Looking Back to Move Forward: An Interview with Dr. Rahul Gupta

Gupta headshotThis is part of a series of interviews with local health department staff who will present at the 2015 Preparedness Summit. Dr. Rahul Gupta, MD, MPH, West Virginia State Health Officer and Commissioner for the West Virginia Bureau of Public Health, previews his workshop, West Virginia Water Crisis – A Look Back: Moving Forward to Building an Evidence-Based Water Security Program for Public Health. At the workshop, Dr. Gupta will be joined by Dr. Elena Savoia, MD, MPH, Deputy Director and Research Scientist, Harvard School of Public Health Preparedness and Emergency Response Learning Center; Michael A. Stoto, PhD, Professor, Health Systems Administration and Population Health, Georgetown University School of Nursing and Health Studies; and Nasandra Wright, MPH, Director, Environmental Health, Kanawha-Charleston Health Department.  

Dr. Gupta was interviewed by Lindsay Beattie, Program Analyst, NACCHO and Geoff Mwaungulu, Program Analyst, NACCHO

Q: Thank you for taking the time to speak with us today regarding your workshop at the 2015 Preparedness Summit.  Could you give us a preview of what you plan to cover?

Dr. Gupta: What we plan to review, in partnership with the Harvard School of Public Health Preparedness and Emergency Response Learning Center, is a look-back/root cause analysis of after action involving a number of partners at the state and local level, as well as a number of community groups. We plan to share the results.

Q: Can you elaborate on the Evidence-Based Water Security Program to be discussed during your workshop? Does this program refer to a look-back, or does it refer to the sharing of information learned as a result of the West Virginia spill with local health departments?

Dr. Gupta: It’s both. Some of it is looking at the way we responded as a system, including the challenges that come with unprecedented events. Since the situation was unprecedented in scale with 9 counties, 300,000 people, you have to consider questions like, “What do you encounter in daily life and how do you mitigate those encounters?” For instance, we didn’t plan for the incidence of inoperable businesses like restaurants and food preparation facilities, offices, and schools; so you have to work towards a continuity of operations for most of these entities. Typically, when you have a storm water advisory or your power goes out, you can’t cook so you go to a restaurant to eat. In our case, however, the restaurants were all shut down. It became an interesting event because, while this happened on Thursday, by Friday afternoon we were already talking about water as a challenge; but it quickly became an attritional issue as well, especially for the special and vulnerable populations who were unable to get sufficient water nor go out and eat. So we needed to figure out a way to find potable water tanks for business to continue. On a 24/7 basis we opened up all the phone lines and emails to allow restaurants to submit their plans for potable water. We would review the plans, go to the restaurant site, approve the plans, and allow the business to open. We started to decompress the system slowly, even before the water was usable again, to fulfill the water and nutritional needs of the community. These are the processes developed out of the event that we hope to share during the session.

From there, we may move to a discussion on the legislation that occurred as a result of this event. The idea of the workshop is to walk people through the process in an interactive manner. We will put the questions we faced in front of the participants and ask what they would do in a similar situation. Furthermore, we will challenge people with a multitude of concerns (e.g. lack of knowledge regarding chemical composition of the water). We will almost make the scenario come to life and will see what people say about it, emphasizing that there are no right or wrong answers.

Q Related to your interview with NACCHO last year, we were curious to hear more about Senate Bill 373 and the connection between that bill, the West Virginia Spill event, and the program you plan on presenting at the NACCHO Preparedness Summit.

Dr. Gupta: We now have some of the strongest regulations to increase water security. To give an example, West Virginia now mandates the use of source water protection plans, whereas most other states only require voluntary compliance for water utilities. We went from an average, everyday situation, to having the best regulations and requirements in the country to the point that we now have other states looking at us as an example.

There are two major parts to this legislation: 1) water safety and security, and 2) chemical plants and above ground storage tanks. The legislation requires all tanks to be accounted for in the state with the provision of their GPS location, their contents, and proximity to water intake zones of critical concern. While our partners in the state environmental protection agency are focusing on these issues, public health is focusing on the water systems to ensure that the zones of critical concern are better delineated, source water protection plans are in place by July 2016, and a list of potential source contaminants is created. This is so utilities are aware of their zone of concern; the nature of potential contaminants; and, if they were to come into the water, what to do. None of this existed prior to January 9, 2014. Senate Bill 373 was a game changer for West Virginia.

Q:  Did Senate Bill 373 have any impacts on inter- and intra- agency communications? Have you witnessed these impacts or have you noticed any improvements outside the scope of the bill?

Dr. Gupta: First, I would like to mention that it goes back to basic public health functions. I think we received such a strong bill because of community action. I believe that the communities across the state wanted this senate bill to happen as a result of this event. This is a success story from a community and people perspective, and thus it was a win for public health since people demanded better protection of their waters.

It is the same thing with the communications part. There were gaps when agencies at different levels are talking to one another, which was recognized in Senate Bill 373. It is no longer allowed or acceptable to have these large gaps in communications within the system. The senate bill was also impacted by a state after action report that the government put online for public consumption in order to promote transparency. It is expected that future rule-making will further define and nail down the communications aspects. Communications has improved tremendously as a result of the chemical spill.

Since the chemical spill, we have had a few events, especially in the past six weeks since I’ve been in this position. Communications-wise, what was multiple hours is now a few hours and things that were a few hours are now a few minutes. Recently, two utilities were shut down within ten minutes of each other because of a potential contaminant. This is another example that communications is much better.

Q: During the last interview you mentioned that local health departments learned about many developments due to media reports; is this still the case?

Dr. Gupta: Well, this could always happen. There are times when the media gets news before anyone else; it just happens and you can’t avoid it. Much of this is the result of living in a world with social media. However, from a response standpoint, when these major events are happening where there is a real potential to shut down water intake and harm the public, it is critical that the local entities are notified as soon as possible. One of my priorities is to ensure that this first notification occurs at the local level. We are working hard to make sure that the utilities are aware that they have a responsibility to their customers, to notify them if there is something of concern; and to notify their local partners, including local health departments, emergency responders, and emergency management agencies. It is critical for local responders to be aware of what is happening in their backyards, something we are actively working on.

The challenge is to make sure we empower the local communities and utilities to share that information in a timely manner.  We are trying to make sure that when utilities work with us we support them in their decision-making. We also work with locals as they are the first responders.

Q: Do you feel that the partnerships have remained from the spill last year, not just between  local and state, but public and private partnerships as well?

Dr. Gupta: Communications have improved but have not yet been perfected. We believe in continuous quality improvement, so things can never truly be perfected. There is a lot of work yet to be done.

As far as partnerships, we have had such great partnerships. There are advocates for a state water system that were actually born out of this event last year, working in this area and regions across the state to make sure that people stay engaged in protecting their water.

One of the problems we have in public health, across the nation, is that people have to know what is surrounding their water and what the potential threats are in order for them to be educated to protect their water. That information has to be counterbalanced with the safety and security of the engineering and infrastructure of the utilities. Public health walks a fine line between some utilities’ desire to not share information due to security and liability concerns versus the importance of community involvement and the public’s interest in being able to protect their own water. That is something that I would welcome more engagement nationally in public health because, ultimately, success comes when more individuals, communities, and locals are involved in protecting their water and are not dumping oil or another chemical in their water knowing that it is not the right thing to do. It is basic core public health. This has to be counterbalanced with the security infrastructure issue. We need to find equilibrium between the two, which is critical to both communities and public health — to be active and think about how to protect water globally.

Q: Thank you for your responses, we have one last question for you. What are you most looking forward to at the 2015 NACCHO Preparedness Summit?

Dr. Gupta: In addition to our workshop, we are really excited to engage with other attendees and local, state, and federal public health participants to see how they would have responded to a similar situation to what happened in West Virginia. We are excited to have an engaging process to see how the session works in a practical aspect.

We are also excited to hear what others are doing in terms of Ebola, to see what other states are doing at a local level to prepare for these types of events and lessons learned from the past.

About Geoffrey Mwaungulu, Jr.

Geoff Mwaungulu, JD, MPH, is a Senior Program Analyst for Public Health Preparedness, Law, and Ethics at NACCHO. His work includes identifying and addressing issues related to the implementation of federal preparedness and response policies at the local level, fostering collaboration between local public health and community partners to address community resilience, and leading initiatives related to public health law.

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