Combating Terrorism: Accountability Over Medical Supplies Needs
Further Improvement (01-MAY-01, GAO-01-666T).
This testimony discusses the status of agencies' actions to
establish effective internal control over federal medical
stockpiles that can be used to treat civilian and military
victims in the event of a chemical or biological attack. In
previous reports, GAO made recommendations to responsible federal
agencies to strengthen their management of these medical
stockpiles. GAO found that these agencies have made significant
progress toward implementing its recommendations. Management at
each of the responsible agencies has given priority to and placed
emphasis on strengthening internal control over stockpiles. As a
result, corrective actions have reduced inventory discrepancy
rates and improved accountability.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-01-666T
ACCNO: A00933
TITLE: Combating Terrorism: Accountability Over Medical Supplies
Needs Further Improvement
DATE: 05/01/2001
SUBJECT: Biological warfare
Emergency medical services
Medical supplies
Terrorism
Chemical warfare
Internal controls
CDC National Pharmaceutical Stockpile
Program
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GAO-01-666T
GAO United States General Accounting Office
Testimony Before the Subcommittee on National Security, Veterans Affairs and
International Relations, Committee on Government Reform, House of
Representatives
For Release on Delivery 2: 00 p. m. Tuesday, May 1, 2001
COMBATING TERRORISM Accountability Over Medical Supplies Needs Further
Improvement
Statement of Linda M. Calbom Director, Financial Management and Assurance
GAO- 01- 666T
Page 1 GAO- 01- 666T
Mr. Chairman and Members of the Subcommittee: I am pleased to be here today
to discuss the status of agencies? actions to establish effective internal
control over the federal medical stockpiles that can be used to treat
civilian and military victims in the event of a chemical
or biological terrorist attack. The United States? ability to effectively
respond to such an incident is dependent, among other things, on the plans,
methods, and procedures that are in place to manage the pharmaceutical and
medical supplies. We testified before this Subcommittee in March 2000 1 on
the need to establish effective control over the stockpiles, which was the
subject of our October 1999 report. 2 That work resulted in several
initiatives by the responsible agencies to correct serious control
weaknesses we identified. It also led your office to request that we follow
up on the status of corrective actions taken by the Department of Health and
Human Services? (HHS) Office of Emergency Preparedness (OEP) and
Centers for Disease Control and Prevention (CDC), the Department of Veterans
Affairs (VA), and the Marine Corps Chemical Biological Incident Response
Force (CBIRF) to address our recommendations that they
1. conduct risk assessments; 2. arrange for periodic, independent
inventories of the stockpiles; 3. implement a tracking system that retains
complete documentation for
all supplies ordered, received, and destroyed; and 4. rotate stock properly.
In completing our most recent work in these four areas, we found that OEP,
CDC, VA, and CBIRF have made significant progress toward implementing our
October 1999 recommendations. Management at each of the
responsible agencies has given priority to and placed emphasis on
strengthening internal control over the stockpiles. As a result, corrective
actions have reduced inventory discrepancy rates and improved
accountability. At the same time, we found that in all of the areas
associated with our prior recommendations, additional steps could be
1 Combating Terrorism: Chemical and Biological Medical Supplies Are Poorly
Managed (GAO/ T- HEHS/ AIMD- 00- 59, Mar. 8, 2000). 2 Combating Terrorism:
Chemical and Biological Medical Supplies Are Poorly Managed (GAO/ HEHS/
AIMD- 00- 36, Oct. 29, 1999).
Page 2 GAO- 01- 666T
taken to ensure that pharmaceutical and medical supplies that can be used to
treat victims of chemical and biological terrorist incidents are current,
accounted for, and readily available for use. Accordingly, we made 13 new
recommendations to the responsible agencies in order that they
minimize the risks associated with partnering with private companies and
other entities; improve accountability over pharmaceutical and medical
supplies; and
ensure the effectiveness of supplies on hand. My statement will summarize
the results of our recent follow- up review and highlight additional actions
needed to further improve control over the stockpiles. A detailed discussion
of our findings is contained in our report
Combating Terrorism: Accountability Over Medical Supplies Needs Further
Improvement (GAO- 01- 463), which is being released today. I will provide
some background information to set the stage.
Background The United States has established a national policy for combating
chemical and biological terrorism and managing the consequences of terrorist
attacks. In the event of a domestic chemical or biological terrorist
incident, local and state governments would be the first to respond in
assisting civilian victims. If the consequences of such an incident
overwhelmed state and local capabilities, federal assistance could be given
to support their efforts. Critical to that assistance are the chemical and
biological medical supplies maintained by OEP, CDC, VA, and CBIRF.
The Federal Emergency Management Agency, through the Federal Response Plan,
has designated HHS as the lead agency to coordinate medical assistance in
the event of a federally declared natural or man- made
disaster, including chemical or biological terrorist incidents. Within HHS,
OEP is responsible for implementing and coordinating this medical assistance
and has, among other efforts, established four National Medical Response
Teams (NMRTs) in different regions of the country and staffed
the teams with specially trained doctors, nurses, other health care
providers, and emergency personnel whose mission it is to decontaminate and/
or treat victims of a terrorist attack. Under a memorandum of agreement
between VA and OEP, VA maintains a medical stockpile containing antidotes,
antibiotics, and medical supplies at locations near each team for responding
to chemical terrorist attacks. In addition, VA also
maintains a smaller stockpile for OEP that contains only antidotes for
Page 3 GAO- 01- 666T
chemical incidents. This stockpile can be loaned to local governments or
predeployed for special events, such as the Olympic Games. Since November
1999, CDC has been building the National Pharmaceutical Stockpile (NPS). CDC
partnered 3 with VA as the purchasing agent for the NPS materiel, providing
CDC access to VA?s purchasing experience and ability to purchase medical
supplies at significant discounts. The NPS is comprised of two types of
inventories. The first is a rapid- response
inventory of pharmaceutical and medical supplies that can be positioned at
any location in the nation within 12 hours of a federal decision to deploy
them. The second is a larger stock of supplies that can be deployed within
24 to 36 hours of notification, and can be tailored to address a particular
type of incident and augment the rapid- response inventory. 4 This second
inventory is referred to as the vendor- managed inventory. The rapidresponse
inventory comprises approximately 20 percent of the NPS; the vendor- managed
inventory comprises the remaining 80 percent of the stockpile. In the event
of an incident, the CDC stock is shipped in bulk and is accompanied by CDC
technical advisors who assist state and local officials in organizing the
medication into individual doses and implement plans to distribute and
dispense the medication.
CBIRF, created in April 1996 by the Commandant of the Marine Corps, is an
incident response force and maintains a working stock of medical materiel to
provide emergency medical care and stabilization of injured CBIRF
personnel and a limited number of other casualties. CBIRF is also trained
and equipped to detect and identify chemical agents as well as extract and
decontaminate victims.
A graphic representation of the relationships of the agencies responsible
for chemical and biological medical supplies that could be used to treat
victims of a terrorist incident is shown in the attachment. I will now
discuss the results of our follow- up work. 3 Partnering, in the context of
this testimony, is the association of two or more entities in a business
relationship. 4 These vendor- managed inventories are carried on the
manufacturers? inventory records as either ?government owned? or ?government
reserved? and may be rotated with the vendor?s normal operating stock in
order to ensure freshness.
Page 4 GAO- 01- 666T
Agencies Performed Risk Assessments but Did Not Recognize or Mitigate All
Relevant Risks
In October 1999, we reported that neither OEP, VA, nor CBIRF had determined
the risks that faced their stockpiles, assessed the likelihood of each
risk?s occurrence, and established plans to detect or mitigate the risks.
Risk assessments are an important aspect of internal control that identify
potential internal and external risks, rank them in terms of their possible
effect on achieving mission objectives, and include actions to mitigate the
risks. Since our 1999 review, each agency has prepared a risk assessment.
CBIRF not only completed a risk assessment, including a physical security
analysis, it also implemented controls to mitigate risks identified in its
assessment. However, for CDC and OEP we found instances where the risk
assessments were not sufficiently comprehensive or where actions
identified to mitigate risks had not been fully implemented. For example,
CDC and OEP are partnering with various federal and commercial entities for
the storage, management, and transport of their pharmaceutical and medical
supplies. As of the completion of our fieldwork in December 2000, neither
agency had considered all of the risks posed by delegating key
responsibilities to other entities, nor had they taken all the necessary
steps to mitigate those risks. Among CDC?s partners is a wholesale
distributor of pharmaceutical and
medical supplies, which stores and/ or manages most of CDC?s rapidresponse
inventories at facilities around the country. While CDC issued standard
operating procedures in the form of a handbook to the wholesale distributor
in November 2000, as of the end of our fieldwork there was no signed
agreement between CDC, VA, and the distributor to cover the
distributor?s responsibilities to CDC or to bind it to the procedures
addressed in the handbook. In commenting on our draft report, CDC stated
that it used existing contractual agreements between VA and its
commercial partners. While these existing agreements are designed to address
VA?s hospital supply needs, they do not address key responsibilities,
requirements, and control activities specific to the NPS Program. CDC
further stated that some of its written contractual agreements with the NPS
Program partners had been finalized, while others were undergoing legal
evaluation. CDC has since finalized its agreement with the wholesale
distributor and provided us with a copy,
which we are now reviewing. In addition, while CDC had finalized the lease
agreements with two private warehouses for the storage of three of the
rapid- response inventories, as of the end of our fieldwork it had not
developed standard operating procedures for those entrusted with the
inventory to cover such
Page 5 GAO- 01- 666T
responsibilities as granting access to the wholesale distributor for
rotating supplies stored in the warehouses. Also, while CDC officials told
us that they plan to use private air cargo and land transport companies to
transport the stockpiles in the event of a terrorist incident, as of the
completion of our fieldwork there were no standard operating procedures or
signed agreements to cover these arrangements. Without adequate written
procedures in place, CDC cannot be assured that mission- critical activities
will be properly carried out by these other parties.
Similarly, OEP did not recognize all the risks associated with delegating
responsibility for the storage and management of its stockpiles to VA.
Although OEP and VA jointly drafted both national and local operating plans
5 in accordance with their memorandum of agreement, these plans had not been
finalized or approved by OEP as of the end of our fieldwork. While the draft
local operating plans had been provided to the VA locations
storing the stockpiles, security personnel at two of the locations were
unable to provide us with a copy of the draft plan or associated training
materials. In addition, they could not demonstrate that the plan had been
communicated to them or that they were prepared to put it into practice. In
commenting on our draft report, OEP stated that the national and local
operating plans had been approved and were being transmitted to VA.
Subsequently, OEP provided us with evidence that the plans had been
approved and sent to VA for immediate implementation. For CDC and OEP, we
also noted instances where risks had been appropriately identified, but
plans for mitigating these risks were not fully implemented. For example,
CDC?s risk assessment identified physical security as a risk, and its
handbook specified a number of actions to mitigate the risks, including the
use of chain link fences at least 10- feet high with lock- secured gates
around the NPS. However, the stockpiles were placed at four locations prior
to erecting fences to segregate the CDC stock
from that of the wholesale distributor or others sharing adjacent warehouse
space. For up to 3 � months, supplies at these locations were not segregated
by fencing, and management was unable to limit or control 5 The OEP/ VA
national plan addresses the responsibilities, concept of operations, and
procedures for the procurement, storage, management and deployment of OEP?s
stockpiles. The local plans address key responsibilities of VA personnel as
they relate to each storage site (e. g., the amount of space and level of
security to be provided and procedures to be followed for the controlled
release of supplies when federal assistance is requested in response to a
chemical or biological terrorist incident).
Page 6 GAO- 01- 666T
access to the supplies as prescribed in CDC?s standard operating procedures.
In another example, one of the risks identified by OEP in its risk
assessment was the sensitivity of the medical supplies to extreme
temperatures, which could damage the drug or medical item. According to
OEP?s risk assessment, should this occur, the items affected were to be
replaced. Since our October 1999 report, OEP had installed temperature
monitoring devices at each location to record temperature minimums and
maximums between site visits. We noted during our November 2000 visit to its
central location that the temperature monitoring device at that facility
registered 95 degrees Fahrenheit, and that manufacturers of some
pharmaceuticals stored in this facility warrant their products only if the
items are stored at temperatures not exceeding 86 degrees. In addition, we
noted that the OEP storage cage used to store medical supplies, including
controlled substances, was not equipped with an alarm system, which upon
unauthorized entry would transmit a signal to VA security or the local
police agency, as required by Drug Enforcement Agency (DEA) regulations. 6
During this site visit, OEP officials told us that they planned to relocate
the stockpile to an environmentally controlled and DEA- compliant facility
in April 2001. At that time, OEP would replace the affected supplies.
Inventory Accuracy
Improved but Additional Actions Are Needed
In 1999 we reported large discrepancies between data recorded in CBIRF?s and
OEP?s inventory systems and physical counts of their inventories. In our
March 2001 report, we noted that while discrepancies still existed, the
accuracy of both CBIRF and OEP inventory records had improved significantly.
However, OEP lacked certain detailed written inventory procedures necessary
to help ensure overall reliability of the inventory records. In addition,
after our October 1999 report CDC began establishing the NPS and just
recently began performing quarterly cyclical inventory
counts, as well as quality assurance reviews. As of the end of our
fieldwork, no unresolved discrepancies had been identified between the
quantities of supplies recorded in its inventory system and physical counts
taken by CDC.
Appropriately maintaining supplies depends on having a complete list of
requirements and stocking supplies in accordance with the list. During our 6
21 CFR 1301. 72 (b)( 4)( v), (2000).
Page 7 GAO- 01- 666T
1999 review, we noted that while OEP had prepared a requirements list, CBIRF
had not. However, we found in our 2000 review that CBIRF had developed a
requirements list, but it did not have on hand all items included in the
list. In addition, we found that OEP had not updated its requirements list
to reflect changes to the composition of its stockpile. Also, we found
that while CDC had established requirements lists for its rapid- response
and vendor- managed inventories, the requirements for the NPS were not
completely filled by the end of our fieldwork. These issues need to be
addressed to help ensure inventory readiness in the event of a chemical or
biological incident.
Since our 1999 inventory count of CBIRF?s medical supplies, the discrepancy
rate has declined from 26 percent to approximately 10 percent. While this is
a significant improvement, we found during counts performed
in 2000 that the inventory system still had inaccurate or incomplete data.
We found discrepancies in quantities, expiration dates, and lot numbers. It
is important to note, however, that no discrepancies were found between
the records for controlled substances and data from the physical inventory
of controlled substances.
In response to our 1999 report, VA began performing quarterly inventory
counts on behalf of OEP in April 2000. As a result, the inventory
discrepancy rate declined from approximately 11 percent, as previously
reported, to less than 1 percent in November 2000. Not included in VA?s
counts were certain expired controlled substances, which VA was holding for
OEP, pending approval by the Food and Drug Administration (FDA) to extend
the shelf life of these items. As of December 2000, 17, 897 expired
items were being held for this purpose. When we counted these expired items
and compared the results to VA?s inventory records, we found that
approximately 5 percent of the expired items were not listed in the system.
VA officials told us that they attribute the higher discrepancy rate for
these expired items to less frequent inventory counts and a lack of periodic
reconciliation of system data to on- hand stock.
While OEP?s overall discrepancy rate had significantly improved, it had not
provided, nor has VA established, written guidance stipulating acceptable
discrepancy rates or the frequency of inventory counts. Sustained progress
is dependent upon setting goals against which performance can be measured
and conducting periodic inventories. Without these, OEP will not be able to
measure improvement or determine the reliability of inventory records. In
commenting on our report, OEP stated that it recently had established a
tolerable discrepancy rate for mission- critical and
Page 8 GAO- 01- 666T
nonmission- critical supplies. It further stated that VA would perform
annual inventory counts of OEP?s medical supplies, beginning in 2001.
During our 1999 review, we also reported that OEP had a complete list of
pharmaceutical and medical supplies and quantities required to meet its
mission. Since then, OEP has made changes in its stockpile to increase the
number of victims it could treat in a chemical incident. However, as of the
end of our fieldwork, OEP had not updated and issued to VA an official
inventory requirements list to reflect those changes. In commenting on our
draft report, OEP stated that on February 27, 2001, it finalized the NMRT
requirements list and asked VA to adjust the inventory at each location to
comply with the list when it performs the June 2001 rotation of expiring
stock. Another issue noted in our October 1999 report was that CBIRF did not
have an approved list of the items that should be kept in its inventory. In
May 2000, CBIRF?s Commanding Officer established an interim requirements
list, pending receipt of the authorized medical allowance list (AMAL),
programming of funds, and development of a fielding plan by the Marine Corps
System Command. While we found that CBIRF did not have on hand all the items
included in its interim requirements list, its officials told us that they
did not plan to order additional stock and risk overstocking supplies based
on the AMAL. At the end of our fieldwork,
CBIRF officials told us that the Marine Corps System Command was developing/
revising the AMAL, which it then planned to compare with onhand materiel to
identify shortfalls or excesses and develop and implement a fielding plan to
adjust on- hand stock to the AMAL.
Since our October 1999 report, CDC has developed an inventory requirements
list and is using the list as a basis for making inventory purchases to
establish the NPS. We found that CDC had developed and followed internal
guidelines for establishing the composition and stock
levels of the pharmaceutical and medical supplies on the list. As of the end
of our fieldwork, approximately 47 percent of the requirements for the
rapid- response inventories had been acquired, and the first of
approximately five contracts for the vendor- managed inventory had been
finalized.
Page 9 GAO- 01- 666T
Current Tracking Systems Do Not Record Inventory Activity Over the Life
Cycle of the Supplies
In 1999, we reported that the responsible agencies? inventory systems were
not adequate, and recommended that they implement tracking systems that
retain complete documentation for all supplies that have been ordered,
received, and destroyed. The current inventory systems used by OEP, VA, CDC,
and CBIRF still lack certain fundamental information, which impedes their
ability to comprehensively track their pharmaceutical and medical supplies.
Each agency is in the process of replacing its current system with one that
is expected to be able to track medical supplies from the time an order is
placed until the item is consumed or otherwise disposed of. CDC?s goal was
to have its new system in place by April 2001. In commenting on our report,
CDC stated that it awarded a contract for a new inventory management system
on March 1, 2001. Because OEP?s and CDC?s system needs are similar, OEP told
us that it planned to rely on the results of CDC?s review of system
capabilities and vendor proposals and use the same system as that selected
by CDC. The Marine Corps has developed a new inventory management system,
the ATLAS II +, that it expects to implement at CBIRF and be fully
operational by June 2001. Rotation Policies and
Practices at CBIRF and CDC Need Improvement
In 1999, we reported that the responsible agencies? inventories included
items that had expired but not been replaced and recommended that they
properly rotate supplies. For example, we found that OEP had 2,000 amyl
nitrite inhalants 7 on hand which had expired 8 months prior to our 1999
visit. In response to our 1999 report, we found that all responsible
agencies
have developed policies and procedures related to rotating stock in their
inventories. However, in some cases, planned approaches were not completely
implemented.
Proper rotation entails replacing pharmaceuticals and medical supplies that
have expired or are close to their expiration dates with current stock.
Agency policies require expired items to be segregated and destroyed,
redistributed, or put into the shelf- life extension program. If expired
items are not appropriately removed and replaced, there is an increased risk
of ineffective items being deployed, an adequate supply of effective items
being unavailable, or contemplated cost savings not being realized. 7 An
inhalation drug that is used as an antidote for cyanide poisoning. It is
also a common recreational stimulant known as a popper.
Page 10 GAO- 01- 666T
During our October 2000 counts at CBIRF, we found 161 expired pharmaceutical
and medical supplies, including 146 controlled substances, on hand. The
senior member of the CBIRF controlled substances inventory board told us
that CBIRF destroyed these expired controlled substances on December 20,
2000. However, as of January 2001, CBIRF had not replaced the expired items
with current stock in sufficient quantities to meet the minimum stock levels
determined by the Commanding Officer?s interim requirements list. As
previously mentioned, CBIRF does not plan to order additional stock until
the Marine Corps System Command provides program funds and the fielding plan
for the CBIRF specific AMAL.
Since our 1999 report, CDC developed a unique concept for medical materiel
management that could result in significant cost savings that could be
funneled back into the program. Under this plan, certain expiring stock of
CDC, for which there was a sufficient market demand, could be returned for
full or partial credit to the pharmaceutical wholesale company. The
wholesale company could then resell these pharmaceuticals to its other
customers, who could use the items before they reached their expiration
dates. The wholesale company would then replace the expiring items with
fresher stock. Thus, it would be unnecessary to hold the CDC stock until
expiration, dispose of it, and replace the disposed items at full cost.
According to CDC officials, the wholesale company requires that the items be
returned not less than 6 months prior to the expiration date to allow it to
redistribute the supplies to its other customers with a 6- month minimum
shelf life remaining on the items. CDC adopted a 12- month ?trigger? date to
ensure that items would be flagged and rotated in time to meet the wholesale
company?s 6- month requirement. However, at the end of our fieldwork, CDC
had not yet finalized an agreement with the wholesaler to rotate the items.
Approximately $4.3 million of CDC?s initial purchase of supplies for its
rapid- response
inventories is scheduled to expire by December 2001. If an agreement is not
finalized so that these supplies can be redistributed by June 2001, or
within the 6- month timeframe required by the wholesaler, CDC could lose the
opportunity for cost savings of up to $4. 3 million. Without finalized
agreements in place, the expiring medical materiel may have to be replaced
at full cost and the expired items destroyed. Conclusion We are encouraged
by the actions taken by the responsible agencies to
improve accountability over the medical supplies designated to treat victims
of chemical or biological terrorism. However, ensuring that
Page 11 GAO- 01- 666T
supplies are current, accounted for, and readily available for use is
dependent in large part on successful collaboration with other entities.
Until CDC and OEP formalize certain ad hoc arrangements with other entities
covering the storage, management, stock rotation, and transport of supplies,
they will face the risk that, should a chemical or biological incident
occur, the appropriate supplies will not be available when needed. Also,
unless the agencies? inventory requirements lists are up to date and
reflective of their own identified needs, the agencies are limited in
assuring that they have the supplies needed to fulfill their mission. We
understand that since the completion of our review some additional steps
have been taken by the agencies to address these issues.
Recommendations For Executive Action
We have included in our March 2001 report the following 13 actions that the
Secretary of Health and Human Services and the Commandant of the Marine
Corps should take to address the issues that I have discussed here today.
We recommended that the Secretary of Health and Human Services require the
Director of the Centers for Disease Control and Prevention to
execute written agreements as soon as possible with all CDC?s partners
covering the storage, management, stock rotation, and transport of medical
supplies designated for treatment of biological or chemical terrorism
victims; issue written guidance on security to private warehouses that
store
stockpiles, addressing such issues as granting access to the wholesale
distributor for stock rotation; and
to the extent practical, install proper fencing prior to placing
inventories at storage locations. In addition, we recommended that the
Secretary of Health and Human Services require the Director of the Office of
Emergency Preparedness to
finalize, approve, and issue an inventory requirements list;
improve physical security at its central location to comply with DEA
regulations, or move the supplies as soon as possible to a location that
meets these requirements;
issue a written policy on the frequency of inventory counts and acceptable
discrepancy rates;
Page 12 GAO- 01- 666T
finalize and implement approved national and local operating plans
addressing VA?s responsibilities for the procurement, storage, management,
and deployment of OEP?s stockpiles;
train VA personnel and conduct periodic quality control reviews to ensure
that national and local operating plans are followed;
immediately contact FDA or the pharmaceutical and medical supply
manufacturers of items stored at its central location to determine the
impact of exposure to extreme temperatures on these items;
replace those items deemed no longer usable; and
either add environmental controls to the current location or move the
supplies as soon as possible to a climate- controlled space.
We recommended that the Commandant of the Marine Corps require the Marine
Corps System Command to program funding and complete the fielding plan for
the CBIRF- specific authorized medical allowance list and require the
Commanding Officer of the Chemical Biological Incident Response Force to
adjust its stock levels to conform with the authorized medical allowance
list; and
remove expired items from its stock and replace them with current
pharmaceutical and medical supplies.
In commenting on our report, the responsible agencies generally agreed with
our recommendations and agreed to take corrective actions. Mr. Chairman,
this completes my prepared statement. I would be happy to respond to any
questions you or other Members of the Subcommittee may have at this time.
Contact and Acknowledgments
For further information regarding this testimony, please contact Linda M.
Calbom, Director, Financial Management and Assurance, at (202) 512- 9508.
Individuals making key contributions to this testimony included Louise
Beck, Cary Chappell, David Grindstaff, Bronwyn Hughes, Charles Norfleet,
Alana Stanfield, McCoy Williams, and Maria Zacharias.
Page 13 GAO- 01- 666T
Page 14 GAO- 01- 666T
Attachment
Agencies Responsible for Chemical and Biological Medical Supplies Used to
Combat Terrorism
Agencies and entities within those agencies directly responsible for the
medical supplies Inventory of medical supplies used to combat terrorism
Agreements
Business partner with delegated responsibility for the medical supplies
Vendor managed inventories
(80%) Working
stock of medical supplies Eight rapid
response inventories
(20%)
Centers for Disease Control
and Prevention
National Medical Response Teams
(NMRT)
1 special events inventory
4 NMRT inventories
Health and Human Services
Coordinates medical assistance
Office of Emergency Preparedness
Department of Veterans Affairs
Department of Defense Marine Corps
Chemical Biological Incident
Response Force
National Pharmaceutical Stockpile (NPS)
Source: GAO analysis based on the review of HHS?s and CDC?s NPSP Operating
Plans and CBIRF documents.
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