1 00:00:00,600 --> 00:00:03,190 I want to call us uh hearing to order . 2 00:00:03,200 --> 00:00:07,180 Um Good morning all . Welcome Dr 3 00:00:07,180 --> 00:00:09,236 Martinez Lopez , General Crossland , 4 00:00:09,236 --> 00:00:11,600 General Dingle General Miller , Admiral 5 00:00:11,600 --> 00:00:15,070 Bellingham . Thank you all for joining 6 00:00:15,070 --> 00:00:18,250 us today . Um I want to especially 7 00:00:18,250 --> 00:00:21,210 welcome Dr Martinez Lopez and General 8 00:00:21,210 --> 00:00:24,510 Crosslin . Uh This is the first time uh 9 00:00:24,520 --> 00:00:26,880 briefing this committee and we look 10 00:00:26,880 --> 00:00:29,270 forward to hearing your brief . I also 11 00:00:29,270 --> 00:00:31,326 want to recognize Admiral Gillingham 12 00:00:31,326 --> 00:00:34,210 who is retiring later this month . 13 00:00:34,950 --> 00:00:37,610 Uh I think thank you for your service 14 00:00:37,610 --> 00:00:40,220 isn't quite adequate . We appreciate 15 00:00:40,220 --> 00:00:42,553 everything you've done over your career . 16 00:00:43,010 --> 00:00:46,320 Two to keep this country , the greatest 17 00:00:46,320 --> 00:00:48,630 country on earth . And uh and so we , 18 00:00:48,630 --> 00:00:51,220 we appreciate you . We wish you much 19 00:00:51,230 --> 00:00:53,300 luck in your next phase of your life 20 00:00:53,300 --> 00:00:56,660 and just know that Maine or Montana are 21 00:00:56,660 --> 00:01:00,030 great places to retire to . So , uh 22 00:01:00,040 --> 00:01:02,270 thank you . Look , the defense Health 23 00:01:02,270 --> 00:01:05,340 program accounts for roughly $39 24 00:01:05,340 --> 00:01:08,400 billion or 5% of the D O D budget . The 25 00:01:08,400 --> 00:01:10,340 Defense Defense Health Agency is 26 00:01:10,340 --> 00:01:12,284 charged with providing health care 27 00:01:12,284 --> 00:01:14,618 services to 9.6 million service members , 28 00:01:14,618 --> 00:01:16,618 their families and retirees through 29 00:01:16,618 --> 00:01:19,330 Tricare . Its mission also includes 30 00:01:19,330 --> 00:01:21,330 managing the D O D medical research 31 00:01:21,330 --> 00:01:23,497 program and I want to acknowledge that 32 00:01:23,497 --> 00:01:26,710 the Defense Health Agency has not been 33 00:01:26,710 --> 00:01:30,160 immune from challenging trends in the 34 00:01:30,170 --> 00:01:32,337 in the national health care industry . 35 00:01:32,337 --> 00:01:34,392 These include escalating costs and a 36 00:01:34,392 --> 00:01:36,670 shortfall of providers . I hear this 37 00:01:36,670 --> 00:01:38,614 firsthand from service members and 38 00:01:38,614 --> 00:01:40,614 veterans in Montana to tell me that 39 00:01:40,614 --> 00:01:42,559 Tricare is not working for them in 40 00:01:42,559 --> 00:01:44,781 rural America . So today , I wanna have 41 00:01:44,781 --> 00:01:46,448 a candid discussion about the 42 00:01:46,448 --> 00:01:48,503 department's delivery of health care 43 00:01:48,503 --> 00:01:50,559 and medical readiness of our force . 44 00:01:50,559 --> 00:01:52,670 The defense budget has enjoyed robust 45 00:01:52,670 --> 00:01:54,726 top line increases in recent years . 46 00:01:54,726 --> 00:01:56,614 However , for this year , we have 47 00:01:56,614 --> 00:01:58,726 members proposing reduced in outdated 48 00:01:58,726 --> 00:02:00,830 funding levels . Congress has 49 00:02:00,830 --> 00:02:02,830 repeatedly failed the department in 50 00:02:02,830 --> 00:02:04,552 recent years by putting you on 51 00:02:04,552 --> 00:02:06,608 automatic continuing resolutions and 52 00:02:06,608 --> 00:02:08,774 getting you a budget that is late . It 53 00:02:08,774 --> 00:02:10,941 is my hope that in this new Congress , 54 00:02:10,941 --> 00:02:13,108 we can break through the vicious cycle 55 00:02:13,108 --> 00:02:15,108 of CRS and I wholeheartedly support 56 00:02:15,108 --> 00:02:17,330 efforts to get back on track and I know 57 00:02:17,330 --> 00:02:19,570 Senator Collins does too . So the 58 00:02:19,570 --> 00:02:21,626 committee needs to know exactly what 59 00:02:21,626 --> 00:02:23,870 reduced funding levels . And a cr would 60 00:02:23,870 --> 00:02:26,060 mean for the defense health program 61 00:02:26,070 --> 00:02:28,181 including for our service members and 62 00:02:28,181 --> 00:02:30,348 their families , medical readiness and 63 00:02:30,348 --> 00:02:32,459 medical research . Uh We have much to 64 00:02:32,459 --> 00:02:34,681 discuss the defense health agency is in 65 00:02:34,681 --> 00:02:36,959 the midst of a significant restructure . 66 00:02:36,959 --> 00:02:39,014 We continue to hear about challenges 67 00:02:39,014 --> 00:02:40,903 with Tricare and I believe mental 68 00:02:40,903 --> 00:02:42,792 health is our biggest health care 69 00:02:42,792 --> 00:02:44,848 problem . Uh There isn't a family in 70 00:02:44,848 --> 00:02:47,080 America that doesn't have a mental 71 00:02:47,080 --> 00:02:49,420 health care problem . Uh somewhere in 72 00:02:49,420 --> 00:02:51,670 their midst . Uh So I want to thank you 73 00:02:51,670 --> 00:02:53,559 for joining the subcommittee this 74 00:02:53,559 --> 00:02:55,337 morning . I look forward to our 75 00:02:55,337 --> 00:02:59,070 discussion um before you . Uh oh , go 76 00:02:59,070 --> 00:03:02,920 ahead , Senator Collins . Thank you , 77 00:03:02,920 --> 00:03:06,060 Mr Chairman . I appreciate your holding 78 00:03:06,060 --> 00:03:08,860 this hearing on the Pentagon's defense 79 00:03:08,860 --> 00:03:12,550 health program to each of our witnesses . 80 00:03:12,560 --> 00:03:15,100 Thank you for being here and for your 81 00:03:15,100 --> 00:03:18,460 service to our country . I would echo 82 00:03:18,460 --> 00:03:22,080 the chairman's special . Thank you to 83 00:03:22,090 --> 00:03:26,040 admiral uh for all of your years of 84 00:03:26,040 --> 00:03:29,350 service , providing for the health care 85 00:03:29,350 --> 00:03:32,120 of our troops and their families is a 86 00:03:32,120 --> 00:03:35,070 no fail mission . Unlike other 87 00:03:35,070 --> 00:03:37,320 healthcare providers , the military 88 00:03:37,320 --> 00:03:40,980 health care system must support and 89 00:03:40,980 --> 00:03:43,480 save the lives of our war fighters in 90 00:03:43,480 --> 00:03:46,390 battlefield environments . I look 91 00:03:46,390 --> 00:03:48,001 forward to hearing about the 92 00:03:48,001 --> 00:03:50,520 department's investments , both the 93 00:03:50,520 --> 00:03:53,990 ongoing and planned to train and 94 00:03:53,990 --> 00:03:56,560 posture medical units to be able to 95 00:03:56,560 --> 00:04:00,300 respond in contested environments far 96 00:04:00,300 --> 00:04:03,850 away from the safety of large hospitals 97 00:04:03,860 --> 00:04:07,370 or military bases . In addition , 98 00:04:07,910 --> 00:04:10,740 as the chairman has indicated , the 99 00:04:10,740 --> 00:04:13,210 military health system continues to 100 00:04:13,210 --> 00:04:17,090 undergo substantial changes intended to 101 00:04:17,090 --> 00:04:19,980 improve health care . All military 102 00:04:19,980 --> 00:04:22,091 hospitals and clinics are now managed 103 00:04:22,091 --> 00:04:24,820 by the defense health agency rather 104 00:04:24,820 --> 00:04:28,470 than the individual military service D 105 00:04:28,470 --> 00:04:31,180 O D s . New electronic health record 106 00:04:31,180 --> 00:04:34,260 system appears to be on track to be 107 00:04:34,260 --> 00:04:36,710 fully implemented this year . Yet 108 00:04:36,720 --> 00:04:39,750 problems remain with interoperability 109 00:04:39,760 --> 00:04:42,820 with the Veterans Affairs Veterans 110 00:04:42,820 --> 00:04:45,920 administration and the long awaited 111 00:04:45,920 --> 00:04:48,640 awards for the next national tricare 112 00:04:48,650 --> 00:04:51,190 managed care contracts were recently 113 00:04:51,190 --> 00:04:54,020 announced as well . Will these 114 00:04:54,020 --> 00:04:57,660 transformations improve the quality and 115 00:04:57,660 --> 00:05:00,180 level of health care for our troops and 116 00:05:00,180 --> 00:05:02,450 their families . That is the bottom 117 00:05:02,450 --> 00:05:05,840 line that depends on D H A , having 118 00:05:05,840 --> 00:05:09,030 enough staff , hospitals , clinics , 119 00:05:09,040 --> 00:05:12,250 and private sector Providers to 120 00:05:12,250 --> 00:05:15,480 provide ready access for the physical 121 00:05:15,490 --> 00:05:18,700 and mental health care needs . Of the 122 00:05:18,700 --> 00:05:21,980 9.6 million service members , their 123 00:05:21,980 --> 00:05:25,920 family members and retirees who rely 124 00:05:25,920 --> 00:05:28,860 upon the military health system . On 125 00:05:28,860 --> 00:05:32,210 this committee , we are also interested 126 00:05:32,220 --> 00:05:35,740 if the cost efficiencies promised by 127 00:05:35,740 --> 00:05:38,670 some of these changes have in fact been 128 00:05:38,670 --> 00:05:41,490 realized . The defense health program 129 00:05:41,490 --> 00:05:44,890 also conducts innovative research that 130 00:05:44,890 --> 00:05:46,920 benefits our war fighters and the 131 00:05:46,920 --> 00:05:50,150 American public , for example , from 132 00:05:50,150 --> 00:05:53,100 2007 to 2018 133 00:05:53,290 --> 00:05:57,180 11 FDA approved drugs that benefited 134 00:05:57,180 --> 00:06:00,010 from congressional directed medical 135 00:06:00,010 --> 00:06:02,590 research funded 136 00:06:02,600 --> 00:06:06,190 programs were prescribed to 137 00:06:06,190 --> 00:06:09,770 more than more than 139,000 138 00:06:09,770 --> 00:06:12,630 times for cancer treatment . And that 139 00:06:12,630 --> 00:06:15,430 only includes those prescriptions 140 00:06:15,430 --> 00:06:18,480 within the military health system . D O 141 00:06:18,480 --> 00:06:21,320 D must continue to transform our health 142 00:06:21,320 --> 00:06:24,500 care system through this impactful 143 00:06:24,500 --> 00:06:27,210 research . It is 144 00:06:27,220 --> 00:06:31,100 unfortunate that here we are in 145 00:06:31,100 --> 00:06:34,120 March and the president has yet to 146 00:06:34,120 --> 00:06:37,660 deliver his budget request for fiscal 147 00:06:37,660 --> 00:06:41,190 year 2020 for it is a little more than 148 00:06:41,190 --> 00:06:44,560 a month overdue . Nevertheless , I look 149 00:06:44,560 --> 00:06:46,560 forward to hearing from our witness 150 00:06:46,560 --> 00:06:49,260 about how the department is using the 151 00:06:49,260 --> 00:06:51,580 resources provided by this committee 152 00:06:51,580 --> 00:06:54,540 for fiscal year 2023 . And what 153 00:06:54,540 --> 00:06:57,440 resources will be needed to care for 154 00:06:57,440 --> 00:06:59,830 our service members , dependents and 155 00:06:59,830 --> 00:07:02,310 retirees . In the future . Again , my 156 00:07:02,310 --> 00:07:04,310 thank you to the witnesses into the 157 00:07:04,310 --> 00:07:06,310 chairman for holding this hearing . 158 00:07:06,340 --> 00:07:09,160 Thank you , Senator Collins . Uh First 159 00:07:09,160 --> 00:07:11,382 briefer will be the Assistant Secretary 160 00:07:11,382 --> 00:07:13,327 of Defense for Health Affairs , Dr 161 00:07:13,327 --> 00:07:15,327 Martinez Lopez . You have the floor 162 00:07:16,910 --> 00:07:19,021 chairman , desperate ranking member , 163 00:07:19,021 --> 00:07:20,021 problem 164 00:07:22,760 --> 00:07:24,593 chairman Tester , ranking member 165 00:07:24,593 --> 00:07:26,760 Collins , distinguished members of the 166 00:07:26,760 --> 00:07:28,871 subcommittee . I'm pleased to present 167 00:07:28,871 --> 00:07:30,927 represent the Office of Secretary of 168 00:07:30,927 --> 00:07:33,038 Defense to discuss the defense health 169 00:07:33,038 --> 00:07:35,093 program and its contributions to the 170 00:07:35,093 --> 00:07:37,093 health and medical readiness of the 171 00:07:37,093 --> 00:07:39,700 department . I am speaking today in 172 00:07:39,700 --> 00:07:41,770 advance of the formal release of the 173 00:07:41,770 --> 00:07:44,800 President proposed fiscal year 2024 174 00:07:44,800 --> 00:07:48,080 budget outline the major activities 175 00:07:48,080 --> 00:07:50,360 unfolding in the military health system 176 00:07:50,370 --> 00:07:52,790 that will inform our soon to be 177 00:07:52,790 --> 00:07:55,650 released budget proposal . The National 178 00:07:55,650 --> 00:07:58,710 Defense Authorization Act N D A for 179 00:07:58,720 --> 00:08:01,920 fy 2017 180 00:08:01,930 --> 00:08:04,120 enacted sweeping reforms to the 181 00:08:04,120 --> 00:08:06,780 organization and management of military 182 00:08:06,780 --> 00:08:09,740 medicine . The expanded responsibility 183 00:08:09,740 --> 00:08:12,370 of the Defense Health Agency are now 184 00:08:12,380 --> 00:08:14,930 largely complete , largely completed 185 00:08:14,940 --> 00:08:17,960 the D H A exercises authority 186 00:08:17,970 --> 00:08:21,370 direction and control over all the MTs 187 00:08:21,380 --> 00:08:23,990 worldwide . Lieutenant General 188 00:08:23,990 --> 00:08:26,212 Crossland , the director of the Defense 189 00:08:26,212 --> 00:08:28,430 Health Agency will provide further 190 00:08:28,430 --> 00:08:31,580 details on specific initiatives that 191 00:08:31,580 --> 00:08:35,270 the D H A is undertaking . The same law 192 00:08:35,280 --> 00:08:38,710 directed the O D to restructure the or 193 00:08:38,710 --> 00:08:41,900 realign NTS to support the department's 194 00:08:41,910 --> 00:08:45,200 readiness requirement . However , in 195 00:08:45,210 --> 00:08:48,630 fy 23 nd a place a one year 196 00:08:48,630 --> 00:08:50,530 moratorium on any changes to the 197 00:08:50,530 --> 00:08:53,750 configurations of R N T S as 198 00:08:53,750 --> 00:08:56,760 requested . Uh We are preparing an 199 00:08:56,760 --> 00:08:59,540 update to Congress on our way ahead in 200 00:08:59,540 --> 00:09:02,910 the coming month . The N D A also 201 00:09:02,910 --> 00:09:05,260 included a five year monetary um on 202 00:09:05,260 --> 00:09:07,300 further military medical personnel 203 00:09:07,300 --> 00:09:09,860 reductions together with the joint 204 00:09:09,860 --> 00:09:12,600 staff , we are updating our medical 205 00:09:12,600 --> 00:09:15,430 requirements as cocom operation plan , 206 00:09:15,440 --> 00:09:19,400 operational plans are also updated . We 207 00:09:19,400 --> 00:09:22,160 are conducting a comprehensive internal 208 00:09:22,160 --> 00:09:24,820 review with our O S T colleagues and 209 00:09:24,820 --> 00:09:27,210 the military departments on the best 210 00:09:27,210 --> 00:09:29,550 configuration of medical infrastructure 211 00:09:29,560 --> 00:09:33,230 and personnel for the long term , we 212 00:09:33,230 --> 00:09:35,119 are resolute in our commitment to 213 00:09:35,119 --> 00:09:37,280 ensure combatant commanders have the 214 00:09:37,280 --> 00:09:40,170 medical resources necessary to protect 215 00:09:40,180 --> 00:09:42,340 treat and provide long term care , 216 00:09:42,340 --> 00:09:45,060 medicine , medical services to our men 217 00:09:45,060 --> 00:09:48,120 and women in uniform . We are also 218 00:09:48,130 --> 00:09:50,530 committing resources and attention to 219 00:09:50,530 --> 00:09:53,890 the ongoing challenge of suicide both 220 00:09:53,890 --> 00:09:56,150 among uniformed service members and 221 00:09:56,150 --> 00:09:59,540 family members . We recently received 222 00:09:59,550 --> 00:10:01,550 the recommendation from the suicide 223 00:10:01,550 --> 00:10:03,850 Prevention and Response Independent 224 00:10:03,850 --> 00:10:07,210 Review Committee and are continuing to 225 00:10:07,210 --> 00:10:09,650 implement strategies that can help 226 00:10:09,660 --> 00:10:12,500 reverse the heartbreaking trends that 227 00:10:12,500 --> 00:10:15,340 we have witnessed both in D O D and in 228 00:10:15,340 --> 00:10:18,090 the nation . The department remains 229 00:10:18,090 --> 00:10:21,300 grateful for the long term support from 230 00:10:21,300 --> 00:10:24,490 this committee for our military medical 231 00:10:24,490 --> 00:10:27,280 research in those areas of most 232 00:10:27,280 --> 00:10:29,360 pressing needs and relevance for 233 00:10:29,360 --> 00:10:32,390 today's emerging threats that includes 234 00:10:32,400 --> 00:10:35,680 infectious diseases , combat casualties 235 00:10:35,690 --> 00:10:38,410 and other areas of importance to our 236 00:10:38,410 --> 00:10:41,190 war fighters and to Congress for the 237 00:10:41,190 --> 00:10:43,570 current fiscal year , our mid year 238 00:10:43,570 --> 00:10:46,340 review is underway As in past years , 239 00:10:46,350 --> 00:10:49,060 the image has continued , is sustained 240 00:10:49,070 --> 00:10:52,370 decade law track record in responsibly 241 00:10:52,370 --> 00:10:55,600 managing healthcare cost which remain 242 00:10:55,600 --> 00:10:58,660 below the national health expenditure 243 00:10:58,670 --> 00:11:02,440 per capita rate . Our FY 2024 244 00:11:02,440 --> 00:11:04,930 budget will present a balance 245 00:11:04,940 --> 00:11:07,750 comprehensive strategy that aligns the 246 00:11:07,750 --> 00:11:10,880 secretary priorities . We look forward 247 00:11:10,880 --> 00:11:12,991 to working with you over these coming 248 00:11:12,991 --> 00:11:15,102 months to further refine , articulate 249 00:11:15,102 --> 00:11:17,130 our requirements . Thank you for 250 00:11:17,130 --> 00:11:19,800 inviting me here today to speak with 251 00:11:19,800 --> 00:11:22,450 you about the growth of military 252 00:11:22,450 --> 00:11:24,710 medicine in supporting our national 253 00:11:24,710 --> 00:11:26,610 security and look forward to your 254 00:11:26,610 --> 00:11:29,140 questions . Thank you doctor . Next 255 00:11:29,140 --> 00:11:31,550 step , we have director of the Defense 256 00:11:31,550 --> 00:11:33,960 Health Agency General Crossland , 257 00:11:34,420 --> 00:11:36,253 Chairman Tester , ranking member 258 00:11:36,253 --> 00:11:38,420 Collins , distinguished members of the 259 00:11:38,420 --> 00:11:40,531 subcommittee . Thank you for inviting 260 00:11:40,531 --> 00:11:42,587 me to join Dr Martinez Lopez and the 261 00:11:42,587 --> 00:11:45,060 services surgeon generals to discuss 262 00:11:45,060 --> 00:11:47,530 the defense health program . I will add 263 00:11:47,530 --> 00:11:49,840 to Dr Martinez Lopez remarks by briefly 264 00:11:49,840 --> 00:11:51,780 focusing on some of the critical 265 00:11:51,780 --> 00:11:53,724 capabilities of the Defense Health 266 00:11:53,724 --> 00:11:55,613 Agency in supporting the military 267 00:11:55,613 --> 00:11:57,836 departments in the combatant commands . 268 00:11:57,836 --> 00:11:59,780 As Dr Martinez Lopez also noted my 269 00:11:59,780 --> 00:12:02,090 comments assess the current state and 270 00:12:02,090 --> 00:12:04,970 do not speak to the FY 2024 budget 271 00:12:04,970 --> 00:12:08,930 which is yet not yet released in 2022 . 272 00:12:08,930 --> 00:12:12,150 And into 2023 the Defense Health Agency 273 00:12:12,160 --> 00:12:14,520 has been able to focus its resources to 274 00:12:14,520 --> 00:12:16,687 supporting operational requirements of 275 00:12:16,687 --> 00:12:18,631 the department while continuing to 276 00:12:18,631 --> 00:12:21,600 manage COVID 19 pandemic . There were a 277 00:12:21,600 --> 00:12:23,822 number important milestones achieved by 278 00:12:23,822 --> 00:12:25,933 the Defense Health Agency in the past 279 00:12:25,933 --> 00:12:27,989 year that will continue to influence 280 00:12:27,989 --> 00:12:31,240 operations in 2023 into 2020 . For , 281 00:12:31,250 --> 00:12:33,417 for my opening comments , I will focus 282 00:12:33,417 --> 00:12:36,650 on just two first , more than 50% of 283 00:12:36,650 --> 00:12:38,372 our military medical treatment 284 00:12:38,372 --> 00:12:40,880 facilities have migrated to our new 285 00:12:40,890 --> 00:12:43,090 electronic health record known as MHS 286 00:12:43,090 --> 00:12:45,530 Genesis . In a few weeks , we will 287 00:12:45,530 --> 00:12:47,697 deploy the system here in the national 288 00:12:47,697 --> 00:12:49,697 capital region and that will take , 289 00:12:49,697 --> 00:12:52,100 take us to approximately 75% . We 290 00:12:52,100 --> 00:12:54,100 remain on track to have this system 291 00:12:54,100 --> 00:12:57,460 fully operational worldwide . By 2024 292 00:12:57,830 --> 00:13:00,050 this modern electronic health record 293 00:13:00,050 --> 00:13:02,272 platform will provide the department of 294 00:13:02,272 --> 00:13:04,217 powerful tool to support our ready 295 00:13:04,217 --> 00:13:05,930 readiness mission , improve 296 00:13:05,940 --> 00:13:08,530 interoperability and record sharing 297 00:13:08,540 --> 00:13:10,484 with care delivered in the private 298 00:13:10,484 --> 00:13:12,650 sector and allow our patients engage 299 00:13:12,650 --> 00:13:14,817 more directly with their providers and 300 00:13:14,817 --> 00:13:17,360 managing their care . The COVID-19 301 00:13:17,360 --> 00:13:19,471 pandemic accelerate , accelerated the 302 00:13:19,471 --> 00:13:22,260 department's use of virtual health for 303 00:13:22,260 --> 00:13:24,427 the coming year . I will build on what 304 00:13:24,427 --> 00:13:26,649 we've learned and how our providers and 305 00:13:26,649 --> 00:13:28,316 patients effectively use this 306 00:13:28,316 --> 00:13:30,204 technology throughout this public 307 00:13:30,204 --> 00:13:32,316 health emergency . I'm creating a new 308 00:13:32,316 --> 00:13:34,204 digital health strategy that will 309 00:13:34,204 --> 00:13:36,260 expand our use of technology in ways 310 00:13:36,260 --> 00:13:38,038 that improve our training , our 311 00:13:38,038 --> 00:13:40,093 preparedness , access and quality of 312 00:13:40,093 --> 00:13:42,110 care . I intend to work with the 313 00:13:42,110 --> 00:13:44,221 military medical leaders and industry 314 00:13:44,221 --> 00:13:46,054 partners to focus on what we can 315 00:13:46,054 --> 00:13:48,221 achieve now and build on our successes 316 00:13:48,221 --> 00:13:51,540 over time . In late 2022 . After a 317 00:13:51,540 --> 00:13:53,762 multi year process , the Defense Health 318 00:13:53,762 --> 00:13:55,873 agency awarded the next generation of 319 00:13:55,873 --> 00:13:58,290 tricare contracts at a value of over 320 00:13:58,330 --> 00:14:01,110 100 and $35 billion over the next eight 321 00:14:01,110 --> 00:14:03,960 years , these contracts will deliver 322 00:14:03,970 --> 00:14:07,000 high value patient centric care that 323 00:14:07,010 --> 00:14:09,177 integrates the military in the private 324 00:14:09,177 --> 00:14:11,850 sector . Care in January protests were 325 00:14:11,850 --> 00:14:14,250 filed that will slightly delay this 326 00:14:14,250 --> 00:14:16,590 transition . We're closely working with 327 00:14:16,590 --> 00:14:18,810 G A O and will ensure that the process 328 00:14:18,810 --> 00:14:20,810 is carried out in a fair and timely 329 00:14:20,810 --> 00:14:23,460 manner . Dr Martinez Lopez noted our 330 00:14:23,460 --> 00:14:25,460 current budgetary status and future 331 00:14:25,460 --> 00:14:27,660 plans . We appreciate that . Congress 332 00:14:27,660 --> 00:14:29,882 continues to grant the department carry 333 00:14:29,882 --> 00:14:31,800 over authority allowing D O D to 334 00:14:31,800 --> 00:14:33,780 maintain a better flow of funds to 335 00:14:33,780 --> 00:14:35,891 minimize disruption , the health care 336 00:14:35,891 --> 00:14:37,947 services and our beneficiaries . I'm 337 00:14:37,947 --> 00:14:39,724 grateful for the opportunity to 338 00:14:39,724 --> 00:14:41,669 represent the men and women of the 339 00:14:41,669 --> 00:14:43,891 defense Health agency . And I thank you 340 00:14:43,891 --> 00:14:45,891 for inviting me here today . I look 341 00:14:45,891 --> 00:14:48,113 forward to your questions . Thank you , 342 00:14:48,113 --> 00:14:50,113 General . Next up , we have surgeon 343 00:14:50,113 --> 00:14:52,113 general of the army general , Scott 344 00:14:52,113 --> 00:14:54,330 Dingle , Chairman Tester , vice 345 00:14:54,330 --> 00:14:57,260 Chairman Collins and distinguished 346 00:14:57,260 --> 00:14:59,482 members of the subcommittee . Thank you 347 00:14:59,482 --> 00:15:01,649 for the opportunity to speak to you on 348 00:15:01,649 --> 00:15:04,400 behalf of the 111,000 that comprised 349 00:15:04,400 --> 00:15:07,130 the total Army Medicine Force . I am 350 00:15:07,130 --> 00:15:09,186 privileged to serve as the 45th army 351 00:15:09,186 --> 00:15:11,352 surgeon general and commanding general 352 00:15:11,352 --> 00:15:13,241 of the United States Army Medical 353 00:15:13,241 --> 00:15:15,186 Command . The U S army is the most 354 00:15:15,186 --> 00:15:17,390 lethal and capable ground combat force 355 00:15:17,400 --> 00:15:19,780 in history . As the army continues to 356 00:15:19,780 --> 00:15:22,280 modernize from multi domain operations . 357 00:15:22,290 --> 00:15:24,512 It is imperative that our medical force 358 00:15:24,512 --> 00:15:27,500 remains ready , responsive and relevant 359 00:15:27,510 --> 00:15:29,970 to conserve the fighting strength . The 360 00:15:29,970 --> 00:15:31,914 chief of staff of the Army General 361 00:15:31,914 --> 00:15:34,081 mcconville says that winning matters . 362 00:15:34,081 --> 00:15:37,240 I agree there is no second place in war 363 00:15:37,250 --> 00:15:39,890 from foxhole to the fixed facility . 364 00:15:39,900 --> 00:15:41,810 Army medicine has achieved a high 365 00:15:41,810 --> 00:15:44,070 survivability rate for soldiers wounded 366 00:15:44,080 --> 00:15:46,470 on and off the battlefield . In recent 367 00:15:46,470 --> 00:15:48,610 decades , we did this by remaining 368 00:15:48,610 --> 00:15:51,160 agile and adapt . We applied the 369 00:15:51,160 --> 00:15:53,382 lessons from operations and developed a 370 00:15:53,382 --> 00:15:55,570 holistic system for future operations 371 00:15:55,570 --> 00:15:58,000 in austere locations . My vision for 372 00:15:58,000 --> 00:16:00,111 going forward remains consistent with 373 00:16:00,111 --> 00:16:02,333 the army medical modernization strategy 374 00:16:02,333 --> 00:16:04,500 and nested with the army modernization 375 00:16:04,500 --> 00:16:06,667 strategy , ensuring our medical forces 376 00:16:06,667 --> 00:16:08,611 trained and ready as an enabler of 377 00:16:08,611 --> 00:16:11,260 combat power , we will synchronize and 378 00:16:11,270 --> 00:16:13,492 integrate the medical effort within the 379 00:16:13,492 --> 00:16:15,437 army . The defense Health agency , 380 00:16:15,437 --> 00:16:17,640 joint staff and combatant commands to 381 00:16:17,640 --> 00:16:19,680 be responsive and steadfast to 382 00:16:19,680 --> 00:16:21,980 teammates of the joint force . This 383 00:16:21,980 --> 00:16:23,869 will ensure that army medicine is 384 00:16:23,869 --> 00:16:26,036 responsive and relevant to execute the 385 00:16:26,036 --> 00:16:28,036 national defense strategy . We will 386 00:16:28,036 --> 00:16:29,869 also build readiness through our 387 00:16:29,869 --> 00:16:32,036 investments and people . Army medicine 388 00:16:32,036 --> 00:16:34,202 must be innovative and agile to remain 389 00:16:34,202 --> 00:16:36,036 competitive with the health care 390 00:16:36,036 --> 00:16:37,758 industry on our recruiting and 391 00:16:37,758 --> 00:16:39,813 retention practices while partnering 392 00:16:39,813 --> 00:16:42,560 with the D H A to deliver high quality 393 00:16:42,570 --> 00:16:45,110 and safe care . Army medicine remains 394 00:16:45,110 --> 00:16:47,100 engaged at echelon to confront the 395 00:16:47,100 --> 00:16:49,370 challenges associated with military 396 00:16:49,370 --> 00:16:52,220 service and suicide . Each life loss 397 00:16:52,220 --> 00:16:54,630 devastates the force and Congress has 398 00:16:54,630 --> 00:16:57,900 spoken loudly as the medical integrator , 399 00:16:57,910 --> 00:17:00,210 we actively support the modernization 400 00:17:00,210 --> 00:17:02,590 of the medical effort . Timely funding 401 00:17:02,590 --> 00:17:04,812 this year will expand our expeditionary 402 00:17:04,812 --> 00:17:06,970 medical capabilities and ensure that 403 00:17:06,980 --> 00:17:09,790 interoperability within the joint force . 404 00:17:09,800 --> 00:17:12,070 Medical reform allow us to update our 405 00:17:12,070 --> 00:17:14,530 capability , design and structure to 406 00:17:14,540 --> 00:17:16,890 optimize resources for operating and 407 00:17:16,890 --> 00:17:19,940 generating forces . Finally , we are 408 00:17:19,940 --> 00:17:21,920 strengthening our alliances and 409 00:17:21,920 --> 00:17:24,020 partnerships in order to enhance 410 00:17:24,030 --> 00:17:26,252 interoperability with the international 411 00:17:26,252 --> 00:17:28,419 community . By providing institutional 412 00:17:28,419 --> 00:17:30,419 medical training , collaboration on 413 00:17:30,419 --> 00:17:32,252 medical research , development , 414 00:17:32,252 --> 00:17:34,670 innovation and and force structure 415 00:17:34,670 --> 00:17:37,230 design across the globe . We offer 416 00:17:37,230 --> 00:17:39,630 solutions to grow capability and 417 00:17:39,630 --> 00:17:42,550 capacity . In closing . I thank the 418 00:17:42,550 --> 00:17:44,550 subcommittee for your long standing 419 00:17:44,550 --> 00:17:46,772 support to the army . And army medicine 420 00:17:46,772 --> 00:17:48,883 are trained and ready . Medical force 421 00:17:48,883 --> 00:17:50,494 depends on timely adequate , 422 00:17:50,494 --> 00:17:52,494 predictable and sustained funding . 423 00:17:52,494 --> 00:17:54,606 Army medicine is army strong . I look 424 00:17:54,606 --> 00:17:56,828 forward to your questions . Thank you , 425 00:17:56,828 --> 00:17:58,828 General . Next up , we have Surgeon 426 00:17:58,828 --> 00:18:01,161 general of the Air Force General Miller , 427 00:18:01,161 --> 00:18:03,290 Chairman Tester , Vice chair Collins 428 00:18:03,300 --> 00:18:05,133 and distinguished members of the 429 00:18:05,133 --> 00:18:07,300 subcommittee . It is my honor to brief 430 00:18:07,300 --> 00:18:09,411 you today on behalf of 31,000 medical 431 00:18:09,411 --> 00:18:11,411 airmen , we respond to our nation's 432 00:18:11,411 --> 00:18:13,240 global needs during peacetime 433 00:18:13,250 --> 00:18:16,240 humanitarian crisis and hostilities are 434 00:18:16,240 --> 00:18:18,650 cornerstones are aerospace medicine and 435 00:18:18,660 --> 00:18:21,180 aeromedical evacuations capabilities 436 00:18:21,180 --> 00:18:23,370 that have saved thousands of lives and 437 00:18:23,370 --> 00:18:25,770 ensure our war fighters come home with 438 00:18:25,770 --> 00:18:27,881 the best medical outcomes . Thank you 439 00:18:27,881 --> 00:18:30,020 for your past and ongoing support to 440 00:18:30,020 --> 00:18:32,170 modernize key readiness capabilities 441 00:18:32,180 --> 00:18:34,940 and sustain our force . Last year , I 442 00:18:34,940 --> 00:18:37,250 charged my leaders to evaluate and re 443 00:18:37,250 --> 00:18:39,220 envision our readiness force and 444 00:18:39,220 --> 00:18:41,510 response structure . The objective is 445 00:18:41,510 --> 00:18:43,677 to provide combatant commanders with a 446 00:18:43,677 --> 00:18:45,899 well trained and equipped medical force 447 00:18:45,899 --> 00:18:47,770 capable of adapting the rapidly 448 00:18:47,770 --> 00:18:50,490 evolving joint force requirements . I 449 00:18:50,490 --> 00:18:53,120 expect a modular growth capability with 450 00:18:53,120 --> 00:18:54,731 a smaller footprint than our 451 00:18:54,731 --> 00:18:56,898 expeditionary medical support system . 452 00:18:57,140 --> 00:18:59,307 It will increase operational abilities 453 00:18:59,307 --> 00:19:01,529 and contested and degraded environments 454 00:19:01,529 --> 00:19:03,390 plus impact future capability 455 00:19:03,390 --> 00:19:06,020 requirements , training , sustainment 456 00:19:06,030 --> 00:19:09,020 recruitment needs and changes to the A 457 00:19:09,020 --> 00:19:11,880 F M s and strength mix . It will also 458 00:19:11,880 --> 00:19:13,713 improve our alignment to the air 459 00:19:13,713 --> 00:19:16,080 force's ace construct . The initial 460 00:19:16,080 --> 00:19:18,247 concept was tested in war gaming table 461 00:19:18,247 --> 00:19:21,070 top exercises in January . Now we're 462 00:19:21,070 --> 00:19:23,237 refining , refining and moving forward 463 00:19:23,237 --> 00:19:25,430 with the test at a joint exercise this 464 00:19:25,430 --> 00:19:28,460 summer , we must also focus on the 465 00:19:28,460 --> 00:19:30,890 daily readiness care of our airmen and 466 00:19:30,890 --> 00:19:33,057 guardians to address the challenges of 467 00:19:33,057 --> 00:19:35,170 their work environment , occupational 468 00:19:35,170 --> 00:19:36,948 and environmental exposure risk 469 00:19:36,948 --> 00:19:39,180 assessments are critical . A current 470 00:19:39,190 --> 00:19:41,460 early stage study on specific risk to 471 00:19:41,460 --> 00:19:43,793 the missile . Your community is ongoing . 472 00:19:43,793 --> 00:19:45,738 We will be transparent during this 473 00:19:45,738 --> 00:19:48,200 process as our responsibility is to 474 00:19:48,200 --> 00:19:50,340 protect the health and safety of our 475 00:19:50,350 --> 00:19:52,410 airmen and guardians . We take that 476 00:19:52,410 --> 00:19:54,670 seriously . We are moving forward with 477 00:19:54,670 --> 00:19:56,503 our operational support teams to 478 00:19:56,503 --> 00:19:58,448 optimize performance and readiness 479 00:19:58,448 --> 00:20:00,340 using evidence based strategies , 480 00:20:00,920 --> 00:20:03,230 access to mental health care improved 481 00:20:03,240 --> 00:20:05,240 through our targeted care program . 482 00:20:05,240 --> 00:20:07,351 Members are vector to the appropriate 483 00:20:07,351 --> 00:20:09,680 place for support based on individual 484 00:20:09,680 --> 00:20:11,902 needs , whether that is a mental health 485 00:20:11,902 --> 00:20:14,013 care provider or non clinical support 486 00:20:14,013 --> 00:20:16,700 like group therapy , family readiness 487 00:20:16,710 --> 00:20:19,400 also impacts member readiness . Those 488 00:20:19,400 --> 00:20:21,567 who are part of our exceptional family 489 00:20:21,567 --> 00:20:23,678 member program may now have access to 490 00:20:23,678 --> 00:20:25,789 expanded care and support through the 491 00:20:25,789 --> 00:20:27,733 Air Force Developmental Behavioral 492 00:20:27,733 --> 00:20:29,900 Family Readiness Centers . The program 493 00:20:29,900 --> 00:20:31,900 is rolling out as it uses a hub and 494 00:20:31,900 --> 00:20:34,011 spoke approach to support our members 495 00:20:34,011 --> 00:20:36,178 families Air Force medics are uniquely 496 00:20:36,178 --> 00:20:38,122 ready and capable to safeguard our 497 00:20:38,122 --> 00:20:40,180 interests both at home and abroad . 498 00:20:40,190 --> 00:20:42,450 Thank you again for your support to the 499 00:20:42,450 --> 00:20:45,290 F M R A F M s and our medics . I look 500 00:20:45,290 --> 00:20:47,410 forward to your questions . Thank you 501 00:20:47,410 --> 00:20:49,354 General . Next , we have a surgeon 502 00:20:49,354 --> 00:20:51,021 general of the Navy . Admiral 503 00:20:51,021 --> 00:20:53,021 Gillingham , Chairman Tester , Vice 504 00:20:53,021 --> 00:20:55,132 chair Collins , distinguished members 505 00:20:55,132 --> 00:20:57,188 of the committee . I'm pleased to be 506 00:20:57,188 --> 00:20:59,354 with you today to provide an update on 507 00:20:59,354 --> 00:21:01,188 Navy Medicine . On behalf of our 508 00:21:01,188 --> 00:21:03,470 mission ready . One navy medicine team , 509 00:21:03,480 --> 00:21:05,536 please know that we are grateful for 510 00:21:05,536 --> 00:21:07,647 the support you provide us as well as 511 00:21:07,647 --> 00:21:09,869 the trust and confidence that you place 512 00:21:09,869 --> 00:21:12,250 in us . Navy medicine is best described 513 00:21:12,250 --> 00:21:14,500 as well trained people working as 514 00:21:14,510 --> 00:21:16,770 expeditionary medical experts on 515 00:21:16,780 --> 00:21:19,340 optimized platforms , demonstrating 516 00:21:19,340 --> 00:21:21,990 high reliability performance as highly 517 00:21:21,990 --> 00:21:25,360 cohesive teams to project medical power 518 00:21:25,370 --> 00:21:28,090 in support of naval superiority . These 519 00:21:28,090 --> 00:21:29,868 priorities guide our deliberate 520 00:21:29,868 --> 00:21:32,034 planning efforts , resource allocation 521 00:21:32,034 --> 00:21:34,150 decisions and strategic program 522 00:21:34,150 --> 00:21:36,570 investments . We're at a critical and 523 00:21:36,570 --> 00:21:38,514 exciting juncture as we pivot from 524 00:21:38,514 --> 00:21:40,570 operating military medical treatment 525 00:21:40,570 --> 00:21:42,570 facilities which are now completely 526 00:21:42,570 --> 00:21:44,792 under the authority direction , control 527 00:21:44,792 --> 00:21:46,848 of the defense health agency . While 528 00:21:46,848 --> 00:21:48,848 our attention is on the operational 529 00:21:48,848 --> 00:21:51,126 mission of delivering manned , trained , 530 00:21:51,126 --> 00:21:53,181 equipped and sustained medical units 531 00:21:53,181 --> 00:21:55,181 who provide enduring support to the 532 00:21:55,181 --> 00:21:57,348 fleet , the Marine Corps and the joint 533 00:21:57,348 --> 00:21:59,070 force . This operational focus 534 00:21:59,070 --> 00:22:01,181 maintains Navy medicine's requirement 535 00:22:01,181 --> 00:22:03,403 to provide health services . It's C and 536 00:22:03,403 --> 00:22:06,560 assure on our platforms and in D H A M 537 00:22:06,560 --> 00:22:09,260 T s as you know , the national security 538 00:22:09,260 --> 00:22:11,316 and defense strategies make it clear 539 00:22:11,316 --> 00:22:13,149 that China represents the pacing 540 00:22:13,149 --> 00:22:15,204 challenge against which we must plan 541 00:22:15,204 --> 00:22:16,982 our war fighting strategies and 542 00:22:16,982 --> 00:22:19,149 investments . For the first time in at 543 00:22:19,149 --> 00:22:20,871 least a generation , we have a 544 00:22:20,871 --> 00:22:22,816 strategic competitor who possesses 545 00:22:22,816 --> 00:22:24,927 naval capabilities that rival our own 546 00:22:24,927 --> 00:22:26,982 and seeks to aggressively employ its 547 00:22:26,982 --> 00:22:28,982 forces to challenge us principles , 548 00:22:28,982 --> 00:22:31,316 partnerships and prosperity . Similarly , 549 00:22:31,316 --> 00:22:33,320 Russia , Iron Iran and other 550 00:22:33,330 --> 00:22:35,760 authoritarian authoritative states 551 00:22:35,770 --> 00:22:37,881 continue to challenge the rules based 552 00:22:37,881 --> 00:22:40,150 international order . Navy medicine is 553 00:22:40,150 --> 00:22:42,150 taking urgent action to support the 554 00:22:42,150 --> 00:22:44,372 Navy and Marine Corps and save lives in 555 00:22:44,372 --> 00:22:46,539 contested battle space that is quickly 556 00:22:46,539 --> 00:22:48,372 growing , growing in lethality , 557 00:22:48,372 --> 00:22:50,490 complexity and scope . Last month , I 558 00:22:50,490 --> 00:22:53,620 released our 2023 campaign order which 559 00:22:53,620 --> 00:22:55,676 outlines our strategic direction for 560 00:22:55,676 --> 00:22:57,420 the next five years and direct 561 00:22:57,430 --> 00:22:59,720 foundational changes to our entire 562 00:22:59,720 --> 00:23:02,000 enterprise operates in order to meet 563 00:23:02,000 --> 00:23:04,500 combatant commander and combatant and 564 00:23:04,500 --> 00:23:06,556 component commander requirements for 565 00:23:06,556 --> 00:23:08,722 the warfighter to get us there . We're 566 00:23:08,722 --> 00:23:10,333 working on several strategic 567 00:23:10,333 --> 00:23:12,556 comparatives including new platforms in 568 00:23:12,556 --> 00:23:14,500 development like the expeditionary 569 00:23:14,500 --> 00:23:16,722 medical ship which will speed to assist 570 00:23:16,722 --> 00:23:18,722 casualties and have three operating 571 00:23:18,722 --> 00:23:20,960 rooms and 60 medical bands . Thank you 572 00:23:20,960 --> 00:23:23,260 for the program increase in the FT fy 573 00:23:23,260 --> 00:23:26,550 23 appropriations bill to procure two 574 00:23:26,550 --> 00:23:28,880 additional ships . I was recently in 575 00:23:28,880 --> 00:23:30,658 Mobile Alabama representing the 576 00:23:30,658 --> 00:23:32,824 Secretary of the Navy as we christened 577 00:23:32,824 --> 00:23:34,900 the USNS Cody , which is our first 578 00:23:34,910 --> 00:23:37,390 expeditionary fast transport flight to 579 00:23:37,640 --> 00:23:39,751 with enhanced medical capabilities to 580 00:23:39,751 --> 00:23:42,170 augment the E M S . These platforms 581 00:23:42,170 --> 00:23:44,390 truly represent a quantum leap forward 582 00:23:44,390 --> 00:23:46,980 for Navy medicine's ability to meet our 583 00:23:46,990 --> 00:23:49,450 mission in future complex conflict on 584 00:23:49,450 --> 00:23:52,000 the water . Another key priority in 585 00:23:52,000 --> 00:23:54,111 ensuring our sailors and marines have 586 00:23:54,111 --> 00:23:56,278 access to the full continuum of mental 587 00:23:56,278 --> 00:23:58,222 health resources . While aiming to 588 00:23:58,222 --> 00:24:00,222 utilize the right care at the right 589 00:24:00,222 --> 00:24:02,389 level . At the right time , embedded , 590 00:24:02,389 --> 00:24:04,556 mental health remains vital for mental 591 00:24:04,556 --> 00:24:06,611 wellness by placing mental health as 592 00:24:06,611 --> 00:24:08,722 far forward as possible . Currently , 593 00:24:08,722 --> 00:24:10,944 36 a half percent of active duty mental 594 00:24:10,944 --> 00:24:13,300 health providers and 31% of behavioral 595 00:24:13,300 --> 00:24:15,790 health technicians serve in operational 596 00:24:15,790 --> 00:24:18,190 and training commands . Navy Medicine 597 00:24:18,190 --> 00:24:20,246 supports readiness from accession to 598 00:24:20,246 --> 00:24:22,301 separation , prioritizing resiliency 599 00:24:22,301 --> 00:24:24,220 efforts , suicide prevention , 600 00:24:24,230 --> 00:24:26,452 providing mental health services within 601 00:24:26,452 --> 00:24:28,397 primary care and specialty clinics 602 00:24:28,397 --> 00:24:30,700 embedded within the fleet and via 603 00:24:30,710 --> 00:24:33,040 virtual health platforms and deploying 604 00:24:33,040 --> 00:24:35,151 disaster mental health intervention . 605 00:24:35,390 --> 00:24:37,501 Navy Medicine is most grateful to the 606 00:24:37,501 --> 00:24:39,668 committee for the resources to support 607 00:24:39,668 --> 00:24:41,779 our research initiatives particularly 608 00:24:41,779 --> 00:24:43,779 in areas of dental technologies and 609 00:24:43,779 --> 00:24:45,834 human performance . The ads that you 610 00:24:45,834 --> 00:24:47,501 provided will improve overall 611 00:24:47,501 --> 00:24:49,557 warfighter readiness and the medical 612 00:24:49,557 --> 00:24:51,612 treatments we provide . In summary , 613 00:24:51,612 --> 00:24:53,834 our center of gravity is the commitment 614 00:24:53,834 --> 00:24:55,723 to provide expeditionary maritime 615 00:24:55,723 --> 00:24:57,990 medical care . Our ability to quickly 616 00:24:57,990 --> 00:25:00,046 deploy and support a crisis response 617 00:25:00,046 --> 00:25:01,960 around the world makes military 618 00:25:01,960 --> 00:25:04,238 medicine unique , but more importantly , 619 00:25:04,390 --> 00:25:06,501 demands that we're both operationally 620 00:25:06,501 --> 00:25:08,820 relevant and clinically prepared again . 621 00:25:08,830 --> 00:25:10,830 Thank you for your leadership and I 622 00:25:10,830 --> 00:25:12,886 look forward to today's discussion . 623 00:25:12,886 --> 00:25:14,997 Thank you , Admiral . There will be a 624 00:25:14,997 --> 00:25:17,163 five minute rounds and I will yield to 625 00:25:17,163 --> 00:25:19,219 Senator Durbin . Thank you , Senator 626 00:25:19,219 --> 00:25:21,219 Tester , let me say at the outset , 627 00:25:21,219 --> 00:25:23,441 congratulations to you for leading this 628 00:25:23,441 --> 00:25:25,608 important subcommittee which I've been 629 00:25:25,608 --> 00:25:27,830 honored to serve on . Let me respond to 630 00:25:27,830 --> 00:25:29,997 my friend , Senator Collins . Uh It is 631 00:25:29,997 --> 00:25:31,774 true that the administration is 632 00:25:31,774 --> 00:25:33,997 probably a few weeks later in producing 633 00:25:33,997 --> 00:25:36,163 a budget resolution , but our hope for 634 00:25:36,163 --> 00:25:38,210 the budget process . Uh This fiscal 635 00:25:38,210 --> 00:25:42,110 year lies in the capable hands of five 636 00:25:42,110 --> 00:25:44,310 people who were featured in a color 637 00:25:44,310 --> 00:25:46,532 photograph on the front page of the New 638 00:25:46,532 --> 00:25:49,030 York Times several weeks ago . It was 639 00:25:49,040 --> 00:25:51,262 article that noted that we have reached 640 00:25:51,262 --> 00:25:53,920 an historic milestone . Both the 641 00:25:53,930 --> 00:25:57,050 director of the O M B , the chair and 642 00:25:57,050 --> 00:25:59,272 ranking members of the House and Senate 643 00:25:59,272 --> 00:26:01,550 Appropriations Committee are all women . 644 00:26:02,110 --> 00:26:05,720 I thought you'd like to hear that . I'm 645 00:26:05,720 --> 00:26:07,831 hopeful . I believe that you're going 646 00:26:07,831 --> 00:26:09,942 to set out as Senator Murray has told 647 00:26:09,942 --> 00:26:11,831 me and I know that you're working 648 00:26:11,831 --> 00:26:14,130 closely together to make history in 649 00:26:14,130 --> 00:26:16,297 that appointment and I'm confident you 650 00:26:16,297 --> 00:26:18,463 will . So I wish you the very best and 651 00:26:18,463 --> 00:26:20,519 I want to help you reach that goal , 652 00:26:20,519 --> 00:26:22,630 Senator Tester . I also want to say a 653 00:26:22,630 --> 00:26:24,741 word or two and praise . I'm sure you 654 00:26:24,741 --> 00:26:26,574 would give me additional time if 655 00:26:26,574 --> 00:26:28,686 necessary . In praise of your role as 656 00:26:28,686 --> 00:26:31,100 chairman , I set out eight years ago to 657 00:26:31,100 --> 00:26:33,900 achieve 5% real growth in medical 658 00:26:33,900 --> 00:26:36,011 research by the Department of Defense 659 00:26:36,011 --> 00:26:38,233 and the National Institutes of Health . 660 00:26:38,233 --> 00:26:40,456 You were my partner in that effort . As 661 00:26:40,456 --> 00:26:42,622 was Senator Blunt of Missouri with the 662 00:26:42,622 --> 00:26:44,820 NIH . And I note that in the fiscal 663 00:26:44,830 --> 00:26:48,380 year 23 omnibus , you have appropriated 664 00:26:48,390 --> 00:26:51,920 3.1 oh $7 billion for 665 00:26:51,920 --> 00:26:54,740 medical research . 5% real growth . 666 00:26:54,740 --> 00:26:56,907 Congratulations , chairman . I hope we 667 00:26:56,907 --> 00:26:59,100 can maintain that going forward . Let 668 00:26:59,100 --> 00:27:01,810 me address the issue that rear Admiral 669 00:27:01,820 --> 00:27:03,950 Gillingham raised at the end which I 670 00:27:03,950 --> 00:27:05,790 think relates to a number of our 671 00:27:05,790 --> 00:27:07,901 witnesses . And my general question , 672 00:27:07,901 --> 00:27:10,890 I'll start with Dr Martinez Lopez . Uh 673 00:27:10,900 --> 00:27:12,890 Mental health , mental health 674 00:27:12,890 --> 00:27:15,480 counseling is so important for all of 675 00:27:15,480 --> 00:27:18,540 us , all of us and especially important 676 00:27:18,540 --> 00:27:20,540 in the military where they're under 677 00:27:20,540 --> 00:27:23,910 stress situations and face trauma 678 00:27:23,920 --> 00:27:27,130 incidents . On a regular basis in the 679 00:27:27,130 --> 00:27:29,340 past . Let's be honest about it . And 680 00:27:29,340 --> 00:27:31,396 virtually every aspect of medicine , 681 00:27:31,396 --> 00:27:33,507 there was a stigma attached to mental 682 00:27:33,507 --> 00:27:35,396 health counseling and there was a 683 00:27:35,396 --> 00:27:37,451 belief that if you conceded that you 684 00:27:37,451 --> 00:27:39,673 needed counseling , it was a black mark 685 00:27:39,673 --> 00:27:41,673 on your record which would hold you 686 00:27:41,673 --> 00:27:43,507 back come time for promotion and 687 00:27:43,507 --> 00:27:45,562 advancement . Has that changed ? Are 688 00:27:45,562 --> 00:27:49,290 you changing it , sir ? I think you 689 00:27:49,290 --> 00:27:51,457 know , there's movement in the bullpen 690 00:27:51,457 --> 00:27:53,568 to really change that culture takes a 691 00:27:53,568 --> 00:27:55,568 while , but the department has been 692 00:27:55,568 --> 00:27:57,568 very entrenched . I can't speak for 693 00:27:57,568 --> 00:28:00,280 secretary and down that mental health 694 00:28:00,280 --> 00:28:02,447 is health . It's like anything else we 695 00:28:02,447 --> 00:28:04,990 need . So we need to really lower that 696 00:28:04,990 --> 00:28:07,350 stigma . People make it very available 697 00:28:07,350 --> 00:28:10,190 close . So everybody will be very easy 698 00:28:10,190 --> 00:28:12,970 to get just like get into sick call for 699 00:28:12,980 --> 00:28:15,440 ingrown toenail or something like that . 700 00:28:15,450 --> 00:28:19,230 But Uh I will tell you that still is an 701 00:28:19,230 --> 00:28:23,070 ongoing uh challenge that 702 00:28:23,070 --> 00:28:25,840 we're really making headways , but 703 00:28:25,840 --> 00:28:29,350 we're not done yet . I can 704 00:28:29,360 --> 00:28:31,840 concede that point very easily in our 705 00:28:31,840 --> 00:28:33,951 own family circumstance . A member of 706 00:28:33,951 --> 00:28:36,140 our family served in Vietnam and came 707 00:28:36,140 --> 00:28:38,140 back from that military service , a 708 00:28:38,140 --> 00:28:40,450 changed person . We never could quite 709 00:28:40,450 --> 00:28:42,570 understand what happened to him . He 710 00:28:42,570 --> 00:28:44,800 did some things which were not good for 711 00:28:44,800 --> 00:28:46,967 his family , for himself . It took him 712 00:28:46,967 --> 00:28:49,050 many years to come to grips with his 713 00:28:49,050 --> 00:28:52,200 experience in Vietnam . Uh We used to 714 00:28:52,200 --> 00:28:54,256 euphemistically refer to them as the 715 00:28:54,256 --> 00:28:56,970 Vietnam generation and I won't go into 716 00:28:56,970 --> 00:28:59,192 detail . But you know what I'm speaking 717 00:28:59,192 --> 00:29:01,359 of contrast that with those who served 718 00:29:01,359 --> 00:29:04,090 in Iraq , I noticed many times these 719 00:29:04,090 --> 00:29:07,790 young military veterans would come home 720 00:29:07,800 --> 00:29:09,980 and be very open and honest about the 721 00:29:09,980 --> 00:29:12,350 need for help and counseling . What a 722 00:29:12,350 --> 00:29:14,410 dramatic reversal that was over the 723 00:29:14,420 --> 00:29:16,930 Vietnam generation . I hope that is the 724 00:29:16,930 --> 00:29:19,097 spirit that the military is looking at 725 00:29:19,097 --> 00:29:21,208 this issue moving forward . Senator . 726 00:29:21,208 --> 00:29:23,319 Absolutely . I mean , we're committed 727 00:29:23,319 --> 00:29:25,541 for , for the overall well being of all 728 00:29:25,541 --> 00:29:27,810 service members and mental health is 729 00:29:27,810 --> 00:29:30,700 one of those issues that thanks to God , 730 00:29:30,710 --> 00:29:32,932 thanks to God . Now we can talk and put 731 00:29:32,932 --> 00:29:34,766 it on top of the table and , and 732 00:29:34,766 --> 00:29:36,710 address it the way issue should be 733 00:29:36,710 --> 00:29:38,821 addressed . And in the Vietnam days , 734 00:29:38,821 --> 00:29:40,988 we didn't , for whatever the reason we 735 00:29:40,988 --> 00:29:43,154 didn't talk openly about these kind of 736 00:29:43,154 --> 00:29:45,266 issues that needed to be spoken about 737 00:29:45,266 --> 00:29:48,860 Uh So stigma is one of the issues of 738 00:29:48,860 --> 00:29:51,082 mental , of mental health , but there's 739 00:29:51,082 --> 00:29:53,193 obviously it's very complex and we're 740 00:29:53,193 --> 00:29:55,249 taking the public health approach to 741 00:29:55,249 --> 00:29:57,450 deal with the mental health crisis . 742 00:29:57,450 --> 00:30:00,250 And what that really means is it's not 743 00:30:00,250 --> 00:30:02,780 just a medical issue is an issue that 744 00:30:02,780 --> 00:30:05,460 encompass personnel actions is an issue 745 00:30:05,470 --> 00:30:08,470 that encompass financial issues . So 746 00:30:08,480 --> 00:30:10,980 anything that brings more stress , we 747 00:30:10,980 --> 00:30:13,350 need to figure out how to level that 748 00:30:13,350 --> 00:30:15,930 load on the service members . So to , 749 00:30:16,730 --> 00:30:19,770 so it's not everybody has to own , 750 00:30:19,780 --> 00:30:22,850 everybody has to own on this exercise 751 00:30:23,180 --> 00:30:25,124 this issue . Thank you very much . 752 00:30:25,124 --> 00:30:27,710 Thank you , Mr Chairman Senator Collins . 753 00:30:28,910 --> 00:30:32,530 Thank you , Mr Chairman Dr Martinez 754 00:30:32,530 --> 00:30:35,950 Lopez . Let me follow up on the mental 755 00:30:35,950 --> 00:30:39,300 health issues that are of such concern 756 00:30:39,300 --> 00:30:42,160 to this subcommittee . You mentioned 757 00:30:42,160 --> 00:30:44,500 the department's suicide Prevention and 758 00:30:44,500 --> 00:30:47,250 Response Independent Review Committee 759 00:30:47,260 --> 00:30:50,910 which recently released a report 760 00:30:50,920 --> 00:30:53,650 with numerous recommendations aimed at 761 00:30:53,650 --> 00:30:57,340 reducing the number of suicides . 762 00:30:57,350 --> 00:31:00,360 I want to make a couple of observations 763 00:31:00,360 --> 00:31:02,880 about that report before asking you a 764 00:31:02,880 --> 00:31:06,410 question first . It is evident that the 765 00:31:06,410 --> 00:31:09,350 department needs to reduce the time 766 00:31:09,360 --> 00:31:13,300 that is required to recruit behavioral 767 00:31:13,310 --> 00:31:16,260 health specialists . In one example 768 00:31:16,260 --> 00:31:19,160 cited in the report , it took on 769 00:31:19,160 --> 00:31:23,100 average a year and a half to hire 770 00:31:23,110 --> 00:31:26,470 civilian psychiatrists in almost a year 771 00:31:26,480 --> 00:31:29,590 to hire psychologists at Walter Reed . 772 00:31:29,760 --> 00:31:33,110 So it's not a big surprise that half of 773 00:31:33,110 --> 00:31:36,050 the psychiatrists ultimately declined 774 00:31:36,050 --> 00:31:38,140 the position after that long delay , 775 00:31:38,140 --> 00:31:41,130 undoubtedly they went elsewhere and 776 00:31:41,140 --> 00:31:43,900 that is unacceptable that we're losing 777 00:31:43,900 --> 00:31:45,844 people because it takes so long to 778 00:31:45,844 --> 00:31:49,590 bring them on board . Second try 779 00:31:49,590 --> 00:31:52,680 cares , policy guidance is that 780 00:31:52,680 --> 00:31:56,000 98% of the claims submitted by 781 00:31:56,000 --> 00:31:59,410 providers should be completed Within 30 782 00:31:59,410 --> 00:32:02,090 days . Yet , the report found that 783 00:32:02,100 --> 00:32:04,910 behavioral health providers were 784 00:32:04,910 --> 00:32:07,410 reluctant to serve military 785 00:32:07,410 --> 00:32:11,200 beneficiaries because it took so long 786 00:32:11,210 --> 00:32:14,630 for Tricare to pay them . One provider 787 00:32:14,630 --> 00:32:17,100 cited . The report said it takes 788 00:32:17,100 --> 00:32:21,050 forever to get paid a pittance if 789 00:32:21,050 --> 00:32:24,500 you get paid at all . So obviously , 790 00:32:24,500 --> 00:32:26,722 our military force will be stronger and 791 00:32:26,722 --> 00:32:28,810 healthier when more providers are 792 00:32:28,810 --> 00:32:31,590 available and more of them are willing 793 00:32:31,590 --> 00:32:34,550 and eager to accept Tricare coverage . 794 00:32:34,560 --> 00:32:37,730 So , here's my question . Will the 795 00:32:37,740 --> 00:32:39,790 upcoming budget requests include 796 00:32:39,790 --> 00:32:42,890 funding to implement the committee's 797 00:32:42,890 --> 00:32:44,390 recommendations . 798 00:32:46,640 --> 00:32:50,410 Senator Collins first , uh , the 799 00:32:50,420 --> 00:32:52,198 secretary and myself , I'm very 800 00:32:52,198 --> 00:32:53,920 grateful to the members of the 801 00:32:53,920 --> 00:32:55,976 committee for spending their time to 802 00:32:55,976 --> 00:32:58,198 come out with the recommendations , you 803 00:32:58,198 --> 00:33:00,253 know , study it out , helping us out 804 00:33:00,253 --> 00:33:02,460 with this big vacation . Second is the 805 00:33:02,470 --> 00:33:04,581 secretary right now has a team and we 806 00:33:04,581 --> 00:33:06,692 are looking , leaning forward each of 807 00:33:06,692 --> 00:33:09,330 the recommendations and we're looking 808 00:33:09,330 --> 00:33:12,360 at ways to first , which one we're 809 00:33:12,360 --> 00:33:14,527 gonna be able to accommodate first and 810 00:33:14,527 --> 00:33:16,638 which ones are gonna come and in that 811 00:33:16,638 --> 00:33:18,527 process , there will be issues of 812 00:33:18,527 --> 00:33:21,020 budgetary requirements . So we , I'm 813 00:33:21,020 --> 00:33:23,353 not prepared to tell you what those are , 814 00:33:23,353 --> 00:33:25,850 look , look like right now . But I'm 815 00:33:25,850 --> 00:33:27,794 telling you , we as a department , 816 00:33:27,794 --> 00:33:31,180 we're looking at all the one by one and 817 00:33:31,180 --> 00:33:34,850 addressing a viable to how much , what 818 00:33:34,850 --> 00:33:37,380 we take to implement those measures . 819 00:33:37,390 --> 00:33:39,730 So as we are ready to do that , we'll 820 00:33:39,730 --> 00:33:41,970 come back to you with the specifics , 821 00:33:41,970 --> 00:33:45,000 ma'am . Thank you , General Crossland . 822 00:33:45,010 --> 00:33:47,580 Just yesterday , I met with a group of 823 00:33:47,580 --> 00:33:51,100 veterans from Maine who told me that 824 00:33:51,110 --> 00:33:53,570 the rollout of the new electronic 825 00:33:53,570 --> 00:33:57,480 health record system within the V A is 826 00:33:57,480 --> 00:34:00,930 still very problematic . Obviously , 827 00:34:00,940 --> 00:34:03,107 even if D O D is going to have its new 828 00:34:03,107 --> 00:34:06,560 system and 75% of its 829 00:34:06,560 --> 00:34:10,560 hospitals , as you testified by the 830 00:34:10,570 --> 00:34:13,560 end of the year . If the V A is not in 831 00:34:13,560 --> 00:34:16,310 sync , we're still gonna have a problem 832 00:34:16,320 --> 00:34:19,430 with transferring medical records once 833 00:34:19,430 --> 00:34:23,390 someone retires from the active duty 834 00:34:23,400 --> 00:34:26,740 military and the veterans were telling 835 00:34:26,740 --> 00:34:28,970 me example , after example of where 836 00:34:28,970 --> 00:34:31,790 they had difficulties in chasing down 837 00:34:31,800 --> 00:34:35,760 records getting them to the V A . So 838 00:34:35,760 --> 00:34:39,080 how is D O D collaborating with the V A 839 00:34:39,090 --> 00:34:42,510 on the electronic health records 840 00:34:42,510 --> 00:34:45,430 rollout and ensuring that once it's 841 00:34:45,430 --> 00:34:49,240 fully implemented that there is the 842 00:34:49,250 --> 00:34:51,350 interoperability that we've been 843 00:34:51,350 --> 00:34:55,300 talking about for years , for years , 844 00:34:58,920 --> 00:35:00,753 Senator Collins , thanks for the 845 00:35:00,753 --> 00:35:02,753 opportunity to comment . Um First , 846 00:35:02,753 --> 00:35:04,976 ironically , last week , I spoke with a 847 00:35:04,976 --> 00:35:06,809 senior leader within the V A and 848 00:35:06,809 --> 00:35:08,976 offered up the opportunity for them to 849 00:35:08,976 --> 00:35:11,031 come and witness our rollouts and to 850 00:35:11,031 --> 00:35:13,290 learn from our lessons on how we're 851 00:35:13,290 --> 00:35:15,260 able to execute our rollout and 852 00:35:15,260 --> 00:35:17,260 potentially things we can offer for 853 00:35:17,260 --> 00:35:19,920 them uh by sharing the lessons learned 854 00:35:19,930 --> 00:35:22,000 um with respect to that value of the 855 00:35:22,000 --> 00:35:24,700 record , there's a lot of value um with 856 00:35:24,700 --> 00:35:26,922 the data , as I mentioned in my opening 857 00:35:26,922 --> 00:35:29,256 comments , having the right information , 858 00:35:29,256 --> 00:35:31,311 being able to follow service members 859 00:35:31,311 --> 00:35:33,478 from the time they're assessed all the 860 00:35:33,478 --> 00:35:35,589 way to the time they transition . And 861 00:35:35,589 --> 00:35:37,756 obviously , if there's a further delay 862 00:35:37,756 --> 00:35:37,710 in the V S roll out , we would have to 863 00:35:37,710 --> 00:35:40,940 work through how we would hand are MHS 864 00:35:40,940 --> 00:35:42,996 Genesis , like trying to record that 865 00:35:42,996 --> 00:35:44,996 we're gonna be on by the end of the 866 00:35:44,996 --> 00:35:46,996 year to the V A . We haven't gotten 867 00:35:46,996 --> 00:35:49,218 that far yet . Thank you . I'm sure the 868 00:35:49,218 --> 00:35:51,440 chairman is going to solve that problem 869 00:35:51,440 --> 00:35:53,384 in his dual role . No , no problem 870 00:35:53,384 --> 00:35:55,551 whatsoever . Moran is gonna help me do 871 00:35:55,551 --> 00:35:58,770 it to center . Right . Okay . Good . 872 00:35:58,780 --> 00:36:00,891 Look , it's , it's , it's a very good 873 00:36:00,891 --> 00:36:03,850 question and , uh , I will just say 874 00:36:03,850 --> 00:36:06,072 that I don't know that there is anybody 875 00:36:06,072 --> 00:36:08,380 that is not frustrated with the whole 876 00:36:08,390 --> 00:36:10,670 electronic health record , the billions 877 00:36:10,670 --> 00:36:12,630 of dollars are being spent and it 878 00:36:12,630 --> 00:36:14,686 doesn't appear that we're moving the 879 00:36:14,686 --> 00:36:16,741 ball . So we've got , we've got some 880 00:36:16,741 --> 00:36:18,940 work to do . Um , I want to start my 881 00:36:18,940 --> 00:36:22,270 question on , on , on , on Tricare . Um , 882 00:36:22,280 --> 00:36:24,880 I just had a town hall meeting , uh , 883 00:36:24,890 --> 00:36:27,890 in Montana . Uh , things were brought 884 00:36:27,890 --> 00:36:31,180 up that I was , I thought were solved 885 00:36:31,180 --> 00:36:33,450 like providers that couldn't get in the 886 00:36:33,450 --> 00:36:35,600 network that offered up but couldn't 887 00:36:35,600 --> 00:36:37,600 get Montana . I don't think you say 888 00:36:37,600 --> 00:36:39,656 this about everywhere in the country 889 00:36:39,656 --> 00:36:41,767 providers or something . We need more 890 00:36:41,767 --> 00:36:43,989 of not fewer of , and then the payments 891 00:36:43,989 --> 00:36:45,933 to those providers were , um , not 892 00:36:45,933 --> 00:36:48,150 being done on time . So the providers 893 00:36:48,160 --> 00:36:51,450 that did sign up , um , weren't getting 894 00:36:51,450 --> 00:36:54,220 their checks when they should have . Um , 895 00:36:54,230 --> 00:36:57,720 so the question is , um , who has 896 00:36:57,720 --> 00:37:01,510 oversight of , of will be tri West , 897 00:37:01,510 --> 00:37:03,621 who has oversight to make sure number 898 00:37:03,621 --> 00:37:05,454 one that they're bringing on the 899 00:37:05,454 --> 00:37:07,677 providers they need . This is for you . 900 00:37:07,677 --> 00:37:09,843 General Crosslin , they're bringing on 901 00:37:09,843 --> 00:37:11,899 the providers they need and that the 902 00:37:11,899 --> 00:37:14,010 providers are getting paid and by the 903 00:37:14,010 --> 00:37:15,899 way that the money isn't , that's 904 00:37:15,899 --> 00:37:18,066 actually going out to provide services 905 00:37:18,066 --> 00:37:20,980 and not being pocketed by somebody In , 906 00:37:20,990 --> 00:37:23,400 uh , in one of these 3rd party 907 00:37:23,400 --> 00:37:25,040 providers pockets . 908 00:37:28,210 --> 00:37:30,099 So senator , the oversight of the 909 00:37:30,099 --> 00:37:32,043 Tricare program is executed out of 910 00:37:32,043 --> 00:37:34,210 defense Health Agency . So that , that 911 00:37:34,210 --> 00:37:36,320 would be my responsibility to engage 912 00:37:36,330 --> 00:37:38,430 with Tri West to make sure they're 913 00:37:38,430 --> 00:37:40,597 honoring the aspects of the contract . 914 00:37:40,597 --> 00:37:43,300 We do have a pretty aggressive auditing 915 00:37:43,300 --> 00:37:45,411 for the last part of the concern that 916 00:37:45,411 --> 00:37:47,744 it's actually not going to the provider , 917 00:37:47,744 --> 00:37:49,856 but there's this potential fraud . We 918 00:37:49,856 --> 00:37:51,800 do have a very robust program that 919 00:37:51,800 --> 00:37:53,800 looks at in , in audits that , um , 920 00:37:53,800 --> 00:37:55,800 with timeliness working harder with 921 00:37:55,800 --> 00:37:58,240 Tricare West is what I owe you , uh , 922 00:37:58,250 --> 00:38:00,700 in the team in Montana to make sure 923 00:38:00,700 --> 00:38:02,867 that they're meeting their contractual 924 00:38:02,867 --> 00:38:05,070 obligations with respect to , uh , 925 00:38:05,080 --> 00:38:07,560 signing up providers , the managed care 926 00:38:07,560 --> 00:38:09,880 contract or given targets . They meet 927 00:38:09,880 --> 00:38:12,150 those targets . I acknowledge that when 928 00:38:12,150 --> 00:38:13,928 they meet those targets for the 929 00:38:13,928 --> 00:38:15,817 beneficiaries that doesn't always 930 00:38:15,817 --> 00:38:18,039 translate that appointments available . 931 00:38:18,180 --> 00:38:22,030 So specifically , if you sign up , 932 00:38:22,040 --> 00:38:23,929 it doesn't translate that we have 933 00:38:23,929 --> 00:38:26,096 actually put appointments out . So the 934 00:38:26,096 --> 00:38:28,500 T five contract , we've added that as a 935 00:38:28,500 --> 00:38:31,170 criteria , not just to , to sign up 936 00:38:31,170 --> 00:38:33,392 providers , but to make sure that their 937 00:38:33,392 --> 00:38:35,614 appointments available for the patients 938 00:38:35,614 --> 00:38:37,670 to book with the providers . So this 939 00:38:37,670 --> 00:38:40,510 was a small sample size , but I had 940 00:38:40,520 --> 00:38:43,580 providers there that had contracts with 941 00:38:43,580 --> 00:38:47,040 Tricare and I had ones that would like 942 00:38:47,040 --> 00:38:49,780 to get contracts with Tricare that 943 00:38:49,780 --> 00:38:51,780 couldn't , these were mental health 944 00:38:51,780 --> 00:38:54,220 providers . So I don't know what the 945 00:38:54,220 --> 00:38:57,160 contract says about the numbers of 946 00:38:57,160 --> 00:38:59,670 people you need . I don't know if it's 947 00:38:59,670 --> 00:39:02,670 based on population or geography or 948 00:39:02,680 --> 00:39:06,670 what it's based on . Um , but I was 949 00:39:06,670 --> 00:39:08,726 shocked by what I heard . I was just 950 00:39:08,726 --> 00:39:10,614 absolutely shocked at a time when 951 00:39:10,614 --> 00:39:12,781 mental health has been already brought 952 00:39:12,781 --> 00:39:14,670 up here several times when mental 953 00:39:14,670 --> 00:39:16,670 health is such a huge issue in this 954 00:39:16,670 --> 00:39:18,837 country . And , and we're not bringing 955 00:39:18,837 --> 00:39:20,930 on as many folks as we can . Doesn't 956 00:39:20,930 --> 00:39:23,850 make a lot of sense to me . Um I want 957 00:39:23,850 --> 00:39:26,180 to move on . I want to talk about China 958 00:39:26,190 --> 00:39:28,540 may strike you as odd discussion and D 959 00:39:28,540 --> 00:39:32,390 O D health care . But we have troops in , 960 00:39:32,400 --> 00:39:35,320 in Japan and in other places where 961 00:39:35,330 --> 00:39:37,720 number one readiness concern we hear 962 00:39:37,720 --> 00:39:40,040 about is lack of health care for the 963 00:39:40,040 --> 00:39:43,140 dependence and their families and D O D 964 00:39:43,150 --> 00:39:47,100 uh civilians . Um Apparently the 965 00:39:47,110 --> 00:39:49,530 Department of Defense Health Agency 966 00:39:49,540 --> 00:39:51,596 recently barred D O D civilians from 967 00:39:51,596 --> 00:39:53,762 receiving care at hospitals , military 968 00:39:53,762 --> 00:39:55,873 hospitals , forcing them to use local 969 00:39:55,873 --> 00:39:59,450 hospitals . Wow . Um I think this is , 970 00:39:59,460 --> 00:40:02,330 it's a disaster and by the way , I 971 00:40:02,330 --> 00:40:04,630 think it's gonna , if it hasn't already 972 00:40:04,630 --> 00:40:06,797 end up being an incredible recruitment 973 00:40:06,797 --> 00:40:08,908 challenge . We've also heard concerns 974 00:40:08,908 --> 00:40:11,074 about a lack of mental health care for 975 00:40:11,074 --> 00:40:13,019 dependents in Japan . Uh This stop 976 00:40:13,019 --> 00:40:15,186 service members from deploying . There 977 00:40:15,186 --> 00:40:17,019 is tremendous stress on military 978 00:40:17,019 --> 00:40:19,186 parents . These reports are concerning 979 00:40:19,186 --> 00:40:21,241 and were repeatedly delivered with a 980 00:40:21,241 --> 00:40:23,352 sense of urgency from senior military 981 00:40:23,352 --> 00:40:25,574 leaders on the ground . Um It's already 982 00:40:25,574 --> 00:40:27,741 been pointed out . China is our number 983 00:40:27,741 --> 00:40:29,852 one pacing threat . So this impact on 984 00:40:29,852 --> 00:40:31,797 military readiness is alarming . I 985 00:40:31,797 --> 00:40:33,852 understand the D O D is now going to 986 00:40:33,852 --> 00:40:36,019 make some changes to this policy , but 987 00:40:36,019 --> 00:40:38,241 quite frankly , um it should have never 988 00:40:38,241 --> 00:40:38,070 happened to begin with . General 989 00:40:38,070 --> 00:40:40,860 Crossland was the impact on military 990 00:40:40,860 --> 00:40:43,027 readiness take into consideration when 991 00:40:43,027 --> 00:40:45,130 announcing this change . So Senator 992 00:40:45,140 --> 00:40:47,251 change , I believe you're referencing 993 00:40:47,251 --> 00:40:49,370 was a policy put out on the 22nd of 994 00:40:49,370 --> 00:40:52,600 December . Uh in the policy limited the 995 00:40:52,600 --> 00:40:55,150 space available access to the system so 996 00:40:55,150 --> 00:40:58,430 that we could preserve readiness for 997 00:40:58,440 --> 00:41:01,810 the force . Uh Specifically saying that 998 00:41:01,810 --> 00:41:03,977 space A would have to call in after 10 999 00:41:03,977 --> 00:41:05,977 o'clock and they would only receive 1000 00:41:05,977 --> 00:41:08,420 acute care . I have since issued 1001 00:41:08,420 --> 00:41:10,420 guidance in the policy was released 1002 00:41:10,420 --> 00:41:12,930 last week , that added clarity to that 1003 00:41:12,930 --> 00:41:15,450 policy which expanded care to the space 1004 00:41:15,450 --> 00:41:18,780 A . So the policy never targeted or 1005 00:41:18,780 --> 00:41:21,300 short access for dependence and their 1006 00:41:21,300 --> 00:41:23,411 family members . It was meant to make 1007 00:41:23,411 --> 00:41:25,578 sure that they got the party that they 1008 00:41:25,578 --> 00:41:27,578 were supposed to get at the expense 1009 00:41:27,578 --> 00:41:29,467 potentially of space . A so we've 1010 00:41:29,467 --> 00:41:32,290 removed the barrier for chronic 1011 00:41:32,290 --> 00:41:34,910 conditions to open up at the community 1012 00:41:34,910 --> 00:41:38,410 level access within our MTs for our 1013 00:41:38,410 --> 00:41:40,980 beneficiaries to include the D O D 1014 00:41:40,980 --> 00:41:44,090 civilians . We signed that out last 1015 00:41:44,100 --> 00:41:46,044 Thursday from okay . And so do you 1016 00:41:46,044 --> 00:41:47,878 believe this fully addresses the 1017 00:41:47,878 --> 00:41:50,211 concerns of the commanders in the field ? 1018 00:41:50,211 --> 00:41:52,044 No , I do not believe this fully 1019 00:41:52,044 --> 00:41:54,156 addresses the command of the , of the 1020 00:41:54,156 --> 00:41:55,989 field . I think the concerns are 1021 00:41:55,989 --> 00:41:58,156 broader than the care that the defense 1022 00:41:58,156 --> 00:42:00,322 health agency is resource to provide . 1023 00:42:00,322 --> 00:42:02,860 So specifically in Japan , the , if you 1024 00:42:02,860 --> 00:42:04,430 have a hospital , then all 1025 00:42:04,430 --> 00:42:06,486 beneficiaries , active duty , active 1026 00:42:06,486 --> 00:42:08,500 duty family members and partnership 1027 00:42:08,500 --> 00:42:10,880 with Tricare I S O S receives care from 1028 00:42:10,880 --> 00:42:12,991 the host nation . I believe that that 1029 00:42:12,991 --> 00:42:15,102 is also part of the concerns that are 1030 00:42:15,102 --> 00:42:18,500 being raised . Okay . Uh Senator 1031 00:42:18,510 --> 00:42:22,340 Moran Mr Chairman , thank you . 1032 00:42:22,350 --> 00:42:24,461 These discussions don't seem to leave 1033 00:42:24,461 --> 00:42:26,406 us whether we're in veterans or in 1034 00:42:26,406 --> 00:42:29,200 defense appropriations . Uh And the 1035 00:42:29,200 --> 00:42:30,970 same challenges that have been 1036 00:42:30,970 --> 00:42:33,137 described particularly with electronic 1037 00:42:33,137 --> 00:42:35,081 health records are ones that we're 1038 00:42:35,081 --> 00:42:37,192 facing in that arena as well . I want 1039 00:42:37,192 --> 00:42:40,340 to focus my few minutes on a challenge 1040 00:42:40,340 --> 00:42:43,210 that I have had in getting information 1041 00:42:43,210 --> 00:42:46,920 from you going back to October . 1042 00:42:47,750 --> 00:42:49,694 There was a period of time then it 1043 00:42:49,694 --> 00:42:51,980 continues in which just military 1044 00:42:51,980 --> 00:42:55,370 retiree after military retiree sought 1045 00:42:55,370 --> 00:42:57,980 me , my staff to tell me about a 1046 00:42:57,980 --> 00:43:00,090 significant change in their pharmacy 1047 00:43:00,090 --> 00:43:03,230 benefit and they were now traveling 1048 00:43:03,230 --> 00:43:05,480 much further or would have to travel 1049 00:43:05,480 --> 00:43:09,110 much further than previously . Then 1050 00:43:09,120 --> 00:43:12,000 that was followed up by the pharmacists 1051 00:43:12,000 --> 00:43:14,620 who have struggled to keep their 1052 00:43:14,620 --> 00:43:18,560 contracts with your agency or 1053 00:43:18,570 --> 00:43:21,740 the story of a number of major pharmacy 1054 00:43:21,750 --> 00:43:24,970 chains who have declined to continue 1055 00:43:24,980 --> 00:43:28,060 dealing with the defense health agency . 1056 00:43:28,750 --> 00:43:32,140 So in Kansas , a pretty rural state , 1057 00:43:32,910 --> 00:43:36,730 um these perhaps you will tell me that 1058 00:43:36,740 --> 00:43:38,970 the requirements are being met for the 1059 00:43:38,980 --> 00:43:41,210 amount of travel , time or distance 1060 00:43:41,210 --> 00:43:44,920 that you must meet . But the 1061 00:43:44,930 --> 00:43:47,240 inconvenience to veterans is 1062 00:43:47,240 --> 00:43:50,150 significant and the complaints are real 1063 00:43:50,160 --> 00:43:54,140 and continuing . In October , I tried 1064 00:43:54,140 --> 00:43:57,980 to get information from you . I 1065 00:43:57,990 --> 00:44:00,190 was told this morning that the letter 1066 00:44:00,190 --> 00:44:02,850 is in the mail , not quite those words 1067 00:44:02,850 --> 00:44:05,850 but uh in , in the phrase that we often 1068 00:44:05,850 --> 00:44:08,700 use , but I and a handful of my 1069 00:44:08,700 --> 00:44:10,756 colleagues who were experiencing the 1070 00:44:10,756 --> 00:44:13,820 same thing have sought the analysis 1071 00:44:13,820 --> 00:44:15,900 that was done a long time ago that 1072 00:44:15,900 --> 00:44:17,980 would explain the decisions that you 1073 00:44:17,980 --> 00:44:20,830 made . And six months later , we still 1074 00:44:20,840 --> 00:44:24,710 don't have that information . I've 1075 00:44:24,710 --> 00:44:27,200 submitted requests for information 1076 00:44:27,200 --> 00:44:30,190 through letters and through our F S to 1077 00:44:30,190 --> 00:44:32,630 the department . I went and visited 1078 00:44:32,630 --> 00:44:35,210 with General Milley seeking his help to 1079 00:44:35,210 --> 00:44:37,970 get answers from the Defense agency , 1080 00:44:37,980 --> 00:44:41,190 Health Agency . But I am disappointed 1081 00:44:41,190 --> 00:44:43,190 by the lack of cooperation that has 1082 00:44:43,190 --> 00:44:45,980 been extended to me and to my 1083 00:44:45,980 --> 00:44:47,940 constituents in an oversight 1084 00:44:47,940 --> 00:44:50,320 responsibility . That I have . 1085 00:44:53,340 --> 00:44:56,730 I have heard the department blaming 1086 00:44:56,730 --> 00:44:58,730 pharmacists for leaving the Tricare 1087 00:44:58,730 --> 00:45:01,100 network . But I also think that 1088 00:45:01,100 --> 00:45:03,780 narrative is unfair and not accurate . 1089 00:45:04,420 --> 00:45:06,476 There were winners and losers in the 1090 00:45:06,476 --> 00:45:08,480 initial solicitation of contracts . 1091 00:45:08,510 --> 00:45:10,580 Some pharmacists were continued in 1092 00:45:10,580 --> 00:45:12,802 network and never received an amendment 1093 00:45:12,802 --> 00:45:14,969 while others received rates lower than 1094 00:45:14,969 --> 00:45:16,858 the cost to fill the prescription 1095 00:45:16,858 --> 00:45:18,802 effectively removing them from the 1096 00:45:18,802 --> 00:45:22,190 network . A question perhaps to you 1097 00:45:22,200 --> 00:45:23,978 General Crossland , how did the 1098 00:45:23,978 --> 00:45:25,922 contractor decide which pharmacies 1099 00:45:25,922 --> 00:45:28,180 received an amended contract at a much 1100 00:45:28,180 --> 00:45:30,310 lower reimbursement rate ? And which 1101 00:45:30,310 --> 00:45:34,090 ones did not first 1102 00:45:36,170 --> 00:45:38,810 sooner , first acknowledge the delay in 1103 00:45:38,810 --> 00:45:42,490 getting back to uh the letters in the 1104 00:45:42,490 --> 00:45:44,630 mail and my apologies that for that , 1105 00:45:44,830 --> 00:45:48,570 um I'm not read on to when what the 1106 00:45:48,580 --> 00:45:51,240 contractors process for negotiating 1107 00:45:51,240 --> 00:45:53,810 rates are . What I am aware of is what 1108 00:45:53,820 --> 00:45:56,730 the decision process was and how many 1109 00:45:56,730 --> 00:45:59,650 to include into the , into the network . 1110 00:45:59,660 --> 00:46:02,140 I I understand that some of the 1111 00:46:02,140 --> 00:46:04,700 Independent pharmacy specifically in 1112 00:46:04,700 --> 00:46:06,867 the initial bid felt like they did not 1113 00:46:06,867 --> 00:46:09,033 have an opportunity to compete for the 1114 00:46:09,033 --> 00:46:10,710 tricare . We released another 1115 00:46:10,720 --> 00:46:14,370 opportunity on one January I believe 1116 00:46:14,380 --> 00:46:17,140 and receive the response from another 1117 00:46:17,140 --> 00:46:19,140 round of independent and grew those 1118 00:46:19,140 --> 00:46:21,430 numbers of independent pharmacies , uh 1119 00:46:21,440 --> 00:46:24,380 specifically for Kansas . 1120 00:46:24,390 --> 00:46:28,160 Uh 55% of the pharmacies or chain 1121 00:46:28,160 --> 00:46:31,540 pharmacies and 45% of Of the 1122 00:46:31,550 --> 00:46:34,660 pharmacies that are contracted with the 1123 00:46:34,660 --> 00:46:37,310 SIR . Independent pharmacies 1124 00:46:37,320 --> 00:46:40,250 acknowledge that in rural areas , the 1125 00:46:40,260 --> 00:46:43,740 burden of the field , when we say 98% 1126 00:46:43,750 --> 00:46:46,500 of individuals are 15 minutes from a 1127 00:46:46,500 --> 00:46:48,556 network contract that will be in the 1128 00:46:48,556 --> 00:46:49,889 letter that we send you 1129 00:46:49,889 --> 00:46:53,580 98% 1130 00:46:53,760 --> 00:46:57,290 drive time for Kansas beneficiaries is 1131 00:46:57,290 --> 00:47:01,200 95% of them are within 15 minutes 1132 00:47:01,200 --> 00:47:03,311 of a pharmacy . And that leaves about 1133 00:47:03,311 --> 00:47:05,630 3000 of your constituents that have to 1134 00:47:05,630 --> 00:47:09,560 travel a little bit beyond 15 minutes . 1135 00:47:09,570 --> 00:47:13,280 99% is overall number . Once we go 1136 00:47:13,290 --> 00:47:15,500 outside of 15 minutes , within 30 1137 00:47:15,500 --> 00:47:17,930 minutes , I would push back or just 1138 00:47:17,940 --> 00:47:21,200 make the case that pharmacy is not just 1139 00:47:21,200 --> 00:47:24,690 a commodity . It's a relationship . And 1140 00:47:24,700 --> 00:47:27,560 our service , men and women have been 1141 00:47:27,560 --> 00:47:29,727 having have had that relationship with 1142 00:47:29,727 --> 00:47:31,949 their pharmacy insist for a long time . 1143 00:47:32,220 --> 00:47:35,000 Uh and to be told that it's no longer 1144 00:47:35,000 --> 00:47:37,460 an option and the pharmacist indicating 1145 00:47:37,460 --> 00:47:40,330 they had no option to continue uh is 1146 00:47:40,330 --> 00:47:42,810 still problematic to me . The 1147 00:47:42,810 --> 00:47:44,921 transition apparently was driven by a 1148 00:47:44,921 --> 00:47:46,921 2,019 independent analysis that the 1149 00:47:46,921 --> 00:47:48,921 department seems to be unwilling to 1150 00:47:48,921 --> 00:47:51,040 provide to me . Is there a reason you 1151 00:47:51,040 --> 00:47:53,910 cannot share that analysis so that I 1152 00:47:53,910 --> 00:47:57,890 and others can analyze the methodology 1153 00:47:57,890 --> 00:48:00,057 by which you reach these conclusions . 1154 00:48:00,057 --> 00:48:02,279 I actually don't have that answer , but 1155 00:48:02,279 --> 00:48:04,446 I will get back to you . Alright . And 1156 00:48:04,446 --> 00:48:06,446 Dr Martinez , my time has run but I 1157 00:48:06,446 --> 00:48:08,612 held your nomination . I put a hold on 1158 00:48:08,612 --> 00:48:10,557 your nomination because of lack of 1159 00:48:10,557 --> 00:48:12,557 cooperation from the Defense Health 1160 00:48:12,557 --> 00:48:16,270 Agency . I lifted that hold with 1161 00:48:16,280 --> 00:48:18,570 it served its purpose . I lifted that 1162 00:48:18,580 --> 00:48:21,920 well , it presumably fulfilled its 1163 00:48:21,920 --> 00:48:24,087 purpose . I lifted that hold and voted 1164 00:48:24,087 --> 00:48:26,980 for your confirmation . The commitment 1165 00:48:26,980 --> 00:48:29,147 was that I would have the answers that 1166 00:48:29,147 --> 00:48:31,147 I've been seeking since October and 1167 00:48:31,147 --> 00:48:33,830 often since then by March , the 1st 1168 00:48:33,840 --> 00:48:36,062 March , the first has come and gone . I 1169 00:48:36,062 --> 00:48:38,270 would ask for your help in fulfilling 1170 00:48:38,270 --> 00:48:41,990 that commitment to me , sir . I , I 1171 00:48:41,990 --> 00:48:44,160 thank you and I thank all the members 1172 00:48:44,170 --> 00:48:46,780 for supporting my confirmation process . 1173 00:48:46,790 --> 00:48:49,440 And yeah , hold me up to that . 1174 00:48:49,450 --> 00:48:53,260 Uh Miss Mullen said that 1175 00:48:53,260 --> 00:48:56,680 response would be , I may be 1176 00:48:56,680 --> 00:48:58,624 satisfied , but let's see what the 1177 00:48:58,624 --> 00:49:01,240 response is . Thank you . Um I just 1178 00:49:01,240 --> 00:49:03,407 want to touch on this . I'm very proud 1179 00:49:03,407 --> 00:49:05,573 of this committee because there's some 1180 00:49:05,573 --> 00:49:07,740 really good people in this committee . 1181 00:49:07,740 --> 00:49:09,907 One of our jobs is oversight . I don't 1182 00:49:09,907 --> 00:49:09,800 need to tell you guys over half the 1183 00:49:09,800 --> 00:49:11,633 money we appropriate goes to the 1184 00:49:11,633 --> 00:49:13,356 military . If somebody on this 1185 00:49:13,356 --> 00:49:15,300 committee wants an answer , unless 1186 00:49:15,300 --> 00:49:17,300 there's a classified reason for not 1187 00:49:17,300 --> 00:49:19,522 having that answer , we should get that 1188 00:49:19,522 --> 00:49:21,578 answer and we should get it in short 1189 00:49:21,578 --> 00:49:23,840 order . And so , um , I don't think 1190 00:49:23,850 --> 00:49:25,683 there should be any reason for a 1191 00:49:25,683 --> 00:49:27,850 senator and this goes for you guys and 1192 00:49:27,850 --> 00:49:30,180 anybody is listening on this committee 1193 00:49:30,190 --> 00:49:32,750 when we're appropriating the money not 1194 00:49:32,750 --> 00:49:35,640 to get the answers we need . Um , it's 1195 00:49:35,640 --> 00:49:39,400 unacceptable , Senator Baldwin . Thank 1196 00:49:39,400 --> 00:49:42,640 you , Mr Chair , um , uh Dr Martinez 1197 00:49:42,640 --> 00:49:44,960 Lopez . Um , as the department is well 1198 00:49:44,960 --> 00:49:47,470 aware , the National Guard has become 1199 00:49:47,470 --> 00:49:50,360 an integral part of our total force , 1200 00:49:50,370 --> 00:49:53,160 one on which we've relied very heavily 1201 00:49:53,170 --> 00:49:55,910 uh for the past 20 years for the global 1202 00:49:55,910 --> 00:49:58,740 war on terror and , and a long list of 1203 00:49:58,750 --> 00:50:01,850 other missions . Increasingly , we have 1204 00:50:01,850 --> 00:50:04,500 seen the National Guard activated on 1205 00:50:04,500 --> 00:50:06,333 short notice to support national 1206 00:50:06,333 --> 00:50:08,920 priorities such as pandemic response , 1207 00:50:08,920 --> 00:50:12,230 domestic unrest . Um and securing our 1208 00:50:12,230 --> 00:50:15,480 southern border for the increasing 1209 00:50:15,480 --> 00:50:17,810 reliance on short notice deployments , 1210 00:50:17,810 --> 00:50:21,130 makes readiness a very key concern 1211 00:50:21,140 --> 00:50:24,290 for both the National Guard and for 1212 00:50:24,300 --> 00:50:27,460 this committee . Um according to the 1213 00:50:27,460 --> 00:50:31,330 National Guard , over 66,000 1214 00:50:31,340 --> 00:50:33,173 guard members do not have health 1215 00:50:33,173 --> 00:50:37,030 insurance . Would you agree that 1216 00:50:37,030 --> 00:50:38,980 providing health coverage to all 1217 00:50:38,980 --> 00:50:40,924 National Guard members would be an 1218 00:50:40,924 --> 00:50:43,660 important part of improving readiness ? 1219 00:50:46,370 --> 00:50:48,660 Senator Collins said the health of the 1220 00:50:48,660 --> 00:50:52,080 garment or reservist active duty is , 1221 00:50:52,090 --> 00:50:54,460 is the most important to all of us in 1222 00:50:54,460 --> 00:50:56,800 the department and the good news is 1223 00:50:56,800 --> 00:50:59,570 because of you . They haven't . The 1224 00:50:59,570 --> 00:51:02,130 first option is the Tricare Reserve 1225 00:51:02,130 --> 00:51:05,170 select . So many of the members of the 1226 00:51:05,180 --> 00:51:07,236 Guard and the Reserves , we have the 1227 00:51:07,236 --> 00:51:09,347 option to enroll in that program . If 1228 00:51:09,347 --> 00:51:11,180 we want to expand that program , 1229 00:51:11,180 --> 00:51:13,236 obviously , we're gonna have to look 1230 00:51:13,236 --> 00:51:15,347 more in details of what does it imply 1231 00:51:15,347 --> 00:51:17,560 that brings me to my second question . 1232 00:51:17,570 --> 00:51:19,737 Would you agree that if a Guard member 1233 00:51:19,737 --> 00:51:23,240 cannot afford Tricare Reserve select 1234 00:51:23,250 --> 00:51:25,950 and they lack access to other forms of 1235 00:51:25,950 --> 00:51:28,710 health care that we should find a way 1236 00:51:28,720 --> 00:51:30,050 to get them covered ? 1237 00:51:34,150 --> 00:51:36,350 We really need , we need to figure out 1238 00:51:36,350 --> 00:51:38,920 a way to care for . We need to figure 1239 00:51:38,920 --> 00:51:41,390 out a way to , to , to make the health 1240 00:51:41,390 --> 00:51:43,740 care that they need available . So , 1241 00:51:43,750 --> 00:51:45,820 yes , I agree . I don't know how 1242 00:51:45,830 --> 00:51:47,886 obviously we're gonna have to do the 1243 00:51:47,886 --> 00:51:51,250 studies , but we have a bill for you . 1244 00:51:51,260 --> 00:51:54,480 But additionally , can you speak 1245 00:51:54,490 --> 00:51:58,240 to any impact to or cost 1246 00:51:58,240 --> 00:52:00,650 savings for the Reserve Health 1247 00:52:00,650 --> 00:52:03,060 Readiness Program ? If we were to 1248 00:52:03,060 --> 00:52:06,840 achieve 100% health care coverage for 1249 00:52:06,840 --> 00:52:09,007 members of both the National Guard and 1250 00:52:09,007 --> 00:52:12,480 Reserve components , Mama , I'm not 1251 00:52:12,480 --> 00:52:14,424 prepared to talk about that . So I 1252 00:52:14,424 --> 00:52:16,424 really would like to do a study and 1253 00:52:16,424 --> 00:52:19,060 look at the information , my background 1254 00:52:19,070 --> 00:52:22,250 so I can make a formal statement . Um 1255 00:52:22,260 --> 00:52:24,850 Dr Martinez Lopez in recent years , 1256 00:52:24,850 --> 00:52:26,794 I've sought and achieved increased 1257 00:52:26,794 --> 00:52:29,320 funding for organizations within the 1258 00:52:29,320 --> 00:52:31,400 National Guard to hire additional 1259 00:52:31,410 --> 00:52:34,330 mental health providers and to expand 1260 00:52:34,330 --> 00:52:36,980 efforts to educate uh civilian 1261 00:52:36,980 --> 00:52:39,950 providers on intervention strategies . 1262 00:52:40,390 --> 00:52:42,880 We have also worked to include suicide 1263 00:52:42,880 --> 00:52:45,560 prevention as a topic eligible for 1264 00:52:45,560 --> 00:52:47,680 funding through the Congressional Lee 1265 00:52:47,680 --> 00:52:51,020 directed medical research program . But 1266 00:52:51,020 --> 00:52:53,370 despite these efforts , suicide rates 1267 00:52:53,370 --> 00:52:55,770 have remained stagnant among the 1268 00:52:55,770 --> 00:52:58,290 reserve and guard populations . Since 1269 00:52:58,290 --> 00:53:01,780 2011 . Last month , the department 1270 00:53:01,780 --> 00:53:03,940 released its recommendations from the 1271 00:53:03,940 --> 00:53:06,520 suicide prevention and response in 1272 00:53:06,530 --> 00:53:09,580 independent review committee . I 1273 00:53:09,580 --> 00:53:11,870 particularly appreciate the reports , 1274 00:53:11,880 --> 00:53:14,240 holistic view of mental health and the 1275 00:53:14,240 --> 00:53:16,420 inclusion of factors that while not 1276 00:53:16,420 --> 00:53:18,780 directly related to clinical care . 1277 00:53:18,790 --> 00:53:21,560 Nevertheless impact prevention efforts . 1278 00:53:21,570 --> 00:53:23,640 For example , the report recommends 1279 00:53:23,640 --> 00:53:26,500 properly funding morale , welfare and 1280 00:53:26,500 --> 00:53:29,920 recreation programs , particularly on 1281 00:53:29,920 --> 00:53:32,700 smaller and remote installations as 1282 00:53:32,700 --> 00:53:35,710 well as recommending spousal employment 1283 00:53:35,710 --> 00:53:38,140 programs . What is your assessment of 1284 00:53:38,140 --> 00:53:40,950 how we can better apply resources to 1285 00:53:40,950 --> 00:53:44,540 make progress in reducing this suicide 1286 00:53:44,540 --> 00:53:48,160 tragedy ? Mom , 1287 00:53:50,120 --> 00:53:54,050 the we , as I said before , the 1288 00:53:54,050 --> 00:53:56,161 public health approach is a way to go 1289 00:53:56,161 --> 00:53:58,210 personally . I believe that as a 1290 00:53:58,210 --> 00:54:01,590 physician , we need to look at three 1291 00:54:01,590 --> 00:54:03,646 things . We need to look at the risk 1292 00:54:03,646 --> 00:54:05,646 factors are affecting these service 1293 00:54:05,646 --> 00:54:07,950 members And figure out a way to relieve 1294 00:54:07,960 --> 00:54:10,127 them from those risk factors , right ? 1295 00:54:10,127 --> 00:54:12,349 If we're not paying them on time , that 1296 00:54:12,349 --> 00:54:14,460 may increase the risk factors , so we 1297 00:54:14,460 --> 00:54:16,460 should be able to figure out how to 1298 00:54:16,460 --> 00:54:18,627 give them payment on time . If there's 1299 00:54:18,627 --> 00:54:20,738 a family , family issues , we need to 1300 00:54:20,738 --> 00:54:22,627 figure out how to deal with those 1301 00:54:22,627 --> 00:54:24,738 family issues . So we need to look at 1302 00:54:24,738 --> 00:54:26,904 those risk factors and we need to look 1303 00:54:26,904 --> 00:54:28,904 at from the preventive standpoint , 1304 00:54:28,904 --> 00:54:31,071 look at ways to decrease them . That's 1305 00:54:31,071 --> 00:54:33,238 issue one Issue two . On the treatment 1306 00:54:33,238 --> 00:54:35,349 side , we need to figure out new ways 1307 00:54:35,349 --> 00:54:37,404 to deliver the care . First thing we 1308 00:54:37,404 --> 00:54:39,516 need to figure out is right care with 1309 00:54:39,516 --> 00:54:41,682 the right provider at the right time . 1310 00:54:41,682 --> 00:54:43,904 So we have to make that right on target 1311 00:54:43,904 --> 00:54:46,071 because you don't have that many . And 1312 00:54:46,071 --> 00:54:48,016 and would you agree that zero cost 1313 00:54:48,016 --> 00:54:50,480 health care to all members of our armed 1314 00:54:50,480 --> 00:54:53,370 forces regardless of duty status is an 1315 00:54:53,370 --> 00:54:56,140 important component of accessing that 1316 00:54:56,140 --> 00:54:59,350 prevention care and treatment . 1317 00:55:02,340 --> 00:55:05,470 Mom . I will have to think and see what 1318 00:55:05,470 --> 00:55:07,692 the repercussions of that before I make 1319 00:55:07,692 --> 00:55:10,130 a statement one way or the other . 1320 00:55:12,150 --> 00:55:15,570 Senator Murkowski . Thank you , Mr 1321 00:55:15,570 --> 00:55:19,420 Chairman and thank you to all those 1322 00:55:19,420 --> 00:55:21,476 that are part of the panel here this 1323 00:55:21,476 --> 00:55:24,210 morning . Um I , I know that there has 1324 00:55:24,210 --> 00:55:28,060 been discussion about the , the 1325 00:55:28,070 --> 00:55:30,292 suicide prevention Response Independent 1326 00:55:30,292 --> 00:55:34,230 Review Committee report on , um , 1327 00:55:34,240 --> 00:55:36,760 the impact of suicide within the 1328 00:55:36,760 --> 00:55:38,960 military . This is something that we 1329 00:55:38,960 --> 00:55:41,590 have been very keenly focused on in , 1330 00:55:41,600 --> 00:55:45,280 in Alaska . Uh , our 1331 00:55:45,290 --> 00:55:47,560 focus really has been on , on Fort 1332 00:55:47,560 --> 00:55:50,140 Wayne , right along with , um , I'll 1333 00:55:50,140 --> 00:55:52,280 send air force base . Both of these 1334 00:55:52,280 --> 00:55:54,620 were identified for site visits and 1335 00:55:54,620 --> 00:55:57,120 Secretary Austin's , uh , independent 1336 00:55:57,120 --> 00:55:58,898 Committee to review the suicide 1337 00:55:58,898 --> 00:56:01,064 prevention reports . I'm sure that you 1338 00:56:01,064 --> 00:56:04,410 are well aware of that . Um , 1339 00:56:04,420 --> 00:56:06,700 I guess this would be a question for 1340 00:56:06,700 --> 00:56:10,010 you , Dr Marty Martinez Lopez . Um , 1341 00:56:10,010 --> 00:56:13,720 and the , I'm curious to know what 1342 00:56:13,720 --> 00:56:16,840 level you all will be working will be 1343 00:56:16,840 --> 00:56:19,370 involved in , in , in Secretary 1344 00:56:19,370 --> 00:56:22,710 Austin's implementation , working group . 1345 00:56:22,720 --> 00:56:25,880 And , and as you , as you answer that I 1346 00:56:25,880 --> 00:56:29,370 would ask for , um , 1347 00:56:29,610 --> 00:56:31,810 I'd ask for your commitment to visit 1348 00:56:31,820 --> 00:56:34,630 some of our bases in Alaska as you look 1349 00:56:34,630 --> 00:56:36,630 at that proposed suicide prevention 1350 00:56:36,630 --> 00:56:39,860 report . And I , I would , um , suggest 1351 00:56:39,860 --> 00:56:42,270 that starting at Fort Wainwright would 1352 00:56:42,270 --> 00:56:44,510 be a pretty good place to begin . Um , 1353 00:56:44,510 --> 00:56:47,530 and then , uh , I don't know if you are 1354 00:56:47,530 --> 00:56:50,330 a walker , but , um , I encourage you 1355 00:56:50,330 --> 00:56:53,660 to take the three mile walk from the 1356 00:56:53,660 --> 00:56:56,290 furthest barrack , it was built back in 1357 00:56:56,290 --> 00:56:59,270 the 50s to the outdated and too small 1358 00:56:59,270 --> 00:57:02,500 dining facility . Um , there at 1359 00:57:02,500 --> 00:57:05,460 Wainright , um , the sun's coming on 1360 00:57:05,460 --> 00:57:07,650 and it's getting warmer , but I would 1361 00:57:07,650 --> 00:57:09,817 challenge you to do it in the dark and 1362 00:57:09,817 --> 00:57:11,980 at 30 below as , as many of our 1363 00:57:11,990 --> 00:57:13,990 soldiers have to do so , if you can 1364 00:57:13,990 --> 00:57:16,170 speak to that , ma'am . Thank you for 1365 00:57:16,170 --> 00:57:18,392 the invitation . But I already accepted 1366 00:57:18,392 --> 00:57:21,130 the distinguished senator from , from 1367 00:57:21,130 --> 00:57:23,352 Alaska when I was doing my hearings . I 1368 00:57:23,352 --> 00:57:25,574 have two places . I need to go the same 1369 00:57:25,574 --> 00:57:27,686 topic , Alaska and North Dakota . I'm 1370 00:57:27,686 --> 00:57:30,180 working in now in April . So I hope to 1371 00:57:30,190 --> 00:57:33,360 be able to have been there . I did the 1372 00:57:33,360 --> 00:57:35,304 Arctic Survival School a couple of 1373 00:57:35,304 --> 00:57:37,416 years back when I was doing aerospace 1374 00:57:37,416 --> 00:57:39,582 medicine . So for a Puerto Rican to be 1375 00:57:39,582 --> 00:57:41,860 out there in Alaska during those times , 1376 00:57:41,860 --> 00:57:43,971 you know , we have significant Puerto 1377 00:57:43,971 --> 00:57:46,193 Rican population out of Fort Greely and 1378 00:57:46,193 --> 00:57:48,740 they love it there . Yes , ma'am . I 1379 00:57:48,750 --> 00:57:52,190 survived , obviously . Uh Yes , this 1380 00:57:52,190 --> 00:57:55,480 issue of uh I already told you , I mean , 1381 00:57:55,490 --> 00:57:58,460 this issue of suicide and mental health 1382 00:57:58,460 --> 00:58:00,990 is very , is very important to me . 1383 00:58:01,000 --> 00:58:03,167 I'll be working with the team and I'll 1384 00:58:03,167 --> 00:58:05,210 be working with the secretary to 1385 00:58:05,210 --> 00:58:07,590 address what we can do . Short term , 1386 00:58:07,590 --> 00:58:09,646 mid term , long term . This is not a 1387 00:58:10,020 --> 00:58:12,210 done and we're done . It's gonna take 1388 00:58:12,210 --> 00:58:14,432 us a while . It's a journey every day . 1389 00:58:14,432 --> 00:58:16,432 We're gonna learn every day . We're 1390 00:58:16,432 --> 00:58:18,599 gonna deploy new ideas . But I'm gonna 1391 00:58:18,599 --> 00:58:20,599 ask on that if I can just interrupt 1392 00:58:20,599 --> 00:58:22,543 their um because we're going to be 1393 00:58:22,543 --> 00:58:24,810 seeing the President's budget laid down 1394 00:58:24,810 --> 00:58:27,880 here um in the next day or so . 1395 00:58:27,890 --> 00:58:31,440 And my , I don't know if you can speak 1396 00:58:31,450 --> 00:58:34,690 to whether or not we're going to see 1397 00:58:34,700 --> 00:58:38,310 any of the , any of this 1398 00:58:38,570 --> 00:58:42,190 um outlined or projected in the 1399 00:58:42,190 --> 00:58:44,870 President's budget . Are we gonna see 1400 00:58:44,870 --> 00:58:47,270 certain military construction projects 1401 00:58:47,270 --> 00:58:50,880 prioritize certain programs prioritize 1402 00:58:50,880 --> 00:58:53,290 that can perhaps help make a difference ? 1403 00:58:53,300 --> 00:58:56,040 Because we know we've got to do 1404 00:58:56,040 --> 00:58:59,040 something and um just doing the 1405 00:58:59,040 --> 00:59:02,450 studies doesn't necessarily 1406 00:59:04,160 --> 00:59:08,120 save lives My 8th day 1407 00:59:08,120 --> 00:59:10,176 on the job . I really don't know the 1408 00:59:10,176 --> 00:59:12,287 answer to that one . My assumption is 1409 00:59:12,287 --> 00:59:15,280 yes . But can anyone else help me ? 1410 00:59:17,040 --> 00:59:19,151 We , we owe you an answer on that one 1411 00:59:19,151 --> 00:59:21,540 senator . 11 thing I will add within 1412 00:59:21,540 --> 00:59:23,873 the army , we definitely have done that . 1413 00:59:23,873 --> 00:59:26,207 And under General mcconville leadership , 1414 00:59:26,207 --> 00:59:28,318 we have what's called quality of life 1415 00:59:28,318 --> 00:59:30,540 in which the Commanding General General 1416 00:59:30,540 --> 00:59:32,873 has been able through holistic approach , 1417 00:59:32,873 --> 00:59:35,160 you know , been giving resources and um 1418 00:59:35,170 --> 00:59:37,660 uh facilities that we're looking at 1419 00:59:37,660 --> 00:59:40,880 adding the manning of the hospitals . 1420 00:59:40,880 --> 00:59:43,090 So we're taking a holistic approach 1421 00:59:43,090 --> 00:59:45,740 which prioritizes Alaska and , and that 1422 00:59:45,740 --> 00:59:47,684 is one of the chief top concerns , 1423 00:59:47,684 --> 00:59:49,962 priorities . Well , thank you for that . 1424 00:59:49,962 --> 00:59:51,907 And we have included in our Arctic 1425 00:59:51,907 --> 00:59:54,190 Warrior Act provisions um to 1426 00:59:54,190 --> 00:59:56,079 authorizing provisions for troops 1427 00:59:56,079 --> 00:59:58,134 stationed there in Alaska , ones for 1428 00:59:58,134 --> 01:00:00,710 cold weather duty duty pay . The other 1429 01:00:00,710 --> 01:00:02,930 one is a requirement that service 1430 01:00:02,930 --> 01:00:05,900 members in Alaska be reimbursed for , 1431 01:00:05,910 --> 01:00:08,090 for the cost of a flight home . And 1432 01:00:08,090 --> 01:00:09,812 when you think about financial 1433 01:00:09,812 --> 01:00:12,420 stressors , the things that , that just 1434 01:00:12,430 --> 01:00:15,090 people cannot handle anymore if they 1435 01:00:15,090 --> 01:00:17,680 need to be reconnected with family and 1436 01:00:17,680 --> 01:00:19,780 they can't afford the 1437 01:00:20,380 --> 01:00:23,510 $2,003,000 flight home 1438 01:00:23,520 --> 01:00:27,130 or they don't have the cold weather 1439 01:00:27,130 --> 01:00:30,730 gear or another issue that we hear is 1440 01:00:30,740 --> 01:00:34,170 pay systems that the service members , 1441 01:00:34,180 --> 01:00:37,190 um , are literally victims of outdated 1442 01:00:37,190 --> 01:00:39,190 technology . They don't get paid on 1443 01:00:39,190 --> 01:00:41,301 time . We've heard , we've heard from 1444 01:00:41,301 --> 01:00:44,190 some young servicemen that um 1445 01:00:45,460 --> 01:00:47,530 it's taken up to seven months to get 1446 01:00:47,530 --> 01:00:51,170 their paycheck situation squared out . 1447 01:00:51,180 --> 01:00:54,560 I don't know how that works , but you 1448 01:00:54,560 --> 01:00:56,449 know , when you have that kind of 1449 01:00:56,449 --> 01:00:58,782 financial stress on our service members , 1450 01:00:58,782 --> 01:01:02,420 that's not right to them . So I'd like , 1451 01:01:02,430 --> 01:01:05,280 I'd like that again as we're looking 1452 01:01:05,290 --> 01:01:07,512 for considerations to be factored in as 1453 01:01:07,512 --> 01:01:10,070 well , Mr Chairman . Thank you . 1454 01:01:12,380 --> 01:01:14,491 Thank you , Mr Chairman and thank you 1455 01:01:14,491 --> 01:01:16,713 to each of you for your testimony today 1456 01:01:16,713 --> 01:01:18,769 and your service to the country . Um 1457 01:01:18,769 --> 01:01:20,920 Our office is still hearing , 1458 01:01:20,930 --> 01:01:22,880 fortunately not as often but still 1459 01:01:22,880 --> 01:01:24,769 hearing from people who have been 1460 01:01:24,769 --> 01:01:27,047 affected by anomalous health incidents . 1461 01:01:27,047 --> 01:01:30,290 Um Can I don't know if this is for you , 1462 01:01:30,290 --> 01:01:33,980 Dr Martina Lopez ? Um but can you speak 1463 01:01:33,980 --> 01:01:36,140 to how the department's understanding 1464 01:01:36,140 --> 01:01:38,251 of those incidents has evolved and to 1465 01:01:38,251 --> 01:01:40,950 what extent you believe people who have 1466 01:01:40,950 --> 01:01:43,880 been affected , both um military 1467 01:01:43,880 --> 01:01:47,250 members and their civilian family 1468 01:01:47,260 --> 01:01:49,850 have , are being treated now 1469 01:01:50,970 --> 01:01:53,400 overarching mom I mean , we need to 1470 01:01:53,400 --> 01:01:55,400 take care of these people , they're 1471 01:01:55,400 --> 01:01:57,567 sick . So when they come to our system 1472 01:01:57,567 --> 01:01:59,344 department , you know , we have 1473 01:01:59,344 --> 01:02:01,233 interagency agreement and we have 1474 01:02:01,233 --> 01:02:03,344 processes to bring them . You help us 1475 01:02:03,344 --> 01:02:05,456 out with that , we're gonna take care 1476 01:02:05,456 --> 01:02:07,344 of them were still doing research 1477 01:02:07,344 --> 01:02:09,320 trying to figure out the causality 1478 01:02:09,330 --> 01:02:12,880 that's gonna take time . Uh But the 1479 01:02:12,880 --> 01:02:14,991 overarching , like with anything , we 1480 01:02:14,991 --> 01:02:17,102 need to take care of the people first 1481 01:02:17,102 --> 01:02:19,102 and then with the best science , we 1482 01:02:19,102 --> 01:02:21,324 have developed science as we learn more 1483 01:02:21,324 --> 01:02:24,990 close that gap , right ? But 1484 01:02:25,580 --> 01:02:28,950 it doesn't stop . So we're gonna need 1485 01:02:28,950 --> 01:02:31,880 the help from you , from you to sustain 1486 01:02:31,880 --> 01:02:35,200 that effort . And what I have heard 1487 01:02:35,200 --> 01:02:37,311 from people who have been affected is 1488 01:02:37,311 --> 01:02:39,830 that um they especially appreciate the 1489 01:02:39,830 --> 01:02:42,052 care they're able to get at Walter Reed 1490 01:02:42,052 --> 01:02:44,730 Medical Center . Can you tell me if 1491 01:02:44,730 --> 01:02:46,750 Walter Reed is still open to those 1492 01:02:46,750 --> 01:02:49,080 people who have been affected by H I S 1493 01:02:49,080 --> 01:02:51,030 not just within the Department of 1494 01:02:51,030 --> 01:02:53,020 Defense , but across the federal 1495 01:02:53,020 --> 01:02:56,040 government . Mom , we're very proud of 1496 01:02:56,040 --> 01:02:58,151 that team and I think the general can 1497 01:02:58,151 --> 01:03:01,820 speak about that . Yes , Walter Reed is 1498 01:03:01,820 --> 01:03:04,570 continuing to care for age . I thank 1499 01:03:04,570 --> 01:03:06,626 you and , and it will continue to do 1500 01:03:06,626 --> 01:03:08,792 that and it will continue to do that . 1501 01:03:08,792 --> 01:03:12,580 Thank you . Um So I maybe wanna 1502 01:03:12,580 --> 01:03:14,636 ask each of you this question . What 1503 01:03:14,636 --> 01:03:17,400 percentage of your force are women ? 1504 01:03:18,310 --> 01:03:22,150 Um Admiral Gilling Ham , I would have 1505 01:03:22,150 --> 01:03:24,094 to get back to you , Ma'am , but I 1506 01:03:24,094 --> 01:03:27,710 believe it's approximately 30% General 1507 01:03:27,710 --> 01:03:30,720 Miller . Now , 1508 01:03:30,730 --> 01:03:34,370 uh Air Force overall is 21% 1509 01:03:34,380 --> 01:03:37,650 and within the A F M S it's 50% . Thank 1510 01:03:37,650 --> 01:03:39,761 you , ma'am . I'd have to get back to 1511 01:03:39,761 --> 01:03:43,660 you their specific numbers , Dr 1512 01:03:43,660 --> 01:03:46,050 Martinez Lopez across the entire 1513 01:03:46,060 --> 01:03:48,430 military . Can you tell me what it is ? 1514 01:03:48,850 --> 01:03:52,530 18% , and that number is going up . Is 1515 01:03:52,530 --> 01:03:55,240 that correct ? So , the women make up a 1516 01:03:55,240 --> 01:03:58,540 very important part of um those who are 1517 01:03:58,540 --> 01:04:01,000 serving on active duty . Uh 1518 01:04:02,200 --> 01:04:05,440 can perhaps this is for you , General 1519 01:04:05,830 --> 01:04:08,052 Austin , what are , what contraceptives 1520 01:04:08,052 --> 01:04:09,997 are currently available to service 1521 01:04:09,997 --> 01:04:13,230 members ? All contraceptives are 1522 01:04:13,240 --> 01:04:15,970 currently available to um are active 1523 01:04:15,970 --> 01:04:18,130 duty women . Um the defense health 1524 01:04:18,130 --> 01:04:20,720 agencies rolled out uh walk in for 1525 01:04:20,720 --> 01:04:23,680 contraception and all 100 33 of our 1526 01:04:23,690 --> 01:04:26,280 clinics that offer that capability to 1527 01:04:26,280 --> 01:04:28,700 include some of the long acting 1528 01:04:28,700 --> 01:04:31,080 contraception so they can walk in uh 1529 01:04:31,090 --> 01:04:33,430 and be taken care of without a referral 1530 01:04:33,430 --> 01:04:35,520 or an appointment . And is that the 1531 01:04:35,520 --> 01:04:37,353 case for people who are deployed 1532 01:04:37,353 --> 01:04:39,520 overseas as well ? It's a case for the 1533 01:04:39,520 --> 01:04:41,687 people who deployed overseas when they 1534 01:04:41,687 --> 01:04:43,742 have access to the capability within 1535 01:04:43,742 --> 01:04:45,798 the , within the theater . So if the 1536 01:04:45,798 --> 01:04:47,742 clinic provides long acting , then 1537 01:04:47,742 --> 01:04:49,798 they're able to walk in and get Long 1538 01:04:49,798 --> 01:04:51,520 Act . And can you tell me what 1539 01:04:51,520 --> 01:04:53,520 percentage of women are deployed in 1540 01:04:53,520 --> 01:04:55,631 places where they can't get access to 1541 01:04:55,631 --> 01:04:57,687 those contraceptives ? I do not have 1542 01:04:57,687 --> 01:04:59,742 that number of what locations do not 1543 01:04:59,742 --> 01:05:01,909 have the capability to provide it . Um 1544 01:05:01,909 --> 01:05:04,020 Is that something that someone within 1545 01:05:04,210 --> 01:05:06,420 the office is able to provide ? 1546 01:05:09,760 --> 01:05:12,970 We'll take that for action . Okay . Um 1547 01:05:12,980 --> 01:05:16,980 We hear from women um on a pretty 1548 01:05:16,980 --> 01:05:19,360 regular basis who tell us that they are 1549 01:05:19,370 --> 01:05:21,580 in places where they don't have access 1550 01:05:21,590 --> 01:05:23,910 contraceptives . Um 1551 01:05:25,260 --> 01:05:27,560 Service members and their families are 1552 01:05:27,560 --> 01:05:29,600 affected by eating disorders at 1553 01:05:29,610 --> 01:05:31,500 elevated rates compared to their 1554 01:05:31,500 --> 01:05:34,040 civilian counterparts . And the serve 1555 01:05:34,040 --> 01:05:36,660 act was passed in fiscal year 1556 01:05:36,660 --> 01:05:40,440 2022 in the N D A and it was 1557 01:05:40,440 --> 01:05:42,480 designed to expand access to eating 1558 01:05:42,480 --> 01:05:44,702 disorder treatments for service members 1559 01:05:44,702 --> 01:05:46,813 and their families . Can you speak to 1560 01:05:46,813 --> 01:05:48,924 the options that are now available as 1561 01:05:48,924 --> 01:05:51,147 the result of the passage of that ? And 1562 01:05:51,147 --> 01:05:53,369 has it been fully implemented ? I guess 1563 01:05:53,369 --> 01:05:55,258 this is for you Dr Martinez Lopez 1564 01:05:58,770 --> 01:06:01,450 mom . I don't know the answer to that 1565 01:06:01,450 --> 01:06:03,570 one . I owe you a response . Ok . 1566 01:06:03,580 --> 01:06:06,930 Everyone else knows . Okay . Well , 1567 01:06:06,930 --> 01:06:09,810 thank you . I , I think it would be , I 1568 01:06:09,810 --> 01:06:11,977 would appreciate hearing that response 1569 01:06:11,977 --> 01:06:14,032 as I'm sure the full committee would 1570 01:06:14,032 --> 01:06:16,420 subcommittee would and I think as part 1571 01:06:16,420 --> 01:06:18,660 of that it would be helpful to know if 1572 01:06:18,660 --> 01:06:21,630 spouses and Children of service members 1573 01:06:21,640 --> 01:06:25,380 are provided the same level of care 1574 01:06:25,390 --> 01:06:28,430 as active duty service members . Thank 1575 01:06:28,430 --> 01:06:31,610 you . Thank you , Mr Chairman . I want 1576 01:06:31,610 --> 01:06:33,610 to welcome the newest member to our 1577 01:06:33,610 --> 01:06:35,740 subcommittee , Sandra Murphy . Thank 1578 01:06:35,740 --> 01:06:37,796 you very much Mr Chairman . It is an 1579 01:06:37,796 --> 01:06:40,150 honor to join this prestigious 1580 01:06:40,150 --> 01:06:42,039 subcommittee and grateful for the 1581 01:06:42,039 --> 01:06:44,150 opportunity . Thank you all for being 1582 01:06:44,150 --> 01:06:46,840 here today . Um I'm really grateful for 1583 01:06:46,840 --> 01:06:48,784 the chairman . The ranking members 1584 01:06:48,784 --> 01:06:51,250 focus on the suicide epidemic and for 1585 01:06:51,250 --> 01:06:53,417 all the work that you've put into it . 1586 01:06:53,417 --> 01:06:56,620 Um I wanted to talk to you Rear Admiral 1587 01:06:56,620 --> 01:06:59,220 about a very specific case that I 1588 01:06:59,220 --> 01:07:01,510 become intimately and tragically 1589 01:07:01,510 --> 01:07:03,732 familiar with . And that's the death of 1590 01:07:03,732 --> 01:07:05,970 seven sailors on the USS George 1591 01:07:05,970 --> 01:07:08,330 Washington just last year . One of them 1592 01:07:08,330 --> 01:07:11,090 was a Connecticut resident . Um seaman 1593 01:07:11,090 --> 01:07:14,200 recruit Xavier Sander took his own life 1594 01:07:14,210 --> 01:07:17,640 with a service issued firearm . Um 1595 01:07:17,640 --> 01:07:21,350 And you know , by now , you know that 1596 01:07:21,360 --> 01:07:23,920 the conditions on this ship and the 1597 01:07:23,920 --> 01:07:25,753 conditions for these sailors was 1598 01:07:25,753 --> 01:07:27,809 frankly just unacceptable . This was 1599 01:07:27,809 --> 01:07:30,031 obviously a ship that was going through 1600 01:07:30,031 --> 01:07:32,309 a major refueling and complex overhaul . 1601 01:07:32,309 --> 01:07:34,710 The conditions on board required a lot 1602 01:07:34,710 --> 01:07:38,120 of these young men to be sleeping in 1603 01:07:38,120 --> 01:07:41,350 their cars um to be making long trips 1604 01:07:41,350 --> 01:07:43,920 home to get away from the chaotic scene . 1605 01:07:43,920 --> 01:07:45,920 And the access to mental health was 1606 01:07:45,920 --> 01:07:48,520 just completely inadequate sailors who 1607 01:07:48,520 --> 01:07:51,480 were seeking routine care um on a ship 1608 01:07:51,480 --> 01:07:53,930 that had significant conditions 1609 01:07:53,930 --> 01:07:55,960 affecting mental health . Um We're 1610 01:07:55,960 --> 01:07:58,280 facing weights of up to two months for 1611 01:07:58,280 --> 01:08:01,540 care . Um Members of um 1612 01:08:01,550 --> 01:08:04,900 uh seaman recruit 1613 01:08:04,910 --> 01:08:07,330 Sanders division reported that they 1614 01:08:07,330 --> 01:08:09,274 were often hesitant to seek mental 1615 01:08:09,274 --> 01:08:11,441 health treatment through navy channels 1616 01:08:11,441 --> 01:08:13,608 because they were under the impression 1617 01:08:13,608 --> 01:08:15,719 that would affect their future career 1618 01:08:15,719 --> 01:08:17,719 opportunities . Obviously , this is 1619 01:08:17,719 --> 01:08:19,497 exceptional that we had so many 1620 01:08:19,497 --> 01:08:21,663 individuals take their life in a short 1621 01:08:21,663 --> 01:08:23,886 period of time and I know that there is 1622 01:08:23,886 --> 01:08:26,430 still a final investigation that is 1623 01:08:26,440 --> 01:08:29,030 outstanding . But what can you tell me 1624 01:08:29,030 --> 01:08:31,340 today about how we're changing 1625 01:08:31,340 --> 01:08:35,170 conditions for um our seamen who 1626 01:08:35,170 --> 01:08:36,892 are living under these kind of 1627 01:08:36,892 --> 01:08:38,948 conditions and how we're making sure 1628 01:08:38,948 --> 01:08:41,114 that they have access to mental health 1629 01:08:41,114 --> 01:08:43,337 services . Thank you , Senator Murphy . 1630 01:08:43,337 --> 01:08:45,559 Um from , from the Secretary of Navy on 1631 01:08:45,559 --> 01:08:47,614 down , we have taken this issue very 1632 01:08:47,614 --> 01:08:49,781 seriously as we have taken the general 1633 01:08:49,781 --> 01:08:52,740 issue of mental health and suicide 1634 01:08:52,740 --> 01:08:55,100 prevention seriously . Uh I can tell 1635 01:08:55,100 --> 01:08:57,470 you that our immediate response was to , 1636 01:08:57,510 --> 01:09:00,120 was to send a special psychiatric 1637 01:09:00,120 --> 01:09:03,010 response team that was to , that was to 1638 01:09:03,010 --> 01:09:04,810 counsel those who were directly 1639 01:09:04,810 --> 01:09:07,080 affected by these incidents , these 1640 01:09:07,080 --> 01:09:09,840 tragic incidents . We've learned also 1641 01:09:09,840 --> 01:09:12,062 that it's important not only to respond 1642 01:09:12,062 --> 01:09:13,840 acutely but to have a prolonged 1643 01:09:13,840 --> 01:09:16,062 response . And so all of the members of 1644 01:09:16,062 --> 01:09:18,150 the George Washington are , are 1645 01:09:18,160 --> 01:09:20,382 enrolled in what's called Orion , which 1646 01:09:20,382 --> 01:09:22,500 is a periodic check in to assess how 1647 01:09:22,500 --> 01:09:24,833 they're doing and ask if they need help . 1648 01:09:24,833 --> 01:09:27,000 Historically , when we've done this on 1649 01:09:27,000 --> 01:09:29,222 five previous occasions , we have about 1650 01:09:29,222 --> 01:09:31,680 a 20% take rate and we directly do a 1651 01:09:31,680 --> 01:09:33,760 warm handoff for those individuals . 1652 01:09:34,040 --> 01:09:36,450 But the larger issue sir is , is 1653 01:09:36,460 --> 01:09:38,340 ensuring that we're creating a 1654 01:09:38,340 --> 01:09:41,630 resilient force . Uh G W certainly is 1655 01:09:41,630 --> 01:09:44,180 an example of a challenging situation 1656 01:09:44,180 --> 01:09:46,420 to be in a shipyard like that . But our 1657 01:09:46,420 --> 01:09:48,476 sailors and marines face challenging 1658 01:09:48,476 --> 01:09:50,920 situations worldwide and so developing 1659 01:09:50,920 --> 01:09:53,740 force resilience is key uh toward that 1660 01:09:53,740 --> 01:09:55,573 end all of our recruits now grow 1661 01:09:55,573 --> 01:09:57,629 through warrior toughness training . 1662 01:09:57,629 --> 01:09:59,796 They learn stress reduction techniques 1663 01:09:59,796 --> 01:10:02,460 as well as meditation . Uh These are 1664 01:10:02,460 --> 01:10:05,490 reinforced through their training . Um 1665 01:10:05,500 --> 01:10:08,580 In addition , um for the G W and for 1666 01:10:08,580 --> 01:10:10,700 the Greater Navy , we haven't , we 1667 01:10:10,700 --> 01:10:12,700 haven't expanded operational stress 1668 01:10:12,700 --> 01:10:14,922 control program . This is a train , the 1669 01:10:14,922 --> 01:10:17,820 train model . Um In addition , as well , 1670 01:10:17,830 --> 01:10:20,780 our Office of Navy Culture enforced 1671 01:10:20,780 --> 01:10:22,780 resiliency just rolled out a mental 1672 01:10:22,780 --> 01:10:25,390 health playbook which provides tools 1673 01:10:25,390 --> 01:10:28,680 for unit level leaders and beyond uh 1674 01:10:28,690 --> 01:10:30,770 ways to prevent suicide , ways to 1675 01:10:30,770 --> 01:10:32,881 recognize an individual in distress . 1676 01:10:32,881 --> 01:10:35,048 All right , thank you very much . I'll 1677 01:10:35,048 --> 01:10:37,159 look forward to follow up with you on 1678 01:10:37,159 --> 01:10:36,450 that . I just want to sneak in one more 1679 01:10:36,450 --> 01:10:38,228 question and that's to you , Mr 1680 01:10:38,228 --> 01:10:40,339 Assistant Secretary , we talked a lot 1681 01:10:40,339 --> 01:10:42,561 about this independent review committee 1682 01:10:42,561 --> 01:10:44,339 report . Um One of their urgent 1683 01:10:44,339 --> 01:10:47,010 recommendations was to address um 1684 01:10:47,020 --> 01:10:50,830 section 15th Seven of the 2011 NDA 1685 01:10:50,830 --> 01:10:52,820 which prohibits the Secretary of 1686 01:10:52,820 --> 01:10:55,790 Defense from collecting any information 1687 01:10:55,790 --> 01:10:59,570 regarding firearm ownership by 1688 01:10:59,570 --> 01:11:01,830 active duty members . Now , I think 1689 01:11:01,830 --> 01:11:03,830 this was due to some concerns about 1690 01:11:03,830 --> 01:11:05,997 overreach , but I don't think that the 1691 01:11:05,997 --> 01:11:08,163 drafters of that language contemplated 1692 01:11:08,340 --> 01:11:10,451 the fact that it is just good medical 1693 01:11:10,451 --> 01:11:12,700 practice if someone is in crisis to 1694 01:11:12,710 --> 01:11:14,600 inquire as to whether they have a 1695 01:11:14,600 --> 01:11:16,870 firearm at home , whether that firearm 1696 01:11:16,870 --> 01:11:20,170 is properly stored , um and locked . 1697 01:11:20,170 --> 01:11:22,281 And so I'm not gonna ask you for your 1698 01:11:22,281 --> 01:11:24,460 view on the law . Um That's a question 1699 01:11:24,460 --> 01:11:27,370 for us . But as a rule is it good 1700 01:11:27,370 --> 01:11:29,900 medical practice for there to be gag 1701 01:11:29,900 --> 01:11:32,120 orders on physicians as to what 1702 01:11:32,120 --> 01:11:34,790 questions they can ask their patients , 1703 01:11:34,800 --> 01:11:36,911 um , what information they can try to 1704 01:11:36,911 --> 01:11:40,530 solicit from their patients as a 1705 01:11:40,530 --> 01:11:42,752 physician . You know , the relationship 1706 01:11:42,752 --> 01:11:45,400 between my patient and I was kind of 1707 01:11:45,400 --> 01:11:48,370 sacred . I mean , we , we , we talk and 1708 01:11:48,370 --> 01:11:51,560 I expect him to be truthful to me so I 1709 01:11:51,560 --> 01:11:54,040 can help him . So anything that 1710 01:11:54,040 --> 01:11:56,310 interferes with that interferes with 1711 01:11:56,310 --> 01:11:59,330 good medical care . So that my position 1712 01:11:59,330 --> 01:12:01,163 is that , I mean , anything that 1713 01:12:01,163 --> 01:12:03,610 interferes with a good open discussion 1714 01:12:03,610 --> 01:12:05,721 between the patient and the physician 1715 01:12:05,721 --> 01:12:07,832 or provider and Australia physician , 1716 01:12:07,930 --> 01:12:09,986 uh , it's not good for either of the 1717 01:12:09,986 --> 01:12:12,460 two parties . If I don't know , I 1718 01:12:12,460 --> 01:12:14,670 cannot help you and if you cannot tell 1719 01:12:14,670 --> 01:12:18,630 me even worse , so we need your 1720 01:12:18,630 --> 01:12:22,450 help uh , to facilitate that 1721 01:12:22,450 --> 01:12:24,672 process . Great . Thank you very much . 1722 01:12:24,672 --> 01:12:27,006 Thank you , Mr Chairman , Senator Hoban . 1723 01:12:27,006 --> 01:12:29,061 Thanks Mr Chairman . Appreciate it . 1724 01:12:29,061 --> 01:12:31,006 Thanks to all of our witnesses for 1725 01:12:31,006 --> 01:12:33,117 being here and for all you do to keep 1726 01:12:33,117 --> 01:12:35,172 us safe and take care of our men and 1727 01:12:35,172 --> 01:12:37,006 women in uniform . I want to ask 1728 01:12:37,006 --> 01:12:39,117 primarily about , uh , well , first , 1729 01:12:39,117 --> 01:12:41,117 some mental health issues and , and 1730 01:12:41,117 --> 01:12:43,117 making sure that those services are 1731 01:12:43,117 --> 01:12:45,283 available to , uh , are members of the 1732 01:12:45,283 --> 01:12:47,450 armed services . But first , I'm gonna 1733 01:12:47,450 --> 01:12:49,506 ask , uh , Lieutenant General Miller 1734 01:12:49,506 --> 01:12:52,110 Miller about the , the cancer study 1735 01:12:52,110 --> 01:12:54,960 that's being done . Um , in regard to , 1736 01:12:54,970 --> 01:12:58,030 uh , actually , uh , the chairman state , 1737 01:12:58,030 --> 01:13:00,450 the Malmstrom Air Force Base , there 1738 01:13:00,450 --> 01:13:03,790 were a number of uh cancer cases there 1739 01:13:03,790 --> 01:13:05,846 in , in response , the Air Force has 1740 01:13:05,846 --> 01:13:09,160 initiated a study on it to determine 1741 01:13:09,160 --> 01:13:11,216 cause and of course , make sure that 1742 01:13:11,216 --> 01:13:13,382 anyone that needs treatment is getting 1743 01:13:13,382 --> 01:13:15,830 it . Uh I did talk to General , met 1744 01:13:15,830 --> 01:13:19,260 with General Bustier uh commander of 1745 01:13:19,270 --> 01:13:21,580 Global Strike Command uh to ask him 1746 01:13:21,580 --> 01:13:23,740 about it . But my first question for 1747 01:13:23,740 --> 01:13:25,962 you is how do you determine that a case 1748 01:13:25,962 --> 01:13:28,220 of cancer or a group of cases of cancer 1749 01:13:28,230 --> 01:13:30,640 are attributable to any particular 1750 01:13:30,640 --> 01:13:34,390 cause ? Thank you , Senator . And 1751 01:13:34,390 --> 01:13:38,290 yes , uh there is an ongoing study 1752 01:13:38,290 --> 01:13:41,190 now based on General Bustiers request 1753 01:13:41,190 --> 01:13:43,570 as he's been offered the initial 1754 01:13:43,570 --> 01:13:46,600 assessment from our team at UCSF SAM 1755 01:13:46,610 --> 01:13:49,870 and he has elected to uh conduct a 1756 01:13:49,870 --> 01:13:52,470 study that will be led by that team at 1757 01:13:52,470 --> 01:13:55,680 UCSF SAN in cooperation with other 1758 01:13:55,680 --> 01:13:59,650 important agencies , the V A uh 1759 01:13:59,660 --> 01:14:02,500 cancer societies and , and others . 1760 01:14:02,510 --> 01:14:05,410 Uh But what is going on right now is 1761 01:14:05,410 --> 01:14:07,577 there's a 10 member team on the ground 1762 01:14:07,577 --> 01:14:10,540 just left F E Warren where Malmstrom , 1763 01:14:10,540 --> 01:14:14,210 they're headed to minot to assess what 1764 01:14:14,220 --> 01:14:16,220 each base is unique and different , 1765 01:14:16,220 --> 01:14:18,276 what , what the situation is like in 1766 01:14:18,276 --> 01:14:20,387 each area , how that study could best 1767 01:14:20,387 --> 01:14:22,664 be done . Because to get your question , 1768 01:14:22,664 --> 01:14:24,831 it is , it is a complicated question , 1769 01:14:24,831 --> 01:14:26,831 especially when you're dealing with 1770 01:14:26,831 --> 01:14:29,109 multiple different uh airmen guardians , 1771 01:14:29,109 --> 01:14:31,109 different career fields , different 1772 01:14:31,109 --> 01:14:33,276 bases , different time frames and even 1773 01:14:33,276 --> 01:14:35,276 different cancer types to determine 1774 01:14:35,276 --> 01:14:37,164 what might be involved . What the 1775 01:14:37,164 --> 01:14:39,331 incidences and then if possible , what 1776 01:14:39,331 --> 01:14:41,890 might be a positive reason that we 1777 01:14:41,890 --> 01:14:43,890 would then take action on since our 1778 01:14:43,890 --> 01:14:45,557 priority is , is a safety and 1779 01:14:45,557 --> 01:14:47,723 environment and guardians . So this is 1780 01:14:47,723 --> 01:14:49,779 a process that will will continue to 1781 01:14:49,779 --> 01:14:51,946 play out over the next 12 to 14 months 1782 01:14:51,946 --> 01:14:54,001 as we take this very seriously and , 1783 01:14:54,001 --> 01:14:56,223 and try to get to the bottom of some of 1784 01:14:56,223 --> 01:14:58,390 these concerns . Do you have any sense 1785 01:14:58,390 --> 01:15:00,390 of timeline at this point ? 12 , 14 1786 01:15:00,390 --> 01:15:02,557 months is , is a reasonable estimate . 1787 01:15:02,557 --> 01:15:04,557 Now , the study will , will plan on 1788 01:15:04,557 --> 01:15:06,612 stage is , and obviously as they get 1789 01:15:06,612 --> 01:15:06,570 information , if there's something 1790 01:15:06,580 --> 01:15:08,636 actionable prior to that , that will 1791 01:15:08,636 --> 01:15:11,730 happen uh in the same regard , um It 1792 01:15:11,730 --> 01:15:15,700 certain uh certain past may result in 1793 01:15:15,700 --> 01:15:17,756 more work being done that that could 1794 01:15:17,756 --> 01:15:19,922 extend this out . But , but the key is 1795 01:15:19,922 --> 01:15:21,811 timeliness and trying to get this 1796 01:15:21,811 --> 01:15:23,978 completed as quickly as possible , the 1797 01:15:23,978 --> 01:15:25,978 best take care of all that might be 1798 01:15:25,978 --> 01:15:27,922 impacted whether active retire all 1799 01:15:27,922 --> 01:15:29,644 beneficiaries and once again , 1800 01:15:29,644 --> 01:15:31,811 partnering with others , like like the 1801 01:15:31,811 --> 01:15:34,033 veterans administration , understanding 1802 01:15:34,033 --> 01:15:36,144 all the potential could be impacted . 1803 01:15:36,144 --> 01:15:38,367 Thank you . The true North task force . 1804 01:15:38,367 --> 01:15:40,533 True North is something I've worked on 1805 01:15:40,533 --> 01:15:42,756 with the chairman of this committee and 1806 01:15:42,756 --> 01:15:44,756 also uh with Air Force Leadership , 1807 01:15:44,756 --> 01:15:46,867 Secretary of Air Force and so forth . 1808 01:15:46,867 --> 01:15:48,922 Uh In the initiative , the two North 1809 01:15:48,922 --> 01:15:50,930 initiative , is there a concerted 1810 01:15:50,930 --> 01:15:52,708 effort to make sure that you're 1811 01:15:52,708 --> 01:15:55,000 addressing mental health , uh you know , 1812 01:15:55,000 --> 01:15:58,680 care adequately across the missile 1813 01:15:58,690 --> 01:16:01,130 bases . Yes , Senator . Uh That's a 1814 01:16:01,130 --> 01:16:03,400 great question . And true North is , is 1815 01:16:03,410 --> 01:16:06,020 the initiative that the A one community 1816 01:16:06,020 --> 01:16:08,210 in the Air Force is rolling out with 1817 01:16:08,210 --> 01:16:10,740 the focus on mental health in a mere 1818 01:16:10,740 --> 01:16:14,010 framework . SG has something called 1819 01:16:14,010 --> 01:16:16,177 operational support teams that will be 1820 01:16:16,177 --> 01:16:18,399 at minot , that will be at every one of 1821 01:16:18,399 --> 01:16:21,290 our 76 Air Force base is knowing that 1822 01:16:21,300 --> 01:16:23,230 our airmen and guardians two main 1823 01:16:23,230 --> 01:16:25,008 reasons that they are often not 1824 01:16:25,008 --> 01:16:27,230 deployable or have issues . It's mental 1825 01:16:27,230 --> 01:16:29,452 health and it's musculoskeletal . So as 1826 01:16:29,452 --> 01:16:31,563 a part teams , five member teams that 1827 01:16:31,563 --> 01:16:33,730 will be embedded in the med group will 1828 01:16:33,730 --> 01:16:35,841 go out to units for a short period of 1829 01:16:35,841 --> 01:16:38,008 time . 8 to 9 weeks , develop trust do 1830 01:16:38,008 --> 01:16:37,990 prevention . Mental health will 1831 01:16:37,990 --> 01:16:40,400 absolutely be a part of that effort . 1832 01:16:40,440 --> 01:16:42,662 And it's addressing family needs to not 1833 01:16:42,662 --> 01:16:44,884 just the service member , right ? And , 1834 01:16:44,884 --> 01:16:47,051 and that's a great question because uh 1835 01:16:47,051 --> 01:16:49,760 family is equally important . OS T is 1836 01:16:49,760 --> 01:16:51,816 based on the active duty members for 1837 01:16:51,816 --> 01:16:54,038 the Air Force . We've created something 1838 01:16:54,038 --> 01:16:56,316 called developmental behavioral family , 1839 01:16:56,316 --> 01:16:58,316 right in the centers . So there are 1840 01:16:58,316 --> 01:17:00,316 eight hubs presently throughout the 1841 01:17:00,316 --> 01:17:02,371 United States that will address , we 1842 01:17:02,371 --> 01:17:04,538 know that there's quite a few Children 1843 01:17:04,538 --> 01:17:04,000 that are impacted by mental health 1844 01:17:04,000 --> 01:17:07,690 issue that these teams go out to bases 1845 01:17:07,690 --> 01:17:09,801 on a quarterly basis and then support 1846 01:17:09,801 --> 01:17:13,120 virtually from afar . Uh So that a 1847 01:17:13,130 --> 01:17:15,241 Wright Patterson , for example , is a 1848 01:17:15,241 --> 01:17:17,241 hub that could go out to a location 1849 01:17:17,241 --> 01:17:19,241 like a minot and , and provide that 1850 01:17:19,241 --> 01:17:21,463 type of support . Those teams right now 1851 01:17:21,463 --> 01:17:23,580 are focused on Children but could be 1852 01:17:23,580 --> 01:17:26,740 expanded to include adult mental health 1853 01:17:26,740 --> 01:17:28,629 providers that could take care of 1854 01:17:28,629 --> 01:17:31,030 dependent family members that have 1855 01:17:31,030 --> 01:17:33,141 mental health needs . Well , with the 1856 01:17:33,141 --> 01:17:35,308 indulgence of the chairman , one final 1857 01:17:35,308 --> 01:17:37,530 question and make it short , please . I 1858 01:17:37,530 --> 01:17:40,970 am past my time but uh both for um , 1859 01:17:40,980 --> 01:17:44,490 Dr Lester Martinez Lopez and uh and 1860 01:17:44,490 --> 01:17:47,270 also for General Crossland uh through 1861 01:17:47,270 --> 01:17:49,750 Tricare . Are you providing enough 1862 01:17:49,760 --> 01:17:51,910 mental health services and providers 1863 01:17:51,920 --> 01:17:55,760 for our service members ? I'll defer 1864 01:17:55,760 --> 01:17:59,250 to General Crossland . So sir , there's 1865 01:17:59,250 --> 01:18:01,361 not enough in our country to meet the 1866 01:18:01,361 --> 01:18:05,000 demand to be honest with you . So we're 1867 01:18:05,000 --> 01:18:07,220 doing our best with the contract . Um 1868 01:18:07,220 --> 01:18:09,440 And as some of our teammates have 1869 01:18:09,440 --> 01:18:11,380 mentioned , uh taken a much more 1870 01:18:11,380 --> 01:18:13,600 holistic approach , partnering with 1871 01:18:13,610 --> 01:18:15,554 other teammates to help folks with 1872 01:18:15,554 --> 01:18:17,721 their mental health , not just medical 1873 01:18:17,721 --> 01:18:19,888 and it is a focus . It is absolutely a 1874 01:18:19,888 --> 01:18:22,110 focus . Thank you again . Thanks to all 1875 01:18:22,110 --> 01:18:24,332 of you . Thank you , Mr Chairman . Just 1876 01:18:24,332 --> 01:18:26,554 one quick follow up on Senator Heaven's 1877 01:18:26,554 --> 01:18:26,480 questions is for you , General Miller , 1878 01:18:26,490 --> 01:18:30,100 what role is the uh the defense health 1879 01:18:30,100 --> 01:18:32,460 agency playing in the assessment ? 1880 01:18:32,460 --> 01:18:34,404 That's being that the Air Force is 1881 01:18:34,404 --> 01:18:38,210 doing under general , there is a 1882 01:18:38,210 --> 01:18:40,210 partnership there and we're in open 1883 01:18:40,210 --> 01:18:43,200 communication . So the uh health 1884 01:18:43,200 --> 01:18:45,422 Surveillance Division part of the D H A 1885 01:18:45,422 --> 01:18:47,422 is absolutely involved . Uh So it's 1886 01:18:47,422 --> 01:18:49,478 important to us that this is in , in 1887 01:18:49,478 --> 01:18:51,700 all the key organizations are playing a 1888 01:18:51,700 --> 01:18:53,811 role like as I mentioned via American 1889 01:18:53,811 --> 01:18:55,700 Cancer Society and others with an 1890 01:18:55,700 --> 01:18:57,478 interest that once the study is 1891 01:18:57,478 --> 01:18:59,533 completed , we may need to have some 1892 01:18:59,533 --> 01:19:01,644 civilian organizations to be involved 1893 01:19:01,644 --> 01:19:03,850 to be another set of eyes based upon 1894 01:19:03,850 --> 01:19:06,760 the results that we receive . Thank you . 1895 01:19:06,770 --> 01:19:09,120 Um We appreciate all of you , your 1896 01:19:09,120 --> 01:19:11,231 testimony , your opening statements . 1897 01:19:11,231 --> 01:19:13,250 Thank you for being here today . Um 1898 01:19:13,260 --> 01:19:15,930 This was a helpful conversation covered 1899 01:19:15,940 --> 01:19:18,750 a number of topics . Uh but our 1900 01:19:18,750 --> 01:19:20,910 oversight responsibilities will not 1901 01:19:20,910 --> 01:19:22,820 stop here later this week , the 1902 01:19:22,820 --> 01:19:24,931 subcommittee will receive your budget 1903 01:19:24,931 --> 01:19:26,931 request and will conduct a thorough 1904 01:19:26,931 --> 01:19:28,764 review . We ask that you provide 1905 01:19:28,764 --> 01:19:30,598 responses in a timely manner and 1906 01:19:30,598 --> 01:19:32,487 continue to keep a surprise . The 1907 01:19:32,487 --> 01:19:34,542 department's health policy decisions 1908 01:19:34,542 --> 01:19:36,598 and implementation similar to what I 1909 01:19:36,598 --> 01:19:38,709 said earlier in this meeting , uh the 1910 01:19:38,709 --> 01:19:38,600 defense committee will reconvene on 1911 01:19:38,600 --> 01:19:41,750 Tuesday , March 28th at 10 a.m. for a 1912 01:19:41,750 --> 01:19:43,860 hearing with the department for a 1913 01:19:43,860 --> 01:19:45,971 hearing with the Department of Navy . 1914 01:19:45,971 --> 01:19:46,270 We stand in recess .