postal 

system on the way to destinations in Florida and New York, and anthrax 

spores were not considered likely to leak out, or escape from, a taped and 

well-sealed envelope in sufficient quantities to cause inhalation anthrax. 

Accordingly, the Postal Service reported that it kept the Brentwood facility 

open in order to keep the mail moving. This goal was important to 

managers whom we interviewed, who cited the psychological importance 

of keeping the mail flowing in the aftermath of the September 11 terrorist 

attacks. 

Page 7 GAO-04-205T Reopening the Brentwood Postal Facility 
On October 18, 2001, CDC confirmed that a postal employee in New Jersey 

had cutaneous anthrax. On that day, the Postal Service, in consultation 

with the New Jersey Department of Health and Senior Services, closed the 

Trenton Processing and Distribution Center. According to New Jersey 

public health officials, the facility was closed to facilitate environmental 

testing of the Trenton facility. While the contaminated letters to Senator 

Daschle and Senator Leahy were both processed through the Trenton and 

Brentwood facilities, it is not clear why the Postal Service did not take the 

same precautionary measures at Brentwood. We are pursuing this issue as 

part of our ongoing work. 

Although the Postal Service followed CDC’s advice and kept Brentwood 

open until CDC confirmed a case of inhalation anthrax, the Postal Service 

took interim steps to protect its employees. First, the Postal Service 

arranged for a series of environmental tests at the Brentwood facility, even 

though it reported that CDC had advised the Postal Service that it did not 

believe such testing was needed at that time. The results of the first test— 

taken and available on October 18, 2001—were from a quick test 

conducted by a local hazardous materials response team. The results were 

negative. Three days later, on October 21, 2001, CDC confirmed that a 

Brentwood employee had inhalation anthrax, and the Postal Service 

closed the facility and referred its employees for medical treatment. The 

positive results of more extensive environmental testing—also conducted 

on October 18, 2001—were not available until October 22—after the 

facility had already closed. In addition, Postal Service managers said they 

asked the D.C. Department of Health three times before October 21 for 

nasal swabs and antibiotics for Brentwood employees; however, the health 

department said the swabs and antibiotics were unnecessary. We have not 

yet been able to confirm this information with the D.C. Department of 

Health. Finally, the Postal Service took actions to protect its employees 

from low-level environmental risks. For example, it provided protective 

equipment such as gloves and masks and, according to postal managers, 

shut down the mail-sorting machine that processed the Daschle letter, at 

least for a time. Additionally, the Postal Service provided information on 

handling suspicious packages and required facility emergency action plans 

to be updated. 

In 1999, the Postal Service developed guidance for responding to anthrax 

and other hazardous incidents. The guidance, which was developed in 

response to hundreds of hoaxes, includes steps for notifying first 

responders, evacuating employees, and providing information and medical 

care to employees. The Postal Service reported that the guidance deals 

with observable events—specifically, spills—not events that are not 

Page 8 GAO-04-205T Reopening the Brentwood Postal Facility 
observable, such as aerosolization of powders. As a result, the Postal 

Service said that it did not view the guidance as being applicable to the 

situation that occurred at Brentwood. 

Given that the situation at Brentwood differed from the situation 

contemplated in its guidance, the Postal Service sought advice from CDC 

and others. According to CDC officials, the health and safety of postal 

employees was always the first concern of postal managers during 

discussions with CDC. Furthermore, they said that the Postal Service was 

receptive to their advice about the need to close Brentwood to protect 

postal employees after a diagnosis of inhalation anthrax was confirmed. 

The Decisions Made at 

Brentwood and Capitol 

Hill Differed Because the 

Circumstances and 

Decisionmakers Differed 

The Postal Service’s decision to wait for a confirmed case of inhalation 

anthrax before closing the facility and referring employees for medical 

treatment differed from the decision to implement precautionary measures 

immediately after anthrax contamination was identified at the Hart 

Building. The decisions differed, in part, because there was an observable 

incident at the Hart Building, but not at Brentwood. In addition, different 

parties made the decisions. At Brentwood, the Postal Service made the 

decision in consultation with CDC and the D.C. Department of Health. 

These parties were not involved in the decision-making at the Hart 

Building. Instead, because the Hart Building is one of many congressional 

offices surrounding the U.S. Capitol, the Attending Physician for the U.S. 

Congress—who functions independently from the District of Columbia— 

provided advice and made decisions about how to deal with the 

contamination there.12 

The incident at the Hart Building was immediately viewed as high risk to 

employees there because the envelope opened in Senator Daschle’s office 

contained a visible white powder that the accompanying letter identified 

as anthrax, which was quickly confirmed by testing of the substance. 

Consequently, the Office of the Attending Physician of the U.S. Congress 

arranged for congressional employees to receive antibiotics immediately 

and advised closure of the Hart Building the following day. 

12 The Office of the Attending Physician, U.S. Congress, is an office of the U.S. Navy. It 

serves as the local health department for Capitol Hill and is responsible for about 30,000 

public officials and other congressional staff, as well as tourists, on Capitol Hill. 

Page 9 GAO-04-205T Reopening the Brentwood Postal Facility 
Since 2001, the Postal Service has developed new guidance to address 

security risks in the mail. Its Interim Guidelines for Sampling, Analysis, 

Decontamination, and Disposal of Anthrax for U.S. Postal Service 

Facilities—first issued in November 2001—states that postal facilities will 

be closed if a confirmed case of inhalation anthrax is identified or when 

evidence suggests that anthrax has been aerosolized in a postal facility. 

The Postal Service said that it plans to complete an update to these 

guidelines soon, and we plan to determine whether the new guidelines will 

adequately address the situation that occurred at Brentwood as part of our 

ongoing work. In addition, the Postal Service has tested and begun to 

install new biodetection technology in postal facilities. This technology is 

designed to enhance safety by quickly identifying unobservable evidence 

of aerosolized anthrax, thereby allowing for a prompt response. We plan to 

review the guidance associated with this technology as we complete our 

work. 

The Postal Service communicated health risk and other information to its 

Brentwood employees during the anthrax crisis, but some of the 

information it initially provided changed as public health knowledge 

evolved, intensifying employees’ concerns about whether adequate 

measures were being taken to protect them. Most significantly, 

information on the amount of anthrax necessary to cause inhalation 

anthrax and the likelihood of postal employees’ contracting the disease 

turned out to be incorrect. Other factors, including difficulties in 

communicating the uncertainty associated with health recommendations 

and employees’ long-standing distrust of postal managers, also challenged 

efforts to communicate effectively. The Postal Service has made additional 

efforts to communicate with Brentwood employees since the facility’s 

closure, but challenges remain, particularly the need to effectively 

communicate information on any possible residual risks. 

Communication 

Problems 

Exacerbated Postal 

Service Employees’ 

Concerns 

Some Information The Postal Service used a wide variety of methods to communicate 

Communicated to Postal information to employees;13 however, some of the information it initially 

Employees Changed provided changed with changes in public health knowledge. For example, 

on the basis of the science at that time, the Postal Service and CDC 

13Methods for communicating information included briefings, newsletters, fact sheets, 

videos played on closed circuit televisions in its facilities, and a toll-free information line. 

In addition, the Postal Service regularly updated its Web site and, after the facility closed, it 

mailed information to its employees’ homes. 

Page 10 GAO-04-205T Reopening the Brentwood Postal Facility 
initially informed employees that an individual would need to be exposed 

to 8,000 to 10,000 spores to contract inhalation anthrax. This view turned 

out to be incorrect when two women in New York and Connecticut died 

from inhalation anthrax in October and November 2001 without a trace of 

anthrax spores being found in their environments. Their deaths caused 

experts to conclude that the number of spores needed to cause the disease 

could be very small, depending on a person’s health status and the 

aerosolization capacity of the spores. 

Postal employees were also told that they were at little risk of contracting 

inhalation anthrax because, in the view of public health officials, anthrax 

was not likely to escape from a taped and well-sealed envelope in 

sufficient amounts to cause inhalation anthrax. In addition, on October 12, 

2001, CDC issued a health advisory, which the Postal Service distributed to 

its employees, indicating that it is very difficult to refine anthrax into 

particles small enough to permit aerosolization. This information also 

proved to be incorrect when the U.S. Army Medical Research Institute of 

Infectious Diseases’ analyses of the anthrax in Senator Daschle’s letter in 

mid-October 2001 revealed that the substance was not only small enough 

to escape from the pores of a taped and well-sealed envelope but also 

highly refined and easily dispersed into the air.14 

Finally, an error occurred on October 10, when the Postal Service 

instructed employees to pick up suspicious letters and isolate them in 

sealed containers. The message was corrected within a few days when 

employees were instructed not to touch suspicious letters. Nevertheless, 

Brentwood employees we spoke with cited the miscommunication as an 

indication that the Postal Service was not concerned about their safety. As 

a result of these and other issues, union and management officials report 

lingering bitterness between Brentwood employees and postal 

management. 

Communicating Communicating information proved challenging for several reasons. First, 

Information Proved the incidents occurred in the turbulent period following the terrorist 

Challenging attacks of September 11, 2001, when the nation was focused on the 

response to those events. In addition, the anthrax incidents were 

unprecedented. The response was coordinated by the Department of 

14According to the Postal Service, it learned the results of the Army’s analysis after the 

Brentwood closure. 

Page 11 GAO-04-205T Reopening the Brentwood Postal Facility 
Health and Human Services, primarily through CDC, and CDC had never 

responded simultaneously to multiple disease outbreaks caused by the 

intentional release of an infectious agent. Furthermore, when the incidents 

began, CDC did not have a nationwide list of outside experts on anthrax, 

and it had not yet compiled all of the relevant scientific literature. 

Consequently, CDC had to do time-consuming research to gather 

background information about the disease before it could develop and 

issue guidance. Moreover, since anthrax was virtually unknown in clinical 

practice, many clinicians did not have a good understanding of how to 

diagnose and treat it. As a result, public health officials at the federal, 

state, and local levels were basing their health-related actions and 

recommendations on information that was constantly changing. According 

to the testimony of CDC’s Associate Director for Science, National 

Institute for Occupational Safety and Health, before a Subcommittee of 

this Committee last year, CDC “clearly did not know what we did not 

know last October [2001] and this is the cardinal sin that resulted in tragic 

deaths.” 

Effective communications were further complicated by the evolving 

nature of the incidents and the media’s extensive coverage of the response 

to anthrax at other localities. Comparing the various actions taken by 

officials at different points in time and in different locations confused 

postal employees and the public and caused them to question the 

consistency and fairness of actions being taken to protect them. For 

example, when employees at the Brentwood postal facility received 

doxycycline for prophylaxis instead of ciprofloxacin, they incorrectly 

concluded that they were receiving an inferior drug. In part, this was 

because the media had characterized ciprofloxacin as the drug of choice 

for the prevention of inhalation anthrax. Ciprofloxacin also had been used 

as the primary medication in earlier responses, including the response to 

anthrax atthe Hart Building. CDC initially recommended ciprofloxacin for 

several reasons;15 however, when CDC subsequently determined that the 

anthrax was equally susceptible to doxycycline and other drugs, it began 

15The first reason for recommending ciprofloxacin was that, absent information about the 

strain’s susceptibility to various drugs, CDC considered it most likely to be effective against 

any naturally occurring strain of anthrax. Also, as the newest antimicrobial available, CDC 

considered it less likely that terrorists would have had time to engineer a resistant strain of 

anthrax. Finally, the Food and Drug Administration had already approved ciprofloxacin for 

the postexposure prophylaxis for inhalation anthrax. 

Page 12 GAO-04-205T Reopening the Brentwood Postal Facility 
 recommending the use of doxycycline instead.16 The switch to 

doxycycline was considered desirable for a variety of reasons, including 

its (1) lower risk for side effects, (2) lower cost, and (3) greater 

availability. Local and CDC officials we spoke with told us that they were 

challenged to explain the switch in medications and to address 

perceptions of differential treatment. 

Additional misunderstandings arose over the administration of nasal 

swabs to postal employees. Nasal swabs are samples taken from the nasal 

passages soon after a possible exposure to contamination to determine the 

location and extent of exposure at a site, but not to diagnose infection. 

Nasal swabs were administered to congressional employees on October 15 

after the contaminated letter was opened to determine which employees 

might have been exposed and based on this where and how far the 

aerosolized anthrax spores had spread. Some Brentwood employees 

questioned why they did not also receive nasal swabs at this time and saw 

this difference as evidence of disparate medical treatment. As noted, the 

Postal Service reported requesting nasal swabs for its employees, but the 

CDC and the D.C. Department did not consider them necessary. Nasal 

swabs were then provided to at least some employees after Brentwood 

was closed on October 21. However, further confusion appears to have 

occurred about the purpose of the nasal swabs when employees who were 

tested did not receive the results of the swabs. The confusion occurred 

partly because the Postal Service issued a bulletin dated October 11, 2001, 

that incorrectly indicated that nasal swabs were useful in diagnosing 

anthrax and the media described nasal swabs as the “test” for anthrax. The 

bulletin was subsequently corrected, but the media continued to refer to 

the swabs as a test. Public health officials acknowledged that this 

confusion about the purpose of the nasal swabs created a great deal of 

anxiety within the postal community and the public. As a result, public 

health entities continued to collect the samples when people asked for 

them, simply to allay the individuals’ fears. 

Another area of confusion relates to the process used to administer the 

anthrax vaccine to interested postal employees. When the vaccine used by 

the military became available in sufficient quantities that it could be 

provided to others, CDC offered it to postal employees and congressional 

staff. While considered safe, it had not been approved for use in 

16The recommendation to use doxycycline also followed the Food and Drug 

Administration’s approval of the drug for inhalation anthrax. 

Page 13 GAO-04-205T Reopening the Brentwood Postal Facility 
postexposure situations. Consequently, the Food and Drug Administration 

required CDC to administer the vaccine using extensive protocols related 

to the distribution of an “investigational new drug.” These protocols 

required postal employees to complete additional paperwork and undergo 

additional monitoring which, according to some Brentwood employees, 

gave some employees the impression that they were being used as “guinea 

pigs” for an unsafe treatment. CDC officials acknowledged that CDC did 

not effectively communicate information about the vaccine program and 

that, in hindsight, these deficiencies probably resulted in the “wrong 

perception.” 

CDC officials have also acknowledged that they were unsuccessful in 

clearly communicating the degree of uncertainty associated with the 

health information they were providing, which was evolving during the 

incidents. For example, although there were internal disagreements within 

CDC over the appropriate length of prophylaxis, this uncertainty was not 

effectively conveyed to postal employees and the public. Consequently, in 

December 2001, when postal employees and others were finishing their 60-

day antimicrobial regimen called for in CDC’s initial guidance, they 

questioned CDC’s advice about the need to consider taking the drugs for 

an additional 40 days. CDC officials have since acknowledged the need to 

clearly state when uncertainty exists about the information distributed to 

the public and appropriately caveating the agency’s statements. 

Long-Standing Labor 

Relations Issues 

Compounded 

Communication Issues 

CDC, local public health officials, union representatives, and postal 

officials told us that employees’ mistrust of postal managers complicated 

efforts to communicate information to them. According to these parties, 

postal employees were often suspicious of management’s motives and 

routinely scrutinized information they received for evidence of any ulterior 

motives. This view appears consistent with the results of our past work, 

which has identified persistent workplace problems exacerbated by 

decades of adversarial labor-management problems. These problems were 

so serious that in 2001, we reported that long-standing and adversarial 

labor-management relations affected the Postal Service’s management 

challenges.17 The need to address this long-standing issue was also raised 

17U.S. General Accounting Office, Major Management Challenges and Program Risks: U.S. 

Postal Service, GAO-01-262 (Washington, D.C.: Jan. 2001). 

Page 14 GAO-04-205T Reopening the Brentwood Postal Facility 
in the July 2003 report of the President’s Commission on the U. S. Postal 

Service.18 

The Postal Service Has 

Made Additional Efforts to 

Improve Communication 

with Employees, but 

Challenges Remain 

According to postal managers, the Postal Service has made additional 

efforts to communicate with the employees who were at Brentwood, 

including holding “town hall” meetings to explain the facility’s 

decontamination process to postal employees and the public. The Postal 

Service has reported that it is also updating its 1999 guidance for 

responding to anthrax and other hazardous materials. At present, 

however, the revision of the guidance has not yet been completed and it is, 

therefore, unclear whether the revisions will address the issues that 

occurred at Brentwood. Nevertheless, the Postal Service assisted the 

National Response Team—a group of 16 federal agencies with 

responsibility for planning, preparing, and responding to activities related 

to the release of hazardous substances—in the development of improved 

guidance entitled Technical Assistance for Anthrax Response. This 

guidance provides a number of recommendations about communicating 

information during emergency situations, including the need for agencies 

to “admit when you have made a mistake or do not know the information.” 

While information on the process and outcome of decontamination efforts 

is technically complex and therefore challenging to present clearly to the 

public, the revised guidelines may be helpful in future discussions about 

the safety of a facility. We have not reviewed the details of the facility’s 

decontamination or its subsequent testing and, therefore, cannot comment 

on the effectiveness of decontamination efforts. However, in general, 

discussions about the success of decontamination and any residual risk to 

individuals center on two related topics. The first topic entails a 

discussion of the degree to which contamination has been reduced, 

bearing in mind that all sampling and analytical methods have a limit of 

detection below which spores may be present but undetected. Against that 

backdrop, it is also important to discuss how many anthrax spores are 

required to infect humans and to explain that the number is variable, 

depending upon the route of infection (e.g., skin contact or inhalation) and 

the susceptibility of each individual to infection. In light of this, it is 

particularly important to properly communicate to Brentwood employees 

a clear understanding of the decontamination approach that was 

18Report of the President’s Commission on the United States Postal Service, Embracing the 

Future: Making the Tough Choices to Preserve Universal Mail Service, July 31, 2003. 

Page 15 GAO-04-205T Reopening the Brentwood Postal Facility 
undertaken at the facility and the nature and extent of any residual risk 

there. Likewise, the Postal Service’s communications to employees must 

be clear and unbiased to (1) clearly communicate the limitations of testing 

and the associated risks while, at the same time, (2) avoid inducing 

unnecessary fear or concern. If provided with clear and unbiased 

information, employees will be able to make informed decisions about 

their health and future employment. In this regard, the Postal Service has 

given employees who worked at Brentwood an opportunity to be 

reassigned to certain other mail processing centers in the region if they do 

not want to return to Brentwood. 

In our view, providing complete information to employees is important for 

them to make informed decisions about working at Brentwood. According 

to recent information that the Postal Service provided to its employees, 

the facility, which public health authorities have certified as safe for 

occupancy, is “100 percent free of anthrax contamination” and there is “no 

remaining health risk” at the facility. This latter information is not 

consistent with what CDC’s Associate Director for Science, National 

Institute for Occupational Safety and Health, told this Committee’s 

Subcommittee on the District of Columbia in July 2002. Specifically, she 

said that while a science-based process can allow workers to safely return 

to Brentwood, it is not possible to eliminate risk entirely or to guarantee 

that a building is absolutely free of risk. We discussed our concerns with 

Postal Service officials about their characterization of the facility as 

completely free of anthrax contamination, and they agreed to revise their 

statements to indicate that it is not possible to guarantee that a building is 

absolutely risk free. According to the Postal Service, a misunderstanding 

resulted in the incorrect information being distributed to employees 

before the document had been fully reviewed. The Postal Service said that 

it would correct the information and distribute the new information to 

employees who worked at Brentwood within the next 2 weeks. 

The Postal Service, CDC, and others have learned a great deal from the 

2001 anthrax incidents and have taken various steps to address the 

problems that occurred and to enhance their preparedness for any future 

incidents. Among the lessons learned are that the risk to employees of 

contracting anthrax through contaminated mail is greater than was 

previously believed and more caution is needed to respond to that greater 

risk. It is now clear, for example, that anthrax spores can be released in 

the air, or aerosolized, when sealed letters pass through the Postal 

Service’s processing equipment and that a limited number of anthrax 

spores can cause inhalation anthrax in susceptible individuals. This 

Lessons Learned and 

Implications for 

Reopening the 

Facility 

Page 16 GAO-04-205T Reopening the Brentwood Postal Facility 
increased risk of contracting inhalation anthrax indicates that decisions 

about closing facilities need to consider other factors as well as the 

presence of an observable substance, such as a powder. The Postal 

Service and CDC have responded to this need for greater caution by 

developing guidance for closing a facility that establishes evidence of 

aerosolization, as well as confirmation of a diagnosis of inhalation 

anthrax, as a criterion for closure. We have not yet evaluated this guidance 

to determine whether it is specific enough to make clear the 

circumstances under which a postal facility should be closed to adequately 

protect employees and the public. We recognize that developing such 

guidance is difficult, given that the Postal Service experiences many 

hoaxes and needs to accomplish its mission as well as ensure adequate 

protection of its employees’ health. 

Another important lesson learned during the 2001 anthrax incidents is that 

clear and accurate communication is critical to managing the response to 

an incident. Because the risk information that was provided to employees 

changed over time and some of the information was communicated in 

ways that employees reportedly found confusing or difficult to 

understand, the fears that would naturally accompany a bioterrorism 

incident were intensified and distrust of management, which already 

existed in the workplace, was exacerbated. CDC, in particular, has 

recognized the importance of communicating the uncertainty associated 

with scientific information to preserve credibility in the event that new 

findings change what was previously understood. In this regard, our work 

on the sampling and analytical methodologies used to test for and identify 

anthrax contamination addresses the uncertainty involved in these efforts. 

The Postal Service agrees that although the Brentwood facility has been 

tested and certified as safe for occupancy, the Postal Service cannot assert 

that the building is 100 percent free of anthrax contamination. 

Accordingly, the Postal Service stated that it would inform Brentwood 

employees before opening the facility that the Postal Service cannot 

guarantee that the building is absolutely risk free. 

This concludes my prepared statement. I will be happy to respond to any 

questions you or other members of the Committee may have. 

Contacts and Should you or your staff have any questions concerning this report, please 

contact me at (202) 512-2834 or Keith Rhodes at (202) 512-6412. I can also 

Acknowledgments be reached by e-mail at ungarb@gao.gov. Individuals making key 

contributions to this testimony were Don Allison, Hazel Bailey, Jeannie 

Page 17 GAO-04-205T Reopening the Brentwood Postal Facility 
Bryant, Derrick Collins, Dwayne Curry, Elizabeth Eisenstadt, and Kathleen 

Turner. Drs. Jack Melling and Sushil Sharma provided technical expertise. 

Page 18 GAO-04-205T Reopening the Brentwood Postal Facility 
Appendix I: Time Line of Selected Events 

Related to the Anthrax Incident in the Fall of 

2001 

Date Events Occurring on That Date 

Tuesday, Terrorist attacks on the World Trade Center and Pentagon prompt heightened concerns about 

9/11/01 possible bioterrorism. 

Tuesday, In Florida, an American Media Inc. (AMI) employee is admitted to the hospital with a respiratory 

10/02/01 condition. 

The Centers for Disease Control and Prevention (CDC) issues an alert about bioterrorism, 

providing information about preventive measures for anthrax. 

Thursday, CDC and the Florida Department of Health announce that AMI employee has inhalation anthrax. 

10/04/01 

Friday, AMI employee dies of inhalation anthrax. 

10/05/01 

Monday, The Postmaster General announces that Postal Inspection Service is working with other law 

10/08/01 enforcement agencies on the Florida incident. 

Wednesday, 10/10/01 	 The Postal Service begins nationwide employee education on signs of anthrax exposure and 

procedures for handling mail to avoid anthrax infection. 

Friday, In NY, the New York City Department of Health (NYCDOH) announces the confirmation of a case 

10/12/01 of cutaneous anthrax in an NBC employee. 

The Postal Service says that it will offer gloves and masks to all employees who handle mail. 

(On or about) Daschle letter passes through Brentwood. 

Boca Raton post office, which had direct access to the AMI mail, is tested for anthrax and Palm 

Beach County Department of Health administers nasal swabs and offers a 15-day supply of 

ciprofloxacin to postal employees. 

Monday, On Capitol Hill, an employee opens a letter addressed to Senator Daschle. Staff in that office, an 

10/15/01 adjacent office, and first responders are given nasal swabs and a 3-day supply of antibiotics. 

In NJ, State Department of Health and Senior Services (NJDHSS) assures Trenton employees that 

they have a low risk of contracting anthrax. 

Anthrax is confirmed at Boca Raton post office. 

Tuesday, 10/16/01 	 Part of the Hart Senate Office Building is closed in the morning, and the remainder of the building is 

closed in the evening. Over the next 3 days, all Hart building and other Capitol Hill employees who 

request them are given nasal swabs and a 3-day supply of antibiotics. 

Wednesday, The Postal Service arranges for environmental testing at Brentwood. 

10/17/01 

Page 19 GAO-04-205T Reopening the Brentwood Postal Facility 
Date Events Occurring on That Date 

Thursday, 

10/18/01 

A local hazardous materials response team conducts “quick tests” of Brentwood, which are 

negative for anthrax. A contractor conducts more extensive testing in the evening. 

Postmaster General Potter holds a press conference at Brentwood, in part to reassure employees 

they are at low risk. 

CDC confirms cutaneous anthrax in New Jersey postal employee, and a second suspected case is 

identified. 

In NJ, the Trenton facility is closed. Employees are sent home. 

In NY, NYCDOH announces another case of cutaneous anthrax, in a CBS employee. 

In Florida, the Postal Service cleans two postal facilities contaminated with anthrax spores. 

CDC distributes a press release announcing that the Food and Drug Administration has approved 

doxycycline for postexposure prophylaxis for anthrax. 

In the DC, a postal employee who works at the Brentwood facility seeks medical attention. 

Friday, 10/19/01	 In NJ, the NJDHSS refers postal employees to their private physicians for medical treatment. 

Employees begin seeking treatment at a local hospital. 

In DC, a postal employee who works at Brentwood is admitted to a hospital with suspected 

inhalation anthrax. 

In NJ, laboratory testing confirms cutaneous anthrax in a second postal employee who works at the 

Trenton postal facility. 

Saturday, In DC, another postal employee who works at the Brentwood facility is admitted to a hospital with a 

10/20/01 respiratory condition. 

CDC arrives at the Brentwood facility to meet with Postal Service management. 

Sunday, 

10/21/01 

In DC, the postal employee who was admitted to the hospital on 10/19/01 is confirmed to have 

inhalation anthrax. 

In DC, Brentwood is closed. Evaluation and prophylaxis of employees begin. 

In DC, a Brentwood employee who had initially sought medical attention on 10/18/01 is admitted to 

a hospital with suspected inhalation anthrax and becomes the first postal employee (and second 

anthrax victim) to die. 

In DC, another postal employee who worked at the Brentwood facility seeks medical attention at a 

hospital. His chest X-ray is initially determined to be normal, and he is discharged. 

Monday, 

10/22/01 

In DC, the postal employee who worked at the Brentwood facility and who sought medical attention 

on 10/21/01 and was discharged is readmitted to the hospital with suspected inhalation anthrax, 

and becomes the second postal employee (and third anthrax victim) to die. 

In DC, prophylaxis is expanded to include all employees and visitors to nonpublic areas at the 

Brentwood facility. 

The postal employee who was admitted to the hospital on October 20 is confirmed to have 

inhalation anthrax. 

The Postal Service learns that environmental tests of Brentwood are positive for anthrax. 

Sunday, In NJ, a postal employee at Trenton is confirmed to have inhalation anthrax. 

10/28/01 

Page 20 GAO-04-205T Reopening the Brentwood Postal Facility 
Date Events Occurring on That Date 

Monday, 

10/29/01 

In NY, preliminary tests indicate anthrax in a hospital employee who was admitted with suspected 

inhalation anthrax on 10/28/01. The hospital where she works is temporarily closed, and NYCDOH 

recommends prophylaxis for hospital employees and visitors. 

In NJ, laboratory testing confirms cutaneous anthrax in a woman who receives mail directly from 

the Trenton facility. The woman originally sought medical attention on 10/18/01 and was admitted 

to the hospital on 10/22/01 for a skin condition. 

In NJ, laboratory testing confirms a second case of inhalation anthrax, in a Trenton postal 

employee who initially sought medical attention on 10/16/01 and was admitted to the hospital on 

10/18/01 with a respiratory condition. 

Wednesday, 10/31/01 In NY, the hospital employee becomes the fourth anthrax victim to die. 

Friday, 

11/2/01 

In NY, NYCDOH announces another case of cutaneous anthrax, in a New York Post employee. 

Wednesday, 11/21/01 	 In Connecticut, an elderly woman, who was admitted to the hospital for dehydration on 11/16/01, 

becomes the fifth anthrax victim to die. 

The Connecticut Department of Public Health, in consultation with CDC, begins prophylaxis for 

postal employees working in the Wallingford postal facility. 

Friday, CDC offers the anthrax vaccine to postal employees. 

12/27/01 

Source: Information provided by U.S. Postal Service, Centers for Disease Control and Prevention, Connecticut Department of Public Health, D.C. Department of Health, Food and Drug Administration, 

Florida Department of Health, New Jersey Department of Health and Senior Services, New York City Department of Health, and Office of the Attending Physician of the U.S. Congress. 

(543082) Page 21 GAO-04-205T Reopening the Brentwood Postal Facility 
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