oversight

U.S. Postal Service: Clear Communication with Employees Needed before Reopening the Brentwood Facility

Published by the Government Accountability Office on 2003-10-23.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                             United States General Accounting Office

GAO                          Testimony
                             Before the Committee on Government
                             Reform, House of Representatives


For Release on Delivery
Expected at 1:30 p.m. EDT
Thursday, October 23, 2003   U.S. POSTAL SERVICE
                             Clear Communication with
                             Employees Needed before
                             Reopening the Brentwood
                             Facility
                             Statement of 


                             Bernard L. Ungar, Director 

                             Physical Infrastructure 


                             Keith Rhodes, Chief Technologist 

                             Center for Technology and Engineering, Applied Research 

                             and Methods 





GAO-04-205T 

                                                October 23, 2003


                                                U.S. POSTAL SERVICE

                                                Clear Communication with Employees
Highlights of GAO-04-205T, a testimony          Needed before Reopening the Brentwood
before the Committee on Government
Reform, House of Representatives                Facility



On October 21, 2001, the U.S.                   The Postal Service’s decision to wait to close the Brentwood facility and
Postal Service closed its                       refer employees for medical treatment until CDC confirmed that a postal
Brentwood mail processing facility              employee had contracted inhalation anthrax was consistent with the advice
after the Centers for Disease                   the Postal Service received from public health advisers and the information
Control and Prevention (CDC)                    about health risk available at the time. However, because circumstances
confirmed that an employee there
had contracted inhalation anthrax,
                                                differed at Brentwood and the Hart Building—an observed spill at the Hart
an often-fatal form of the disease.             Building and no observable incident at Brentwood—the Postal Service’s
On October 21 and 22, two other                 response differed from the response at Capitol Hill, leading some Brentwood
Brentwood employees died of                     employees to question whether the Postal Service was taking adequate steps
inhalation anthrax. The                         to protect their health.
contamination was linked to a
letter that passed through the                  The Postal Service communicated information to its Brentwood employees
facility on or about October 12,                during the anthrax incident, but some of the health risk information changed
before being opened in the office of            over time, exacerbating employees’ concerns about the measures being
Senator Daschle (see fig.) in the               taken to protect them. Notably, employees later learned that their risk of
Hart Senate Office Building on
                                                contracting the disease was greater than originally stated. Other factors,
October 15. The Hart Building was
closed the next day. The                        including difficulties in communicating the uncertainty associated with
Brentwood facility has since been               health recommendations and employees’ distrust of postal managers, also
decontaminated and will soon                    challenged efforts to communicate effectively. Recently, the Postal Service
reopen. This testimony, which is                informed employees that Brentwood, which has been tested and certified as
based on ongoing work, provides                 safe for occupancy, is “100 percent free of anthrax contamination.”
GAO’s preliminary observations on               However, in discussions with GAO, the Service agreed to revise future
the decisions made in closing the               communications to acknowledge that although any remaining risk at the
facility and problems experienced               facility is likely to be low, complete freedom from risk cannot be guaranteed.
in communicating with employees,
as well as lessons learned from the             The Postal Service and others have learned since the 2001 anthrax incidents
experience.
                                                that (1) the risk of contracting anthrax through the mail is greater than was
                                                previously believed and more caution is needed to respond to that greater
                                                risk and (2) clear, accurate communication is critical to managing the
Because the Postal Service agreed               response to an incident and its aftermath. The Postal Service is revising its
to inform Brentwood employees                   guidance to respond more quickly and to communicate more effectively to
before the facility is reopened that            employees and the public in the event of a future incident.
it could not guarantee that the
facility is completely risk free, GAO
                                                Anthrax-Contaminated Letter Opened in Hart Building on October 15, 2001
is making no recommendations at
this time.




www.gao.gov/cgi-bin/getrpt?GAO-04-205T.

To view the full product, including the scope
and methodology, click on the link above.
For more information, contact Bernard L.
Ungar at (202) 512-2834 or ungarb@gao.gov.
Mr. Chairman and Members of the Committee:

We are pleased to be here to discuss issues related to the U. S. Postal
Service’s response to the anthrax1 contamination at the Washington D.C.
Processing and Distribution Center, or Brentwood, as it was commonly
known.2 As you know, the facility was renamed the Joseph Curseen Jr. and
Thomas Morris Jr. Processing and Distribution Center in memory of the
two Brentwood employees who died of inhalation anthrax on October 21
and 22, 2001. Inhalation anthrax is the most lethal form of the disease. The
facility is about to reopen after being closed 2 years ago this week for
decontamination and renovation. My testimony today will focus on the (1)
decisions made by the Postal Service in closing the Brentwood facility and
(2) problems the Postal Service experienced in communicating to its
employees as well as (3) lessons that can be learned from the experience.
While you also asked us to address the effectiveness of the facility’s
decontamination, we are unable to do so because this issue is outside the
scope of work that we have under way. However, we will relay our
observations about communication issues associated with the facility’s
decontamination.

My testimony today is based largely on our ongoing work addressing the
treatment of postal employees at several postal facilities, including the
Brentwood facility, that were contaminated with anthrax spores in late
2001. This work, which we expect to complete within the next several
months, is being done at the request of Senator Joseph I. Lieberman and
Representatives Christopher H. Smith and Eleanor Holmes Norton. Our
work thus far has involved interviews with individuals involved in the
response to the contamination, including representatives from the Postal
Service, the Department of Defense, the Centers for Disease Control and
Prevention (CDC), and state and local public health agencies and postal
unions as well as reviews of relevant documents and literature related to
the anthrax response. We are also drawing from our completed work
addressing anthrax contamination at a postal facility in Connecticut,3



1
 Technically, the term “anthrax” refers to the disease caused by Bacillus anthracis and not
the bacterium or its spores. In this report, we use the term “anthrax” for ease of reading
and to reflect terminology commonly used in the media and by the general public.
2
In this report, we refer to the facility as Brentwood.
3
 U.S. General Accounting Office, U.S. Postal Service: Better Guidance Is Needed to
Improve Communication Should Anthrax Contamination Occur in the Future,
GAO-03-316 (Washington, D.C.: Apr. 7, 2003).



Page 1                               GAO-04-205T Reopening the Brentwood Postal Facility
issues related to the testing for anthrax in that facility,4 and the public
health response to the 2001 anthrax incidents.5 Our work is being
performed in accordance with generally accepted government auditing
standards. The observations that we are making are based on our ongoing
work and should be viewed as preliminary.

Before I discuss the decisions made in closing the Brentwood facility, let
me briefly place these decisions in context. When the Postal Service
learned that a letter contaminated with anthrax spores had been sent
through the mail and opened in the office of Senator Daschle within the
Hart Senate Office Building (Hart Building) on October 15, 2001, the Postal
Service reports that it immediately understood that the letter passed
through its Brentwood facility. However, at that point, the risk of
contamination and its consequences at the facility were uncertain. The
Postal Service sought advice and guidance from CDC and the District of
Columbia (D.C.) Department of Health, provided information to its
employees, arranged for environmental tests of the facility, and provided
some protective equipment, but it did not close the facility or refer the
facility’s employees for medical treatment until October 21, when CDC
confirmed that a Brentwood employee had inhalation anthrax. The Postal
Service’s actions contrasted with those taken by the Attending Physician
for the U.S. Capitol—the individual responsible for the health of public
officials and other congressional employees on Capitol Hill. The Attending
Physician decided to make antibiotics available to the most directly
exposed congressional employees on the same day the contaminated letter
was opened and advised closure of the Hart Building the following day.

In summary:

The Postal Service’s decision to wait for CDC’s confirmation of a case of
inhalation anthrax before closing Brentwood and referring its employees
for medical treatment was consistent with the advice it received from CDC
and the D.C. Department of Health as well as the information about health
risk available at the time. However, the decision raised questions among
Brentwood employees about whether their health was being adequately
protected. At the time, CDC advised waiting for such confirmation before


4
 U.S. General Accounting Office, U.S. Postal Service: Issues Associated with Anthrax
Testing at the Wallingford Facility, GAO-03-787T (Washington, D.C.: May 19, 2003).
5
 U.S. General Accounting Office, Bioterrorism: Public Health Response to Anthrax
Incidents of 2001, GAO-04-152 (Washington, D.C.: Oct. 15, 2003).



Page 2                             GAO-04-205T Reopening the Brentwood Postal Facility
recommending closing a facility or recommending medical treatment
because CDC and local public health authorities believed it unlikely that
postal employees could contract inhalation anthrax from exposure to
contaminated mail. The Postal Service’s decision differed from the
decision to close the Hart Building, in large part, because there was an
observable incident of anthrax contamination there—which was
immediately recognized as a potentially high-risk situation—whereas there
was no observable incident at Brentwood. However, even before CDC
confirmed the first case of inhalation anthrax at Brentwood, some Postal
Service employees questioned whether the Postal Service’s actions
adequately protected their health.

The Postal Service communicated health risk and other information to its
Brentwood employees during the anthrax incident, but some of the
information it initially provided changed as public health knowledge
evolved—exacerbating employees’ concerns about the adequacy of the
measures being taken to protect them. Most significantly, employees later
learned that their risk of contracting the disease was greater than
originally stated. Other factors, including difficulties in communicating the
uncertainty associated with health recommendations, the appearance of
disparate treatment between Brentwood and congressional employees,
and employees’ long-standing distrust of postal managers, also challenged
efforts to communicate effectively. According to postal managers, the
Postal Service has made additional efforts to communicate with
Brentwood employees since the facility’s closure, but challenges remain,
including before the facility opens to clearly communicate the
impossibility of eliminating all risk of contamination from the
environment. Recently, for example, the Postal Service informed
employees that Brentwood, which has been tested and certified as safe for
occupancy, is “100 percent free of anthrax contamination.” However,
following discussions with us about the impossibility of eliminating all risk
of contamination, the Postal Service agreed to revise future
communications to acknowledge that although any remaining risk at the
facility is likely to be low, complete freedom from risk cannot be
guaranteed.

The Postal Service, CDC, and others have learned a great deal from the
2001 anthrax incidents and have taken various steps to address the
problems that occurred and to enhance their preparedness for any future
incidents. One of the lessons learned is that the risk of employees
contracting anthrax through the mail is greater than was previously
believed and more caution is needed to respond to that greater risk.
Another important lesson learned is that clear and accurate

Page 3                        GAO-04-205T Reopening the Brentwood Postal Facility
               communication to employees is critical to managing the response to an
               incident and its aftermath. The Postal Service, CDC, and others have taken
               steps to revise their guidance to respond more quickly in the event of a
               future anthrax incident and to communicate more effectively about such
               an incident with employees and the public. The Postal Service told us that
               it would inform Brentwood employees prior to opening the Brentwood
               facility that while the facility is safe for occupancy, it is impossible to
               guarantee that it is risk free.


               Anthrax is an acute infectious disease caused by the spore-forming
Background 	   bacterium called Bacillus anthracis. The bacterium is commonly found in
               the soil and forms spores (like seeds) that can remain dormant for many
               years. Although anthrax can infect humans, it occurs most commonly in
               plant-eating animals.

               Human anthrax infections are rare in the United States and have normally
               resulted from occupational exposure to infected animals or contaminated
               animal products, such as wool, hides, or hair. Infection can occur in three
               forms, two of which are relevant to this testimony. They are (1) cutaneous,
               which usually occurs through a cut or abrasion6 and (2) inhalation, which
               results from breathing aerosolized anthrax spores into the lungs.7
               Aerosolization occurs when anthrax spores become airborne, thus
               enabling a person to inhale the spores into the lungs. After the spores
               enter the body, they can germinate into bacteria, which then multiply and
               secrete toxins that can produce local swelling and tissue death. The
               symptoms are different for each form of infection and are thought to
               appear within about 7 days of exposure, although individuals have
               contracted inhalation anthrax as long as 43 days after exposure.
               Depending on the extent of exposure and its form, a person can be
               exposed to anthrax without developing an infection. Before the 2001
               incidents, the fatality rate for inhalation anthrax was approximately 75
               percent, even with appropriate antimicrobial medications.8 People coming
               in contact with anthrax in its natural environment have generally not been



               6
                Cutaneous means of, relating, to or affecting the skin. Cutaneous anthrax is characterized
               by lesions on the skin.
               7
                The third form of anthrax infection is gastrointestinal, which results from ingesting
               undercooked contaminated meat.
               8
                An antimicrobial medication either kills or slows the growth of microbes. Antibiotics are
               an example of antimicrobial medications.


               Page 4                               GAO-04-205T Reopening the Brentwood Postal Facility
at risk for inhalation anthrax, and before 2001, no cases of inhalation
anthrax had been reported in the United States since 1976, although 224
cases of cutaneous anthrax were diagnosed between 1944 and 1994.9
Fatalities are rare for cutaneous anthrax.

Because so few instances of inhalation anthrax have occurred, scientific
understanding about the number of spores needed to cause the disease is
still evolving. Before the 2001 incidents, it was estimated that a person
would need to inhale thousands of spores to develop inhalation anthrax.
However, based on the cases that occurred during the fall of 2001, experts
now believe that the number of spores needed to cause inhalation anthrax
could be very small, depending on a person’s health status and the
aerosolization capacity of the anthrax spores.

In total, the contaminated letters caused 22 illnesses and resulted in 5
deaths from inhalation anthrax. Numerous postal facilities were also
contaminated. The first two cases of disease involved media employees in
Florida. The employees—one of whom died—contracted inhalation
anthrax and were thought to have contracted the disease through
proximity to opened letters containing anthrax spores. Media employees
also developed anthrax in New York—the second location known to be
affected. The initial cases in New York were all cutaneous and were also
thought to have been associated with opened envelopes containing
anthrax spores. The initial cases at the next site—New Jersey—involved
postal employees with cutaneous anthrax. The postal employees were
believed to have contracted the disease through handling the mail—as
opposed to opening or being exposed to opened letters containing anthrax
spores. Unlike the incidents at other locations, which began when cases of
anthrax were detected, the incident at the Hart Building—the fourth
location—began with the opening of a letter containing anthrax spores
and the resulting exposure to the contamination. The discovery of
inhalation anthrax in the first postal worker from Brentwood revealed that
even individuals who had been exposed only to taped and sealed
envelopes containing anthrax could contract the inhalation form of the
disease. Subsequent inhalation cases in Washington, D.C.; New Jersey;
New York; and Connecticut—the sixth location affected—underscored
that finding and also demonstrated that exposure and illness could result




9
 Journal of American Medical Association, Anthrax as a Biological Weapon: Medical and
Public Health Management, May 12, 1999. Volume 281, No. 18.



Page 5                            GAO-04-205T Reopening the Brentwood Postal Facility
from cross contamination of mail.10 (See app. I for a time line of selected
events related to the anthrax incident in the fall of 2001.)

On or about October 9, 2001, at least two letters containing anthrax spores
entered the U.S. mail stream—one was addressed to Senator Thomas
Daschle, the other to Senator Patrick Leahy. The letters were mailed in
Trenton, New Jersey, and forwarded to the Brentwood facility in
Washington, D.C., where they were processed on high-speed mail sorting
machines and further processed in the facility’s government mail section
before delivery.11 On October 15, a staff member in Senator Daschle’s
office opened the contaminated envelope. The envelope contained a
powdery substance, which the accompanying letter identified as anthrax,
that was released in a burst of dust when the envelope was opened. The
U.S. Capitol Police were notified, and the substance was quickly tested
and confirmed to be anthrax. Brentwood managers analyzed the path of
the letter through the facility. Although the machine that processed the
letter was reportedly shut off—at least for a period of time—the facility
itself was not closed or evacuated at that time. Within days, a Brentwood
employee was suspected of having contracted inhalation anthrax. The
Postal Service closed the facility on October 21, 2001, after CDC confirmed
that the employee had the disease. Thereafter, two other Brentwood
employees, Mr. Curseen, Jr., and Mr. Morris, Jr., died. Both were
subsequently found to have died of inhalation anthrax.

The Brentwood facility is a large 2-story facility that operated 24 hours a
day, 7 days a week. About 2,500 employees worked at Brentwood,
processing mail on one of three shifts. Brentwood processed all the mail
delivered to addresses on Capitol Hill, including the Hart Building.
Brentwood was the second processing and distribution center closed for
an extended period because of anthrax contamination. The Postal Service
reported that it plans to reopen the facility in phases; by late November
administrative personnel will begin working in the facility and limited mail
processing operations will begin shortly after that. Brentwood is expected
to be fully operational by spring 2004. The other facility—the Trenton
Processing and Distribution Center—located in Hamilton, New Jersey, was
closed 3 days before Brentwood on October 18, 2001, after CDC confirmed


10
  Cross contamination occurs when other pieces of mail or equipment come in contact with
the original source of the anthrax.
11
 The letter addressed to Senator Leahy was never delivered. Instead, it was recovered in
November 2001 in mail that had been quarantined on Capitol Hill on October 17, 2001.



Page 6                             GAO-04-205T Reopening the Brentwood Postal Facility
                        that a New Jersey postal employee had cutaneous anthrax. It is in the
                        process of being decontaminated.


                        The Postal Service’s decision to wait for CDC’s confirmation of a case of
Brentwood               inhalation anthrax before closing Brentwood and referring the facilities’
Employees               employees for medical treatment was consistent with the public health
                        advice the Postal Service received and the health risk information
Questioned Whether      available at the time. However, the Postal Service’s decision contrasted
the Decision to Wait    with the more immediate decision to close the Hart Building after anthrax
                        contamination occurred. As a result, postal employees questioned whether
for Confirmation of     the Postal Service’s decision adequately protected their health.
Inhalation Anthrax
Adequately Protected
Their Health

The Postal Service’s    The Postal Service’s decision to wait for CDC’s confirmation of a case of
Decision Was Based on   inhalation anthrax before closing Brentwood and referring its employees
CDC’s Advice and        for medical treatment was consistent with the advice provided by CDC
                        and the D.C. Department of Health, as well as the available health risk
Available Health Risk   information. CDC called for such confirmation before closing a facility or
Information             recommending medical treatment because, at the time, public health
                        authorities believed postal employees were unlikely to contract inhalation
                        anthrax from exposure to contaminated mail. Postal officials reported that
                        they consulted CDC and the D.C. Department of Health about the possible
                        health risks to Brentwood employees after learning that Senator Daschle’s
                        letter—opened on October 15, 2001—contained anthrax. Even though the
                        letter would have passed through Brentwood, the public health authorities
                        said that they did not consider the facility’s employees at risk, given the
                        results of ongoing investigations of anthrax incidents in Florida and New
                        York and the scientific understanding at that time. Specifically, as
                        discussed, no postal employees were known to have developed symptoms
                        of anthrax after contaminated letters had passed through the postal
                        system on the way to destinations in Florida and New York, and anthrax
                        spores were not considered likely to leak out, or escape from, a taped and
                        well-sealed envelope in sufficient quantities to cause inhalation anthrax.
                        Accordingly, the Postal Service reported that it kept the Brentwood facility
                        open in order to keep the mail moving. This goal was important to
                        managers whom we interviewed, who cited the psychological importance
                        of keeping the mail flowing in the aftermath of the September 11 terrorist
                        attacks.

                        Page 7                        GAO-04-205T Reopening the Brentwood Postal Facility
On October 18, 2001, CDC confirmed that a postal employee in New Jersey
had cutaneous anthrax. On that day, the Postal Service, in consultation
with the New Jersey Department of Health and Senior Services, closed the
Trenton Processing and Distribution Center. According to New Jersey
public health officials, the facility was closed to facilitate environmental
testing of the Trenton facility. While the contaminated letters to Senator
Daschle and Senator Leahy were both processed through the Trenton and
Brentwood facilities, it is not clear why the Postal Service did not take the
same precautionary measures at Brentwood. We are pursuing this issue as
part of our ongoing work.

Although the Postal Service followed CDC’s advice and kept Brentwood
open until CDC confirmed a case of inhalation anthrax, the Postal Service
took interim steps to protect its employees. First, the Postal Service
arranged for a series of environmental tests at the Brentwood facility, even
though it reported that CDC had advised the Postal Service that it did not
believe such testing was needed at that time. The results of the first test—
taken and available on October 18, 2001—were from a quick test
conducted by a local hazardous materials response team. The results were
negative. Three days later, on October 21, 2001, CDC confirmed that a
Brentwood employee had inhalation anthrax, and the Postal Service
closed the facility and referred its employees for medical treatment. The
positive results of more extensive environmental testing—also conducted
on October 18, 2001—were not available until October 22—after the
facility had already closed. In addition, Postal Service managers said they
asked the D.C. Department of Health three times before October 21 for
nasal swabs and antibiotics for Brentwood employees; however, the health
department said the swabs and antibiotics were unnecessary. We have not
yet been able to confirm this information with the D.C. Department of
Health. Finally, the Postal Service took actions to protect its employees
from low-level environmental risks. For example, it provided protective
equipment such as gloves and masks and, according to postal managers,
shut down the mail-sorting machine that processed the Daschle letter, at
least for a time. Additionally, the Postal Service provided information on
handling suspicious packages and required facility emergency action plans
to be updated.

In 1999, the Postal Service developed guidance for responding to anthrax
and other hazardous incidents. The guidance, which was developed in
response to hundreds of hoaxes, includes steps for notifying first
responders, evacuating employees, and providing information and medical
care to employees. The Postal Service reported that the guidance deals
with observable events—specifically, spills—not events that are not

Page 8                        GAO-04-205T Reopening the Brentwood Postal Facility
                            observable, such as aerosolization of powders. As a result, the Postal
                            Service said that it did not view the guidance as being applicable to the
                            situation that occurred at Brentwood.

                            Given that the situation at Brentwood differed from the situation
                            contemplated in its guidance, the Postal Service sought advice from CDC
                            and others. According to CDC officials, the health and safety of postal
                            employees was always the first concern of postal managers during
                            discussions with CDC. Furthermore, they said that the Postal Service was
                            receptive to their advice about the need to close Brentwood to protect
                            postal employees after a diagnosis of inhalation anthrax was confirmed.


The Decisions Made at       The Postal Service’s decision to wait for a confirmed case of inhalation
Brentwood and Capitol       anthrax before closing the facility and referring employees for medical
Hill Differed Because the   treatment differed from the decision to implement precautionary measures
                            immediately after anthrax contamination was identified at the Hart
Circumstances and           Building. The decisions differed, in part, because there was an observable
Decisionmakers Differed     incident at the Hart Building, but not at Brentwood. In addition, different
                            parties made the decisions. At Brentwood, the Postal Service made the
                            decision in consultation with CDC and the D.C. Department of Health.
                            These parties were not involved in the decision-making at the Hart
                            Building. Instead, because the Hart Building is one of many congressional
                            offices surrounding the U.S. Capitol, the Attending Physician for the U.S.
                            Congress—who functions independently from the District of Columbia—
                            provided advice and made decisions about how to deal with the
                            contamination there.12

                            The incident at the Hart Building was immediately viewed as high risk to
                            employees there because the envelope opened in Senator Daschle’s office
                            contained a visible white powder that the accompanying letter identified
                            as anthrax, which was quickly confirmed by testing of the substance.
                            Consequently, the Office of the Attending Physician of the U.S. Congress
                            arranged for congressional employees to receive antibiotics immediately
                            and advised closure of the Hart Building the following day.




                            12
                              The Office of the Attending Physician, U.S. Congress, is an office of the U.S. Navy. It
                            serves as the local health department for Capitol Hill and is responsible for about 30,000
                            public officials and other congressional staff, as well as tourists, on Capitol Hill.



                            Page 9                               GAO-04-205T Reopening the Brentwood Postal Facility
                         Since 2001, the Postal Service has developed new guidance to address
                         security risks in the mail. Its Interim Guidelines for Sampling, Analysis,
                         Decontamination, and Disposal of Anthrax for U.S. Postal Service
                         Facilities—first issued in November 2001—states that postal facilities will
                         be closed if a confirmed case of inhalation anthrax is identified or when
                         evidence suggests that anthrax has been aerosolized in a postal facility.
                         The Postal Service said that it plans to complete an update to these
                         guidelines soon, and we plan to determine whether the new guidelines will
                         adequately address the situation that occurred at Brentwood as part of our
                         ongoing work. In addition, the Postal Service has tested and begun to
                         install new biodetection technology in postal facilities. This technology is
                         designed to enhance safety by quickly identifying unobservable evidence
                         of aerosolized anthrax, thereby allowing for a prompt response. We plan to
                         review the guidance associated with this technology as we complete our
                         work.


                         The Postal Service communicated health risk and other information to its
Communication            Brentwood employees during the anthrax crisis, but some of the
Problems                 information it initially provided changed as public health knowledge
                         evolved, intensifying employees’ concerns about whether adequate
Exacerbated Postal       measures were being taken to protect them. Most significantly,
Service Employees’       information on the amount of anthrax necessary to cause inhalation
                         anthrax and the likelihood of postal employees’ contracting the disease
Concerns                 turned out to be incorrect. Other factors, including difficulties in
                         communicating the uncertainty associated with health recommendations
                         and employees’ long-standing distrust of postal managers, also challenged
                         efforts to communicate effectively. The Postal Service has made additional
                         efforts to communicate with Brentwood employees since the facility’s
                         closure, but challenges remain, particularly the need to effectively
                         communicate information on any possible residual risks.


Some Information         The Postal Service used a wide variety of methods to communicate
Communicated to Postal   information to employees;13 however, some of the information it initially
Employees Changed        provided changed with changes in public health knowledge. For example,
                         on the basis of the science at that time, the Postal Service and CDC


                         13
                           Methods for communicating information included briefings, newsletters, fact sheets,
                         videos played on closed circuit televisions in its facilities, and a toll-free information line.
                         In addition, the Postal Service regularly updated its Web site and, after the facility closed, it
                         mailed information to its employees’ homes.



                         Page 10                               GAO-04-205T Reopening the Brentwood Postal Facility
                     initially informed employees that an individual would need to be exposed
                     to 8,000 to 10,000 spores to contract inhalation anthrax. This view turned
                     out to be incorrect when two women in New York and Connecticut died
                     from inhalation anthrax in October and November 2001 without a trace of
                     anthrax spores being found in their environments. Their deaths caused
                     experts to conclude that the number of spores needed to cause the disease
                     could be very small, depending on a person’s health status and the
                     aerosolization capacity of the spores.

                     Postal employees were also told that they were at little risk of contracting
                     inhalation anthrax because, in the view of public health officials, anthrax
                     was not likely to escape from a taped and well-sealed envelope in
                     sufficient amounts to cause inhalation anthrax. In addition, on October 12,
                     2001, CDC issued a health advisory, which the Postal Service distributed to
                     its employees, indicating that it is very difficult to refine anthrax into
                     particles small enough to permit aerosolization. This information also
                     proved to be incorrect when the U.S. Army Medical Research Institute of
                     Infectious Diseases’ analyses of the anthrax in Senator Daschle’s letter in
                     mid-October 2001 revealed that the substance was not only small enough
                     to escape from the pores of a taped and well-sealed envelope but also
                     highly refined and easily dispersed into the air.14

                     Finally, an error occurred on October 10, when the Postal Service
                     instructed employees to pick up suspicious letters and isolate them in
                     sealed containers. The message was corrected within a few days when
                     employees were instructed not to touch suspicious letters. Nevertheless,
                     Brentwood employees we spoke with cited the miscommunication as an
                     indication that the Postal Service was not concerned about their safety. As
                     a result of these and other issues, union and management officials report
                     lingering bitterness between Brentwood employees and postal
                     management.


Communicating        Communicating information proved challenging for several reasons. First,
Information Proved   the incidents occurred in the turbulent period following the terrorist
Challenging          attacks of September 11, 2001, when the nation was focused on the
                     response to those events. In addition, the anthrax incidents were
                     unprecedented. The response was coordinated by the Department of



                     14
                      According to the Postal Service, it learned the results of the Army’s analysis after the
                     Brentwood closure.



                     Page 11                              GAO-04-205T Reopening the Brentwood Postal Facility
Health and Human Services, primarily through CDC, and CDC had never
responded simultaneously to multiple disease outbreaks caused by the
intentional release of an infectious agent. Furthermore, when the incidents
began, CDC did not have a nationwide list of outside experts on anthrax,
and it had not yet compiled all of the relevant scientific literature.
Consequently, CDC had to do time-consuming research to gather
background information about the disease before it could develop and
issue guidance. Moreover, since anthrax was virtually unknown in clinical
practice, many clinicians did not have a good understanding of how to
diagnose and treat it. As a result, public health officials at the federal,
state, and local levels were basing their health-related actions and
recommendations on information that was constantly changing. According
to the testimony of CDC’s Associate Director for Science, National
Institute for Occupational Safety and Health, before a Subcommittee of
this Committee last year, CDC “clearly did not know what we did not
know last October [2001] and this is the cardinal sin that resulted in tragic
deaths.”

Effective communications were further complicated by the evolving
nature of the incidents and the media’s extensive coverage of the response
to anthrax at other localities. Comparing the various actions taken by
officials at different points in time and in different locations confused
postal employees and the public and caused them to question the
consistency and fairness of actions being taken to protect them. For
example, when employees at the Brentwood postal facility received
doxycycline for prophylaxis instead of ciprofloxacin, they incorrectly
concluded that they were receiving an inferior drug. In part, this was
because the media had characterized ciprofloxacin as the drug of choice
for the prevention of inhalation anthrax. Ciprofloxacin also had been used
as the primary medication in earlier responses, including the response to
anthrax atthe Hart Building. CDC initially recommended ciprofloxacin for
several reasons;15 however, when CDC subsequently determined that the
anthrax was equally susceptible to doxycycline and other drugs, it began




15
  The first reason for recommending ciprofloxacin was that, absent information about the
strain’s susceptibility to various drugs, CDC considered it most likely to be effective against
any naturally occurring strain of anthrax. Also, as the newest antimicrobial available, CDC
considered it less likely that terrorists would have had time to engineer a resistant strain of
anthrax. Finally, the Food and Drug Administration had already approved ciprofloxacin for
the postexposure prophylaxis for inhalation anthrax.



Page 12                              GAO-04-205T Reopening the Brentwood Postal Facility
 recommending the use of doxycycline instead.16 The switch to
doxycycline was considered desirable for a variety of reasons, including
its (1) lower risk for side effects, (2) lower cost, and (3) greater
availability. Local and CDC officials we spoke with told us that they were
challenged to explain the switch in medications and to address
perceptions of differential treatment.

Additional misunderstandings arose over the administration of nasal
swabs to postal employees. Nasal swabs are samples taken from the nasal
passages soon after a possible exposure to contamination to determine the
location and extent of exposure at a site, but not to diagnose infection.
Nasal swabs were administered to congressional employees on October 15
after the contaminated letter was opened to determine which employees
might have been exposed and based on this where and how far the
aerosolized anthrax spores had spread. Some Brentwood employees
questioned why they did not also receive nasal swabs at this time and saw
this difference as evidence of disparate medical treatment. As noted, the
Postal Service reported requesting nasal swabs for its employees, but the
CDC and the D.C. Department did not consider them necessary. Nasal
swabs were then provided to at least some employees after Brentwood
was closed on October 21. However, further confusion appears to have
occurred about the purpose of the nasal swabs when employees who were
tested did not receive the results of the swabs. The confusion occurred
partly because the Postal Service issued a bulletin dated October 11, 2001,
that incorrectly indicated that nasal swabs were useful in diagnosing
anthrax and the media described nasal swabs as the “test” for anthrax. The
bulletin was subsequently corrected, but the media continued to refer to
the swabs as a test. Public health officials acknowledged that this
confusion about the purpose of the nasal swabs created a great deal of
anxiety within the postal community and the public. As a result, public
health entities continued to collect the samples when people asked for
them, simply to allay the individuals’ fears.

Another area of confusion relates to the process used to administer the
anthrax vaccine to interested postal employees. When the vaccine used by
the military became available in sufficient quantities that it could be
provided to others, CDC offered it to postal employees and congressional
staff. While considered safe, it had not been approved for use in



16
 The recommendation to use doxycycline also followed the Food and Drug
Administration’s approval of the drug for inhalation anthrax.



Page 13                          GAO-04-205T Reopening the Brentwood Postal Facility
                       postexposure situations. Consequently, the Food and Drug Administration
                       required CDC to administer the vaccine using extensive protocols related
                       to the distribution of an “investigational new drug.” These protocols
                       required postal employees to complete additional paperwork and undergo
                       additional monitoring which, according to some Brentwood employees,
                       gave some employees the impression that they were being used as “guinea
                       pigs” for an unsafe treatment. CDC officials acknowledged that CDC did
                       not effectively communicate information about the vaccine program and
                       that, in hindsight, these deficiencies probably resulted in the “wrong
                       perception.”

                       CDC officials have also acknowledged that they were unsuccessful in
                       clearly communicating the degree of uncertainty associated with the
                       health information they were providing, which was evolving during the
                       incidents. For example, although there were internal disagreements within
                       CDC over the appropriate length of prophylaxis, this uncertainty was not
                       effectively conveyed to postal employees and the public. Consequently, in
                       December 2001, when postal employees and others were finishing their 60-
                       day antimicrobial regimen called for in CDC’s initial guidance, they
                       questioned CDC’s advice about the need to consider taking the drugs for
                       an additional 40 days. CDC officials have since acknowledged the need to
                       clearly state when uncertainty exists about the information distributed to
                       the public and appropriately caveating the agency’s statements.


Long-Standing Labor    CDC, local public health officials, union representatives, and postal
Relations Issues       officials told us that employees’ mistrust of postal managers complicated
Compounded             efforts to communicate information to them. According to these parties,
                       postal employees were often suspicious of management’s motives and
Communication Issues   routinely scrutinized information they received for evidence of any ulterior
                       motives. This view appears consistent with the results of our past work,
                       which has identified persistent workplace problems exacerbated by
                       decades of adversarial labor-management problems. These problems were
                       so serious that in 2001, we reported that long-standing and adversarial
                       labor-management relations affected the Postal Service’s management
                       challenges.17 The need to address this long-standing issue was also raised




                       17
                        U.S. General Accounting Office, Major Management Challenges and Program Risks: U.S.
                       Postal Service, GAO-01-262 (Washington, D.C.: Jan. 2001).


                       Page 14                          GAO-04-205T Reopening the Brentwood Postal Facility
                             in the July 2003 report of the President’s Commission on the U. S. Postal
                             Service.18


The Postal Service Has       According to postal managers, the Postal Service has made additional
Made Additional Efforts to   efforts to communicate with the employees who were at Brentwood,
Improve Communication        including holding “town hall” meetings to explain the facility’s
                             decontamination process to postal employees and the public. The Postal
with Employees, but          Service has reported that it is also updating its 1999 guidance for
Challenges Remain            responding to anthrax and other hazardous materials. At present,
                             however, the revision of the guidance has not yet been completed and it is,
                             therefore, unclear whether the revisions will address the issues that
                             occurred at Brentwood. Nevertheless, the Postal Service assisted the
                             National Response Team—a group of 16 federal agencies with
                             responsibility for planning, preparing, and responding to activities related
                             to the release of hazardous substances—in the development of improved
                             guidance entitled Technical Assistance for Anthrax Response. This
                             guidance provides a number of recommendations about communicating
                             information during emergency situations, including the need for agencies
                             to “admit when you have made a mistake or do not know the information.”

                             While information on the process and outcome of decontamination efforts
                             is technically complex and therefore challenging to present clearly to the
                             public, the revised guidelines may be helpful in future discussions about
                             the safety of a facility. We have not reviewed the details of the facility’s
                             decontamination or its subsequent testing and, therefore, cannot comment
                             on the effectiveness of decontamination efforts. However, in general,
                             discussions about the success of decontamination and any residual risk to
                             individuals center on two related topics. The first topic entails a
                             discussion of the degree to which contamination has been reduced,
                             bearing in mind that all sampling and analytical methods have a limit of
                             detection below which spores may be present but undetected. Against that
                             backdrop, it is also important to discuss how many anthrax spores are
                             required to infect humans and to explain that the number is variable,
                             depending upon the route of infection (e.g., skin contact or inhalation) and
                             the susceptibility of each individual to infection. In light of this, it is
                             particularly important to properly communicate to Brentwood employees
                             a clear understanding of the decontamination approach that was



                             18
                              Report of the President’s Commission on the United States Postal Service, Embracing the
                             Future: Making the Tough Choices to Preserve Universal Mail Service, July 31, 2003.



                             Page 15                           GAO-04-205T Reopening the Brentwood Postal Facility
                      undertaken at the facility and the nature and extent of any residual risk
                      there. Likewise, the Postal Service’s communications to employees must
                      be clear and unbiased to (1) clearly communicate the limitations of testing
                      and the associated risks while, at the same time, (2) avoid inducing
                      unnecessary fear or concern. If provided with clear and unbiased
                      information, employees will be able to make informed decisions about
                      their health and future employment. In this regard, the Postal Service has
                      given employees who worked at Brentwood an opportunity to be
                      reassigned to certain other mail processing centers in the region if they do
                      not want to return to Brentwood.

                      In our view, providing complete information to employees is important for
                      them to make informed decisions about working at Brentwood. According
                      to recent information that the Postal Service provided to its employees,
                      the facility, which public health authorities have certified as safe for
                      occupancy, is “100 percent free of anthrax contamination” and there is “no
                      remaining health risk” at the facility. This latter information is not
                      consistent with what CDC’s Associate Director for Science, National
                      Institute for Occupational Safety and Health, told this Committee’s
                      Subcommittee on the District of Columbia in July 2002. Specifically, she
                      said that while a science-based process can allow workers to safely return
                      to Brentwood, it is not possible to eliminate risk entirely or to guarantee
                      that a building is absolutely free of risk. We discussed our concerns with
                      Postal Service officials about their characterization of the facility as
                      completely free of anthrax contamination, and they agreed to revise their
                      statements to indicate that it is not possible to guarantee that a building is
                      absolutely risk free. According to the Postal Service, a misunderstanding
                      resulted in the incorrect information being distributed to employees
                      before the document had been fully reviewed. The Postal Service said that
                      it would correct the information and distribute the new information to
                      employees who worked at Brentwood within the next 2 weeks.


                      The Postal Service, CDC, and others have learned a great deal from the
Lessons Learned and   2001 anthrax incidents and have taken various steps to address the
Implications for      problems that occurred and to enhance their preparedness for any future
                      incidents. Among the lessons learned are that the risk to employees of
Reopening the         contracting anthrax through contaminated mail is greater than was
Facility              previously believed and more caution is needed to respond to that greater
                      risk. It is now clear, for example, that anthrax spores can be released in
                      the air, or aerosolized, when sealed letters pass through the Postal
                      Service’s processing equipment and that a limited number of anthrax
                      spores can cause inhalation anthrax in susceptible individuals. This

                      Page 16                        GAO-04-205T Reopening the Brentwood Postal Facility
                  increased risk of contracting inhalation anthrax indicates that decisions
                  about closing facilities need to consider other factors as well as the
                  presence of an observable substance, such as a powder. The Postal
                  Service and CDC have responded to this need for greater caution by
                  developing guidance for closing a facility that establishes evidence of
                  aerosolization, as well as confirmation of a diagnosis of inhalation
                  anthrax, as a criterion for closure. We have not yet evaluated this guidance
                  to determine whether it is specific enough to make clear the
                  circumstances under which a postal facility should be closed to adequately
                  protect employees and the public. We recognize that developing such
                  guidance is difficult, given that the Postal Service experiences many
                  hoaxes and needs to accomplish its mission as well as ensure adequate
                  protection of its employees’ health.

                  Another important lesson learned during the 2001 anthrax incidents is that
                  clear and accurate communication is critical to managing the response to
                  an incident. Because the risk information that was provided to employees
                  changed over time and some of the information was communicated in
                  ways that employees reportedly found confusing or difficult to
                  understand, the fears that would naturally accompany a bioterrorism
                  incident were intensified and distrust of management, which already
                  existed in the workplace, was exacerbated. CDC, in particular, has
                  recognized the importance of communicating the uncertainty associated
                  with scientific information to preserve credibility in the event that new
                  findings change what was previously understood. In this regard, our work
                  on the sampling and analytical methodologies used to test for and identify
                  anthrax contamination addresses the uncertainty involved in these efforts.
                  The Postal Service agrees that although the Brentwood facility has been
                  tested and certified as safe for occupancy, the Postal Service cannot assert
                  that the building is 100 percent free of anthrax contamination.
                  Accordingly, the Postal Service stated that it would inform Brentwood
                  employees before opening the facility that the Postal Service cannot
                  guarantee that the building is absolutely risk free.

                  This concludes my prepared statement. I will be happy to respond to any
                  questions you or other members of the Committee may have.


                  Should you or your staff have any questions concerning this report, please
Contacts and      contact me at (202) 512-2834 or Keith Rhodes at (202) 512-6412. I can also
Acknowledgments   be reached by e-mail at ungarb@gao.gov. Individuals making key
                  contributions to this testimony were Don Allison, Hazel Bailey, Jeannie



                  Page 17                       GAO-04-205T Reopening the Brentwood Postal Facility
Bryant, Derrick Collins, Dwayne Curry, Elizabeth Eisenstadt, and Kathleen
Turner. Drs. Jack Melling and Sushil Sharma provided technical expertise.




Page 18                     GAO-04-205T Reopening the Brentwood Postal Facility
Appendix I: Time Line of Selected Events
Related to the Anthrax Incident in the Fall of
2001
Date                    Events Occurring on That Date
Tuesday,                Terrorist attacks on the World Trade Center and Pentagon prompt heightened concerns about
9/11/01                 possible bioterrorism.

Tuesday,                In Florida, an American Media Inc. (AMI) employee is admitted to the hospital with a respiratory
10/02/01                condition.
                        The Centers for Disease Control and Prevention (CDC) issues an alert about bioterrorism,
                        providing information about preventive measures for anthrax.
Thursday,               CDC and the Florida Department of Health announce that AMI employee has inhalation anthrax.
10/04/01
Friday,                 AMI employee dies of inhalation anthrax.
10/05/01
Monday,                 The Postmaster General announces that Postal Inspection Service is working with other law
10/08/01                enforcement agencies on the Florida incident.

Wednesday, 10/10/01 	   The Postal Service begins nationwide employee education on signs of anthrax exposure and
                        procedures for handling mail to avoid anthrax infection.
Friday,                 In NY, the New York City Department of Health (NYCDOH) announces the confirmation of a case
10/12/01                of cutaneous anthrax in an NBC employee.
                        The Postal Service says that it will offer gloves and masks to all employees who handle mail.
                        (On or about) Daschle letter passes through Brentwood.
                        Boca Raton post office, which had direct access to the AMI mail, is tested for anthrax and Palm
                        Beach County Department of Health administers nasal swabs and offers a 15-day supply of
                        ciprofloxacin to postal employees.
Monday,                 On Capitol Hill, an employee opens a letter addressed to Senator Daschle. Staff in that office, an
10/15/01                adjacent office, and first responders are given nasal swabs and a 3-day supply of antibiotics.
                        In NJ, State Department of Health and Senior Services (NJDHSS) assures Trenton employees that
                        they have a low risk of contracting anthrax.
                        Anthrax is confirmed at Boca Raton post office.
Tuesday, 10/16/01 	     Part of the Hart Senate Office Building is closed in the morning, and the remainder of the building is
                        closed in the evening. Over the next 3 days, all Hart building and other Capitol Hill employees who
                        request them are given nasal swabs and a 3-day supply of antibiotics.
Wednesday,              The Postal Service arranges for environmental testing at Brentwood.
10/17/01




                                  Page 19                             GAO-04-205T Reopening the Brentwood Postal Facility
Date                Events Occurring on That Date
Thursday,           A local hazardous materials response team conducts “quick tests” of Brentwood, which are
10/18/01            negative for anthrax. A contractor conducts more extensive testing in the evening.
                    Postmaster General Potter holds a press conference at Brentwood, in part to reassure employees
                    they are at low risk.
                    CDC confirms cutaneous anthrax in New Jersey postal employee, and a second suspected case is
                    identified.
                    In NJ, the Trenton facility is closed. Employees are sent home.
                    In NY, NYCDOH announces another case of cutaneous anthrax, in a CBS employee.
                    In Florida, the Postal Service cleans two postal facilities contaminated with anthrax spores.
                    CDC distributes a press release announcing that the Food and Drug Administration has approved
                    doxycycline for postexposure prophylaxis for anthrax.
                    In the DC, a postal employee who works at the Brentwood facility seeks medical attention.
Friday, 10/19/01	   In NJ, the NJDHSS refers postal employees to their private physicians for medical treatment.
                    Employees begin seeking treatment at a local hospital.
                    In DC, a postal employee who works at Brentwood is admitted to a hospital with suspected
                    inhalation anthrax.
                    In NJ, laboratory testing confirms cutaneous anthrax in a second postal employee who works at the
                    Trenton postal facility.
Saturday,           In DC, another postal employee who works at the Brentwood facility is admitted to a hospital with a
10/20/01            respiratory condition.
                    CDC arrives at the Brentwood facility to meet with Postal Service management.
Sunday,             In DC, the postal employee who was admitted to the hospital on 10/19/01 is confirmed to have
10/21/01            inhalation anthrax.
                    In DC, Brentwood is closed. Evaluation and prophylaxis of employees begin.
                    In DC, a Brentwood employee who had initially sought medical attention on 10/18/01 is admitted to
                    a hospital with suspected inhalation anthrax and becomes the first postal employee (and second
                    anthrax victim) to die.
                    In DC, another postal employee who worked at the Brentwood facility seeks medical attention at a
                    hospital. His chest X-ray is initially determined to be normal, and he is discharged.
Monday,             In DC, the postal employee who worked at the Brentwood facility and who sought medical attention
10/22/01            on 10/21/01 and was discharged is readmitted to the hospital with suspected inhalation anthrax,
                    and becomes the second postal employee (and third anthrax victim) to die.
                    In DC, prophylaxis is expanded to include all employees and visitors to nonpublic areas at the
                    Brentwood facility.
                    The postal employee who was admitted to the hospital on October 20 is confirmed to have
                    inhalation anthrax.
                    The Postal Service learns that environmental tests of Brentwood are positive for anthrax.
Sunday,             In NJ, a postal employee at Trenton is confirmed to have inhalation anthrax.
10/28/01




                              Page 20                             GAO-04-205T Reopening the Brentwood Postal Facility
 Date                                              Events Occurring on That Date
 Monday,                                           In NY, preliminary tests indicate anthrax in a hospital employee who was admitted with suspected
 10/29/01                                          inhalation anthrax on 10/28/01. The hospital where she works is temporarily closed, and NYCDOH
                                                   recommends prophylaxis for hospital employees and visitors.
                                                   In NJ, laboratory testing confirms cutaneous anthrax in a woman who receives mail directly from
                                                   the Trenton facility. The woman originally sought medical attention on 10/18/01 and was admitted
                                                   to the hospital on 10/22/01 for a skin condition.
                                                   In NJ, laboratory testing confirms a second case of inhalation anthrax, in a Trenton postal
                                                   employee who initially sought medical attention on 10/16/01 and was admitted to the hospital on
                                                   10/18/01 with a respiratory condition.
 Wednesday, 10/31/01                               In NY, the hospital employee becomes the fourth anthrax victim to die.
 Friday,                                           In NY, NYCDOH announces another case of cutaneous anthrax, in a New York Post employee.
 11/2/01
 Wednesday, 11/21/01 	                             In Connecticut, an elderly woman, who was admitted to the hospital for dehydration on 11/16/01,
                                                   becomes the fifth anthrax victim to die.
                                                   The Connecticut Department of Public Health, in consultation with CDC, begins prophylaxis for
                                                   postal employees working in the Wallingford postal facility.
 Friday,                                           CDC offers the anthrax vaccine to postal employees.
 12/27/01
Source: Information provided by U.S. Postal Service, Centers for Disease Control and Prevention, Connecticut Department of Public Health, D.C. Department of Health, Food and Drug Administration,
Florida Department of Health, New Jersey Department of Health and Senior Services, New York City Department of Health, and Office of the Attending Physician of the U.S. Congress.




(543082)
                                                                  Page 21                                             GAO-04-205T Reopening the Brentwood Postal Facility
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