[House Hearing, 107 Congress]
[From the U.S. Government Publishing Office]
CHEMICAL AND BIOLOGICAL DEFENSE: DOD MEDICAL READINESS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY,
VETERANS AFFAIRS AND INTERNATIONAL
RELATIONS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 7, 2001
__________
Serial No. 107-114
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
______________
U. S. GOVERNMENT PRINTING OFFICE
82-172 WASHINGTON : 2002
___________________________________________________________________________
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COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
ILEANA ROS-LEHTINEN, Florida EDOLPHUS TOWNS, New York
JOHN M. McHUGH, New York PAUL E. KANJORSKI, Pennsylvania
STEPHEN HORN, California PATSY T. MINK, Hawaii
JOHN L. MICA, Florida CAROLYN B. MALONEY, New York
THOMAS M. DAVIS, Virginia ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
BOB BARR, Georgia DENNIS J. KUCINICH, Ohio
DAN MILLER, Florida ROD R. BLAGOJEVICH, Illinois
DOUG OSE, California DANNY K. DAVIS, Illinois
RON LEWIS, Kentucky JOHN F. TIERNEY, Massachusetts
JO ANN DAVIS, Virginia JIM TURNER, Texas
TODD RUSSELL PLATTS, Pennsylvania THOMAS H. ALLEN, Maine
DAVE WELDON, Florida JANICE D. SCHAKOWSKY, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
ADAM H. PUTNAM, Florida DIANE E. WATSON, California
C.L. ``BUTCH'' OTTER, Idaho STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia ------
JOHN J. DUNCAN, Jr., Tennessee BERNARD SANDERS, Vermont
------ ------ (Independent)
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
James C. Wilson, Chief Counsel
Robert A. Briggs, Chief Clerk
Phil Schiliro, Minority Staff Director
Subcommittee on National Security, Veterans Affairs and International
Relations
CHRISTOPHER SHAYS, Connecticut, Chairman
ADAM H. PUTNAM, Florida DENNIS J. KUCINICH, Ohio
BENJAMIN A. GILMAN, New York BERNARD SANDERS, Vermont
ILEANA ROS-LEHTINEN, Florida THOMAS H. ALLEN, Maine
JOHN M. McHUGH, New York TOM LANTOS, California
STEVEN C. LaTOURETTE, Ohio JOHN F. TIERNEY, Massachusetts
RON LEWIS, Kentucky JANICE D. SCHAKOWSKY, Illinois
TODD RUSSELL PLATTS, Pennsylvania WM. LACY CLAY, Missouri
DAVE WELDON, Florida DIANE E. WATSON, California
C.L. ``BUTCH'' OTTER, Idaho STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
Kristine McElroy, Professional Staff Member
Jason Chung, Clerk
David Rapallo, Minority Counsel
C O N T E N T S
----------
Page
Hearing held on November 7, 2001................................. 1
Statement of:
Kingsbury, Nancy, Managing Director for Applied Research and
Methods, General Accounting Office, accompanied by Betty
Ward-Zukerman, Assistant Director, Applied Research and
Methods, General Accounting Office; and William W. Cawood,
Assistant Director, Defense Capabilities and Management,
General Accounting Office.................................. 9
Winkenwerder, William, Assistant Secretary of Defense for
Health Affairs, Department of Defense, accompanied by Lt.
General Paul K. Carlton, Jr., the Surgeon General, U.S. Air
Force, Department of Defense; Lt. General James B. Peake,
the Surgeon General, U.S. Army, Department of Defense; and
Read Admiral Donald C. Arthur, Jr., Deputy Surgeon General,
U.S. Navy, Department of Defense........................... 31
Letters, statements, etc., submitted for the record by:
Kingsbury, Nancy, Managing Director for Applied Research and
Methods, General Accounting Office, prepared statement of.. 12
Kucinich, Hon. Dennis J., a Representative in Congress from
the State of Ohio, prepared statement of................... 5
Winkenwerder, William, Assistant Secretary of Defense for
Health Affairs, Department of Defense, prepared statement
of......................................................... 34
CHEMICAL AND BIOLOGICAL DEFENSE: DOD MEDICAL READINESS
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WEDNESDAY, NOVEMBER 7, 2001
House of Representatives,
Subcommittee on National Security, Veterans Affairs
and International Relations,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:04 a.m., in
room 2154, Rayburn House Office Building, Hon. Christopher
Shays (chairman of the subcommittee) presiding.
Present: Representatives Shays, Putnam, Gilman, Lewis,
Schrock, Kucinich, Allen, Lantos and Tierney.
Staff present: Lawrence J. Halloran, staff director and
counsel; Kristine K. McElroy, professional staff member; Jason
Chung, clerk; Michael Bloomrose, intern; David Rapallo,
minority counsel; and Earley Green, minority assistant clerk.
Mr. Shays. Good morning. I would like to call this hearing
to order and welcome our witnesses and our guests.
The modern battleground can be a toxic and biological
minefield. In far-flung deployments, indigenous diseases,
parasites and environmental exposures pose unique health
threats. Fighting and surviving in battle space contaminated by
chemical and biological weapons demand medical countermeasures
and treatment capabilities beyond those needed to deal with
bullets and bombs.
To be ready to prevail on distant and increasingly dirty
battlefields, the Department of Defense [DOD], is charged to
recruit, train--retrain, train, equip and motivate a force
capable of meeting diverse missions. One critical element of
that readiness mandate is the capacity of medical personnel to
protect the health of the men and women in uniform and, when
necessary, treat the wounds of modern warfare.
The Gulf war brought home some hard lessons about the
adequacy of medical readiness in the face of microbial as well
as military assault. Baseline medical data on deployed troops
was found lacking. Records on the use of vaccines and drugs
against chemical and biological [CB], threats were not kept.
The military services appeared to have different approaches to
health surveillance, training of medical personnel, and
treatment protocols.
Soon after the war, the General Accounting Office [GAO],
and the DOD inspector general [IG], identified a number of
shortcomings in DOD's capacity to provide medical support for
the numbers of contaminated casualties anticipated. In 1996,
the GAO and IG found many of those same problems persisted; so
the subcommittee requested GAO determine what the Department is
doing to adapt military medical force structure and training to
meet emerging CB threats. We asked GAO to assess whether DOD is
augmenting medical rosters with the specialists needed to
diagnose and treat CB casualties, and we wanted to know the
extent all medical personnel are receiving mandatory
standardized training in the treatment of chemical and
biological warfare exposures.
The GAO findings released today indicate DOD has some
efforts under way, but has yet to succeed in reshaping
conventional medical planning to address the unique challenges
of chemical and biological warfare. Training in medical
management of CB casualties is limited, and treatment scenarios
are almost never included in combat exercises.
One intractable aspect of the longstanding disconnect
between the Department's assessment of the CB threat and
medical readiness to meet it appears to be an inability or
unwillingness to approach the problem jointly. The service
branches cling to different assumptions about casualty
estimates and evacuation rates. Based on those assumptions,
each service reaches different conclusions on which and how
many medical personnel will be needed to treat CB injuries.
The war against terrorism is being fought against an
unconventional enemy with no compunction about using
unconventional weapons. Those being sent to fight the war
deserve to know medical support will be available whether they
face tanks or toxins, mines or microbes. To help ensure they
have that support, GAO today made several specific
recommendations to clarify planning assumptions and improve
medical readiness. The Department of Defense will address those
proposals and describe current and planned capabilities to
protect the health of deployed forces.
Our witnesses this morning bring important information and
insights to our oversight of defense medical readiness. We
anticipate their being here--we appreciate their being here and
look forward to their testimony.
At this time I would like to recognize the ranking member,
Mr. Kucinich.
Mr. Kucinich. Thank you, Mr. Chairman.
Good morning, and let me welcome all those who will be
witnesses from the General Accounting Office and the Department
of Defense. I am glad you could be with us today.
Mr. Chairman, thank you for holding this hearing. The topic
is extremely important. Our military has recognized a grave
threat, the threat that chemical or biological agents might be
used against them in the theater of war. They've made some
movement toward dealing with this contingency, but as we will
hear in a few moments, it appears they have not been fully able
to realign and prepare the medical force for this threat.
The General Accounting Office report lays out some
disturbing findings, and the Department of Defense appears to
agree with the majority of them, that the Pentagon leadership
is not providing adequate guidance. They should not have
developed tools--they have not developed tools to determine how
the medical force should be structured, and the services
disagree among themselves on a host of issues. Medics are not
trained sufficiently, and even those that have received
training do not feel they are proficient; that is, if the
military leadership can locate them without a functioning
tracking system in place.
I am glad that the Assistant Secretary is with us today to
respond to these comments and provide us with his view of the
steps DOD must take to overcome these challenges. In his
position he no doubt will play a key role in advocating for
these changes within the Pentagon.
I would highlight, however, one important observation in
the GAO report. While the Assistant Secretary's commitment is
essential, most exercises are controlled by those responsible
for warfighting. As GAO points out, ``concurrence of the
military operation staff will be essential if medical
participation is to be included in combat exercises and not the
first they cut when it gets in the way of other goals or
becomes too hard.'' So in addition to having a task of his own
to focus on as he returns to the Pentagon, I hope the Assistant
Secretary carries this additional message back with him.
Finally, Mr. Chairman, I would like to raise an issue that
I believe is an urgent priority for members of this
subcommittee. As you know, the administration announced last
spring that it was considering reversing the previous
administration by opposing the ongoing international
negotiations for mandatory facility inspections under the
Biological Weapons Convention. I was concerned when I heard
this because I believe that inspections are the core component
of these negotiations. They force proliferators to either hide
their activities at legitimate locations or go underground into
rudimentary and dangerous facilities. Either way their lives
are made more difficult. In fact, Ambassador Mahley himself,
the State Department official in charge of the negotiations,
previously testified before this subcommittee in favor of
inspections, and he said, ``actually talking to scientists and
production workers on the ground as well as observing the
atmospherics at a facility are ways for experienced observers
to detect anomalies. One can never discount either the
whistleblower prospect of an employee or the ineptitude of a
coverup of an elicit activity. While there is no way to judge
the likelihood of such an outcome, the deterrence component is
useful since it complicates the life of a potential
proliferator.''
When the new administration came in, however, Ambassador
Mahley ordered an interagency review of the negotiations.
According to recent press accounts, this review is what spurred
the administration's reversal. Although I was concerned by the
administration's reversal, I was somewhat heartened that this
subcommittee will have the opportunity to conduct its oversight
role and examine the rationale behind the decision.
At a hearing in July, Congressman Tierney asked Ambassador
Mahley to deliver to the subcommittee a copy of the interagency
review he ordered. Congressman Tierney's request would have
allowed us to better understand why the administration saw no
value in continuing to negotiate. Ambassador Mahley agreed to
provide the report, and Mr. Tierney's request was adopted on
the record without objection. Unfortunately this was 4 months
ago, and we've received nothing from the administration in the
meantime. And particularly in light of recent events, I would
have expected the administration to seriously have rethought
its position, but from the press I've seen, it appears they're
going full throttle in an effort to kill the negotiations for
mandatory inspections.
Congresswoman Schakowsky also asked about this at our last
hearing. While acknowledging the State Department officials
were busy with counterterrorism efforts, Ms. Schakowsky rightly
questioned why it had taken the Department so long to deliver
the analysis. This subcommittee recognized Ms. Schakowsky's
concerns and promised they would be addressed. That was over 3
weeks ago, and still the administration has not provided that
information.
This issue has become even more urgent, Mr. Chairman,
because the United States is about to send Ambassador Mahley to
Geneva in 2 weeks to convince the world of our newly reversed
position. We will be telling them that inspections are not
necessary anymore, even though the United States originally
called for them, and even though Ambassador Mahley himself once
listed a litany of reasons we urgently needed them. We will be
telling them that inspections are not necessary anymore even
after September 11th attacks and even after multiple anthrax
attacks.
The administration is sending the Ambassador to Geneva with
a reverse foreign policy predicated on the executive analysis
that Congress has had no opportunity whatsoever to review. Mr.
Chairman, you are planning a December delegation to Geneva for
subcommittee members to discuss these very negotiations, but
without cooperation from the State Department, participation in
such a delegation will be fruitless. I'm really concerned about
how this committee can conduct adequate oversight of
administration policies if the most basic requests are not met
with cooperation. This is a vitally important issue of
inspections under the Biological Weapons Convention. It
definitely needs to be addressed. I hope that all members of
the committee will join in demanding full cooperation from the
administration, and we are certainly at a link between that and
the issue of medical readiness, because if we don't do
something to control the proliferation of biological weapons,
all these hearings are going to be in vain because you will
never be ready. We have to try to stop these weapons at their
inception.
Thank you, Mr. Chairman, for your time.
Mr. Shays. I thank the gentleman.
[The prepared statement of Hon. Dennis J. Kucinich
follows:]
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Mr. Shays. Mr. Schrock is next in line, but I understand he
doesn't have a statement; so I would call on Mr. Gilman.
Mr. Gilman. Thank you, Mr. Chairman.
Chairman Shays, I want to thank you for holding today's
hearing in conjunction with the other hearings you've held on
medical readiness in the event of a bio or chemical attack. We
have to truly examine the overall state of the Department of
Defense's ability to treat casualties resulting from any
chemical or biological attack on U.S. military personnel, and
we're all very much concerned about making certain our military
personnel are properly taken care of as they address some of
the problems confronting our Nation today.
For many years the armed services have placed, regrettably,
a minimal amount of resources into training medical personnel
in the treatment of chemical or biological injuries. While the
possibility existed that these weapons could be used against
our personnel in the field, the fact remained that such forces
had not encountered the use of such agents during World War I
or World War II, and ever since, regrettably and sadly, the
terrible events of September 11th as well as the anthrax
episode last month have sharply focused our national attention
on terrorism and underscored our vulnerability to future
chemical and biological attacks. Indeed the bioterrorism debate
has been transformed from a question of if to the inevitability
of when.
We're dealing with an evil enemy that's fanatical in its
beliefs and apparently has no qualms whatsoever about using any
and all weapons at its disposal, not only nuclear, but
including chemical and biological agents. Given this, it makes
sense for the armed services to adjust their training for
medical personnel to incorporate a greater emphasis on the
diagnosis and treatment of chemical and biological casualties.
Initial examinations of the services' medical structures,
however, are not encouraging. None of the armed services, the
Army, the Navy, the Air Force, even the Coast Guard, have
updated their medical requirements--have not updated their
medical requirements to include chemical/bio scenarios, and
while specialized training is offered, only 37,000 of the more
than 203 medical personnel have received any specialized
chemical/bio warfare training in the past 4 years.
Mr. Chairman, while we cannot expect the military to
overhaul its entire medical training program overnight, we
would expect to see some major changes being planned in the
wake of the events that have occurred since September 11th. We
look forward to hearing from our witnesses today on the
progress that the Department of Defense has made in this now
sadly necessary new requirement as we fight a fanatical enemy.
Thank you, Mr. Chairman.
Mr. Shays. Thank the gentleman.
Mr. Lantos. Not here.
Mr. Tierney.
Mr. Tierney. Mr. Chairman, thank you, but I'm going to put
remarks on the record if I decide to do that, and we will move
this along for you. Thank you.
Mr. Shays. Mr. Allen.
Mr. Allen. Mr. Chairman, I want to thank you. I'll do the
same.
Mr. Shays. And we have Mr. Lewis.
OK. Thank you. I appreciate the Members being here. I know
many of you have many other committee meetings today. Wednesday
is not the day we should have hearings, frankly.
Let me recognize our witness, and we'll swear her in. Her
name is Dr. Nancy Kingsbury, Managing Director for Applied
Research and Methods, U.S. General Accounting Office. Is there
anyone, Doctor, who would possibly be responding to a question
that should stand when we swear you in? If so, that would make
sense to have them do that.
Ms. Kingsbury. Betty Ward-Zukerman and Bill Cawood, who
have done a lot of work on chem/bio issues.
Mr. Shays. OK. Why don't we have them stand up as well, and
we'll swear you all in. Raise your right hands, please.
[Witnesses sworn.]
Mr. Shays. Note for the record all three have responded in
the affirmative. And just before I recognize you to begin your
testimony, I'll take care of some housekeeping here.
I ask unanimous consent that all members of the
subcommittee will be permitted to place an opening statement in
the record, and that the record remain open for 3 days for that
purpose. Without objection, so ordered.
I ask further unanimous consent that all witnesses be
permitted to include their written statements in the record,
and without objection, so ordered.
What we do, Doctor, as I think you know, is we keep the
clock on for 5 minutes, and then we roll it over for another 5
minutes and hope you would finish before you get to 10.
Ms. Kingsbury. I will plan on it, thank you.
STATEMENT OF NANCY KINGSBURY, MANAGING DIRECTOR FOR APPLIED
RESEARCH AND METHODS, GENERAL ACCOUNTING OFFICE, ACCOMPANIED BY
BETTY WARD-ZUKERMAN, ASSISTANT DIRECTOR, APPLIED RESEARCH AND
METHODS, GENERAL ACCOUNTING OFFICE; AND WILLIAM W. CAWOOD,
ASSISTANT DIRECTOR, DEFENSE CAPABILITIES AND MANAGEMENT,
GENERAL ACCOUNTING OFFICE
Ms. Kingsbury. I very much appreciate being here, Mr.
Chairman and members of the committee, to share with you our
work today, and I'm going to give you the very short version of
the main points of our work here this morning since we have the
report that's just out. Everybody can see the details.
You asked us to determine how DOD had adapted its medical
personnel to emerging chemical and biological threats.
Specifically we looked at two things, how DOD and the services
had addressed chemical and biological threats in planning for
medical personnel in their distribution across medical
specialties, and the training provided to medical personnel in
the treatment of chemical and biological casualties.
We found that neither DOD nor the services had
systematically examined the current distribution of medical
personnel across specialties with respect to their adequacy for
chemical and biological defense. Although the services had
begun a review of the staffing of deployable medical units for
chemical warfare scenarios, they had not done so for biological
warfare scenarios. General assessments of requirements have at
best roughly extrapolated from the results of modeling for
other medical requirements to factor in chemical and biological
warfare requirements.
As recommended by DOD studies, joint protocols for treating
chemical and biological casualties have recently been
completed, but agreement has not been reached among the
services on which medical personnel are appropriate to provide
treatment. This is important to provide integration of medical
treatment in the event of an attack.
DOD officials attributed the lack of systemic efforts to
several factors, including the failure to establish chemical
and biological readiness as a medical priority in defense
planning guidance, data and methodological constraints that
complicate the task, disagreements among the services about the
capacity to implement evacuation policy, and pessimism that
medical personnel could effectively treat substantial numbers
of chemical and biological casualties.
In general, service medical planning officials maintain
that specialized training rather than systematic assessment of
needed specialties is the appropriate way to address any need
for additional medical skills in the military setting. However,
we found that the extent of training as well as testing and
exercises for medical management of chemical and biological
casualties is limited. While progress has been made since the
Gulf war in increasing the availability of such specialized
training, the courses are voluntarily and, except for basic
training and daunting chemical protective gear, not widely
attended. From 1997 to 2000, as Mr. Gilman suggested, fewer
than a fifth of the uniformed medical personnel completed any
specialized training, and only about 2\1/2\ percent have taken
the 7-day onsite medical management of chemical and biological
casualties course, which is the most comprehensive training
available.
We note that most training does not currently include
individual proficiency testing, and in one study that we are
aware of where proficiency testing was conducted, proficiency
was not demonstrated in a number of key tasks, such as clearing
airways or controlling bleeding. Notwithstanding these negative
results, however, we think the effort to do proficiency testing
is encouraging.
Even medical personnel who have been trained cannot readily
be identified in the event of an emergency because tracking
systems either do not exist or are not currently functioning.
Thus the availability of trained personnel in a given situation
is uncertain.
Another way the DOD provides combat readiness training is
the conduct of field exercises. However, exercise scenarios
that include chemical and biological defense elements have been
almost nonexistent. For example, the last joint chemical and
biological medical exercise that was completed was in 1994, and
the next one is not planned until 2005. Officials told us that
exercises involving medical support for chemical and biological
casualties were rare because of conflicting priorities
encountered by both warfighters and medical personnel and
because of the difficulty and expense of conducting them.
Officials also said that such exercises are not planned because
of the potential that the chemical or biological elements would
overwhelm the exercise and prevent the other objectives from
being achieved.
In our report we make a number of recommendations to DOD to
resolve these issues, including clarification of the
requirements for chemical and biological contingencies in
defense planning guidance, reaching agreement among the
services and joint staff about which medical personnel are
qualified to provide specific treatments to ensure consistent
approaches in joint activities, developing medical training
requirements for chemical and biological contingencies,
assessing the effectiveness of training with rigorous
proficiency standards and tests, and tracking individual
training and proficiency, and increased chemical and biological
exercises involving medical personnel to an extent commensurate
with current chemical and biological threat assessments.
Given the threat of mass casualties in a chemical and
biological event, exercises should explore the extent of
medical capabilities and the full consequences of scenarios
that overwhelm them.
I think I will stop my statement here, Mr. Chairman. I will
be happy to take your questions.
Mr. Shays. Short, concise, and right to the point.
[Note.--The report entitled, ``chemical and Biological
Defense, DOD Needs to Clarify Expectations for Medical
Readiness,'' may be found in subcommittee files.]
[The prepared statement of Ms. Kingsbury follows:]
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Mr. Shays. Mr. Gilman.
Ms. Kingsbury. I take that as a compliment, sir.
Mr. Shays. You should.
Mr. Gilman. Thank you, Mr. Chairman.
We want to thank GAO for their review at a very critical
time and for your very alarming review of what has been done to
date. Why is chemical and biological training not mandatory?
Ms. Kingsbury. It has not been. I am not actually sure we
know.
Do we know that there have been reasons?
Mr. Gilman. Is there any reason given to you?
Ms. Kingsbury. I suppose there is only so much training
that can be done, and you have to prioritize it.
Mr. Shays. I think you have chairs on either side. This way
you can whisper in their ears if you want.
Mr. Gilman. Why don't you bring your assistants----
Mr. Shays. Hold on 1 second. We will keep the clock
running. The two I swore in, would you please--whom did I swear
in?
Ms. Kingsbury. Bill.
Mr. Shays. Come on.
Mr. Gilman. Don't be shy. We won't bite.
Ms. Kingsbury. Thank you.
In the overall scheme of things, I think training is
something that you spend part of your time on, and you spend
part of your time on your job. It's just the way the priorities
have been. We have noticed, though, that at the same time the
training has been voluntary and not been done, the people who
talk about the threat have been quite alarmist, if you will,
quite concerned about the threat, and perhaps justifiably so as
recent events have shown. So I look forward to your asking the
DOD witnesses about that.
Mr. Gilman. I note in your report that key readiness--I'm
quoting from your report on page 3--key readiness evaluations
used to advise the President on readiness to implement the
national security strategy had never set a scenario for the
unified commanders requiring medical support for weapons of
mass destructions, and officials told you that CB medical
support is rarely exercised because of conflicting priorities
encountered by warfighters and medical staff and because it's
difficult and expensive. Did you explore that any further?
Ms. Kingsbury. I have personally had a couple of
discussions about that because I think it's important to
understand why that happens. My own sense of it, and I have
actually been told by a couple of officials, that the serious
chemical and biological scenarios are showstoppers. They stop
the exercises, and so they just don't do them.
Mr. Gilman. And you also indicate that in sum, the DOD and
the services had not fully addressed weaknesses and gaps in
modeling, planning, training, and tracking or proficiency
testing for the treatment of CB casualties, and resulting
medical structures not being rigorously tested for its capacity
to deliver the required medical support.
Did you explore that with them to see what was going to be
done to correct that?
Ms. Kingsbury. Well, they have agreed with our
recommendations in that regard and note in our report in their
comments that they are planning to do some additional things to
try to address these issues, and I'll be happy to let them talk
about that. We've been making these recommendations since 1993,
and we--that's often a role that GAO plays. We make
recommendations, and agencies do or don't followup on them, and
this is one where I think the story is still a little
disappointing.
Mr. Gilman. Since 1993, you've been making these
recommendations, and there has been no progress?
Ms. Kingsbury. There's been some progress. I think that's
fair to say. They have developed additional training. They are
training more people as we go along, but we still can see gaps
between what they seem to say they need and what is actually
being delivered.
Mr. Gilman. Well, my time has run, but just one last
question. Why has the medical training been limited here in
this area in your----
Ms. Kingsbury. Some officials have told us it's a matter of
expense. Some officials have told us it's a matter of
priorities. It's been limited.
Mr. Gilman. We gather that. All right. I hope we can
explore that further.
Thank you, Mr. Chairman.
Mr. Shays. I thank the gentleman.
Mr. Kucinich.
Mr. Kucinich. Dr. Kingsbury, thank you for your work on
this report, and I would like to address a practical
consequence of this report with this question: If we had ground
troops in Afghanistan, does the Department of Defense have a
medical training structure in place to adequately protect or
respond to soldiers who would be injured by a biological or
chemical weapon attack?
Ms. Kingsbury. Our work predates the Afghan adventure, and
I don't think I want us to talk about whether they have
adequate forces in place. There are representatives in the
military here to deal with that. That's a very----
Mr. Kucinich. But you----
Ms. Kingsbury [continuing]. Sensitive issue, and I would
rather let the Department of Defense answer that question, sir.
Mr. Kucinich. But wait a minute. You gave us a report, Dr.
Kingsbury----
Ms. Kingsbury. I did.
Mr. Kucinich [continuing]. That says as a consequence,
medical readiness for CB scenarios cannot be insured. Did you
say that?
Ms. Kingsbury. In general we support that statement, sir. I
just can't speak to the situation in Afghanistan.
Mr. Kucinich. If you say in your report that the Department
of Defense and services--I am quoting directly--had not fully
addressed weaknesses and gaps in modeling, planning, training,
tracking, or proficiency testing for the treatment of CB
casualties, wouldn't it follow that if we were to have our men
and women on the ground in Afghanistan, and they were subjected
to a biological or chemical weapon assault, that we might not
be able to care for them given this report?
Ms. Kingsbury. I think the phrase ``we might not be able
to'' is a fair statement.
Mr. Kucinich. I thank you. No other questions.
Mr. Shays. Thank you.
Mr. Lewis.
Mr. Lewis. Thank you, Mr. Chairman.
Thank you, Dr. Kingsbury, for your testimony. Why do you
think the medical personnel training has been limited--and the
reason I ask that is because, of course, we're talking about
chemical and biological here, but after all the years that we
faced the threat of a nuclear attack, was there any training
for medical personnel to deal with a major catastrophe in
regards to the nuclear equation that could be brought around to
the possibility of a chemical or biological attack?
Ms. Kingsbury. Well, the military structure--the military
medical structure serves two purposes. It serves a peacetime
purpose, and it serves a wartime purpose, and I think those two
things create a very difficult challenge to make sure you're
prepared for the perhaps unlikely but nonetheless devastating
possibilities of a chemical or biological attack. And this is
made more complicated by the fact that the issues that you need
to address medically for nuclear, chemical or biological are
actually quite different and require different skills.
So it's a very complicated issue, and I wish we saw a
really clear solution to it. We make some recommendations in
our report and hope that the Department of Defense can move
quickly in the right direction.
Mr. Lewis. What are some of those steps that could bring
them in a more positive direction in medical training?
Ms. Kingsbury. Well, we address many of those in our
report. We talk about the need to track who's had the training;
the need to do proficiency testing and make sure that the
people who are there in fact can demonstrate the skills, not
just say they know it; better planning in defense planning
guidance, clearer priority for this. That's what drives what
the warfighters do. That's what drives what DOD ultimately
thinks is going to happen on the battlefield, and I think
that's where it has to start.
Mr. Lewis. OK. Thank you.
Mr. Shays. Thank the gentleman.
At this time recognize Mr. Tierney.
Mr. Tierney. Thank you, Mr. Chairman.
Dr. Kingsbury, thank you for your testimony. In your report
you conclude that the persistence of this troublesome situation
has been caused by one of three factors, a disagreement about
the significance of the threat, the failure of leadership, or
an acceptance of a high level of risk. Can you walk us through
each of those three?
Ms. Kingsbury. Wait a minute. I've just gone blank.
Mr. Tierney. OK. Well, the first one was----
Ms. Kingsbury. What page are you on?
Mr. Tierney [continuing]. A disagreement about the
significance of the threat. The second was a failure of
leadership. The third was an acceptance of a high level of
risk. You know, each of those would contribute in some degree
to the persistence of the situation.
Ms. Kingsbury. Well, let's start with the threat first. I
mean, I think that although there has been a great deal of
commentary about the threat and obvious concern about it, if
you really look in a lot of the places we've looked across a
whole spectrum of issues related to chemical and biological
warfare, the resources, the training, the commitment to meet
the threat doesn't seem to match the level of threat assessment
that's out there, and we've been sort of puzzling about that as
we've put this work together, some of the work that Bill Cawood
has done and others. We really think it starts with that
problem.
With respect to leadership, I point particularly to the
difficulties of achieving a joint outcome here. I think it's
very important because we're fighting jointly increasingly so
that the services get together and reach agreement on how
medical casualties in this arena need to be managed.
And with respect to risk, I think the events of the last
couple of months clearly have heightened our sense that risk is
real, and that the medical difficulties are a real challenge.
Just identifying what's happening is perhaps one of the more
real challenges.
I am encouraged actually by a byproduct of the last 2
months. I am a great believer that if you're looking for
something, you're more likely to find it, and I think that the
last couple of months has heightened perhaps our ability to
detect these things going forward.
Mr. Tierney. Just as a comment, I have to say that when
earlier you were talking about there being a reason for the
services not addressing this gap between the appraisal of the
threats and the Department of Defense medical preparedness to
meet them, as some people say, it's an expense, and some people
say it's the priorities, well, at $330 billion plus in that
Department of Defense budget every year, I would have to say
that it's a lack of responding to your priorities more so than
not a lack of having the money. Or God help us if it's the
other way around.
Of the three items that we just discussed on which you base
your analysis, which one of those do you think is the more
prominent, the primary cause of this situation?
Ms. Kingsbury. Right now I think I need to go back to the
starting point. I think it needs to be sorted out in how DOD is
choosing to plan for warfare going forward. If these priorities
get into the defense planning guidance, they will get fielded.
They will get done. All of the services are very capable of
doing things when they decide to do them. I think it's
important to start there.
Mr. Tierney. On page 10 of your report, you said that the
Army Medical Department officials said they were not authorized
to structure medical care for biological contingencies. I am
wondering what do these medics mean when they say they're not
authorized to prepare for attacks using biological weapons?
Ms. Kingsbury. I'm sorry, sir, where are you?
Mr. Tierney. Page 10. Do you--yeah. Why don't you----
Ms. Ward-Zukerman. I think they were indirectly referring
to the fact that preparation for biological contingencies was
not something that the DPG had directed them to do.
Mr. Tierney. The DPG being?
Ms. Ward-Zukerman. The defense planning guidance.
Mr. Tierney. Did you determine any reason why they hadn't
been directed to do that? I mean, it's pretty amazing at this
point in time to think that they hadn't been.
Ms. Ward-Zukerman. We just, you know, looked at the sort of
the immediate reason that they had not done it.
Mr. Tierney. On the question of evacuations, at least as I
understand it, the faster the injured are removed or lifted
from the area, the fewer medical personnel may be needed in the
field. Is that a fair assessment?
Ms. Kingsbury. Yes, sir.
Mr. Tierney. And in that regard what is the joint and
strategic capabilities plan?
Ms. Kingsbury. The joint and strategic----
Ms. Ward-Zukerman. The joint and strategic capabilities
plan is developed to provide missions to the commanders-in-
chief in the various areas that DOD operates, and it follows
the guidance in the defense that's put together by OSD in the
form of defense planning guidance.
Mr. Tierney. And is there, in fact--one of the things they
talk about is following that pattern of getting the people that
are affected out of the area quickly so that there is less need
for medics on the front line.
Ms. Ward-Zukerman. We didn't specifically look at the joint
strategic capabilities plan, but Army officials did cite
concerns about the actual speed with which people could be
evacuated.
Mr. Tierney. Thank you.
I see my time is up, Mr. Chairman. Thank you.
Mr. Shays. It's my intention to come back, but if the
gentleman would like to ask questions now, he could do that if
he's not coming back.
Mr. Allen. I could do it very quickly.
Mr. Shays. OK. Mr. Allen.
Mr. Allen. Thank you, Mr. Chairman. My questions will be--
I'll try to keep this well under 5 minutes.
Based on your analysis of the availability of medical
personnel in the military services, let's just imagine that the
outbreak of anthrax was an outbreak of smallpox instead. How
many military health care personnel are there available to
treat someone infected with smallpox who's been vaccinated? I
mean, is there anyone in the services among their health care
personnel who can walk in and care for a smallpox victim
without fear of contracting the disease themselves?
Ms. Kingsbury. Mr. Allen, we did not specifically look at
that issue, and with three very distinguished Surgeons General
in the room, I would rather defer that question to them.
Mr. Allen. Mr. Chairman, is there a way to get an answer to
that question either later, or can we bring that out?
Mr. Shays. Let me just ask you. Your response to the
question is based on what?
Ms. Kingsbury. Well, we did--as you well know, Mr.
Chairman, we tend not to want to make observations about things
that were not included in the scope of our work, and we did not
specifically ask questions about the preparation to treat
smallpox victims in the present moment, and I just--I don't
have any basis at all for answering your question. It's not
that I don't think it's a fine question.
Mr. Shays. But I do think that we can ask the next panel
and pursue that.
Ms. Kingsbury. I would prefer that. Thank you, sir.
Mr. Allen. Mr. Chairman, my point was we've been talking
about training of personnel, and that's sort of one area, but
having personnel who can treat patients without being
themselves subject to getting the disease, it seems to me at
least equally important.
Ms. Kingsbury. I would agree with you, and it applies not
only to smallpox, but any other number of biological toxins out
there. I think that's an important part of the bigger picture.
Mr. Shays. We're going to stand at recess. We just have one
vote, and we'll be back----
Ms. Kingsbury. Yes, sir.
Mr. Shays [continuing]. And then we'll finish up.
[Recess.]
Mr. Shays. Call this hearing to order and apologize. We had
two votes, not one.
What I would like to do is first state--I would like to
acknowledge that there appears to be very good will between GAO
and DOD and cooperation between both. And also to express
appreciation that there wasn't an attempt to try to smother
this report or, if there was, that it wasn't something that was
pursued.
Because we're in new territory here. This is, I think, a
very, very significant report but one that needs to be
addressed. I think, frankly, by making sure that this is
public, we have an added incentive to have people understand
why resources need to be spent for DOD. I mean, we are clearly
in a race with the terrorists to shut them down before they
have a better system for chemical and biological weapons,
nuclear waste or nuclear weapons. We're at war, and I think a
lot of people in our country don't fully appreciate it.
We all have to kind of think distinctly. We have to
reorient our military differently. We need to reorient how we
think about foreign aid. We need to do a lot of things. I mean,
I've had some in the military tell me if we had put more
resources into the State Department we might have prevented
some of our military from having to be in some places risking
their lives.
When President Lincoln addressed Congress when--it's
unbelievable to me, but we lost 10,000 men a month for 4 years
in the Civil War. He addressed Congress, and he said, the
dogmas of the quiet past are inadequate to the stormy present.
The occasion is piled high with difficulty, and we must rise
with the occasion. As our case is new, so we must think anew
and act anew. We must disenthrall ourselves, and then we shall
save our country.
My view is that we're all being asked to think anew. And
obviously the military is part of that. So I just want to put
that on the table and say that I don't have a lot of judgment
as to why we're here, but I am interested in what we can do to
see us think anew and act anew.
What I wanted to do was I wanted to go down, Dr. Kingsbury,
the recommendations that you made and understand what each one
was and understand what you think DOD's response was. I'm
referring to page 47 in your report. Specific comments on
recommendations made by DOD. It appears that they basically
concurred with every one.
Ms. Kingsbury. Yes, sir.
Mr. Shays. Is your mic on?
Ms. Kingsbury. It is now, yes, sir.
Mr. Shays. Let me say that so, in your judgment, they
concurred with every one. Is there any one recommendation or
more than one in which you feel they qualified their response
to it?
Ms. Kingsbury. I don't think I would feel that they
qualified their response. At the time they made their response
they said they are taking certain actions, and the actions they
described I would say were the first step necessary to actually
make something happen differently. So, being GAO, we always
maintain a certain healthy skepticism that this is actually
going to move forward in the way it needs to, but it was
certainly a positive first step.
Mr. Shays. What I'm going to do is do 5 minutes, then roll
over for the next 5.
I missed that last sentence, I'm sorry, that last part.
Ms. Kingsbury. The point I'm making, sir, is that they did
concur explicitly with each of our recommendations. Then they
described the steps that they were going to take. The first
step that they were going to take, referring it to the Joint
Planning Council or whatever. As I say, we will be happy to
watch and make sure that something comes from that first step.
Mr. Shays. What I get a sense of is there's an obvious
concern--I had one. I had a concern that they agreed with the
criticisms, but there wasn't a sense of time line or when
certain things would actually take place.
Ms. Kingsbury. That's correct, sir.
Mr. Shays. You had--basically, the GAO recommended the
SECDEF, which is--what is that?
Ms. Ward-Zukerman. Secretary of Defense.
Mr. Shays. For EF? Oh, Secretary of Defense--``address the
gap between the stated CB threat and the current level of
medical readiness by clarifying the Department's expectations
regarding medical preparation for CB contingencies and, as
appropriate, by directing the Joint Staff to integrate
biological medical readiness in DPG.''
And again DPG is----
Ms. Kingsbury. Defense Planning Guidance.
Mr. Shays. That's the key document.
Ms. Kingsbury. Yes.
Mr. Shays. DOD responds, concur. It says, ``As the
coordinating body with the services and the CINCs on issues of
this nature, the Joint Staff will be requested to conduct a
reexamining of CB medical training issues and provide suggested
adjustments to enhance the DOD's medical readiness posture.''
What does that say to you?
Ms. Kingsbury. That says they're going to look at the issue
again. It does not say what solutions they expect to come out
of it.
Mr. Shays. OK. The second recommendation--if you just look
at DOD's response and tell me what you think that's saying and
if you're satisfied with that.
Ms. Kingsbury. Well, again they're going to--they've asked
the Joint Staff to address the issue of what the steps are that
are going to be taken to actually get a Common User Data base
established. It is not evident from this response.
Mr. Shays. So on the second DOD response you would want to
know what steps they're going to take.
Ms. Kingsbury. Yes, sir.
Mr. Shays. OK. The third one.
Ms. Kingsbury. Oh, let's see----
Mr. Shays. They basically are agreeing, and we just need to
know now what ``agree'' means.
Ms. Kingsbury. Well, in this response they do cite certain
NATO standardization agreements which are certainly steps in
the right direction of this effort. But there's a great deal
that needs--I would say there's a great deal that needs to be
done here in terms of the planning models and so forth that
don't at the moment explicitly account for chemical and
biological needs except very roughly.
Mr. Shays. Let me just read on the next page. It says,
``However, if the GAO recommendation pertains to the
evacuation, EVAC, policy, DOD non-concurs.''
So here we have a non-concurs. So what does it relate to?
Ms. Ward-Zukerman. I think that the response that DOD gave
made reference to evacuation policy, but it was our sense that
the real disagreement was about evacuation capability. The Army
officials specifically indicated to us that they had developed
a medical force structure adjusting for the fact that they were
skeptical about the actual evacuation capabilities that would
be available when needed. Their response basically talks about
evacuation policy which there is a policy that's written on
paper that, you know, that is agreed. But the issue is more----
Ms. Kingsbury. Implementation.
Mr. Shays. On recommendation 4, ``the GAO recommended that
the services develop CB medical training requirements and
assess the effectiveness of training with rigorous proficiency
metrics and standards.''
What do you feel their response is there? And what's----
Ms. Kingsbury. Well, again, it's been referred for further
development, and the proof is in the pudding. The
implementation of these--the actual existence of proficiency
tests is what we would ultimately look for to see whether that
recommendation was carried out. We would not conclude that it
was until we began to see some of that----
Mr. Shays. OK.
Ms. Kingsbury [continuing]. In practice.
Mr. Shays. When you get a concurrence, do you then in your
documents respond to the concurrence? In other words, I'm kind
of puzzled why we wouldn't go the next step and say the things
that specifically they need to do some kind of time line to do
it.
Ms. Kingsbury. Well, we certainly continue to follow what
they do. I think as a general matter, unless we have done
specific work that points to a particular solution to a problem
of this sort, we would not substitute our judgment for the
agency's or the service's about how best to do it. We believe
that's their responsibility. We would look to see what they did
and whether it met either the spirit or the literal meaning of
our recommendation, and we do track these over time.
Mr. Shays. The GAO recommendation 5, ``The GAO recommended
that the services develop and maintain information management
systems to monitor completion of required CB training and track
the proficiency of medical personnel, at least for the first
responders and key personnel in high risk areas of
operations.''
Then they say they concur. How did you respond to their
concurrence?
Ms. Kingsbury. Well, they concur with the suggestion which
in principle I would not disagree with which is that it might
be better to actually track proficiency itself, rather than
tracking training. Training is, at best, a surrogate for
proficiency. If they could develop a system to actually track
the proficiency of medical personnel, that would be, in fact, a
better solution. That is, in our experience, probably harder to
do.
Mr. Shays. Let me just say, for DOD's benefit here, I would
love when they--and would expect that they will expound on the
DOD response and give us some kind of sense of what's required
and time lines of some kind, not obviously by month but give us
a sense of what it's going to take to do these things.
The last one, ``The GAO recommended that the Joint Staff,
CINCs and services increase the realistic exercise of medical
support to a level commensurate with current CB threat
assessments. To the extent there is a threat of mass
casualties, exercises should explore the limits of medical
capabilities and the full consequences of the scenarios that
overwhelm them.''
What about this one?
Ms. Kingsbury. Well, as I said earlier, we are concerned
that, as we look at the conduct of exercises, that the exercise
of the medical piece, particularly in the chemical and
biological scenario, is rarely, if ever, addressed. And when we
ask why we are often told it's because it's such a big piece of
it and would get in the way of achieving the other objectives
of the training.
I certainly can be sympathetic to that, but that implies
that if it actually happens you couldn't deal with it, and I
think if we are going to be truly prepared we would have to
have some knowledge of at what point is this manageable with
great effort and at what point is it not and is there anything
we can do about that. Recognizing that this may be a low
probability event in the overall scheme of things, it is a very
high consequence of that. It seems to us that some real
exercises need to be done.
Mr. Shays. I want your definition of low probability. Not
that there would be chemical and biological attacks but they'll
be massive, that they're low probability. It's not low
probability that there will be an attack.
Ms. Kingsbury. Relative to being shot at I expect it's a
lower possibility, but it's perceived as higher now than
before.
Mr. Shays. Is there--you've done an assessment----
Ms. Kingsbury. I don't know what the actual probability is.
The current threat assessments tend to describe it as a low
probability, low consequence attack. That's the only place we
would draw that conclusion. We're not making an independent
assessment of that.
Mr. Shays. You didn't really look at the probability.
Ms. Kingsbury. No, sir. We just looked at what the threat
assessment said.
Mr. Shays. Because I just want to make sure that you're not
kind of giving credibility to something I think is not true.
Ms. Kingsbury. I would not want to do that, sir. Thank you.
Mr. Shays. The bottom line is you made an assumption, if
there was an attack, how could we respond to it. You did not
look at the threat assessment.
Ms. Kingsbury. Well, we looked at it. We did not make an
assessment of it. But I am reflecting what we were told by the
people who were responsible for conducting exercises about why
they did not include these scenarios in the exercises. Those
descriptions were a part of those discussions.
Mr. Shays. Mr. Kucinich.
Mr. Kucinich. I want to go back to something you said a
moment ago that implies if it happened we wouldn't be able to
deal with it. What do you mean? If what happened?
Ms. Kingsbury. If we actually had an attack that resulted
in mass casualties in the battlefield.
Mr. Kucinich. What do you mean we wouldn't?
Ms. Kingsbury. At this point we don't know whether we would
be able to deal with it, because it has not been exercised. The
people who do the exercise believe it can't be dealt with. I'm
talking mass casualties here.
Mr. Kucinich. I understand that. And today in the front
page of the L.A. Times President Bush is quoted as saying the
threat is that terrorists also want chemical and germ weapons,
President warns, as he tries to rally support from abroad. And
in the article it says that the President had not previously
raised such a concern in public, that the terrorist network is
seeking weapons of mass destruction.
Now, in this context which we're in, maybe not when you
first started your report, we've got to look at this current
context.
Ms. Kingsbury. I completely agree with that, sir.
Mr. Kucinich. We are in a conflict now.
Ms. Kingsbury. Yes, sir, we are. And those weapons are
probably out there.
Mr. Kucinich. For the first time we have a President saying
publicly that terrorists are trying to obtain nuclear,
biological, chemical weapons; and we have the GAO saying that
the Department of Defense does not have a structure in place to
protect the health of the troops essentially, if I read your
report correctly.
And I see from other reports, Mr. Chairman, that there's
questions about whether enough vaccines are available from the
private sector. There is even discussion in the government
going on right now about the government itself being involved
in the production of vaccines.
Now, this isn't the question you have to answer, but it's a
question I want our friends from the military to get ready for,
and that is, under these circumstances, how could the military
possibly recommend a ground assault in Afghanistan where our
men and women could be exposed to a biological or chemical
weapons attack and not have structures in place to make sure
that they have some protection?
This is a very serious issue here. The context has changed
from when this report first began to be worked on. And, you
know, I think that we have to remember back in World War I when
soldiers were met with mustard gas, they had no idea of how to
deal with it. You know, the gas mask came up but still there
were people dying in the trenches.
We need to be very--I think this issue that is brought to
this committee of a low-probability, high-consequence effect
needs to be looked at more carefully. Because if the
probability increases, that means that the consequences have to
increase commensurately.
So I appreciate the Chair calling this hearing. But we need
to look at the very severe implications of this for not only
the health care infrastructure of the Department of Defense but
the linkage to military strategic analysis, planning and
initiation. Thank you.
Mr. Shays. If the gentleman would let me followup before
Mr. Putnam, you may want to followup because I may be
qualifying your concern. But I want to make sure you looked
force wide, correct?
Ms. Kingsbury. Yes, sir.
Mr. Shays. So, you know, my recollection when I have had
the opportunity, as this committee has a great opportunity to
do, to be out in the field with some of our special forces,
they do have capabilities that would not be force wide; and I
think that we'll be able to address that later.
But your statement, if this were an all-out attack with
lots of people, we'd have some real challenges. But I think,
frankly, that if the numbers are small, we have that limited
capability to do it.
Mr. Kucinich. If I may, Mr. Chairman, I'm just making my
statement and analysis from what's presented on the record, not
from any secret information I have.
Mr. Shays. It's not that this report--and that's what I
want to clarify. This report was a report done based on looking
at the entire services. You didn't look at any specific,
specific unit or did you?
Ms. Kingsbury. No, in this work we did not. We've had other
work in the past where we have.
I think it's also important to recognize in this report we
only looked at how they do planning for medical resources and
how they train for responding to these kinds of events. We did
not look at equipment and things of that sort as a part of this
work.
Mr. Kucinich. If the Chair would just permit me to make
this observation, and that is it has been broadly stated and
reported in the media that the use of ground troops in
Afghanistan has not been ruled out. So that's why I raise the
issue. I thank the Chair.
Mr. Shays. I think it's very important to make that point.
Is it your intention to stay while we have the testimony of
our second panel?
Ms. Kingsbury. I'm at your disposal, sir.
Mr. Shays. I would welcome that. It may be that we would
want you to just respond or add some clarification.
In your statement which, as I said, was short and to the
point, you attribute the lack of systematic evidence to several
factors, including failure to establish chemical and biological
readiness as a medical priority to defense planning guidance.
There's no dispute about that. That hasn't been done. Data
methodology constraints that complicate the task. Just
elaborate what you mean by that.
Ms. Kingsbury. Well, the whole question--I mean, there are
models that are used and we haven't looked at them in depth to
make a determination about what kinds of medical resources are
needed in the various services and in the various scenarios.
And the data to support those with respect to--certainly to
biological and chemical areas has never been developed because
they haven't actually had any experience on which to develop
them. So it's a very rough kind of order of magnitude kind of
analysis that goes into adding and factoring in chemical and
biological.
Mr. Shays. Disagreements among the services about capacity
to implement evacuation policy. If you could just elaborate,
give it some color, so we know how to ask the--our three
branches what that means. I mean, can you give me some example?
Ms. Kingsbury. One service, if they're on the ground like
the Army, needs to make certain assumptions about how many
people who are casualties can be evacuated by forces provided
by another service, for example, the Air Force. And those
assumptions, when written in planning guidance, the officials
that we met with told us that they did not believe that
capacity would actually be delivered when it was implemented.
So the guidance says that it will be there, but there is
differences of opinion among the warfighters and the medical
folks about whether that would actually happen.
Mr. Shays. Pessimism that medical personnel could
effectively treat substantial numbers of chemical and
biological casualties. In other words, even if they had a plan
or because they don't? In other words----
Ms. Kingsbury. Certainly because they don't. And, again,
the way you work these things out is in planning for exercises
and the like. And if you look at the possibility of an exercise
and mass casualties, I think the people involved in it reach
conclusions that they can't do it and it would stop the
exercise. My own reaction to that is, yes, and it would stop
the battle, so you really ought to think about it. But I think
that's why we raised the issue in that way. It's such a big
problem and everybody understands it to be a very big problem,
almost so big that there haven't been the resources to try to
understand it well enough.
Mr. Shays. And probably the thought that it wouldn't have
to because people wouldn't cross that red line.
Ms. Kingsbury. Right.
Mr. Shays. Which we know after September 11th there is no
red line.
Ms. Kingsbury. Doesn't appear to be.
Mr. Shays. No, there is no red line.
On page 3, you said, even medical personnel who had been
trained could not be readily identified in the event of an
emergency because tracking systems either do not exist or are
not currently functioning. Thus the availability of trained
personnel in a given situation is uncertain.
What we learned with the Gulf war is there were very few
people in the Department of Veterans Affairs and DOD that dealt
with hazards--dealt with what toxic material that you would
deal with in the workplace, and so there weren't a lot of
people who had specialties. In fact, there were only--out of
over 2,000 there were only like 3. And it was so stunning that
it was almost incomprehensible. You couldn't comprehend it. But
what you're saying is, if you have medical personnel who are
trained, we don't really know where they are right now.
Ms. Kingsbury. That's correct.
Mr. Shays. OK. Within the system.
Ms. Kingsbury. That's correct.
Mr. Shays. Let me do this--do you have another question?
Mr. Kucinich. No.
Mr. Shays. I think that your recommendations are on the
record. We know what their response was. Your comment would be
that they agree with the recommendations. It's really a
question of what agree means. In other words, how they go about
implementing the recommendations, what kind of time line
they're on and so on.
Ms. Kingsbury. And what kind of priority it has, yes, sir.
Mr. Shays. Well, we're going to try to give it a high
priority. But I honestly don't think we need to. I think it was
a real wake-up call from hell on September 11th. So thank you
very much, and we'll look forward to maybe calling you back
and, if we do, you have still been sworn in so we'll just
remember that. Thank you.
We'll go to panel No. 2. We have one testimony from Dr.
William Winkenwerder, Assistant Secretary of Defense for Health
Affairs, Department of Defense; accompanied by General Paul K.
Carlton, Jr., Surgeon General, U.S. Air Force; General James B.
Peake, Surgeon General, U.S. Army; and Admiral Donald C.
Arthur, Jr., Deputy Surgeon General, U.S. Navy.
We would welcome you to stand and swear you in. Then we'll
take testimony.
[Witnesses sworn.]
Mr. Shays. Note for the record all four of our witnesses
have responded in the affirmative.
I want to say again from the outset that what we're
ultimately all interested in is how we deal with the
recommendations given, that you concur with them. And we want
to understand the implications. We want to know what kind of
task this represents for the military and how we can be helpful
in getting you to a position I know you all would like to be
in. And also, candidly, the implication of what Mr. Kucinich
raised as well.
So what we're going to do, Doctor, is take your testimony,
and we'll roll over the clock, and invite all of you to respond
to the questions. So thank you for being here.
STATEMENTS OF WILLIAM WINKENWERDER, ASSISTANT SECRETARY OF
DEFENSE FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE, ACCOMPANIED
BY LT. GENERAL PAUL K. CARLTON, JR., THE SURGEON GENERAL, U.S.
AIR FORCE, DEPARTMENT OF DEFENSE; LT. GENERAL JAMES B. PEAKE,
THE SURGEON GENERAL, U.S. ARMY, DEPARTMENT OF DEFENSE; AND READ
ADMIRAL DONALD C. ARTHUR, JR., DEPUTY SURGEON GENERAL, U.S.
NAVY, DEPARTMENT OF DEFENSE
Mr. Winkenwerder. Chairman Shays and distinguished----
Mr. Shays. Is the mic on?
Mr. Winkenwerder. OK. Chairman Shays and distinguished
committee members, thank you for inviting me to appear today
before your committee.
I'm Dr. William Winkenwerder, Assistant Secretary of
Defense for Health Affairs. Today I'm going accompanied by the
Surgeons General from the Air Force and the Army and the Deputy
Surgeon General of the Navy.
I have already submitted a written statement, but with your
permission I would like to make a brief opening statement.
As we all know, the perception of threats posed by
nonconventional weapons has changed dramatically----
Mr. Shays. If you tilt this, bend this up. Like this. So
you don't talk straight in.
Mr. Winkenwerder. Is that OK--has changed dramatically in
the last 8 weeks. As our Nation addresses this threat, DOD
plays a supporting role to civilian authorities where we have
the capability to do so. The Department is working closely with
Federal partners for homeland and defense matters.
DOD is the primary Federal agency responsible for
administering the national disaster medical system and sharing
responsibilities with the Department of Health and Human
Services, FEMA and the VA. We have many capabilities that can
be used in support of civilian agencies to assist in both the
prevention and the management of chemical and biological
attacks, and these DOD assets have been used extensively in the
current response to the domestic anthrax attacks.
Our focus, however, has been and continues to be our men
and women in uniform, not only because their medical readiness
is a critical aspect of the success of any military operation
but also because they are the most important asset. I can tell
you without equivocation that this is my No. 1 priority as
Assistant Secretary of Defense for Health Affairs.
Since coming to this office just 2 weeks ago, I have begun
to review our medical readiness training programs. It is clear
to me that a solid foundation has been laid, much good work has
been done in the past few years, but clearly we can do better.
And I want to emphasize this, the threat is no longer
theoretical. The events in the past 2 months have shifted
priorities. Indeed, my mandate from Secretary Rumsfeld and
Under Secretary Chu is clear, we will focus on a deliberate but
accelerated process for improving our medical readiness
training programs across the board to meet chemical and
biological threats. Secretary Rumsfeld identified this
requirement and this issue of asymmetric threats in his
Quadrennial Defense Review as he has moved the Department from
a threat-based planning model to a capabilities-based model.
I will work closely with the Surgeons General to identify
areas of concern and address those issues directly now.
I will outline some of the actions we plan to undertake in
the Department, but first I want to identify those areas in
which we already have made significant progress.
In recent years the military health system has placed
increased emphasis on chemical and biological readiness.
Training has increased at all levels, from individual training
to the unit level. The military services have developed
numerous training courses and other resources focused on the
medical response to chemical and biological events.
The courses that the Department has conducted on training
materials that have been distributed have been broad and
substantive. We have provided educational opportunities at
every skill level within the range of our medical personnel,
from junior enlisted to speciality physicians. These training
methods vary from in-house, multi-day courses, abbreviated
exportable courses, live and rebroadcast satellite courses,
Web-based courses, printed manuals, newly printed manuals and
handbooks that outline chemical or biological casualty
management. With the added emphasis on domestic response, both
military and civilian health providers have also attended these
courses, I might note.
Additionally, the Uniform Services University at the Health
Sciences has robust and longstanding educational programs in
the medical aspects of chemical and biological terrorism
developed for our military medical students and graduate
students. The university is now actively involved in adapting
these programs to the civilian medical education community in
both traditional and interactive Web-based formats. In this
regard, I believe the value of our military medical educational
institution is a national asset and a national leader in the
development of education in the area of biological and chemical
terrorism.
It's very appropriate that this committee ask where we are
in the Department with respect to medical readiness training in
the areas of responding to chemical, biological or nuclear
threats. In my view, the goal of the military health system
should be to ensure all medical personnel receive appropriate
training commensurate with their medical skill level and that
all necessary medical planning and exercises have occurred that
will ensure our personnel are ready.
Since my swearing in 9 days ago, I have begun reviewing the
basis upon which our military medical readiness plans have been
constructed, the medical infrastructure needed to accomplish
our mission, training requirements of the total medical force,
active and reserve officer and enlisted, and the means by which
we monitor and evaluate the training we provide.
The General Accounting Office's report is helpful. I
believe it provides a road map of many actions that I and the
Surgeons General and others will undertake expediently to
improve our ability to respond to these acts of terrorism.
From my perspective, there are three main prongs related to
medical preparedness for chemical and biological attacks:
prevention, detection and response to the attack.
Prevention of disease remains the preferred course in any
aspect of health care delivery. It's especially true in
considering the consequences of chemical and biological
warfare. With anthrax as the current biological threat and
cause of disease in our citizens, DOD and the services have
taken precautions for the men and women in uniform. We have
ensured that both adequate supplies of antibiotics and proper
guidance are available to the deployment forces.
Additionally, the Department also initiated an anthrax
vaccine immunization program, as you know, to provide our
service members with protection against this particular type of
attack. I will be reviewing this program to ensure that it is
effective for its stated goal.
The detection of a chemical and biological attack requires
the logistical element of equipment and emerging technology
that the Department has aggressively pursued. Detection also
encompasses the medical expertise required to identify signs
and symptoms at an early stage of an attack, particularly a
biological event in which the awareness of the attack could be
delayed for days or week.
Finally, proper medical response to an attack is essential
for minimizing casualties and for sustaining our ability to
fight the war. We must ensure that we have the right people to
perform these missions, that these people are trained and that
we know specifically who is trained at what level. To address
this matter, my office and the Offices of the Surgeon General
and the Joint Chiefs of Staff have already undertaken a number
of initiatives.
First, let me outline that we will be conducting a
comprehensive review of current chemical biomedical training,
and I'm here to tell you that we will be making some level of
training mandatory at all levels. If we can make mandatory
training on sexual harassment, we can make this kind of
training mandatory which, obviously, is of high importance.
Second, we will be standardizing medical response protocols
across the services.
Third, we will be enhancing medical planning tools to
include development of a Common User Data base to enable the
services to conduct medical planning for contingencies
involving weapons of mass destruction.
Fourth, we will be ensuring that future training and
exercises include greater medical play and providing
challenging and realistic scenarios that adequately assess the
capabilities of our medical units to function in a chem/bio
environment.
Additionally, DOD will be developing a tracking system to
monitor the training and the proficiency of health personnel to
function in a chem/bio environment.
Taken together, I'm confident that these actions will
result in a military health system better prepared to support
our military men and women in the coming months and years
ahead.
I want to thank you for the opportunity to appear today. I
appreciate the committee's commitment to our service members
and look forward to working together to keep their safety and
protection our first priority. I look forward to answering any
questions you might have at this time.
Mr. Shays. Thank you.
[The prepared statement of Mr. Winkenwerder follows:]
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Mr. Shays. We'll start with Mr. Putnam.
Mr. Putnam. Thank you, Mr. Chairman.
Dr. Winkenwerder--did I say that correctly?
Mr. Winkenwerder. Winkenwerder, that's correct.
Mr. Putnam. This is a whale of a 2 weeks for to you have
started out in this position.
Mr. Winkenwerder. An incredible time to arrive.
Mr. Putnam. We appreciate your presence here and your
commitment to improving the level of quality of care in the
health services.
According to the GAO report, between 1996 and 2000, you had
over 1,300 service medical personnel take your 6\1/2\ day
course. Your testimony says that, since 1997, 7,800 personnel
have taken that course. Is there--how do you explain that
disparity?
Mr. Winkenwerder. Well, I would say that, due to the short
notice that we had, that certainly is nobody's fault. In
preparing for this hearing, the written remarks that were
provided to the committee did omit a number of important
preparedness activities and programs that have been undertaken
by all three services in the past few years and some in just
the past few months and weeks. That's why I was very much
pleased that you've allowed me to have my colleagues here, the
Surgeons General, to talk about some of those, that there have
been more people trained than was----
Mr. Shays. Can you move your mic a little further away?
Move it back away from you a little bit.
Mr. Winkenwerder. There have been more people trained than
has been indicated. I don't want to suggest that in my response
that enough people or all the people that we want to be trained
have been trained. But the numbers are something better than
has been provided, and we would--thank you--and we would be
glad to provide those numbers to you.
Mr. Putnam. OK. I would certainly appreciate that. But
you're standing by at least 7,800.
Mr. Winkenwerder. Yes.
Mr. Putnam. OK. You also said that 19 percent of the
uniformed health service personnel have completed the specific
chem/bio training and not more than a little over 2 percent of
medical officers have completed the full 6\1/2\ day course and
then those who have been through it we don't really have any
way to track where they are to get them in a hurry. How are we
addressing that issue? Why aren't the uniformed health service
personnel required to take a specialized course and what steps
do you have in mind as you embark on this to bump that up and
increase the number who will be exposed--excuse me--who will be
trained for a chem/bio event?
Mr. Winkenwerder. Well, just in a matter of the past few
days I have requested the surgeons to develop a plan that would
include the level of training and courses that we believe would
be mandatory for all personnel. Obviously, one size doesn't fit
all here. Our goal would not be to have everybody who's a
military health care provider attend a 3 or 6-day course. We
need to target the level of training to the particular kind of
provider or professional. But, whatever that level is, we want
to make sure that everybody has the training that they need to
have.
Mr. Putnam. I guess the part about the raw numbers of this
that is a little bit disturbing is that all of us on the
civilian first response side probably slept pretty well at
night prior to the 11th knowing that somebody out there on the
military side had a large team of people equipped to deal with
these types of scenarios. I think that we're finding that there
weren't quite as many people out there as we may have
previously thought. So to the degree what we can help you turn
that around and share some of that knowledge and training with
the civilian first responders would be very helpful.
And I see that my time is up.
Mr. Winkenwerder. We would very much like to do that.
Mr. Putnam. I yield back the balance, Mr. Chairman.
Mr. Shays. Thank you.
Mr. Kucinich.
Mr. Kucinich. Thank you.
Mr. Secretary, it was encouraging to hear your response to
the GAO report in saying that you will train, you will help
personnel to become more ready. At no time in your testimony
have I heard you say that the Department of Defense is ready to
protect its troops in the event of a biological or chemical
weapons attack. Is that correct? You did not say that, did you?
Mr. Winkenwerder. I believe that we are prepared to protect
our troops.
Mr. Kucinich. At this very moment you're saying that we're
prepared to protect our troops. And how are we prepared to
protect our troops?
Mr. Winkenwerder. Well, Congressman, protection of the
troops really is a multifaceted set of activities.
Mr. Kucinich. I understand that.
Mr. Winkenwerder. Let me just for everyone's information
talk about that for just a moment. There's issues of
intelligence and intelligence on the ground. There's issues of
chemical and biological detectors, early detectors in the field
where we can detect agents prior to their dispersal or at the
time they might be dispersed. There is the issue of protective
clothing and equipment. Training, obviously, we've talked about
of troops and medical personnel, antibiotics, vaccinations. So
there's a whole host of things.
I don't want to minimize some of the deficiencies that have
been pointed out in the area of training and planning.
Mr. Kucinich. I understand. It's good to hear that you're
trying to address this, and I understand you've only been on
the job for 9 days. This report questions the readiness of the
Department of Defense, the medical readiness. You know, not
whether you have intelligence on the ground, not whether you
have chemical or biological detectors, but whether or not there
is a medical readiness. As this report says, as a consequence
of their study, they're saying medical readiness for CB
scenarios cannot be insured.
And the reason why I'm focusing on this, you know, we have
to get our time tense straight. We are ready, which means we're
ready today, or we will be ready, which means some time in the
future, that we're planning on this, we're thinking about it.
But the difference is, if you have men and women in the field
and they're subjected to an attack, you can't tell them we will
be ready. They need to know they are ready.
So, based on that, Mr. Secretary, would you at this moment,
understanding the work that needs to be done, be ready to
recommend that or even be asked whether circumstances exist
which would be conducive to sending troops into the field in
Afghanistan without the proper medical structure in place?
Would you comment on that?
Mr. Winkenwerder. Well, in the final analysis, we rely on
our commanders in the field and on the Joint Staff, I think
that has been pointed out, to make the determination of overall
readiness. And that includes medical readiness. I think the
events of recent weeks and the perception that possibly an
enemy would be willing to use certain agents may have changed
the threat assessment.
Mr. Kucinich. We're on the same team here. We're working
together. Because you want to make sure that the men and women
who serve are going to be protected. I know that's true of all
the officers who are here. That's your life's work. I
understand that. It's our life's work, too.
I just want to make sure, though, that the political
imperatives which may exist somehow mesh with the realities of
the medical readiness. And I'm hopeful that the Generals and
the Admiral here, that somebody in the command level at the
Department of Defense is going to talk to you and then that
somebody is going to go over this report before we start
committing troops to an invasion of a country that, given the
geography is tough enough, but the medical readiness, that's
what I'm concerned about. I just want to make sure that if we
send our sons and daughters over to Afghanistan in order to
fight terrorists that they're not going to be injured and not
have a structure in place to be able to help them. That's all.
And General----
General Carlton. I just returned from down range and looked
at the medical preparedness. I believe that we are in perfect
harmony with your concerns. We've addressed every known factor
that we will face. We've made our point. We have hardened
facilities that are in the evacuation chain.
Again, raw numbers are confusing. When we say 2 percent of
the medical providers have been trained, this is a 7-day train,
the trainer course; and that's about right for the people that
will train ours that deploy in harms way. We have a readiness
skill verification program where we certify that people are
prepared to go do what they will encounter in that environment.
So all of these things have stood up.
Mr. Kucinich. General, again we all understand what a
different environment you're in. And again we're working
together here. This isn't an adversary proceeding at all.
Because we need to make sure that our men and women are going
to be safe.
Now in this report here, Mr. Chairman, staff, just on page
10 of the report, I would ask the gentlemen at the table if you
would refer to page 10 of the report, paragraph 2, the middle
of the paragraph. It says, ``Army Medical Department officials
indicated both that they were not authorized to structure
medical care for biological contingencies and that battlefield
CB scenarios causing mass casualties would overwhelm current
medical capabilities.''
So, you know, that's the purpose of this meeting, to
discuss this report.
Again, as a Member of Congress, as a fellow American, I
just want to express my concern that this discussion take place
in the upper echelons of the Department of Defense before any
decision is made to commit to ground troops. And the reason I'm
saying that is that, if that decision is made, we want to make
sure that all of the areas that are covered in this report are
given careful consideration so we're not in a situation after
the fact where somebody comes back to any one of you and says,
now what do we do. And that's why we're all here listening to
this right now.
But, you know, in a few weeks from now we could be learning
of mobilization of troops to Afghanistan, and I just want to
make sure that our men and women, that they and their families
are assured that this government is going to do everything it
can to make sure that those enlisted people would be protected
as best as possible under the circumstances.
So I thank the Chair for giving me this opportunity. I want
to thank the witnesses for the service that each of you gives
to our country.
Mr. Winkenwerder. I can assure you that it is and will be a
top priority, that these matters that are in this report and
the concerns will be reviewed at the highest levels.
Mr. Shays. Mr. Secretary, it's pretty amazing to come into
a job in 2 weeks and have to present a response to a report
before Congress; and I appreciate you being here.
I would welcome the participation of the rest of your panel
as well in any of these questions. Because you all have been
involved in this obviously a lot longer.
On page 9 of the report it talks about, under the
subheading, that DOD and the services have not systematically
reviewed the adequacies of the medical specialist mix for the
treatment of CB casualties. And then it says, service methods
for personnel planning do not specify the personnel required to
manage CB casualties.
And, page 12, I want to read to you a long paragraph. I'd
like all four of you to respond, if you will.
On page 12 it says, ``While maintaining that the current
specialty mix is generally appropriate to these emerging
threats, service planners did identify additional skills that
would be key to successful medical management of CB warfare
casualties.''
So, in addition to this whole issue of training people for
6 days, ``some Army officials expected that chemical warfare
readiness would require an increase in respiratory therapy,
ward nursing, and internal medicine. Others noted that the Army
did not have a lot of infectious disease experts in deployed
hospitals for surveillance and prevention. Similarly, Air Force
officials expected that chemical warfare scenarios would
require more respiratory technicians, pulmonologists, critical
care nurses and intensive care beds. They stated that the
threat of biological warfare would increase the need for
infectious disease and preventive medical personnel as well as
personnel to collect baseline, predeployment data. Air Force
and Navy medical planners both anticipated that chemical
scenarios would require more emergency personnel who could
recognize and respond to symptoms quickly.''
Although these informal assessments vary, they imply that
the current speciality mix needed revision. I'd love you to
respond to that, and then I'd like each of the branches to
respond.
Mr. Winkenwerder. Let me make two general points and then
would like very much my colleagues to respond as well. I think
with respect to chemical and biological weapons there are two
areas that come to mind that we will need to review and look at
with respect to the medical personnel mix and the numbers. One
is infectious disease, and the second is in the area of
pulmonary medicine and the support personnel because of the way
the agents work, and those would be the areas that I would
expect we will be looking at and reviewing to ensure that we've
got adequate numbers and adequate mix deployed in proper
locations, etc. And so with that, I'll turn it over to General
Peake.
General Peake. Sir, we have a modular structure--all of us
basically have a modular structure that can be added to or
taken from. The bases in our hospital situation is a combat
support hospital. We have the ability to bring modules,
infectious disease, laboratory and so forth to add where we see
that threat, where that threat exists and as the threat
changes. We have what we call smart teams, special medical
augmentation response teams that reside in our medical
treatment facilities that include intensive care as an example.
It includes epidemiologic expertise such as that we have loaned
to HHS as they look at the Capitol Hill, as a matter of fact.
Those teams are available to be moved into theatre if that were
required.
We rely on the commander in chief of that theater who looks
at the threat, who makes those assessments, and then our Title
X responsibility is to provide him trained and ready folks to
deal with that. Many of those folks get their training and
experience in our military treatment facilities. There was a
comment by Dr. Kingsbury about the dichotomy, sir, if you
would, of the peacetime health care and the go-to-war health
care. Well, those infectious disease folks are--they need to be
at the top of their game in their field as an example.
So I think there is a translation there and we have quality
people because of our ability to have that infrastructure that
takes care of patients every day, and then added to that is
their expertise that they get as military physicians. We are
actually kind of proud of that 2-week course. We are proud of
the fact that we push those courses out.
Mr. Shays. There is a big difference, though, between a 2-
week course for your medics and your nurses and so on, and your
doctors versus someone who has an actual specialty.
General Peake. Yes, sir. But the infectious disease folks
that--I mean, we have folks that are infectious disease
specialists just as--that work in our teaching programs, that
work in our hospitals and they're the same folks that come out
of that and deploy as part of these specialized teams or as an
internist in one of our combat support hospitals. So we have--
it's a leavening of the force of quality people of their solid
basis of clinical medicine, and then in addition to that, as
they go through the developmental process of an Army physician
as an example, come into the Army basic course and they have
training in MBC. Come back to the officer advanced course, and
there's hours of training associated with that.
Mr. Shays. You attempted to answer my question or may have.
I'm not sure I fully understand why some of what of you're
saying relates to this specific issue, and that's probably my
fault, not yours. But the bottom line, there seems to be
disagreement among the different branches from this statement
and it would be--first, I will come back.
Admiral, if you would just respond to the statement and
let's see what we get, and then I will make my point.
Admiral. Arthur. Yes. Good morning. Thank you.
Mr. Shays. Good morning.
Admiral. Arthur. I agree with much of what General Peake
has said. We have our operational forces, which are----
Mr. Shays. Move the mic a little closer, but not as close
as the doctor had it.
Admiral. Arthur. Have we got it calibrated now? Great.
Thank you. We're staffed to provide forces in response to our
lines projected operational requirements, and we have just
about as many people as we need to do that and not very much in
excess. We have many operational courses that we use to train
people who go with our operational forces. We have people who
go with the surface ships and they get a 6-week course. The
flight surgeons get a 6-month course. The undersea medical
officers who do the diving and submarines go to a 6-month
course, and the Marines have their own course of 4 weeks, and
in each of these courses there are didactic segments which deal
with chemical and biological, and there are varying lengths.
These are mainly physicians that I'm talking about.
Mr. Shays. Yes. But with all due respect, what we are
learning is that you really haven't--none of the branches have
seemed to adjust to this new world environment. So you're
telling me the courses that you have, but are we really focused
on chemical and biological? And it appears that we're not. I
don't see how we can say you are when you agree with every one
of the points being made in the report, and then you're telling
me we're doing it, and that's why I'm confused.
Admiral. Arthur. Well, we're not as prepared as we now know
we should be, and I think that was one of the points that Dr.
Winkenwerder made. We have been awakened by the September 11th
incidents in that we have an area of vulnerability that we had
not recognized was of such magnitude. I would say, though, that
we have to perhaps temper the discussions with enormous
difficulty in retraining the staff and equipment that would be
required for an all-out response to this when they're basically
unused for the majority of the time and in peacetime, with the
tremendous pressure we've had to deliver the health benefit in
an austere funding environment.
So it's very difficult to say let's have 100 more
pulmonologists that we might need, and have the health benefit
in some area go wanting.
Mr. Shays. See, the problem is a whole host of problems
exist. Our committee has had all three commissions come before
us and said no one is known, we have not made a proper
assessment of the terrorist threat. They said we don't have a
strategy to deal with the terrorist threat, and they say we're
not organized as a government to maximize our ability to be as
successful as we could with our resources.
So that's what they said to your government. We saw, sadly,
the military mix, the terrorist threat and the military threat,
and we're kind of confusing the two, it seems to me. I mean one
of the things which still have some certainty is that you're
more likely to have a chemical and biological attack if the
person can disguise that they actually delivered it and not
have to have retribution.
So now what we've done is we've said if a terrorist is
moving forward and doing these acts, we're going to hold
somebody we can identify, a country, accountable; so we are
going to hold countries accountable. But we don't know because
we haven't done the proper threat assessment, both in the
military, frankly, and the civilian threat, the terrorist
threat, but it's probably less likely that you would encounter
chemical or biological from a military force unless they
decided to commit suicide, which obviously is a possibility as
well.
I guess where I'm coming down to, though, is that as a
committee, we saw the military say everybody in the military
had to have anthrax vaccine and we used it all up, and we only
have less than 20,000 left, and then we have 5 million that's
unapproved at BioPort, some of it before they did their plan,
some of it after they'd done it; so that's kind of this mess we
find ourselves in and what we're trying to sort out is--what
I'm trying to first sort out is, I understand now that you are
doing programs you didn't do in the past, your 5-day, your 6-
day, your 7-day, I'm trying to understand the quote from the
GAO's report where it says either medical personnel who have
been trained cannot be readily identified in the event of an
emergency, because tracking systems either do not exist or are
not currently functioning, lest the availability of trained
personnel given the situation is uncertain. I would like just
the GAO to affirm, was that basically on identifying those in
the 6-day courses, in the 7-day courses, or is it also meaning
doctors with specialties?
Ms. Ward-Zukerman. That was with respect to training
courses.
Mr. Shays. I want you to just get to the mic. If she could
do that.
Ms. Kingsbury. That was just with respect to tracking the
people who had attended the training.
Mr. Shays. OK. Just the training. So it's not an issue of
being able to track those with specialties. Because
unfortunately at the VA, they're unable to track people very
easily with specialties, the Department of Veterans Affairs. We
don't have that problem in our three branches as it relates to
people with specialties?
General Peake. We can track people with specialties. Let me
just comment on in terms of tracking the training. We would
like to be able to do better with tracking training. Looking at
that 6-day course as an example, this morning I said pull it
up, I can identify 1,747 people, 672 docs, 112 general core
officers, 508 nurses that have had that training. I can pull
them out of the data base by name. So I don't think I have
captured all of them. I can tell you that. There are some data
issues that----
Mr. Shays. The question is, though, can you get that out to
the field?
General Peake. Yes, sir. We can pull them off of mods.
There was----
Mr. Shays. OK. Let me just go to--but the specialty issue
that, wasn't a claim from GAO. General Carlton, you wanted to
make--you were doing a lot of writing. Either you wanted to
make a comment or you wanted to just----
General Carlton. Yes, sir. I'd like to make a couple
comments. We have been focused for the last 6 years on
terrorists, specifically biological and chemical, and we've
invested heavily in them. Regarding page 12, we have something
called the critical care transport team that can be a ground
asset or an air asset. We have more than 200 such teams that
we've identified more than 150 trained to be able to fill this
specific requirement. We've thought it through. We can building
block those in, as General Peake indicated to you, very early.
We recently certified a level 4, which the most highly
infectious disease problem for air vac use, a joint Air Force/
Army discussion.
Before we send people to the field, we have a readiness
skills verification program that is a check, and we certify
that they are certified to deploy depending on their skill
level. We've been working on that for several years now. Every
one of our GME institutions gives us military unique training.
To answer that second piece that we'd require more emergency
personnel, we train the personnel to be able to do that. One or
two infectious disease people cover a medical center currently.
We have been training through those infectious disease people
extensively, and actually have our premier course, which starts
next week, which is called a hospital-focused approach to
biological weapons and toxins. It's filled up immediately and
has been for 6 months.
We've really been focused on these for a long time, and I
believe that as you look at these, it raises a level of concern
and our approach was, yes, we can do better, which is the
reason that we concurred, but I don't want you all to leave
with an impression that we have not focused on this, and we are
ready at this time for the expected illnesses in the bright
percentages. If somebody threw me 2,000 casualties at one of my
deployed locations and all need ventilators, I have a problem,
but that's not the current threat.
Mr. Kucinich. Excuse me. If I may, General, you're with the
Air Force; right?
General Carlton. Yes, sir.
Mr. Kucinich. What does the Army say?
General Peake. I would say exactly the same thing. That is,
we structured our force to where would see the risk. We
understand the environment that our soldiers are in. We
understand what their force protection capabilities are and you
work with them--the maximum, you know, a credible event, and
you try to structure your forces to cover that. I believe we
have good--as General Carlton said, we would--there's always
more things to do, but in terms of having a level of comfort of
being able to care for our soldiers and being proactive about
it, recently we just pumped antibiotics as part of our DRB, or
defense division ready brigade support packages, so that, you
know, we plussed them out looking at the new threat. We've done
that since September 11th.
So as everybody sort of alluded to, this has been an, OK,
now let's pay attention to this one a little bit more, but
it's--I sort of feel a little that we probably sound a bit
defensive, sir----
Mr. Kucinich. You don't have to be because you're not under
attack here. We're together.
General Peake. But the fact is there have been a number of
things gone on. The issue of the planning tool that was
mentioned, it's true, there is not one in the map, but since
the early mid 1990's, we have been working with NATO to work up
planning scenarios and casualty models we now have that we are
investing in a tool to be able to go ahead and use the patient
time test TRTA files that have been developed that was alluded
to in the report. We expect we will work with the other
services to move that into the medical planning tool, but we do
have a desktop model that I was looking at this morning.
So there are a lot of positive things that are a part of
this journey to getting better and we're along that journey, as
Dr. Winkenwerder has indicated, and we will accelerate along
that highway.
Mr. Winkenwerder. Let me also add in here if I might, just
in terms of the exercises, and I don't want to sound as if I'm
quibbling here too much, but based on the information that
these men have given me, we have had more exercises of some
sort than is indicated in the report, and I'm told roughly in
the range of 20, 21 in the last couple of years, many of them
with civilian, we also have to look at the home front issue of
how to support them. So we have an area that the military
supports its civilian authorities, and so there have been
exercises, tabletop. You've heard of some of them. Dark Winter
and----
Mr. Kucinich. I actually read your testimony, and I'm
impressed with what you're trying to do on a domestic front,
and all Americans are concerned with that. But with all due
respect, you've got a lot of work to do, I would think, and
hope before you get to a point of saying send the troops in,
and you know, that's not a decision you're going to make, but
you're going to be called upon for an evaluation of the medical
readiness.
Now, Mr. Chairman I just want to ask one other question
here of Admiral Arthur, and that is, you raised this report,
actually touched on, and that is the question of available
resources, because that's something that none of us can escape.
There are financial budget issues and, as you said, whether or
not you can have--you may have used a figure 100 pulmonologists
and have them waiting and seeing if anything develops. I think
that's one of the discussions considering this constantly
changing picture. I think that's one of the discussions that
you're going to have to have, and then if there is a need for
additional funding, I'm hopeful that you'll come back to this
Congress and inform the Members of Congress that in order to
assure medical readiness that you need to--that this is what
you need. We cannot hold you accountable if you don't have the
resources and feel that you can't have access to the resources.
So I would just say that as surgeons general, that we need to
know from you just exactly what you need in order to do the job
and have a high level of medical readiness in the event that we
find ourselves on the ground with a full-scale effort in
Afghanistan. So that----
Admiral Arthur. Sure.
Mr. Kucinich. And I just want you to know I heard you,
Admiral.
Admiral Arthur. Yes, sir. I'd like to amplify one point,
and General Carlton brought this up. They have two, for
example, infectious disease specialists at a medical center. We
can't have 100 like we would like. But what we do, as General
Carlton said, is we cross-train a lot of people. We have a lot
of people familiar with the basics. So I think we are capable,
and we could never interest 100 pulmonologists in staying if
they weren't truly busy. But we also train our Reserves. We
train a lot of people to come in and fill in when the
requirements exist, and it's different than the civilian sector
where people just do their one thing because they're
compensation driven. We have a system that is very much more
flexible than anything in the civilian sector, and I think
that's our No. 1 strength.
The No. 2 strength is this is where the expertise is for
chemical and biological issues, and I think one of the ways
that we can help as a service, and you can help us, is to
assist us in getting out the information to our civilian sector
to allow them to be more flexible when some of these issues are
raised in the domestic front.
Mr. Kucinich. I would like to ask one final question. In
the report at the conclusions and recommendations on page 36,
it says that the DOD has not developed comprehensive meaningful
training requirements, adequate tracking system, or rigorous
proficiency testing. The available evidence indicates that
proficiency is low from training only a fraction of personnel
to failing to conduct realistic challenging combat field
exercises that include CB medical treatment, DOD has not fully
responded to the threat as stated, and what you're saying
today, gentlemen, is that you're moving in that direction of
addressing that; is that correct?
Mr. Winkenwerder. Yes.
Mr. Kucinich. I want to thank the witnesses and thank all
of you for your commitment and service to the country.
Mr. Winkenwerder. Let me, if I might, just say one other
thing with respect to the funding. We have put in requests that
are related to the additional emergency funds that have been
distributed out to the Federal Government and to DOD to lay
claim to part of that for these very issues. And as we develop
our plans here over the next days and weeks, we'll be coming
forward inside the Department to identify the requirements that
we think need to be met, and any funding or resources that are
associated with that.
Mr. Kucinich. I want to thank the Chair for allowing this
opportunity to ask questions. I want to thank Mr. Putnam for
his participation as well. I think this has been a productive
hearing.
Mr. Shays. Thank the gentleman. Mr. Putnam, if you don't
mind, if I could just finish. I think I'm figuring out that
we're probably not going to get some answers at a hearing that
we need to get because of some of it is a time line issue, and
we don't have a sense of what it's going to take, but where I'm
getting a little concerned is I feel like we're mixing
different things together. For instance, Dr. Winkenwerder, when
the military is telling you that they have had training, I
believe it's training on the civilian side. In other words,
we're coming in and there's a challenge in the United States.
My understanding is we're not going through exercises on the
field with, you know, a massive chemical attack or not even a
massive, or a biological attack. I don't think that's happening
yet, and so I just want to be clear as to what we're saying is
happening.
General, you kind of wanted to finish and I'm happy to have
you finish your point, and I'd love you to address the point I
just asked.
General Carlton. Yes, sir. We added them up to find out is
the criticism true.
Mr. Shays. I just need to know adding what up? What are you
really adding up? What exercises?
General Carlton. Military-specific exercise that included
chem-bio activities in the last 2 years number 12. Civilian-
specific exercises where we did things military and civilian
together involving chem-bio exercises, No. 9.
Mr. Shays. Right. But there is a difference, there truly is
a difference between the two.
General Carlton. Yes, sir. The presentations to senior
meetings in international presentations by just the Air Force
staff number 1,000 in the last 2 years.
Mr. Shays. What does that mean? Slow down, I want to
understand. In other words, there is dialog with people about--
--
General Carlton. No, sir. Delivering a key note speech as I
will do tomorrow in Detroit, as one of my brigadiers will do at
the Southern Medical Association on Thursday.
Mr. Shays. And so that means that you're thinking about the
issue.
General Carlton. That means that we've addressed their
civilian folks--on the military side I'm very comfortable.
We've thought these through. We even planned the attack on the
Pentagon and we exercised it in May. We're prospectively
thinking this ahead. We planned the attack on New York City and
D.C., invested in the equipment to diagnose it 3 years ago, and
we have all the teams trained now. So we're thinking ahead and
we're trying to get to our civilian colleague to help them
understand the world's changed, and all of a sudden they're
listening, and it's delightful.
Mr. Shays. OK. Let me just tell you now why I'm confused.
You can't concur with all of the criticisms that GAO made and
then say that the report isn't--doesn't reflect what is
happening. That's my disconnect. I feel like I should take a
lunch break and read the report again and see if I have read
this report properly and your concurrences. It's not----
Mr. Winkenwerder. Let me try to clarify it because----
Mr. Shays. You can do that with 2 weeks on the job----
Mr. Winkenwerder [continuing]. I do need to speak for all
of us. We concur and we agree, and agree means agree.
Mr. Shays. Yes.
Mr. Winkenwerder. OK? It's very simple. We agree. That
said, I think the difference of the discrepancy may be that we
want to leave you with the impression that some more things
have been done, are being done than maybe the report was able
to recognize because of the timing.
Mr. Shays. If the glass is one third full, you want me to
know at least it's one third full and not empty.
Mr. Winkenwerder. It may be a little more than one third
full.
Mr. Shays. OK. I didn't want to use one half. Something
below half. OK. You're smiling, General. Is that----
General Carlton. No, sir. I think it's a very valid
concern. I'm very comfortable with the overseas piece. I'm
scared to death for homeland defense, and medically we have
some work to do but we've been engaged for 6 years----
Mr. Shays. But you're talking as it relates to the
military.
General Carlton. As it relates to the military for our
overseas pieces.
Mr. Shays. Right. But are you saying--are you scared here
for your military or are you scared here for the civilians?
General Carlton. I'm scared for our civilian population,
that we have a lot to share with our civilian friends on what
we have done in the last several years on the BWCW discussion.
Mr. Shays. OK. Well, you know what? I'm going to come back,
but I still want this paragraph identified as to where you
agree and disagree with the various points. You're basically
saying respiratory and infectious diseases is your greatest
need. I'm going to make an assumption, unless you correct me,
that you feel you have the limited numbers of people in these
specialties and you're looking to get more, I'm making an
assumption if you have a limited number, that means that if you
were having to defend your forces around the world, you
wouldn't have enough, but if we're in Afghanistan, you can
bring these resources to the field, and I make an assumption,
and I would like to have a ``yes'' on this one, that you have
the medical personnel and will have the medical personnel in
the field of contention to deal with whatever bio or chemical
challenge you're faced with. Is that accurate, General?
General Carlton. Yes, sir, it is.
Mr. Shays. Is that accurate?
General Peake. Yes, sir, it is.
Mr. Shays. OK. Mr. Putnam. Don't even give him a clock.
Mr. Putnam. Thank you, Mr. Chairman. I have been listening
with great interest in this, and I find myself a little bit
confused about the different training portions that have been
taking place.
General Carlton, you said that what keeps you up at night
is fear for the civilian population, and I think that what you
had implied in some earlier comments was that you have been
trying to prepare some civilian health care professionals for
some time, and only since the 11th, have they been particularly
interested in listening to the progress that you've made? And I
certainly understand that. How prepared is the civilian
population and how prepared is the military for a situation
that it's very conceivable 6 or 8 months from now where you
have a chemical or biological attack on ground troops engaged
in combat and a massive civilian incident in an urban area that
would require substantial expertise from the health care
community? So if you could take those couple of bites of the
apple first before I go further.
Mr. Winkenwerder. I'm going to try to speak for us as one
voice here on this. I think it's not fair for us to speak for
civilian preparedness across the board. I think that's really
the domain of Secretary Thompson and the leadership at the
Department of Health and Human Services to speak to that issue.
I think we all know there's a tremendous amount of interest and
training and activity going on across the civilian sector as we
speak, many cities and towns across the country, people trying
to learn and get up to speed on these issues, and we're here to
help and support, but I think it wouldn't be fair to try to
quantify or qualify how, you know, where that degraded.
Mr. Putnam. Is it fair to say that the military is further
along in preparedness than civilian?
Mr. Winkenwerder. I think it would be fair to say that,
yeah, and everyone should hope so. I think we are.
Mr. Putnam. And that in many situations, these Governors
and mayors are returning to their own military to help prepare
their own city and State for these types of incidents?
Mr. Winkenwerder. Well, I think they're turning to wherever
the knowledge is, and that to the point that earlier brought
General Peake and General Arthur is that we can be a real
source of support that we want to be. We feel like one of our
greatest capabilities is to train and educate and--on the
civilian side and to--and we are in active discussions with the
Department of Health and Human Services around concepts of, you
know, protecting people, protecting populations of people, how
to ensure good command and control and biological event
situations and all of that.
Mr. Putnam. I'm not trying to box you into a position of
making any comments about the preparedness or the lack thereof
of civilian health care population, professional population.
What I'm trying to point out is that there is a symbiotic
relationship between civilian health care professionals and
military health care professionals.
Mr. Winkenwerder. Absolutely.
Mr. Putnam. It's been 10 years since you were engaged in a
major combat situation; so you've put a number of your medical
professionals in emergency rooms and trauma centers in urban
areas to see what gunshot wounds are like. The civilians depend
on your expertise to prepare for chem-bio-type situations and
in a major incident that would occur while we are engaged in
ground combat, we would have a limited number of people spread
around the world and so that was really the direction I was
interested in taking us which was, you know, how are we going
to deal with that type of situation? How quickly can we
standardize just the services much less spread it out to the
civilians being able to be prepared. You have a shortage of
specialists, pulmonologists and ear, nose and throat, and
there's a number of others identified in the footnotes. To keep
those folks sharp when we're not engaged in war they've got to
be doing something else----
Mr. Winkenwerder. That's right.
Mr. Putnam. So there is a very connected----
Mr. Winkenwerder. There is.
Mr. Putnam [continuing]. Relationship between you and
civilian population. So that was only the purpose of my
question.
Mr. Winkenwerder. Thank you.
Mr. Putnam. There is a recent Washington Times article that
highlights your board surgical teams, the Army's board--General
Peake's surgical teams, and indicates that they--attached to
every brigade, the closest thing yet to battle field surgery,
the article points out significant medical treatment literally
is right over the hill. Are those folks prepared for a chem-bio
attack? And simultaneously, let me also ask, do the benefits of
having them close for conventional type of warfare put your
first responders in jeopardy for this new type of asymmetric
threat, General Peake?
General Peake. Sir, they are at--when you're putting them
that close, they're at jeopardy for even conventional warfare,
depending on how far forward you have to go, depending on the
tactical scenario, and they are--therefore have the period
defensive medical protective--chem-bio protective posture as
the rest of the troops that they're supporting in terms of
masks and so forth.
And so they basically share the hazards. You try to employ
them so you protect them reasonably, but that's the
organization's design to go far forward with the brigade. In
terms of their ability to take care of chem-bio casualties,
those folks, like our division surgeons as well, are folks that
go get targeted to go to that course that we were speaking
about before; so they have that kind of experience. We have
within that unit ventilator support, a limited amount, but the
idea is to stabilize folks and then transfer them further back
to a more definitive facility.
Mr. Putnam. Mr. Secretary, you have made very clear that
one of your top priorities is to eliminate any disparities
between the services and the standardization of readiness.
Mr. Winkenwerder. Absolutely.
Mr. Putnam. Do you feel that you are there?
Mr. Winkenwerder. We're not all the way there, but I can
assure you that we're going to be trained on to this entire
issue, including that aspect of it as we speak and in the days
and weeks ahead. It's my top priority.
Mr. Putnam. What sense of time line have you established as
an objective?
Mr. Winkenwerder. I haven't set a time line other than to
set the idea in motion that it's now, we're moving, we're
acting, we're doing, and I would be glad to get back to the
committee at a later date in terms of if that's of interest to
you with respect to what might be realistically accomplished
over what period of time. We're glad to try to, you know,
properly set expectations, but we're working on this. It's our
top priority.
General Peake. Sir, there are things that are still coming
about. I will give you an example. I'm going tomorrow to look
at chem-bio protective shelters that are part of a Humvie that
we have had in the pipeline as developmental. Our intent is to
be able to put one of those board surgical teams within a chem-
bio protective shelter, because we do understand the
environment that changed on September 11th. That's the kind of
thing that we will put on the fast track to field, and quickly
put into place where we see that threat.
So we're willing to change our structure on the fly. We're
required to try to meet the threat that we see evolving.
Mr. Winkenwerder. There is one other thing that I'd like to
leave the committee with, and that is the notion that much of
the discussion here is focused on managing an attack once it
occurs, and assuming there's casualties. I know that's not all
of the discussion, but there has been a fair amount of that. It
would be my plan coming into this role that we focus a great
deal of effort on how to detect events at an early stage, and
how we can prevent certain things from happening and how we can
address things during that early phase where there's the
opportunity to treat people, whether it's biological with
antibiotics or even a chemical situation with antidotes and so
forth, so that the whole matter of detection, the kind of
equipment we have to detect and how it works, that's part of
all of this and that's important and just sort of our readiness
in terms of intelligence and thinking, both in the deployed
situation as well as on the home front.
And let me add to that the whole area of vaccination. I
think that's another issue that we've got to look at and relook
at in the context of the situation that we now find ourselves
in.
Mr. Putnam. Thank you. Thank you, Mr. Chairman.
Mr. Shays. We're going to get you out of here pretty soon.
I'd like the counsel to ask a few questions and then I would
like to ask a few and then we will be done.
Mr. Halloran. Thank you. With regard to proficiency
testing, which is a matter the GAO raised, the training
numbers, as she said, are a surrogate for how capable people
actually are, what might your near-term plans be in terms of
determining the proficiency of medical units in CB casualty
management?
Mr. Winkenwerder. I'm not steeped into the details of our
current proficiency testing capabilities or programs, but what
I'm--would plan to do is to work with the surgeons with respect
to determining what levels of proficiency we ought to have for
different levels of personnel and that we get rapid agreement
on that and that we, sort of going along with that, have the
capabilities in place to track the proficiency.
Mr. Halloran. You might just solve two problems at once in
terms--are proficiency determinations made as a result of
exercises?
Mr. Winkenwerder. That's a good question.
General?
General Peake. It is one measure of proficiency. You have--
you sort of have to break it down. Individual proficiency with
technical expertise, hands-on expertise, cognitive expertise,
those are all elements of proficiency. And then there is unit
proficiency, how that unit works together internally, and then
in the larger, it's the systems proficiency, the evacuation
system feeding the medical system and then the further
evacuations. So each of those are looked at in a little bit
different way, some from the larger exercise perspective, some
from the CPX nonfield training perspective to see how well you
do with that. And then others are sort of the hands-on skill
testing that, for instance, we are initiating as we change the
military occupational specialty to 91 Whiskey in the Army,
where twice a year they want to do the specific hands-on skills
to prove that they can start that IV, to maintain that airway,
can assess that patient. It's not a single question, sir, it's
an expanded question.
Mr. Halloran. Understood. Thank you. Sir.
Admiral Arthur. I'd like to add that the insulting agent
may be different than what we're commonly seeing. For instance,
it may be a chemical agent or may be a biologic agent, but the
underlying pathology, the actual disease process, is common to
many of the diseases and injuries and illnesses that we see
every day, and I think the pathology and the skills that are
existent in our health care professionals today once recognized
will be able to adequately treat those same symptoms and signs
that would be from chemical or naturally occurring disease.
Mr. Halloran. But that's good news and bad news. I mean,
we're all learning everything looks like the flu in the first
48 hours.
Admiral Arthur. And many of them are treated
symptomatically or with specific agents. Now, we have to have
an awareness that we've been infected perhaps with anthrax to
treat appropriately, but we have specialists who do this, and
once recognized, the treatment is fairly standardized and think
we're well equipped to do that.
Mr. Halloran. Finally, let me just change the subject. And
it's not really a curve ball because I shared this with you
before, but there is a report out today on the military blood
tracking system that the Inspector General has found it lacking
in some significant respects, and just for the record if you
could comment on that, please.
Mr. Winkenwerder. I'm going to let General Peake do that
because of his responsibility.
General Peake. I just briefly saw the report and I haven't
read it in detail, but I'd be more than happy to get back to
you for the record on----
Mr. Halloran. Please.
General Peake [continuing]. On the details of it. It is an
important issue to be able to track in an automated fashion the
blood and that's why we put the DIB system in place. I know we
have some investment that we are putting in to try to improve
the product, but it's an important issue for all of us.
Mr. Halloran. If you would get that to the committee, I'd
appreciate it.
General Peake. I will be happy to, sir.
Mr. Halloran. Thank you.
Mr. Shays. Dr. Winkenwerder, I appreciate the tone you set,
one of, I think, just trying to be candid, and all of you. It
tells me that we can work well with each other, and on that
basis, what I would like is on all these--on the report which
is your response where you concur, rather than just going
through it in this public session, I think we will probably get
a clearer response if you have time to think about it a little
longer. But on page 47 and 48 of the report, it talks about the
recommendation and DOD's response, and what I'd like is for you
to work with the committee and give us a sense--I think it's
fairly clear that GAO felt, and I would agree that the
responses are somewhat general.
In other words, it's kind of like we agree and we're going
to look into it or we're going to--you know, as an example, it
talks about how, just taking this as an example, with the first
recommendation, concur as the coordinating body with the
services in sync on issues of this nature. The joint staff will
be requested to conduct a reexamination of CV medical training
issues and provide suggested adjustments. You know, that's a
pretty general response, and I would like to know when that's
likely to happen and then what's the result of that. And so
that would be--so if we----
Mr. Winkenwerder. I will be glad to do that.
Mr. Shays. If we could do that, it would give us a little
clearer idea as to what some of your responses mean. The second
thing I want to do is just I honestly believe that there has
been a lot of good work obviously to deal with this issue, but
I don't want to overstate where we're at. For instance the 12
exercises, I don't--can't grasp your version of exercise versus
mine or what I think of it. Can you give me an example of what
kind of exercise we're talking about? Are we talking about an
exercise where all of a sudden we've got, you know, 60 people
who have got a chemical--been exposed to chemicals? Are we
talking about 200 people who have smallpox? What are we talking
about here?
General Carlton. Yes, sir. I'm happy to do that. Alamo
alert is the best example that we have. It was a mil/civ
cooperation, a 3-day symposium that we put on. The first day
was educational. The second day was a smallpox attack with our
city leaders in place to include the mayor, the fire department
chief, the police chief, etc., and they're the shot callers.
And then we played the scenario based on what they responded.
We had an outside company orchestrate this response. The third
day, then, were the critiques of what happened on the second
day.
Mr. Shays. This committee has participated in those kinds
of exercises in what we called them, the rapid deployment--the
ray teams. But how about civilians off--not the civilians. I
thought the 12 was the civilians----
General Carlton. That was a mil/civ. The example of a mil/
mil was at the joint training center where we practiced our new
scenarios. The Shugart-Gordon is a training range that looks
like a city to most of us. Two years ago they started doing
chemical scenarios involved there. It was a force-on-force
discussion. Chemicals are here, how do you detect, how do you
protect, how do you take care of people?
Mr. Shays. Was that a U.S. target?
General Carlton. That's the U.S. Army. It is was a joint
exercise down at Fort Polk, LA.
Mr. Shays. Is that a field exercise?
General Carlton. It's field exercise, yes, sir.
Mr. Shays. And how many casualties?
General Carlton. I'm sorry. I can't tell you. I didn't have
enough time to prepare that.
Mr. Shays. Would it be fair to say that there have been a
minimal number given the need?
General Carlton. I can't give you the number.
Mr. Shays. No. I don't mean the casualties. I'm sorry. I
didn't ask my question properly. We're talking--I guess I don't
want to leave--I don't want to set a false impression that we
aren't doing enough. I don't want to set an impression that
we've been doing these exercises, and that they have really
constituted a significant military exercise, and so----
General Carlton. Yes, sir. Pacific Warrior in February of
this year was a 2,000-person exercise that was the Korean
scenario that we played in Hawaii, and it involved a chem
environment.
General Peake, I don't think it had a biological component
to it.
Mr. Shays. Because what we're hearing is that there really
haven't been many bio in particular. In other words, even this
number of 7,800 versus the 1,718, what I'm being told is that
you have onsite and you have offsite exercises, and the offsite
training exercises and that the offsite have not involved the
bio exposure, it's just mostly chemical.
General Carlton. In the military exercises that I have been
involved with, only three have involved biological activities.
None of them were in the field. They were think tank type
exercises.
Mr. Shays. Right.
General Carlton. So when you start adding 17----
Mr. Shays. So that's really the tabletop kind of exercise?
General Carlton. Yes, sir.
Mr. Shays. I guess really when I'm thinking of an exercise,
I'm really thinking what you're out in the field and you're
trying to expose your troops to this kind of training exercise.
General Carlton. Yes, sir. Without exercises--some of the
things that have been very exciting are surveillance systems.
We had a real world exercise last summer, the summer of 2000
where we had a food borne illness break out in one of our
forward deployed places. The year before we had a 60 percent
casualty rate from that food borne illness. Because we had
installed a new surveillance system, we had a 2.5 percent. When
we could identify it quickly, it involved using the rapid
pathogen identification, and so we've had some real world that
we don't call exercises, but real world experiences with our
equipment, with our toys that have worked beautifully.
Mr. Winkenwerder. Mr. Chairman, if it would be helpful,
we'd be glad to try to summarize these----
Mr. Shays. Yeah. Why don't we do that. Because I'm really
left with the feeling that some of these are civilian responses
to terrorist activities and some of them----
Mr. Winkenwerder. Yeah.
Mr. Shays. But in other words, this isn't foreign to you, I
agree, but my sense is that you do agree with this report, and
the report says there is a lot that needs to happen and I'm
going to kind of----
Mr. Winkenwerder. And you deserve to know exactly what we
have done here, and a little more clarification on the
exercises that have taken place.
Mr. Shays. And Admiral Arthur, have you had many exercises
in the last--on the field, not over a desktop and not in a room
on bio?
Admiral Arthur. We've--not specifically on by bio or
chemical, but we do incorporate that aspect into our training
when we train specifically on the ground with the Marines, when
we exercise the fleet hospitals in support of the Marines or
the medical battalion in support of the Marines. We also have
our shipboard casualty drills where we do drill for chemical
and biological, when we lock down the ship and we wash the ship
and we----
Mr. Shays. That's mostly for chemical; right?
Admiral Arthur. Chemical and biological.
Mr. Shays. I'm sorry. I interrupted. So you wash down the
ship and----
Admiral Arthur. And we have the exercises where we isolate
certain portions of the ship based on contamination. So we do
these exercises. We don't do much with submarines. We figure
they're pretty protected.
Mr. Shays. All right. Is there a question that you want to
ask yourself that you wished I had asked?
Mr. Winkenwerder. I can't think of one.
Mr. Shays. I'd like to know if GAO would just like to make
any comment before we adjourn? OK.
Well, in the spirit of the obvious need, we look forward to
working with you and we'll all take a fresh start at this. We
will think anew, we will act anew, and we'll disengage
ourselves and try to break out of the box and in the spirit of
what Mr. Kucinich said, we need to know where there are needs,
and if you tell us the needs, then it's our fault if we don't
respond. But if you don't tell us the needs, then it won't lie
on our shoulders and we'd like to share in that responsibility.
So we will adjourn this hearing and thank all four of you for
coming.
[Whereupon, at 12:49 p.m., the subcommittee was adjourned.]
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