updated 8/30/2005 6:03:47 PM ET 2005-08-30T22:03:47

One health clinic officer told a caller describing botulism symptoms to go back to bed. Another told a caller describing signs of bubonic plague not to worry.

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And not one of 19 public health clinics surveyed by the RAND Corporation suggested isolating a patient whose face, arms and legs were said to be covered with pustules or other smallpox symptoms.

The RAND study, funded by the Health and Human Services Department and being released Tuesday, describes a wide variety of response times and medical advice given its researchers, who posed as doctors in telephone calls to clinics across the country in a test that stretched over nine months.

Overall, public health clinics responded to 91 percent of all calls within 30 minutes, the report noted. But some clinics failed to return calls for days, while others offered troubling medical guidance to people pretending to need help.

Of the clinics called about patients showing “pustules on the face, arms and legs with lesions in the same stage of development, none suggested isolation of the patient or advised the caller to use personal protective equipment,” the RAND report found.

'Go back to bed'
“Similarly, when presented with a case consistent with botulism, one action officer responded, 'You’re right, it does sound like botulism. I wouldn’t worry too much if I were you,”’ the report found. “In response to classic symptoms of bubonic plague, the action officer told the caller not to worry and to 'go back to bed' because no similar cases had been reported that day.”

RAND researchers posed as emergency physicians when calling the health clinics — in small, medium and large communities in the Northeast, Mideast, South and West — for medical advice. The study did not identify any of the health clinics by name or specific location as a condition of their participation.

Local health clinic officials questioned the report’s focus, noting that the 91 percent callback rate probably represents a vast improvement over response times before the Sept. 11, 2001, terror attacks.

“Should we be doing better? Yes,” said Patrick Libbey, executive director of the National Association of County and City Health Officials in Washington. “But a 91 percent response rate might very well be a step in progress. One wouldn’t get that from reading the report.”

Funding shortages
The study reflected the struggle by local public health departments as they attempt to meet sometimes varying and vague preparedness guidelines set by the Centers for Disease Control and Prevention.

Dr. Georges C. Benjamin, a former secretary of Maryland’s Health and Mental Hygiene Department, called preparedness “a complex task” beset by a lag in federal bioterrorism funding reaching local levels.

Moreover, there are no set federal standards on how the nation’s estimated 2,800 public health clinics should dispense medical advice, said David J. Dausey, the report’s lead author.

“They’re trying not to be alarmists,” Dausey said, referring to the local health officials’ seemingly cavalier responses to calls about the symptoms for highly infectious diseases. “They receive calls all the time, and 99 percent of them turn out to be nothing, or turn out to be something else. And what happens is they become hardened over time.”

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