Summary
In September and October 2001, at least four letters containing anthrax spores were mailed to news media personnel and two U.S. Senators, leading to the first cases of bioterrorism-related anthrax in the United States. The contaminated letters, which were delivered through the U.S. mail system, caused 22 cases of anthrax, 5 of them fatal. Nine postal employees associated with two postal facilities that processed the letters--Trenton in New Jersey and Brentwood in Washington, D.C.--contracted anthrax and two Brentwood employees died. The U.S. Postal Service closed Trenton and Brentwood, but other contaminated postal facilities remained open. GAO's review covers Trenton, Brentwood, and three of these other facilities. As requested, this report describes (1) the factors considered in deciding whether to close the five facilities, (2) the information communicated to postal employees about health risk and the extent of the facilities' contamination, and (3) how lessons learned from the response to the contamination could be used in future situations.
According to Postal Service managers, public health officials, and union representatives, the Postal Service considered the health risks to its employees ahead of its mission to deliver the mail in deciding whether to close postal facilities. The Postal Service relied on public health agencies to assess the health risks to its employees. These agencies believed the risks to be minimal until the Centers for Disease Control and Prevention (CDC) confirmed cases of anthrax in postal employees at Trenton and Brentwood. The Postal Service then closed these facilities. Public health agencies underestimated the health risks to postal employees, in part, because they did not know that anthrax spores could leak from taped, unopened letters in sufficient quantities to cause a fatal form of anthrax. The Postal Service kept the three other facilities covered by GAO's review open because public health officials had advised the agency that employees at those centers were at minimal risk. CDC and the Postal Service have said they would have made different decisions if they had earlier understood the health risks to postal employees. The Postal Service communicated information to affected postal employees about the health risks posed by, and the extent of, anthrax contamination at the five facilities in GAO's review, but problems with accuracy, clarity, and timeliness led employees to question the information they received. Problems with accuracy stemmed from incomplete information about health risks, and problems with clarity occurred as information on the medical response to anthrax contamination changed with experience. Problems with timeliness occurred when the Postal Service delayed the release of quantitative data (anthrax spore counts) for one facility, in part because it was uncertain what the results meant for worker safety and public health. To communicate more effectively, the Postal Service has established a center to coordinate information within the postal system and has worked with other agencies to develop guidelines for responding to anthrax. The response to anthrax contamination revealed several lessons, the most important of which is that agencies need to choose a course of action that poses the least risk of harm when considering actions to protect people from uncertain and potentially life-threatening health risks. Because public health officials underestimated the health risks involved, actions to protect postal employees were delayed. In addition, agencies' guidance did not cover all of the circumstances that occurred. The Postal Service has since revised its guidance, but the revised guidance (1) does not define some key terms, including those that would trigger a decision to evacuate a facility, (2) includes some outdated references that could cause confusion during a future response, and (3) does not address certain issues, such as what steps would be taken during the interval between a diagnosis of anthrax in a postal employee and confirmation of the disease. In addition, the guidance does not reflect proactive measures, including facility closures, that the Postal Service has recently implemented in response to suspected contamination.
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.
Director:
Team:
Phone:
Katherine A. Siggerud
Government Accountability Office: Physical Infrastructure
No phone on record
Recommendations for Executive Action
Recommendation: To help ensure that the Postal Service has accurate, clear, comprehensive, and up-to-date guidance for responding to an emergency, the Postmaster General should, working with other agency officials as appropriate, revise its December 2003 Interim Guidelines to define key terms, such as "suspected release" and "strong suspicion" of contamination.
Agency Affected: United States Postal Service
Status: Not Implemented
Comments: While USPS provided us with vast portions of its Integrated Emergence Management Plan, according to postal officials, the plan is not expected to be finalized this fiscal year. Furthermore, the context in which our recommendations were made has changed. Our recommendations were made prior to USPS developing and installing biological detectors in its mail processing facilities. USPS considers the biological detectors to be extremely reliable in detecting anthrax and preventing potential contamination downstream. Nearly all of the portions of the plan we reviewed deal with what USPS and others would do if a biological detector activates at a mail processing facility. While USPS could have provided additional guidance on what it would do in a facility without the biological detectors, such as a post office, it chose not to.
Recommendation: To help ensure that the Postal Service has accurate, clear, comprehensive, and up-to-date guidance for responding to an emergency, the Postmaster General should, working with other agency officials as appropriate, revise its December 2003 Interim Guidelines to ensure that any references to earlier guidance are still applicable.
Agency Affected: United States Postal Service
Status: Not Implemented
Comments: While USPS provided us with vast portions of its Integrated Emergence Management Plan, according to postal officials, the plan is not expected to be finalized this fiscal year. Furthermore, the context in which our recommendations were made has changed. Our recommendations were made prior to USPS developing and installing biological detectors in its mail processing facilities. USPS considers the biological detectors to be extremely reliable in detecting anthrax and preventing potential contamination downstream. Nearly all of the portions of the plan we reviewed deal with what USPS and others would do if a biological detector activates at a mail processing facility. While USPS could have provided additional guidance on what it would do in a facility without the biological detectors, such as a post office, it chose not to.
Recommendation: To help ensure that the Postal Service has accurate, clear, comprehensive, and up-to-date guidance for responding to an emergency, the Postmaster General should, working with other agency officials as appropriate, revise its December 2003 Interim Guidelines to clarify the actions that the Postal Service would take under various scenarios, such as when (1) the Postal Service receives preliminary evidence of anthrax contamination or (2) a postal employee is diagnosed with either inhalation or cutaneous anthrax.
Agency Affected: United States Postal Service
Status: Not Implemented
Comments: While USPS provided us with vast portions of its Integrated Emergence Management Plan, according to postal officials, the plan is not expected to be finalized this fiscal year. Furthermore, the context in which our recommendations were made has changed. Our recommendations were made prior to USPS developing and installing biological detectors in its mail processing facilities. USPS considers the biological detectors to be extremely reliable in detecting anthrax and preventing potential contamination downstream. Nearly all of the portions of the plan we reviewed deal with what USPS and others would do if a biological detector activates at a mail processing facility. While USPS could have provided additional guidance on what it would do in a facility without the biological detectors, such as a post office, it chose not to.
Recommendation: To help ensure (1) the availability of timely and appropriate emergency medical treatment and (2) that medical providers receive timely payment for emergency medical services provided to postal employees exposed to anthrax or other threatening substances, the Postal Service should establish and meet a definitive time frame for developing interim policies and procedures on paying for such services.
Agency Affected: United States Postal Service
Status: Not Implemented
Comments: The Postal Service believes that the ultimate responsibility for the availability of emergency medical treatment, including the payment for such services, lies with the Department of Homeland Security, state and municipal public health departments, and employee health plans--not the Postal Service. Nevertheless, the Postal Service reported that it continues to work with federal, state, and local first responders to plan for the availability of medical treatment in the event of another bioterrorism attack.
