Audit of the Disease Outbreak Control Division of the Department of Health

Hawaii State Auditor, Report No. 17-14,

Auditor’s Summary

What problems did the audit identify?

IN REPORT NO. 17-14, Audit of the Disease Outbreak Control Division of the Department of Health, we assessed the division’s surveillance and response to three disease outbreaks: dengue fever on Hawai‘i Island, hepatitis-A involving frozen scallops on O‘ahu and Kaua‘i, and salmonella-infected ogo on O‘ahu. We found that, during these outbreak responses, the Disease Outbreak Control Division (the Division) and the Department of Health (DOH) experienced communication breakdowns with other DOH divisions, State and County response representatives, and the general public. During the outbreaks, DOH did not have a formal communications plan that would have provided established guidance on issues such as the timing of the first public announcement about the outbreak and procedures for sharing outbreak information with other agency officials. The confusion and, at times, discord, may have been avoided if DOH had established and followed a full communications plan.

We also found that the Division has inconsistent processes and procedures for recordkeeping, internal reviews, and reporting. We note that neither DOH nor the Division could provide us with a comprehensive account, timeline, or summary of the outbreak responses. In addition, the Division does not follow the disease specific investigation protocols it does have in place. 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.

In our review of the summary and final reports for the outbreaks, we found that the Division’s final summary reports do not consistently follow a scientific format as recommended by the Centers for Disease Control and Prevention. The Division also does not consistently complete end-of-outbreak reviews, debriefs, or after-action reports. Such a review would help assess lessons learned and determine areas for improvement so that the Division is better prepared for future outbreaks.

Why do these problems matter?

As State agencies, the Division and DOH are obligated to collect and maintain proper records to help ensure an open and accountable government. State agencies must maintain sufficient documentation to allow the State Legislature — and more importantly, the public — to be assured that public resources are being used effectively, efficiently, and responsibly. Perhaps just as important is that proper recordkeeping preserves institutional memory, so that agency officials and their successors can make decisions informed by past results. In other words, even though a disease may be unique, with complete documentation and reliable data available for reference, the ensuing outbreak response need not be a one-of-a-kind effort.

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HNN: Audit: State fumbled response to 3 recent outbreaks and 'reinvented the wheel' each time

SA: State auditor slams Health Department for bad communication  

HTH: Audit slams outbreak response: Poor communication by DOH during dengue crisis among issues cited in state report

CB: Audit: Hawaii Needs To Get Its Act Together In Responding To Outbreaks