Bioterror Threat Strains County Coffers

In a year where California counties already are struggling from increased energy costs and a softening economy, bioterrorism preparedness could drain an additional $80 million from the coffers of those governments, which supply most of the social services used by poor people and others.

Health officials estimate counties will need that much money to buy equipment and pay the first six months of salaries for new employees--vital steps in preparing to identify and track diseases in the event germ agents are released, according to a report by the County Health Executives Assn. of California and California Conference of Local Health Officers.

Part of the reason for the increased need is that the public health system and its labs have for years been the victims of tight budgets, officials said. And funding for germ warfare typically has remained at the federal level, where it has been used to develop vaccines and stockpile medicines and where attention was focused on the reasoning that troops, not cities, were considered more likely targets of a bioterrorism attack.

With those assumptions now dashed, counties have been thrust into the issue as never before and are playing a lead role in responding to the threat of bioterrorism--in part because county governments are responsible for public health. The costs are so significant and the challenge so enormous that officials in some counties are beginning to advocate a sales tax hike for next year to help pay their mounting bills.

Santa Clara County supervisors, for example, recently approved $5 million to shore up that county’s health department in case of an attack.

Los Angeles County supervisors have approved just under $3 million for new equipment and workers in the health department over the next two years. Officials in Orange County estimate they will spend $2.1 million over the next year.

That’s not to say county supervisors are signing blank checks. San Diego County supervisors responded to a $20-million request from their public health department by approving $6 million for immediate needs, such as lab and field equipment. The board ordered officials to get public input on prioritizing the rest of the list.

“It’s not a good time because of the state budget deficit,” said Rich Robinson, deputy chief administrator for public safety for San Diego County. Next year’s state budget shortfall, which has been estimated at up to $14 billion, “is affecting how we do everything, because of our expectation that the state is going to pass on some of its problem to us, as it has in the past.”

Preparation for a bioterrorist attack is much like preparing for a natural disaster with a public health twist, officials said.

In addition to all the things government needs to do in an earthquake or fire, for instance, public health officers need lab equipment to detect the germs. Epidemiologists, meanwhile, track symptoms and illnesses, as well as train physicians, paramedics and law enforcement officials on the signs of deadly agents.

They also need to be able to quickly alert hospitals, physicians and others of an outbreak. Those so-called first responders need protective gear, decontamination equipment and medicine to treat the victims, another aspect of bioterror response that adds to its complexity and cost.

None of this was a priority for many agencies before Sept. 11, so counties have since been scrambling to figure out what they need and how much it’s going to cost.

“What the events since Sept. 11 and the anthrax cases have taught us is that each one of us needs to get much more specific about what we would actually do in these cases,” said Dr. Mark Horton, health officer for Orange County.

“If the federal government arrived with a 747 full of antibiotics, what would we do with it? How would we distribute it across the county? If busloads of sick people showed up at the hospitals’ doorsteps, what triage systems would they set up to respond? How would they reorganize? We’ve got to get the plans down to that level of specificity,” Horton said.

A statewide group of health officials surveyed California counties to determine the cost and came up with a preliminary estimate of at least $70 million to $80 million to cover start-up costs and the first six months of new workers’ salaries. After that, annual ongoing expenses could run $50 million to $60 million, according to Judith Reigal of the County Health Executives Assn. of California.

The Los Angeles amounts are projections because the county did not respond to the survey, but an estimate the county released last week is in line with those projections, according to Reigal.

It’s hard to know precisely how much counties already have spent on the measures because some costs have been absorbed by diverting staff from other work.

In Ventura County and others, for example, nurses were tapped to answer phones to help deal with a flood of calls from panicky residents worried about mailed anthrax.

In Santa Clara County--one of the most progressive areas in the country for bioterrorism readiness--bioterror response, known as “BT,” has eclipsed many important functions for the last two months. The head of the county’s hospital system, its health officer and his assistants have worked on almost nothing else.

But it is a pace they cannot sustain, said Dr. Marty Fenstersheib, the county’s health officer.

He and others say that without federal and state funds, counties cannot meet the financial burdens of being ready for biological or chemical attacks. But federal appropriations for defense against such attacks have historically not been passed on to local governments.

“It has got to make its way to the counties. It cannot stay in the top-down fashion it’s been for so long in the area of weapons of mass destruction,” Fenstersheib said. “This is a different scenario. We are now the first line of defense and we have got to be prepared to deal with it from day one on our own.”

Some health officials are pushing for a quarter-cent sales tax increase that would raise $1 billion to help cover terrorism-related public health costs, including boosts to trauma and emergency room costs and disease-tracking.

Anthony Wright, spokesman for Health Access of California, said that because of the state’s expected deficit, a sales tax increase may be the counties’ only hope for state help. Budget cuts this year already trimmed money for trauma centers and community clinics, he said.

Law enforcement and fire officials also are seeking a quarter-cent increase to fund additional expenses in light of Sept. 11. But it is unclear whether either of the tax hikes will be approved.

There are also moves in Washington to help with the costs. The Bush administration has proposed spending $1.5 billion on emergency funds, in addition to $345 million budgeted for bioterrorism programs in the Department of Health and Human Services. Officials said some of the federal money would be spent on state and local readiness and expanding stores of antibiotics and vaccines.

“The question is how much of those funds will come down” to the counties, said Reigal.

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Times staff writer Kay Saillant contributed to this report.