Audit critical of state’s response to disease outbreaks

The state auditor is slamming the Health Department for failing to properly communicate with its own divisions, health responders and the public during three major disease outbreaks in Hawaii.

State Auditor Les Kondo said there were “communication breakdowns” during the dengue fever outbreak on Hawaii island, when hepatitis A was found in frozen scallops on Oahu and Kauai, and when salmonella was found in ogo on Oahu in 2015 and 2016.

Specifically, the Department of Health’s Disease Outbreak Control Division, led by state Epidemiologist Sarah Park, did not have a formal communications plan or established guidelines on initial public announcements, nor did it have procedures for sharing information with other agencies, though it is responsible for public safety during major disease outbreaks, acts of terrorism and natural disasters.

“The confusion and at times, discord, may have been avoided if DOH had established and followed a full communications plan,” Kondo said in the report.

The division had “inconsistent processes and procedures for recordkeeping, internal reviews, and reporting” and was unable to provide a “comprehensive account, timeline or summary of the outbreak responses.” It also did not follow its own disease investigation policies, the audit found.

“Without plans, policies, and protocols in place prior to an outbreak, and proper recordkeeping and assessment during and after the effort, it appears that the Division had to ‘reinvent the wheel’ for each response,” he said. “These deficiencies result in limited accountability to the public and could also result in missed investigation steps and possible delays and/or replication of efforts during an outbreak response.”

The Health Department said it it was aware of the issues and has been reorganizing for the past year and developing guidelines to clearly define the roles and responsibilities of employees to keep the public informed with accurate, timely information on outbreaks. The department received approval a week ago from Gov. David Ige to undergo a major reorganization that shifts oversight of response to public health emergencies to DOH Director Virginia Pressler.

The Disease Outbreak Control Division’s Public Health Preparedness Branch, which has been without a chief for more than a year, is being turned into an office under the director. DOH is recruiting for a new administrator to head the office and said the reorganization is expected to be complete within a year.

“The Department of Health understands that during an outbreak, communication within our department, with other response agencies and the public is essential,” Pressler wrote in a letter to the auditor. Pressler is now directly overseeing disease outbreak response. “Protecting the health of Hawaii’s people is our top priority. As a publicly funded entity, this is a responsibility the Department of Health takes very seriously.”