The haste has drawn a round of cautious questions from some members of Congress and state lawmakers, who are waiting to see what emerges when the HHS completes its review of most of the applications later this month.
"There's a lot of concern about the speed; there's a lot of concern about whether they're done right," said Dean Rosen, a senior aide to Tennessee Sen. Bill Frist, a Republican. Frist is a physician recognized as a leading voice on bio-terror issues on Capitol Hill.
Building the nation's public health system to significantly reduce the threat of a terrorist attack using such biological agents as anthrax bacteria or the smallpox virus is a top national security priority. The $915 million in grant money administered by the federal Centers for Disease Control for state and local public health preparedness was the largest single homeland security item in the FY2002 supplemental appropriation bill.
A second pot of money funneled through states to help hospitals and emergency caregivers assess needs and develop coordinated plans tacked on another $125 million, and more time-consuming paperwork.
Federal health grants often come with a short timetable. But Jack Pittman, Florida's brand new director of public health preparedness, says the speedy turnaround on a grant the size of the one prepared by HHS in January -- $47 million for Florida alone -- is "unprecedented."
State public health officials stand by the quality of their submissions, which required even faster action by numerous city, county and private sector partners in each state.
"We have a realistic plan," said Dr. Richard Burton, Associate Director of the California Department of Health Resources. Burton led the work on California's $71 million bid and hustled to link it with the separate effort of Los Angeles County.
The stories from Florida and California of how things got done echo those told elsewhere: Late nights and working weekends; dozens of employees dividing time between work on the bio-terror grant and other duties; meetings organized on the fly; and "rigorous" debates over proposals as they were plugged into the federal framework.
California officials say their years of responding to the state's legendarily destructive fires, floods and earthquakes gave them an advantage. New York officials tapped into the experience and data they gathered during the state's reaction to the arrival of the West Nile virus.
And Florida? "We set an aggressive schedule and beat ourselves mercilessly in order to meet it," Pittman said.
The aid program requires states to survey the status of state, local and hospital readiness plans, facilities, equipment and training needs system-wide. States also must indicate when they expect to have plans in place for such things as establishing authority in the event of an attack and how they would handle a shipment of antibiotics, vaccines and medical equipment from the National Pharmaceutical Stockpile (NPS).
State plans identified dozens of gaps that would frustrate or even prevent them from responding quickly and effectively to a biological attack. California found local health districts in the state unprepared to receive materials from an NPS shipment. Several districts lack 24-hour accessibility and caregivers are often unsure how to contact key health personnel.
All but four states -- Minnesota, Montana, Texas and Utah -- delivered applications for both funding sources on time. Minnesota's application for the larger CDC grant appeared on April 17.
"It wasn't unexpected that some folks might request an extension due to the large amount of information they had to compile in a relatively short amount of time," said CDC spokeswoman Karen Hunter. "We are trying to be as flexible as possible."
Minnesota health planning director Jill DeBoer has no complaints.
"We take this very, very seriously, as we do with any grant," she said. "I think the pace is fine."
But not all of her colleagues were as comfortable. Texas put its application for the smaller hospital fund on the back burner to make sure it could get its CDC application in on time.
"'Impossible' is a generous word" to describe the work required to evaluate Texas's 550 hospitals and scores of emergency units in the time prescribed, state epidemiologist Dennis Perrotta said.
Pittman and Burton both said they expect to see every cent of their grants spent before the fund expires in August 2003. They point to the unusual flexibility of the program.
Making good on that prediction would set the HHS grants apart.
An in-house Department of Justice audit of a five-year-old, $243 million anti-terror program for first responders found that only 15 cents of every dollar appropriated for aid to states and localities has been allocated and spent as Congress intended. The Bush Administration's FY2003 budget request directs $3.5 billion to the same purpose.
"Our biggest concern is, 'Are they actually going to be able to spend it and spend it well?'" Office of Homeland Security policy director Richard Falkenrath said of the first responder readiness grants during a recent gathering of leading homeland security strategists in College Park, Maryland.
As for how well the bio-terror aid is spent in Florida, Pittman says the buck stops with him.
"The easiest thing to do is to buy stuff; I want to make sure that with this grant - we're improving a segment of public health," he said.
John Nagy, Stateline.org
