[Congressional Record Volume 149, Number 160 (Thursday, November 6, 2003)]
[Senate]
[Pages S14087-S14090]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CARE AND TREATMENT OF RETURNING GUARD AND RESERVE FORCES
Mr. BOND. Madam President, a couple of weeks ago we received reports
from inquiring UPI reporter Mark Benjamin and a very active veterans
advocate Steve Robinson, director of the National Gulf War Resource
Center, that there was a significant problem with the care and
treatment of returning guardsmen and reserves coming back from Iraq and
Afghanistan to Fort Stewart, GA. There were, at the time, indications
that some of the Guard and Reserve perceived they were not getting the
same priority of care, treatment, and housing as was received by those
who had been on active duty before they were sent to the combat
theater.
So working with my colleague, Senator Leahy, with whom I cochair the
National Guard caucus, we sent our military LAs to visit Fort Stewart,
GA, and on to Fort Knox and Fort Campbell, KY. We wanted to visit other
sites and will continue to visit other sites to see if the problems at
Fort Stewart were isolated or were they present at other Army
mobilization and demobilization sites.
What Senator Leahy and I found is detailed in the report. I ask
unanimous consent that it be printed in the Record following my
remarks.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1.)
Mr. BOND. Madam President, I don't have time to go over the entire
report, but I think many colleagues will find it of interest to know
what we experienced.
First, let me say that the Army was very open and responsive to our
staff when they came to review the situation. They were most anxious to
have us get a complete look at the situation and to offer to help in
any way they could. So they recognized there was a problem.
Basically, there are not enough medical personnel--doctors,
clinicians, support staff, specialists--available during ``peak''
mobilization and demobilization phases at a number of mobilization
sites. Consequently, injured and ill soldiers have a difficult time
scheduling appointments with medical care providers and seeing the
specialists required to get the best possible care. Some of them had
been waiting literally months to get the kind of care they deserve.
Compounding the problem, large numbers of soldiers either mobilizing
or demobilizing created shortages of available housing at mobilization
sites, which resulted in some of the returning guards and reservists
being placed in housing totally inadequate for their medical condition.
Some of these Guard and Reserve members who had been activated and were
coming back were put in temporary barracks, with outside latrines,
where they normally would house Guard or Reserve members called up for
summer maneuvers.
[[Page S14088]]
We could neither confirm nor deny that there was any difference in
medical treatment between the returning formerly Active and Guard and
Reserve soldiers coming back, but one of the things that was different
when the Active came back to the bases from which they had been
mobilized was that they already had their housing, so they could go
back to the housing from which they started. The Guard and Reserve
coming back from service had to be put in some form of temporary
housing, which, in some instances, was clearly inadequate for people
with injuries or illnesses.
So what is being done? Senator Leahy and I issued the report to
highlight the problems to senior leaders at the Army, National Guard,
and the Army Reserve. I was very encouraged by the response the
military gave us. The Acting Secretary of the Army, Les Brownlee,
visited Fort Stewart on Saturday, the weekend after we sent our teams
there. He met with me last week to lay out his plans for dealing with
the situation. He recounted what he discovered at Fort Stewart and
promised swift support and changes, where necessary.
Specific issues addressed by Secretary Brownlee included the adequacy
of facilities and where they would get treatment. He said, if
appropriate, soldiers will be moved to facilities where they can
provide more timely care. We suggested that if they don't have the
medical personnel available there, why not send them someplace else. He
said he would encourage the commands to contract out for special
services, such as MRIs, for example. If they don't have the equipment,
they can contract out.
I also asked the Secretary to allow soldiers in a medical hold status
to be moved to facilities closer to their home, using military,
veterans health administration, or civilian providers, as necessary.
Secretary Brownlee told me some of the soldiers at Fort Stewart had
already been moved to nearby Fort Gordon, where the medical staff was
not so badly overworked. Also, at his direction, the Army Medical
Command is transferring medical care clinicians to mobilization sites
that need them.
The Secretary has also established minimum standards for housing in
medical hold status. He said, No. 1, facilities will be climate
controlled, meaning air-conditioned and heated. Some of the facilities
didn't have that. Second, facilities must have showers and restrooms
indoors, and not a path in the back, and facilities must be clean and
in good repair. The Secretary also indicated he is considering erecting
prefab facilities to alleviate the housing shortages during
mobilization and demobilization surges that could be used to house
medical hold soldiers.
Secretary Brownlee has issued policy guidance that allows the Army to
deactivate Guard and Reserve personnel who do not meet the physical
requirements for deployment due to a preexisting condition. One of the
problems at Fort Stewart was the fact that some 10 percent of the Guard
and Reserve called up had not had adequate pre-callup medical care, a
situation we are addressing with the TRICARE measures, and they could
not be deployed. They were then the responsibility of the Army at Fort
Stewart, and at the time we were there, a third of the 650 soldiers on
medical hold had never even been deployed because they did not meet the
standards for deployment. Those people will be sent home rather than
kept on medical hold.
Also, after meeting with Secretary Brownlee, I followed up with LTG
Steven Blum, Chief of the National Guard Bureau and LTG James Helmly,
Chief of the Army Reserve, asking them to work with the Army in
resolving these issues. Specifically, we asked their cooperation:
No. 1, by doing a better job medically prescreening Guard and Reserve
soldiers so they do not activate soldiers who cannot serve.
No. 2, to coordinate the callup and retention of medical personnel--
clinicians, support staff, specialists--to ensure the Army mobilization
sites have sufficient medical personnel onsite.
I saw in the news today where the Department of Defense is looking to
call up certain support personnel from other Reserve units, other than
the Army, to provide perhaps naval medical personnel to assist with
caring for the sick and injured soldiers.
No. 3, we asked them to check on Guard and Reserve soldiers who are
on medical hold, making sure somebody was looking after them, to let
them know they have not been forgotten, or to find out if they have
other needs.
Further, Senator Leahy and I have asked the GAO to conduct a survey
into the Army's medical hold process to ascertain the breadth of the
problems that we saw at Fort Stewart and Fort Knox, and to determine if
there is any disparity in medical treatment of returning guardsmen and
reservists who come back in demobilization and have health care
problems.
It is our understanding that the Senate Armed Services Committee, as
well as its House counterpart, is going to conduct hearings into the
conditions uncovered by Mark Benjamin and confirmed by Senator Leahy's
and my investigation, but I regret very much, as all of us do, that
this situation has occurred. It is unacceptable to all of us to think
that injured, ill soldiers returning from the theater of battle would
not get the medical care they need, would not be placed in appropriate
housing.
Once it came to our attention and we brought it to the Army's
attention, we are very encouraged by the way everybody is handling
this, from the garrison commanders and medical directors to
mobilization staff to the Acting Secretary of the Army. This is a
matter of taking care of our soldiers regardless of whether they are
traditional active-duty soldiers or National Guard and Army Reserve
soldiers.
Senator Leahy and I are going to continue to monitor the progress of
the Army in addressing these issues. We plan on sending staff to
additional mobilization sites in the next few weeks and months to make
sure there are no problems. We know that in the next few months the
National Guard and Reserve will be mobilizing thousands of additional
troops. We want to make sure the Army gets it right and keeps it right.
The next mobilization schedule is to begin in the January-April
timeframe, which means when they go, we want to make sure soldiers get
timely care and housing, suitable to getting well, no exceptions.
We know the Army knows of the problems and is aggressively tackling
them. We expect garrison commanders at mobilization sites to continue
to do their best, and we will continue to support them, as well as
every soldier in the war on terrorism. We owe a great debt of gratitude
to our fighting men and women. They have and deserve our highest regard
and respect. We will do all we can to ensure they get the kind of care
we would expect for them.
I thank the Chair, and I yield the floor.
Exhibit 1
U.S. Senate National Guard Caucus Report
Senators Kit Bond and Patrick Leahy, co-chairs of the U.S.
Senate National Guard Caucus, dispatched their aides to Ft.
Stewart to investigate reports that activated Guard and
Reserve members were being poorly housed, with inadequate
medical attention, while on ``medical hold.''
Summary
Approximately 650 members of the National Guard and the
Army Reserve who have answered the call-to-duty and in many
cases were wounded, injured or became ill while serving in
Iraq, are currently on medical hold at Ft. Stewart, GA. Army
base. As a result of an investigation by a reporter and
expeditious follow-up by a veteran service organization
representative it has come to our attention that these
National Guard and Army Reserve soldiers have been receiving
inadequate medical attention and counsel while being housed
in living accommodations totally inappropriate to their
condition. Of the roughly 650 injured soldiers currently
awaiting medical care and follow-up evaluations,
approximately one-third of these soldiers were found not
physically qualified for deployment and therefore never
deployed overseas. The remaining two-thirds deployed overseas
and were returned to Ft. Stewart as a result of wounds or
injuries sustained while serving or as the result of illness
encountered either before or after deployment. Regardless of
the nature of the medical malady, these soldiers have been
enduring unacceptable conditions for as many as 10 months.
The return of the 3rd Infantry Division from the Middle
East (18,000-strong which is permanently stationed at the
base), has forced commanders to lease barracks from the
Georgia National Guard that were designed as temporary
quarters for National Guard soldiers undergoing annual
training. They are not designed to accommodate wounded,
injured or ill soldiers awaiting
[[Page S14089]]
medical care and evaluation. The Army has designed a
Disability Evaluation System that is purposely slow to ensure
that National Guard and Army Reserve citizen-soldiers who are
found not physically qualified for duty receive a fair and
impartial review when undergoing a medical evaluation board.
The process, similar in many respects to the workmen's
compensation process, requires that these soldiers be given
every opportunity to recover. If full recovery is not
possible, the system works to establish a baseline condition
before the soldier is evaluated by a medical evaluation
board.
The situation at Ft. Stewart unfortunately was, and
remains, hampered by an insufficient number of medical
clinicians and specialists, which has caused excessive delays
in the delivery of care. Exacerbating the situation, was the
Army's placement of wounded and injured soldiers in housing
totally unsuitable for their medical condition. Additionally,
these soldiers were placed under the leadership of soldiers
who were also injured, resulting in a situation where the
sick and injured were leading the sick and injured.
Furthermore, the perception among these soldiers is that the
traditional active duty soldier is receiving better care,
compounding an already deteriorating situation that had a
devastating and negative impact on morale. Most of the
soldiers in the medical hold battalion, which was established
administratively to provide a military structure for the
soldiers, have families living within hundreds of miles; yet
they have been unable to join their families while awaiting
the final deliberation of their cases.
In the short term, we must alleviate the unacceptable
conditions at Ft. Stewart and determine if the problem is
isolated to Ft. Stewart alone or part of a larger system wide
problem.
Alleviating the problem at Ft. Stewart will require the
immediate assignment of additional medical clinicians,
specialists and medical support personnel and/or the
transfer, where appropriate, of our National Guard and Army
Reserve soldiers to faculties close to their families so they
can continue to receive quality care and await further
medical reviews if necessary in an environment conducive to
healing. We must also ensure that the conditions at Ft.
Stewart are not replicated elsewhere, while ensuring the
fixes we install at Ft. Stewart are applied throughout the
Army if necessary. In the long term, the Congress must
address the physical readiness of the National Guard and the
Reserve by passage of a pending bill, TRICARE for Guard and
Reservists, to ensure that every member of the Guard and
Reserves has adequate health insurance coverage and is
medically ready to deploy.
Fundamental Problem
More than 650 members of the National Guard and Army
Reserve, who have been activated and put on active duty (some
of whom have already served in Iraq or Afghanistan) are
currently on medical hold at Ft. Stewart, GA. These numbers
change almost daily as some soldiers are returned to duty,
others receive medical evaluations for medical conditions
that prohibit their continued service on active duty, while
more soldiers are brought into the system (the result of
sustaining injuries, wounds or falling ill overseas; or
failing to qualify for deployment after being mobilized
because of injuries or preexisting conditions.)
About one-third of the citizen-soldiers currently in the
disability evaluation system at Ft. Stewart could not
originally deploy with their units because they were not
medically fit, while approximately two-thirds were injured,
wounded or fell ill while on deployment overseas and were
returned stateside to receive special medical attention. When
the 3rd Infantry Division, which is based at Ft. Stewart,
returned from its deployment in Iraq, available housing was
in short supply which resulted in those on medical hold being
moved from one barracks to another in a form of musical
housing. The U.S. Army resorted to leasing open-bay barracks
with detached restroom facilities and no air-conditioning in
most cases, which are normally used to house Georgia National
Guard troops during their two weeks of annual training.
These National Guard and Army Reserve soldiers have been
kept in place at Ft. Stewart according to standard Army
policy while they await medical care and work-ups, which
senior officials say is designed to protect their careers
and ensure they receive the best medical care. The goal is
to put these medically held Reserve soldiers in a holding
pattern until they are healthy enough to return to duty
and go back to their units or to prevent soldiers from
being permanently discharged from service until the nature
of their conditions have been fully assessed and optimal
treatment regime prescribed. When soldiers cannot return
to duty, a final determination about their status is made
by a Medical Evaluation Board (MEB). The MEB process can
take anywhere from an average of 42 days to 76 days after
the soldier's treatment has been ``optimized.'' That is
when a sufficient diagnosis and treatment regime has been
put in place to establish enough confidence to make a
decision. Some troops have been on medical hold for more
than 10 months.
The primary task of the Army Medical Department is to
return these soldiers to duty. While undergoing medical care
and reviews they can be assigned light duty around the post.
Adequate convalescence requires a great deal of rest in most
cases and cannot be properly pursued if there are unnecessary
life stressors, such as placement in housing that is designed
to house ``healthy'' National Guard forces on annual
training--not injured, wounded or ill soldiers.
The barracks for these medically held National Guard and
Army Reservists are totally inappropriate for soldiers
injured, wounded or ill who are in need of quality care and
are garrisoned in a stateside Army installation. The worst
accommodations to which these medically challenged soldiers
were subjected are 1950s-style, concrete-foundation barracks
with no air-conditioning or insulation and detached toilets
and shower facilities, though they do have heat. On a
relatively cooler day in the area (October 22nd), the
temperature in one of these huts was noticeably warm if not
stifling. Bunks sit in open bays, no more three feet apart.
In some cases, there are no footlockers for the troops to
store their gear. In a few of the better barracks, for
soldiers with more severe medical conditions, there is air
conditioning, indoor-plumbing, and storage space.
The fundamental problem, as summarized colorfully by one of
the base commanders, is that soldiers are going through a
``go slow medical review system while living in `get them the
hell out of here barracks.''' Many of the medically held
reservists--mostly from Southern states like Georgia,
Alabama, and Florida--expressed frustration and anger over
the duration of their medical hold and the quality of their
housing while in this seemingly interminable holding pattern.
complicating factors
Feeding these justifiable frustrations are several real and
perceived considerations regarding their medical care and
treatment on the base.
There has been a shortage of clinicians and specialists to
see the medically held Reservists and to accelerate the
review and treatment process. At various points over the past
several months there may have been only a handful of doctors
to care for these hundreds of troops, as well as to assist
with regular forces and their families. Most reserve doctors
called to active duty were deployed forward, and those
remaining in the states can stay on duty for only 90 days
before returning to their civilian practices. One soldier on
medical hold said it took him almost three weeks to get a
follow-on appointment necessary to optimize his care.
Further feeding the anger and frustration is inadequate
leadership. Typically, a soldier will receive advice,
counsel, and assistance in accessing the military's health
system from the soldiers's unit or from upper echelon chain-
of-command. The units of the medically held reservists,
however, have deployed abroad in most cases, and their
commanders are focused on their operational mission overseas.
The Reservists at Ft. Stewart have been grouped together in a
``medical hold'' battalion for administrative purposes but
the effectiveness of the unit chain of command is suspect.
Additionally, many of the battalion leaders--at the officer
and NCO level--are sick themselves, raising the question of
whether these leaders are capable to care for themselves, let
alone hundreds of their comrades. Without a familiar advisor
and leader, deployed away from home and their parent National
Guard or Army Reserve commands, and lacking experience
dealing with a huge bureaucracy like the Army, these
Reservists were left without the leadership to which they
were accustomed.
Moreover, many of the medically held Reservists perceive
bias against them on the post. Whenever they go the hospital,
PX, or dining hall, they are asked whether they are a
Reservist or a traditional active duty service member. This
question is made for accounting purposes, but it makes the
Reservists--many of whom are likely disappointed about being
on sick call in the first place--feel like they are being
singled out. Similarly, many of the medically held
Reservists, lacking sufficient knowledge of the military's
medical bureaucracy, chalk up delays in treatment to
preferential treatment for active forces.
an avoidable situation
This situation could have been avoided. In early June,
medical and garrison staff realized that there would be a
surge in housing needs when the 3rd Infantry Division
returned from Iraq. The division was manned at over 115
percent authorized strength, which would force commanders to
use triple bunks to accommodate 6500 troops in their barracks
that usually hold about 4300. These commanders recognized
then that these permanently assigned troops would have to
take priority over the troops temporarily at the post on
medical hold. Six weeks ago, medical staff submitted a
request up the chain-of-command for 18 additional care
providers who could help manage and accelerate the reviews of
the medical holds. No action was taken on the request.
At about the same time, the garrison commander submitted a
request to 1st Army Headquarters at Ft. MacPherson, Georgia,
for additional funds to renovate the barracks that are leased
from the Georgia National Guard. The command provided $4
million, divided into two parts, but the prospective
contractors could not begin work until this week. That
project, which would have taken 90 days at the very least,
was postponed pending the outcome of the investigations the
Army has currently undertaken after media reports about the
medical hold situation surfaced.
Additionally, it is reported that the Army had the
opportunity in the initial stages of
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the mobilization process to provide for rear-detachment
elements staffed by National Guard personnel. These elements
are designed to provide stateside oversight and support to
National Guard personnel and units deployed overseas. Had
they been present it is possible the conditions described
herein might have been identified and rectified before they
reached a crisis point.
medical readiness of the guard and reserves
It is clear that part of the situation was created by the
fact that some of the mobilized reservists were not as
healthy as possible. Almost ten percent of Guard/Reserve
personnel mobilized for duty at Ft. Steward could not deploy
because of a medical condition and were put on medical hold
status for some period of time.
In the barracks visits, there were also troubling
indications that a handful of Reservists were knowingly
activated and sent to mobilize with medical conditions that
would preclude them from actually deploying. Such an
unjustified deployment might have been designed to take
advantage of the fact that once soldiers are activated (put
on active duty orders) they become the full-scale
responsibility of the U.S. Army. The service is then charged
with their care and feeding to include medical care and
medical evaluations.
The hundreds of Reservists who could not deploy because
they were medically unready raises a number of larger
questions, which the caucus has already begun to address
through its effort to ensure every member of the Guard and
Reserves has adequate health insurance. The caucus will
continue to address the issue in detail during its ongoing
investigation of the medical readiness and mobilizations,
examining questions like whether the resources and process
for screening at the unit level within the National Guard and
Army Reserve ranks are sufficient, and how to explain the
recall of soldiers to active duty who are not fit for duty.
recommendations
There are a number of actions that the Army must take to
address this situation at Ft. Stewart and the larger issue of
``medical holds,'' which will continue to arise as the
country pursues the war against terrorism and sustains
operations in Iraq, Afghanistan and other areas where
military forces are operating.
In the short term, the Army National Guard and the Army
Reserve must jointly provide for the leadership, guidance and
medical care our Reservists require to operate at maximum
proficiency. These dedicated and loyal soldiers need to know
what to expect in the medical review process. They need to
understand thoroughly the Army's health care system, warts
and all. This strong, steady leadership must have the goal of
reaffirming the Army's seamless support for the ``Army of
One'' and the country's gratitude for their service and
sacrifice, reassuring them that they are not forgotten
despite the fact they are separated from their units.
To move the Reservists along to a Medical Evaluation Board
if required, many more doctors need to be assigned to Ft.
Stewart and, specifically, to these cases. The biggest delay
in getting the Reservists off medical hold is the wait to
optimize care. Many soldiers are seeing a different doctor
every time they enter the hospital, each of whom may
prescribe a different remedy. Additional doctors and
specialists, who could help coordinate care, would provide
greater continuity-of-care, one of the central reasons to
keep them at their mobilization station in the first place.
It is unacceptable to have these citizen-soldiers--every
one of whom answered the call-to-duty--living in such
inadequate housing. However, more adequate barracks cannot be
completed quickly because it will take almost three months to
complete any upgrades. Other 3rd Infantry Division barracks
are unlikely to become available soon.
It would be far better to send these troops back home. They
could be assigned to another Military Treatment Facility
(MTF), a State Area Command (STARC) or possibly a VHA medical
facility closer to their families. Liaisons from the TRICARE
management authority could ensure that they are receiving
adequate care and that they would be available to return to
Ft. Stewart if they get better and can return to duty. The
benefit to morale among the medically held Reservists would
far outweigh any of the unlikely risks that might go along
with moving troops away from their mobilization station.
Current Army Regulation 40-501 directs medically held
soldiers to remain near their mobilization post, but there is
no statutory restriction against assigning them to another
facility close to home.
In the longer-term, the Army, working together with the
leadership of the National Guard and the Army Reserve, must
ensure that our citizen-soldiers who are identified for
activation are medically ready to deploy. Enactment of the
cost-share TRICARE proposal for Reservists, currently
attached to the Senate version of the Fiscal Year 2004
Supplemental Spending Bill for Iraq and Afghanistan, would
ensure that every member of the Reserves has access to health
insurance and would increase the likelihood that citizen-
soldiers are medically and physically ready for duty.
Currently, reservists are required to complete a physical
once every five years. The high percentage of reservists
found to be physically unable to deploy raises the questions
of whether this five-year interval is too long. Another
question the Caucus may want to raise, is the Army's
mobilization and demobilization policy sufficient in
providing a housing standard for soldiers on medical hold?
Furthermore, is the working relationship between the Army's
medical department and the Veterans Health Administration
(VHA) structured to allow for the transfer of soldiers on
medical hold from Army military facilities to VHA facilities?
Also, new medical case management software included in the
second version of the military's Composite Health Care System
(CHCS II) will permit continuity-of-care wherever a soldier
accesses care. Guard and Reserve units across the country
could assign liaisons to help manage a Reservist's care and
maintain contact with their mobilization base at any point.
Lastly, it has been reported that architectural hardware
and software exist that will allow the Army to equip its
hospitals, dining halls, and commissaries with scanners that
could read an ID that can show whether a member of the
service is from the active component or the Reserves. Perhaps
the Caucus should look at such systems as a means of
addressing the perceived bias that exists when reservists are
queried about their service status.
The PRESIDING OFFICER. The Senator from Alabama.
Mr. SESSIONS. Madam President, I thank Senator Bond for his
leadership on veterans issues throughout this Congress, as he always
does. I have been over to Walter Reed Army Hospital on three different
occasions. Families tell me they are being treated extremely well. The
soldiers are very complimentary of the health care they have received,
but there have been some problems.
It is important we make sure every soldier injured in the service of
the United States of America be given the best medical care, wherever
he or she is in this country.
I salute Senator Bond for his work in that regard. We want to make
sure that happens. I believe it is happening, at least in the areas I
have personally examined. We will continue to monitor them.
____________________