U.S. Postal Service: Clear Communication with Employees Needed before Reopening the Brentwood Facility
Published: 2003-10-23T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: On October 21, 2001, the U.S. Postal Service closed its Brentwood mail processing facility after the Centers for Disease Control and Prevention (CDC) confirmed that an employee there had contracted inhalation anthrax, an often-fatal form of the disease. On October 21 and 22, two other Brentwood employees died of inhalation anthrax. The contamination was linked to a letter that passed through the facility on or about October 12, before being opened in the office of Senator Daschle in the Hart Senate Office Building on October 15. The Hart Building was closed the next day. The Brentwood facility has since been decontaminated and will soon reopen. This testimony, which is based on ongoing work, provides GAO's preliminary observations on the decisions made in closing the facility and problems experienced in communicating with employees, as well as lessons learned from the experience.
section_title: What GAO Found
paragraphs: The Postal Service's decision to wait to close the Brentwood facility and refer employees for medical treatment until CDC confirmed that a postal employee had contracted inhalation anthrax was consistent with the advice the Postal Service received from public health advisers and the information about health risk available at the time. However, because circumstances differed at Brentwood and the Hart Building--an observed spill at the Hart Building and no observable incident at Brentwood--the Postal Service's response differed from the response at Capitol Hill, leading some Brentwood employees to question whether the Postal Service was taking adequate steps to protect their health. The Postal Service communicated information to its Brentwood employees during the anthrax incident, but some of the health risk information changed over time, exacerbating employees' concerns about the measures being taken to protect them. Notably, employees later learned that their risk of contracting the disease was greater than originally stated. Other factors, including difficulties in communicating the uncertainty associated with health recommendations and employees' distrust of postal managers, also challenged efforts to communicate effectively. Recently, the Postal Service informed employees that Brentwood, which has been tested and certified as safe for occupancy, is "100 percent free of anthrax contamination." However, in discussions with GAO, the Service agreed to revise future communications to acknowledge that although any remaining risk at the facility is likely to be low, complete freedom from risk cannot be guaranteed. The Postal Service and others have learned since the 2001 anthrax incidents that (1) the risk of contracting anthrax through the mail is greater than was previously believed and more caution is needed to respond to that greater risk and (2) clear, accurate communication is critical to managing the response to an incident and its aftermath. The Postal Service is revising its guidance to respond more quickly and to communicate more effectively to employees and the public in the event of a future incident.

section_title: Letter
paragraphs: We are pleased to be here to discuss issues related to the U. S. Postal  Service’s response to the anthrax contamination at the Washington D.C.  Processing and Distribution Center, or Brentwood, as it was commonly  known. As you know, the facility was renamed the Joseph Curseen Jr. and  Thomas Morris Jr. Processing and Distribution Center in memory of the  two Brentwood employees who died of inhalation anthrax on October 21  and 22, 2001. Inhalation anthrax is the most lethal form of the disease. The  facility is about to reopen after being closed 2 years ago this week for  decontamination and renovation. My testimony today will focus on the (1)  decisions made by the Postal Service in closing the Brentwood facility and  (2) problems the Postal Service experienced in communicating to its  employees as well as (3) lessons that can be learned from the experience.  While you also asked us to address the effectiveness of the facility’s  decontamination, we are unable to do so because this issue is outside the  scope of work that we have under way. However, we will relay our  observations about communication issues associated with the facility’s  decontamination.
My testimony today is based largely on our ongoing work addressing the  treatment of postal employees at several postal facilities, including the  Brentwood facility, that were contaminated with anthrax spores in late  2001. This work, which we expect to complete within the next several  months, is being done at the request of Senator Joseph I. Lieberman and  Representatives Christopher H. Smith and Eleanor Holmes Norton. Our  work thus far has involved interviews with individuals involved in the  response to the contamination, including representatives from the Postal  Service, the Department of Defense, the Centers for Disease Control and  Prevention (CDC), and state and local public health agencies and postal  unions as well as reviews of relevant documents and literature related to  the anthrax response. We are also drawing from our completed work  addressing anthrax contamination at a postal facility in Connecticut,issues related to the testing for anthrax in that facility, and the public  health response to the 2001 anthrax incidents. Our work is being  performed in accordance with generally accepted government auditing  standards. The observations that we are making are based on our ongoing  work and should be viewed as preliminary.
Before I discuss the decisions made in closing the Brentwood facility, let  me briefly place these decisions in context. When the Postal Service  learned that a letter contaminated with anthrax spores had been sent  through the mail and opened in the office of Senator Daschle within the  Hart Senate Office Building (Hart Building) on October 15, 2001, the Postal  Service reports that it immediately understood that the letter passed  through its Brentwood facility. However, at that point, the risk of  contamination and its consequences at the facility were uncertain. The  Postal Service sought advice and guidance from CDC and the District of  Columbia (D.C.) Department of Health, provided information to its  employees, arranged for environmental tests of the facility, and provided  some protective equipment, but it did not close the facility or refer the  facility’s employees for medical treatment until October 21, when CDC  confirmed that a Brentwood employee had inhalation anthrax. The Postal  Service’s actions contrasted with those taken by the Attending Physician  for the U.S. Capitol—the individual responsible for the health of public  officials and other congressional employees on Capitol Hill. The Attending  Physician decided to make antibiotics available to the most directly  exposed congressional employees on the same day the contaminated letter  was opened and advised closure of the Hart Building the following day.
The Postal Service’s decision to wait for CDC’s confirmation of a case of  inhalation anthrax before closing Brentwood and referring its employees  for medical treatment was consistent with the advice it received from CDC  and the D.C. Department of Health as well as the information about health  risk available at the time. However, the decision raised questions among  Brentwood employees about whether their health was being adequately  protected. At the time, CDC advised waiting for such confirmation before  recommending closing a facility or recommending medical treatment  because CDC and local public health authorities believed it unlikely that  postal employees could contract inhalation anthrax from exposure to  contaminated mail. The Postal Service’s decision differed from the  decision to close the Hart Building, in large part, because there was an  observable incident of anthrax contamination there—which was  immediately recognized as a potentially high-risk situation—whereas there  was no observable incident at Brentwood. However, even before CDC  confirmed the first case of inhalation anthrax at Brentwood, some Postal  Service employees questioned whether the Postal Service’s actions  adequately protected their health.
The Postal Service communicated health risk and other information to its  Brentwood employees during the anthrax incident, but some of the  information it initially provided changed as public health knowledge  evolved—exacerbating employees’ concerns about the adequacy of the  measures being taken to protect them. Most significantly, employees later  learned that their risk of contracting the disease was greater than  originally stated. Other factors, including difficulties in communicating the  uncertainty associated with health recommendations, the appearance of  disparate treatment between Brentwood and congressional employees,  and employees’ long-standing distrust of postal managers, also challenged  efforts to communicate effectively. According to postal managers, the  Postal Service has made additional efforts to communicate with  Brentwood employees since the facility’s closure, but challenges remain,  including before the facility opens to clearly communicate the  impossibility of eliminating all risk of contamination from the  environment. Recently, for example, the Postal Service informed  employees that Brentwood, which has been tested and certified as safe for  occupancy, is “100 percent free of anthrax contamination.” However,  following discussions with us about the impossibility of eliminating all risk  of contamination, the Postal Service agreed to revise future  communications to acknowledge that although any remaining risk at the  facility is likely to be low, complete freedom from risk cannot be  guaranteed.
The Postal Service, CDC, and others have learned a great deal from the  2001 anthrax incidents and have taken various steps to address the  problems that occurred and to enhance their preparedness for any future  incidents. One of the lessons learned is that the risk of employees  contracting anthrax through the mail is greater than was previously  believed and more caution is needed to respond to that greater risk.  Another important lesson learned is that clear and accurate  communication to employees is critical to managing the response to an  incident and its aftermath. The Postal Service, CDC, and others have taken  steps to revise their guidance to respond more quickly in the event of a  future anthrax incident and to communicate more effectively about such  an incident with employees and the public. The Postal Service told us that  it would inform Brentwood employees prior to opening the Brentwood  facility that while the facility is safe for occupancy, it is impossible to  guarantee that it is risk free.
subsections: section_title: Background
paragraphs: Anthrax is an acute infectious disease caused by the spore-forming  bacterium called Bacillus anthracis. The bacterium is commonly found in  the soil and forms spores (like seeds) that can remain dormant for many  years. Although anthrax can infect humans, it occurs most commonly in  plant-eating animals.
Human anthrax infections are rare in the United States and have normally  resulted from occupational exposure to infected animals or contaminated  animal products, such as wool, hides, or hair. Infection can occur in three  forms, two of which are relevant to this testimony. They are (1) cutaneous,  which usually occurs through a cut or abrasion and (2) inhalation, which  results from breathing aerosolized anthrax spores into the lungs.Aerosolization occurs when anthrax spores become airborne, thus  enabling a person to inhale the spores into the lungs. After the spores  enter the body, they can germinate into bacteria, which then multiply and  secrete toxins that can produce local swelling and tissue death. The  symptoms are different for each form of infection and are thought to  appear within about 7 days of exposure, although individuals have  contracted inhalation anthrax as long as 43 days after exposure.  Depending on the extent of exposure and its form, a person can be  exposed to anthrax without developing an infection. Before the 2001  incidents, the fatality rate for inhalation anthrax was approximately 75  percent, even with appropriate antimicrobial medications. People coming  in contact with anthrax in its natural environment have generally not been  at risk for inhalation anthrax, and before 2001, no cases of inhalation  anthrax had been reported in the United States since 1976, although 224  cases of cutaneous anthrax were diagnosed between 1944 and 1994.Fatalities are rare for cutaneous anthrax.
Because so few instances of inhalation anthrax have occurred, scientific  understanding about the number of spores needed to cause the disease is  still evolving. Before the 2001 incidents, it was estimated that a person  would need to inhale thousands of spores to develop inhalation anthrax.  However, based on the cases that occurred during the fall of 2001, experts  now believe that the number of spores needed to cause inhalation anthrax  could be very small, depending on a person’s health status and the  aerosolization capacity of the anthrax spores.
In total, the contaminated letters caused 22 illnesses and resulted in 5  deaths from inhalation anthrax. Numerous postal facilities were also  contaminated. The first two cases of disease involved media employees in  Florida. The employees—one of whom died—contracted inhalation  anthrax and were thought to have contracted the disease through  proximity to opened letters containing anthrax spores. Media employees  also developed anthrax in New York—the second location known to be  affected. The initial cases in New York were all cutaneous and were also  thought to have been associated with opened envelopes containing  anthrax spores. The initial cases at the next site—New Jersey—involved  postal employees with cutaneous anthrax. The postal employees were  believed to have contracted the disease through handling the mail—as  opposed to opening or being exposed to opened letters containing anthrax  spores. Unlike the incidents at other locations, which began when cases of  anthrax were detected, the incident at the Hart Building—the fourth  location—began with the opening of a letter containing anthrax spores  and the resulting exposure to the contamination. The discovery of  inhalation anthrax in the first postal worker from Brentwood revealed that  even individuals who had been exposed only to taped and sealed  envelopes containing anthrax could contract the inhalation form of the  disease. Subsequent inhalation cases in Washington, D.C.; New Jersey;  New York; and Connecticut—the sixth location affected—underscored  that finding and also demonstrated that exposure and illness could result  from cross contamination of mail. (See app. I for a time line of selected  events related to the anthrax incident in the fall of 2001.)
On or about October 9, 2001, at least two letters containing anthrax spores  entered the U.S. mail stream—one was addressed to Senator Thomas  Daschle, the other to Senator Patrick Leahy. The letters were mailed in  Trenton, New Jersey, and forwarded to the Brentwood facility in  Washington, D.C., where they were processed on high-speed mail sorting  machines and further processed in the facility’s government mail section  before delivery. On October 15, a staff member in Senator Daschle’s  office opened the contaminated envelope. The envelope contained a  powdery substance, which the accompanying letter identified as anthrax,  that was released in a burst of dust when the envelope was opened. The  U.S. Capitol Police were notified, and the substance was quickly tested  and confirmed to be anthrax. Brentwood managers analyzed the path of  the letter through the facility. Although the machine that processed the  letter was reportedly shut off—at least for a period of time—the facility  itself was not closed or evacuated at that time. Within days, a Brentwood  employee was suspected of having contracted inhalation anthrax. The  Postal Service closed the facility on October 21, 2001, after CDC confirmed  that the employee had the disease. Thereafter, two other Brentwood  employees, Mr. Curseen, Jr., and Mr. Morris, Jr., died. Both were  subsequently found to have died of inhalation anthrax.
The Brentwood facility is a large 2-story facility that operated 24 hours a  day, 7 days a week. About 2,500 employees worked at Brentwood,  processing mail on one of three shifts. Brentwood processed all the mail  delivered to addresses on Capitol Hill, including the Hart Building.  Brentwood was the second processing and distribution center closed for  an extended period because of anthrax contamination. The Postal Service  reported that it plans to reopen the facility in phases; by late November  administrative personnel will begin working in the facility and limited mail  processing operations will begin shortly after that. Brentwood is expected  to be fully operational by spring 2004. The other facility—the Trenton  Processing and Distribution Center—located in Hamilton, New Jersey, was  closed 3 days before Brentwood on October 18, 2001, after CDC confirmed  that a New Jersey postal employee had cutaneous anthrax. It is in the  process of being decontaminated.
section_title: Brentwood Employees Questioned Whether the Decision to Wait for Confirmation of Inhalation Anthrax Adequately Protected Their Health
paragraphs: The Postal Service’s decision to wait for CDC’s confirmation of a case of  inhalation anthrax before closing Brentwood and referring the facilities’  employees for medical treatment was consistent with the public health  advice the Postal Service received and the health risk information  available at the time. However, the Postal Service’s decision contrasted  with the more immediate decision to close the Hart Building after anthrax  contamination occurred. As a result, postal employees questioned whether  the Postal Service’s decision adequately protected their health.
subsections: section_title: The Postal Service’s Decision Was Based on CDC’s Advice and Available Health Risk Information
paragraphs: The Postal Service’s decision to wait for CDC’s confirmation of a case of  inhalation anthrax before closing Brentwood and referring its employees  for medical treatment was consistent with the advice provided by CDC  and the D.C. Department of Health, as well as the available health risk  information. CDC called for such confirmation before closing a facility or  recommending medical treatment because, at the time, public health  authorities believed postal employees were unlikely to contract inhalation  anthrax from exposure to contaminated mail. Postal officials reported that  they consulted CDC and the D.C. Department of Health about the possible  health risks to Brentwood employees after learning that Senator Daschle’s  letter—opened on October 15, 2001—contained anthrax. Even though the  letter would have passed through Brentwood, the public health authorities  said that they did not consider the facility’s employees at risk, given the  results of ongoing investigations of anthrax incidents in Florida and New  York and the scientific understanding at that time. Specifically, as  discussed, no postal employees were known to have developed symptoms  of anthrax after contaminated letters had passed through the postal  system on the way to destinations in Florida and New York, and anthrax  spores were not considered likely to leak out, or escape from, a taped and  well-sealed envelope in sufficient quantities to cause inhalation anthrax.  Accordingly, the Postal Service reported that it kept the Brentwood facility  open in order to keep the mail moving. This goal was important to  managers whom we interviewed, who cited the psychological importance  of keeping the mail flowing in the aftermath of the September 11 terrorist  attacks.
On October 18, 2001, CDC confirmed that a postal employee in New Jersey  had cutaneous anthrax. On that day, the Postal Service, in consultation  with the New Jersey Department of Health and Senior Services, closed the  Trenton Processing and Distribution Center. According to New Jersey  public health officials, the facility was closed to facilitate environmental  testing of the Trenton facility. While the contaminated letters to Senator  Daschle and Senator Leahy were both processed through the Trenton and  Brentwood facilities, it is not clear why the Postal Service did not take the  same precautionary measures at Brentwood. We are pursuing this issue as  part of our ongoing work.
Although the Postal Service followed CDC’s advice and kept Brentwood  open until CDC confirmed a case of inhalation anthrax, the Postal Service  took interim steps to protect its employees. First, the Postal Service  arranged for a series of environmental tests at the Brentwood facility, even  though it reported that CDC had advised the Postal Service that it did not  believe such testing was needed at that time. The results of the first test—  taken and available on October 18, 2001—were from a quick test  conducted by a local hazardous materials response team. The results were  negative. Three days later, on October 21, 2001, CDC confirmed that a  Brentwood employee had inhalation anthrax, and the Postal Service  closed the facility and referred its employees for medical treatment. The  positive results of more extensive environmental testing—also conducted  on October 18, 2001—were not available until October 22—after the  facility had already closed. In addition, Postal Service managers said they  asked the D.C. Department of Health three times before October 21 for  nasal swabs and antibiotics for Brentwood employees; however, the health  department said the swabs and antibiotics were unnecessary. We have not  yet been able to confirm this information with the D.C. Department of  Health. Finally, the Postal Service took actions to protect its employees  from low-level environmental risks. For example, it provided protective  equipment such as gloves and masks and, according to postal managers,  shut down the mail-sorting machine that processed the Daschle letter, at  least for a time. Additionally, the Postal Service provided information on  handling suspicious packages and required facility emergency action plans  to be updated.
In 1999, the Postal Service developed guidance for responding to anthrax  and other hazardous incidents. The guidance, which was developed in  response to hundreds of hoaxes, includes steps for notifying first  responders, evacuating employees, and providing information and medical  care to employees. The Postal Service reported that the guidance deals  with observable events—specifically, spills—not events that are not  observable, such as aerosolization of powders. As a result, the Postal  Service said that it did not view the guidance as being applicable to the  situation that occurred at Brentwood.
Given that the situation at Brentwood differed from the situation  contemplated in its guidance, the Postal Service sought advice from CDC  and others. According to CDC officials, the health and safety of postal  employees was always the first concern of postal managers during  discussions with CDC. Furthermore, they said that the Postal Service was  receptive to their advice about the need to close Brentwood to protect  postal employees after a diagnosis of inhalation anthrax was confirmed.
section_title: The Decisions Made at Brentwood and Capitol Hill Differed Because the Circumstances and Decisionmakers Differed
paragraphs: The Postal Service’s decision to wait for a confirmed case of inhalation  anthrax before closing the facility and referring employees for medical  treatment differed from the decision to implement precautionary measures  immediately after anthrax contamination was identified at the Hart  Building. The decisions differed, in part, because there was an observable  incident at the Hart Building, but not at Brentwood. In addition, different  parties made the decisions. At Brentwood, the Postal Service made the  decision in consultation with CDC and the D.C. Department of Health.  These parties were not involved in the decision-making at the Hart  Building. Instead, because the Hart Building is one of many congressional  offices surrounding the U.S. Capitol, the Attending Physician for the U.S.  Congress—who functions independently from the District of Columbia—  provided advice and made decisions about how to deal with the  contamination there.
The incident at the Hart Building was immediately viewed as high risk to  employees there because the envelope opened in Senator Daschle’s office  contained a visible white powder that the accompanying letter identified  as anthrax, which was quickly confirmed by testing of the substance.  Consequently, the Office of the Attending Physician of the U.S. Congress  arranged for congressional employees to receive antibiotics immediately  and advised closure of the Hart Building the following day.
Since 2001, the Postal Service has developed new guidance to address  security risks in the mail. Its Interim Guidelines for Sampling, Analysis,  Decontamination, and Disposal of Anthrax for U.S. Postal Service  Facilities—first issued in November 2001—states that postal facilities will  be closed if a confirmed case of inhalation anthrax is identified or when  evidence suggests that anthrax has been aerosolized in a postal facility.  The Postal Service said that it plans to complete an update to these  guidelines soon, and we plan to determine whether the new guidelines will  adequately address the situation that occurred at Brentwood as part of our  ongoing work. In addition, the Postal Service has tested and begun to  install new biodetection technology in postal facilities. This technology is  designed to enhance safety by quickly identifying unobservable evidence  of aerosolized anthrax, thereby allowing for a prompt response. We plan to  review the guidance associated with this technology as we complete our  work.
section_title: Communication Problems Exacerbated Postal Service Employees’ Concerns
paragraphs: The Postal Service communicated health risk and other information to its  Brentwood employees during the anthrax crisis, but some of the  information it initially provided changed as public health knowledge  evolved, intensifying employees’ concerns about whether adequate  measures were being taken to protect them. Most significantly,  information on the amount of anthrax necessary to cause inhalation  anthrax and the likelihood of postal employees’ contracting the disease  turned out to be incorrect. Other factors, including difficulties in  communicating the uncertainty associated with health recommendations  and employees’ long-standing distrust of postal managers, also challenged  efforts to communicate effectively. The Postal Service has made additional  efforts to communicate with Brentwood employees since the facility’s  closure, but challenges remain, particularly the need to effectively  communicate information on any possible residual risks.
subsections: section_title: Some Information Communicated to Postal Employees Changed
paragraphs: The Postal Service used a wide variety of methods to communicate  information to employees; however, some of the information it initially  provided changed with changes in public health knowledge. For example,  on the basis of the science at that time, the Postal Service and CDC  initially informed employees that an individual would need to be exposed  to 8,000 to 10,000 spores to contract inhalation anthrax. This view turned  out to be incorrect when two women in New York and Connecticut died  from inhalation anthrax in October and November 2001 without a trace of  anthrax spores being found in their environments. Their deaths caused  experts to conclude that the number of spores needed to cause the disease  could be very small, depending on a person’s health status and the  aerosolization capacity of the spores.
Postal employees were also told that they were at little risk of contracting  inhalation anthrax because, in the view of public health officials, anthrax  was not likely to escape from a taped and well-sealed envelope in  sufficient amounts to cause inhalation anthrax. In addition, on October 12,  2001, CDC issued a health advisory, which the Postal Service distributed to  its employees, indicating that it is very difficult to refine anthrax into  particles small enough to permit aerosolization. This information also  proved to be incorrect when the U.S. Army Medical Research Institute of  Infectious Diseases’ analyses of the anthrax in Senator Daschle’s letter in  mid-October 2001 revealed that the substance was not only small enough  to escape from the pores of a taped and well-sealed envelope but also  highly refined and easily dispersed into the air.
Finally, an error occurred on October 10, when the Postal Service  instructed employees to pick up suspicious letters and isolate them in  sealed containers. The message was corrected within a few days when  employees were instructed not to touch suspicious letters. Nevertheless,  Brentwood employees we spoke with cited the miscommunication as an  indication that the Postal Service was not concerned about their safety. As  a result of these and other issues, union and management officials report  lingering bitterness between Brentwood employees and postal  management.
section_title: Communicating Information Proved Challenging
paragraphs: Communicating information proved challenging for several reasons. First,  the incidents occurred in the turbulent period following the terrorist  attacks of September 11, 2001, when the nation was focused on the  response to those events. In addition, the anthrax incidents were  unprecedented. The response was coordinated by the Department of  Health and Human Services, primarily through CDC, and CDC had never  responded simultaneously to multiple disease outbreaks caused by the  intentional release of an infectious agent. Furthermore, when the incidents  began, CDC did not have a nationwide list of outside experts on anthrax,  and it had not yet compiled all of the relevant scientific literature.  Consequently, CDC had to do time-consuming research to gather  background information about the disease before it could develop and  issue guidance. Moreover, since anthrax was virtually unknown in clinical  practice, many clinicians did not have a good understanding of how to  diagnose and treat it. As a result, public health officials at the federal,  state, and local levels were basing their health-related actions and  recommendations on information that was constantly changing. According  to the testimony of CDC’s Associate Director for Science, National  Institute for Occupational Safety and Health, before a Subcommittee of  this Committee last year, CDC “clearly did not know what we did not  know last October  and this is the cardinal sin that resulted in tragic  deaths.”
Effective communications were further complicated by the evolving  nature of the incidents and the media’s extensive coverage of the response  to anthrax at other localities. Comparing the various actions taken by  officials at different points in time and in different locations confused  postal employees and the public and caused them to question the  consistency and fairness of actions being taken to protect them. For  example, when employees at the Brentwood postal facility received  doxycycline for prophylaxis instead of ciprofloxacin, they incorrectly  concluded that they were receiving an inferior drug. In part, this was  because the media had characterized ciprofloxacin as the drug of choice  for the prevention of inhalation anthrax. Ciprofloxacin also had been used  as the primary medication in earlier responses, including the response to  anthrax atthe Hart Building. CDC initially recommended ciprofloxacin for  several reasons; however, when CDC subsequently determined that the  anthrax was equally susceptible to doxycycline and other drugs, it began   recommending the use of doxycycline instead. The switch to  doxycycline was considered desirable for a variety of reasons, including  its (1) lower risk for side effects, (2) lower cost, and (3) greater  availability. Local and CDC officials we spoke with told us that they were  challenged to explain the switch in medications and to address  perceptions of differential treatment.
Additional misunderstandings arose over the administration of nasal  swabs to postal employees. Nasal swabs are samples taken from the nasal  passages soon after a possible exposure to contamination to determine the  location and extent of exposure at a site, but not to diagnose infection.  Nasal swabs were administered to congressional employees on October 15  after the contaminated letter was opened to determine which employees  might have been exposed and based on this where and how far the  aerosolized anthrax spores had spread. Some Brentwood employees  questioned why they did not also receive nasal swabs at this time and saw  this difference as evidence of disparate medical treatment. As noted, the  Postal Service reported requesting nasal swabs for its employees, but the  CDC and the D.C. Department did not consider them necessary. Nasal  swabs were then provided to at least some employees after Brentwood  was closed on October 21. However, further confusion appears to have  occurred about the purpose of the nasal swabs when employees who were  tested did not receive the results of the swabs. The confusion occurred  partly because the Postal Service issued a bulletin dated October 11, 2001,  that incorrectly indicated that nasal swabs were useful in diagnosing  anthrax and the media described nasal swabs as the “test” for anthrax. The  bulletin was subsequently corrected, but the media continued to refer to  the swabs as a test. Public health officials acknowledged that this  confusion about the purpose of the nasal swabs created a great deal of  anxiety within the postal community and the public. As a result, public  health entities continued to collect the samples when people asked for  them, simply to allay the individuals’ fears.
Another area of confusion relates to the process used to administer the  anthrax vaccine to interested postal employees. When the vaccine used by  the military became available in sufficient quantities that it could be  provided to others, CDC offered it to postal employees and congressional  staff. While considered safe, it had not been approved for use in  postexposure situations. Consequently, the Food and Drug Administration  required CDC to administer the vaccine using extensive protocols related  to the distribution of an “investigational new drug.” These protocols  required postal employees to complete additional paperwork and undergo  additional monitoring which, according to some Brentwood employees,  gave some employees the impression that they were being used as “guinea  pigs” for an unsafe treatment. CDC officials acknowledged that CDC did  not effectively communicate information about the vaccine program and  that, in hindsight, these deficiencies probably resulted in the “wrong  perception.”
CDC officials have also acknowledged that they were unsuccessful in  clearly communicating the degree of uncertainty associated with the  health information they were providing, which was evolving during the  incidents. For example, although there were internal disagreements within  CDC over the appropriate length of prophylaxis, this uncertainty was not  effectively conveyed to postal employees and the public. Consequently, in  December 2001, when postal employees and others were finishing their 60- day antimicrobial regimen called for in CDC’s initial guidance, they  questioned CDC’s advice about the need to consider taking the drugs for  an additional 40 days. CDC officials have since acknowledged the need to  clearly state when uncertainty exists about the information distributed to  the public and appropriately caveating the agency’s statements.
section_title: Long-Standing Labor Relations Issues Compounded Communication Issues
paragraphs: CDC, local public health officials, union representatives, and postal  officials told us that employees’ mistrust of postal managers complicated  efforts to communicate information to them. According to these parties,  postal employees were often suspicious of management’s motives and  routinely scrutinized information they received for evidence of any ulterior  motives. This view appears consistent with the results of our past work,  which has identified persistent workplace problems exacerbated by  decades of adversarial labor-management problems. These problems were  so serious that in 2001, we reported that long-standing and adversarial  labor-management relations affected the Postal Service’s management  challenges. The need to address this long-standing issue was also raised  in the July 2003 report of the President’s Commission on the U. S. Postal  Service.
section_title: The Postal Service Has Made Additional Efforts to Improve Communication with Employees, but Challenges Remain
paragraphs: According to postal managers, the Postal Service has made additional  efforts to communicate with the employees who were at Brentwood,  including holding “town hall” meetings to explain the facility’s  decontamination process to postal employees and the public. The Postal  Service has reported that it is also updating its 1999 guidance for  responding to anthrax and other hazardous materials. At present,  however, the revision of the guidance has not yet been completed and it is,  therefore, unclear whether the revisions will address the issues that  occurred at Brentwood. Nevertheless, the Postal Service assisted the  National Response Team—a group of 16 federal agencies with  responsibility for planning, preparing, and responding to activities related  to the release of hazardous substances—in the development of improved  guidance entitled Technical Assistance for Anthrax Response. This  guidance provides a number of recommendations about communicating  information during emergency situations, including the need for agencies  to “admit when you have made a mistake or do not know the information.”
While information on the process and outcome of decontamination efforts  is technically complex and therefore challenging to present clearly to the  public, the revised guidelines may be helpful in future discussions about  the safety of a facility. We have not reviewed the details of the facility’s  decontamination or its subsequent testing and, therefore, cannot comment  on the effectiveness of decontamination efforts. However, in general,  discussions about the success of decontamination and any residual risk to  individuals center on two related topics. The first topic entails a  discussion of the degree to which contamination has been reduced,  bearing in mind that all sampling and analytical methods have a limit of  detection below which spores may be present but undetected. Against that  backdrop, it is also important to discuss how many anthrax spores are  required to infect humans and to explain that the number is variable,  depending upon the route of infection (e.g., skin contact or inhalation) and  the susceptibility of each individual to infection. In light of this, it is  particularly important to properly communicate to Brentwood employees  a clear understanding of the decontamination approach that was  undertaken at the facility and the nature and extent of any residual risk  there. Likewise, the Postal Service’s communications to employees must  be clear and unbiased to (1) clearly communicate the limitations of testing  and the associated risks while, at the same time, (2) avoid inducing  unnecessary fear or concern. If provided with clear and unbiased  information, employees will be able to make informed decisions about  their health and future employment. In this regard, the Postal Service has  given employees who worked at Brentwood an opportunity to be  reassigned to certain other mail processing centers in the region if they do  not want to return to Brentwood.
In our view, providing complete information to employees is important for  them to make informed decisions about working at Brentwood. According  to recent information that the Postal Service provided to its employees,  the facility, which public health authorities have certified as safe for  occupancy, is “100 percent free of anthrax contamination” and there is “no  remaining health risk” at the facility. This latter information is not  consistent with what CDC’s Associate Director for Science, National  Institute for Occupational Safety and Health, told this Committee’s  Subcommittee on the District of Columbia in July 2002. Specifically, she  said that while a science-based process can allow workers to safely return  to Brentwood, it is not possible to eliminate risk entirely or to guarantee  that a building is absolutely free of risk. We discussed our concerns with  Postal Service officials about their characterization of the facility as  completely free of anthrax contamination, and they agreed to revise their  statements to indicate that it is not possible to guarantee that a building is  absolutely risk free. According to the Postal Service, a misunderstanding  resulted in the incorrect information being distributed to employees  before the document had been fully reviewed. The Postal Service said that  it would correct the information and distribute the new information to  employees who worked at Brentwood within the next 2 weeks.
section_title: Lessons Learned and Implications for Reopening the Facility
paragraphs: The Postal Service, CDC, and others have learned a great deal from the  2001 anthrax incidents and have taken various steps to address the  problems that occurred and to enhance their preparedness for any future  incidents. Among the lessons learned are that the risk to employees of  contracting anthrax through contaminated mail is greater than was  previously believed and more caution is needed to respond to that greater  risk. It is now clear, for example, that anthrax spores can be released in  the air, or aerosolized, when sealed letters pass through the Postal  Service’s processing equipment and that a limited number of anthrax  spores can cause inhalation anthrax in susceptible individuals. This  increased risk of contracting inhalation anthrax indicates that decisions  about closing facilities need to consider other factors as well as the  presence of an observable substance, such as a powder. The Postal  Service and CDC have responded to this need for greater caution by  developing guidance for closing a facility that establishes evidence of  aerosolization, as well as confirmation of a diagnosis of inhalation  anthrax, as a criterion for closure. We have not yet evaluated this guidance  to determine whether it is specific enough to make clear the  circumstances under which a postal facility should be closed to adequately  protect employees and the public. We recognize that developing such  guidance is difficult, given that the Postal Service experiences many  hoaxes and needs to accomplish its mission as well as ensure adequate  protection of its employees’ health.
Another important lesson learned during the 2001 anthrax incidents is that  clear and accurate communication is critical to managing the response to  an incident. Because the risk information that was provided to employees  changed over time and some of the information was communicated in  ways that employees reportedly found confusing or difficult to  understand, the fears that would naturally accompany a bioterrorism  incident were intensified and distrust of management, which already  existed in the workplace, was exacerbated. CDC, in particular, has  recognized the importance of communicating the uncertainty associated  with scientific information to preserve credibility in the event that new  findings change what was previously understood. In this regard, our work  on the sampling and analytical methodologies used to test for and identify  anthrax contamination addresses the uncertainty involved in these efforts.  The Postal Service agrees that although the Brentwood facility has been  tested and certified as safe for occupancy, the Postal Service cannot assert  that the building is 100 percent free of anthrax contamination.  Accordingly, the Postal Service stated that it would inform Brentwood  employees before opening the facility that the Postal Service cannot  guarantee that the building is absolutely risk free.
This concludes my prepared statement. I will be happy to respond to any  questions you or other members of the Committee may have.
section_title: Contacts and Acknowledgments
paragraphs: Should you or your staff have any questions concerning this report, please  contact me at (202) 512-2834 or Keith Rhodes at (202) 512-6412. I can also  be reached by e-mail at ungarb@gao.gov. Individuals making key  contributions to this testimony were Don Allison, Hazel Bailey, Jeannie  Bryant, Derrick Collins, Dwayne Curry, Elizabeth Eisenstadt, and Kathleen  Turner. Drs. Jack Melling and Sushil Sharma provided technical expertise.
section_title: Appendix I: Time Line of Selected Events Related to the Anthrax Incident in the Fall of 2001
paragraphs: Events Occurring on That Date  Terrorist attacks on the World Trade Center and Pentagon prompt heightened concerns about  possible bioterrorism.
In Florida, an American Media Inc. (AMI) employee is admitted to the hospital with a respiratory  condition.
The Centers for Disease Control and Prevention (CDC) issues an alert about bioterrorism,  providing information about preventive measures for anthrax.
CDC and the Florida Department of Health announce that AMI employee has inhalation anthrax.
AMI employee dies of inhalation anthrax.
The Postmaster General announces that Postal Inspection Service is working with other law  enforcement agencies on the Florida incident.
The Postal Service begins nationwide employee education on signs of anthrax exposure and  procedures for handling mail to avoid anthrax infection.
In NY, the New York City Department of Health (NYCDOH) announces the confirmation of a case  of cutaneous anthrax in an NBC employee.
The Postal Service says that it will offer gloves and masks to all employees who handle mail.  (On or about) Daschle letter passes through Brentwood.
Boca Raton post office, which had direct access to the AMI mail, is tested for anthrax and Palm  Beach County Department of Health administers nasal swabs and offers a 15-day supply of  ciprofloxacin to postal employees.
On Capitol Hill, an employee opens a letter addressed to Senator Daschle. Staff in that office, an  adjacent office, and first responders are given nasal swabs and a 3-day supply of antibiotics.
In NJ, State Department of Health and Senior Services (NJDHSS) assures Trenton employees that  they have a low risk of contracting anthrax.
Anthrax is confirmed at Boca Raton post office.
Part of the Hart Senate Office Building is closed in the morning, and the remainder of the building is  closed in the evening. Over the next 3 days, all Hart building and other Capitol Hill employees who  request them are given nasal swabs and a 3-day supply of antibiotics.
The Postal Service arranges for environmental testing at Brentwood.
Events Occurring on That Date  A local hazardous materials response team conducts “quick tests” of Brentwood, which are  negative for anthrax. A contractor conducts more extensive testing in the evening.
Postmaster General Potter holds a press conference at Brentwood, in part to reassure employees  they are at low risk.
CDC confirms cutaneous anthrax in New Jersey postal employee, and a second suspected case is  identified.
In NJ, the Trenton facility is closed. Employees are sent home.
In NY, NYCDOH announces another case of cutaneous anthrax, in a CBS employee.
In Florida, the Postal Service cleans two postal facilities contaminated with anthrax spores.
CDC distributes a press release announcing that the Food and Drug Administration has approved  doxycycline for postexposure prophylaxis for anthrax.
In the DC, a postal employee who works at the Brentwood facility seeks medical attention.
In NJ, the NJDHSS refers postal employees to their private physicians for medical treatment.  Employees begin seeking treatment at a local hospital.
In DC, a postal employee who works at Brentwood is admitted to a hospital with suspected  inhalation anthrax.
In NJ, laboratory testing confirms cutaneous anthrax in a second postal employee who works at the  Trenton postal facility.
In DC, another postal employee who works at the Brentwood facility is admitted to a hospital with a  respiratory condition.
CDC arrives at the Brentwood facility to meet with Postal Service management.
In DC, the postal employee who was admitted to the hospital on 10/19/01 is confirmed to have  inhalation anthrax.
In DC, Brentwood is closed. Evaluation and prophylaxis of employees begin.
In DC, a Brentwood employee who had initially sought medical attention on 10/18/01 is admitted to  a hospital with suspected inhalation anthrax and becomes the first postal employee (and second  anthrax victim) to die.
In DC, another postal employee who worked at the Brentwood facility seeks medical attention at a  hospital. His chest X-ray is initially determined to be normal, and he is discharged.
In DC, the postal employee who worked at the Brentwood facility and who sought medical attention  on 10/21/01 and was discharged is readmitted to the hospital with suspected inhalation anthrax,  and becomes the second postal employee (and third anthrax victim) to die.
In DC, prophylaxis is expanded to include all employees and visitors to nonpublic areas at the  Brentwood facility.
The postal employee who was admitted to the hospital on October 20 is confirmed to have  inhalation anthrax.
The Postal Service learns that environmental tests of Brentwood are positive for anthrax.
In NJ, a postal employee at Trenton is confirmed to have inhalation anthrax.
Events Occurring on That Date  In NY, preliminary tests indicate anthrax in a hospital employee who was admitted with suspected  inhalation anthrax on 10/28/01. The hospital where she works is temporarily closed, and NYCDOH  recommends prophylaxis for hospital employees and visitors.
In NJ, laboratory testing confirms cutaneous anthrax in a woman who receives mail directly from  the Trenton facility. The woman originally sought medical attention on 10/18/01 and was admitted  to the hospital on 10/22/01 for a skin condition.
In NJ, laboratory testing confirms a second case of inhalation anthrax, in a Trenton postal  employee who initially sought medical attention on 10/16/01 and was admitted to the hospital on  10/18/01 with a respiratory condition.
In NY, the hospital employee becomes the fourth anthrax victim to die.
In NY, NYCDOH announces another case of cutaneous anthrax, in a New York Post employee.
In Connecticut, an elderly woman, who was admitted to the hospital for dehydration on 11/16/01,  becomes the fifth anthrax victim to die.
The Connecticut Department of Public Health, in consultation with CDC, begins prophylaxis for  postal employees working in the Wallingford postal facility.
CDC offers the anthrax vaccine to postal employees.
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