Our review of California's preparedness for responding to an infectious disease emergency revealed the following:
Although California has completed several tasks related to responding to infectious disease emergencies, it has more to do to improve its preparedness. Preparedness is ongoing in that an entity is never totally prepared; rather it can only be as prepared as resources and planning allow. Proper preparedness can save lives, protect property, and reduce the costs associated with responding to an emergency.
We found that California has emergency plans to guide its response during infectious disease emergencies, has participated in emergency exercises, and has completed many critical benchmarks associated with cooperative agreements with two federal agencies, which are designed to help prepare states and local entities for public health threats and emergencies. However, the Emergency Medical Services Authority (Medical Services) has not updated two plans that are critical for California's successful response to infectious disease emergencies: the Disaster Medical Response Plan, last issued in 1992, and the Medical Mutual Aid Plan, last issued in 1974. The chief of the Disaster Medical Services Division within Medical Services said these plans have not been updated because Medical Services lacks resources and has competing priorities. We also found that, unlike Medical Services and the Governor's Office of Emergency Services (Emergency Services), the Department of Health Services (Health Services) does not have a tracking method for following up on recommendations identified in postexercise evaluations, known as after-action reports. Without such a method, Health Services reduces the likelihood that it will take appropriate and consistent corrective action.
Further, we have concerns about the State's implementation of the cooperative agreements with two federal agencies. Although Health Services has completed 12 of 14 critical benchmarks that one of the cooperative agreements required it to complete by June 2004, we cannot conclude it completed the other two. In addition, Health Services has been slow in spending funds from another cooperative agreement. As of June 30, 2005, Health Services had spent only about $29 million (33 percent) of the almost $88 million that the federal government provided for its use from April 2002 through August 2005. Factors such as the State's hiring freeze and compliance with the State's contracting requirements appear to have impeded Health Services' ability to provide prompt funding to local public health jurisdictions, such as county or city public health departments, and private health care providers.
We visited five local public health departments (local health departments) and found room for improvement despite several factors we identified that increase their overall preparedness for responding to infectious disease emergencies. The local health departments had emergency plans that contained sufficient guidance in general for three of the four elements we reviewed that related to the process of requesting assistance from other jurisdictions for additional resources during emergencies (mutual aid), the roles and responsibilities for individuals and entities during an emergency, and the logistics and facilities used for emergency operations centers. However, neither the plans nor other local health department policies fully addressed the fourth element, which relates to exercises, evaluations, and corrective actions, because they did not include written procedures for following up on recommendations identified in after-action reports. Nonetheless, four of the five local health departments took corrective action on a sample of four recommendations identified in their after-action reports for an exercise hosted by Medical Services. Without such procedures in writing, however, the local health departments limit their ability to ensure that they take appropriate and consistent corrective action on recommendations and make necessary changes to emergency plans. In addition, none of the local health departments had fully implemented all the critical benchmarks for a federal cooperative agreement by the June 2004 deadline.
Factors we identified that serve to increase local health departments' preparedness for infectious disease emergencies included emergency plans, mutual aid, and exercises and after-action reports. Additionally, all of the State's local public health laboratories (local health laboratories), which include county and city public health laboratories, obtained certifications or accreditations to ensure that they perform certain types of laboratory tests accurately, have equipment that is in working order, and possess qualified personnel. Further, each local health department can request mutual aid formally during times of emergency and informally during nonemergencies if it becomes too overwhelmed to respond effectively using its own resources. Also, each local health department we visited participated in emergency preparedness exercises related to infectious disease emergencies. Together, these factors help improve local health departments' ability to respond effectively to infectious disease emergencies.
Finally, laboratory directors at four local health departments we visited warned us that they might have a difficult time filling laboratory director positions in the future because of certain federal and state requirements. A local health department without a laboratory director could lose its certification or accreditation. The options available to it include contracting with another local health laboratory to provide services or contracting with the director of another local health laboratory to direct its laboratory as well.
To ensure that California is better prepared to respond efficiently and effectively to infectious disease emergencies, the following steps should be taken:
Health Services stated that it has taken steps to implement one of the two recommendations we directed to it. Additionally, it provided some new information regarding one of the 14 critical benchmarks. Medical Services agrees with our conclusions and the recommendation we directed to it and provided clarifying comments. In general, the local health departments agreed with our recommendations.