Anthrax Teamwork Is a Struggle

After a colony of anthrax bacteria was found growing in a mail bin at the Princeton, N.J., post office last month, the FBI and public health agencies couldn’t settle on which group should take environmental swabs.

So they both did. And the state’s public health laboratory was forced to process two batches of samples to be reviewed by two agencies instead of one batch in a combined effort.

“We used our samples to make public health decisions,” explained Dr. George T. DiFerdinando Jr., the state’s acting health and senior services commissioner. “They can hold onto their samples if they need to go to court.”

Critics say it was just another day in the national anthrax probe, with public safety and public health officials proceeding down separate tracks, unable or unwilling to collaborate on basic tasks.

The five-week investigation has been “a bureaucratic snafu of the first order,” said Sen. Max Cleland (D-Ga.). “Any time you have two government agencies, it’s like two pretty sisters--you always compete.”

In this case, however, the usual bureaucratic competition has been heightened by a clash of cultures between law enforcement and public health. The two sides often approach their jobs in opposite--or at least very different--ways. Each has distinct habits and styles.

The FBI, police and prosecutors tend to keep information secret to win a conviction at trial. Public health authorities, by contrast, tend to share every detail they know, hoping to prevent diseases from spreading and treat people already infected.

Publicly, the sides say they are getting along remarkably well as they scramble to investigate 17 anthrax infections, four of them fatal.

“I think it’s working out better and we’re working to improve it,” Health and Human Services Secretary Tommy G. Thompson said last week, calling the reported differences between health and law enforcement officials “completely blown out of proportion.”

But several instances in the last five weeks show a tenuous relationship marked by duplication of effort, delays, communication breakdowns and missed opportunities.

Consider:

* The FBI sent virulent anthrax samples taken from the office of Senate Majority Leader Tom Daschle (D-S.D.) last month to a military lab in Maryland rather than to the Centers for Disease Control and Prevention’s lab in Atlanta. As a result, public health officials learned of the results later than criminal investigators. Confusion over the meaning of the results led to further delays.

Two postal workers employed at the Brentwood mail processing facility, which handles most of the federal government’s mail in Washington, died of inhalation anthrax before they could be treated. If officials had moved more quickly and prescribed antibiotics to the Brentwood employees, the two men might have been saved, critics of the operation say.

“You can see where the Postal Service and the postal workers fell through the bureaucratic cracks here,” Cleland said.

* The New Jersey health department was forced to take its own environmental swabs at a post office in Ewing, N.J., because the military lab hadn’t processed the FBI samples from the same location after two weeks. The swabs came back negative.

* The FBI didn’t notify New York City health officials of a suspicious letter sent to NBC News until after the city learned of a network employee’s possible anthrax skin infection from a private doctor.

* District of Columbia health officials learned from the news media about anthrax spores found in the mail rooms of several federal agencies.

“Had law enforcement and medical epidemiology been connected, I think we would have been in a better position to anticipate a problem,” said Dr. Larry Siegel, senior deputy director of the District of Columbia Department of Health.

“If you’re talking about information sharing, there is a disconnect. . . . I don’t think we’ve had the kind of coordinated response to this that should be in place.”

* When the FBI took over the investigation of the first anthrax death, in Florida, press briefings by public health officials halted. The law enforcement agency, seeking to protect the integrity of its investigation, urged health officials to keep mum, which stopped the flow of information about anthrax precautions and risks to a worried public, Cleland said.

“When it took the criminal bent and FBI took over, there really was no public health message out there,” said Dr. Jean Malecki, director of the Palm Beach County health department. Without assessing blame, she said: “The public health message has got to be No. 1, no matter what bent an investigation takes.”

FBI officials say they are not free to share all the information they collect, but they do pass along anything that may have a bearing on public health, including the results of anthrax swabbing.

“When the potential for a biological release exists, the primary mission of law enforcement and the public health community is saving lives,” J.T. Caruso, the FBI’s deputy assistant director, said at a Senate hearing this week.

At the same time, there is a level of secrecy, and sometimes duplication of efforts, that is required in a criminal investigation, law enforcement officials say.

If evidence does not have a direct bearing on the public health, “then it is a part of the criminal investigation and we’re not at liberty to disclose the details,” said Special Agent Sandra Carroll, spokeswoman for the New Jersey FBI office.

“There is clearly a division of labor that exists throughout the course of this process and as it stands, the lines of expertise are divided,” she explained, adding that “given the circumstances, there has been extraordinary effort on all parts.”

But keeping secrets from partners is “really just silliness,” said Jerome M. Hauer, former director of the New York City Office of Emergency Management and currently managing director of Kroll Inc., an investigation firm.

“The FBI is not a public health agency. The FBI is not a medical agency. And anything they do in withholding information really jeopardizes public health and can significantly impact the health of the public.”

Psychologists say they are not at all surprised by the uneasy working relationship between the two camps.

“Law enforcement people are . . . very concerned with control. They have to fix things. They have to make it better,” said Harvey Schlossberg, who was chief psychologist for the Port Authority of New York and New Jersey during the 1993 World Trade Center bombing.

In public health, “they recognize that things have scientific error involved with them. Not everything works on schedule and is as predictable,” he said.

Law enforcement workers tend to feel that “the people in the health field are not cooperating or they’re not working fast enough or they’re not specific enough,” Schlossberg said. Public health workers sometimes “feel like they’re being used” by law enforcement.

Bob Hogan, an industrial psychologist and personality test pioneer in Tulsa, Okla., says: “They’re from different planets.”

Making matters worse, the two groups have little experience working together. Said Dr. William Roper, former director of the CDC. “It’s hard to have a warm, mutually supportive relationship when you’ve never met the people.”

Cleland said he blames conflicting federal laws for the problem.

In One Case, Contact Is Continual

A law passed by Congress last year designates the CDC as the lead agency in a bioterrorism attack, he said. But an executive order from President Bush designates the Justice Department as the lead agency. Another executive order from Bush says Director of Homeland Security Thomas J. Ridge is in charge.

Cleland said he will push legislation that would, once and for all, designate the CDC as the top dog.

CDC officials downplay the differences with law enforcement.

“Let me emphasize that CDC is in constant contact with the FBI,” said Dr. Julie Gerberding, acting deputy director of the CDC’s National Center for Infectious Diseases. “I personally am on the phone with the FBI at least two hours a day. . . . If there’s a report of a suspicious powder that has a public health implication, you can be sure that the CDC is aware of it.”

Experts say Bush’s appointment of Ridge has created an outside arbiter who can force the two sides to work together. Ridge quickly summoned both sides to a White House meeting last month, where he told them to improve their relations.

Meanwhile, officials say they are struggling--and sometimes failing--to forge an effective alliance.

“What you’re seeing is people learning how to do this,” DiFerdinando said. “It’s not pretty watching learning. It never is. . . . In any learning process, people make mistakes.”