Public Health Preparedness: Information on the Use of Medical Reserve Corps Volunteers during Emergencies

What GAO Found

Almost all states have a network of health care volunteers—the Medical Reserve Corps—who can augment federal, state, and local capabilities in response to public health emergencies, such as those arising from wildfires and hurricanes, and infectious disease outbreaks. Having sufficient, trained personnel, such as these volunteers, is critical to a state’s capability to respond and recover from public health emergencies. According to federal data, 48 states and the District of Columbia reported 102,767 health care volunteers in 838 Medical Reserve Corps units as of September 2019, with nurses making up 43 percent.

Number of Medical Reserve Corps Volunteers by Type, as of September 2019

Note: These data illustrate 90 percent of total health care volunteers. The remaining five types volunteers each make up less than 5 percent of the total. Other Public Health Medical volunteers may include cardiovascular technicians, sonographers, and phlebotomists.

Medical Reserve Corps volunteers in states included in GAO’s review—Alabama, California, North Carolina, and New Mexico—were deployed in response to natural disasters in 2018 and 2019, migrants at the southern border in 2019, and COVID-19 in 2020. Department of Health and Human Services (HHS) documentation shows these volunteers performed a variety of health care activities, such as providing medical services, setting up and providing support at shelters, and distributing medical supplies. Volunteers from these four states and others also participated in the response to COVID-19 by supporting testing sites, collecting specimens, and performing administrative tasks, such as data entry. For example, one unit deployed four volunteers a day for 3 days to work alongside nurses at a drive-through testing site. In addition to responding to public health emergencies, volunteers participated in preparedness activities, such as an initiative to train the public on how to respond to emergencies.

HHS oversees the Medical Reserve Corps program and has assisted units in developing their volunteer capabilities. For example, HHS

  • funded the development of a checklist of activities that should occur during volunteer deployment such as re-verifying medical credentials;
  • provided training to new unit leaders on developing, managing, and sustaining Medical Reserve Corps units; and
  • issued generally accepted practices, such as periodically re-evaluating volunteer recruitment procedures.

Why GAO Did This Study

The Medical Reserve Corps consists of health care volunteers—medical and public health professionals—who donate their time to help strengthen a response to public health emergencies and build community resilience. These volunteers prepare for and respond to public health emergencies, which may include natural disasters—such as hurricanes and wildfires—as well as disease outbreaks, whether intentional or natural.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 included a provision for GAO to review states’ use of health care volunteers during public health emergencies. This report describes (1) the number and type of Medical Reserve Corps volunteers; (2) the types of public health emergencies volunteers have participated in; and (3) how HHS has assisted in developing volunteer capabilities.

To conduct this work, GAO analyzed data reported to HHS as of September 2019; reviewed HHS documentation on four states’ use of volunteers, which GAO selected based on population, number of volunteers, and event; and interviewed officials from HHS who oversee the Medical Reserve Corps program.

GAO plans to further examine how states have used health care volunteers to respond to public health emergencies, including COVID-19, and any associated challenges to doing so in a future report.

GAO provided a draft of this report to HHS. In response, HHS provided technical comments, which were incorporated as appropriate.

For more information, contact Mary Denigan-Macauley at (202) 512-7114 or deniganmacauleym@gao.gov.

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    The Justice Department and the U.S. Attorney’s Office for the District of Connecticut today announced an agreement with the City of Meriden, Connecticut to resolve allegations that the city violated the Religious Land Use and Institutionalized Persons Act of 2000 (RLUIPA) by denying the application of the Omar Islamic Center to establish a mosque in March 2019, and by maintaining a zoning code that treats religious assemblies and institutions on less than equal terms with nonreligious assemblies and institutions in nine zoning districts.
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  • Colorado Man Convicted of Production, Transportation, and Possession of Child Pornography
    In Crime News
    An Englewood, Colorado, resident was convicted today after a three-day jury trial on six child exploitation offenses, announced Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division and U.S. Attorney Gregg Sofer of the Western District of Texas.
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  • Passengers with Disabilities: Airport Accessibility Barriers and Practices and DOT’s Oversight of Airlines’ Disability-Related Training
    In U.S GAO News
    What GAO Found Passengers with disabilities face infrastructure, information, and customer service barriers at U.S. airports, according to representatives of selected airports, disability advocacy organizations, as well as a review of relevant literature. Infrastructure barriers can include complex terminal layouts and long distances between gates and can be difficult for some to navigate. Essential travel information is not always available in a format accessible to all. For example, a person with hearing loss could miss crucial gate information that is solely provided over a loudspeaker. A passenger might not receive appropriately sensitive service, such as wheelchair assistance, at the airport, although the service provided is required by the Air Carrier Access Act of 1986 (ACAA) regulations. According to stakeholders, while no solution meets all needs, a number of practices can help reduce or eliminate some of these barriers to equal access at airports. For example, some selected airports use external disability community and passenger groups to proactively engage in identifying barriers and develop solutions. Other airports have implemented technology-based solutions, such as mobile phone applications to make airport navigation easier. Examples of Stakeholder-Identified Features to Assist Airport Passengers with Disabilities The Office of Aviation Consumer Protection within the Department of Transportation (DOT) is responsible for oversight of airlines' compliance with the ACAA. In 2008, DOT updated its entire ACAA regulation, including adding new training requirements for airline personnel, such as requiring training to be recurrent. Following this update, DOT conducted outreach to domestic and foreign airlines on the changes and reviewed airlines' disability training sessions and materials. Agency officials said that in recent years, DOT has conducted reviews of airlines' training only when passengers' complaints indicate a possible problem, as officials' analyses have not shown training generally to be a significant cause of service violations. DOT officials and stakeholders said other factors, such as limited availability of staff to assist passengers with disabilities, at times may affect the service passengers with disabilities receive. DOT is assessing some of these factors through the statutorily mandated ACAA Advisory Committee, formed in late 2019 to make recommendations to improve accessibility to air travel. The committee met in 2020, established three subcommittees, and plans to reconvene by summer 2021. Why GAO Did This Study Approximately 43 million people in the United States have some type of disability, which may affect mobility, vision, hearing, and cognition. Without accessible airport facilities and accommodations—such as appropriate assistance from the check-in counter to the gate, or effective communication of flight information—air travel for people with disabilities can be extremely challenging. The FAA Reauthorization Act of 2018 includes provisions for GAO to review leading airport accessibility practices for passengers with disabilities, as well as required training for airline and contract service personnel who assist these passengers within the airport. This report examines, among other objectives: stakeholder-identified barriers that passengers with disabilities face when accessing airport facilities, accessibility practices to assist passengers with disabilities, as well as how DOT has overseen airlines' disability-related training. GAO reviewed relevant federal laws, regulations, DOT documents, literature, as well as information describing disability training provided by selected airlines and contractors. GAO interviewed a non-generalizable sample of stakeholders, including those at 16 U.S. airports selected based on size and geography, eight large and low-cost domestic airlines selected based on the greatest number of disability-related passenger complaints and enplanements, and six aviation service contractors working for those airlines. GAO also conducted interviews with DOT officials and 10 disability advocacy organizations, among others. For more information, contact Heather Krause at (202) 512-2834 or krauseh@gao.gov.
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  • Singaporean National Sentenced to 14 Months in Prison for Acting in the United States As an Illegal Agent of Chinese Intelligence
    In Crime News
    Jun Wei Yeo, also known as Dickson Yeo, was sentenced today in federal court to 14 months in prison. Yeo pled guilty on July 24, 2020 to acting within the United States as an illegal agent of a foreign power without first notifying the Attorney General, in violation of 18 U.S.C. § 951. The announcement was made by John G. Demers, Assistant Attorney General; Michael R. Sherwin, Acting United States Attorney for the District of Columbia; James A. Dawson, Acting Assistant Director in Charge of FBI Washington Field Office; Alan E. Kohler, Jr., Assistant Director of the FBI's Counterintelligence Division; and Deputy Assistant Secretary Ricardo Colón, Domestic Operations Deputy Assistant Secretary Ricardo Colón, Domestic Operations.
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  • Electromagnetic Spectrum Operations: DOD Needs to Take Action to Help Ensure Superiority
    In U.S GAO News
    What GAO Found The electromagnetic spectrum (the spectrum) consists of frequencies worldwide that support many civilian and military uses, from mobile phone networks and radios to navigation and weapons. This invisible battlespace is essential to Department of Defense (DOD) operations in all domains—air, land, sea, space, and cyberspace. The interruption of U.S. forces' access to the spectrum can result in a military disadvantage, preventing U.S. forces from operating as planned and desired. According to the studies by DOD and others that GAO reviewed for its December 2020 report on military operations in the spectrum, adversaries, such as China and Russia, are also aware of the importance of the spectrum and have taken significant steps to improve their own capabilities that challenge DOD and its operations. For example, studies described how China has formed new military units and fielded new unmanned aerial vehicles with spectrum warfare capabilities, and Russian electromagnetic warfare forces have demonstrated their effectiveness through successful real-world applications against U.S. and foreign militaries. These developments are particularly concerning in the context of challenges to DOD's spectrum superiority. GAO's analysis of the studies highlighted DOD management challenges such as dispersed governance, limited full-time senior-level leadership, outdated capabilities, a lengthy acquisition process, increased spectrum competition and congestion, and a gap in experienced staff and realistic training. GAO found that DOD had issued strategies in 2013 and 2017 to address spectrum-related challenges, but did not fully implement either strategy because DOD did not assign senior leaders with appropriate authorities and resources or establish oversight processes for implementation. DOD published a new strategy in October 2020, but GAO found in December 2020 the department risks not achieving the new strategy's goals because it had not taken key actions—such as identifying processes and procedures to integrate spectrum operations across the department, reforming governance structures, and clearly assigning leadership for strategy implementation. Also, it had not developed oversight processes, such as an implementation plan, that would help ensure accountability and implementation of the 2020 strategy goals (see figure). Actions to Ensure DOD Superiority in the Electromagnetic Spectrum Why GAO Did This Study The spectrum is essential for facilitating control in operational environments and affects operations in the air, land, sea, space, and cyberspace domains. Spectrum use is pervasive across warfighting domains and thus maintaining or achieving spectrum superiority against an adversary is critical to battlefield success. This statement summarizes: (1) the importance of the spectrum; (2) challenges to DOD's superiority in the spectrum; and (3) the extent to which DOD has implemented spectrum-related strategies and is positioned to achieve future goals. This statement is based on GAO's December 2020 report (GAO-21-64) and updates conducted in March 2021. For the report, GAO analyzed 43 studies identified through a literature review, reviewed DOD documentation, and interviewed DOD officials and subject matter experts. For the updates, GAO reviewed materials that DOD provided in March 2021.
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  • Justice Department Files Complaint to Stop Distribution of Unapproved, Misbranded, and Adulterated “Poly-MVA” Products
    In Crime News
    The United States filed a civil complaint to stop a California company from distributing unapproved and misbranded drugs and adulterated animal drugs, the Department of Justice announced today.
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  • Iranian Nationals Charged with Conspiring to Evade U.S. Sanctions on Iran by Disguising $300 Million in Transactions Over Two Decades
    In Crime News
    A federal criminal complaint unsealed today charges 10 Iranian nationals with running a nearly 20-year-long scheme to evade U.S. sanctions on the Government of Iran by disguising more than $300 million worth of transactions – including the purchase of two $25 million oil tankers – on Iran’s behalf through front companies in the San Fernando Valley, Canada, Hong Kong and the United Arab Emirates.
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  • Operators of California Charity Scam Sentenced to Prison for Mail Fraud Conspiracy and Tax Evasion
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    Geraldine Hill and Clayton Hill, a California couple who operated a charity that purported to provide goods to the needy, were sentenced to prison for conspiracy to commit mail fraud and tax evasion. Geraldine Hill was sentenced to 15 months in in prison, and Clayton Hill was sentenced to 9 months in prison, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division and U.S. Attorney Robert S. Brewer, Jr. for the Southern District of California.
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  • University of Arkansas Professor Indicted for Wire Fraud and Passport Fraud
    In Crime News
    The Department of Justice announced today that Simon Saw-Teong Ang, 63, of Fayetteville, Arkansas, was indicted by a federal grand jury in the Western District of Arkansas on 42 counts of wire fraud and two counts of passport fraud.
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  • Farmworkers: Additional Information Needed to Better Protect Workers from Pesticide Exposure
    In U.S GAO News
    The U.S. Environmental Protection Agency (EPA) and states ensure compliance with the Agricultural Worker Protection Standard (WPS) primarily through inspections of farms. The states collect some information—such as the number of inspections they conduct—and provide that information to EPA as part of cooperative agreements between EPA and the states. The extent of use of the designated representative provision of the WPS, and its effect on the availability of pesticide information, are not known because EPA does not collect information on the use of the provision and does not coordinate with states to do so. EPA's guidance to states for conducting inspections encourages, but does not require, state inspectors to ask farmers and farmworkers about whether a designated representative has been used. EPA officials said that the agency has not asked states to collect information on the provision because the agency has focused on compliance with other aspects of the WPS. By coordinating with states, through the cooperative agreements or some another mechanism, to collect information on the use of the designated representative provision, EPA would be better positioned to determine whether the provision is serving its intended purpose. Some stakeholders have raised concerns about potential misuse of pesticide information, such as other farmers using the information obtained by a designated representative to gain a competitive advantage. However, EPA officials, state officials, and stakeholders told us they did not know of any instance in which a person serving as a designated representative misused the pesticide information obtained from farmers. Neither EPA's guidance nor its website explain the agency's expectations for appropriate use or describe how such information could be misused. EPA officials said that the agency has not explained what constitutes misuse. By explaining, in the agency's guidance, on its website, or through another mechanism, EPA's expectations about appropriate use of pesticide information obtained by designated representatives, including the misuse of such information, the agency could ensure designated representatives understand the importance of the information in reducing the consequences of pesticide exposure. Farmworkers Picking Strawberries at a Farm The use of pesticides contributes to U.S. agricultural productivity by protecting crops against pests or weeds, but this use may pose risks to human health. To reduce the consequences of pesticide exposure to farmworkers' health, EPA revised the WPS in 2015 to include a provision that allows a farmworker to identify a person who can request, for their benefit, certain pesticide information from their employer—this is called the designated representative provision. This report examines (1) what is known about the extent of use and effect of the designated representative provision on the availability of pesticide information and (2) what is known about any misuse of information obtained through the provision. GAO reviewed laws, regulations, and guidance, and interviewed officials from EPA and 13 selected states about how they implement and oversee compliance with the standard. GAO also interviewed stakeholders, such as farmer groups and farmworker advocacy groups. GAO is making two recommendations to EPA to (1) coordinate with states to collect information on the use of the designated representative provision and (2) take steps to explain, in guidance, on its website, or through another mechanism, the agency's expectations about appropriate use of pesticide information obtained by a designated representative and describe potential misuse of such information. EPA agreed, in part, to both recommendations. For more information, contact Steve D. Morris at (202) 512-3841 or morriss@gao.gov.
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  • Justice Department Files Lawsuit Against Two California Doctors for Discrimination Against Patient with HIV
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    The Justice Department filed lawsuits today alleging that two obstetrician-gynecologist (OB/GYN) doctors in Bakersfield, California refused to provide routine medical care to a patient on the basis of her HIV status, in violation of Title III of the Americans with Disabilities Act (ADA).
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