Monday, July 31, 2006 | 7:23 a.m.
Suppose you got $1,000 from your uncle to pay the rent, then went out and bought a bedroom set with the money.
Should your uncle be upset?
After all, it's not as if you spent the money frivolously. You bought something you needed.
That same logic apparently has guided the Nevada State Division of Health in applying for a bioterrorism preparedness grant.
And Nevada's uncle - as in Sam - says, "That's fine with me."
If only your uncle were so accommodating.
The federal Health Resource Services Administration (HRSA) allocated more than $460 million for states to spend on bioterrorism preparedness this year. A fancy press release heralded the grants and the fact that the money would help develop medical surge capacity and the capability to deal with mass casualty events.
Surge capacity is bureaucratese for the ability to care for a large influx of patients in a short period of time.
The press release also said the money should focus on local and regional preparation.
In its grant application, however, Nevada earmarks some of its $3.8 million share for personnel, travel, office equipment and supplies. The lion's share, more than $2.8 million, will go to contractual spending on such items as a universal badge system to identify health-services professionals and poison-control services paid to companies in Colorado and Oregon.
Officials also acknowledge that some of the contract services, such as the agreement with the poison-control centers, are more frequently used for everyday concerns, which raises the question of whether it is an appropriate allocation for a bioterrorism grant.
Dr. Bradford Lee, the Nevada state health officer, said monitoring functions performed by the centers are a kind of early-warning service: "There's some surveillance stuff you can do with the poison-control centers that also kind of highlights some abnormalities that may be the first indication of a disease outbreak in an area."
HRSA officials, however, said grant money is not intended to be used for essential services that might offer additional benefits in a mass casualty event.
Lee acknowledges poison control is an essential service.
The badge program will cost more than $600,000 in Clark County alone. The start-up cost for the program was about $300,000, and it will cost an additional $400,000, which will be requested in a future grant, to bring the rest of the state online.
The state-of-the-art system would allow health care professionals to move between locations and would provide detailed information about them, including credentials and qualifications.
With the exception of the badge money and $454,000 set aside for ventilator equipment packs, it's hard to link any of the funds to equipment used specifically for bioterrorism surge capability or mass casualty events.
While HRSA officials say they can't comment specifically on Nevada's application because it has not yet been reviewed, they acknowledge states have considerable leeway in how they spend the grant.
"They have to spend it on things that are allowable costs," said Laura Lamprecht, of the Department of Health and Human Services.
"We can't say to a certain state, you need to spend it on beds or surveillance or whatever."
The devil is in the details.
And there are many of them, all contained in a 79-page, grant-guidance document that provides considerably more latitude than the press release - or most federal grants, it seems - and appears to be intentionally vague. It allows for such ambiguous disbursements as "other authorized equipment" and "other items."
The only expenditures prohibited under all circumstances by the guidelines are weapons and ammunition. Only the U.S. Virgin Islands and Puerto Rico so far have shot themselves in the foot. They were denied funding because of problems with their grant applications, but they can resubmit them.
No state has ever been denied its full funding allotment, and Nevada expects that its will be approved.
HRSA officials said it is possible a state could obtain grant approval without addressing any of the issues outlined in its press release - surge capacity and mass casualty capability - but called such a scenario highly unlikely.
"If we felt that money was not being used correctly, we would make them re-submit the budget and the work plan in accordance with this guidance," said Melissa Sanders, HRSA's branch chief for the bioterrorism hospital preparedness program. "If they can't do that or won't do that, then we absolutely would look at not funding that state."
HRSA has come under fire in recent years over a lack of accountability for the Bioterrorism Hospital Preparedness Plan. The funds are supposed to be used specifically by hospitals and other health care institutions in preparing to deal with large numbers of casualties.
Four years and millions of dollars after the program was implemented, however, Nevada officials say the state still does not have enough beds, facilities or personnel to accommodate the anticipated surge of patients in a mass casualty event.
It also does not have enough ventilators for patients or personal protective equipment for hospital staff for an incident of any duration.
The latter is a major concern because state officials say many hospital personnel simply will not report to work if adequate protective equipment is not available.
Partly because of this, but also because there are not enough health care professionals in the state to deal with a mass casualty event even if all responded, the state has begun to recruit volunteers.
Clark County and Washoe County have each requested $100,000 in the grant for a medical reserve coordinator and supplies. What is not clear is how officials plan to persuade volunteers to respond in a crisis if large numbers of hospital personnel, whose career calling revolves around helping the sick, don't.
Lee admits this is a concern.
"That's certainly a legitimate question," he said. "We'll never know until the event occurs."
archive
