United States General Accounting Office

GAO Report to the Chairman, Subcommittee

on Military Personnel, Committee on

National Security, House of

Representatives

September 1996 WARTIME MEDICAL

CARE

DOD Is Addressing

Capability Shortfalls,

but Challenges Remain

G O A

years

1921 - 1996

GAO/NSIAD-96-224

GAO United States

General Accounting Office

Washington, D.C. 20548

National Security and

International Affairs Division

B-274015 

September 25, 1996

The Honorable Robert K. Dornan

Chairman, Subcommittee on Military Personnel

Committee on National Security

House of Representatives

Dear Mr. Chairman:

As you requested, we determined whether the Department of Defense’s

(DOD) and the services’ efforts to reassess and improve their medical

capabilities have been properly focused and coordinated to result in the

most effective wartime medical system. Specifically, we reviewed DOD’s

development, management, and implementation of its Medical Readiness

Strategic Plan (MRSP) and the services’ medical reengineering efforts. We

also examined DOD’s ongoing project to identify future wartime medical

system requirements.

Background Operation Desert Storm revealed many weaknesses in medical capabilities

of U.S. forces. Subsequent studies conducted by us and the DOD Inspector

General revealed shortcomings in DOD’s ability to provide adequate, timely

medical support during contingencies and problems with the planning and

execution of these efforts. The Joint Staff also identified problems with the

current design of DOD’s wartime medical system. In response to these

problems, DOD and the services embarked on initiatives to correct

shortfalls in wartime medical capabilities and improve medical readiness.

The decisions that emanate from these efforts over the next few years will

determine how wartime medical care will be provided for the foreseeable

future.

In March 1995, DOD published MRSP to serve as a road map for attaining and

sustaining military medical readiness into the 21st century. The Office of

the Assistant Secretary of Defense for Health Affairs is responsible for

managing MRSP. In developing its MRSP, Health Affairs convened panels of

both military and civilian experts to assess medical capability shortfalls in

nine functional areas: planning; requirements, capabilities, and

assessment; command, control, communications, computers, and

information management; logistics; medical evacuation; personnel;

training; blood supply; and readiness oversight. For each functional area,

the expert panels developed strategic objectives to support the continuum

of military operations envisioned in the defense planning guidance for

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fiscal years 1996-2001. A total of 42 action plans were developed to

address shortfalls in the 9 functional areas. In assessing these shortfalls,

the panels relied heavily on the reports that we and the DOD Inspector

General prepared on the medical reponse during Operation Desert Storm.

The panels also identified the offices to be responsible for developing and

executing detailed implementation plans.

DOD is engaged in other efforts related to the wartime medical care system.

Each service initiated a reengineering program to reassess and reconfigure

its wartime medical capabilities to be more compatible with plans for two

major regional conflicts and operations other than war. DOD is also trying

to forecast the wartime medical demands in the year 2020 and design a

military health services system that will be responsive to those demands

(known as the MHSS 2020 project). In a separate effort, DOD is also updating

an April 1994 study (known as the 733 update) to determine wartime

medical personnel requirements for the year 2001.

Results in Brief DOD and the services are making progress in addressing the medical

capability shortfalls that hampered their operations during Operation

Desert Storm and other smaller scale operations. MRSP appears to

appropriately focus on the medical problems that we, the Joint Staff, and

the DOD Inspector General have observed. Although Health Affairs got off

to a slow start in managing the implementation process for MRSP, the office

has been placing increased emphasis in this area. About 44 percent of the

corrective action tasks have been reported as completed. However, Health

Affairs does not know whether these actions have corrected the problems.

Some corrective action plans have not been submitted, and about

7 percent of corrective action tasks have been reported as behind

schedule. Funding may also be an obstacle to implementation, since many

key tasks requiring funding are either unfunded or partially funded.

The services’ medical reengineering programs are addressing common

goals: to be lighter, smaller, more mobile, and adaptable to different

mission requirements. The changes arising from these reengineering

programs appear to provide significant enhancements to current medical

system capabilities. To respond to the mobility problems encountered in

Operation Desert Storm, for example, the services are reconfiguring their

combat hospitals into smaller components.

Even though DOD’s MRSP and the services’ reengineering programs are

focused on correcting current and near-term medical problems, DOD’s MHSS

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2020 project has yet to reveal how the future wartime medical system

should look. Consequently, it is unknown how compatible the current

efforts to improve wartime medical care will be with the future military

health services system.

DOD Needed to

Improve Its Wartime

Medical Capabilities

To respond to the new national military strategy resulting from the end of

the Cold War and problems that we, the Joint Staff, and the DOD Inspector

General identified, DOD initiated efforts to improve its wartime medical

capabilities. Defense planning guidance, modified in May 1994, requires

DOD to be ready to engage in two nearly simultaneous major regional

conflicts and prepare for smaller scale operations other than war. DOD

assumed that future operations would have far shorter warning times and

durations than Cold War scenarios.

The transition to the current defense planning guidance, particularly the

projected shorter warning times, increased DOD’s emphasis on joint service

operations and the need to react quickly to a major regional conflict or an

operation other than war. This transition has also underscored the need

for the services to redesign their wartime medical systems to reduce

transportation demands because of limited lift capacity. Medical systems

must compete with the movement of combat troops and other war-fighting

materials to the theater.

On the basis of war games conducted in December 1994, the Joint Staff

determined that the commanders in chief were unable to provide adequate

lift capability to move medical logistics and deployable hospitals to

support two nearly simultaneous major regional conflicts. The Joint Staff

recommended that the services investigate the possibility of evacuating

casualties more quickly to the United States for treatment. The Joint Staff

believed anticipated conflicts might be of such short duration that it would

be unlikely that the soldiers would be well enough to return to duty after

treatment in the theater. On the basis of war games completed in

March 1995, the Joint Staff also recommended that the services approach

medical operations from a joint perspective and redesign their medical

systems assuming smaller and lighter deployable hospitals and quicker

evacuation of patients to the United States for treatment.

On September 30, 1993, the DOD Inspector General issued a report

outlining several wartime medical problems that were consistent with

Joint Staff observations.1

 The Inspector General criticized DOD for a lack of

1

Medical Mobilization Planning and Execution, DOD Inspector General (93-INS-13, Sept. 30, 1993).

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joint medical planning. The report stated that DOD could not ensure the

deployability of medical personnel during contingencies for several

reasons, including outdated methods for determining personnel

requirements, assignment of personnel to incorrect skill areas, and

inadequate training of medical personnel. The report also stated that DOD’s

deployable hospitals lacked sufficient mobility and had incompatible

communication capability that limited their ability to prepare for incoming

casualties.

We have issued a series of reports that describe problems in DOD’s wartime

medical planning and capability to provide wartime medical care.2

 We

found that understaffed and inadequately supplied and equipped medical

units in Operation Desert Storm might not have been able to provide

adequate care if the predicted number of casualties had occurred. Also,

the medical units were not staffed and equipped to provide noncombat

care and were unable to support the evacuation of casualties from the

combat theater or receive large numbers of chemically contaminated

casualties. Other medical force problems included (1) large numbers of

nondeployable medical personnel due to unacceptable physical

conditions, lack of required skills, and mismatches in medical specialties;

(2) a widespread lack of training for the wartime missions; and

(3) inadequate or missing equipment and supplies.

In addition, we testified in March 1995 that several key factors, such as the

population at risk and wounded-in-action rates, that affect the demand for

wartime medical care were still being debated.3

 We also stated that

reaching agreement on the key factors was critical to arriving at the best

wartime medical care system for the future, as it would allow

decisionmakers to direct their attention to optimizing the medical care

system for that demand. We reported in June 1996 that DOD was still having

difficulty reaching agreement on such factors.4

2

Operation Desert Storm: Problems with Air Force Medical Readiness (GAO/NSIAD-94-58, Dec. 30,

1993); Operation Desert Storm: Improvements Required in the Navy’s Wartime Medical Program

(GAO/NSIAD-93-189, July 28, 1993); Operation Desert Storm: Full Army Medical Capability Not

Achieved (GAO/NSIAD-92-175, Aug. 18, 1992).

3

Wartime Medical Care: Aligning Sound Requirements With New Combat Care Approaches Is Key to

Restructuring Force (GAO/T-NSIAD-95-129, Mar. 30, 1995).

4

Wartime Medical Care: Personnel Requirements Still Not Resolved (GAO-NSIAD-96-173, June 28,

1996).

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MRSP Appropriately

Describes Readiness

Problems, but

Challenges Remain

Our comparison of problems highlighted by MRSP with those we, the Joint

Staff, and the DOD Inspector General had previously identified shows that

MRSP appropriately describes medical readiness problems needing

resolution. The problems outlined in MRSP are also consistent with the

recent changes in the Defense Planning Guidance. For example, MRSP

points out that current medical planning is based on Cold War

assumptions in which the services planned to fight the former Soviet

Union individually rather than jointly. This lack of a joint approach made

the DOD medical system unresponsive to the full continuum of anticipated

contingencies, including major regional conflicts, peacemaking, and

disaster relief. Accordingly, MRSP lists specific tasks Health Affairs, the

services, the Joint Staff, and other DOD activities should take to ensure that

joint medical planning becomes standard throughout DOD.

MRSP also identifies the need for the services to modernize their deployable

hospitals to reduce their weight and size. This reduction will decrease

transportation demands and improve the mobility and transportability of

such hospitals. It lists steps, such as incorporating technological

advancements and equipment modernization, to correct these problems.

Similarly, MRSP describes many factors that inhibit the deployability of

medical personnel and lists steps to improve the training and certification

of medical personnel to ensure they are adequately prepared to perform

functions expected of them while deployed.

MRSP outlines corrective actions to address problems in the

communications area such as ensuring interoperability and adaptability of

individual service medical communication with global communications

systems. It also requires specific DOD offices to ensure the availability of

critical medical materials needed for a conflict. MRSP also stresses the need

for DOD and the services to reexamine and validate the key factors that

affect the demand for wartime medical care.

Three additional areas are currently being added to MRSP: nuclear,

biological, and chemical warfare; operations other than war; and research

and development. For each area, an expert panel identified capability

shortfalls and developed corrective actions. Health Affairs plans to add

these new areas to MRSP by December 31, 1996.

MRSP Started Slowly Health Affairs got off to a slow start in monitoring progress being made in

correcting medical readiness problems. The primary tool Health Affairs

uses to monitor progress is its review of periodic updates of

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implementation plans submitted by the responsible offices. These plans

summarize how and when a responsible office intends to correct a

particular medical readiness problem described in MRSP. Although the

implementation plans do not indicate the amount of funding involved, they

describe whether specific corrective actions are fully or partially funded

or unfunded. MRSP requires 400 implementation plans because of the

multiple tasks and multiple offices responsible for carrying out needed

actions.

Initially, Health Affairs had difficulty obtaining complete implementation

plans in a consistent format from the responsible offices. Although the

offices were to submit the plans by the end of June 1995, Health Affairs

had not obtained 19 (5 percent) of the required implementation plans as of

April 30, 1996. The Joint Staff was responsible for six (32 percent) of the

missing plans. A Joint Staff official said that staff turnover and competing

priorities delayed the submission of the implementation plans but that

they would be completed by the fall of 1996. The other offices responsible

for the missing plans were Health Affairs, the Defense Modeling and

Simulation Office, and the Office of the Assistant Secretary of Defense for

Reserve Affairs. In commenting on our draft report, Health Affairs

reported that it had obtained an additional 10 implementation plans,

including all of the missing plans from the Joint Staff.

Health Affairs also had difficulty collecting and analyzing the initial

submissions because of the volume of information. Health Affairs

corrected this situation by developing computer software to facilitate the

quarterly updating and analysis of the implementation plans and sharing it

with the responsible offices. In addition, Health Affairs entered into a

contract with an outside firm to put the implementation plans on a

computerized network so the responsible offices could continually keep

them updated. This project is expected to be accomplished in

December 1996.

As a part of its monitoring efforts, in February 1996, Health Affairs

convened most of the experts that helped develop MRSP to determine

whether (1) the individual offices given responsibility for correcting

medical readiness problems in MRSP were still appropriate and (2) the

anticipated corrective actions described by those offices were responsive

to the current readiness problems. These panels recommended several

changes in both responsibilities and needed corrective actions. If

approved, the changes are expected to be made to MRSP in October 1996.

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Corrective Actions Are

Underway, but Many Are

Behind Schedule

Our analysis of the 1,362 specific tasks included in 400 MRSP

implementation plans shows that the responsible offices are making

progress in correcting medical readiness problems but that some tasks are

behind schedule. More specifically, 604 (44.3 percent) of the 1,362 tasks

were reported as completed, but 94 (6.9 percent) were reported as behind

schedule as of April 30, 1996.5

 Milestones for completing the remaining 664

tasks have not yet occurred.

During the summer of 1995, the Assistant Secretary of Defense for Health

Affairs and the Surgeons General of the services identified the following

six plans for priority monitoring: joint medical planning, information

management, joint medical logistics and planning, medical evacuation,

deployability of medical personnel, and medical readiness oversight. The

tasks for the six priority plans and their implementation status are shown

in table 1.

Table 1: MRSP Tasks That Were

Completed and Behind Schedule for

Six Priority Action Plans (as of Apr. 30,

1996) 

Tasks completed

Tasks behind

schedule

Action plan Total tasks Number Percent Number Percent

Joint medical planning 29 12 41 2 7

Information management 17 7 41 0 0

Joint medical logistics and

planning 52 27 52 4 8

Medical evacuation 29 6 21 1 3

Deployability of medical personnel 6 1 17 0 0

Medical readiness oversight 3 3 100 0 0

Total 136 56 41 7 5

Our analysis is meant to provide a general overview of how the

responsible DOD activities view their attempts to correct the medical

readiness problems assigned to them without regard to whether one task

is more critical than another. Also, the corrective actions may not be

directly attributable to the MRSP process; some of the DOD offices

responsible for such issues had already undertaken corrective actions.

(MRSP does not duplicate these efforts but attempts to consolidate their

oversight.)

Several Obstacles May

Inhibit Progress

Although progress is being made in implementing MRSP, some potential

obstacles may hamper the timely correction of problems noted in the plan.

5

This date was the last time the implementation plans were updated by the responsible offices.

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One of these obstacles involves the three offices (Health Affairs, the

Defense Modeling and Simulation Office, and the Office of the Assistant

Secretary of Defense for Reserve Affairs) that have not yet submitted

detailed implementation plans for corrective actions, which raises

questions about whether problems are being addressed. Some DOD officials

told us that they were concerned that those offices outside the control of

Health Affairs have not given implementation of MRSP the level of attention

it deserves. In this regard, the officials believe that MRSP would have been

given higher visibility and priority for implementation if it had been

published with the signature of the Secretary of Defense or Deputy

Secretary of Defense rather than the Assistant Secretary of Defense for

Health Affairs.

Lack of funding may also hamper implementation of MRSP. When MRSP was

published, no additional funding was given to responsible program offices

for implementing the plan. Although the offices were expected to fund the

corrective actions from their ongoing appropriations, many corrective

actions were not funded or were only partially funded as of April 30, 1996.

Health Affairs officials did not know the amount of these funding

shortfalls, but they were planning to assess the impact of the shortfalls in

1997.

Moreover, Health Affairs has limited knowledge regarding the extent to

which problems noted in MRSP have been resolved by the corrective

actions identified in the implementation plans. Health Affairs is in the

process of developing a methodology for making this assessment and

plans to begin using it shortly after its completion in March 1997.

Services’

Reengineering

Programs Offer

Improvement

Each service has initiated a medical reengineering program to address

shortfalls in medical capabilities. Each reengineering program is at a

different stage of development but all are expected to yield enhancements

to current system capabilities by making organizational changes,

reconfiguring deployable systems, and adapting clinical capabilities to

different mission requirements. The services anticipate that these

programs will meet their reengineering goals of developing smaller and

more mobile systems.

Army In early 1994, the Army’s Surgeon General initiated a medical

reengineering program to reconfigure the Army’s combat health support

operations. This program was to incorporate the lessons learned from

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Operation Desert Storm and other operations and reflect the types of

combat operations anticipated for the 21st century.

In assessing how its combat health support system should be

reconfigured, the Army Medical Command assembled panels of experts for

10 functional areas, such as hospitalization, medical evacuation, and

medical logistics. The panels assessed current medical capabilities and

proposed organizational and operational changes. The proposed changes

are designed to make medical systems modular and more mobile and

flexible. Also, the changes are intended to make the systems capable of

effectively operating simultaneously in multiple locations and tailored to

accommodate missions ranging from intense combat to peacekeeping and

humanitarian operations.

Significant changes are proposed for hospital care, which is currently

provided in three types of facilities: the Combat Support Hospital, Field

Hospital, and General Hospital. The Army is moving toward smaller

hospital modules that can provide a full range of services and be

self-sufficient and ready for rapid response. One reconfigured 248-bed

hospital will replace the 3 current types of hospitals. This new hospital will

consist of two self-supporting modules: a mobile 84-bed module and a

larger 164-bed module. The 84-bed module will provide increased

flexibility because 3 of the modules can be prepositioned aboard a ship

and later deployed in separate units if needed. The current Combat

Support Hospital must be deployed as a single unit.

The Mobile Army Surgical Hospitals are being phased out. Their mission of

providing urgent resuscitative surgery will be assumed by the mobile

forward surgical teams, which will perform surgery at locations deeper in

the battlefield or closer to the place of wounding. To provide increased

flexibility, a medical detachment will be available to augment capability at

hospitals throughout the theater. Specialty augmentation teams using the

same equipment will be consolidated, and another team will be added to

provide capabilities for operations other than war. The proposal also

includes improved communications technology, information systems, and

use of telemedicine.

In December 1995, the Army’s Surgeon General approved the proposed

reengineering changes, and they are currently under review by the Army’s

Training and Doctrine Command, the commanders in chief, and major

commands. The changes are expected to be submitted to the Army’s Chief

of Staff for approval in September 1996. If approved, implementation of

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the proposals will begin in fiscal year 2000 and be completed by fiscal year

2005.

Air Force The Air Force Surgeon General initiated a project in January 1994 to

reengineer approaches for delivering medical care during conflicts or

other kinds of operations. The initiative consists of three phases: concept

development, determination of feasibility, and implementation.

In June 1995, the Air Force Surgeon General approved a new concept that

envisions small deployable medical systems to allow commanders more

flexibility to tailor their medical care response to a specific mission.

Currently, the Air Force generally deploys a 50-bed, surgically intensive,

air transportable hospital to a conflict. Under the new concept, more than

40 clinical modules, including general surgery, primary care, intensive

care, and dental services, can be deployed individually or in various

combinations. According to Air Force officials, the use of a more tailored

approach requires less airlift capacity and provides the types of services

that are appropriate for a specific mission.

To provide additional mobility and flexibility, the standard air

transportable hospital can be scaled down to 25 beds, with an option of

deploying a 10-bed trauma clinic to stabilize trauma patients and provide

outpatient care. The concept also uses telemedicine to give forward

deployed medical personnel the capability to obtain remote consultations

in several disciplines, including radiology, dermatology, and pathology.

To evacuate patients more quickly from the theater, the Air Force plans to

use critical care aeromedical transport teams to stabilize and evacuate

critically ill patients to the United States or other locations for treatment.

Each team can be tailored to meet the needs of specific patients, but the

teams generally consist of a physician, nurse, and respiratory therapist.

The Air Force is testing this concept and has formed seven teams that

have transported critically ill patients from Bosnia and Saudi Arabia.

During the summer of 1996, the Air Force realized that its proposed

reengineering changes were feasible. As a result, officials have initiated

the implementation phase. In addition, the officials were trying to obtain

funding through the 1998-2002 Program Objective Memorandum cycle so

that the changes could be fully implemented by the end of fiscal year 2002.

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Navy The Navy’s fleet hospital reconfiguration project began in the fall of 1995

with the goal of making fleet hospitals lighter and more mobile and

mission flexible. Two working groups are involved in the study; one is

focusing on reconfiguring fleet hospitals until the year 2010, and the other

is focusing on changes in 2010 and beyond.

The first working group developed a preliminary design of a small

hospital, but the design has not been approved by Navy leaders. The

proposed design, called the Naval Expeditionary Medical Support System,

focuses wartime medical capability around a core unit with a capacity of

20 to 130 beds. Although the current 500-bed fleet hospital will be

maintained, Navy officials envision that either the 130- or the 500-bed

hospital will be set up in a given theater, but not both. In addition, the

concept includes an option to extract a 100-bed unit from the standard

500-bed fleet hospital to use during an operation other than war. Under

this concept, the Navy will not maintain any duplicate equipment. If the

new concept is approved, the fleet hospitals will be repackaged as they are

brought in for their periodic modernizing, beginning as early as 1998.

The Navy is also revising its procedures for staffing hospitals. The Navy’s

requirement for fleet hospitals has decreased from 17 to 12. Six of these

hospitals will be staffed primarily by active duty personnel and six will be

staffed by reserve personnel. To increase staffing efficiency and

productivity, the Navy will now staff its active duty deployable hospitals

with personnel from specific medical treatment facilities. In the past, fleet

hospitals were staffed by pulling medical personnel from any location, but

this approach did not work particularly well in Operation Desert Storm.

The revised concept presumes that medical personnel who work together

on a day-to-day basis will perform better than staff who are taken from

different locations within the system. Similarly, the Navy plans to

designate specific reserve units to staff the six reserve component fleet

hospitals. Other reserve medical units will be designated to replace active

duty staff taken from specific medical treatment facilities.

To ensure that active duty medical personnel earmarked for deployment

get the periodic readiness training they need, the Navy designated the

executive officers of medical treatment facilities as the commanding

officers of the fleet hospitals when they deploy. For reserve medical

personnel in units designated to staff fleet hospitals, Navy officials

anticipate that the units will train together at a fleet hospital every 2 years.

When the reservists do not train at a fleet hospital, they will complete their

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annual 2-week training session at a Navy medical treatment facility or at

their units’ designated hospital.

Marine Corps In late 1993, the Marine Corps began to reassess the reconfiguration of its

medical battalions, which are part of its combat units. The need to

reconfigure these battalions grew out of lessons learned from Desert

Storm showing that the battalions were too heavy to keep pace with and

support the movement of the ground combat units. The Marine Corps

found that the capabilities of the medical battalions had been expanded

during the Vietnam War era to compensate for the lack of deployable

hospitals at higher echelons of care. However, these expanded capabilities

were beyond the battalions’ mission. The medical supplies and equipment

included in each battalion, which should have been assigned to a higher

echelon of care, had greatly increased the battalion’s weight and size, and

hampered its mobility.

The restructuring of the medical battalion essentially reduced those

specialty care capabilities that were beyond the mission requirements.

This restructuring also placed more reliance on evacuating patients

needing such specialty care to higher echelons of care provided by the

Navy or other services. In addition, the restructuring reduced the number

of cots by 52 percent, from 540 to 260, and reduced the weight of the

medical battalion by 20 percent. The new surgical companies within the

battalion are staffed with general surgeons and trauma care providers and

no longer contain orthopedic and other surgical subspecialties, such as

thoracic surgeons. Patients requiring specialty care will be evacuated to

other facilities where such care is available. Marine Corps officials believe

that the restructured medical battalion, with its decreased lift requirement

and smaller footprint, will allow the battalion to move with the combat

maneuver elements and provide direct resuscitative health service support

to the combat forces.

The Commandant of the Marine Corps approved the restructured medical

battalion in November 1995. Two of the four Marine Corps medical

battalions have begun implementing the restructuring, and the others will

begin reconfiguration by October 1996. Full implementation of the

restructuring is expected by the year 2000, assuming funding is available

from the Program Objective Memorandum process.

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Compatibility of

DOD’s Future Military

Medical System With

Current Efforts Is

Unknown

In February 1996, Health Affairs began its MHSS 2020 project to forecast

changes in health care delivery, with the goal of facilitating the integration

of these future health care practices into the design of the military health

services system. The project is designed to identify 25-year trends and

breakthroughs in both clinical and nonclinical technologies; determine

how to apply these technologies across DOD health care responsibilities,

which range from personal fitness to treatment of war zone casualties; and

identify how the military health services system should be funded and

staffed to transition to the year 2020.

Participants in the project include practitioners, researchers, and

academicians from several disciplines in the federal and private sectors.

The project will involve three stages. First, about 200 experts—organized

into 20 specialized working groups concentrating on clinical,

administrative, and information management issues—will identify future

trends in their fields. Second, 10 multidisciplinary groups will develop

strategic planning scenarios for specific areas of military health from the

trend information. Third, teams will identify general and specific proposals

to help transition the current military health services system from today to

the year 2020. DOD expects the future scenarios to be finalized in

December 1996.

The MHSS 2020 project could serve as the mechanism for identifying future

medical system requirements against which MRSP and the services’

reengineering programs should be focused. However, the extent to which

MRSP and these reengineering programs will be compatible with future

medical system requirements will not be known until the MHSS 2020 project

is completed.

Recommendations We recommend that the Secretary of Defense direct Health Affairs, the

Defense Modeling and Simulation Office, and the Office of the Assistant

Secretary of Defense for Reserve Affairs to develop and begin

implementing plans to correct the medical capability problems noted in

MRSP. Without such direction, these offices might continue to give low

priority to medical readiness.

We also recommend that the Secretary of Defense direct the Assistant

Secretary of Defense for Health Affairs to (1) assess the extent to which

actions taken in response to MRSP have corrected medical capability

problems, (2) take steps to resolve other unsettled problems, and (3) use

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the results of the MHSS 2020 project to guide the focus of MRSP and service

reengineering initiatives.

Agency Comments In commenting on a draft of this report, DOD concurred with our

recommendations and agreed with the accuracy of the report. DOD stated

that it was aggressively pursuing resolution of the problems described in

our report. For example, through Health Affairs/Joint Staff coordination,

all of the missing Joint Staff implementation plans have been developed.

DOD also commented that Health Affairs has begun the process of

assessing the extent to which actions taken in response to MRSP have

corrected medical capability problems. From these assessments, DOD will

develop strategies for resolution of unresolved problems.

DOD provided some technical comments to our report and we incorporated

them into the text of our report where appropriate. DOD’s comments

appear in appendix I.

Scope and

Methodology

To obtain information for the report, we reviewed documents, reports, and

information relevant to the development and implementation of MRSP,

services’ medical reengineering programs, and MHSS 2020 project. We

interviewed officials from the Office of the Assistant Secretary of Defense

for Health Affairs, Joint Staff and Office of the Assistant Secretary of

Defense for Reserve Affairs in Washington, D.C; and the Offices of the

Surgeons General at Navy and Air Force Headquarters in Washington,

D.C., and at the Army Medical Command in San Antonio, Texas. We also

interviewed officials from the U.S. Central Command, Tampa, Florida; U.S.

Transportation Command, Scott Air Force Base, Illinois; U.S. Atlantic

Command, Norfolk, Virginia; Defense Medical Standardization Board, Fort

Detrick, Maryland; and the Marine Corps Combat Development Command,

Quantico, Virginia.

We reviewed the methodology used to develop MRSP and discussed its

reasonableness with several DOD officials. We compared the content of

MRSP with the medical capability problem areas identified in our work on

Operation Desert Storm and with similar work conducted by the DOD

Inspector General. We reviewed the detailed implementation plans

prepared by the primary action offices and identified the extent to which

tasks in the plans were reported to be completed, on schedule, or delayed.

We did not weigh the relative importance of one task against another. We

used the funding status information provided by the primary action

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offices. We discussed potential obstacles in implementing MRSP with

officials at the locations we visited.

We obtained briefings from all of the services on their medical

reengineering programs and reviewed documentation concerning the

factors that led to the reengineering efforts, process used to identify

needed changes, extent to which the programs address common goals for

future medical capabilities, and current status of the reengineering

programs. We interviewed agency officials regarding any overlaps or

inconsistencies among the services’ reengineering programs. We examined

the content of each services’ reengineering program to learn whether

proposed changes were responsive to the problems we and the DOD

Inspector General had previously reported for wartime medical

capabilities.

We conducted our review from July 1995 to August 1996 in accordance

with generally accepted government auditing standards.

We are sending copies of this report to other interested congressional

committees; the Secretaries of Defense, the Army, the Navy, and the Air

Force; the Commandant of the Marine Corps; and the Director of the

Office of Management and Budget. We will also send copies to others on

request.

If you or your staff have any questions about this report, please call me on

(202)512-5140. Major contributors to this report are listed in appendix II.

Sincerely yours,

Mark E. Gebicke

Director, Military Operations

 and Capabilities Issues

Page 15 GAO/NSIAD-96-224 Wartime Medical Care
Appendix I 

Comments From the Department of Defense

Page 16 GAO/NSIAD-96-224 Wartime Medical Care
Appendix I 

Comments From the Department of Defense

Now on p. 13.

Now on p. 13.

Page 17 GAO/NSIAD-96-224 Wartime Medical Care
Appendix II 

Major Contributors to This Report

National Security and

International Affairs

Division, Washington,

D.C.

Sharon A. Cekala

Paul L. Francis

Valeria G. Gist

Dade B. Grimes

Norfolk Field Office Steve J. Fox

Lynn C. Johnson

William L. Mathers

Dawn R. Godfrey

(703104) Page 18 GAO/NSIAD-96-224 Wartime Medical Care
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