State Auditor Les Kondo is sounding alarms over how the Hawaii Department of Health responds to disease outbreaks, citing the lack of a communication plan and consistent processes for internal reviews and record keeping.

In a 40-page report released Thursday, Kondo warns that the deficiencies could result in the lack of accountability, missed investigative steps and possible delays in response to future outbreaks.

The report reviewed how the department’s Disease Outbreak Control Division — which investigates diseases “declared to be communicable or dangerous to the public health” — responded to three recent outbreaks: dengue fever, hepatitis A infections from tainted scallops and salmonella infections from tainted ogo.

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First reported in October 2015, the dengue fever outbreak lasted for nearly five months and sickened nearly 270 people. The hepatitis A outbreak, which was traced to frozen scallops imported from the Philippines and served raw at Genki Sushi, infected 292 people in 2016. And the salmonella outbreak, which originated from an Oahu seaweed growing operation, sickened 15 people late last year.

The report found that the department had no “formal communications plan” to guide the timing of its initial public announcements about the outbreaks and clarify what it should share with other state and county agencies.

The report also faulted the department for not being consistent in conducting “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,” the report said.

“We appreciate the complexity of the division’s responsibilities to protect public health, and we understand that every disease is unique; but that doesn’t mean every outbreak response should be a one-of-a-kind effort,” Kondo said in a statement.

“That seems to have been the case for the three disease outbreak responses that we reviewed,” Kondo said. “Without plans, policies and protocols in place prior to an outbreak, and proper record keeping and assessment during and after the effort, it appears that the division had to ‘reinvent the wheel’ for each response.”

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In response to the report’s findings, Dr. Virginia Pressler, state health director, noted that “there is always room for improvement,” and that the department has been reorganizing, putting her directly in charge of overseeing its outbreak response.

“This reorganization is a major shift,” Pressler wrote in a letter to Kondo. “It takes the response to disease outbreak from a divisional responsibility and elevates it to one that has direct oversight and involvement by the director of health. … Under the reorganization, keeping the public informed by providing accurate, timely information is identified as a response objective.”

In a statement to Civil Beat, Pressler stressed that the department’s priority during an outbreak is still public safety, which “takes precedence over documentation and record keeping especially when our resources are limited.”

“The report should not detract from the great work done by the individuals in our Disease Outbreak Control Division,” Pressler added. “Those individuals put their heart and soul into the response and did excellent work to respond to and control these outbreaks. Their hard work and commitment is indisputable and should not be discounted by the report.”