COPING WITH TWIN DISASTERS:


HHS RESPONSE TO THE 1989


HURRICANE AND EARTHQUAKE


'ERVICES. 

ItYd3a 

OFFICE OF INSPECTOR GENERAL 

OFFICE OF EVALUATION AND INSPECTIONS 

DECEMBER 1990 
COPING WITH TWIN DISASTERS:


HHS RESPONSE TO THE 1989


HURRICANE AND EARTHQUAKE


Klcnaro r. l\usserow 

INSPECTOR GENERAL 

OEI-09-90-01040 DECEMBER 1990

EXECUTIVE SUMMARY 

PURPOSE 

This inspection evaluated the Deparent of Health and Human Services ' (HS) response to 

Hurrcane Hugo and the Lorna Preta earhquake and identified ways to improve response 

effons to futur disasters. 

BACKGROUND 

In 1989, HHS provided disaster recovery assistace and some emergency relief after 

(a) Hurcane Hugo devastated pars of Pueno Rico, the Virgin Islands and Nonh and South 

Carolina, and (b) the Lorna Preta earquake caused massive destrction in Nonhern 

California. These combined disasters were the most destrctive and costly this centur. 

The Federal Government always provides financial assistace for recovery when the 

President declares a major disaster but only assists with dict relief when State and local 

capabilties ar overwhelmed. The HHS provides both imedate response and long term 

recovery assistace under the diection of the Federal Emergency Management Agency 

(FMA), which coordinates the entie Federal response. 

We interviewed 68 Federal, State and local offcias who had fist hand experience with the 

relief and reovery effons in the affected areas. We reviewed situation repons and other 

documents descrbing the disasters and the response. We did not study Nonh Carolina 

experiences. 

FINDINGS 

The Department responded promptly and appropriately to the earthquake and hurrcane to 

restore program operatons ant! provide direct disaster relief. 

Managers in HHS took all necessar steps to restore progr operations promptly and to 

provide immedate relief and reovery assistace. The effects of the disasters, and hence the 

responses, were different in Pueno Rico, the Vlfgi Islands, South Carlina and California. 

Government services broke down in St. Croix, Vlfgin Islands, but not in the other areas. 

Although some Head Sta and other HHS program centers were closed, most were restored 

within a few days. A few in the Vlfgin Islands were still closed at the time we issued our draft 

repon. Social Securty Admnistrtion (SSA) facilties were daaged, but all were restored in 

a week or less. Social Securty benefits were not interrpted. The Public Health Service 

(PHS) provided some immediate disaster response in the Vlfgin Islands and Pueno Rico, and 

the PHS National Institute for Menta Health provided the fundig mechanisms for counseling 

to disaster victims in each affected area. 
The Department experienced internal communicaton problems as well as both 

communicatn and coordinaton problems with FEMA. 

Some HHS managers, parcularly at the regional level, were confused about which agency 

within the Deparent is responsible for coordinating the disaster response. This confusion 

had not been resolved by the Januar 1990 trsfer of primar disaster authority from the 

Offce of the Secretar to PHS. Both HHS and State officials had problems communicating 

and coordinatig with FEMA. Some of these problems caused delays in transportng needed 

supplies and personnel that could result in deaths in a catastrophic disaster. 

Arrangements for funding disaster response activitis are inaequate. 

Few discretionar or formula grant funds are available within the Deparent for use in 

disaster relief to fill gaps not covere by FEMA or other federa agencies. Curnt accounting 

systems used by all components to pay trvel and personnel expenses for disaster relief are 

inadequate and result in delays in charging payments to the proper accounts. 

The Departent laks clearly defined, up-to-dae plans for restoring programs in future 

disasters. 

Regional and national plans for program restoration and long term disaster recovery contan 

outdated information and rely too heavily on telephone systems. In contrast, the HHS plans 

for emergency medcal relief are much more thorough and useful, parcularly preparedess 

plans for a California earquake. Most HHS managers said they need plans that are simple, 

flexible, updated and practiced fruently. 

RECOMMENDATIONS 

The Office of the Secretary (OS) and the PHS Offce of the Assistant Secretary for Health 

(DASH) should clarify HHS disaster recovery roles and responsibilities. 

The OS and OASH should (a) defme precisely how they will implement the Januar 1990 

delegation of authority and (b) clarfy the disaster relief and reovery responsibilties of PHS, 

other operating divisions (OPDIVs), regional diectors and regional OPDIVs. 

The DASH should issue guidelines to improve diaster planning. 

The guidelines should mandate simple, flexible plans and fruent practice of these plans. 

The plans of each operating and sta division should spell out lines of communication with 

each other and should intermesh with the overal HHS disaster plan. The disaster plan should 

specify headquarrs and regional lines of communication with FEMA, which should then be 

reflected in OPDIV plans. Each plan should be updated periodcally. 
The DASH should establish backup communicaton systems and regional command posts. 

The backup system could include cellular telephones and radio communication utilizing the 

frequency aleady set aside for HHS. To faciltate better communication, the OASH should 

mandate that each region establish a regional command post. 

The DASH should improve procedures to pay for disaster relief expenditures. 

The OASH, working with the HHS Offce of the Assistat Secreta for Management and 

Budget, should (a) set up a system to identify existing HHS discretionar and formula grant 

funds that could be used to supplement FEMA funding for disaster relief, (b) establish an 

improved system, including a common accountig number, to account for disaster payments 

and (c) develop procedurs to ensur that the suppon agrment with FEMA for each declared 

disaster provides appropriate reimbursement. 

AGENCY COMMENTS 

The PHS, SSA and Offce of Human Development Services concured with the 

recommendations. The Health Car Financing Admistration had no comments. The PHS is 

takng steps to clarfy the emergency preparess and disaster reovery roles and 

responsibilties of the regional ditors, regional health adnistrtors and others. The PHS 

is also revising and simplifying emergency planning and response guidace for OPDIVS and 

Staf Divisions, improving internal emergency communication systems and developing 

procedurs with FEMA to assur prompt reimbursement for HHS operations in disasters 

declared by the President. 

We also solicite comments from FEMA. While agreeing with the repon s recommendations, 

FEMA generally considere its actions in the disasters to be appropriate, citing (a) limits on 

the Federal role durng disasters, (b) the less than catastrophic natue of the earquake and (c) 

the necessity for quick action in a disaster allowing litte time for trainig or screening of 

non-FEMA personnel. While we did not undenae a comprehensive review ofFEMA' 

actions in the dual disasters, we disagree with FEMA' s premise that the nee for quick action 

in disaster response precludes carful planning which would optimize the use of HHS 

personnel. 

The complete texts of the comments are contaed in Appendix A. 
................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

TABLE OF CONTENTS 

EXECUTIVE SUMMARY 

INTRODUCTION 

FINDI NGS 


The Department responded promptly and 

appropriately to the earthquake and hurricane to 

. restore program operations and provide direct 

disaster relief. 


The Department experienced internal communication 

problems as well as both communication and


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


Arrangements for funding disaster response activities 

are inadequate. 


The Department lacks clearly defined, up-to-date


plans for restoring programs in future disasters. . . 


RECOMMENDATIONS 

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


This inspection evaluated the Deparent of Health and Human Services ' (HS) response to 

Hurcane Hugo and Calfornia s earhquake and identified ways to improve futue disaster 

response effons. These combined disasters were the most destrctive and costly this centu. 

In September 1989, Hurcane Hugo devastated pars of Puert Rico, the Vlfgin Islands and 

Nonh and South Carolina. Less than a month later, the Lorna Preta earquake caused 

widespread death and destrction in Nonhern California. Both affecte HHS because they (a) 

trggered emergency health and other assistace durg the immediate recovery periods and 

(b) daaged office buildings and temporarly disrupte some program operations. 

The Federa Government always provides financial assistace in the recovery stage when the 

President declares a major disaster, but only assists with diect disaster relief when State and 

local governments ar unable to do so. When a disaster occurs, local authorities within 

damaged areas use all available resoures. If local resources ar inadequate or exhausted, 

assistace is requested fIrst from State agencies and then from the Federal government. 

Federal effons are coordiated by the Federal Emergency Management Agency (FMA) 

which also provides financial assistace to individuals and businesses for repais, physical 

rehabiltation and economic reconstrction. 

When a disaster stres, HHS offcials have two major responsibilties: (a) to restore HHS 

progr operations as quickly as possible and (b) to provide emergency medcal and public 

health services when a State or local government is overwhelmed by the disaster. Executive 

Order 12656, issued in November 1988, diects HHS to mobilze the health industr in 

national securty emergencies to provide mecal servces and to assist State and local 

governments in providing huma servces, including lodgig, foo, clothing and social 

services. In major disasters, the Public Health Service (PHS) is the lead agency to provide 

emergency medcal and health services under the overal diection of FEMA. Within PHS, the 

Offce of the Assistat Secreta for Health (OASH) manages the National Disaster Medical 

System, and the Centers for Disease Control (CDC) mae public health expertse avaiable to 

the disaster area. Each HHS operating division is responsible for developing adequate 

emergency plans for its progrs. The HHS regional diectors ar responsible for preparg 

and dissemiating regional emergency plans and for coordinating the regional office response. 

METHODOLOGY 

We interviewed 68 offcials from HHS, FEMA, other Fedra agencies and State and local 

governments who had fist hand information about the relief and recovery efforts in Pueno 

Rico, the Vlfgin Islands, South Caolina and California. We did not study Nonh Carolina 

experiences. We reviewed arcles, news clippings, situation reports, disaster plans and other 

documents perting to the disasters and the governments' responses. 
FINDINGS 

The Department responded promptly and appropriately to the earthquake and hurrcane to 

restore program operations and provid direct disaster relief. 

Following Hurcane Hugo and the Lorn Preta earquake, HHS was responsible primaly 

for restorig normal progr operations. The only signifcant dict relief required in these 

two emergencies occurd though PHS medcal services in the Vlfgin Islands. The Offce of 

Human Development Services (OHDS) and the Famly Suppon Admnistrtion (FSA) 

provided relief funding to each afected ara. 

The effects of the disasters, and hence the nee for relief, were dierent in Pueno Rico, the 

Virgin Islands, South Carolina and California. In St. Croix, 90 percent of homes, the island' 

main hospital and most programs and services were destroyed and disrupted. Law and order 

broke down, and local government was not able to cope with the situation. In the rest of the 

Virgi Islands, in Pueno Rico and in South Carolina, Hurcane Hugo dage was severe, 

but State and local governments were able to deal with most emergency medcal nees. The 

Lorn Preta earquake caused 66 deaths and extensive daage to propeny, bridges and 

highways, but State and local governments were also able to provide neeed emergency 

medical services. 

. Offcials quickly restored HHS programs after the disater. 

Managers in HHS acted immedately to ensur employee safety and restore program 

operations. They used initiative without awaiting instrctions. Following the earquake and 

the hurcane, most HHS maagers attempted to reach al their employees to ensur that they 

were safe. Although all employees eventualy were trcked, the process took a few days 

because telephone lies fruently were jamed or out of order, and may managers did not 

have complete lists of employees ' home phone numbers. 

Social Securty Admnistration (SSA) field offces in all four afected aras were closed for up 

to a week, but benefits contiued without interrption. In San Francisco, however, some 

Social Securty recipients would not have received their checks except for the prompt action 

of SSA sta. Although the genera delivery window of the daaged post offce building was 

closed, the SSA sta worked with the U.S. Posta Servce to get notices out and develop 

alternative ways to deliver the checks. In South Carolina, the regional and field offces 

worked together to assure that Supplementa Securty Income benefits were paid on time delivery problems. Sta also requested ban drts from headquarers in case 

they neeed to make emergency payments. 

despite mail 


The PHS sent architects and engieers to help FEMA and the terrtorial agencies in Pueno 

Rico and the Virgin Islands assess health facilty daage and provided funding for repais 

PHS-supported clinics. Health Care Financing Admnistrtion (HCFA) regional offces 

contacted State health agencies, which in tur determned the extent of facilty dage and the 
effects on hospita and nursing home patients. In Region IV, HCFA gave the South Carolina 

Deparent of Health and Environmenta Control permssion to suspend surey reviews of 

damaged nursing homes and hospitals for a couple of weeks and asked the Peer Review 

Organization to be reasonable in their expetations and demads durg the hardship period. 

In all disaster areas, however, the HCFA role was prily to gather informtion from State 

agencies. In Pueno Rico, one of the two HCFA fiscal intermedares maaged to reimburse 

hospitas by using an old manual tyewrter and a flashlight. Loal bans were then notied 

that these checks were valid and asked not to bounce them. 

Head Star and other OHDS programs were disrupted in all areas. Although most programs 

closed only for a few days, some Vlfgin Islands program were disrupted up to 6 weeks and a 

few were still closed at the tie we issued our drt repon. Several senior centers and 

developmenta disabilty facilties also were daged, but were quickly restored. When the 

disasters closed Head Sta facilties, grante sta worked with famlies and children in their 

homes. Several Head Star centers were used as emergency shelters, and their staf worked at 

FEMA disaster assistace centers. Grantes also encourged their famlies to go to these 

centers to obtan financial assistace. The OHDS sta obtaned daage assessments from 

grantees, mae funds avaiable for repai and worked with grantees to secure FEMA 

assistace for facilty restoration. At the time we issued our drt report a few facilties on St. 

Croix also had not been restored beause of disagreements with FEMA about funding. 

The earquake daaged the San Francisco HHS regional offce. Workig with the General 

Services Admnistrtion, HHS offcials were able to make repai and restore operations 

promptly. Although the building was closed for a week to most employees, the closure did not 

seriously interrpt HHS progr operations. 

Departmental programs provided limited direct emergency assistance. 

In the Vlfgin Islands, much of the health care delivery system was daged. The St. Croix 

hospita remans closed beause of water daage. It had ben decertfied even before the 

hurcane. In St. John, the hospita was 85 percent destroyed and took 

5 months to restore. In St. Thomas, the hospita was daged but remained operational. 

Hospitas located on the eastern side of Pueno Rico were closed due to lack of utilities and 

diesel fuel for emergency generators. In both Calfornia and South Carolina, hospitals were 

able to car for their regular patients as well as disaster victims without strning the facilties. 

Nursing home patients were moved from baner islands to an inland facilty for about 10 days, 

but services were not denied. Severa community health centers were daaged, but were 

restored to full service within a week. 

The PHS provided medical sta to both Pueno Rico and the Vlfgin Islands and sent St. Croix 

a disaster medcal assistace team includig vector control staf. Ths team staed the 

evacuation hospita and operated an emergency rom, clinic and inpatient car facilty. Pueno 

Rico did not need diect medcal assistace, although PHS staf worked with Commonwealth 
health officials to place patients evacuated from the Virgin Islands. In South Carolina, CDC 

provided several staff for mosquito abatement, the only PHS direct assistance in that region. 

Both PHS and FEMA officials stated that emergency medical relief services were ready in all 

affected areas in California, even though they were not needed because the State and local 

governments had the situation under control. Immediately following the earquake, PHS had 

medical teams set up west of the Mississippi, alen and ready to go if needed. A PHS official 

stated, "All the buttons were there waiting to be pressed to send a lot of people into action. 

California let PHS know early, however, that little direct Federal medical assistance was 

needed. County governments were able to handle the immediate emergency and did not have 

to turn to the State, let alone to the Federal government. 

The Food and Drug Administration (FDA) and the National Institutes of Mental Health 

(NIMH) also provided direct relief in all the affected areas. Staff from FDA removed 

contaminated food and monitored damage to pharaceutical manufacturing plants. All 59 

FDA employees stationed in Pueno Rico were assigned to work with the Commonwealth food 

and drg agency. The FDA staff faced danger from the public while disposing of 

contaminated food because people wanted to consume it. Accordig to the FDA manager for 

the San Juan distrct, "We had to call in the police to get rid of food at dump sites and keep 

people away. People were fighting us off, tearng off our shins, to get at the perishable, 

already spoiled food." Overal, there were no repons of ilness because of spoiled food in 

Pueno Rico or the Virgin Islands, and eventually an emergency food distrbution system was 

set up by local governments. 

The FDA regional manager in San Francisco reponed that his staff completed emergency 

inspection work even though the damaged office and laboratory were closed for a week. The 

SSA provided FDA with temporar offce space and supplies. The FDA manager said, " 

did without some fies. We used our laboratory people to supplement our investigations staff 

and we shipped lab samples to our Los Angeles laboratory. 

The Department experienced internal communication problems as well as both 

communication and coordination problems with FEMA. 

HHS experienced problems with FEMA. 

Both HHS and State offcials had problems coordinating and communicating with FEMA. 

Some of these problems caused delays that could have resulted in deaths in a more 

catastrophic disaster. For example, FEMA gave a low priority to HHS requests for 

transponation to the Virgin Islands, and key equipment and personnel did not arve when they 

should. An HHS official in Puerto Rico could not get FEMA to help fly an employee to the 

Virgin Islands. He finally aranged transponation through the Customs Service. A local 

agency director in the Virgin Islands had to go to several locations to request FEMA' 

assistance, but could not locate the correct site. On the other hand, SSA reported good 

communication with FEMA in the Virgin Islands because FEMA operated out of the SSA 
, 

offce in St. Thomas. A FEMA manager commended PHS staf for their wilingness to accept 

assignments in the Vlfgin Islands and Pueno Rico and to coordinate with other agencies. 

Some significant interagency coordination and communication problems occured when 

FEMA asked for HHS Region IX volunteers to work in disaster assistace centers following 

the earquake. Initially, FEMA requested 250 HHS sta. About 40 HHS staf showed 

for training on the Saturday following the earquake, but several hundred FEMA and State 

employees also came. The FEMA traiing was disorganiz. As a result, HHS staff were left 

. with unclear assignments. underassignments or no assignments. The FEMA also used 

untrained California Conservation Corps sta when skiled case and eligibilty workers were 

available. The FEMA brought people frm distat communities and paid them per diem when 

many traied Federa sta were available localy. Most HHS sta said that FEMA needs to 

have better deployment procedures. According to an FSA sta person FEMA would not 

even let HHS people go out and conduct outreach, something that the HHS people are used to 

and goo at. " Region IX HHS officials also had problems getting reimbursement for salares 

and expenses of staf detaled to the disaster assistace centers. 

The FEMA sent confusing messages about what level of disaster response HHS should 

provide. A diective issued immediately following the earquake did not clearly say whether 

Federal catastrophic earquake proedures would be invoked. The FEMA took 2 days to 

clarfy its policy that the earquake did not meet the catastrophic crteria. Because of this 

confusion, regional PHS sta were concerned that they may have given the wrong signals to 

others durg the flfst 48 hour following the earquake. One PHS manager said, "It was not 

clear when or if FEMA would cal on us. There cenaly was fuzziness when we tred to cal 

FEMA that fIrst night. There is no goo way to access FEMA in its regional offce or 

headquarrs. " Although FEMA was ambiguous, State disaster officials clearly declared 

within hour after the earquake that Federal emergency medcal assistace would not be 

needed. 

Telephone problems were widespread. 

Telephone systems in the disaster aras often were inoperative or jamed, and HHS staf 

lacked adequate backup communication equipment. It took frm severa days to severa 

weeks to establish contact with pars of Pueno Rico and the Vlfgin Islands. Telephone 

communication was absent for more than a month in St. Croix and for 

10 days in St. Thomas. A local official in the Vlfgi Islands had to (a) use a radio to 

communicate or (b) drve from place to place to deliver messages. One office in Region II 

could not get though to Puerto Rico because the regular phone lines were busy and fmally 

used the separate electronic mail line. Following the earquake, all Region IX telephones 

were inoperative except for a few old-fashioned .dial phones. Region IV offcials had to wait 

for phone servce to retur before contactig South Carolina program dictors about the level 

of damage and nee for assistace. 
The HHS lacked any kind of systematic emergency rado communication system to replace 

inoperative telephones. A dedcate radio fruency set aside for the Secretar has been 

sittig idle fer many year. Even when telephone service retured, some Region IX managers 

did not have curnt telephone numbers for sta. This hampered effons to ensur that 

employees were accounted for and safe. In one office, employee home phone numbers were 

locked in the offce vault and were inaccessible after the earquake. Regional staf utilized 

several ad hoc, alternative communication methods to replace lost telephone service. The 

regional inspector general. for investigations in San Fracisco had a cellular phone in a 

government car. San Fracisco s actig regional diector set up a commd center in one of 

the few offces in the daaged regional offce building with a workig telephone. The smal 

group of regional maagers who collocate to that offce said that the command center 

surounte many communication problems. 

Internal HHS coordination problems caused delays. 

Some HHS officials said that delays and duplication of effon resulted from the lack of 

headquarrs and regional coordination. They were not sure who was supposed to coordiate 

the overall HHS response and criticize the lack of clear procedurs in how to work with other 

agencies. Region II maagers expressed the most concern about communication and 

coordiation problems, followed by Region IV managers. For example, effons to contact 

HHS employees and fmd out whether they were safe were accomplished by individual agency 

components, not as a coordinate regional effort. Region n HCFA sta reported that 

duplication resulted frm failur to coordinate PHS and HCFA efforts to restore daaged 

health facilties in Pueno Rico and the Vlfgi Islads. Region n HCFA sta did not 

understand how coordiation was to be achieved The regional diector s offce in Atlanta 

cited the need for clear policy guidace on headquarers ' role. 

Prmar responsibility for HHS emergency preparedess and response has changed since the 

hurcane and earquake. In Januar 1990, Secta Sullvan transferred primar authority 

to the Offce of the Assistat Secta for Health (DASH). Under the delegation, OASH

provides policy guidace and monitors the performance of all HHS offcials. 

Regional diectors and regional health admnistrtors do not understad their respective 

responsibilties following the trsfer of authority. They do not know how much dict 

authority OASH or the regional health adnistrtors have over HCFA, SSA and other 

components or what the working relationship is between the regional health admnistrtor and 

CDC. They also wonder whether regional ditors are sti the priar HHS contact with 

State and local officials or whether this function also has been trsferred to OASH. The 

OASH has not yet issued policy guidace on roles and responsibilties to implement the 

delegation of disaster authority. 
Arrangements for funding disaster response activitis are inadquate. 

Using FEMA funding, NIMH provided -grts to the States for menta health counseling. All 

areas reponed that this program is useful and effective, but some complained that funding 

delays for second-phase longer term grts slowed the provision of neeed counseling. In 

fact, NIMH was overloaded with applications for grants from State and local menta health 

agencies. The NIM is working with FEMA to spee up the application review and approval 

process. 

Both OHDS and FSA provided discretionar grant funds for Hurcane Hugo relief. The 

OHDS Admistration on Aging (AOA) has a small grt program for disaster relief, and FSA 

provided funds to the Vlfgin Islands for projects FEMA could not fund to provide jobs to 

rebuild senior housing. However, OHDS and FSA did not provide simiar discretionar grant 

funds immediately after the earquake. The AOA mae a disaster grt to California later, in 

Februar 1990. Some San Fracisco regional officials said this was because of ting--the 

hurrcane occur at the end of one fiscal year and the earquake at the beginning of another. 

These officials also felt that the HHS operating divisions (OPDIVS) gave a lower priority to 

the earhquake than to Hurcane Hugo. 

Regional progr staf stated that few discretionar or formula grt funds ar avaiable 

within the Deparent for use in disaster relief to fil gaps not covered by FEMA or other 

Federal agencies. Discretionar funds are usualy encumbered for other puroses, and no 

tracking system exists to identify them. Formula grant funds are diffcult to use for disaster 

relief because they often reuire speial authorization. 

The OASH disaster relief sta reponed that curnt HHS accountig systems used by all 

components to pay trvel and personnel expenses for disaster relief ar inadequate and result 

in delays in charging payments to the proper accounts. Severa regional program sta 

reponed that no agrments or proedures exist within the Deparent or between the 

Deparent and FEMA for reimburement for salar and expenses of sta detaled outside 

HHS for disaster relief activities. Furermore, no clear HHS guidelines exist to document 

disaster-related costs. This creates diffculties trcking and reimbursing costs to HHS 

OPDNs and sta divisions (STAFIVs).

The Department laks clearly defined, up-to-dae plans for restoring programs in future 

disasters. 

While HHS .has many plans spelling out general roles for restoring program following a 

disaster, most ar obsolete, ineffective or overly detaled. In Region IX, for example, at least 

seven national and regional earquake and genera disaster maagement plans were in place 

prior to the earquake. Yet few people knew about them. Each of the affected regions lacked 

simple reportng rosters and diectories showing where to reach people at work and home. 

One San Fracisco offce had no paper copies of the emergency telephone lists; the 

computerized list was unavailable because the power was out. A regional manager said that 

the national PHS response plan is wrtten as if PHS were all "within the Washington, D. 
, 

beltway" and that the plan does not spell out regional responsibilties sufficiently. Most of the 

plans depend on telephones, yet the phone lines to disaster areas were all disrupted. 


Many respondents said that the general management plans were irrelevant to the actual 

hurrcane and earhquake responses. Program restoration steps which regional managers took 

were based on logic and reason and not on a disaster management plan that listed emergency 

actions. A South Carolina manager said that every SSA office is required to have a security 

action plan, but the plan does not address disasters the magnitude of Hurrcane Hugo. One 

PHS manager said that they have a plan for program restoration, but it has been so long since


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


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


equally ineffective. According to the Virgin Islands health diector We stared to use our 

plans and then discovered problems. Communications were wiped out. We could not contact 

St. Croix for a full day. The key to the plans is getting in touch with key people, and we could 

not get in touch. 

In contrast, emergency medical plans are more thorough and useful, especially in California. 

These plans are intended primarly for disaster specialists who wil be deployed in medical 

relief activities , and many have been updated recently. 

Region IX has been the lead region for earhquake and general disaster planning, serving as a 

model for the other regions. For example, "Response ' 89," a 2-day training exercise designed 

to simulate a catastrophic earhquake was held by FEMA in California in August 1989 for 

Federal and State officials. This training proved useful when the Lorna Preta earthquake 

strck 2 months later. The HHS Region IX earhquake plan is more complete than any other 

HHS disaster relief plan. Accordig to FEMA offcials, however, even the Region IX plan 

needs to be coordinated better with its national plan. 

Officials in HHS suggest that disaster plans be practiced more regularly. A Region IX PHS 

offcial suggested, "Plans should be simple loose-leaf reference manuals, involve all staff and 

not just emergency specialists, be practiced regularly and be kept up to date. " According to 

the deparmental coordinator, FEMA is planning a major training exercise for 1992 to 

replicate "Response ' 89" in other pars of the countr. Although the greatest attention has 

been given to California, the possibilty for a big disaster exists everywhere. 
RECOMMENDATIONS


The OS and the DASH should clafy HHS disaster recovery roles and responsibilities. 

They should define clearly how they wil implement the Januar 1990 delegation of authority 

for disaster relief and clarfy the disaster relief and reovery responsibilties of PHS, other 

operating divisions, regional ditors and regional OPDIVs. 

Regional diectors and regional health adnistrtors do not understad their respective roles 

in disaster response activities. This is still not sort out under the delegation of authority to 

OASH. Duplication of effort and delays in providing disaster relief can be reduced if roles 

and responsibilties for each component ar defied clearly. 

The DASH should issue guidelines to improve diaster planning. 

The OASH should (a) issue overal planning guidace to al operating divisions and sta 

divisions based on the reent disaster experience; (b) diect each operating division, regional 

office and field instalation to develop a simple, clear, concise and flexible set of procedures 

for dealng with emergency contingencies; (c) mandate that each plan spell out lines of 

communication within HHS and between HHS and FEMA; (d) ensure that individual 

component plans ar compatible with the overal deparenta plan and ar reviewed and 

updated periodcally; and (e) conduct fruent, brief traiing sessions at both national and 

regional levels. 

The Deparent has an overabundance of obsolete, ineffective and overly detaled disaster 

plans for restoring progrs. Pror to the 1989 disasters, few sta knew about the plans or 

about their roles and responsibilties in disaster reovery. Clear and frequently practiced plans 

wil allow a prompt and effective HHS disaster response. 

The DASH should establish backup communicaton systems and regional command posts. 

This backup communication system could include cellular telephones and radio 

communication utilzing the frequency aleady set aside for HHS. The OASH also should 

mandate that each region establish a command post. 

Curently HHS lacks adequate backup communication systems to use when prima systems, 

such as telephones, are out of service. Communication breakdowns occur in both the 

hurcane and the earquake. A rado frequency set aside for the Secta has not been used. 

Adequate backup systems would ensure that vita communication links are maintaed 

between disaster areas and response agencies. Collocatig sta in a command post would 

faciltate emergency communication. 
The DASH should improve procedures to pay for disaster relief expendiures. 

The OASH, working with the Offce of the Assistat Secreta for Management and Budget, 

should (a) set up a system to identify existing HHS discrtionar and formula grant funds that 

could be used to supplement FEMA fundig for disaster relief, 

(b) establish an improved system, including a common accounting number, to account for 

disaster payments and (c) develop procedures to ensur that the suppon agreement with 

FEMA for each declared disaster provides appropriate reimbursement 

An improved accounting and funds trcking system would enable HHS to respond more 

rapidly and effectively to disasters and ensure that each HHS component is fully reimbursed 

for disaster relief expenses. 

AGENCY COMMENTS 

The PHS, SSA, and OHDS concured with the reommendations. The HCFA had no 

comments. The PHS is tang steps to clarfy the emergency preparedess and disaster 

recovery roles and responsibilties of the regional ditors, regional health admnistrators and 

others. The PHS is also revising and simpliing emergency planning and response guidance 

for OPDIVS and Staf Divisions, improvig internal emergency communication systems and 

developing procedurs with FEMA to assur prompt reimbursement for HHS operations in 

disasters declared by the Prsident. 

We also solicite commnts from FEMA. While agreeing with the repon s recommendations, 

FEMA generally considere its actions in the disasters to be appropriate, citing (a) limits on 

the Federal role durng disasters, (b) the less than catastrphic natue of the earquake and (c) 

the necessity for quick action in a disaster allowing litte time for trainig or screening of 

non-FEMA personnel. While we did not undenae a comprehensive review of FEMA' 

actions in the dual disasters, we disagree with FEMA' s premise that the nee for quick action 

in disaster response preludes carful planning which would optimize the use of HHS 

personnel. 

The complete texts of the comments are contaed in Appendix A. 
APPENDIX A


Agency Comments

.. ..

&. :. ,.. ;;, , ....

DEPARTMENT OF HEATH HUMA SERVICES Public Healt Serice 

.t""no (; Memorandum 

SEP '1 199


Date 

From Assistant Secretary for Health 

o I G D r aft R e p 0 r t " Cop i n g Wit h T win D i s a s t e r s: RH S Res p 0 n se t 0


Subjec the 1989 Hurricane and Earthquake , " OEI-09-90-01040


Inspector General, OS


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

subj ect draft report. Though we agree that the HHS disaster 

response to Hurricane Hugo and the Loma Prieta earthquake was
 improved prompt and appropriate, we are supportive of


Departmental capabilities to respond to emergencies and 

disasters. 

s re co mmenda t ions and have taken 0 r We concur wi t h the re port are taking action to implement hem. 

(), /k Mason, M. , Dr.


Attachment 

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EX SEC V; 

DATE q I/

COMMENTS OF THE PUBLIC HETH SERVICE ON TH OFFICE OF 

INSPECTOR GENERA' S DRAT REPORT " COPING WITH TWIN 

DISASTERS: HHS RESPONSE TO THE 1989 HUICAE AND EATHQUAKE" 

OEI-09-90-01040, JULY 31, 1990 

OIG Recommendation


1) --The Office of the Secretary (OS) and the Office of the

Assistant Secretary for Health (OASH) should clarify 

HHS disaster recovery roles and responsibilities. 

PHS Cornen 

We concur. OASH has taken the lead in this area by hosting a


meeting, chaired by the Deputy Assistant Secretary for Health 

(DASH), that was held on June 29 with headquarters Operating

Divi' sion (OPDIV) emergency preparedness officials. At that 

time, implications of the Secretary s January 8 delegation of 

authori ty were discussed. Plans for updating and revising the 

Departmen t Emergency Planning and Operations Maual and the 

Disaster Response Guides were discussed and input was requested 

from the Social Securi ty Admnistration, Heal th Care Financing

Admnistration, Office of Human Development Services, and

Famly Support Admnistration. 

OASH, through the Office of Emergency Preparedness (OEP), is


fostering continuing dialogue between the HHS Regional
 Directors (RDs) and the PHS Regional Health Adnistrators 

(RH). A statement clarifying the respective emergencyRH has preparedness roles and responsibilities of the RDs and 

been prepared. This statement was approved by the RH and, on 

August 1, was forwarded by the DASH to the Deputy Under 

Secretary for Intergovernental Affairs, Boards and Commssions 

for his review and that of the RDs. On August 10, OASH staff 

met with the RDs to discuss this draft statement and other


emergency preparednes s concerns. This meeting resolved many of 

the RDs' concerns. OASH is awaiting comments on the draft 

statement from the Deputy Under Secretary for Intergovernental 

Affairs, Boards and Commssions. Following approval of a 

statement of roles and responsibilities, forml delegations of 

authori ty to the RDs and RH will be prepared, approved, and 

published in the 
 Federal Reqister


OASH Office of Emergency Preparedness (OEP) staff participated


in a series of meetings with PHS regional emergency


preparedness officials that were held in conjunction with the 

National Disaster Medical System Conference, August 6-9, in


Memphis, Tennessee. These meetings helped to reinforce the


roles and responsibilities on the RHs. To further 

coordination on emergency preparedness matters, OEP staff meet


with the RHs during their regular quarterly meetings and


participate in regional conference calls as needed.

Page 2. 

OIG Recommendation 

2) --The OASH should issues guidelines to improve disaster

planning. 

PHS Comment


We concur. OASH OEP has undertaken the revis ion, updating, and 

simplification of emergency planning and response guidance for 

OPDIVs, Staff Divisions, and Agencies at Headquarters and 

Regional levels. It is expected that draft guidance will be 

available for review and comment by October 1, 1990. In 

addition, OASH OEP will coordinate the development of HHS 

Disaster Response Guides, which will outline the types 

emergency assistance provided by the Departent, and the 

primary and supporting agencies for providing such assistance. 

The target date for completion of these guides is October 1990. 

OIG Recommendation


3) --The OASH should establish backup communications systems 

and regional commnd posts. 

PHS Comment


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


resource implications of emergency communications systems for


regional command post operations during emergencies and disasters. Also, OASH is analyzing the need to enhance 

headquarters emergency communications systems and provide 

improved emergency communications capability for deployment to 

areas affected by major disasters or emergencies.


OIG Recommendation


4) --The OASH should Lmprove procedures to pay for disaster 

relief expenditures. 

PHS Comment


We concur. OASH is working with appropriate Federal Emergency 

Management Agency (FEM) officials to simplify FEM tasking and 

mission assignment procedures to assure prompt reimursement 

for HHS operations associated with a Presidentially-declared 

disaster or emergency. The FEMA mission assignent contains 

commi tments for FEM to reimurse HHS for specific tasks. 
ge 3. 

Staff from OEP and the OASH Division of Financial Maagement 

have discussed the need for clear gudance and procedures for 

tracking disaster related expenditures, includiq the assignent of a Common Accountinq Numer (CA) to each disaster operation. Such CAs were assigned followinq Huricane Huqo 

and the Loma Prieta Earthquake. Improved trackiq procedures 

will be developed in coordination with the PHS Aqencies, other 

OPDIVs and the Assistant Secretary for Maagement and Budget 

(ASMB) . OASH will work with ASMB to establish a system to 

identify existing HHS discretionary and for.ula grant funds 

that might be used to supplement FEM disaster relief fundinq. 
;; . .. (

I Y/J Cd /K. u- u t;": &. HUMAN SERVICES
 Social Security Adminisfration

PEPARTMENT OF HEALTH 

Refer to: 

SEP 24 199


Anr

Date: 

From: securi ty 

Subject: Off' e of Inspe r General Draft Report, "Coping with Disasters: 

Response to the 1989 Hurricane and Eartquake" I-09-90-01040) --INFORMTION 

To: 

Mr. Richard P. KUsserow


Inspector General


Attached is the response to your draft report. furer assistance, please let us know. 

Attachment: 

SSA response


If we can be of


moo =:1' V1 :: :: 


V5 c:
 ...- j- J r: 
. .

.

COMMNTS OF THE SOCIAL SECUITY ADMINISTRTION ON TH OFFICE OF 

INSPECTOR GENERAL DRAFT REPORT, "COPING WITH TWIN DISASTERS: HHS 

RESPONSE - TO TH 1989 HUICAN AND EARTHOUAKE" (OEI-09-90-01040) 

Office of Inspector General (OIG) Recommendation 

The Office of the Secretary and the Office of the Assistant Secretary for Health (OASH) should clarify the Health and Human Services (HHS) disaster recovery roles and responsibilities. 

SSA Response 

We concur with this recommendation. We believe that coordination 

at the regional office level will improve emergency preparedness. 

OIG Recommendation 

The OASH should issue guidelines to improve disaster planning. 

SSA Response 

We concur with this recommendation. SSA field offices are 

required to possess both an office security plan which includes 

physical and systems security and an Occupant Emergency Plan 

which addresses safeguarding lives and property, including in the event of huricanes and eartquakes. Each region has been 

directed to review and update its Emergency Operating Plan and 

forward appropriate portions to central office. 

OIG Recommendation 

The OASH should establish backup communication systems and


regional command posts.


SSA Response


We concur with this recommendation. We agree that adequate 

backup systems would assure that vital communication links are 

maintained between disaster areas and response agencies. 

OIG Recommendation 

The OASH should improve procedures to pay for disaster relief 

expenditures . 

SSA Response


We concur with this recommendation. An improved accounting and


funds tracking system would enable HHS to respond more rapidly


and effectively to disasters and ensure that each component 

within the departent is fully reimbursed for disaster relief


expenses. 
: , ..

!\ ;. . ; :.: ;

!t,,,VIC, . 

,Jt.(/(.,?1 Offce of 

DEPARTMT OF REm HUN SEVICE Human Development Services 

Asistant Secretar 41a Washington DC 20201-0001 

,Jw 

C" ':
 I": il1 m 

I'.) 

e_.- ..­ ;; c


TO:	 Richard P. Kusserow . ri f" 

Inspector General 

FROM: Assistant Secretary 

for Human Development Services 

SUBJECT:	 OIG Draft Report: "Coping with Twin Disasters: HHS Response to the 1989 Hurricane and Earthquake,

OEI-09-90-0l040 

We agree with the findings of the subject draft report. The report accurately describes the assistance given and the 

inadequac ies in federal emergency procedures. 

We wish to emphasize in particular our concurrence with the recommendations that seek to clarify HHS disaster recovery roles and respons ibili ties, provide guidelines to improve disaster planning, establish backup communication systems, and improve procedures to pay for disaster relief expenditures. 

Thank you for this opportuni : review t


Gall 

PDIG


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OGC/IG 

EX SEC


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199 :: I: 

1 ; 
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Federal Emergency 
 ent Agency

Washington, D. C. 20472 DIG­


DIG-I 

AIGOCT 2 5 !990 

SE!IT Mr. Richard P. Kusserow 

Inspector Genera 

Department of Health & Human Services 

Office of Inspector General 

Washington, D.C. 20201 

Dear Mr. Kusserow: 09- 'It; 01040 

, r 

This is in response to your letter of July 31, 1990, to Mr. J ry ' D. Jennings, Deputy Director, Federal Emergency Management Agency 


(FEMA) , in which you requested review and comment on the diit 

inspection report entitled "coping With Twin Disasters: HHS 

Response to the 1989 Hurricane and Earthquake.


agree in general regarding the need for better coordination 

between FEMA and HHS on disaster response plans and 

responsibi ities. Most of the problems cited in the draft report in-depth are valid, but the report does not always communicate an 


understanding of the real issues, systems and procedures utilized

by FEM and other agencies in responding' to the disasters. The 

report appears too subj ecti ve rather than being a mechanism for 

fact finding and subsequent problem correction. I suggest changing

Descr on of the Problem the format of the report to include (1) 

followed by (2) Pro osal for Solution . Using this format, we offer


the following suggestions to better serve as the basis for improved


procedures in the fu ture .


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


The system, under which local governents are responsible for


responding to local disaster situations and under which local


governments must request assistance from and provide information


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


must become familiar with the system and their responsibilities in


order to reduce false expectations. Under the "Plan for Federal


Response to a Catastrophic Eartquake" (the "Plan ), the Public


Health service h.as the responsibility to coordinate with the 


State medical counterpart regardinq need. for supp emental Federal


assistance and to provide information on medical requirements to


FEM . 

Since Hurricane Hugo and the Loma Prieta earthquake, FEMA has
 the been reviewing the concept of operations as developed in 


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


these disasters, the structure of the Plan, grouping essentialand
 activities such as transportation, communications, and health 

.

medical services under Emergency Support Functions (ESFs) was 

utilized successfully in the Loma Prieta response. The Plan is IIFederal Natural Disaster being extensively rewritten as the 


Response Plan" to better address any disaster situation which


requires Federal response.


The revised Plan focuses particularly on the need for individuals 

to deploy as part of an interagency response team in order 

establish early liaison both with F 1A and the affected state. 

This team will also be the nucleus of the ESP operational acti vi tie? to follow. We believe that based on our experience 

Hurricane Hugo and the Lama Prieta eartquake, we are better 

prepared to utilize the resources of the Federal governent in 

providing timely assistance to a state affected by a disaster. 

ISSUE :2: Leve+ of Dj aster Response (page ,.6) - The "Planlf was 

originally based on a catastrophic eartquake of unprecedented 

proportions in which the State would be quickly overwhelmed and 

imediate Federal assistance to provide lifesavinq and protection 

of life would be required. A severe but ,less than catastrophic 

disaster, such as the Loma Prieta eartquake, did result in some 

unclear information ceinq provided by FEM headquarters to the 

Federal coordinating Officer and from the Federal coordinatinq


e Federal agencies as to whether or not


the Plan was ceinq activated and to what extent it would 


officer and staff to 


utilized to conduct the response. 
 o correct this problem, lEM has eveloped an operational concept using a response and


recovery organization which will address the requirements of any


disaster situation. This concept is also being incorporated


into the revised Plan-


ISSUE 3: Ear cation (page 6) The Reqion IX Interagency 

steering Committee had not completed the notification and


activation procedures before the Loma Prieta earthquake. This


resul ted in lack of timely and appropriate communication between 

and the other Federal agencies. The Region IX steering


Committee meets monthly to develop and refine procedures for a


catastrophic disaster. The Fiscal Year 1990 work plan included


developing the regional notification, deployment, and disaster
 field office procedures. As the Loma Prieta eartquake occued 

before these procedures were fully developed, there were limited 

notification and activation procedures utilized durinq the 

disaster. By the end of Fiscal Year 1990 interim supplements will 

be developed and the notification procedures will be drilled and 

activated. The Fiscal Year 1991 work plan includes continuing 

development of these detailed procedures and will involve all 

agencies under the Plan. 
IS UE : FEMA Tr . ina Was Disor anized a e 6 In view of the 

urgency of the situation, and the requirement for the entire 

Federal government to respond quickly to a disaster of the

magnitud of the Lama Prieta Eartquake, it was necessary to requirements train personnel as rapidly as possible in the basic
 for the positions they were to assume. since the Disaster 

Application Centers (DACs) were to be opened within several days 

following the President' s declaration, and since these facilities 

were the initial focal point of the response operation, the 

effort. The
 immediate staffing of the DACs became a critical to be
 training was considered by most of those receiving it 


adequate to provide the fourtdations for their assiqnments to the
 inadequate. DACs, although the physical traininq environment was prior
 ApproximatelY 300 personnel were given one day of trainin
 DACs. Individual and in-depth to their assignment to specific 


training was not possible under the circustances, and it was


clear that furter training would have to be accomplished on the 

job. We do, however, recognize the requirement 

c effectively


numer of staff for such an event,. and efficiently train a large 


and we are enhancing our current traininq capability withfuture


additional resources to better address this situation inform, and
 disasters - We are revising our basic DAC reqistration
 1991. This development are also proceeding to automate it in staff


will result in the need for only minimal training of DAC
 function. before they will be able to perform the 


th Unclear Assianments
 ISSUE 5: ijS Staff Were Left 
 (paae 6). There was not Underassi nments or No Assianments situation, for sufficient time allowed, due to the urgency of the 


detailed personnel screening to determine the best person for the
 staff, an this 

best job. The initial requirement was for DAC the


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


initial assignments. Some HHS personnel were assigned different


duties; however , without the opportunity to conduct a detailed
 specific assignents analysis of the initial staffing charts time. The effort was 

HHS personnel cannot be provided at this
 assignments, and to make such
 made to continuously review additional


reassignments as was necessary in the light of 


information on personnel capabilities.


Amonq resources available , FEMA used California conservation
 inqual assistance
 corps (CCC) personnel in the DACs to provide bi other CCC staff were


to the applicants and the DAC staff. erie and 

assigned to various duties consistent with their e r tra ng, training. Some of these personnel, because of thecontrol. 

were assigned duties in data entry and document 

. . .

I trust these comments will be helpf in developing your final


report . 

nt C. Peterson


Associate Director


State and Local Proqr


and support