Toxic Trailers: Have the Centers for Disease Control Failed to Protect Public Health?

Date: Tuesday, April 1, 2008 Time: 12:00 AM Location: Washington, DC

Opening Statement By Chairman Bart Gordon

The country depends on the Agency for Toxic Substances and Disease Registry to warn of health dangers that come with exposure to chemicals. In the wake of Hurricanes Katrina and Rita, hundreds of thousands of Americans found themselves placed in mobile homes and travel trailers as semi-permanent housing. Formaldehyde has historically been found at higher levels in this kind of manufactured housing than in traditional construction. It should come as no surprise, then, that within months of families being placed in these trailers, some complaints about sicknesses – nose bleeds and asthma-like symptoms most prominently – began to filter back to FEMA.

The people in these trailers include the most vulnerable among us – children, the elderly, the handicapped. Many of these are people who were really stuck in the trailers twenty-four hours a day, seven days a week. Children and babies breathe faster than adults and are less able to process formaldehyde so it builds up in their bodies faster than in adults. These are the same populations that you might expect to be most sensitive to formaldehyde – lower levels of exposure triggering stronger health reactions. These are the very segments of the public that we most expect the government to act to protect.

In the summer of 2006, ATSDR began working with the Environmental Protection Agency and FEMA to develop a test protocol to examine formaldehyde in trailers. The ATSDR leadership was aware of this effort. They did not assign their top formaldehyde or toxicology people to this task. Rather, they left it to two emergency response staff with no special training on formaldehyde. Those staffers then analyzed the data that came back from the EPA testing, and they produced a report that went directly to the Director and Deputy Director for review through the Director’s Office of Terrorism Preparedness and Emergency Response. Apparently neither the Director nor Deputy Director asked any questions about how the report was produced or who else had seen it. Their memories of dealing with that report are vague on what they knew, what they saw, what they said or what they did.

However, they must have approved the report because it went to FEMA on February 1, 2007. The report suggests that if people just open windows and doors of their trailers, they can keep formaldehyde levels below "levels of concern" regarding health effects. But as we know, another round of testing and more careful analysis – by another office at the CDC – led to a very different conclusion from the same agency. In February of 2008 the CDC announced that people should be moved out of these trailers as quickly as possible. Getting it wrong in February of 2007 consigned tens of thousands of Americans to a year in unhealthful housing. That hardly sounds like the public health was well served.

Our review of the way the original formaldehyde Health Consultation was handled demonstrates a complete managerial collapse at ATSDR. The wrong people were assigned to write it under the Katrina emergency consultation process set up by the Director. Then the wrong people reviewed the report – in this case, those people consist solely of the Director and Deputy Director of the agency. When the mess is made apparent to the Director, he does virtually nothing to correct the situation. Only when the mess becomes more public do the leaders of the agency swing into action to issue a corrected consultation and shift blame to others.

Among those blamed for the poor original consultation was Dr. Chris DeRosa. Ironically, it was Dr. DeRosa that first brought problems with the report to the attention of the Director of ATSDR, Dr. Frumkin. He continued to push on the health conditions in trailers and other matters throughout 2007. His reward for these efforts was to be blamed for the failed health consultation and removed from his post as director of the Division of Toxicology and Emergency Medicine – a job he had held for 16 years.

The Science and Technology Committee considers Dr. De Rosa a whistleblower. He sought to repeatedly raise the alarm within the corridors of the CDC that a public health disaster was unraveling before them. I strongly believe that raising the alarm on a critical public health issue that has impacted thousands of individuals should be rewarded, not punished.

I trust that we will receive assurances today from Dr. Frumkin that retaliation against Dr. De Rosa will cease, and that he will be recognized for his efforts to fulfill the mission of ATSDR: "to serve the public" by "taking responsive public health actions [in order] to prevent harmful exposures and disease related to toxic substances."

Opening Statement By Chairman Brad Miller (Investigations and Oversight)

The Agency for Toxic Substances and Disease Registry – ATSDR – is a constituent agency of the Centers for Disease Control and Prevention (CDC). Its mission is to "serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances."

The staff of this Subcommittee has engaged in more than a hundred hours of interviews and read thousands of pages of documents in preparing this morning’s hearing on this matter. The ATSDR failed in its mission in producing a health consultation for the Federal Emergency Management Agency – FEMA – on the possible health consequences of formaldehyde exposure in trailers provided by FEMA to survivors of Hurricanes Katrina and Rita. ATSDR failed in what it did in producing the consultation, but ATSDR's greatest failings were in what it left undone.

ATSDR’s failures were not just in scholarship, in academic disputation in obscure learned journals. Tens of thousands of Katrina and Rita survivors were living in the trailers. ATSDR released the consultation to FEMA on February 1, 2007. The consultation concluded that formaldehyde levels in the trailers would be "below levels of concern" so long as the doors and windows were left open to air out the trailers. The "level of concern" was established at .3 parts per million. We will hear this morning that is a level well above the level of exposure that would likely cause adverse health reactions in sensitive people. And the report was entirely silent on risks associated with continuous, long-term exposure to formaldehyde.

In short, ATSDR issued a scientifically flawed report and failed to correct the record when they knew that the report was significantly flawed. And the result of that failure was that thousands of Americans were exposed to unsafe levels of formaldehyde fumes for a full year after ATSDR and FEMA knew or should have known the real health risks. It was not until February 13, 2008 that Julie Gerberding announced that CDC encouraged people to be moved out of trailers as rapidly as possible.

This was not an instance of lower level employees acting without the knowledge of the leadership of ATSDR or CDR. The facts are these:

The analysts who did this job were approved for this task by the Deputy Director of the agency, Dr. Tom Sinks, in July of 2006;
The analysts produced a report that was then sent directly to the emergency response officials in the Director’s Office;
On January 8, 2007, the draft report was briefed to the Director, the Deputy Director and the senior staff of the Director – this briefing did not include the Division Directors that possess the technical expertise to evaluate toxicological or epidemiological studies;
The Director of ATSDR was given a copy of the draft report and told Committee staff that he cannot remember whether he ever read it or not in January of 2007;
The Deputy Director was given a copy of the draft report and remembers reviewing it at least one time – the analysts believe that review process went through four rounds – providing comments back to the analysts on what they needed to do to improve the report;
There was no process in place to guarantee that anyone else between the two analysts and the Director and Deputy Director had a chance to review the report;
There was no control sheet to indicate to the Director who else had reviewed it – in most agencies this is a standard form to guarantee that a document has received the proper clearances;
This whole process for moving Katrina-related consultations was established at the personal direction of the Director of ATSDR, Dr. Howard Frumkin.

In sum, there was a complete failure by leadership to establish effective systems to guarantee that important public health documents were properly reviewed and based on the best science. There was also a stunning lack of concern for how important this consultation was to thousands of American families. It appears that this consultation received only a cursory review in the Director’s office by the Director himself and the Deputy Director claims only the vaguest memories of any concerns regarding the report.

Another official at ATSDR had a very different reaction to this formaldehyde consultation when he saw it. After the report was reviewed and approved by the Director, ATSDR sent the report to FEMA. Then it was distributed to some within ATSDR. When it landed on the desk of Dr. Chris DeRosa, the head of the Division of Toxicology and Environmental Medicine, he was appalled. He immediately e-mailed Dr. Frumkin to urge that they send a letter to FEMA to effectively withdraw the report.

When he didn’t receive a response, De Rosa resent his letter draft and said that Dr. Frumkin would have to get back to him by close of business the next day or would assume Frumkin’s silence implied support and Dr. DeRosa would send the letter to FEMA himself. Frumkin then agreed to have ATSDR send the letter over the signature of an official from the responsible office – in this case an official in the Director’s office.

ATSDR finally sent that letter on March 17, 2007. That letter read, in relevant part, "the Health Consultation… has been completed without a policy review by our senior technical staff. I am concerned that this health consultation is incomplete and perhaps misleading." This letter – like the prior consultation – was sent to an attorney in the Office of Chief Counsel at FEMA, Mr. Rick Preston. Mr. Preston told our staff that he simply filed the letter and did not send it to anyone else at FEMA.

With that letter of repudiation, the leadership of ATSDR washed their hands of the report until awkward questions were raised at a hearing by Chairman Waxman last July. In the wake of that hearing, Dr. Frumkin ordered a revised consultation – posted in October 2007, and shifted the blame for the consultation. Dr. Frumkin argued that Dr. DeRosa – who first questioned that report – should be removed due to the poor quality of the formaldehyde health consultation.

I want to make it very clear to the management at CDC that the Committee considers Dr. DeRosa to be a whistleblower. I have joined Chairmen Gordon and Lampson in signing a letter to Dr. Gerberding expressing this position very forcefully. I think I have made it clear who at ATSDR I believe would most benefit from Professional Improvement Plan and it isn’t Dr. DeRosa – who has been put on one by Drs. Frumkin and Sinks. I want to emphasize that we believe that nothing is to happen to Dr. DeRosa short of restoring him to his post.

Think back to when you were a child and sick. The safest place to be was at home in bed. But here we have a situation where the government has provided families with homes that are making children sick. Where do those children go to be safe? Who do their families turn to for help? ATSDR is mandated to intervene to protect the public from the adverse health consequences of toxic chemicals. But in this case we find the leadership at the very top of that agency with no interest in the actual work it would take to carry out that role. Take a look at their testimony. In inspiring tones, they utter the right words of concern and commitment, but their actions and inactions speak much louder than their words. The nation needs better leadership from ATSDR and the CDC.

Witnesses

Panel 1

1 - Dr. Heidi Sinclair
Assistant Professor of Pediatrics, Louisiana State University Medical Director of Baton Rouge Children's Health Program Medical Director of Baton Rouge Children
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2 - Ms. Becky Gillette
Formaldehyde Campaign Director, Gulf Coast Environmental Restoration Task Force Sierra Club Sierra Club
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3 - Mrs. Lindsay Huckabee
Resident of FEMA-provided mobile home in Kiln, Mississippi from October 2005 to the present in Kiln, Mississippi from October 2005 to the present
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Panel 2

2 - Dr. Christopher De Rosa
Former Director, Division of Toxicology and Environment Medicine Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Age
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1 - Dr. Meryl Karol
Professor Emerita, Department of Environmental and Occupational Health, Graduate School of Public Health University of Pittsburgh University of Pittsburgh
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Panel 3

1 - Dr. Howard Frumkin
Director, National Center for Environmental Health Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Agency for Toxic
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2 - Dr. Tom Sinks
Deputy Director, National Center for Environmental Health Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Agency for
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3 - Vice Admiral (ret.) Harvey E. Johnson
Deputy Administrator Federal Emergency Management Agency Department of Homeland Security Federal Emergency Management Agency Department of Homeland Security
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