A Denver-based federal counterterrorism team charged with saving lives after nerve gas, nuclear or dirty-bomb attacks is facing its own challenges that threaten its ability to quickly respond.
“If getting there early is going to save lives, we are not going to save as many lives,” said Dr. Charles Goldstein, commander of the 90-member unit.
The team of doctors, nurses and paramedics – a unique unit in the 107-team National Disaster Medical System – is supposed to be able to mobilize within hours, then fly into chaos and work through the crucial first few days after an attack to contain casualties.
But overspending has mired the system in debt, forcing the suspension of funding for such teams while Federal Emergency Management Agency supervisors scramble to sort out irregularities.
Team members say the problems threaten to compromise their work in a disaster by impeding maintenance of equipment, limiting paid training and increasing the time it takes to prepare to go.
The Denver team now requires eight hours to mobilize, two hours more than the FEMA standard, for lack of a functioning centralized pager-notification system, Goldstein said. He blames poor FEMA oversight.
More than a year after Hurricane Katrina called FEMA’s management into question, the agency’s stewardship of the disaster medical system “is dysfunctional and complex,” Goldstein said.
The problems have shaken the entire National Disaster Medical System, which was formed during the Cold War as a prized asset of the Public Health Service.
FEMA took over the system after the Sept. 11, 2001, attacks amid concerns that terrorists would launch more attacks inside the United States. Congress gave it $34 million a year. It includes teams with specialized capabilities ranging from handling heaps of dead bodies to helping distressed animals.
Now – on orders from the White House – the U.S. Department of Health and Human Services is poised to take back the system as part of a post-Katrina reorganization.
Three teams in nation
Goldstein’s team operates out of a beige warehouse in north Denver holding millions of dollars’ worth of equipment and vehicles. It is one of three elite medical teams in the system. Others are positioned in Los Angeles and Raleigh-Durham, N.C.
It is the nation’s only team configured to travel on short notice by air using collapsible gear that fits into easily transportable containers.
Its mission is responding to terrorist attacks involving weapons of mass destruction, though all teams in the system can work after natural disasters and other crises as well. The Denver team worked in Houston for two weeks after Katrina.
But team spending on training and maintenance so exceeded the system’s budget that FEMA supervisors shut down funding in September. The deficit amount “is still being reviewed,” said Jack Beall, chief of the system at FEMA, in response to written questions from The Denver Post.
Goldstein said that he couldn’t say how much he spent this year but that the total doesn’t exceed his roughly $800,000 annual budget from 2005.
“They’ve never told me how much money I’m allowed to spend” in 2006, he said.
Team members are classified as “intermittent federal employees” and until recently received from $13 to $50 an hour, depending on their skill level, for work devoted to the team. As a doctor, Goldstein, 59, said he has collected $50 an hour for 24 hours a week of work outside his private medical practice to run the team – about $57,600 a year.
If FEMA officials “tell me what the rules are, I’m going to play by them,” he said. “But they are not telling us what the rules are. And then they keep changing them midstream.
“We are doing things, utilizing our best judgment, to accomplish the mission and keep our teams in a state of appropriate readiness and alertness.”
Outside work questioned
Some units of the National Disaster Medical System, including the Denver-based team, solicit additional outside funding. Goldstein arranged a $75,000- a-year sponsorship from the Hospital Corporation of America. At FEMA headquarters, Beall said the sponsorship is illegal under federal rules to guard against conflicts of interest.
Said Goldstein: “We weren’t told we can’t do that. We were told there were potential conflicts of interest. They said they were going to investigate teams individually. That never went anyplace.”
The Denver team formed a nonprofit foundation after the Sept. 11 attacks to raise money and do outside work. This nonprofit sought and won a $600,000 state government contract to run a database and train local medical volunteers.
FEMA officials said teams can do outside work like this and accept payment as long as they are not acting in their federal capacity. It’s unclear whether that means team members can work together and use federally funded equipment.
Now the interruption of funding threatens response capabilities. For example, Goldstein said, his 13 vehicles no longer are fully maintained, and crews are hard-pressed to handle tedious but crucial tasks such as charging more than 425 batteries that run respirators, air-monitoring devices and other tools.
Limited funding resumed this month, but the Denver team now operates at “a sub-optimal level,” Goldstein announced in a recent memo to team members.
At FEMA headquarters in Washington, new managers hired after the Hurricane Katrina debacle acknowledged problems with the disaster medical teams. They say they’re investigating and scrambling to put in order a system the nation could need any day.
Supervisors cut off funds in September because “a number of teams had overspent their budgets,” said Glenn Cannon, director of FEMA’s response division.
Team leaders “got in trouble because they tried to make it like there were full-time positions when in fact there weren’t,” Cannon said, declining to single out specific teams.
“Now,” Cannon said, “we will watch, much more closely, the spending rates of the teams.”
U.S. Health and Human Services officials who will take over the disaster-response system in January said they’ll have lawyers review all FEMA decisions.
The system “needs strengthening,” said Public Health Service Rear Adm. Dr. Craig VanDerwagen, an assistant secretary for public health emergency preparedness.
Maintaining an elite team that can fly into a crisis within four hours is essential, VanDerwagen said.
Team members around the country “are appropriately anxious, perhaps frustrated, and somewhat angry because of the movement back and forth (between agencies) over the past two years,” he said.
Where the cuts will hurt
Now, after the sudden suspension of funding, Denver team members train on a volunteer basis. This month, managers were allotted a combined total of 48 paid hours a week to coordinate training and keep equipment ready, Goldstein said.
“There are things that are going to suffer,” he said. “I have 13 vehicles that are supposed to be driven 50 miles a month. I can’t pay people to do that anymore. … Is fuel going to start leaking from one of my trucks because it hasn’t been lubricated?”
Last Sunday, a dozen or so nurses, doctors and paramedics gathered for training in their rented 16,600-square-foot warehouse, east of Interstate 25, amid millions of dollars’ worth of gear, from drug supplies to nerve gas detectors.
Clad in chocolate-colored protective overalls, lime-green rubber boots and double gloves, they practiced inserting breathing tubes into a mannequin while wearing gas masks that made their voices sound pinched and faraway.
“Like working underwater,” said team member Dr. David Levine, 57. “Cumbersome.”
Team members set up collapsible stretchers. They set up a collapsible decontamination tent and an accordion-like apparatus for moving unconscious victims on backboards through a scrubbing zone. They reviewed procedures for jamming injectors filled with atropine, a nerve gas antidote, into their thighs.
Now, with federal funding reduced and seemingly uncertain, some team leaders seek new jobs to make up lost income.
“I can do this for a couple months, but then it will start getting tight,” said team administrator Wendy Colon, whose paid hours were cut from 40 a week to 24. “And there are some things that aren’t being done.”
Yet despite uncertainties, every terrorism-related news bulletin, such as the recent one about possible radiological bombs in football stadiums, sends team member Edie Lindeburg, 40, bolting to a spare room in her house, where her black duffel bag sits ready to go.
“I run and check my equipment. I think: ‘Did I do the battery check? Who do I have to notify if I go?”‘ said Lindeburg, an 18-year-veteran hospital and emergency room nurse.
“I’d be scared to death” to walk into the scene of a nuclear or chemical attack, she said. “But I still am ready to do that.”
Staff writer Bruce Finley can be reached at 303-954-1700 or bfinley@denverpost.com.
