Energy Employees Compensation: Adjustments Made to Contracted Review Process, But Additional Oversight and Planning Would Aid the Advisory Board in Meeting Its Statutory Responsibilities
Published: 2006-02-10T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: For the last several decades, the Department of Energy and its predecessor agencies and contractors have employed thousands of individuals in secret and dangerous work in the atomic weapons industry. In 2000, Congress enacted the Energy Employees Occupational Illness Compensation Program Act to compensate those individuals who have developed cancer or other specified diseases related to on-the-job exposure to radiation and other hazards at these work sites. Under Subtitle B, determining the eligibility of claimants for compensation is a complex process, involving several federal agencies and a reconstruction of the historical evidence available. The Department of Labor must consider a claimant's case based on records of his or her employment and work activities, which are provided by the Department of Energy. Labor considers the compensability of certain claims by relying on estimates of the likely radiation levels to which particular workers were exposed. These "dose reconstructions" are developed by the National Institute for Occupational Safety and Health (NIOSH) under the Department of Health and Human Services (HHS). NIOSH also compiles information in "site profiles" about the radiation protection practices and hazardous materials used at various plants and facilities, which helps complete the dose reconstructions. Because certain facilities are known to have exposed employees to radiation while keeping few records of individuals' exposure, their employees have been designated under the law as members of a "special exposure cohort," and their claims may be paid without individual dose reconstructions. The law also allows the Secretary of HHS to add additional groups of employees to the special exposure cohort. For quality control and to raise public confidence in the fairness of the claims process, the compensation act also created a citizen's advisory board of scientists, physicians, and employee representatives--the President's Advisory Board on Radiation and Worker Health. Members of the board serve part-time and the board has limited staff support. The advisory board is tasked to review the scientific validity and quality of NIOSH's dose reconstructions and advise the Secretary of HHS. The board has the flexibility to determine the scope and methodology for this review. We assessed how well the advisory board's review and the contracted work with SC&A are proceeding. We focused on three questions: (1) Are the roles of key federal officials involved in the review of NIOSH's dose reconstructions sufficiently independent to assure the objectivity of the review? (2) Have the agency's management controls and the advisory board's oversight been sufficient to ensure that the contract to review site profiles and dose reconstructions is adequately carried out? and (3) Is the advisory board using the contractor's expertise in reviewing special exposure cohort petitions?
section_title: What GAO Found
paragraphs: The roles of certain key federal officials initially involved in the advisory board's review of the dose reconstructions may not have been sufficiently independent and actions were taken to replace these officials. Nonetheless, continued diligence by HHS is required to prevent such problems from recurring as new candidates are considered for these roles. Initially, the project officer assigned responsibility for reviewing the monthly progress reports and monitoring the technical performance of the contractor was also a manager of the NIOSH dose reconstruction program being reviewed. In addition, the designated federal officer for the advisory board, who is responsible for scheduling and attending board meetings, was the director of the dose reconstruction program being reviewed. The progress of the contracted review of NIOSH's site profiles and dose reconstructions has been hindered by the complexity of the work. Specifically, in the first 2 years, the contractor spent almost 90 percent of the $3 million that had been allocated to the contract for a 5-year undertaking. Various adjustments have been made in the review approach in light of the identified complexities, which were not initially understood. However, further improvements could be made in the oversight and planning of the review process. With regard to reviewing special exposure cohort petitions, the advisory board has asked for and received the contractor's assistance, expanded its charge, and acknowledged the need for the board to review the petitions in a timely manner. The board has reviewed eight petitions as of October 2005, and the contractor assisted with six of these by reviewing the site profiles associated with the facilities. The contractor will play an expanded role by reviewing some of the other submitted petitions and NIOSH's evaluation of those petitions and recommending to the advisory board whether the petitioning group should be added to the special exposure cohort. The contractor will also develop procedures for the advisory board to use when reviewing petitions. While NIOSH is generally required by law to complete its review of a petition within 180 days of determining that the petition has met certain initial qualification requirements, the advisory board has no specified deadline for its review of petitions. However, the board has discussed the fact that special exposure cohort petition reviews have required more time and effort than originally estimated and that the advisory board needs to manage its workload in order to reach timely decisions.

section_title: Letter
paragraphs: For the last several decades, the Department of Energy and its  predecessor agencies and contractors have employed thousands of  individuals in secret and dangerous work in the atomic weapons industry.  In 2000, Congress enacted the Energy Employees Occupational Illness  Compensation Program Act to compensate those individuals who have  developed cancer or other specified diseases related to on-the-job  exposure to radiation and other hazards at these work sites. Under  Subtitle B, determining the eligibility of claimants for compensation is a  complex process, involving several federal agencies and a reconstruction  of the historical evidence available. The Department of Labor must  consider a claimant’s case based on records of his or her employment and  work activities, which are provided by the Department of Energy. Labor  considers the compensability of certain claims by relying on estimates of  the likely radiation levels to which particular workers were exposed.  These “dose reconstructions” are developed by the National Institute for  Occupational Safety and Health (NIOSH) under the Department of Health  and Human Services (HHS). NIOSH also compiles information in “site  profiles” about the radiation protection practices and hazardous materials  used at various plants and facilities, which helps complete the dose  reconstructions. Because certain facilities are known to have exposed  employees to radiation while keeping few records of individuals’  exposure, their employees have been designated under the law as  members of a “special exposure cohort,” and their claims may be paid  without individual dose reconstructions. The law also allows the Secretary  of HHS to add additional groups of employees to the special exposure  cohort.
For quality control and to raise public confidence in the fairness of the  claims process, the compensation act also created a citizen’s advisory  board of scientists, physicians, and employee representatives—the  President’s Advisory Board on Radiation and Worker Health. Members of  the board serve part-time and the board has limited staff support. The  advisory board is tasked to review the scientific validity and quality of  NIOSH’s dose reconstructions and advise the Secretary of HHS. The board  has the flexibility to determine the scope and methodology for this review.  In addition, the advisory board is tasked with reviewing NIOSH’s  evaluation of petitions for special exposure cohort status and  recommending whether such status should be granted. To facilitate the  advisory board’s review, HHS awarded a 5-year $3 million contract to  Sanford Cohen & Associates (SC&A) in October 2003 to perform a variety  of tasks, such as examining selected site profiles and a sample of dose  reconstructions.  The contract awarded was an indefinite-delivery,  indefinite-quantity type of contract, which establishes the basic terms of  the contract but then allows the advisory board to develop specific task  orders requiring the contractor to complete certain tasks within specified  time frames and budgets. SC&A is to be reimbursed for its costs and  receive an additional fixed fee. However, this effort has been marked by  delays and higher than originally anticipated costs and some concerns  over the roles of the federal officials assigned by the Secretary of HHS to  oversee this work. Because citizen advisory bodies do not have direct  authority to spend federal monies, the government is responsible for  awarding and managing support contracts. Insofar as the charge of the  advisory board has been not merely to advise but to review the scientific  validity and quality of NIOSH’s work, there could potentially be a conflict  of roles for agency officials responsible for the program under review if  they also oversee the contract work or assist the advisory board. In  addition, there are congressional concerns about whether the advisory  board is using the contractor’s expertise as the board evaluates special  exposure cohort petitions.
There is another contractor—Oak Ridge Associated Universities  (ORAU)—that also plays an important role in the Energy Employees  Occupational Illness Compensation Program. In September 2002, NIOSH  awarded a 5-year contract to ORAU to support NIOSH in performing its  responsibilities related to the program, such as developing site profiles  and performing dose reconstructions.  About $70 million was originally  allocated to this contract, but this figure had increased to over $200  million by 2004.
We assessed how well the advisory board’s review and the contracted  work with SC&A are proceeding. We focused on three questions: (1) Are  the roles of key federal officials involved in the review of NIOSH’s dose  reconstructions sufficiently independent to assure the objectivity of the  review? (2) Have the agency’s management controls and the advisory  board’s oversight been sufficient to ensure that the contract to review site  profiles and dose reconstructions is adequately carried out? and (3) Is the  advisory board using the contractor’s expertise in reviewing special  exposure cohort petitions?
To perform our review, we analyzed pertinent contract-related materials,  including the contract; monthly progress reports submitted by the  contractor; minutes of advisory board meetings; special exposure cohort  regulations; and correspondence between the contractor, agency, and  advisory board. In addition, we interviewed agency officials, contractor  officials, and advisory board members, and also attended meetings of the  advisory board. The scope of our work did not include examining NIOSH’s  contract with ORAU. We conducted our review from March 2005 to  November 2005 in accordance with generally accepted government  auditing standards. On December 13, 2005, we briefed your office on the  results of our work (see app. I). This report conveys the information  provided at that briefing, as updated to reflect changes we made in  response to comments received on a draft of this report.
subsections: section_title: Summary of Findings
paragraphs: The roles of certain key federal officials initially involved in the advisory  board’s review of the dose reconstructions may not have been sufficiently  independent and actions were taken to replace these officials.  Nonetheless, continued diligence by HHS is required to prevent such  problems from recurring as new candidates are considered for these roles.  Initially, the project officer assigned responsibility for reviewing the  monthly progress reports and monitoring the technical performance of the  contractor was also a manager of the NIOSH dose reconstruction program  being reviewed. In addition, the designated federal officer for the advisory  board, who is responsible for scheduling and attending board meetings,  was the director of the dose reconstruction program being reviewed. In  response to concerns about the appearance of conflicting roles, the  director of NIOSH replaced both of these officials in December 2004 with a  senior NIOSH official not involved in the NIOSH program under review.  The contractor and members of the board told us that implementation of  the contract improved after these replacements were made. With regard to  structural independence, we found it appropriate that the contracting  officers, who are responsible for managing the contract on behalf of the  advisory board, have been federal officials with the Centers for Disease  Control and Prevention (CDC), NIOSH’s parent agency. The contracting  officers do not have responsibilities for the NIOSH program under review  and are not accountable to its managers. Members of the advisory board  helped facilitate the independence of the contractor’s work by playing the  leading role in developing and approving the initial statement of work for  the contractor and the independent cost estimate for the contract.
The progress of the contracted review of NIOSH’s site profiles and dose  reconstructions has been hindered by the complexity of the work.  Specifically, in the first 2 years, the contractor spent almost 90 percent of  the $3 million that had been allocated to the contract for a 5-year  undertaking. Various adjustments have been made in the review approach  in light of the identified complexities, which were not initially understood.   However, further improvements could be made in the oversight and  planning of the review process. First, the contractor’s expenditure levels  were not adequately monitored by the agency in the initial months and the  contractor’s monthly progress reports did not provide sufficient details on  the level of work completed compared to funds expended.  The monthly  report for each individual task order was subsequently revised to provide  more details but developing more integrated data across the various tasks  could further improve the board’s ability to track the progress of the  overall review. Second, while the advisory board has made mid-course  adjustments to the contractor’s task orders and review procedures, the  board has not comprehensively reexamined its long-term plan for the  overall project. The board revised the task orders for the contractor  several times, in part to reflect adjustments made as the board gained a  deeper understanding of the needs of the project.  Nonetheless, the board  has not reexamined its original plan for the total number of site profile and  dose reconstruction reviews needed, and the time frames and funding  levels for completing them. Third, there is still a gap with regard to  management controls for the resolution of the findings and  recommendations that emerge from SC&A’s review. The advisory board  developed a six-step resolution process to help resolve technical issues  between the contractor and NIOSH, and this process uses matrices to  track the findings and recommendations of the contractor and advisory  board.  However, NIOSH currently lacks a system for documenting that  changes it agrees to make as part of this resolution process are  implemented.
With regard to reviewing special exposure cohort petitions, the advisory  board has asked for and received the contractor’s assistance, expanded its  charge, and acknowledged the need for the board to review the petitions  in a timely manner. The board has reviewed eight petitions as of October  2005, and the contractor assisted with six of these by reviewing the site  profiles associated with the facilities. The contractor will play an  expanded role by reviewing some of the other submitted petitions and  NIOSH’s evaluation of those petitions and recommending to the advisory  board whether the petitioning group should be added to the special  exposure cohort. The contractor will also develop procedures for the  advisory board to use when reviewing petitions. While NIOSH is generally  required by law to complete its review of a petition within 180 days of  determining that the petition has met certain initial qualification  requirements, the advisory board has no specified deadline for its review  of petitions. However, the board has discussed the fact that special  exposure cohort petition reviews have required more time and effort than  originally estimated and that the advisory board needs to manage its  workload in order to reach timely decisions.
section_title: Conclusions
paragraphs: Credibility is essential to the work of the advisory board and the  contractor, and actions were taken in response to initial concerns about  the independence of federal officials in certain key roles. Nonetheless, it is  important for HHS to continue to be diligent in avoiding actual or  perceived conflicts of roles as new candidates are considered for these  roles over the life of the advisory board.
The advisory board’s review of site profiles and dose reconstructions has  presented a steep learning curve for the various parties involved.  These  experiences have prompted the board to make various adjustments to the  contractor’s work that are intended to better meet the needs of the review,  such as the establishment of a formal six-step resolution process that  increases transparency. Nonetheless, further improvements could be made  to the oversight and planning of the contracted review. Even though the  advisory board has made numerous midcourse adjustments to the work of  the contractor, the board has not comprehensively reexamined its long- term plan for the project to determine whether the plan needs to be  modified in light of the knowledge gained over the past few years.  In  addition, while the contractor’s monthly reports were modified to provide  more detailed expenditure data, the lack of integrated and comprehensive  data across the various tasks makes it more difficult for the advisory board  to track the progress of the overall review or make adjustments to funding  or deliverables across tasks. Finally, without a system to track the actions  taken by NIOSH in response to the findings and recommendations of the  advisory board and contractor, there is no assurance that any needed  improvements are being made.
section_title: Recommendations for Executive Action
paragraphs: We are making three recommendations to the Secretary of HHS.
To assist the advisory board meet its statutory responsibilities, we  recommend that the Secretary of HHS  (1) direct the contracting and project officers to develop and share with  the advisory board more integrated and comprehensive data on contractor  spending levels compared to work completed and  (2) consider the need for providing HHS staff to collect and analyze  pertinent information that would help the advisory board comprehensively  reexamine its long-term plan for assessing the NIOSH site profiles and  dose reconstructions.
To ensure that the findings and recommendations of the advisory board  and the contractor are promptly resolved, we recommend that the  Secretary of HHS direct the Director of NIOSH to establish a system to  track the actions taken by the agency in response to these findings and  recommendations and update the advisory board periodically on the status  of such actions.
section_title: Agency and Other Comments and Our Evaluation
paragraphs: We provided a draft of this report to HHS, the contractor, and all the  members of the advisory board for comment.  We received comments  from HHS, the contractor, and four individual members of the advisory  board.  The comments from the four members of the board represent the  views of these individuals and not an official position of the advisory  board.  HHS agreed with GAO’s recommendations to provide more  integrated and comprehensive data to the advisory board and said that it  will consider the need to provide staff to help the advisory board  reexamine its overall plan for assessing NIOSH site profiles and dose  reconstructions.  With regard to the third recommendation, HHS stated  that a system is already in place to track actions taken by the agency in  response to advisory board recommendations in letters from the board to  the Secretary of HHS.  HHS added that matrices used in conjunction with  the six-step resolution process outline the contractor’s concerns, NIOSH’s  response, and the actions to be taken.  However, we believe that these  matrices do not provide sufficient closure with regard to tracking the  actions NIOSH has actually implemented in response to advisory board  and contractor findings and recommendations.  For example, in some of  the matrices, the advisory board has made numerous recommendations  that NIOSH perform certain actions to resolve various issues, but there is  no system in place to provide assurance that these actions have in fact  been taken.  Thus, we continue to see a need for this recommendation.
Some individual advisory board members who provided comments  expressed concerns about our recommendations, although differing in  their reasons.  One individual board member expressed concern about the  recommendations to provide more integrated and comprehensive data to  the advisory board or to provide staff to help in reexamining the overall  review plan, suggesting that these changes might not be very helpful.  We  still believe that these recommendations are necessary to ensure that the  advisory board has more complete information to better oversee the  review as well as a long-term plan for completing the review; hence we did  not revise the recommendation.  Another individual board member  suggested that a system be established to track the advisory board’s  recommendations rather than the contractor’s recommendations since it is  these that should be of greater concern.  While GAO believes it is  important to track the resolution of the board’s recommendations, it also  important to track the resolution of the contractor’s recommendations,  and we therefore revised the wording of our recommendation to reflect  this position.
HHS, the contractor, and individual advisory board members took issue  with statements in the report about the contractor being over budget and  behind schedule.  While they agreed with GAO’s assessment that the  review process got off to a slow start, they thought that the report did not  provide sufficient information about the various factors that complicated  or led to an expansion of work for the contractor, the revisions to the  contractor’s task orders, and the performance of the contractor with  respect to the revised task orders.  For example, commenters pointed out  that in some instances, the contractor had to review a site profile more  than once after NIOSH had revised the site profile to include additional  information.  Commenters added that the contractor’s work also had to  shift to accommodate changing priorities.  For instance, NIOSH’s  increased reliance on using the site profiles to complete dose  reconstructions prompted a shift in contractor priorities to devote more  time and resources to site profile reviews than originally anticipated.  The  commenters added that since the task orders were revised, the contractor  has been meeting the time frames and budgets specified in the task orders.   We therefore revised the report to incorporate additional information on  factors that complicated or led to an expansion in the work of the  contractor, the revisions that were made to the task orders, and the  contractor’s progress in meeting the terms of the revised task orders.
HHS, the contractor, and some of the individual members of the advisory  board maintained that the advisory board has taken actions to reexamine  and adjust its strategy for reviewing site profiles and dose reconstruction  cases.  For instance, HHS stated that during the advisory board’s meetings  in 2005, the board regularly discussed the future of contract activities and  altered the review schedule and scope of work several times.  For  example, the contractor was asked to perform site profile reviews for sites  not originally anticipated in order to facilitate the advisory board’s review  of related special exposure cohort petitions.  Other commenters pointed  out the board’s development of a six-step resolution process for use by  NIOSH and the contractor to resolve differences on technical issues.  We  revised the report to more fully reflect actions taken by the advisory board  to reexamine and adjust its strategy for the review.  We also changed the  report title to reflect changes made in the report in this regard.  However,  we continue to see a need for the advisory board to build on its actions by  comprehensively reexamining whether its original long-term plan for the  overall project is still appropriate.
Several individual advisory board members commented that they remain  concerned about the independence of the board and its contractor.   Although acknowledging that replacement of the original officials  appointed as the designated federal officer and project officer has helped  reduce possible challenges to independence, the members pointed out that  NIOSH officials remain involved in managing the contract and could still  potentially influence the work of the contractor.  These individual board  members also emphasized that the board has no independent budgetary  authority and that it relies on NIOSH to obtain funding.  Our review  suggests that the contractor has been able to demonstrate its  independence during the review.  For instance, our report notes that the  contractor’s reports have criticized numerous aspects of NIOSH site  profiles and dose reconstructions.  Further, contractor officials told us  that they believe relations with NIOSH are thoroughly professional and  board members told us that they are satisfied with the information  provided by the contractor.  We acknowledge that the potential for  impairment of the contractor’s efforts remains. In fact, our draft report  concluded that there is a need for continued diligence in avoiding actual or  perceived conflicts of roles as new candidates are considered for certain  positions over the life of the advisory board. We have further highlighted  this point in the final report.
HHS’s comments are provided in appendix II, and the contractor’s  comments are provided in appendix III.  HHS, the contractor, and  individual board members also provided technical comments, which we  have incorporated as appropriate.
As arranged with your office, unless you publicly announce its contents  earlier, we plan no further distribution of this report until 30 days from the  issue date. At that time, we will send copies of this report to the Secretary  of Health and Human Services, interested congressional committees, and  other interested parties. We are also sending copies to the Chair and  members of the advisory board. We will make copies available to others  upon request. In addition, the report will be available at no charge on  GAO’s Web site at http://www.gao.gov.
If you have any questions about this report, please contact me at (202) 512- 7215. Contact points for our Offices of Congressional Relations and Public  Affairs may be found on the last page of this report. GAO staff that made  major contributions to this report are listed in appendix III.
section_title: Appendix I: Briefing Slides
subsections: section_title: Introduction
subsections: section_title: • For the last several decades, the Department of Energy and its
paragraphs: predecessor agencies and contractors have employed thousands of  individuals in secret and dangerous work in the atomic weapons industry.
The Energy Employees Occupational Illness Compensation Program Act  (EEOICPA) of 2000 compensates individuals who have developed cancer  or other specified diseases related to on-the-job exposure to radiation and  other hazards at these work sites.
Under Subtitle B, determining a claimant’s eligibility for compensation  involves developing estimates of the likely radiation levels a worker was  exposed to based on information such as exposure records.  These estimates are referred to as “dose reconstructions” and are developed by  the National Institute for Occupational Safety and Health (NIOSH) under  the Department of Health and Human Services (HHS).
section_title: Introduction (cont.)
paragraphs: NIOSH also compiles information in “site profiles” about the radiation  protection practices and hazardous materials used at various plants and  facilities, which assist NIOSH in completing the dose reconstructions.
Employees at certain facilities were designated under the law as members  of a “special exposure cohort” because it was believed that exposure  records were insufficient and the reasonable likelihood was that the  workers’ radiation exposure caused their cancers.  Their claims are paid  without completing exposure estimates.
The law also allows the Secretary, HHS, to designate additional groups of  employees as members of the special exposure cohort.
section_title: Introduction (cont.)
subsections: section_title: For quality control and to raise public confidence in the fairness of the
paragraphs: claims process, EEOICPA created a citizen’s advisory board of scientists,  physicians, and employee representatives—the President’s Advisory Board  on Radiation and Worker Health (advisory board).  Members of board  serve part-time, and the board has limited staff support.
The advisory board is tasked with reviewing the scientific validity and  quality of NIOSH’s dose reconstructions and advising the Secretary of  HHS.  The board has the flexibility to determine the scope and  methodology for this review.  In addition, the advisory board is tasked with  reviewing NIOSH’s evaluation of petitions for special exposure cohort  status and recommending whether such status should be granted.
To facilitate the advisory board’s review, HHS awarded a 5-year, $3-million  contract to Sanford Cohen & Associates (SC&A) in October 2003 to examine a sample of dose reconstructions and particular site profiles and  to perform a variety of other tasks.
section_title: Introduction (cont.)
subsections: section_title: NIOSH awarded a 5-year contract to Oak Ridge Associated Universities to
paragraphs: assist NIOSH in developing site profiles and in performing dose  reconstructions.  Originally, about $70 million was allocated to the contract,  but this figure had increased to over $200 million by 2004.
section_title: Key Questions
paragraphs: We focused our work on three questions: Are the roles of key federal officials involved in the review of NIOSH’s  dose reconstructions sufficiently independent to assure the objectivity  of the review?
Have the agency’s management controls and the advisory board’s  oversight been sufficient to ensure that the contract to review site  profiles and dose reconstructions is adequately carried out?
Is the advisory board using the contractor’s expertise in reviewing  special exposure cohort petitions?
section_title: Scope and Methodology
subsections: section_title: We reviewed pertinent contract-related materials and correspondence among
paragraphs: key officials and interviewed these officials to document their roles.  We  used the broad principles specified in various criteria, including those  specified in the Federal Acquisition Regulation and Government Auditing  Standards, to assess the independence of key officials’ roles.
We analyzed the contract provisions, including the specific task orders and  monthly progress reports as well as the actions taken by officials to  manage the contract.  We assessed whether the management controls  were adequate, considering criteria such as the Federal Acquisition  Regulation.
section_title: Scope and Methodology (cont.)
subsections: section_title: We analyzed the special exposure cohort regulations and advisory board
paragraphs: meeting minutes as well as interviewed key officials and attended advisory  board meetings, to determine the process the advisory board has used and  plans to use to evaluate petitions.
The scope of our work did not include examining the contract NIOSH awarded  to Oak Ridge Associated Universities.
We conducted this review from March 2005 through November 2005 in  accordance with generally accepted government auditing standards.
section_title: Summary of Findings
paragraphs: The roles of certain key federal officials initially involved in the  review of dose reconstructions may not have been sufficiently  independent and these officials were replaced. However,  continued diligence by HHS is required to prevent such problems  from recurring as new candidates are considered for these roles.
The progress of the contracted review of site profiles and dose  reconstructions has been hindered, largely by the complexity of  the work.  Some adjustments have been made, but further  improvements could be made to the oversight and planning of the  review.
The advisory board is using the contractor’s work in reviewing  special exposure cohort petitions and has acknowledged the need  to review the petitions in a timely manner.
subsections: section_title: Multiple Entities and Officials Involved in the Review of NIOSH’s Dose Reconstructions
paragraphs: (HHS) (CDC)
National Institute for Occupational Safety and Health  (PGO)
Designated federal officer (since 12/04)
Project officer (since 12/04)
Office of Compensation Analysis and Support  (OCAS)
subsections: section_title: Designated federal officer (prior to 12/04)
paragraphs: Project officer (prior to 12/04) (SC&A)
section_title: Roles of HHS and CDC
subsections: section_title: HHS The Secretary of HHS has overall responsibility for the advisory board, as
paragraphs: delegated by the President, and is tasked by executive order with providing  administrative services, funds, facilities, staff, and other necessary support  services to assist the advisory board in carrying out its responsibilities.
CDC  NIOSH’s parent agency awarded the contract on behalf of the advisory  board.
A CDC Procurement and Grants Office (PGO) official serves as the contracting officer.
The contracting officer is responsible for administering and providing  management of the contract on the advisory board’s behalf.  This includes reviewing the monthly progress reports and paying the  contractor for its approved costs.
section_title: Role of NIOSH
subsections: section_title: NIOSH The Office of Compensation Analysis and Support (OCAS) is responsible
paragraphs: for preparing the site profiles and completing the dose reconstructions.
NIOSH officials serve as the project officer for the contract and the  designated federal officer for the advisory board.
The project officer is responsible for reviewing the monthly progress  reports and monitoring the technical performance of the contractor.
The designated federal officer schedules and attends meetings of  the advisory board.
section_title: Roles of Advisory Board and Contractor
subsections: section_title: Advisory Board Required to (1) review the scientific validity and quality of NIOSH’s dose
paragraphs: reconstructions and (2) review NIOSH’s evaluation of special exposure  cohort petitions and recommend whether such status should be granted.
Operates under Federal Advisory Committee Act (FACA) requirements  such as conducting its meetings in public.
Contractor - SC&A  Under contract, assists the advisory board in meeting its statutory  responsibilities by reviewing a sample of dose reconstructions and their  associated site profiles and providing assistance with special exposure  cohort petitions.
Provides monthly progress reviews to the contracting officer, project officer,  and advisory board.
section_title: Contract Initiated in October 2003 for 5 years and $3 Million Maximum
subsections: section_title: Task Orders for contractor now include:
paragraphs: Task 1:  Review selected NIOSH-developed site profiles.   Task 2:  Develop automated system to track NIOSH dose reconstruction  cases.
Task 3:  Review NIOSH dose reconstruction procedures.  Task 4:  Review a sample of NIOSH dose reconstruction cases.
Review NIOSH’s special exposure cohort petition procedures and individual  petitions.
Provide administrative (logistical) support to advisory board (monthly  progress reports, attendance at advisory board meetings, etc.).
section_title: Two Federal Officials Were Replaced to Protect Independence of Review
subsections: section_title: Two officials were replaced by the Director of NIOSH because of concerns
section_title: Initially, certain officials performing key roles did not appear to be sufficiently independent of the review and actions were taken to replace these officials. Advisory board members and the contractor have said that the implementation of the contract has improved as a result. Nonetheless, continued diligence is required to prevent such problems from recurring as new candidates may be considered for these roles.
paragraphs: The contracting officer is a CDC employee whose organization is  independent of the NIOSH program under review.
section_title: Two Federal Officials Were Replaced
subsections: section_title: Replacement of Project Officer
paragraphs: In 2003-2004, the project officer also served as a NIOSH program  manager of the program under review.
In December, 2004, a senior NIOSH official, who does not have  responsibilities for the program under review, took over this role.
section_title: Replacement of Designated Federal Officer
paragraphs: In 2002-2004, the designated federal officer also served as the NIOSH  director of the program under review.
In December 2004, a senior NIOSH official, who does not have  responsibilities for the program, took over this role.
section_title: Other Officials Are Independent of the Program under Review
subsections: section_title: Members of the advisory board played the leading role in developing and
paragraphs: approving the initial statement of work for the contractor and the  independent government cost estimate for the contract, actions which  helped facilitate the independence of the contractor’s work.
section_title: Adjustments Were Made to SC&A’s Review But Further Improvements in Oversight and Planning Could be Made
subsections: section_title: The project officer did not adequately monitor contract spending relative to
paragraphs: overall project performance in the initial months.  More detailed expenditure  data were subsequently provided to facilitate monitoring but developing  more comprehensive data would be useful.
While the advisory board has made various adjustments to the contractor’s  task orders and work processes after the contractor encountered initial  difficulties, the board has not comprehensively reexamined its long-term  plan for the project.
Additionally, NIOSH lacks a process for documenting actions it has taken in  response to the contractor’s findings that are reported to the advisory board  and the advisory board’s recommendations to HHS.
section_title: CDC Did Not Adequately Monitor Contract Spending Compared to Work Completed
paragraphs: The contractor’s expenditure levels were not adequately monitored in the initial months.
Although the contractor’s reports indicated that costs were higher than anticipated, the project  officer was caught by surprise in October 2004 when the contractor announced a need for work  stoppage because expenditures on a specific task order had approached budget ceilings.  The  contracting officer noted that during this period the contractor’s reports did not reflect the actual  percent of work completed, making it very difficult to identify the actual cost of performance.
Work was suspended on the site profile review task and a smaller task for several days in  November until additional funds were authorized.
Separate monthly progress reports are submitted for each task order.  However, there is no  single comprehensive report on overall contract performance, which could facilitate tracking the  progress of the overall review or making strategic adjustments where needed.
section_title: Initial Task Order Budgets and Schedules Proved Unrealistic
paragraphs: Initial task orders called for the contractor to complete:  12 to 16 site profile reviews by February 2005 for $426,000  60 dose reconstruction reviews by August 2004 for $467,000  These tasks cost more or took longer to complete than originally estimated.
At the end of January 2005, the contractor had completed 2 site profile  reviews and partially completed 2 others while spending $481,000.
The contractor completed the first 60 dose reconstruction reviews by  September 2005 while spending about $1.0 million.  (According to SC&A, the cost increase consisted of costs related to overall contract  management, not to increased dose reconstruction review costs.)
Overall, in the first 2 years, the contractor spent almost 90 percent of  the $3 million allocated for a 5-year undertaking.
section_title: Several Factors Hindered Contractor from Meeting Original Task Order Goals and Budgets
section_title: Complexity of work was much greater than originally
paragraphs: anticipated.
Both the contractor and NIOSH officials involved in the review reported  that reviews of site profiles and dose reconstructions have proven  considerably more complex than originally anticipated; thus the original  cost estimates for the project (based on very limited information and  experience) were not realistic.
Contractor encountered initial delays in obtaining information.  The contractor's progress was initially hindered by substantial delays it  encountered in obtaining necessary security clearances and access  from NIOSH to various technical documents.  These early  implementation issues have generally been resolved, according to the  contractor.
section_title: The Advisory Board Has Significantly Revised Major Task Orders during First 2 Fiscal Years
section_title: Site profile review task modified 5 times
paragraphs: Contractor has met these revised task order requirements.
section_title: Task Order Revisions In Part Reflect Board’s Changing Needs for Contractor Support As Operations Matured
subsections: section_title: Board shifted more contractor resources to site profile reviews in response
paragraphs: to NIOSH’s increased reliance on site profiles.
Site profiles were originally seen as one of numerous resources to be used in  developing dose reconstructions.  However, as site profiles became the primary  resource used by NIOSH, the advisory board wanted assurance that these site  profiles were credible.
NIOSH revisions to site profiles required the contractor to complete multiple  reviews in some instances.
For example, the contractor completed four reviews of the Mallinckrodt site  profile as a result of NIOSH’s changes. NIOSH views the site profiles as “living  documents” that can be added to as new information is identified or changes  need to be made.  In addition, as NIOSH worked to complete many of the site  profiles within an 18-month time frame, many “loose ends” remained in the site  profiles, according to the contractor.
section_title: Board developed a six-step process for use by NIOSH
paragraphs: and contractor to resolve their differences of views on  technical issues.  This process expanded the time and  resources needed for reviews.
Unanticipated site profile reviews (e.g., Iowa Army  Ammunition Plant) were needed to facilitate the advisory  board’s review of special exposure cohort petitions.
section_title: Congress provided $4.5 million in fiscal year 2006 for
paragraphs: use by, or in support of, the advisory board.
The advisory board has authorized a new set of  contractor reviews for fiscal year 2006.
An additional 6 site profile reviews, 60 dose  reconstruction case reviews, and 6 special exposure  cohort petition reviews.
section_title: … the Advisory Board Has Not Comprehensively Reassessed Its Long-Term Plan for the Project
subsections: section_title: Contract with SC&A included estimates of total work to be performed:
paragraphs: In August 2005, the designated federal officer pointed out that at the current rate of  progress, the original plan to review a total of 600 dose reconstructions would  require about 10 years to complete.
But the advisory board has not comprehensively reexamined its original long-term  plan for the project to determine if it needs to be modified.
Total number of site profile reviews needed? Total number of dose reconstruction case reviews needed? Time frames for completion and funding levels required?
section_title: NIOSH Lacks Processes to Track Actions Taken in Response to Contractor’s Findings and Board’s Recommendations
subsections: section_title: The contractor’s reports have criticized various aspects of NIOSH’s site
paragraphs: profiles and dose reconstructions, such as NIOSH’s failure to consider  information provided by site experts in its site profiles and certain  assumptions NIOSH used to calculate dose reconstructions.
As part of the six-step resolution process, the contractor and NIOSH  develop matrices that specify NIOSH’s response and any planned actions  for each of the contractor’s findings and recommendations.  In some  matrices, space is provided for the board to recommend that NIOSH take  certain actions to resolve issues.
However, there is no system in place to track NIOSH’s implementation of  these actions or advisory board recommendations.  Procedures for prompt  resolution and implementation of audit findings and other reviews should  be part of all federal agencies’ internal controls.
section_title: The Advisory Board Is Using the Contractor’s Work in Reviewing Special Exposure Cohort Petitions
subsections: section_title: The advisory board is using the contractor’s work in reviewing special
paragraphs: exposure cohort petitions.
A recent task order expands the contractor’s role for this facet of the  board’s work.
A potentially large increase in the board’s petition review workload did not  occur because many petitions did not meet initial qualification  requirements.
The advisory board has acknowledged the need to review the petitions in  a timely manner.
section_title: The Advisory Board Is Using the Contractor’s Work in Reviewing Petitions
subsections: section_title: Advisory Board’s Efforts as of October 31, 2005:
section_title: The advisory board has reviewed eight petitions representing five sites.
paragraphs: For six of these petitions, the contractor reviewed the site profiles  (though not the actual petitions associated with the named facilities).
For the other two petitions, the advisory board did not request the  contractor’s assistance.
section_title: Recent Task Order Expands the Contractor’s Role in Reviewing Petitions
subsections: section_title: Specifics of the Task Order include:
section_title: The contractor will review some of the submitted petitions and NIOSH’s
paragraphs: evaluations of these petitions to recommend to the advisory board whether  the petitioning group should be added to the special exposure cohort.
The contractor will also develop the procedures for the advisory board to  use when reviewing petitions.
section_title: A Potentially Large Increase in the Board’s Petition Review Workload Did Not Occur
subsections: section_title: Many petitions did not meet the initial qualification requirements and
paragraphs: thus did not need to be reviewed by the board.
As of October 2005, NIOSH had determined that 18 of the submitted  petitions did not meet the qualification requirements.
section_title: The advisory board may have to review five to eight more petitions
paragraphs: filed as of October 2005:  One petition is ready for the advisory board to review.
NIOSH is completing its evaluation of four more petitions that will be  sent to the board for review.
NIOSH is assessing three other petitions to determine if they meet the  qualification requirements.
section_title: The Advisory Board Has Acknowledged the Need for Timely Review of Petitions
subsections: section_title: The number of new petitions that may be submitted and that may qualify
paragraphs: for evaluation is unknown.
While NIOSH is generally required by law to complete its review of a  petition within 180 days of the petition’s being qualified, there is no  specified time frame for the advisory board’s review of petitions.
Nonetheless, the advisory board has discussed the fact that special  exposure cohort petition reviews have required more time and effort to  reach a recommended decision than originally estimated and that the  advisory board needs to manage its workload in order to reach timely  decisions.
section_title: Conclusions
subsections: section_title: Independence of Roles
section_title: After concerns were raised about the independence of certain federal officials
paragraphs: performing key roles, actions were taken to replace these officials.
Credibility is essential to the work of the advisory board and the contractor.  Thus, it  is important to continue to be diligent in avoiding actual or perceived conflicts of  roles as new candidates are considered for certain positions over the life of the  advisory board.
Management and Oversight of the Review of Site Profiles and Dose  The advisory board’s review has presented a steep learning curve for the various  parties involved.  Despite some adjustments, further improvements could be made: reassessing the long-term plan for the project integrating data on contractor expenditures tracking resolution of board and contractor findings and recommendations.
section_title: Conclusions (cont.)
paragraphs: Reassessing the long-term plan for the project   The advisory board has made numerous midcourse adjustments to the work of the  contractor as operations have matured.
It would thus be appropriate for the advisory board to comprehensively reexamine its  long-term plan for the overall project to determine whether this plan needs to be  modified.
Integrated data on contractor expenditures  Contractor’s monthly reports were modified to provide more detailed data for  individual tasks on expenditures compared to work completed.
However, the lack of integrated and comprehensive data across the various tasks  makes it more difficult for the advisory board to track the progress of the overall  review or make strategic adjustments to funding or deliverables across tasks.
section_title: Conclusions (cont.)
paragraphs: Tracking resolution of findings and recommendations  The advisory board developed a six-step resolution process that uses matrices to  track the findings and recommendations of the contractor and board.  However,  without a system for documenting the actions NIOSH has taken in response, there is  no assurance that any needed improvements are being made.
section_title: Recommendations
subsections: section_title: To assist the advisory board meet its statutory responsibilities, we
paragraphs: direct the contracting and project officers to develop and share with the  advisory board more integrated and comprehensive data on contractor’s  spending levels compared to work completed and   consider the need for providing HHS staff to collect and analyze pertinent  information that would help the advisory board comprehensively reexamine its  long-term plan for assessing the NIOSH site profiles and dose reconstructions.
section_title: Recommendations (cont.)
subsections: section_title: To ensure that the findings and recommendations of the advisory
paragraphs: direct the Director of NIOSH to establish a system to track the actions  taken by the agency in response to these findings and  recommendations and update the advisory board periodically on the  status of such actions.
section_title: Related GAO Products
subsections: section_title: Energy Employees Compensation: Even with Needed Improvements in Case
paragraphs: Processing, Program Structure May Result in Inconsistent Benefit Outcomes. GAO- 04-516. Washington, DC: May 28, 2004.
Energy Employees Compensation:  Many Claims Have Been Processed, but Action  Is Needed to Expedite Processing of Claims Requiring Radiation Exposure  Estimates. GAO-04-958. Washington, DC: Sept.10, 2004.
section_title: Appendix II: Comments from the Department of Health & Human Services
section_title: Appendix III: Comments from S. Cohen & Associates
section_title: Appendix IV: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact:
section_title: Staff Acknowledgements:
paragraphs: Andy Sherrill, Assistant Director; Margaret Armen, Richard Burkard,  Susan Bernstein, Sandra Chefitz, Mary Nugent, and Robert Sampson made  significant contributions to this report.
section_title: Related GAO Products
paragraphs: Energy Employees Compensation: Many Claims Have Been Processed,  but Action Is Needed to Expedite Processing of Claims Requiring  Radiation Exposure Estimates. GAO-04-958. Washington, D.C.: Sept. 10,  2004.
Energy Employees Compensation: Even with Needed Improvements in  Case Processing, Program Structure May Result in Inconsistent Benefit  Outcomes. GAO-04-516. Washington, D.C.: May 28, 2004.