U.S. agency: DHHR can’t handle chemical incidents

CHARLESTON, W.Va. — The state Department of Health and Human Resources lacks a program and properly trained staff to assess community-wide chemical exposures like those that followed the Elk River chemical leak in January, federal public health officials said in a new review made public Tuesday.

U.S. Agency for Toxic Substances and Disease Registry officials reported that the DHHR and its Bureau for Public Health do not have a program aimed at assessing patterns, causes and effects of chemical or radiological incidents, or other environmental emergencies. The ATSDR recommended that the state start such a program, hire new staff for it, and ensure those staff are properly trained.

“There is potential for many different types of disasters to occur in West Virginia, such as an infectious-disease pandemic, winter storms with widespread power outages, wind disasters such as tornadoes or derechos, flooding, wildfires and extreme heat,” the ATSDR said. “Man-made disasters such as chemical or nuclear incidents or mass-casualty incidents like bridge collapses could occur as a result of an accident or be deliberate terrorist attacks.”

The ATSDR, a sister agency of the Centers for Disease Control and Prevention, made its recommendations in a Monday memo to Loretta Haddy, director of DHHR’s Office of Epidemiology and Prevention Services. DHHR officials released the six-page memo Tuesday morning.

Haddy said the new report was “not a criticism of West Virginia’s epidemiological capacity during response, but rather what we can do to strengthen the next response.”

“The Bureau for Public Health has already started addressing many of the issues that were cited as areas for improving our response for future disasters,” Haddy said, in a response to Gazette questions provided by DHHR spokeswoman Allison Adler.

ATSDR officials issued the memo as part of their review of the impacts of the leak by Freedom Industries of a mixture of Crude MCHM and other chemicals that contaminated the drinking water supply for 300,000 people in Charleston and surrounding counties.

In the wake of the leak, Bureau for Public Health Commissioner Letitia Tierney and other state officials suggested that symptoms that were sending residents to hospital emergency rooms could turn out to be related to the flu, driven by anxiety over the leak, or were no more serious than sunburn.

But in April, an earlier ATSDR found that hundreds of West Virginians who sought emergency-room care in January were treated for symptoms — such as rashes, nausea and headaches — that were “consistent” with exposure to MCHM, the primary chemical leaked by Freedom. The ATSDR review of 584 medical charts from area emergency rooms found that only 45 cases involved people who were given a diagnosis, such as the flu, strep throat or shingles, “that was considered a more likely explanation for their illness.”

In its new memo, the ATSDR focused on assessing the capacity of the Bureau for Public Health to conduct needed epidemiology during a chemical disaster. Epidemiology is a science that studies the causes, patterns and effects of health impacts or disease within a given population. The ATSDR memo explained that “disaster epidemiology” tried to “produce actionable information for decision makers and planners following natural and man-made disasters.”

“Data should be collected, analyzed and reported within sufficient time to inform decision-makers and the general public about health effects; make recommendations for prevention and control of diseases and conditions; dispel rumors and myths; gather credible evidence to support information and health services needed by the affected population; as well as develop strategies to better respond to similar situations,” the ATSDR memo explained.

The ATSDR said that the Bureau for Public Health has a total of 34 epidemiology staff positions, but five of those posts are currently vacant. Sixteen staffers work in the Office of Epidemiology and Prevention Services, nine in the Office of Maternal Child and Family Health, five in the Health Statistics Center, two in the Office of Community Health Systems and Health Promotion and one each in the Office of Environmental Health Services and the Bureau for Behavioral Health and Health Facilities.

During the water crisis that followed January’s chemical leak, the Bureau for Public Health’s response was handled by epidemiologists who normally work on infectious-disease issues, the ATSDR said.

“Currently, there are no epidemiologists in positions that respond to acute chemical or radiological releases, or specifically tasked with natural disaster response,” the federal agency’s memo said. “There also are no programs to enhance occupational safety and health of responders.”

Haddy said that having an environmental epidemiologist working on the chemical leak response team would have been ideal, but “given the diverse experience and training of the bureau’s epidemiologists, [was] not an absolute requirement.”

The ATSDR said the bureau’s staff “have training and experience for some of the possible disaster responses, but not all.”

ATSDR officials noted that the agency monitored the 2013 Boy Scout Jamboree in Fayette County for “disease outbreaks,” but that involved “months of planning” for a scheduled event, something that “is not possible” when an emergency like a chemical exposure occurs.

The ATSDR report said that Bureau for Public Health epidemiologists “were able to take advantage” of a regional environmental emergency training event that took place in Richmond, Virginia, in late March — nearly three months after the Freedom Industries leak. The report noted that the bureau’s epidemiologists have a “journal club” that meets monthly and could review papers about responding to environmental emergencies.

The ATSDR said West Virginia officials should “plan for an epidemiological response to different types of disasters that might occur in West Virginia.”

“DHHR may want to consider additional resources such as hiring an epidemiologist who would lead the response for environmental disasters and acute environmental incidents,” the agency said. “Since this is a new position within the agency, the epidemiologist would need sufficient training and experience in environmental epidemiology to be able to effectively develop the agency’s program.”

In a prepared statement released with the ATSDR report, Haddy said the Bureau for Public Health “has professional and capable epidemiologists that step in during disaster situations to help protect the safety and well-being of West Virginians.” She said the agency’s recommendations “confirm we’re taking the appropriate steps to ensure this continues.”

The statement did not say if DHHR plans to create an new disaster epidemiology program of the sort recommended by the ATSDR report. It said that the state “has been exploring additional training opportunities that will further strengthen preparedness of our agency’s epidemiologists during times of disaster” and said DHHR was working with West Virginia University’s School of Public Health “to create internship opportunities to help further recruit epidemiologists.”

In response to questions from the Gazette, Haddy said the bureau “plans to research its options in creating this [new disaster epidemiologist] position with the Division of Personnel.”

Reach Ken Ward Jr. at kward@wvgazette.com, 304-348-1702 or follow @kenwardjr on Twitter.

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