A Stronger Health Department Rises From 9/11 Attacks

"They were everywhere," said Sherry Adams, assistant senior deputy director of the emergency health office.

Today, that office has 38 positions, including Natarajan's. Its budget has mushroomed from $350,000 a year to over $13 million, thanks largely to federal grants, Adams said. In addition to money distributed through the city Health Department, hospitals have received other government grants to upgrade their emergency capacity.

So much federal money has rained down to prepare for terrorism that the Health Department has been criticized for not spending it fast enough.

That's where Natarajan's job comes in.

"A large piece of it is just overseeing the CDC grant . . . making sure we're spending the money effectively," he said. He was referring to an annual grant to help prepare for health emergencies, including bioterrorism. That grant totaled $11.8 million for the District in 2005-06.

The anti-terror funds clearly have left their mark. In the past few years, the Health Department has funded disaster response training exercises at hospitals and clinics. Software has been distributed on how to recognize infectious diseases. The department has also created its own reserve corps of doctors, nurses and other personnel for emergencies.

And, the next time there's a disaster, CDC experts won't have to cram into a small computer room. Now the Health Department boasts its own crisis center, a vast room fitted out with computers linked to the city's Emergency Management Agency. Large screens will beam in CNN, videoconferences and even images from Health Department trucks at the site of an emergency.

But two audits in 2005 by the inspector general of the U.S. Department of Health and Human Services found that city health officials weren't spending all the new funds promptly and weren't correctly tracking the money.

One report, released in August, said the D.C. Health Department had used about half of the $3.6 million in federal grants awarded between April 2002 and August 2004 to prepare hospitals for a bioterrorism attack.

Another audit, released two months earlier, found that the city Health Department had spent about half of $24.5 million in federal grants for bioterrorism preparedness awarded to the city between 1999 and August 2004.

The District wasn't alone in struggling with the deluge of anti-terrorism funds. According to the June audit, a study of 17 states receiving bioterrorism grants found that "many awardees across the nation found it difficult to obligate large sums of money in short periods."

City Health Department officials said they fell behind because they were spending another $20 million in Defense Department funds approved just after the 2001 attacks. And they faced fierce competition in hiring specialists, because state governments and law enforcement agencies around the country also were beefing up their staffs.