[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2011
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
________
SUBCOMMITTEE ON DEFENSE
NORMAN D. DICKS, Washington, Chairman
PETER J. VISCLOSKY, Indiana C. W. BILL YOUNG, Florida
JAMES P. MORAN, Virginia RODNEY P. FRELINGHUYSEN, New Jersey
MARCY KAPTUR, Ohio TODD TIAHRT, Kansas
ALLEN BOYD, Florida JACK KINGSTON, Georgia
STEVEN R. ROTHMAN, New Jersey KAY GRANGER, Texas
SANFORD D. BISHOP, Jr., Georgia HAROLD ROGERS, Kentucky
MAURICE D. HINCHEY, New York
CAROLYN C. KILPATRICK, Michigan
TIM RYAN, Ohio
NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full
Committee, and Mr. Lewis, as Ranking Minority Member of the Full
Committee, are authorized to sit as Members of all Subcommittees.
Paul Juola, Greg Lankler, Sarah Young, Paul Terry, Kris Mallard, Adam
Harris,
Ann Reese, Brooke Boyer, Tim Prince, B G Wright, Chris White,
Celes Hughes, and Adrienne Ramsay, Staff Assistants
Sherry L. Young, and Tracey LaTurner, Administrative Aides
________
PART 4
Page
Defense Health Program / Wounded Warrior........................ 1
Missile Defense Agency........................................... 125
Public Witnesses................................................. 179
________
Printed for the use of the Committee on Appropriations
PART 4--DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2011
DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2011
_______________________________________________________________________
HEARINGS
BEFORE A
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
________
SUBCOMMITTEE ON DEFENSE
NORMAN D. DICKS, Washington, Chairman
PETER J. VISCLOSKY, Indiana C. W. BILL YOUNG, Florida
JAMES P. MORAN, Virginia RODNEY P. FRELINGHUYSEN, New Jersey
MARCY KAPTUR, Ohio TODD TIAHRT, Kansas
ALLEN BOYD, Florida JACK KINGSTON, Georgia
STEVEN R. ROTHMAN, New Jersey KAY GRANGER, Texas
SANFORD D. BISHOP, Jr., Georgia HAROLD ROGERS, Kentucky
MAURICE D. HINCHEY, New York
CAROLYN C. KILPATRICK, Michigan
TIM RYAN, Ohio
NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full
Committee, and Mr. Lewis, as Ranking Minority Member of the Full
Committee, are authorized to sit as Members of all Subcommittees.
Paul Juola, Greg Lankler, Sarah Young, Paul Terry, Kris Mallard, Adam
Harris,
Ann Reese, Brooke Boyer, Tim Prince, B G Wright, Chris White,
Celes Hughes, and Adrienne Ramsay, Staff Assistants
Sherry L. Young, and Tracey LaTurner, Administrative Aides
________
PART 4
Page
Defense Health Program / Wounded Warrior........................ 1
Missile Defense Agency........................................... 125
Public Witnesses................................................. 179
________
U.S. GOVERNMENT PRINTING OFFICE
66-611 WASHINGTON : 2011
COMMITTEE ON APPROPRIATIONS
DAVID R. OBEY, Wisconsin, Chairman
NORMAN D. DICKS, Washington JERRY LEWIS, California
ALAN B. MOLLOHAN, West Virginia C. W. BILL YOUNG, Florida
MARCY KAPTUR, Ohio HAROLD ROGERS, Kentucky
PETER J. VISCLOSKY, Indiana FRANK R. WOLF, Virginia
NITA M. LOWEY, New York JACK KINGSTON, Georgia
JOSE E. SERRANO, New York RODNEY P. FRELINGHUYSEN, New
ROSA L. DeLAURO, Connecticut Jersey
JAMES P. MORAN, Virginia TODD TIAHRT, Kansas
JOHN W. OLVER, Massachusetts ZACH WAMP, Tennessee
ED PASTOR, Arizona TOM LATHAM, Iowa
DAVID E. PRICE, North Carolina ROBERT B. ADERHOLT, Alabama
CHET EDWARDS, Texas JO ANN EMERSON, Missouri
PATRICK J. KENNEDY, Rhode Island KAY GRANGER, Texas
MAURICE D. HINCHEY, New York MICHAEL K. SIMPSON, Idaho
LUCILLE ROYBAL-ALLARD, California JOHN ABNEY CULBERSON, Texas
SAM FARR, California MARK STEVEN KIRK, Illinois
JESSE L. JACKSON, Jr., Illinois ANDER CRENSHAW, Florida
CAROLYN C. KILPATRICK, Michigan DENNIS R. REHBERG, Montana
ALLEN BOYD, Florida JOHN R. CARTER, Texas
CHAKA FATTAH, Pennsylvania RODNEY ALEXANDER, Louisiana
STEVEN R. ROTHMAN, New Jersey KEN CALVERT, California
SANFORD D. BISHOP, Jr., Georgia JO BONNER, Alabama
MARION BERRY, Arkansas STEVEN C. LaTOURETTE, Ohio
BARBARA LEE, California TOM COLE, Oklahoma
ADAM SCHIFF, California
MICHAEL HONDA, California
BETTY McCOLLUM, Minnesota
STEVE ISRAEL, New York
TIM RYAN, Ohio
C.A. ``DUTCH'' RUPPERSBERGER,
Maryland
BEN CHANDLER, Kentucky
DEBBIE WASSERMAN SCHULTZ, Florida
CIRO RODRIGUEZ, Texas
LINCOLN DAVIS, Tennessee
JOHN T. SALAZAR, Colorado
PATRICK J. MURPHY, Pennsylvania
Beverly Pheto, Clerk and Staff Director
(ii)
DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2011
---------- --
--------
Thursday, April 22, 2010.
DEFENSE HEALTH PROGRAM/WOUNDED WARRIOR
WITNESSES
DR. CHARLES L. RICE, PRESIDENT, UNIFORMED SERVICES UNIVERSITY OF THE
HEALTH SCIENCES, PERFORMING THE DUTIES OF THE ASSISTANT SECRETARY
OF DEFENSE FOR HEALTH AFFAIRS, AND ACTING DIRECTOR, TRICARE
MANAGEMENT ACTIVITY
LIEUTENANT GENERAL ERIC SCHOOMAKER, ARMY SURGEON GENERAL AND COMMANDER,
U.S. MEDICAL COMMAND
VICE ADMIRAL ADAM M. ROBINSON, JR., MC, USN, SURGEON GENERAL OF THE
NAVY
LIEUTENANT GENERAL (DR.) CHARLES B. GREEN, AIR FORCE SURGEON GENERAL
Opening Statement of Chairman Dicks
Mr. Dicks. The Committee will come to order. Today, the
committee will receive testimony regarding the Defense Health
Program and the Wounded Warrior Program. This hearing will
cover the fiscal year 2011 budget request and various medical
treatment issues pertaining to Soldiers and their family
members.
The Department faces a tremendous challenge with the
growing cost and long-term sustainability of the military
health system. The military health system has taken several
important steps to prepare our military forces and our military
medical forces for the future. For the first time, the
Department of Defense has fully funded the Defense Health
Program in the fiscal year 2011 budget submission. The request
also includes $2.5 billion for the wounded, ill, and injured.
The request includes $30.9 billion for operations and
maintenance, procurement, research and development. The total
military health program is $49.6 billion for 2011. This
includes the payment of $9.3 billion to the Department of
Defense Medicare-eligible Retiree Health Care Fund and $9.3
billion in personnel, Base Closure and Realignment Commission
(BRAC), and military construction costs.
The Department continues to focus on the need for mental
health counseling and readjustment support for our
servicemembers returning from deployments. It is important for
the Department to get to the heart of the issues that soldiers
and their families face during and after lengthy deployments.
The Department is making strides with improvements to
psychological health screening, but much more still needs to be
done.
The Defense Health Program's cost continues to grow at a
similar rate to that experienced in the United States health-
care system at large. In addition, it is likely that benefits
for members, their families, and military retirees are likely
to expand over the coming years. As such, one of the themes
from this hearing is what initiatives should Congress consider
that would sustain health-care benefits, support the needs of
troops and their family members, and improve care, yet control
cost growth.
We look forward to your testimony and to a spirited and
informative question-and-answer session.
Now, before we hear your testimony, I would like to call on
the ranking member, my good friend, Mr. Young, who was formerly
Chairman of this subcommittee.
Mr. Young.
Remarks of Mr. Young
Mr. Young. Mr. Chairman, thank you very much. I want to add
my welcome to our distinguished witnesses today. I think no one
is going to be surprised when I say that it is the opinion--my
opinion and the opinion of most of this committee--that this is
one of the most important hearings that we will have this year.
As the Chairman has said, the well-being and health of our
troops, their families, is something that Mr. Murtha took very
seriously, something that Mr. Dicks, the present chairman takes
very seriously, and I and the rest of this subcommittee. And we
have been stressing for years that it is essential that we take
care of our Soldiers, Sailors, Marines, Airmen, Air women, and
their families. They deserve the best and most affordable
health care we can provide them, as do our veterans.
Just yesterday morning, in a similar hearing, we discussed
the consolidation of medical facilities in the National Capital
Region and what will it take to ensure a world-class health
care system. If it is not already, that world-class standard
should be the goal across all of medical treatment facilities,
not just those in the capital region.
It is our job, your job, to make sure we take care of our
injured heroes, and there is perhaps no job more important to
the subcommittee than that. I know that you take this very
seriously, and I appreciate your commitment to providing them
the best care possible.
So welcome, again. I look forward to your testimony. Just
be assured that whatever it is that you need to guarantee the
proper care of our wounded warriors, our heroes, this
subcommittee is interested in providing that. So let us know
what it is. Thank you very much.
Thank you, Mr. Chairman.
Mr. Dicks. Thank you, Mr. Young.
Dr. Rice, would you like to start first?
Dr. Rice. Yes, sir.
Mr. Dicks. We will put all the statements in the record and
you may proceed as you wish.
Summary Statement of Dr. Rice
Dr. Rice. Thank you, sir.
Thank you, Mr. Chairman and distinguished members of the
committee, for the opportunity to come before you today. I am
honored to be able to testify on behalf of the men and women
who serve in our Military Health System, and deeply
appreciative of the support that this committee has always
provided military medicine. I have, as you note, submitted my
written comments to the committee. I would like to make a few
very brief opening remarks.
I approach my role as the Senior Medical Advisor to
Secretary Gates and Secretary Stanley, at least on a temporary
basis, with the advantages of multiple perspectives: as a
trauma surgeon, as an educator, as a retired Navy medical
officer, and as the father of an Active Duty naval aviator.
The performance of our military medics in combat remains
nothing short of remarkable. In addition to the lifesaving care
on the battlefield, we are continuously improving the medical
readiness of the total force. We monitor and record the health
of servicemembers in the most comprehensive manner ever
witnessed throughout the cycle of deployment: before, during,
and after their service in the combat theaters. Despite the
breakneck pace of combat, most recently our medical personnel
have responded heroically to the natural disasters in Haiti and
Chile. I know that you share this pride in the people who serve
in our system.
Today I want to focus on those areas where greater
attention is required for me, during the hopefully short time I
serve in this capacity, so that you will understand where I am
focusing my energies. First, our deepest obligations are
reserved for the casualties returning to the United States, and
to the families and other caregivers who support them.
Substantial progress has been made since the problems with
Wounded Warrior first came to light in 2007. More needs to
happen on our end to ensure that the programs, services, health
information, and communication are knitted together more
tightly, so that we can provide clearer and more cohesive
services to the families who continue to sacrifice so much.
Second, I am intently focused on the performance and the
perception of the electronic health record. My intention is not
to micromanage the many technological issues, but to determine
whether our proposed solutions will result in a better
capability for our providers, nurses, physicians, pharmacists,
and all the other key members of the health care team, and
deliver value for patients. The only real test for a successful
electronic health record is whether it leads to higher-quality
care and the improvement of the health of the population that
it serves. It must not and cannot fail that test.
Third, the Department continues to implement the broad
changes required by the 2005 BRAC Commission. Our approach to
the right organizational construct and how we build medical
facilities design must result in better services, better
quality, and better access for our patients. Investments in
evidence-based design concepts for our new facilities are
critically important. They offer a better healing environment
for patients and their families. Belvoir will be a showcase for
this new approach, a truly dazzling design that will create an
unmatched healing environment.
Fourth, we are working to resolve the serious matters
identified in the protests that were upheld by the General
Accountability Office regarding the T3 contract awards. While
the issues that we must address are serious, I am reassured and
want to reassure you that the internal issues affecting these
awards have not affected the day-to-day service for our
beneficiaries.
Nonetheless, our efforts to control TRICARE cost growth are
closely linked to the effective implementation of new
contracts, and it is in the best interest of the government and
of the organizations involved in these contract decisions to
move toward a definitive conclusion.
Finally, I want to briefly comment on the larger issue of
national health care reform that has been the focus of so much
recent attention. Although the military health care system is a
unique system of care, we do not function apart from the
civilian health care system used by the American people. In
fact, almost 70 percent of the care our beneficiaries receive
is delivered by our civilian colleagues.
TRICARE benefits are administered separately from the new
health-care reform law. We know that the DOD medical benefit
is, appropriately, one of the most comprehensive benefits of
any employer. One visit to the Walter Reed or the National
Naval Medical Center or Wilford Hall or Brooke, demonstrates
why this should be so, more than any words I can offer here.
Yet there are other potential benefits that will accrue to
the military services when more Americans are covered by
insurance. This includes a more medically fit recruiting pool,
greater investments in comparative effectiveness research that
will help all practitioners of care with developing
scientifically validated approaches to medicine, and a more
secure transition for those members of our Armed Forces who
decide to separate prior to full retirement.
I will be working with my health care colleagues at Health
and Human Services and elsewhere to ensure that we are
appropriately involved in the implementation of health care
reform initiatives that both reassure our beneficiaries and
promote the goals of reform.
One area in which legislation has been proposed to match
TRICARE to the new health insurance requirements is the
extension of health insurance coverage to children of eligible
beneficiaries to the age of 26. Our staff is performing
preliminary actuarial work to determine the anticipated
additional cost to the Department for this coverage expansion
and to develop an equitable premium for this expanded coverage
as directed by legislation.
Mr. Chairman, I want to thank you again for your leadership
and for your steadfast support of the military health system,
and I look forward to answering your questions.
Mr. Dicks. Thank you, Dr. Rice.
[The statement of Dr. Rice follows:]
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Mr. Dicks. General Schoomaker.
Summary Statement of General Schoomaker
General Schoomaker. Chairman Dicks, Representative Young,
distinguished members of the Defense Subcommittee, thank you
for inviting us to discuss the Defense Health Programs and our
respective service medical programs. I am now in my third
congressional hearing cycle as the Army Surgeon General and the
Commanding General of the Army Medical Command. I can tell you
that these hearings are valuable opportunities for me to talk
about the accomplishments of Army medicine and to hear your
collective perspectives regarding military health promotion and
health care.
I, and I know my colleagues as well, are saddened to be in
this hearing today without one of military medicine's strongest
supporters. Chairman Jack Murtha was a friend of the Military
Health System, of Army medicine, and a soldier on point for the
Nation. I extend my personal sympathies to his family and to
those with whom he worked closely, to those in his district he
represented so faithfully, and to those he inspired. He is
deeply missed.
Chairman Dicks, I certainly look forward to working with
you in your new role and to continue the great support and
guidance this committee has provided for the Military Health
System.
I am pleased to tell you that the President's budget
submission for fiscal year 2011 fully funds the Army Medical
Department's needs. Your support of the President's proposed
budget will be greatly appreciated.
One area of special interest to this subcommittee is our
comprehensive effort to improve warrior care, from the point of
injury through evacuation and inpatient treatment to
rehabilitation and return to duty. This is really a tri-service
effort and done very cooperatively with my colleagues to the
left. There is nothing more gratifying than to care for these
wounded or injured heroes.
We in Army medicine continue to focus our effort on
wounded, ill, and injured warriors, and I want to thank
Congress for your unwavering support. You all have been very,
very instrumental in the improvements that Army medicine has
made in this regard and across the Joint force. The support of
this committee has allowed us to hire additional providers to
staff our Warrior Transition Units, to conduct relevant medical
research, and to build the healing campuses, the first of which
will be opened at Fort Riley, Kansas in late May.
I am convinced that Army has made some lasting
improvements. The most improvement may be a change in the
mindset from a focus on disability to an emphasis on ability
and achievement. Each of these warriors has an opportunity and
the resources to create their own future as soldiers or as
productive private citizens. In fulfilling our moral obligation
to our soldiers, we have established a comprehensive program of
world-class medical care, of rehabilitation, professional
development, and personal goal setting.
Today, we have 29 Warrior Transition Units and nine
community-based Warrior Transition Units out in individual
States, staffed by more than 3,900 personnel who manage the
care and support for approximately 9,000 soldiers and their
families who are currently in the program.
The cornerstone of any warrior's successful transition is
what we call the Army's Comprehensive Transition Plan. It is
the warrior's holistic plan for his or her future. As detailed
in my written testimony, the Comprehensive Transition Plan is
tailored to a warrior's individual situation. It takes account
of six demands: career, physical, social, emotional, spiritual,
and family support needs.
A second area of special interest for this committee is
psychological health. Army Medicine, under the direction of our
new Deputy Surgeon General, Major General Patty Horoho, most
recently the Commanding General of the Western Regional Medical
Command--and, sir, I know that you know her very well--at Fort
Lewis, is finalizing a comprehensive behavioral health system
of care plan. This comprehensive system of care is intended to
standardize and to synchronize the vast array of behavioral
health activities that occur across the Medical Command and
throughout the Army's force generation cycle--this iterative
cycle of deployment, of support for families and the soldier,
while they are in deployment, and reintegrating them when they
return from deployment. I look forward to sharing more
information with you over the next months as we roll out this
exciting initiative.
In keeping with our focus on preventing injury and illness,
Army Medicine and Army leadership is currently engaged in an
all-out effort to change the military mindset regarding
traumatic brain injury, especially the milder form, or
concussion. Our goal is nothing less than a cultural change in
fighter management after potential concussive events on the
battlefield. To achieve this goal, we are educating the force
so as to have trained and prepared soldiers, leaders, and
medical personnel to provide early recognition, treatment, and
tracking of concussive injuries, ultimately designed to protect
the warrior's health--no different than what would occur on a
sports field in America today.
I brought with me today a packet. It is called ``The Brain
Injury Awareness Tool Kit.'' I ask that we be permitted to
share this with you and your staffs. It contains patient
information materials as well as an informative DVD--a kind of
concussive brain injury 101, that is used to educate soldiers
before they deploy overseas. This further highlights strong
efforts by Army's leadership and the DOD leadership to reduce
the stigma associated with seeking help for this injury and for
any behavioral health problem that may occur jointly or
separately from the brain injury.
The end state of these efforts is that every servicemember
sustaining a possible concussion will receive early detection,
state-of-the-art treatment, and a return-to-duty evaluation in
the long-term digital health record that Dr. Rice referred to
earlier, to track their management. I truly believe our
evidence-based directive approach to concussion management will
change the military culture regarding head injuries and impact
the well-being of the force.
In closing, I am very optimistic about the future of Army
Medicine. I feel very privileged to serve the men and women of
Army Medicine as soldiers, Americans, and as global citizens.
Thanks for holding this hearing and for your steadfast support
of the Military Health System and Army Medicine.
[The statement of General Schoomaker follows:]
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Mr. Dicks. Admiral Robinson.
Summary Statement of Admiral Robinson
Admiral Robinson. Good morning, Chairman Dicks,
distinguished members of the subcommittee. I want to thank you
for your unwavering support of Navy Medicine, particularly as
we continue to care for those who go in harm's way, their
families, and all beneficiaries.
I am honored to be with you today to provide an update on
Navy Medicine. Navy Medicine: World-Class Care Anytime,
Anywhere. This poignant phrase is arguably the most telling
description of Navy Medicine's accomplishments in 2009, and
continues to drive our operational tempo and priorities for the
coming year and beyond.
Throughout the last year, we saw challenges and
opportunities. And moving forward, I anticipate the pace of
operations and demands will continue to increase. We have been
stretched in our ability to meet our increasing operational and
humanitarian assistance requirements as well as maintain our
commitment to provide care to a growing number of
beneficiaries. However, I am proud to say that we are
responding to this demand with flexibility and agility more so
than ever before.
The foundation of Navy Medicine is force health protection.
Nowhere is this more evident than in Iraq and Afghanistan.
During my October 2009 trip to theater, I again saw the
outstanding work of our medical personnel. The Navy Medicine
team is working side by side with Army and Air Force, medical
personnel and coalition forces to deliver outstanding health
care to our troops and civilians alike. As our Wounded Warriors
return from combat and begin the healing process, they deserve
a seamless and comprehensive approach to their recovery. We
want them to mend in body, mind, and spirit.
Our patient- and family-centered concept of care brings
together medical treatment providers, social workers, case
managers, behavioral health providers, and chaplains. We are
working closely with our line counterparts in the Marine Corps
Wounded Warrior Regiments and the Navy's Safe Harbor program to
support the process for Sailors, Marines, and for their
families.
An important focus area for all of us continues to be
traumatic brain injury. We are expanding TBI training to health
care providers throughout the Fleet and Marine Corps. We are
also implementing a new in-theater traumatic surveillance
system and conducting important research. Our strategy is both
collaborative and integrative, by actively partnering with the
other services, the Defense Center of Excellence for
Psychological Health and Traumatic Brain Injury, the Department
of Veterans Affairs, and leading academic medical and research
centers to make the best care available to our warriors.
We must act with a sense of urgency to continue to help
build resiliency among our Sailors and Marines as well as the
caregivers who support them. We are aggressively working to
reduce the stigma surrounding psychological health and
operational stress concerns. Programs such as the Navy's
Operational Stress Control, Marine Corps Combat Operational
Stress Control, FOCUS (Families Overcoming Under Stress)
Caregiver Occupational Stress Control, and our suicide
prevention programs are in place and maturing to provide
support to personnel and their families.
Mental health specialists are being placed in operational
environments and forward-deployed to provide services where and
when they are needed. The Marine Corps is sending more mental
health teams to the front lines, and Operational Stress Control
and Readiness teams, known as OSCAR, will soon be expanded to
include the battalion level. A mobile care team of Navy
Medicine mental health professionals is currently deployed to
Afghanistan, conducting mental health surveillance, consulting
with command leadership, and coordinating mental health care
for Sailors throughout the Area of Responsibility (AOR).
An integral part of Navy's Maritime Strategy is
humanitarian assistance and disaster relief. In support of
Operation United Response-Haiti, we deployed USNS Comfort from
her homeport in Baltimore within 77 hours of the order and
ahead of schedule. She was on station in Port au Prince 5 days
later. From the beginning, the operational tempo onboard
Comfort was high, and our personnel were challenged both
professionally and personally. For many, this was a career-
defining experience. And I was proud to welcome the crew home
last month and congratulate them for their outstanding
performance.
I am encouraged with our recruiting efforts within Navy
Medicine and we are starting to see the results of new
incentive programs. But while overall manning levels for both
officer and enlisted personnel are relatively high, ensuring we
have the proper specialty mix continues to be a challenge both
in the Active and the Reserve components. Several wartime
critical specialties as well as advanced practice nursing and
physician assistants are in demand. We are facing shortfalls
for general dentists, oral maxillofacial surgeons, and many of
our mental health specialists, including clinical
psychologists, and social workers. We continue to work hard to
meet this demand, but fulfilling the requirement among these
specialties is expected to present a continuing challenge.
Research and development is critical to Navy Medicine's
success and our ability to remain agile to meet the evolving
needs of our warfighters. It is where we find solutions to our
most challenging problems and, at the same time, provide some
of medicine's most significant innovations and discoveries.
Research efforts targeted at wound management, including
enhanced wound repair and reconstruction, as well as extremity
and internal hemorrhage control and phantom limb pain in
amputees present definitive benefits. These efforts support our
emerging expeditionary medical operation and aid in support of
our Wounded Warriors.
Clearly, one of the most important priorities for the
leadership of all the services is the successful transition to
the Walter Reed National Military Medical Center onboard the
campus of the National Naval Medical Center Bethesda. We are
working diligently with the lead DOD organization--Joint Task
Force, National Capital Region Medical--to make sure that this
significant and ambitious project is executed properly and
without any disruption of services to our Sailors, Marines, and
their families, and all other beneficiaries for whom we are
privileged to serve.
In summary, I believe we are at an important crossroads for
military medicine. Commitment to our Wounded Warriors and their
families must never waver, and our programs of support and hope
must be built and sustained for the long haul. And the long
haul is the rest of the century, when the young Wounded
Warriors of today mature into our aging heroes in the years to
come. They will need our care and support, as will their
families, for a lifetime.
On behalf of the men and women of Navy Medicine, I want to
thank the committee for your tremendous support, for your
confidence, and for your leadership. It has been my pleasure to
testify before you today, and I look forward to your questions.
Mr. Dicks. Thank you, Admiral Robinson.
[The statement of Admiral Robinson follows:]
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Mr. Dicks. We want to welcome General Green. This is his
first time testifying before our subcommittee. We welcome you.
Summary Statement of General Green
General Green. Thank you, sir. Chairman Dicks,
Representative Young, and distinguished members of the
committee, thank you for the opportunity to join you today and
address our common goal of providing the best care to our
warriors and families. The Air Force Medical Service does
whatever it takes to get our Wounded Warriors home safely.
Over 1,600 Air Force medics are currently deployed to 40
locations in 20 countries, delivering state-of-the-art
preventive medicine, rapid lifesaving care, and critical care
air evacuation. We have now moved over 70,000 patients safely
from Iraq and Afghanistan. Air Force medics are responding
globally in humanitarian missions as well as on the
battlefield, and in the last 6 months we contributed
significant support to the treatment and evacuation of
Indonesian, Haitian, and Chilean earthquake victims.
You may have heard or seen national news reports about an
amazing operation that took place last month at Craig Joint-
Theater Hospital in Bagram. Air Force Major Doctor John Bini is
a seasoned theater hospital trauma surgeon stationed at Wilford
Hall Medical Center who is deployed to Bagram. When the
radiologist discovered a live explosive round in an Afghan
patient's head, there was no hesitation as Major Bini and his
anesthesiologist, Major Doctor Jeffrey Rengel put on body armor
and went to work. They evacuated the OR, leaving only the two
of them and a bomb technician with a patient, and within 10
minutes removed the live round. Miraculously, the patient has
been discharged and is recovering, able to walk, talk, and feed
himself.
At home, our health-care teams share patient-centered care
to produce healthy and resilient airmen and provide families
and retirees with full-spectrum health care. Our suicide and
resiliency programs are targeting those at highest risk for
interventions. We have embedded mental health in our family
health clinics to increase access and reduce stigma. Family
liaison officers and recovery care coordinators assist our
Wounded Warriors and families with seamless transition and are
the backbone of the Air Force Wounded Warrior and Survivor Care
programs.
This is what Air Force and Army medics, along with Navy
corpsmen, are all about. We are trained and ready as a team to
meet the mission wherever, whenever, and however needed, with
cutting-edge techniques and equipment or the most basic of
resources, if this is our only option. We have the lowest died-
of-wounds rate in history because of well-trained, highly
skilled, and extraordinary people. Our brave and dedicated men
and women put service before self and demonstrate excellence in
all they do.
Thank you for your immeasurable contributions to the
success of our mission. We deeply appreciate all that you do to
ensure we recruit and retain these very special medics who are
devoted to providing trusted care anywhere. We could not
achieve our goals of better readiness, better health, and best
value for our heroes and their families without your support.
I thank you and stand ready to take any questions from the
committee.
Mr. Dicks. Thank you for your statement.
[The statement of General Green follows:]
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IMPACT OF VOLCANIC ASH ON WOUNDED WARRIOR TRANSPORT
Mr. Dicks. It is very impressive to be at Ramstein and
Landstuhl and see these planes fly in with these wounded
warriors.
Mr. Young.
Mr. Young. Mr. Chairman, I wanted to say we had a really
good hearing yesterday. Dr. Rice pretty much led the
discussions, and was very, very helpful. There were a couple of
questions that we presented, and I am not sure we got the
answers exactly accurately, so I want to go back to one or two
of them.
One, the Chairman mentioned about Landstuhl and Ramstein
and the transporting of wounded heroes. We have both been there
a number of times and experienced seeing this happen. But my
question yesterday was--there was some kind of notice was
published that said that we would be bypassing Landstuhl now
and coming directly to Andrews. The response was that they
think that was just temporary because of the volcanic ash. I
would like to get confirmation on that; whether that is the
case or whether--if in fact it is the practice now to bypass
Landstuhl when you can.
General Green. No, sir. That was done solely because of the
restrictions on aircraft in Europe because of the volcanic ash.
And so we basically rerouted the airplanes through Balad and
rotated them up through Rota and then back into here. It is
very temporary. We have had four or five airplanes do it. There
has been no effect on the casualty evacuation. As of today,
Ramstein and Landstuhl are back up again and the casualties
will go through there again.
WALTER REED/BETHESDA CONSOLIDATION
Mr. Young. Well, I am amazed at how well that system works.
These kids are getting good care immediately on the scene, at
the battlefield, and on the way home. I have met a lot of those
aircraft as they brought wounded heroes. I am just impressed
with the care that they get. As a matter of fact, I get in
trouble on occasion, because every time there is a little news
story about something that went wrong with military medicine,
my comments are brought back to haunt me. But I have seen
miracles, what I consider miracles, at Walter Reed and at
Bethesda.
And, General Green, I am not that familiar with your
medical facilities, just because of the proximity here. But I
think that our Wounded Warriors get outstanding medical care
and I think your medical professionals are outstanding.
Having said that, also, again, yesterday we talked briefly
about the merger of the medical facilities in the capital area.
I get different responses when I talk to different people,
those who are at the hospitals. How is that going? You all have
a little different position than the witnesses that were here
yesterday because each of you represent your service. But now
we have this merger. What happens to the identity of your
service, what happens to the chain of command? Who is really in
charge of this consolidated medical facility? Let's start with
that.
General Schoomaker. Sir, I will take the first. We are the
Army, and we are losing one of our major and most vulnerable
institutions. As you know, Walter Reed and the Walter Reed
campus, which is 100 years old this year--or last year--I
think, sir, it is going remarkably well. I think we already
know, the three of us sitting here, that on a day-to-day basis
at Walter Reed and Bethesda and Malcolm Grow, and at Fort
Belvoir, for that matter, but to a lesser degree, the staffs
are already integrated. Training programs are already
integrated.
I personally have undergone surgeries over the last several
years at Walter Reed and at Bethesda. Frankly, the staffs are
fully integrated. You have Navy surgeons working on soldiers,
marines, and airmen in an Army hospital, and you have Army
surgeons and dermatologists and OBs that are delivering
services to the same mix at a Navy facility.
And so I think what we are now doing is all the necessary
steps at a granular level to make sure the civilian workforce
from Walter Reed--which is the one most affected by this--is
moved successfully; that they know where they are going and
what jobs they are going to have.
But as Admiral Robinson and his subordinate commander
there, Admiral Nathan, points out, even 90 percent of the
people currently working at Navy are going to go to different
slots within different sites within a brand-new facility. So
everybody is being affected, and I think it is being done in a
very proactive way.
I might say, sir, in reference to the earlier comment about
the trip through Rota, correct me if I am wrong, but it is
still an onerous trip. It adds considerably to the length of
the evacuation. I would also comment that every time you see a
patient at Walter Reed or Bethesda, you are seeing the results
of Air Force Medicine, because they wouldn't be there and they
wouldn't be alive and doing as well as they are, were it not
for the intensive care that they receive in the air from the
Air Force.
Admiral Robinson. I would like to underscore what General
Schoomaker said. I think he hit many of the major issues that
are there. I would emphasize that in terms of care, the CCAT,
Air Force, Army, and Navy, and the care of Wounded Warriors and
trauma care, et cetera, there is no equal in the world. We have
come together to give that care. And it shows in the
interoperability and the ethos of all three services in making
sure we get what we need for our Wounded Warriors.
I think the same continues in the National Capital Area. I
think that I am going to take my Chief of Naval Operation's
position here today to say the care that we give here must
follow the rule of first principles. First principles say: Let
us do what we have to do. So let us do the BRAC and let us at
the same time take care of Wounded Warriors. And then, since
our services are already integrated and we are joint from a
medical-care perspective, then we can take on some of the
challenges of the governance and the other things that we need
to look at in terms of the long haul for medical care.
But in terms of making sure that we are focused on patient
care and on Wounded Warriors and care issues, which are the
issues that we cannot leave behind, I think we are doing that.
If we continue to do that, I think we are going to be very
successful in the BRAC issue.
And just like the Army said that it is losing a venerable
institution, the Navy is losing a venerable institution, too,
in the National Naval Medical Center and the Bethesda Naval
Hospital. Both of those institutions go away. There is a new
institution called the Walter Reed National Military Medical
Center. It may sit on a Navy base on Wisconsin Avenue, but it
is no longer a Navy hospital in the tradition of Bethesda, nor
will it be an Army hospital in the tradition of Walter Reed.
And it will also include Air Force physicians, medics, nurses,
and ancillary medical personnel from Malcolm Grow. It will be a
joint hospital that will care for our Wounded Warriors into the
future.
JOINT MEDICAL FACILITIES
General Green. Malcolm Grow, which is the smaller of the
medical centers here in town, was actually due to close about 2
years ago. Because of the BRAC and trying to ensure that we had
extra capability as we saw all of the construction, we have
kept the doors open in terms of the inpatient facility through
the end of 2011. It will become an ambulatory surgical
facility, and we are keeping roughly the same amount of
manpower here, with nearly 172 of our staff that will be
working up in the Walter Reed National Military Medical Center.
We have also combined residencies with the Army down at Belvoir
and have family practice residents in the residency at Belvoir.
My response in terms of how it is going is, I think it is
going well. We know how to execute a JTF. Air Force is simply
one component of that JTF. We believe that they have the
authorities that they need and that we are working closely with
them. If you go to Bethesda campus today, you will find that
roughly 55 of the nurses, the ICU nurses, are there. Those same
nurses are the ones we trained to do Critical Care Air
Transport Teams (CCATs) and also provide a lot of the work on
aircraft when it is their turn to deploy.
So I think it is a very good joint effort in terms of how
we are bringing this together. There are still issues in terms
of financing and guidance as we move into more joint operations
back here at home. But we know how to do this. Our clinical
care is very joint. And so I would say it is going well, sir.
FORT HOOD
Mr. Young. Well, I appreciate what you have said. If you
recall, two of you were here last year for the hearing, and I
expressed some concern about morale, because a lot of the
medical professionals, the doctors, were wondering where do I
go next; what is my next job; where is my next location? But
having been in Walter Reed and Bethesda considerably, and
recently, I see at Walter Reed a lot of Navy doctors and
nurses. At Bethesda I see a lot of Army doctors and nurses. And
I think the morale issue is basically dramatically improved
because people didn't--last year they didn't really know what
was happening. This year I think they have a pretty good idea
of what is happening. I give you all credit for making sure
that your services were identified, but that you have been able
to make this merger.
I know I have taken an awful lot of time. Mr. Chairman, one
more question I wanted to ask. We are concerned--many of us--
many are concerned about the situation with Major Hasan and the
shooting at Fort Hood. There has been some criticism that maybe
his problem should have been detected before he ever got to
Fort Hood. Are there any changes in watching something like
this to make sure that if there is a suspicion, that we deal
with it before it becomes a threat to life and limb?
Dr. Rice. Congressman Young, I will speak with my hat on as
the President of the Uniformed Services University. As you
know, Major Hasan received his M.D. Degree at the Uniformed
Services University and then came back to do a fellowship. I
want to be careful in what I say because we have not yet sent
our report on our analysis up to Secretary Gates. As you know,
there is an ongoing criminal investigation.
This touched the faculty, staff, students, and alumni of
the Uniformed Services University very deeply. And we have
undertaken a very thorough review. I have received a summary of
that analysis just this morning, and I think we will be able to
provide some recommendations to Secretary Gates very shortly.
I will defer to General Schoomaker, who can discuss the
Army side of that review.
General Schoomaker. Yes, sir. Again, mindful that this is
an open investigation, the Army's subsequent completion of the
investigation that was begun by the Wes Clark Commission, the
Army component of which was conducted by General Hamm, the
Commanding General of the United States Army-Europe, is still
ongoing and is about to be completed. But I would submit, sir,
that there have been many lessons, all the way from the
recognition of self-radicalization within the force, which is a
real threat, and how we identify that--senior Army leadership,
DOD leadership, is focused on that--to how we respond in the
event of a calamity like this at a local installation like Fort
Hood, to include its emergency response to how we manage
subsequent consequences of that.
We launched a fairly unique behavioral health response with
the help of the Uniformed Services University and others,
targeting subpopulations like children, like victims, family
members, and other members of the community that would be
affected by that. All of these have provided lessons to us.
But to your point, I have been very clear with my Command
and with those who have asked, I think although, again, it is
an open investigation, we all agree there are many aspects of
the training of Major Hasan that we are looking at very
closely. But I will stand by my earlier comments that none of
his behavior, I think, would have been predictive of a mass
murderer.
ACCESS TO PRIMARY CARE HEALTH CARE
Mr. Young. Well, I think your comment ``lessons learned''
was a good comment. I am just happy that you are really paying
attention to those lessons that we have learned from this
incident, which was a calamity.
Mr. Chairman, thank you very much.
Mr. Dicks. Thank you, Mr. Young. Since we are talking about
Fort Bragg, there was an article in the Fayetteville, North
Carolina Observer saying that General Casey had just visited
Fort Bragg and officials at the Womack Army Medical Center said
they are aware of problems with access, because the number of
enrolled beneficiaries at Womack has exceeded the available
primary care capacity; patients have at times experienced
difficulty obtaining timely appointments, largely in the area
of routine and wellness care, Shannon Lynch, a Womack
spokesman, said in a written statement.
How serious is this problem and what are you doing about
it, General Schoomaker?
General Schoomaker. Sir, access to primary care I would say
is a problem across the Army. The Chief of Staff of the Army,
General Casey, and his wife, Mrs. Casey, have made this a very
important focus of their leadership. For the last 18 months to
2 years, we have been working very hard across the Army with a
series of initiatives, beginning with properly sizing our
facilities and health-care providers to accommodate reasonably
the enrolled population of soldiers and Active Duty family
members. Recognizing that the Army has grown by 65,000 soldiers
and has brought on many, many more beneficiaries in the form of
Reserve component soldiers, this continues to challenge us at a
time that the Nation is challenged to provide primary care
health care.
We have a very aggressive program. We have been seeing
steady improvements in overall patient satisfaction, overall
ability of a patient to get to his or her primary care provider
or the team. All three services have embraced the patient-
centered medical home concept, which is a fundamental
transformation of how we deliver care at the primary care
level. And we have recently, with the help of the TRICARE
Management Agency and Dr. Rice's deputy, Rear Admiral Christine
Hunter in the TRICARE Management Agency, have gotten consent
for standing up in 14 different communities in the Army, to
include Fort Bragg, the building of and leasing of community-
based primary care clinics that are going to expand the
capacity.
So we are very aware of the problems that Fort Bragg
especially has. It happens to be one of the hospitals that we
continue to have--because of the size of the population and
growth--some of the bigger problems with, but we are seeing
steady improvements across the Army, sir.
Mr. Dicks. They also mention behavioral health care to
Active Duty soldiers and their families is on a space-available
basis. Is that pretty much standard?
General Schoomaker. Sir, behavioral health care across the
Army, and I think almost across the services--I don't want to
speak for the others--but across the Nation as well, is under
challenge. We are about 86 percent of our estimated
requirements for behavioral health specialists, uniformed and
non-uniformed.
Admiral Robinson in his opening statement alluded to the
problems they are having with social workers and psychologists.
We have a problem with psychiatrists, both civilians and, of
course, uniforms. Understanding that although we have doubled
the amount, the capacity to train social workers and
psychologists recently, the lead time for training or acquiring
a psychiatrist is upwards of 8 to 10 years. So these are tough
nuts for the whole Nation to crack.
I would have to say it is one of the reasons that we are
really focusing a lot, as well, on building resiliency and
trying to identify problems as close as possible to when they
are first recognized and to use the primary care arena--our
family medicine docs, our internal medicine docs, our PAs, our
pediatricians--to be one of the first line of defense in
treating behavioral health issues.
SUICIDES
Mr. Dicks. One of the major issues of concern to the
Defense Department and to the Congress is the suicide rate,
particularly in the Army and Marine Corps. We had some
discussion of this prior to the meeting. I thought some of the
things that are being done we should put on the record. Dr.
Rice, do you want to start on this?
Dr. Rice. Yes, sir. Thank you, Mr. Chairman. Dr. Tom Insel,
who is the Director of the National Institute of Mental Health,
has identified suicide as a public health problem for the
Nation as a whole. There are approximately 32,000 completed
suicides in the United States each year. That is a number at or
slightly above the number of fatalities related to motor
vehicle collisions.
In the military services for a number of years the suicide
rate was lower than the population as a whole. But recently,
over the last several years, that rate has gone up, so that it
is now at or perhaps slightly above the rate for the country.
The line leadership and the Service Secretary in all three
Services have been very concerned about this. Particularly, I
will let General Schoomaker speak in more detail about the
Army's approach. But the Vice Chief of Staff of the Army is
personally engaged in this issue. In fact, I am attending one
of his monthly reviews of suicides in the Army this afternoon.
He does this every month with the commanding generals of the
various military facilities where a suicide has occurred.
He takes this personally and seriously. He identified a
need for a detailed study on suicide and turned to the National
Institute of Mental Health for assistance in developing a grant
application. A number of academic institutions around the
country responded to that application. And I am pleased to say
Dr. Robert Ursano, Chair of the Department of Psychiatry at the
Uniformed Services University, and his team--he is assisted by
very experienced investigators from the University of Michigan,
from Harvard University, and from Columbia--were the successful
applicants for that grant.
Mr. Chairman, you are familiar with the Framingham study in
Massachusetts, which over a number of years has contributed
enormously to our understanding of the risk factors associated
with heart disease. What is intended with this study is a
similar longitudinal study on a large number of individuals
followed sequentially over a number of years that will
similarly inform us about the risk factors associated with
suicide.
General Schoomaker, did you want to add?
General Schoomaker. What Dr. Rice has talked about is the
program known as STARS, begun by our former Secretary of the
Army Pete Geren, and is being maintained by Mr. McHugh, our
current Secretary. It is a $50 million, 5-year study which
promises to be the largest longitudinal study that examines all
the factors that are relevant to suicidal ideations and
suicidal behavior. It follows about a year and a half's worth
of work led by Vice Chief of Army Pete Chiarelli himself to try
to get inside the problem of suicide in the Army. We have seen
over the last 5 to 6 years a doubling of suicide rates from
what were roughly half of an age-and-sex-adjusted population
rate against our civilian colleagues, to one that is on par and
may even exceed the current civilian population. It is hard to
tell because civilian statistics are 2 years behind the
military's statistics.
General Chiarelli is really focused hard on this. About a
third of our suicides are from soldiers in their first year,
before they have even been deployed; often, we think, due to
problems that they bring into uniform with them; and it tracks
with what we know from health behavior studies that have been
conducted over the last several decades where 30 to 40 percent
young soldiers, airmen, sailors, will admit to bringing
significant psychological problems into uniform. About a third
occurred in deployment, often with a weapon, and about a third
from soldiers who have been deployed in the last 2 years.
We are looking at all the factors. The one transcendent
factor we see across the board is a correlation with fractured
relationships--the loss of a spouse, a divorce, breakup with a
girlfriend. As I explained to you, sir, before the meeting,
even for marines and sailors and soldiers and airmen, the
relationship they have with the service, they can forge a very
close relationship with the Army and then get caught in
misconduct, be administratively dealt with through the Uniform
Code of Military Justice, leave the commander's office and go
out and kill themselves.
So these are the things that we are dealing with. We are
working very hard with the help of the STARS program to see
what we can do to interrupt this.
SUICIDE PREVENTION
Mr. Dicks. Admiral Robinson.
Admiral Robinson. I would like to just also say that, in
addition to everything being said, taking it to the individuals
in question, this becomes a leadership issue. And it is a
leadership issue not only at the highest ranks but also at the
lowest ranks. It has to be taken to the level of the Soldier,
of the Sailor, of the Marine, of the Airman, and there has to
be an awareness of the people around you and how they are
doing. That comes through education and that comes through
training. That also comes through destigmatizing mental health
issues so that people are not afraid and do not think their
career will be hindered or harmed by seeking psychological
help.
It also calls for individuals to look at one another.
Friends and buddies know each other better than anyone. When
things aren't right, then they have to institute those programs
so that they can can ask, how are you doing, how are you
sleeping? They can actually look into the eyes of individuals
and see who they are and see whether they are hurting. And then
they can take the appropriate action by getting them to
counseling, getting them to a chaplain, making sure they take
responsibility for their shipmate. I think that is another
important aspect of this.
Another aspect is making sure that we have time between
deployments so that we can reset from a social and a family and
an emotional and psychological point of view, come back into a
more regimented existence, and home, before going back into an
operational and combat environment.
General Green. Sir, for the Air Force, we have a 14-year
history of effective suicide prevention program. We were able
to drop our rates below 10 per 100,000 for nearly ten years.
Since 2007, we have seen our rates also edging up. And so we
are reemphasizing many of the things we put in place over those
years.
The newest thing is to target specific groups we have seen
who are at higher risk, such as our security forces, our intel
groups, and some of our aircraft maintenance, who have a much
higher rate, perhaps related to operational tempo and dwell
rates. Those things are not determined yet, but we are watching
very closely.
Our focus is on trying to get face-to-face training for
those high-risk groups and have the training and get the
experience to be wingmen, if you will; someone who will watch
after those who are working with them. We think, like the other
Services, if we can get the leadership and the people who are
overseeing these folks to know what is going on with their
troops, that we can make a difference in this.
Like the other Services, we see relationship problems as
number one in terms of risk factors; financial problems as a
second area; and then UCMJ and disciplinary problems also can
lead to issues. We have not seen any association with
deployment. In fact, over the last 8 years, only two occurred
while deployed. The only potential association has to do with
relationship difficulties that may be caused by recurrent
deployments. And so we are watching that very closely.
We do see something that is in fourth category now in terms
of things that are rising. We can't yet tell you whether that
is people who are depressed or who have other diagnostic
categories, but we are seeing a larger number of the people who
actually commit suicide who have been involved with mental
health care, and we still have been unable to break the cycle
that led to that impulsive decision.
General Schoomaker. If I could add real quickly to what
both these gentlemen said, and especially the comment that
Admiral Robinson made about the importance of small-unit
leadership and fellow Soldiers, Sailors, Airmen, and Marines.
You may have read a recent story of a hooch mate, a bunk mate
of a soldier downrange, who knew that his fellow young enlisted
soldier had just received a Dear John e-mail and was in
distress. Took the firing pin out of his weapon without his
knowing it. While he was out of his billets, his buddy, the
suicidal one, tried to kill himself with his M-16. Of course,
it didn't go off. When he came back in he said, My weapon
doesn't fire. His bunkmate said, How do you know that? They got
to talking about the fact that he was aware that his buddy was
suffering a lot of problems. That soldier whose life was saved
by his friend is still a soldier. He is continuing on Active
Duty. He has started a new relationship and he is going to be
leaving sometime in the next year to marry her and start a new
life.
These things that Adam talked about are very, very
important.
Mr. Dicks. Thank you. Mr. Visclosky.
IMPLANTED STIMULATORS
Mr. Visclosky. Thank you, Mr. Chairman. Gentlemen, thank
you for your service.
Admiral, I usually take this opportunity to congratulate
Naval witnesses on beating Notre Dame in football at home,
twice. Now Mr. Moran is upset with me. But I also notice that
you graduated from Indiana University Medical School.
Admiral Robinson. I did.
Mr. Visclosky. You obviously know what you are talking
about. I have got to get in a plug.
Gentlemen, my understanding is the Department of Defense is
doing research on implanted stimulators that would send
impulses to reanimate limbs for people who have had strokes and
traumatic injuries. I find the issue fascinating. If, one, you
could bring me up to date as to where you are, and is there an
ongoing study and is there progress being made?
General Schoomaker. Yes, sir, real briefly. We have a very,
very robust program across the Services on amputee care and
extremity injury, very heavily endorsed by the American
orthopedic community at large, and the Congress has been
generous by providing research funds for us. We are in our
third generation of prostheses. The upper arm, the upper
extremity prostheses, is the most demanding for an amputee.
Lower extremity prostheses--of course, the loss of any limb or
extremity is a problem. I don't mean to trivialize that. But
the advances in lower limb prostheses have resulted in now the
ability to retain soldiers or marines or others who have lost a
lower limb, especially below the knee, much more easily.
We have retained about 140 amputees in the Army on Active
Duty. Forty of them we have redeployed to combat. Three of the
40 have gone back to combat, having lost their limbs not in
combat, but in motor vehicle accidents or training accidents
back here, and are being deployed as amputees for the first
time.
The upper extremity prosthesis is a challenge. We are in
the third generation. And DARPA has been in the lead of much of
this. Geoff Ling is the name associated with this, a
neurosurgeon and neuroscientist who is working with linking
brain thought--just as in your and my case, who have limbs--
with the movement of the limb. Heretofore, we were reliant on
the upper extremity prostheses to either retrain a muscle to
flex and make a mechanical device in the hand or the arm move.
Then we went to the advance of linking a sensor in the muscle
on the remaining part of the body so when someone thought to
move his thumb or close his hand, they thought, and began to
move that muscle.
We have gone to now the generation that eventually will
allow people to move that prostheses because of a thought in
their brain. That is the one I think that you are thinking
about.
CLINICAL AND REHABILITATIVE MEDICINE RESEARCH PROGRAM
Mr. Visclosky. Is there a funding request for 2011 for
that? One of the other questions I was going to address--you
had mentioned DARPA--is that it was our understanding the
Department was going to ask for $125 million to DARPA for
development of force enhancements. I assume that is a separate
issue.
General Schoomaker. Yes, sir, I believe so. I can get back
on the details of funding for the extremity research alone.
Mr. Visclosky. If you could, I would appreciate that very
much.
General Schoomaker. Yes, sir.
[The information follows:]
Yes. For Fiscal Year 2011, the Clinical and Rehabilitative Medicine
Research Program has requested, through the Defense Health Program, $30
million for the development, evaluation and optimization of extremity
orthotics and prosthetic component research. The primary impetus is on
the development of arm interface technology and the further development
of upper extremity prosthetics. The requested funding will support
upper extremity prosthetic clinical optimization studies and subsequent
optimization of the devices.
ORGANIZATIONS WORKING WITH WOUNDED WARRIORS
Mr. Visclosky. I also understand that at a number of DOD
facilities there are individual installations or not-for-profit
organizations working with Wounded Warriors. Are there a fair
number of these established, and how would I distinguish them
from military programs for Wounded Warriors? Is there care
given to make sure there is not duplication of services?
Dr. Rice. Well, sir, there are two very prominent programs
funded by Mr. Arnold Fisher and his foundation, the National
Intrepid Foundation; one is at Brooke Army Medical Center at
Fort Sam Houston in San Antonio, which General Schoomaker can
describe; the other is under construction now at the new Walter
Reed National Military Medical Center, the National Intrepid
Center of Excellence, focused on traumatic brain injury and
psychological health. In addition, there are a number of
support activities around all military installations. USO is a
good example. I am sure my colleagues can describe those in
more detail.
General Schoomaker. I think all the services have very,
very good relationships with a whole range of nonprofit groups
out there that have leaned forward in assisting our wounded and
injured soldiers, sailors, airmen, and marines in all our camps
and stations where these are done. At all of those Warrior
Transition units I described earlier, we have got relationships
with a variety of local and national groups.
One of the problems, I think, is how to focus and
distribute those services. Recently, the USO has offered to
serve as a kind of national clearinghouse to be able to provide
that service for us. But I think, as Dr. Rice mentioned, we
have a very large number of very generous nonprofit groups that
have helped build facilities such as the National Intrepid
Center at Fort Sam Houston, and is building right now the
National Intrepid Center of Excellence for traumatic brain
injury on the campus at Bethesda.
Another good example is the Warrior and Family Support
Center that is down--attached to Brooke Army Medical Center,
which was built entirely by a very large number of private
donors on land that was given over by the Army. None of the
donors, largely, were over about a hundred dollars apiece. So,
like the National Intrepid Center, which is the amputee center
down at Fort Sam Houston which was built by 600,000 donors,
there has been a huge outpouring of support from the public.
Mr. Visclosky. Gentlemen, thank you. Thank you, Mr.
Chairman.
Mr. Dicks. Mr. Frelinghuysen.
JOINT THEATER TRAUMA REGISTRY
Mr. Frelinghuysen. Thank you, Mr. Chairman. Gentlemen,
thank you for the extraordinary work you do. Since this is a
public hearing, will one of you talk about the remarkable track
record of survival rate for battlefield injuries? Would one of
you just mention--the statistics are very high, this is like no
other war--the things that your men and women have done?
General Schoomaker. I agree. This is a tri-service effort.
It is probably best attributed to the Joint Trauma Theater
System, the JTTS. It employs an electronic record, known as the
Joint Theater Trauma Registry. It is maintained by the Army,
Navy, Air Force, and Marines.
This is a group that, for all intents and purposes, has
built a trauma system comparable to what you would have in any
large metropolitan area in the country, but it has done it
across three continents and 8,000 miles. They meet virtually
online and by video teleconferencing at least once a week to
discuss cases. And they use evidence-based practices that
literally follow almost from the point of injury back through
evacuation and rehabilitation back in the States to make sure
that any improvements that can be made in how a case is managed
are being done, and then looks for evidence for improvement.
And doing that has resulted in a case fatality rate that is
unprecedented in past wars.
Mr. Frelinghuysen. Would you give that rate?
General Schoomaker. It is very high. The case fatality rate
is less than 10 percent, meaning that over 90 percent of
casualties in combat survive. If you make it to a forward
surgical team or forward Marine unit or combat support hospital
or the hospital at Balad or Bagram, then your survival rate is
over 90 percent.
MEDICAL RECORDS
Mr. Frelinghuysen. All of us pay tribute to that--Medevac
people, airlift people from Balad and Bagram, the hospital in
the air. It truly is remarkable.
The focus of my question is sort of on medical records. Can
you talk about just the issue of medical records, the integrity
of the medical records? Maybe it is anecdotal, but we do hear
periodically that there are issues that medical records don't
often follow the patient. I sort of wondered where, generally,
the services were. You do extraordinary work here, but
obviously we have battlefield injuries and people are
transported long distances, and done in a remarkably wonderful
way, but some general comments about medical records.
We talked about this with Dr. Rice yesterday, the integrity
of those records and also the susceptibility in today's world
that somebody could sort of bring down the whole damn system,
as evil as people are. Can we have some general comments and
reaction on the medical records issue?
Dr. Rice. Happy to talk about that, sir. I bring,
unfortunately, a very long perspective. I am considerably older
than my colleagues here. So I was on Active Duty at the
National Naval Medical Center during the Vietnam War, where
casualties would come back, often 4 or 5 weeks after wounding,
just because the Air-vac system was not anywhere close to what
the sophistication level is today. They may have stopped at two
or three hospitals along the way. And the likelihood that their
record would actually accompany them back to us at Bethesda was
relatively low.
I am pleased to say that that is not the case now; that
almost always an accurate record of the care that has been
rendered both at the forward support hospital, the combat
support hospital, the theater hospitals, and in the air at
Landstuhl, makes it back.
ELECTRONIC MEDICAL RECORDS
Mr. Frelinghuysen. Is it indeed electronic or is it sort of
a combination of paper and electronic?
Dr. Rice. In some cases, it is. But by and large, it is
electronic. The issue of security of the medical record is one
of not just military, not just national, but actually
international concern, as I know you are aware. The Department
is working very hard towards our next generation of electronic
health record. And the three pillars that must be there are
security, stability, and scalability. The security issue is of
paramount importance. We must protect the integrity of the
record, and the Department is going to great lengths to make
sure that that happens.
Mr. Frelinghuysen. So you think that is being well done. I
know you each take pride in your service. I assume that all the
services have the same high standards.
Dr. Rice. We are taking a common approach to that across
the Services, so that it will be a single system that serves
all three of our Services and ultimately links with the VA
system so we can seamlessly pass the relevant and important
data from the DOD system into the VA.
Mr. Frelinghuysen. You said ``ultimately.'' I know around
the table we have talked about the VA at one point was sort of
in a crisis. They sort of are leading the way. It was the
seamlessness they have now that they didn't have. They had all
the different hospitals, but records couldn't be transferred
from people in the Northeast to the South. So our Services, as
represented here today, how are they doing in terms of linking
medical records?
Dr. Rice. We have a pilot project.
Mr. Frelinghuysen. We did hear yesterday that we couldn't
get I think from Walter Reed--from Bethesda to Fort Belvoir.
Hopefully, that was an exception.
Dr. Rice. Admiral Madison commented on that yesterday. I
think by and large, the ability to transfer the relevant and
important data across the systems from one military treatment
facility to another is a problem that we have accomplished a
great deal on. We don't hear that as a major issue with our
providers.
Mr. Frelinghuysen. We are counting on it. We are the
resource committee. So if there is anything lacking, we would
love to hear about it.
General Schoomaker. No, sir. I think across the three
services, that is not an issue. Bidirectional health
information flow to the major polytrauma centers, the VA, is
also not a problem. My own electronic health record began in
about 2002 in the Southeast. I have moved four times and my
record has moved with me each time without any problems. Saved
a lot of money, saved a lot of unnecessary x-rays and shots.
The one hole that we have in the electronic system is from
the point of injury to the surgical site. That still is paper-
dependent. We have tried electronics. We have given hand-held
PDAs to medics and corpsmen. It is a problem and an issue, and
we continue to try to penetrate that. Right now, it is still
reliant on a handwritten record.
Dr. Rice. Sir, if I could just add one comment to that.
That is not different from the civilian world. If you look in
emergency rooms, even in those hospitals that have electronic
records, it is the ER that still is largely paper-dependent
because of the press of time.
Mr. Frelinghuysen. Thank you, Mr. Chairman.
Mr. Dicks. Thank you. Mr. Moran.
TRAFFIC AT BETHESDA
Mr. Moran. Thanks, Mr. Chairman. Actually, I am going to
relate a little story. A few months ago, the retina in my left
eye was peeling off. It is about 5:30 at night.
Mr. Dicks. Free medical advice?
Mr. Moran. No. You will see the relevancy; it is going
somewhere. So I drive to Bethesda through traffic and so on.
Get there about 6:30 or so. They said, You're about to lose
your eyesight. This retina is going to be gone. They said, I
don't know what we are going to do about it because all our
folks are gone; but perhaps the best guy to do this operation
is over at Walter Reed, Dr. Chun. I am going to call him. We
might as well start this coordination stuff now.
So they call Dr. Chun. He was on his way home. He comes
back to Bethesda. They put a couple of tables together to have
me lie down at the top of it. He takes his hypodermic needle
and sucked out all the liquid behind the eye, except it was
probably the most excruciating thing, because there was no time
for anesthesia.
Then they broke into a room that was locked and got a
machine that had this gas stuff and put gas in the eye and held
it down. Anyway, they saved the eye. They said among
themselves, you know, had we not been able to do this together,
the Navy and the Army ophthalmologist, I would have lost my
eyesight in my left eye.
There was some relevance here, Mr. Chairman. So I really am
a believer in this, that as we coordinate at Walter Reed--I
know, as Admiral Robinson said, the Navy is also losing its
principal medical care facility in terms of the public
visibility, as is Walter Reed. They are both losing their
identity, but we are going to have something new that is even
better, and the colocation is going to work for a lot of
people.
My concern, of course, is that both at Bethesda and at
Walter Reed, the traffic is almost impossible. You know that.
And I am wondering--I am not going to get into all the BRAC
stuff--I am wondering the extent to which you were consulted in
terms--I know it is a mundane issue, it would seem, but if your
staff, if your physicians, let alone your patients, can't get
in there, that no matter how good the care is, it is moot if
they can't get to the hospital in some reasonable period of
time when there is an emergency.
So have you given any thought? Were you able to offer
advice in this process of the logistics around the facility to
have real adequate access?
Dr. Rice. Congressman Moran, I experience this personally
when I am back at the Uniformed Services University because, as
you know, it sits on the Bethesda campus. I live about 10
minutes north. It is 10 minutes when I come into work at a
little after 5:00 in the morning. It is considerably longer
than that going home in the evening because of the traffic on
Wisconsin Avenue.
Mr. Moran. It could be as much as 40 minutes just to get
out.
Dr. Rice. It can be as much as 40 minutes to get from Jones
Bridge Road to Cedar Lane. Admiral Robinson experiences it,
because he lives on the base at Bethesda. It is a complex
problem, and I know a number of people have given this issue
serious thought. We are hoping that DARPA will shortly come up
with a transporter beam so that we could move around without
vehicles.
But I think a large part of the effort that we are
undertaking with the new Commander of the Naval Support
Activity at Bethesda is to do everything we can to encourage
staff, particularly staff and the students at the university,
to use Metro to the maximum extent possible. It is a complex
issue.
General Schoomaker. Congressman, first of all, we are glad
to hear your eye was saved. I suspect the contributions of the
soldiers involved was breaking down that door to let the Navy
surgeons work.
Admiral Robinson. At least we have solved that break-in
now. Thank you.
General Schoomaker. Two comments I would make. First of
all, many of you, after the 2007 February stories in the
Washington Post about Walter Reed, came out and visited. I was
then put in command of Walter Reed, and commented about whether
there was reason to pause and think about the decision to close
the old Walter Reed campus. My comment, in addition to the fact
that we want to be in compliance with law, was that for the
same reasons that you describe the problem at Bethesda, we have
the same problem at Walter Reed. It is very tough to get there;
patients don't like to get there; and we don't even have the
benefit of the Bethesda or the National Institute of Health
(NIH) Metro station.
FT. BELVOIR
Mr. Moran. Incidentally, you have got a similar problem at
Fort Belvoir. It is a beautiful facility but there is no Metro
there either. We are going to have trouble getting patients in
emergency condition there.
General Schoomaker. That brings up my second point; that
often overlooked is that although the most proximate demand, as
Adam has pointed out, is the merger of three hospitals into
two, the larger plan of 37 facilities and 400,000 beneficiaries
in a greater metropolitan area, which makes up the National
Capital Region, is the real motherlode here. It is how do we
integrate services across the three services for over 400,000
beneficiaries.
This will be the 40th largest HMO in the country once it is
completed, for 37 different military treatment facilities.
Putting care close to where families and Soldiers, Sailors,
Airmen, and Marines live is going to be important, which is why
the Belvoir campus is so important to us. It is much closer to
where people live.
It is also why, as I said from the beginning with my
colleagues here, that siting a lot of the high-intensity
warrior care and accommodating their families on the Bethesda
campus, which won't necessitate trans-gate traffic, is so
important. If you can provide care for an injured soldier or
patient and amputees and intensely injured and ill Soldiers on
that campus, then you reduce the necessity to move traffic in
and out of the campus.
Admiral Robinson. Representative Moran, I think that that
is correct. I agree. I think that your comments are, we are
consulted, and when I say ``we,'' as we have the Corps of
Engineers and as the Navy's NAVFAC, the Navy Facilities Command
that builds, those things such as traffic loads and others are
studied and taken into account. We need to attend to how the
growth goes.
I think that, as you stated, making sure that we can get
staff into the hospital and--that is as important as the
patients. One of the reasons we have a large number of barracks
for our enlisted onboard the base, and have for years, is the
fact that not only are we in a hugely expensive county, much
more expensive than most of our junior enlisted can pay for,
they also are within the skin of the ship, as it were. So snow
days and traffic days, we can depend on those corpsmen to make
sure they are with patients and doing those jobs.
So yes, we are consulted; and yes, this is a major point.
No way around it.
Mr. Moran. Thank you. Thanks, Mr. Chairman.
Mr. Dicks. Thank you, Mr. Moran. I am very glad you had a
positive outcome.
Mr. Moran. I wouldn't have shared it if it hadn't been
positive.
Mr. Dicks. I am glad you shared it. Thank you. Mr. Tiahrt.
WARRIOR TRANSITION UNITS
Mr. Tiahrt. Thank you, Mr. Chairman. Welcome to the
committee. I was recently in Fort Riley, where they have a
Wounded Warrior transition unit that they are standing up. Even
though they don't have the facilities yet, they have the
program in place.
I have had the opportunity to pheasant hunt with some of
the Soldiers that returned from the front lines and have
suffered traumatic brain injury, and some are suffering from
posttraumatic stress syndrome. They seem to have a pretty good
way of helping them readjust back to life here in America.
I was wondering if you are satisfied with the progress that
they are having so far and if you can explain a little bit
about the uniqueness about the unit. Because they have a pretty
good rate of success; at least that is what they have told me.
General Schoomaker. Yes, sir. The Fort Riley program is one
of the 29 Warrior Transition Units that are in hospitals, major
health centers, and medical centers across the Army. We have
about 9,000--about 7,000 Soldiers in that program and another
2,000 Soldiers in nine States that are centered around nine
States--Arkansas, Utah, Virginia, Florida, and the like, and
Massachusetts. These Warrior Transition Units have an Active
Duty cadre made up of primary care managers, squad leaders,
just like any other military unit, and nurse case managers that
track the care.
A very important part of our program is with comprehensive
transition planning for vocational rehabilitation; for career
development; for social, medical and emotional needs. And for
programs like our posttraumatic stress program, we have got a
fairly high rate of return to duty for those Soldiers. Overall,
the WTUs are returning about 50 percent of Soldiers back into
uniform to continue service or back into the Reserves to
continue service.
The campus associated with that program, the one at Fort
Riley, will be our first physical campus that we are standing
up with new construction on the 27th of May. That will be the
first of about 20 of these campuses that will be built across
the country, including the one that we are building down at
Fort Belvoir.
POST TRAUMATIC STRESS DISORDER
Mr. Tiahrt. At what point do you sort of take the
temperature of people as far as trying to find PTSD or some
mental capability? When they are deployed, do you test them or
talk with them before they return, and when they return and how
long afterwards? What is your pattern now that you shoot for?
General Schoomaker. Sir, we do it whenever it is
appropriate. Frankly--I am not being coy--what we are moving
away from is a kind of arbitrary surveying of people at key
points. Heretofore, we did it before they were deployed; the
predeployment health assessment. Immediately upon
redeployment--it was called the post-deployment health
assessment, and then 90 to 180 days later, it was called the
post-deployment health reassessment.
What we are finding is it is more important to move in a
direction of tracking the individual and their problems,
because they frequently arise out of major events. For example,
the last time I was in Afghanistan, there was some intense
fighting on the eastern part of Afghanistan. The brigade
commander told me that one of the unexpected findings was 30 to
60 days after they were deployed, some of the experienced young
officers and noncommissioned officers who had deployed before
and been in fights before were experiencing stress reactions to
this new deployment. We didn't expect that to occur 30 to 60
days after they had arrived in theater.
So we are beginning to track longitudinally through this
comprehensive program when care is provided. But, in general,
what we look for most often was immediately before deployment
to make sure people are sound, immediately after they return,
and then the 90 to 180 days later.
The last thing I will say is that part of the program that
both the Marines and the Army are doing downrange is to find
both concussive events--which we think have a high correlation
with posttraumatic stress disorder--and overlap with that. That
is, if you have had a concussion in combat, it predicts more
often than not that you are going to have posttraumatic stress
later, or possibly posttraumatic stress if it is enduring. So
we are trying to find those problems as close to the actual
incidents as possible and begin treatment in theater.
Mr. Tiahrt. As you know, we have a lot of Guard and Reserve
units that have gone forward, and they don't have access to a
permanent facility like Fort Riley or Fort Belvoir. How are you
dealing with PTSD with the Reserve and the Guard units?
Dr. Rice. Yes, sir. You are exactly right. There is a
challenge for the Guard and Reserve in particular as they
return to areas that are remote from military treatment
facilities. With the support of this committee and under the
leadership of Chairman Young, we established a program at the
University, the Center for Deployment Psychology, which is
focused on behavioral health providers, on the peculiar types
of experiences that these servicemen and -women have
experienced in theater, so that they can better provide
behavioral health care for them. We have educated a substantial
number of civilian providers now, and I am very pleased with
the success of that program.
Mr. Dicks. The gentleman's time has expired. Mr. Boyd.
SUPPLEMENTAL FUNDING
Mr. Boyd. Thank you, Mr. Chairman. And, gentlemen, thank
you for being here today.
Dr. Rice, I want to direct my question to you and talk a
little bit about the budget side. Obviously, I think many of us
have been concerned that over the last 8 or 10 years that we
have relied on supplemental budgets for much of our funding. I
wanted to pick your brain a little bit about the current
supplemental that we have before us; what part of that will be
for funding Active military personnel and dependents, and also
what you might have in your current budget that you are talking
about here today that might not be covered, we might have to
cover in a supplemental later on.
Dr. Rice. Congressman Boyd, thank you. First, let me say
that I am relatively newly arrived in this position, and the
preparation of this year's budget happened before I got here. I
do not think that any of the basic funding of the military
health-care system was dependent on the supplemental budget. I
think that the budget proposal that has come before you now
fully funds the Military Health System.
Mr. Boyd. Okay. Would any of the Surgeon Generals have
any--do you have any knowledge about the current supplemental
as it relates to any health funding that is in that?
General Schoomaker. Sir, in the past, the supplementals
have helped us mainly with closing the gap in military medical
construction, which had a very large hole in the program. You
all very generously filled that for us, and we are building new
hospitals, to include the one at Fort Riley and Fort Benning.
Mr. Boyd. But not health services.
General Schoomaker. Not direct health services, although
there has been supplemental dollars attached to, for example,
Army support of Grow the Army and the medical support that went
into that. But I fully agree with what Dr. Rice said; that is,
the President's budget in the base provides the necessary
dollars for health care.
Admiral Robinson. For the Navy, as an example, I think the
recent Unified Response-Haiti, there will be an additional
amount of money that will be covered by the supplemental. And
that is operational. I am not sure that is really in the
definition of health services, but I agree, again, with what my
colleagues have said.
General Green. What my financial people tell me is
beginning 2010, there were dollars that were reprogrammed from
previous supplementals into the baseline. The dollars for the
Air Force were about just under $35 million. About $22 million
of that was for TBI and psychological health, another $4.5
million for OCO tasks, and about $8.3 million for Wounded
Warriors.
If your question is whether we can get by without any
supplemental in 2011, we are fully funded. The trick is with
ongoing contingency operations, the dollars that come in that
backfill some of our deployed people, we can't absorb it; but
actually a lot of that contract that fills in for care back
home and ensures access does comes from OCO funds, which is
part of the supplemental, if that answers your question.
Mr. Boyd. Thank you. Thank you very much. Mr. Chairman, I
brought that up because, obviously, as we enter this era where
we have to begin to focus on budget deficits, it is going to be
really important that we understand what the requirements are
going to be.
Dr. Rice, in your testimony you have laid out some very
instructive information there about the rising health-care
costs under your purview, both Active Duty and retirees. So I
just wanted to bring that to the attention of the committee. I
thank you, Mr. Chairman.
Mr. Dicks. Thank you.
Mr. Rogers.
PRESCRIPTION DRUG ABUSE
Mr. Rogers. On March 23, when we had Secretary McHugh and
General Casey here, I brought up with them the prescription
drug abuse problem that we have--and it is not limited, of
course, to the military. It is a problem in the civilian world
as well. But a recent USA Today article about it mentioned a
Pentagon survey in 2008 which showed that one in four soldiers
admitted abusing prescribed drugs, mostly pain relievers, in
the 12 months prior to the survey; 15 percent said they had
abused drugs in the 30 days before the survey. The records show
that the abuse of prescription drugs is higher in the military
than in the civilian world.
I am wondering, A, what you think about this, and what are
we doing about it, and what should we be doing about it?
General Schoomaker. Well, sir, I will speak for the Army.
We are very concerned about prescription drug use. As you
alluded to--and you and your district are experiencing as
well--there is a nationwide problem of, first of all,
accidental overdose from prescription drugs now leads or
exceeds deaths or complications from illegal drugs in the
country. The Centers for Disease Control tell us that. The
second is that diversion of drugs--that is, prescription drugs
that are used for recreational purposes, not for what they were
intended--is a major problem both outside the gate and inside
the uniform.
Last year, I stood up a task force within the Army for pain
management oversight, working with the other services and the
VA. And in anticipation of legislation that came out last year
requiring that we have a DOD approach to pain management, we
are starting to get our arms around the size, the magnitude of
the problem of pain management, and the use of prescription
pain-managing drugs. We are looking at all sources of care for
pain management, to include alternative medical care practices
like acupuncture and yoga and the like.
At the same time, we are, especially in our Warrior
Transition Units and in other clinical settings, taking a very
aggressive approach to what we call sole provider programs,
where only a single physician, nurse practitioner, or PA can
prescribe drugs for a patient if they are at risk for abusing
those drugs, and very careful programs of counting and watching
the inventory of drugs that our soldiers might have. But we are
very concerned about the problems that you address.
Mr. Rogers. Abuse of prescribed drugs is a huge problem in
my district and, as you say, across the country. It is not
limited to the military, obviously. However, the Pentagon
survey said that the problem is higher in the military than
civilian. I am told that Army Secretary Thomas Lamont, said
that a multiservice task force is examining how the Army gives
pain relief pills to its soldiers. Eventually, it will outline
how to limit prescription medication use and ensure that Army
hospitals all use the same procedure for dispensing medicine.
He said, We found every Army medical center was dealing with
pain in altogether different ways, all individual, but not an
Army-wide program at all. There was no consistency. Do you
agree with that?
General Schoomaker. Yes, sir, that is exactly what the pain
management task force that I chartered has found. That is not
unique to the services. Frankly, that is a national problem. It
is a problem even within the Veterans Administration. We don't
have a standard kind of approach and we don't necessarily
leverage all techniques, to include nonpharmacological
problems. We have had a problem of acute versus chronic pain.
We have pain from a variety of sources. Pain is subjective. It
is not objective in the sense of something measurable.
What we are trying to do is standardize our approaches,
leverage every technique that we can, in cooperation with the
other services and the Veterans Administration and leading
academics in the private sector and in the academic sector who
can help us. But you have identified, sir, I think a problem
that we recognize as a medical system.
Mr. Rogers. In the civilian world we have been pushing
prescription drug monitoring drug programs; each State, with a
grant from the Federal Government to require pharmacies,
doctors, hospitals, anyone in the medical field, when a
prescription is filled, to notify the central computer in our
State capital so that a person will not be able to double-fill
a single prescription. I think you have what is called a
Pharmacy Data Transaction Service, a similar type.
General Schoomaker. In fact, we can track every
prescription across not only our military facilities but also
civilian pharmacies. Any time a military prescription
electronically is used and any time the military system is
billed, even if it is outside in the civilian sector, we can
track.
In fact, I can give you for the record a tabulation of
exactly what the use of prescription drugs of various
categories is right now for the entire force of 550,000
soldiers.
Mr. Rogers. I would like to see that.
[The information follows:]
We can query the comprehensive pharmacy database of all DoD
pharmacies and contracted network pharmacies (provided the service
member has the DoD pay for the prescription so it is recorded in the
database). We can provide a summary of how many Soldiers have current,
open and active prescriptions.
Active Duty Soldier Prescription Data
(March 2010)
558,840 Active Duty Army Personnel (Includes 4,498 USMA Cadets):
--200,255 (35.8%) Active Duty Army Soldiers with any
medication prescription
---------------------------------------------------------------------------
Does not include WT Soldiers
---------------------------------------------------------------------------
--2,504 (0.4%) for combination (sleep, psychotropic*,
narcotics)
---------------------------------------------------------------------------
* Psychotropic medications include the drugs in the following
classes: anti-anxiety, anti-seizure, anti-psychotic, anti-depressant,
or stimulant
---------------------------------------------------------------------------
--43,578 (7.8%) for narcotics
--20,027 (3.6%) for anti-depressants
--11,448 (2.0%) for sleep medications
--5,500 (1.0%) for anti-anxiety medications
--5,119 (0.9%) for anti-seizure medications
--2,671 (0.5%) for anti-psychotic medications
--170 (0.03%) for fentanyl patch
General Green. Sir, if I can add, the PTDS system also
allows us to place restrictions, like the systems you are
talking about, where people would not be able to get their
prescriptions filled, even when written by another provider. So
they can only get it from one source.
PRESCRIPTION DRUG MONITORING PROGRAMS
Mr. Rogers. I think that service works for all except
medications in-theater. I think I can understand that, but
explain that.
General Schoomaker. Sir, we don't have--except in selected
facilities such as Balad or Bagram, where we have an electronic
record available--in the average or the usual combat outpost or
forward operating base where we may not have that available and
where things are done out of troop medical clinics or battalion
aid stations--we don't have the same oversight and ability to
roll up the aggregate abuse of prescription drugs.
Mr. Rogers. I think, Admiral Robinson, the data from ships
is also not a part of this.
Admiral Robinson. It is not, but we have the data from
ships rolled up into our SAMs program and to other electronic
programs we use. But it is not a part of PTDS.
Mr. Rogers. Well, the problem has been growing. The abuse
of prescription drugs in the military is growing rather
dramatically, as a matter of fact; partly, of course, because
of the wars. It seems to me like we are dealing with a real
problem here. Do you think it is a real problem?
General Schoomaker. Yes, sir, I think that is exactly what
prompted me to charter the task force that I did for the Army,
to try to get our arms around it, especially when it is related
to pain use. We are doing the same thing with respect to drugs
that are being given for behavioral health problems and can
give you the same comprehensive tabulation of who is taking a
psychotropic drug, a drug that influences mood or behavior.
Mr. Rogers. What do you expect out of the task force, and
when?
General Schoomaker. Sir, I have the final draft in hand.
Right now, I am reviewing that. We hope to present that to the
leadership of DOD Medicine very shortly.
Mr. Dicks. The gentleman's time has expired.
Mr. Rogers. Mr. Chairman, I think Dr. Rice has something.
Dr. Rice. Sir, if I may, Congressman Rogers, you have put
your finger on a very complex problem. One of the challenges
that we face is that for many, many years we in the medical
profession undertreated pain. Through the efforts of a lot of
people, including the Joint Commission, we have recognized that
undertreatment, and now begun to take steps to make sure that
patients are not needlessly enduring pain.
I think the challenge for us all is to know what the
appropriate treatment is, and while the use has undoubtedly
gone up, that increased use is entirely appropriate. Pain is
the most common reason that people seek medical attention. And,
therefore, paying appropriate attention to pain relief is an
important part of clinical practice.
Mr. Rogers. Thank you.
Mr. Dicks. Thank you. Mr. Bishop.
HYPERBARIC OXYGEN THERAPY
Mr. Bishop. Thank you very much. Let me welcome you all
back again. I would like to ask the panel to return to an issue
that we visited last year, and that has to do with the related
treatments for traumatic brain injury and the hyperbaric oxygen
therapy.
Lieutenant General Schoomaker, I have been informed that
the hyperbaric oxygen therapy equipment and the medical
personnel have been contracted by DOD for a 2-year, $20 million
pilot program that was supposed to start up in January of this
year. I am told that the equipment and the personnel are
positioned at Camp Pendleton, Camp Lejeune, Fort Carson, and
Fort Hood, but to date they haven't been used to treat any
injured personnel.
I wanted to ask if you would just describe for the
committee what the hyperbaric oxygen therapy is, and tell us
about the situation with the equipment being available but not
yet in use.
General Schoomaker. Yes, sir, I will do my best, and then I
think my colleagues have even more visibility over it. But in a
nutshell, hyperbaric oxygen is the delivery at a pressure above
the sea level atmospheric pressure of air or oxygen, which then
raises tissue levels of oxygen above the normal range. It is
recognized as a treatment for a variety of things; for example,
wound healing for resistant infections, especially by organisms
that are sensitive to oxygen; or for reversal of complications
of diving accidents, for example, and that is where the Navy
and those who work with pressurized environments have some
experience with them.
There are some recognized medical indications for the use
of hyperbaric oxygen. Its use in traumatic brain injury or for
posttraumatic stress disorder is not currently recognized by
the national groups that, in a sense, certify or authorize use
for that clinical application. We are looking very, very hard
for good scientific evidence that it adds value in those
situations. We are compelled----
Mr. Bishop. That was the status last year. I thought you
told us last year that that was underway and that we would
probably have some kind of indications soon.
General Schoomaker. My understanding is that we have two or
three outstanding trials right now that are just about to
report and give us some early indication whether there is some
utility to it. There are some recently reported nonrandomized
and noncontrolled studies, meaning that patients were given the
treatment, but knowing they were getting the treatment, and
there was no control arm that didn't use that treatment mode to
see if there was any real effect of the hyperbaric oxygen. So
we are compelled to use randomized clinical trials. We have a
good program now. Maybe Admiral Robinson would summarize.
Admiral Robinson. Representative Bishop, last year, and
actually for the last couple of years, we have been--there have
been a number of reports by researchers and clinicians on
hyperbaric oxygen therapy. As has already been summed up,
hyperbaric oxygen therapy has a usefulness with evidence-based
treatments and clinical protocols for a variety of different
cases.
There has never been one for brain injuries and for PTSD.
There have been a number of anecdotal reports, a number of
anecdotal reports that people benefit from hyperbaric oxygen
therapy with traumatic brain injury and with PTSD. In those
reports--and this is what General Schoomaker is referring to--
they were not done in a randomized fashion. They were not done
so we can take evidence-based scientific study and actually
produce clinical protocols that we can give to the world and
say, this is based upon clear evidence of working.
Mr. Bishop. Why have we not done that?
Admiral Robinson. That is what I am getting to. Over the
course of the last 3 months, and we have been working on this
for well over a year--but working with Colonel Scott Miller, an
Army internist researcher, infectious disease expert--and I
will caveat now, he has no knowledge of hyperbaric oxygen
therapy, but he is a master and a professional at designing
prospective studies--has in fact helped us, through the Army
Research Facility, to actually put together studies that we are
conducting. He has included, at Camp Pendleton, Lejeune,
Carson, and San Antonio, we now have more people enrolled in
those studies and actually under investigation. So those sites,
the Pendleton site and the San Antonio site, are working. And
for sure the San Antonio site. We have more people enrolled
than ever before.
We will have a definitive result of does hyperbaric oxygen
work over the course of the next 24 to 36 months. That seems
like a lot of time, but in the world of research, to get that
type of evidence and then to put clinical guidelines together,
clinical guidelines that are going to go forward and be the
standard of care worldwide, that is not too long.
Mr. Dicks. Will the gentleman yield? I may have missed
this, but I think there are some situations where this is being
prescribed now.
Admiral Robinson. There are conditions treated with
hyperbaric oxygen therapy today.
Mr. Dicks. What have been the results of those?
Admiral Robinson. The results have been phenomenal.
Wonderful. They have been absolutely unable to base it on any
objective criteria that we can produce. Since oxygen therapy is
a device, it is being looked at by the FDA. In fact, the FDA
has stepped in and asked for some of those studies to be
stopped, because they are not sure whether this would be
harmful to the patients, and there has been no objective
evidence in a properly controlled study to prove that it works.
General Schoomaker. I think, Mr. Dicks and Congressman
Bishop, one of the frustrations we all have up here is we want
the very best treatment for our people. There are far more
traumatic brain injuries generated and far more posttraumatic
stress disorder generated in the civilian sector every year
than there is in combat--on motor vehicle accidents, on sports
fields. We have had decades and decades of brain injury and
posttraumatic stress disorder and have asked the field to
provide good scientific evidence that it works.
We finally, as the Department of Defense, have come
together and said, Okay, we can't seem to get academics to do
good trials for us, so we will do the trials. And, frankly,
they are getting off the ground now.
Mr. Dicks. How can the doctor, if this hasn't been vetted
or whatever you call it, how can they go ahead and make these
prescriptions, and do it, and find out it works very well, and
how does that happen?
Admiral Robinson. Representative Dicks, I think that there
have been all sorts of people who have sold all sorts of
remedies in past years and centuries that have proclaimed the
efficacy and effectiveness of things that have been really
sham.
Mr. Dicks. Yeah, but this works.
Admiral Robinson. It hasn't been proven to work
scientifically. It works according to the anecdotal
explanations of patients.
General Schoomaker. Legally, a licensed physician can
prescribe so-called ``off label.''
Mr. Dicks. That is what I want to know.
General Schoomaker. You can take a drug which is not
labeled for use in a particular way and try it ``off label.''
You are responsible for the outcome of that. But you can do
that. About 90 percent of all pediatric drugs, for example, are
prescribed to children ``off label,'' meaning that there isn't
a definitive trial to show its utility. It would be too
expensive to do that.
In the case of hyperbaric oxygen, a licensed and certified
provider can do that as a trial. The problem we have there is
what Admiral Robinson says: We don't have definitive proof.
Mr. Dicks. Keep moving the trials ahead as best you can. We
have to do it in a scientific way, I understand that. But there
does seem to be some evidence that there are positive outcomes
here.
We have a vote underway. I am trying to wrap this up. Have
you got anything? Can I go ahead to Mr. Hinchey?
MEDICAL MALPRACTICE
Mr. Hinchey. Thank you very much, Mr. Chairman. Thank you
very much. I deeply appreciate everything you are doing and we
all know how important it is. It is a very complex set of
circumstances also, under some set of circumstances. What I
want to ask you about is the medical malpractice situation.
This is something that comes about as a result of a Supreme
Court decision back in 1950, which has created a whole host of
problems that really needs to be addressed.
There are many cases of military medical malpractice which
have been highlighted in the media recently, and a number seem
to involve very preventable medical errors. One group reports
10,000 veterans were exposed to HIV and hepatitis after at
least three VA hospitals failed to sterilize colonoscopy
equipment. This contamination is considered a ``never'' event,
but it is completely preventable and it should never happen. So
this is a situation that I think comes about as a result of
this situation of medical malpractice under a set of
circumstances that is not really overseen.
My attention was drawn as a result of a former constituent
of mine, a sergeant by the name of Carmella Rodriguez, who was
repeatedly misdiagnosed by military doctors as having a wart
when he actually had a melanoma. And that melanoma led to his
death.
So I am wondering a couple of things. Do the Armed Forces
keep track of how much money is wasted yearly on preventable
medical errors? And how can this rate be lowered if the
military is immune from liability for the harm it causes? I
think that the focus of that attention has to be on this,
unfortunately, Active Duty military personnel who have no legal
resources in the face of medical negligence, due to this 1950
Supreme Court decision that Justice Scalia says was a mistake.
This is health care that comes about not in the context of
military actions but it comes in the context of just normal
life. So I wonder if you could focus a little attention on
that.
What do you think about that Supreme Court decision? It
seems to me that Scalia is right; this is something that really
needs to be dealt with. You have civilians that still have
legal recourse, civilians that are members of military
families. But you don't have the military personnel themselves
who have the recourse as a result of that 1950 decision. Can we
afford to kill and injure our own soldiers through negligent
medical care?
General Schoomaker. I think you are alluding to the Feres
Doctrine, which was a law passed to protect uniformed
commanders and members of the military from liability for
decisions made in a military setting. That has been expanded to
caregivers in a practice setting, in medical practice, and
surgical practice.
Just a point of information about the first cases you
raised in the VA. The Veterans Administration, not being a part
of the Department of Defense, I am not sure its relationship to
the Feres Doctrine. But in that case--in fact, our practices in
our hospitals would have protected our patients from HIV
because we do the necessary sterilization and check for it.
Mr. Hinchey. I appreciate the focus on that. There is no
question about it. But there are cases where we have documented
where they come up, where they weren't paid attention to
adequately. That is the one I am mentioning.
General Schoomaker. We look very carefully at medical
errors. We look at those cases that either result in a claim
against it; or, even when a claim is not filed, when an error
has resulted in adverse outcome for a patient, or a near
adverse outcome. I am, frankly, not aware of any connection
between medical liability and improvements in medical error.
Dr. Rice. Congressman Hinchey, I have never presumed to
quarrel with Justice Scalia, particularly on an issue of legal
doctrine. But I think General Schoomaker is exactly right. The
government is liable under the Federal Tort Claims Act for an
act committed by a uniformed practitioner acting within the
scope of his duties and responsibilities. As General Schoomaker
has pointed out, there is a standard-of-care investigation
taken in the case of any assertion of medical malpractice or an
unfortunate outcome.
In my personal experience, having spent most of my career
in the civilian academic world, I do not think that the threat
of litigation is a particularly helpful way to improve
practice. The judgment of one's peers is profoundly effective.
Mr. Hinchey. That is something that I am going to disagree
with you on, because I think that the liability is something
that is going to focus attention on the health care that people
need much more effectively than it is so often. Now, almost
always in the vast majority of times, it is focused
appropriately and people get appropriate health care. But if
you have people who don't care about it, and knowing they are
not going to be held accountable as a result of it, then there
can be a lot of negligence in some cases.
I think that negligence comes about as a result of the fact
that there is no accountability; that they don't have to behave
in the right way in the context of dealing with people who have
normal health-care problems in the military. And if the people
suffer as a result of that, well, they are not going to be held
responsible.
Dr. Rice. Sir, I guess I would take issue with your
statement that there is no accountability. There may not be
accountability in a civil court, but within the military system
there is a lot of accountability. The behavior and performance
of a military officer delivering health care is scrutinized
very carefully, and there are profound implications.
Mr. Hinchey. I think that is right. I think that that is
effective. But at the same time, there are a number of other
people who are not subject to accountability, and they are not
subject to accountability because there is no legal
accountability that they have to deal with. They don't have to
deal with the legal accountability as a result of that 1950
Supreme Court decision.
Dr. Rice. I think on this one we will have to agree to
disagree.
Mr. Hinchey. All right.
General Schoomaker. I would echo that. All of our
practitioners are fully accountable for their actions. Except
for the Active Duty soldier who, through the Feres Doctrine,
cannot raise a claim under tort law, all family members, for
example, are eligible for recourse.
Mr. Hinchey. Family members are eligible.
General Schoomaker. I don't know any relationship between
improvements in standard of care and the ability of patients to
sue for that care.
Mr. Hinchey. The families are, but the military personnel
are not. And that is something that I think really has to be
dealt with. Frankly, I must say, candidly, I am disappointed in
the way that you feel about it because it is going to, and has,
clearly diminished the likelihood of the high quality,
effective quality for health care for military personnel across
the board. There are some number of military personnel who have
suffered as a result of this.
Mr. Dicks. The gentleman's time has expired. Ms. Kaptur.
VETERANS CLINIC
Ms. Kaptur. Thank you, Mr. Chairman. Welcome, gentlemen.
Thank you for the work that you do. In our region, we have no
major bases that I represent that are Active Duty. But we have
a lot of Guard and Reserve and returning soldiers. The Veterans
Department has announced they want to rebuild this little
veterans clinic we have in our area. If your advice--and
knowing everything you know about what is occurring in theater
and afterwards as these soldiers rotate out and they come back
home, what would you advise them in terms of what to think
about as they construct this clinic? Any considerations based
on what you see happening to those in theater and in support of
them compared to past wars?
Dr. Rice. Congresswoman, if you are referring primarily to
guardsmen and reservists, then I think a couple of things
should be kept in mind by the VA, and I know the VA does a very
good job of thinking through these issues. As my colleagues
alluded to earlier, the biggest challenge that our
beneficiaries face is access to primary care. So I think
building a robust primary care system at such a clinic and then
establishing referral relationships with a secondary and
tertiary care facility in the nearby region is of paramount
importance.
Admiral Robinson. Additionally, with the comprehensive
primary care, make sure that you have ready access, and I mean
onsite access, to mental health capabilities--licensed clinical
social workers, licensed occupational therapists that can do
counseling. Psychologists, psychiatrists, of course. But it
doesn't have to be only professionals; it can be a lesser
person that can still give adequate and good mental health
counseling.
General Green. The studies have clearly shown that if you
establish what we call collaborative care, which is the
integration of the mental health into the primary care area,
that that decreases stigma, encourages use of mental
healthcare, and aids the primary care folks as they take care
of some of the issues that come up with veterans.
Ms. Kaptur. Your comments are very useful, because one of
the challenges locally is, we have got veterans organizations,
largely from past wars, they are more willing to participate
than the current veterans--and one of the issues is mental
health. And they are saying, We don't want to go in the same
door, because when they call our number then everybody knows--
if we go down the elevator they know who we are. So we want a
door built in the back of the building and we are going to
drive our car back there so we are not with those other
veterans. Collaborative care. I hadn't heard about that.
Admiral Robinson. The deployment health clinics in Navy, we
have about 17 now across the United States, are based exactly
on the collaborative care model. It is helping to reduce stigma
in terms of getting mental health care. So your veterans groups
will be pleased because you go to the deployment health center
for primary care. While you are there, you can also get mental
health therapy, but no one knows where you are going to in the
clinic.
Ms. Kaptur. Admiral, could you send me some sort of summary
of that from places where it is working? I know that you don't
have responsibility for the VA. However, I have found in my
career a huge gap between what happens at DOD and then when
they come home at VA. It is a huge abyss in between.
General Schoomaker. If I might, ma'am, really quickly. In
fact, a lot of the behavioral health services that can be
provided at a primary care site were developed in conjunction
with the Veterans Administration. Durham VA, for example, was
very, very active in developing a program called Respect-Mil
which teaches and trains primary care providers.
Ms. Kaptur. They probably have a big hospital there, right?
When you get down to the hinterlands where you have got people
coming home, and they are only going to clinics.
General Schoomaker. This is a training program that can be
applied wherever it is.
The other things that I would add real quickly in terms of
this clinic is dental care; a robust alcohol and drug treatment
program; and because they are a younger population of veterans
now, and more females, we suggest having child care available
for women veterans onsite so that they can attend their
appointments.
SINGLE-PLAYER PODCAST DEVICE FOR VETERANS
Ms. Kaptur. Interesting. Thank you, gentlemen, very much.
I wanted to mention something that I saw that I will try to
get to each of you, because I have ordered extras, and that is
a single-player podcast device that is just as big as a little,
tiny telephone. And what it is, the current soldiers aren't
going to VFW posts and participating in veterans organizations
when they are coming home. So especially where you don't have a
big hospital or big base, they go out into the counties, and
they are out there, and if they have mental challenges, mental
illness challenges, it is likely untreated.
And I found this over at the VA in Cleveland. And working
with some of the psychologists, they have developed this
program that can be hand-held, where a veteran can just take
it--and I don't say it is self-administered care, but it works
them through questions and so forth. We are finding it to be
very effective.
And so I wasn't aware if you had seen these types of
devices and were using them on a regular basis. If they are out
in some rural county and they have nothing, it is better than
nothing. If they are not going to come into the major urban
clinic, it gives them a lot of alternatives. A lot of people
working with them in the Cleveland system seem to feel it
provides a new way forward. And the new veterans are all
independent. They don't want to go to group sessions. A lot of
them don't do that.
Have you ever seen these types of devices?
General Schoomaker. I am personally not familiar with it,
but I have written it down. Maybe we can get some details.
Ms. Kaptur. We are trying to order you some cassettes.
General Schoomaker. I am going to be at the Cincinnati VA
Friday or Saturday, talking to Kate Chard, one of the leading
posttraumatic stress treaters. I will talk to her.
DRUG ADDICTIONS
Ms. Kaptur. I will make sure we get one of these to her so
she can give it to you. Give me your evaluation of it, if you
think it is as useful as we have been told.
My final question has to do, sort of following on what
Congressman Rogers was dealing with, I think about Vietnam. I
remember that era and the numbers of our Soldiers that were
addicted and what happened in theater and when they came home.
We have got soldiers now over in Afghanistan, and we know what
the primary crop in that country is.
What are you seeing? Are you seeing any evidence of
additional addiction as a result of where our Soldiers are
deployed, and what is happening in those circumstances and what
comes to you in the health field?
General Schoomaker. No, ma'am, not that we are aware. I am
not aware through the drug screening programs that are applied
to all Soldiers that there has been any increase as a
consequence of those deployments.
HEALTH CHALLENGES
Ms. Kaptur. If each of you were, in summary, were to tick
off a major health challenge you feel that you face in your
branch or in your responsibility at the university, what would
it be?
Admiral Robinson. Just to name a major challenge, it would
be smoking.
General Green. I would say obesity. It mirrors what is
going on with the country.
Ms. Kaptur. Obesity. In the Air Force.
General Green. Obesity with our beneficiary population, not
just Active Duty. It is a problem with Active Duty, retirees,
family members. Our problems tend to mimic the general society.
General Schoomaker. We have the same problem in the Army.
Army statistics show the Active Duty soldier on average is at
lower body mass index, but as soon as they retire--and their
family members are on par with the country. So we are targeting
childhood obesity as one of the health improvement programs
within Army Medicine.
Ms. Kaptur. Thank you. Thank you very much, Mr. Chairman.
TRICARE REGION NORTH AND SOUTH PROTESTS
Mr. Dicks. What is the basis for the protest in the TRICARE
Region North?
Dr. Rice. Chairman Dicks, the General Accountability Office
reviewed the contract in the North and found evidence of an
undue competitive advantage. That is a public report. And the
Department is working through resolution of that issue.
Mr. Dicks. UNDO competitive advantage. What does that mean?
Dr. Rice. Unfair competitive advantage. The assertion is
that the winning contractor had access to inside information.
Mr. Dicks. What is the basis for the protest in TRICARE
Region South?
Dr. Rice. In the South region, one of the bidders offered
discounts for services. The protest was based on the fact that
even though the TRICARE Management Activity had indicated that
it was not going to take discounts into consideration in the
award of the contract because they could not be guaranteed, the
General Accountability Office found that those should have been
taken into account.
So the technical evaluation of those two contracts, those
two proposals, is now underway to define precisely how the
proposed discounts can be factored in.
Mr. Dicks. So what is the status? Are you redoing them?
Dr. Rice. No, sir. The contracting office has reached a
conclusion on those and on the one in the North, and that is
now under legal review at the highest levels of the Department.
We hope to be able to resolve that issue quickly. In the South,
again, the technical reevaluation is underway or the technical
standards are being redefined.
We will give the two proposing organizations the
opportunity to refine their proposals just within those narrow
technical limits. We will then evaluate those. And we hope to
be able to reach a conclusion on that issue within a month to 6
weeks.
Mr. Dicks. What is the status of the award at the TRICARE
Region West?
Dr. Rice. Sir, that is an agency protest that did not go to
the General Accountability Office. Under the rules of
competition, a health-care or managed-care support contractor
can win in only one of the three regions. One of the
organizations that was apparently successful in the South
region lodged an agency protest in the West region so that in
the event they lost in the South, they would be able to reopen
discussions in the West.
Mr. Dicks. When will that be resolved?
Dr. Rice. The resolution of the West is dependent on the
resolution of the South.
Mr. Dicks. So, interrelated.
Dr. Rice. Yes, sir.
Mr. Dicks. Is it possible to change the current contracts
to reflect the enhancements of T3, the third-generation TRICARE
contracts?
Dr. Rice. No, sir. The existing TNEX contracts, which are
the ones that we are operating under right now, they have run
their course in the North. Where the contract has been extended
with the existing contractor, that remains under the TNEX
contract. That is one of the reasons that we are eager to move
ahead with the resolution of these awards, so that we can
transition to T3.
In the meantime, we will very shortly begin the development
of the generation of--the characteristics of the generation to
follow that one, which we have, very imaginatively, tentatively
named T4, which we hope to be able to take into account some of
the new thinking that may help us bend the curve so that
health-care costs under TRICARE do not continue to escalate as
rapidly as they have.
Mr. Dicks. How fast have they been going up? What has been
the percentage per year?
Dr. Rice. Mr. Chairman, the MHS costs are projected to
increase between about between 5 and 7 percent per year through
the year 2015. If that growth rate remains unchecked, they are
projected to approach $64 billion in 2010 dollars in fiscal
2015. As the chairman knows, the subject of escalating health-
care cost has been one that the Congress has been intently
focused on for the country as a whole. The Military Health
System is not immune from those same pressures.
Mr. Dicks. At least this year, you set up a budget that had
all your costs in it.
Dr. Rice. Yes, sir. The budget proposal is fully funded.
WARRIOR TRANSITION UNITS
Mr. Dicks. How many Warrior Transition Units currently
exist to date?
General Schoomaker. Twenty-nine within the uniformed system
associated with hospitals and clinics. And there are nine that
are based in the Adjutants General for nine different States.
They are more regional; as I said, at Utah, Virginia,
Massachusetts, Florida, Arkansas.
Mr. Dicks. There are nine of them?
General Schoomaker. Yes, sir.
Mr. Dicks. Not one in Washington State, I take it.
General Schoomaker. Utah is the closest one.
Mr. Dicks. We have a big one at Fort Lewis at Madigan.
General Schoomaker. Yes, sir. And there is one at Fort
Richardson in Alaska.
Mr. Dicks. The committee understands that the WTUs are not
fully resourced. Why are the WTUs not fully resourced?
General Schoomaker. Sir, I am not aware that they aren't.
In what respect?
Mr. Dicks. Well, why don't you look into that? If you can
just verify that. Our staff seems to think that there are some
issues here. Are there funds in the 2011 budget to enhance
Warrior Transition Units?
General Schoomaker. Yes, sir. Part of the funding is for
fully funding the Warrior Transition Units.
Mr. Dicks. Okay. I was just out to the one at Fort Lewis. I
was very impressed. I was also impressed by the fact that the
commander of the unit was a wounded veteran, who was very
impressive.
General Schoomaker. It may be worth noting that the Army
Wounded Warrior Program, which is a part of the Warrior
Transition Command that has oversight over all of these units,
is going to be Lieutenant Colonel, promotable, Greg Gadson, the
double amputee, who remained on Active Duty, and was the
inspiration for the New York Giants to win the Super Bowl 2
years ago.
Mr. Dicks. Is the Army Medical Action Plan fully resourced?
General Schoomaker. Yes, sir. The AMAP, the Army Medical
Action Plan, that was stood up after an execution order in May-
June of that year of 2007, was the forerunner of the Warrior
Transition Unit process. That led off the whole process of
transforming wounded and injured warrior care.
Mr. Dicks. How do the services differ in the provision of
care in transitioning of Wounded Warriors?
General Schoomaker. Sir, I would say that the inpatient and
outpatient care is identical across the services, independent
of what the color of the uniform is. What we differ in is how
we administer the programs, subtleties in the support of
families and nonmedical attendants and the like--and I will let
my colleagues address that--but use a more decentralized
process and the like. In the main, what we are all aspiring to
do, and our transition into the VA and the like, is very, very
similar.
Admiral Robinson. I think that from the Navy's perspective,
as General Schoomaker has said, the decentralized approach, all
of the Warrior Transition Units and the men and women who may
be there are still under the auspices of the Surgeon General of
the Army; in the Navy, the Warrior Transition Units or Wounded
Warrior regiments at Camp Lejeune and Camp Pendleton, and at
Quantico in this particular region. The Marine Corps takes
those--they are in charge of those particular units and the
Marines are in control. Those units all have medical clinics or
medical facilities that are with them, but we are there to
provide medical care to them, but the line has control of those
members.
General Green. For the Air Force, we have a centralized
program that oversees our warrior and survivor care, all
overseen by our A1, so done by our personnel community. But we
do decentralize in terms of the recovery care coordinators and
the community readiness consultants, et cetera, that provide
support. Our Wounded Warriors are all tracked centrally, so we
know exactly what is happening with each of them, but they
actually can receive their care locally and then have regional
recovery care coordinators.
Mr. Dicks. Does the budget cut provide adequate funding to
take care of the Wounded Warrior Programs? As far as you know,
is this fully funded?
General Schoomaker. Yes, sir.
Admiral Robinson. Yes.
General Green. Yes.
Mr. Dicks. All right. The committee stands adjourned until
May 5th at 10 a.m. in H-140 when we will hold a hearing on the
Missile Defense Agency programs.
Thank you, gentlemen. I appreciate your testimony.
[Clerk's note.--Questions submitted by Mr. Young and the
answers thereto follow:]
Question. VA and DOD medical facilities have improved markedly over
the last several years, which is good for those people who live in
close proximity to them. However, a great many National Guardsmen and
Reservists live in rural communities far removed from those types of
support facilities. In the past I have championed efforts to provide
telephonic psychological counseling services to mitigate those types of
challenges. Though accomplished at a distance, the intent of these
services is to have an active medical professional manage cases over a
period of time in order to both treat and diagnose psychological issues
that may also appear long after a veteran leaves the service. What
other things can this committee do to ensure the welfare of servicemen
and women in rural areas?
Dr. Rice's Answer. The Department appreciates the Committee's
support for telephonic counseling for the mental health needs of our
Service members. As we review our options for best solutions, the
Department will continue to work closely with the Committee on this
important issue.
General Schoomaker's Answer. There are three actions I recommend to
your committee in order to improve the welfare of servicemen and women
in rural areas. First, continue to fully fund the Defense Health
Program (DHP) budget. Eligible Reserve Component (RC) Soldiers and
their Families use DHP-funded TRICARE medical and dental services
before, during, and after mobilization. RC Soldiers who are issued
delayed-effective-date active duty orders for more than 30 days in
support of a contingency operation are covered as active duty service
members and receive active duty medical and dental benefits generally
from the time they receive their mobilization orders until six months
after their demobilization. Eligible RC Soldiers living in rural areas
use the TRICARE provider network in their local area to receive medical
and dental care, and this benefit is critical to those Soldiers who
lose employer-provided healthcare insurance while deployed.
RC Soldiers are also eligible to purchase TRICARE Reserve Select
(TRS) and the TRICARE Dental Program when not on active duty for more
than 30 days. DHP funds subsidize a significant portion of both
programs, making these plans affordable to RC members throughout the
U.S. In some rural areas RC Soldiers may have few other affordable
medical and dental insurance options, so your funding support for DHP
enables TRICARE to continue to offer these beneficial programs.
Second, continue to support and fund the Yellow Ribbon
Reintegration Program. The Secretary of Defense initiated the Yellow
Ribbon Reintegration Program to provide information, services,
referral, and proactive outreach programs to RC Soldiers and their
Families through all phases of the deployment cycle. The goal of the
Yellow Ribbon Reintegration Program is to prepare Soldiers and Families
for mobilization, sustain Families during mobilization, and reintegrate
Soldiers with their Families, communities, and employers upon
redeployment or release from active duty. The program includes
information on current benefits and resources available to help
overcome the challenges of reintegration. This program provides vital
resources to rural-based Family members of deployed Soldiers as they
are geographically dislocated from military installations that
routinely provide similar services to Soldiers and Families in the
immediate area.
Third, the Army will need your continued support as we review
statutory limitations that impact the provision of telemedicine across
state lines. State laws governing contract providers vary regarding
licensure reciprocity and/or other sharing arrangements, while
Uniformed and Government civilian providers can practice across state
lines as long as they have a valid state license and are working in
their Federal capacity. The Army would like to remove barriers such as
this in order to provide world-class telemedicine care to Soldiers and
their Families regardless of proximity to the provider. We value your
support of this issue as we continue to work with our Department of
Defense partners to improve access to care for all Soldiers and their
Families.
Admiral Robinson's Answer. The Committee can continue to support
psychological health outreach and support activities such as those
being provided by the Navy Reserve Psychological Health Outreach
Program. This program was established by Navy Medicine in 2008 to
provide a Psychological Health ``safety net'' for Navy Reservists and
their families at risk for stress injuries. Five teams consisting of
two Psychological Health Outreach Coordinators and two to four
Psychological Health Outreach Team Members are located at each of the
five Reserve Component Commands for a total of 25 personnel. The
Psychological Health Outreach Team Members provide outreach phone calls
to Navy Reservists, especially those returning from mobilization, to
check on their psychological health status. Additionally, they provide
referrals to mental health care providers (TRICARE, VA or civilian
health care provider based on eligibility) as indicated and assist in
arranging follow up care as needed. Finally, the Outreach Team Members
make periodic visits to each of the Navy Operational Support Centers
(NOSCs) in their respective regions where they provide the Operational
Stress Control (OSC) and Suicide Prevention briefings and have the
opportunity to meet with individual Reservists. As of 1 April, 2010,
the Navy Reserve Psychological Health Outreach Teams have:
--Assessed over 2,000 Reservists; 975 required further
services and follow-up
--Provided outreach calls to an additional 2,100 returning
Reservists
--Made 225 visits to NOSCs providing OSC awareness brief to
over 23,400 Reservists and NOSC staff.
This program was expanded to provide services to the Marine Corps
Reserves in 2009. There are six Psychological Health Outreach Teams
(total of 30 licensed Social Workers) providing services to Marine
Corps Reservists and their family members.
General Green's Answer: The Air Force Reserve Command provides the
following suggestions:
Air Force Reserve Command (AFRC) currently has no Director of
Psychological Health (DPH) positions. AFRC wants to hire DPHs who will
be in charge of coordinating access to mental health services for
reservists. Defense Health Program (DHP) funds have been appropriated,
but because of appropriation rules this money cannot be used to provide
administrative oversight positions. Recommend committee investigate how
long-term funding for the AFRC DPH program can be provided. Funding of
DPHs will provide recourses to assist Reserve members having difficulty
accessing care and assistance, especially in rural areas.
The Air National Guard provides the following feedback:
Regarding psychological health, the National Guard Bureau has
contracted to have a Director of Psychological Health (DPH) in every
State and Territory. These individuals are tasked with evaluating and
providing case management for National Guard service members and their
loved ones, regardless of their location. Unfortunately, there is only
one allotted for each State and Territory. In addition, there are
efforts to implement video teleconferencing for behavioral health
consultation. At present, the Air National Guard has five sites where
telemental health equipment has been placed. However, it is unknown how
readily the systems are being used.
The committee could investigate the possibility of expanding the
availability of DPH's at the State and Territory level. This would help
ensure that service members, especially those in geographically remote
areas can have rapid and convenient access to behavioral health care
practitioners.
Question: The Center for Deployed Psychology (CDP) has an excellent
curriculum to train military and civilian psychologists and other
mental health professionals to provide high quality deployment related
service. Do you have any thoughts on how the CDP can appeal to a larger
audience, to effectively expand the number of providers that are
``deployment psychology'' certified? Are certain incentives to attend
the training the answer?
Dr. Rice's Answer: My thoughts of how CDP can appeal to a large
audience is to address the three issues that currently limit
participation: (1) costs in time and dollars associated with attending
the programs, (2) lack of incentives making the programs a worthwhile
endeavor for providers to attend, and (3) lack of awareness of the
programs.
To address these issues, we are offering certain incentives. With
regard to costs, the CDP has made efforts to defray the costs
associated with attending their programs (e.g., funding TDY costs for
military providers, regional distribution of 1-week courses).
Additional resources (i.e., TDY funds, funding for additional civilian
courses, CDP staffing) would allow for larger audiences. The CDP
generally offers free or low-cost Continuing Education Credits to
provide incentives for attending its courses but there is some evidence
that providing additional direct incentives might not attract providers
who are likely to use these skills with Service members, veterans, or
their families. We are considering additional incentives that target
providers likely to treat these populations, such as contract providers
working on military installations.
General Schoomaker Answer. The Center for Deployment Psychology
(CDP), a tri-Service center, was established to promote the deployment-
related training of behavioral health providers in support of service
members and their Families. The CDP provides education to military and
civilian behavioral health providers. This two-week training takes
place quarterly, and is a mandated training requirement for all student
interns completing their American Psychological Association Internship
at every Military Treatment Facility within the Army, Navy, and Air
Force. There are several ways that the CDP can appeal to a larger
audience, including retaining central travel funding for attending the
two-week course and not shifting this burden to the Services. When
units fund the travel, they are less likely to send personnel. Also,
adding programs for mobile training at Military Treatment Facilities,
as well as for additional one-week civilian courses would mean CDP
trainers could reach more providers. Military Treatment Facility
training may be particularly important to reach contractors who can not
travel as easily as military or government service personnel. An
advanced CDP training course has also been suggested specifically for
providers who have already attended the two-week course and then
deployed. The demand is unknown and although CDP is able to develop
such a course, funding would be needed to cover additional costs.
The Army also provides additional training to our behavioral health
providers including Active and Reserves Components. All providers
(e.g., psychiatrists, psychologists, social workers, psychiatric
nurses, enlisted mental health specialists) are mandated to receive
Combat and Operational Stress Control training prior to deploying for
the first time. Providers who have not deployed within the previous 24
months are also required to attend this training, and those who are re-
deploying to a different operational site are strongly encouraged to
attend. This one-week training emphasizes the most current, cutting
edge information, lessons-learned from combat operations, and tools to
effectively deliver behavioral healthcare downrange.
Our network providers who care for service members and families
also have numerous opportunities for education and training related to
deployment psychology. TriWest Healthcare Alliance offers extensive
education for their network providers. At this year's annual American
Psychiatric Association Meeting, a number of presentations will be
delivered by military and Department of Veterans Affairs (VA) providers
to help civilian psychiatrists understand deployment psychology and the
needs and strengths of Soldiers and their Families. In July, the
Massachusetts General Hospital Psychiatric Academy is partnering with
military and VA clinicians to provide an intense course on the
management of complex post traumatic stress disorder and traumatic
brain injury.
Admiral Robinson's Answer. Since 2008 Navy Medicine has coordinated
closely with Dr. David Riggs and the Center for Deployment Psychology
(CDP) to develop and provide evidence-based training programs for Navy
mental health providers in the treatment of Post Traumatic Stress
Disorder and other combat related stress illnesses. CDP training has
been provided at Navy Military Treatment Facilities, Navy Psychology
Internship training programs, and Navy Medicine Deployment Health
Centers, with plans to expand to our growing Social Work community.
Offering Continuing Medical Education (CME) and Continuing
Education Units (CEUs) for CDP training would increase the appeal and
participation in CDP trainings.
General Green's Answer. Currently Air Force psychologists, social
workers, and psychiatry residents attend the Center for Deployed
Psychology (CDP) during training. Adding courses/topics specific to
psychiatry (e.g. medication use in Post Traumatic Stress Disorder,
medication use in theater) will increase attendance by psychiatrists.
We recommend advertising this to Mental Health Nurse Practitioners. In
addition, we recommend CDP reach out to State and Territorial mental
health departments or private sector clinicians, identifying additional
clinicians treating Guard and Reserve Airmen, who would benefit from
this training. We also recommend CDP certify their online educational
resources for continuing education credit hours, giving providers an
incentive to complete on-line trainings. We support CDP's plan to
conduct an ongoing series of workshops and seminars throughout the
United States in an effort to disseminate information on deployment-
related behavioral health. This is especially important for our Guard
and Reserve members who may not have ready access to military or
veteran's medical services.
Question. Battlefield medicine has come a long way and survival
rates are the highest they have ever been, yet there is still room for
improvement. During the past decade, the Army Surgeon General's office
has been supportive of developing the advanced life support technology
known as LSTAT, which is essentially an automated life support trauma
pod. It seems like promising technology and apparently lighter versions
were developed, cleared by the FDA, with requests coming in from the
field for them. Can you tell me why AMEDD has not fielded the FDA
approved smaller versions of the system? Furthermore, can you tell me
why AMEDD has stopped development of the next generation LSTAT and why
it has withheld FY2009 and FY2010 Congressional dollars from the
program?
General Schoomaker's Answer. The Army Medical Department has a
long-standing interest along with the other Services in a portable,
interoperable, and modular life support module which allows us to
transfer seriously injured and ill patients from field hospitals to
medical evacuation (MEDEVAC) ambulances, helicopters, and planes and
through the MEDEVAC chain from far forward to hospitals in the
continental United States. We have been working with industry on this
for many years including current development of lighter weight LSTATS.
Existing automated life support equipment demonstrates some critical
deficiencies in operational testing and does not meet all functional
capability requirements. The FY2010 congressional procurement funding
is being reprogrammed to be used as Research, Development, Test, and
Evaluation funds to further develop and improve the equipment's
capability. The FY2009 procurement funding will not be expended for
several months pending the result of current development efforts. If
the outcome of these efforts is acceptable, we will invite vendors to
compete for the procurement solicitation to provide the best currently
available products to the battlefield. We are confident that this will
give us the best solution and provide the Warrior and the taxpayer the
best value.
Question. Hyperbaric oxygen treatment appears to show some promise
when it comes to the treatment of brain related injuries, burns, and
certain medical conditions such as cerebral palsy and autism. Can you
please describe the military's position on the viability of this
treatment option and how it is being assessed? Possible Follow-up: When
do you expect to see results from any studies and how quickly could
treatment options become available for the vast majority of patients?
Dr. Rice's Answer. The DoD position on the viability of the
Hyperbaric oxygen (HBO2) treatment is that it has shown
promise in randomized controlled trials in acute severe traumatic brain
injury (TBI), and anecdotally has shown promise in case reports and
case series in relief of symptoms in chronic mild TBI or concussion.
The results in mild TBI are not outside the realm of a placebo
response, however, and attribution of the observed improvement to the
HBO2 cannot be determined due to the lack of rigorous
scientific design. Moreover, no data on durability of any improvement
has been reported.
The viability of the treatment has been assessed by the required
randomized clinical trials to generate this evidence through a program
of clinical studies. Three preliminary randomized, double-blind, sham-
controlled trials within DoD are underway or due to start shortly to
look at the best doses of oxygen, sham procedures, and validation of
measures to assess improvement in symptoms and objective neurologic
function. To date, 34 warriors with chronic TBI have volunteered in the
first trial and 25 have completed all testing. A second study is
actively recruiting and a third is due to kick off soon.
We expect to see more results from these pilot trials by early next
calendar year. DoD plans for a definitive trial to kick off at that
time, which will take approximately three years to complete. That study
will enroll approximately 300 symptomatic warriors over two years, and
follow the volunteers for the durability of any response for at least a
year.
General Schoomaker's Answer. Hyperbaric oxygen (HBO2) is
approved by the FDA for 13 medical conditions, but not brain injury.
HBO2 has demonstrated promise in randomized controlled
trials in acute severe traumatic brain injury (TBI), and anecdotally
has shown promise in case reports and case series in relief of symptoms
in chronic mild TBI or concussion. The results in concussion are not
outside the realm of a placebo response, however, and attribution of
the observed improvement to the hyperbaric oxygen cannot be determined
due to the lack of rigorous scientific design. Moreover, no data on
durability of any improvement has been reported. In summary, there
remains no randomized controlled trial evidence to support the use of
HBO2 for chronic TBI, and four independent reviews have
failed to endorse its use for this purpose citing lack of strong
evidence.
The DoD response has been to support and to perform the required
randomized clinical trials (RCT) to generate this evidence through a
program of clinical studies, and then allow the data to guide policy
decisions. These studies are in fact the only RCTs of HBO2
for chronic TBI ongoing in the United States. Furthermore, the Defense
Centers of Excellence for Traumatic Brain Injury, along with the Army
Medical Research and Materiel Command, has been awarded an
investigational new drug application (IND) to study hyperbaric oxygen,
and has established an independent data monitoring board to review the
results of the data and make policy recommendations to senior
leadership. Three preliminary or phase II randomized, double blind,
sham-controlled trials within DoD are underway or due to start shortly
to look at the best doses of oxygen, sham procedures, and validation of
measures to assess improvement in symptoms and objective neurologic
function. To date, 34 warriors with chronic TBI have volunteered in the
first trial and 25 have completed all testing. Two additional studies
are due to kick off in the next couple months. We expect some data
( 100 volunteers) from these pilot trials by early next calendar year,
and DoD plans for a definitive or Phase III trial to kick off at that
time, which will take approximately three years to complete.
Admiral Robinson's Answer. Navy Medicine is committed to providing
all available therapies to Service Members and their families as soon
as there is sufficient evidence to ensure safety and efficacy of the
therapy. The Department of Defense has three trials planned or in
progress (two efficacy studies, one feasibility study) to assess the
effects of hyperbaric oxygen therapy on the symptoms of mild and
moderate traumatic brain injury. The two efficacy studies will have
data available in January 2011. The feasibility study will have data
available in 2014.
General Green's Answer. At the present time, Air Force research on
Hyperbaric oxygen treatment (HBOT) is centered on treatment of
Traumatic Brain Injury (TBI). Although anecdotal case reports and small
series of trials report benefit in TBI, it is an unproven therapy and
is not accepted as a standard treatment. There are several prospective
randomized clinical trials underway within the DoD and civilian
institutions to provide more conclusive evidence regarding use for TBI.
There are four major prospective randomized Phase II trials
underway to evaluate HBOT. The first is being conducted by the United
States Air Force at United States Air Force School of Aerospace
Medicine and Wilford Hall Medical Center with initial results expected
in August 2010. The second is being conducted jointly by Defense
Advanced Research Projects Agency (DARPA), the U.S. Navy, and Virginia
Commonwealth University. The third is sponsored by the Defense Centers
of Excellence (DCoE) and the US Army Medical Research and Material
Command (USAMRMC). And the fourth trial is sponsored by Intermountain
Health Care.
The definitive phase 3 clinical trial is being sponsored by DCoE
and USAMRMC which will be a randomized, multi-center (DoD facilities
only), double blind, definitive clinical trial to be conducted under
the auspices of the Food and Drug Administration with an
Investigational new Drug registration. This study will enroll 300
participants across multiple military locations where TBI affected
members reside and will use the outcome measures validated in the Phase
2 studies previously conducted. This Phase 3 trial is projected to
start in the fall of 2010 under the supervision of Dr. Lindell Weaver,
a critical care pulmonologist, hyperbaric physician, and Professor of
Medicine at the University of Utah School of Medicine, and Director of
Hyperbaric Medicine at Latter Day Saints Hospital and Intermountain
Medical Center, Murray, Utah.
To ensure that the data from these trials are rapidly and
independently assessed, the DCoE has chartered an independent Data
Safety Monitoring Board (DSMB) that will review the results of the
Phase 2 and Phase 3 trials. They will ensure the safety of the study
participants and will be authorized to stop the study early if it
proves to be futile or if a conclusive benefit if found.
If HBO therapy is found to be effective in the treatment of TBI,
the evidence will be presented to the Undersea and Hyperbaric Medical
Society for consideration as an accepted indication for use of HBO.
This phase 3 study will likely take 2-3 years to get results.
Question. For Admiral Robinson: In your written testimony, you
mention the humanitarian missions the Navy is involved in as a ``Force
for Good.'' You specifically mentioned Haiti and the roles the USNS
Comfort and Mercy have played in that tragedy and elsewhere. Such
expeditionary medical capabilities seem invaluable to me, both from a
humanitarian standpoint and a diplomatic one. Please tell me what long
term role you see in the Navy for ships like the Mercy and Comfort.
Possible Follow-up: For the other services, how do you view your
expeditionary medical capabilities? Is the humanitarian assistance
mission an important one?
Answer:
CNO's Sea Basing concept requires robust medical capability afloat
to support the Chief of Naval Operations Maritime Strategy: A
Cooperative Strategy for 21st Century Seapower.
Both T-AHs (hospital ships) are assigned forces in DOD Forces for
Unified Commands supporting their operational capability.
Through Disaster Response and Humanitarian and Civic
Assistance missions, Theater Security Cooperation is achieved with
international military partners, Non-Governmental Organizations and
academic institutions.
The T-AH, as a national asset, provides a unique image of
national resolve in the forward presence sea-basing strategy.
USNS MERCY (T-AH 19) and USNS COMFORT (T-AH 20) continue to provide
now, and in the future, a unique and flexible capacity with up to 12
operating rooms and associated medical support. This capability of the
hospital ships includes 80 beds for intensive care (including 11
isolation beds), 20 beds for recovery, 440 beds for intermediate care,
and 440 beds for minimal care which allows them to treat a wide range
of patients in partnership with the international community. Alliance
with non-governmental organizations enhances capacity and enduring
support in remote areas.
The hospital ships serve as cornerstones for Shaping and Stability
operations which help to address many of the root causes of conflict.
To be effective in Overseas Contingency Operations, our Combatant
Commanders need tools that are not only instruments of war, but
implements of stability, security and reconstruction. Operating from
the sea-base, the hospital ships provide a highly visible, positive,
engaged, and reassuring presence when deployed for Theater Security
Cooperation or when called to respond to foreign humanitarian
assistance (FHA) or Defense Support of Civil Authorities (DSCA)
missions. The hospital ships are part of the Navy's proactive influence
plans and partnerships-for-peace missions.
The two hospital ships (USNS MERCY and USNS COMFORT) have a life
expectancy to approximately 2020/21. Alterations to extend their
service life beyond 2020, and to enhance their ship-to-shore patient
transfer capabilities for shallow water coastal regions (such as
larger, higher capacity, faster, and more seaworthy boats), may be
considered. It is conceivable, subject to life extension studies being
accomplished, that these ships might be capable of a life extension
approaching 2030. Currently, there is no recapitalization plan for
hospital ships, but possible smaller, more flexible alternative
platforms are being examined. Continued studies are needed to define
future capabilities for wartime and peacetime support and to develop an
assessment of more effective, less costly, methods of providing health
services support from the sea-base. Examining alternatives of sea-to-
shore health services capabilities would expand the flexibility to meet
a range of future missions with more agility.
The hospital ships of the past, present, and the next generation
ships, have a strong role in fostering the good will stemming from the
contributions of our government and citizens towards meeting the
humanitarian needs of the people from other nations, and of our own
nation. While serving with an enormous medical benefit to the
contingency purposes of our own country in times of war and disaster
response, recent missions have won the hearts of countless people, not
only from those who serve on them, both military and civilian, foreign
and domestic, but also with the hearts and minds of those who received
care and support from those ``big white American ships with the red
crosses on them.'' Humanitarian missions are very important, and the
future generation of T-AH hospital ships will remain a central
contributor to that civic duty of our country.
General Schoomaker's Answer. I see humanitarian assistance and
foreign disaster response missions as extremely important. The Army
Medical Department has incredibly diverse and robust capabilities, both
in our operating force forward deployed, and in our generating force
here at home. We have statutory authority under Title 10 (U.S. Code,
Section 401) to support a variety of peacetime engagement projects, of
which humanitarian assistance missions are a subset, principally as
training missions for our forces. In addition to the training benefits,
we involve our forces in humanitarian activities for several other
reasons, including, of course, the moral humanitarian imperative, but
also because the Army has unique capabilities, we can foster goodwill
through nonthreatening engagement with foreign governments, and because
there are positive public affairs outcomes that influence recruiting.
Few organizations outside of the military have the capacity to move
materiel, establish secure routes for aid delivery, develop command and
control mechanisms, and provide direct assistance at the levels often
required especially in disasters such as the earthquake in Haiti.
Humanitarian operations benefit the American political process by
showing other countries the diverse American population working
together to achieve common goals and thus improving global public
relations.
The deployment of military forces to assist with a foreign disaster
is a very visible show of support for the affected government and
people. It also helps develop skills in our forces that are necessary
for successful civil-military operations. The knowledge of, and
relationships with, civil authorities' and non-governmental response
organizations' processes, needs, goals, and constraints foster
increased capabilities within the Army medical force to respond within
the context of the Combatant Commander's theater engagement plans and
within the scope of our federal responses to disasters within the
United States. For these reasons, the Army Medical Department will
continue to evolve our organizations, training, and equipment to ensure
we can provide world class health care, any time, any place to meet our
missions. We have to be able to apply the right mix of medical and
public health expertise, knowledge and experience in civil military
engagements, and cultural intelligence to successfully support the
United States' expeditionary medical missions anywhere on the globe.
Army medical forces provided support in the aftermath of Hurricanes
Andrew in 1992, Mitch in 1998 and Katrina in 2005. With each of these
opportunities to support our own citizens, we have evolved our
processes and procedures to improve our response capabilities.
Similarly, Army medical units were called on to provide disaster
response medical support to earthquakes in Pakistan in 2006, and to
both Haiti and Chile in 2010. The Army Medical Department is regularly
engaged in Medical Readiness Training Exercises (MEDRETES) and Medical
Civil Action Programs in support of the Combatant Commanders providing
disease surveillance, remote clinical support and medical, veterinary
and dental training. The Army Medical Department is presently involved
in a MEDRETE in Honduras and is preparing for two additional exercises,
one in the Dominican Republic and one in Paraguay. We have gained from
our experiences some key insights about the value of these programs. We
are extremely aware that creating false expectations in a foreign
country is sometimes as detrimental as doing nothing. That insight led
us to the awareness that building or fostering capabilities as well as
capacity creates better long term impacts. By training the host
country's providers, we enable them to continue programs and build
medical capacity long after the Army departs.
Finally, in alignment with this goal of building host nation
capacity to improve health and provide healthcare to their citizens,
the Army Medical Command through its subordinate Medical Research and
Materiel Command has several pivotal foreign medical research
laboratories--one in Germany, one in Kenya, and one in Thailand. These,
in parallel with the Naval Medical Research Units in Indonesia, Egypt,
and Peru, represent ``intellectual power projection platforms'' which
foster host nation capacity and Combatant Command-centered theater
health engagement.
The laboratory in Thailand (the Armed Forces Research Institute of
Medical Sciences, AFRIMS), working with the U.S. National Institute of
Allergy and Infectious Disease and Thai government health officials
recently completed an important HIV vaccine clinical trial that for the
first time demonstrated modest protection against HIV infection. In the
past, AFRIMS has helped develop--in partnership with host nation
scientists and health officials--vaccines protective against hepatitis
A and Japanese Encephalitis 2 in Thailand; rapid diagnostic tests for
malaria; work on plague in Vietnam; and other related health
initiatives in the Pacific Command area of responsibility.
The Kenya laboratory (US Army Research Unit--Kenya, USAMRU-K) has
done similar work with the Kenyans on malaria, leishmania, HIV, and
trypanosomiasis (African sleeping sickness) and is a pivotal African
regional asset for implementation of the President's Emergency Plan For
Aids Relief. Further, in partnership with the President's Malaria
Initiative, USAMRU-K has developed a regional center for the training
of African laboratory technicians in the proper diagnosis of malaria.
General Green's Answer. Absolutely! The Air Force Medical System
(AFMS) provides a Total Force contingency response capability,
leveraging both our Active and Reserve (Air Reserve and Air National
Guard) Components, to deliver world-class patient care on the ground
and in the air. We are light, lean and are designed to move quickly to
wherever needed. Our Expeditionary Medical System (EMEDS) is a time-
tested and proven medical capability around which the AFMS has built
its deployed operations over the past decade. It is extremely adaptive
across all mission areas to include combat operations, homeland
response, and humanitarian disaster relief. When linked with our highly
developed patient movement system to include Critical Care Air
Transport Teams (CCATT's), we are able to stabilize and move even the
most critical patients within hours of injury to the highest levels of
care anywhere in the world, truly a good news story for our Wounded
Warriors. This `system' of care is fast becoming the system of choice
in responding to contingencies. A recent demonstration of the EMEDS
success was in support of United States response to the 8.8 Chile
earthquake. The United States Agency for International Development
(USAID) specifically requested the EMEDS in their efforts to restore
medical care and provide a temporary medical facility to the city of
Angol. Within 72 hours of notification, we deployed 84 medical
personnel and 67 tons of cargo to Chile and within 48 hours of hitting
the ground, our facility was fully operational. Over the course of the
next 14 days our Air Force medics treated 276 patients, performed 38
surgeries, and integrated/transitioned the facility over to the local
healthcare providers. The entire operation was well received, praised
by both the Mayor of Angol and the U.S. Ambassador. We continue to
perfect this expeditionary medical capability to solidify the EMEDS as
the system of choice. Although the AFMS provides a vital niche
capability to deploy rapidly with small modular personnel teams and
equipment packages tailored to specific mission requirements, we
recognize that we are still part of a much larger medical response
effort that includes not only our sister Services, other U.S.
governmental agencies, and coalition partners, but also a host of
nongovernmental agencies specializing in providing support. Our
humanitarian mission is an important one, as non-kinetic `soft power'
in the DoD arsenal to win today's fight, and through partnership and
partnership capacity building to enhance stability and cooperation
around the globe. In conclusion, the AFMS, as always, stands ready,
willing, and able to respond to our nation's call, wherever that may
be.
Question. For General Schoomaker: I enjoyed reading your written
testimony about the improvements the Army has made with its Warrior
Transition Units and ensuring that our wounded warriors are being
properly cared for throughout the entire process. The Comprehensive
Transition Plan seems like a good idea and the Army Wounded Warrior
(AW2) advocates also appear to be a prudent step in giving individual
attention when it comes to navigating the many decisions that need to
be made by our wounded warriors. Are those advocate positions
adequately manned and are there enough on hand now? Are there
corresponding advocates in the VA if someone is transitioned into that
system? Possible Follow-up for all services: How effective is the
transition today from DoD to VA?
Answer. Army Wounded Warrior (AW2) has 150 Advocates located at
major Military Treatment Facilities (MTFs), Army Installations Warrior
Transition Units (WTUs), and Department of Veterans Affairs Medical
Centers (VAMCs) throughout the Continental United States, Alaska,
Hawaii, 4 U.S. Territories and Germany. The current ratio of AW2
Soldiers and Veterans to Advocates is appropriately 45:1. The AW2
program has undertaken various innovative and cutting edge business
protocols in an effort to continue providing its renowned first rate
customer support and assistance to both the Service members and their
Families. Over the past few months, the AW2 leadership has conducted a
comprehensive assessment and has implemented a thorough growth
management initiative that will ensure that every assigned Soldier and
their Family members are adequately supported within the provisions of
the AW2 program. The AW2 program is expanding its core of government
personnel, who are augmented by a robust and flexible contract support
vehicle. In addition to this initiative, the AW2 program has developed
and is in the process of field testing new methodologies and processes
for assessing, defining and managing assigned Soldiers under the
Lifecycle Management Program (LCMP). LCMP allows Advocates, with the
concurrence of assigned Soldiers, to more effectively provide
assistance and support based on the needs and desires of the Wounded
Warriors. The general premise is--as Soldiers and Families progress
back to advanced levels of independence, the frequency of Advocate
interactions and involvement can be tailored to meet the needs of our
Soldiers and Families. This initiative has the benefit of providing AW2
with a resource tool to measure and develop a more efficient Wounded
Warrior to Advocate ratio.
The Army and the VA have made great strides in the development and
integration of sound collaborative efforts in the realm of jointly
managing, supporting and assisting our severely injured and ill Wounded
Warriors. The Army currently has Advocates positioned in 75 VA
facilities (VAMCs or Community Based Outpatient Clinics--(CBOCs)). This
relationship, like other VA/DoD joint ventures in the area of support
services to Wounded Warriors, is on the increase. By the end of this
fiscal year, it is anticipated that this collaborative effort will
witness the growth of approximately 15 new Advocates sharing and
supporting dually-eligible beneficiaries from VA locations. The Army
and the VA will continue to reach out to each other to explore all
available options that are likely to enhance our mutual support to
Wounded Warriors and their Families.
The Army and the VA have integrated several procedures to ensure
Soldiers and their Families have a successful transition. Since FY2008,
both organizations use Senior Advisors to ensure coordination and open
communication between departments. There are 27 VA liaisons (Social
Workers) currently assigned to 15 military treatment facilities to
coordinate the transition of Warriors in Transition (WTs) to VA medical
facilities and VA polytrauma centers. VA liaisons register and enroll
service members into the VA healthcare system, coordinate care with VA
program managers, coordinate with the Veterans Benefits Administration
(VBA) staff to provide Soldiers with benefit information, integrate
with Army staff at MTFs, and educate veterans, service members and
Families about VA benefits.
To ensure severely wounded Soldiers have a plan covering all
clinical and non-clinical issues, the VA has assigned 20 Federal
Recovery Coordinators to major MTFs. The VA has also assigned VBA
advisors (currently there are 58 VBA Military Service Coordinators
assigned to WTUs and their supporting Soldier Family Assistance
Centers) to educate wounded Soldiers and their Families about VA
benefits and claims processing at all WTUs. VBA and Veterans Health
Administration (VHA) personnel support the nine Community-Based WTUs in
the same manner. There currently are 37 Vocational Rehabilitation and
Employment (VR`E) counselors assigned to WTUs who provide employment,
career and educational counseling to Soldiers separating from Active
Duty. VBA and VHA personnel are learning about the Army's Comprehensive
Transition Plan (CTP) and how the plan supports WTs. Both VR`E
counselors and VA liaisons will use the CTP to better understand
Soldiers and their Families.
The VA is assigning clinical and non-clinical personnel to support
the ongoing Disability Evaluation System pilot at many major MTFs. At
most Army installations, the VA has established ``Benefits Delivery at
Discharge'' (BDD) sites to support the VA claims process, ensuring all
Soldiers submit any necessary claims before discharge. By doing this,
Soldiers can track the processing of their VA claim, and the VBA can
start processing the claim before separation. In addition to the BDD
sites, VA healthcare enrollment is supported at the 12 Army
demobilization sites ensuring all Army Reserve and Army National Guard
Soldiers are enrolled in VA healthcare and understand VA benefit
programs. Lastly, the VA is part of a team that supports the Army
Career and Alumni Program (ACAP), providing a detailed benefits
briefing under the Transition Assistance Program. ACAP has been a
successful program since 1991, and continues to be one of the main ways
to provide VA benefits to all Soldiers separating from the Army.
Admiral Robinson's Answer. The Departments of Defense (DoD) and
Veterans Affairs (VA) work in a close and unified effort in support of
Wounded Warriors. Transition support within the Navy consists of
medical care case managers and non-medical care managers working
collaboratively and with Recovery Care Coordinators (RCC) and VA
Federal Recovery Coordinators and Case Managers. This close cooperation
ensures a smooth and seamless handoff of each patient's recovery needs
as a member transitions between DoD care locations, or from DoD to the
VA and/or into the civilian sector.
In support of this process, Navy Medicine has increased medical
care case managers to over 190 individuals and tracks acuity to ensure
that adequate staffing is available to meet the case management needs
of our Wounded Warrior and beneficiary population. All Navy Medicine
medical care case managers receive training on Post Traumatic Stress
Disorder (PTSD), Traumatic Brain Injury (TBI) and other combat-related
conditions/injuries. Navy Military Treatment Facilities and VA Poly
Trauma Facilities hold multidisciplinary clinical case video
teleconferences to discuss patient transition and care needs and to
provide follow up information on previously transferred patients.
Navy Safe Harbor has increased to 19 the number of non-medical care
manager positions across a nation-wide network to facilitate close
coordination during transition. Safe Harbor has also implemented the
Anchor Program, assigning a Navy Reserve volunteer ``near peer'' mentor
and senior mentor from community-based organizations such as the Navy
League, Fleet Reserve Association, American Legion, Retired Affairs
organizations and others, to support individual Sailors and their
family members as they relocate to communities across the country. Safe
Harbor non-medical care managers receive training on psychological
health and traumatic brain injury as part of annual programmed training
plans.
General Green's Answer. The Air Force Medical Service is committed
to ensuring that our wounded, ill, and injured Airmen are provided
effective and efficient transition from the military to the Department
of Veterans Affairs (VA). There are multiple initiatives aimed at
streamlining and standardizing a service member's transition from DoD
to VA. The Air Force created the Warrior and Survivor Care office (AF/
1) to oversee the Air Force Survivor Assistance Program, the Air Force
Recovery Coordination Program, and the Air Force Wounded Warrior
program, to ensure continual contact with the wounded, ill or injured
Airman and his or her family throughout the entire recovery,
rehabilitation, and reintegration process. These efforts have resulted
in significant improvements in the transition process from DoD to VA.
The following are examples of DoD/VA programs and working groups to
further enhance transitions and simplify processes for our warriors:
The DES Pilot
The Benefits Delivery and Discharge
The Quick Start
The Benefits Executive Council
The Pre-Discharge Working
The Disability Evaluation System Working
The DoD/VA Benefits Communication Working
The Medical Records Working
The Information Sharing/Information Technology Working
The AF Survivor Assistance Program (AFSAP)
The Recovery Coordination Program
The Air Force Wounded Warrior Program
[Clerk's note.--End of questions submitted by Mr. Young.
Questions submitted by Mr. Moran and the answers thereto
follow:]
Question. Over the past several years there has been an increasing
burden on the civilian health care community to provide services to
active duty members, their dependents and retirees that had previously
been provided by military treatment facilities. For example, Ft Eustis,
in my state of Virginia, recently closed its post hospital and now
buses soldiers daily to the nearby Mary Immaculate Hospital Emergency
Room to receive care. Because Tricare reimbursement rates to civilian
hospitals are often below the actual cost of care, these hospitals are
incurring financial losses. Four areas in particular suffer the most
due to a high concentration of military servicemembers: Hampton Roads,
Virginia, Killeen, Texas, Colorado Springs, CO and the area surrounding
Fr. Carson.
Is the Department exploring alternative reimbursement solutions to
hospitals that serve a high-volume of TRICARE enrollees?
Answer. The Department is not exploring alternative reimbursement
solutions to hospitals that serve a high-volume of TRICARE enrollees
beyond what is already available through regulations and policy. After
reviewing regulations and policies governing the TRICARE Outpatient
Prospective Payment System (OPPS), we have found that the General
Temporary Military Contingency Payment Adjustments (TMCPA) adequately
reimburse hospitals that serve a high volume of TRICARE beneficiaries.
[Clerk's note.--End of questions submitted by Mr. Moran.
Questions submitted by Mr. Dicks and the answers thereto
follow:]
Question. Dr. Rice, you testified before HASC that DOD is facing a
significant nurse shortage. 2010 NDAA included language (Section 525)
authorizing OSD to take the lead on the establishment of an
undergraduate nurse training program, and directed the Secretary to
report to Congress within 180 days of passage on the plan for
implementation of the program. Dr. Rice, can you talk about how you
envision that program coming to fruition, and the status of the report
to Congress? Do you intend to take an active role in the development of
the undergraduate nursing program considering it is an OSD directive or
defer it to the Services? If so, why do believe that is the appropriate
course of action considering the clear congressional intent provided in
Section 525?
Answer. The way I envision this program is OSD and the Services
collaborating to meet our need for nurses while ensuring that we are
mindful of how we are using our resources. We should also ensure that
establishment of this program does not adversely affect existing
Service nursing accession programs (such as ROTC and enlisted to nurse
educational programs) and that the Services address this new accession
source in the context of their personnel management systems. The final
report to Congress, with formal Service coordination, will be submitted
by July 2010.
Yes, I intend to take an active role in developing an undergraduate
nursing program. For that reason, we have developed plans to establish
a Tri-Service Academic Nursing Partnership program, which will meet the
intent of the National Defense Authorization Act for Fiscal Year 2010,
Section 525, to expand training programs aimed at increasing the number
of nurses serving in the Armed Forces. We plan to establish
partnerships with accredited schools of nursing near our largest
military installations. The Department's Office of the Assistant
Secretary of Defense for Health Affairs will have program oversight for
the development of consolidated budget and reporting requirements.
However, the operational aspects required to implement and maintain
this program will be at the Service level.
We believe this is the most appropriate course of action because it
will best support existing unique Service nursing accession programs
and integration with existing personnel management programs.
[Clerk's note.--End of questions submitted by Mr. Dicks.]
Wednesday, May 5, 2010.
MISSILE DEFENSE AGENCY
WITNESS
LIEUTENANT GENERAL PATRICK J. O'REILLY, USA DIRECTOR, DEFENSE MISSILE
AGENCY
Opening Statement of Chairman Dicks
Chairman Dicks. The committee will come to order, Mr. Young
has a motion.
Mr. Young. Mr. Chairman, I move that those portions of the
hearing today, which involve classified material, be held in
executive session because of the classification of the material
to be discussed.
Chairman Dicks. All those in favor of the motion say aye.
Opposed, no.
The ayes have it and the hearing is closed.
The committee will come to order. Today the Defense
Appropriations Subcommittee will receive testimony from
Lieutenant General Patrick J. O'Reilly, Director of the Missile
Defense Agency. Fiscal year 2010 was a year of significant
transition and high operational tempo for the Ballistic Missile
Defense program, and MDA participated in several warfighter
activities in support of real-world events, tested new
capabilities, and delivered hardware and software to the
warfighter in defense of the Nation.
MDA also restructured the test program and subsequently
developed an Integrated Master Test Plan. The Agency supported
the administration's development of the Phased Adaptive
Approach, formerly European capability, that can be used for
defense of deployed U.S. forces, friends, new allies and allies
in Europe.
The fiscal year 2011 President's budget request reflects
significant new policies and initiatives in homeland and
regional defense, enhanced testing, and technology development
to adapt and respond to future threats.
Restructuring of the Missile Defense Agency's test program
and plan was a significant accomplishment in fiscal year 2010.
MDA worked with the services, operational test agencies, and
the warfighter, represented by the Joint Forces Component
Command for Integrated Missile Defense, with the support of the
Director of Operational Test and Evaluation.
MDA transitioned to test objectives to verify, validate,
and accredit BMDS models in simulations and collected data to
determine operational effectiveness, suitability and
survivability of programs. The Integrated Master Test Plan,
which extended through fiscal year 2015, focuses on proving
system capabilities through the collection of identified flight
test data to ensure adequate test investments and a solid
foundation to anchor BMDS models and simulations.
We look forward to your testimony and a very spirited and
informative question and answer.
Now, before I go to Mr. Young, I just want to say that I
had a chance to meet with General O'Reilly and a program that
our committee has been strongly supportive of, the airborne
laser, has had some very successful tests, and I think is
really--we really moved forward dramatically, and we are going
to have a demonstration after the General makes his statement
of this so that the committee members and staff can see it.
But first I want to turn to Mr. Young, the ranking member,
and our former chairman. Mr. Young.
Opening Statement of Mr. Young
Mr. Young. Mr. Chairman, thank you very much. And I want to
add my welcome to yours, to our distinguished guest, General
O'Reilly.
Protecting our Nation, including our troops abroad and our
interests abroad, is an extremely important job, especially as
rogue nations and other less-than-friendly nations develop more
and more ability to attack with their missiles. We spent a lot
of money on the Missile Defense Program over the years; most of
the money well spent, I hope, but that can only be determined
by testing.
Sometimes the committee has taken a few raps because we
have supported programs that maybe weren't quite as effective
as they should have been, but we are prepared to do that. We
just cannot overemphasize the importance of our missile defense
to our Nation.
General, your fiscal year 2011 budget builds upon your last
year's transition and I commend you for some significant
accomplishes. I do remain concerned, however, about our test
and targets program. Continued test schedule delays or test
failures due to target malfunctions only make your job and our
job a little more difficult.
But as Chairman Dicks stated, you and I had an opportunity
to meet at length earlier yesterday, and I found that meeting
extremely interesting, and look forward to your testimony
today. Again, welcome.
Chairman Dicks. General, why don't we go ahead with your
statement and then we will take a look at the airborne laser
tape.
Summary Statement of General O'Reilly
General O'Reilly. Good morning, Chairman Dicks, Congressman
Young and other distinguished members of the committee. It is
an honor to testify before you today on the Missile Defense
Agency's activities to continue developing and fielding an
integrated, layered, Ballistic Missile Defense System to defend
the United States, its deployed forces, allies and friends.
Under the oversight and direction of the Department of
Defense's Missile Defense Executive Board, the Missile Defense
Agency proposes an $8.4 billion fiscal year 2011 program that
is balanced to achieve the six policy goals of the Ballistic
Missile Defense Review report and the combatant commanders' and
the services' missile defense needs as stated in the latest
U.S. Strategic Command's prioritized capabilities list.
First, defense of the homeland against limited missile
attack. The Ground-based Midcourse Defense system, or GMD, will
continue to be our primary defense against raids of
Intercontinental Ballistic Missiles, or ICBMs, from regional
threats for the next decade and beyond. The missile fields in
Alaska and California are in an optimum location to intercept
missiles from either Northeast Asia or the Middle East. We
continue to upgrade GMD to increase its reliability,
survivability and ability to leverage a new generation of
missile defense sensors. We also continue more expansive
testing of GMD to accredit our simulations.
The purchase of five additional Ground-based Interceptors,
or GBIs, and the production of components to support extensive
reliability testing and missile refurbishment, will sustain our
GBI production capability until 2016, and our critical
component manufacturing beyond 2020.------
Additionally, the previous European Missile Defense program
did not cover most of Southeastern Europe, which is exposed to
today's ballistic missile threats. It would not have been
available till 2017 and was not adaptable to changes in future
missile threats to Europe.
Therefore, instead of the previous program, we plan to
deploy a larger number of SM-3 interceptors in Europe over the
next decade, in four phases, as the missile threats from the
Middle East evolve. The first two phases, in 2011 and 2015
respectively, provide protection against short- and medium-
range ballistic missiles. The third phase in 2018 provides
protection against intermediate-range ballistic missiles. And
the fourth phase in 2020 provides capability to intercept ICMBs
from the region in which they are launched.
Third, prove the Ballistic Missile Defense System works. We
have submitted a comprehensive Integrated Master Test Plan,
signed by the Director of Operational Test and Evaluation, to
service the operational test agencies and the Commander, U.S.
Strategic Command, to ensure we comprehensively test our
missiles before we buy them.
The two greatest challenges we face in developing missile
defense is acquiring cost-effective, reliable targets and
improving quality control in all products. Over the past year,
we have initiated a new target acquisition strategy to increase
competition, improve quality control, reduce costs and provide
backup targets starting in 2012.
However, the precise performance of Missile Defense Systems
requires stringent manufacturing standards. Until we complete
planned competitions, including the greater use of firm fixed-
price contracts and defect clauses, we have to motivate some
senior industry management through intensive inspections, low
award fees, issuing cure notices, stopping the funding of new-
contract scope and documenting inadequate quality control to
influence future contract awards.
Fourth, hedging against the threat uncertainty. Due to the
uncertainty in the intelligence estimates of a potential North
Korean or Iranian ICBM threat over the next decade, we are
augmenting our current capability today to destroy 8 to 15
simultaneously launched ICMBs using our 30 GBIs in Alaska and
California, with 8 additional silos. We are also completing the
development of a two-stage GBI which adds several minutes to
our battle space.
Additionally, in accordance with the warfighters'
priorities, we are focusing our future technologies to develop
more accurate and faster tracking sensors on forward-deployed
platforms to enable early intercepts, to enhance command and
control networks, to rapidly fuse sensor data, to handle large-
scale missile attacks, to develop a more agile SM-3 interceptor
to destroy long-range missiles, to enhance the discrimination
of reentry vehicles from other objects, and to develop a high-
energy laser technology to destroy missiles while they are
boosting at great ranges.
Fifth, develop new fiscally sustainable capabilities over
the long term. The Missile Defense Agency is complying with the
Weapons Systems Acquisition Reform Act by establishing and
managing six baselines--costs, schedule, technical, tests,
contract and operational baselines--increasing service in COCOM
participation and increasing emphasis on competition in all
phases of a program's acquisition life cycle. We are reviewing
over $37 billion in contracts for competition over the next 2
years.
Six, expand international missile defense cooperation. We
are currently engaged in missile defense projects, studies and
analysis in many countries, including Japan, Poland, the Czech
Republic, Israel, Australia, the United Kingdom, Germany, South
Korea, United Arab Emirates, Bahrain, Saudi Arabia, Kuwait and
NATO. Additionally, Poland and Romania have agreed to host our
Aegis ashore sites, and we are cooperatively developing the SM-
3 2A interceptor with Japan. We also continue to support expert
dialogue on cooperative efforts with the Russian Federation.
Relative to the recently expired START treaty, the new
START treaty actually reduces constraints on the development of
missile defenses. For example, our targets are no longer
subject to START constraints, which previously limited our use
of air-to-surface and waterborne launches of targets. The new
START treaty also does not constrain our plans to employ
ballistic missile defenses. The treaty prohibits the conversion
of ICBM silos to new missile defense silos.
However, if more silos are needed in the future, they would
be less expensive and more reliable if we built new silos--
which are not prohibited from the treaty--than converting
existing ICBM silos.
In conclusion, MDA has teamed with the combatant
commanders, services, other DOD agencies, academia, industry
and other international partners to address the challenges of
managing, developing, testing and fielding capabilities to
deter the use of ballistic missiles and effectively destroy
them, once launched.
Thank you, Mr. Chairman, I look forward to answering the
committee's questions.
[The statement of General O'Reilly follows:]
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AL&B TESTING VIDEO
General O'Reilly. I have brought a 2-minute classified
video, which I am prepared to show.
Chairman Dicks. I just want to commend you, General
O'Reilly, for your approach on this competition issue and your
approach to dealing with these contractors. You and I had a
discussion a year or so ago, where I complained, and I have
been complaining, about the performance of many of our major
companies. It is unfortunate, but the people, there is just a
lack of performance.
And I think what you have done here should be a model for
the rest of the Department of Defense of aggressively going
after those people who are not performing and, in essence,
taking away their contracts and putting them out to bid and
letting other people bid who will perform. And, somehow, you
know, with the amount of programs in trouble and overruns at
the Pentagon, I hope this works. And we are going to be
watching very closely to see if this does work, because we have
got to get this under control somehow.
I am glad that you have taken this on so aggressively, and
we look forward to seeing how it turns out.
So why don't we--and I know Mr. Tiahrt will--we are going
to have a little 2-minute video on the airborne laser here.
Mr. Tiahrt. Excellent.
General O'Reilly. Sir, if it is okay with the committee: I
am going to project it on the wall. I would recommend some of
you may want to stand in a position where you can see it. It
will be very quick. ------
Chairman Dicks. Now, weren't there a lot of critics who
just said this is impossible to do?
General O'Reilly. Absolutely, sir. My background is in
laser physics, and there was a lot of discussion, including
previous directors of the Agency, that said this was
impossible. The main difficulty I will show you is we actually
fired through the atmosphere into space to destroy this
missile. This is a scientific breakthrough in the area of
anchoring our models and simulations, which is what some of the
physicists were saying why it was impossible. ------
Chairman Dicks. One other thing, just one point. You will
see the missile launch. And then when it breaks apart, it keeps
alight, but it is only on the pieces of the thing as the debris
goes away. So I would just point that out so you will
understand it better. ------
It was quite impressive. Let us go ahead and show the start
of the video. ------
So at this point we adjusted the optics and we deformed the
laser, the main laser, so that when it leaves the aircraft it
is unfocused. Since we now know basically the prescription of
the atmosphere, kind of like my glasses. We used the Earth's
atmosphere to focus the laser. When it arrives on the target it
is perfectly focused. ------
Unfortunately, with the movies that have been out for the
last 20 years, this doesn't impress. I show this to high school
classes and others in an unclassified form. People are not
reacting to it because they are saying, of course, you have got
a laser beam. This has never happened before. This is the first
one in history.
Chairman Dicks. It is easier to do it in Hollywood, right?
General O'Reilly. Yes, sir. It does look like what you just
saw in the movies. But what you just saw was real. ------
It is hard to see, but that is the destruction of the
missile. Now the laser is irradiating the pieces. So that is
what it actually looks like for the pilots. They actually see a
gigantic beam leaving the front of the aircraft.
Can you just show it one time in real-time without
stopping? And what we are doing today, while this tees up
again. Here is the launch. You are watching the entire flight
test here. And that is the destruction of the missile. ------
We did this morning find a blemish on one of the mirrors.
We are trying to clean it today. We have to change it out. It
might take 2 more weeks before we do the next test.
Thank you, sir.
ALTB DEVELOPMENT
Chairman Dicks. Well, I want to compliment you on this,
because this subcommittee was one of the steadfast supporters
of this program over many years, especially when, a few years
ago, there was a funding issue whether this should go forward
or not.
And I must say that there were some in this body who are no
longer serving here, but are serving at the State Department,
who had great doubts about this. And I think the point you make
about the fact that the refocusing of this laser was the
critical issue: Could you go through the atmosphere and this
thing, the beam, would come and hit where it is supposed to?
But I just want to compliment you because a lot of us
thought this could be done, and I like your new approach to the
program.
And I think it is also important to know that out at
Lawrence Livermore, which has been one of the great places for
the development of laser capability, there is now a--why don't
you tell them about this new laser that they are developing and
how it relates to the aircraft and the fact that you can have
two lasers on this plane?
General O'Reilly. Sir, the Office of Secretary of Defense
is executing a study right now on all high-energy laser
programs. Last year there was over $325 million in laser
programs across the Agency. They are reviewing them all in
order to see if we can consolidate and get a better return on
investment.
But as part of that program, and under that review, they
have identified the airborne laser to become the airborne laser
test bed for most of these lasers. The aircraft actually has
the mounting for two lasers. It had from the beginning. So you
can actually put two different lasers on this aircraft. ------
Chairman Dicks. As I understand it, DDR&E is creating a
report for Deputy Secretary Lynn on defense high-energy laser
research to be completed in June. General O'Reilly, can you
tell you about this report?
General O'Reilly. Yes, sir. It is the one I referred to
before. Last year, in all services and the Department of
Defense, we spent $325 million on various laser programs. They
are reviewing all of those programs. By June they can make a
recommendation on how the Department should move forward on
high-energy laser research.
I will tell you that in all the other applications, it is
about 150 kilowatts. This is the only megawatt laser system or
megawatt capability requirement that we have in the Department.
And, sir, as you said, that will be done by the end of next
month.
Chairman Dicks. The committee would like a copy of the
report when it is completed, General, if you could help arrange
that.
General O'Reilly. Yes, sir. I will pass that to the Office
of the Secretary of Defense.
Chairman Dicks. Thank you. Mr. Young.
Mr. Young. Well, Mr. Chairman, thank you very much. That
was a very interesting video, General.
Can you give us--look into the future and tell us when this
system might be available to be used?
General O'Reilly. ------
Chairman Dicks. And when might we anticipate that they
would be actually an IOC, where we could actually put them into
the war?
General O'Reilly. Well, sir, the engineers themselves on
this program have indicated they have learned so much--because
this was a breakthrough technology--that if they were going to
build a second aircraft, they would use what they have learned
and design a different design. That is what the Secretary of
Defense acknowledged last year when he said we will build one
aircraft and we will test the aircraft and operate from them.
------
Mr. Young. General, as you look at the world and you see so
many rogue nations developing missiles of one type or another,
how many airborne laser systems do you think that the United
States will need to give us the type of protection that this
demonstration shows that we could have?
General O'Reilly. Sir, our budget is proposing the
development of several different classes of missile defense
systems. I think the combatant commanders, who I work with
every day, are looking at a spectrum of capabilities. Airborne
laser does serve us very well in certain capabilities where you
can deploy for a limited period of time, like we surge aircraft
today, because they would have to be on station. It is
expensive to do that, operationally difficult to do it, but it
can be done.------
Mr. Young. General, one of the realistic points during the
negotiations for the new START agreement had to do with missile
defense. Does that new START treaty affect the airborne laser?
General O'Reilly. No, sir. I have been to Moscow seven
times in the last 2\1/2\ years. One of the proposals we have
had for cooperation on missile defense, besides sharing early-
warning data and so forth, is development in laser technology
with the Russians.
They have world-class experts at the University of Moscow.
There are some of the best theoretical physicists and optics
and such, and they can contribute a lot. Previously the
Russians have not responded. ------
Mr. Young. So if they become unhappy with and withdraw from
the treaty, which we have seen some suggestions that they might
do that, you don't think this would be one of the reasons that
they might make that decision?
General O'Reilly. No, sir. They are pursuing this
technology, as we are, and as the Chinese are also.
Mr. Young. Well, as Chairman Dicks has said, this committee
has been involved with and supporting airborne laser for many
years, and it is pretty exciting to see the success that you
have showed us here today. Thank you very much.
Thank you, Mr. Chairman.
Chairman Dicks. Thank you. Mr. Moran.
GROUND-BASED INTERCEPTOR TESTING
Mr. Moran. Thank you, Mr. Chairman.
I think we are all impressed by your laser capability that
you showed in that video. But the General Accountability Office
is less impressed with your Ground-Based Missile System and, in
fact, according to the GAO--and I will quote--``The Missile
Defense Agency continues to put the Ground-Based Interceptor
program at risk with cost growth and scheduled delays by buying
and placing enhanced interceptors before this configuration has
been demonstrated in a realistic environment.
In January of this year, you attempted to intercept a
target missile using the Ground-Based Interceptor with the--I
will only use this full term once and then I will use the
acronym--the capability enhancement 2 XO atmospheric kill
vehicle. So we will just call it the CE-2. But it failed to
intercept the target because of a failure of the X-Band Radar
to track the target, as well as a failure of the CE-2 EKV.
But about 40 percent of the EKVs have been delivered to
date, notwithstanding the fact that in the first real-world
test, the CE-2 EKV failed to intercept the target missile.
What are the cost estimates for redesigning the EKV and
when will a new functioning EKV be produced and fielded?
General O'Reilly. Sir, as I testified last year and as I
mentioned before, we have restructured our test program to more
comprehensively test the GMD program.
In the past, we have launched our targets out of Kodiak,
Alaska, launched our targets. And our interceptors have come
out of California. That is a 3,500-kilometer threat.
What we have gone to now is testing against ICBM ranges.
Our test in January was the first test to more thoroughly test
the system out. It traveled--the test was over 8,500
kilometers. We launched the target out of Kwajalein, and we
launched the interceptor out of Vandenberg. That is the
equivalent of a type of defense if you had to launch out of
Alaska and defend Miami. ------
AEGIS SM-3 PRODUCTION
Mr. Moran. Well, the problem that the GAO has, as you know,
is that you were 40 percent--you had gone 40 percent of the way
into production, whereas the only test showed that it was not
operable as yet.
And with regard to the Aegis Ballistic Defense Missile
System, the GAO said that it believes that four of the five
critical technologies are immature and that there are no plans
to intercept a target using a fully integrated prototype SM-3
Block 1B missile until the second quarter of fiscal year 2011.
Yet production begins this year. It is not that we are not
excited and we don't want to be supportive, but our job is to
ask questions, particularly when GAO raises them.
Given the fact that the SM-3 Block 1B production is set to
begin before testing a fully integrated prototype in a relevant
environment, what are the Department's plans to employ design
changes to that SM-3 Block 1B should problems be discovered
down the line? That is our concern. You have moved ahead with
production, and yet the testing raises issues that seem
legitimate, certainly in the mind of the GAO.
General O'Reilly. Sir, I do not agree with the
characterization that the GAO made regarding the 1B because
those missiles we have in production right now are the test
missiles.
We do not have a full production decision made. We are not
going to make that decision until the flight tests.
What the GAO was referring to was production of the
missiles to go test them, and then we will go to a full
production decision. We are following the prudent traditional
path of thoroughly testing these systems before we put them
into production. The GBIs in the past were not procured that
way, as you said, sir. We have procured CE-2s. We are, as
rapidly as we can, doing the types of tests I just referred to,
but our policy from this point on is to test first and then go
into production.
So, again, what we are buying right now are the test
missiles to go to production. They are not production missiles.
Mr. Moran. Okay, that is a good answer. And I won't want to
take up any more time. If we get into a second round, though--
and I will just prepare you--I do want to better understand why
we have to pay for Europe's missile defense. But at this point
I will yield to the next questioner.
Thanks, Mr. Chairman.
Chairman Dicks. Mr. Lewis.
NATO AND MISSILE DEFENSE
Mr. Lewis. Thank you, Mr. Chairman.
General O'Reilly, thank you very much for being here. I am
very much concerned about the point that Jim was just about to
make, but perhaps we fall on a different side of this question.
It is very clear that our European friends for some time now
have been wallowing in their own resources because they spent a
lot less money in defense. America, on the other hand, has been
the strength providing defense for much of the world, certainly
beyond the developing world.
It is very important that we be willing to make sure we
carefully measure where we are going in connection with those
expenditures. If America doesn't continue to commit itself to
our national security and much of the world's security, who
will, is the question.
If we decide to make, Mr. Chairman, a move in the other
direction and continue to fund social programs here instead of
defense, and Europe is not spending money on defense, who will?
It is a pretty fundamental question in terms of our future.
I am very concerned, General, about Iran and the testing
that they are about and the implications of their future
missile capability relative to the European theater and how
that impacts our responsibilities in the world.
Would you enlighten us more about your thinking relative to
Iran, especially as a major target?
General O'Reilly. Yes, sir. Do you also want me to address
the question on the contribution of the allies?
Mr. Lewis. Yes. We would like to hear it. Sure, if you want
to.
General O'Reilly. Sir, the most effective defense is not by
looking at a map and see if it is covered or not. It is
actually a side view. To have effective missile defense you
need at least two shots at a target. You would like them to be
from two different systems, so that if you have countermeasures
in something and you can spoof one, you can't spoof the other.
If each missile system has, per se, a 60 percent
probability of destroying the target that it is launched at,
you put those two together and you now have an 88 percent
probability of killing it as it comes in. You add a third layer
and you get high into the 90s. Therefore, we want layered
missile defenses.
Our proposal for Europe is the upper tier where we have the
capability, and the proposal is they would provide the lower
tier. The lower-tier systems, you need more of them than you do
upper-tier, so their net investment actually would be greater
than ours if they were going to cover Europe themselves.
Their current NATO policy is to protect their forward-
deployed forces.
They have just finished a NATO Ministerial where they are
proposing to defend the soil of Europe itself with their NATO
Missile Defense Systems. This proposal will go to a decision by
NATO heads of state in Lisbon in November.
My understanding--and I work with this every day--is we
will provide the upper-tier defense. They are going to have to
provide the lower-tier defense. Why do we do it in a classified
session?------
Mr. Lewis. General, as you responded to Congressman Young's
question about timing, when will this be available? I wasn't--
maybe I missed it. I didn't quite get your response in terms of
the actual time frame. You are in the process of development.
You suggested, I think, that we would have this capability
operable sometime near the end of the decade?
General O'Reilly.------
Mr. Lewis. General O'Reilly, the person who said this will
go unnamed, but one of my colleagues has said he never saw a
four-star general with so little support behind him.
Congratulations. I am talking about numbers of people in the
audience.
General O'Reilly. Well, yes, sir, I am a three-star; thank
you, sir.
Chairman Dicks. He doesn't need as much. Mr. Rothmans.
COOPERATION WITH COCOMS
Mr. Rothmans. Thank you, Mr. Chairman.
Secretary, thank you for all your outstanding work
throughout your career and in this matter in particular, and
these matters in particular. Secretary Gates, it was revealed
in the general press, had sent a memo back in January or
February, I think, or maybe it was December, encouraging
greater planning and coordination or upgrading of the planning
and coordination for a military contingency option against Iran
should diplomacy and sanctions fail. And that got a lot of
attention recently in the press.
I actually had asked him that in this subcommittee's
hearing in April of 2009, in open session, and he and Admiral
Mullen at the time said that they were confident they have the
capabilities and were constantly working that offensive
military option.
But I would imagine that part of an offensive military
operation would be a defensive capability, a simultaneous
defensive operation to protect the homeland or our forces in
the region or our allies in the region.
Are you working, coordinated with the offensive military
missile folks, in those kinds of contingency plans, Avis Iran?
General O'Reilly. Yes, sir, we are. Both EUCOM, the U.S.
Forces in Europe, under the command of Admiral Stauridis, and
CENTCOM under General Petraeus are both--we are working with
both of them to develop and modify and update their war plans
against the protection of our assets from a strike from Iran
and the offensive site. For example, our missile defense
systems can, within seconds of identifying a missile being
launched, determine where it came from.
So we are providing that data, we are integrating it into
our offensive command and control system. So they immediately
know that while the missile is still in flight, we have already
launched strike attacks against the point where it came from.
Mr. Rothman. And, of course, we want to make sure that
there is not a conflict between our offensive and defensive
systems. So have you done exercises so that your defense of
launches are not misinterpreted by our offensive folks? I know
in Operation Juniper Cobra--from what I have been told and
read--that you had in Israel in 2009, where you coordinated
that kind of information-sharing between the Israelis and the
American forces so that they weren't shooting at each other's
rockets, et cetera. Do we have that--have we done that with our
own forces?
General O'Reilly. Yes, sir; extensively with simulations
supported BY MDA with EUCOM and CENTCOM. The same commanders
that are in charge of the missile defense assets that we have
employed in other commands are the same commanders that have
the offensive capabilities. So at the top and their staffs,
they are responsible for developing both plans so it is
integrated.
COOPERATION WITH ISRAEL
Mr. Rothman. Right. And then regarding Operation Juniper
Cobra, from what I understand it was at an unprecedented level
of cooperation and showing of strength and commitment of
resources and that it went well; but nothing goes perfectly,
and that there were lessons to be learned and there is a review
going on. There is some issue as to whether the U.S. is sharing
the lessons learned and the mistakes with the Israelis and vice
versa.
Can you comment on that?
General O'Reilly. ------
missile coming in, we immediately provide that data to the
Israelis.
Mr. Rothman. Two last questions, and I will leave him with
the questions, if I may, just the questions. You say one of the
two biggest challenges you face--and this is from your written
testimony--are reliable targets.
General O'Reilly. Yes, sir.
AEGIS INTERCEPTORS
Mr. Rothman. And the last question would be, we need more
of these Aegis ships and missiles. Are you comfortable with the
budget for more ships and more Aegis missiles and your targets
that you say are your number one priority?
General O'Reilly. No, sir. I am not comfortable with the
number of standard missiles. We need more today. It takes 2
years to build one, though. And the decision in 2008, the
proposed budget, was to build a total of 105 standard missiles,
total. Today we are asking for funding for 431. The problem
is----
Chairman Dicks. Is that fiscal year 2011?
General O'Reilly. It starts in fiscal year 2011; yes, sir.
Chairman Dicks. Four hundred five?
General O'Reilly. I think it is 435 SM-3s and 431 THAAD
missiles across the FYDP. It starts the production line. The
problem is it takes 2 years to build the first missile.
So because of the decisions made in 2008, we could use many
more missiles than we have today. The Joint Staff is
conducting, with all the combatant commanders in the services,
a capabilities mix study. The study will determine what the
ultimate number is, so that our next year's budget can have
that in there. But we know we need to ramp up, and we are doing
that under this budget as quickly as we can.
But, again, we need to test first and then put into
production these new missiles.
STANDARD MISSILE
Chairman Dicks. On this point, why don't you describe kind
of in a general overall sense, how we are going to do this
missile defense and where the standard missile fits into this?
General O'Reilly. ------
That standard missile, we made the determination it works
very well on an Aegis ship. If you just take it off the ship
and put it on the land, you don't have to do very much
development. It is mainly the building itself and the
structure. And if you put it on the land, now we have a land-
based capability equivalent to a Navy capability and, more
importantly, the sailors are trained. The logistics system, the
worldwide logistics system, is there. There is a savings of
billions of dollars to have this same missile system on the
land as you do at sea.
But more revolutionary is the Joint Chiefs approved earlier
this year that the Navy would be the lead service for the land-
based SM-3, which will be the first time that the Navy is
operating and fully responsible for a land-based weapons
system. The Army fully agreed with that.
The problem the Navy had was, with all their sailors at sea
for Aegis, they did not have the type of shore assignments
where they could rotate them. The Chief of Naval Operations now
has land assignments and sea assignments which will help
retention, it helps training, it helps across the board. So we
thought that this was a very prudent way to move forward to
have land- and sea-based capability, same command and control.
Where the sailors walk into a room on a land-based SM-3, it
looks identical to the way it does on a ship.
And when we have remote locations such as Guam, Okinawa,
Diego Garcia, and other places in the past that have been
problematic to station a ship near them, we can now permanently
put one of these land-based SM-3 sites--or, as the Navy calls
them, Aegis ashore--and you have now that protection. ------
Mr. Young. When will this global defense system be in place
or be available to use in the event of an attack?
General O'Reilly. Sir, the first capability is against
medium-range ballistic missiles, 3,000 kilometers or less, and
that will be deployed in 2011.
Mr. Young. Is that worldwide?
General O'Reilly. No, sir. Until this budget is requested,
we are requesting at least 37 ships, and, between THAAD and
Aegis, about 800 interceptors. By 2015, we should have the
capability now that we can start deploying around the world
against MRBMs. We need the Japanese missile that we are working
with the Japanese by 2018. And by 2020, we will have had many
independent reviews. We believe we will have the capability to
develop a missile that can destroy ICBMs from a ship or one of
these forward bases by 2020.
Mr. Dicks. Mr. Frelinghuysen.
CHINA AND BALLISTIC MISSILES
Mr. Frelinghuysen. Thank you, Mr. Chairman.
Just within the last week, for the first time we have
revealed a lot about our nuclear stockpile. It will be
interesting to see whether the Chinese and Russians will be
willing to go through the same full measure of public
disclosure.
My question, sort of general question, is what do we know
about the Russians' and Chinese offensive ballistic capability?
Do we know how many missiles they have? I assume we have done
the intel on that?
General O'Reilly. ------
Mr. Frelinghuysen. The view here oftentimes is what the
Chinese have is crude, and often we say that about the North
Koreans. But some people sort of have a different take on it.
It impacts their moving fairly rapidly with the development of
their missile program, particularly the Chinese. There continue
to be stories circulating in the media that China is working to
modify their land-based B-21 ballistic missiles.
General O'Reilly. Yes, sir.
Mr. Frelinghuysen. To potentially use against our carrier
assets. Can you talk about that? I understand the idea is to
have a satellite or over-the-horizon radar or maybe a UAV guide
these heavy missiles towards our carrier groups at very high
speeds. We have a range reportedly of about 2,000 kilometers,
so that would make our fleet out there or our ships out there
fairly vulnerable. And more importantly, do we have the ability
to protect the carrier groups that are out there?
General O'Reilly. ------
Mr. Frelinghuysen. This is idiocy.
General O'Reilly. We have looked at that extensively in the
past, us and the Navy. It is very cost-prohibitive. It is very
complex. We are not looking at using submarines to launch GBIs.
Mr. Dicks. Not offense.
General O'Reilly. I was referring to defensive missiles.
Mr. Dicks. I think what you are suggesting in the START
agreement is that the number of launchers, you use some, but I
know of no system that you would use off a submarine as a
defensive system against----
General O'Reilly. We are not pursuing that.
Mr. Frelinghuysen. But we are limiting on the offensive
side.
Mr. Dicks. Both sides are coming down. I mean, to answer
the gentleman's points, any of these acts that you are talking
about would be an act of war, and we have our whole, you know,
strategic term that would--they are going to have to
contemplate that they are going to be retaliated against,
massively and overwhelmingly, if they were to launch such an
attack.
Mr. Frelinghuysen. My point is that there is a degree of
vulnerability.
Mr. Dicks. One thing that wasn't mentioned, at least for
the carriers, our ships' defense systems. I mean Phalanx is not
anything to write home to mother about, but it is a final
system that can shoot down these missiles.
General O'Reilly. Yes, sir.
Mr. Dicks. There are limits to its effectiveness. But there
are ship defense systems.
General O'Reilly. ------
Mr. Dicks. Mr. Visclosky.
PHASED ADAPTIVE APPROACH
Mr. Visclosky. General, I would like to talk about the
phased adaptive approach, and part of this is just to clarify
the program in my mind, if I could.
You have the SM-3 block, and as I understand the relation
of Block 1, Block 2, those can be launched from land or sea; am
I correct? I want to make sure I am clear.
General O'Reilly. That is our proposal, sir. We have tested
the standard missiles before from the land at White Sands so it
is not unprecedented. But that is what we plan to develop, the
land-based launchers, so we can deploy them--so you can launch
the same missiles at sea as you can on the land.
Mr. Visclosky. Are they launched today on land or sea?
General O'Reilly. Today they are launched at sea on
destroyers and cruisers.
Mr. Visclosky. And the proposal would be to have them also
be adaptive--I guess that is the ``adaptive'' word there--on
land as well.
General O'Reilly. Yes, sir. The ``adaptive'' word is we can
move them if we find a threat changes in the future. It takes a
couple of months to disassemble the whole deployment and move
it to another location if we see some in the future.
Mr. Visclosky. And also, obviously, there are multiple at
sea.
General O'Reilly. Yes, sir.
Mr. Visclosky. On the Ground-Based Interceptor, that is
land exclusively. That is not launching from sea.
General O'Reilly. That is correct.
Mr. Visclosky. The SM-3 is for short and intermediate
intercepts essentially?
General O'Reilly. Sir, there are several variances of the
SM-3. The SM-3 IA is for short--which is up to 1,000
kilometers--and medium range, which is up to 3,000 kilometers.
So the SM-3 IA and IB will be to engage targets up to 3,000
kilometers, the range of the target, 3,000 kilometers. And the
SM-2s would be able to handle targets of 5,000 kilometers, the
IIA and the IIB ICBMs.
Mr. Visclosky. So the A and the B in Block II would be
modified to be long-term interceptors as well; or would it be A
is short and medium, and A is long term?
General O'Reilly. The SM-3 I series is the short and medium
range. The SM-3 IIA would be against IRBMs up to 5,500
kilometers, and the SM-3 IIB would be ICBMs, 12,000 kilometers.
Mr. Dicks. Are these the ones that are under development
with the Japanese?
General O'Reilly. The IIA is.
Mr. Dicks. But not the IIB.
General O'Reilly. Not the IIB, sir. That is a new missile
start.
Mr. Visclosky. That is not under development currently. It
is a proposal?
General O'Reilly. We are going through the technology today
of verifying the high-risk parts which we believe we have in
hand, the high-risk technologies for the next 2 years for the
IIB, and then we would start a formal program start after that.
Mr. Visclosky. And the IIA would still be adaptable for
short and intermediate intercepts?
General O'Reilly. ------
Mr. Visclosky. And B would be long?
General O'Reilly. Yes, sir.
Mr. Visclosky. There is no further development or changes
proposed for, then, the Ground-Based Interceptor, which is long
range?
General O'Reilly. ------
Mr. Visclosky. What about the missile itself?
General O'Reilly. ------
Mr. Visclosky. General, if I could follow up. You are not
in those upgrades looking to also make it a sea-launched
system, though?
General O'Reilly. No, sir. We have no plans for a sea-
launched GBI.
Mr. Visclosky. Then the question in my mind, understanding
that the Block IIB is not yet developmental--you are looking at
it--why proceed with that if you are upgrading your current
land-based system?
General O'Reilly. Sir, it is a quantity. A GBI costs about
$70 million apiece. The estimate for a IIB would be on the
order of $15 million.
Mr. Visclosky. One-five, 15?
General O'Reilly. One-five, yes, sir.
And the difference is the GBIs, if we are going to add a
new silo--if we found out we needed more GBIs, it takes 5 years
to expand a missile field. The ships at sea, we are building
these new missiles so they fit in the existing launcher
systems. So a cruiser has 120 launching cells on it. So we can
put up to 120 missiles, four times as many as we have in
Alaska----
Mr. Visclosky. Short, intermediate, and long?
General O'Reilly. Yes, sir.
Mr. Visclosky. On your land-based, that would also hold
true, $15 million per copy?
General O'Reilly. Yes, sir. That is the II--what we refer
to as the IIB and IIA. They are about $15 million, is our
estimate.
Mr. Visclosky. If you have a missile that is long-range and
one copy--of course you haven't built one yet--that is $15
million and the other $70 million, what is the cost disparity
when I am comparing apples and apples; that is, land-based IIB
and the land-based GBI?
General O'Reilly. ------
Mr. Visclosky. So the upgrade, then, to the GBI is not
necessarily to increase their quantity but to make sure, as
long as you have that investment in them, it is an effective
investment, then you keep them effective. If you have
additional quantities, you go with the IIB that you have in
your proposal.
General O'Reilly. Yes, sir.
Mr. Visclosky. I know I don't have a lot of time.
If the IIB, you have not started development but obviously
you have a plan for and you have a cost assessment for it, will
there be a time when you need more of--will you need at some
point some of the additional GBI in the interim until all of
this is built?
General O'Reilly. Sir, there is a threat uncertainty. Our
current plans, we are going to procure 52 missiles, GBIs, and
five additional booster stacks. Now, that is what we are
proposing. With those 52, we are going to be flight-testing
some of them. By 2020 when we have planned on fielding the
newer missile, we should have 36 GBIs at that point. If we find
we need more, we are going to be in production until 2016. So
we have 5 more years to continue to assess the intel and
determine if we need more.
We don't want to get into the situation I am in today. Our
last time we bought a GBI was 2006. Our production is stopped
on most of the vendor base, and I have to restart it next year,
which I am. But we are trying to make--allow decisions to be
made in the future before we shut down that production line
again.
Mr. Visclosky. Which--industrial base would be a concern.
But I know my time is up, and I thank the general and the
chairman.
Mr. Dicks. Mr. Tiahrt.
ALT B FUNDING
Mr. Tiahrt. Thank you, Mr. Chairman, thank you for your
support for the Missile Defense Program. I think you have been
a great visionary.
One of the things I would like to pick up on what Mr.
Rothman talked about and the cooperation with Israel. They are
developing great new technology over there. In fact, you can't
buy a new computer today without the incorporation of some
ideas that originated in Israel on processing. And I think
there is a great deal of synergism that we could gain by close
cooperation. So if there are any problems with that
cooperation, I have got to join with Mr. Rothman in trying to
smooth the bumps in the road, because I think it gives us an
advantage on defense issues as well.
There is something that happened last year that I want to
point out to you. The ABL is about 12 years old. Last year, the
optics needed to be recoded. It took 6 weeks to get a supplier
up and running. So there was like a 6-week delay. It is an
indication of how our national defense industry base is
shrinking and making us more vulnerable.
While this is occurring within the United States, our own
Pentagon is looking outside the United States as a supplier.
You have heard a lot about the tanker program where they are
trying to buy a French tanker and put an American paint job on
it and call it American. And even though this is a country that
I don't think we can fly over today to get our men and material
to Iraq and Afghanistan, I am very concerned about this
outsourcing of our national security.
We are also doing it through a program called Imminent
Fury, where we are going to Brazil for aircraft which have a
competitor that is made right here in America. So again, we are
outsourcing our national defense base, and I think it is very
ill-advised. And this ABL program is an example.
When you are in confrontation, you can't afford a 6-week
delay or 6-day delay. And we have seen this in the Gulf War,
Japan disappointed us by delay. In Operation Iraqi Freedom,
Belgium disappointed us with a delay in war materials. So we
can't make ourselves more vulnerable. And I think the committee
needs to know that by diluting our defense industrial base, we
are making ourselves more vulnerable.
And I don't think any of you are going to run for
reelection on the platform that we are going to increase the
employment in France when we have got almost 10-percent
unemployment in America; or we are going to run on the platform
of increasing the employment in Brazil when we have got almost
10-percent unemployment in America. So we need to be very
concerned about this outsourcing of our national security,
whether it is Imminent Fury or an air refueling tanker or the
ABL program. ------
For us to now cut back the funding on this program concerns
me greatly, especially in light of all of these advancements
you have made in technology, in compressing the package
carrying.
If the Department was provided with the same level of
funding as last year, which would be an additional hundred
million, I believe, how would that money be spent and how would
we use that to progress the program and the technology?
General O'Reilly. ------
Mr. Tiahrt. Please explain to the committee what the 98 or
99 million will buy in 2011 that we have in program now. Is
that just the one test you are talking about?
General O'Reilly. The one test, but the 1-year program. The
one major test, but we have a lot of smaller tests.
Mr. Tiahrt. The hundred million would get the smaller
tests, the advanced?
General O'Reilly. Yes. And a part of that does pay for the
newer laser work going on at Lawrence Livermore.
Mr. Tiahrt. ------
General O'Reilly. ------
Mr. Tiahrt. I think I want to emphasize the need for
increased testing because of the versatility of this weapon.
And we just are thinking, you know, how many kilometers away
and all of this. But by increasing the testing, I think the
capability will dramatically increase. And if you take it to--
you know, using my imagination, I can imagine the capability in
the back of a Humvee, and it can protect a platoon, at the
platoon level, from incoming objects like a handheld rocket. So
it has great potential as we compress it further, and I think
that can be revealed. ------
Mr. Dicks. Mr. Hinchey.
COUNTERFEIT PARTS
Mr. Hinchey. Thank you very much, Mr. Chairman.
I think you made a very good point, as everybody else did
here, but I want to express my agreement with you of the kinds
of things that--what you were saying and why I think it needs
to be done. So if there is anything I can do to work with you
on that, I would be happy to do that.
General O'Reilly, thank you very much. Thank you for
everything you are doing and the opportunity that we have to
understand this situation much more clearly.
The safety and security on this planet is diminishing, and
it is something that really has to be dealt with more
effectively, including diplomatically. But that is another
issue here that really has to be addressed.
The safety and security issue with North Korea and Iran, it
is just remarkable why they would be engaging in the
capabilities they are engaged in, when, if they were to do
anything militarily dramatic in the context of this, it would
be a disaster for them. No question about it.
And of course the safety and security issue was
demonstrated in New York just a couple of days ago, and we know
that kind of situation that we are likely to continue to see
over time, and it is something that we have to be very, very
careful about and very, very intensive about.
I wanted to ask you a technical question. It has to do with
a number of things, including a company in a district that I
represent, Endicott Interconnect Technologies, working with the
Department of Defense.
The situation basically is this: Last year, the New York
Times reported that despite a 6-year effort to build trusted
computer chips for military systems, the Pentagon now
manufacturers in secure facilities run by American companies
only about 2 percent of the more than $3-1/2 billion of
integrated circuits that are bought annually for use in
military gear. And the effectiveness of that gear, the
reliability of it, is something that is obviously very
important.
So recently the GAO released a report regarding counterfeit
parts and the potential of such parts to potentially seriously
disrupt the Department of Defense supply chain, do other things
like delay missions and affect the integrity of weapons
systems.
The report found that the Department of Defense is limited
in its ability to determine the extent to which counterfeit
parts exist in its supply chain because it does not have a
Department-wide definition of the term ``counterfeit'' and a
consistent means to identify instances of suspected counterfeit
parts.
Apparently, while some Department of Defense entities have
developed their own definitions of ``counterfeit,'' these can--
they vary on the context of the definitions that are being put
out there. Two Department of Defense databases that track
deficient parts--and they are those that do not conform to
standards--are not designed to track counterfeit parts. A third
database can track suspected counterfeit parts; but according
to officials, reporting is low and that reporting is low due to
the perceived legal implications of reporting prior to a full
investigation, reporting something that you may not have all of
the information about, so are you going to report it in any
case before you know everything about it. Well, that is just
one aspect of what is now a deeply complicated set of
circumstances here. And it has to do a lot with security.
So I am wondering to what extent you may have looked into
this and may have understood this situation.
Has the MDA been impacted by counterfeit parts? Does MDA
have its own definition of counterfeit? And what anti-
counterfeiting measures are being considered by MDA?
General O'Reilly. Sir, first of all, that GAO report cites
us as one of the organizations that is aggressively pursuing
counterfeit parts. We do have a definition of counterfeit
parts, and it is both not building the part to the exact design
that was proposed in our approved designs for our components of
our missile systems by our prime contractors, but also built by
someone different than was originally identified when we
approved the design. So that is our definition of counterfeit
parts: change the part or been built by somebody differently.
So we hold our prime contractors accountable for that.
Yes, we have been affected. Yes, we have called in the FBI.
Yes, the Justice Department has pursued them. And so yes, sir,
we do see it as a growing problem.
Mr. Hinchey. So to what extent do we have or to what extent
is the reliability of this situation increasing, do you think,
over recent time?
General O'Reilly. Sir, we have been aggressively pursuing
them. I have inspectors in almost every one of the plants. So
does the Defense Contracting Agency. A lot of our reporting,
though, of this is actually coming from our prime contractors
themselves or major subcontractors. These counterfeit parts are
not coming from large companies, but it is the smaller ones.
What we have added in is additional screening. So we test
the first thing, to identify if something is not operating
right, when you take the component. Years ago, we had--in order
for acquisition reform and reducing the cost of acquisition, we
had removed some of those tests. We have installed those tests
back in to do more parts screening when they come in.
And second of all, it is a crime and we do pursue that.
So through inspection, making it a contract requirement,
and our prime contractors themselves have been vigilant. ------
Mr. Hinchey. Is it generally considered to be a serious
situation where you have essentially 98 percent of the products
here that are being manufactured, apparently, in places outside
of the country, and the reliability of the integrity of these
operations comes into question? Is the situation concerned
about; is it being looked into effectively? I know you just
mentioned some of the ways in which it has been.
General O'Reilly. Yes, sir. It is a concern. Screening is
the first order we do to protect at the piece-part level to
catch them when they are coming in, but more is needed.
Mr. Hinchey. Is there any potential for this operation, or
is it significant enough to have it be focused in the context
of being manufactured here in ways that can be seen more
effectively?
General O'Reilly. Sir, that obviously is a viable solution
that would solve that. Some of our counterfeit parts, though,
we have found in the past some of them are from U.S. entities,
and the Justice Department has taken over at that point. We
have had to redesign parts of a component and go procure them
from somebody else. But it is not just overseas; it is U.S.
too, where we have run into this problem.
Mr. Young. Will the gentleman yield?
This is a field I have cared for for a long time. We all
know the technology exists in the world to embed programs into
certain types of electronics, certain types of technology that
could cause a failure or a disruption of the system.
And as Mr. Hinchey and Mr. Tiahrt have raised the issue of
foreign producers or counterfeit producers, are we vulnerable
to having that type of attack made against us by embedding
something that we can detect but an enemy could disrupt our
missile with one of those embedded programs?
General O'Reilly. Sir, as far as a foreign component, we
prohibit the use of foreign components by any of our
contractors unless we provide them a waiver. And the waiver is
not just the Department of Defense, but the Department of
Commerce also. So we go through a process. It has to be a
trusted source. We have trusted sources in the U.K. Obviously,
this is something that we work very closely with the Japanese
in our development with the SM-3 IIA. We do have processes to
provide waivers, but without a waiver, they cannot use a
foreign piece-part in any of our systems.
Mr. Dicks. Mr. Kingston.
Mr. Kingston. General, that just seems outrageous to me.
And it would appear to me that within your Department that
there would be equal outrage; in fact, that your outrage would
be bigger than our outrage in terms of anybody selling
counterfeit parts to a missile system so important.
Do you feel it? You don't strike me as a real emotional
guy, which is good. But is anybody there pounding the desk and
saying this is--somebody has got to go to jail?
General O'Reilly. Sir, our process for that is, first of
all, we turn it over to the Justice Department. Second of all,
we prohibit them as a supplier to the Defense Department,
immediately to MDA. We submit them to be a prohibited supplier
in the future. So what we try to do is put it out of business.
Mr. Dicks. Will the gentleman yield on this point?
Has anybody been put out of business?
General O'Reilly. We have--sir, I know of several
incidences a couple of years ago. I can provide you the data on
that.
Mr. Dicks. That would be good.
[The information follows:]
MDA has experienced several instances of counterfeit parts. For
example, a counterfeit operational amplifier, which can be used on
multiple MDA systems, was identified on MDA hardware during testing.
The failed part was found on a circuit board supplied by a
subcontractor. It was later determined that the subcontractor purchased
these parts from a parts broker who was not authorized to distribute
parts by the original component manufacturer. In another instance, a
counterfeit microcircuit, which can be used on multiple MDA systems,
was identified on MDA hardware. MDA's visual inspection showed that the
part was resurfaced and remarked, which prompted authenticity testing.
Tests revealed surface scratches, inconsistencies in the part marking,
and evidence of tampering. These parts were purchased from a parts
broker who was not authorized to distribute parts by the original
component manufacturer.
MDA reports instances of counterfeit parts to the Department of
Justice (DOJ) for criminal investigation and possible prosecution. In
October 2009, DOJ announced that it had indicted three individuals in
connection with sales of counterfeit electronic components through
several distributors, including MVP Micro, Red Hat Distributors, Force-
One Electronics, Becker Components, and Pentagon Components. In January
2010, one of the defendants pleaded guilty to charges of Conspiracy to
Traffic in Counterfeit Goods and Defraud the United States and to the
Trafficking in Counterfeit Goods. MDA also issued a formal advisory to
its program offices to determine whether there had been any other parts
procurements from these distributors and confirm that these entities
had been removed from all Approved Vendor Lists at the contractor and
subcontractor level.
Counterfeit parts are addressed as part of MDA Parts, Materials,
and Processes Mission Assurance Plan which includes instructions on
part selection, procurement, receipt, testing, and use of parts. MDA
further has applied DOD's item-unique identification technology that
provides for the marking of individual items. In addition, MDA issues
formal bulletins that alert MDA staff of counterfeiting techniques and
how to detect them.
Mr. Dicks. Also, what is their excuse? What do they say
when they are confronted with this?
General O'Reilly. Sir, we deal with the prime contractor. I
don't know. It is a criminal act and we turn it over to the
Justice Department. We then immediately find a new supplier and
change the design if we have to avoid ever using those
components again.
Mr. Dicks. But you are not getting a new prime. You are
just getting a new subcontractor.
General O'Reilly. Yes, sir.
Mr. Kingston. It would seem to me that the prime contractor
would have some vulnerability.
Mr. Dicks. He is the one that selected the prime--the
subcontractor, right?
General O'Reilly. That is right. Sir, this is a problem
that we deal with in the Department; that is the use of cost-
plus contract. A cost-plus contract is intended in order to say
that there is a risky technology or something we are pursuing
that is not mature. And instead of the contractor absorbing the
whole risk, the government, for most risky technologies, like a
lot of the missile defense ones, we share the risk of them
proceeding in a risky development. It was never intended, but
there is no distinction in our contracts today, our older
contracts, to distinguish between a legitimate development risk
and negligence or a defect.
And so our new contracts that we are moving forward--and we
are reviewing $37 billion in contracts right now--our new
contracts, we are aggressively using fixed-price contracts
where we can; which means when you spot counterfeit parts it is
on the prime contractor to pay for the impact of that.
And we are also adding in defects clauses.
HOMELAND DEFENSE
Mr. Kingston. I want to move on a little bit.
I want a Rotary Club takeaway here. When we move from
agriculture to education to health care to ballistic missile
defense, what would you say in terms of your number one goal,
defending the homeland against a limited ballistic missile
attack, where are we on the scale of 1 to 10, 10 being 100
percent secure?
General O'Reilly. Sir, we have conducted three out of three
successful tests of a geometry that shows missiles being
launched from North Korea and our interceptors coming out of
Alaska. That is the tests where we launch the interceptor--the
target out of Kodiak and we launch out of Vandenberg. We have
shown it is technically viable.
The Director of Operational Tests and Evaluation has
calculated that to have a statistical confidence you would need
to repeat that test 17 times, and each test is over 200
million.
So I think what is more critical is when we are going to
complete the testing on these systems--and that is what our
integrated master test plan does--to validate our models so we
can run thousands of runs in order to get a high confidence
level in this capability.
We know we have capabilities, sir, but I can't quantify
like I would like to be able to of what that probability is.
Mr. Kingston. Two hundred million dollars just for one
test?
General O'Reilly. For a GBI test, yes, sir. Again, we are
now testing at greater ranges. The latest one was $279 million.
We were launching out of the Marshall Islands and the
intercepter out of Vandenberg.
Mr. Kingston. If you were going to guess where our biggest
threat is, what would you say, what could be--fast forward in
the tape if you could make a prediction.
General O'Reilly. In defense, sir?
Mr. Kingston. Yes
General O'Reilly. ------
Mr. Kingston. Would it come from a rogue nation or where
would it come from?
General O'Reilly. Sir, our concern is they are being sold
on the arms market. So they do not discriminate. So nonstate
actors do have a potential to have these.
NATO BMD FUNDING
Mr. Kingston. Okay, then I have one more question, Mr.
Chairman.
I wanted to know on the European contribution, you had said
they do the first level.
General O'Reilly. That is the proposal, yes, sir.
Mr. Kingston. And how much is that in terms of a percent of
the total of their defense? What is their lift compared to
American taxpayers?
General O'Reilly. Sir, our rough calculation of the value
of the missile defense assets they own today, and several
countries do, is about $2 billion that they already procured.
Mr. Kingston. What would be the total defending Europe--and
I understand it is not just defending Europe--but defending
Europe, what is the total price tag for that?
General O'Reilly. ------
Mr. Kingston. I am really worried about the dollars here.
General O'Reilly. They need a lot more of them.
Mr. Kingston. But we are spending $12 billion. What are we
proposing that they spend?
General O'Reilly. They would have to make a determination
of what they want to protect at that lower level. And that is
what is going to occur in the Lisbon Summit, between the heads
of states of NATO. Today they haven't declared that they will
protect territory of Europe, and that is a first step.
Then the second step--and NATO does have studies going on
looking at what is the priority of what they are trying to
protect and their investment strategy.
Mr. Kingston. At Lisbon, if they vote not to participate,
what do we do with the upper tier?
General O'Reilly. ------
Congresswoman Kilpatrick.
STRATEGY BALLISTIC MISSILES
Ms. Kilpatrick. Interesting discussion. I think I am trying
to visualize.
Let me ask you this: What missile system is the strongest
defense system in the world? What countries?
General O'Reilly. For missile systems?
Mr. Dicks. Are you talking about offensive or defensive?
Ms. Kilpatrick. How can you separate them?
General O'Reilly. Offensive, the threat missiles, if you
remove the United States----
Ms. Kilpatrick. I don't want to remove them.
General O'Reilly. The country that has the most missiles
today is Russia; the second country is the United States; and
the third is China.
Ms. Kilpatrick. Do you base my question on the number of
missiles they have or the best defense system that there is?
General O'Reilly. Our intelligence estimates look at the
effectiveness of the threat. So it is the most egregious
threats are the ones that have the most potential.
Ms. Kilpatrick. So which is the best system of the three
that you named?
General O'Reilly. ------
Ms. Kilpatrick. So U.S. in that regard.
General O'Reilly. For offensive strategic accurate weapon.
Ms. Kilpatrick. And Russia would be how in that same
scenario?
General O'Reilly. ------
Ms. Kilpatrick. And Russia is now our friends. We work with
them. They are one of our allies, are they not?
General O'Reilly. They are not an ally, but we do work with
them. We have agreements that we do surveillance on each
other's systems. So we do know--and they do inform us and they
have done that--every time they move their systems.
Ms. Kilpatrick. So we have a working relationship, say, not
allies. What would they be to us? We use their parts.
We meet with them. We discuss the security thing.
General O'Reilly. We have an ongoing open dialogue for
years, going back to the original STARTs. We exchange data back
and forth on our systems.
Ms. Kilpatrick. I am trying to move to Iran and North Korea
and all of them.
Is Iran--you didn't name them in that top three. Do they
have the capability that the other three that you mentioned
have?
General O'Reilly. No. They are pursuing it, is our
intelligence estimate. So are the North Koreans. But, no, they
don't today. ------
Ms. Kilpatrick. Okay, so that is good. They are still in
testing, then. They are trying to get there.
General O'Reilly. They are trying to get there.
Ms. Kilpatrick. So between Syria, Iran, China, North Korea,
we have better offensive and defensive missile defense systems
than they at the current time?
General O'Reilly. Yes.
Ms. Kilpatrick. If we use some of our other partners--I
guess Russia would be one of those--does Russia have the same
relationship with Iran and North Korea that we have? Are they
in that realm? They agree on some things and some things they
don't, or are they like our country?
General O'Reilly. They do have ongoing dialogues and
relationships with both North Korea and Iran.
Ms. Kilpatrick. Then on the video that we saw, the laser.
Does it operate in bad weather, in clouds? Is any of that
interrupted?
General O'Reilly. ------
Ms. Kilpatrick. How much is it going to cost to develop
that testing? We want to get you what you need. Is it in
addition to--in our Congress, everyone wants to cut the Defense
budget because it is the money that we need to secure, and I am
for securing as much as we need.
Is the phase-in 2014 that you mentioned, 2015, going to
mean that we can reprogram some old money, or is it all new
money that we are talking?
General O'Reilly. It is all new money that we are proposing
in this budget. However, there are two reprogramming actions on
the Hill here today right now; one to complete the missile
field in Alaska to provide us the eight additional silos to
give us some additional hedge for the future; and the other is
to upgrade more Aegis ships to BMO capability sooner. So those
actions are on the Hill today.
STANDARD MISSILE-3 IIB DEVELOPMENT
Ms. Kilpatrick. I commend you for your knowledge, and the
physics background that you have obviously helps that.
Lastly for me, if there was one thing that you would ask
this committee to do or support in your capacity as Director of
MDA, what would that be?
General O'Reilly. I believe it is the support for the SM-3
IIB missile. And the reason for that is that regardless of the
intelligence estimates, my concern is these technologies are
out of the box. People are aggressively working on long-range
mobile missiles and they have shown over and over again they
are willing to sell them to anybody who will buy them.
So it may not be this decade, but it would be hard to say
it wouldn't be the next decade that we could face threats from
all directions. We have to convince these people it is not
worth even pursuing. And therefore having missiles like an SM-3
II8 that could shoot down a missile over a country that is
launching the missile would deter them and persuade them, like
we have done with their air forces, to stop investing in these
missiles.
Ms. Kilpatrick. Thank you very much.
Thank you, Mr. Chairman.
Mr. Dicks. Now I want to recognize Mrs. Granger, and I
notice that she has an apple there.
And General, can you tell us why that apple is there?
General O'Reilly. My mother taught me to always bring an
apple and give it to your teacher. And believe it or not, I
don't know what the odds are of missile defense, but the odds
here are pretty high.
Should I say how long ago it was, ma'am?
Mr. Dicks. That is one thing you don't. Strike that from
the record. If you were both much younger.
General O'Reilly. A few years ago I was briefing
Congresswoman Granger and she asked me where I was from, and I
informed her I was from her district. And then she asked me
where I went to high school and where my parents lived. And it
became quickly apparent that we have known each other many
years ago when I was 16, and I don't know how old she was.
Mr. Dicks. But she was the teacher, right?
General O'Reilly. Yes, sir. Congresswoman Granger was my
high school English teacher, I believe my junior year in high
school.
Mr. Dicks. You told us that she vigorously corrected your
papers.
General O'Reilly. You may think I am worried about these
questions that committees ask. I am worried about having my
former English teacher correcting my grammar.
ARROW-3 DEVELOPMENT
Ms. Granger. When you were talking about the defense of
Europe and you said, ``We are going to have to propose,'' and
so I was going to come back to you and say, Does that mean they
haven't decided not to? Then you told us about the Lisbon
Summit, so we will watch that very carefully.
I want to ask you to go back to something that we have
talked about, you and I talked about, and that is the critical
importance of the relationship with the U.S. and Israel. And I
want to ask you about the Arrow-3 program and how that is
progressing and the challenges it presents and how we are
coming along with the project agreement.
General O'Reilly. ------
So we have a program laid out with them that very
systematically monitors their progress, and we do assist with
them, and U.S. companies like Boeing are participating with
them on this program.
Ms. Granger. I was aware that it was more costly and going
to take more time, but they are absolutely committed to it. So
I thank you.
I would suggest to anyone--I did, because I am his former
teacher, and because I wanted more information. You gave me a
briefing that was very helpful just generally on all of these
missile programs and what they do. And it was very helpful to
me in understanding and be able to then zero in on particular
issues.
Mr. Kingston. Was he still trying to get extra credit? Is
that what this was about?
General O'Reilly. When I briefed her, she gave me a gold
star at the end. I was hoping there was no homework.
PHASED ADAPTIVE APPROACH
Mr. Dicks. Mr. Rogers.
Mr. Rogers. General, some people are concerned that the new
Nuclear Posture Review weakens our missile defense efforts. In
2009, the administration scrapped the planned missile defense
systems in Poland and the Czech Republic, coincidentally
turning its back on two very staunch allies in the effort to, I
think, appease Russia. Am I correct on that?
General O'Reilly. No, sir. When I was advising the
Secretary of Defense and others in this, our primary concern
with the other program is it takes 5 years to build the missile
field. And if we found we didn't have enough missiles, we would
be vulnerable for 5 more years until you can upgrade the
missiles. ------
So the concern was not enough missile defense. We needed to
procure or pursue a system that was more affordable, that could
in fact--because GBI cost 70 million apiece, the missiles we
are proposing now are between 10 to 15 million apiece. We
project we are going to need hundreds--instead of 10, hundreds
of interceptors in Europe if the threat emerges, as some of the
intel predictions are.
Mr. Rogers. Why did we scrap Poland and the Czech Republic?
General O'Reilly. Sir, I was part of the--Under Secretary
Tauscher and Under Secretary Flournoy and I went to Poland the
day the President made the announcement.
When we landed at the airfield in Warsaw, the first thing
we saw was a London Financial Times telling us how the meeting
went that we hadn't even held yet. There was a complete
fabrication on what had occurred in the announcement. I was one
of the three that announced this to the Polish Government.
We listened for an hour respectively, as they were very
upset that we had left them hanging. And at the end of the
hour, we then explained to them we still want to put an
intercepter system in Poland; and they looked at us and said,
But that is not what we were told.
And myself and Secretary Flournoy and Secretary Tauscher
said, ``We are here on behalf of the President. We do want to
have missile defense here. We are continuing our agreements on
the deployments of Patriot and to put the command and control
system we had before.'' And frankly, instead of having 10
interceptors in Poland, they could have as many as a hundred
and----
Mr. Rogers. Where do we stand now? Are we going to have
missiles in Poland?
General O'Reilly. Yes. And they have agreed to that, sir.
Mr. Rogers. And effectively, what will those missiles
defend against and whom?
General O'Reilly. ------
Mr. Rogers. Well, again, the question is why are we paying
for the protection of Europe, especially those areas where we
do not have troops of our own or installations that we need to
protect? Why are we doing this? Are they going to help us with
the costs, the Europeans?
General O'Reilly. Sir, that, again--NATO is reviewing that
right now, and the first step is to agree to protect
themselves. That is the Lisbon Summit.
But, second of all, once you have this separate tier
protection for ourselves, it does have zones of about 2,000
kilometers. With Article 5 and NATO, if we have a capability to
defend NATO, we must under the article launch our interceptors
to defend NATO, which is part of the indivisability of NATO
that goes back to the very beginning.
Mr. Rogers. Well, will we be pushing NATO and/or the
Europeans to help pay the costs of these deployments?
General O'Reilly. Yes, sir. Two weeks, ago, I spent 4
hours, privately, with the Secretary General of NATO. He came
to Colorado, and we showed him all of our demonstrations and
our simulations and so forth, and we had very long discussions
on what would be the cost to NATO and what would be the changes
in the command and control and so forth, for them to have an
Integrated Missile Defense System. ------
Mr. Rogers. So the Lisbon Summit will, hopefully, decide
the European defense posture; correct? Who pays for it, where
the missiles will be?
General O'Reilly. Yes, sir. Without their agreement to
protect themselves, and it is a U.S. commitment only, or
bilateral, with each of the countries.
Mr. Rogers. Well, in September of 2009, the President
introduced what is called a Phased Adaptive Approach for
missile defense in Europe. What is that and what does it have
in relation to the Lisbon Summit?
General O'Reilly. ------
The second step, then, would be the Phased Adaptive
Approach. As we are developing new missile capabilities with
the SM-3 and the THAAD and our forward-based radars, we will
deploy the capability, as they are being tested and proven and
accepted by the services, first deployment in 2011, the second
deployment in 2015. And these deployments are geared by our
intelligence estimates of what range the Iranians can reach if,
in fact, they are successful in the development of their own
systems.
Mr. Rogers. So this will be a NATO-run program, do you
think?
General O'Reilly. ------
ALTB CONCEPT OF OPERATIONS
Mr. Rogers. Now, in closing, a wholly different subject. In
the video, what is the planned protocol for stationing the
aircraft, the laser-armed aircraft, in a defensive situation?
Obviously the plane has to be fairly close to the launch phase,
right? How would you have those planes deployed on a routine
basis?
General O'Reilly. ------
Mr. Rogers. Well, on a worldwide mission, you are going to
need a lot of planes.
General O'Reilly. Sir, that is why this would be a great
capability to surge. That is why we are proposing to have many
different missile defense systems so that the combatant
commanders that I am working with today put the appropriate
system against the appropriate threat.
Chairman Dicks. Would the gentleman yield?
Mr. Rogers. Yes.
Chairman Dicks. A possibility would be you would have
planes off of North Korea.
General O'Reilly. Yes, sir.
Chairman Dicks. Or off of Iran as a possibility. So if
tensions rose, we had some indication that they might do
something, then you could deploy these airplanes and you could
attack a missile in boost phase.
Mr. Rogers. Well, that is what I am talking about. And,
like Iran, where to get close to a launch site that might be
inside the middle of Iran, I don't know how you would be able
to patrol close enough to----
General O'Reilly. Well, again it is what we call goal-
tending from hockey. If you know where the threat missiles are
coming and you know what you are trying to defend, and you have
a mobile defense, you can put the defense and put the aircraft
between where they are being launched and where they are going.
So we have an idea. We know what trajectories they would
have to use if they were going to threaten the United States.
So we are in their path, and we let them come towards us as
well as shooting them. That would be part of the strategy.
But, again, this would be more applicable to a system
where, when tensions rise, like many of our defense systems, we
surge them into an area and then you have, for a limited time,
a very high capability.
But to deploy them globally, constantly, we do not do that
with any of our defense systems because of affordability.
Mr. Rogers. But I assume you would, for the moment. You
would be patrolling around Iran and North Korea, would you not,
if you had the capability?
General O'Reilly. Sir, that is why we work with the
combatant commanders, and they would determine that capability
because of training and other things. That is why we went with
an Aegis ashore, where you can have a semipermanent protection
and then you have mobile systems, both sea and aircraft. They
are not to act as--our proposal is they are not to act as a
permanent defense. They are surged when they are needed because
it would be cost-prohibitive to keep them there constantly.
Mr. Rogers. Final question. In your realism talk, what do
you think the distance, the range, will finally be of the
airplane-borne laser capability?
General O'Reilly. ------
Mr. Rogers. Got you. Thanks, General.
Chairman Dicks. Mr. Rothman then has a final question.
Mr. Rothman. Yes, sir, thank you, Mr. Chairman. I
appreciate it.
It is a two-part question. It is regarding the airborne
laser and part one is, how high will it fly? My concern is
countries objecting, certain countries to our overflying their
territory, albeit at 400 kilometers out. But what countries
would those be, and are they all friendlies who would permit to
us overfly their countries, and how high would they be?
Mr. Rothman. Right.
General O'Reilly. And you could actually use the defensive
systems of Japan in order to assist our aircraft. So it really
does depend on geometries, but what we are working for is to
give the combatant commanders this capability so that they can
determine the best use.
Mr. Rothman. And so you build in--the SAMs will have a
longer range in the future,
General O'Reilly. Yes, sir.
Mr. Rothman. So at 50,000 feet we don't care about
overflight rights?
General O'Reilly. Yes, sir, we do. And that is an issue
that we have today. But usually this is used in a time of war
and when tensions have risen and those are--we are given those
rights----
Mr. Rothman. We have already identified those countries,
the racetracks?
General O'Reilly. No, sir. We actually work with that all
the time. We have recently received overflight rights from the
Russians but it is a continual diplomatic dialogue.
Mr. Rothman. Thank you, General. Thank you,
Mr. Chairman.
THAAD TESTING/PRODUCTION
Chairman Dicks. Let me just go through, give us a little
update on THAAD. How is THAAD doing?
General O'Reilly ------
The next two big decisions for THAAD is, number one, that
the Army formally accepts it and it will be transferred, the
first unit to the Army, and the Army will operate it, not MDA
at that point. That will occur in January; it is scheduled
upcoming January.
Chairman Dicks. 2011.
General O'Reilly. 2011. That will be the Army's first fully
operational THAAD unit. ------
I am requiring that they solve that before, in fact, we go
to our first full-rate production decision. The United Arab
Emirates have put in a request to purchase two THAAD units and
a forward THAAD-based radar at the cost of $6.9 billion, and
their request is to have a THAAD unit by 2014.
Chairman Dicks. Who is the contractor on THAAD?
General O'Reilly. Lockheed Martin is the developer of the
missile and the whole system, and Raytheon develops the fire-
control system and the radar.
Chairman Dicks. How is Raytheon performing?
General O'Reilly. In the Raytheon area, they have performed
very well with their radar and their fire-control system on
this.
PAC-3 INTEGRATION
Chairman Dicks. Okay, what about PAC-3?
General O'Reilly. Sir, I currently do not have
responsibilities for PAC-3. That is an Army program. The Army
is looking at, in discussions today, and has been asking us
about a possible transfer of PAC-3 back to MDA. And that is a
decision that they are discussing at this time.
Chairman Dicks. What is the reason for that?
General O'Reilly. The approach to MDA used to be, back 5
years and beyond, was that we would develop the technologies
and develop systems ready for production, and then we would
hand them off to the services and we would produce the systems.
The decision has been made since then, over the previous
administration and this administration, is that due to the
constant need to upgrade our missile defense systems as the
threat keeps changing, I am now responsible for the lifetime of
the systems, for the Navy systems, for all of them, and PAC-3
had just matured early, or matured at the point where it was
transferred to the Army. Today it wouldn't have been
transferred to the Army; just like Aegis and THAAD, stay with
the Missile Defense Agency.
So because of that, they are going back and looking at
should they revisit the decision on moving PAC-3 possibly back
to MDA so that the Army then gets the benefits of the rest of
our national effort that I lead.
Chairman Dicks. How do you feel about it?
General O'Reilly ------
Chairman Dicks. So who in the Army--this will go up to
General Casey?
General O'Reilly. Yes, sir--and the Secretary of the Army
are currently reviewing this. At their request--it was their
initiative, not MDA's, to retook this decision.
SBX TESTING
Chairman Dicks. We have discussed a lot of things today,
but is there anything on the radars, again, that stands out in
your mind that we need to----
General O'Reilly ------
When you are dealing with a solid rocket motor, it
actually, what we call chuffs, it produces bits and pieces that
are burning still, that come out of the back end of the missile
and produce a lot of fiery hot objects, that are just part of
the debris that comes out of the back of a missile, a solid
missile, as it burning. ------
And as we said, the Iranians are working on a solid rocket
motor missile, so we need this capability for the future, sir.
Chairman Dicks. Okay. Well, thank you very much.
The committee stands adjourned until May 13 at 10:00 a.m.,
when we will hold a hearing on the United States Pacific
Command and U.S. Forces-Korea.
Thank you, General. You did a great job.
[Clerk's note.--Questions submitted by Mr. Dicks and the
answers thereto follow:]
Precision Tracking Space System (PTSS)
Question. Another new program in the FY2011 budget request is PTSS
which is intended to track a missile after boost phase and cue Aegis.
This is a follow on program to STSS however is still a demonstration
satellite
How is this new demonstration satellite different that STSS that
was launched on September 25, 2009?
Answer. The Space Tracking Surveillance System (STSS) was designed
from pre-existing work on the Space-Based Infrared System (SBIRS)
program and will accomplish the following objectives:
Provide critical data on how a space-based sensor
could be used to track missiles and their released mid-course
objects to close the fire control loop from space;
Assess space layer performance in Launch-on/Engage-
on Remote scenario of an intercept of a ballistic missile in
flight;
Measure latency of BMDS communications and weapon
system/Command and Control, Battle Management, Communications
(C2BMC) integration and interfaces;
Assess user/warfighter (i.e., CONOPS gaps) in
operating a Low Earth Orbit (LEO) space constellation in
support of BMDS operations;
Familiarize the warfighter with precision space
tracking;
Collect LEO based phenomenology, atmospheric and
environmental data; and
Conduct observations and monitoring in support of
other missions, not necessarily related to BMDS tracking.
The objective of the Precision Tracking Space System (PTSS) program
is to address the ascent-phase, midcourse tracking challenge facing the
joint warfighter. PTSS is a simplified system with the minimum
necessary functionality to cost effectively provide midcourse tracking
data and is an integral part of the extended Aegis fire-control system
and early intercept capability--a key focus of the Missile Defense
Agency (MDA). PTSS will leverage high Technology Readiness Level (TRL)
space system components and improvements in BMDS Command and Control,
Battle Management, and Communications. This approach will minimize the
need for new technology development that may drive up costs and
increase development timelines.
MDA is incorporating lessons learned from the STSS demonstration
satellites to inform our decisions on the development of PTSS,
specifically in the areas of phenomenology and fire control. STSS
phenomenology data (i.e., infrared scene collections such as
atmospheric GC 611 315 lot backgrounds, clouds, earth limb
observations, etc.) will be used to anchor models essential to the
missile tracking mission. In the case of PTSS, this category of
collections is planned to be used in payload design, and validate the
selection of optics, focal planes, wavebands of interest and data
processing. STSS uses on-board processing to autonomously generate
missile target tracks and pass that data to the ground control system.
The PTSS program will analyze STSS processing performance to determine
the level of on-board processing required, from a system- wide
perspective for PTSS.
PTSS program goals are to:
Develop an operational, end-to-end, missile tracking
capability from space focusing on regional ballistic missiles;
Develop and test a space system prototype and
integrated ground system with BMDS to precisely track missiles
with sufficient accuracy and low enough latency to provide
sensor data to BMDS interceptors to defeat large raids from
regional threats;
Establish the technical and programmatic foundation
for procuring the operational system;
Develop space qualified technology to hedge against
future missile threat growth; and Fully integrate PTSS space
and ground systems into the BMDS architecture.
Question. Why is MDA pursuing another demonstration satellite that
will not have the appropriate capabilities?
Answer. The objective of the Precision Tracking Space System (PTSS)
program is to address the ascent-phase, midcourse tracking challenge
facing the joint warfighter. PTSS is an integral part of the extended
Aegis fire-control system and early intercept capability, which is a
key focus of the Missile Defense Agency (MDA).
Challenges and problems associated with past satellite development
programs indicate that a stable baseline and risk reduction is
necessary to improve development timelines. To that end, the Missile
Defense Agency (MDA) will establish Precision Tracking Space System
(PTSS) requirements baseline upfront and early and discourage future
growth without operational necessity. The MDA also intends to leverage
heritage, high TRL space system components for the PTSS. This approach
focuses on component reuse and integration and minimizes the need for
new technology development and custom design which will drive costs up
and increase development timelines.
Developing prototypes prior to making production decisions will
ensure that proper Technology Readiness Levels (TRL) are achieved,
thereby improving our development timelines. The PTSS acquisition
strategy is to develop a prototype system with Johns Hopkins
University's Applied Physics Laboratory before awarding production
development contracts to industry. Additionally, we will award
contracts to several industry participants during concept development
and exploration to insure the prototype can be readily produced by
industry. Industry engagement during the prototyping phase will greatly
improve the level of understanding by the contractors and reduce risk
for PTSS production. This partnership between industry and the
scientific community will ensure our understanding of requirements
before we award production development contracts.
The crawl-walk-run approach to space system development has shown
great success in prior programs, such as the efforts that led to the
Global Positioning System program.
Question. How are the mission requirements different than those for
STSS?
Answer. The Precision Tracking Space System (PTSS) plan calls for
simplification of STSS as much as possible and takes advantage of
several improvements in capability over the past decade. PTSS will
utilize MDA's Command and Control, Battle Management, Communications
(C2BMC), significantly reducing the requirements on PTSS for command,
control, battle management, and communications as compared to those
levied on Space Tracking Surveillance System (STSS). In addition, PTSS
will receive missile launch cues from Overhead Persistent Infrared
systems, reducing the sensor requirements on PTSS, again, as compared
to those on STSS. PTSS will also be integrated as part of space layer
leveraging external space systems with a common ground processing node
that is interfaced to the battle manager.
Question. Will PTSS have mid-course tracking capabilities?
Answer. Yes. The requirement for Precision Tracking Space System
(PTSS) is to enable mid-course tracking, closing the fire-control loop
and enabling early intercept.
Target Acquisition
Question. MDA is also addressing the need to have more reliable and
less costly targets. The new target acquisition strategy, initiated in
FY 2009, streamlines a set of target classes to increase quality
control, account for intelligence uncertainties, control costs, and
ensure the availability of backup targets.
Since it takes about two years to build and deliver a high quality
target, when do you expect to complete the new target acquisition
strategy?
Answer. Request for Proposal (RFP) was issued for the Intermediate
Range Ballistic Missile (IRBM) targets in the second quarter of FY10.
The draft RFP for the InterContinental Ballistic Missile (ICBM) target
is anticipated for release 4QFY10. The IRBM contract award schedule is
dependent on the volume/quantity of proposals received, but award is
planned for 1QFY11. The ICBM contract award is planned for 4QFY11.
Question. What is the timeframe the new strategy will be realized?
Answer. Over the past year, the Agency has initiated steps to
implement the new target acquisition strategy. The initial step was to
streamline the current Lockheed Martin contract to provide the near
term IRBM targets with the LV-2. Secondly, two classes of new targets
are to be procured.
The IRBM class of targets is being acquired through the
release of an RFP in 2QFY10 with contract award 2QFY11 and first target
delivery milestone in 2QFY14.
The ICBM class of targets is being acquired by release of
RFP in 4QFY10 with contract award 4QFY11 and first target delivery
milestone in 3QFY14.
Question. What types of targets will you be acquiring?
Answer. In accordance with the Targets and Countermeasures
Acquisition Plan (3 November 2009), MDA will acquire targets in the
following classes:
Intermediate Range Ballistic Missiles (3000-5500 km
or 1620-2970 nm)
InterContinental Ballistic Missiles (greater than
5500 km or 2970km)
GMD Flight Test Delays
Question. GMD has planned 11 flight tests and 14 ground tests in
fiscal year 2011. Many previous tests have been delayed or cancelled.
This test schedule contained 9 additional tests compared to FY2010.
The Committee understands that many test events scheduled in
previous years have been delayed. Please outline the tests that have
been delayed.
Answer. In 2005 the Missile Defense Agency (MDA) Director
established a Mission Readiness Task Force (MRTF) to address all issues
contributing to flight test mission preparedness and strengthen systems
engineering and quality. The new processes that were adopted greatly
improved the success of Ground-based Midcourse Defense (GMD) testing.
The attached ``GMD Flight Test Delay History--FY06 to FY10'' chart
shows each flight test incurring delay since FY2006 and the reasons for
the delay.
In Fiscal Year 2009, MDA transitioned from an architecture-based
approach to a Models and Simulations (M&S) Verification, Validation,
and Accreditation parameters-based test objectives approach. The
Integrated Master Test Plan (IMTP) is used to evaluate research and
development milestones, technology maturity levels, and coverage and
performance analysis. The IMTP establishes and documents test
requirements of the GMD element with specific focus on collecting data
needed for the Verification, Validation, and Accreditation (VV&A) of
missile and threat models and simulations. Models and simulations
permit repeated assessments of performance and provide a statistical
determination of effectiveness of GMD capabilities. Ground tests using
these high fidelity models and simulations test GMD capabilities across
a range of threats and environments that cannot be affordably
replicated in flight tests.
The Missile Defense Agency remains committed to successfully
executing and completing the IMTP. The development and testing schedule
within the IMTP is realistic, accounts for the possibility of testing
anomalies, and is updated semi-annually. The next update is expected to
be complete by July 30, 2010.
Question. Can you explain primary reasons behind the rescheduling
of prior year test events?
Answer. In Fiscal Year 2009, MDA transitioned from an architecture-
based approach to a Models and Simulations (M&S) Verification,
Validation, and Accreditation parameters-based test objectives
approach. The Integrated Master Test Plan (IMTP) is used to evaluate
research and development milestones, technology maturity levels, and
coverage and performance analysis. The IMTP establishes and documents
test requirements of the GMD element with specific focus on collecting
data needed for the Verification, Validation, and Accreditation (VV&A)
of missile and threat models and simulations. Models and simulations
permit repeated assessments of performance and provide a statistical
determination of effectiveness of GMD capabilities. Ground tests using
these high fidelity models and simulations test GMD capabilities across
a range of threats and environments that cannot be affordably
replicated in flight tests.
The Missile Defense Agency remains committed to successfully
executing and completing the IMTP. The development and testing schedule
within the IMTP is realistic, accounts for the possibility of testing
anomalies, and is updated semi-annually. The next update is expected to
be complete by July 30, 2010.
Specific challenges in the Ground-based Midcourse Defense (GMD)
flight test program include acquiring a cost effective set of reliable
targets and Ground-Based Interceptor quality control issues. MDA has
taken action to address both of the challenges.
For example, as a result of a Short Range Air Launched Target
(SRALT) failure during a THAAD flight test in December 2009 MDA issued
a Cure-Notice and directive to cease air-launch operations to repair
program deficiencies. This resulted in a delay to the BMDS test program
impacting cost and schedule of multiple major BMDS weapon systems and
capability delivery to the Warfighter. To bridge the time between the
delivery of these targets and our new competitive target procurements
next year, the MDA initiated a limited procurement of Air Launched
Targets through its existing Lockheed Martin contract. Lockheed Martin
is evaluating the target options to satisfy MDA's requirements and have
not made a final target solution decision. As with all of our target
providers, MDA fully expects Lockheed Martin to select and deliver a
target solution that meets the performance specification thresholds
within the cost and schedule parameters.
Over the past year MDA also initiated steps to acquire a new set of
targets for all ranges, including Foreign Material Acquisitions, needed
to verify the performance of the BMDS. Our new target acquisition
strategy, initiated in FY 2009, procures targets in production lots to
increase competition, quality control, reduce costs, and ensures the
availability of backup targets starting in 2012. Accordingly, MDA
issued a Request for Proposal (RFP) for the Intermediate Range
Ballistic Missile (IRBM) targets in the second quarter of FY10; a draft
RFP for the InterContinental Ballistic Missile (ICBM) target is
anticipated for release 4QFY10 with contract award planned for 4QFY11;
the IRBM contract award is planned for 1QFY11, but the contract
schedule is dependent on the volume/quantity of proposals received.
Nevertheless, until backup targets are available starting in 2012, we
will continue to rely on an intensive inspection and oversight process
to enhance mission assurance.
Quality issues are also a primary driver and a high focus area for
GMD. Built-in-test software and test silo quality issues caused delays
in 2005. Challenges in Exoatmospheric Kill Vehicle (EKV) development,
hardware quality, and target availability and target development issues
drove test schedule delays in 2007-2009 affecting flight tests FTG-03,
FTG-04, and FTG-05.
MDA is committed to improving missile defense acquisition to
overcome significant flight test delays, target and interceptor
failures, cost growth, quality control, and program delays we have
encountered in the past. Moving forward, MDA is implementing the Weapon
Systems Acquisition Reform Act of 2009, including provisions related to
contract competition, and it is our intent to use greater firm fixed
price contracts and defect clauses as we complete planned competitions.
We are increasing emphasis on competition at all phases of a program's
acquisition life cycle to ensure the highest performance and quality
standards are sustained throughout development.
However, until we complete planned competitions we will have to
motivate some senior industry management through intensive inspections,
low award fees, issuing cure notices, consideration of pending quality
concerns during funding decisions for new contract scope, and
documenting inadequate quality control performance to influence future
contract awards by DoD.
Question. What issues remain to be resolved to reschedule delayed
test events?
Answer. There are no current delayed test events that have not been
rescheduled or are in the process of being rescheduled. FTG-06a is
being added as an incremental step in correcting the shorts comings of
FTG-06. FTG-06a scheduling is in work. FTG-09 is being deleted and the
objectives are transitioning to FTG-08.
FTG-06 was conducted on January 31, 2010 and resulted in a failed
intercept. A Formal Independent Failure Investigation Team (FIT) was
established to conduct Missile Defense Agency investigations into the
failures to meet test objectives. The scope of the FIT included
investigating all potential target, interceptor, ground systems, and
any other area deemed relevant in the determination of root cause and
contributing conditions associated with the failure; recommending
corrective actions to preclude the reoccurrence of a similar event on
future missions; and identifying design, integration, test, and
readiness deficiencies discovered during the investigation that did not
directly contribute to the failure. The FIT results will aid decisions
on future GMD flight tests.
The FTG-06 Failure Investigation Team final report and its effect
on possible courses of action to ensure a successful FTG-06a follow-on
flight test are driving final planning activities and the overall GMD
test schedule. Decisions on the FTG-06a test design and schedule are
expected in June 2010. The Integrated Master Test Plan is under semi-
annual review and will be updated to capture all GMD test planning
changes as well as other BMDS test planning.
Question. How will this impact the current test plan for GMD?
Answer. The FTG-06 Failure Investigation Team (FIT) final report
and its effect on possible courses of action to ensure a successful
FTG-06a follow-on flight test are driving final planning activities and
the overall GMD test schedule. Decisions on the FTG-06a test design and
schedule are expected in June 2010. The Integrated Master Test Plan is
under semi-annual review and will be updated to capture all GMD test
planning changes as well as other BMDS test planning.
FTG-06a is an incremental step in correcting the short comings of
the FTG-06 mission. Once the FIT final report is complete modifications
to the Ground Based Interceptor will be incorporated as needed.
Question. How will the test plan review change the way MDA tests?
Answer. In FY09, MDA transitioned from an architecture-based
approach to a Models and Simulations (M&S) Verification, Validation,
and Accreditation parameters-based test objectives approach. This new
test approach focuses on collecting data needed for the Verification,
Validation, and Accreditation of the BMDS Models and Simulations and
identifies the specific data to be gathered and the circumstances in
which to measure them. For example, Critical Engagement Conditions
(CECs) and Empirical Measurement Events (EMEs) will examine the
accuracy of GMD and BMDS models and simulation by measuring key factors
affecting a kill vehicle's ability to see a target and adequately
maneuver in time to collide with it. Key factors include: solar and
lunar backgrounds; low intercept altitudes; timing between salvo
launches; long times of flight; high closing velocities (ICBM-class
targets); correcting for varying booster burnout velocities; and
responding to countermeasures. This test approach will establish
confidence that the M&S used to evaluate the BMDS represents real world
behavior and enable simulation based performance assessment to verify
system functionality. DOT&E and the operational test communities are
key partners in this effort. The Integrated Master Test Plan describes
each CEC and EME and is updated semi-annually. The next update is
expected to be completed by 30 July, 2010.
Testing and Lack of Sufficient Number of Targets
Question. One of the key limiting factors of MDA's test program has
been the lack of sufficient number of missile defense targets and the
inventory of foreign assets.
Do you currently have a sufficient amount of targets to execute
your testing program? For the current fiscal year? For fiscal year
2011? Does the FYDP provide for sufficient number of targets?
Answer. Yes, we have sufficient quantity of primary targets on
contract for the current fiscal year (FY10) and FY11; however, we do
not have a sufficient number of spare targets in case of a target
failure or other processing problems. Spare targets will be available
starting in FY12. MDA plans to update the Integrated Master Test Plan
(IMTP) twice a year ensuring executability within budget controls. For
the remainder of the FYDP, we currently have the required targets on
contract to support tests scheduled in FY12. The new Targets
Acquisitions to be awarded in FY10 and FY11 will provide the remainder
of the targets required across the FYDP in support of the IMTP Version
10.1, which was delivered to Congress in March 2010.
Question. If not, what can we do to improve the number of targets?
Answer. We have sufficient primary targets to support the PB11
program, but due to the 18-24 month lead time to produce a target,
there is no opportunity to improve the availability of spare targets
till FY13.
Question. Would additional funds in this area be helpful?
Answer. The Targets and Countermeasures acquisition strategy for
the new target procurements provides the opportunity to acquire
flexible threat representative target configurations. The President's
budget request represents an appropriate balance of risk given
competing priorities for resources.
Question. Would having a procurement account be beneficial?
Answer. No. The Targets and Countermeasures program will require
RDT&E funding to perform non-recurring engineering activities
associated with target development in the MRBM, IRBM, and ICBM classes
against our new acquisition program in FY10 and FY11. Additionally,
several on-going development activities in countermeasures along with
improvements in existing target configurations require RDT&E funding.
If procurement funding were provided it would be applied to the fixed
price hardware Contract Line Item Numbers (CLINs) for targets procured
on the new acquisition contracts only. The remaining CLINs for
engineering services, modeling and simulation activities, or other
related engineering activities would still require RDT&E funding.
[Clerk's note.--End of questions submitted by Mr. Dicks.]
Thursday, May 20, 2010.
TESTIMONY OF MEMBERS OF CONGRESS AND OTHER INTERESTED INDIVIDUALS AND
ORGANIZATIONS
----------
AMERICAN MUSEUM OF NATURAL HISTORY/OHIO STATE UNIVERSITY
WITNESSES
WARD WHEELER, Ph.D., CURATOR AND CHAIR, DIVISION OF INVERTEBRATE
ZOOLOGY, AND PROFESSOR, RICHARD GUILDER GRADUATE SCHOOL, AMERICAN
MUSEUM OF NATURAL HISTORY
DAN JANIES, Ph.D., ASSOCIATE PROFESSOR, THE OHIO STATE UNIVERSITY,
DEPARTMENT OF BIOMEDICAL INFORMATICS, COLLEGE OF MEDICINE
Introduction
Mr. Dicks. The committee will come to order. This morning
the committee will hear testimony from witnesses outside of the
executive branch. The committee is finishing its hearing
process for the fiscal year 2011 period, and we have heard from
all the Secretaries and Chiefs of each service.
The committee held hearings regarding the military's
personnel programs, medical programs, intelligence programs,
acquisition programs, the missile defense program. Now we are
turning our attention to hear from 17 different public
organizations which will highlight issues that the committee
should consider as work continues on the 2011 base
appropriations bill that we will fund in support of our men and
women in uniform over the next year.
This hearing will allow the committee to understand the
unique capabilities that outside entities can contribute to the
needs of our servicemembers. The committee is aware that many
of you have an existing relationship with the Department of
Defense as it relates to medical research in support of the
unique needs of our warfighters.
The structure of today's hearing will follow a format that
ensures all witnesses will have an opportunity to highlight
their key points on the record. Further, each of your prepared
statements will appear in full in the published hearing volume.
We ask that you summarize your testimony in 5 minutes or
less. Because President Calderon is speaking at 11 o'clock, the
hearing has to end, so at 5 minutes you are going to hear the
gavel. We don't have the clock, do we?
I would like to express my gratitude to each and every one
of you for the work you do on behalf of our Armed Forces. We
look forward to your testimony, and I now yield to Mr.
Frelinghuysen for any comments that he would like to make.
Mr. Frelinghuysen. I join the chairman and welcome you all
this morning, and I commend him for having this hearing. Thank
you very much.
Mr. Dicks. Our first witness is Dr. Ward Wheeler, Ph.D.,
curator and chair, Division of Invertebrate Zoology, and
Professor, Richard Guilder Graduate School, American Museum of
Natural History; and Dr. Dan Janies, Ph.D., associate
professor, the Ohio State University, Department of Biomedical
Informatics, College of Medicine.
We will start you at 5 minutes to 9:00. You may proceed. We
will put your statement in the record.
Mr. Wheeler. Good morning. Chairman Dicks, my name is Ward
Wheeler, and as chair of the Invertebrate and Zoology Division
and Professor at the American Museum of Natural History, it is
a pleasure and honor to testify before you about the global
spread of emergent infectious disease and human health
implications of viral evolution. With me today is Dr. Megan
Cevasco, a research scientist who is actively involved in the
project.
The recent emergence of a pandemic influenza and SARS has
shown that new diseases can affect human populations without
warning, presenting critical threats to our troops, public
health and our economic welfare. Rapid genomic sequencing of
these pathogens has become the primary method by which we
understand, fight and infer their spread.
Analysis of these data, however, is difficult, requiring
new algorithmic approaches and high-performance computation. To
provide an important basis for forecasting these outbreaks, the
AMNH has been working over the past several years to apply our
research expertise in evolution, geography and computation to
the problems of the emergence and spread of pathogens.
Recognizing the potential of this work to aid the
Department of Defense in its goal to prepare for and respond to
the full range of threats, the AMNH seeks $3.5 million in
fiscal year 2011 to continue contributing our unique resources
to the advancement of research in this area. By increasing the
Nation's capacity to infer where disease outbreaks might occur,
and to effectively monitor disease-causing agents and their
global spread, this research works directly to combat
bioterrorism and to protect both troops in the field and
civilian populations at home.
While the AMNH has been a recognized leader in education,
educating the public on complex scientific issues, many people
may not realize that we are also an active research and
training institution, much like a research university, with
major innovative research programs that are positioned to
advance the Nation's capacity to prepare for and respond to
security threats.
AMNH research staff, who number over 200, publish nearly
450 scientific articles each year and enjoy a success rate in
competitive peer-reviewed scientific grants that is
approximately double the national average. AMNH is also the
only American museum authorized to grant the Ph.D. degree. Our
Richard Guilder Graduate School encompasses both a doctoral
program in comparative biology and long-standing graduate
training partnerships with such universities as Columbia,
Cornell and NYU.
As our research on infectious disease requires biomedical
expertise, as well as evolutionary and computational expertise,
AMNH has bonds with Dr. Dan Janies of The Ohio State University
Medical Center in these efforts. Dr. Janies is here with me
today and will testify in just a moment.
First I would like to tell you what we have been able to
accomplish with DOD support thus far. In fiscal year 2005, DOD
and the AMNH launched a multifaceted research partnership via
DARPA that leverages the AMNH's unique expertise and capacity.
The first phase of this project focused on the development and
application of a high-performance computational system to study
the complex conditions that underlie the evolution and spread
of infectious diseases, specifically analyzing genetic and
functional changes in hosts and pathogens across time and
space.
Concurrently we develop methods to visualize these data by
projecting an evolutionary tree onto a virtual globe, such as
Google Earth or NASA Whirlwind, and the resulting
visualizations are akin to weather maps that show the spread of
pathogens and their key mutations over time, space and various
hosts. These maps provide not only situational awareness, but
also diagnostic and inferential power.
We are now able to track the global spread of any pathogen
and can identify for any geographic region sources,
destinations, mutations and host shifts by pathogens.
Mr. Dicks. You have got 2 minutes left, so if you are going
to share any time here, it is 5 minutes for the both of you.
Mr. Wheeler. We continue work, particularly in influenza.
And I appreciate the opportunity to speak to you today. I will
now give the floor to my colleague Dan Janies.
Mr. Janies. Mr. Chairman, members of the subcommittee, I,
too, am honored to have been invited to testify today. My name
is Daniel Janies, and I am an associate professor of biomedical
informatics at Ohio State. I bring biomedical expertise to the
project. My efforts have focused on meeting deliverables,
ensuring that the tools are highly interoperable, and
communicating our results to military planners, public health
scientists and policymakers.
We have engaged in a variety of outreach programs. We have
conducted workshops and symposia, have published results in
peer-reviewed scientific journals, results that have been
covered by journalists in many media. We have testified on
pandemic influenza before the U.S. Senate Committee on Homeland
Security and have been invited to present our research to DHS.
We have also worked with the Department of State on efforts
to build capacity in public health abroad to foster data
sharing. We have discussed the evolution of drug resistance and
pandemic influenza with the White House Office of Medical
Preparedness. Throughout our partnership, DARPA program
managers have supported the AMNH's work and made our research
known to other DOD-supported scientists, have invited
scientists from the AMNH and Ohio State to participate in
today's conferences for research, planning and force
protection.
Our work moves forward. We plan to continue our outreach
efforts and plan to hold workshops and symposia annually, as
well as to rapidly respond to requests for information,
consultations and briefings.
As you know, the committee has supported our work over the
last several years. Should the committee fully support our
fiscal year 2011 requests, the AMNH will be able to advance to
the next phase of the project, focusing on more complex
pathogens and the host side of the infectious disease problem.
Mr. Dicks. Thank you very much. We will take this under
very serious consideration.
[The statement of Mr. Wheeler and Dr. Janies follows:]
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Mr. Dicks. Mr. Frelinghuysen.
Mr. Frelinghuysen. No comment.
Mr. Dicks. Thank you.
----------
Thursday, May 20, 2010.
HEART OF A CHAMPION
WITNESS
STEVE RIACH, FOUNDER AND BOARD MEMBER, HEART OF A CHAMPION FOUNDATION
Mr. Dicks. Next is Mr. Steve Riach, founder and board
member, Heart of a Champion Foundation.
Mr. Riach, welcome.
Mr. Riach. Good morning.
Mr. Dicks. You have 5 minutes. You understand the drill.
Mr. Riach. Chairman Dicks and distinguished Members, thank
you. It is an honor for me to be here and provide testimony
this morning regarding military families and the unique
challenges that they face, and the unique challenges that we
face in terms of educating our military families, and the role
that character-development programs can play, such as our very
successful Heart of a Champion Program, in meeting those
challenges.
We know that 1 million military-connected students today
are living in what is called a ``new normal'' environment,
dealing with multiple wartime deployments, lengthy parent-child
separations, mental illness, injuries and even death. These
unique stresses can create chaos in the lives of affected
students and negatively impact their motivation, their grades,
their behavior, their peer relations, family life and
graduation rates in military-impacted schools and districts.
And while each of our Nation's military services has made
strong covenants to assist families and students, much greater
support and specialized programs are needed to follow those
military students into DOD, DEA and non-DOD public school
systems. Our research has proven that an important part of the
solution must be character-development programs taught in these
schools.
During the past 9 years our Nation has been at war, DODEA
schools have had to deal with special significant challenges to
teach our military children. But more than just our military
bases, schools in districts such as the Killeen Independent
School District, which, of course, serves Fort Hood, Texas,
where Active Duty military enrollment can be as much as 80
percent of that population, they struggle to meet those
challenges.
It is my view that character-development programs such as
ours can be a vital, in fact, necessary, tool to help these
young children of our servicemen and women deal with the many
unique stresses they face on a daily basis.
When we launched Heart of a Champion 14 years ago, started
by business leaders around the United States who had a desire
to impact the lives of children in any kind of environment, it
was our goal to create the finest character-development program
around that would deliver measurable results. We spent 4 years
researching with educators around the United States to
determine what would create the most efficient and effective
program. And now, since 2001, we have deployed our program in
24 States, to reaching about a half a million young people in
any kind of environment you can imagine, public schools, after-
school programs, partnering with people like the Big Brothers/
Big Sisters, Boys and Girls Clubs, and in juvenile justice
facilities, where we impact students who are--or young people
who are the most hard-core teen offenders in the United States,
as well as those who are in the probation system, and
redirecting them out of the juvenile system.
So we know that this program works and character education,
character-development programs work to create change in the
lives of young people in any type of population. We know it can
be the same in the population of military families.
We have seen results that are dramatic. We have seen not
only attitudinal behavioral changes, we have seen increased
graduation rates, in some cases as many of 100 percent of
students in some areas graduating; decreased truancy; decreased
dropouts; decreased drug and alcohol use, in some cases as much
as 40 percent; increased grade average; increased test scores.
We know that what has occurred is in changing the heart of
the student. We have seen students perform better. We have seen
them make better life choices.
Mr. Dicks. The gentleman has 1 minute to summarize, or if
you want us to ask a question or two.
So how do you work this with the school? Are you doing this
with the DOD schools?
Mr. Riach. Currently not in DOD schools; in public schools.
Mr. Dicks. But you just do it in public schools that are
near the bases?
Mr. Riach. Correct.
Mr. Dicks. How do you get organized? How do you work it out
with the local school district?
Mr. Riach. We work directly with the local school district
and the individual schools. We train their teachers. Those
teachers deploy the program in the school. We certify them.
They deploy it during the class day, in class during the school
day. And we work with them. We pre- and post-assess and deliver
measurables, empirical data showing the results that I
mentioned earlier.
Mr. Dicks. And do they do after school, too? Is it after
school as well?
Mr. Riach. Absolutely. Worked with Big Brothers/Big
Sisters, Boys and Girls Clubs, a number of after-school
programs, both on school campus and in the community.
Mr. Dicks. Any other questions?
Thank you very much. If you want to summarize.
Mr. Riach. Thank you.
I just, in conclusion, would say that if there is anything
this committee can do to look at the critical need with these
families and these students, and the deployment of a character
program that actually works and changes their hearts and helps
them make better decisions, we will see a decrease in suicides,
drug and alcohol use and those things that are plaguing young
people who are military family members in this current day.
Mr. Dicks. Thank you very much.
Mr. Riach. Thank you.
[The statement of Mr. Riach follows:]
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Thursday, May 20, 2010.
LUNG CANCER ALLIANCE
WITNESS
LAURIE FENTON-AMBROSE, PRESIDENT AND CEO, LUNG CANCER ALLIANCE
Mr. Dicks. Laurie Fenton-Ambrose, president and CEO, Lung
Cancer Alliance. Welcome, Laurie.
Ms. Fenton-Ambrose. Thank you, Mr. Chairman.
Mr. Dicks. You have 5 minutes. We will let you know when
you have 1 minute so you can summarize.
Ms. Fenton-Ambrose. Thank you very much.
Dave Hobson also says hello, who I also had the pleasure of
seeing this morning. So he wanted me to say hello.
Mr. Dicks. Thank you.
Ms. Fenton-Ambrose. I am delighted to be here, Mr.
Chairman, members of the subcommittee. My name is Laurie Fenton
Ambrose, and I am president and CEO of the Lung Cancer
Alliance, which is the only national organization that is
providing patient support and advocacy to those either living
with or at risk for lung cancer.
And it is my great privilege to be here to talk with you
about a program that we had the great pleasure of working to
see established, along with our former board chairman Admiral
Phil Coady; and our current board members, former Secretary of
Transportation Norman Mineta, who is a lung cancer survivor,
and along with Joe Lopez; and certainly with the late chairman
John Murtha, who saw the need to create this program to help
our military men and women who are at greater risk for the
disease.
To summarize, lung cancer is a public health epidemic. It
is the leading cause of cancer deaths among men, among women,
in every ethnic group, and in our military, conservatively
speaking, is at a 25 percent higher risk for this disease not
just because of smoking, but because of exposures to toxins,
battlefield fuels and the like. It is a disease that, even with
this proportion of deaths, has received the least amount of
Federal funding. What we are doing today is to try to ensure
that a very comprehensive plan of action is brought to bear on
all of those who are either living with or at risk for this
disease.
It is important to note that today, based on CDC surveys,
60 percent of those with this disease are former smokers, most
who quit decades ago. Another 20 percent are those who have
never smoked at all. So what we are faced with is the fact that
today, tomorrow----
Mr. Dicks. Is that a different kind of cancer; is that a
different disease for the people who don't have--who have never
smoked?
Ms. Fenton-Ambrose. I wish I could say we knew. There are
many variations to this disease. We don't have enough research
to understand why, for example, men and women have differences
in the type of diagnosis and progression with the disease. But
it is lung cancer.
So if you think about the fact that 80 percent of those
with this disease today, tomorrow and decades to come do not
have the research to support earlier intervention or certainly
to have a robust treatment pipeline, no doubt we need tobacco
control and prevention strategies, but that alone will not
address those who actually heard the message and quit their
addiction to ensure that we find it early or then have
treatments best to manage it.
This brings us really to why we are here today. Even last
week the President's Panel on Cancer produced a report about
the environmental risk factors that highlighted among our
military exposures that are putting them at greater risk.
Lung Cancer Alliance has been advocating strongly and
persistently for a greater focus on our military men and women
who are at great risk. Whether it is Agent Orange, whether it
is battlefield fuels, whether it is smoking, our military men
and women do not deserve to have this disease, and we have
worked to establish a program within the CDMRP that is focused
on an early intervention program to help our at-risk military.
Chairman Murtha was so quick to recognize the need. We are
grateful that he helped us to establish this in 2007. This is a
program not intended to duplicate, but rather supplement, the
research programs under the National Cancer Institute. This has
a particular focus on the patient and patient outcomes rather
than the basic science which has been the purview of NCI.
This patient-oriented, mission-oriented program, if
properly implemented, will have an immediate impact on our
high-risk military and quickly lead to other earlier detection
and improvement of treatments for the entire civilian
population.
I have attached supporting documents----
Mr. Dicks. Thank you.
Ms. Fenton-Ambrose [continuing]. I am happy to present for
you today.
Mr. Dicks. Thank you.
[The statement of Ms. Fenton-Ambrose follows:]
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Mr. Dicks. Any questions?
Mr. Frelinghuysen. Good to have you back.
Mr. Dicks. Thank you very much for your testimony. We
appreciate it. Thank you very much.
----------
Thursday, May 20, 2010.
NEUROFIBROMATOSIS
WITNESS
KAREN GUNSUL, VICE PRESIDENT, WASHINGTON STATE NEUROFIBROMATOSIS
FAMILIES--WSNF
Mr. Dicks. Karen Gunsul.
Ms. Gunsul. Good morning.
Mr. Dicks. Good morning, Karen, welcome.
Ms. Gunsul. Thank you.
Mr. Dicks. We will put your statement in the record. You
have 5 minutes to summarize.
Ms. Gunsul. I understand.
I am a business owner from Seattle, Washington.
Mr. Dicks. Well, welcome.
Ms. Gunsul. Thank you. Your whole State said hello.
I am representing the Washington State Neurofibromatosis
Families and a national coalition of States under NF, Inc. We
are asking for $20 million to continue the Army's highly
successful peer-reviewed Neurofibromatosis Research Program. I
am also the mother of a 17-year-old son Sam who has NF.
Neurofibromatosis, if you don't know, is a genetic disorder
involving uncontrolled tumor growth along the nervous system,
which can result in a variety of symptoms; disfigurement,
deformity, deafness, blindness, brain tumors, cancer and/or
death. NF is not rare.
Mr. Dicks. Is it a lung disease, too?
Ms. Gunsul. No, not yet, but it does cause tumors to grow
anywhere along nerve pathways, so it can be. You just don't
know when and where it is going to strike. It is more common
than muscular dystrophy and cystic fibrosis times three. It is
not as widely known because for years it has been poorly
diagnosed, and approximately 100,000 Americans currently have
NF, and it occurs in 1 in 2,500 births.
It strikes worldwide without regard to gender or race, and
approximately 55 percent of those cases are spontaneous
mutations of genes, such as my son's. We have no history of NF
in our family, and 50 percent of the cases are inherited.
There are two types of NF, NF1, which is more common, that
my son has, and NF2, which primarily causes deafness, tumors
that affect the ears and balance problems.
When my son was diagnosed in 1996, I learned as much as I
possibly could about neurofibromatosis, and the one thing that
stood out to me is that there are no known treatments and no
known cure. And 14 years ago that was tough news to take.
While there are broad implications for the general public,
the Army can see direct military application. Research on NF
stands to benefit the military because this disorder is closely
linked to cancers, brain tumors, learning disabilities, brain
tissue degeneration, nervous system degeneration, deafness,
memory loss and balance. And because NF manifests in the
nervous system, findings generated by the Army-supported
research on NF address peripheral nerve regeneration. This is
very important to understand for wound healing and war-related
illnesses.
In recognizing NF's importance to both the military and to
the general population, Congress has given the Army's NF
program strong bipartisan support for years. After the initial
3-year grants were successfully completed, Congress
appropriated continued funding for the Army NF research program
on an annual basis. From fiscal year 1996 through now, this
funding has amounted to $214 million in addition to the
original $8 million, 3-year grant. These grants, through the
Army program, reach across all 50 States, and they are highly
regarded in the medical community.
There are currently five clinical trial sites located
across the country, and they are all coordinated and monitored
through the Huntsville, Alabama, central site. The Army program
funds innovative, groundbreaking research which would not
otherwise have been pursued.
At our last meeting with Army officials administering the
program, they indicated that they could easily fund more
applications if funding were available because of the high
quality of the applications received. They stated they felt
they were turning away good science.
In order to ensure maximum efficiency, the Army
collaborates closely with other Federal agencies that are
involved in NF research, National Institutes of Health. They
have several members of the National Institute of Neurological
Disorders and Stroke. The NINDS group sits on the Army's NF
Integration Panel----
Mr. Dicks. You have 1 minute.
Ms. Gunsul. Thanks--which sets the oversight and long-term
vision strategies for the program.
The results from this program have been fast, and we are
right on the brink of some very exciting findings.
The difference was brought home to me personally last
month. After my son had three very large tumors removed from
his left leg, I sat down with Sam's surgeon, and we discussed
potential therapies that are now right on the horizon for
restricting tumor growth and stopping the formation of tumors.
The science is real, and we are very excited by the
potential. We are asking for $20 million to continue the Army's
important NF research. It is money well spent. Thank you.
Mr. Dicks. Thank you very much. We appreciate your
testimony.
[The statement of Ms. Gunsul follows:]
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Mr. Dicks. Any questions? Thank you. Thank you very much.
---------- --
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Thursday, May 20, 2010.
MELANOMA RESEARCH FOUNDATION (MRF)
WITNESS
MARTIN A. WEINSTOCK, M.D., PH.D., PROFESSOR OF DERMATOLOGY AND
COMMUNITY HEALTH, BROWN UNIVERSITY ALPERT MEDICAL SCHOOL
Mr. Dicks. Martin A. Weinstock, M.D., Ph.D., professor of
dermatology and community health, Brown University. Welcome.
Dr. Weinstock. Thank you very much, Mr. Chairman, for the
opportunity to testify before you. I am here representing
melanoma research and the Melanoma Research Foundation, which
is the largest independent national organization devoted to
melanoma in the United States.
Mr. Chairman, I am requesting $10 million for melanoma
research in fiscal year 2011 defense appropriations bill
through the Peer-Reviewed Cancer Research Program within the
Defense Health Account.
Melanoma, as you may know, is a type of cancer which nearly
always arises in the skin. Invasive melanoma affects nearly
70,000 Americans every year, and about 9,000 of those die every
year. I met the sister of one of those people who succumbed to
melanoma just last year about an hour ago, just coming to
Washington, D.C. It is actually quite common. That is actually
about one an hour dying from this disease.
It has been increasing over time. At a time when most
cancers are decreasing in incidence and mortality, melanoma is
increasing. It is the most rapidly increasing of any of the
common types of cancer. And, indeed, since about the 1930s,
when we started collecting these data, melanoma had an incident
rate that has increased twentyfold. That's not 20 percent, that
is 2,000 percent, twentyfold since that time.
Melanoma also, compared to other cancers, tends to affect
younger adults. So people in the 25- to 29-year age group, it
is the most common cancer in the United States in that age
group.
We have learned in recent years through the various
research that has gone that, in fact, melanoma is more than
just one disease, it is multiple diseases. The most common
types of melanoma are related to intense ultraviolet radiation
exposure from the sun or from artificial sources either in
childhood or in the early adult years. This is the type of
exposure that our military has.
Also, many people who are afflicted by melanoma are,
indeed--have the type of melanoma that is related to cumulative
ultraviolet exposure either from the sun or artificial sources
over the course of their lives. So recent exposure is
important. For many people, the most common type of melanoma,
it is early adult life and childhood exposure.
So the connection to the military, obviously, is obviously
very important, because we put our military men and women in
areas of intense sun exposure, and that has been linked to
increased risk of melanoma. There are some recent publications
to that effect, and we know the etiology of melanoma, so that
that is an important risk factor.
In order to appropriately treat those people, we need to
detect those melanomas early, and for those that aren't
detected early enough, we need to find a cure.
So right now we have about 150,000 Army National Guard,
Coast Guard, Air Force and Marines in Iraq where the intensity
of sun exposure is quite great, and that is common, such as in
Vietnam in years past, and it generates melanomas in these
people years after their service.
Mr. Dicks. You have 1 minute to summarize.
Dr. Weinstock. Okay. So basically the peer-review cancer
research----
Mr. Dicks. Can I ask a question?
Dr. Weinstock. Sure.
Mr. Dicks. Why hasn't the National Cancer Institute funded
this? I just don't understand why melanoma, which is a very
serious cancer, would not get more attention from the National
Cancer Institute. Is there an answer to that?
Dr. Weinstock. Well, I can say that there is some funding
from the National Cancer Institute, but more is needed. I can't
answer why in their wisdom they have decided not to increase
levels. I can just say that the Peer-Reviewed Cancer Research
Program established in fiscal year 2009 is specifically geared
towards this purpose, which uniquely affects members who have
served in the military, and so we respectfully request $10
million for melanoma research.
Mr. Dicks. Thank you very much. We appreciate your
testimony.
[The statement of Dr. Weinstock follows:]
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Mr. Dicks. Any questions?
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Thursday, May 20, 2010.
THE NATIONAL ASSOCIATION TO PROTECT CHILDREN
WITNESS
DAVID KEITH, SPOKESPERSON
Mr. Dicks. David Keith, National Association to PROTECT
Children.
Mr. Keith. Thank you, Mr. Chairman and distinguished
members, for giving me this opportunity to speak to you.
Mr. Chairman, in 1980, when you and I were 26, I enjoyed
filming An Officer and a Gentleman in your district.
Mr. Dicks. Great movie, one of the best. Port Townsend. I
was there last weekend.
Mr. Keith. It is a beautiful place. I understand that----
Mr. Dicks. Rhododendron Festival.
Mr. Keith. I understand that hotel, that motel room,
tourists come to see where I hung myself in that thing. Pretty
weird.
I want to come and tell you about what I have decided to do
with the final chapter of my life. The members of this
committee remember how shocked and appalled Americans were to
see the graphic photographs of cruelty and abuse in the Iraqi
prison Abu Ghraib.
I ask for your full attention now as I describe something
much, much worse. Those Abu Ghraib photos are eclipsed in
volume and savagery by the millions of images of little
children being raped, tortured, sodomized and bleeding that
flood the Internet to fill the bottomless appetite of a global
pedophile marketplace.
Child exploitation is the great blind spot to a homeland
security focused on protecting our ports, financial assets and
intellectual property, but is bafflingly oblivious to
international criminal networks soliciting the filmed abuse of
American children. Children in the U.S. military families are
no exception.
A 2008 investigation by the London Times delivered a
stunning indictment to our cybersecurity response when it
reported British officials had found secret coded messages
between terrorists embedded in child pornographic images and
pedophilic Web sites because this is ``a secure way of passing
information between terrorists.''
Internet-facilitated child exploitation is investigated by
four military criminal investigative organizations in each
military branch, or MCIOs. These MCIOs do their best, but their
capacity is a national disgrace. Only half a dozen of their
investigators are trained and ready to conduct on-line
investigations, about the size of the police force of Forks,
Washington, Mr. Chairman, to protect the entire U.S. military.
This small ghost patrol knows the locations of hundreds of
child exploitation suspects and their victims in the U.S. right
now, but they cannot take action due to sheer lack of
resources.
Last month PROTECT coordinated a meeting of the best and
the brightest. At a table here in Washington were Federal and
State law enforcement agents, computer scientists from Oak
Ridge National Laboratory and Cray Computer, makers of the
world's most powerful supercomputers. Since that meeting those
partners began a research and development project that could
dramatically change the game for law enforcement.
The one indispensable partner not participating is the
United States Government. In addition to underfunded MCIOs, the
ICE Cyber Crimes Center, C3, took crippling budget cuts this
year. DOJ lags far behind, leaving the National Internet Crimes
Against Children Data System, NIDS, and the PROTECT Our
Children Act, which reshaped our national child exploitation
response, unfunded. Shame on us.
Modest emergency funding from this Congress is a simple----
Mr. Dicks. This is in the Justice Department budget; is
that what you are saying?
Mr. Keith. I realize that part of these things are outside
of this committee.
Mr. Dicks. No, no. We are not being critical of your
pointing this out. We just want to get your ideas.
Mr. Keith. Yes, sir. I understand that. Thank you.
A modest emergency funding from this Congress and a simple
three-pronged attack will significantly advance the war against
child predators in the military and those attacking our
homeland; provide at least $2 million in defense funding to the
four military criminal investigation organizations for
investigation of child exploitation, the development and
deployment of new technology; provide at least 10 million in
Homeland Security funding to ICE Cyber Crimes Center for the
specific purpose of research and development in high-speed
computing and related technology; provide at least 2 million in
Justice funding for the implementation of the NIDS computer
platform as authorized by the PROTECT Our Children Act of 2008.
I understand that two of these proposals for funding are
beyond the purview of this subcommittee; however, no piecemeal
attack will be an effective or an efficient use of precious
taxpayer dollars, and I ask each of you to champion this simple
three-pronged solution with the full House Appropriations
Committee.
Finally, let me share one other project that PROTECT is
working on that is gathering congressional momentum. The Hero
to Hero bill will provide financial assistance and training to
returning and disabled veterans, allowing them to transition
into jobs combating child exploitation and abuse, allowing them
literally to go from hero to hero.
Since the dawn of history, men have gone off to war
understanding that they were leaving behind what they held most
dear. Protecting our children and our families are why we
fight, and it is why we are all here today. Given our children
face this clear and present danger, we cannot fund wars
overseas without first funding this war at home. It will take
your leadership right now to make that happen.
Thank you.
Mr. Dicks. Thank you. You make a very compelling statement.
[The statement of Mr. Keith follows:]
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Mr. Dicks. Mr. Frelinghuysen.
Mr. Frelinghuysen. Thank you.
Mr. Dicks. Any of my colleagues have any questions?
Mr. Moran. I should be sitting down there. Nice to see you,
David.
He really has been working hard, and he is trying to get an
across-the-board approach to this issue. It is very convincing
testimony.
Thank you.
Mr. Dicks. Thank you. We appreciate your good work. I hope
you get back to Port Townsend or Forks.
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Thursday, May 20, 2010.
AMERICAN SOCIETY OF TROPICAL MEDICINE AND HYGIENE (ASTMH)
WITNESS
DR. BERMAN, AMERICAN SOCIETY OF TROPICAL MEDICINE AND HYGIENE (ASTMH)
Mr. Dicks. Dr. Berman, American Society of Tropical
Medicine and Hygiene.
Thank you, Dr. Berman, you have 5 minutes to present your
statement and summarize.
Colonel Berman. Thank you, Mr. Chairman. I am Dr. Berman,
Colonel, United States Army Medical Corps, Retired,
representing the American Society of Tropical Medicine and
Hygiene, which is the principal professional medical
organization in the United States and actually in the world for
tropical medicine and global health. ASTMH represents
physicians, researchers, epidemiologists and other health
professionals dedicated to the control and prevention of
tropical diseases.
Because the military operates in so many tropical regions,
reducing the risk that tropical diseases present to service
personnel is critical to mission success. Malaria and other
insect-transmitted diseases, such as leishmaniasis and dengue,
are particular examples of this. Antimalarial drugs have saved
countless lives throughout the world, including troops serving
in tropical regions during World War II, Korea and Vietnam. The
U.S. military has taken a primary role in the development of
antimalarial drugs, and nearly all antimalarial drugs and most
promising vaccines to date were developed, at least in part, by
U.S. military researchers.
Three hundred fifty million people are at risk of
leishmaniasis in 88 countries; 12 million are currently
infected. Leishmaniasis was a particular problem for Operation
Iraqi Freedom as a result of which 700 American service
personnel became infected.
Because of leishmaniasis's prevalence in Iraq and Southwest
Asia in general, the DOD has spent large resources on this
disease, and DOD personnel are the leaders in development of
new antileishmanial drugs. I might add both for malaria and
leishmaniasis, I count or did count am still counting as one of
those leadership personnel.
Dengue is the leading cause of illness and death in the--a
leading cause in the tropics and subtropics. One hundred
million people are affected yearly. Although dengue rarely
occurs in the continental United States, it is endemic in
Puerto Rico, many tourist destinations, and periodic outbreaks
occur in Samoa and Guam.
The intersection of militarily important diseases and
tropical medicine is the reason that 15 percent of ASTMH
members are also members of the military. For this reason we
respectfully request that the subcommittee expand funding for
the DOD's long-standing and successful efforts to develop new
drugs, vaccines and diagnostics to protect servicemen and women
from malaria and tropical diseases.
Specifically we request that in fiscal year 2011 the
subcommittee ensure 70 million to DOD to support its infectious
disease research efforts through USAMRIID, WRAIR and NMRC.
Presently DOD funding for this important research is about 47
million. To keep up with biomedical inflation, fiscal year 2011
funding needs to be 60 million, and to fill the gaps that have
been created by underfunding, ASTMH urges Congress to fund DOD
ID research at 70 million in fiscal year 2011.
We very much appreciate the subcommittee's consideration of
our views. We stand ready to work with the committee and staff
on these and other tropical disease matters.
Thank you.
Mr. Dicks. Thank you very much for your statement.
[The statement of Ms. Finney follows:]
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Mr. Dicks. Karen Mason, Ovarian Cancer National Alliance.
Good morning, and you have 5 minutes to summarize. Your
statement will be put in the record.
Ms. Mason. Good morning, Mr. Chairman, ranking member and
members of the subcommittee. I am honored to appear before you
in support of the Ovarian Cancer National Alliance's request of
$30 million for the Department of Defense Ovarian Cancer
Research Program.
My name is Karen Mason, and I am an intensive care nurse
from Pitman, New Jersey. I also serve as an Integration Panel
member of the Ovarian Cancer Research Program, which I will
refer to as the OCRP for the rest of my testimony.
As a 9-year survivor of late-stage ovarian cancer, I feel a
strong sense of responsibility to my community and sit before
you today as the voice of all women with this disease, past,
present and future. It is my hope that today I can beseech you
to share this responsibility to fund research conducted by the
OCRP to find new treatments and an early detection for women
with or at risk of ovarian cancer.
This year approximately 20,000 women will be diagnosed with
ovarian cancer; 15,000 women will die of this disease. Ovarian
cancer has no tests, like the mammogram for breast cancer or
the Pap test for cervical cancer. Because there is no reliable
early detection test, women must rely on their and their
doctors's knowledge of ovarian cancer symptoms. However, most
women and even their doctors do not know the symptoms of
ovarian cancer, which are bloating, pelvic or abdominal pain,
urinary urgency or frequency, difficulty eating or feeling full
quickly. These symptoms are often confused with less
threatening conditions.
Unfortunately, even with symptom awareness, by the time a
woman has symptoms, she will already have late-stage cancer.
Two out of three women with ovarian cancer are diagnosed when
their cancer is late stage, as mine was.
Care and treatments are brutal and consist of long
debulking surgeries followed by months of chemotherapies. Even
when the initial treatment response seems positive, around 70
to 95 percent of women diagnosed at stages 3 or 4 will have a
recurrence.
During my 9 years of survivorship, I have befriended many
women who also had late-stage ovarian cancer. One by one I have
watched most of these women die. Today, in the Delaware Valley,
I know of no other woman diagnosed at a late stage who has
survived as long as I have. I still speak to women newly
diagnosed to offer them hope, but now I must hold a piece of my
heart in reserve.
The OCRP has one bold aim, to eliminate ovarian cancer.
Since 1997, the OCRP has funded out-of-the-box, innovative
research focused on detection, diagnosis, prevention and
control of ovarian cancer. Many of the funded proposals can be
characterized as high risk and high reward. Although we take
risks in the research we fund, we believe that investing in
innovative research will result in great breakthroughs in the
fight against ovarian cancer.
The OCRP is also special in that it involves patient
advocates at all levels. I have volunteered my time for the
past 3 years to serve as an Integration Panel member for the
OCRP. I work alongside physicians, scientists and other patient
advocates, and together we select proposals we think merit
funding. Patient advocates hold equal weight with the
scientists and physicians when funding proposals and deciding
the program's vision for the future.
Mr. Dicks. You have 1 minute.
Ms. Mason. The OCRP needs increased funding. This spring we
have received approximately 350 preapplications. In the end we
will only be able to fund approximately 32 full proposals. The
ovarian cancer community worries that the cure could be heading
into the trash can. Only with increased funding can the OCRP
grow and continue to contribute to the fight against ovarian
cancer.
The ovarian cancer community was very disappointed last
year when our funding was cut from 20 million to 18.75 million
for 2010. This cut is shocking when you consider our mortality
has not decreased, and new treatments and an early detection
test are so desperately needed. By increasing our funding to 30
million for 2011 so that more research can be carried out, we
not only help women in battling the deadly beast, but the
future generations of women at risk for having ovarian cancer.
Thank you again for this opportunity.
Mr. Dicks. Thank you for your statement. You make a very
compelling case.
Ms. Kilpatrick.
Ms. Kilpatrick. Thank you, Mr. Chairman, and thank you for
your testimony. I understand you are a registered nurse.
Ms. Mason. Yes.
Ms. Kilpatrick. You are 9 years----
Ms. Mason. Yes, of late stage.
Ms. Kilpatrick. And I am sure you have seen in your career
what procedures, medications allowed you to resist.
Ms. Mason. I think that my initial surgery that was done in
a major cancer center was just long and tedious, and the
doctors stayed there and removed every bit of cancer. Ovarian
cancer has a way of spreading like Rice Krispies throughout
your abdomen and pelvis. And once the big tumors are removed,
the physician then has to spend hours picking out all these
little tiny pieces.
Ms. Kilpatrick. So then the people who have this disease
obviously are not getting the proper care?
Ms. Mason. Well, my long surgery was followed by months of
chemotherapy. I think that my own particular body was very
sensitive to the chemotherapy drugs. There aren't many women
like me. I was extremely lucky, and I do feel a great sense of
responsibility to help change, you know, the facts of this
cancer.
And although cancer survival rates have improved since the
war on cancer was declared for ovarian cancer, that is not
true. We are kind of basically where we were 40, 50 years ago.
Ms. Kilpatrick. I am with you on that. I look forward to
following up.
Thank you, Mr. Chairman.
Mr. Dicks. Mr. Frelinghuysen.
Mr. Frelinghuysen. I just wanted to thank you, Ms. Mason. I
work pretty closely with Kaleidoscope of Hope and Paint the
Town Teal, and there is a critical mass up there which I think
is spreading the message. Thank you for being here.
Ms. Mason. Thank you.
[The statement of Ms. Mason follows:]
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Thursday, May 20, 2010.
SOCIETY OF GYNECOLOGIC ONCOLOGISTS
WITNESS
DANIEL L. CLARKE-PEARSON, M.D., PRESIDENT, SOCIETY OF GYNECOLOGIC
ONCOLOGISTS, PROFESSOR AND CHAIR, OBSTETRICS AND GYNECOLOGY,
UNIVERSITY OF NORTH CAROLINA MEDICAL SCHOOL, CHAPEL HILL, NORTH
CAROLINA
Mr. Dicks. Our next witness is Daniel L. Clarke-Pearson,
M.D., president, Society of Gynecologic Oncologists. Thank you,
sir, welcome.
Dr. Clarke-Pearson. Thank you. Good morning, Mr. Chairman
and members of the subcommittee. Thank you for inviting me to
testify at today's hearing.
My name is Daniel Clarke-Pearson. I am a physician and
president of the Society of Gynecologic Oncologists. The
Society of Gynecologic Oncologists is a national medical
specialty organization of physicians who are trained in the
comprehensive management of women with malignancies of the
reproductive tracts, such as ovarian cancer. Our purpose is to
improve the care of women with gynecologic cancers by
encouraging research, raising the standards of practice,
disseminating knowledge, and the prevention and treatment of
gynecologic malignancies.
I also practice medicine at the University of North
Carolina in Chapel Hill, where I am a professor in the School
of Medicine, and I am the chairman of the department of
obstetrics and gynecology. A large part of my clinical practice
is committed to the care of women with ovarian cancer.
I am honored to be here and pleased that this subcommittee
is focusing its attention on the Department of Defense
Congressionally Directed Medical Research Program in Ovarian
Cancer, OCRP.
As this subcommittee may know, ovarian cancer causes more
deaths than any other cancers of the female reproductive tract.
One of our biggest challenges lies in the fact that only 19
percent of all ovarian cancers are detected in a localized
stage when the 5-year survival rate is about 90 percent.
Unfortunately, as Ms. Mason just said, most ovarian cancer
is diagnosed at a late stage when the cancer is spread
throughout the abdomen and pelvis. In these cases the 5-year
survival is only about 30 percent. We, the members of SGO,
along with out patients who are battling ovarian cancer, depend
on the DOD OCRP research funding. It is through this research
funding that a screening and early detection method for ovarian
cancer can be identified. Therefore, the SGO respectfully
recommends that the subcommittee provide DOD OCRP with a
minimum of $30 million for Federal funding in fiscal year 2011.
Since its inception, the DOD OCRP has funded 209 research
grants totaling more than $140 million in funding. The common
goal of these research grants has been to promote innovative,
integrated and multidisciplinary research that will lead to
prevention and early detection and ultimate control of ovarian
cancer.
Much has been accomplished in the last decade to move us
forward. In my home State of North Carolina, DOD OCRP has
funded research on important questions such as the designing of
personalized cancer treatments that may prolong survival based
on individual cancer gene expression. We are also looking to
adapt a radiology imaging technique used successfully in
prostate cancer to potentially detect early ovarian cancers.
Mr. Chairman, in your home State of Washington, the DOD
OCRP has funded five grants in the last 5 years either at the
University of Washington or at the Hutchinson Cancer Center,
looking at questions such as the development of tests to detect
new small molecules in blood that are present in high levels in
early ovarian cancers that might be used for early ovarian
cancer detection.
Another research project is examining the entire human
genome in women, searching for genes or other groups of genes
that may cause ovarian cancer in a familial inheritance rather
than just focusing just on BRCA genes, and also developing an
infrastructure for the collection and storage and testing of
new biomarker blood tests.
In Ranking Member Young and Mr. Boyd's State of Florida,
nine grants have been funded since the inception of OCRP. These
have contributed much to ovarian cancer research enterprise,
specifically through the creation of a model of ovarian cancer
in mice that allows the evaluation of the interaction of gene
mutations in female hormones, and through studies to determine
whether a gene, Bcl-2, which is expressed in ovarian cancer,
can be used as a novel marker for early detection.
Mr. Dicks. You have 1 minute to wrap it up.
Dr. Clarke-Pearson. Yes, sir.
Mr. Dicks. But you are doing very well.
Dr. Clarke-Pearson. These examples of achievement are
obscured to a great degree by opportunities that have been
missed because of underfunding.
The program's success has been documented in numerous ways,
including 469 publications in professional journals, 576
abstracts and presentations, and 24 patents and applications.
The Society of Gynecologic Oncologists joins with the
Ovarian Cancer National Alliance and the American Congress of
Obstetricians and Gynecologists to urge this subcommittee to
increase Federal funding at a minimum to $30 million in fiscal
year 2011. I thank you for your leadership and the leadership
of the subcommittee on this issue.
Mr. Dicks. Thank you for your statement. We appreciate it
very much.
Ms. Kilpatrick.
Ms. Kilpatrick. Thank you very much.
How are you funded? How is the society funded?
Dr. Clarke-Pearson. Mostly membership dues and fees for our
annual meeting.
Ms. Kilpatrick. And the OCRP is funded----
Dr. Clarke-Pearson. Yes, in terms of developing projects.
Of course, the National Cancer Institute as well funds some
research by our members.
Ms. Kilpatrick. Thank you.
Thank you, Mr. Chairman.
Mr. Dicks. Thank you.
[The statement of Dr. Clarke-Pearson follows:]
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Thursday, May 20, 2010.
AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
WITNESS
MARY F. MITCHELL, SENIOR DIRECTOR OF PROFESSIONALISM AND GYNECOLOGIC
PRACTICE, AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
Mr. Dicks. Mary F. Mitchell, American College of
Obstetricians and Gynecologists. We will put your entire
statement in the record, Mary, and you have 5 minutes to
summarize.
Ms. Mitchell. Mr. Chairman, ranking member and members of
the subcommittee, thank you for inviting me to testify at
today's hearing. My name is Mary Mitchell, and I am the Senior
Director of Professionalism and Gynecologic Practice at the
American College of Obstetricians and Gynecologists. I am here
today on behalf of the college's companion organization, the
American Congress of Obstetricians and Gynecologists, or ACOG,
representing more than 54,000 physicians and partners in
women's health. The gynecologist is often the first health care
provider a woman sees, and ACOG and its fellows are committed
partners in the fight against gynecologic cancer.
This morning I will outline the great need for research
into all aspects of ovarian cancer and some of the important
contributions made by the Department of Defense Congressionally
Directed Medical Research Program in ovarian cancer, the OCRP.
These needs and the contributions of the OCRP lead ACOG to
respectfully request a minimum of $30 million in Federal
funding for the OCRP in fiscal year 2011. We believe that the
unique structure of the program and its success in funding
innovation combine to yield a high return on the Federal
financial investment.
In the more than 30 years since passage of the National
Cancer Act, ovarian cancer mortality rates have not
significantly improved. In large part this is because we do not
have a reliable screening test for ovarian cancer. Without this
critical tool, ovarian cancer, as you have heard, is too often
diagnosed in a late stage when the 5-year survival rate is only
29 percent. And, as you have heard from Ms. Mason, 13,000 women
die each year from ovarian cancer.
In contrast, since the 1950s, we have had an effective
screen for cervical cancer, the Pap test, which has reduced
mortality from cervical cancer by over half in the past 30
years. We need a test like the Pap test for ovarian cancer, and
the research supported by DOD's OCRP can help us get there.
Unfortunately, inadequate funding is a barrier to
scientific progress. At the National Institutes of Health and
the Centers for Disease Control and Prevention, funding for
ovarian cancer research has not kept pace with inflation. Even
in the DOD medical research program, ovarian cancer research is
significantly underfunded relative to other cancers, and, as
you have heard, funding was cut to $18.75 million in fiscal
year 2010.
We recognize the challenges of funding research, given so
many competing demands, but we believe that the OCRP's flexible
and collaborative approach ensures that the maximum value is
gained for the dollars spent through Federal appropriations.
Through the Integration Panel structure mentioned by Ms. Mason,
the OCRP is able to actively manage and evaluate its current
grant portfolio and fill gaps in ongoing research at other
agencies. With seed money from the OCRP, possible research
strategies are efficiently reviewed, and then the most
promising can be funded by other agencies. Collaboration is one
reason the OCRP is so effective.
Mr. Dicks. You have 1 minute, ma'am.
Ms. Mitchell. The new Ovarian Cancer Academy for junior
faculty will allow early career researchers to optimize the
pace of their career development, and the Consortium Award will
bring together researchers from multiple institutions to study
the early signs of ovarian cancer.
The OCRP has been an unqualified success, but as you have
heard from other speakers, the current level of funding allows
only a fraction of the approved proposals to actually receive a
grant. ACOG joins with the American Society of Gynecologic
Oncologists and Ovarian Cancer National Alliance to urge this
subcommittee to increase Federal funding for the OCRP to at
least $30 million in fiscal year 2011 and allow for the further
development of discoveries and research breakthroughs achieved
in the first 13 years of this program.
We thank you very much for your leadership.
Mr. Dicks. Thank you. Thank you for your testimony.
[The statement of Ms. Mitchell follows:]
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Mr. Dicks. Michelle Galvanek, The Leukemia & Lymphoma
Society. Thank you, Michelle. We will put your statement in the
record. You have 5 minutes to summarize.
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Thursday, May 20, 2010.
THE LEUKEMIA & LYMPHOMA SOCIETY
WITNESS
MICHELLE GALVANEK
Ms. Galvanek. Thank you. Good morning, Mr. Chairman and
members of the subcommittee. My name is Michelle Galvanek, and
I am a volunteer with the Leukemia & Lymphoma Society. And I
would like to thank you for allowing me to testify today on
behalf of the LLS and the thousands of blood cancer patients we
serve. Since 1949, the Society has been dedicated to finding a
cure for blood cancers. To that end, in fiscal year 2009, the
Society provided approximately $69 million in research grants.
A number of our grant recipients also received funds from the
National Institute of Health, private foundations and the
Department of Defense. The funding from the Department of
Defense is through the congressionally directed medical
research program.
For fiscal year 2011, the Leukemia & Lymphoma Society,
along with other cancer groups, the C3 Colorectal Cancer
Coalition, the Kidney Cancer Association, the International
Myeloma Foundation, the Lymphoma Research Foundation, and the
Vietnam Veterans of America support the peer reviewed cancer
research program and request it to be funded at $50 million in
fiscal year 2011.
Additionally, we request that the program fund research
into the same cancers it did in 2010, namely blood, kidney,
colorectal, pediatric brain and melanoma. I know firsthand
about the benefits of research as my husband is an 11-year
leukemia survivor. The LOS supports the inclusion of all 5
cancers in the PRCR, and particularly blood cancer. The reasons
for having a blood cancer research program at the DOD are the
benefits such a program would have for military service members
and the fact that blood cancer research has led to break
throughs in the treatment of other cancers. Civil agencies in
the Federal Government have recognized the importance of blood
cancers to those who serve in our military.
For example, the Department of Veterans Affairs has
determined that service members who have been exposed to
ionizing radiation and contract multiple myeloma, non-Hodgkin
lymphoma or leukemia other than chronic lymphocytic leukemia
are presumed to have contracted those diseases as a result of
their military service. Secondly, in-country Vietnam veterans
who contract Hodgkin's disease, chronic lymphocytic leukemia,
multiple myeloma or non-Hodgkin's lymphoma are presumed to have
contracted these diseases as a result of their military
service. Because these diseases are presumed to have been
service connected in certain instances, VA benefits are
available to affected veterans.
Furthermore, the Institute of Medicine has found that Gulf
War veterans are at risk for contracting a number of blood
cancers due to exposure to Benzene, solvents and insecticides.
One example is IOM has found sufficient evidence of a causal
relationship between exposure to Benzene and acute leukemias.
In addition, the C.W. Bill Young Department of Defense Marrow
Donor Program works to develop and apply bone marrow
transplants to military casualties with marrow damage resulting
from radiation or exposure to chemical warfare agents
containing mustard. Bone marrow transplants are also a commonly
used second-line therapy for blood cancers more so than other
cancers.
Finally, research into blood cancers have produced results
that can help patients with other cancers too. The idea of
combination chemotherapy was first developed to treat blood
cancers in children and is now common among cancer treatments.
Bone marrow transplants were first used as curative treatments
for blood cancer patients, and these successes led the way to
stem cell transplants and immune cell therapies for patients
with other diseases. In general, blood cancer cells are easier
to access themselves from solid tumors, making it easier to
study cancer causing molecules in blood cancers and to measure
the effects of new therapies that target these molecules that
are frequently also found in other cancers.
Mr. Dicks. You have 1 minute.
Ms. Galvanek. Thank you, sir. Several agents designed only
to kill cancer cells and leave healthy cells undamaged were
first developed for blood cancer patients and are already
helping or being developed to help other cancer patients as
well. In conclusion, because blood cancer research is relevant
to our Nation's military and because blood cancer research
often leads to treatment in other cancers, I would urge the
subcommittee to include $50 million for the Peer Reviewed
Cancer Research Program for funding into blood, colon, skin and
kidney cancer, as well as pediatric brain tumors. Thank you
very much.
Mr. Dicks. Thank you very much. I would just point out that
Mr. Young, the ranking member and former chairman of the
subcommittee, has been a leader on this particular form of
cancer and has been a great advocate in this committee for more
research in this area. Ms. Kaptur.
Ms. Kaptur. Mr. Chairman, just very quickly, I just wanted
to ask whether your data provides you with any statistics that
show for veterans from any of our conflicts--you mentioned
Benzene. Do veterans contract these particular type of cancers,
blood-related cancers at a higher rate than others? Can you
provide that--you sort of mentioned some of it.
Ms. Galvanek. I don't have that answer off the top of my
head, but I can follow up with you and get that to you.
Mr. Dicks. Her statement has a few examples. Thank you for
being a volunteer.
Ms. Galvanek. Thank you. It is the best way I spend my
time. Thank you.
[The statement of Ms. Galvanek follows:]
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Mr. Dicks. Thank you. We appreciate it. The National Breast
Cancer Coalition, Fran Visco, J.D., president of the coalition.
Hold on just a second. We are going to switch here. Mr. Moran
has got a problem, and he wants to hear this witness. If you
would just give us Carlea Bauman, President of the Colorectal
Cancer Coalition. Welcome.
----------
Thursday, May 20, 2010.
C3: COLORECTAL CANCER COALITION
WITNESS
CARLEA BAUMAN, PRESIDENT, C3: COLORECTAL CANCER COALITION
Ms. Bauman. Good morning. Thank you. Mr. Chairman and
members of the subcommittee, thank you for the opportunity to
testify in support of the research that is being funded through
the DOD's Peer Reviewed Cancer Research Program. My name is
Carlea Bauman. I am the president of the C3: Colorectal Cancer
Coalition. C3 is a nonprofit, nonpartisan advocacy organization
seeking to eliminate suffering and death due to colorectal
cancer. Last year, our advocates asked Congress to include
colorectal cancer in the DOD's Peer Reviewed Cancer Research
Program. Thank you for listening to them. We were thrilled that
in the fiscal year 2010 bill, for the first time, colorectal
cancer research is being funded through the DOD's PRCRP.
Because when you fund research for a disease, people diagnosed
without disease live longer and enjoy a higher quality of life.
In 2010, there are $15 million for 8 research areas that
includes colorectal cancer. C3 is working with other advocacy
groups to increase that funding for fiscal year 2011. We hope
we can count or your support. We respectfully ask that you
increase the funding for this important program in fiscal year
2011. Specifically we ask that you fund the DOD's PRCRP at $50
million. Although the cancers included in this program are
diverse, the research on these disease types is often
synergistic. Efforts to develop a genetic profile for pediatric
brain tumors will direct research efforts and permit greater
targeting of treatment options and molecular profiling of
melanoma will permit better predictions of therapeutic response
and informed research efforts.
And researchers today working on colorectal cancer are
producing biomarker tests that provide important information
about which treatments will work and which will not. Today,
treatment options for colorectal cancer have expanded to seven
drugs, more precise surgery and radiation. Continuing to fund
innovative research will result in more treatment option for
colorectal cancer patients. 30 years ago, people diagnosed with
metastatic colorectal cancer lived approximately 6 months after
their diagnosis. Today they are living on average over 2 years
past their diagnosis and some are even cured.
In the general population, colorectal cancer is the third
most commonly diagnosed cancer and the second most common cause
of cancer deaths for men and women in the United States. Nearly
147,000 people will be diagnosed with colorectal cancer and
nearly 50,000 people will die this year. Funding for the DOD's
PRCRP is an opportunity to advance the best research to
eradicate diseases and support the warfighter for the benefit
of the American public. A continued investment by the
subcommittee in research focusing on these cancers may yield
benefits beyond the specific cancers.
A study published in the Cancer Epidemiology Biomarkers and
Prevention found differences in cancer incidence rates between
military personnel and the general population. Rates were lower
among military personnel than the general population for
colorectal, lung and cervical cancers. However, for colorectal
cancer, the difference in rates between the two populations was
significant only among white males. Screening rates in the
military for colorectal cancer like in the general population
are much too low.
In 2008, only about 58 percent of those in the military who
should be screened for colorectal cancer had been screened. And
every day precancerous polyps that could be detected through
screening are not being found. Today only 39 percent of
colorectal cancer patients have their cancers detected at an
early stage. For many patients, a diagnosis of colorectal
cancer means a diagnosis of late stage colorectal cancer. Not
nearly enough research is being done into late stage colorectal
cancer treatments. The PRCRP represents an opportunity to
conduct such research. Areas of focus for colorectal cancer
research in the PRCRP could be an inexpensive, noninvasive
accurate screening test, predicted markers to identify who will
benefit from which treatments and accurate diagnostics that can
evaluate the markers.
Mr. Dicks. You have 1 minute.
Ms. Bauman. Thank you, sir. Discoveries resulting from
investment in PRCRP research have the potential to transform
the investigation of cancer through the development of new
prevention strategies and therapies and some day cures. I thank
you for your commitment to cancer research at the Department of
Defense and efforts to improve the lives of Americans facing
and living with a cancer diagnosis. I respectfully request that
this subcommittee continue to support the important work of the
DOD's congressionally directed medical research programs by
funding the PRCRP at $50 million for fiscal year 2011. Once
again, thank you for the opportunity to provide this testimony
to this subcommittee.
Mr. Dicks. Thank you. Thank you very much.
Mr. Moran. Mr. Chairman.
Mr. Dicks. Yes, Mr. Moran.
Mr. Moran. If I could, the next speaker will represent the
Breast Cancer Survivors Coalition, which all of these groups
really have to thank for initiating medical research. I am glad
we have been as robust in funding that. When you look at what
the Lung Cancer Coalition has submitted, lung is the largest,
then colorectal cancer, then, of course, breast cancer and then
pancreatic cancer and then prostate cancer, which we have
specific funding for. Colorectal cancer is in a larger group,
including pediatric cancer and the like. But we made so much
progress.
Mr. Chairman, I want to thank you particularly for having
this public hearing because otherwise we don't really hear from
the other side. It is just a line item. These folks are putting
a face to it. But in colorectal cancer, so much of this is a
matter of screening. That is how you save lives. You have got
to get it before it gets into the body and takes hold. And to
think that only about half of our military are being adequately
screened for colorectal cancer is just wrong when the incidence
is over 50,000 deaths a year. Many of those are military folks.
So I wanted to make that point and I appreciate, Ms. Bauman's
testimony.
Ms. Bauman. Great. Thank you very much.
[The statement of Ms. Bauman follows:]
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Mr. Dicks. Thank you. Now we will go to Fran Visco,
president of the National Breast Cancer Coalition. Thank you
for being patient.
----------
Thursday, May 20, 2010.
NATIONAL BREAST CANCER COALITION
WITNESS
FRAN VISCO, PRESIDENT, NATIONAL BREAST CANCER COALITION
Ms. Visco. You are welcome. Thank you for inviting me. So I
am Fran Visco. I am a 22-year breast cancer survivor and head
of the National Breast Cancer Coalition, which is a coalition
and umbrella for over 600 groups from across the country. I
want to begin by thanking you for your leadership over the
years in support of this program. I am not going to talk to you
about the details of what we funded and what the specific
successes of the program have been. I give you some examples in
my testimony and all of the information is available on the
program's Web site. What I do want to tell you is that this
government program has been an incredible success on every
level and it warrants level funding, this Competitive Peer
Reviewed Biomedical Research Program.
This program is a unique structure. It is a collaboration
among scientists, trained consumers and the United States Army.
Its vision is to eradicate breast cancer by funding innovative
research. This program funds gaps. It doesn't replicate or
duplicate what other funding agencies and private funders do.
This program can rapidly respond to what is happening in the
world of breast cancer. Why? There is no bureaucracy. The
United States Army has done an incredible job administering
this program. It is streamlined, it is efficient. The
administrative costs don't even rise to 10 percent. And
importantly for the public, this is a transparent program. It
is accountable to the taxpayers. The public can go to the Web
site and see where the money is going, where their tax dollars
are being spent. Every other year at a meeting called the Era
of Hope, everyone who has been funded by this program has to
present the results of their research to the public.
Mr. Dicks. When does that occur?
Ms. Visco. Every other year. It is going to happen again in
August of 2011 will be the next Era of Hope meeting.
Mr. Dicks. Can Members of Congress go?
Ms. Visco. Oh, yes. Absolutely. We would love to have you.
This program has been successful because it has been free of
outside influence and it has the strongest conflict of interest
policy of any research funding entity within or without
government. What this program does is it pushes science to new
levels. It challenges the status quo. It creates new models,
some of which you have heard from other programs that you have
funded. We create new models of research. We don't direct the
research questions to be asked. We leave that to the scientific
community. It has been replicated by other programs, by other
countries, by breast cancer programs in other States from its
mission to the mechanisms it creates to the structure of the
program.
In fact, a number of years ago, the then general in charge
of the program, General Martinez, told me that even the
mechanisms and the way the integration panel works, he took
that and used it elsewhere within the Department of the Army
because he was so impressed with what we were able to do. So
this works on every level. It doesn't just save lives. It
changes how research is done. I want you to know that this
program is where the hope lies, the hope of the women and men
across the country and actually around the world who are
dedicated to ending breast cancer. This is the program they
look to because they know this is the program that is
responding to the needs of patients. And that is really making
a difference for all of us. Thank you.
Mr. Dicks. Thank you very much. Are there any questions? We
have a little time here for anyone who has a question. Thank
you. Let me ask you this. Do you think this is a better program
than National Cancer Institute?
Ms. Visco. Yes, I do. Without question, I think this
program for breast cancer is a better program than the National
Cancer Institute.
Mr. Dicks. Why is that?
Ms. Visco. For all the reasons I said. It is incredibly
transparent, it is accountable, it is able to rapidly respond.
There is no huge bureaucracy here that you have to try to
overcome. It is looking at innovation. A couple of years ago,
the then head of the National Institutes of Health testified to
Congress. And he was talking about how proud he was of the four
new innovations at NIH. And all four of them were copied from
the DOD Breast Cancer Research Program. This is the program
where the creativity and the innovation lie. This is the
program that brings the public into it. The NCI, while it is
doing very good work, does not rise to the level of the breast
cancer research that the DOD program funds.
Ms. Kaptur. Mr. Chairman, since this witness is so
articulate and though I won't only focus on breast cancers, I
have listened to the various witnesses come before us this
morning whether it is colorectal or lung or breast cancer, we
thank you so much for the great work you are doing. What I fail
to understand from a scientific standpoint is knowing
everything we know about genetics, knowing everything we know
about blood typing and analysis, why isn't it just a simple
matter of genetic marking so that we can find better detection
regimens. We spend so much money as a country.
Ms. Visco. I could answer that. I am not sure by 11:00, but
I could answer that. I will be as quick as I can. But I would
love to have the conversation with you outside the hearing. The
problem is that this isn't just an issue of early detection,
nor is it an issue of genetic mutation. It isn't. It is much
more complicated than that. Cancer is more complicated than
that. We can find a pathway or a gene that is mutated. We can
find people who are at high risk, but we don't know what to do
with them. And when you find a mutated pathway or a mutated
gene, there are some other pathways and genes and proteins that
come into the story that it is not just one target that is
going to make a difference, that is going to cure women or that
is going to detect it early enough for everyone to make a
difference.
We don't understand enough about the biology of this
disease or really any cancer. The question was asked about
ovarian cancer. Why am I here? I am a 22-year survivor. I had a
pretty difficult breast cancer. I had lymph node involvement. I
had state-of-the-art treatment. I don't think that is why I am
here. We don't know why I am here. There is something about my
DNA, the biology of my disease that responded to therapy, maybe
didn't need therapy at all. We don't know enough about these
diseases. They are incredibly complicated. We can't just focus
on early detection because that is so far from the answer to
these diseases.
The same thing with ovarian cancer, that woman thankfully
is alive 9 years later. I don't know if it was her surgery or
her treatment. It was probably something about the biology of
her disease that we don't know yet. Those are the kinds of
questions that we have to answer to really get rid of these
diseases.
Mr. Ryan. Mr. Chairman, if I could just add something here.
Of all of these diseases, I think there is an issue that I hope
over time we can start focusing on and that is stress,
especially in the military environment, military families, is
how we can begin to reduce levels of stress, teach people how
to cope with their levels of stress because it has been proven
that over time stress will just accelerate cancer and other
diseases. So I hope that we can continue that and make that a
part of our focus.
Ms. Visco. Actually I mention in my submitted testimony we
actually are funding looking at stress levels in the military
and accelerated breast cancer. That is one of the concepts that
was funded by the program.
Mr. Ryan. It was just in the earlier testimony too on the
schools with the kids and the families and everything else
here. I think we are going to see a theme running through a lot
of this stuff. I think if we really want to kind of focus on
something that is a cause of or something that increases these
problems, we are going to find out time and time again it is
stress. So we need to figure out how to get to the root of the
problem too at the same time.
Mr. Moran. Mr. Chairman, I hate to belabor this. But the
other thing that would be helpful is that in terms of
prevention, we hear so many conflicting things. Breast feeding
is good or aggressive exercise, any number of things, vitamins
and so on. But one day we will see that this is the secret and
then several months later we will say no, they were absolutely
wrong. It would be helpful for a group such as yours to provide
the kind of consistent device because women are desperate for
credible information that they can use to apply to their own
lives.
Ms. Visco. Yes. And prevention research, of course, is one
of the most underfunded areas of any disease but certainly in
cancer. We really don't know enough about how to prevent these
diseases. You are absolutely right.
Mr. Moran. Thank you.
Mr. Dicks. Thank you very much.
Ms. Visco. You are welcome.
[The statement of Ms. Visco follows:]
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Mr. Dicks. We appreciate it. Now we will have Kendra Sharp,
associate professor of mechanical, industrial and manufacturing
engineering at Oregon State University. A great northwest
school.
Ms. Sharp. Yeah. I just moved to the Pacific Northwest.
Mr. Dicks. Some of my best friends went to Oregon State.
Terry Baker played there. A great quarterback.
Ms. Sharp. Okay. Great. I just moved there to the Pacific
Northwest and I am quite pleased to have moved to that part of
the country.
Mr. Dicks. Corvallis? You are in Corvallis, right?
Ms. Sharp. Yes.
Mr. Dicks. Thank you.
----------
Thursday, May 20, 2010.
ASME, DEPARTMENT OF DEFENSE TASK FORCE
WITNESS
KENDRA SHARP, ASSOCIATE PROFESSOR, MECHANICAL, INDUSTRIAL, AND
MANUFACTURING ENGINEERING, OREGON STATE UNIVERSITY
Ms. Sharp. Mr. Chairman, Mr. Ranking Member and members of
the committee, I am Kendra Sharp, associate professor at Oregon
State University's mechanical, industrial, manufacturing and
engineering. On behalf of the ASME Department of Defense task
force, I am pleased to have the opportunity to testify on the
fiscal year 2011 Department of Defense budget request. The
American Society of Mechanical Engineers is a 120,000 member
professional organization focused on technical, educational and
research issues. Our Nation's engineers play a critical role in
national defense through research discoveries and technology
development for military systems. Therefore, my comments will
focus on the DOD's science and technology budget. The
administration has requested $76.7 billion for the RDT&E
portion of the fiscal year 2011 DOD budget, a 5.1 percent
decline from last year. Of concern to our task force, funds for
operational tests and evaluation function are still at reduced
levels by historical standards.
And while the fiscal year 2011 request represents an
improvement from recent years, even this amount does not
represent the importance of OT&E as mandated by Congress. The
administration's request for defense S&T of $11 billion
represents a 12.2 percent reduction from last year. Our task
force strongly urges this committee to consider additional
resources to maintain stable funding in the S&T portion of the
DOD budget.
We note that up to $16.4 billion would be needed for
defense S&T funding to meet the 3 percent of total obligational
authority guideline recommended by the National Academies and
set in the 2001 Quadrennial Defense Review, recommendations
which were broadly supported in Congress only a few years ago.
The basic research 6.1 account supports programs which are
crucial to fundamental scientific advances and for maintaining
a highly skilled science and engineering workforce. Maintaining
a skilled workforce is critical given the large turnover that
will occur in the next few years in key science and engineering
industries.
The National Science Foundation's 2010 Science and
Engineering Indicators Report shows that the U.S. severely lags
the rest of the world in both real terms and on a percentage
basis in the granting of first degrees in engineering with only
4.5 percent of first university degrees being granted in
engineering versus 12.6 percent for the European Union and over
21 percent across Asia. Combined with the NSF findings that the
average age and retirement rate of the engineering workforce
will continue to rise over the next several years, our task
force reiterates the need for robust S&T programs at DOD as
critical to our economic competitiveness and national security.
Several of the proposed reductions to individual S&T program
elements are dramatic and could have negative impacts on future
military capabilities. While basic research accounts are
properly weighted under the President's request, applied
research, the 6.2 accounts would receive an 11.2 percent
reduction. Applied research programs may involve laboratory
proof of concept and are generally conducted at universities,
government laboratories or by small businesses. Many successful
demonstrations lead to the creation of small companies and 6.2
applied research has also funded the education of many of our
best defense industry engineers. Failure to properly invest in
applied research would stifle a key source of technological and
intellectual development and stunt the creation and growth of
small entrepreneurial companies. Advanced technology
development, 6.3, would experience a dramatic 18.3 percent
decline under the President's budget.
These resources support programs where ready technology can
be transitioned into weapon systems. This line item funds
research in a range of critical material technologies,
including improved body armor to protect troops against IEDs
and in developing lightweight armor for vehicle protection.
With the problems faced in Iraq and Afghanistan with IEDs and
the need for improved armor systems, it does not seem wise to
cut materials research.
Another key program for the defense S&T community is the
university research initiative which supports graduate
education in mathematics, science and engineering. Under the
proposed budget, this program would see a 2.1 percent decrease
to 335.9 million. Sufficient funding for the URI is critical to
educating the next generation of engineers and scientists for
the defense industry. A lag in program funds will have a
serious long-term negative consequence on our ability to
develop a highly skilled scientific and engineering workforce
to build weapon systems for years to come.
Mr. Dicks. You have 1 minute.
Ms. Sharp. Thank you. While DOD has enormous current
commitments, these pressing needs should not be allowed to
squeeze out the small but very important investments required
to create the next generation of highly skilled technical
workers for the American defense industry.
In closing, I have three recommendations from our task
force. The first is that we urge the subcommittee to support
the President's request for the 6.1 basic research accounts for
S&T programs. The second is that the task force recommends the
subcommittee provide an additional $563 million in support for
the 6.2 applied research account function in order to ensure
workforce and project stability in this critical area of
defense research.
And third, we also recommend that the committee support the
Pentagon's stated goal of devoting 3 percent of the
department's baseline budget to Defense S&T program, 6.1, 6.2
and 6.3 accounts. I thank the committee for its ongoing support
of defense science and technology. Our task force appreciates
the difficult choices that Congress must make in this tight
budgetary environment. We believe, however, that there are
critical shortages in the DOD S&T areas, particularly in those
that support basic research and technical education that are
critical to U.S. military in the global war on terrorism and
defense of our homeland. Thank you.
[The statement of Ms. Sharp follows:]
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Mr. Dicks. Thank you very much. I appreciate your
statement. John Boslego, M.D., director of the Vaccine
Development Global Program, PATH. I am very glad to have you
here today.
----------
Thursday, May 20, 2010.
PATH
WITNESS
JOHN BOSLEGO, M.D., DIRECTOR, VACCINE DEVELOPMENT GLOBAL PROGRAM
Dr. Boslego. Good morning, sir. My name is John Boslego and
I am the director of the Vaccine Development Global Program at
PATH. I would like to begin by thanking Chairman Norman Dicks
and Ranking Member Bill Young for the opportunity to testify
before the subcommittee. Chairman Dicks understands the mission
at PATH, has been a strong supporter of PATH programs.
I speak for all of my colleagues at PATH when I thank him
for his support and key leadership on the issues that are
critical to our work. PATH is an international NGO and creates
sustainable, culturally relevant solutions enabling communities
worldwide to break longstanding cycles of poor health. By
collaborating with diverse public and private sector partners,
we help provide appropriate health technologies and vital
strategies that change the way people think and act. We wish to
take this opportunity to recognize the specific and unique
areas of expertise that the DOD brings to bear in advancing
innovation that ensures people in low resource settings have
access to lifesaving interventions and technologies. Through
DOD, the U.S. Government is able to apply this core capacity to
improving health throughout the world. The global health
research efforts of DOD respond to diseases many Americans
never see up close, but which military personnel stationed in
developing worlds experience, alongside local communities.
Medicines, vaccines and diagnostics for health threats that
disproportionately affect the developing world are critical for
their protection. Health is also an important factor in global
stability and security. The heavy burden of disease in
developing world hinders economic and social development, which
in turn, perpetrates conditions that breed political
instability.
DOD health research therefore benefits not only the U.S.
military but also has the potential to reduce this health
burden, by doing so reduce the likelihood of physical conflict.
PATH requests of fiscal year 2011 that the subcommittee provide
robust support for DOD research and development programs aimed
at addressing health challenges, particularly for military
malaria vaccine development research, as well as for research
at DARPA aimed at developing protective countermeasures and
developing health care to military personnel and civilians in
remote resource poor and unstable locations.
More than one-third of the world's population is at risk
for malaria, with approximately 250 million cases each year.
The most of nearly 1 million annual deaths from malaria are
among children in Africa under the age of 5. According to the
2006 Institute of Medicine report, malaria has affected almost
all military deployments since the American Civil War and
remains a severe and ongoing threat.
The same report noted that a vaccine would be the best
method of averting the threat of malaria, given the likely
increasing number of deployments to high-risk areas. Military
researchers within the military infectious disease program are
at the forefront of efforts to develop the malaria vaccine. One
example of DOD's impact in malaria research is the most
promising vaccine candidate in existence today. It is called
RTSS. Research at Walter Reed contributed to the development of
the vaccine candidate in early testing of RTSS created by
GlaxoSmithKline was done in collaboration with the U.S.
military.
Today thanks to innovative partnership between GSK Bio and
PATH, the malaria vaccine initiative works to accelerate
development of malaria vaccines and assure their availability
and accessibility in the developing world. RTSS is now in a
large-scale phase 3 trial, typically the last stage of testing
prior to licensure. The U.S. Army is assisting in this trial by
supporting one of the field sites in Kenya. Although the
efficacy of RTSS in its current formulation is unlikely to
prove adequate for military purposes despite its potential
benefit to young children in Africa, it has shown that
developing a vaccine against malaria is possible and paved the
way for other development efforts that could ultimately allow
the military to vaccinate its men and women against malaria
before deploying them to endemic regions.
Unfortunately, DOD's spending on military infectious
diseases research in general and specifically on malaria
research has been declining for several years from levels that
were already comparatively small given the historic impact of
malaria on overseas deployments. Current funding levels are
nowhere near what is needed to develop urgently needed
countermeasures against malaria. PATH requests that the
subcommittee reverse this trend and provide the resources
needed to develop the necessary tools, including vaccines to
protect soldiers, sailors, airmen and Marines from this deadly
and debilitating disease.
Another program making great contributions to research and
development is DARPA. DARPA has identified as a priority the
development of technologies that can both help the U.S.
military and be of use to DOD sponsored humanitarian relief
operations. One example is the technology pioneered by DARPA
that has led to electrochemical generators of chlorine that may
be able to fulfill a community's need for effective
disinfectants for water or surfaces by using just salt water
and a simple battery source. PATH has partnered with Cascade
Designs on a new generation of smart electrochlorinators that
has the potential to expand the project initiated by DARPA to
broader community reach for both military and civilian
benefits.
The device effectively inactivates bacteria, viruses and
some protozoa to create safe drinking water. Since the
generators can be powered by solar-charged batteries, they are
accessible to communities that do not have electricity
infrastructure. The costs are significantly less than required
for the current large scale community systems, putting this
solution within reach of very poor and small communities. The
defense threat reduction agency, DTRA, is also doing
groundbreaking work as it investigates innovations in vaccine
and chemical reagent thermostabilization and point of care
diagnostic tests for infectious diseases.
This has positive implications for global health and U.S.
military support in low-resource settings. Such technologies
will enable rapid pathogen identification in field and threat
zones to more rapidly enlist target interventions.
In conclusion, in light of the critical role that DOD plays
in global health research and development and the fact that the
investments in this area have been falling, we respectively
request that the subcommittee provide the resources to maintain
this important core capacity. We thank you very much for your
consideration.
Mr. Dicks. Let me ask you, the Gates Foundation is doing
some significant work on malaria; isn't that correct.
Dr. Boslego. Yes, sir.
Mr. Dicks. Are you involved with that as well?
Dr. Boslego. Yes, we are.
Mr. Dicks. That is what I thought. And you think that
DARPA's role in this is constructive?
Dr. Boslego. Yes, sir, very much so. Although DARPA is not
working on the malaria piece per se. They are working on some
of these newer innovations that would help, in this case, the
purification of water.
Mr. Dicks. On Homeland Security, we had some problems
initially with vaccines and various other treatments for
various things that could happen in that relationship. Has that
relationship between Homeland Security and HHS improved or is
it still pretty shaky?
Dr. Boslego. I cannot comment on that, sir. I am not
familiar with those discussions.
Mr. Dicks. There was a significant problem there. Thank
you. Any other questions? Okay. Thank you very much.
[The statement of Dr. Boslego follows:]
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Mr. Dicks. Sherry S. Galloway, registered nurse, board
member of ZERO, the project to end prostate cancer.
---------- --
--------
Thursday, May 20, 2010.
ZERO
WITNESS
SHERRY GALLOWAY, R.N., BOARD MEMBER, ZERO, THE PROJECT TO END PROSTATE
CANCER
Ms. Galloway. Mr. Chairman, members of the committee, thank
you very much for the opportunity to speak to you today about
the Prostate Cancer Research Program and the congressionally
directed medical research programs at the Department of
Defense. Many people can speak to you effectively about the
research this program has done or is doing, about its history,
funding levels and accomplishments. But I want to talk to you
about how we can affect the future of prostate cancer research
by looking at two men in my life who fought this deadly
disease. My husband, Tom, and my son, Jeremy. When we leave
here today, I hope you understand why I hold out hope for the
future that research promises to give us and why I ask you to
increase prostate cancer research funding so that the PCRP can
lead us there.
My name is Sherry Galloway. I am a nurse, a mother, a wife
and a sister. I have a personal relationship with prostate
cancer after watching its horrific impact on both my son and my
husband. My husband's diagnosis was made when he was 54 and
that made a little more sense at that age to me, although that
is not old. And we do think of this disease often as an old
man's disease. The treatment my husband received was not
without side effects. His nerve-sparing prostatectomy left him
impotent. While that persists today at 60, he is alive and
cancer free. I would give anything to have my son alive and
cancer free. Jeremy's prostate cancer was diagnosed 4 years
after my husband's and he was 35 years old. 18 months later he
was dead.
When he was 34, Jeremy complained of back pain that would
not subside. He was fit, he was healthy and strong. He turned
35 in Burma where he was delivering medicine to villages there.
When he returned home, he felt tired and he was still in
unremitting pain. He was having night sweats. So he went to an
infectious disease specialist thinking maybe he had caught
something in the jungle or in the forest. They did blood tests
and found that he was walking around with almost no platelets.
They sent him to the ER. His own physician reviewed his MRI,
saw that he had no platelets and they immediately thought of
lymphoma, which is more typical in young men. They also thought
about testicular cancer also in young men. And both are very
treatable. His first bone biopsy revealed cells that were
suspicious of prostate cancer, however the oncologist couldn't
believe that. So they continued to test him, transfuse him and
look for everything else. And finally they called in a
urologist. At that time, my son's DRE was normal and ultrasound
of his prostate was normal. His PSA was 441. When repeated, it
was more like 460. At that time, he was diagnosed with advanced
metastatic hormone refractory prostate cancer. Three months
later--actually the hormones after 3 months. It was hormone
refractory. The hormones did not work.
When you looked at his CAT scan, his bone scan, all you saw
was black throughout his axial skeleton and his clavicle with
little spots on his brain. That was all tumor. So his back pain
was due to his metastasis, not due to the prostate cancer which
was asymptomatic, completely. Jeremy was married on a Saturday
in September of 2006 and 2 days after his wedding he started
chemotherapy. Things began to slip for him about a year after
his diagnosis. There were nights when he would sit in a hot tub
with Epsom salts and just sob because he was in pain and he was
depressed and scared.
And I would just sit by the tub. There was nothing I could
do but listen. On good days, he dedicated time to research. He
discovered numerous prostate cancer research projects, each one
of which became a source of hope for us. He was started in the
Provenge trials, clinical trials. Unfortunately he was in the
control group. So he never received the Provenge which today is
an accepted treatment for advanced metastatic prostate cancer.
That was a huge disappointment.
Later he was accepted into an experimental treatment at the
University of Oregon in which he would have received a mini
allogenic total bone marrow transplant. Fortunately, the
approval of this came about 3 days before he died. So he was
unable to get this. Jeremy accepted being experimented on with
grace, even when elephant doses of pain medication did not
work. He was in excruciating bone pain 24/7. He couldn't sit,
he couldn't stand, he couldn't lay down anywhere without pain.
He slept through most of his first wedding anniversary because
he was so highly drugged and in so much pain. And his wife had
to sit there alone and sometimes with me because Jeremy
couldn't play, although he tried to remain positive about his
life.
For 33 years, Jeremy was healthy and he worked tirelessly
for human rights and environmental sustainability. Among his
many accomplishments was a special award given to him while he
was sick by the Rain Forest Action Network. He also brokered an
agreement between several guitar companies and Greenpeace
whereby no old growth forest trees would be used in the
manufacture of guitars. Six weeks before his death, I literally
had to kidnap him from the hospital so he could go get his
award. We had to cover up our dress clothes with hospital gowns
and sneak out of the hospital and go in a rickety RV to get him
to these awards. I wheeled him down the aisle to a standing
ovation of over 300 people.
Then he stood up on the stage and spoke with such power
that during those moments, it was hard to imagine that he was
so sick. After receiving his award and returning to the
hospital, the staff came in and spoke with him and his wife and
then his father and I were asked to join them while they gave
the talk about preparing for the end of life. It was the speech
where they kindly ask you whether you want to just continue
with treatment that isn't going to work or you want to go home.
Jeremy and Beth decided that Jeremy would die at home. During
the final weeks of his life, Jeremy was in agony. There were no
comfortable positions. He vomited and retched repeatedly and
with extreme force because of all the radiation treatments he
had had that went through his abdomen to affect his spine to
keep from paralyzing him. He took medication for pain, nausea,
constipation, appetite, anxiety and sleep. He began to wander
at night, even on medication, and maybe because of it.
His friends organized into teams so 2 or 3 of us would be
with Jeremy around the clock. I slept so little that Jeremy's
friends nicknamed me ``zombie mom.'' Jeremy's morphine pump
wasn't working and he became incontinent of stool and urine. My
proud, strong, beautiful son would stand docile at the toilet
while his wife or I wiped a continuing stream of stool that was
running down his legs until it stopped and we could put a
diaper on him. We had diapers, we had clothing, we had water
and medication with us at all times if we did go outside.
Jeremy's ankles became so swollen and painful that he could
barely walk.
In Jeremy's final days, his diet consisted largely of
mashed potatoes, which is all he wanted most of the time. He
also ate his favorite cookies that I baked for him and special
granola that his stepsister made for him. He slept on a
hospital bed in his living room and at night he would pull
himself up and with help shamble into the bedroom to kiss his
wife goodnight. When he could, he would sit at his computer and
try to do a little work. There are some pictures here of him
healthy and also in these final stages that I will pass around
for you to look at. He tried to do a little e-mail. And then
finally he just opted to stop. He just stopped eating, stopped
drinking and asked the hospice nurses to up his morphine so he
could sleep his last days away. It was Thanksgiving week of
2007 and he slept but was restless. He had fallen out of bed a
week earlier when friends couldn't stay awake and he was in
constant pain every time he even moved in bed. He began to have
that nauseatingly sweet smell of ketosis that has when your
body is wasting. The day before Thanksgiving, he woke up in the
afternoon and told my husband and I very clearly I am dying,
but it is all right.
And he had a smile on his face. He said some very loving
things to us and went back to sleep. That night he actually
awoke and sang and chanted with his friends. That was the last
time he woke up. On Thanksgiving day, he did not wake up again,
although his eyes were slightly open at all times and his mouth
was hanging open. But he was not conscious. On Friday, the day
after Thanksgiving, my sister's 50th birthday, the autumn
weather was gentle and the space was quiet, respectful. We sang
and read to Jeremy. We wandered around. We were tired, we were
exhausted and wandering and waiting. That night at about 7:00,
I could tell that his breathing had changed and I knew the end
was coming. He died peacefully, his wife holding his right hand
and me holding his left as I had promised. His dad, step-dad,
siblings and friends were all there as were my sister and best
friend.
A helium balloon that had been floating about the room for
several days slipped out the window and floated skyward. Jeremy
had a peaceful look on his face for the first time in months.
We send our sons off to war and they may not come back or they
come back less than whole when they left home. We send them off
to college not knowing where they will go from there but still
we have hope for their futures. We have hope for their lives.
My son chose a dangerous path. He was an activist. He was shot
at, he was threatened, he was in jungles. He was not safe. I
knew this and I feared for him, but at the same time I was
proud. I never expected that prostate cancer would kill him.
Prostate cancer took away my hope. I learned that it is an old
man's disease and I know that it is not. 300 men die each year
in the United States under the age of 40. If that is not enough
for you to fund research, then look at the almost 30,000 men
that will die this year alone in the United States from
prostate cancer. We need to increase funding. What I have
described to you today is the life of someone dying of a highly
aggressive form of prostate cancer. This is not rare. His own
oncologist is the same age and has lost 4 young men to prostate
cancer and many more older men. Perhaps if a more accurate test
for prostate cancer existed, my child would have known about
his cancer earlier and he could be here talking to you himself.
I will never know because there just aren't enough funds to
do all the research that needs to be done. Perhaps had the
research been done on newer techniques, my husband would not be
impotent. It is because of the research we know that it does
not work. There is no question that the PSA is not a good
enough diagnostic test but it is all we have. There is no
question that there are aggressive cancers that we cannot watch
and wait. Prostate cancer kills more men than any cancer except
lung cancer and has a mortality rate comparable to breast
cancer. Each month, I read another article about the inadequacy
of the PSA test and each day I wait for a better test. And
every day I question why more and more funding seems to go to a
few types of cancer, none of which are the greatest killer of
men in this country. It is one thing to criticize the test we
currently have to screen men for this insidious killer and
quite another to find a viable solution.
Unless you increase funding for the Prostate Cancer
Research Program, I fear good research will be left unfunded.
No one is asking you to make the same sacrifice Jeremy made. No
one is asking you to go through the pain that my son went
through, the embarrassment, the deterioration and a very
horrific and painful death. All I ask is that you consider
increasing funding for prostate cancer research so that no more
mothers, children, husbands, wives have to suffer the way my
family has. Thank you for your time.
[The statement of Ms. Galloway follows:]
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Mr. Dicks. Thank you for your very compassionate statement.
We appreciate it very much. Any questions? Thank you. Jonathan
W. Simons, Prostate Cancer Foundation. Welcome.
----------
Thursday, May 20, 2010.
PROSTATE CANCER FOUNDATION
WITNESS
JONATHAN SIMONS, M.D., PRESIDENT AND CHIEF EXECUTIVE OFFICER, PROSTATE
CANCER FOUNDATION
Dr. Simons. Thank you very much. I am Dr. Jonathan Simons.
I am the President and chief executive officer of the Prostate
Cancer Foundation. Nothing I can say can be as profound or as
important as what Ms. Galloway said about her son. I am just
speaking on behalf of the other 27,000 families that aren't
here right now from 2009 that could not articulate the pain and
the courage of the experience of human prostate cancer.
In the last 22 years, I have been involved myself as an
oncologist and the scientist funded by the American taxpayer in
the care of over 1,000 prostate cancer patients. Today I lead a
foundation that in its 17-year history has raised over $400
million through the Prostate Cancer Foundation and actually
funded 1,200 laboratories around the United States and America
and the world in order to see a cure for prostate cancer and
eradicate death and suffering. Our single and total goal is to
put ourselves out of business as a foundation and end suffering
from prostate cancer. What the committee doesn't know is that
probably in the entire history you have been briefed--certainly
Chairman Murtha was briefed this quietly--last year we reduced
deaths from prostate cancer since projected from 1993.
In fact, a 30 percent reduction in deaths doesn't bring
back Jeremy Galloway. But actually between 1993 and 2010,
180,000 American men have not died from prostate cancer who
were projected to through a concerted effort of earlier
detection, advocacy, better care and biomedical research
supported by the defense appropriations committee, the National
Cancer Institute, the Prostate Cancer Foundation. If we did
nothing more except for never except the unacceptable, by 2013,
with that reduction in death rate, we would have saved more
American men's lives than have died in the history of American
warfare on the battlefield from Bunker Hill to the Persian
Gulf, which is actually a pretty remarkable statement, which I
expect the committee has not heard either. But if you save the
half a million American lives by 2039 with the current effort,
you would still be losing an American man, whether young or old
by your definition, every 19 minutes around the clock, 365 days
a year.
Prostate cancer is a molecular form of terrorism and one of
the greatest threats to the lives of the citizens of the
American people. Now, it is true that prostate cancer is
complicated. The committee will learn in July at a press
conference we will hold that out of Ann Arbor there are 24
kinds of prostate cancer. The American people's investment in
the human genome research has actually brought us a very
interesting and complicated story. Unlike breast cancer, unlike
colon cancer, there are 24 kinds of prostate cancer. You can
see it in the DNA and it is unique to prostate cancer. What
would that mean? One, it would mean you have gotten a huge
return on your investment out of this committee. Because after
our foundation, which has put over $8 million into it, the
second leading funder of this research has been the Department
of Defense, a congressionally mandated research program. The
understanding of these genes has come from the National Cancer
Institute and the NIH. It is a concert, a symphony concert of
public-private partnership and biomedical research but where
American people are giving philanthropically, paying taxes and
actually medical scientists and patients like the Galloways and
their families have all come together.
July of this year is one of the most important months in
the history of over 50 years of concerted prostate cancer
research. If there are 24 kinds of prostate cancer, what could
that mean? Well, it could mean that there is a kind of prostate
cancer that will never take your life and it will probably show
up when you are 80. There is a kind of prostate cancer that can
strike you down by 50. And actually there ought to be a test
for everyone. When we indict the PSA test as being an
insufficient test, which it is, we are actually only indicting
our ignorance in our inability to sort of prosecute, so to
speak, molecular diagnostics.
But now we have this ability and actually the DOD has the
program in place, which I will discuss in a second, to actually
fast forward progress. The other thing is I have no personal
relationship with Don Berwick and CMS. But if I were running
CMS in August, one of the most important contributions in
diagnostics for cancer would have actually come out of the DOD.
This test of 24 clona types or what kind of clone it is should
change forever the future of prostate cancer care.
I cannot speak to the pain and suffering of Sherry
Galloway, but I can actually make a specific set of
recommendations for the committee to consider. In my testimony,
I have asked the committee to consider $40 million over the
additional 80 million to fast forward three things that would
improve the lives of families like the Galloways in the future.
One would be to simply put $10 million into fast forwarding
this new kind of test. It is cancer specific. It is prostate
cancer specific and the DOD already has that infrastructure.
Secondly, the committee has probably not been briefed, but
there are four drugs up for FDA approval this year, Provenge,
the vaccine which did not work for Jeremy Galloway, which was
just FDA approved; Abiraterone, which was just in license by
Johnson & Johnson up for phase III review.
There is also going to be Ipilimumab and there will be
MDV3100. All four of these new medicines in phase III trials
came through the Department of Defense prostate cancer clinical
trials program in cities like Portland, Seattle, Baltimore, Ann
Arbor. Actually through an early clinical trials network which
is not supported by the National Cancer Institute but actually
is funded by your appropriation, run by the doctors, the same
doctors that are NCI cancer centers. This is widely
unappreciated as well. But again, prostate cancer has been
largely underappreciated in American life historically. All
this being said, there is a lot more work to do in biomedical
research. The public debate around PSA is really a debate about
a better test and I submitted the data to your taxpayers money
and mine.
We actually have real hope for patients if we can fast
forward that kind of research. What is interesting, though, is
also that the DOD congressionally mandated research program
asks scientists like myself and doctors like myself to do three
things that are unusual in NCI funding or NIH funding which are
largely underappreciated.
When I had the occasion to talk with Chairman Murtha last
year, he squinted and he said why don't we know more about
this. What he is referring to is that when you get a grant
which I have gotten several in my career at Emory University,
and before that on the faculty of Johns Hopkins from the DOD
from this program, you are expected to provide milestones and
actually endpoints and contingencies just in the same kind of
culture that logistics and procurement are a part of life in
the military.
And since I am the son of the greatest generation GI Bill
father, I kind of got it although at first when I was asked to
provide timelines for my research I said this is not your NIH
as I knew it. If you want to put patients on clinical trials,
if you want to study how vaccines work, if you wanted to define
genes and you are held somewhat accountable to simply report
your progress, it has turned out that most cancer scientists
and physicians like myself enjoy it, welcome it because the
program also incentivizes higher performance.
It is the first Federal program for biomedical research
where actually some of the culture of excellent tactics in the
field are rewarded in cancer research. Completely unexpected as
a consequence of giving Captain Kami or others actually in the
Pentagon control the program. It is not a workaround.
It is a new invention in cancer research. And I would
recommend to the committee that it ought to be reviewed as it
actually may be better practice for certain aspects of our NIH
right now. Lastly, with the 24 kinds of prostate cancer, there
are a significant number of new medicines that might be
developed for a Jeremy Galloway. In fact, if you have a disease
that is now 24 diseases but it looks like one under the
microscope, it is no different than saying if you have 24
diseases you have 24 treatments. For our biotech and
pharmaceutical industry there is a huge opportunity and most
practically in terms of asking for 20 million to fast forward
new medicines, 10 million for a new better test than the PSA,
10 million for additional clinical trials--yeah, go ahead.
Mr. Dicks. You have 1 minute.
Dr. Simons. I have got it. In addition to doing all these
things, I cannot emphasize enough the courage of the patients
and families that participate in these clinical trials, Mr.
Chairman. Without DOD funding, the progress I reviewed for you
today would not have happened. Thank you.
Mr. Dicks. Thank you. Another very compelling case.
Ms. Kilpatrick. Mr. Chairman.
Mr. Dicks. Yes, Ms. Kilpatrick.
Ms. Kilpatrick. Thank you, Mr. Chairman. Why would the
National Cancer Institute not approve a DOD project for their
doctors and researchers to participate in as well? Is it
competition or is it who is the best or----
Dr. Simons. It is just that NCI doesn't fund it. In
prostate cancer, early clinical trials, there is not a program
at NCI for early----
Ms. Kilpatrick. So they don't----
Dr. Simons. The DOD funds it.
Ms. Kilpatrick. Right. So they fund it, but you ought to be
partners in the illness because it is catastrophic.
Dr. Simons. I agree, Ms. Kilpatrick. But the last time that
prostate cancer research was reviewed, I was on the panel, was
in the Clinton administration for coordination between the DOD.
After 9/11, a lot of things happened in this country. But a
research strategy for American medical research did not take
place in the last--we haven't--our government hasn't actually
looked at our strategy in prostate cancer for 10 years.
Ms. Kilpatrick. Thank you.
[The statement of Dr. Simons follows:]
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Mr. Dicks. The committee is adjourned until early June when
testimony will be provided by the head of the U.S. Special
Operations Command. Thank you.
[The following organization, Aplastic Anemia & MDS
International Foundation did not appear before the committee
but submitted testimony for the record:]
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