Implementation of Security Recommendations Delayed and Confused

by DR. JAMES “JIM” BLAIR, COL RET, ARMY AMEDD November 12, 2010
At the Center for Emergency Healthcare Readiness, we have witnessed changes in Homeland Security Congressional leadership for almost a decade. Over those years we have seen reams of reports identifying what the previous administration had failed to accomplish in preparing the private sector in general and Public Health and Healthcare in particular; the gaps in readiness have been identified and underscored at each transition of leadership.
I wrote in early 2008 that Implementation of 9/11 Commission Recommendations on Private Sector Readiness appeared to have dropped off the radar screen. We have had little success in our (numerous) attempts to communicate our concerns to members and staff in Senate and House Homeland Security Committees. 
Our basic question to them was:
Whatever happened to the 9/11 Commission Recommendations on Private Sector Readiness?
HR1 and P.L.110-53, Title IX “Implementing Recommendations of the 9/11 Commission Act of 2007” (pdf document) is designed to take full advantage of the unfulfilled potential of the 9/11 Recommendations. We have been perplexed by the lack of actionable guidance for the non-federal healthcare sector. Our inquires to appropriate House and Senate leadership have remained unanswered with one senior staffer saying candidly “you know more about that than we do”.
These  inquiries are centered on two recommendations:
“ …We strongly support the decision that federal homeland security funding will be contingent, as of October 1,2004, upon the adoption and regular use of ICS and unified Command procedures. In the future, the Department of Homeland Security should consider making funding contingent on aggressive and realistic training in accordance with ICS and unified command procedures. ….the private sector remains largely unprepared for a terrorist attack. We responded by asking the American National Standards Institute (ANSI) to develop a consensus on National Standard for Preparedness for the private sector. …”. 
We also encourage the insurance and credit-rating industries to look closely at a company’s compliance with ANSI [American National Standards Institute] standards in assessing its insurability and creditworthiness.We believe that compliance with the standard should define the standard of care owed by a company to its employees and the public for legal purposes. Private-sector preparedness is not a luxury; it is a cost of doing business in the post-9/11 world. It is ignored at a tremendous cost in lives, money, and national security”
To give some historical perspective to the national concern for potential non-state terrorist’s attacks on the U. S. we must go back over two decades. Hard on the heels of the end of the Cold War and a brief “Peace Dividend”, the specter of non-state terrorists, armed with Weapons of Mass Destruction (WMD) from the former Soviet Union stockpiles seemed creditable.
A recent report entitled “World at Risk”(pdf) was released by the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, led by Senator Bob Graham. This underpinned longstanding concerns about the post-cold war non-state terrorist threat. 
On Wednesday July 30, 2008, the Federal Emergency Management Agency (FEMA) announced the introduction of the Certification Program:
The Department of Homeland Security announced that it has signed an agreement with the ANSI-ASQ National Accreditation Board (ANAB) to establish and oversee the development and implementation of the accreditation and certification requirements for the Voluntary Private Sector Preparedness Accreditation and Certification Program. This program is directed by Public Law 110-53, Implementing the Recommendations of the 9/11 Commission Act of 2007, requiring the department to establish a common set of criteria for private sector preparedness in disaster management, emergency management and business continuity.
Past efforts to encourage the healthcare sector to address these issues on a voluntary basis have been disappointing. In October 2009, Department of Homeland Security (DHS) Secretary Janet Napolitano announced a key milestone in the Department’s efforts to develop a robust small business preparedness solution, soliciting public comment on a private sector readiness certification program specifically tailored to the needs of small businesses:
DHS published a notice in the Federal Register seeking public comment on its proposed plan for implementing separate classifications and methods of certification for small businesses under PS-Prep. This first-of-its-kind program will tailor voluntary private sector preparedness certification standards to specifically meet the needs and capabilities of America’s small businesses.
The small business preparedness plan is part of the Private Sector Preparedness Accreditation and Certification Program (PS-Prep)—a 9/11 Commission recommended voluntary partnership between DHS and the private sector to improve businesses’ preparedness and resilience for disasters and emergencies. PS-Prep enables private sector entities to receive emergency preparedness certification from a DHS program created in coordination with the private sector.
Comments may be submitted to or, in Docket ID FEMA-2008-0017.
The comment period was extended to January 15, 2009. Hospital and healthcare trade organizations strongly supported the established external oversight second and third party mechanisms as appropriate models for Public Health and Healthcare sectors Standards.
These mechanisms have repeatedly failed to prepare the sector for the 9/11 terrorist attack response, Tropical Storm Allison, hurricanes Katrina/Rita and Ike. Our next book, working title ”Deadly Neglect: Act of God vs. Apathy and Denial” - addresses the tragic loss of life and horrors associated with caring for abandoned vulnerable inpatient populations before, during and after hurricane Katrina.
The fate of our formal submission to ID FEMA-2008-0017 on January 14, 2009 is a tale that defies comprehension. A courtesy copy of the document was forwarded to a contact at the American National Standards Institute (ANSI). Follow-on calls to ANSI were at first frustrating in that the comment submission had not been received. Another follow-on call explained that the comment had not been received by either receipt because it had been rejected – “This e-mail has violated the RACIAL Discrimination POLICY Quarantine - entire message has been taken.” A courtesy copy which was sent to the National Accreditation Board (ANAB) met with the same response.
The comment document was forwarded to a number of professional associates to review the wording for some stray “politically incorrect” statement, none was identified. The same review was performed by ANSI personnel, none was identified.
On to the ANAB IT expert for an explanation. He confirmed that Yes, it is possible for a message to be blocked for the use of obscene or offensive statements. Asked for an example of an insensitive word or phrase which could be racially offensive he replied “cotton picking”. Numbed by the experience, I reflected on this new information.
The reality that a formally submitted comment on a time-sensitive review of the Federal Register could fall victim to a Content Filtering Device which had taken random words - out of context - to deny participation in the open process which should or could have impact on a national standard for Homeland Security Readiness is appalling.
We are still looking for a rational explanation on how that can happen in a forum looking for wide-ranging opinions on such an important issue. To be clear, no “politically incorrect”, racial or obscene content was ever included or could be identified – suggesting a seriously overly sensitive or simply broken email filtering system.
Fast forward, no!, slow forwarding to June 3, 2010. Letter addressed to Secretary, Department of Homeland Security, from Chairman, Senate Homeland Security & Government Affairs and Chairman, House Committee on Homeland Security imploring action on the delinquent PS-Prep Recommendations of the 9/11 Commission Act of 2007. On June 15, 2010 Secretary of Homeland Security announced New Standards for Private Sector Preparedness.
An article by Mickey McCarter was originally published by Homeland Security Today last month. This is entitled “The Man Who Would Be King”, and is reproduced on the website of Congressman Pete King (R-NY), who features in the article. King is the ranking Republican member of the House Homeland Security Committee. The article predicted significant changes in the House Homeland Security Committee if the Republicans take the House in Mid-Term elections.
They did. Contributor Dr. James Blair, DPA, MHA, FACHE, FABCHS, CAS, is president and CEO of the Center for HealthCare Emergency Readiness. He is the author of the book, Unready: To Err is Human: The Other Neglected Side of Hospital Safety and Security, which was published in June. He is also a career-retired army colonel with 28 years of active service. Among his private sector experiences, he served as VP of Hospital Corporation of America, Middle East Limited and as an independent consultant to Joint Commission International.

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