WEBVTT

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- Hearing on the Military
Personnel Subcommittee

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on Military Health System Reform to order.

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Today this hearing is focused on

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the status of military health reforms

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Congress enacted in the 2017 NDAA,

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and whether the department
and the military services

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are working towards achieving
congressional intent.

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The reform that most
impacts service members

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and their families is the transition

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of management of the
military treatment facilities

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from services to the
Defense Health Agency,

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which is the focal point of this hearing.

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The last time we had a
briefing on this issue

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was in December of 2017.

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I recall there was some disagreement among

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the military departments and DOD

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on how to implement these changes.

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I understand this
transition began, at least

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in part, as of October 1st this year,

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but it was painful getting to that point

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and it was a very small step towards

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accomplishing the overall goal of a single

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military health system instead of

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three separate service health systems.

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There also are many important reforms

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critical to making the
MTF transition successful

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that are lagging behind,
such as implementation

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of the new electronic
health records, Genesis,

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the proper analysis of what medical skills

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and the number of medical
providers are needed

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to support the warfighters
and beneficiaries,

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the appropriate number and sizes

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of medical facilities,
and reforms that could

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create economies of scale

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and effective efficiencies within the MHS.

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To be clear, budget cuts
are not the same thing

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as efficiencies in MHS.

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And many rumored cuts to the
military medical workforce,

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whether primary care physicians

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or ophthalmologist, lack
rationale or evidence

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that they would actually
save taxpayers money.

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One of the top concerns
many of my colleagues

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have heard over the past eight months

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was about the military
medical manpower cuts

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in the president's FY 2020 budget.

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This was done to repurpose 17,944

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military department officer and enlisted

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health specialty medical billets

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and transition them to other manning needs

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in the military departments.

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I was baffled as to why this request

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was submitted when the
services and the Joint Staff

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had not completed the analysis

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of the operational
requirements for supporting

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combatant commanders in
time of conflict of war.

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It appeared to me that this proposal

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prioritized cost cutting over

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operational needs and common sense.

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In February 2019, the GAO
confirmed our concerns

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when they reported that the DOD

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has not determined the required size

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and composition of its operational medical

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and dental personnel who support

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the wartime mission or
submitted a complete report

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to Congress, as required under the NDAA

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for fiscal year 2017.

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We have also heard that there

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is a defense-wide review underway

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that is considering a wide variety

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of cost-cutting proposals,
including shuttering

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major military medical centers,

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a restructured Tricare benefit that could

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significantly increase
copays, closure of the

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Uniformed Service University
of the Health Sciences

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and the potential
destruction of some reforms

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that we've made into law
over the past three years.

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The goal of military health reform

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is not to reduce the military's ability

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to deliver healthcare in
times of peace or war.

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The goal is to find ways
to be more efficient

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so that we can save taxpayers money

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while providing better quality healthcare

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for our service members
and their families.

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Private insurance and private providers

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may serve these goals for
some types of services

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in some communities, but privatization

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can also threaten worse outcomes

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and higher costs if done
without care and consideration.

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The ranking member and I recently visited

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Madigan Army Medical Center,
Naval Hospital Bremerton

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and the David Grant Air
Force Medical Center,

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where we spoke with military spouses

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about quality of life issues.

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Access to military healthcare came up

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at every discussion.

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At each installation, we
heard about challenges

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with the lack of mental health resources

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in the local community.

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We heard about civilian
healthcare networks

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that either lack the
capacity or are unwilling

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to admit Tricare beneficiaries.

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And we've heard about challenges

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accessing appointments at
military treatment facilities.

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The larger problem we heard is not

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that local providers think
Tricare reimbursement rates

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are low, it's that the healthcare market

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is already oversaturated,

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even in large metropolitan areas

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like Seattle and San Francisco.

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It's not all bad news.

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At Travis Air Force Base, we saw a busy

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military treatment facility working

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hand in hand with the VA in collaboration

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that could, along with civilian providers,

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create an integrated delivery system.

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The 2017 NDAA encouraged

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these types of relationships

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with local healthcare facilities.

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We need to see more of
this kind of cooperation

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and hear more from these programs

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in order to replicate their successes.

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Instead, DOD seems intent on gutting

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our Military Health System

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and calling it an efficiency.

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The system is costing less.

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It has saved billions of dollars,

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at least $1 billion in just the last year,

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but there remains urgent coverage needs

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that should be addressed by reinvesting

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any savings in the
military healthcare system,

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not continuing to squeeze every last penny

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out of the system

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in order to fund other priorities.

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Healthcare is a need and right

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we must continue to provide
for our military families.

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Weakening the delivery system will only

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cost us and our service
members more down the road.

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The department must do better.

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Today, we will hear from a panel

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of senior leaders from across

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the Department of Defense
that are responsible

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for implementing the Military
Health System Reform.

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We are seeking to better
understand how DOD

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is implementing major Military
Health System Reforms,

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how they are determining Tricare success

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in meeting the needs of its beneficiaries,

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and how DOD plans to
repurpose roughly 18,000

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medical positions and how that

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will affect health services.

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We will also hear how DOD is balancing

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readiness with efficiency,
and how the Joint Staff

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and the service surgeon general

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are approaching readiness to ensure that

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we have the right personnel

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and the right capabilities
at the right time.

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I now would like to have

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Ranking Member Mr. Kelly

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offer us any opening remarks.

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- Thank you, Chairwoman Speier.

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And that's as long as I've heard

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our chairwoman talk on any subject,

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and mine's gonna be
lengthier than usual, too.

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And that's because we're very passionate

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about it and getting this right.

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This is one of the most important things

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I think we do on this subcommittee.

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I wanna welcome our
witnesses today's hearing

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and thank you for your service

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to our service members and their families.

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The Military Health System
is one of the largest

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healthcare systems in the world,

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and you all have the critical mission

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of providing care to one of the most

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venerated segments of the
United States population,

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our service members,
veterans and their families.

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We hold the Military Health System

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to a higher standard
than civilian healthcare

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given your important mission, and I know

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that you share that commitment.

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That is why this committee
has worked continuously

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with the Department of Defense to ensure

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that our Military Health System

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has the resources and systems in place

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to provide exceptional healthcare.

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The 2017 Military Health System Reforms

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are an integral part of
improving healthcare delivery.

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The primary goal of that reform effort

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was to improve medical readiness,

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standardize patient experience

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in military medical treatment facilities

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and, where possible, improve efficiency.

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I am encouraged by the progress that DOD

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and the services have made in implementing

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these reforms, but there remain

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several areas of concern.

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In particular, I'm very concerned

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with the department's current efforts

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to restructure and realign
military treatment facilities,

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commonly known as Section
703 implementation.

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I believe that the department
may be viewing this

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as a cost-saving exercise,
when the actual purpose

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is to improve efficiency
and healthcare quality.

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It is crucial that prior to any reductions

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in MTF services that DOD fully understand

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the civilian network capability
to absorb those patients.

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In our visit to military installations

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around the country, I can tell you

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that many civilian healthcare networks

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are oversaturated and will not be able

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to absorb more patients.

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I look forward to hearing what analysis

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has been done regarding network adequacy

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in preparation for any MTF realignment.

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I'm also very concerned
about the planned reduction

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in military healthcare billets.

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The services identified over 17,000

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healthcare billets for elimination.

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While some of these positions

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are purely administrative in nature,

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many of them are medical
professional billets.

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At nearly every military
installation I visited,

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one of the chief complaints
regarding healthcare

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is that patients must wait weeks

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in order to get an appointment.

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That is unacceptable.

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And I'm concerned that
further personnel reductions

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will make the problem worse.

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I would like to hear more about

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what analysis was done to
support these reductions.

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Finally, I'm concerned about the state

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of behavioral healthcare in the military.

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I've repeatedly heard
from medical providers,

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service members and their families

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about chronic staffing shortages

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and long wait times for appointments.

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Meanwhile, the rates of
suicide in our military

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continue to increase.

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I understand that this
is a national problem,

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but I wanna know what the services

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and the Defense Health Agency are doing

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to fix this program in the military.

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In a recent report, each
of the services said

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that the number one recruiting challenge

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for behavioral health providers

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is low pay and a lengthy hiring process.

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So now that you have
identified the problem,

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what specific authorities do you need

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in order to fix it?

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I wanna thank our witnesses for their

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considerable efforts to improve healthcare

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and institute the Military
Health System Reforms.

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I look forward to a robust discussion

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that is focused on
readiness and quality care.

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Thank you, and I yield back, Chairwoman.

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- Thank you, Ranking Member.

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As you can see from
both of our statements,

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they're fairly consistent,
which is a recognition,

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I think, that we here in Congress

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are very concerned about what's happening.

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We now welcome our
distinguished panelists.

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Mr. Thomas McCaffery is the
assistant secretary of defense

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for Health Affairs.

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Lieutenant General Ronald Place,

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director of the Defense Health Agency.

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Lieutenant General Dorothy Hogg,

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surgeon general of the Air Force.

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Lieutenant General Scott Dingle,

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surgeon general of the Army.

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Rear Admiral Bruce Gillingham,

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surgeon general of the Navy.

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Brigadier General Paul Friedrichs,

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Joint Staff surgeon.

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I will ask unanimous consent to allow

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any members not on the subcommittee

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to participate in today's hearing

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and be allowed to ask questions

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after all subcommittee
members have been recognized.

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Without objection?

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- [Trent] Without objection.

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- That is granted.

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Let us then ask each of you

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to summarize your testimony

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in five minutes or less.

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Your written comments and statements

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will be made part of the hearing record,

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and each member has the opportunity

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to question the witnesses
for five minutes.

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We will start with Mr. McCaffery,

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and you may offer your opening statement.

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- Thank you, Chairwoman Speier

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and Ranking Member Kelly,
members of the committee.

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Thank you for the opportunity today

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to discuss our combined efforts

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to maintain and strengthen
our Military Health System.

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The men and women of the MHS

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are justifiably proud of what they do.

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They provide the platform to train

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our uniformed medical
force and they ensure

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our active duty service
members have access

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to the healthcare they need in order

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to do their jobs anywhere, anytime.

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They support one of the largest

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and most successful medical
research enterprises

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in the country.

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They operate a global
health surveillance network

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that monitors for infectious threats

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to our forces and our homeland.

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They manage of the
country's largest networks

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of hospitals and clinics.

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They do all that will
unfailing professionalism,

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and I might add with incredible passion.

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They, and we, are grateful

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for the committee's support of this work.

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Our primary mission, as you
had indicated, is readiness.

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The readiness of the
medical personnel to support

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our forces in battle,
and the medical readiness

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of combat forces to
complete their missions.

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And that readiness mission also entails

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caring for the families of our troops

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and our retirees.

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After all, while service
members who deploy

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must be medically ready to do their jobs,

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they also need to know that their families

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back home are cared for,
and that in retirement,

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they will receive a health benefit

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that recognizes the
value of their service.

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Meeting this obligation
to our beneficiaries

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is vital to recruiting and retaining

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a high-quality force.

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In order to advance these goals,

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we believe the MHS, like the rest

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of the Department of Defense,

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must adapt and change
in order to carry out

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our mission in an ever-evolving
security environment,

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and very importantly for us,

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a consistently dynamic medical landscape.

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And we know that Congress
shares this belief.

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In the past three National
Defense Authorization Acts,

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Congress has given the department

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very clear direction on
the fundamental reforms

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it expects us to implement.

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Building off that
direction, we are changing

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to ensure that the system
can most effectively

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meet our mission.

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Some of the things that the reforms

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that we are partnering with Congress on

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are aimed at ensuring that
the uniformed medical force

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is properly sized and has the skills

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to respond to operational requirements.

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Ensuring that our system of hospitals

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and clinics is optimally sized and shaped

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to support the readiness
of our medical forces,

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the medical readiness of combat forces

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and our obligations to our beneficiaries.

13:52.250 --> 13:54.160
Better organizing and integrating

13:54.160 --> 13:56.880
our direct-care system to form a true

13:56.880 --> 14:00.100
unified medical enterprise
that can improve

14:00.100 --> 14:02.130
our effectiveness and efficiency

14:02.130 --> 14:04.990
and provide a more
standardized, dependable,

14:04.990 --> 14:07.610
high-quality experience
for our active duty,

14:07.610 --> 14:09.430
their families and our retirees.

14:09.430 --> 14:12.040
And finally, most effectively managing

14:12.040 --> 14:13.650
private sector care through

14:13.650 --> 14:16.070
Tricare's managed care networks.

14:16.070 --> 14:18.750
General Place and I
outlined in more detail

14:18.750 --> 14:23.120
in our written testimony
each of these reform efforts,

14:23.120 --> 14:24.780
but the point we'd like to emphasize

14:24.780 --> 14:27.520
is that all of these efforts
are aimed at ensuring

14:27.520 --> 14:28.820
that the Military Health System

14:28.820 --> 14:31.700
provides maximum support to the department

14:31.700 --> 14:34.563
as it executes the
National Defense Strategy.

14:38.310 --> 14:41.090
It's our privilege to
testify before you today

14:41.090 --> 14:43.237
on this critical mission
of the health system

14:43.237 --> 14:45.730
and to provide you
information on the status

14:45.730 --> 14:47.880
of the numerous reforms Congress

14:47.880 --> 14:50.010
has directed us to pursue.

14:50.010 --> 14:51.470
Thank you to the members of this committee

14:51.470 --> 14:53.257
for their support of that mission

14:53.257 --> 14:55.750
and the men and women who carry it out.

14:55.750 --> 14:58.960
And we look forward to
answering your questions.

14:58.960 --> 15:00.130
- Thank you.

15:00.130 --> 15:01.380
Lieutenant General Place.

15:03.920 --> 15:05.480
- Chairman Speier, Ranking Member Kelly,

15:05.480 --> 15:06.890
members of the committee.

15:06.890 --> 15:10.410
I'll add a few comments to Mr.
McCaffery's opening comments.

15:10.410 --> 15:11.930
As he made clear, our principal mission

15:11.930 --> 15:13.410
is enabling readiness.

15:13.410 --> 15:16.310
And within that mission are
two distinct responsibilities.

15:16.310 --> 15:18.630
First, to ensure every person in uniform

15:18.630 --> 15:20.810
is, in fact, medically ready to perform

15:20.810 --> 15:22.360
their job anywhere in the world.

15:22.360 --> 15:24.750
And then secondarily,
to ensure our military

15:24.750 --> 15:26.690
medical personnel are individually

15:26.690 --> 15:28.810
and collectively prepared to support

15:28.810 --> 15:31.970
the full range of military
medical operations.

15:31.970 --> 15:33.290
The Defense Health Agency serves

15:33.290 --> 15:36.760
as the supporting agency
in this readiness mission

15:36.760 --> 15:39.690
to the combatant commands and
to the military departments,

15:39.690 --> 15:41.620
the Military Health System.

15:41.620 --> 15:44.480
Performance on the
battlefield is exemplifying

15:44.480 --> 15:46.610
historically high survival rates

15:46.610 --> 15:48.800
from combat wounds, and
historically low rates

15:48.800 --> 15:51.060
of disease and non-battle injuries.

15:51.060 --> 15:53.620
These successes reflect the processes

15:53.620 --> 15:56.650
in which joint solutions
contributed to these outcomes.

15:56.650 --> 15:59.210
Now, the DHA was established to strengthen

15:59.210 --> 16:01.610
our health system in both
the deployed settings

16:01.610 --> 16:04.760
and in the fixed healthcare
facilities around the world.

16:04.760 --> 16:06.930
Our combat support
responsibilities include

16:06.930 --> 16:09.770
a broad range of military health support.

16:09.770 --> 16:11.920
They include management
of the Armed Services

16:11.920 --> 16:14.430
blood program, the Joint Trauma System,

16:14.430 --> 16:16.830
public health, Armed
Forces medical examiners,

16:16.830 --> 16:18.880
medical logistics in the
operational environment,

16:18.880 --> 16:20.110
health information and technology

16:20.110 --> 16:21.240
in the operational environment,

16:21.240 --> 16:23.540
and really a whole lot more.

16:23.540 --> 16:25.440
But as the DHA assumes responsibility

16:25.440 --> 16:27.520
for managing all the military's hospitals

16:27.520 --> 16:29.240
and clinics, we continue to view

16:29.240 --> 16:33.400
these medical facilities
as readiness platforms

16:33.400 --> 16:35.290
where medical professionals from the Army,

16:35.290 --> 16:36.860
from the Navy and from the Air Force

16:36.860 --> 16:40.330
obtain and sustain their
knowledge and skills,

16:40.330 --> 16:42.060
and for which these professionals deploy

16:42.060 --> 16:43.983
in support of our military missions.

16:44.910 --> 16:47.730
The DHA approach better enables the MHS

16:47.730 --> 16:50.270
to optimize the care we can deliver,

16:50.270 --> 16:52.870
along with clinical skill
sustainment experiences

16:52.870 --> 16:54.630
for our medical staff within

16:54.630 --> 16:57.600
and across geographic markets.

16:57.600 --> 16:59.530
As DOD leadership evaluates the size

16:59.530 --> 17:01.670
of the medical force
and makes determinations

17:01.670 --> 17:03.440
about the configurations of hospitals

17:03.440 --> 17:06.300
and clinics, the DHA is also prepared

17:06.300 --> 17:07.860
to ensure our beneficiaries have access

17:07.860 --> 17:09.240
to care they need through the management

17:09.240 --> 17:11.260
of the Tricare program.

17:11.260 --> 17:12.360
Now, the department has long relied

17:12.360 --> 17:13.600
on civilian healthcare to provide

17:13.600 --> 17:15.510
and deliver care to our beneficiaries

17:15.510 --> 17:17.470
in locations where we don't operate

17:17.470 --> 17:19.720
medical facilities or when the needs

17:19.720 --> 17:21.630
of our patients exceed the capabilities

17:21.630 --> 17:23.220
that we have locally.

17:23.220 --> 17:25.040
Over the past three decades,

17:25.040 --> 17:26.660
with changes in military basing,

17:26.660 --> 17:28.850
reductions in the military force strength,

17:28.850 --> 17:31.540
we've successfully increased specific

17:31.540 --> 17:33.700
civilian healthcare networks.

17:33.700 --> 17:35.540
We're performing those
assessments again today,

17:35.540 --> 17:37.233
and will do so continuously.

17:38.440 --> 17:40.280
And we're working with
the military departments

17:40.280 --> 17:43.270
to ensure military families and retirees

17:43.270 --> 17:45.340
continue to enjoy access
to high-quality care

17:45.340 --> 17:49.100
if military medical
capabilities are exceeded.

17:49.100 --> 17:50.530
I'm grateful for the opportunity to share

17:50.530 --> 17:52.550
our detailed plans to further improve

17:52.550 --> 17:54.910
military medical support
to combatant commands

17:54.910 --> 17:56.840
and to the military departments.

17:56.840 --> 17:58.780
Thank you, again, to the
members of this committee

17:58.780 --> 18:00.610
for your time and your continuing service

18:00.610 --> 18:02.317
to the men and women of our Armed Forces

18:02.317 --> 18:04.017
and the families who support them.

18:05.110 --> 18:05.943
- Thank you.

18:05.943 --> 18:06.776
Lieutenant General Hogg.

18:07.860 --> 18:10.090
- Chairwoman Speier, Ranking Member Kelly

18:10.090 --> 18:12.410
and distinguished members
of the subcommittee,

18:12.410 --> 18:14.210
thank you for the opportunity to provide

18:14.210 --> 18:17.370
an update on Air Force
Medical Service reform.

18:17.370 --> 18:19.730
This committee is well
aware of the reemergence

18:19.730 --> 18:24.440
of great power competition,
such as China and Russia,

18:24.440 --> 18:26.990
and the Air Force's need
to increase lethality,

18:26.990 --> 18:30.100
strengthen alliances and realign resources

18:30.100 --> 18:33.690
in preparation of these potential threats.

18:33.690 --> 18:36.090
The Air Force Medical Service is evolving

18:36.090 --> 18:38.270
in support of these overarching

18:38.270 --> 18:40.490
national defense objectives.

18:40.490 --> 18:43.230
Air Force medics continue
to answer the call

18:43.230 --> 18:46.580
across a broad spectrum of operational,

18:46.580 --> 18:50.240
humanitarian and disaster
response missions.

18:50.240 --> 18:53.870
We specialize in aerospace
and operational medicine,

18:53.870 --> 18:56.880
most notably, aeromedical evacuation,

18:56.880 --> 18:58.370
while ensuring the readiness

18:58.370 --> 19:01.200
and deployability of our warfighters.

19:01.200 --> 19:04.400
Our charge is crystal
clear, and I am confident

19:04.400 --> 19:06.800
that these reforms will
maximize our ability

19:06.800 --> 19:09.310
to meet combatant commander requirements

19:09.310 --> 19:12.110
and support line of the
Air Force operations

19:12.110 --> 19:14.410
across the enterprise.

19:14.410 --> 19:17.530
With this renewed focus
on operational readiness,

19:17.530 --> 19:19.540
we restructured our headquarters

19:19.540 --> 19:22.720
by deactivating the Air
Force Medical Support Agency

19:22.720 --> 19:26.920
and re-designating the Air
Force Medical Operations Agency

19:26.920 --> 19:30.000
as the Air Force Medical Readiness Agency.

19:30.000 --> 19:33.540
This new organization
directly supports readiness,

19:33.540 --> 19:36.450
aerospace and operational
medicine activities,

19:36.450 --> 19:38.930
and provides oversight of strategic

19:38.930 --> 19:40.510
medical readiness initiatives

19:40.510 --> 19:43.000
at Air Force installations.

19:43.000 --> 19:46.330
We are also realigning medical resources

19:46.330 --> 19:49.560
at our base installations
in order to improve

19:49.560 --> 19:52.750
airmen deployability and overall wellness.

19:52.750 --> 19:55.350
This initiative reorganizes medical groups

19:55.350 --> 19:56.860
into two squadrons,

19:56.860 --> 20:00.020
an Operational Medical
Readiness Squadron, which serves

20:00.020 --> 20:02.470
active duty guard and reserves,

20:02.470 --> 20:04.860
and a Health Care Operations Squadron,

20:04.860 --> 20:08.890
which serves non-uniformed
members and dependents.

20:08.890 --> 20:11.410
While these squadrons are interconnected,

20:11.410 --> 20:14.060
they have a singular focus which allows

20:14.060 --> 20:17.030
each of the squadrons to optimize care

20:17.030 --> 20:19.113
for its designated population.

20:20.010 --> 20:21.990
We continue to enhance our ability

20:21.990 --> 20:25.300
to save lives both on
and off the battlefield

20:25.300 --> 20:28.190
by investing in our
most vital pacing units,

20:28.190 --> 20:30.570
our critical care air transport teams

20:30.570 --> 20:32.930
and our ground surgical teams.

20:32.930 --> 20:35.010
Complementing these efforts is one of my

20:35.010 --> 20:38.160
strategic initiatives called Medic X.

20:38.160 --> 20:40.860
This goal is to develop
multifunctional medics

20:40.860 --> 20:42.550
who can perform duties beyond

20:42.550 --> 20:44.810
their primary specialty, which will have

20:44.810 --> 20:48.520
exponentially expanded
clinical capabilities.

20:48.520 --> 20:51.620
Our partnerships with
military, educational

20:51.620 --> 20:54.770
and civilian medical
institutions will remain

20:54.770 --> 20:57.210
a critical component to maintaining

20:57.210 --> 21:01.100
medical airmen's clinical
skills and currency.

21:01.100 --> 21:04.180
Collectively, these efforts
increase our ability

21:04.180 --> 21:07.830
and agility to support homeland defense,

21:07.830 --> 21:10.330
deployed requirements and operate in

21:10.330 --> 21:13.310
tomorrow's highly contested environment.

21:13.310 --> 21:14.930
I would like to highlight the progress

21:14.930 --> 21:17.860
and the collaboration with
the Defense Health Agency

21:17.860 --> 21:20.680
in transitioning authority,
direction and control

21:20.680 --> 21:22.660
of military treatment facilities

21:22.660 --> 21:24.790
to the Defense Health Agency.

21:24.790 --> 21:26.650
The Air Force Medical
Service will continue

21:26.650 --> 21:30.030
to provide direct support
to the Defense Health Agency

21:30.030 --> 21:32.260
until it can establish its headquarters,

21:32.260 --> 21:34.810
markets and functional capabilities.

21:34.810 --> 21:37.510
We are committed to a
successful transition

21:37.510 --> 21:39.190
that will continue delivering

21:39.190 --> 21:42.900
high-quality readiness
and beneficiary care.

21:42.900 --> 21:45.640
My testimony gives the
committee a clear picture

21:45.640 --> 21:47.410
of the Air Force Medical Service

21:47.410 --> 21:49.560
and how we are aligning our efforts

21:49.560 --> 21:54.300
with Defense Department
and Air Force priorities.

21:54.300 --> 21:56.870
As our nation faces new challenges,

21:56.870 --> 21:59.340
preparing for an uncertain future

21:59.340 --> 22:01.970
requires bold and innovative thinking.

22:01.970 --> 22:04.800
I have no doubt we are moving
in the right direction,

22:04.800 --> 22:07.260
and our medics throughout
the Military Health System

22:07.260 --> 22:09.210
will rise to the occasion.

22:09.210 --> 22:10.480
Thank you, again, for your time,

22:10.480 --> 22:12.370
and I look forward to your questions.

22:12.370 --> 22:13.370
- Thank you.

22:13.370 --> 22:14.670
Lieutenant General Dingle.

22:15.510 --> 22:18.110
- Chairwoman Speier, Ranking Member Kelly,

22:18.110 --> 22:20.220
distinguished members of the subcommittee,

22:20.220 --> 22:21.900
it is an honor to speak before you today

22:21.900 --> 22:24.490
as the 45th Army surgeon general

22:24.490 --> 22:27.600
representing over 130,000 soldiers

22:27.600 --> 22:30.470
and civilians in Army medicine.

22:30.470 --> 22:32.880
I also would like to thank
my Military Health System

22:32.880 --> 22:35.360
and my sister service
colleagues here today.

22:35.360 --> 22:37.930
We all share a common commitment

22:37.930 --> 22:39.670
to ensuring our Military Health System

22:39.670 --> 22:43.250
is manned, recognized,
trained and equipped

22:43.250 --> 22:45.070
to meet the needs of our services

22:45.070 --> 22:46.870
and the Joint Force.

22:46.870 --> 22:49.750
The chief of staff of the
Army states winning matters

22:49.750 --> 22:53.150
and people are our number one priority.

22:53.150 --> 22:55.220
As the Army modernizes and prepares

22:55.220 --> 22:57.810
for large-scale combat operations,

22:57.810 --> 22:59.560
it is imperative that our medical force

22:59.560 --> 23:02.800
remains ready, responsive and relevant

23:02.800 --> 23:04.610
in order to conserve
their fighting strength

23:04.610 --> 23:08.390
in the multi-domain
battlespace because in combat,

23:08.390 --> 23:10.400
winning not only matters,

23:10.400 --> 23:12.880
but there is no second place.

23:12.880 --> 23:16.030
As required by law, the
Army transitioned authority,

23:16.030 --> 23:18.090
direction and the control of our

23:18.090 --> 23:21.730
medical treatment facilities
to the Defense Health Agency.

23:21.730 --> 23:23.610
The transfer has been transparent

23:23.610 --> 23:27.620
to our soldiers, civilians
and our beneficiaries.

23:27.620 --> 23:29.520
Partnering with the Defense Health Agency,

23:29.520 --> 23:31.370
we will continue to deliver

23:31.370 --> 23:34.290
high-quality and safe care.

23:34.290 --> 23:36.870
The Army is continually
assessing the risks

23:36.870 --> 23:39.160
with changes to medical and strength.

23:39.160 --> 23:41.880
Personnel changes currently under review

23:41.880 --> 23:44.240
are a necessary part of our modernization

23:44.240 --> 23:45.850
and our force shaping.

23:45.850 --> 23:49.320
We will ensure that
adjustments are informed

23:49.320 --> 23:51.730
and support the operational force,

23:51.730 --> 23:54.780
as well as the healthcare
delivery mission.

23:54.780 --> 23:57.200
As we reform and
reorganize, we are committed

23:57.200 --> 24:00.380
to providing ready and
responsive health services

24:00.380 --> 24:02.290
and force health protection.

24:02.290 --> 24:04.500
I have established my priorities to ensure

24:04.500 --> 24:07.600
that we remain ready, reformed,

24:07.600 --> 24:10.970
reorganized, responsive and relevant.

24:10.970 --> 24:14.270
Ready to deploy, fight
and win when called upon.

24:14.270 --> 24:16.980
Reformed in accordance with the law.

24:16.980 --> 24:20.120
Reorganized to support Army modernization.

24:20.120 --> 24:23.800
Responsive to the demands of
the multi-domain operations,

24:23.800 --> 24:27.470
and relevant to the rapid
changes in modern warfare.

24:27.470 --> 24:29.860
Finally, Army medicine must change

24:29.860 --> 24:31.550
at the speed of relevance.

24:31.550 --> 24:34.440
This includes modernization
of key capabilities,

24:34.440 --> 24:37.320
innovation of organizational concepts,

24:37.320 --> 24:40.260
advancement of technology
and integration with

24:40.260 --> 24:43.370
the joint and inter-agency community.

24:43.370 --> 24:46.130
In closing, I am committed

24:46.130 --> 24:48.420
to meeting the congressional intent

24:48.420 --> 24:51.330
and sustaining the
readiness of Army medicine.

24:51.330 --> 24:54.610
Further, I am committed to
my statutory responsibilities

24:54.610 --> 24:56.750
in support of the secretary of the Army

24:56.750 --> 24:58.230
and as the chief advisor

24:58.230 --> 25:01.170
to the Defense Health Agency for the Army.

25:01.170 --> 25:04.050
I will inform the committee
as we make strides

25:04.050 --> 25:08.040
in Military Health System
Reform and Army medicine.

25:08.040 --> 25:09.700
I want to thank the committee

25:09.700 --> 25:12.260
for your longstanding support to Army

25:12.260 --> 25:14.410
and military medicine.

25:14.410 --> 25:16.850
For the service and
sacrifice of our soldiers

25:16.850 --> 25:20.610
and their families, we
must get this right.

25:20.610 --> 25:23.570
This is our solemn
obligation to our nation.

25:23.570 --> 25:25.330
Thank you for the
opportunity to come before

25:25.330 --> 25:27.130
this committee, and I look forward

25:27.130 --> 25:28.630
to answering your questions.

25:28.630 --> 25:29.820
Thank you.
- Thank you.

25:29.820 --> 25:31.183
Rear Admiral Gillingham.

25:32.590 --> 25:34.820
- Chairwoman Speier, Ranking Member Kelly,

25:34.820 --> 25:36.960
distinguished members of the subcommittee,

25:36.960 --> 25:40.350
on behalf of the mission-ready
Navy medicine team,

25:40.350 --> 25:41.450
I'm pleased to be here today

25:41.450 --> 25:43.460
with my colleagues to
provide you an update

25:43.460 --> 25:45.520
on an important issue for us all:

25:45.520 --> 25:47.810
Military Health System Reform.

25:47.810 --> 25:49.820
As we move forward with systemic changes

25:49.820 --> 25:51.630
in the MHS, I want to assure you

25:51.630 --> 25:55.040
that the foundation of
Navy medicine is readiness.

25:55.040 --> 25:57.090
Our highest priority is keeping sailors

25:57.090 --> 25:59.940
and Marines healthy and ready to deploy,

25:59.940 --> 26:02.050
and ensuring they get
the best care possible

26:02.050 --> 26:04.450
from trained and confident providers

26:04.450 --> 26:06.370
when they are wounded or injured.

26:06.370 --> 26:08.830
The nation depends upon
Navy medicine's unique

26:08.830 --> 26:11.240
expeditionary medical expertise

26:11.240 --> 26:13.960
to prepare and support our naval forces.

26:13.960 --> 26:16.550
To this end, our priorities of people,

26:16.550 --> 26:19.370
platforms, performance and power

26:19.370 --> 26:21.530
are aligned to this commitment.

26:21.530 --> 26:25.080
Well-trained people
working as cohesive teams

26:25.080 --> 26:27.140
on optimized platforms,

26:27.140 --> 26:29.340
demonstrating high-velocity performance

26:29.340 --> 26:31.410
that will project medical power

26:31.410 --> 26:34.260
in support of maritime superiority.

26:34.260 --> 26:36.550
On any given day, Navy medicine personnel

26:36.550 --> 26:38.980
are deployed and operating forward

26:38.980 --> 26:41.310
in a full range of diverse missions,

26:41.310 --> 26:43.540
including austere damage control,

26:43.540 --> 26:45.760
resuscitation and surgery teams

26:45.760 --> 26:48.630
in Central Command and Africa Command.

26:48.630 --> 26:49.870
Trauma care at the

26:49.870 --> 26:54.330
NATO Role 3 Multinational
Medical Unit in Kandahar.

26:54.330 --> 26:58.750
Humanitarian assistance aboard
hospital ship USNS Comfort.

26:58.750 --> 27:00.530
And expeditionary health service support

27:00.530 --> 27:02.850
with joint, fleet and fleet Marine forces

27:02.850 --> 27:04.490
around the world.

27:04.490 --> 27:07.140
A week ago, I had the honor
of celebrating Thanksgiving

27:07.140 --> 27:09.450
with our Navy medicine personnel

27:09.450 --> 27:12.360
forward deployed at Camp
Lemonnier, Djibouti,

27:12.360 --> 27:15.890
as part of the Combined Joint
Task Force- Horn of Africa.

27:15.890 --> 27:17.410
I saw firsthand the important work

27:17.410 --> 27:19.860
they continue to do to ensure the health

27:19.860 --> 27:21.770
and readiness of our service members

27:21.770 --> 27:23.780
and multinational partners.

27:23.780 --> 27:26.210
All of us can be justifiably proud

27:26.210 --> 27:27.773
of the great work that they do.

27:28.880 --> 27:31.920
Collectively, the substantive
reform legislation

27:31.920 --> 27:33.917
contained in the fiscal years 2017

27:33.917 --> 27:37.470
and 2019 National Defense
Authorization Acts

27:37.470 --> 27:39.830
represents an important inflection point

27:39.830 --> 27:42.590
for military medicine,
and catalyzed our efforts

27:42.590 --> 27:44.690
to strengthen our integrated system

27:44.690 --> 27:46.420
of readiness and health.

27:46.420 --> 27:48.740
Navy and Marine Corps
leadership recognized

27:48.740 --> 27:51.250
the tremendous opportunity we have

27:51.250 --> 27:54.350
to refocus our efforts
on medical readiness

27:54.350 --> 27:57.470
while transitioning healthcare
benefit administration

27:57.470 --> 27:59.610
to the Defense Health Agency.

27:59.610 --> 28:01.350
I want to emphasize that while

28:01.350 --> 28:04.162
significant organizational change

28:04.162 --> 28:06.770
in healthcare is inherently complex,

28:06.770 --> 28:09.320
all of us testifying before you today

28:09.320 --> 28:11.190
know we have a shared responsibility

28:11.190 --> 28:13.330
to ensure that both the services

28:13.330 --> 28:16.090
and the Defense Health
Agency are successful.

28:16.090 --> 28:17.710
Our efforts will continue to reflect

28:17.710 --> 28:19.363
this imperative moving forward.

28:20.536 --> 28:23.160
Integral to the MHS-wide transformation

28:23.160 --> 28:25.830
is the transition of our
military treatment facilities

28:25.830 --> 28:26.663
to the DHA.

28:27.520 --> 28:29.380
In October, as you know, the DHA

28:29.380 --> 28:31.740
assumed authority, direction and control

28:31.740 --> 28:34.420
of all MTFs in the
continental United States,

28:34.420 --> 28:36.840
including Alaska and Hawaii.

28:36.840 --> 28:39.500
As a component of this
significant transition,

28:39.500 --> 28:42.110
we are continuing to
provide defined support

28:42.110 --> 28:44.280
to the DHA as it progresses

28:44.280 --> 28:46.760
to full operating capability.

28:46.760 --> 28:48.880
In addition, Navy medicine is making

28:48.880 --> 28:50.490
important changes at all levels

28:50.490 --> 28:53.290
to support our refocus on readiness.

28:53.290 --> 28:54.890
We are streamlining activities

28:54.890 --> 28:57.260
that directly impact our capabilities

28:57.260 --> 28:59.390
to support operational requirements

28:59.390 --> 29:03.050
and ensure we have a trained
and ready medical force.

29:03.050 --> 29:06.500
We must have the agility to rapidly deploy

29:06.500 --> 29:09.400
anytime, anywhere to support fleet

29:09.400 --> 29:12.140
and fleet Marine force
missions and platforms,

29:12.140 --> 29:14.310
including expeditionary medical facilities

29:14.310 --> 29:16.450
and units, hospital ships,

29:16.450 --> 29:20.160
as well as casualty receiving
and treatment ships.

29:20.160 --> 29:21.670
The success of Navy medicine

29:21.670 --> 29:23.970
is inextricably linked to a dedicated

29:23.970 --> 29:25.970
and well-trained workforce.

29:25.970 --> 29:27.880
We continue to emphasize recruiting

29:27.880 --> 29:30.980
and retaining personnel
with the proper skillsets

29:30.980 --> 29:33.200
to care for sailors and Marines,

29:33.200 --> 29:36.520
particularly those with
critical wartime specialties.

29:36.520 --> 29:39.420
Thank you for your
support, both in resources

29:39.420 --> 29:41.710
and authorities, to help us maintain

29:41.710 --> 29:44.863
our most important asset,
the Navy medicine team.

29:46.070 --> 29:48.410
In summary, we continue to make progress

29:48.410 --> 29:50.270
in our tranformation efforts.

29:50.270 --> 29:52.330
However, all of us recognize there is much

29:52.330 --> 29:54.840
hard work ahead as we continue to build

29:54.840 --> 29:57.580
an efficient and sustainable
integrated system

29:57.580 --> 29:59.090
of readiness and health.

29:59.090 --> 30:00.250
Once again, thank you,

30:00.250 --> 30:02.053
and I look forward to your questions.

30:03.100 --> 30:03.933
- Thank you.

30:03.933 --> 30:05.650
Brigadier General Friedrichs.

30:05.650 --> 30:07.170
- Thank you, Chairwoman Speier,

30:07.170 --> 30:09.550
Ranking Member Kelly and
distinguished members

30:09.550 --> 30:11.620
of the Military Personnel Subcommittee.

30:11.620 --> 30:12.910
On behalf of Chairman Milley

30:12.910 --> 30:15.040
it's truly an honor and a privilege

30:15.040 --> 30:16.740
to be here this afternoon to provide

30:16.740 --> 30:18.140
the Joint Staff perspective

30:18.140 --> 30:19.960
on health system transformation

30:19.960 --> 30:22.210
and its impacts on the
operational readiness

30:22.210 --> 30:24.150
of the Joint Force.

30:24.150 --> 30:25.860
As the 15th Joint Staff surgeon,

30:25.860 --> 30:28.290
I also want to thank you
for the strong support

30:28.290 --> 30:31.190
you've continuously provided
to military personnel,

30:31.190 --> 30:32.250
including to me.

30:32.250 --> 30:34.950
This support's impacted more personnel

30:34.950 --> 30:36.973
than we can acknowledge this afternoon.

30:37.840 --> 30:39.362
But I'd like to tell ya a little bit,

30:39.362 --> 30:40.440
(clears throat) excuse
me, about my father,

30:40.440 --> 30:42.380
who grew up in Southern Louisiana

30:42.380 --> 30:43.940
on a farm during the Depression.

30:43.940 --> 30:46.032
Served at the end of World War II,

30:46.032 --> 30:47.220
and through the GI Bill,

30:47.220 --> 30:48.850
received his college education.

30:48.850 --> 30:50.910
Went on to help design aircraft carriers

30:50.910 --> 30:52.453
at the Brooklyn Navy Shipyard.

30:53.930 --> 30:55.020
He inspired me.

30:55.020 --> 30:56.970
Later, he met my mother, who was born

30:56.970 --> 30:59.250
in Hungary, fought in the '56 Revolution,

30:59.250 --> 31:01.240
was tortured by the KGB,

31:01.240 --> 31:04.500
eventually came to this
country to teach, married.

31:04.500 --> 31:06.350
And the two of them taught me the value

31:06.350 --> 31:08.620
of freedom and the price that must be paid

31:08.620 --> 31:09.543
to preserve it.

31:10.920 --> 31:13.430
They've inspired me to
become a military physician,

31:13.430 --> 31:15.993
and I'm honored to be here in that role.

31:16.850 --> 31:18.710
I also want to thank you
for your continued support

31:18.710 --> 31:20.720
of the Reserve Officer Training Program,

31:20.720 --> 31:21.830
which allowed me to attend

31:21.830 --> 31:24.370
the Louisiana State
University and then Tulane,

31:24.370 --> 31:26.790
and your support for the
Uniformed Services University,

31:26.790 --> 31:29.420
which provided a phenomenal
medical education

31:29.420 --> 31:31.410
and alllowed me to be a competent,

31:31.410 --> 31:33.320
and more than competent, surgeon in Iraq

31:33.320 --> 31:36.190
when people relied on me to care for them.

31:36.190 --> 31:38.370
And they relied on many
of us to care for them,

31:38.370 --> 31:40.810
whether it was in Iraq or Afghanistan,

31:40.810 --> 31:42.530
the North Pole, the South Pole

31:42.530 --> 31:45.400
and all the other places
where military service members

31:45.400 --> 31:47.423
receive care from military medics.

31:48.800 --> 31:50.110
I'm grateful for your commitment

31:50.110 --> 31:51.610
to Joint Medical Operations.

31:51.610 --> 31:53.470
I met my wife, an Army physician,

31:53.470 --> 31:55.770
in the back stairs of
the old Beach Pavilion

31:55.770 --> 31:57.960
at Brooke Army Medical Center.

31:57.960 --> 32:00.110
We have a much better facility today,

32:00.110 --> 32:02.020
thanks to you, but we've always had

32:02.020 --> 32:04.300
great facilities in which we provided

32:04.300 --> 32:06.373
great care for our service members.

32:07.470 --> 32:10.010
As the son of a Navy service member,

32:10.010 --> 32:12.770
the husband of a former
Army service member,

32:12.770 --> 32:14.510
the father of two young men who hope

32:14.510 --> 32:17.460
to serve in the Navy,
I am fiercely committed

32:17.460 --> 32:20.640
to continuing to ensure
we provide great care.

32:20.640 --> 32:23.000
My wife now works for the
Veterans Health Administration

32:23.000 --> 32:24.810
and is a constant reminder to me

32:24.810 --> 32:27.200
of the importance not
only of getting it right

32:27.200 --> 32:28.780
while people are serving,

32:28.780 --> 32:31.970
but also as Americans transition from

32:31.970 --> 32:34.210
the Department of Defense to the VA,

32:34.210 --> 32:35.460
we must continue to improve

32:35.460 --> 32:37.970
that inter-agency collaboration.

32:37.970 --> 32:39.750
As Chairman Milley recently noted,

32:39.750 --> 32:42.040
we're in a period of
great power competition

32:42.040 --> 32:45.480
within a complex and dynamic
security environment.

32:45.480 --> 32:46.840
The fundamental character of war

32:46.840 --> 32:50.030
is changing rapidly, the
threats are worsening,

32:50.030 --> 32:51.610
and we must evolve to meet them.

32:51.610 --> 32:54.810
And thanks to your continued
help, we are doing so.

32:54.810 --> 32:56.970
You asked us in Section 732 of the

32:56.970 --> 32:59.750
2019 National Defense Authorization Act

32:59.750 --> 33:01.650
to develop a joint medical estimate,

33:01.650 --> 33:03.850
and our office is leading that effort.

33:03.850 --> 33:06.460
We will put the initial
draft in coordination

33:06.460 --> 33:08.450
next month, and plan to publish it in May.

33:08.450 --> 33:10.390
That will be an annual report

33:10.390 --> 33:13.420
in which, as other functional
communities have done,

33:13.420 --> 33:16.100
we will describe requirements, gaps

33:16.100 --> 33:18.080
and the risks that those gaps create

33:18.080 --> 33:19.810
to the mission and to the force

33:19.810 --> 33:22.050
based on the National Defense Strategy,

33:22.050 --> 33:25.720
co com inputs, the
inputs from the services,

33:25.720 --> 33:28.610
our inter-agency partners and our allies.

33:28.610 --> 33:30.710
After the JME is published, if helpful,

33:30.710 --> 33:32.260
it would be a privilege to return

33:32.260 --> 33:34.343
and brief you on its contents.

33:35.350 --> 33:37.140
The National Defense Strategy describes

33:37.140 --> 33:40.900
significant challenges, and
the 2019 capstone concept

33:40.900 --> 33:43.160
of Joint Operations begins to describe

33:43.160 --> 33:46.320
how the department
integrates those requirements

33:46.320 --> 33:49.520
across the force in order
to reshape the force.

33:49.520 --> 33:51.410
In addition, we know our nation continues

33:51.410 --> 33:53.940
to face natural disasters and other events

33:53.940 --> 33:56.580
which require a whole
of government response,

33:56.580 --> 33:58.010
and we continue to partner with

33:58.010 --> 33:59.750
the Department of Health
and Human Services,

33:59.750 --> 34:01.630
Department of Veterans Affairs,

34:01.630 --> 34:03.610
other federal, state, regional,

34:03.610 --> 34:06.160
tribal and local stakeholders to ensure

34:06.160 --> 34:08.270
we are ready when our nation

34:08.270 --> 34:09.893
requires us to respond.

34:10.780 --> 34:12.730
But regardless of the technology employed

34:12.730 --> 34:14.790
by our warfighters, there's always

34:14.790 --> 34:16.430
a human being in that process,

34:16.430 --> 34:18.630
and our job as military medics

34:18.630 --> 34:22.640
is to maintain that human weapon system.

34:22.640 --> 34:24.720
Our job is to ensure that human

34:24.720 --> 34:26.440
is ready to deploy

34:26.440 --> 34:28.510
and that we are there and
ready to care for them

34:28.510 --> 34:30.480
when they need us.

34:30.480 --> 34:32.420
I'm grateful for your
support for our mission

34:32.420 --> 34:33.680
and for our service members,

34:33.680 --> 34:35.710
grateful for the opportunity to serve

34:35.710 --> 34:38.270
as a military medic and
grateful for the opportunity

34:38.270 --> 34:39.950
to answer your questions this afternoon.

34:39.950 --> 34:40.783
Thank you.

34:43.940 --> 34:46.340
- Thank you all for your testimony.

34:46.340 --> 34:49.950
Let me begin by asking

34:49.950 --> 34:53.510
the question that probably is on the minds

34:53.510 --> 34:54.563
of a lot of people.

34:56.510 --> 34:59.730
Are there going to be 18,000 billets

34:59.730 --> 35:02.660
that are going to be reduced as part

35:02.660 --> 35:04.323
of this defense-wide review?

35:05.520 --> 35:08.060
Is that a question for you, Mr. McCaffery?

35:08.060 --> 35:09.550
- Yes, I will start

35:10.560 --> 35:12.330
the initial response.

35:12.330 --> 35:15.310
The proposal that you're referring to,

35:15.310 --> 35:17.430
in terms of the proposed reduction

35:17.430 --> 35:19.690
of around 18,000 medical billets,

35:19.690 --> 35:22.400
is something that was put forward

35:22.400 --> 35:26.670
in the president's 2020
budget, so last year.

35:26.670 --> 35:29.520
That is distinct and separate from

35:29.520 --> 35:31.170
your reference to the defense-wide review,

35:31.170 --> 35:33.370
which is something that just started

35:33.370 --> 35:35.200
within the last three months

35:35.200 --> 35:36.260
by Secretary Esper,

35:36.260 --> 35:39.020
so the two are separate.

35:39.020 --> 35:41.200
To get to your question about the plans

35:41.200 --> 35:44.210
for the 18,000, I will let each

35:44.210 --> 35:45.690
of the military departments kinda weigh in

35:45.690 --> 35:48.460
in more specifics, but the bottom line,

35:48.460 --> 35:51.240
last year, each of the
military departments

35:51.240 --> 35:55.270
determined that their
current medical force

35:55.270 --> 35:57.900
exceeded the operational
requirements they needed,

35:57.900 --> 36:00.510
and each military
department made a decision

36:01.970 --> 36:04.740
to look at a subset of
their medical billets

36:04.740 --> 36:08.610
and repurpose them for
other high priorities

36:08.610 --> 36:11.050
tied to the military department's needs

36:11.050 --> 36:13.623
in meeting national defense goals.

36:16.228 --> 36:19.910
That is the basis for
the proposed reductions.

36:19.910 --> 36:22.210
I will defer to the military departments

36:22.210 --> 36:25.290
in terms of giving a little more detail,

36:25.290 --> 36:27.913
in terms of the numbers and the timing.

36:29.480 --> 36:33.010
The initial planning here is in,

36:33.010 --> 36:36.710
I think with some exceptions, in 2020,

36:36.710 --> 36:39.580
the plan would be to only make changes

36:39.580 --> 36:42.480
to vacant billets, so
billets that don't have

36:42.480 --> 36:45.110
somebody currently occupying, doing a job.

36:45.110 --> 36:48.110
And right now, our focus, working with

36:48.110 --> 36:50.500
the military departments,
the Defense Health Agency,

36:50.500 --> 36:52.570
is really around what would be

36:52.570 --> 36:56.627
the scheduled reductions coming in FY '21

36:56.627 --> 37:00.120
and what would our plans
be to implement that

37:00.120 --> 37:03.300
in a way that we maintain the capability

37:03.300 --> 37:06.450
in our system, be it through contractors,

37:06.450 --> 37:09.900
the Tricare network, hiring civilians

37:09.900 --> 37:12.860
to restore that capability that could

37:12.860 --> 37:17.027
be removed based upon the
medical billet reduction.

37:17.027 --> 37:17.860
- [Jackie] All right.

37:17.860 --> 37:19.670
Do you have numbers for each

37:19.670 --> 37:20.683
of the services?

37:21.640 --> 37:23.490
- I think I will let each of the services

37:23.490 --> 37:25.303
get into their particular numbers.

37:27.020 --> 37:28.180
- Yes, ma'am.

37:28.180 --> 37:30.840
So every year in the Air
Force Medical Service,

37:30.840 --> 37:33.240
we go through a process to identify

37:33.240 --> 37:36.370
what our operational
medical requirement is.

37:36.370 --> 37:37.560
And that process is called

37:37.560 --> 37:40.500
the Critical Operational
Readiness Requirement.

37:40.500 --> 37:42.880
And in that process, it identifies

37:42.880 --> 37:44.800
what I need in uniform to do

37:44.800 --> 37:46.433
my operational mission.

37:50.330 --> 37:52.040
Last year's review of that

37:52.040 --> 37:55.700
indicated that I had a
little over 4,000 medics

37:55.700 --> 37:58.593
that were over my uniformed requirement.

37:59.620 --> 38:01.489
- Okay, I'm gonna have to,

38:01.489 --> 38:02.322
we're gonna have to move
quickly 'cause I have

38:02.322 --> 38:03.820
a number of other question I wanna ask.

38:03.820 --> 38:05.750
Lieutenant General Dingle.

38:05.750 --> 38:08.521
So 4,000 in the Air Force, is that right?

38:08.521 --> 38:10.430
- [Dorothy] Yes, ma'am.

38:10.430 --> 38:13.900
- Ma'am, in the Army, we have 6,935

38:13.900 --> 38:17.090
billets that we have
identified for conversion.

38:17.090 --> 38:19.880
In our analysis, these do not impact

38:19.880 --> 38:22.680
any services or any risk to mission,

38:22.680 --> 38:24.640
and we continue to do analysis

38:24.640 --> 38:27.000
with the DHA and the other service

38:27.000 --> 38:28.490
to ensure that it's not impacting

38:28.490 --> 38:30.520
the multi-service markets.

38:30.520 --> 38:32.230
- [Jackie] All right, Admiral.

38:32.230 --> 38:33.830
- Chairwoman Speier, the number

38:33.830 --> 38:37.650
for the Navy is 5,386.

38:37.650 --> 38:39.530
This was based on a careful analysis

38:39.530 --> 38:41.480
of the National Defense Strategy.

38:41.480 --> 38:44.250
But as General Dingle stated,

38:44.250 --> 38:46.980
we continue to assess this against

38:46.980 --> 38:48.343
the DHA requirement.

38:51.020 --> 38:51.940
- All right.

38:51.940 --> 38:54.010
I think we're gonna need to have you

38:54.010 --> 38:57.003
provide us something a
little more detailed.

38:58.130 --> 39:00.360
So if you would, make a point

39:00.360 --> 39:05.360
of providing us the specific specialties

39:05.590 --> 39:08.780
that you are extracting

39:09.915 --> 39:10.865
these billets from,

39:14.705 --> 39:15.538
and then we'll go from there.

39:15.538 --> 39:17.070
We may have to do a deeper dive than that.

39:17.070 --> 39:19.500
But Ranking Member Kelly, do you have

39:19.500 --> 39:21.300
any other thoughts about that?

39:21.300 --> 39:23.670
- Just any adds that they got 'cause

39:23.670 --> 39:26.340
you know the OBGYN shortage
that we talked about

39:26.340 --> 39:28.530
with our female combat (mumbles).

39:28.530 --> 39:29.650
So I see the subtractions,
but would ya have

39:29.650 --> 39:30.810
any adds, we'd like to know those, too.

39:30.810 --> 39:31.963
- Okay, very good.

39:33.310 --> 39:35.510
Now, my time has expired,
but I'm gonna take

39:36.809 --> 39:39.143
the privilege of asking
just one more question.

39:40.280 --> 39:44.140
Mental health was an issue we heard about

39:44.140 --> 39:46.120
over and over again when we visited

39:46.120 --> 39:47.430
the various bases.

39:47.430 --> 39:51.750
That initial assessment may be made

39:51.750 --> 39:55.370
within 72 hours, but then they wait

39:55.370 --> 39:57.630
upwards of three months.

39:57.630 --> 40:01.070
Now, that's an unacceptable length of time

40:01.070 --> 40:03.540
to wait for mental health services.

40:03.540 --> 40:06.150
So I don't know that you could

40:06.150 --> 40:09.130
speak to that today, but I think

40:09.130 --> 40:10.890
I would like for you to be on notice

40:10.890 --> 40:15.330
that I am not confident

40:15.330 --> 40:17.000
that we are providing the level

40:17.000 --> 40:19.150
of mental health services we need.

40:19.150 --> 40:21.430
And I would like for you

40:21.430 --> 40:24.840
to each go back and look at the length

40:24.840 --> 40:28.140
of time between initial assessment

40:28.140 --> 40:32.420
and the ability to actually

40:32.420 --> 40:35.520
get the regular services.

40:35.520 --> 40:38.200
And then, the oversaturation,

40:38.200 --> 40:40.780
I think it's a, we heard it loud and clear

40:40.780 --> 40:43.460
in Seattle, in particular,
when we were there.

40:43.460 --> 40:46.150
People are, families are not able

40:46.150 --> 40:49.080
to access the services in Tricare.

40:49.080 --> 40:52.140
And there's some speculation that

40:52.140 --> 40:54.290
Tricare is paying at a lower rate,

40:54.290 --> 40:55.940
which doesn't make sense to me because,

40:55.940 --> 40:58.680
ostensibly, it's linked to Medicare,

40:58.680 --> 41:00.180
and, therefore, should

41:01.810 --> 41:02.850
meet the needs.

41:02.850 --> 41:05.060
But if it's not, that needs
to be assessed, as well.

41:05.060 --> 41:07.010
And with that, I will turn it over

41:07.010 --> 41:08.210
to Ranking Member Kelly.

41:09.740 --> 41:10.907
- Thank you, Chairwoman Speier.

41:10.907 --> 41:12.200
And I'm glad you,

41:12.200 --> 41:14.460
we're pretty much locked up on this.

41:14.460 --> 41:17.020
And I just want you guys to know

41:18.760 --> 41:20.910
that's a lotta billets
that are going away.

41:21.920 --> 41:23.990
And you talk about near peer

41:23.990 --> 41:25.970
and future threats, let me tell you what.

41:25.970 --> 41:27.390
Civilians don't go downrange

41:27.390 --> 41:28.960
when we hit 'em downrange.

41:28.960 --> 41:31.460
It takes guys and girls in uniform

41:31.460 --> 41:34.120
to get our soldiers to the right level

41:34.120 --> 41:35.883
of care in that magic hour.

41:36.810 --> 41:38.930
And if they're not
there, we have soldiers,

41:38.930 --> 41:41.370
sailors, airmen and Marines that die.

41:41.370 --> 41:42.553
And so we need to make sure

41:42.553 --> 41:44.590
that we're looking at each and every one.

41:44.590 --> 41:46.460
We need to scrutinize every single

41:46.460 --> 41:48.350
medical professional we can.

41:48.350 --> 41:50.220
And then going back to my point

41:50.220 --> 41:52.813
with Chairwoman Speier,

41:53.960 --> 41:56.150
we talked to female combat soldiers

41:56.150 --> 42:00.180
and there is a lack of
medical professionals

42:00.180 --> 42:02.500
that are able to provide specific,

42:02.500 --> 42:04.760
whether it be medics or OB-GYNs

42:04.760 --> 42:06.730
or things that can apply specific

42:06.730 --> 42:08.650
medical procedures for women,

42:08.650 --> 42:10.240
and we need to make sure
we're addressing that.

42:10.240 --> 42:11.630
So we shouldn't just be subtracting,

42:11.630 --> 42:13.140
we should be adding in some areas

42:13.140 --> 42:15.227
and saying, "Hey, we can
get rid of these folks,

42:15.227 --> 42:16.670
"but we need more in this area."

42:16.670 --> 42:19.840
So I ask that ya do a
comprehensive review.

42:19.840 --> 42:21.210
As I mentioned in my opening statement,

42:21.210 --> 42:23.130
I'm extremely concerned
about the lengthy delays

42:23.130 --> 42:25.600
for routine behavioral health appointments

42:25.600 --> 42:28.350
and the shortage of mental
health professionals.

42:28.350 --> 42:30.060
The services have told us for years

42:30.060 --> 42:34.200
that low pay and complex
hiring processes are to blame.

42:34.200 --> 42:35.820
What are the services and DHA

42:35.820 --> 42:37.100
doing to fix this issue?

42:37.100 --> 42:38.960
And I think if either Mr. McCaffery

42:38.960 --> 42:40.450
or Lieutenant General
Place can answer this,

42:40.450 --> 42:41.410
I'll just stick with you so I can

42:41.410 --> 42:42.510
get more questions in.

42:47.750 --> 42:49.473
- Sir, we agree with you.

42:49.473 --> 42:52.680
The challenges, some of it are within

42:52.680 --> 42:54.820
the regulations, the
requirements that we have

42:54.820 --> 42:56.850
of hiring civilians into
any part of our programs.

42:56.850 --> 42:58.850
Certainly in high-yield areas

42:58.850 --> 43:01.490
like mental health, it's
even more of a problem.

43:01.490 --> 43:03.350
We do have a wide range of

43:04.220 --> 43:06.840
incentives and bonus pays
that we apply to them.

43:06.840 --> 43:08.330
In some areas, they're
relatively effective,

43:08.330 --> 43:10.560
in other areas, they're just not.

43:10.560 --> 43:12.370
The reality is across the systems,

43:12.370 --> 43:13.250
I can give you examples.

43:13.250 --> 43:14.083
I prefer

43:15.300 --> 43:17.760
not to, but rural America in particular,

43:17.760 --> 43:19.810
it's very difficult to
find these sorts of things,

43:19.810 --> 43:22.070
irrespective of the incentives

43:22.070 --> 43:22.940
that we put against it.

43:22.940 --> 43:24.530
So for a worldwide organization,

43:24.530 --> 43:26.230
that's the challenge that we face.

43:29.820 --> 43:31.190
- We've heard from several families

43:31.190 --> 43:32.780
in veterans service organizations

43:32.780 --> 43:35.250
that increased copays for
specialty care visits,

43:35.250 --> 43:37.610
like care for autism, have made this care

43:37.610 --> 43:39.810
unaffordable for many military families.

43:39.810 --> 43:41.330
In a recent report to Congress,

43:41.330 --> 43:43.310
DOD stated that approximately 1/4

43:43.310 --> 43:45.610
of military beneficiaries
with household incomes

43:45.610 --> 43:48.330
below 50,000 reported postponing

43:48.330 --> 43:52.010
primary care sometimes, often or usually.

43:52.010 --> 43:53.550
This is unacceptable.

43:53.550 --> 43:55.653
What has the department done to fix this?

44:05.359 --> 44:06.553
- I'm not aware that,

44:08.010 --> 44:10.840
you mentioned with regard
to increasing cost shares

44:10.840 --> 44:13.730
for certain services, that that has

44:13.730 --> 44:16.340
been identified as a barrier

44:16.340 --> 44:18.530
in terms of seeking
primary care appointments,

44:18.530 --> 44:20.380
other appointments.

44:20.380 --> 44:22.580
I know one of the things that we

44:22.580 --> 44:25.210
have done at DHA last year,

44:25.210 --> 44:28.100
we're continuing to
look at it, is, indeed,

44:28.100 --> 44:30.560
have there been a difference
in terms of utilization

44:30.560 --> 44:32.970
of services based upon some of the

44:32.970 --> 44:34.440
increased co-shares?

44:34.440 --> 44:36.570
I don't believe we have
finished that analysis,

44:36.570 --> 44:38.730
but that would, I think, inform

44:38.730 --> 44:40.067
what would be the next steps to--

44:40.067 --> 44:42.080
- And I won't interrupt you, but you guys

44:42.080 --> 44:43.640
always have an answer on the record.

44:43.640 --> 44:46.500
That is definitely, that is
exactly and specifically.

44:46.500 --> 44:47.540
And if you need me to give you

44:47.540 --> 44:49.130
the question again after so we can get

44:49.130 --> 44:51.260
specific replies, but we can't afford.

44:51.260 --> 44:53.730
Our families of our
soldiers and our soldiers

44:53.730 --> 44:57.930
or our airmen or our sailors
are the most important things

44:57.930 --> 44:59.203
that we have, and we've gotta make sure

44:59.203 --> 45:01.350
that we don't put any impediments

45:01.350 --> 45:04.000
to primary care for those folks.

45:04.000 --> 45:06.270
And for Mr. McCaffery or
Lieutenant General Place,

45:06.270 --> 45:09.700
I wanna ask you about
MTF realignment process.

45:09.700 --> 45:11.710
Can you explain what
you're doing to ensure

45:11.710 --> 45:14.330
the civilian healthcare network can absorb

45:14.330 --> 45:18.345
the patients that would be
displaced from the MTFs?

45:18.345 --> 45:20.060
Because I know in as early as 2017,

45:20.060 --> 45:22.140
I was in Italy and we were talking about

45:22.140 --> 45:23.930
shutting down in Naples,

45:23.930 --> 45:26.940
where there was no primary care available

45:26.940 --> 45:28.070
on the local economy.

45:28.070 --> 45:30.310
So tell me how you're
gonna address that, please.

45:30.310 --> 45:32.750
- So what you're referring to is,

45:32.750 --> 45:34.600
as you mentioned in
your opening statement,

45:34.600 --> 45:36.040
one of the things that Congress

45:36.040 --> 45:37.800
directed the department to do

45:37.800 --> 45:41.740
in NDA 2017 was, for
lack of a better word,

45:41.740 --> 45:43.820
was they asked us to optimize

45:43.820 --> 45:44.710
our direct-care system.

45:44.710 --> 45:47.500
And what I mean by that is to look back

45:47.500 --> 45:50.310
and say the essential purpose of our

45:50.310 --> 45:52.380
medical treatment facilities is to serve

45:52.380 --> 45:54.317
as training platforms for our providers

45:54.317 --> 45:56.710
and to provide access
to care to active duty

45:56.710 --> 45:58.350
so that they can do their jobs.

45:58.350 --> 46:00.180
And so the ask was

46:01.040 --> 46:04.490
looking at a particular
MTF and the services,

46:04.490 --> 46:07.170
the capabilities they have,
how does it tie to that?

46:07.170 --> 46:09.530
How does it tie to
supporting that mission?

46:09.530 --> 46:12.150
And part of that is there may be areas

46:12.150 --> 46:15.020
where there is no civilian network,

46:15.020 --> 46:18.080
and so ya need to have an MTF there.

46:18.080 --> 46:19.990
But there may be places, not everywhere,

46:19.990 --> 46:21.570
but there may be places where

46:21.570 --> 46:23.840
the civilian network is robust.

46:23.840 --> 46:27.200
We can provide care to non-active duty

46:28.824 --> 46:30.220
at less cost.

46:30.220 --> 46:33.620
And that helps optimize
the use of that MTF.

46:33.620 --> 46:34.480
- We're over time, Mr. McCaffery,

46:34.480 --> 46:37.140
but I do wanna make one final point.

46:37.140 --> 46:40.860
We were just at Joint Base Lewis-McChord,

46:40.860 --> 46:44.090
and we've oversaturated that, based on

46:44.090 --> 46:45.810
civilian capability that was there.

46:45.810 --> 46:47.890
And so we've sent all
our people with problems,

46:47.890 --> 46:49.410
with the identical problems there

46:49.410 --> 46:50.600
because they had it, and now we've

46:50.600 --> 46:52.320
oversaturated the civilian market.

46:52.320 --> 46:53.570
We have to pay attention to second

46:53.570 --> 46:54.842
and third-order effect.

46:54.842 --> 46:56.910
And then I have to yield back, Chairwoman.

46:56.910 --> 46:58.390
- Thank you.

46:58.390 --> 46:59.623
Congresswoman Davis.

47:01.843 --> 47:02.927
- Thank you.

47:02.927 --> 47:04.027
Thank you, Madam Chair

47:05.457 --> 47:06.660
and thank you to all
of you for being here,

47:06.660 --> 47:08.470
for your dedication.

47:08.470 --> 47:11.120
We know this is really complex.

47:11.120 --> 47:13.930
When any large organization
tries to integrate

47:13.930 --> 47:17.620
in a different way, it's
gonna be very difficult.

47:17.620 --> 47:20.370
But I wonder if you could,

47:20.370 --> 47:21.373
for a moment.

47:22.760 --> 47:25.385
I think, actually, Mr. McCaffery,

47:25.385 --> 47:26.850
you sort of just summed up, I think,

47:26.850 --> 47:29.680
what the goals, what
the expectations were,

47:29.680 --> 47:30.793
to a certain extent,

47:31.660 --> 47:33.560
but what I'm hearing, and I think

47:33.560 --> 47:36.580
what we're concerned about, is that

47:36.580 --> 47:38.640
perhaps the push for

47:40.960 --> 47:44.460
cost savings is,

47:44.460 --> 47:47.410
could overshadow not just efficiencies,

47:47.410 --> 47:51.130
but services to beneficiaries.

47:51.130 --> 47:53.630
And my understanding is that

47:53.630 --> 47:55.620
there's some difference in the way

47:55.620 --> 47:57.910
the different services see this.

47:57.910 --> 48:00.830
And could you talk, maybe just going down

48:00.830 --> 48:01.930
the line a little bit,

48:02.950 --> 48:05.600
was there a difference in what we were,

48:05.600 --> 48:09.640
you were trying to
accomplish through this?

48:09.640 --> 48:12.870
And how are, what were
those differences expressed?

48:12.870 --> 48:13.703
- Sure.

48:13.703 --> 48:15.720
And Congresswoman Davis,

48:15.720 --> 48:17.440
I appreciate your opening statement

48:17.440 --> 48:19.410
about this being hard.

48:19.410 --> 48:21.760
My background is in private sector

48:21.760 --> 48:23.570
and public sector healthcare.

48:23.570 --> 48:25.130
And what we've talked about,

48:25.130 --> 48:27.120
in terms of this MTF transition,

48:27.120 --> 48:28.980
is really, in essence, like a merger,

48:28.980 --> 48:32.060
a merger of separate healthcare systems.

48:32.060 --> 48:35.290
It is a big, heavy lift.

48:35.290 --> 48:38.590
And anyone that would think,
whether it's the military

48:38.590 --> 48:40.060
or any other organization,

48:40.060 --> 48:42.700
that wouldn't have challenges,

48:42.700 --> 48:46.053
wouldn't have contention
about that change,

48:47.295 --> 48:48.410
they're not speaking realistically.

48:48.410 --> 48:49.410
Have we had those?

48:49.410 --> 48:51.230
Yes, we have.

48:51.230 --> 48:53.480
But that being said,

48:53.480 --> 48:56.500
I believe we are in an excellent spot

48:56.500 --> 48:58.380
in terms of how we manage this.

48:58.380 --> 48:59.530
We've already started it.

48:59.530 --> 49:02.480
A year ago, we moved 31 facilities

49:02.480 --> 49:04.360
under the DHA, and as you heard

49:04.360 --> 49:07.130
from the panel, we are actually working

49:07.130 --> 49:08.900
in direct support relationship with each

49:08.900 --> 49:10.930
of the military departments

49:10.930 --> 49:13.240
to manage this transition in a way

49:13.240 --> 49:14.930
that we don't let it affect

49:14.930 --> 49:17.890
our active duty or our beneficiaries.

49:17.890 --> 49:20.280
Number two, the issue you mentioned about

49:20.280 --> 49:22.930
is this about cost savings or efficiency,

49:22.930 --> 49:25.430
I'd say it's about effectiveness.

49:25.430 --> 49:28.410
I think Congress recognized in 2017

49:28.410 --> 49:30.090
that we could be more effective

49:30.090 --> 49:32.850
as a military medical enterprise

49:32.850 --> 49:35.380
if we didn't have four separate systems,

49:35.380 --> 49:38.170
but we had a consolidated system

49:38.170 --> 49:41.220
that could respond to
the mission requirements

49:41.220 --> 49:43.280
as an enterprise, that we could have

49:43.280 --> 49:46.240
more standardization across the system

49:46.240 --> 49:48.590
not just for our beneficiaries

49:48.590 --> 49:50.170
and their experience of care,

49:50.170 --> 49:51.740
but most importantly for how

49:51.740 --> 49:53.650
it affects operational missions.

49:53.650 --> 49:55.870
Meaning the fact that you could have

49:55.870 --> 49:57.920
the same equipment or devices

49:57.920 --> 49:59.357
that our uniformed providers are using

49:59.357 --> 50:01.520
in the MTFs are the same ones

50:01.520 --> 50:02.460
they're using downrange.

50:02.460 --> 50:06.010
So this is, to me, more
about effectiveness,

50:06.010 --> 50:08.340
of making the Military Health System

50:09.270 --> 50:11.120
even more successful
in meeting the mission,

50:11.120 --> 50:12.540
as opposed to.

50:12.540 --> 50:14.120
Do I think there's gonna
be savings out of it?

50:14.120 --> 50:15.340
Yes.

50:15.340 --> 50:16.694
I think you get that

50:16.694 --> 50:18.530
out of that consolidation
and standardization.

50:18.530 --> 50:20.140
But the focus is on effectiveness.

50:20.140 --> 50:21.210
- Mm-hm.

50:21.210 --> 50:22.950
If anybody else wants to comment on that.

50:22.950 --> 50:24.960
I think the difficult thing is what

50:24.960 --> 50:27.540
we're dealing with people, (laughs) right?

50:27.540 --> 50:30.990
Employees who have to sort of work through

50:30.990 --> 50:33.040
what this is gonna mean to them.

50:33.040 --> 50:34.920
And so I'm wondering a little bit, too,

50:34.920 --> 50:36.510
about how you're messaging for them

50:36.510 --> 50:38.990
because if you're losing
that many billets,

50:38.990 --> 50:41.333
that's having an effect on people.

50:42.180 --> 50:43.860
And I think it does translate

50:43.860 --> 50:46.433
into beneficiary services.

50:46.433 --> 50:48.780
And I know, as well, I
mean, having served on

50:48.780 --> 50:50.670
the Mil Pers committee at the height

50:50.670 --> 50:54.323
of our wars, I mean,
from 2001 until today,

50:55.370 --> 50:58.320
there were so many families
that were ready to walk

50:59.160 --> 51:01.510
because, initially, they were not getting

51:01.510 --> 51:03.530
the support that they needed.

51:03.530 --> 51:06.260
And so talk a little bit more about,

51:06.260 --> 51:09.610
I mean, what comes together is that

51:09.610 --> 51:11.250
there are needs that are difficult

51:11.250 --> 51:12.460
and difficult to work through

51:12.460 --> 51:14.010
in a very short period of time.

51:16.941 --> 51:18.700
What is it today that you would like

51:18.700 --> 51:19.840
to share with us that's going

51:19.840 --> 51:23.723
to get this job done
perhaps a little faster?

51:26.660 --> 51:30.140
- To get the transition done faster?

51:30.140 --> 51:31.940
- Well, I think to

51:34.150 --> 51:36.450
help with the transition,
while at the same time

51:36.450 --> 51:38.680
respecting the men and
women not just who serve,

51:38.680 --> 51:41.930
but all the people who
are part of this system.

51:41.930 --> 51:44.510
How are they gonna be part of it?

51:44.510 --> 51:47.580
- So right now, General Place

51:47.580 --> 51:50.010
and each of the surgeons general

51:50.010 --> 51:52.190
are actively part of this transition

51:52.190 --> 51:55.270
of moving administration of the MTFs

51:55.270 --> 51:58.130
to DHA is about, well, how do we

51:58.130 --> 52:00.720
make sure that that knowledge

52:00.720 --> 52:03.600
and the resources that
are now in the services

52:03.600 --> 52:05.410
get moved over to the DHA?

52:05.410 --> 52:06.960
And we're talking about people.

52:08.509 --> 52:10.810
It's easier for us to move
uniformed people around,

52:10.810 --> 52:12.140
but the civilians are different.

52:12.140 --> 52:15.970
And so what we're doing is
we are working together to,

52:15.970 --> 52:19.910
as much as possible,
allow a clean transfer

52:19.910 --> 52:22.880
of folks doing certain responsibilities

52:22.880 --> 52:24.380
in the service medical headquarters,

52:24.380 --> 52:27.093
bring them over to DHA.

52:28.100 --> 52:31.070
And where we're not being able to do that,

52:31.070 --> 52:32.900
look at different tools that we can

52:32.900 --> 52:35.380
do management directive transfers so that

52:35.380 --> 52:38.580
we ensure not only the DHA get that

52:38.580 --> 52:40.880
people resource that we need,

52:40.880 --> 52:42.110
but that's also the same time

52:42.110 --> 52:44.430
ensuring that those employees

52:44.430 --> 52:46.110
that are doing that mission

52:46.110 --> 52:47.420
continue to do that mission,

52:47.420 --> 52:48.890
but under a different management.

52:48.890 --> 52:50.360
- Yeah, I appreciate that.

52:50.360 --> 52:51.193
My time is up.

52:51.193 --> 52:54.260
I'm gonna turn it back to the chairwoman,

52:54.260 --> 52:56.000
but I, just sort of hearing from

52:57.307 --> 52:58.920
all of you, as well,
and in terms of, like,

52:58.920 --> 53:00.620
so what do you have to
do to make sure that

53:00.620 --> 53:03.240
that happens, and we're not just saying

53:03.240 --> 53:06.647
we're gonna do it, but we're gonna act

53:06.647 --> 53:07.480
on what we say?

53:07.480 --> 53:08.313
- Thank you.

53:08.313 --> 53:09.146
Dr. Abraham.

53:09.146 --> 53:10.350
- Thank you, Madam Chair.

53:10.350 --> 53:12.840
Dr. Friedrichs, I listened to your resume

53:12.840 --> 53:14.850
and I know where you
went to medical school.

53:14.850 --> 53:17.260
And I know in your heart of hearts,

53:17.260 --> 53:19.270
you do understand that LSU

53:19.270 --> 53:21.566
will be the national champion this year.

53:21.566 --> 53:22.480
(group laughing)

53:22.480 --> 53:23.480
- Absolutely, sir.

53:23.480 --> 53:25.265
I strongly endorse that.

53:25.265 --> 53:26.820
(group laughing)

53:26.820 --> 53:29.160
- On a sad note,

53:29.160 --> 53:32.310
we were discussing with you,

53:32.310 --> 53:35.150
ladies and gentlemen, that our veterans

53:35.150 --> 53:37.900
are being moved to the
civilian population.

53:37.900 --> 53:40.310
And I still practice pro bono

53:40.310 --> 53:41.370
in a medical practice.

53:41.370 --> 53:45.180
That certainly takes
those wonderful people.

53:45.180 --> 53:46.950
But we still have problems with

53:46.950 --> 53:50.230
Tricare West and others not being accepted

53:50.230 --> 53:51.063
in the civilian.

53:51.063 --> 53:51.940
I've taken this up with with the

53:51.940 --> 53:53.810
Veterans Affairs Committee,
where, of course,

53:53.810 --> 53:54.790
jurisdiction lies.

53:54.790 --> 53:57.390
But you need to be aware that

53:57.390 --> 53:59.390
when we move these veterans

53:59.390 --> 54:01.210
from an active military

54:02.730 --> 54:05.810
situation to a civilian situation,

54:05.810 --> 54:08.580
it becomes problematic that if

54:08.580 --> 54:10.690
that particular insurance is not taken

54:10.690 --> 54:12.810
by civilians, those patients,

54:12.810 --> 54:15.640
those veterans are denied, unfortunately,

54:15.640 --> 54:17.200
care in some places.

54:17.200 --> 54:18.690
We, of course, take 'em regardless,

54:18.690 --> 54:21.770
but some practices
can't afford to do that.

54:21.770 --> 54:24.720
And toward General Kelly's point,

54:24.720 --> 54:27.530
there is a barrier, Mr. Secretary,

54:27.530 --> 54:30.190
when that copayment is higher

54:30.190 --> 54:33.500
for certain specialties.

54:33.500 --> 54:35.890
As to those families
that may not can afford

54:35.890 --> 54:39.170
if it goes from 10 to 25 to 50, whatever.

54:39.170 --> 54:40.970
So that is something that we

54:40.970 --> 54:42.330
have to continue to address.

54:42.330 --> 54:44.750
My question, and I'll start with all

54:44.750 --> 54:46.600
the surgeon generals here,

54:46.600 --> 54:50.650
just please explain any inefficiencies

54:50.650 --> 54:53.830
or structural difficulties that you have

54:53.830 --> 54:56.117
with DHA at this time.

54:56.117 --> 54:59.083
And General Place, I'll
start with you, sir.

55:02.193 --> 55:04.123
- I don't think there's any
structural problems with DHA.

55:05.700 --> 55:07.903
I see a collaborative
process that enables us

55:07.903 --> 55:10.660
to come together to have overlap.

55:10.660 --> 55:11.870
Now, one of the problems with overlap,

55:11.870 --> 55:13.794
overlap takes more time.

55:13.794 --> 55:16.090
And it's crucial to not have gaps

55:16.090 --> 55:18.030
and drop a solider,

55:18.030 --> 55:20.230
drop a family member, drop a retiree.

55:20.230 --> 55:21.780
So to

55:23.730 --> 55:24.960
Miss Davis' point before,

55:24.960 --> 55:27.118
ma'am, I get that we wanna go fast,

55:27.118 --> 55:28.420
but not at the expense of one

55:28.420 --> 55:29.830
of our service members or their family.

55:29.830 --> 55:34.333
So that's, if anything, I
see that as the problem.

55:34.333 --> 55:37.710
That is the challenge,
is the timeliness of,

55:37.710 --> 55:39.110
but it's based on not wanting

55:39.110 --> 55:40.670
to drop anyone through the system.

55:40.670 --> 55:42.580
I think we're set up well.

55:42.580 --> 55:45.090
- [Ralph] Yeah, General Hogg.

55:45.090 --> 55:46.140
- Yes, sir.

55:46.140 --> 55:48.950
So I believe we are working well together

55:48.950 --> 55:52.790
in trying to address
some of the difficulties.

55:52.790 --> 55:55.189
This is hard.
- I understand.

55:55.189 --> 55:58.100
- It's very challenging to bring all us

55:58.100 --> 56:00.030
together at one time.

56:00.030 --> 56:02.370
And we are working well together.

56:02.370 --> 56:04.503
I would articulate that,

56:06.580 --> 56:08.420
I like to say I would like to transition

56:08.420 --> 56:10.140
before I transform.

56:10.140 --> 56:12.880
So let's get the Defense Health Agency

56:12.880 --> 56:16.360
on its feet with 702 to where they can

56:16.360 --> 56:18.220
truly take over authority, direction

56:18.220 --> 56:21.100
and control of the military
treatment facilities.

56:21.100 --> 56:24.690
And then we can start
finding those efficiencies

56:24.690 --> 56:26.083
that I know we can find.

56:27.090 --> 56:29.850
But if we try to do both at the same time,

56:29.850 --> 56:32.640
I do have concern that we might

56:32.640 --> 56:35.360
miss some very important things.

56:35.360 --> 56:36.537
- [Ralph] General Dingle.

56:36.537 --> 56:39.430
- And I would echo the same comment.

56:39.430 --> 56:43.070
I believe that it has to
be focused and deliberate.

56:43.070 --> 56:46.570
That we must focus on the
medical treatment facilities

56:46.570 --> 56:50.040
transferring and the
electronic health record,

56:50.040 --> 56:53.310
get that correct before
we do anything else,

56:53.310 --> 56:55.370
and that's my decision.

56:55.370 --> 56:58.200
- The EHRs are problematic, as we know.

56:58.200 --> 57:00.470
That's why about 1/2
of the gray hair I have

57:00.470 --> 57:03.620
on my head is there
now, dealing with that.

57:03.620 --> 57:04.453
Admiral.

57:05.430 --> 57:06.510
- Yes, Congressman.

57:06.510 --> 57:08.890
I would say as the new kid on the block,

57:08.890 --> 57:11.390
having been in this position
for about five weeks,

57:12.483 --> 57:14.630
I'm incredibly impressed
by the collaboration

57:14.630 --> 57:18.090
that exists with my partners.

57:18.090 --> 57:19.540
I would say in terms of the structure,

57:19.540 --> 57:22.450
I think the establishment of
the direct support agreements

57:22.450 --> 57:24.440
has been a very important step

57:24.440 --> 57:25.963
to ease that transition,

57:27.321 --> 57:30.560
rather than just a complete
turn the switch in October.

57:30.560 --> 57:34.080
So I would say that continuing that work,

57:34.080 --> 57:36.990
but having a clear roadmap for hand-off

57:36.990 --> 57:40.290
of those functions is a
critical step going forward.

57:40.290 --> 57:41.760
- [Ralph] General.

57:41.760 --> 57:44.080
- Thank you, sir, and I would echo that

57:44.080 --> 57:45.280
from the Joint Staff perspective,

57:45.280 --> 57:47.040
one of the great strengths of DHA

57:47.040 --> 57:48.640
has been how they have helped us

57:48.640 --> 57:50.350
to better collaborate

57:50.350 --> 57:53.780
in the combat support arena,

57:53.780 --> 57:55.780
things like the Joint Trauma System.

57:55.780 --> 57:57.150
We recently hosted a meeting with

57:57.150 --> 57:58.990
the combatant command surgeons in which

57:58.990 --> 58:01.430
they highlighted the significant progress

58:01.430 --> 58:03.210
that we've made in what was already

58:03.210 --> 58:05.540
a world-class Joint Trauma System,

58:05.540 --> 58:07.430
making it even better as we continue

58:07.430 --> 58:09.440
to work more closely together.

58:09.440 --> 58:11.240
So I think there's great progress.

58:11.240 --> 58:12.880
Obviously, much more work to be done.

58:12.880 --> 58:15.130
There will always be
opportunities for improvement.

58:15.130 --> 58:17.040
- Well, I'm glad to hear the cohesion.

58:17.040 --> 58:18.990
Madam Chair, I just request that we enter

58:18.990 --> 58:22.410
into the record this
article on Military Times,

58:22.410 --> 58:25.392
the military needs for a unified command.

58:25.392 --> 58:26.225
And that's from Brad--

58:26.225 --> 58:27.509
- [Jackie] No objection.

58:27.509 --> 58:28.342
- Thank you.

58:28.342 --> 58:29.880
I yield back, I'm out of time.

58:29.880 --> 58:31.023
- General Friedrichs,

58:32.770 --> 58:35.400
one of the articles that our good friend

58:36.310 --> 58:39.690
Dr. Wenstrup had brought to our attention

58:39.690 --> 58:42.640
that was put out by the
U.S. News & World Report

58:42.640 --> 58:46.050
spoke about how surgeons in the military

58:46.050 --> 58:48.620
are not getting the kind of

58:49.900 --> 58:52.790
experience that they should be getting

58:52.790 --> 58:56.070
in order to be more proficient.

58:56.070 --> 58:58.040
That they're getting about 20%

58:58.040 --> 59:01.300
of what a surgeon in civilian workforce

59:01.300 --> 59:03.380
would be getting, in terms of the number

59:03.380 --> 59:05.283
of cases they handle a year.

59:06.330 --> 59:08.290
And you just spoke about
the trauma care issue.

59:08.290 --> 59:10.940
So I'm curious how we're going to address

59:10.940 --> 59:14.200
the fact that they are
lacking in the opportunities

59:14.200 --> 59:18.330
to handle enough
surgeries and be prepared,

59:18.330 --> 59:21.260
then, in terms of readiness
when they're out on--

59:21.260 --> 59:22.530
- So thank you, ma'am.

59:22.530 --> 59:25.690
And I would say from the
Joint Staff perspective,

59:25.690 --> 59:28.020
we define the requirement, we describe

59:28.020 --> 59:30.960
what the combatant
command requirements are,

59:30.960 --> 59:34.600
and rely on the services and
the Defense Health Agency

59:34.600 --> 59:37.463
to organize, train and equip
to meet that requirement.

59:38.330 --> 59:40.730
I believe as a surgeon that

59:40.730 --> 59:42.860
the article captured a number of points

59:42.860 --> 59:44.180
on which we're already working.

59:44.180 --> 59:47.030
One of our responsibilities
in the Joint Staff

59:47.030 --> 59:48.720
is joint capability development.

59:48.720 --> 59:50.290
And we've been working on improving

59:50.290 --> 59:52.200
through the Joint Trauma System

59:52.200 --> 59:55.470
a number of areas, whether
it's expanding opportunities

59:55.470 --> 59:57.620
for currency or expanding equipment,

59:57.620 --> 01:00:01.390
improving equipment availability,
for several years now.

01:00:01.390 --> 01:00:03.590
Those articles capture very valid concerns

01:00:03.590 --> 01:00:05.090
that are expressed by some surgeons.

01:00:05.090 --> 01:00:06.860
I can tell you, I was in San Antonio

01:00:06.860 --> 01:00:09.770
two weeks ago at the Committee on Trauma,

01:00:09.770 --> 01:00:13.460
which is the assemblage
of our senior leaders.

01:00:13.460 --> 01:00:15.700
And I heard a much more optimistic story

01:00:15.700 --> 01:00:17.960
of progress being made

01:00:17.960 --> 01:00:19.087
across the services.

01:00:19.087 --> 01:00:20.910
And so I would respectfully ask

01:00:22.404 --> 01:00:24.060
if my colleagues from
the services could also

01:00:24.060 --> 01:00:26.320
talk about what they're doing on that.

01:00:26.320 --> 01:00:28.570
- All right, I wanna
give Congresswoman Trahan

01:00:28.570 --> 01:00:29.750
her opportunity first.

01:00:29.750 --> 01:00:31.630
We'll come back to this issue, thank you.

01:00:31.630 --> 01:00:32.463
- Thank you.

01:00:32.463 --> 01:00:33.523
Thank you, Madam Chairwoman.

01:00:34.450 --> 01:00:35.970
I'm gonna switch gears.

01:00:35.970 --> 01:00:37.640
I'm not sure this is going to really fall

01:00:37.640 --> 01:00:38.990
with the five minutes, but I'm going

01:00:38.990 --> 01:00:41.270
to give it a shot, given that I've got

01:00:41.270 --> 01:00:43.440
so many surgeon generals

01:00:43.440 --> 01:00:46.900
and military healthcare
professionals in front of me.

01:00:46.900 --> 01:00:48.770
I wanted to talk about suicide

01:00:48.770 --> 01:00:51.650
for our active duty members.

01:00:51.650 --> 01:00:54.890
Data shows that there are approximately

01:00:54.890 --> 01:00:57.400
60% of military personnel
who are experiencing

01:00:57.400 --> 01:01:00.253
mental health problems, and
they're not seeking help.

01:01:01.248 --> 01:01:02.690
And when I reviewed the medical standards

01:01:02.690 --> 01:01:05.570
for appointment, enlistment and induction,

01:01:05.570 --> 01:01:07.730
it precludes things like sleep disorders,

01:01:07.730 --> 01:01:11.170
ADHD, depressive disorder,
anxiety disorders,

01:01:11.170 --> 01:01:13.420
so I don't think it's any surprise that

01:01:13.420 --> 01:01:15.770
there are studies that suggest

01:01:15.770 --> 01:01:18.683
that many are skirting
the rules to enlist.

01:01:19.720 --> 01:01:22.050
And I'm wondering can you briefly

01:01:22.050 --> 01:01:25.920
touch upon maybe the cognitive assessments

01:01:25.920 --> 01:01:28.723
taken on service members as they join?

01:01:33.408 --> 01:01:36.600
And also, what is preventing service men

01:01:36.600 --> 01:01:40.483
and women to self-report
potential risk factors,

01:01:41.650 --> 01:01:43.050
like sleeplessness

01:01:44.865 --> 01:01:47.513
and depression?

01:01:56.284 --> 01:01:57.117
- [Jackie] It's not a good sign

01:01:57.117 --> 01:01:58.773
that none of you are responding here.

01:02:03.692 --> 01:02:04.710
- The reason is just in terms of some

01:02:04.710 --> 01:02:06.020
of the questions that you're asking

01:02:06.020 --> 01:02:09.080
with regard to military
department processes,

01:02:09.080 --> 01:02:11.163
in terms of accession, standards.

01:02:12.770 --> 01:02:14.600
I think one of the surgeons would be

01:02:17.183 --> 01:02:18.330
most able to kind of respond

01:02:18.330 --> 01:02:20.450
to some of those specifics.

01:02:20.450 --> 01:02:22.310
- Okay, I'll start.

01:02:22.310 --> 01:02:25.150
Yes, ma'am, it definitely
is a very important aspect.

01:02:25.150 --> 01:02:28.270
So at the point of accessions,

01:02:28.270 --> 01:02:30.480
behavior health screening,
physical screenings

01:02:30.480 --> 01:02:33.000
are very important, and
you are absolutely correct

01:02:33.000 --> 01:02:34.833
that we can improve it to make sure

01:02:34.833 --> 01:02:37.353
that we're not missing
it and then taking it on

01:02:37.353 --> 01:02:39.910
when they come on to active duty.

01:02:39.910 --> 01:02:44.300
In reference to why
are they not reporting,

01:02:44.300 --> 01:02:48.810
it has been a challenge
in removing the stigma.

01:02:48.810 --> 01:02:51.370
It is improve imperative that we educate

01:02:51.370 --> 01:02:54.120
and that we change the
climate and cultures

01:02:54.120 --> 01:02:57.130
of commands and organizations so that

01:02:57.130 --> 01:03:00.310
soldiers, sailors and
airmen are not afraid

01:03:00.310 --> 01:03:02.780
to report because of retribution

01:03:02.780 --> 01:03:04.460
or impact on their career.

01:03:04.460 --> 01:03:06.130
And so that is the bottom line

01:03:06.130 --> 01:03:08.520
why service members do not report.

01:03:08.520 --> 01:03:11.520
They do not want it to
impact their careers.

01:03:11.520 --> 01:03:13.450
However, one of the greatest things

01:03:13.450 --> 01:03:16.410
that I saw at the DOD VA
Suicide Prevention Conference

01:03:16.410 --> 01:03:18.830
this summer was that we have to move

01:03:18.830 --> 01:03:21.280
to prevention, getting ahead of the act,

01:03:21.280 --> 01:03:23.070
by changing the culture.

01:03:23.070 --> 01:03:25.120
And we change that culture by removing

01:03:25.120 --> 01:03:28.760
the stigma and education
and the holistic approach

01:03:28.760 --> 01:03:30.253
from the command itself.

01:03:33.500 --> 01:03:34.560
- Yes, ma'am.

01:03:34.560 --> 01:03:36.600
So in the Air Force, we're actually seeing

01:03:36.600 --> 01:03:39.320
an increase in people
coming to mental health

01:03:42.050 --> 01:03:43.860
because of the outreach that we're doing.

01:03:43.860 --> 01:03:45.790
We're embedding our mental health

01:03:45.790 --> 01:03:49.000
into units where they
can build a relationship

01:03:50.223 --> 01:03:51.650
with those providers and they feel

01:03:51.650 --> 01:03:54.740
more comfortable coming in to get care.

01:03:54.740 --> 01:03:56.020
The other thing that we're doing

01:03:56.020 --> 01:03:59.870
is we are, a lot of this is really

01:03:59.870 --> 01:04:02.900
giving people the capability

01:04:02.900 --> 01:04:06.390
to handle stress without

01:04:08.610 --> 01:04:09.590
crisis.

01:04:09.590 --> 01:04:13.070
And so in our basic training

01:04:13.070 --> 01:04:16.180
military capacity, we are actually

01:04:16.180 --> 01:04:20.430
providing classes to our new recruits

01:04:21.499 --> 01:04:23.090
in how to handle stress

01:04:23.090 --> 01:04:26.660
and what are the ways to seek care

01:04:26.660 --> 01:04:30.500
if needed and reach out and touch people.

01:04:30.500 --> 01:04:31.523
- [Lori] Mm-hm.

01:04:32.540 --> 01:04:34.100
- And Congresswoman
Trahan, I would just say

01:04:34.100 --> 01:04:36.290
from the Navy perspective,

01:04:36.290 --> 01:04:40.210
we very much endorse embedding
mental health personnel

01:04:40.210 --> 01:04:43.230
at the deckplate and in
stressful training commands.

01:04:43.230 --> 01:04:46.320
So 1/4 of our mental health professionals

01:04:46.320 --> 01:04:48.950
are actually in the operational force.

01:04:48.950 --> 01:04:52.020
And so we have seen a
commensurate increase

01:04:52.020 --> 01:04:56.770
in access, and decrease in stigma.

01:04:56.770 --> 01:04:59.950
The other benefit is that those

01:04:59.950 --> 01:05:01.600
mental health professionals

01:05:01.600 --> 01:05:04.680
do tremendous training
for the senior officers

01:05:04.680 --> 01:05:06.830
in those, for example,
submarine squadrons,

01:05:06.830 --> 01:05:09.330
so that they're extenders, in terms

01:05:09.330 --> 01:05:11.950
of identifying those at risk.

01:05:11.950 --> 01:05:13.700
And similar to the Air Force,

01:05:13.700 --> 01:05:17.100
we are piloting teaching meditation

01:05:17.100 --> 01:05:19.500
to new recruits at bootcamp as a way

01:05:20.357 --> 01:05:23.400
to help deal with stressful situations.

01:05:23.400 --> 01:05:26.223
- Congresswoman, was your
question actually answered?

01:05:28.558 --> 01:05:29.391
I thought what you were asking

01:05:29.391 --> 01:05:32.820
was when recruits

01:05:32.820 --> 01:05:37.033
are reluctant to identify
these conditions,

01:05:39.932 --> 01:05:41.500
how are you able to assess that

01:05:41.500 --> 01:05:44.270
as they are going through
the training process?

01:05:44.270 --> 01:05:45.610
Is that what your question was?

01:05:45.610 --> 01:05:46.973
- Yeah.

01:05:46.973 --> 01:05:47.860
So, one, I think it's great

01:05:47.860 --> 01:05:50.890
to sort of diagnose and help embed

01:05:50.890 --> 01:05:53.970
and to treat people who are suffering

01:05:53.970 --> 01:05:55.343
from mental illness.

01:05:57.185 --> 01:06:00.150
And culture is, some organizations

01:06:00.150 --> 01:06:01.670
do it better than others

01:06:01.670 --> 01:06:03.320
when it's time to change culture.

01:06:05.147 --> 01:06:07.750
My question is, I mean,
certainly we've got

01:06:07.750 --> 01:06:09.410
generations of young people who

01:06:09.410 --> 01:06:12.650
are taking medication to prevent

01:06:12.650 --> 01:06:14.580
sleep disorder, to prevent ADHD.

01:06:14.580 --> 01:06:16.120
They're working.

01:06:16.120 --> 01:06:19.130
Is there any discussion around?

01:06:19.130 --> 01:06:21.140
My fear is that people are going off

01:06:21.140 --> 01:06:23.740
their medication when they enlist

01:06:23.740 --> 01:06:25.890
because that's a requirement.

01:06:25.890 --> 01:06:29.010
And that can cause great mental,

01:06:29.010 --> 01:06:31.880
that can, obviously, cause harm

01:06:33.195 --> 01:06:35.970
and mental disorders to flare up

01:06:35.970 --> 01:06:38.880
in non-traumatic situations, even.

01:06:38.880 --> 01:06:41.210
So I'm wondering if
there's been any discussion

01:06:41.210 --> 01:06:44.540
around revisiting some of these protocols,

01:06:44.540 --> 01:06:46.480
or if there's been any sort of study

01:06:46.480 --> 01:06:50.210
or discussion around that

01:06:50.210 --> 01:06:53.030
being a root cause for some of the

01:06:53.030 --> 01:06:55.380
mental health problems and suicide rates

01:06:55.380 --> 01:06:57.180
that we're seeing in our non-deployed

01:06:57.180 --> 01:06:58.980
activity duty service men and women?

01:07:01.730 --> 01:07:04.700
- So not to my knowledge,

01:07:04.700 --> 01:07:06.570
but is certainly something that we

01:07:06.570 --> 01:07:10.140
can take back and take a view

01:07:10.140 --> 01:07:12.610
and see if we have something

01:07:12.610 --> 01:07:15.320
that we can improve upon.

01:07:15.320 --> 01:07:17.390
- You know, Miss Trahan, I think that

01:07:17.390 --> 01:07:18.780
you've touched on an issue that

01:07:18.780 --> 01:07:21.820
probably deserves having a briefing on

01:07:22.850 --> 01:07:26.670
because there is an ability

01:07:26.670 --> 01:07:30.080
for people to be very functional on

01:07:31.300 --> 01:07:33.410
drugs to combat ADHD.

01:07:33.410 --> 01:07:34.690
- [Lori] Yeah.

01:07:34.690 --> 01:07:37.320
- And yet, I'm sure that if that

01:07:37.320 --> 01:07:39.520
was identified in an application

01:07:39.520 --> 01:07:41.780
before a recruiter, that person would

01:07:41.780 --> 01:07:44.670
be declined the opportunity to serve.

01:07:44.670 --> 01:07:46.090
So maybe we need to just have

01:07:46.090 --> 01:07:49.500
a generalized discussion on

01:07:49.500 --> 01:07:53.230
whether or not the basis on which

01:07:54.080 --> 01:07:57.890
individuals are allowed to enlist

01:07:57.890 --> 01:08:02.000
meets the medical technology

01:08:02.000 --> 01:08:03.190
and advancements we've made

01:08:03.190 --> 01:08:07.930
relative to drugs and other things.

01:08:07.930 --> 01:08:09.648
- [Lori] I would love
to attend that hearing.

01:08:09.648 --> 01:08:10.929
Thank you, Madam Chairwoman.

01:08:10.929 --> 01:08:11.762
- Thank you.

01:08:11.762 --> 01:08:12.595
Congressman Bacon.

01:08:12.595 --> 01:08:13.590
- Thank you, Madam Chair.

01:08:13.590 --> 01:08:14.590
I wanna thank all the witnesses

01:08:14.590 --> 01:08:16.310
for being here tody
and for your commitment

01:08:16.310 --> 01:08:17.920
to the health, the readiness

01:08:17.920 --> 01:08:20.030
of America's most
important weapons system.

01:08:20.030 --> 01:08:22.050
That's our warriors and their families.

01:08:22.050 --> 01:08:22.990
I'd like to focus for a moment

01:08:22.990 --> 01:08:25.440
on a medical readiness
challenge that concerns me,

01:08:25.440 --> 01:08:27.227
and perhaps an opportunity, as well.

01:08:27.227 --> 01:08:30.110
And most Americans would
be surprised to learn

01:08:30.110 --> 01:08:32.700
that in World War I, more
soldiers actually died

01:08:32.700 --> 01:08:35.720
due to disease than to enemy action,

01:08:35.720 --> 01:08:37.700
largely as a result of the 1918

01:08:37.700 --> 01:08:40.130
influenza epidemic, or pandemic.

01:08:40.130 --> 01:08:41.380
Today we know that our enemies

01:08:41.380 --> 01:08:44.070
are relentlessly pursuing
ways to kill Americans

01:08:44.070 --> 01:08:45.240
in large numbers.

01:08:45.240 --> 01:08:47.890
We also know that naturally
occurring infectious diseases

01:08:47.890 --> 01:08:51.160
in our increasingly interconnected world

01:08:51.160 --> 01:08:53.400
have the ability to
spread faster than ever.

01:08:53.400 --> 01:08:54.910
The risk to infectious diseases

01:08:54.910 --> 01:08:56.570
is significant and growing,

01:08:56.570 --> 01:08:57.800
not only for our general population,

01:08:57.800 --> 01:09:00.187
but also for our defenders
in the Armed Forces

01:09:00.187 --> 01:09:01.800
and our first responders.

01:09:01.800 --> 01:09:03.860
So as these threats
grow, I'm concerned that

01:09:03.860 --> 01:09:05.930
our capacity to prepare, detect

01:09:05.930 --> 01:09:08.510
and respond with specialized care

01:09:08.510 --> 01:09:11.130
for chemical, radiological, biological

01:09:11.130 --> 01:09:13.480
and infectious disease is far less

01:09:13.480 --> 01:09:15.860
than we need, and may
actually be declining.

01:09:15.860 --> 01:09:17.470
So my question is to General Friedrichs,

01:09:17.470 --> 01:09:19.820
and if we have time,
we'll come back to others,

01:09:19.820 --> 01:09:21.520
but my question to you,
General Friedrichs,

01:09:21.520 --> 01:09:24.500
is as you contemplate
the 21st-century force

01:09:24.500 --> 01:09:26.917
health protection threats
facing our military

01:09:26.917 --> 01:09:29.720
and the shrinking of our
uniformed medical service,

01:09:29.720 --> 01:09:31.450
how do we better position the military

01:09:31.450 --> 01:09:34.730
and our civilian health
systems to work together

01:09:34.730 --> 01:09:35.930
to address this mission?

01:09:37.040 --> 01:09:38.370
- Sir, thank you very much,

01:09:38.370 --> 01:09:41.030
and I would offer several observations.

01:09:41.030 --> 01:09:41.863
First,

01:09:43.280 --> 01:09:45.690
absolutely agree with your points

01:09:45.690 --> 01:09:47.630
about the rapidly evolving threats.

01:09:47.630 --> 01:09:49.760
There's no question that the threats

01:09:49.760 --> 01:09:51.570
that we faced in previous conflicts

01:09:51.570 --> 01:09:54.010
are not the threats we
will face in the future,

01:09:54.010 --> 01:09:56.290
and we must continue to evolve

01:09:56.290 --> 01:09:59.980
our detection capability,
our attribution capability,

01:09:59.980 --> 01:10:02.140
our ability to prevent the effects

01:10:02.140 --> 01:10:04.130
of those agents that are being used,

01:10:04.130 --> 01:10:06.710
and then to treat those
once they're exposed.

01:10:06.710 --> 01:10:08.580
All of that is work that must continue,

01:10:08.580 --> 01:10:10.460
and it will require a robust

01:10:10.460 --> 01:10:14.530
whole of government
cooperation, partnering across

01:10:14.530 --> 01:10:16.350
the Department of Health
and Human Services,

01:10:16.350 --> 01:10:17.750
the Department of Homeland Security

01:10:17.750 --> 01:10:19.320
and the Department of Defense.

01:10:19.320 --> 01:10:20.850
But more importantly, we're grateful

01:10:20.850 --> 01:10:22.670
that we have partners at the state level

01:10:22.670 --> 01:10:24.510
who have recognized these threats

01:10:24.510 --> 01:10:26.150
and have joined in those partnerships

01:10:26.150 --> 01:10:28.560
to develop new capabilities.

01:10:28.560 --> 01:10:30.750
That sort of partnership is imperative

01:10:30.750 --> 01:10:32.900
because the threat is
not just somewhere else.

01:10:32.900 --> 01:10:35.010
It's not just in another continent.

01:10:35.010 --> 01:10:37.160
It can just as easily happen here.

01:10:37.160 --> 01:10:38.710
It can be a pandemic that occurs

01:10:38.710 --> 01:10:41.323
on our own soil or an
attack on our own soil.

01:10:42.200 --> 01:10:44.580
To your specific comment
about the capabilities

01:10:44.580 --> 01:10:47.110
that we need, as these threats evolve,

01:10:47.110 --> 01:10:50.400
we must develop new
detection capabilities,

01:10:50.400 --> 01:10:52.580
we must develop new training capabilities

01:10:52.580 --> 01:10:55.360
for our medics, we must
develop the ability

01:10:55.360 --> 01:10:57.840
to have better treatments that allow us

01:10:57.840 --> 01:11:01.750
to function wherever
that new agent is used

01:11:01.750 --> 01:11:02.860
as we go forward.

01:11:02.860 --> 01:11:04.930
And that's important work
which is gonna require

01:11:04.930 --> 01:11:07.840
partnership, as I said,
across the whole of government

01:11:07.840 --> 01:11:09.340
and with key state partners.

01:11:09.340 --> 01:11:10.370
Thank you, sir.

01:11:10.370 --> 01:11:13.150
- So, look, we have facilities in Omaha,

01:11:13.150 --> 01:11:15.340
like the University of
Nebraska Medical Center,

01:11:15.340 --> 01:11:17.530
that is the world's center of excellence

01:11:17.530 --> 01:11:19.550
for Ebola, as an example.

01:11:19.550 --> 01:11:20.990
So let me just follow up and ask ya,

01:11:20.990 --> 01:11:23.620
how do you take advantage
of civilian centers

01:11:23.620 --> 01:11:25.343
of medical excellence, like UNMC,

01:11:26.370 --> 01:11:27.500
in developing solutions?

01:11:27.500 --> 01:11:29.560
Do you see a role for more creative

01:11:29.560 --> 01:11:32.270
public/private partnerships, like we now

01:11:32.270 --> 01:11:33.740
are doing in communities like Omaha

01:11:33.740 --> 01:11:35.880
with the new VA Medical Center?

01:11:35.880 --> 01:11:38.440
So I appreciate your insights on that.

01:11:38.440 --> 01:11:41.490
- Sir, first, thank you for the question,

01:11:41.490 --> 01:11:43.300
and more importantly, thank you

01:11:43.300 --> 01:11:45.270
for the community support across

01:11:45.270 --> 01:11:46.770
the state of Nebraska.

01:11:46.770 --> 01:11:48.530
That was not just an Omaha initiative,

01:11:48.530 --> 01:11:50.510
that was a statewide initiative that,

01:11:50.510 --> 01:11:53.200
in many respects, is a model

01:11:53.200 --> 01:11:55.420
public/private partnership.

01:11:55.420 --> 01:11:58.400
The work that has occurred across

01:11:58.400 --> 01:12:01.610
the agencies in order to work with

01:12:01.610 --> 01:12:05.400
the Nebraska community does set a model

01:12:05.400 --> 01:12:07.260
that we can use in the
future going forward

01:12:07.260 --> 01:12:10.520
because this is not
solely a military problem.

01:12:10.520 --> 01:12:12.300
We are part of our nation's response,

01:12:12.300 --> 01:12:14.370
but we cannot be the only response.

01:12:14.370 --> 01:12:16.630
It begins with local capabilities,

01:12:16.630 --> 01:12:19.100
local leaders who recognize the threat,

01:12:19.100 --> 01:12:23.110
and then partner with
state and federal experts

01:12:23.110 --> 01:12:25.820
to develop those
capabilities that we can use,

01:12:25.820 --> 01:12:28.130
whether it's a local
event or a national event

01:12:28.130 --> 01:12:30.550
or, unfortunately, as
may occur in the future,

01:12:30.550 --> 01:12:32.030
an international event.

01:12:32.030 --> 01:12:34.860
I think that the capability
that's been developed

01:12:34.860 --> 01:12:38.360
for Ebola, the partnership
for the VA hospital,

01:12:38.360 --> 01:12:40.110
some of the cutting-edge research

01:12:40.110 --> 01:12:41.890
that's being done there at Nebraska

01:12:41.890 --> 01:12:45.160
is exactly the sort of
work and collaboration

01:12:45.160 --> 01:12:48.070
that we need to move
forward in the future.

01:12:48.070 --> 01:12:49.880
- Thank you, and, Madam
Chair, I see an opportunity

01:12:49.880 --> 01:12:52.540
for public/private
partnerships working together

01:12:53.793 --> 01:12:55.193
for the whole country and
beyond just the military.

01:12:55.193 --> 01:12:57.690
I have a follow-up for
General Hogg, if I may.

01:12:57.690 --> 01:13:00.240
Don Bacon's gonna ask our question here.

01:13:00.240 --> 01:13:01.460
(laughs)

01:13:01.460 --> 01:13:02.620
We've been working off and on together

01:13:02.620 --> 01:13:03.810
for a long time.

01:13:03.810 --> 01:13:06.530
So have we already had cuts made

01:13:06.530 --> 01:13:08.253
at the bases at the medical centers?

01:13:08.253 --> 01:13:09.913
Have those cuts already occurred?

01:13:10.820 --> 01:13:11.890
- No, sir, they have not.

01:13:11.890 --> 01:13:13.340
- 'Cause I've been getting
more and more reports

01:13:13.340 --> 01:13:17.030
from concerned constituents,
retirees, primarily,

01:13:17.030 --> 01:13:18.510
that feel like they're being pushed out,

01:13:18.510 --> 01:13:20.210
made to go to the VA and not allowed

01:13:20.210 --> 01:13:21.360
to do the Tricare.

01:13:21.360 --> 01:13:24.160
So these phone calls I'm getting

01:13:24.160 --> 01:13:26.140
are not related to the proposal

01:13:26.140 --> 01:13:27.053
that's going on here?

01:13:27.053 --> 01:13:29.170
Is that what I'm hearing?

01:13:29.170 --> 01:13:30.843
- Right, yes.
- Okay, thank you.

01:13:33.720 --> 01:13:35.940
- All right, we're gonna do a second round

01:13:35.940 --> 01:13:38.670
for those that are interested in staying

01:13:38.670 --> 01:13:39.913
to ask more questions.

01:13:41.760 --> 01:13:44.680
I'd like to go back to that question

01:13:44.680 --> 01:13:47.350
that I asked about surgeons

01:13:47.350 --> 01:13:49.510
and their ability to have

01:13:49.510 --> 01:13:52.440
enough experience with cases

01:13:52.440 --> 01:13:54.910
and what we're doing to try and.

01:13:54.910 --> 01:13:56.660
If, in fact, the average surgeon

01:13:56.660 --> 01:14:00.500
has 500 cases a year,
and the average surgeon

01:14:00.500 --> 01:14:03.960
in the military has only 20% of that,

01:14:03.960 --> 01:14:08.130
that's a real vacuum, I think.

01:14:08.130 --> 01:14:11.230
So let's start with you,
Lieutenant General Hogg.

01:14:11.230 --> 01:14:12.063
- Yes, ma'am.

01:14:12.960 --> 01:14:14.780
In the Air Force, we have,

01:14:14.780 --> 01:14:16.500
for a long time, had what we call

01:14:16.500 --> 01:14:18.360
training affiliation agreements

01:14:18.360 --> 01:14:20.990
where we send out our medics

01:14:20.990 --> 01:14:24.890
to civilian or other federal institutions

01:14:24.890 --> 01:14:27.690
to get those touches,
the what I like to call

01:14:27.690 --> 01:14:30.660
volume, acuity and diversity of cases

01:14:30.660 --> 01:14:32.410
because we know in our direct-case system,

01:14:32.410 --> 01:14:34.300
we won't have that.

01:14:34.300 --> 01:14:37.600
And so for a long time,
we have been sending

01:14:37.600 --> 01:14:39.770
our specialized medics, trauma surgeons,

01:14:39.770 --> 01:14:43.070
orthopedic surgeons, nurses, out into

01:14:43.070 --> 01:14:45.140
civilian facilities to get that.

01:14:45.140 --> 01:14:49.060
Nellis is a good, UMC is
a good example of that,

01:14:49.060 --> 01:14:52.200
Baltimore Shock Trauma is
a good example of that,

01:14:52.200 --> 01:14:53.543
and many others.

01:14:54.530 --> 01:14:57.190
We are also now having some success

01:14:57.190 --> 01:14:59.330
in getting our enlisted medics

01:14:59.330 --> 01:15:02.510
into those treatment facilities in order

01:15:02.510 --> 01:15:04.883
to have the touches that they need.

01:15:05.920 --> 01:15:07.520
One of the difficulties that we have

01:15:07.520 --> 01:15:11.180
is gathering the data on exactly how--

01:15:11.180 --> 01:15:12.880
- All right, so I'd like to get

01:15:12.880 --> 01:15:13.890
to the other services.

01:15:13.890 --> 01:15:16.480
Could you just provide that data to us?

01:15:16.480 --> 01:15:19.640
Because, in part, General Friedrichs,

01:15:19.640 --> 01:15:21.620
I think what I would like to see

01:15:21.620 --> 01:15:24.370
is a response to those articles,

01:15:24.370 --> 01:15:26.820
as to where we are falling short

01:15:26.820 --> 01:15:30.270
and where we have actually
made some advances.

01:15:30.270 --> 01:15:31.590
General Dingle.

01:15:31.590 --> 01:15:33.710
- And, ma'am, we are coming
on the critical point

01:15:33.710 --> 01:15:35.200
because what we've also done

01:15:35.200 --> 01:15:37.360
as a collective joint workgroup,

01:15:37.360 --> 01:15:40.030
we've identified what's
called those knowledge skills

01:15:40.030 --> 01:15:42.250
and attributes that are required

01:15:42.250 --> 01:15:44.240
for surgical proficiency.

01:15:44.240 --> 01:15:45.850
And not just surgical proficiency,

01:15:45.850 --> 01:15:49.150
but all of our specialties
across the militaries.

01:15:49.150 --> 01:15:51.680
Within the Army, we then
build on top of that

01:15:51.680 --> 01:15:54.080
with what we call ICTLs,

01:15:54.080 --> 01:15:56.120
individual critical task lists.

01:15:56.120 --> 01:15:57.880
So for that trauma surgeon,

01:15:57.880 --> 01:15:59.810
how many procedures do you need,

01:15:59.810 --> 01:16:00.710
as you mentioned?

01:16:00.710 --> 01:16:03.350
And then we, for the
first time in our history,

01:16:03.350 --> 01:16:05.680
are tracking and documenting those

01:16:05.680 --> 01:16:07.530
as it goes towards readiness.

01:16:07.530 --> 01:16:09.430
And we'll continue to build upon those

01:16:09.430 --> 01:16:10.390
internally with the--

01:16:10.390 --> 01:16:11.920
- So you recognize that there is-

01:16:11.920 --> 01:16:13.108
- Yes, ma'am.

01:16:13.108 --> 01:16:13.941
- An issue and you're attempting--

01:16:13.941 --> 01:16:15.560
- Yes, ma'am.
- To address it.

01:16:15.560 --> 01:16:16.393
Admiral.

01:16:16.393 --> 01:16:17.620
- Chairwoman Speier, I would agree.

01:16:17.620 --> 01:16:18.973
Yes, we do.

01:16:19.850 --> 01:16:22.870
We are approaching this in
two different directions.

01:16:22.870 --> 01:16:25.180
Internally, within the direct-care system,

01:16:25.180 --> 01:16:28.090
you may be aware that Naval
Medical Center Camp Lejeune

01:16:28.090 --> 01:16:30.090
was designated a trauma center,

01:16:30.090 --> 01:16:32.020
and we're seeing tremendous value,

01:16:32.020 --> 01:16:34.620
both within Lejeune and also

01:16:34.620 --> 01:16:35.963
to the local community.

01:16:36.880 --> 01:16:38.990
And then externally, we also have

01:16:38.990 --> 01:16:41.210
existing partnerships, which also include

01:16:41.210 --> 01:16:43.760
our corpsmen, which we all recognize

01:16:43.760 --> 01:16:45.520
at the tip of the spear are some

01:16:45.520 --> 01:16:48.800
of the most important part
of the trauma response.

01:16:48.800 --> 01:16:49.700
- Okay, thank you.

01:16:51.090 --> 01:16:52.720
What we have seen since

01:16:52.720 --> 01:16:56.110
the budget year 2015

01:16:56.110 --> 01:16:59.670
is an actual reduction

01:16:59.670 --> 01:17:04.410
in the cost of providing military health

01:17:04.410 --> 01:17:07.150
by about at least a billion dollars.

01:17:07.150 --> 01:17:09.480
So I guess to you, Mr. McCaffery,

01:17:09.480 --> 01:17:10.893
where is that money going?

01:17:11.950 --> 01:17:16.400
- So is the question

01:17:16.400 --> 01:17:19.300
with regard to change from

01:17:19.300 --> 01:17:21.510
fiscal year '19 to what

01:17:21.510 --> 01:17:23.685
the president's budget
proposed for '20 or?

01:17:23.685 --> 01:17:25.410
- No, I think the staff has looked back

01:17:25.410 --> 01:17:28.350
at the Defense Health Program

01:17:28.350 --> 01:17:31.380
spending since 2015.

01:17:31.380 --> 01:17:33.990
And the program has had a decrease

01:17:33.990 --> 01:17:37.270
in funding, and it
appears that it's costing

01:17:37.270 --> 01:17:40.700
less money and that the savings,

01:17:40.700 --> 01:17:42.700
whether it's a billion or three billion,

01:17:43.787 --> 01:17:45.570
we've seen different figures,

01:17:45.570 --> 01:17:48.140
there's a savings of about a billion

01:17:48.140 --> 01:17:48.973
to three billion.

01:17:48.973 --> 01:17:51.290
And I wanna know where
that money is going.

01:17:51.290 --> 01:17:53.640
- So in some of the data I'm looking at

01:17:53.640 --> 01:17:56.410
right now, and I'm looking at the

01:17:56.410 --> 01:17:58.550
Defense Health Program appropriation,

01:17:58.550 --> 01:18:02.610
so that is what is funding
our direct-care system,

01:18:02.610 --> 01:18:06.030
the purchase care system,
some of the R and D,

01:18:06.030 --> 01:18:11.030
what I am looking at for FY 2015 shows

01:18:11.920 --> 01:18:14.760
that DHP plus military construction

01:18:14.760 --> 01:18:18.890
for health facilities is about 33 billion.

01:18:18.890 --> 01:18:22.660
It dipped a little bit in '16.

01:18:22.660 --> 01:18:24.806
33 billion in '17.

01:18:24.806 --> 01:18:27.390
34 in 2018.

01:18:27.390 --> 01:18:31.490
And just under 35 in 2019.

01:18:31.490 --> 01:18:34.780
So I'm not sure

01:18:34.780 --> 01:18:38.205
if we're looking at different numbers or?

01:18:38.205 --> 01:18:40.540
- [Jackie] Why don't you respond?

01:18:40.540 --> 01:18:42.650
We'll have our resident expert.

01:18:42.650 --> 01:18:44.860
- Mr. McCaffery, we're actually,

01:18:44.860 --> 01:18:46.483
the question is really

01:18:46.483 --> 01:18:48.780
the unified medical budget, the DHP.

01:18:48.780 --> 01:18:49.613
- Okay.

01:18:53.319 --> 01:18:56.147
So I'm looking at that
now for the same figure.

01:18:58.285 --> 01:19:01.100
The unified medical budget, in '15,

01:19:01.100 --> 01:19:03.050
I have 48 billion.

01:19:03.050 --> 01:19:06.183
It then dipped a little under 48 billion.

01:19:07.198 --> 01:19:08.413
Then 49 billion in FY 2017,

01:19:09.858 --> 01:19:11.775
and 50 billion in 2018.

01:19:13.962 --> 01:19:16.295
And a little over 50 billion

01:19:17.380 --> 01:19:19.823
at least enacted for FY '19.

01:19:22.060 --> 01:19:24.240
So, now, I know

01:19:25.190 --> 01:19:28.713
in the FY '20 proposed budget,

01:19:30.330 --> 01:19:31.440
the president's proposed budget

01:19:31.440 --> 01:19:34.350
has it down at 49 billion,

01:19:34.350 --> 01:19:36.810
but my understanding,
and I could be wrong,

01:19:36.810 --> 01:19:41.210
is every year, Congress adds in

01:19:41.210 --> 01:19:43.470
roughly a billion, between, I think,

01:19:43.470 --> 01:19:46.620
800 million and a billion in additional

01:19:46.620 --> 01:19:49.260
R and D dollars.

01:19:49.260 --> 01:19:53.330
That's not in the base budget proposal

01:19:53.330 --> 01:19:54.790
in the president's budget.

01:19:54.790 --> 01:19:58.060
And so that probably is one explanation

01:19:58.060 --> 01:20:02.150
for a delta between what
was actually enacted

01:20:02.150 --> 01:20:04.410
in FY '19 versus

01:20:04.410 --> 01:20:06.960
what the president proposed in '20.

01:20:06.960 --> 01:20:09.660
But we can, I can go back and double check

01:20:09.660 --> 01:20:10.783
and confirm that.

01:20:10.783 --> 01:20:13.613
- So the question becomes
if it's basically stagnant,

01:20:15.001 --> 01:20:15.980
is that actually savings?

01:20:15.980 --> 01:20:18.350
'Cause we're not seeing the
cost of living increase.

01:20:18.350 --> 01:20:20.140
I don't wanna take any more time.

01:20:20.140 --> 01:20:23.250
Maybe we can have a subsequent
conversation on that.

01:20:23.250 --> 01:20:24.300
Ranking Member Kelly.

01:20:26.050 --> 01:20:28.180
- Thank you, Chairwoman Speier.

01:20:28.180 --> 01:20:31.020
And just real quick, and I think

01:20:31.020 --> 01:20:33.630
you answered this, Admiral Gillingham,

01:20:33.630 --> 01:20:35.630
but the embeds you were talking about

01:20:35.630 --> 01:20:37.190
on behavioral health,
you're also doing that

01:20:37.190 --> 01:20:38.660
with your corpsmen with the Marines

01:20:38.660 --> 01:20:40.810
that are forward, is that correct?

01:20:40.810 --> 01:20:42.700
- Yes, sir, that is across--

01:20:42.700 --> 01:20:43.800
- Okay, very good.

01:20:43.800 --> 01:20:45.271
I'm satisfied with your answer.

01:20:45.271 --> 01:20:46.770
I just wanna make sure we're
taking care of our Marines.

01:20:46.770 --> 01:20:47.952
- [Bruce] Yes, sir.

01:20:47.952 --> 01:20:48.785
- And then, Lieutenant General Dingle,

01:20:48.785 --> 01:20:51.520
I didn't hear the Army
talk about embeds at all.

01:20:51.520 --> 01:20:53.680
And I would argue that the people

01:20:53.680 --> 01:20:55.580
who are the hardest and need that the most

01:20:55.580 --> 01:20:57.090
are the Army and the Marine Corps,

01:20:57.090 --> 01:21:00.750
based on the duties and the
unit types that they have.

01:21:00.750 --> 01:21:01.720
So what are we doing?

01:21:01.720 --> 01:21:03.250
- Mr. Kelly, you are spot on.

01:21:03.250 --> 01:21:05.640
We did embeds many years ago,

01:21:05.640 --> 01:21:07.190
and we continue to champion that

01:21:07.190 --> 01:21:09.490
as part of our behavioral
health system of care.

01:21:09.490 --> 01:21:11.100
Embeds are a very important part

01:21:11.100 --> 01:21:13.610
of our brigade combat teams forward.

01:21:13.610 --> 01:21:14.550
- So we are doing that?

01:21:14.550 --> 01:21:15.770
- [Scott] Absolutely, yes, sir.

01:21:15.770 --> 01:21:16.930
- But is there a shortage there

01:21:16.930 --> 01:21:18.770
of behavioral health because my experience

01:21:18.770 --> 01:21:20.450
in the Army, and especially in the Guard

01:21:20.450 --> 01:21:23.580
and Reserve, is that there
is an extreme shortage

01:21:23.580 --> 01:21:25.720
of professional behavioral
health specialists

01:21:25.720 --> 01:21:27.190
that are in the Army units that

01:21:27.190 --> 01:21:29.260
are filling those MTO slots.

01:21:29.260 --> 01:21:31.900
We got the slots, but
we don't have the docs.

01:21:31.900 --> 01:21:34.340
- What we're doing, again, improving

01:21:34.340 --> 01:21:36.530
the recruitment to try to get those

01:21:36.530 --> 01:21:37.890
specialties in there.

01:21:37.890 --> 01:21:40.223
In addition to that, within the Army,

01:21:42.010 --> 01:21:44.190
we did a bottom-up review where

01:21:44.190 --> 01:21:46.700
we looked at the mental health requirement

01:21:46.700 --> 01:21:48.180
and identified even more.

01:21:48.180 --> 01:21:51.010
So as we're looking at H2F,
Holistic Health and Fitness,

01:21:51.010 --> 01:21:52.530
it's from a mental health perspective,

01:21:52.530 --> 01:21:54.550
as well as a physical therapist

01:21:54.550 --> 01:21:56.530
and occupational therapist, also,

01:21:56.530 --> 01:21:57.977
augmenting our brigade combat teams

01:21:57.977 --> 01:21:59.320
and our divisions forward.

01:21:59.320 --> 01:22:00.610
- Have you been down to Bragg lately

01:22:00.610 --> 01:22:01.550
and seen what they're doing down there

01:22:01.550 --> 01:22:03.530
with our special operators at Bragg,

01:22:03.530 --> 01:22:05.380
as far as psychological health

01:22:05.380 --> 01:22:07.200
and just total package?

01:22:07.200 --> 01:22:08.150
- [Scott] Yes, sir.

01:22:09.151 --> 01:22:10.730
- We need to do that across the services

01:22:10.730 --> 01:22:11.920
'cause that's all services,

01:22:11.920 --> 01:22:12.910
and we need to figure out how we

01:22:12.910 --> 01:22:15.500
can do that better across
the entire services.

01:22:15.500 --> 01:22:16.790
And I'm sure you've been down there, too,

01:22:16.790 --> 01:22:18.360
General, but I just wanna make sure

01:22:18.360 --> 01:22:20.170
that we're doing that.

01:22:20.170 --> 01:22:23.420
Second, real quickly, what authorities

01:22:23.420 --> 01:22:26.000
do you guys need to help you

01:22:26.000 --> 01:22:28.320
assess behavioral health experts?

01:22:28.320 --> 01:22:30.200
'Cause we've asked you, and you guys

01:22:30.200 --> 01:22:31.540
need to give us what authorities

01:22:31.540 --> 01:22:33.180
or what things do you need

01:22:33.180 --> 01:22:35.380
in order to get this
to where we need to be.

01:22:38.540 --> 01:22:40.149
For accessions of behavioral
health specialists.

01:22:40.149 --> 01:22:41.270
- Right.

01:22:41.270 --> 01:22:43.500
I don't believe there's authorities,

01:22:43.500 --> 01:22:47.240
in terms of statute or policy direction.

01:22:47.240 --> 01:22:49.900
I believe that you've kind
of heard a common theme

01:22:49.900 --> 01:22:51.580
from everybody, and it's also common

01:22:51.580 --> 01:22:54.600
in the private sector, is resources,

01:22:54.600 --> 01:22:57.743
resources to be able to hire.

01:22:59.172 --> 01:23:00.400
And even if you have resources,

01:23:00.400 --> 01:23:03.110
there are gonna be certain areas

01:23:03.110 --> 01:23:06.020
that you're gonna have
a hard time recruiting,

01:23:06.020 --> 01:23:08.250
even if you can pay them,

01:23:08.250 --> 01:23:11.230
recruiting mental health providers.

01:23:11.230 --> 01:23:14.067
But I would say it's probably
more around resources

01:23:14.067 --> 01:23:15.650
and what else we can do

01:23:17.317 --> 01:23:19.570
to entice folks to join

01:23:21.263 --> 01:23:22.096
and provide that services.

01:23:22.096 --> 01:23:22.940
- [Jackie] Will the gentleman yield?

01:23:22.940 --> 01:23:24.473
- [Trent] Yes.

01:23:24.473 --> 01:23:26.320
- When you say mental health providers,

01:23:26.320 --> 01:23:28.260
I mean, are we also talking about

01:23:28.260 --> 01:23:29.880
marriage and family counselors?

01:23:29.880 --> 01:23:31.340
I mean, we're talking
about the whole gamut,

01:23:31.340 --> 01:23:33.250
it's not just psychiatrists
and psychologists?

01:23:33.250 --> 01:23:34.363
- Correct, correct.

01:23:35.325 --> 01:23:38.030
And I can't speak to kinda each service

01:23:38.030 --> 01:23:42.520
in particular, but I know
in certain classification

01:23:42.520 --> 01:23:45.670
of mental health providers,
we are pretty good.

01:23:45.670 --> 01:23:48.480
I think it's hit and miss based upon

01:23:49.723 --> 01:23:51.694
the classification of provider.

01:23:51.694 --> 01:23:53.140
- And then the final
thing I want all you guys

01:23:53.140 --> 01:23:55.463
to look at is we are a total force,

01:23:57.110 --> 01:23:59.100
but docs can make a lot more money

01:23:59.100 --> 01:24:00.830
on the civilian world
than they can in the Army,

01:24:00.830 --> 01:24:02.670
Navy, Air Force, okay?

01:24:02.670 --> 01:24:04.630
I mean, there's a lot
more money to be made.

01:24:04.630 --> 01:24:05.710
It's kinda like being in Congress.

01:24:05.710 --> 01:24:07.030
There's a lot better ways to make money

01:24:07.030 --> 01:24:08.500
than to do this job, okay?

01:24:08.500 --> 01:24:10.530
So you guys do it because you love it.

01:24:10.530 --> 01:24:11.950
But there's an opportunity out there

01:24:11.950 --> 01:24:14.290
in our Guard and Reserves
for the Air Force

01:24:14.290 --> 01:24:18.480
and Navy and Army, there's an opportunity

01:24:18.480 --> 01:24:19.900
'cause these guys wanna serve.

01:24:19.900 --> 01:24:21.370
I mean, the reason people are doctors

01:24:21.370 --> 01:24:22.920
is 'cause they wanna help people.

01:24:22.920 --> 01:24:24.700
It's not about money, okay?

01:24:24.700 --> 01:24:27.810
But there's a point where
they have other obligations.

01:24:27.810 --> 01:24:30.360
So let's make sure that
each of our services

01:24:30.360 --> 01:24:32.260
are looking at our Reserves

01:24:32.260 --> 01:24:33.907
and our National Guards, and saying,

01:24:33.907 --> 01:24:36.020
"Do we pay 'em better?"

01:24:36.020 --> 01:24:37.710
How do we get them in the rotation

01:24:37.710 --> 01:24:40.460
so that they fill behavioral
health specialties?

01:24:40.460 --> 01:24:43.090
Maybe we have those seeing soldiers

01:24:43.090 --> 01:24:46.010
or airmen at Joint Base Lewis-McChord

01:24:46.010 --> 01:24:48.100
on the weekends, or maybe they do

01:24:48.100 --> 01:24:50.730
their two-week AT there
and we schedule 'em in.

01:24:50.730 --> 01:24:52.730
So as a whole, as an Air Force

01:24:52.730 --> 01:24:54.810
or as an Army or as a DHA,

01:24:54.810 --> 01:24:57.240
how are we integrating especially

01:24:57.240 --> 01:24:59.730
behavioral health
specialists into the Guard?

01:24:59.730 --> 01:25:02.170
I mean, into the total force

01:25:02.170 --> 01:25:04.370
so that we're using that to our benefit?

01:25:04.370 --> 01:25:06.040
And maybe we need to
pay them a little more.

01:25:06.040 --> 01:25:07.370
Maybe we need to make their incentives

01:25:07.370 --> 01:25:09.260
a little better so that when a guy

01:25:09.260 --> 01:25:11.970
comes off active duty, or a doctor

01:25:11.970 --> 01:25:13.590
who wants to serve, man,

01:25:13.590 --> 01:25:15.100
everybody likes to wear a uniform.

01:25:15.100 --> 01:25:16.800
'Cause, I mean, they do.

01:25:16.800 --> 01:25:18.010
I mean, 'cause it's the same thing

01:25:18.010 --> 01:25:19.110
that makes people wanna be doctors

01:25:19.110 --> 01:25:20.630
that make 'em wanna be soldiers.

01:25:20.630 --> 01:25:21.850
They wanna serve.

01:25:21.850 --> 01:25:24.420
So how do we get those
guys so they can serve

01:25:24.420 --> 01:25:25.850
in a capacity and help our total force?

01:25:25.850 --> 01:25:28.003
And with that, Chairwoman, I yield back.

01:25:29.030 --> 01:25:30.158
- [Jackie] Thank you.

01:25:30.158 --> 01:25:31.570
Congresswoman Davis.

01:25:31.570 --> 01:25:32.480
- Thank you.

01:25:32.480 --> 01:25:34.970
Again, I think what I know I'm hearing

01:25:34.970 --> 01:25:36.970
and what I really wanted to ask you about,

01:25:36.970 --> 01:25:39.390
as well, is was what's the strategy,

01:25:39.390 --> 01:25:40.490
what's the plan?

01:25:40.490 --> 01:25:44.140
How do we make certain that as we

01:25:44.140 --> 01:25:48.040
move further into Tricare
for our beneficiaries

01:25:48.040 --> 01:25:49.940
that there's some, (laughs)

01:25:49.940 --> 01:25:52.370
there's a there there for them,

01:25:52.370 --> 01:25:55.080
and they're not going to lose

01:25:55.080 --> 01:25:58.120
in of the benefits that
they've already had?

01:25:58.120 --> 01:26:00.460
I know that it's a great source of anxiety

01:26:00.460 --> 01:26:02.400
for our families.

01:26:02.400 --> 01:26:06.970
And certainly, and when
we go on a full op tempo

01:26:07.814 --> 01:26:10.400
and deployment, all the pediatricians

01:26:10.400 --> 01:26:11.740
go to war, right?

01:26:11.740 --> 01:26:13.140
So we don't have them.

01:26:13.140 --> 01:26:16.850
And it's important that
we figure that out.

01:26:16.850 --> 01:26:18.140
So for mental health, I mean,

01:26:18.140 --> 01:26:20.790
one of the questions
that I was interested in

01:26:20.790 --> 01:26:23.480
is we talked a lot, while a number

01:26:23.480 --> 01:26:24.760
of our troops and our corpsmen

01:26:24.760 --> 01:26:26.620
were coming home from the war,

01:26:26.620 --> 01:26:29.440
some of them had developed a real aptitude

01:26:31.090 --> 01:26:34.360
for being able to help one another

01:26:34.360 --> 01:26:35.610
in the mental health field.

01:26:35.610 --> 01:26:38.740
And I hope, and, again, part of this

01:26:38.740 --> 01:26:40.070
really thinking ahead about it

01:26:40.070 --> 01:26:44.120
is how do we make sure
and identify those people,

01:26:44.120 --> 01:26:46.530
and I think the ranking
chair mentioned this,

01:26:46.530 --> 01:26:48.440
that are coming out of the service,

01:26:48.440 --> 01:26:51.390
that, perhaps at another time,

01:26:51.390 --> 01:26:52.770
they woulda never thought about

01:26:52.770 --> 01:26:55.090
going into the behavioral health field,

01:26:55.090 --> 01:26:57.140
but they are now?

01:26:57.140 --> 01:26:59.250
We talked a lot about social workers

01:26:59.250 --> 01:27:00.350
a number of years ago.

01:27:00.350 --> 01:27:02.450
How does the military identify

01:27:04.060 --> 01:27:06.610
those people who, with proper training

01:27:06.610 --> 01:27:09.010
and with loan forgiveness,

01:27:09.010 --> 01:27:10.540
that they can do that?

01:27:10.540 --> 01:27:13.690
And so I'm hoping that perhaps

01:27:13.690 --> 01:27:15.810
we think a little bit
more about the future

01:27:15.810 --> 01:27:17.860
because there's no way in the world

01:27:17.860 --> 01:27:19.940
that we're gonna be able to rely on

01:27:19.940 --> 01:27:23.940
the civilian world to satisfy the needs

01:27:23.940 --> 01:27:25.780
that we're gonna have.

01:27:25.780 --> 01:27:27.900
And the other thing is, just quickly,

01:27:27.900 --> 01:27:30.950
finding a better way, and we have

01:27:30.950 --> 01:27:32.710
some wonderful folks in San Diego

01:27:32.710 --> 01:27:34.650
that have really looked into this

01:27:34.650 --> 01:27:37.970
because of a family suicide,

01:27:37.970 --> 01:27:42.740
how do we, within our system of privacy,

01:27:42.740 --> 01:27:46.430
HIPAA, whatever, make
certain that families

01:27:46.430 --> 01:27:49.130
can be more involved in the mental healths

01:27:49.130 --> 01:27:51.030
of their loved ones?

01:27:51.030 --> 01:27:52.810
It's a deep, dark secret sometimes

01:27:52.810 --> 01:27:54.090
that somebody needs help,

01:27:54.090 --> 01:27:55.460
and it shouldn't be that way.

01:27:55.460 --> 01:27:58.080
As a parent, you feel like I wanna

01:27:58.080 --> 01:28:01.332
be a partner here, but I don't know how.

01:28:01.332 --> 01:28:03.530
And there's some men and
women in the services

01:28:03.530 --> 01:28:05.310
who are not gonna call their families

01:28:05.310 --> 01:28:06.450
and tell 'em they're struggling,

01:28:06.450 --> 01:28:08.680
but maybe there's a
better way of doing that.

01:28:08.680 --> 01:28:10.530
And I know the VA's been working on that.

01:28:10.530 --> 01:28:14.380
So thinking about how
do we do a better job.

01:28:14.380 --> 01:28:17.020
That certainly our spouses, and I remember

01:28:17.020 --> 01:28:19.060
talking to so many spouses about this.

01:28:19.060 --> 01:28:21.400
Yeah, they were afraid to share

01:28:21.400 --> 01:28:23.060
the fact that their
husbands were screaming

01:28:23.060 --> 01:28:25.610
in the night because they were afraid

01:28:25.610 --> 01:28:28.550
that they would be kicked
out of the service.

01:28:28.550 --> 01:28:31.370
And they need to be involved, as well.

01:28:31.370 --> 01:28:35.140
And certainly having good practitioners

01:28:35.140 --> 01:28:36.290
to help them out, as well.

01:28:36.290 --> 01:28:39.040
So I hope that all those
issues will be looked at.

01:28:39.040 --> 01:28:41.220
And we were talking about that,

01:28:41.220 --> 01:28:44.030
the issue that I think,
Admiral Gillingham,

01:28:44.030 --> 01:28:46.083
you would be aware, too, in San Diego,

01:28:48.040 --> 01:28:50.950
we really did not have the patients

01:28:50.950 --> 01:28:53.010
for our (laughs) surgeons

01:28:54.000 --> 01:28:57.280
to be able to help there.

01:28:57.280 --> 01:29:00.470
And so they go to L.A. County Hospital.

01:29:00.470 --> 01:29:03.530
That's where they go for their
gunshot wounds, honestly.

01:29:03.530 --> 01:29:06.670
And that's what we have to
do sometimes in partnering.

01:29:06.670 --> 01:29:09.060
But just as it's been
difficult for you all

01:29:09.060 --> 01:29:11.510
to work together (laughs)

01:29:11.510 --> 01:29:16.090
to have this change, it's not so easy

01:29:16.090 --> 01:29:17.890
for them, as well, although our military

01:29:17.890 --> 01:29:20.000
has often been trained
in the civilian world,

01:29:20.000 --> 01:29:22.300
and back and forth, and
we train them very well.

01:29:22.300 --> 01:29:23.740
But, sorry.

01:29:23.740 --> 01:29:25.190
I think my time is almost up?

01:29:26.170 --> 01:29:27.500
Maybe you gave me more time.

01:29:27.500 --> 01:29:29.392
- [Jackie] You have another minute.

01:29:29.392 --> 01:29:30.225
(group laughs)

01:29:30.225 --> 01:29:32.190
You can actually have
them answer you. (laughs)

01:29:32.190 --> 01:29:34.290
- Yes, please, please.

01:29:34.290 --> 01:29:36.360
So is there that kind of planning,

01:29:36.360 --> 01:29:37.850
that we're really looking at all

01:29:37.850 --> 01:29:40.290
the parameters possible to be able

01:29:40.290 --> 01:29:42.530
to serve our men and women?

01:29:42.530 --> 01:29:45.020
- So let me start with one of the

01:29:45.020 --> 01:29:47.860
first questions you
asked in terms of where

01:29:47.860 --> 01:29:49.510
does the Tricare program,

01:29:49.510 --> 01:29:51.890
where does our partnership
with the civilian sector

01:29:51.890 --> 01:29:55.050
fit into where we're going

01:29:55.050 --> 01:29:56.810
in terms of reforming the whole system

01:29:56.810 --> 01:29:59.810
because that is a key, it's a linchpin.

01:29:59.810 --> 01:30:02.470
And even though the
current Tricare contract

01:30:03.330 --> 01:30:07.330
is only, well, a little
less than two years onboard,

01:30:07.330 --> 01:30:09.370
we are already starting the effort

01:30:09.370 --> 01:30:11.460
in terms of the next generation,

01:30:11.460 --> 01:30:13.090
the next procurement,

01:30:13.090 --> 01:30:16.410
because just for what you said.

01:30:16.410 --> 01:30:19.570
It has to be critical to support

01:30:19.570 --> 01:30:20.690
the change in the system.

01:30:20.690 --> 01:30:22.840
So if we're gonna be consolidating

01:30:22.840 --> 01:30:25.410
all of our MTFs under one management,

01:30:25.410 --> 01:30:27.430
under the same roof

01:30:27.430 --> 01:30:29.640
that manages the Tricare program,

01:30:29.640 --> 01:30:31.943
we need to make sure that we have that,

01:30:33.035 --> 01:30:35.950
that we are requiring
more from our contractors,

01:30:35.950 --> 01:30:37.780
both to make sure we get the,

01:30:37.780 --> 01:30:39.680
what I would call the
readiness-related caseload

01:30:39.680 --> 01:30:42.420
we need into our system,
for all the reasons

01:30:42.420 --> 01:30:44.370
we've talked about, in terms of keeping

01:30:45.211 --> 01:30:46.710
our surgeons, our providers current.

01:30:46.710 --> 01:30:48.870
So we need to be able to do more of that.

01:30:48.870 --> 01:30:50.700
We need to make sure that we do have

01:30:50.700 --> 01:30:52.960
the adequate networks to support

01:30:52.960 --> 01:30:55.380
our families and our beneficiaries

01:30:55.380 --> 01:30:58.190
if, when, indeed, we are making changes

01:30:58.190 --> 01:31:02.180
to the system, and we realign services

01:31:02.180 --> 01:31:04.640
in certain areas in terms
of what MTFs are providing,

01:31:04.640 --> 01:31:06.460
we need to make sure that we have

01:31:06.460 --> 01:31:08.710
that partnership with those contractors

01:31:08.710 --> 01:31:11.770
to make sure that the
capability doesn't go away.

01:31:11.770 --> 01:31:14.210
You may not get something
from a uninformed provider,

01:31:14.210 --> 01:31:17.320
but we have to make sure
you get it from a provider.

01:31:17.320 --> 01:31:20.000
So I think those are some key things

01:31:20.000 --> 01:31:22.633
that we are looking at, as to how,

01:31:23.970 --> 01:31:25.590
what we need to do to support this,

01:31:25.590 --> 01:31:26.900
the reform, going forward.

01:31:26.900 --> 01:31:30.480
- Yeah, and looking at
increased pay, obviously,

01:31:30.480 --> 01:31:31.533
is gonna be an issue.

01:31:32.872 --> 01:31:34.860
- [Jackie] All right, Dr. Abraham.

01:31:34.860 --> 01:31:36.840
- General Friedrichs,
educate me, sir, please.

01:31:36.840 --> 01:31:39.200
You said Lejeune has been designated

01:31:39.200 --> 01:31:40.073
a trauma center.

01:31:41.430 --> 01:31:42.580
Oh, I'm sorry, Admiral.

01:31:43.640 --> 01:31:44.473
Is that true?

01:31:44.473 --> 01:31:45.920
Is it a level I?

01:31:45.920 --> 01:31:46.830
- Level III, sir.

01:31:46.830 --> 01:31:47.663
- [Ralph] Okay, a level III.

01:31:47.663 --> 01:31:49.560
- But there are
aspirations for a level II.

01:31:49.560 --> 01:31:51.920
- [Ralph] Okay, and so you are seeing

01:31:51.920 --> 01:31:53.690
civilians in that capacity?

01:31:53.690 --> 01:31:54.523
- Yes, sir, that's correct.

01:31:54.523 --> 01:31:55.590
- [Ralph] You've worked
out getting the ambulance

01:31:55.590 --> 01:31:58.090
through the gate,
insurance, all that stuff?

01:31:58.090 --> 01:31:58.923
Okay.
- Yes, sir.

01:31:58.923 --> 01:32:01.480
- So the reason I ask is I know that

01:32:02.500 --> 01:32:05.910
the Armed Services
surgeons are not getting

01:32:05.910 --> 01:32:10.240
enough cases, or as many as they desire.

01:32:10.240 --> 01:32:11.980
And I know that in some cases,

01:32:11.980 --> 01:32:13.700
you're meeting some headwinds

01:32:13.700 --> 01:32:15.030
from the civilian docs

01:32:16.130 --> 01:32:17.260
taking their cases.

01:32:17.260 --> 01:32:20.120
And so we understand the dynamics there

01:32:20.120 --> 01:32:22.270
of there is just a set number

01:32:22.270 --> 01:32:25.020
of trauma patients, and everybody wants

01:32:25.020 --> 01:32:26.350
to have their gloves on

01:32:26.350 --> 01:32:29.270
and hands in fixing that patient.

01:32:29.270 --> 01:32:32.420
So I think it's a wonderful concept,

01:32:32.420 --> 01:32:35.770
of designating as many camps

01:32:35.770 --> 01:32:38.700
as we can as trauma centers so we can

01:32:38.700 --> 01:32:41.940
get that expertise that you people need

01:32:41.940 --> 01:32:45.180
with your doctors in play,
so it's a good concept.

01:32:45.180 --> 01:32:47.520
Mr. Secretary, just one question for you.

01:32:47.520 --> 01:32:49.540
Do you see value in placing the DHA

01:32:50.560 --> 01:32:52.743
under a unified operational command?

01:32:54.170 --> 01:32:56.470
- I mean, I think one of the things

01:32:56.470 --> 01:32:57.900
that Congress has asked us to do,

01:32:57.900 --> 01:33:00.020
and we're in the kind of final stages,

01:33:00.020 --> 01:33:03.547
was actually to look at is it feasible

01:33:03.547 --> 01:33:07.730
to morph DHA into a
unified health command,

01:33:07.730 --> 01:33:09.620
a defense health command?

01:33:09.620 --> 01:33:12.700
And we are putting together what we think

01:33:12.700 --> 01:33:14.603
could be feasible options.

01:33:16.328 --> 01:33:17.800
The key thing is what would we

01:33:17.800 --> 01:33:18.970
wanna get out of that?

01:33:18.970 --> 01:33:21.670
I mean, it could be, is it because we

01:33:21.670 --> 01:33:24.970
wanna have more clear command authority

01:33:24.970 --> 01:33:28.530
over all medical forces
across the services?

01:33:28.530 --> 01:33:30.340
Is it efficiency?

01:33:30.340 --> 01:33:32.900
And that's the thing that I think

01:33:32.900 --> 01:33:35.810
ya have to determine first before

01:33:35.810 --> 01:33:39.810
you can assess whether
that's the right direction.

01:33:39.810 --> 01:33:42.340
But the one thing I
think there's unanimity

01:33:42.340 --> 01:33:44.860
within the department is we don't believe

01:33:44.860 --> 01:33:47.080
this is the time for us

01:33:47.080 --> 01:33:49.347
to go down that path, only in that

01:33:49.347 --> 01:33:51.440
you've heard us all talk about

01:33:51.440 --> 01:33:54.800
the enormous change
we've already launched.

01:33:54.800 --> 01:33:58.030
And our feeling is it's better to see

01:33:58.030 --> 01:34:00.600
how does DHA function with their

01:34:00.600 --> 01:34:04.374
new responsibilities before we were

01:34:04.374 --> 01:34:07.190
to talk about would you convert that

01:34:07.190 --> 01:34:09.453
or change the Defense Health Agency

01:34:09.453 --> 01:34:12.750
into an even larger command

01:34:12.750 --> 01:34:13.610
across the departments.

01:34:13.610 --> 01:34:16.710
So we do think it's worthwhile looking at,

01:34:16.710 --> 01:34:18.710
but we wanna revisit that in probably

01:34:18.710 --> 01:34:20.450
the next three to four years,

01:34:20.450 --> 01:34:23.790
once we have some more
stability in the system.

01:34:23.790 --> 01:34:24.918
- [Ralph] Okay, thank you.

01:34:24.918 --> 01:34:25.751
Madam Chair, I yield back.

01:34:25.751 --> 01:34:27.320
- Thank you.

01:34:27.320 --> 01:34:30.120
- I think it was you, Lieutenant
General Hogg, who said.

01:34:31.177 --> 01:34:32.010
Is it Hoag or Hogg?

01:34:32.010 --> 01:34:33.640
I'm sorry, Hogg.

01:34:33.640 --> 01:34:34.700
Who said that

01:34:36.542 --> 01:34:38.520
it's really important for us

01:34:38.520 --> 01:34:43.000
to bring all of these services together

01:34:43.000 --> 01:34:45.840
under one roof before we start

01:34:45.840 --> 01:34:49.590
moving forward on some
of these other aspects.

01:34:49.590 --> 01:34:52.660
I'm presuming you mean
these billets, as well.

01:34:52.660 --> 01:34:53.520
Is that correct?

01:34:53.520 --> 01:34:54.910
Or is that something that you're going

01:34:54.910 --> 01:34:59.143
to implement while this
process is going on?

01:35:00.240 --> 01:35:01.720
- So the billets are

01:35:02.830 --> 01:35:06.210
from the Air Force, higher
Air Force level, right?

01:35:06.210 --> 01:35:10.190
And the plan right now
is while they're there,

01:35:10.190 --> 01:35:12.980
we will not reduce the faces until

01:35:12.980 --> 01:35:16.270
the system can handle the workload.

01:35:16.270 --> 01:35:17.103
- All right.

01:35:17.103 --> 01:35:19.770
And how about you, General Dingle?

01:35:19.770 --> 01:35:20.603
- Yes, ma'am.

01:35:20.603 --> 01:35:23.070
We, likewise, the billets

01:35:23.070 --> 01:35:26.250
have been identified and
we are coming together,

01:35:26.250 --> 01:35:30.050
working with the DHA, to
see impacts of billets.

01:35:30.050 --> 01:35:32.290
However, we also have a large number

01:35:32.290 --> 01:35:34.560
of unfilled billets that we are looking at

01:35:34.560 --> 01:35:35.543
this fiscal year.

01:35:36.460 --> 01:35:39.190
- Well, are you going to hold off

01:35:39.190 --> 01:35:40.600
reducing the billets, or are you

01:35:40.600 --> 01:35:43.000
going to reduce the
billets, is what I'm asking.

01:35:44.230 --> 01:35:45.880
- Our unfilled billets, ma'am,

01:35:45.880 --> 01:35:48.600
have already been converted over.

01:35:48.600 --> 01:35:51.140
There will be no further reductions

01:35:51.140 --> 01:35:54.150
until we do the complete
analysis with the DHA.

01:35:54.150 --> 01:35:55.340
- But what happens if those billets

01:35:55.340 --> 01:35:56.940
are mental health professionals?

01:36:01.530 --> 01:36:03.260
I mean, one of the issues that we've

01:36:03.260 --> 01:36:04.990
talked about a lot today is the fact

01:36:04.990 --> 01:36:06.690
that we need more mental health providers.

01:36:06.690 --> 01:36:09.030
So arbitrarily, if you're just going

01:36:09.030 --> 01:36:11.813
to not fill these unfilled billets,

01:36:12.880 --> 01:36:14.250
don't you have to make an assessment

01:36:14.250 --> 01:36:15.650
as to whether or not they're

01:36:16.610 --> 01:36:19.029
important to be filled?

01:36:19.029 --> 01:36:19.862
- Yes, ma'am.

01:36:19.862 --> 01:36:22.170
And one thing, a little more details,

01:36:22.170 --> 01:36:25.410
as we have done conversion of billets,

01:36:25.410 --> 01:36:27.870
some of the billets we have converted are,

01:36:27.870 --> 01:36:31.630
in fact, those towards
Holistic Health and Fitness,

01:36:31.630 --> 01:36:33.000
mental health providers,

01:36:33.000 --> 01:36:35.830
but on the operational
force side of the house.

01:36:35.830 --> 01:36:39.010
The empty billets that are in the MTF

01:36:39.010 --> 01:36:41.400
side of the house, again, are unfilled.

01:36:41.400 --> 01:36:45.660
And as we move them to
the operational force,

01:36:45.660 --> 01:36:48.010
we have done bottoms-up
review in which we have,

01:36:48.010 --> 01:36:50.590
in fact, identified more
medical requirements

01:36:50.590 --> 01:36:52.990
for our operational
force that we will move

01:36:52.990 --> 01:36:55.093
to recruit to fill those billets in.

01:36:56.440 --> 01:36:57.273
- All right.

01:36:57.273 --> 01:36:58.650
Admiral.

01:36:58.650 --> 01:36:59.483
- Yes, ma'am.

01:36:59.483 --> 01:37:02.900
For the Navy, the faces
remain in the billets,

01:37:02.900 --> 01:37:05.520
and looking very carefully

01:37:05.520 --> 01:37:07.660
at the impact on DHA.

01:37:07.660 --> 01:37:10.380
I will say, to your point
about mental health,

01:37:10.380 --> 01:37:12.450
very few of the planned reductions

01:37:12.450 --> 01:37:15.180
were in mental health billets.

01:37:15.180 --> 01:37:16.013
- All right.

01:37:17.060 --> 01:37:18.000
- [Trent] Would the gentlewoman--

01:37:18.000 --> 01:37:19.460
- Of course.

01:37:19.460 --> 01:37:21.350
- I just wanna make sure.

01:37:21.350 --> 01:37:22.810
I get the unfilled billets,

01:37:22.810 --> 01:37:24.990
but from a lotta years of experience,

01:37:24.990 --> 01:37:26.240
the unfilled billets are generally

01:37:26.240 --> 01:37:29.190
the low-density, hard to get billets.

01:37:29.190 --> 01:37:30.023
And I just wanna make sure that those

01:37:30.023 --> 01:37:31.287
aren't the behavioral health

01:37:31.287 --> 01:37:33.290
and the OB-GYNs and all the areas

01:37:33.290 --> 01:37:35.570
we have difficulty getting enough people,

01:37:35.570 --> 01:37:38.320
that we're not, just because those billets

01:37:38.320 --> 01:37:40.200
aren't full, that those are the slots

01:37:40.200 --> 01:37:41.150
where the people that we're going,

01:37:41.150 --> 01:37:42.820
so we're not going out
and recruiting those,

01:37:42.820 --> 01:37:44.440
if that makes sense.

01:37:44.440 --> 01:37:46.210
We've gotta make sure that we're not,

01:37:46.210 --> 01:37:47.850
just because we don't have a filled billet

01:37:47.850 --> 01:37:49.580
with a behavioral health specialist,

01:37:49.580 --> 01:37:51.290
that we don't do away with that slot.

01:37:51.290 --> 01:37:52.580
We gotta fill that slot.

01:37:52.580 --> 01:37:53.770
We gotta do away with another slot

01:37:53.770 --> 01:37:55.260
when it goes away.

01:37:55.260 --> 01:37:56.110
And I yield back.

01:37:57.730 --> 01:38:00.260
- Let me also make note

01:38:00.260 --> 01:38:02.580
of the fact that when we were visiting

01:38:02.580 --> 01:38:06.320
the bases, it was
astonishing to both of us

01:38:06.320 --> 01:38:08.130
that there was such a high incidence

01:38:08.130 --> 01:38:11.040
of autism among

01:38:11.040 --> 01:38:13.140
the families of service members,

01:38:13.140 --> 01:38:16.300
many of whom were officers, as well.

01:38:16.300 --> 01:38:18.730
In the military system

01:38:18.730 --> 01:38:20.650
and the health system to provide

01:38:20.650 --> 01:38:22.683
the services to these families.

01:38:23.910 --> 01:38:26.060
And finally, there's a lotta talk today

01:38:26.060 --> 01:38:29.610
about effectiveness and readiness

01:38:29.610 --> 01:38:31.570
and efficiency.

01:38:31.570 --> 01:38:32.520
And what was left out

01:38:32.520 --> 01:38:36.340
of all of those terms

01:38:36.340 --> 01:38:40.313
is the fact that it's not just for that.

01:38:41.620 --> 01:38:44.420
The families are a huge component

01:38:44.420 --> 01:38:48.430
of the healthcare system
within the military.

01:38:48.430 --> 01:38:50.250
And if we don't have a robust system

01:38:50.250 --> 01:38:51.880
that provides the services,

01:38:51.880 --> 01:38:54.900
I think we're gonna have
a problem with retention.

01:38:54.900 --> 01:38:58.780
And so it's really important

01:38:58.780 --> 01:39:01.190
that we have

01:39:01.190 --> 01:39:03.550
the quality of healthcare

01:39:04.540 --> 01:39:07.980
that each of these families deserves.

01:39:07.980 --> 01:39:10.350
And if we're falling short there,

01:39:10.350 --> 01:39:13.023
we're falling short in
many other areas, as well.

01:39:14.330 --> 01:39:15.990
So with that, if there's not any

01:39:15.990 --> 01:39:17.850
further comments to be made,

01:39:17.850 --> 01:39:19.610
thank you very much for your service

01:39:19.610 --> 01:39:21.960
and for your participation here tonight.

01:39:21.960 --> 01:39:23.276
And we stand adjourned.

01:39:23.276 --> 01:39:24.109
(gavel banging)

01:39:24.109 --> 01:39:25.560
I guess it is night, isn't it?