A Stronger Health Department Rises From 9/11 Attacks

But Some Say Next Crisis Will Find City Unready

Rod Blair, left, Sherry Adams and Nitin Natarajan are part of an expanded Emergency Health and Medical Services office, part of the city Health Department. From five employees, the office has grown to 38 since 2001. (By James M. Thresher -- The Washington Post)

Nitin Natarajan was attending a meeting of emergency medical officials in Albany, N.Y., when the room suddenly went quiet. On a hotel TV screen, a plane was hurtling into the World Trade Center, detonating a monstrous cloud of debris.

Natarajan was only 25, but he already was in charge of regulating EMS training throughout the Hudson Valley. This was his stuff. The paramedic jumped in his car and headed south. By the evening of Sept. 11, 2001, he was with a federal medical team at Ground Zero.

"It was surreal, almost. Being a New York-based team, we all lost friends," he recalled.

Now Natarajan is helping the District prepare for the next attack. Since last summer, he has been the city's first bioterrorism coordinator, part of a greatly expanded city Health Department focused on natural and man-made disasters.

Natarajan's appointment reflects how parts of the city government have been transformed in the wake of the 2001 attacks on New York City and the Pentagon, and the subsequent anthrax crisis. The change is obvious in the police and fire departments, which have new equipment including radios and ambulances.

Less evident are the kinds of changes at the Health Department: more funds for emergency training, specialists such as Natarajan and a high-tech system that monitors patients' symptoms and looks for patterns signaling a biological attack.

The city still is not as prepared as it should be for such health crises, experts say. A recent report by Trust for America's Health, a nonprofit group that evaluates disaster readiness, highlighted shortcomings such as the District's lack of laboratory facilities to test for deadly pathogens and the need for a plan to ensure that health professionals report to work in the event of an outbreak. More generally, the city Health Department suffers from a legacy of neglect, underfunding and leadership changes, said Shelley Hearne, executive director of the nonprofit group.

However, she said, "the signs have been very positive recently. They've had more stable leadership. [Emergency preparedness] has gotten a lot of attention."

Natarajan, who was born in India and spent his childhood in Canada, took up his post in August, leaving a job as a hospital administrator in New York's Westchester County. Even as a child, he dreamed of being an emergency room doctor; at 16, he began riding on an ambulance as an EMS volunteer. He worked as a firefighter, paramedic and hazardous-materials technician before moving into supervisory positions.

Natarajan was attracted to the District in part because of its importance as a terrorist target. In other cities, he noted, "people are looking at exercises, modeling [for emergencies]. D.C. has actually done it."

The D.C. Health Department was as stunned as the rest of Washington when the city suffered its first bioterrorism attack in October 2001. Anthrax spores were released from mysterious letters sent to congressional offices, killing two postal workers.

At the time, the Health Department's Emergency Health and Medical Services office had just five employees. Scores of experts from the Centers for Disease Control and Prevention descended on the department's headquarters at 825 North Capitol St. NE, occupying all the empty cubicles and using a small computer-training room as an operations center.