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tv   Hearing on Coronavirus Military Defense Health Programs  CSPAN  March 9, 2020 7:18pm-8:53pm EDT

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watch a 10 am eastern on c-span 3 online at c-span.org or listen live on the free c-span radio app. follow the federal response to the coronavirus at c-span.org slash coronavirus. you can house fine white house briefings with key public health officials and interviews with public health specialist. review the latest events anytime and slash coronavirus. surgeons general from the army navy air force we're here to talk about the coronavirus and
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held him until or is responding to the outbreak. the subcommittee hearing is one hour and a half. tom todd (inaudible) surgeon general of the united states air force mr. cavity assistance
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secretary of defense world ealth affairs lieutenant ronald shea pace, director of the fence health agency and mr. systems. bill (inaudible) program executiveve health care and management systems. ted today we have serious quests on how medical reforms have accounted for on the president's budget for fiscal 2021.ng as b you will notice we will hae numbers coming inn and out. we are getting briefings on o covetedn bu 19 as we speak and other meetings going meon. and your full testimonies we will get started across thebudgt spectrum of military health care system for military readiness to benefit care, and manydeci cases budget justifican slacks that detail. for the subcommittee to make informed decisions. we hope the witnesses today can address the subcommittees questions and concerns at a
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particular interest, we look forward to hearing about the rule and the department in addressing in assisting other faith agencies dealing with pandemic possible outbreaks such as covid-19. the department study on reducing and eliminating certain health care services and mentally many mid military treatment facilities, heand an update on the departments ge electronic health care system and the sage genesis. we look forward tok yoyoap hearg about these topics and more. i want to thank you once againn appearing before the subk committee and i want ts we'd like to mr. covered for cod his comments. thank you madam chairman andon thank you fora, referring to ths horrible disease. i'm from california we want to makeid it sure -- i want to welcome our panel.ished
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this is a critical year for the mid-military health care system or trying to keep the cove it fires from impacting readiness and structural stints changes to the system. these changes include changingad military treatment facilities to's consolidating some facilities and shifting more on operational readiness. plate.ile continuing to implement a new electronic health records system. we have a lot on your plate. given these issues will impact a broad population including military personnel, dependences and and retirees, i cannot overstate the importance of keeping us upright prized of your when you need help. we must make sure --es s during my time, i will ask you to starting with the preparedness and resourcing for covid-19. intwe all know the impact it hg
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globally andat i will be interested inorce. your plans to mitigate its effect on the force. theialaska about your views on structural changes to the military health care system and the potential impact on readiness. nicfinally, i look forward to hearing about the progress on with implementing the new electronic health records. thank you for your service. i will fortuitous des moines. mwith that madam chairman i yield. back joining >> thank you.u. we will break for any statements that they wish toced they arrive. as i said earlier, your full was written testimony will be rif placed in the record and members have copies at their seats, and i told you i was i reading it last night and we have it and we thank you for. it's in the interest of time,t however i will strongly encourage eachch one of you to keep your summarized statements toinut three minutes or less. i will let you know when you are at three minutes. i will do so gently, and it
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might get a little louder with the gavel. lieutenant general dingell will you lead us off with the three minute remark? >>. thank you madam chairman distinguished members of the south committee it is an honor to speak before you today. we would conserve the fighting strength as armies are called upon to deploy fighting one wars nationalnted defense strat. we are part of a center just a joint voicee that is represented before you today. chief of staff of the or army rely on our prst like general mcconville i and everyone army medicineneso recognize the streh my vision on our people, soldis families, civilians and fo soldiers for. like our greatest strength and are most importanty, asset. we are sure that we remain ready informed responsive an relevant in this era of
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unpleasant did global change and uncertainty. large-scale combat operations oremic pandemic emergencies as e armyidomai undergoes modernizata supportin battlefield, we will ead t hethrough change and reorganize to remain relevant to the warsive fighting. our unwavering commitment to save lives on the battlefield will never change. obusour adversaries may possesso robust anti access and area car. denial capabilities that would test prolonged field care.ide consequently on medics, we will have to sustain life and austere occasions. this requires changes in our training. army medicine must leverage 21st century along with cutting sting edge p research andreve development in remain professors and disea proficient. medicines system and treatment of infectious lea diseases similar to hiv andd t
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ebolao responses, army medicina working with an agencies and institutions to combat cove it 19. our ability to prevent and treat infectious diseases depends on army research the development and capabilities that enable a medical ready force and a force that is medically ready. and closing, i to want to thank the committee for allowing my colleagues and i to speak before you this morning. america and trust the military health system, army medicine,er. it and the services, with thisrighe most precious resources our sons andment daughters. it is imperative that we get it righ and we will. your commitment and continuous supportort assures the joint ful force that causwhen a wounded a soldier cries out and medic in combat we will be there ready to respondestion because our mee is army strong. de look forward to answering your questions. >> thank you that was delivered would precision timing. >> good morning manning chairwoman mccullough, ranking o
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member and subcommittee. on behalfe th of the over 60,000 men and women who mission ready medicine team i'm pleased toedic be here today. is i'm grateful for the contind place and. itss mari mission of navy medics tightly linked pre to those we serve, theoss united states nay and marine corps. tarab illiteracy to prevail across the range military operations depends on the medical greatness and capability to enhanced survival, at its this core survive abilits navy medicines contribution to lethality. to the senate, p medicine priorities people platform performance and power strategically aligned to meets some paradise. well trained people working as cohesive themes on an optimizepl platform, demonstrating violence city performance that will protect medical power andnn supportive naval superiority. i'm telling you that these priorities are rapidly taking hold. in any given day navy medicine personnel report and full range
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including damage control, resuscitation and surgery teams, traumadaha care, natal role national medical unit in our airfields, afghanistan ships, humanitarian assistancetection hospitals, expeditionary health service support and protection around the world.. no doubt that people are the upper center of everything we do. dedicated, active and reserve personnel navy civilian serving around thehe world's tot support our. mission in order to make current future challenge we worr must recruit and retain talent medical and civilian workforce. medicine continue -- spe including critical wartime an specialties as well asng mental health care providers. importantly combatting dir 29% of our unifoo mental health providers directly with fleet fleet marine force and training commands to improve access to care and help reduce stigma. all of us have a responsibility
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to do everything possible to reduce dthe incidence ofs suicide. it's impact it's devastating and effects families, shipmates and commands. collectively, substance of military health systems reform directed by congress fiscal year 2017 and 2019, national defensetaly authorization actsrr represents an important inflection rea 0.4 important medicine to catalyze our efforts in health. navy and marine corps leadership recognized the tremendous opportunity we have to refocus our efforts well trained transitioning health me. care benefits and death. rtunit may just reform presentsh challenges and opportunities. point to progress made to date u all of us recognize there's much workti seahead. nation depends on our unique medical expertise to prepare and support our naval forces. it is a privilege to carryllum: sailors marines and families
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thank you for your leadership and we look for two questions. >> thank you. k,>> lieutenant. >> i.c.e. chairwoman mcallenfy n and distinguished members of the subcommittee it is my distinct offer honor to testify on behalf of the 64,000 active duty guard reserve and civilian airman to comprise the airports air force medical service. >> we answer calls a cross broad spectrum operational and o humanitarian response missions. from the clinic to thethe most n battlefield and even the backe of an airplane,,most our abilitn deliver a life sustaining care is the most challenging in the moststthe challenging environme ensures that our warriors return home toetency their fami. the air force medical services n core competency of aerospace movement medicine and medical evacuation focuses on the needs conductnd space operators and containers. since september 11, air force medical of vibe regulationmovemt crews have conducted more than
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340,000 global patient dep movements, including 13,500 critical carerang missions. in 30% of downrange careist, isea trauma related. battthe remaining 70% is disease non battle injuries. he's injuries d range from occupational, dental, and musculoskeletal injuries. training and currencyto opportunity mirror the scenarios to produce well-rounded, flexible medics, who can accomplish any mission under the most unpredictable conditions. as a national defense strategyc, shifts focus, the global conflict, and pure competition, the air forces posture to increase lethality, strengthen areas.ces and relying resources. medicalrce ilmedical servicesl evolving in support of these national offense objectives. cal teby investing in our medicl evacuation platforms, around surgicalepar teams and broadeniy every medic skill sets. preparing them to deliver where
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we may not have the access function in the air feels oror state-of-the-artequi equipment. a story of senior airman, colleen mitchell a youngmitchels medical technician drives home the critic elegy of this lastwhn point. and january aaron mitchell is on her first employment when i'll show bomb militantsy the c, attacked the airfield in kenya f killing three americans. awakened by the chaos, she tria, assumed the role of league spending hours operated we triage-ing and treating patients. working with limited personnel she operated well above her payy great and outside her comfort zonequal to save li. makairman mitchell demonstrates the qualities that makes our medics remarkable. leadership, technical skills and an unwavering commitment t missions in those who we serve. didas a surgeon general my responsibility is to forebear every medic and prepare medics and i do not take this type task lightly. our primary readiness platform sometimes fall short of patient
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volume diversity and acuityunith needed to sustain medicaltion currency. leveraging additional training opportunities through civilian and government healthhealth care organization has paramount. and will event it visited bleak grow military medicine presents uniquecont challenges that a civilian health care system does not encounter. our medics will continue to rise to those challenges. thank you for your continued support and i look forward to your questions. >> thank you lieutenant generalc >> miss chairman column and ranking members of the committee thank you for ther opportunity i just have a few comments. principle mission is support and tha readiness. within that u mission or two distinct responsibilities, t first to ensure that every person in a uniform is medically ready to perform their job anywhere in the
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world. secondly is to ensure our military personnel have the cognitive and technical skills to support the full range ofcy s military operations which our leaders may call us to perform. agency ise healthth accountable to the secretary of defense to combat and commands andor the military departments. the dhs zoom responsibility for managing all military hospitals and clinics and october of last year. closely with my colleagues the service surgeonss general and the joint staff search and, we continue to view our medical facilities asir readiness platforms or medicalf professionals from the army-navy air force both attain and sustain their skills and which these professionalscal deploy and support of military operations. the d.o.d.'s latest leadership implemen assessment of which medical's es facilities best support this a readiness missionmann provides e basis for moving forward and implementing these decisions. we intend to execute this plan in the matter that continues tot ensure that have timely access to qualityy
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i'll highlight a few important points. first active duty family members or required to out-of-p transition to civilian network . providers who incur little tooia little tori no additional out oe pocket price for their care. second all beneficiaries in cha these locations will still enjoy access to pharmacy. finally, will implement changes inin reass local market handles can handle. that particularly location is more constrained als than estimd weween will re-assessment our plants and adjust them. u the surgeons generals and nifoie proposing infrastructure and uniform medical personnel is coordinated. synchronization will bee reflected in medical personal theuction plan required by fy 20 nba section 7:19 as to thensur congressman in june. budget to make sure using ther resources provided in our congress in a matter that most effectively supports our readiness mission.
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establish cou health care markes to specific regions of the country. ywillea be establishing otheria market throughout this. your local military andhat medl leaders will have the authority andeful responsible that improvs patient care and already knowsmt functions. i'm grateful for the upon opportunity on our efforts to mf standardize military support to commit military departments and tore patients. thank you to the members of this committee to yourcollum: commitment to the men and women of our armed forces in the families to support them. >> ranking member subcommittee members of thef of subcommitteen behalf offens the secretary of defense it is an honor to ore sk before you today, representing military ande for civilian professionals at the health systemem, to support our war fighters and care for the 9.6 beneficiariesr that our system serves. i am pleased to present to the defense health budget for the
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fiscal year 2021. a budget that prioritize is a medical readiness of our military force and there isalitr readiness of our medical force while sustaining access to: quality health care for our beneficiaries. our proposed fy 21 budget request 33.1 billion dollars for the defense health program. this proposed budget reflects our continuedth s implementatiof a number of comprehensivend dept reforms to our health system as directed by congress andnd departmentco leadership. some of the significant reforms are the s anfollowing. consolidating administration and management of our military hospitals and clinics under the defense health agency. right sizing wit our military medical infrastructure to focus readiness within our direct care system and finally, optimizing the size and composition of the military medical force, to best meet our readiness mission. in implementing these reforms, the department is guided by two
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critical principles, first that our military hospitals and clinics are first and foremost military facilities, whose operations need to be focused on meeting military readinesse y requirements. that means that our empty f's serve as a primary platform byit which we ensure service members are medically ready to be trained and deployed it also means that our and tee appsthate will enable or military personnel to require andmat maintain the clinical skills that prepare them for deployment and support of continue combat operations. second, as we reform the qualityy health system, we continue to make good on our commitment to provide ourlth sy, beneficiaries with access to health quality health care. while we implement theseio changes to the health ritysyste cont we also continue to pursue ourl other prior terry initiatives that have contributed to the woa achievement of the highest of battlefield survival rates in historycont while providing worc
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class health care tore millions of benefit fisheries. we continue deployment of our electronic health records, our ongoing operation of cutting edge research and development w programs which congress in thisl committee have long championed. of that work in that area is playing a significant role in whole government effort on the covid-19 issue. i want to thank the community for you continued supports in efforts into the men and women of the military health system in the millions depending on us. your support has helped us achieve and continue to driveh forward unparalleled success in building and sustaining the military health system that delivers for our service members our beneficiaries and our nation. thank you. >> thank you mister tilston. embers of the su ranking member killed her distinguished members of the subcommittee thank you for your invitation. i
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executive office health care managing systems. it is my honor to represent this team of professionals and their s efforts to achieve singe comment and or health records veterans in their families. patient center cares, not only the way to describe permission but fundamental to our design. capturing critical data on the field and medical facilities. we understand the patients are focus our patient centered model highlights the broad spectrum of people who depend on hims do a chess genesis. the systems do not create success people do our progress engineers and other business professionals who comprise our aim h. as genesis team. i want to thank our champion tof general pain and our might be a counterpart as we deliver single common record. september 2019 we completed installations acrossted california and idahoen without anyesis patient issues.
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damedical air force base itss demonstrated confidence in any chestefor genesis.iv e, ta patient arrived with suddn cardiac arrest the team had a choice. chose them age as genesis and that was the right decision. with every employment we improve capability delivery for instance establishing purity peer training successful, that major general page as we move forward with the employments -- the summer aim ages genesis will employ more than doubling theg employed sites as we movedr forward we seek todeli industrialize our process while meeting the unique needs in each side in order to optimizen. an delivery to the nfs. we've proven that mh has p genesisar improves patientcess,l experience anytime we can enhance patient care we absolutely should. as part of that process we will. cr continue to assess risks andun ensuret that fiscal dollarshinw count.
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critical to making dollars countill la is up to my easing , efficiencies within the next few months we will joint help pe ith the va expanding d.o.d. connections with private sector signifiare and closing, as the stalin brothers i'm truly reed m invested in the success of thisi program spending significant time paul to read critical lucky of tra delivering patient centered care. i'm confident e we have the rigt in the right place, we c value transparency and you the community,y, car as the wise. ge sentiment goes it's amazing what can be achieved as long as gets thecare who credit. thenity and age as genesis teamr makes a difference in the lives of every american. thank you i look for tier questions. mrs.hank you with humility and honor i turn to the full chair as the appropriations community miss lowey for a first questions. >> thank you.
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oh boy. thank you i need some health care i think at this moment. but that it was all checked up. i just lost my voice. i wanted to come to this hearing. , thas you probably know, this committee and the other committee focusing on veterans has been waiting to get a w health care record system that works. as you probably know, mr. tensed in, for decades this committee has funded efforts ton modernize the health system both the va and the department of defense in particular efforts to address electronicfi, health records. i understand, because i've had so i briefings, hearings on this. the last five years at least. i know it is difficult.
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but frankly, our service members and their families haveo been waiting for far too long, and the taxpayers have invested too much to continue with problems and delays.a. a i am not saying that it is all va and d.o.d., is perfect. ad aare you learning anything b this? we had a hearing not too long ago with the va, and the last i looked at is the department is requesting sai another billion, and case anyone thinks i said million i said another billion in fy 21. whyi don't get it maybe you can explain why this is taking so
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long. if this happened in the private sector, they would probably be out of business, but you are too valuable and in no way can you be out of business, but i do not understand why you cannot get this done. my colleague, mr. rogers is not here. we have had closed door hearings. open hearings. r biprivate discussions. another billion dollars. why can you not get this right? >> ma'am, in september we deployed to weigh travis which was we a couple of our installd paces of deployment. we change the way we delivered the infrastructure, the way we delivered the training wewe prepared people to be effective and doing their jobs and at this point, we have 66 sites underway with the way coming up next with ten sites.
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i think we're doing, we're making tremendous progress from age genesis to the militarygram health system. working very closely with thegle program because really a deploying thes joint system here. it's a single record for bothcee departments. as the da starts to bring theirt sights, we will have one instance of the record about the patient and not where it was delivered in the care to any provider.anatio >> can you give me a better explanation as to why you're still bringing on sites? why is this so complicated? the va, if the va isn't up to standards, they can't getm a records from incidents that may have happened two or three. years ago and getting adequatey health care?th
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>> when you're delivering an health record of the transform nhs genesis, it's a small piece of transformation it's an you organizational transformation and the training challenge andus you deliver theto right the phy capabilities, you then have to b customize the record of the facilities you're supporting andntro have to train people toe effective with what you've introduced and have to be very deliberate well bringing people up to speed so that we don't compromise the health care delivery as we deploy hhs genesis. >> 4.6 billion and now you want another billion. i am sure that our great
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military has had many, many complicated missions and're say, frankly, i don't understand. i understand what you are saying bye don't understand why you can't get it right. i just hope that next year you won't has ask for another billion with 4.6 billion dollars and the expertise that you have in the military and that this task could have beennf completed. i've been hearing one excuse after the year and as mycause colleague mr. rogers was hereme we would be getting even read meetings, nd we've had public meetings, private meetings ok, i guess we'll have to give you . another billion dollars i can other things. of i sure hope you get it right this time. can you guarantee this is going
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to do it? >> you have finally the tinston: expertise to do it? >> congresswoman, we have the ha right people in the right place to be effective at delivering -- >> i've heard this the laste five years, you know. >> yes, ma'am. yea>> these people are morems? mr expert. they really understand the systems. >> yes. >> okay. mark that down in the record. thank you very much. >> so noted. i recognize mr. calvert.airm >> thank you, madam chairmanere. i' and thank you again >> >> chime in. mr.town the u.s. army headquarters that they have over in the change was surrounded by new cases of a virus and indicated
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unfortunately so far there's not anything new this morning. they have not been affected and that's a testament to the great work and their preparedness to protect our force. as this virus continues to spread, what steps are you taking insurance with overseas r and within the united states to make sure the protected and you need additional resources fiscal yearar 2020 at the presidents request or in the supplemental that may be available to military also. to continue the safeguardmaybe l against covid-19. iown don't know where to start maybe will start down here at thechime end. >> i'd be happy to kick it off and my colleague can chime in. >> chime in. mr. calvert, so when the d.o.d.
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looks at the covid-19 issue, there's really a handful of priorities we look at. first is the safety and health and well being of ourvern servie members. that's very much tied to ourpp ability to, as we deal with this issue, to continue to meet mission, and third how we the d.o.d. can support the rest of the federal government in the all of government approach and strategy on the covid-19 issue. regard to the: with to guidanm around the healthen and well being of our service members, the department has issued a series of forceerie healtho protection guidance toou our service members and ourcommande. commanders built largely cdc guidance and soce things around identifying best science and cdc guidance on risk to personnel, healthrote care workr protocols for screening of patients and reporting any detected virus,
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it's also around giving guidance on to self-protection, you know, common hygiene in terms of protection against virus and deparwe also are givg guidance with regard to working the cdc and the department of state travel guidance in coma terms of restriction of travel r to and from selectec countries. most recently, sir, giving installation combatant, the commanders with regard to how particulartheir situation on the ground, be it at installations here or overseas, and what kind of ma guidance they should use in making their flexible judgments about protectionsir to put in place on their bases. again, everything from restricted travel and access to their bases. as the cdc issues additional guidance or things change in terms of travel advisories, we will continue to update that
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guidance for the field. >> thank you for that. any other comments on the forcee itself? i was curious since yesterday, has there >> been any other transmissions? >> not that i'm aware of. we have had disease y containmet plans and pandemic influenza plans we have exercised at different points -- in time and now we're usingngno those planso help guide andacti direct our actions inlth relationship to e cdc and health and human services guidance. >> >> from an army perspective, we've taken a three-prong pproach of prevent, detect, and treat. arenesthe prevention is the edun awareness of fooall the soldies and family members within that installation commander or senior commander's footprint. as wting tothe detection piece e
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screenings we're doing as well as the testing to verify the presence to acknowledge if it is, in fact,mr. symptomatic and those have been identified. >> south korea specifically. >> yes, sir. >> are we -- you still have nod hat additional transmissions you're aware of? >> no additional. one soldier and we havena soldio dependents right now in the treatment mode and then that is the last phase ofof treatment where we haveve pandemic expansion plans or response plans and every installation, e emergency preparedness and we're even going as far as worse case scenarios on bed expansion plans. treae taking a wholistic of pr approach of prevent, detect t a> treat as an army. >> in south korea specifically, is it general abrams pretty much has all the facilities shut down at this point? >>tedor the prevention piece toa ensure we are not spreading and they have not implemented some of the normal activities that bring together large gatherings. whether if it's school,l,instalh installation commander makes that call under the guidance of general abrams, yes, sir. >> >> okay. admiral, anything to add? >> yes, sir.
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i would just say that i would like to thank the committee for the investment that has been made over the president's budget for our worldwide network, triservice network, of research in , specifically can say for navy, our research labs that are in singapore, as well as in italy, are at the forefront of the global response to this emerging pandemic. invesbut that investment has -n our scientists andndle really world-leading knowledge and research is now bearing fruit and you're seeing that dividend in thee14 sense that we now have 12 of 14 d.o.d. labs actively able to dok you. diagnostic testing around the world. >> thank you. >> and congressman, just d.o.d. hawide, so we have, as of last12
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night, >> four confirmed cases and 12 suspected that are being tested. >> where are those cases at? he>> i don't have that breakdow. this is across the d.o.d. .>> any cases within the united states you're aware noof? >> i do not believe d.o.d. cases as of yet but i can get you the updated numbers today and break it down. >> appreciate that. >> thank you. ai'm going >> >> (inaudible) ts
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fda, cdc are developing the vaccine. the other information i would like to share as soon as of ress possible, for example the our federal government maintains the stockpiles those respirators and that comes to to all of oure attention a number of these respirators are about to logistd expire. the military does logistics and. stockpiling with great like infm precision. sohe , we would like information on the department and how you are maintaining your own stockpile of respirators andn ow you wouldld distribute them on the different branches ofou servicesld needed. this sarea, what role should thk d.o.d. play in working with our public agencies to maintain p proper stockpile supplies for our country so it could be that are prepared of health care crisis.
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if you could follow up and give that information to us. my question is on military downsizing. the a department provided congress on february 19th, planned closing and downsizing of 15 d.o.d. d facilities. i would stress reward report because it's just a list ofuld e impacted facilities. some of the comments on the downsizing where there would be no out of pocket costs for soldiers -- soldiers or airman that havenift changed. but there are other things that can impact health care not only to thed person wearing theto uniform but the family that's behind thatlies person. our uniform members need to know the families are well taken care of. bottom line is, we still don't have a timeline and projections of costwhile saving our plan fr implementation and these readin downsizing in cultures. i understand theoops department wants toe im focus on increasint
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medical readiness for medical f forces and the impact of this im changes.ion will be significant and trust me, we willumbe hear from the individus family cate impacted by these changes. some members i have seen up to 200 familyaw --.o.d 200,000 family members and retireess across the country pro would be pushed away from d.o.d.. medical treatment and facilities none to civilian providers. we need to understand what that like. oks secretary, your office has been thinking about this for a long i time since you do have a list of facilities that have been impacted. liti be a document somewhere to backup these facilities and how they were chosen. mister secretary, how can you expect us to be -- doing our due diligence with our funds and our militaries treatment facilities when we haven't seen a comprehensive transparent plan from your department on what? when?
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on how this will be implemented? additionally, reports are outd february 19th states and i quote, upon submission of thisth report, detailed implementation planning will begin with outguae limitation in less than 90 days sounds later and we need thehough the t information. language to me and too manyngre sounds like the departt moving mlieves it does not require congressional approval prior to moving forward of the implementation. doesrior the congress need to sp its approval on the plans to ecommendation prior to the departments moving forward withe the important point -- inflammationd plans and focuses on military treatment written facilities? final question for now, t as we rate your written us response as soon as possible. if you are not ready to tra transmit to us a comprehensive andndth transparent plan, why nt just not asked for a delay of tr organization so we can get it rightin and not cause any
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confusion or of appropriating it's funds. eswhen ask your patience, soldi, marines ask us what is happening to them and their families? >> i will try to go through each of the questions and if i miss something let me know and we will follow up. with regard to the department this is coming out of the direction from congress to assess all of our hospitals and clinics to ensure that we were matched with our primaryat missionform of the facilities ae training platforms for medical force and ensuring that our active duty could have access to care to give anybody to be able to do their job. that is the focus and the reason why in our report to
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congress we identify with some attempt to that we recommend in a reduction in the services available and it is because of attempt to tie the empty effort to that raid this readiness mission. what i meantient by that there s facilities where the volume ofc caseload and type of k shun caseload is provided in that particular empty f is not e a good matchd for the type of caseload that our providers needect to maintain proficiency and those skills that we expect them to have. >> we have a limited time andccf when can we expect to follow upu and in making you're documents to follow up with them and in a time frameexpe within a matter p monthspo they charge you with
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this and when can we expect to follow up? i wills outline that. creethe report to congress with8 u.s. based hospitals and clinics they determined 77we needed a deep dive and theas report went through to identify those and the methodology that wa used in the community and vulnerability of care and health care and out of the 77s h and we determine 21. >> we have the report and whatt when iseach the implementation r coming? >>e bemmen in the report, theree facility there's an entire use s case that we use specific and the report very clearly says
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there won't be any immediate changeill be there's not a one d fits all and based on our work in our community. >> i would agree what i've seen that we need some mores information here so i look to followwant t up with the commite can have a lot of members here of a lot of what you want to hear what's on the i w mind of e members of congress. i thank you for that but i would say ready the appropriatis committee doesn't feel as fully informed and ready to go. >> i'd be happy to provide. >> and with that i lost -- mr. carter, you >> thank you.
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tryingi appreciate all of you bg here. i'm trying to learn all this stuff. this gets dang complicated. trlieutenant general place, how is the transition of military treatment facilities to the dha going? cartwhat are some of the success you've seen? what are the challenges you're facing? while these treatment micilities transition to dhs,s, this past october, the services are still supporting dha to keep the train on the tracks. litary tthe surgeon general dess the support that you continue to provide to the military treatment facilities in dha. lieutenant general place, what
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is the plan to decrease from the service?at >> it's a complee context and complicated transition. it's not going according to the plan but not that everything is perfect, not that we're having challenges but in general the effectiveness of the delivering of our actions to plan, were actually making good improvements in the quality of care in which we're delivering care and use of resources that's been generous enough to provide. in terms of the successes, he success were finding is in a particular regional market, our ability to utilize all ourropriy resources in the facilities to include staff. to align the more appropriately to where they l occan best prove healthe care. similarly, we're using aeatm
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particular location in this achi particular military facility care from another to move patientsiz around to achieve their best quality of care. the standard within a marketth has beenat a success. in terms of the challenger exactly right. that is the reliance on thehe department to doing it provide the reason for that, the staff that's been doing it fororhe decades are slowly but surely transferring into both our headquarters and into our regional markets. r thas of doing that, we're shas responsibility with everyone for oversight of that staff.ar that shouldti continue for approximately another six months and anticipation at the end of the w summer with the majority of the staff will need to be transferred into these self agency headquarters and the service medical departments that are u.s. based. they will be significantlyo diminished in the whole area. there's some that are still
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somee for the way we do our financing because we use different financing systems and we still need to collaborate on some things about the majority of them have transferred. i think i got to all yourould questions. yes sir (inaudible) >> yes, sir, i would echo this is a very complicated w merger of four cultures, if you will, and we'll get there as long as we get there using manageable risk. what that means for me is wenue need to transition before we t transform, so we need tohe be able to continue supporting the defense health agency and standing up it's capabilities to manage these military treatment facilities because if you remember in the past, dha wasn't -- didn't come out of that. they came out of the old tri care management activity, and their core competency was writing and managingting contra, not managing mtfs so we need to
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help them do this mission. and so i would ask if we not add additional changes until the defense health agency is standing on their own, is well-established and has been managing the market with period demonstrated success for a period of time. >> and mr. carter, i would add thective, wt complexity as you mentioned is extremely difficult, and from the army perspective,cham you k, what we have always at th champd is that we cannotight. fail at . et iwe have to get this right, d in order to get it right, the focus should be on the mtf transitions, which starts with headquarters. the headquarters is not up and operational and running, and it will continue to require their direct aftesupport. heafter you get that headquartes stood up, you can start
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transitioning the military medical facilities and we should also be focusing in that transition on the electronic health record. from the army perspectived. thet is the most key thing as those tractors are not allowing us to get right. >> is there anything that is not complex? (laughs) the real question we ought to be asking rig is what do you base that on? about anything as throwing it off balance? is that glum going to hear from? t'she will be telling me they're not getting what they need. >> we continue to track the patient every location that has already transitioned into the defense health agency, and the patient satisfaction scores at each of those installations are at or above at every single locationer
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that's transitioned is at or so above what they were at baseline before transition. not perfect, i'm not trying to tell you that its, b is, but improving. >> sir, i would just add that >> we remain committed in navy medicine to creating a truly integrated system of readiness and health. going through this transition has forced us to look very carefully at our medical readiness requirements, and i will tell you that as we have done that, we have identified opportunities for focus. i mentioned in my opening remarks, we now have almost one-third of our mental health professionals embedded in the fleet and fleet marine force, so we believe that we are >> seeing as citing as success, we are seeing increased focus on the wellness and readiness of our war fighters. >> well, and not to change -- take too much more time, but this morning i was thinking
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about the navy because a cruise ship is coming back into the united states waters because of the -- once again, the virus, and i thought, my gosh what happens if we >> get that on an aircraft carrier or a submarine and the complications that's going to make for our naval forces. >> i appreciate that concern, in and that's something we've thought very carefully about. and as mr. edmccaffery said we are workingr closely with the cdc,ld worldjo health organization,in north com and other joint staff to understand how to eliminate that risk, so that is why one of the -- one of the requirements is that we've established in the fleet is that no ship, no ship having left port will go to another port or arrive in another port and disembark within 14 days. >> thank you. >> thank you. >> thank you mr. >> thank you madam chair.
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thank you for being here and appreciate your work. i want to direct my question on the coronavirus and the use of basis as you know the secretary of defense proved a request of the department of health services for health and support for those that have to beict quarantined. one of those places and san antonio at the air force baseid as you know there was a particular situation that waskn releasing anow individual. you are all providing report serviceshat and are allest. coordinating. they release somebody that had a a test and that person would got to the mall and when around sana antonio and that caused the problemroto because the second t camehat back and it was a protu
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modification that the cdc director sent off and are you all familiar with this letter that got sent off about the modification of protocols? mr. cuella sure which communication you referringr: t. >> just basically the modification of the cdc changesd and there were two changes. one, it's quarantinedperson had individual and that person ought to be released if that person had to negative tests within 24 hours. theymodification number one,t no pe modification number two which is the most important where i think they messed up was, no personthat would be released in their impending test result.st i that's what wes saw in the san antonio area.in g my request is that i knowd you'rebe supporting those services but i think the it's is modification should be
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something whether it's in south korea, pl wherever the case may be and i wouldthis. ask you if you're not familiar with this to please be familiar with this. any thoughts or comments and i want to ask we you a second question. >> e whwe will make sure we have the same guidance and i believe we do have the picture of what you're tshowing us. as you pointed out, this is a good example of where the department isn't a supportingsta roletions in and make an efforto the use of military installation and the citizens and their role there within our installation to help services and cdc once those folks are on the ground with that privateibility and our life and care. due to the testing and any kind of referrals of the health care we sector. we deferred to them on managing
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mr. cu that area but will take a look at it. i >> understand but and have you'reprovided services off in south korea and you better be familiarar with this protocol. second thing, what i want torc ask youh is is the wall to reads working on a vaccine against theon corona virus and can you give us theer o status of that d number one and i think they're working on a state testing kit and how close are we to those two points. >>f th so, the military health system is part of the broader inner agency looking at canrything from diagnostics, vaccine research as well as their apiece for if you have the condition on how they can be treated. in.i.h. fact, we at cdc and nihe all in progress on what's going
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on on the vaccine. it has been ongoing, i believe clinical trials for that might be for another few months, so in terms of a final determined fda approved vaccine i say we're looking at 16, 18 or 24 months. that's from the research we're doing and we can't speak to similar research through what we cdc is doing on that. similarly on an anti viral therapy we may be closer there in terms of something that could be usable that's actually. in clinical trials right now mr. cuel for testing of it. >> as a close, i would just askk youou and i know we're putting a dollars in research andng i understand in different areas i want to make sure that we'res coordinating working together as the we use this large amountf federall house passed supplemente
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yesterday so i just want to make sure we're all coordinating, thank you for your service. >> the mr. womack. thank you to the entire panel. i want to direct my question to emerald dillingham. i will pivot away with all these flavors of the month and i want to come back to tactical the las medicine. it is my strong belief that in the last two decades, thanks too efforts in the entire scenario to better prepare our men and women to perform battlefield there are melon medicine which has savedoo
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banged up aves and a lot of people that have been able to go to their families albeit bangededpr up, a lot and in previous wars they died on the e battlefield and in my regiment that many years ago, we had abal robust program and i think combat lifesaver program was we. probably the reason why we've done m so well. i know that the military services are transitioning from traditional combat programs to a more robust tactical combat casualty program. is wouldstil like an update, iy understanding that that process is still evolving. that the tear to tc three program will become that bedrock training for our
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readiness posture in the event that we were to engage in a near peer combat scenario and a must more mobilized combat are program that would be important. can you explain to me where we are in this process? how is this going and where do it unfolding in the next year or two? >> mr. womack, first and foremost foremost, let me thank you for recognizing the first responders. oftentimes a combat medic and that combat lifesaver do not get the recognition that they deserve when they are the very first responders that stop the are enablers to the sustainment of life in combat. gramwith that said, you are absolutely correct. our program is goingmy tremendously within the army. we call it the army medicine medical skillsch sustainment program, which it involves everything fromat expeditionary
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combat medic care where we're teaching them expeditionary medicine and how to provide pro prolonged care in austere are environments all the way to where we're taking our trauma teams as you mentioned, and embedded them in our civilian facilities, those trauma te centers so that they can get the touches not just as a trauma surgeon but a trauma team. urremswe're going to expand thas year in fy 20 for those trauma teams to three more, and then we have about another eight more that are right behind those. ein reference to those enlisted training officers, we have what we called our strategic medicals asset readiness training. that focuses once again on that just trainingnot them in simple training environments, butttin also pullg them out andraum putting them io some of those trauma centers, too, sohe they can get those >> individual critical task listsar trained to proficiency,e so whn
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they are called upon they'll be ready to respond. tobruce.spon d.>> thank you, congressman womack. as an orthopedic surgeon whowas served as the officer in charge of a surgical shock trauma platoon in fallujah in 2004, this is an particular interesting to me that we continue to get this right. i will tell you that in addition to moving up in terms of the capability at the -- for the -- our enlisted providers for tccc, we're actually in the process of training the entirety of the ship to have those basic skills because as terrific as our independent duty corpsmen are who are responsible for the medical care on our ships we are in the process of training the entire crew with fundamentals of care. >> i have one follow-up
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regarding there is a lot of technology out there regarding plotting material in the application of certain bandages. are we okay with our stockpiles? are we peeled brokering these new technological advances in a timely way? so we can use the very best that we have? and that golden hour and in those first few minutes, those would be losipment will be >> iical to helping save lives when otherwise they will be lost immediately. >> i can't speak directly to the supply but perhaps generalem price orendo mcafee can speak in bettersear detail. but there is tremendous commitment avein the research enterprise to make sure we haven
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absolutely the best possible equipment and technology in our providers. >> in terms of quality and quantity, the research that has been occurring which is a problem on the batterer -- battlefield, for extremities come in and in the avenue and the cutting edge research to be able to use in those conditions. it's not just the quality of the qualities that we have. >> thank you for the service and appreciate the answers to my questions and i yield back. >> thank you. i saw the techniques we were working on and it's truly amazing and we'll have an
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application with civilian health care world as well. ms. kirk thepatrick. >> thank you, madame chair, >> and thank you to all of the panel. excuse me for being here. prior to coming to congress, i was a hospital attorney. i represented a regional hospital that had a number of smaller clinics within it and spent a great deal of my time on medical records completion. it's not easy. it's very complicated, and one of the things that i discovered was that there was a real reluctance by some members of the medical staff to use electronic medical records, so they were used to dictating their charts as they made their rounds, and then that chart would go to medical records, and then somebody would transcribe that chart in medical records so that it could be electronic. it was very cumbersome, took weeks, and weeks and weeks to
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complete. so i want to know a couple of things. the other thing we've found is that it's really difficult to attract young people to residencies in the v.a. , and so i'd like you to address what you're doing to recruit and attract young people into the health care system, in the delivery system, and then what's been done to improve the use of electronic records, let alone let alone interoperable interoperable, we can't even get to that until we have the electronic records in the system. that's an open question to anyone on the panel that can address that. >> let me start with the largern question that you asked and would defer to the militarynd rn department in terms of thee specific that were looking to recruit andtary retain young people ando the medical side of the military. youcord a indicated the challenf
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adoptingoot a public health recd and i think that's something ser that's a foott stomps here for my experience in the private a sector and even systems like kaiser that are very sophisticated and the health record took several years and many of the reasons you pointed out is not just this technology it's how you train the workforce in new technology. what other were flows you need to match it up and this changesl ins. management. it weighs in with some moreparts detail but we purposefullyrolled ruled out the department of defense and we did it in a test way in for facilities and those upgraded to learn and inform the larger deployment in many of those things. n sethat is what has led to thee
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most recent deployment in posits september, which went far betterer than we were really wes positioned out to pursueue ways of getting it on that. throughout the system. i don't know if you have anything to add on that? >> we took some time to make sure we had the capabilities rightth and we began training to get the job ready which is one d of the mistakes we made. we had much better results and continuous improvements as we s proceed to waive malice and future waves.
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>> malice and future waves. as i said earlier,r,[ind we hav6 sites in the adeployment proces at this moment. medicalou working withrere schools to train young doctors before they get to residency how to use that >> i.t.t. sofsoftware? well, >> ma'am, most of the medical students who are on the scholarship programs that end up bringing them into our into on our do rotations inin our organizations already, sotht yes, they are being trained onon our systems before they ever get into it. let me add one other comment to it. we'vehe been using anal electroc health record within the system for twoh decades, so the challenge that you're describing is really not a challenge that we're having. we're used to using electronic health record. the downside of it it was home grown, it was clunky. there were challenges with it. our culture has challenged to accepting the rec electronic heh record. the challenge we're having now where we did our own work flows even locally .sometimes differently to the commercial
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off the shelf that we purchased, transitioning to that. it's not the reliance on kirk>>e electronic health record that we're having the challenge with. >> are you using software you just purchased off the shelf? th >> yes, ma'am, it a commercial off the shelf software program. >> all right. there other challenge we ran ino was maintainingerre confidentiality. so around when records are being transferred around to different institutions, howlity do you maintain the confidentiality of the medical record? >> so we're fortunate in that we're part of the department of defense, and so from a cyber security and a data protection perspective, we have the baseline of the department's cyber rules and i standards to base ourwe implementation off o. ctioso we manage the cyber protection with the v.a. because it's a joint record that we're creatinge between the d.o.d. and the v.a. to meet the d.o.d. standards. tand as far as the proirgs, we interoperability and exchange d of data with external providers, we do that through the -- there's data use agreements in
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place, and we do that through hl7 standards and we're engaged with the standards agency organizations to make sure that we have influence on how thosepa are. >> it is a tremendous trpprepro, and i appreciate your attention to it. anything that i can do to help solve that problem, i've been working on it forca ll mdecadeso feel free to call on me. thankk. you, and i yield back. >> >> thank you, mr. ruppersberger. >> first thing, panel thank you for being here. what you're doing is very to get important. we appreciate your competence. i want to get into the would strategic readiness program. i know congressman womack dealt with it. lieutenant dingle, we must ensure that we continue to take care of our american soldiers. a few weeks ago i had the. privilege to accompany your eputy chief of staff to the shock trauma at the university of maryland. that is rated one of the top trauma centers in the world, research, development, and we have the air force has been there for many years and has a really good relationship, and we're focused right now on the
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army and maybe the navy andhe nd marines later. in fact, that trauma center saved my life 50 years ago, and if it weren't for their expertise and competence, i wouldn't be here today. maybe that's a good thing for some people. anyhow, during our visit, we discussed the smart program, which provides combat medics the opportunity to get hands on training alongside their civilian counter parts and the studies show that during the first few years of wars in afghanistan and in iraq, we could have saved one in seven troops lost if they had access to reliable trauma care. now, what are your plans to expand this vital program? does the fy21 budget support this, and as our military shifts to near peer competition, can you >> explain why trauma care experience is so important to our medical corps? >> thank you, representative. as you've experienced the great treatment from the baltimore shock and trauma, one of the beauties of the smart program is it's taking, again, that
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combat med skpik medic and expoupding and building upon something we've had in the army called medical proficiency training in the old day to where we were leveraging our military medical treatment facilities. andse hand then those hospitalso are those civilian trauma centers, they're exposing these medics in a two-week rotation with the ability to put hands-on trauma injuries, and and it cases, so that isis exponentially increasing their skill set, their individual critical task exp list, and it s just thpriceless. isear we are expanding to two programs this fiscal year, this summer we have plans to expand to about six, seven more almost each year, and again, we have not had any issues with funding as we continue to expand and our intent is to expand across >> the -- a>> that's good. kno>> yes, sir. so as you know, we've used baltimore for quite some time. we have other c stars capabilities out there with in .
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cincinnati and university of wee medical center in nevada. what we are also looking at is embedding entire teams inn civilian mr. ruppersberwe're there gettig the touches on a regular and consistent basis. >> that's good, keep up. i want to move to the peer review orthopedicic research program, secretary i'd like to ask you about this program the orthopedic research program. i've been supporting thisdic h program for years. deit's a research program whichi has demonstrated results enrolling more than 15,000 patients to date in military relevant research with the potential to provide healthe care solutions for injured service members, veterans and civilians. onflnow, the conflicts in iraq d afghanistan have result in 52,000 battlefield injuries including more than 2,200 major limb amputations. the unique nature of these wounds which primarily results from explosive blasts and high
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velocity gun shot has been well documented. thocthe orthopedic research prm has been funded since 2009 and has received level funding at 30 million per year since fy 2012. these funds have allowed a our orthopedic docs to work stabili miracles stabilizing limbs,ze helping with tissue regeneration and even the full face transplant. askithey are conducting the research are asking for an increase to 35 million in order to provide stable funding for the consortiums. which includes the majortrem extremity trauma researchversit. consortium metric anchored at johns hopkins university. can can you walk us through the history of the orthopedic research program ograand the consortiums at work, and also, do you believe the tprogram could benefit fromor t increased fundinges o doesn't need an on going basis and in force multiplier by the greatest return of investment? >>ough thank you for the questi
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congressman and i cannot walkck you through the history of this particular research program. i would need to get back to yous i'm not aware of the request fortake this particular research program but i'm'm back your questions. t >> i'll get my staff to get in contact with you and i'll b try to make this a priority. me >> if we can have the army follow up on that. mr>> charlie crist jr. committee. mr. crist. >> thank you very much, madame chair, and i thank all of you for being here today. we appreciate your service to our country. as you know, iran launched 11 ballistic missiles at the al asad air base in iraq. while we thought that all service members were safe, over 100 service members have since been diagnosed with traumatic brain injury.
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what is the status of the service members who were in the attack, and out of thosee who have returned to duty, how many are on light or restricted service? >> and that's for any of you who feel comfortable responding. >> so congressman crist, this may be a little dated. this is probably numbersrs couple of days ago, but mymy understanding out of roughly 100, 109 serviceviewed d members that were identified, bk 75 have been reviewed, evaluated, and are actually nee back in duty in iraq. ngthe remainder i would need to go back and check in terms of what is the statusrd with regd evaluation, and are they -- have they been returned to duty and what type of duty? i don't have that handy, but i can get back to you on that. >> iate appreciate that very much. i'm concerned obviously because even though the bunkers mostly
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held and they had ample warning to take shelter over 100 service members were and diagno, and that's veryonce disconcertig obviously. that number will likely increase, too, i'm told. as general miley said, the for troops in the attack will needr to be monitored for the rest of their lives, but he also said, quote, that there's nothing we could have because the missiles were so powerful if we are making investments to counter russia and china, we also need to protect our service members service the powerful weapon systems, including thewhat ballistic missiles. arewhat we are doing to protect service members, what are we doing to protect service members from ballistic missiles or other causes of tbi? >> so a couple of things. one of the areas that congress has asked the department to work on and we are in process, and that is focused especially implications of blast to
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exposure. it>> right. >> and we are in the middle ofof doing a study on that to figure out better ways to measure it, but then more importantly, what we find out about the impacts of blastxpos exposure on brain health that to then needs to inform everything from what weapons we acquire, the training we put in place, not just in a deployed setting but training, you know, here at home to inform what we can do i to best protect our service members, and then most importantly, i think you kindt of referenced it was what we are doing, i believe it's the special forces command right now is really doing a good jobhe at baselining all of irtheir service members with regard to their cognitive abilities and have that ass an the benchmark n to evaluate over time to see if any of their, you know, in training and deployments, any potentially concussive events have affected that baseline as a way to monitor and evaluate. so those are some of the things
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that we are looking at. >> great. we've known that brain injuries are a problem, and we've known that our adversaries have these weapons, so how have we not considered what would happen in an attack like this? an >> so i believe we have e kind ofred based upon the evidence we have and what kind of protective gear based upon research we have done, what we believe, you know,rms tect makee in terms of protection, and most importantly we do have standard across the board policy with regard to if a service member has experienced a concussive areevent, there are very strict protocols around reporting that, screening that service member, getting the to evaluation, and then pursuing whatever medical care is required before a return to duty or something else. >> thank you, sir. ist:we've seen patches ofcludiny coronavirus here at home tampa b including in my home of tampa bay, home to cent com and so lar
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com. as you know, there are also larger outbreaks near military installations overseas. versou doiwhat are you doing to spread of coronavirus in our troops? hasso we -- the department issued a series over the last four to five weeks, force health protection guidance, largely built around cdc guidance, and part of that, though, is how we apply that guidance to the military environment andiron guidance we installation commanders both here and abroad and how they can apply that to their particular situations on the ground to inform what they want to do with their service members in terms ofms of screen, access to thee part of theon as any infection at their base or t surrounding area. >> thank you, i appreciate that. ojust finally, do military tec
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installations have access to testing? and then i yield back. >> the installations, so it's tied to where we have the lab technology at military installations in terms of our mtfs. right now, my last information is i thought we had nine or ten of our military labs had the access for the testing that's cs approved by the cdc. we're seeking to get all of our labs, which is aboutcris 14 or 5 to have that ability. mcco>> thank you very much. thank you, >> madame chair. >> if you'd follow up with the s committee on that testing. mr. ryan. >> thank you madame chairman, tt thank you for your service, thank you for being here. i want to go in a little bit of direction.ferent i think i'm the only one who sits on the defense appropriations subcommittee and the military -- or the military construction v.a. subcommittee. so the issue of health aslth ast relates to all of you and to connectstsy and as it to veterans is imp important.
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and one of the things and i've tried to look through a lot of your testimony. andit's very technical. records andg about all of that. obesity rates.alk to you about from what i can gather, the obesity rates for active duty are going up. 15. 8% a couple of years back, and now 17.4%. in the navy it's 22%, air force is 18, army is 17. males between 35 and 44 yearse old have almost a 30% obesity rate and when youan look at te increase in blood, pressure and diabetes andhis heart disease, l of the stuff you know way betterrbe than i do, this is a problem that we're not even talkingd about, and it's got a
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relatively simple or simpler solution than everything we've just talked about, andfew for te last few years, my staff and i have been trying to dig in on the food that is being fed to our soldiers, the fact that the, you know, commissaries and cafeteria cafeterias are closed and people are working late and the only thing left on the whole base is the burger king that's open, and so they go and do that over the course of many years. nowowty r, we need a bigat strao reverse the obesity rates, and i mean, i think most people would be shocked to think that we watch tom brady and we see these high performing athletes, and we look at their diets, and we look at their lifestyles,
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and we are spending billions of dollars to have high performing men and women serving our country, performing at peak to levels in very high pressured situations, and for us to have % an obesity rate that's creeping up to 20% and zero strategy on how to fix it, that's a real problem, and then you come back and you want more money for this andndpr and there's all kinds of research going on in reversing type 2 diabetes with food as medicine and all kinds of innovative things that are happening in the real world that we have goting.gett to make it's getting into the military. now here's the connection for us who sit at, you know, 30,000 feet. the diabetes rate for diaveters is one in five. the diabetes rate for the -- average american is one in ten, so here we're blowing all this money. shipssanan -- i've been on
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before, and you walk in and it's all the sugary cereals. look., i'm not a prude on this d stuff. i'm an 80%er right, 80% of the time you work out, you eat healthy 80% of the time, but we can't have this, folks. ing this is unacceptable that we going to continue. is there any strategy that's in place, mr. >> secretary, that is addressing this in an what aggressive way? >> so we have in part workingd l with your office, i know last year have been putting together what i would call more of a framework or af skeleton in terms of what would be the key components of a strategy. as you mentioned, part of it in terms of -- on the health side is, you know, hea what are the health guidelines and health recommendations that then feed into how our installations are operated and the decisions made about what types of food,
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access to cturthat, and where we have not completed that is that closure, that link between thee medical side and how we are operating our infrastructure so to speak in delivery of food. so there is more work to bend a done on that, and you make very good points in terms of, you know, >> part of lethality is ours a service members and the health and their ability to do their job. wasand this is a negative impat on that. >> it's a waste of money is a g what it is. oe it's obviously it goes to production. system and they have diabetes, and then diabetesickn when you k at diabetes with any other sickness just jacks up the cost. ts.it extends your stays in the hospital. it complicates any other issue you may have. if you have to go to heavesurgr if you've got a heart problem and diabetes, it just makes it this much worse. d taso i'll leave here and i'llo sit in anotherave committee, te v.a.
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and talk about how we don't have any money. and so we've got to start ug dis seeing these systems as integrated, and you know, we could have a whole discussion k on k through 12 school. when i walk into a school andco these kids are getting a rice crispy treat and a thing laof chocolate milk and start their day with 80 grams ofof medicaid're on thehe program, and with the public money we spent to buy them rice crispy treatsts milk.chocolate american people are sick of this. this does not make any sense, and i want the only military ie united states to be the leader in this. so i only have probably a little bit of time left, and i would just like to give it to the surgeon generals if any one of you have a comment on this. th>> sir, i'll be real quick, m. ryan.pr within the army, we are -- >> have a very pragmatic approach to the health of the force, and we have manyms programs from go green, healthy choices, spartan thates t get after the eating as well as the activity, as well as the entire life process or approach to living, and then
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our holistic health and fitness, going after the spiritual, physical and mental well being of our soldiers. the wellness centers, all designed to educate our soldiers where we've got programs that are also inculcated into the units, not just >> special forces, but treating every soldier asnd athlete. >> i'd certainly agree very impa similarly in the navy we havenca similar program. certainly we understand theng importance of wellness. s i think, sir, one of the poins you make are the t social determinants of health that we really have to get after, and the environments in which our sailors,nd marines, and soldiers live and so we are working with commissaries, for example, with our dietitians to gui provide guidance so it'sand available in the commissary as individuals purchase their groceries. ng versir, we agree with you 10, and we are working very y hard. we've got a lot of work to: i doings this will work to make
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this happen. >> everyone has the message and we actually are out of time and i do want to follow up with oneg question and notoe to be responded here today but reported to the staff.o. d.goes back to the militaryt health and restructuring. the d.o.d. in your announcement plan of health caretions restructuring roughly 18,000 uniformed health positions will in the be gone with the plan to replace them. you talk about putting people into the marketplace and that there is a shortage one our health care system throughout this country. we're also concerned about yourd ability for these facilities ton some of thed docks in the teacht individuals that are serving us. ing they function as teaching hospitals are closing in you a
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limiting the number of trainingn opportunities all across this country. mil we can't afford to lose you as part of our backbone not only for a military health but for all the u.s. health care system, when it comes to ob/gyn and with more women serving and we have some familiarity with them pad livid both of my children and we can't afford to beare losing those in retraining women as well as women that our family members. we've got some serious questions on that we want to be helpful as you make that decision but we need to look at. a whole of health care. i want toon thank you so much fr coming and this also goes to mr. carter's question about some ofu. the outside treatment
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thank yo happening as well. thank you so much for being here, thank you for your meeting service and thank you for giving back to us because we're starting to market up and withts that this meeting is adjourne.

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