Summary
The ability of the United States to effectively respond to terrorist attacks involving chemical or biological weapons is compromised by poor management controls and the lack of items on a list of required inventory. For example, GAO's review of stockpiles maintained by the Department of Veterans Affairs found discrepancies of more than 12 percent with this list. Although most of these discrepancies were overages, GAO also found shortages. The underlying cause of these problems is that federal agencies have lagged in implementing basic internal controls to help ensure that all medical supplies and pharmaceuticals are current, accounted for, and ready for use. The stakes will be even higher in the future as the Centers for Disease Control and Prevention (CDC) establishes the National Pharmaceutical Stockpile Program, which will set aside large quantities of antidotes and other medical supplies to be used in the event of domestic chemical and biological attacks. Although CDC is still in the early stages of developing this program, its current plan lacks comprehensive internal controls that would prevent the types of problems that GAO found at other agencies.
GAO noted that: (1) the U.S. ability to effectively respond to chemical or biological terrorist incidents is compromised by poor management controls and the lack of required items; (2) GAO's physical inventory of the Office of Emergency Preparedness' (OEP) stockpiles, which the Department of Veterans Affairs (VA) manages, compared with OEP's required list showed a discrepancy of more than 12 percent; (3) although most discrepancies were overages, GAO also found shortages; (4) GAO found 3,400 excess gloves at one location and 400 extra diazepam vials at another; (5) GAO also found that the inventory was short of 1,000 required diazepam injectors at one location and another location had 500 fewer vials of diazepam than required; (6) in addition, when GAO compared its inventory with VA's inventory records, GAO found expired items; (7) at one location, the entire amount of amyl nitrate listed in VA's records had expired 8 months before GAO's visit, and at another location GAO found more than 400 vials of pralidoxime whose expiration date was recorded incorrectly; (8) in comparing the Marine Corps Chemical Biological Incident Response Force's (CBIRF) medical supplies with the records in its inventory tracking system, for approximately 26 percent of the inventory items GAO found either discrepancies between the inventory records and the amount in stock or errors in the recording of lot numbers and expiration dates; (9) the principal cause of problems GAO identified is that the responsible federal agencies did not implement basic internal controls that would reasonably assure that all medical supplies and pharmaceuticals are current, accounted for, and available for use; (10) consistent with the Federal Managers' Financial Integrity Act of 1982, agencies should have efficient and effective internal controls over their operations and programs; (11) neither OEP nor CBIRF explained its lack of compliance, and GAO identified problems in all major aspects of internal controls; (12) as a result, these systems cannot be relied upon to consistently and accurately account for the items required to be in the stockpiles; (13) even more will be at stake in the future as the Centers for Disease Control and Prevention (CDC) establishes the National Pharmaceutical Stockpile Program; and (14) although CDC is still in the early phases of developing this program, its current plan does not include comprehensive internal controls to prevent the types of problems found at the other agencies.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
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Recommendations for Executive Action
Recommendation: To address internal control weaknesses, the Department of Health and Human Services' OEP, CDC, CBIRF, and VA should establish sufficient systems of internal control over their chemical and biological stockpile management. The agencies need to reasonably assure that personnel conduct risk assessments and organize program activities to identify and mitigate risks.
Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
Status: Implemented
Comments: CDC conducted a risk assessment of their National Pharmaceutical Stockpile Program and produced a report.
Agency Affected: Department of Health and Human Services: Office of Emergency Preparedness
Status: Implemented
Comments: OEP has completed risk assessments that identify and mitigate risks to its stockpiles.
Agency Affected: Department of Veterans Affairs
Status: Implemented
Comments: According to VA, an internal expert panel was chartered to conduct a subsequent risk assessment. The group issued a final report of recommendations that have been reviewed by OEP and VA. All other recommendations that were approved by OEP are completed.
Recommendation: To address internal control weaknesses, HHS' OEP, CDC, CBIRF, and VA should establish sufficient systems of internal control over their chemical and biological stockpile management. The agencies need to reasonably assure that personnel arrange for periodic, independent inventories.
Agency Affected: Department of Defense: United States Marine Corps: Chemical Biological Incident Response Force
Status: Implemented
Comments: Beginning January 2000, CBIRF began to conduct periodic inventories in accordance with governing directives and will submit results of the inventories to the CBIRF commanding officer and senior medical officer. CBIRF's policies now require that a quarterly inventory of the CBIRF stockpile be conducted, and CBIRF has submitted a request to higher headquarters for an independent inventory of its stockpile.
Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
Status: Implemented
Comments: CDC has developed an inventory requirements list and is using the list as a basis for making inventory purchases to establish the National Pharmaceutical Stockpile. It has also begun performing periodic inventory counts (p.18; GAO-01-463).
Agency Affected: Department of Health and Human Services: Office of Emergency Preparedness
Status: Implemented
Comments: OEP, along with VA, have conducted or been a part of inventories of their stockpiles.
Agency Affected: Department of Veterans Affairs
Status: Implemented
Comments: VA conducted four inventories during calendar year (CY) 2000 with assistance from OEP. OEP required one complete inventory for CY 2001, and CY 2002. OEP provided oversight during these inventories. The CY 2001 inventory was completed in June 2001. The CY 2002 inventory will be completed in October 2002.
Recommendation: To address internal control weaknesses, HHS' OEP, CDC, CBIRF, and VA should establish sufficient systems of internal control over their chemical and biological stockpile management. The agencies need to reasonably assure that personnel rotate supplies properly.
Agency Affected: Department of Defense: United States Marine Corps: Chemical Biological Incident Response Force
Status: Implemented
Comments: The CBRIF developed written policies in accordance with governing Marine Corps and Department of Navy policies to ensure proper rotation of medical supplies in their stockpile. CBIRF's Medical Supply Policy Letter identifies the procedures to be followed to rotate and dispose of CBIRF supplies.
Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
Status: Implemented
Comments: CDC developed policies and procedures related to rotating stock in their inventories.
Agency Affected: Department of Health and Human Services: Office of Emergency Preparedness
Status: Implemented
Comments: OEP, through its Memorandum of Agreement with VA, requires VA to rotate stockpiles items properly. VA's computerized tracking system will provide reports indicating future expiration dates that will allow for improved planning for ordering, receiving, shipping, and rotating items on a timely basis in the OEP stockpiles (see GAO-01-463, p. 22).
Agency Affected: Department of Veterans Affairs
Status: Implemented
Comments: VA stated that it uses automated reports of expiration dates to order products needed for each stockpile stock rotation. Stock rotations have resulted in no outdated products during fiscal year 2002.
Recommendation: To address internal control weaknesses, the Department of Health and Human Services' OEP, CDC, CBIRF, and VA should establish sufficient systems of internal control over their chemical and biological stockpile management. The agencies need to reasonably assure that personnel implement a tracking system that retains complete documentation for all supplies that have been ordered, received, and destroyed.
Agency Affected: Department of Defense: United States Marine Corps: Chemical Biological Incident Response Force
Status: Implemented
Comments: In March 2002, the U.S. Marine Corps Chemical Biological Incident Response Force (CBIRF)began using MAXIMO (a computerized system) to track its medical supply inventory throughout its lifecycle. MAXIMO allows the CBIRF to know what inventory they have, where it is located, and whether certain supplies are nearing their expiration dates.
Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
Status: Implemented
Comments: CDC has implemented an Interim Security Plan for electronic tracking of the NPS program inventory.
Agency Affected: Department of Health and Human Services: Office of Emergency Preparedness
Status: Implemented
Comments: OEP relies on VA as its inventory manager to have a system that documents that supplies have been ordered, received, and destroyed. According to VA, it uses a computerized record system to track stockpile orders, receipts, inventory, and product destruction.
Agency Affected: Department of Veterans Affairs
Status: Implemented
Comments: According to VA, it now uses a computerized record system to track stockpile orders, receipts, inventory, and product destruction.
