A Stronger Health Department Rises From 9/11 Attacks
But Some Say Next Crisis Will Find City Unready

By Mary Beth Sheridan
Washington Post Staff Writer
Thursday, March 9, 2006

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.

"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.

"There was a huge spike in demand for people and supplies and equipment" related to homeland security, Natarajan said.

In addition, the Health Department was roiled by changes in leadership. In August 2004, Gregg A. Pane became the third city health director in five years. Pane, a former emergency room physician, has vowed to improve the department's handling of the anti-terrorism money.

Health Department officials say they are trying to spend the new funds carefully, investing in equipment and training that will be useful in any kind of disaster, from a hurricane to pandemic flu.

"We're not just looking at anthrax," Natarajan said.

Among the biggest outstanding jobs in preparing for a bioterrorist attack is upgrading the city laboratory. Although the lab has made improvements, it can't fully test for dangerous pathogens such as smallpox. The Health Department has agreements with federal labs to handle such crises.

Other challenges facing Natarajan and his colleagues involve humans rather than sophisticated equipment. They have been trying to improve communication with federal and local agencies after city officials learned belatedly of two bioterrorism scares last year. Neither proved dangerous.

And one of the biggest tasks is simply increasing public awareness. The Health Department is preparing an educational campaign about quarantines, which could be imposed in the event of pandemic flu or an outbreak of smallpox or plague.

"We hope to never need it," Natarajan said. "We hope all of this is an exercise in futility."