The doctor makes House calls

So while the timing couldn’t be better, one more doctor apparently will do little at present to add to the preparedness capabilities of the federal government.
Dr. Jeffery Runge introduced himself to a panel of the House Homeland Security Committee in a hearing on Oct. 27. Homeland Security Secretary Michael Chertoff recruited Runge from his last job as the administrator of the National Highway Traffic Safety Administration at the Department of Transportation to become the first chief medical officer of DHS last July.
As chief medical officer, Runge holds a post within the department’s new Preparedness Directorate, which also houses the US Fire Administration and a new assistant secretary for Cyber and Telecommunications Security. But so far he doesn’t seem to do much other than link up with federal agencies outside of DHS to provide them with the help they need in the case of a medical emergency.
The fiscal 2006 Homeland Security Appropriations Act (PL 109-90) provides only $2 million to the Office of Chief Medical Officer for its first full year of operations. Runge told Congress that money largely would be spent to staff up his office.
"We’re already involved in ‘ 07 budget planning," Runge said. "Unfortunately, when it was ‘ 06 budget planning time, I was planning the budget for the National Highway Traffic Safety Administration."
The budget provides Runge with the authority to hire 10 full-time personnel to staff his office, plus he is pushing for several additional executive positions within the chief medical office. Runge’s plans call for a deputy chief medical officer — a position still vacant at press time — who would have "an appropriate doctoral degree in medicine or veterinary medicineand expertise at the state and local level in emergency management, public health and other skills," Runge said.
The deputy would administer an office staffed with associate chief medical officers for science and policy, medical preparedness, operations and response and mission support, Runge added.
Rep. Bennie Thompson (D-Miss.) did the math and figured that most, if not all, of the chief medical officer’s $2 million will pay for staffing, leaving little for medical preparedness. Runge responded that he would continue to form relationships across the federal government that would enable DHS to play an appropriate role in a medical emergency.
"I spent a lot of time in the last month going out and making a lot of house calls," Runge said. "I’ve been to the CDC [the Centers for Disease Control and Prevention) — I’ve certainly met with Dr. [Richard] Besser, who’s the bioterrorism and emergency response director, with [CDC Director] Dr. [Julie] Gerberding, with Stu Simons and his staff, Jerry Parker at HHS."
Runge also has started discussions with the office of the assistant secretary of Defense for Health Affairs and the medical director of US Northern Command.
Pandemic response
With concerns that avian flu could threaten the health of millions across the United States, Runge said DHS was considering the appointment of a full-time veterinarian to his staff. Meanwhile, DHS is consulting with two veterinarians on the problem of avian influenza.
"You know, one of the beauties of DHS is that resources abound, and we just have to be smart about how we access those," Runge told Congress. "I’ve got two of the finest veterinarians who have been working with us on the avian flu task force, who are also readily available for our consultation for just about anything that we ask."
Runge made it clear, however, that his office was a supporting element for emergencies like avian flu under the National Response Plan. The plan designates public health and medical services as Emergency Support Function Eight (ESF-8) and assigns to HHS the authority to respond to those concerns.
"When I walked in the door, I was given responsibility to come up with a DHS plan," Runge said. "The first call was to HHS — because they have the lead in avian flu — wanting to make sure that whatever planning function we did would dovetail with the HHS plan so that they could give it a national plan for avian flu. That work is ongoing."
DHS also has a memorandum of understanding with HHS to provide border protection for infectious diseases to cover issues such as quarantine and data sharing of passengers traveling via air, sea or land.
Some experts, however, have expressed concern that the chief medical officer should have the authority to do more than just serve as the DHS liaison in a medical emergency. Dr. Jeffrey A. Lowell, who served as a medical advisor to former DHS Secretary Tom Ridge, shared his recommendations with the House panel. Lowell, currently a professor of surgery and pediatrics at the Washington University School of Medicine in St. Louis, endorsed moving the National Strategic Stockpile from HHS to DHS and providing additional authority to the DHS chief medical officer.
Lowell also endorsed moving the Metropolitan Medical Response System from the Federal Emergency Management Agency to the chief medical officer and moving the tactical medical training center called Counter Narcotics & Terrorism Operational Medical Support from Immigration and Customs Enforcement to the chief medical officer.
"All of the medical and health assets, in my opinion, in DHS should be consolidated in one office reporting to one person," Lowell said.
Lowell also said he believed the Homeland Security Act of 2002 (PL 107-296) intended to make DHS the leading authority in "medical and health response with the events of national significance," but that the National Response Plan contradicts that intent.
Analysis
Much of the intelligence on which the chief medical office acts comes from material threat assessments conducted by the DHS Science and Technology Directorate. Runge said that five such material threat assessments have been completed to date, and his role is to consult with Chertoff on how to react to the assessments.
"I do not expect to insert myself into the material threat assessments. That’s very much of a scientific and intelligence function. However, when it comes to determination, we’ll be there in the complicated process, and I’ll advise the secretary accordingly," Runge said.
Runge said he expects another batch of assessments to come in a report due in February.
In addition, HHS makes its own assessments as to what vaccines to stockpile through Project BioShield, as Runge admits, providing his office with very little input into the process.
Lowell developed a report for former DHS Secretary Tom Ridge that suggested combining intelligence functions that address medical intelligence into a DHS readiness office. Lowell told Congress that those functions were currently dispersed across the federal government at the Defense Intelligence Agency, the National Biodefense Countermeasures and Analysis program and HHS. The dispersal of these intelligence functions makes it difficult to determine which agency would be in the best position to act during specific crises.
David Heyman, director of homeland security at the Center for Strategic and International Studies, suggested the Homeland Security Committee coordinate a massive joint hearing with committees that have oversight on HHS and the US Department of Agriculture to see exactly who is in charge during an outbreak of avian flu or a similar health crisis. That’s a prescription Congress should fill promptly.

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