This is an archive page. The links are no longer being updated.
ROBERT F. KNOUSS, M.D.
DIRECTOR, OFFICE OF EMERGENCY PREPAREDNESS
DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCOMMITTEE ON NATIONAL SECURITY, VETERANS AFFAIRS AND
COMMITTEE ON GOVERNMENT REFORM
U. S. HOUSE OF REPRESENTATIVES
MAY 1, 2001
Mr. Chairman and Members of the Committee,
Once again, it is my pleasure to appear before this Committee to discuss
program activities of the Office of Emergency Preparedness (OEP). I am Dr. Robert
Knouss, the Director of OEP.
Last year, I appeared here to discuss the General Accounting Office (GAO)
report that had been recently released about the four specialized pharmaceutical
caches used by our National Medical Response Teams (NMRTs).
These pharmaceutical stockpiles were designed to be deployed with our NMRTs
in responding to a weapon of mass destruction (WMD) event and providing medical
care to its victims. Three of the teams (West Coast, Central and East Coast) can be
deployed anywhere in the country. The Mid-Atlantic team is committed to responding to
incidents in the Washington, D.C. metropolitan area, including the U.S. Capitol. The
stockpiles associated with each of these four teams contain specialized
pharmaceuticals to treat up to 5,000 victims of a chemical exposure to nerve agents
such as sarin and VX; vesicants, such as mustard gas; and pulmonary agents such as
phosgene. In addition, each stockpile has medicines to provide the initial care at the
scene for these victims, stabilizing them medically until they arrive at a health care
In the original report on the status of the stockpiles, GAO raised concerns about
the manner in which the caches were managed and the oversight provided by OEP.
We have appreciated GAO's comments, suggestions and insights, and have been
working diligently with the Department of Veterans Affairs (VA) to correct problems,
improve internal controls and tighten OEP management practices.
We have made a great deal of progress in these areas. We have assured
appropriate storage and physical security of the stockpiles; strengthened internal
controls, including 100 percent inventories of all of the caches, as well as independent
reviews; established regular communications with the VA; conducted risk assessments;
ensured regular and recurring management oversight by OEP; approved operational
plans for each location; and ensured that an approved, updated inventory requirement
list is maintained.
However, we still have a number of things to do. GAO recently completed its
final report on the stockpiles. We appreciate that they noted the significant progress
that we have made to bring these caches into compliance with all regulations and
appropriate internal control procedures.
In its recently released report, GAO commented on some progress that still
needed to be made, and made some recommendations to OEP. At this time, I would
like to address these recommendations and discuss what we are still doing to complete
the activities, to ensure that the stockpiles meet all requirements and to be able to
deploy them in a timely and effective response.
Within the next month or two, we will be moving our Central cache to a new
location, in order to ensure that appropriate physical security and safeguards are in
place, as well as to ensure that temperature controls are maintained. This action will
mitigate problems that have occurred at the current location with some of the cache
being exposed to higher than acceptable temperatures. We do not believe that the
observed temperature fluctuation degraded the effectiveness of the pharmaceuticals.
However, we will be replacing all of the affected drugs when the cache is moved. While
the GAO report notes that the items that were exposed to the higher temperature may
not be effective in the event of a terrorist incident, we would note that we have three
other caches that can be moved if necessary.
GAO noted that OEP lacked detailed written inventory procedures necessary to
help ensure overall reliability of inventory records. They also said that OEP had not
updated its requirements list for significant increases to its stockpile. Both of these
issues have subsequently been addressed. Detailed inventory procedures and
operating plans have been approved for each cache location and detailed requirements
lists have been updated and transmitted to the VA. I would add that this was, in large
part, a procedural matter in that plans that had been approved lacked solely the final
GAO also stated that there were no published discrepancy rates, and that in the
absence of this information, there was no data with which to measure the inventory
results. Error rates have been discussed with the VA. We established a zero tolerance
error rate for controlled substances and an error rate of three to five percent for low cost
Finally, GAO expressed concern about the lack of training for VA personnel
involved in stockpile management. Later this month, we will be bringing VA personnel,
in addition to other Public Health Service teams to the Noble Training Center in
Anniston, AL, to conduct training, in conjunction with CDC, on deploying and
distributing the National Pharmaceutical Stockpile. We will be providing Oracle
software training to VA staff for managing cache inventories. And we recently provided
HAZMAT training for VA staff at the National Disaster Medical System conference that
was held last month in Dallas.
Mr. Chairman, OEP has been working diligently to ensure that all internal control
procedures are met, that the stockpiles are current and adequately safeguarded, and
that we can deploy them quickly. It is my sincere hope that these stockpiles will never
have to be used, but we will continue to assure our readiness to respond, if necessary.
That concludes my prepared remarks. I would be pleased to answer any
questions you may have.
Last revised: May 30, 2001