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- With us today and we welcome them,

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Lieutenant General R. Scott
Dingell, Surgeon of the US Army,

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Rear Admiral Bruce L. Gillingham,
Surgeon of the US Navy.

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Lieutenant General Dorothy A. Hogg,

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Surgeon General of the
United States Air Force,

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Mr. McCaffery, Assistant Secretary

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of Defense for Health Affairs,

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and Lieutenant Ronald J. Place,

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Director of Defense Health Agency

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and Mr. Bill Tinston,
Program Executive Officer of

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Defense Healthcare and Management Systems.

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Today we have serious questions
on how medical reforms

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have been accounted for
in the President's budget

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for fiscal year 2021.

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As you will notice we will
have members coming in and out.

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We are getting briefings
on COVID-19 as we speak

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and there's a few other meetings going on.

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But your full testimony is available

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and I know members had it

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like I did last night to read through it.

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So we'll get started.

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Across the spectrum of
Military Healthcare System

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from military readiness to benefit care,

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in many cases the budget justifications

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lacks adequate detail for the subcommittee

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to make informed decisions.

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We hope the witnesses today

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can address the subcommittee's
questions and concerns.

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Out of particular interest we look forward

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to hearing about the role of
the Department in addressing

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or assisting other
federal agencies dealing

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with the epidemic or
pandemic, possible outbreaks,

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such as COVID-19, the
Department study on reducing

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and eliminating certain
healthcare services

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at many Military Treatment Facilities

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and an update on the department's

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Electronic Healthcare
Record System, MHS GENESIS.

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We look forward to hearing
about these topics and more

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and with that I wanna once again thank you

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for appearing before the subcommittee

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and now I want to
recognize our distinguished

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Ranking Member Mr.
Calvert for his comments.

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- Thank you Madam Chairman
and I wanna thank you

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for referring to this
horrible disease as COVID-19.

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I'm from Corona, California
so we wanna make sure

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that we call the disease what it is.

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- [Betty] I did it for you.

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- And I appreciate that very much.

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I wanna welcome our distinguished panel.

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This is a critical year

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for the Military Healthcare
System with a lot at stake.

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We're trying to keep the COVID-19 virus

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from impacting readiness, while also going

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through significant structural
changes to the system.

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These changes include transitioning

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Military Treatment
Facilities from the services

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to the Defense Health Agency,
consolidating some facilities

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and shifting medical
specialties to focus more

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on operational readiness,
all while continuing

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to implement a new Electronic
Health Record system.

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Currently, you have a lot on your plate.

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Given that these issues will
impact a broad population

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to include military personnel,
dependents and retirees,

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I can't overstate the importance
of keeping us apprised

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of your progress and informing
us when you need help.

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We must ensure that health and safety

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are not adversely impacted as a result

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of these structural changes.

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During my time I'll
ask you to address some

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of these issues starting
with your preparedness

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and resourcing for COVID-19.

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We all know the impact it has globally

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and I'll be interested in your plans

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to mitigate its effect on the Force.

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In addition, I'll ask about your views

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on the structural changes to
the Military Healthcare System

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and their potential impact on readiness.

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And finally, I look forward
to hearing about the progress

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on implementing the new
Electronic Health Record.

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Thank you for your service.

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I look forward to your testimony.

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With that Madam Chairman I yield back.

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- Thank you.

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Ms. Lowey and Ms. Granger
are hoping to be joining us

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and we will break for any statements

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that they wish to make when they arrive.

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As I said earlier, your
full written testimony

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would be placed in the record and members

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have copies at their seats
and I told some of you

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I was riveted in reading last night.

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So we have it and we thank you for it.

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In the interest of time however,

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I'm gonna strongly
encourage each one of you

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to keep your summarized statement
to three minutes or less

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and I will let you know when
you're at three minutes.

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I will do so gently and then it might

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get a little louder with the gavel.

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So Lieutenant General
Dingle will you lead us off

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with a three minute remark.

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- Thank You Vice Chairwoman McCollum.

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Rank and member Calvert
and distinguished members

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of the subcommittee, it is an honor

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to speak before you today.

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The mission of Army medicine

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is to conserve the fighting
strength as the army

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is called upon to deploy,
fight and win wars

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in support of our
National Defense Strategy.

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We accomplish this not independently,

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but as part of a synergistic joint force

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that is represented before you today.

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The Chief Staff of the
Army says people first

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and winning matters,

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because there is no
second place in combat.

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Like General McConville, I
and everyone in Army Medicine

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recognize the foundational
strength of our Army lies

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in our people, our
soldiers, their families,

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our civilians and our soldiers for life.

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They are our greatest strength
and our most important asset.

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My vision for Army Medicine is to ensure

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that we remain ready, reformed,
reorganized, responsive

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and relevant in this era of
unprecedented global complexity,

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change and uncertainty, whether support

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of multi-domain operations,
large-scale combat operations,

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or pandemic emergencies.

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As the Army undergoes modernization

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to support the multi-domain battlefield,

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we will lead through change and reorganize

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to remain relevant and
responsive to the war fighter.

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However, our unwavering
commitment to save lives

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on the battlefield will never change

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and tomorrow's multi-domain
battlefield, our adversaries,

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may possess robust anti-access
and area denial capabilities

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that will test our ability to
provide prolonged field care.

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Consequently, our medics will have

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to sustain life in austere locations.

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This requires changes in our doctrine,

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training and material solutions.

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To remain relevant in
this new environment,

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Army Medicine must leverage 21st century

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digital technologies along
with cutting-edge research

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and development in order
to remain proficient.

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Army Medicine, is assisting
in the prevention, deterrence,

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detection and treatment
of infectious diseases.

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Similar to HIV and the Ebola
responses, Army Medicine

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is working with leading agencies

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and institutions to combat COVID-19.

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Army Medicine's ability to prevent,

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detect and treat infectious
diseases depends greatly

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on the Army's research and development

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and public health capabilities

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that enable a medical ready Force

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and a Force that is medically ready.

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In closing, I want to thank the committee

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for allowing my colleagues and I

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to speak before you this morning.

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America entrusts the
Military Health System,

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Army Medicine and the Services

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with this most precious
resources, our sons and daughters.

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It is imperative that we
get it right and we will.

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Your commitment and continued support

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assures the Joint Force
that when a wounded soldier

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cries out medic in combat,
we will be there ready

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to respond, because Army
Medicine is Army strong.

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I look forward to
answering your questions.

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- Sir, that was delivered
with precision timing.

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Thank you.

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(chuckling)

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Rear Admiral Gillingham,
your statement please.

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- Good morning Madam Chairwoman McCollum,

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Ranking Member Calvert,

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distinguished members of the subcommittee.

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On behalf of the over 60,000
men and women who comprise

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the Mission Ready Navy Medicine team.

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I'm pleased to be here today.

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I'm grateful for the continued
trust you place in us.

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The mission of Navy
Medicine is tightly linked

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to those we serve; the United States Navy

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and the United States Marine Corps.

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Their ability to prevail across the range

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of military operations depends
on their medical readiness

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and our capability to
enhance their survival

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on the high end fight.

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At its core, survivability

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is Navy Medicine's
contribution to lethality.

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To this end, our one Navy
Medicine priorities of people,

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platforms, performance and
power are strategically aligned

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to meet these imperatives.

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Well-trained people
working as cohesive teams

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on optimized platforms demonstrating

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high velocity performance that
will project medical power

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in support of naval superiority.

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I can tell you that these priorities

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are rapidly taking hold.

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On any given day Navy Medicine
personnel are deployed

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and operating for the full
range of diverse missions

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including damage control,
resuscitation and surgery teams,

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trauma care at the NATO Role
3 Multinational Medical Unit,

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Kandahar Airfield Afghanistan,

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humanitarian assistance
aboard our hospital ships

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and expeditionary health service support

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and Force health protection
around the world.

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There is no doubt that
people are at the epicenter

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of everything we do; dedicated
active and reserve personnel,

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Navy civilians serving around the world

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in support of our mission.

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In order to meet current
and future challenges

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we must recruit and
retain talented medical

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and civilian work force.

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Navy Medicine continues to
focus on several key areas,

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both our officer and
enlisted in communities,

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including critical wartime
and operational specialties

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as well as mental health care providers..

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Importantly, we are now embedding 29%

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00:09:11,070 --> 00:09:14,270
of our uniformed mental
health providers directly

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with Fleet, Fleet Marine
Force and training commands

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to improve access to care
and to help reduce stigma.

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All of us have a responsibility
to do everything possible

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to reduce the incidence of suicide.

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It's important.

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Its impact is devastating
and affects families,

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shipmates and commands.

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Collectively, substantive
military health system reforms

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directed by Congress, fiscal years 2017

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00:09:36,807 --> 00:09:40,050
and 2019 National Defense
Authorization Acts

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represents an important inflection point

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for military medicine,
catalyzed our efforts

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to strengthen our integrated
system of readiness and health.

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Navy and Marine Corps leadership

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recognized the tremendous
opportunity we have

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to refocus our efforts
on medical readiness

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while transitioning Health
Care Benefit Administration

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to Defense Health Agency.

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You would expect from a transformation

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of this scale MHS reform
presents us with both challenges

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00:10:03,920 --> 00:10:07,220
and opportunities and point
to progress made to date;

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00:10:07,220 --> 00:10:10,370
however, all of us recognize
there is much work ahead.

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In summary, nation depends upon our unique

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expeditionary medical expertise to prepare

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and support our naval forces.

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It is a privilege to care for our sailors,

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Marines and families.

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Again, thank you for your leadership.

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I look forward to your question.

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- Thank You.

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00:10:27,050 --> 00:10:29,163
Lieutenant General Hogg please.

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00:10:30,030 --> 00:10:32,700
- Vice Chairwoman McCollum,
Representative Culver

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00:10:32,700 --> 00:10:34,750
and distinguished members
of the subcommittee,

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00:10:34,750 --> 00:10:37,240
it is my distinct honor
to testify on behalf

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00:10:37,240 --> 00:10:42,240
of the 64,600 active duty Guard,
Reserve and civilian Airmen

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00:10:42,570 --> 00:10:45,120
who comprise the Air
Force Medical Service.

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At home and abroad Air
Force Medics answer the call

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00:10:48,140 --> 00:10:50,780
across a broad spectrum of operational,

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00:10:50,780 --> 00:10:54,640
humanitarian and disaster
response missions from the clinic

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00:10:54,640 --> 00:10:57,370
to the battlefield and even
the back of an airplane,

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00:10:57,370 --> 00:10:59,660
our ability to deliver life staining care

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00:11:01,704 --> 00:11:03,350
in the most challenging
environments ensures

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00:11:03,350 --> 00:11:06,570
that our warriors return
home to their families.

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00:11:06,570 --> 00:11:09,200
The Air Force medical
Services core competency

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00:11:09,200 --> 00:11:13,190
of aerospace medicine and
aeromedical evacuation focuses

260
00:11:13,190 --> 00:11:16,970
on the needs of air and space
operators and maintainers.

261
00:11:16,970 --> 00:11:20,710
Since September 11th Air Force
Aeromedical Evacuation Crews

262
00:11:20,710 --> 00:11:25,230
have conducted more than 340,000
global patient movements,

263
00:11:25,230 --> 00:11:29,330
including 13,500 critical care missions.

264
00:11:29,330 --> 00:11:32,903
In the deployed environment,
roughly 30% of downrange care

265
00:11:32,903 --> 00:11:36,410
is trauma related and the remaining 70%

266
00:11:36,410 --> 00:11:38,900
is disease non-battle injuries.

267
00:11:38,900 --> 00:11:41,560
These injuries range
from occupational, dental

268
00:11:41,560 --> 00:11:44,130
and musculoskeletal injuries.

269
00:11:44,130 --> 00:11:47,720
Training, our training
and currency opportunities

270
00:11:47,720 --> 00:11:50,920
mirror these scenarios
to produce well-rounded,

271
00:11:50,920 --> 00:11:53,950
flexible medics who can
accomplish any mission

272
00:11:53,950 --> 00:11:56,700
under the most unpredictable conditions.

273
00:11:56,700 --> 00:11:59,470
As the National Defense
Strategy shifts focus

274
00:11:59,470 --> 00:12:02,270
to global conflict and peer competition,

275
00:12:02,270 --> 00:12:04,980
the Air Force is postured
to increase lethality,

276
00:12:04,980 --> 00:12:07,830
strengthen alliances
and realign resources.

277
00:12:07,830 --> 00:12:09,710
The Air Force Medical Service is evolving

278
00:12:09,710 --> 00:12:12,370
in support of these
National Defense objectives

279
00:12:12,370 --> 00:12:15,460
by investing in our medical
evacuation platforms,

280
00:12:15,460 --> 00:12:19,550
ground surgical teams and
broadening every medics skillset,

281
00:12:19,550 --> 00:12:22,690
preparing them to deliver
care in denied environments

282
00:12:22,690 --> 00:12:25,530
where we may not have the
access to functioning airfields,

283
00:12:25,530 --> 00:12:27,720
or state-of-the-art equipment.

284
00:12:27,720 --> 00:12:30,070
The story of Senior
Airman Colleen Mitchell,

285
00:12:30,070 --> 00:12:32,580
a young medical technician drives home

286
00:12:32,580 --> 00:12:34,780
the criticality of this last point.

287
00:12:34,780 --> 00:12:37,870
In January, Airman Mitchell
was on her first deployment

288
00:12:37,870 --> 00:12:40,170
when al-Shabaab militants
attacked the airfield

289
00:12:40,170 --> 00:12:43,540
at Manda Bay, Kenya
killing three Americans.

290
00:12:43,540 --> 00:12:46,840
Awakened by the chaos, she
assumed the role of lead medic,

291
00:12:46,840 --> 00:12:49,890
spending hours triaging
and treating patients,

292
00:12:49,890 --> 00:12:52,430
working with limited
personnel and supplies,

293
00:12:52,430 --> 00:12:54,700
she operated well above her pay grade

294
00:12:54,700 --> 00:12:57,700
and outside her comfort
zone to save lives.

295
00:12:57,700 --> 00:12:59,880
Airman Mitchell demonstrates the qualities

296
00:12:59,880 --> 00:13:02,660
that makes our medics
remarkable; leadership,

297
00:13:02,660 --> 00:13:05,510
technical skill and an
unwavering commitment

298
00:13:05,510 --> 00:13:07,880
to mission and those whom we serve.

299
00:13:07,880 --> 00:13:10,060
As a Surgeon General, my responsibility

300
00:13:10,060 --> 00:13:13,380
is to prepare every medic to
do what Airman Mitchell did

301
00:13:13,380 --> 00:13:16,000
and I do not take this task lightly.

302
00:13:16,000 --> 00:13:17,280
Military Treatment Facilities

303
00:13:17,280 --> 00:13:19,780
remain our primary readiness platform,

304
00:13:19,780 --> 00:13:22,460
but sometimes fall short
of offering patient volume,

305
00:13:22,460 --> 00:13:26,850
diversity and acuity needed
to stain clinical currency.

306
00:13:26,850 --> 00:13:28,980
Leveraging additional
training opportunities

307
00:13:28,980 --> 00:13:31,410
through civilian and
government health organization

308
00:13:31,410 --> 00:13:33,500
is paramount, it will inevitably grow

309
00:13:33,500 --> 00:13:36,190
as we re-scope the direct care system.

310
00:13:36,190 --> 00:13:38,680
Military medicine
presents unique challenges

311
00:13:38,680 --> 00:13:41,820
that a civilian healthcare
system does not encounter.

312
00:13:41,820 --> 00:13:45,030
Our medics will continue to
rise to those challenges.

313
00:13:45,030 --> 00:13:46,860
Thank you for your continued support

314
00:13:46,860 --> 00:13:48,710
and I look forward to your questions.

315
00:13:55,860 --> 00:13:56,840
- Thank you.

316
00:13:56,840 --> 00:13:58,663
Lieutenant General Place.

317
00:14:02,840 --> 00:14:05,390
- Vice Chairwoman McCollum,
Ranking Member Calvert,

318
00:14:05,390 --> 00:14:07,333
members of the committee,
thanks for the opportunity.

319
00:14:07,333 --> 00:14:10,000
Just a few comments to my colleagues.

320
00:14:10,000 --> 00:14:12,970
The DHA's principle mission
is supporting readiness.

321
00:14:12,970 --> 00:14:15,870
Within that mission are two
distinct responsibilities:

322
00:14:15,870 --> 00:14:18,570
First to ensure that
every person in uniform

323
00:14:18,570 --> 00:14:21,620
is medically ready to perform their job

324
00:14:21,620 --> 00:14:23,010
anywhere in the world.

325
00:14:23,010 --> 00:14:25,890
Second is to ensure our
military medical personnel

326
00:14:25,890 --> 00:14:27,920
have the cognitive and technical skills

327
00:14:27,920 --> 00:14:30,490
to support the full range
of military operations

328
00:14:30,490 --> 00:14:33,090
which our leaders may
call on us to perform.

329
00:14:33,090 --> 00:14:35,230
The Defense Health Agency is
accountable to the Assistant

330
00:14:35,230 --> 00:14:37,490
Secretary of Honorable Arnold McCaffery,

331
00:14:37,490 --> 00:14:38,690
the combatant commands

332
00:14:38,690 --> 00:14:41,210
and the military departments for same.

333
00:14:41,210 --> 00:14:43,280
The DHA assumed
responsibility for managing

334
00:14:43,280 --> 00:14:45,710
all military hospitals and
clinics in the United States

335
00:14:45,710 --> 00:14:47,610
in October of last year.

336
00:14:47,610 --> 00:14:49,140
Working closely with my colleagues;

337
00:14:49,140 --> 00:14:50,220
the Service Surgeon's General

338
00:14:50,220 --> 00:14:52,300
and the Joint Staff Surgeon we continue

339
00:14:52,300 --> 00:14:56,280
to view our medical facilities
as readiness platforms

340
00:14:56,280 --> 00:14:58,040
where medical professionals
from the Army, Navy

341
00:14:58,040 --> 00:15:01,350
and Air Force both obtain
and sustain their skills

342
00:15:01,350 --> 00:15:03,010
from which these professionals deploy

343
00:15:03,010 --> 00:15:05,888
in support of military operations.

344
00:15:05,888 --> 00:15:07,800
The DOD's leadership's recent assessment

345
00:15:07,800 --> 00:15:09,840
of which medical facilities best support

346
00:15:09,840 --> 00:15:12,210
this readiness mission provides the basis

347
00:15:12,210 --> 00:15:14,820
for moving forward and
implementing these decisions.

348
00:15:14,820 --> 00:15:16,920
We intend to execute this plan in a manner

349
00:15:16,920 --> 00:15:18,740
that ensures our patients continue

350
00:15:18,740 --> 00:15:23,120
to have timely access
to quality medical care.

351
00:15:23,120 --> 00:15:25,010
I'll highlight a few important points.

352
00:15:25,010 --> 00:15:27,230
First, active duty family
members who are required

353
00:15:27,230 --> 00:15:30,120
to transition to civilian
network providers

354
00:15:30,120 --> 00:15:31,730
will incur little to no additional

355
00:15:31,730 --> 00:15:34,300
out-of-pocket costs for their care.

356
00:15:34,300 --> 00:15:37,520
Second, all beneficiaries
in these locations

357
00:15:37,520 --> 00:15:40,373
will still enjoy access
to the MTF pharmacy.

358
00:15:41,440 --> 00:15:43,820
Finally, we'll implement
changes in a deliberate fashion

359
00:15:43,820 --> 00:15:46,630
at a pace local healthcare
markets can handle.

360
00:15:46,630 --> 00:15:48,570
If market capacity in
a particular location

361
00:15:48,570 --> 00:15:50,430
is more constrained than we estimated,

362
00:15:50,430 --> 00:15:53,990
we'll reassess our plans
and potentially adjust them.

363
00:15:53,990 --> 00:15:55,810
The Surgeons General and I are ensuring

364
00:15:55,810 --> 00:15:58,090
that the proposed
reduction in infrastructure

365
00:15:58,090 --> 00:16:00,340
and uniform medical
personnel is coordinated.

366
00:16:01,210 --> 00:16:02,720
This synchronization will be reflected

367
00:16:02,720 --> 00:16:05,210
in the department's Medical
Personnel Reduction Plan

368
00:16:05,210 --> 00:16:09,640
required by the FY20 NDAA section 719

369
00:16:09,640 --> 00:16:11,720
that's due to the Congress in June.

370
00:16:11,720 --> 00:16:14,270
The DHA is scrutinizing every
part of our health budget

371
00:16:14,270 --> 00:16:17,070
to ensure we're using the
resources provided by Congress

372
00:16:17,070 --> 00:16:18,360
in a manner that most effectively

373
00:16:18,360 --> 00:16:20,890
supports our readiness mission.

374
00:16:20,890 --> 00:16:22,480
We've established four healthcare markets

375
00:16:22,480 --> 00:16:25,250
to integrate healthcare in
specific regions of the country.

376
00:16:25,250 --> 00:16:26,770
We'll be establishing additional markets

377
00:16:26,770 --> 00:16:28,280
throughout this year.

378
00:16:28,280 --> 00:16:30,610
Local military medical leaders
will have the authority

379
00:16:30,610 --> 00:16:33,350
and responsibility to
allocate resources in a way

380
00:16:33,350 --> 00:16:37,010
that improves patient care
and our readiness functions.

381
00:16:37,010 --> 00:16:39,620
I'm grateful for the opportunity
to provide further detail

382
00:16:39,620 --> 00:16:42,210
on our efforts to standardize
military medical support

383
00:16:42,210 --> 00:16:45,060
to combatant commands,
the military departments

384
00:16:45,060 --> 00:16:46,660
and to our patients.

385
00:16:46,660 --> 00:16:48,120
Thank you to the members of this committee

386
00:16:48,120 --> 00:16:50,820
for your commitment to the men
and women of our armed forces

387
00:16:50,820 --> 00:16:52,760
and the families who support them.

388
00:16:52,760 --> 00:16:54,123
- Mr. McCaffery please.

389
00:16:57,660 --> 00:17:00,620
- Vice Chairman McCollum,
ranking member Calvert

390
00:17:00,620 --> 00:17:02,760
and members of the subcommittee, on behalf

391
00:17:02,760 --> 00:17:04,620
of the Secretary of Defense it is an honor

392
00:17:04,620 --> 00:17:06,820
to speak before you today representing

393
00:17:06,820 --> 00:17:09,780
the dedicated military
and civilian professionals

394
00:17:09,780 --> 00:17:13,350
of the Military Health System
who support our war fighters

395
00:17:13,350 --> 00:17:16,580
in care for the 9.6 million beneficiaries

396
00:17:16,580 --> 00:17:18,930
that our system serves.

397
00:17:18,930 --> 00:17:21,380
I'm pleased to present to
you the Defense Health Budget

398
00:17:21,380 --> 00:17:25,520
for fiscal year 2021, a
budget that prioritizes

399
00:17:25,520 --> 00:17:28,450
the medical readiness
of our military force

400
00:17:28,450 --> 00:17:30,920
in their readiness of our medical force,

401
00:17:30,920 --> 00:17:33,470
while sustaining access
to quality health care

402
00:17:33,470 --> 00:17:35,610
for our beneficiaries.

403
00:17:35,610 --> 00:17:40,350
Our proposed FY21 budget
requests 33.1 billion dollars

404
00:17:40,350 --> 00:17:42,510
for the Defense Health Program.

405
00:17:42,510 --> 00:17:45,930
This proposed budget reflects
our continued implementation

406
00:17:45,930 --> 00:17:49,840
of a number of comprehensive
reforms to our Health System

407
00:17:49,840 --> 00:17:53,550
as directed by Congress
and Department leadership.

408
00:17:53,550 --> 00:17:56,690
Some of the significant
reforms are the following:

409
00:17:56,690 --> 00:17:59,060
Consolidated administration and management

410
00:17:59,060 --> 00:18:00,470
of our military hospitals

411
00:18:00,470 --> 00:18:03,730
and clinics under the
Defense Health Agency.

412
00:18:03,730 --> 00:18:06,730
Right-sizing our military
medical infrastructure

413
00:18:06,730 --> 00:18:10,250
to focus on readiness within
our direct care system.

414
00:18:10,250 --> 00:18:13,970
And finally optimizing
the size and composition

415
00:18:13,970 --> 00:18:15,740
of the military medical force

416
00:18:15,740 --> 00:18:18,670
to best meet our readiness mission.

417
00:18:18,670 --> 00:18:20,410
In implementing these reforms,

418
00:18:20,410 --> 00:18:23,640
the department is guided
by two critical principles:

419
00:18:23,640 --> 00:18:27,120
First, that our military
hospitals and clinics are first

420
00:18:27,120 --> 00:18:30,870
and foremost military
facilities whose operations need

421
00:18:30,870 --> 00:18:34,460
to be focused on meeting
military readiness requirements.

422
00:18:34,460 --> 00:18:38,770
That means that our MTFs serve
as the primary platform by

423
00:18:38,770 --> 00:18:40,400
which we ensure servicemembers

424
00:18:40,400 --> 00:18:43,320
are medically ready to train and deploy.

425
00:18:43,320 --> 00:18:46,640
It also means that our MTFs
are effectively utilized

426
00:18:46,640 --> 00:18:48,440
as training platforms that enable

427
00:18:49,320 --> 00:18:52,030
our military medical personnel to acquire

428
00:18:52,030 --> 00:18:54,550
and maintain the clinical skills

429
00:18:54,550 --> 00:18:56,287
that prepare them for deployment

430
00:18:56,287 --> 00:18:59,060
and support of combat operations.

431
00:18:59,060 --> 00:19:02,550
Second, that as we reform
the military Health System,

432
00:19:02,550 --> 00:19:04,730
we continue to make good on our commitment

433
00:19:04,730 --> 00:19:07,740
to provide our beneficiaries with access

434
00:19:07,740 --> 00:19:09,730
to quality health care.

435
00:19:09,730 --> 00:19:12,470
While we implement these
changes to the Health System

436
00:19:12,470 --> 00:19:16,300
we also continue to pursue
our other priority initiatives

437
00:19:16,300 --> 00:19:18,670
that have contributed to the achievement

438
00:19:18,670 --> 00:19:21,560
of the highest battlefield
survival rates in history,

439
00:19:21,560 --> 00:19:23,600
while providing world-class healthcare

440
00:19:23,600 --> 00:19:25,760
to our millions of beneficiaries.

441
00:19:25,760 --> 00:19:27,670
That includes our continued deployment

442
00:19:27,670 --> 00:19:30,870
of our Electronic Health Record
and our ongoing operation

443
00:19:30,870 --> 00:19:34,400
of our cutting-edge research
and development programs

444
00:19:34,400 --> 00:19:38,170
which Congress and this
committee have long championed.

445
00:19:38,170 --> 00:19:41,500
That work in that area is
playing a significant role

446
00:19:41,500 --> 00:19:43,740
in support of the whole
of government effort

447
00:19:43,740 --> 00:19:45,983
on the COVID-19 issue.

448
00:19:46,830 --> 00:19:49,060
I want to thank the committee
for your continued support

449
00:19:49,060 --> 00:19:51,150
of these efforts into the men and women

450
00:19:51,150 --> 00:19:52,627
of the Military Health System

451
00:19:52,627 --> 00:19:55,180
and the millions depending on us.

452
00:19:55,180 --> 00:19:57,920
Your support has helped
us achieve and continue

453
00:19:57,920 --> 00:20:01,620
to drive forward unparalleled
success in building

454
00:20:01,620 --> 00:20:03,970
and sustaining a Military Health System

455
00:20:03,970 --> 00:20:06,440
that delivers for our servicemembers,

456
00:20:06,440 --> 00:20:08,890
our beneficiaries and our nation.

457
00:20:08,890 --> 00:20:09,723
Thank you.

458
00:20:12,010 --> 00:20:12,843
- Thank You.

459
00:20:12,843 --> 00:20:14,200
Mr. Tinston.

460
00:20:14,200 --> 00:20:17,160
- Vice Chairwoman McCollum,
Ranking Member Calvert

461
00:20:17,160 --> 00:20:19,380
and distinguished members
of the subcommittee.

462
00:20:19,380 --> 00:20:20,930
Thank you for your invitation.

463
00:20:20,930 --> 00:20:22,860
I represent the Program Executive Office,

464
00:20:22,860 --> 00:20:24,570
Defense Health Care Management Systems,

465
00:20:24,570 --> 00:20:26,810
also known as the PEO DHMS.

466
00:20:26,810 --> 00:20:29,070
It's my honor to represent
this team of professionals

467
00:20:29,070 --> 00:20:31,220
in their efforts to
achieve a single common

468
00:20:31,220 --> 00:20:33,600
Electronic Health Record
for our servicemembers,

469
00:20:33,600 --> 00:20:35,550
veterans and their families.

470
00:20:35,550 --> 00:20:37,940
Patient-centered care is
not only an ethos we use

471
00:20:37,940 --> 00:20:40,690
to describe our mission, it's
fundamental to our design.

472
00:20:40,690 --> 00:20:42,920
From capturing critical
data on the battlefield

473
00:20:42,920 --> 00:20:44,300
to documenting care at military

474
00:20:44,300 --> 00:20:46,120
and veteran medical facilities,

475
00:20:46,120 --> 00:20:48,280
we understand the patient is our focus.

476
00:20:48,280 --> 00:20:51,560
Our patient-centered model
highlights the broad spectrum

477
00:20:51,560 --> 00:20:54,290
of people who depend on MHS GENESIS.

478
00:20:54,290 --> 00:20:56,960
Systems do not create success, people do.

479
00:20:56,960 --> 00:20:59,450
Our progress depends on
the hard work and talent

480
00:20:59,450 --> 00:21:03,170
of clinicians, engineers and
other business professionals

481
00:21:03,170 --> 00:21:05,690
who comprise our MHS GENESIS team.

482
00:21:05,690 --> 00:21:07,280
I wanna thank our functional champion,

483
00:21:07,280 --> 00:21:09,700
Major General Payne and my VA counterpart,

484
00:21:09,700 --> 00:21:11,500
Mr. John Windham for their partnership

485
00:21:11,500 --> 00:21:13,350
as we deliver a single common record.

486
00:21:14,230 --> 00:21:17,090
In September 2019, we
completed Wave Travis

487
00:21:17,090 --> 00:21:19,010
at four installations across California

488
00:21:19,010 --> 00:21:21,830
and Idaho without any
patient safety issues.

489
00:21:21,830 --> 00:21:23,670
The medical staff at Travis Air Force Base

490
00:21:23,670 --> 00:21:27,280
demonstrated confidence
in MHS GENESIS on day one

491
00:21:27,280 --> 00:21:29,160
when a patient arrived
at the emergency room

492
00:21:29,160 --> 00:21:30,920
in sudden cardiac arrest two hours

493
00:21:30,920 --> 00:21:32,950
before the official go live.

494
00:21:32,950 --> 00:21:35,480
The team had a choice,
they chose MHS GENESIS

495
00:21:35,480 --> 00:21:37,660
and that was the right decision.

496
00:21:37,660 --> 00:21:39,650
With every deployment we hone our process

497
00:21:39,650 --> 00:21:41,110
and improve capability delivery.

498
00:21:41,110 --> 00:21:43,710
For instance, establishing
peer-to-peer training

499
00:21:43,710 --> 00:21:46,470
proved very successful,
so successful in fact

500
00:21:46,470 --> 00:21:49,410
that Major General Payne
initiated a Commander's Workshop

501
00:21:49,410 --> 00:21:50,850
to strengthen commander's engagement

502
00:21:50,850 --> 00:21:53,110
as we move forward with deployments.

503
00:21:53,110 --> 00:21:55,820
This summer MHS GENESIS
will deploy to Wave Nellis,

504
00:21:55,820 --> 00:21:58,270
more than doubling the
number of deployed sites.

505
00:21:58,270 --> 00:22:00,955
As we move forward, we seek
to industrialize our process,

506
00:22:00,955 --> 00:22:03,520
while meeting the unique
needs of each site in order

507
00:22:03,520 --> 00:22:06,440
to optimize delivery to the enterprise.

508
00:22:06,440 --> 00:22:08,740
We've proven that MHS
GENESIS significantly

509
00:22:08,740 --> 00:22:10,430
improves the patient experience.

510
00:22:10,430 --> 00:22:13,200
Anytime we can enhance patient
care we absolutely should.

511
00:22:13,200 --> 00:22:16,700
As part of that process we
will continue to assess risks

512
00:22:16,700 --> 00:22:19,950
and ensure fiscal stewardship
making every dollar count.

513
00:22:19,950 --> 00:22:21,690
Critical to making every dollar count

514
00:22:21,690 --> 00:22:23,140
is optimizing decisions

515
00:22:23,140 --> 00:22:25,500
with the VA to increase efficiencies.

516
00:22:25,500 --> 00:22:27,080
For example, within the next few months

517
00:22:27,080 --> 00:22:29,040
we will launch a joint
health information exchange

518
00:22:29,040 --> 00:22:31,870
with the VA expanding DOD connections

519
00:22:31,870 --> 00:22:34,170
with private sector healthcare providers.

520
00:22:34,170 --> 00:22:36,170
In closing, as the son
and brother of veterans,

521
00:22:36,170 --> 00:22:39,150
I'm truly invested in the
success of this program,

522
00:22:39,150 --> 00:22:41,590
spending significant time at
Walter Reed with my parents,

523
00:22:41,590 --> 00:22:43,230
I understand the criticality

524
00:22:43,230 --> 00:22:45,140
of delivering patient-centered care.

525
00:22:45,140 --> 00:22:46,740
I'm confident we have the right people

526
00:22:46,740 --> 00:22:48,970
in the right place to
complete this mission.

527
00:22:48,970 --> 00:22:51,820
We value transparency and
we value you, the committee.

528
00:22:51,820 --> 00:22:53,180
As the wise sentiment goes,

529
00:22:53,180 --> 00:22:54,660
it's amazing what can be achieved

530
00:22:54,660 --> 00:22:56,860
as long as we don't care
who gets the credit.

531
00:22:56,860 --> 00:23:00,120
The MHS GENESIS team
exemplifies this wisdom.

532
00:23:00,120 --> 00:23:01,550
Together we have the opportunity

533
00:23:01,550 --> 00:23:02,730
to make a tangible difference

534
00:23:02,730 --> 00:23:04,730
in the lives of millions of Americans.

535
00:23:04,730 --> 00:23:05,563
Thank you again for your time

536
00:23:05,563 --> 00:23:07,980
and I look forward to your questions.

537
00:23:07,980 --> 00:23:12,980
- Thank you and with great
humility and honor I turn

538
00:23:14,600 --> 00:23:17,120
to the Full Chair of the
Appropriations Committee,

539
00:23:17,120 --> 00:23:19,423
Ms. Lowey for her first questions.

540
00:23:21,524 --> 00:23:22,440
(Nita throat clearing)

541
00:23:22,440 --> 00:23:26,030
- Thank you, oh boy, thank you,

542
00:23:26,030 --> 00:23:30,147
I need some healthcare
I think at this moment.

543
00:23:30,147 --> 00:23:30,980
(chuckling)

544
00:23:30,980 --> 00:23:34,740
But it was all checked
out, I just lost my voice.

545
00:23:34,740 --> 00:23:37,540
But I wanted to come to this hearing,

546
00:23:37,540 --> 00:23:41,350
because as you probably
know this committee

547
00:23:41,350 --> 00:23:45,240
and the other committee
focusing on veterans

548
00:23:45,240 --> 00:23:48,520
has been waiting with bated breath

549
00:23:48,520 --> 00:23:52,483
to get a Healthcare
Records System that works.

550
00:23:54,120 --> 00:23:57,163
As you probably know Mr. Tinston,

551
00:23:58,020 --> 00:24:01,870
for decades this committee
has funded efforts

552
00:24:01,870 --> 00:24:05,940
to modernize the Health
System at both the VA

553
00:24:05,940 --> 00:24:09,840
and the Department of
Defense, in particular,

554
00:24:09,840 --> 00:24:13,513
efforts to address
Electronic Health Records.

555
00:24:14,590 --> 00:24:17,420
Now I understand 'cause
I've had briefings,

556
00:24:17,420 --> 00:24:21,720
hearings on this for the
last five years at least,

557
00:24:21,720 --> 00:24:23,223
so I know it's difficult.

558
00:24:24,370 --> 00:24:29,370
But frankly our servicemembers
and their families

559
00:24:29,570 --> 00:24:32,250
have been waiting for far too long

560
00:24:32,250 --> 00:24:35,950
and the taxpayers have invested too much

561
00:24:35,950 --> 00:24:38,943
to continue with problems and delays.

562
00:24:41,210 --> 00:24:46,210
I'm not saying that it's all
VA and that DOD is perfect,

563
00:24:48,380 --> 00:24:50,940
but are you learning anything by this?

564
00:24:50,940 --> 00:24:55,800
We had a hearing not
too long ago with the VA

565
00:24:56,770 --> 00:25:01,770
and the last number I
looked at is the department

566
00:25:03,090 --> 00:25:07,240
is requesting another billion, billion,

567
00:25:07,240 --> 00:25:10,340
case anyone in the audience
think I said million,

568
00:25:10,340 --> 00:25:13,140
another billion in FY21.

569
00:25:16,210 --> 00:25:17,173
I don't get it.

570
00:25:18,070 --> 00:25:22,193
Maybe you can explain why
this has taken so long?

571
00:25:23,460 --> 00:25:25,560
If this happened in the private sector,

572
00:25:25,560 --> 00:25:27,130
they'd probably be out of business,

573
00:25:27,130 --> 00:25:30,000
but you are too valuable

574
00:25:30,000 --> 00:25:32,210
and no way can you be out of business.

575
00:25:32,210 --> 00:25:36,023
But I don't understand why
you can't get this done.

576
00:25:37,270 --> 00:25:39,973
My colleague Mr. Rogers is not here.

577
00:25:41,270 --> 00:25:46,270
We've had closed-door
hearings, open hearings,

578
00:25:46,520 --> 00:25:51,300
private discussions,
another billion dollars?

579
00:25:51,300 --> 00:25:53,063
Why can't you get this right?

580
00:25:55,640 --> 00:25:59,343
- Ma'am, in September we deployed,

581
00:26:00,760 --> 00:26:02,450
the DOD deployed to Wave Travis

582
00:26:03,330 --> 00:26:04,950
which doubled our installed base.

583
00:26:04,950 --> 00:26:07,100
It was a very successful deployment.

584
00:26:07,100 --> 00:26:09,290
We changed the way we
delivered the infrastructure.

585
00:26:09,290 --> 00:26:11,670
We changed the way we
delivered the training.

586
00:26:11,670 --> 00:26:14,630
We prepared people to be
effective at doing their jobs

587
00:26:14,630 --> 00:26:17,150
and we found it to be a
very effective deployment.

588
00:26:17,150 --> 00:26:19,880
At this point we have 66 sites underway

589
00:26:19,880 --> 00:26:22,660
with Wave Nellis coming
up next with 10 sites,

590
00:26:22,660 --> 00:26:26,020
so I think we're doing, we
are making tremendous progress

591
00:26:26,020 --> 00:26:29,700
in getting MHS GENESIS, the
modern Electronic Health Record

592
00:26:29,700 --> 00:26:32,140
deployed to the Military Health System.

593
00:26:32,140 --> 00:26:35,960
We also work very, very
closely with the VA program,

594
00:26:35,960 --> 00:26:38,210
because we're really
deploying a joint system here.

595
00:26:38,210 --> 00:26:40,620
It's a single record for both departments

596
00:26:40,620 --> 00:26:43,500
and so as the VA starts
to bring their sites on

597
00:26:43,500 --> 00:26:45,637
we will have one instance of the record

598
00:26:45,637 --> 00:26:48,470
about the patient, not
where the care was delivered

599
00:26:48,470 --> 00:26:49,930
or who delivered the care available

600
00:26:49,930 --> 00:26:53,330
to any provider about the
patient when it's necessary.

601
00:26:53,330 --> 00:26:56,480
- Can you give me a better explanation

602
00:26:56,480 --> 00:27:00,150
as to why you're still bringing on sites?

603
00:27:00,150 --> 00:27:03,023
Why is this so complicated?

604
00:27:03,933 --> 00:27:04,766
- [Bill] So when you--

605
00:27:04,766 --> 00:27:09,766
- The VA, if the VA isn't up to standards

606
00:27:09,850 --> 00:27:14,850
and they can't get records
from a disaster incident

607
00:27:15,320 --> 00:27:18,760
that may have happened two
years ago, three years ago,

608
00:27:18,760 --> 00:27:20,773
they're not getting adequate healthcare.

609
00:27:23,520 --> 00:27:25,520
- So when you're delivering
an enterprise system,

610
00:27:25,520 --> 00:27:29,030
like an Enterprise Health
Record, Electronic Health Record

611
00:27:29,030 --> 00:27:33,610
that MHS GENESIS is, the IT
element of it is a small piece

612
00:27:33,610 --> 00:27:35,240
of the transformation that has

613
00:27:35,240 --> 00:27:37,010
to happen in the organization.

614
00:27:37,010 --> 00:27:39,590
It's an organizational transformation.

615
00:27:39,590 --> 00:27:41,160
It's a training challenge.

616
00:27:41,160 --> 00:27:44,440
So you have to work so you
deliver the right capability

617
00:27:44,440 --> 00:27:46,810
in the record which we've done,

618
00:27:46,810 --> 00:27:49,040
you then have to customize that record

619
00:27:49,040 --> 00:27:51,220
to meet the physical
plant of the facilities

620
00:27:51,220 --> 00:27:53,600
that you're supporting and
you have to train people

621
00:27:53,600 --> 00:27:55,290
to be effective clinically

622
00:27:55,290 --> 00:27:57,100
with the new workflows
that you've introduced.

623
00:27:57,100 --> 00:27:58,890
So it's not just to turn it on

624
00:27:58,890 --> 00:28:00,160
and let everyone start using it.

625
00:28:00,160 --> 00:28:03,050
You have to be very deliberate
about bringing people up

626
00:28:03,050 --> 00:28:04,950
to speed so that they can be effective,

627
00:28:04,950 --> 00:28:07,760
so that we don't compromise
the healthcare delivery

628
00:28:07,760 --> 00:28:10,573
as we as we deploy MHS GENESIS.

629
00:28:13,260 --> 00:28:18,260
- 4.6 billion, now you
want another billion.

630
00:28:18,340 --> 00:28:23,340
I am sure that our great
military has had many,

631
00:28:23,550 --> 00:28:28,550
many complicated missions and
frankly I don't understand.

632
00:28:29,960 --> 00:28:31,530
I understand what you're saying,

633
00:28:31,530 --> 00:28:35,090
but I don't understand why
you can't get it right.

634
00:28:35,090 --> 00:28:38,090
I just hope that next year you won't ask

635
00:28:38,090 --> 00:28:41,140
for another billion again
and another billion.

636
00:28:41,140 --> 00:28:45,560
With 4.6 billion dollars and the expertise

637
00:28:45,560 --> 00:28:49,210
that you have in the
military, it would seem to me

638
00:28:50,470 --> 00:28:52,900
that this task could have been completed,

639
00:28:52,900 --> 00:28:56,770
but I've been hearing
one excuse after another

640
00:28:56,770 --> 00:29:00,520
year after year and if my
colleague Mr. Rogers was here

641
00:29:01,540 --> 00:29:05,110
he'd probably get even
redder-faced than I am,

642
00:29:05,110 --> 00:29:08,780
because we've had public
meetings, private meetings,

643
00:29:08,780 --> 00:29:11,870
one-to-one meetings, two-to-one meetings.

644
00:29:11,870 --> 00:29:13,280
Okay, I guess we're gonna have

645
00:29:13,280 --> 00:29:15,430
to give you another billion dollars.

646
00:29:15,430 --> 00:29:17,080
I could think of a lot of other things,

647
00:29:17,080 --> 00:29:20,270
so I sure hope you get it right this time.

648
00:29:20,270 --> 00:29:23,240
Can you guarantee that
this is gonna do it?

649
00:29:23,240 --> 00:29:27,250
You have finally the expertise to do it?

650
00:29:27,250 --> 00:29:28,290
- Congressman we have the right people

651
00:29:28,290 --> 00:29:30,320
in the right place to be
effective at delivering--

652
00:29:30,320 --> 00:29:33,454
- [Nita] I've heard this for
the last five years you know.

653
00:29:33,454 --> 00:29:34,287
- [Bill] Yes ma'am.

654
00:29:34,287 --> 00:29:35,230
- These people are more expert?

655
00:29:35,230 --> 00:29:38,630
They really understand the systems?

656
00:29:38,630 --> 00:29:39,463
- [Bill] Yes.

657
00:29:40,660 --> 00:29:43,163
- [Nita] Okay, mark
that down in the record.

658
00:29:44,240 --> 00:29:45,240
Thank you very much.

659
00:29:45,240 --> 00:29:46,253
Done, Chair.

660
00:29:47,430 --> 00:29:48,810
- [Betty] So noted.

661
00:29:48,810 --> 00:29:50,593
I Recognize Mr. Calvert.

662
00:29:52,150 --> 00:29:53,470
- Thank you Madam Chairman

663
00:29:53,470 --> 00:29:55,930
and thank you again for
you're all being here.

664
00:29:55,930 --> 00:29:57,730
I'd like to start off with a question

665
00:29:57,730 --> 00:30:00,080
on COVID-19 since we're all aware

666
00:30:00,080 --> 00:30:04,070
of the significant impact
it's having around the world.

667
00:30:04,070 --> 00:30:07,670
I was speaking to General
Townsend the AFRICOM commander

668
00:30:07,670 --> 00:30:10,560
earlier this weekend and he noted

669
00:30:10,560 --> 00:30:13,580
that a map showed the US
Army Africa Headquarters,

670
00:30:13,580 --> 00:30:16,340
the part they have over in Vicenza, Italy

671
00:30:16,340 --> 00:30:21,340
is surrounded by new cases of
the virus in a local community

672
00:30:22,600 --> 00:30:24,380
indicated that fortunately

673
00:30:24,380 --> 00:30:28,960
so far they have not assessed
anything new this morning.

674
00:30:28,960 --> 00:30:31,340
They have not been affected
and that's a testament

675
00:30:31,340 --> 00:30:34,360
to the great work that people have done

676
00:30:34,360 --> 00:30:39,360
in their preparedness
to protect our Force.

677
00:30:40,170 --> 00:30:42,150
As this virus continues to spread,

678
00:30:42,150 --> 00:30:44,890
what steps are you taking
to ensure installations

679
00:30:44,890 --> 00:30:48,870
both overseas and in the
United States are protected?

680
00:30:48,870 --> 00:30:51,690
And do you need additional resources

681
00:30:51,690 --> 00:30:55,030
beyond the fiscal year 2021
President's Budget Request

682
00:30:56,300 --> 00:30:59,400
or in the Supplemental,
there may be some assistance

683
00:30:59,400 --> 00:31:01,860
may be available to military also,

684
00:31:01,860 --> 00:31:06,860
but to continue to safeguard
for the Force against COVID-19?

685
00:31:08,080 --> 00:31:10,640
So I dunno where to start,
so maybe we'll start

686
00:31:10,640 --> 00:31:13,370
with the Admiral, or down here at the end.

687
00:31:13,370 --> 00:31:15,137
- I'd be happy to kick it off

688
00:31:15,137 --> 00:31:19,700
and my colleagues can
chime in Mr. Calvert.

689
00:31:19,700 --> 00:31:24,090
So when the DOD looks
at the COVID-19 issue,

690
00:31:24,090 --> 00:31:26,860
there's really a handful
of priorities we look at.

691
00:31:26,860 --> 00:31:29,630
First is it's the safety
and health and well-being

692
00:31:29,630 --> 00:31:32,710
of our servicemembers,
that's very much tied

693
00:31:32,710 --> 00:31:37,390
to then our ability to as
we deal with this issue

694
00:31:37,390 --> 00:31:39,160
to continue to meet mission.

695
00:31:39,160 --> 00:31:42,600
And third, how we, the
DOD, can support the rest

696
00:31:42,600 --> 00:31:45,610
of the federal government in
the all of government approach

697
00:31:45,610 --> 00:31:48,970
and strategy on the COVID-19 issue.

698
00:31:48,970 --> 00:31:51,500
With regard to the guidance we are giving

699
00:31:51,500 --> 00:31:54,320
on that first priority around the health

700
00:31:54,320 --> 00:31:56,720
and well-being of our servicemembers,

701
00:31:56,720 --> 00:31:58,500
the department has issued a series

702
00:31:58,500 --> 00:32:03,410
of Force Health Protection
Guidance to our servicemembers

703
00:32:03,410 --> 00:32:08,410
and our commanders built
largely around CDC guidance

704
00:32:08,490 --> 00:32:12,340
and so things around
identifying best science

705
00:32:12,340 --> 00:32:15,763
and CDC guidance on risk to personnel,

706
00:32:16,680 --> 00:32:20,390
health care worker protection,
protocols for screening

707
00:32:20,390 --> 00:32:25,060
of patients and reporting,
reporting any detected virus.

708
00:32:25,060 --> 00:32:29,510
It's also around giving guidance
on to a self-protection.

709
00:32:29,510 --> 00:32:31,810
You know, common hygiene in terms

710
00:32:31,810 --> 00:32:34,670
of protection against viruses.

711
00:32:34,670 --> 00:32:37,410
And we also are getting
guidance with regard

712
00:32:37,410 --> 00:32:39,117
to working with the CDC

713
00:32:39,117 --> 00:32:42,030
and the Department of
State Travel Guidance

714
00:32:42,030 --> 00:32:44,220
in terms of restriction of travel

715
00:32:44,220 --> 00:32:46,120
to and from select countries.

716
00:32:46,120 --> 00:32:49,340
And then most recently,
sir, giving guidance

717
00:32:49,340 --> 00:32:52,810
to installation commanders,
the combatant commanders,

718
00:32:52,810 --> 00:32:57,370
with regard to how to assess
their particular situation

719
00:32:57,370 --> 00:33:01,760
on the ground, be it at
installations here or overseas

720
00:33:01,760 --> 00:33:03,860
and what kind of guidance they should use

721
00:33:03,860 --> 00:33:07,300
in making their flexible
judgments about protections

722
00:33:07,300 --> 00:33:09,920
to put in place on their bases.

723
00:33:09,920 --> 00:33:12,400
Again, everything from restricted travel

724
00:33:13,665 --> 00:33:15,580
and access to their bases.

725
00:33:15,580 --> 00:33:18,717
As the CDC issues additional guidance,

726
00:33:18,717 --> 00:33:22,080
or things change in terms
of travel advisories,

727
00:33:22,080 --> 00:33:25,633
we will continue to update
that guidance for the field.

728
00:33:29,070 --> 00:33:30,640
- Thank you for that.

729
00:33:30,640 --> 00:33:32,092
Any other comments?

730
00:33:32,092 --> 00:33:34,730
On the Force itself, I was curious,

731
00:33:34,730 --> 00:33:37,480
since yesterday has there
been any other transmissions?

732
00:33:39,220 --> 00:33:40,500
- Not that I'm aware of, sir.

733
00:33:40,500 --> 00:33:44,910
But for many years we have
had Disease Containment Plans

734
00:33:44,910 --> 00:33:46,560
and Pandemic Influenza Plans

735
00:33:46,560 --> 00:33:50,030
that we have exercised at
different points in time.

736
00:33:50,030 --> 00:33:52,930
And so now we're using
those plans to help guide

737
00:33:52,930 --> 00:33:56,520
and direct our actions in relationship

738
00:33:56,520 --> 00:34:00,230
to the CDC and Health and
Human Services guidance.

739
00:34:00,230 --> 00:34:01,490
- [Ken] Yeah.

740
00:34:01,490 --> 00:34:02,540
General?

741
00:34:02,540 --> 00:34:04,660
- And sir, from an army perspective

742
00:34:04,660 --> 00:34:06,340
we've taken a three-prong approach

743
00:34:06,340 --> 00:34:09,690
of prevent, detect, and treat.

744
00:34:09,690 --> 00:34:11,650
The prevention is the education awareness

745
00:34:11,650 --> 00:34:13,410
of all the soldiers and family members

746
00:34:13,410 --> 00:34:15,040
within that installation commander

747
00:34:15,040 --> 00:34:17,000
or senior commanders footprint.

748
00:34:17,000 --> 00:34:19,860
The detection piece, or the
screenings that we're doing,

749
00:34:19,860 --> 00:34:22,410
as well as the testing
to verify the presence

750
00:34:22,410 --> 00:34:24,640
to acknowledge if it
is in fact symptomatic

751
00:34:24,640 --> 00:34:26,990
and those have been identified that--

752
00:34:26,990 --> 00:34:28,670
- [Ken] South Korea specifically.

753
00:34:28,670 --> 00:34:29,503
- Yes sir.

754
00:34:29,503 --> 00:34:31,277
- Are we, you still have not had

755
00:34:31,277 --> 00:34:33,220
any additional transmissions
you're aware of?

756
00:34:33,220 --> 00:34:34,053
- No, no additional.

757
00:34:34,053 --> 00:34:35,910
Right now we have one soldier

758
00:34:35,910 --> 00:34:39,600
and we have two dependents
right now in the treatment mode

759
00:34:39,600 --> 00:34:41,910
and then that is the last
phase of the treatment

760
00:34:41,910 --> 00:34:46,080
where we have implemented
our pandemic expansion plans,

761
00:34:46,080 --> 00:34:48,965
or response plans and every
installation emergency

762
00:34:48,965 --> 00:34:51,200
preparedness and we're even going

763
00:34:51,200 --> 00:34:54,680
as far as worst-case scenarios
on bed expansion plans.

764
00:34:54,680 --> 00:34:56,610
So we're taking a holistic
approach of prevent,

765
00:34:56,610 --> 00:34:58,620
detect and treat as an Army.

766
00:34:58,620 --> 00:35:01,980
- In South Korea specifically
is it General Abrams

767
00:35:01,980 --> 00:35:06,030
pretty much has all the facilities
shut down at this point?

768
00:35:06,030 --> 00:35:08,060
- Sir, the prevention piece to ensure

769
00:35:08,060 --> 00:35:12,040
that we are not spreading and
they have not implemented some

770
00:35:12,040 --> 00:35:13,530
of the normal activities

771
00:35:13,530 --> 00:35:15,030
that bring together large gathering.

772
00:35:15,030 --> 00:35:17,820
So whether if it's school, each
installation commander makes

773
00:35:17,820 --> 00:35:20,620
that call under the guidance
of General Abrams, yes sir.

774
00:35:21,809 --> 00:35:22,642
- Admiral, anything to add?

775
00:35:23,710 --> 00:35:25,610
- Yes sir, I would just
say that I would like

776
00:35:25,610 --> 00:35:28,312
to thank the Committee for the investment

777
00:35:28,312 --> 00:35:29,980
that has been made over the years

778
00:35:29,980 --> 00:35:33,580
in the President's Budget for our network,

779
00:35:33,580 --> 00:35:38,330
worldwide network, tri-service
network of research labs.

780
00:35:38,330 --> 00:35:42,730
I can specifically say for
Navy, our research labs

781
00:35:42,730 --> 00:35:46,090
that are set in NAMRU-2 in Singapore,

782
00:35:46,090 --> 00:35:51,090
as well as NAMRU in Sigonella,
Italy are at the forefront

783
00:35:51,420 --> 00:35:56,420
of the global response to
this emerging pandemic,

784
00:35:57,770 --> 00:36:01,520
but that investment in our scientists

785
00:36:01,520 --> 00:36:05,760
and really world leading
knowledge and research

786
00:36:05,760 --> 00:36:09,210
is now bearing fruit and
you're seeing that dividend

787
00:36:09,210 --> 00:36:14,210
in the sense that we now
have 12 of 14 DOD labs

788
00:36:14,260 --> 00:36:17,163
actively able to do diagnostic
testing around the world.

789
00:36:18,580 --> 00:36:19,500
- [Ken] Thank you.

790
00:36:19,500 --> 00:36:22,810
- And Congressman, just DOD-wide,

791
00:36:22,810 --> 00:36:27,810
so we have as of last
night four confirmed cases

792
00:36:27,980 --> 00:36:30,243
and 12 suspected that are being tested.

793
00:36:31,300 --> 00:36:32,922
- [Ken] And where are those cases at?

794
00:36:32,922 --> 00:36:34,490
- That, I don't have that breakdown.

795
00:36:34,490 --> 00:36:37,650
So this is across the DOD
both, you know, here and--

796
00:36:37,650 --> 00:36:39,806
- [Ken] Both CONUS and
outside the United States?

797
00:36:39,806 --> 00:36:40,639
- Yeah.

798
00:36:40,639 --> 00:36:41,620
- [Ken] Is there any cases

799
00:36:41,620 --> 00:36:43,440
within the United States
that you're aware of?

800
00:36:43,440 --> 00:36:46,870
- I do not believe DOD cases as of yet,

801
00:36:46,870 --> 00:36:50,250
but I can get you the
updated numbers today

802
00:36:50,250 --> 00:36:51,110
and break it down.

803
00:36:51,110 --> 00:36:52,422
- [Ken] I appreciate that thank you.

804
00:36:52,422 --> 00:36:54,076
Thank you Madam Chair.

805
00:36:54,076 --> 00:36:57,409
- Thank you I'm gonna ask you to submit

806
00:36:57,409 --> 00:37:01,750
to the report to the
committee as soon as possible

807
00:37:01,750 --> 00:37:03,610
on the two following
questions following up

808
00:37:03,610 --> 00:37:06,593
on my colleague from
California and COVID-19.

809
00:37:07,560 --> 00:37:09,670
Three billion dollars of the supplemental

810
00:37:09,670 --> 00:37:12,270
go towards research and
development of vaccines.

811
00:37:12,270 --> 00:37:13,740
Considering the department's experience

812
00:37:13,740 --> 00:37:16,400
in working with SARS or
MERS over the past 20 years,

813
00:37:16,400 --> 00:37:20,150
two respiratory illnesses
that are similar to COVID-19,

814
00:37:20,150 --> 00:37:21,827
I'd like to know what
the Department of Defense

815
00:37:21,827 --> 00:37:23,640
and the Army in particular are doing

816
00:37:23,640 --> 00:37:26,250
to work with our other
federal agencies and partners;

817
00:37:26,250 --> 00:37:31,250
the FDA, CDC and HHS in
developing a vaccine.

818
00:37:31,410 --> 00:37:34,540
The other information I
would like you to share back

819
00:37:34,540 --> 00:37:37,150
with us as soon as possible; for example,

820
00:37:37,150 --> 00:37:40,780
the federal government maintains
stockpiles of respirators

821
00:37:40,780 --> 00:37:42,850
and it's come to all of our attention

822
00:37:42,850 --> 00:37:44,380
that a number of these respirators

823
00:37:44,380 --> 00:37:46,130
have been allowed to expire.

824
00:37:46,130 --> 00:37:49,050
Once again, the military
usually does logistics

825
00:37:49,050 --> 00:37:52,210
and stockpiling with
great, great precision,

826
00:37:52,210 --> 00:37:55,440
so we would like information
on the department

827
00:37:55,440 --> 00:37:58,090
and how you've been
maintaining your own stockpile

828
00:37:58,090 --> 00:38:01,350
of respirators en masse and
how you would distribute them

829
00:38:01,350 --> 00:38:05,200
within the different branches
of service if needed.

830
00:38:05,200 --> 00:38:07,850
And also again, with your
knowledge in this area,

831
00:38:07,850 --> 00:38:11,060
what role should the
DOD play, or could play

832
00:38:11,060 --> 00:38:12,680
in working with our public agencies

833
00:38:12,680 --> 00:38:16,910
to maintain proper stockpiles
or critical medical supplies

834
00:38:16,910 --> 00:38:18,970
so our country can be better prepared

835
00:38:18,970 --> 00:38:20,910
for future health care crisis?

836
00:38:20,910 --> 00:38:22,310
If you would please follow up

837
00:38:22,310 --> 00:38:24,980
and get that information to us.

838
00:38:24,980 --> 00:38:28,793
My question is on military downsizing.

839
00:38:29,810 --> 00:38:32,080
Secretary McCaffery, as
you know the department

840
00:38:32,080 --> 00:38:35,260
provided Congress with a
report on February 19th

841
00:38:35,260 --> 00:38:37,440
for planned closing and downsizing of up

842
00:38:37,440 --> 00:38:40,970
to 50 DOD Military Treatment Facilities

843
00:38:40,970 --> 00:38:42,850
and I would stress a word, report, here,

844
00:38:42,850 --> 00:38:46,970
because most of it is just a
list of impacted facilities.

845
00:38:46,970 --> 00:38:49,158
Some of the comments on the downsizing;

846
00:38:49,158 --> 00:38:52,310
where there would be no
out-of-pocket cost to families,

847
00:38:52,310 --> 00:38:54,330
or soldiers, or Airmen

848
00:38:54,330 --> 00:38:56,700
and that their prescriptions
wouldn't change.

849
00:38:56,700 --> 00:38:59,260
But there are other things
that can impact the delivery

850
00:38:59,260 --> 00:39:02,190
of health care not only to the
person wearing the uniform,

851
00:39:02,190 --> 00:39:04,390
but the family that's behind that person

852
00:39:04,390 --> 00:39:05,820
and our uniformed members need

853
00:39:05,820 --> 00:39:08,400
to know their families
are well taken care of.

854
00:39:08,400 --> 00:39:11,770
So bottom line is we still
don't have a timeline,

855
00:39:11,770 --> 00:39:15,710
projections of cost savings,
a real plan for implementation

856
00:39:15,710 --> 00:39:17,810
of these downsizing and closures.

857
00:39:17,810 --> 00:39:19,560
Now while I understand
the department wants

858
00:39:19,560 --> 00:39:22,760
to focus on increased medical
readiness of our troops

859
00:39:22,760 --> 00:39:26,020
and Medical Forces, the
impacts of this organization

860
00:39:26,020 --> 00:39:28,240
will be significant and trust me,

861
00:39:28,240 --> 00:39:30,410
we will hear from the individuals

862
00:39:30,410 --> 00:39:32,860
that are impacted by these changes.

863
00:39:32,860 --> 00:39:37,780
Some numbers I have seen
indicate up to 200,000

864
00:39:37,780 --> 00:39:40,840
family members and
retirees across the country

865
00:39:40,840 --> 00:39:43,800
would be pushed away from DOD
medical treatment facilities

866
00:39:43,800 --> 00:39:46,810
and onto civilian providers.

867
00:39:46,810 --> 00:39:50,270
We need to understand
what that plan looks like.

868
00:39:50,270 --> 00:39:52,920
So Mr. Secretary, your office
has clearly been thinking

869
00:39:52,920 --> 00:39:55,890
about this for a long time
since you do have a list

870
00:39:55,890 --> 00:39:58,000
of facilities that have been impacted,

871
00:39:58,000 --> 00:40:00,730
so there must be a document somewhere

872
00:40:00,730 --> 00:40:04,140
to back up these facilities
and how they were chosen.

873
00:40:04,140 --> 00:40:09,140
So Mr. Secretary, how can you
expect us to be, you know,

874
00:40:09,520 --> 00:40:12,810
do due diligence with our
appropriate necessary funds

875
00:40:12,810 --> 00:40:15,340
to reorganize the military's
treatment facilities

876
00:40:15,340 --> 00:40:17,630
when we haven't seen a comprehensive,

877
00:40:17,630 --> 00:40:21,400
transparent plan from the
Department on what, when,

878
00:40:21,400 --> 00:40:24,080
or how this restructuring
will be implemented?

879
00:40:24,080 --> 00:40:27,880
Additionally, the report
submitted on February 19th states,

880
00:40:27,880 --> 00:40:30,897
and I quote: "Upon
submission of this report,

881
00:40:30,897 --> 00:40:35,157
"detailed implementation
planning will begin

882
00:40:35,157 --> 00:40:38,700
"with implementation beginning
not less than 90 days later."

883
00:40:38,700 --> 00:40:41,050
We need the information.

884
00:40:41,050 --> 00:40:43,960
That language to me and to many sounds

885
00:40:43,960 --> 00:40:46,080
that though the department
believes it does not

886
00:40:46,080 --> 00:40:48,660
require congressional approval prior

887
00:40:48,660 --> 00:40:51,300
to moving forward with the implementation.

888
00:40:51,300 --> 00:40:53,550
Secretary McCaffery,
does the Congress need

889
00:40:53,550 --> 00:40:56,350
to stamp its approval on
the recommendation prior

890
00:40:56,350 --> 00:40:58,250
to the department's moving forward

891
00:40:58,250 --> 00:41:00,310
with the implementation plans

892
00:41:00,310 --> 00:41:04,200
to descope services at
Military Treatment Facilities?

893
00:41:04,200 --> 00:41:07,100
And the final question for now,

894
00:41:07,100 --> 00:41:10,530
as we wait your written
response as soon as possible:

895
00:41:10,530 --> 00:41:15,280
If you are not ready to
transmit to us a comprehensive

896
00:41:15,280 --> 00:41:19,040
and transparent plan, why
not just ask for a delay

897
00:41:19,040 --> 00:41:21,760
of the reorganization
so we can get it right

898
00:41:21,760 --> 00:41:25,530
and not cause any confusion for Congress

899
00:41:25,530 --> 00:41:30,530
in appropriating its funds when
your patients, our soldiers,

900
00:41:30,880 --> 00:41:33,220
airmen and Marines ask us

901
00:41:33,220 --> 00:41:35,470
what is happening to
them and their families?

902
00:41:36,680 --> 00:41:37,960
Mr. McCaffery.

903
00:41:37,960 --> 00:41:40,800
- Yes, so I will I will
try to go through each

904
00:41:40,800 --> 00:41:43,498
of the questions and if
I've missed something

905
00:41:43,498 --> 00:41:46,620
let me know and we will follow up.

906
00:41:46,620 --> 00:41:50,010
With regard to the review
that the Department has done,

907
00:41:50,010 --> 00:41:55,010
this was coming out of NDA
17, direction from Congress

908
00:41:55,340 --> 00:41:59,320
to assess all of our military
hospitals and clinics

909
00:41:59,320 --> 00:42:02,350
to ensure that we were aligned and matched

910
00:42:02,350 --> 00:42:06,220
with their primary mission
being military facilities,

911
00:42:06,220 --> 00:42:09,680
in being training platforms
for our medical force

912
00:42:09,680 --> 00:42:12,810
as well as ensuring that our active-duty

913
00:42:12,810 --> 00:42:14,930
are getting convenient access to care

914
00:42:14,930 --> 00:42:17,723
in order to be medically
ready to do their jobs.

915
00:42:18,580 --> 00:42:21,060
So that's the focus.

916
00:42:21,060 --> 00:42:24,300
The reason why in our report to Congress

917
00:42:24,300 --> 00:42:28,823
we identify some facilities
that we are recommending

918
00:42:28,823 --> 00:42:33,823
for a reduction of the
services available to an MTF,

919
00:42:33,830 --> 00:42:37,630
it is because of this
attempt to tie the operation

920
00:42:37,630 --> 00:42:39,380
of the MTF to that readiness mission.

921
00:42:39,380 --> 00:42:40,760
What do I mean by that?

922
00:42:40,760 --> 00:42:45,390
There are some facilities
where the volume of caseload

923
00:42:45,390 --> 00:42:48,010
and the type of patient caseload

924
00:42:48,010 --> 00:42:50,860
that is provided at that particular MTF

925
00:42:50,860 --> 00:42:54,870
is not a good match for the
type of caseload and acuity

926
00:42:54,870 --> 00:42:58,060
that our uniformed military providers need

927
00:42:58,060 --> 00:43:00,660
to maintain proficiency and those skills

928
00:43:00,660 --> 00:43:03,270
that we expect them to have currency in--

929
00:43:03,270 --> 00:43:05,720
- Mr. McCaffery, we have limited time.

930
00:43:05,720 --> 00:43:08,990
When can we expect the follow
up you seem to have made,

931
00:43:08,990 --> 00:43:11,100
I believe, that you did due diligence

932
00:43:11,100 --> 00:43:13,050
in making your decisions,
but we were given none

933
00:43:13,050 --> 00:43:16,370
of the supporting documents
to follow up with them.

934
00:43:16,370 --> 00:43:19,330
We're being asked to make
decisions in a timeframe

935
00:43:19,330 --> 00:43:21,680
within a matter of months and as you said

936
00:43:21,680 --> 00:43:24,640
Congress charged you with
this so when can we expect

937
00:43:24,640 --> 00:43:26,792
to follow up in the supporting documents?

938
00:43:26,792 --> 00:43:31,792
- I will outline that, so the
report to Congress identified

939
00:43:32,860 --> 00:43:34,280
and shared that we did a screen

940
00:43:34,280 --> 00:43:38,070
of 340 US-based hospitals and clinics,

941
00:43:38,070 --> 00:43:41,160
out of those the department determined 77

942
00:43:41,160 --> 00:43:44,170
needed a deep dive examination.

943
00:43:44,170 --> 00:43:47,000
The report went through
the methodology we used

944
00:43:47,000 --> 00:43:50,300
to identify those, the
methodology that was used

945
00:43:50,300 --> 00:43:53,520
in looking at the community availability

946
00:43:53,520 --> 00:43:57,000
of community care healthcare.

947
00:43:57,000 --> 00:44:01,630
We then, out of the 77, we
actually determined 21--

948
00:44:01,630 --> 00:44:03,710
- Sir, so we have the
report as you pointed out.

949
00:44:03,710 --> 00:44:04,543
- [Thomas] Yes and--

950
00:44:04,543 --> 00:44:06,120
- When's the implementation plan coming?

951
00:44:06,120 --> 00:44:09,810
- Well including in the
report there is for each

952
00:44:09,810 --> 00:44:12,310
of the 50 facilities that
are being recommended

953
00:44:12,310 --> 00:44:14,940
for a change there's an entire use case

954
00:44:14,940 --> 00:44:16,100
that goes through all of the data

955
00:44:16,100 --> 00:44:18,830
that we use specific to that MTF.

956
00:44:18,830 --> 00:44:22,520
The report very clearly
says there's not going

957
00:44:22,520 --> 00:44:25,230
to be any immediate change to operations,

958
00:44:25,230 --> 00:44:28,930
that it's not a one-size-fits-all
implementation timeline.

959
00:44:28,930 --> 00:44:31,500
It will be based upon our work

960
00:44:31,500 --> 00:44:34,496
with the individual
MTF in that community--

961
00:44:34,496 --> 00:44:38,940
- Mr. McCaffery, our staff
seems to think and I would agree

962
00:44:38,940 --> 00:44:41,950
with based on what I and others have seen

963
00:44:41,950 --> 00:44:45,070
that we need some more information here.

964
00:44:45,070 --> 00:44:49,040
So I will ask you to please
follow up with the committee,

965
00:44:49,040 --> 00:44:50,540
because I have a lot of members here

966
00:44:50,540 --> 00:44:52,230
who have a lot of other questions

967
00:44:52,230 --> 00:44:53,950
that I know you're gonna wanna hear about,

968
00:44:53,950 --> 00:44:56,420
what's on the mind of
other members of Congress.

969
00:44:56,420 --> 00:44:58,260
So I thank you for that, but at this point

970
00:44:58,260 --> 00:45:00,700
in time I would say that
the Appropriations Committee

971
00:45:00,700 --> 00:45:05,669
doesn't feel as fully informed
and ready to go, so with--

972
00:45:05,669 --> 00:45:06,777
- [Thomas] We'll be happy

973
00:45:06,777 --> 00:45:07,610
to provide you additional information.

974
00:45:07,610 --> 00:45:08,443
- Thank You.

975
00:45:08,443 --> 00:45:13,343
With that, I lost my, um, Mr. Carter.

976
00:45:16,020 --> 00:45:16,853
Thank you.

977
00:45:19,960 --> 00:45:22,040
- Thank you. (throat clearing)

978
00:45:22,040 --> 00:45:24,193
I've got a voice problem too.

979
00:45:25,750 --> 00:45:27,400
Appreciate all of you being here.

980
00:45:30,060 --> 00:45:31,570
We're trying to learn all this stuff.

981
00:45:31,570 --> 00:45:34,260
This gets pretty dang complicated.

982
00:45:34,260 --> 00:45:37,370
Lieutenant General Place,
how's the transition

983
00:45:37,370 --> 00:45:41,600
of Military Treatment
Facilities the DHA going?

984
00:45:41,600 --> 00:45:43,940
What are some of the
successes you've seen?

985
00:45:43,940 --> 00:45:46,263
One of the biggest
challenges you're facing?

986
00:45:47,100 --> 00:45:51,210
And while, these treatment
facilities transition to DHS,

987
00:45:51,210 --> 00:45:55,140
this past October the services
are still supporting DHA

988
00:45:57,430 --> 00:46:00,040
to keep the train on the tracks.

989
00:46:00,040 --> 00:46:03,540
Surgeon General describes
the support that you continue

990
00:46:03,540 --> 00:46:08,300
to provide to the Military
Treatment Facilities in DHA.

991
00:46:08,300 --> 00:46:11,170
Lieutenant General Place, what is the plan

992
00:46:11,170 --> 00:46:15,273
to decrease reliance on
support from the services.

993
00:46:17,906 --> 00:46:19,120
Forgive my voice.

994
00:46:19,120 --> 00:46:21,343
- Sir, thanks for that question.

995
00:46:22,360 --> 00:46:24,940
So in in terms of the
first part: How's it going?

996
00:46:24,940 --> 00:46:26,270
I'd say that I agree with you,

997
00:46:26,270 --> 00:46:27,900
it's an extraordinarily complex

998
00:46:27,900 --> 00:46:29,860
and challenging transformation.

999
00:46:29,860 --> 00:46:33,960
That said, overall I think
we are going very smoothly

1000
00:46:33,960 --> 00:46:35,310
according to the plan.

1001
00:46:35,310 --> 00:46:36,710
Not that everything is perfect.

1002
00:46:36,710 --> 00:46:39,350
Not that there haven't been
challenges associated with it,

1003
00:46:39,350 --> 00:46:42,530
but in general as we
measure the effectiveness

1004
00:46:42,530 --> 00:46:43,810
of the care that we're delivering

1005
00:46:43,810 --> 00:46:48,810
and measure the effectiveness
of our actions to plan,

1006
00:46:49,170 --> 00:46:50,740
we're actually making good improvements

1007
00:46:50,740 --> 00:46:53,020
in the quality of care,
in the in the speed

1008
00:46:53,020 --> 00:46:54,300
with which we're delivering the care

1009
00:46:54,300 --> 00:46:55,750
and the use of the resources

1010
00:46:55,750 --> 00:46:58,590
that the Congress has been
generous enough to provide.

1011
00:46:58,590 --> 00:47:02,720
In terms of the successes,
the success we're finding

1012
00:47:02,720 --> 00:47:05,630
actually is in a
particular regional market

1013
00:47:05,630 --> 00:47:07,850
and I'll use here in DC for example,

1014
00:47:07,850 --> 00:47:10,890
our ability to utilize all the resources

1015
00:47:10,890 --> 00:47:14,910
of each of the facilities
to include the staff

1016
00:47:14,910 --> 00:47:16,540
to align them more appropriately

1017
00:47:16,540 --> 00:47:19,290
to the location where they
can best provide healthcare.

1018
00:47:19,290 --> 00:47:21,760
Similarly, we're able to
use the particular location

1019
00:47:21,760 --> 00:47:23,933
whether you're enrolled to this particular

1020
00:47:23,933 --> 00:47:25,540
military medical treatment facility

1021
00:47:25,540 --> 00:47:27,510
or another to move patients around

1022
00:47:27,510 --> 00:47:30,060
to achieve the best quality of care.

1023
00:47:30,060 --> 00:47:33,290
So the standardization within
a market has been a success.

1024
00:47:33,290 --> 00:47:35,310
In terms of the challenge,
you're exactly right.

1025
00:47:35,310 --> 00:47:39,170
And that is the reliance on
the Service Medical Departments

1026
00:47:39,170 --> 00:47:41,470
continue to provide direct support.

1027
00:47:41,470 --> 00:47:43,770
The reason for that is the staffs

1028
00:47:43,770 --> 00:47:45,220
that have been doing it for decades

1029
00:47:45,220 --> 00:47:48,720
in the Services are slowly
but surely transferring

1030
00:47:48,720 --> 00:47:50,920
into our both our headquarters

1031
00:47:50,920 --> 00:47:53,060
and into our regional markets.

1032
00:47:53,060 --> 00:47:56,200
As we're doing that we're
sharing responsibility

1033
00:47:56,200 --> 00:47:57,190
for the delivery of healthcare

1034
00:47:57,190 --> 00:47:59,910
and sharing responsibility
for oversight of that staff.

1035
00:47:59,910 --> 00:48:01,860
That plan should continue
for approximately

1036
00:48:01,860 --> 00:48:03,520
another six months or so.

1037
00:48:03,520 --> 00:48:05,520
My anticipation at the end of the summer,

1038
00:48:05,520 --> 00:48:07,610
the majority of the staff who will need

1039
00:48:07,610 --> 00:48:09,430
to be transferred will be transferred

1040
00:48:09,430 --> 00:48:12,730
into the Defense Health
Agency headquarters

1041
00:48:12,730 --> 00:48:15,140
and the reliance on the
Service Medical Departments,

1042
00:48:15,140 --> 00:48:17,370
at least for a US-based support,

1043
00:48:17,370 --> 00:48:21,060
will be significantly
diminished in almost every area.

1044
00:48:21,060 --> 00:48:23,150
There's some challenge
that are still there

1045
00:48:23,150 --> 00:48:25,880
for the way we do our
financing for example,

1046
00:48:25,880 --> 00:48:27,670
because we use different financing systems

1047
00:48:27,670 --> 00:48:28,840
in each of the different Services,

1048
00:48:28,840 --> 00:48:31,510
so we still have to
collaborate on some functions,

1049
00:48:31,510 --> 00:48:35,740
but the majority of them
will have transferred.

1050
00:48:35,740 --> 00:48:37,070
I think I got to all your questions, sir.

1051
00:48:37,070 --> 00:48:39,050
If I didn't, please remind me.

1052
00:48:39,050 --> 00:48:41,910
- Do any of the other
services have any comment?

1053
00:48:43,620 --> 00:48:47,483
- Yes sir, I would echo this
is a very complicated merger

1054
00:48:48,920 --> 00:48:52,630
of four cultures if you
will and we'll get there

1055
00:48:52,630 --> 00:48:55,273
as long as we get there
using manageable risk.

1056
00:48:56,710 --> 00:48:58,240
What that means for me is we need

1057
00:48:58,240 --> 00:49:00,660
to transition before we transform.

1058
00:49:00,660 --> 00:49:03,460
So we need to be able
to continue supporting

1059
00:49:03,460 --> 00:49:06,370
the Defense Health Agency in
standing up its capabilities

1060
00:49:06,370 --> 00:49:10,060
to manage these Military
Treatment Facilities,

1061
00:49:10,060 --> 00:49:12,110
because if you remember in the past,

1062
00:49:12,110 --> 00:49:15,410
DHA didn't come out of that,

1063
00:49:15,410 --> 00:49:18,290
they came out of the old
TRICARE Management Activity

1064
00:49:18,290 --> 00:49:20,540
and their core competency was writing

1065
00:49:20,540 --> 00:49:23,340
and managing contracts,
not managing the MTFs.

1066
00:49:23,340 --> 00:49:27,900
So we need to help them do this mission

1067
00:49:27,900 --> 00:49:30,690
and so I would I would ask

1068
00:49:30,690 --> 00:49:33,230
that we not add additional system changes

1069
00:49:33,230 --> 00:49:37,680
until the defense health agency
is standing on their own,

1070
00:49:37,680 --> 00:49:40,890
is well-established and has
been managing the market

1071
00:49:40,890 --> 00:49:43,273
with demonstrated success
for a period of time.

1072
00:49:45,450 --> 00:49:49,620
- And Mr. Carter I would
add the complexity,

1073
00:49:49,620 --> 00:49:52,120
as you mentioned, is extremely difficult.

1074
00:49:52,120 --> 00:49:54,560
And from the Army perspective, you know,

1075
00:49:54,560 --> 00:49:56,440
what we have always championed

1076
00:49:56,440 --> 00:49:58,980
is that we cannot fail at this.

1077
00:49:58,980 --> 00:50:00,490
We have to get this right.

1078
00:50:00,490 --> 00:50:03,250
And in order to get it
right, the focus should be

1079
00:50:03,250 --> 00:50:07,150
on the MTF transitions,
which starts with the step,

1080
00:50:07,150 --> 00:50:08,750
the stand up of that headquarters,

1081
00:50:08,750 --> 00:50:11,970
if the headquarters is not up
and operational and running,

1082
00:50:11,970 --> 00:50:14,693
then it will continue to
require that direct support.

1083
00:50:15,690 --> 00:50:17,990
After you get that headquarters stood up

1084
00:50:17,990 --> 00:50:19,570
then you can start transition

1085
00:50:19,570 --> 00:50:22,480
the military Medical Treatment Facilities

1086
00:50:22,480 --> 00:50:25,190
and then we should also be
focusing in that transition

1087
00:50:25,190 --> 00:50:27,120
on that Electronic Health Record.

1088
00:50:27,120 --> 00:50:29,163
From the Army perspective, we believe

1089
00:50:29,163 --> 00:50:30,730
that is the most key thing

1090
00:50:30,730 --> 00:50:32,970
and anything else are just distractors

1091
00:50:32,970 --> 00:50:35,020
that are not allowing us to get it right.

1092
00:50:35,980 --> 00:50:37,372
- Is there anything

1093
00:50:37,372 --> 00:50:39,996
in the Department of Defense's
(speaking off microphone)?

1094
00:50:39,996 --> 00:50:42,480
(chuckling)

1095
00:50:42,480 --> 00:50:45,650
The question, I guess,
the real question we ought

1096
00:50:46,500 --> 00:50:49,105
to be asking, maybe we
need to talk to the NCOs,

1097
00:50:49,105 --> 00:50:51,063
when they come forward.

1098
00:50:51,063 --> 00:50:52,883
What do (speaking off microphone)

1099
00:50:52,883 --> 00:50:56,637
are the patients feeling about the care?

1100
00:50:56,637 --> 00:50:59,782
Do they feel anything that's
pulling them off balance,

1101
00:50:59,782 --> 00:51:01,764
or just they're not getting treated well?

1102
00:51:01,764 --> 00:51:04,334
'Cause that's who I'm gonna
hear from this morning

1103
00:51:04,334 --> 00:51:08,187
is the ordinary folks and
he's gonna be telling me

1104
00:51:08,187 --> 00:51:10,426
if he's not getting what he needs.

1105
00:51:10,426 --> 00:51:11,259
- So that's a great point.

1106
00:51:11,259 --> 00:51:13,630
We continue to track
the patient satisfaction

1107
00:51:13,630 --> 00:51:16,460
at every location that
has already transitioned

1108
00:51:16,460 --> 00:51:18,810
into the Defense Health Agency

1109
00:51:18,810 --> 00:51:20,980
and the patient
satisfaction scores at each

1110
00:51:20,980 --> 00:51:23,770
of those installations are at or above,

1111
00:51:23,770 --> 00:51:25,790
at every single location
that's transitioned,

1112
00:51:25,790 --> 00:51:29,430
is at or above what they were
at baseline before transition.

1113
00:51:29,430 --> 00:51:30,588
So we're not perfect.

1114
00:51:30,588 --> 00:51:33,338
We're not trying to tell you
that it is, but improving.

1115
00:51:36,950 --> 00:51:40,511
- Sir, I would just add
that we remain committed

1116
00:51:40,511 --> 00:51:44,500
in Navy Medicine to creating
a truly integrated system

1117
00:51:44,500 --> 00:51:45,930
of readiness and health.

1118
00:51:45,930 --> 00:51:49,440
Going through this
transition has forced us

1119
00:51:49,440 --> 00:51:52,520
to look very carefully at our
medical readiness requirements

1120
00:51:52,520 --> 00:51:54,230
and I will tell you that as we have done

1121
00:51:54,230 --> 00:51:57,270
that we have identified
opportunities for focus.

1122
00:51:57,270 --> 00:52:01,160
I mentioned in my opening
remarks, we now have almost 1/3

1123
00:52:01,160 --> 00:52:03,070
of our mental health
professionals embedded

1124
00:52:03,070 --> 00:52:05,410
in the fleet and Fleet Marine Force.

1125
00:52:05,410 --> 00:52:09,460
So we believe that we are
seen as setting a success.

1126
00:52:09,460 --> 00:52:13,134
We are seeing increased
focus on the wellness

1127
00:52:13,134 --> 00:52:16,433
and readiness of our war fighters.

1128
00:52:18,850 --> 00:52:21,720
- Well and not to change,
take too much more time,

1129
00:52:21,720 --> 00:52:24,230
but this morning I was
thinking about the Navy

1130
00:52:24,230 --> 00:52:27,100
because a cruise ship is coming back

1131
00:52:27,100 --> 00:52:30,020
into the United States waters,

1132
00:52:30,020 --> 00:52:32,770
because of, once again, the virus.

1133
00:52:32,770 --> 00:52:35,010
And I thought, my gosh,
what happens if we get that

1134
00:52:35,010 --> 00:52:38,210
on an aircraft carrier or a submarine

1135
00:52:39,260 --> 00:52:41,570
and the complications that's gonna make

1136
00:52:41,570 --> 00:52:42,970
for our Naval Forces.

1137
00:52:42,970 --> 00:52:45,310
- Yes sir, I appreciate that
concern and that's something

1138
00:52:45,310 --> 00:52:47,170
that we've thought very carefully about.

1139
00:52:47,170 --> 00:52:50,130
And as Mr. McCaffery said,
we have worked closely

1140
00:52:50,130 --> 00:52:54,370
with the CDC, World Health
Organization, NORTHCOM

1141
00:52:54,370 --> 00:52:57,430
and other Joint Staff to understand how

1142
00:52:57,430 --> 00:52:59,560
to eliminate that risk.

1143
00:52:59,560 --> 00:53:03,580
And so that is why one of the requirements

1144
00:53:03,580 --> 00:53:05,530
is that we've established in the fleet

1145
00:53:05,530 --> 00:53:10,360
is that no ship having left
port will go to another port

1146
00:53:10,360 --> 00:53:15,053
or arrive in another port
and disembark within 14 days.

1147
00:53:16,748 --> 00:53:17,599
- [Betty] Thank you.

1148
00:53:17,599 --> 00:53:18,450
- [John] Thank you.

1149
00:53:18,450 --> 00:53:19,702
- [Betty] Thank you Mr. Judge Carter.

1150
00:53:19,702 --> 00:53:20,702
Mr. Cuellar.

1151
00:53:21,850 --> 00:53:23,750
- Thank you Madam Chair.

1152
00:53:23,750 --> 00:53:26,853
Thank you for being here,
appreciate your work.

1153
00:53:27,840 --> 00:53:31,260
I wanna direct my question
on the coronavirus

1154
00:53:31,260 --> 00:53:35,553
and the use of bases.

1155
00:53:36,530 --> 00:53:40,070
As you know, the Secretary
of Defense, Mr. Esper,

1156
00:53:40,070 --> 00:53:42,160
approved the requests for assistance

1157
00:53:42,160 --> 00:53:44,240
from the Department of
Health and Human Services

1158
00:53:44,240 --> 00:53:48,200
for housing support for those
that had to be quarantined.

1159
00:53:48,200 --> 00:53:50,230
One of those places is my area

1160
00:53:50,230 --> 00:53:52,943
in San Antonio, Lackland Air Force Base.

1161
00:53:54,469 --> 00:53:56,620
As you know, there was
a particular situation

1162
00:53:56,620 --> 00:53:58,760
that they released an individual

1163
00:53:58,760 --> 00:54:01,490
and I know that y'all are
providing support services,

1164
00:54:01,490 --> 00:54:04,633
but just wanna know if
you all are coordinating.

1165
00:54:05,560 --> 00:54:09,400
They released somebody that
was still pending a test.

1166
00:54:09,400 --> 00:54:11,890
That person went to North Star Mall,

1167
00:54:11,890 --> 00:54:14,830
when went around San Antonio, of course

1168
00:54:14,830 --> 00:54:18,960
that caused a problem, because
the second test came back.

1169
00:54:18,960 --> 00:54:22,330
There was a protocol modification

1170
00:54:22,330 --> 00:54:27,150
that the CDC Director sent
off, are you all familiar

1171
00:54:27,150 --> 00:54:30,060
with this letter that got sent off

1172
00:54:30,060 --> 00:54:32,783
on the modification of protocols, anybody?

1173
00:54:34,350 --> 00:54:37,820
- I'm not sure which communication
you're referring to but--

1174
00:54:37,820 --> 00:54:42,820
- Yeah it's just basically the
modification on CDC changes,

1175
00:54:43,190 --> 00:54:45,790
that is, there were two changes:

1176
00:54:45,790 --> 00:54:49,980
One, that is if you have
a quarantine individual,

1177
00:54:49,980 --> 00:54:52,460
that person will only be
released if that person

1178
00:54:52,460 --> 00:54:56,440
has had two sequential
negative tests within 24 hours,

1179
00:54:56,440 --> 00:54:58,080
modification number one.

1180
00:54:58,080 --> 00:55:00,930
Modification number two, which
is the most important one

1181
00:55:00,930 --> 00:55:04,520
where I think they messed
up, was that no person

1182
00:55:04,520 --> 00:55:08,223
will be released if there's
a pending test result.

1183
00:55:09,280 --> 00:55:13,480
And that's what we saw
in the San Antonio area.

1184
00:55:13,480 --> 00:55:17,590
My request is that I know
that y'all are supporting,

1185
00:55:17,590 --> 00:55:22,170
provide support services, but
I think these modifications

1186
00:55:22,170 --> 00:55:24,990
should be something that we should apply,

1187
00:55:24,990 --> 00:55:27,830
whether it's in South Korea
or wherever the case might be,

1188
00:55:27,830 --> 00:55:30,140
I would ask you if you are
not familiar with this,

1189
00:55:30,140 --> 00:55:33,293
I would ask you to please
be familiar with this.

1190
00:55:34,610 --> 00:55:36,140
Any thoughts or comments on this?

1191
00:55:36,140 --> 00:55:40,133
And then I wanna ask
you a second question.

1192
00:55:40,133 --> 00:55:43,300
- Sir, we will make sure that
we have the same guidance.

1193
00:55:43,300 --> 00:55:46,840
I believe we do have
what you're showing us

1194
00:55:46,840 --> 00:55:49,520
and as you pointed out
this is a good example

1195
00:55:49,520 --> 00:55:52,630
of where the department
is in a supporting role

1196
00:55:52,630 --> 00:55:54,390
to the all of government effort

1197
00:55:54,390 --> 00:55:57,220
and so the use of military installations

1198
00:55:57,220 --> 00:56:01,630
in terms of receiving
repatriated citizens.

1199
00:56:01,630 --> 00:56:05,080
The role there was we made
available our installations

1200
00:56:05,080 --> 00:56:07,860
and then Health and Human
Services and the CDC were really,

1201
00:56:07,860 --> 00:56:09,800
once those folks were on the ground,

1202
00:56:09,800 --> 00:56:12,050
had that responsibility
in terms of managing them,

1203
00:56:12,050 --> 00:56:14,760
providing them care, doing the testing

1204
00:56:14,760 --> 00:56:17,000
and then any kind of referrals out

1205
00:56:17,000 --> 00:56:19,000
in their private healthcare sector.

1206
00:56:19,000 --> 00:56:22,900
And so we we defer to them on
making and managing that area,

1207
00:56:22,900 --> 00:56:24,610
but we will take a look at--

1208
00:56:24,610 --> 00:56:26,500
- Yeah and that I understand,

1209
00:56:26,500 --> 00:56:30,100
but even if you're
providing support services.

1210
00:56:30,100 --> 00:56:33,650
If you're off off abroad
somewhere, let's say South Korea,

1211
00:56:33,650 --> 00:56:35,860
then we better be familiar
with this protocol.

1212
00:56:35,860 --> 00:56:37,270
So I would ask you to do that.

1213
00:56:37,270 --> 00:56:39,140
Second thing is what I would ask you

1214
00:56:39,140 --> 00:56:43,150
is the Walter Reed Army
Institute of Research

1215
00:56:43,150 --> 00:56:47,390
is working on a vaccine
against the coronavirus,

1216
00:56:47,390 --> 00:56:52,390
can you give us the status on
that progress and number one

1217
00:56:52,800 --> 00:56:56,410
and also I think they're working
on Diagnostic Testing Kits

1218
00:56:56,410 --> 00:56:59,190
and how close are we on those two points?

1219
00:56:59,190 --> 00:57:02,160
- Yes, so the Military Health System

1220
00:57:02,160 --> 00:57:04,970
is part of the broader interagency

1221
00:57:04,970 --> 00:57:09,010
on looking at everything from
diagnostics, vaccine research,

1222
00:57:09,010 --> 00:57:11,780
as well as antiviral therapies for,

1223
00:57:11,780 --> 00:57:14,350
if you have the condition,
how it can be treated.

1224
00:57:14,350 --> 00:57:19,280
And so in fact, we are,
we, CDC, NIH, are all,

1225
00:57:19,280 --> 00:57:21,600
have in progress, have research going

1226
00:57:21,600 --> 00:57:24,803
on on a vaccine and it has been ongoing.

1227
00:57:25,810 --> 00:57:28,910
I believe clinical
trials for that will not

1228
00:57:28,910 --> 00:57:31,370
be for another few months and so in terms

1229
00:57:31,370 --> 00:57:35,690
of a final determined
FDA approved vaccine,

1230
00:57:35,690 --> 00:57:40,580
likely we're looking at, you
know, 16, 18 to 24 months.

1231
00:57:40,580 --> 00:57:42,340
That's from the research we're doing.

1232
00:57:42,340 --> 00:57:44,930
I can't speak to similar research NIH

1233
00:57:44,930 --> 00:57:47,960
or CDC are doing on that.

1234
00:57:47,960 --> 00:57:52,960
Similarly, on an anti-viral
therapy we may be closer there

1235
00:57:54,150 --> 00:57:56,890
in terms of having something
that can be usable.

1236
00:57:56,890 --> 00:57:58,960
It's actually in clinical trials right now

1237
00:57:58,960 --> 00:58:01,400
for testing of efficacy.

1238
00:58:01,400 --> 00:58:04,383
- Well, as I close I just ask you all to,

1239
00:58:05,330 --> 00:58:08,920
I know we're putting a lot of
federal dollars and research

1240
00:58:08,920 --> 00:58:10,760
and I understand that, in different areas,

1241
00:58:10,760 --> 00:58:13,860
I just wanna make sure
that we're coordinating

1242
00:58:13,860 --> 00:58:18,860
working together as we
use this large amount

1243
00:58:18,880 --> 00:58:21,650
of federal dollars and as
you saw the House passed

1244
00:58:21,650 --> 00:58:24,610
the supplemental bill
yesterday, appropriation.

1245
00:58:24,610 --> 00:58:26,820
So I just wanna make sure
we're all coordinating.

1246
00:58:26,820 --> 00:58:28,340
Thank you for your service all of you.

1247
00:58:28,340 --> 00:58:29,190
Thank you.

1248
00:58:29,190 --> 00:58:30,023
- Thank you.

1249
00:58:30,023 --> 00:58:30,856
Mr. Womack.

1250
00:58:30,856 --> 00:58:34,433
- Thank you Madam Chair and
thanks to the entire panel.

1251
00:58:36,020 --> 00:58:38,490
I wanna direct my
question to General Dingle

1252
00:58:38,490 --> 00:58:43,010
and Admiral Gillingham and I'm gonna pivot

1253
00:58:43,010 --> 00:58:47,693
away from all these flavors of the month,

1254
00:58:47,693 --> 00:58:50,950
COVID-19 et cetera, et
cetera and I wanna come back

1255
00:58:50,950 --> 00:58:54,560
to tactical medicine for just a minute.

1256
00:58:54,560 --> 00:58:59,560
It is my strong belief that
in the last two decades,

1257
00:59:01,750 --> 00:59:06,750
thanks to the efforts of, in
the entire readiness scenario,

1258
00:59:10,600 --> 00:59:13,680
to better prepare our
men and women in uniform

1259
00:59:14,610 --> 00:59:19,610
to perform Battlefield medicine
has saved a lot of lives.

1260
00:59:24,100 --> 00:59:27,050
There are a lot of people
that have been able to go home

1261
00:59:27,050 --> 00:59:29,933
to their families, albeit
maybe banged up a lot,

1262
00:59:31,110 --> 00:59:33,840
that in many previous wars

1263
00:59:33,840 --> 00:59:36,124
would have died on the battlefield.

1264
00:59:36,124 --> 00:59:39,290
And in my regiment back many years ago

1265
00:59:40,198 --> 00:59:43,090
we had a robust Combat Lifesaver Program

1266
00:59:43,090 --> 00:59:45,270
and I think that Combat Lifesaver Program

1267
00:59:45,270 --> 00:59:50,270
was probably the reason
why we've done so well.

1268
00:59:51,160 --> 00:59:56,160
I know that the military of
the Services are transitioning

1269
00:59:56,310 --> 00:59:59,930
from the traditional
Combat Lifesaver Program

1270
00:59:59,930 --> 01:00:04,930
to a more robust Tactical
Combat Casualty Program,

1271
01:00:06,970 --> 01:00:08,780
so I'd like an update.

1272
01:00:08,780 --> 01:00:13,420
It is my understanding that
that process is still evolving

1273
01:00:13,420 --> 01:00:18,420
and that the Tier 2 TC3
Program is going to become

1274
01:00:18,820 --> 01:00:23,490
that bedrock training
for our readiness posture

1275
01:00:23,490 --> 01:00:27,250
that in the event that we were to engage

1276
01:00:28,517 --> 01:00:31,310
in a near-peer combat scenario,

1277
01:00:31,310 --> 01:00:32,950
more force-on-force scenario,

1278
01:00:32,950 --> 01:00:37,010
that a much more robust Combat Program,

1279
01:00:37,010 --> 01:00:40,540
Combat Medic Program, would be important.

1280
01:00:40,540 --> 01:00:43,620
So can you explain to me
where we are in this process,

1281
01:00:43,620 --> 01:00:48,580
how it is going and what you see unfolding

1282
01:00:48,580 --> 01:00:51,610
in the next year or two?

1283
01:00:51,610 --> 01:00:53,220
- Mr. Womack, first and foremost

1284
01:00:53,220 --> 01:00:57,580
let me thank you for recognizing
the first responders.

1285
01:00:57,580 --> 01:01:00,240
Oftentimes, the combat medic
and that combat lifesaver

1286
01:01:00,240 --> 01:01:04,760
do not get the recognition
that they deserve

1287
01:01:04,760 --> 01:01:06,930
when they are the very first responders

1288
01:01:06,930 --> 01:01:10,270
that stop the bleeding, that are enablers

1289
01:01:10,270 --> 01:01:12,910
to the sustainment of life in combat.

1290
01:01:12,910 --> 01:01:15,240
With that said, you
are absolutely correct,

1291
01:01:15,240 --> 01:01:17,680
our program is growing
tremendously within Army,

1292
01:01:17,680 --> 01:01:20,340
we call it the Army Medicine Medical

1293
01:01:20,340 --> 01:01:23,140
Skill Sustainment Program,
which it involves everything

1294
01:01:23,140 --> 01:01:25,470
from expeditionary combat medic care

1295
01:01:25,470 --> 01:01:28,130
where we're teaching them
expeditionary medicine

1296
01:01:28,130 --> 01:01:30,820
and how to provide prolonged care

1297
01:01:30,820 --> 01:01:32,690
in austere environments all the way

1298
01:01:32,690 --> 01:01:36,210
to where we're taking our
trauma teams, as you mentioned,

1299
01:01:36,210 --> 01:01:38,860
and embedding them in
our civilian facilities,

1300
01:01:38,860 --> 01:01:41,670
those trauma centers, so that
they can get the touches,

1301
01:01:41,670 --> 01:01:45,320
not just as a trauma surgeon,
but as a trauma team.

1302
01:01:45,320 --> 01:01:47,380
Right now as we expand that we currently

1303
01:01:47,380 --> 01:01:50,650
have three programs going on
right now across the country.

1304
01:01:50,650 --> 01:01:51,710
We're gonna expand that this year

1305
01:01:51,710 --> 01:01:54,770
in FY20 for those trauma
teams to three more

1306
01:01:54,770 --> 01:01:57,120
and then we have about another eight more

1307
01:01:57,120 --> 01:01:59,120
that are right behind those.

1308
01:01:59,120 --> 01:02:01,480
In reference to those
enlisted training also,

1309
01:02:01,480 --> 01:02:05,180
we have what we called
our our Strategic Medical

1310
01:02:05,180 --> 01:02:08,370
Asset Readiness Training
and so that SMART focuses

1311
01:02:08,370 --> 01:02:12,200
once again on that combat
medic, not just training them

1312
01:02:12,200 --> 01:02:14,710
in simple training environments,

1313
01:02:14,710 --> 01:02:17,340
but also pulling them out and putting them

1314
01:02:17,340 --> 01:02:19,080
into some of those trauma centers too,

1315
01:02:19,080 --> 01:02:22,870
so they can get those
individual critical task lists,

1316
01:02:22,870 --> 01:02:24,110
training to proficiency,

1317
01:02:24,110 --> 01:02:27,320
so when they are called upon
they'll be ready to respond.

1318
01:02:27,320 --> 01:02:28,840
Bruce.

1319
01:02:28,840 --> 01:02:30,890
- Thank You Congressman Womack.

1320
01:02:30,890 --> 01:02:33,980
As an orthopedic surgeon who
has served as the Officer

1321
01:02:33,980 --> 01:02:37,146
in Charge of a Surgical Shock
Trauma Platoon in Fallujah

1322
01:02:37,146 --> 01:02:40,060
in 2004, I can tell you this
is a particular interest

1323
01:02:40,060 --> 01:02:42,460
to me that we continue to get this right,

1324
01:02:42,460 --> 01:02:44,030
particularly as the nature

1325
01:02:44,030 --> 01:02:46,580
of our adversary potentially changes.

1326
01:02:46,580 --> 01:02:51,580
I will tell you that in
addition to moving up in terms

1327
01:02:51,720 --> 01:02:56,720
of the capability for our
enlisted providers for TCCC,

1328
01:02:57,370 --> 01:03:00,380
we're actually in the process
of training the entirety

1329
01:03:00,380 --> 01:03:05,090
of the ship to have those basic skills,

1330
01:03:05,090 --> 01:03:07,500
because as terrific as our
independent duty corpsman

1331
01:03:07,500 --> 01:03:10,160
are who are responsible
for the medical care

1332
01:03:10,160 --> 01:03:13,310
on our smaller ships, they
would be rapidly overwhelmed.

1333
01:03:13,310 --> 01:03:16,720
So we are in the process
of training the entire crew

1334
01:03:16,720 --> 01:03:20,540
in fundamentals of
Tactical Casualty Care sir.

1335
01:03:20,540 --> 01:03:24,170
- I have one follow-up
question regarding new medicine

1336
01:03:24,170 --> 01:03:27,670
and that is: There's a lot
of technology out there

1337
01:03:27,670 --> 01:03:32,430
regarding clotting
material in the application

1338
01:03:32,430 --> 01:03:34,050
of certain bandages
and this sort of thing.

1339
01:03:34,050 --> 01:03:37,030
Are we okay with our stockpiles?

1340
01:03:37,030 --> 01:03:42,030
Are we procuring these
new technological advances

1341
01:03:43,340 --> 01:03:47,010
in a timely way so that we can

1342
01:03:47,010 --> 01:03:48,980
use the very best that we have?

1343
01:03:48,980 --> 01:03:52,330
Because, you know, in that golden hour,

1344
01:03:52,330 --> 01:03:57,330
or in those first few minutes,
that type of equipment

1345
01:03:58,470 --> 01:04:02,350
is going to be critical
to helping save lives

1346
01:04:02,350 --> 01:04:05,143
when otherwise they would
be lost immediately.

1347
01:04:06,170 --> 01:04:09,200
- Sir, I can't speak directly
to the supply that we have,

1348
01:04:09,200 --> 01:04:12,690
but I will tell you that there
and perhaps General Place

1349
01:04:12,690 --> 01:04:15,540
or Mr. McCaffery can
speak at greater detail,

1350
01:04:15,540 --> 01:04:18,500
but I can tell you there
is a tremendous commitment

1351
01:04:18,500 --> 01:04:21,140
in our research enterprise to make sure

1352
01:04:21,140 --> 01:04:25,300
that we have absolutely the
best possible, you know,

1353
01:04:25,300 --> 01:04:27,460
equipment and technology

1354
01:04:27,460 --> 01:04:29,733
in the hands of our first providers.

1355
01:04:31,160 --> 01:04:32,310
- Yes sir, I'll add onto that.

1356
01:04:32,310 --> 01:04:35,740
Both in terms of quality and
in terms of the quantity,

1357
01:04:35,740 --> 01:04:37,930
the research that has been occurring

1358
01:04:37,930 --> 01:04:39,170
within the Military Health System,

1359
01:04:39,170 --> 01:04:42,080
specifically for intra-abdominal
clotting for example,

1360
01:04:42,080 --> 01:04:44,160
which is a problem on the battlefield

1361
01:04:44,160 --> 01:04:45,700
or in junctional hemorrhage cases,

1362
01:04:45,700 --> 01:04:49,640
so where extremities come in to the thorax

1363
01:04:49,640 --> 01:04:52,300
or into the abdomen,
those are also important.

1364
01:04:52,300 --> 01:04:53,320
We have cutting-edge research

1365
01:04:53,320 --> 01:04:55,840
that has given us new
clotting technologies

1366
01:04:55,840 --> 01:04:57,130
to be able to use in those conditions.

1367
01:04:57,130 --> 01:04:59,660
So it's not just a
quantity of them, yes sir,

1368
01:04:59,660 --> 01:05:02,680
we have good stocks of them,
but it's also new qualities

1369
01:05:02,680 --> 01:05:04,983
of hemorrhage control
capacities that we have.

1370
01:05:06,720 --> 01:05:09,040
- Thank you for the service
for all of your service

1371
01:05:09,040 --> 01:05:10,860
and I appreciate the answers

1372
01:05:10,860 --> 01:05:12,120
to my questions here this morning.

1373
01:05:12,120 --> 01:05:13,360
I'll yield back.

1374
01:05:13,360 --> 01:05:14,492
- Thank you.

1375
01:05:14,492 --> 01:05:15,580
I saw some of the clotting techniques

1376
01:05:15,580 --> 01:05:19,180
that they were working on out
at Fort Detrick just recently.

1377
01:05:19,180 --> 01:05:21,780
Truly amazing and we'll
later on have application

1378
01:05:21,780 --> 01:05:25,450
in the civilian healthcare world as well.

1379
01:05:25,450 --> 01:05:26,423
Ms. Kirkpatrick.

1380
01:05:27,880 --> 01:05:31,273
- Thank you Madam Chair and
thank you to all of the panel.

1381
01:05:32,150 --> 01:05:34,570
Excuse me for being here, prior to coming

1382
01:05:34,570 --> 01:05:36,970
into Congress I was a hospital attorney.

1383
01:05:36,970 --> 01:05:41,290
I represented a Regional
Hospital that had a number

1384
01:05:41,290 --> 01:05:46,160
of smaller clinics within
it and spent a great deal

1385
01:05:46,160 --> 01:05:50,270
of my time on medical records completion.

1386
01:05:50,270 --> 01:05:51,540
It's not easy.

1387
01:05:51,540 --> 01:05:54,700
It's very complicated
and one of the things

1388
01:05:54,700 --> 01:05:58,860
that I discovered was that
there was a real reluctance

1389
01:05:58,860 --> 01:06:01,190
by some members of the medical staff

1390
01:06:01,190 --> 01:06:04,280
to use Electronic Medical Records.

1391
01:06:04,280 --> 01:06:07,910
So they were used to
dictating their charts

1392
01:06:07,910 --> 01:06:11,050
as they made their rounds
and then that chart would go

1393
01:06:11,050 --> 01:06:13,360
to medical records and then
somebody would transcribe

1394
01:06:13,360 --> 01:06:15,550
that chart in medical records

1395
01:06:15,550 --> 01:06:18,000
so that it could be electronic.

1396
01:06:18,000 --> 01:06:20,650
It was very cumbersome, took weeks

1397
01:06:20,650 --> 01:06:22,720
and weeks and weeks to complete.

1398
01:06:22,720 --> 01:06:26,090
So I wanna know a couple of things.

1399
01:06:26,090 --> 01:06:28,832
The other thing we found is
that it's really difficult

1400
01:06:28,832 --> 01:06:33,360
to attract young people
to residencies in the VA

1401
01:06:33,360 --> 01:06:36,090
and so I'd like you to
address what you're doing

1402
01:06:36,090 --> 01:06:39,240
to recruit and attract young people

1403
01:06:39,240 --> 01:06:41,870
into the healthcare system
and the delivery system.

1404
01:06:41,870 --> 01:06:46,470
And then what's been
done to improve the use

1405
01:06:46,470 --> 01:06:50,963
of Electronic Records, let
alone interoperability.

1406
01:06:52,053 --> 01:06:54,830
I mean we can't even get
to that until we actually

1407
01:06:54,830 --> 01:06:57,680
have the electronic records in the system.

1408
01:06:57,680 --> 01:06:59,970
So that's an open question to anyone

1409
01:06:59,970 --> 01:07:01,840
on the panel who feels like
they could address that.

1410
01:07:01,840 --> 01:07:02,673
Thank you.

1411
01:07:02,673 --> 01:07:05,920
- Let me let me start with the
kind of the larger question

1412
01:07:05,920 --> 01:07:07,900
that you asked and how we would defer

1413
01:07:07,900 --> 01:07:09,980
to the military departments in terms

1414
01:07:09,980 --> 01:07:12,580
of this specific question
of things that we're doing

1415
01:07:12,580 --> 01:07:16,150
to recruit and retain, you
know, young people into,

1416
01:07:16,150 --> 01:07:17,260
I mean from our perspective,

1417
01:07:17,260 --> 01:07:20,020
into the the medical side of the military.

1418
01:07:20,020 --> 01:07:22,340
But you indicated the challenge

1419
01:07:22,340 --> 01:07:25,850
of adopting Electronic
Health Record and I think

1420
01:07:25,850 --> 01:07:29,160
that's something to foot
stomp here for everybody.

1421
01:07:29,160 --> 01:07:32,890
My experience in the
private sector is, you know,

1422
01:07:32,890 --> 01:07:37,370
even systems like Kaiser
that have been around,

1423
01:07:37,370 --> 01:07:39,910
very sophisticated, when they adopted

1424
01:07:39,910 --> 01:07:43,000
a new Electronic Health Record
it took it took several years

1425
01:07:43,000 --> 01:07:46,110
for them to do for just many
of the reasons you pointed out.

1426
01:07:46,110 --> 01:07:48,450
it's not so much the technology it is:

1427
01:07:48,450 --> 01:07:51,540
How do you train your your workforce,

1428
01:07:51,540 --> 01:07:54,770
including clinicians,
on that new technology?

1429
01:07:54,770 --> 01:07:57,610
What are the workflows you
need to use to match it up?

1430
01:07:57,610 --> 01:07:59,980
And it's change management and I think

1431
01:07:59,980 --> 01:08:03,510
and I'll let Mr. Tinston weigh
in with some more detail,

1432
01:08:03,510 --> 01:08:05,820
but we purposely when we rolled out

1433
01:08:05,820 --> 01:08:09,540
for the Department of
Defense, rolled out the EHR,

1434
01:08:09,540 --> 01:08:13,050
we did it in a test way in four facilities

1435
01:08:13,050 --> 01:08:16,133
to see what we needed to learn

1436
01:08:16,133 --> 01:08:18,810
and it informed the larger deployment.

1437
01:08:18,810 --> 01:08:20,670
And we learned many of
those things and I think

1438
01:08:20,670 --> 01:08:24,520
that is what has led to
the most recent deployment

1439
01:08:24,520 --> 01:08:26,780
in September went far better.

1440
01:08:26,780 --> 01:08:29,720
And we believe we're
really well positioned now

1441
01:08:29,720 --> 01:08:32,440
as we pursue additional waves

1442
01:08:32,440 --> 01:08:34,280
of getting it out throughout the system.

1443
01:08:34,280 --> 01:08:35,910
But I don't know if you have anything

1444
01:08:35,910 --> 01:08:37,353
to add Mr. Tinston on that.

1445
01:08:41,120 --> 01:08:45,203
- [Bill] So Mr. McCaffery,
we did learn a lot.

1446
01:08:46,245 --> 01:08:48,423
We even did the initial
Pacific Northwest sites.

1447
01:08:50,270 --> 01:08:51,540
(speaking off microphone)

1448
01:08:51,540 --> 01:08:52,580
- [Betty] Sir, if you would speak

1449
01:08:52,580 --> 01:08:53,805
into a microphone so that
it could be picked up.

1450
01:08:53,805 --> 01:08:54,840
- [Bill] Sorry about that.

1451
01:08:54,840 --> 01:08:56,250
- [Betty] Not a problem.

1452
01:08:56,250 --> 01:08:58,073
- We took some time to make sure

1453
01:08:58,073 --> 01:09:00,500
we had the capabilities
right with the record

1454
01:09:00,500 --> 01:09:03,460
and the workflows and we
began training those workflows

1455
01:09:03,460 --> 01:09:06,920
to get people job ready by
teaching them how to use the IT,

1456
01:09:06,920 --> 01:09:09,320
which is one of the mistakes
we made out of the gate.

1457
01:09:09,320 --> 01:09:11,720
And so we've had much better
results with Wave Travis

1458
01:09:11,720 --> 01:09:16,390
and we anticipate continuous
improvements as we proceed

1459
01:09:16,390 --> 01:09:18,110
to Wave Nellis and future Waves.

1460
01:09:18,110 --> 01:09:21,536
And as I said earlier, we have 66 sites

1461
01:09:21,536 --> 01:09:26,536
in the deployment process at this moment.

1462
01:09:26,800 --> 01:09:28,270
- Are you working with medical schools

1463
01:09:28,270 --> 01:09:32,700
to train young doctors,
before they get to residency,

1464
01:09:32,700 --> 01:09:35,293
how to use that IT software?

1465
01:09:37,610 --> 01:09:40,650
- Well Ma'am most of the
the medical students who are

1466
01:09:40,650 --> 01:09:43,580
on the scholarship programs
that end up bringing them

1467
01:09:43,580 --> 01:09:45,630
into our system, they do rotations

1468
01:09:45,630 --> 01:09:47,320
in our organizations already.

1469
01:09:47,320 --> 01:09:48,780
So yes, they are being trained

1470
01:09:48,780 --> 01:09:51,770
on our systems before
they ever get into it.

1471
01:09:51,770 --> 01:09:53,590
Let me add one other comment to it.

1472
01:09:53,590 --> 01:09:55,480
We've been using an
Electronic Health Record

1473
01:09:55,480 --> 01:09:58,220
within the Military Health
System for two decades.

1474
01:09:58,220 --> 01:10:01,130
So the challenge that you're describing

1475
01:10:01,130 --> 01:10:02,790
is really not a challenge
that we're having.

1476
01:10:02,790 --> 01:10:05,050
We're used to using
Electronic Health Record.

1477
01:10:05,050 --> 01:10:07,530
The downside of it, it was
homegrown it was clunky,

1478
01:10:07,530 --> 01:10:09,230
there were challenges with it,

1479
01:10:09,230 --> 01:10:10,400
but our culture has changed too

1480
01:10:10,400 --> 01:10:12,200
accepting the Electronic Health Record.

1481
01:10:12,200 --> 01:10:13,350
The challenges that we're having now

1482
01:10:13,350 --> 01:10:16,470
is from our homegrown
Electronic Health Record

1483
01:10:16,470 --> 01:10:18,170
where we did our own workflows

1484
01:10:18,170 --> 01:10:19,780
even locally sometimes differently,

1485
01:10:19,780 --> 01:10:22,360
to the commercial off-the-shelf
that we purchased,

1486
01:10:22,360 --> 01:10:25,290
transitioning to that
it's not the reliance

1487
01:10:25,290 --> 01:10:26,123
on the Electronic Health Record

1488
01:10:26,123 --> 01:10:28,221
that we're having a challenge with.

1489
01:10:28,221 --> 01:10:31,520
- Are you using software you
just purchased off-the-shelf?

1490
01:10:31,520 --> 01:10:32,650
- Yes ma'am, it's a commercial

1491
01:10:32,650 --> 01:10:34,414
off-the-shelf software program.

1492
01:10:34,414 --> 01:10:35,247
- All right.

1493
01:10:35,247 --> 01:10:37,570
The other challenge we ran into

1494
01:10:37,570 --> 01:10:39,740
was maintaining confidentiality.

1495
01:10:39,740 --> 01:10:44,470
So when records are
being transferred around

1496
01:10:44,470 --> 01:10:47,820
to different institutions,
how do you maintain

1497
01:10:47,820 --> 01:10:50,623
the confidentiality of the medical record?

1498
01:10:51,990 --> 01:10:53,970
- So we're fortunate in that we're part

1499
01:10:53,970 --> 01:10:56,680
of the Department of Defense
and so from a cybersecurity

1500
01:10:56,680 --> 01:10:59,840
and a data protection
perspective we have the baseline

1501
01:10:59,840 --> 01:11:02,840
of the department's cyber rules

1502
01:11:02,840 --> 01:11:06,030
and standards to base our
implementation off of.

1503
01:11:06,030 --> 01:11:08,480
So we manage the cyber
protection with the VA,

1504
01:11:08,480 --> 01:11:10,340
because it's a joint
record that we're creating

1505
01:11:10,340 --> 01:11:14,130
between the DOD and the VA
to meet the DOD standards.

1506
01:11:14,130 --> 01:11:16,900
And as far as the interoperability

1507
01:11:16,900 --> 01:11:19,567
and exchange of data
with external providers,

1508
01:11:19,567 --> 01:11:24,107
we do that through there's
data use agreements in place

1509
01:11:24,107 --> 01:11:26,250
and we do that through HL7
Standards and we're engaged

1510
01:11:26,250 --> 01:11:29,020
with the standards agency organizations

1511
01:11:29,020 --> 01:11:33,300
to make sure that we have
influence on how those provided.

1512
01:11:33,300 --> 01:11:34,337
- Well it has a tremendous problem

1513
01:11:34,337 --> 01:11:36,790
and I appreciate your attention to it.

1514
01:11:36,790 --> 01:11:39,760
Anything that I can do to
help solve that problem,

1515
01:11:39,760 --> 01:11:41,240
I've been working on it for decades,

1516
01:11:41,240 --> 01:11:42,960
so feel free to call on me.

1517
01:11:42,960 --> 01:11:44,490
Thank you and I yield back.

1518
01:11:44,490 --> 01:11:45,809
- [Betty] Thank you.

1519
01:11:45,809 --> 01:11:46,680
Mr. Ruppersberger.

1520
01:11:46,680 --> 01:11:48,450
- Okay, first thing, panel,
thank you for being here.

1521
01:11:48,450 --> 01:11:50,150
What you do is very important.

1522
01:11:50,150 --> 01:11:53,060
We appreciate your
confidence and I wanna get

1523
01:11:53,060 --> 01:11:56,290
into the Strategic Medical
Asset Readiness Program, SMART.

1524
01:11:56,290 --> 01:11:59,530
I know Congressman Womack dealt with it.

1525
01:11:59,530 --> 01:12:03,130
Lieutenant Dingle, we must
ensure that we continue

1526
01:12:03,130 --> 01:12:05,150
to take care of our American soldiers.

1527
01:12:05,150 --> 01:12:06,590
A few weeks ago I had the privilege

1528
01:12:06,590 --> 01:12:09,740
to accompany your Deputy
Chief of Staff Jim McCrossan

1529
01:12:09,740 --> 01:12:11,100
to the Baltimore Shock Trauma

1530
01:12:11,100 --> 01:12:13,050
at the University of Maryland
and that is rated one

1531
01:12:13,050 --> 01:12:15,290
of the top trauma centers in the world.

1532
01:12:15,290 --> 01:12:18,910
Research, development
and we have the Air Force

1533
01:12:18,910 --> 01:12:20,610
has been there for many years

1534
01:12:20,610 --> 01:12:22,310
and have a really good relationship.

1535
01:12:22,310 --> 01:12:23,740
And we're focused right now on the Army

1536
01:12:23,740 --> 01:12:27,170
and maybe the Navy and Marines later.

1537
01:12:27,170 --> 01:12:29,830
In fact, that trauma center
saved my life 50 years ago.

1538
01:12:29,830 --> 01:12:31,890
And if it weren't for their expertise

1539
01:12:31,890 --> 01:12:33,870
and competence I wouldn't be here today.

1540
01:12:33,870 --> 01:12:36,100
Maybe that's a good thing for some people.

1541
01:12:36,100 --> 01:12:40,060
Anyhow, (chuckles) during our visit

1542
01:12:40,060 --> 01:12:42,600
we discussed the SMART
Program which provides

1543
01:12:42,600 --> 01:12:46,000
combat medics the opportunity
to get hands-on training

1544
01:12:46,000 --> 01:12:49,220
alongside their civilian counterparts.

1545
01:12:49,220 --> 01:12:51,680
The studies show that during
the first few years of wars

1546
01:12:51,680 --> 01:12:53,780
in Afghanistan and in Iraq we could

1547
01:12:53,780 --> 01:12:55,530
have saved one in seven troops lost

1548
01:12:55,530 --> 01:12:58,350
if they had access to
reliable trauma care.

1549
01:12:58,350 --> 01:13:01,500
Now what are your plans to
expand this vital program?

1550
01:13:01,500 --> 01:13:04,110
Does the FY21 budget support this?

1551
01:13:04,110 --> 01:13:09,110
And as our military shifts
to near-peer competition,

1552
01:13:09,280 --> 01:13:11,050
can you explain why trauma care experience

1553
01:13:11,050 --> 01:13:13,033
is so important to our medical corps?

1554
01:13:14,500 --> 01:13:16,020
- Thank You Representative.

1555
01:13:16,020 --> 01:13:18,240
As you've experienced the great treatment

1556
01:13:18,240 --> 01:13:20,170
from the Baltimore Shock and Trauma,

1557
01:13:20,170 --> 01:13:22,800
one of the the beauties
of the SMART Program

1558
01:13:22,800 --> 01:13:26,840
is it's taking again that
combat medic and expounding

1559
01:13:26,840 --> 01:13:28,730
and building upon something that we've had

1560
01:13:28,730 --> 01:13:31,240
within the Army called
Medical Proficiency Training

1561
01:13:31,240 --> 01:13:33,500
in the old days where we were leveraging

1562
01:13:33,500 --> 01:13:36,010
just our Military Medical
Treatment Facilities.

1563
01:13:36,010 --> 01:13:38,910
With Baltimore Shock and
Trauma and then those hospitals

1564
01:13:38,910 --> 01:13:41,250
who are those civilian trauma centers,

1565
01:13:41,250 --> 01:13:45,470
they're exposing these
medics in a two-week rotation

1566
01:13:45,470 --> 01:13:47,870
with the ability to put hands-on

1567
01:13:47,870 --> 01:13:50,280
trauma injuries and trauma cases.

1568
01:13:50,280 --> 01:13:53,430
So that is exponentially
increasing their skillset,

1569
01:13:53,430 --> 01:13:55,450
their individual critical task list

1570
01:13:55,450 --> 01:13:57,070
and it is just priceless.

1571
01:13:57,070 --> 01:14:00,350
We are expanding to two
programs this fiscal year

1572
01:14:00,350 --> 01:14:02,330
this summer with plans to expand

1573
01:14:02,330 --> 01:14:04,870
to about six, seven more almost each year.

1574
01:14:04,870 --> 01:14:07,570
And again, we have not had any issues

1575
01:14:07,570 --> 01:14:10,480
with funding as we continue
to expand and our intent

1576
01:14:10,480 --> 01:14:11,510
is to expand this across the country.

1577
01:14:11,510 --> 01:14:13,587
- Okay that's good.

1578
01:14:13,587 --> 01:14:14,420
Lieutenant Hogg.

1579
01:14:14,420 --> 01:14:17,890
- Yes sir, so as you
know we've used Baltimore

1580
01:14:17,890 --> 01:14:19,120
for quite some time.

1581
01:14:19,120 --> 01:14:22,050
We have other Seastar's
capabilities out there

1582
01:14:22,050 --> 01:14:27,050
with Cincinnati and University
Medical Center in Nevada.

1583
01:14:27,610 --> 01:14:31,680
What we are also looking at
is embedding entire teams

1584
01:14:31,680 --> 01:14:36,680
in civilian facilities,
24/7, 365 days a year

1585
01:14:37,640 --> 01:14:39,980
where they're getting the touches

1586
01:14:39,980 --> 01:14:41,410
on a regular and consistent basis.

1587
01:14:41,410 --> 01:14:42,243
- That's good, you keep up.

1588
01:14:42,243 --> 01:14:43,420
All right, I wanna move

1589
01:14:43,420 --> 01:14:46,380
to the Peer Review
Orthopedic Research Program.

1590
01:14:46,380 --> 01:14:49,230
Secretary McCaffery I'd like to ask you

1591
01:14:49,230 --> 01:14:52,540
about this program the
Orthopedic Research Program.

1592
01:14:52,540 --> 01:14:54,590
I've been supporting
this program for years.

1593
01:14:54,590 --> 01:14:57,490
It's a research program which
has demonstrated results,

1594
01:14:57,490 --> 01:15:00,270
enrolling more than
15,000 patients to date

1595
01:15:00,270 --> 01:15:03,080
in military-relevant
research with the potential

1596
01:15:04,443 --> 01:15:05,730
to provide healthcare solutions

1597
01:15:05,730 --> 01:15:08,410
for injured servicemembers,
veterans and civilians.

1598
01:15:08,410 --> 01:15:10,730
Now the conflicts in Iraq
and Afghanistan have resulted

1599
01:15:10,730 --> 01:15:14,380
in 5,300 deaths and 52,000
battlefield injuries

1600
01:15:14,380 --> 01:15:16,340
among American service personnel,

1601
01:15:16,340 --> 01:15:19,400
including more than 2,200
major limb amputations.

1602
01:15:19,400 --> 01:15:21,100
The unique nature of these wounds

1603
01:15:21,100 --> 01:15:23,620
which primarily result
from explosive blasts

1604
01:15:23,620 --> 01:15:26,960
and high-velocity of gunshot
has been well-documented.

1605
01:15:26,960 --> 01:15:28,260
The Orthopedic Research Program

1606
01:15:28,260 --> 01:15:32,300
has been funded since 2009,
has received level funding

1607
01:15:32,300 --> 01:15:36,820
at 30 million per year since FY2012.

1608
01:15:36,820 --> 01:15:39,070
These funds have allowed
our Orthopedic Docs

1609
01:15:39,070 --> 01:15:41,360
to work miracles stabilizing limbs,

1610
01:15:41,360 --> 01:15:42,780
helping with tissue regeneration

1611
01:15:42,780 --> 01:15:45,333
and even the full face transplant.

1612
01:15:46,200 --> 01:15:49,090
Those conducting the research
are asking for an increase

1613
01:15:49,090 --> 01:15:52,430
to 35 million in order
to provide stable funding

1614
01:15:52,430 --> 01:15:55,650
for the consortiums, which includes

1615
01:15:55,650 --> 01:15:58,480
the major extremity trauma
Research Consortium metric

1616
01:15:59,490 --> 01:16:02,123
and that's anchored at
Johns Hopkins University.

1617
01:16:03,170 --> 01:16:04,670
Can you walk us through the history

1618
01:16:04,670 --> 01:16:06,730
of the Orthopedic Research Program

1619
01:16:06,730 --> 01:16:08,130
and the consortium it works?

1620
01:16:08,130 --> 01:16:10,190
And also, do you believe the program

1621
01:16:10,190 --> 01:16:12,350
could benefit from
increased funding designated

1622
01:16:12,350 --> 01:16:15,170
to support these sources
on an ongoing basis?

1623
01:16:15,170 --> 01:16:17,710
Do you agree the consortiums
are a force multiplier

1624
01:16:17,710 --> 01:16:19,960
to provide the greatest
return on investment?

1625
01:16:20,860 --> 01:16:23,570
- So I thank you for the
question Congressman.

1626
01:16:23,570 --> 01:16:27,710
To be candid I cannot walk
you through the history

1627
01:16:27,710 --> 01:16:29,710
of this particular research program.

1628
01:16:29,710 --> 01:16:31,073
I would need to get back
to you in terms of--

1629
01:16:31,073 --> 01:16:32,530
- [Charles] Well I probably
can more than you--

1630
01:16:32,530 --> 01:16:35,320
- Some of the questions, I'm not aware

1631
01:16:35,320 --> 01:16:37,400
of the request for increased funding

1632
01:16:37,400 --> 01:16:39,870
in this particular research program,

1633
01:16:39,870 --> 01:16:42,990
but I'm happy to take back your questions

1634
01:16:42,990 --> 01:16:44,723
and provide you the--

1635
01:16:44,723 --> 01:16:46,230
- Well I'll get my staff
to get in contact with you

1636
01:16:46,230 --> 01:16:47,810
or your staff today and I wanna try

1637
01:16:47,810 --> 01:16:49,570
to make this a priority if we can.

1638
01:16:49,570 --> 01:16:50,403
- [Thomas] Sure.

1639
01:16:50,403 --> 01:16:51,388
- Okay.

1640
01:16:51,388 --> 01:16:52,305
Yield back.

1641
01:16:53,260 --> 01:16:54,810
- [Betty] If we could
have the Army follow up

1642
01:16:54,810 --> 01:16:56,393
on that to the committee.

1643
01:16:57,450 --> 01:16:58,333
Mr. Crist.

1644
01:17:04,000 --> 01:17:05,440
- Thank you very much Madam Chair

1645
01:17:05,440 --> 01:17:07,240
and thank all of you for being here today.

1646
01:17:07,240 --> 01:17:09,900
We appreciate your service to our country.

1647
01:17:09,900 --> 01:17:13,640
As you know, Iran launched
11 ballistic missiles

1648
01:17:13,640 --> 01:17:16,370
at the Al-Asad Airbase in Iraq.

1649
01:17:16,370 --> 01:17:19,270
While we thought that all
servicemembers were safe,

1650
01:17:19,270 --> 01:17:22,930
over 100 servicemembers
have since been diagnosed

1651
01:17:22,930 --> 01:17:24,330
with traumatic brain injury.

1652
01:17:25,520 --> 01:17:27,310
What is the status of the servicemembers

1653
01:17:27,310 --> 01:17:29,210
who were in the attack?

1654
01:17:29,210 --> 01:17:31,610
And out of those who
have returned to duty,

1655
01:17:31,610 --> 01:17:34,060
how many are on light
or restricted service?

1656
01:17:34,060 --> 01:17:36,923
And that's for any of you who
feel comfortable responding.

1657
01:17:38,400 --> 01:17:42,150
- So Congressman Crist,
this may be a little dated.

1658
01:17:42,150 --> 01:17:45,470
This is probably numbers
from a couple of days ago.

1659
01:17:45,470 --> 01:17:50,380
But my understanding out
of the roughly 100, 109

1660
01:17:50,380 --> 01:17:54,650
servicemembers that were
identified, 75 have been reviewed,

1661
01:17:54,650 --> 01:17:59,650
evaluated and are actually
back in duty in Iraq.

1662
01:18:00,040 --> 01:18:03,440
The remainder, I would need
to go back and check in terms

1663
01:18:03,440 --> 01:18:07,170
of what is the status with
regard to their evaluation

1664
01:18:07,170 --> 01:18:10,180
and have they been returned
to duty and what type of duty,

1665
01:18:10,180 --> 01:18:12,780
I don't have that handy, but
I can get back to you on that.

1666
01:18:12,780 --> 01:18:15,130
- Thank you sir, I
appreciate that very much.

1667
01:18:15,130 --> 01:18:17,760
I'm concerned obviously,
because even though the bunkers

1668
01:18:17,760 --> 01:18:22,760
mostly held and they had
ample warning to take shelter,

1669
01:18:24,560 --> 01:18:27,720
over 100 servicemembers were diagnosed.

1670
01:18:27,720 --> 01:18:30,870
And that's that's very
disconcerting obviously.

1671
01:18:30,870 --> 01:18:33,423
That number will likely
increase too, I'm told.

1672
01:18:34,576 --> 01:18:36,610
As General Milley said,
the troops in the attack

1673
01:18:36,610 --> 01:18:40,640
will need to be monitored
for the rest of their lives,

1674
01:18:40,640 --> 01:18:42,637
but he also said quote,

1675
01:18:42,637 --> 01:18:44,610
"That there's nothing we could have done."

1676
01:18:44,610 --> 01:18:45,443
Unquote.

1677
01:18:46,310 --> 01:18:48,350
Because the missiles were so powerful.

1678
01:18:48,350 --> 01:18:51,850
If we are making investment
to counter Russia and China,

1679
01:18:51,850 --> 01:18:54,200
we also need to protect our servicemembers

1680
01:18:54,200 --> 01:18:56,510
against the powerful weapons systems,

1681
01:18:56,510 --> 01:18:58,160
including the ballistic missiles.

1682
01:19:01,213 --> 01:19:02,610
What we are doing to
protect servicemembers

1683
01:19:02,610 --> 01:19:05,373
from ballistic missiles
or other causes of TBI?

1684
01:19:06,690 --> 01:19:09,660
- So a couple of things, one of the areas

1685
01:19:09,660 --> 01:19:12,890
that Congress has asked
the department to work on

1686
01:19:12,890 --> 01:19:16,670
and we are in process and
that is focused especially

1687
01:19:16,670 --> 01:19:21,670
on the implications of
blast exposure and we are

1688
01:19:22,040 --> 01:19:24,540
in the middle of doing a study on that

1689
01:19:24,540 --> 01:19:27,210
to figure out better ways to measure it.

1690
01:19:27,210 --> 01:19:31,520
But then more importantly what
we find out about the impacts

1691
01:19:31,520 --> 01:19:35,200
of blast exposure on brain
health that then needs

1692
01:19:35,200 --> 01:19:39,270
to inform everything from
what weapons we acquire,

1693
01:19:39,270 --> 01:19:40,690
the training we put in place,

1694
01:19:40,690 --> 01:19:41,920
not just in a deployed setting,

1695
01:19:41,920 --> 01:19:44,630
but training you know here at home

1696
01:19:44,630 --> 01:19:48,840
to inform what we can do to
best protect our servicemembers.

1697
01:19:48,840 --> 01:19:51,000
And then most importantly,

1698
01:19:51,000 --> 01:19:53,200
and I think you kind of referenced it,

1699
01:19:53,200 --> 01:19:54,860
was what we are doing

1700
01:19:55,740 --> 01:19:58,880
I believe it's the Special
Forces Command right now

1701
01:19:58,880 --> 01:20:02,670
is really doing a good
job at baselining all

1702
01:20:02,670 --> 01:20:04,130
of their servicemembers with regard

1703
01:20:04,130 --> 01:20:05,770
to their cognitive abilities

1704
01:20:05,770 --> 01:20:10,380
and have that as the benchmark
then to evaluate over time

1705
01:20:10,380 --> 01:20:13,300
to see if any of their, you know,

1706
01:20:13,300 --> 01:20:15,510
in training and deployments,

1707
01:20:15,510 --> 01:20:19,100
any potentially concussive
events have affected

1708
01:20:19,100 --> 01:20:22,210
that baseline as a way
to monitor and evaluate.

1709
01:20:22,210 --> 01:20:24,570
So those are some of the
things that we are looking at.

1710
01:20:24,570 --> 01:20:27,220
- Great, we've known the
brain injuries are a problem

1711
01:20:28,310 --> 01:20:30,670
and that we've known that our adversaries

1712
01:20:30,670 --> 01:20:31,503
have these weapons.

1713
01:20:31,503 --> 01:20:34,950
So how have we not
considered what would happen

1714
01:20:34,950 --> 01:20:36,253
in an attack like this?

1715
01:20:38,050 --> 01:20:43,010
- So I believe we have
considered based upon, you know,

1716
01:20:43,010 --> 01:20:46,513
the evidence we have and
what kind of protective gear,

1717
01:20:47,450 --> 01:20:50,440
based upon research we
have done, what we believe,

1718
01:20:50,440 --> 01:20:52,930
you know, makes sense
in terms of protection.

1719
01:20:52,930 --> 01:20:56,550
And most importantly we do have standard

1720
01:20:56,550 --> 01:20:59,080
across the board policy with regard

1721
01:20:59,080 --> 01:21:04,080
to if a servicemember has
experienced a concussive event

1722
01:21:04,237 --> 01:21:07,520
there are very strict protocols
around reporting that,

1723
01:21:07,520 --> 01:21:10,929
screening that servicemember
getting the evaluation

1724
01:21:10,929 --> 01:21:13,350
and then pursuing whatever medical care

1725
01:21:13,350 --> 01:21:18,350
is required before return
to duty or something else.

1726
01:21:18,391 --> 01:21:19,224
- Thank you sir.

1727
01:21:19,224 --> 01:21:21,950
We've seen patches of
coronavirus here at home,

1728
01:21:21,950 --> 01:21:23,943
including in my home of Tampa Bay,

1729
01:21:25,560 --> 01:21:28,020
home to CENTCOM and SOCOM.

1730
01:21:28,020 --> 01:21:29,860
As you know there are
also larger outbreaks

1731
01:21:29,860 --> 01:21:32,460
near military installations overseas.

1732
01:21:32,460 --> 01:21:33,970
What are you doing to stop the spread

1733
01:21:33,970 --> 01:21:36,640
of the coronavirus in our troops?

1734
01:21:36,640 --> 01:21:39,560
- So we at the department
has issued a series

1735
01:21:39,560 --> 01:21:42,120
over the last four to five weeks

1736
01:21:42,120 --> 01:21:44,510
Force Health Protection Guidance,

1737
01:21:44,510 --> 01:21:47,020
largely built around CDC guidance

1738
01:21:47,880 --> 01:21:51,470
and part of that though is
how we apply that guidance

1739
01:21:51,470 --> 01:21:54,250
to the military environment
and guidance we give

1740
01:21:54,250 --> 01:21:57,830
to installation commanders
both here and abroad

1741
01:21:57,830 --> 01:22:01,380
and how they can apply that
to their particular situations

1742
01:22:01,380 --> 01:22:03,450
on the ground to inform what they wanna do

1743
01:22:03,450 --> 01:22:06,260
with their servicemembers
in terms of screening,

1744
01:22:06,260 --> 01:22:09,817
access to the installation,
as part of the effort

1745
01:22:09,817 --> 01:22:14,817
to contain any infection at
their base or surrounding area.

1746
01:22:16,060 --> 01:22:17,340
- Thank you, I appreciate that.

1747
01:22:17,340 --> 01:22:19,570
Just finally, do military installations

1748
01:22:19,570 --> 01:22:21,820
have access to testing
and then I yield back.

1749
01:22:22,820 --> 01:22:25,790
- The installations that so
it's, we believe it's tied

1750
01:22:25,790 --> 01:22:29,900
to where we have the lab technology

1751
01:22:29,900 --> 01:22:32,970
at military installations
in terms of our MTFs.

1752
01:22:32,970 --> 01:22:36,650
Right now, my last information
is what I thought we had nine

1753
01:22:36,650 --> 01:22:39,810
or 10 of our military labs have the access

1754
01:22:39,810 --> 01:22:42,140
for the testing that's
approved by the CDC.

1755
01:22:42,140 --> 01:22:43,930
We're seeking to get all of our labs

1756
01:22:43,930 --> 01:22:48,472
which is about 14 or 15
to have that ability.

1757
01:22:48,472 --> 01:22:49,305
- [Charlie] Thank you very much.

1758
01:22:49,305 --> 01:22:50,138
Thank you Madam Chair.

1759
01:22:50,138 --> 01:22:50,971
- [Betty] Thank you, if you'd follow up

1760
01:22:50,971 --> 01:22:51,870
with the Committee on that,

1761
01:22:51,870 --> 01:22:52,703
on the testing.

1762
01:22:52,703 --> 01:22:54,020
Mr. Ryan.

1763
01:22:54,020 --> 01:22:54,853
- Thanks Madam Chair.

1764
01:22:54,853 --> 01:22:56,460
Thank you for your service.

1765
01:22:56,460 --> 01:22:57,713
Thank you for being here.

1766
01:22:58,630 --> 01:23:00,700
I wanna go in a little bit
of a different direction.

1767
01:23:00,700 --> 01:23:04,500
I am a little bit unique, I
think I'm the only one who sits

1768
01:23:04,500 --> 01:23:09,180
on the Defense Appropriations
Subcommittee and the military

1769
01:23:09,180 --> 01:23:11,933
or the Military Construction
VA Subcommittee.

1770
01:23:12,950 --> 01:23:17,950
So the issue of health as
it relates to all of you

1771
01:23:19,200 --> 01:23:23,750
and active duty and as
it connects to veterans

1772
01:23:23,750 --> 01:23:26,940
is important and one of the things

1773
01:23:26,940 --> 01:23:30,540
and I've tried to look through
a lot of your testimony,

1774
01:23:30,540 --> 01:23:33,390
it's very technical, we're
talking about records

1775
01:23:33,390 --> 01:23:35,010
and in all of that.

1776
01:23:35,010 --> 01:23:37,143
I wanna talk to you about obesity rates.

1777
01:23:39,570 --> 01:23:43,720
From what I can gather the
obesity rates for active duty

1778
01:23:43,720 --> 01:23:48,720
are going up 15.8% a couple
of years back and now 17.4%.

1779
01:23:54,250 --> 01:23:56,900
In the Navy it's 22%.

1780
01:23:56,900 --> 01:23:58,140
Air Force is 18.

1781
01:23:58,140 --> 01:24:00,320
Army is 17.

1782
01:24:00,320 --> 01:24:04,980
Males between 35 and 44 years old

1783
01:24:04,980 --> 01:24:08,503
have almost a 30% obesity rate.

1784
01:24:09,680 --> 01:24:14,680
And when you look at the
increase in blood pressure

1785
01:24:14,740 --> 01:24:17,410
and diabetes and heart
disease, all of the stuff,

1786
01:24:17,410 --> 01:24:19,853
you know way better than better than I do,

1787
01:24:21,960 --> 01:24:25,100
this is a problem that
we're not even talking about

1788
01:24:25,100 --> 01:24:30,100
and it's got a relatively
simple or simpler solution

1789
01:24:30,750 --> 01:24:32,750
than everything we've just talked about.

1790
01:24:34,060 --> 01:24:37,890
And for the last few years my
staff and I have been trying

1791
01:24:37,890 --> 01:24:42,890
to dig in on the food that
is being fed to our soldiers.

1792
01:24:45,950 --> 01:24:48,380
The fact that the, you know, commissaries

1793
01:24:48,380 --> 01:24:51,120
and cafeterias are closed
and people are working late

1794
01:24:51,120 --> 01:24:52,880
and the only thing left on the whole base

1795
01:24:52,880 --> 01:24:55,400
is a Burger King that's
open and so they go

1796
01:24:56,720 --> 01:25:00,180
and do that over the course of many years.

1797
01:25:00,180 --> 01:25:05,180
Now we need a big strategy
to reverse the obesity rates.

1798
01:25:10,110 --> 01:25:13,730
And I mean I think most
people would be shocked

1799
01:25:13,730 --> 01:25:16,000
to think that we watch Tom Brady

1800
01:25:16,000 --> 01:25:18,560
and we see these high-performing athletes

1801
01:25:18,560 --> 01:25:22,060
and we look at their diets and
we look at their lifestyles

1802
01:25:22,060 --> 01:25:26,160
and we are spending billions of dollars

1803
01:25:26,160 --> 01:25:31,160
to have high-performing men
and women serving our country

1804
01:25:31,360 --> 01:25:36,360
performing at peak levels in
very high-pressured situation

1805
01:25:36,530 --> 01:25:41,530
and for us to have an obesity
rate that's creeping up to 20%

1806
01:25:41,820 --> 01:25:45,520
and zero strategy on how to
fix it, that's a real problem.

1807
01:25:45,520 --> 01:25:47,430
And then you come back and
you want more money for this

1808
01:25:47,430 --> 01:25:50,010
and more money for that
and there's all kinds

1809
01:25:50,010 --> 01:25:54,420
of research going on and
reversing type II diabetes

1810
01:25:54,420 --> 01:25:58,610
with food as medicine and all
kinds of innovative things

1811
01:25:58,610 --> 01:26:00,720
that are happening in the
real world that we have got

1812
01:26:00,720 --> 01:26:03,180
to make sure that it's
getting into the military.

1813
01:26:03,180 --> 01:26:06,930
Now here's the connection
for us who sit at, you know,

1814
01:26:06,930 --> 01:26:11,930
30,000 feet, the diabetes rate
for veterans is one in five.

1815
01:26:15,060 --> 01:26:18,543
The diabetes rate for average
Americans, one in ten.

1816
01:26:19,540 --> 01:26:22,240
So here we're blowing all this money.

1817
01:26:22,240 --> 01:26:24,490
I've been on ships before and you walk in

1818
01:26:24,490 --> 01:26:25,920
and it's all the sugary cereals.

1819
01:26:25,920 --> 01:26:28,990
Now look, I'm not a prude on this stuff,

1820
01:26:28,990 --> 01:26:30,270
I'm an 80 percenter right?

1821
01:26:30,270 --> 01:26:32,710
80% of the time you do
what's right, you work out,

1822
01:26:32,710 --> 01:26:35,830
you eat healthy 80% of the time,

1823
01:26:35,830 --> 01:26:38,530
but we can't have this folks.

1824
01:26:38,530 --> 01:26:41,530
This is unacceptable that
we're gonna continue.

1825
01:26:41,530 --> 01:26:45,170
Is there any strategy that's
in place Mr. Secretary

1826
01:26:45,170 --> 01:26:48,053
that is addressing this
in an aggressive way?

1827
01:26:51,170 --> 01:26:54,370
- So we have in part
working with your office,

1828
01:26:54,370 --> 01:26:57,930
I know last year have
been putting together

1829
01:26:57,930 --> 01:27:00,850
what I would call more of
a framework, or a skeleton

1830
01:27:00,850 --> 01:27:03,930
in terms of what would be the
key components of a strategy.

1831
01:27:03,930 --> 01:27:06,080
As you mentioned, part of it in terms

1832
01:27:06,080 --> 01:27:07,970
of on the health side is, you know,

1833
01:27:07,970 --> 01:27:11,240
what are the health guidelines
and health recommendations

1834
01:27:11,240 --> 01:27:16,220
that then feed into how our
installations are operated

1835
01:27:16,220 --> 01:27:19,470
and the decisions made
about what types of food,

1836
01:27:19,470 --> 01:27:20,750
access to that.

1837
01:27:20,750 --> 01:27:25,310
And where we have not
completed that is that closure,

1838
01:27:25,310 --> 01:27:27,736
that link between the medical side

1839
01:27:27,736 --> 01:27:30,470
and how we are operating
our infrastructure

1840
01:27:30,470 --> 01:27:32,750
so to speak in delivery of food.

1841
01:27:32,750 --> 01:27:35,100
So there is more work to be done on that

1842
01:27:35,100 --> 01:27:39,100
and you make very good points
in terms of you know part

1843
01:27:39,100 --> 01:27:42,980
of lethality is our service
members and their health

1844
01:27:42,980 --> 01:27:44,410
and their ability to do their job

1845
01:27:44,410 --> 01:27:47,780
and this is a negative impact on that.

1846
01:27:47,780 --> 01:27:50,300
- Well it's it's a waste
of money is what it is.

1847
01:27:50,300 --> 01:27:52,270
I mean it's inefficient, it's obviously,

1848
01:27:52,270 --> 01:27:56,173
it goes to production, then
they go into the VA system

1849
01:27:56,173 --> 01:27:59,550
and they have diabetes and then diabetes

1850
01:27:59,550 --> 01:28:03,380
when you look at diabetes
with any other sickness

1851
01:28:03,380 --> 01:28:04,900
just jacks up the cost.

1852
01:28:04,900 --> 01:28:07,680
It extends your stays in the hospital.

1853
01:28:07,680 --> 01:28:10,690
It complicates any other
issue that you may have.

1854
01:28:10,690 --> 01:28:12,050
If you have to go to surgery,

1855
01:28:12,050 --> 01:28:13,900
or if you got heart problem and diabetes

1856
01:28:13,900 --> 01:28:15,630
it just makes it that much worse.

1857
01:28:15,630 --> 01:28:16,730
And so now I'll leave here

1858
01:28:16,730 --> 01:28:18,450
and I'll go sit in another committee,

1859
01:28:18,450 --> 01:28:20,970
VA and talk about how
we don't have any money

1860
01:28:22,210 --> 01:28:26,540
And so we've gotta start seeing
these systems as integrated

1861
01:28:26,540 --> 01:28:28,006
and it's aimed, you know,

1862
01:28:28,006 --> 01:28:29,840
we could have a whole discussion
on K through 12 school.

1863
01:28:29,840 --> 01:28:32,643
When I walk into a school
and these kids are getting

1864
01:28:32,643 --> 01:28:35,240
a Rice Krispies treat and
a thing a chocolate milk

1865
01:28:35,240 --> 01:28:37,900
and they start their day out
with about 80 grams of sugar

1866
01:28:37,900 --> 01:28:39,960
and then they're on the Medicaid program

1867
01:28:39,960 --> 01:28:42,770
and they end up getting
diabetes with the public money

1868
01:28:42,770 --> 01:28:44,960
that we spent to buy
them Rice Krispie treats

1869
01:28:44,960 --> 01:28:46,860
and chocolate milk and then
the public money we spend

1870
01:28:46,860 --> 01:28:48,030
to take care of him on a Medicaid.

1871
01:28:48,030 --> 01:28:49,430
American people are sick of this.

1872
01:28:49,430 --> 01:28:53,370
This does not make any sense
and I want the military

1873
01:28:53,370 --> 01:28:55,800
in the United States to
be the leader in this.

1874
01:28:55,800 --> 01:28:57,910
So I only have probably
a little bit of time left

1875
01:28:57,910 --> 01:28:58,880
and I would just like to give it

1876
01:28:58,880 --> 01:29:00,867
to the Surgeon General's if anybody,

1877
01:29:00,867 --> 01:29:03,133
if one of you have a comment on this.

1878
01:29:04,150 --> 01:29:06,130
- Sir I'll be real quick Mr. Ryan.

1879
01:29:06,130 --> 01:29:09,790
Within the Army we have
a very pragmatic approach

1880
01:29:09,790 --> 01:29:11,300
to the health of the Force

1881
01:29:11,300 --> 01:29:15,240
and we have many programs from
Go Green, Healthy Choices,

1882
01:29:15,240 --> 01:29:18,510
Spartan-IV that get after
the eating as well as

1883
01:29:18,510 --> 01:29:22,560
the activity, as well as the
entire life process or approach

1884
01:29:22,560 --> 01:29:25,880
to living and then our
Holistic Health and Fitness.

1885
01:29:25,880 --> 01:29:27,350
Going after the spiritual, physical

1886
01:29:27,350 --> 01:29:29,955
and mental well-being of our soldiers.

1887
01:29:29,955 --> 01:29:34,200
The ACFT, APFT, the Wellness
Center's all designed to one,

1888
01:29:34,200 --> 01:29:36,150
educate our soldiers,
where we got programs

1889
01:29:36,150 --> 01:29:38,920
that are also inculcating
this into the unit's,

1890
01:29:38,920 --> 01:29:42,010
not just special forces
but treating every soldier

1891
01:29:42,010 --> 01:29:42,893
as an athlete.

1892
01:29:44,260 --> 01:29:45,810
- I'd certainly agree.

1893
01:29:45,810 --> 01:29:48,990
Very similarly in the Navy
we have a similar program.

1894
01:29:48,990 --> 01:29:51,200
Certainly we understand
the importance of wellness.

1895
01:29:51,200 --> 01:29:52,870
I think sir, one of the points you make

1896
01:29:52,870 --> 01:29:55,900
are the social determinants
of health that we really have

1897
01:29:55,900 --> 01:29:59,270
to get after and in the
environments in which our sailors,

1898
01:29:59,270 --> 01:30:03,833
Marines and soldiers live
and so we are working

1899
01:30:03,833 --> 01:30:06,930
with commissaries for
example, with our dieticians

1900
01:30:06,930 --> 01:30:08,850
to provide guidance so that it's available

1901
01:30:08,850 --> 01:30:13,040
in the commissary as individuals
purchase their groceries.

1902
01:30:13,040 --> 01:30:15,547
So sir, we agree with you 100%

1903
01:30:15,547 --> 01:30:17,698
and we are working very hard to get--

1904
01:30:17,698 --> 01:30:19,200
- We got a lot of work
to do and this committee

1905
01:30:19,200 --> 01:30:21,850
is gonna push every single one
of you to make this happen.

1906
01:30:21,850 --> 01:30:22,907
- Thank You Mr. Ryan.

1907
01:30:22,907 --> 01:30:24,450
I think everybody's gotten the message

1908
01:30:24,450 --> 01:30:27,780
and I know there's more to
say, but we actually are out

1909
01:30:27,780 --> 01:30:30,470
of time for a vote and
I do want to follow up

1910
01:30:30,470 --> 01:30:34,460
with one question not to
be responded here today,

1911
01:30:34,460 --> 01:30:37,850
but reported back to the staff.

1912
01:30:37,850 --> 01:30:41,013
It goes back to the Military
Health Personnel Restructuring,

1913
01:30:41,993 --> 01:30:43,400
on the DOD in your announcement

1914
01:30:43,400 --> 01:30:45,990
of the Plan of Healthcare Restructuring,

1915
01:30:45,990 --> 01:30:50,990
roughly 18,000 uniformed
health positions will be gone

1916
01:30:52,080 --> 01:30:54,440
with no plan to replace
them, yet you're talking

1917
01:30:54,440 --> 01:30:56,670
about putting people into the marketplace.

1918
01:30:56,670 --> 01:30:59,470
We know that there is a shortage

1919
01:30:59,470 --> 01:31:04,470
in our healthcare system
throughout this country.

1920
01:31:05,460 --> 01:31:07,990
We're also concerned about your ability

1921
01:31:07,990 --> 01:31:09,850
when these facilities close, to be able

1922
01:31:09,850 --> 01:31:11,300
to retain some of the docs

1923
01:31:11,300 --> 01:31:15,230
and high specialized
individuals that are serving us.

1924
01:31:15,230 --> 01:31:18,770
You also function as teaching hospitals.

1925
01:31:18,770 --> 01:31:22,250
And teaching hospitals are
closing and limiting the number

1926
01:31:22,250 --> 01:31:25,440
of training opportunities
all across this country.

1927
01:31:25,440 --> 01:31:29,950
We can't afford to lose
you as part of our backbone

1928
01:31:29,950 --> 01:31:32,300
for not only our military health,

1929
01:31:32,300 --> 01:31:36,230
but for our all over US healthcare system,

1930
01:31:36,230 --> 01:31:40,730
especially when it comes to
OB/GYNs and pediatricians.

1931
01:31:40,730 --> 01:31:44,270
And with more women
serving, OB/GYNs I have

1932
01:31:44,270 --> 01:31:47,070
to say I have some familiarity with them,

1933
01:31:47,070 --> 01:31:50,930
having had an Army doctor
deliver both of my children

1934
01:31:50,930 --> 01:31:54,860
and you know we can't afford
to be losing those kinds

1935
01:31:54,860 --> 01:31:58,830
of specialties and keep and
recruit and retrain women,

1936
01:31:58,830 --> 01:32:02,260
as well as women who are family members.

1937
01:32:02,260 --> 01:32:05,490
so we've got some serious
questions on that.

1938
01:32:05,490 --> 01:32:08,830
We wanna be helpful with you
as you make that decision,

1939
01:32:08,830 --> 01:32:11,800
but I think we need to look
at a whole of healthcare.

1940
01:32:11,800 --> 01:32:14,940
So I wanna thank you so much for coming

1941
01:32:14,940 --> 01:32:18,000
and now this also goes
to Mr. Carter's question

1942
01:32:18,000 --> 01:32:20,150
about, you know, some of the

1943
01:32:20,150 --> 01:32:24,650
outside treatment happening as well.

1944
01:32:24,650 --> 01:32:27,530
Thank you so much for being here.

1945
01:32:27,530 --> 01:32:30,010
Thank you for your service
and thank you for getting back

1946
01:32:30,010 --> 01:32:33,080
to us promptly, 'cause we're
starting to mark-up the bills.

1947
01:32:33,080 --> 01:32:35,150
With that, this meeting is adjourned,

1948
01:32:35,150 --> 01:32:36,400
this hearing's adjourned.

1949
01:32:38,160 --> 01:32:38,993
Okay.

1950
01:32:38,993 --> 01:32:41,327
(faint chatter)