U.S. Postal Service: Clear Communication with Employees Needed	 
before Reopening the Brentwood Facility (23-OCT-03, GAO-04-205T).
                                                                 
On October 21, 2001, the U.S. Postal Service closed its Brentwood
mail processing facility after the Centers for Disease Control	 
and Prevention (CDC) confirmed that an employee there had	 
contracted inhalation anthrax, an often-fatal form of the	 
disease. On October 21 and 22, two other Brentwood employees died
of inhalation anthrax. The contamination was linked to a letter  
that passed through the facility on or about October 12, before  
being opened in the office of Senator Daschle in the Hart Senate 
Office Building on October 15. The Hart Building was closed the  
next day. The Brentwood facility has since been decontaminated	 
and will soon reopen. This testimony, which is based on ongoing  
work, provides GAO's preliminary observations on the decisions	 
made in closing the facility and problems experienced in	 
communicating with employees, as well as lessons learned from the
experience.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-04-205T					        
    ACCNO:   A08768						        
  TITLE:     U.S. Postal Service: Clear Communication with Employees  
Needed before Reopening the Brentwood Facility			 
     DATE:   10/23/2003 
  SUBJECT:   Postal facilities					 
	     Chemical and biological agents			 
	     Hazardous substances				 
	     Health hazards					 
	     Communication					 
	     Industrial relations				 
	     Postal service employees				 
	     Postal service					 
	     Occupational safety				 
	     Building inspection				 
	     Infectious diseases				 
	     Anthrax						 

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GAO-04-205T

United States General Accounting Office

GAO Testimony

Before the Committee on Government Reform, House of Representatives

For Release on Delivery Expected at 1:30 p.m. EDT

Thursday, October 23, 2003

U.S. POSTAL SERVICE

    Clear Communication with Employees Needed before Reopening the Brentwood
                                    Facility

Statement of

Bernard L. Ungar, Director
Physical Infrastructure

Keith Rhodes, Chief Technologist
Center for Technology and Engineering, Applied Research
and Methods

GAO-04-205T

Highlights of GAO-04-205T, a testimony before the Committee on Government
Reform, House of Representatives

On October 21, 2001, the U.S. Postal Service closed its Brentwood mail
processing facility after the Centers for Disease Control and Prevention
(CDC) confirmed that an employee there had contracted inhalation anthrax,
an often-fatal form of the disease. On October 21 and 22, two other
Brentwood employees died of inhalation anthrax. The contamination was
linked to a letter that passed through the facility on or about October
12, before being opened in the office of Senator Daschle (see fig.) in the
Hart Senate Office Building on October 15. The Hart Building was closed
the next day. The Brentwood facility has since been decontaminated and
will soon reopen. This testimony, which is based on ongoing work, provides
GAO's preliminary observations on the decisions made in closing the
facility and problems experienced in communicating with employees, as well
as lessons learned from the experience.

Because the Postal Service agreed to inform Brentwood employees before the
facility is reopened that it could not guarantee that the facility is
completely risk free, GAO is making no recommendations at this time.

www.gao.gov/cgi-bin/getrpt?GAO-04-205T.

To view the full product, including the scope and methodology, click on
the link above. For more information, contact Bernard L. Ungar at (202)
512-2834 or [email protected].

October 23, 2003

U.S. POSTAL SERVICE

Clear Communication with Employees Needed before Reopening the Brentwood
Facility

The Postal Service's decision to wait to close the Brentwood facility and
refer employees for medical treatment until CDC confirmed that a postal
employee had contracted inhalation anthrax was consistent with the advice
the Postal Service received from public health advisers and the
information about health risk available at the time. However, because
circumstances differed at Brentwood and the Hart Building-an observed
spill at the Hart Building and no observable incident at Brentwood-the
Postal Service's response differed from the response at Capitol Hill,
leading some Brentwood employees to question whether the Postal Service
was taking adequate steps to protect their health.

The Postal Service communicated information to its Brentwood employees
during the anthrax incident, but some of the health risk information
changed over time, exacerbating employees' concerns about the measures
being taken to protect them. Notably, employees later learned that their
risk of contracting the disease was greater than originally stated. Other
factors, including difficulties in communicating the uncertainty
associated with health recommendations and employees' distrust of postal
managers, also challenged efforts to communicate effectively. Recently,
the Postal Service informed employees that Brentwood, which has been
tested and certified as safe for occupancy, is "100 percent free of
anthrax contamination." However, in discussions with GAO, the Service
agreed to revise future communications to acknowledge that although any
remaining risk at the facility is likely to be low, complete freedom from
risk cannot be guaranteed.

The Postal Service and others have learned since the 2001 anthrax
incidents that (1) the risk of contracting anthrax through the mail is
greater than was previously believed and more caution is needed to respond
to that greater risk and (2) clear, accurate communication is critical to
managing the response to an incident and its aftermath. The Postal Service
is revising its guidance to respond more quickly and to communicate more
effectively to employees and the public in the event of a future incident.

Anthrax-Contaminated Letter Opened in Hart Building on October 15, 2001

Mr. Chairman and Members of the Committee:

We are pleased to be here to discuss issues related to the U. S. Postal
Service's response to the anthrax1 contamination at the Washington D.C.
Processing and Distribution Center, or Brentwood, as it was commonly
known.2 As you know, the facility was renamed the Joseph Curseen Jr. and
Thomas Morris Jr. Processing and Distribution Center in memory of the two
Brentwood employees who died of inhalation anthrax on October 21 and 22,
2001. Inhalation anthrax is the most lethal form of the disease. The
facility is about to reopen after being closed 2 years ago this week for
decontamination and renovation. My testimony today will focus on the (1)
decisions made by the Postal Service in closing the Brentwood facility and
(2) problems the Postal Service experienced in communicating to its
employees as well as (3) lessons that can be learned from the experience.
While you also asked us to address the effectiveness of the facility's
decontamination, we are unable to do so because this issue is outside the
scope of work that we have under way. However, we will relay our
observations about communication issues associated with the facility's
decontamination.

My testimony today is based largely on our ongoing work addressing the
treatment of postal employees at several postal facilities, including the
Brentwood facility, that were contaminated with anthrax spores in late
2001. This work, which we expect to complete within the next several
months, is being done at the request of Senator Joseph I. Lieberman and
Representatives Christopher H. Smith and Eleanor Holmes Norton. Our work
thus far has involved interviews with individuals involved in the response
to the contamination, including representatives from the Postal Service,
the Department of Defense, the Centers for Disease Control and Prevention
(CDC), and state and local public health agencies and postal unions as
well as reviews of relevant documents and literature related to the
anthrax response. We are also drawing from our completed work addressing
anthrax contamination at a postal facility in Connecticut,3

1Technically, the term "anthrax" refers to the disease caused by Bacillus
anthracis and not the bacterium or its spores. In this report, we use the
term "anthrax" for ease of reading and to reflect terminology commonly
used in the media and by the general public.

2In this report, we refer to the facility as Brentwood.

3U.S. General Accounting Office, U.S. Postal Service: Better Guidance Is
Needed to Improve Communication Should Anthrax Contamination Occur in the
Future,

GAO-03-316 (Washington, D.C.: Apr. 7, 2003).

issues related to the testing for anthrax in that facility,4 and the
public health response to the 2001 anthrax incidents.5 Our work is being
performed in accordance with generally accepted government auditing
standards. The observations that we are making are based on our ongoing
work and should be viewed as preliminary.

Before I discuss the decisions made in closing the Brentwood facility, let
me briefly place these decisions in context. When the Postal Service
learned that a letter contaminated with anthrax spores had been sent
through the mail and opened in the office of Senator Daschle within the
Hart Senate Office Building (Hart Building) on October 15, 2001, the
Postal Service reports that it immediately understood that the letter
passed through its Brentwood facility. However, at that point, the risk of
contamination and its consequences at the facility were uncertain. The
Postal Service sought advice and guidance from CDC and the District of
Columbia (D.C.) Department of Health, provided information to its
employees, arranged for environmental tests of the facility, and provided
some protective equipment, but it did not close the facility or refer the
facility's employees for medical treatment until October 21, when CDC
confirmed that a Brentwood employee had inhalation anthrax. The Postal
Service's actions contrasted with those taken by the Attending Physician
for the U.S. Capitol-the individual responsible for the health of public
officials and other congressional employees on Capitol Hill. The Attending
Physician decided to make antibiotics available to the most directly
exposed congressional employees on the same day the contaminated letter
was opened and advised closure of the Hart Building the following day.

In summary:

The Postal Service's decision to wait for CDC's confirmation of a case of
inhalation anthrax before closing Brentwood and referring its employees
for medical treatment was consistent with the advice it received from CDC
and the D.C. Department of Health as well as the information about health
risk available at the time. However, the decision raised questions among
Brentwood employees about whether their health was being adequately
protected. At the time, CDC advised waiting for such confirmation before

4U.S. General Accounting Office, U.S. Postal Service: Issues Associated
with Anthrax Testing at the Wallingford Facility, GAO-03-787T (Washington,
D.C.: May 19, 2003).

5U.S. General Accounting Office, Bioterrorism: Public Health Response to
Anthrax Incidents of 2001, GAO-04-152 (Washington, D.C.: Oct. 15, 2003).

recommending closing a facility or recommending medical treatment because
CDC and local public health authorities believed it unlikely that postal
employees could contract inhalation anthrax from exposure to contaminated
mail. The Postal Service's decision differed from the decision to close
the Hart Building, in large part, because there was an observable incident
of anthrax contamination there-which was immediately recognized as a
potentially high-risk situation-whereas there was no observable incident
at Brentwood. However, even before CDC confirmed the first case of
inhalation anthrax at Brentwood, some Postal Service employees questioned
whether the Postal Service's actions adequately protected their health.

The Postal Service communicated health risk and other information to its
Brentwood employees during the anthrax incident, but some of the
information it initially provided changed as public health knowledge
evolved-exacerbating employees' concerns about the adequacy of the
measures being taken to protect them. Most significantly, employees later
learned that their risk of contracting the disease was greater than
originally stated. Other factors, including difficulties in communicating
the uncertainty associated with health recommendations, the appearance of
disparate treatment between Brentwood and congressional employees, and
employees' long-standing distrust of postal managers, also challenged
efforts to communicate effectively. According to postal managers, the
Postal Service has made additional efforts to communicate with Brentwood
employees since the facility's closure, but challenges remain, including
before the facility opens to clearly communicate the impossibility of
eliminating all risk of contamination from the environment. Recently, for
example, the Postal Service informed employees that Brentwood, which has
been tested and certified as safe for occupancy, is "100 percent free of
anthrax contamination." However, following discussions with us about the
impossibility of eliminating all risk of contamination, the Postal Service
agreed to revise future communications to acknowledge that although any
remaining risk at the facility is likely to be low, complete freedom from
risk cannot be guaranteed.

The Postal Service, CDC, and others have learned a great deal from the
2001 anthrax incidents and have taken various steps to address the
problems that occurred and to enhance their preparedness for any future
incidents. One of the lessons learned is that the risk of employees
contracting anthrax through the mail is greater than was previously
believed and more caution is needed to respond to that greater risk.
Another important lesson learned is that clear and accurate

communication to employees is critical to managing the response to an
incident and its aftermath. The Postal Service, CDC, and others have taken
steps to revise their guidance to respond more quickly in the event of a
future anthrax incident and to communicate more effectively about such an
incident with employees and the public. The Postal Service told us that it
would inform Brentwood employees prior to opening the Brentwood facility
that while the facility is safe for occupancy, it is impossible to
guarantee that it is risk free.

Background 	Anthrax is an acute infectious disease caused by the
spore-forming bacterium called Bacillus anthracis. The bacterium is
commonly found in the soil and forms spores (like seeds) that can remain
dormant for many years. Although anthrax can infect humans, it occurs most
commonly in plant-eating animals.

Human anthrax infections are rare in the United States and have normally
resulted from occupational exposure to infected animals or contaminated
animal products, such as wool, hides, or hair. Infection can occur in
three forms, two of which are relevant to this testimony. They are (1)
cutaneous, which usually occurs through a cut or abrasion6 and (2)
inhalation, which results from breathing aerosolized anthrax spores into
the lungs.7 Aerosolization occurs when anthrax spores become airborne,
thus enabling a person to inhale the spores into the lungs. After the
spores enter the body, they can germinate into bacteria, which then
multiply and secrete toxins that can produce local swelling and tissue
death. The symptoms are different for each form of infection and are
thought to appear within about 7 days of exposure, although individuals
have contracted inhalation anthrax as long as 43 days after exposure.
Depending on the extent of exposure and its form, a person can be exposed
to anthrax without developing an infection. Before the 2001 incidents, the
fatality rate for inhalation anthrax was approximately 75 percent, even
with appropriate antimicrobial medications.8 People coming in contact with
anthrax in its natural environment have generally not been

6Cutaneous means of, relating, to or affecting the skin. Cutaneous anthrax
is characterized by lesions on the skin.

7The third form of anthrax infection is gastrointestinal, which results
from ingesting undercooked contaminated meat.

8An antimicrobial medication either kills or slows the growth of microbes.
Antibiotics are an example of antimicrobial medications.

at risk for inhalation anthrax, and before 2001, no cases of inhalation
anthrax had been reported in the United States since 1976, although 224
cases of cutaneous anthrax were diagnosed between 1944 and 1994.9
Fatalities are rare for cutaneous anthrax.

Because so few instances of inhalation anthrax have occurred, scientific
understanding about the number of spores needed to cause the disease is
still evolving. Before the 2001 incidents, it was estimated that a person
would need to inhale thousands of spores to develop inhalation anthrax.
However, based on the cases that occurred during the fall of 2001, experts
now believe that the number of spores needed to cause inhalation anthrax
could be very small, depending on a person's health status and the
aerosolization capacity of the anthrax spores.

In total, the contaminated letters caused 22 illnesses and resulted in 5
deaths from inhalation anthrax. Numerous postal facilities were also
contaminated. The first two cases of disease involved media employees in
Florida. The employees-one of whom died-contracted inhalation anthrax and
were thought to have contracted the disease through proximity to opened
letters containing anthrax spores. Media employees also developed anthrax
in New York-the second location known to be affected. The initial cases in
New York were all cutaneous and were also thought to have been associated
with opened envelopes containing anthrax spores. The initial cases at the
next site-New Jersey-involved postal employees with cutaneous anthrax. The
postal employees were believed to have contracted the disease through
handling the mail-as opposed to opening or being exposed to opened letters
containing anthrax spores. Unlike the incidents at other locations, which
began when cases of anthrax were detected, the incident at the Hart
Building-the fourth location-began with the opening of a letter containing
anthrax spores and the resulting exposure to the contamination. The
discovery of inhalation anthrax in the first postal worker from Brentwood
revealed that even individuals who had been exposed only to taped and
sealed envelopes containing anthrax could contract the inhalation form of
the disease. Subsequent inhalation cases in Washington, D.C.; New Jersey;
New York; and Connecticut-the sixth location affected-underscored that
finding and also demonstrated that exposure and illness could result

9Journal of American Medical Association, Anthrax as a Biological Weapon:
Medical and Public Health Management, May 12, 1999. Volume 281, No. 18.

from cross contamination of mail.10 (See app. I for a time line of
selected events related to the anthrax incident in the fall of 2001.)

On or about October 9, 2001, at least two letters containing anthrax
spores entered the U.S. mail stream-one was addressed to Senator Thomas
Daschle, the other to Senator Patrick Leahy. The letters were mailed in
Trenton, New Jersey, and forwarded to the Brentwood facility in
Washington, D.C., where they were processed on high-speed mail sorting
machines and further processed in the facility's government mail section
before delivery.11 On October 15, a staff member in Senator Daschle's
office opened the contaminated envelope. The envelope contained a powdery
substance, which the accompanying letter identified as anthrax, that was
released in a burst of dust when the envelope was opened. The U.S. Capitol
Police were notified, and the substance was quickly tested and confirmed
to be anthrax. Brentwood managers analyzed the path of the letter through
the facility. Although the machine that processed the letter was
reportedly shut off-at least for a period of time-the facility itself was
not closed or evacuated at that time. Within days, a Brentwood employee
was suspected of having contracted inhalation anthrax. The Postal Service
closed the facility on October 21, 2001, after CDC confirmed that the
employee had the disease. Thereafter, two other Brentwood employees, Mr.
Curseen, Jr., and Mr. Morris, Jr., died. Both were subsequently found to
have died of inhalation anthrax.

The Brentwood facility is a large 2-story facility that operated 24 hours
a day, 7 days a week. About 2,500 employees worked at Brentwood,
processing mail on one of three shifts. Brentwood processed all the mail
delivered to addresses on Capitol Hill, including the Hart Building.
Brentwood was the second processing and distribution center closed for an
extended period because of anthrax contamination. The Postal Service
reported that it plans to reopen the facility in phases; by late November
administrative personnel will begin working in the facility and limited
mail processing operations will begin shortly after that. Brentwood is
expected to be fully operational by spring 2004. The other facility-the
Trenton Processing and Distribution Center-located in Hamilton, New
Jersey, was closed 3 days before Brentwood on October 18, 2001, after CDC
confirmed

10Cross contamination occurs when other pieces of mail or equipment come
in contact with the original source of the anthrax.

11The letter addressed to Senator Leahy was never delivered. Instead, it
was recovered in November 2001 in mail that had been quarantined on
Capitol Hill on October 17, 2001.

  Brentwood Employees Questioned Whether the Decision to Wait for Confirmation
  of Inhalation Anthrax Adequately Protected Their Health

that a New Jersey postal employee had cutaneous anthrax. It is in the
process of being decontaminated.

The Postal Service's decision to wait for CDC's confirmation of a case of
inhalation anthrax before closing Brentwood and referring the facilities'
employees for medical treatment was consistent with the public health
advice the Postal Service received and the health risk information
available at the time. However, the Postal Service's decision contrasted
with the more immediate decision to close the Hart Building after anthrax
contamination occurred. As a result, postal employees questioned whether
the Postal Service's decision adequately protected their health.

The Postal Service's Decision Was Based on CDC's Advice and Available
Health Risk Information

The Postal Service's decision to wait for CDC's confirmation of a case of
inhalation anthrax before closing Brentwood and referring its employees
for medical treatment was consistent with the advice provided by CDC and
the D.C. Department of Health, as well as the available health risk
information. CDC called for such confirmation before closing a facility or
recommending medical treatment because, at the time, public health
authorities believed postal employees were unlikely to contract inhalation
anthrax from exposure to contaminated mail. Postal officials reported that
they consulted CDC and the D.C. Department of Health about the possible
health risks to Brentwood employees after learning that Senator Daschle's
letter-opened on October 15, 2001-contained anthrax. Even though the
letter would have passed through Brentwood, the public health authorities
said that they did not consider the facility's employees at risk, given
the results of ongoing investigations of anthrax incidents in Florida and
New York and the scientific understanding at that time. Specifically, as
discussed, no postal employees were known to have developed symptoms of
anthrax after contaminated letters had passed through the postal system on
the way to destinations in Florida and New York, and anthrax spores were
not considered likely to leak out, or escape from, a taped and well-sealed
envelope in sufficient quantities to cause inhalation anthrax.
Accordingly, the Postal Service reported that it kept the Brentwood
facility open in order to keep the mail moving. This goal was important to
managers whom we interviewed, who cited the psychological importance of
keeping the mail flowing in the aftermath of the September 11 terrorist
attacks.

On October 18, 2001, CDC confirmed that a postal employee in New Jersey
had cutaneous anthrax. On that day, the Postal Service, in consultation
with the New Jersey Department of Health and Senior Services, closed the
Trenton Processing and Distribution Center. According to New Jersey public
health officials, the facility was closed to facilitate environmental
testing of the Trenton facility. While the contaminated letters to Senator
Daschle and Senator Leahy were both processed through the Trenton and
Brentwood facilities, it is not clear why the Postal Service did not take
the same precautionary measures at Brentwood. We are pursuing this issue
as part of our ongoing work.

Although the Postal Service followed CDC's advice and kept Brentwood open
until CDC confirmed a case of inhalation anthrax, the Postal Service took
interim steps to protect its employees. First, the Postal Service arranged
for a series of environmental tests at the Brentwood facility, even though
it reported that CDC had advised the Postal Service that it did not
believe such testing was needed at that time. The results of the first
test- taken and available on October 18, 2001-were from a quick test
conducted by a local hazardous materials response team. The results were
negative. Three days later, on October 21, 2001, CDC confirmed that a
Brentwood employee had inhalation anthrax, and the Postal Service closed
the facility and referred its employees for medical treatment. The
positive results of more extensive environmental testing-also conducted on
October 18, 2001-were not available until October 22-after the facility
had already closed. In addition, Postal Service managers said they asked
the D.C. Department of Health three times before October 21 for nasal
swabs and antibiotics for Brentwood employees; however, the health
department said the swabs and antibiotics were unnecessary. We have not
yet been able to confirm this information with the D.C. Department of
Health. Finally, the Postal Service took actions to protect its employees
from low-level environmental risks. For example, it provided protective
equipment such as gloves and masks and, according to postal managers, shut
down the mail-sorting machine that processed the Daschle letter, at least
for a time. Additionally, the Postal Service provided information on
handling suspicious packages and required facility emergency action plans
to be updated.

In 1999, the Postal Service developed guidance for responding to anthrax
and other hazardous incidents. The guidance, which was developed in
response to hundreds of hoaxes, includes steps for notifying first
responders, evacuating employees, and providing information and medical
care to employees. The Postal Service reported that the guidance deals
with observable events-specifically, spills-not events that are not

observable, such as aerosolization of powders. As a result, the Postal
Service said that it did not view the guidance as being applicable to the
situation that occurred at Brentwood.

Given that the situation at Brentwood differed from the situation
contemplated in its guidance, the Postal Service sought advice from CDC
and others. According to CDC officials, the health and safety of postal
employees was always the first concern of postal managers during
discussions with CDC. Furthermore, they said that the Postal Service was
receptive to their advice about the need to close Brentwood to protect
postal employees after a diagnosis of inhalation anthrax was confirmed.

The Decisions Made at Brentwood and Capitol Hill Differed Because the
Circumstances and Decisionmakers Differed

The Postal Service's decision to wait for a confirmed case of inhalation
anthrax before closing the facility and referring employees for medical
treatment differed from the decision to implement precautionary measures
immediately after anthrax contamination was identified at the Hart
Building. The decisions differed, in part, because there was an observable
incident at the Hart Building, but not at Brentwood. In addition,
different parties made the decisions. At Brentwood, the Postal Service
made the decision in consultation with CDC and the D.C. Department of
Health. These parties were not involved in the decision-making at the Hart
Building. Instead, because the Hart Building is one of many congressional
offices surrounding the U.S. Capitol, the Attending Physician for the U.S.
Congress-who functions independently from the District of Columbia-
provided advice and made decisions about how to deal with the
contamination there.12

The incident at the Hart Building was immediately viewed as high risk to
employees there because the envelope opened in Senator Daschle's office
contained a visible white powder that the accompanying letter identified
as anthrax, which was quickly confirmed by testing of the substance.
Consequently, the Office of the Attending Physician of the U.S. Congress
arranged for congressional employees to receive antibiotics immediately
and advised closure of the Hart Building the following day.

12 The Office of the Attending Physician, U.S. Congress, is an office of
the U.S. Navy. It serves as the local health department for Capitol Hill
and is responsible for about 30,000 public officials and other
congressional staff, as well as tourists, on Capitol Hill.

Since 2001, the Postal Service has developed new guidance to address
security risks in the mail. Its Interim Guidelines for Sampling, Analysis,
Decontamination, and Disposal of Anthrax for U.S. Postal Service
Facilities-first issued in November 2001-states that postal facilities
will be closed if a confirmed case of inhalation anthrax is identified or
when evidence suggests that anthrax has been aerosolized in a postal
facility. The Postal Service said that it plans to complete an update to
these guidelines soon, and we plan to determine whether the new guidelines
will adequately address the situation that occurred at Brentwood as part
of our ongoing work. In addition, the Postal Service has tested and begun
to install new biodetection technology in postal facilities. This
technology is designed to enhance safety by quickly identifying
unobservable evidence of aerosolized anthrax, thereby allowing for a
prompt response. We plan to review the guidance associated with this
technology as we complete our work.

The Postal Service communicated health risk and other information to its
Brentwood employees during the anthrax crisis, but some of the information
it initially provided changed as public health knowledge evolved,
intensifying employees' concerns about whether adequate measures were
being taken to protect them. Most significantly, information on the amount
of anthrax necessary to cause inhalation anthrax and the likelihood of
postal employees' contracting the disease turned out to be incorrect.
Other factors, including difficulties in communicating the uncertainty
associated with health recommendations and employees' long-standing
distrust of postal managers, also challenged efforts to communicate
effectively. The Postal Service has made additional efforts to communicate
with Brentwood employees since the facility's closure, but challenges
remain, particularly the need to effectively communicate information on
any possible residual risks.

  Communication Problems Exacerbated Postal Service Employees' Concerns

Some Information The Postal Service used a wide variety of methods to
communicate Communicated to Postal information to employees;13 however,
some of the information it initially Employees Changed provided changed
with changes in public health knowledge. For example,

on the basis of the science at that time, the Postal Service and CDC

13Methods for communicating information included briefings, newsletters,
fact sheets, videos played on closed circuit televisions in its
facilities, and a toll-free information line. In addition, the Postal
Service regularly updated its Web site and, after the facility closed, it
mailed information to its employees' homes.

initially informed employees that an individual would need to be exposed
to 8,000 to 10,000 spores to contract inhalation anthrax. This view turned
out to be incorrect when two women in New York and Connecticut died from
inhalation anthrax in October and November 2001 without a trace of anthrax
spores being found in their environments. Their deaths caused experts to
conclude that the number of spores needed to cause the disease could be
very small, depending on a person's health status and the aerosolization
capacity of the spores.

Postal employees were also told that they were at little risk of
contracting inhalation anthrax because, in the view of public health
officials, anthrax was not likely to escape from a taped and well-sealed
envelope in sufficient amounts to cause inhalation anthrax. In addition,
on October 12, 2001, CDC issued a health advisory, which the Postal
Service distributed to its employees, indicating that it is very difficult
to refine anthrax into particles small enough to permit aerosolization.
This information also proved to be incorrect when the U.S. Army Medical
Research Institute of Infectious Diseases' analyses of the anthrax in
Senator Daschle's letter in mid-October 2001 revealed that the substance
was not only small enough to escape from the pores of a taped and
well-sealed envelope but also highly refined and easily dispersed into the
air.14

Finally, an error occurred on October 10, when the Postal Service
instructed employees to pick up suspicious letters and isolate them in
sealed containers. The message was corrected within a few days when
employees were instructed not to touch suspicious letters. Nevertheless,
Brentwood employees we spoke with cited the miscommunication as an
indication that the Postal Service was not concerned about their safety.
As a result of these and other issues, union and management officials
report lingering bitterness between Brentwood employees and postal
management.

Communicating Communicating information proved challenging for several
reasons. First, Information Proved the incidents occurred in the turbulent
period following the terrorist Challenging attacks of September 11, 2001,
when the nation was focused on the

response to those events. In addition, the anthrax incidents were
unprecedented. The response was coordinated by the Department of

14According to the Postal Service, it learned the results of the Army's
analysis after the Brentwood closure.

Health and Human Services, primarily through CDC, and CDC had never
responded simultaneously to multiple disease outbreaks caused by the
intentional release of an infectious agent. Furthermore, when the
incidents began, CDC did not have a nationwide list of outside experts on
anthrax, and it had not yet compiled all of the relevant scientific
literature. Consequently, CDC had to do time-consuming research to gather
background information about the disease before it could develop and issue
guidance. Moreover, since anthrax was virtually unknown in clinical
practice, many clinicians did not have a good understanding of how to
diagnose and treat it. As a result, public health officials at the
federal, state, and local levels were basing their health-related actions
and recommendations on information that was constantly changing. According
to the testimony of CDC's Associate Director for Science, National
Institute for Occupational Safety and Health, before a Subcommittee of
this Committee last year, CDC "clearly did not know what we did not know
last October [2001] and this is the cardinal sin that resulted in tragic
deaths."

Effective communications were further complicated by the evolving nature
of the incidents and the media's extensive coverage of the response to
anthrax at other localities. Comparing the various actions taken by
officials at different points in time and in different locations confused
postal employees and the public and caused them to question the
consistency and fairness of actions being taken to protect them. For
example, when employees at the Brentwood postal facility received
doxycycline for prophylaxis instead of ciprofloxacin, they incorrectly
concluded that they were receiving an inferior drug. In part, this was
because the media had characterized ciprofloxacin as the drug of choice
for the prevention of inhalation anthrax. Ciprofloxacin also had been used
as the primary medication in earlier responses, including the response to
anthrax atthe Hart Building. CDC initially recommended ciprofloxacin for
several reasons;15 however, when CDC subsequently determined that the
anthrax was equally susceptible to doxycycline and other drugs, it began

15The first reason for recommending ciprofloxacin was that, absent
information about the strain's susceptibility to various drugs, CDC
considered it most likely to be effective against any naturally occurring
strain of anthrax. Also, as the newest antimicrobial available, CDC
considered it less likely that terrorists would have had time to engineer
a resistant strain of anthrax. Finally, the Food and Drug Administration
had already approved ciprofloxacin for the postexposure prophylaxis for
inhalation anthrax.

recommending the use of doxycycline instead.16 The switch to doxycycline
was considered desirable for a variety of reasons, including its (1) lower
risk for side effects, (2) lower cost, and (3) greater availability. Local
and CDC officials we spoke with told us that they were challenged to
explain the switch in medications and to address perceptions of
differential treatment.

Additional misunderstandings arose over the administration of nasal swabs
to postal employees. Nasal swabs are samples taken from the nasal passages
soon after a possible exposure to contamination to determine the location
and extent of exposure at a site, but not to diagnose infection. Nasal
swabs were administered to congressional employees on October 15 after the
contaminated letter was opened to determine which employees might have
been exposed and based on this where and how far the aerosolized anthrax
spores had spread. Some Brentwood employees questioned why they did not
also receive nasal swabs at this time and saw this difference as evidence
of disparate medical treatment. As noted, the Postal Service reported
requesting nasal swabs for its employees, but the CDC and the D.C.
Department did not consider them necessary. Nasal swabs were then provided
to at least some employees after Brentwood was closed on October 21.
However, further confusion appears to have occurred about the purpose of
the nasal swabs when employees who were tested did not receive the results
of the swabs. The confusion occurred partly because the Postal Service
issued a bulletin dated October 11, 2001, that incorrectly indicated that
nasal swabs were useful in diagnosing anthrax and the media described
nasal swabs as the "test" for anthrax. The bulletin was subsequently
corrected, but the media continued to refer to the swabs as a test. Public
health officials acknowledged that this confusion about the purpose of the
nasal swabs created a great deal of anxiety within the postal community
and the public. As a result, public health entities continued to collect
the samples when people asked for them, simply to allay the individuals'
fears.

Another area of confusion relates to the process used to administer the
anthrax vaccine to interested postal employees. When the vaccine used by
the military became available in sufficient quantities that it could be
provided to others, CDC offered it to postal employees and congressional
staff. While considered safe, it had not been approved for use in

16The recommendation to use doxycycline also followed the Food and Drug
Administration's approval of the drug for inhalation anthrax.

postexposure situations. Consequently, the Food and Drug Administration
required CDC to administer the vaccine using extensive protocols related
to the distribution of an "investigational new drug." These protocols
required postal employees to complete additional paperwork and undergo
additional monitoring which, according to some Brentwood employees, gave
some employees the impression that they were being used as "guinea pigs"
for an unsafe treatment. CDC officials acknowledged that CDC did not
effectively communicate information about the vaccine program and that, in
hindsight, these deficiencies probably resulted in the "wrong perception."

CDC officials have also acknowledged that they were unsuccessful in
clearly communicating the degree of uncertainty associated with the health
information they were providing, which was evolving during the incidents.
For example, although there were internal disagreements within CDC over
the appropriate length of prophylaxis, this uncertainty was not
effectively conveyed to postal employees and the public. Consequently, in
December 2001, when postal employees and others were finishing their
60-day antimicrobial regimen called for in CDC's initial guidance, they
questioned CDC's advice about the need to consider taking the drugs for an
additional 40 days. CDC officials have since acknowledged the need to
clearly state when uncertainty exists about the information distributed to
the public and appropriately caveating the agency's statements.

Long-Standing Labor Relations Issues Compounded Communication Issues

CDC, local public health officials, union representatives, and postal
officials told us that employees' mistrust of postal managers complicated
efforts to communicate information to them. According to these parties,
postal employees were often suspicious of management's motives and
routinely scrutinized information they received for evidence of any
ulterior motives. This view appears consistent with the results of our
past work, which has identified persistent workplace problems exacerbated
by decades of adversarial labor-management problems. These problems were
so serious that in 2001, we reported that long-standing and adversarial
labor-management relations affected the Postal Service's management
challenges.17 The need to address this long-standing issue was also raised

17U.S. General Accounting Office, Major Management Challenges and Program
Risks: U.S. Postal Service, GAO-01-262 (Washington, D.C.: Jan. 2001).

in the July 2003 report of the President's Commission on the U. S. Postal
Service.18

The Postal Service Has Made Additional Efforts to Improve Communication
with Employees, but Challenges Remain

According to postal managers, the Postal Service has made additional
efforts to communicate with the employees who were at Brentwood, including
holding "town hall" meetings to explain the facility's decontamination
process to postal employees and the public. The Postal Service has
reported that it is also updating its 1999 guidance for responding to
anthrax and other hazardous materials. At present, however, the revision
of the guidance has not yet been completed and it is, therefore, unclear
whether the revisions will address the issues that occurred at Brentwood.
Nevertheless, the Postal Service assisted the National Response Team-a
group of 16 federal agencies with responsibility for planning, preparing,
and responding to activities related to the release of hazardous
substances-in the development of improved guidance entitled Technical
Assistance for Anthrax Response. This guidance provides a number of
recommendations about communicating information during emergency
situations, including the need for agencies to "admit when you have made a
mistake or do not know the information."

While information on the process and outcome of decontamination efforts is
technically complex and therefore challenging to present clearly to the
public, the revised guidelines may be helpful in future discussions about
the safety of a facility. We have not reviewed the details of the
facility's decontamination or its subsequent testing and, therefore,
cannot comment on the effectiveness of decontamination efforts. However,
in general, discussions about the success of decontamination and any
residual risk to individuals center on two related topics. The first topic
entails a discussion of the degree to which contamination has been
reduced, bearing in mind that all sampling and analytical methods have a
limit of detection below which spores may be present but undetected.
Against that backdrop, it is also important to discuss how many anthrax
spores are required to infect humans and to explain that the number is
variable, depending upon the route of infection (e.g., skin contact or
inhalation) and the susceptibility of each individual to infection. In
light of this, it is particularly important to properly communicate to
Brentwood employees a clear understanding of the decontamination approach
that was

18Report of the President's Commission on the United States Postal
Service, Embracing the Future: Making the Tough Choices to Preserve
Universal Mail Service, July 31, 2003.

undertaken at the facility and the nature and extent of any residual risk
there. Likewise, the Postal Service's communications to employees must be
clear and unbiased to (1) clearly communicate the limitations of testing
and the associated risks while, at the same time, (2) avoid inducing
unnecessary fear or concern. If provided with clear and unbiased
information, employees will be able to make informed decisions about their
health and future employment. In this regard, the Postal Service has given
employees who worked at Brentwood an opportunity to be reassigned to
certain other mail processing centers in the region if they do not want to
return to Brentwood.

In our view, providing complete information to employees is important for
them to make informed decisions about working at Brentwood. According to
recent information that the Postal Service provided to its employees, the
facility, which public health authorities have certified as safe for
occupancy, is "100 percent free of anthrax contamination" and there is "no
remaining health risk" at the facility. This latter information is not
consistent with what CDC's Associate Director for Science, National
Institute for Occupational Safety and Health, told this Committee's
Subcommittee on the District of Columbia in July 2002. Specifically, she
said that while a science-based process can allow workers to safely return
to Brentwood, it is not possible to eliminate risk entirely or to
guarantee that a building is absolutely free of risk. We discussed our
concerns with Postal Service officials about their characterization of the
facility as completely free of anthrax contamination, and they agreed to
revise their statements to indicate that it is not possible to guarantee
that a building is absolutely risk free. According to the Postal Service,
a misunderstanding resulted in the incorrect information being distributed
to employees before the document had been fully reviewed. The Postal
Service said that it would correct the information and distribute the new
information to employees who worked at Brentwood within the next 2 weeks.

The Postal Service, CDC, and others have learned a great deal from the
2001 anthrax incidents and have taken various steps to address the
problems that occurred and to enhance their preparedness for any future
incidents. Among the lessons learned are that the risk to employees of
contracting anthrax through contaminated mail is greater than was
previously believed and more caution is needed to respond to that greater
risk. It is now clear, for example, that anthrax spores can be released in
the air, or aerosolized, when sealed letters pass through the Postal
Service's processing equipment and that a limited number of anthrax spores
can cause inhalation anthrax in susceptible individuals. This

  Lessons Learned and Implications for Reopening the Facility

increased risk of contracting inhalation anthrax indicates that decisions
about closing facilities need to consider other factors as well as the
presence of an observable substance, such as a powder. The Postal Service
and CDC have responded to this need for greater caution by developing
guidance for closing a facility that establishes evidence of
aerosolization, as well as confirmation of a diagnosis of inhalation
anthrax, as a criterion for closure. We have not yet evaluated this
guidance to determine whether it is specific enough to make clear the
circumstances under which a postal facility should be closed to adequately
protect employees and the public. We recognize that developing such
guidance is difficult, given that the Postal Service experiences many
hoaxes and needs to accomplish its mission as well as ensure adequate
protection of its employees' health.

Another important lesson learned during the 2001 anthrax incidents is that
clear and accurate communication is critical to managing the response to
an incident. Because the risk information that was provided to employees
changed over time and some of the information was communicated in ways
that employees reportedly found confusing or difficult to understand, the
fears that would naturally accompany a bioterrorism incident were
intensified and distrust of management, which already existed in the
workplace, was exacerbated. CDC, in particular, has recognized the
importance of communicating the uncertainty associated with scientific
information to preserve credibility in the event that new findings change
what was previously understood. In this regard, our work on the sampling
and analytical methodologies used to test for and identify anthrax
contamination addresses the uncertainty involved in these efforts. The
Postal Service agrees that although the Brentwood facility has been tested
and certified as safe for occupancy, the Postal Service cannot assert that
the building is 100 percent free of anthrax contamination. Accordingly,
the Postal Service stated that it would inform Brentwood employees before
opening the facility that the Postal Service cannot guarantee that the
building is absolutely risk free.

This concludes my prepared statement. I will be happy to respond to any
questions you or other members of the Committee may have.

Contacts and Should you or your staff have any questions concerning this
report, please contact me at (202) 512-2834 or Keith Rhodes at (202)
512-6412. I can also Acknowledgments be reached by e-mail at
[email protected]. Individuals making key contributions to this testimony
were Don Allison, Hazel Bailey, Jeannie

Bryant, Derrick Collins, Dwayne Curry, Elizabeth Eisenstadt, and Kathleen
Turner. Drs. Jack Melling and Sushil Sharma provided technical expertise.

Appendix I: Time Line of Selected Events Related to the Anthrax Incident
in the Fall of 2001

                       Date Events Occurring on That Date

Tuesday, Terrorist attacks on the World Trade Center and Pentagon prompt
heightened concerns about 9/11/01 possible bioterrorism.

Tuesday, In Florida, an American Media Inc. (AMI) employee is admitted to
the hospital with a respiratory 10/02/01 condition.

The Centers for Disease Control and Prevention (CDC) issues an alert about
bioterrorism, providing information about preventive measures for anthrax.

Thursday, CDC and the Florida Department of Health announce that AMI
employee has inhalation anthrax. 10/04/01

Friday, AMI employee dies of inhalation anthrax. 10/05/01

Monday, The Postmaster General announces that Postal Inspection Service is
working with other law 10/08/01 enforcement agencies on the Florida
incident.

Wednesday, 10/10/01 	The Postal Service begins nationwide employee
education on signs of anthrax exposure and procedures for handling mail to
avoid anthrax infection.

Friday, In NY, the New York City Department of Health (NYCDOH) announces
the confirmation of a case 10/12/01 of cutaneous anthrax in an NBC
employee.

The Postal Service says that it will offer gloves and masks to all
employees who handle mail.

(On or about) Daschle letter passes through Brentwood.

Boca Raton post office, which had direct access to the AMI mail, is tested
for anthrax and Palm Beach County Department of Health administers nasal
swabs and offers a 15-day supply of ciprofloxacin to postal employees.

Monday, On Capitol Hill, an employee opens a letter addressed to Senator
Daschle. Staff in that office, an 10/15/01 adjacent office, and first
responders are given nasal swabs and a 3-day supply of antibiotics.

In NJ, State Department of Health and Senior Services (NJDHSS) assures
Trenton employees that they have a low risk of contracting anthrax.

Anthrax is confirmed at Boca Raton post office.

Tuesday, 10/16/01 	Part of the Hart Senate Office Building is closed in
the morning, and the remainder of the building is closed in the evening.
Over the next 3 days, all Hart building and other Capitol Hill employees
who request them are given nasal swabs and a 3-day supply of antibiotics.

Wednesday, The Postal Service arranges for environmental testing at
Brentwood. 10/17/01

                       Date Events Occurring on That Date

Thursday, 10/18/01

A local hazardous materials response team conducts "quick tests" of
Brentwood, which are negative for anthrax. A contractor conducts more
extensive testing in the evening.

Postmaster General Potter holds a press conference at Brentwood, in part
to reassure employees they are at low risk.

CDC confirms cutaneous anthrax in New Jersey postal employee, and a second
suspected case is identified.

In NJ, the Trenton facility is closed. Employees are sent home.

In NY, NYCDOH announces another case of cutaneous anthrax, in a CBS
employee.

In Florida, the Postal Service cleans two postal facilities contaminated
with anthrax spores.

CDC distributes a press release announcing that the Food and Drug
Administration has approved doxycycline for postexposure prophylaxis for
anthrax.

In the DC, a postal employee who works at the Brentwood facility seeks
medical attention.

Friday, 10/19/01	In NJ, the NJDHSS refers postal employees to their
private physicians for medical treatment. Employees begin seeking
treatment at a local hospital.

In DC, a postal employee who works at Brentwood is admitted to a hospital
with suspected inhalation anthrax.

In NJ, laboratory testing confirms cutaneous anthrax in a second postal
employee who works at the Trenton postal facility.

Saturday, In DC, another postal employee who works at the Brentwood
facility is admitted to a hospital with a 10/20/01 respiratory condition.

CDC arrives at the Brentwood facility to meet with Postal Service
management.

Sunday, 10/21/01

In DC, the postal employee who was admitted to the hospital on 10/19/01 is
confirmed to have inhalation anthrax.

In DC, Brentwood is closed. Evaluation and prophylaxis of employees begin.

In DC, a Brentwood employee who had initially sought medical attention on
10/18/01 is admitted to a hospital with suspected inhalation anthrax and
becomes the first postal employee (and second anthrax victim) to die.

In DC, another postal employee who worked at the Brentwood facility seeks
medical attention at a hospital. His chest X-ray is initially determined
to be normal, and he is discharged.

Monday, 10/22/01

In DC, the postal employee who worked at the Brentwood facility and who
sought medical attention on 10/21/01 and was discharged is readmitted to
the hospital with suspected inhalation anthrax, and becomes the second
postal employee (and third anthrax victim) to die.

In DC, prophylaxis is expanded to include all employees and visitors to
nonpublic areas at the Brentwood facility.

The postal employee who was admitted to the hospital on October 20 is
confirmed to have inhalation anthrax.

The Postal Service learns that environmental tests of Brentwood are
positive for anthrax.

Sunday, In NJ, a postal employee at Trenton is confirmed to have
inhalation anthrax. 10/28/01

                       Date Events Occurring on That Date

Monday, 10/29/01

In NY, preliminary tests indicate anthrax in a hospital employee who was
admitted with suspected inhalation anthrax on 10/28/01. The hospital where
she works is temporarily closed, and NYCDOH recommends prophylaxis for
hospital employees and visitors.

In NJ, laboratory testing confirms cutaneous anthrax in a woman who
receives mail directly from the Trenton facility. The woman originally
sought medical attention on 10/18/01 and was admitted to the hospital on
10/22/01 for a skin condition.

In NJ, laboratory testing confirms a second case of inhalation anthrax, in
a Trenton postal employee who initially sought medical attention on
10/16/01 and was admitted to the hospital on 10/18/01 with a respiratory
condition.

  Wednesday, 10/31/01 In NY, the hospital employee becomes the fourth anthrax
                                 victim to die.

Friday, 11/2/01

In NY, NYCDOH announces another case of cutaneous anthrax, in a New York
Post employee.

Wednesday, 11/21/01 	In Connecticut, an elderly woman, who was admitted to
the hospital for dehydration on 11/16/01, becomes the fifth anthrax victim
to die.

The Connecticut Department of Public Health, in consultation with CDC,
begins prophylaxis for postal employees working in the Wallingford postal
facility.

Friday, CDC offers the anthrax vaccine to postal employees. 12/27/01

Source: Information provided by U.S. Postal Service, Centers for Disease
Control and Prevention, Connecticut Department of Public Health, D.C.
Department of Health, Food and Drug Administration, Florida Department of
Health, New Jersey Department of Health and Senior Services, New York City
Department of Health, and Office of the Attending Physician of the U.S.
Congress.

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