One of the curious things about the response to Katrina was the relative invisibility of CDC Director Gerberding. She may be a catastrophically bad manager who likes to meddle in everything, but her great strength is as a superb communicator. Yet she appeared relatively little despite the many public health related questions in the aftermath of hurricane.
CDC has done its own internal critique of their response, a response they have trumpeted as one of the high points of the last few years, proof they say the Director's agency-wrecking re-organization that she has shoved done everyone's throat hasn't hurt CDC a bit. How do we know the Katrina response was so wonderful? Because CDC tells us it was:
"Our performance was excellent, but it was not perfect. And we will always work hard to find every area where we can improve," CDC spokesman Tom Skinner, speaking for Gerberding, said Monday.Dr. Richard Besser, who coordinated the CDC's response to the catastrophic hurricane on the Gulf Coast in 2005, agreed.
"I think that CDC's response to Hurricane Katrina was really one of its shining moments," said Besser, director of the agency's Coordinating Office for Terrorism Preparedness and Emergency Response.
Pressed further in an interview Friday, he said: "There were a number of critical issues that were identified in Katrina." (Alison Young Atlanta Journal Constitution)
Superlative, but still not quite perfect. Not perfect how? Sorry. The report is secret. Still in draft form. But pushed by the Atlanta Journal Constitution (AJC), CDC gave some details on their website of just how really good they were:
While the CDC was in charge of only a small portion of the federal response to Katrina, its performance is, in the agency's words, a "gauge" of its ability to coordinate logistics in a major public health crisis.
[snip]
At the time Katrina hit, the CDC acknowledges it was not fully prepared to use federal command structures and standard operating procedures required by the National Response Plan, the nation's blueprint for disaster response.
"At the time, (standard operating procedures) either did not exist, were in draft form, or were in conflict with those of other response organizations," said the CDC Web site article, titled "CDC Learns From Katrina, Plans for Pandemic."
The CDC article also said: "A clear, publicized Incident Action Plan (IAP) was not implemented, which led to confusion among our responders ... Incident action plans are now the norm for CDC's emergency response."
In internal e-mails obtained by the AJC, that confusion was evident even weeks after Hurricane Katrina made landfall near New Orleans on Aug. 29, 2005.
A Sept. 19, 2005, e-mail circulated among senior agency staff reported that, among CDC staff dispatched to the disaster area, "travel orders are missing or wrong, assignments are vague, the equipment issued from the (Director's Emergency Operations Center) doesn't work, especially the laptops, and epidemiologists are filling in to do clerical work because there is really nothing for them to do and they were not expected when they arrived."
In a Sept. 10, 2005, e-mail to dozens of CDC employees involved in the Katrina response, Dr. Douglas Hamilton described communication problems stemming from the CDC Director's Emergency Operations Center, a command center known as DEOC.
"We've all seen in the last week how problems with communication" within the operations center and between it and the field teams "and the rest of the world have created difficulties," wrote Hamilton, who directed the disease detectives in the CDC's Epidemic Intelligence Service.
Hamilton's e-mail also relayed an anecdote about a CDC employee dispatched to Mississippi who was called by the Director's Emergency Operations Center and asked: "Who is your team leader?" He added, "But enough DEOC bashing (it's wayyy too easy)."
This is all management failure, the very thing the vaunted Gerberding reorganization is supposed to address.
But enough bashing of the reorganization. It's way-y-y too easy.
- Log in to post comments
/cringe
This makes me wonder if there is a flu pandemic if we would get better numbers (e.g. incidence/mortaliy) sampling neighborhoods door-to-door (1918 way) than listening to the CDC. It is quite unfortunate because I'm guessing the people doing the legwork are qualified and motivated. Here's hoping the motivation leads to fixing the problem.
Speaking of busted laptops, I was chatting with a military friend of mine who has said that the supply system is literally leftover from the Cold War. In order to have quality gear in a timely manner, supply officers are giving the OIC (officer in charge) a credit card and saying "don't go crazy, but spend what you need". When a system is failing AND it survives regardless, it's constituents will adapt.
So, the hound-dog fox-wanna-be says, Everything is hunky-dory in the henhouse, and have the taxpayers keep that public trough filled, eh?
The Public Health Service Corps, on the other hand, seemed to do a good job. Isn't the PHSC the primary service provider? (compared to CDC anyway). It doesn't make me very confident in outbreak surveillance, however...
I have not kept up with this issue, but have heard one doctor say that (even six months after the storm) she could not get a TB test performed in New Orleans. She had to send the sample out of town and wait for a response.
Based on this, I for one wonder how good a job anyone did with this disaster.
Of course, this is not to defend the CDC, or denigrate the efforts of individuals. There were many fine efforts, which kept the near-total disaster from becoming... well... a total disaster, I guess.
You refer to Gerberding as "catastrophically bad manager" who has a propensity to "meddle in everything". As an employee of the CDC for over a decade, I must bear unfortunate witness here and testify that your withering assessment is actually an understatement of the reality of the situation.
One might ask how such a severe and harsh critique could be an understatement of the current reality at CDC? Simple: she is not MERELY an incredibly incompetent micromanager, she is ALSO:
1. malevolent
2. deceitful
3. arrogant (to an astonishing degree)
4. more prone to cronyism than all of her predecessors combined
5. mediocre as a scientist (at best)
6. unwilling to either grasp or acknowledge the core functions of a public health agency, dismissing them as irrelevant to the "new paradigm" of health issues supposedly faced by this country.
It is this last characteristic that is both the most damming and damaging. Her rationale for reinventing the agency, to adapt to the shifting demands of the new century, is a demonstration of her hubris and her lack of wisdom in appreciating and preserving the core of the agency's strengths while enhancing its ability to communicate within and outside itself. Instead, she has thrown the baby out with the bathwater and caused frustration and chaos beyond what even I had imagined she could possibly do to the place. Having known her before her rise to power, I expected as much. But not THIS much.
I could write for hours. But why? The congressional investigations have begun, the national and even international press has taken notice, and those of us without easy options to exit the place eagerly await her inevitable departure, and hope that the damage is not beyond repair. I fear that such hopes are in vain . . . it will take a decade (minimum) to undo what has already been set into motion. It may not be properly defined as a tragedy of public health . . . but it sure is sad.