Hurricane Katrina demonstrated that some major disasters can exceed the response/relief capacities of the American Red Cross (ARC) and other Emergency Support Function #6 (ESF-6) Mass Care Providers (described in the National Response Framework (NRF) Annex).In response to post-Katrina lessons realized, the NRF shifted primary ESF-6 Mass Care Responsibilities from the ARC to FEMA (Before/After and After).

While this change is a great start, the ARC will still serve a similar function, as demonstrated by recent Mass Care responses to recent tornado disasters. The change will allow the ARC to avoid taking accountability for under-performing after a disaster because main Mass Care responsibilities now lie with FEMA.

While the ARC and other ESF-6 organizations have the capacity to help a few hundred families affected by a tornado, these non-governmental organizations will likely run into the same challenges experienced after Katrina should they face another disaster of greater proportion.

Furthermore, so long as organizations like the ARC are raising funds in the immediate aftermath of a disaster, there will be strong efforts within these organizations to gloss over or avoid media exposure of mistakes, oversights, or gaps in critical services…. bad press results in fewer donated dollars… These “public affairs” efforts present an inherent conflict of interest for organizations simultaneously fulfilling a role tasked by the federal government and raising billions of dollars in private donations. The public should know exactly what limitations exist for organizations providing such critical services.

The Role of Volunteers: The mostly volunteer force serving along the Gulf Coast after Katrina consisted of a number of highly-skilled volunteers that took unpaid time from work, individuals in-between jobs, many retirees, religious groups, first-time volunteers, and many others that simply wanted to get away for three weeks. America must decide if key Mass Care functions should be managed by a volunteer force. For example, see the following position description for a volunteer ESF-6 Mass Care Team Chief with responsibilities that include:

Prepare, submit and track all Action Request Forms with FEMA; report status daily to the ESF #6 Mass Care lead in the Disaster Operations Center.

Identify gaps and shortfalls in Mass Care.

While there were many highly skilled volunteers, many could not apply their skills because (we were told) ARC insurance policies capped the level of care Client Service Centers could provide at basic first aid. A large population of survivors that had not received any care for weeks after the storm could not receive tetanus shots, IVs, and other basics. Such necessities could only be provided by those carrying a sufficient insurance policy: National Guard Medics, lone doctors, and ambulances (some of the ambulances we regularly called to our Site had been driven down from Connecticut).

While organizations like the ARC have allegedly made many changes to their response capacity, few changes have been publicly disclosed…. and the public is largely in the dark about the capacity of these multi-billion dollar organizations to respond to a major disaster.

Ice: FEMA announced last month that ice would no longer be distributed after disasters… or, rather, ice would only be available to those that need it for medical emergencies. How would this work? FEMA typically gets called when States need help — during emergencies. How will every mother with baby formula, every diabetic with insulin, and every other prescription drug user requiring refrigeration for their medications, and others– prove that they are deserving of ice– to FEMA’s temp workers that get hired by the hundreds, after a disaster? I’m not convinced that the reasoning here is sound.

The Durable Medical Equipment (DME) Crisis: The Centers for Medicare and Medicaid Services (CMS) conducted a bidding process for durable medical equipment reimbused by Medicare in 10 Metropolitan Service Areas (MSAs). Somehow, the bidding process somehow “forgot” to include any considerations of disaster preparedness and post-disaster response capacities. For example, in South Florida, there are 501 suppliers of oxygen. Through the new bidding process, only 44 suppliers were chosen to continue their Medicare contracts.

While DAP is not passing judgment on the need to reduce the number of suppliers of oxygen, deeply troubling is the result of having only 44 suppliers of oxygen and other important life-sustaining DMEs in areas so disaster prone.

According to current DME suppliers, after previous FL hurricanes, fewer than half of the suppliers were functional in the immediate aftermath. An oxygen shortage could lead to even larger emergency room surges after a disaster— something that could overwhelm hospitals already potentially overwhelmed by a hurricane or other disaster. Surprisingly, CMS requires emergency and evacuation planning for hospitals and nursing homes. From GAO Report GAO-08-544R:

At the federal level, HHS’s Centers for Medicare and Medicaid Services (CMS) has requirements related to hospital and nursing home evacuation planning as a condition of participation in the Medicare and Medicaid programs. (page 6)

How did an agency so “disaster conscious” forget to include similar considerations in its DME bidding process? The public deserves an answer…. before Hurricane Season begins.

With Hurricane Season around the corner, the public remains vulnerable because the organizations and agencies responsible for providing Mass Care lack transparency. As a result, it is hard for the public to know what has improved to prevent the same bungled Katrina disaster response in 2005 from happening again in 2008.

Note: Ben Smilowitz is Founder and Executive Director of the Disaster Accountability Project. After Katrina, he served as the site manager of a Red Cross Client Service Center in Gulfport, MS.