Mr. MILLER. No questions. Thank you.

POST TRAUMATIC STRESS

Mr. MURTHA. One last item, Dr. Mendez. As you know, Greensburg, Pennsylvania suffered more casualties than any other town in all the Nation during the Persian Gulf war. We called the Reserves up and we had a devastating loss to that small unit. Now, I am working with Senator Inouye to put some language in our bill to ask that there be a study of the impact of that attack on these people.

Now, Walter Reed Medical Center did a brilliant job on these individuals when they came back. They received good care out in the field. There was a very derogatory article in one of the Pittsburgh papers. Secretary Stone reacted very quickly, called every person he could reach, had people on his staff contact everyone. I went to Walter Reed, saw the last two people who are still in the hospital and had an opportunity to visit with them, and I know that you are working on their cases. The VA reacted, because some of the problems were with the VA. But reservists were ready. Reserve sergeants served ten to 12 years where regular sergeants are five to six years in some instances.

I have seen firsthand the emotional problems that those folks deal with. I told the families when they came back that if they have emotional problems, I would like to know about it, knowing the physical problems, and some of them were injured very badly. They have emotional problems.

We put a small amount of money in the budget for a study and that money has been proposed for rescission by some bureaucrats over there in the department. Now, I cannot believe that the department doesn't think it is significant when you have a group of reservists that were killed and wounded, that that is worth taking a look at.

Now, if we are going to depend on the Reserves more in the future, we have to know the impact that a situation like that has on a community and on the unit itself, emotionally and physically. I would expect you to go forward and not wait for this rescission, because I can assure you that this rescission is not going to be approved by this Congress. I would expect the department to go forward with this study starting as quickly as possible. And I know the money will be available later on, but I think it is important for us to know the impact so that we can judge in the future what happens to a community and to a unit when they are hit so hard when they are reservists. We are doing the same thing for active duty units, and I would like to see you go forward with both those studies as quickly as possible.

COMMENTS ON PERSIAN GULF WAR

I can't say enough about how well the medical services did during the war. The only complaint I received when I was overseas aboard the ships was that some of the equipment was antiquated, but they did not say that there was any problem. It is just they didn't have the most up-to-date equipment, but they could operate with it, and they were completely satisfied.

Some of the skills were deteriorating, but obviously the alternative to the skills deteriorating was having a lot of casualties so they could operate. So that is not something that any of us felt bad about a bit. But I would hope that we didn't lose a lot of reservists, and we did insist that they be called up.

I think you did it exactly right. I think the call-up was orderly. I think it was quick, and I think it was a phenomenal feat by the medical services themselves. So I compliment you and the departments on the magnificent job.

You spent a lot of time away from home and took care of a small amount of casualties, but the ones that were taken care of were taken care of very well and very quickly. And if something catastrophic would happen, we would have been prepared, and it is due in large measure to the funding by this Committee. But the work that you and the Surgeon Generals have done is really to be complimented and all of us appreciate the dedication to the people in the active duty. And I hope we can get the same kind of money available so that we can take care of the dependents in the same regard. Dr. MENDEZ. Thank you, sir. If I may make a comment, Mr. Murtha. It is something that did not come up and if you will allow me, I will bring it up. I simply want to tell you about the tremendous cooperation and the fine spirit that I saw in my office during the Persian Gulf conflict, week after week after week with these three gentlemen and myself. And also from the JCS.

We met there-and two of these gentlemen were not there as yet, but indeed their predecessors were frequently. I know your interest in interservice cooperation and all of these things that lead to better and more efficient work. And that was exactly what happened.

It was perhaps one of the most rewarding things to me, to see that cooperation almost on a daily basis as it occurred, during those times of pressure for everyone.

Mr. MURTHA. Thank you very much. We will have additional questions for the record from Members of the Committee and from Congressman Pete Geren of Texas. The Committee is adjourned until 10:00 o'clock Tuesday.

[CLERK'S NOTE.-Questions submitted by Mr. Sabo and the answers thereto follow:]

HOSPITAL ADMINISTRATORS

Question. Last year, this Committee adopted a provision which banned DOD from appointing doctors to command military treatment facilities. That action was prompted by our concern that the Department of Defense was misallocated a valuable medical resource by using doctors to command hospitals, and not to provide patient care. In conference, we accepted a position stating that health care professionals should be appointed to command positions only if they "can demonstrate professional administrative skills," and urging DOD to establish formal training guidelines. I understand that Secretary Atwood directed you to issue guidelines by March 18, 1992, detailing what administrative skills an individual must demonstrate before being considered for a command position. Have those guidelines been issued?

Answer. No. My deputies are currently reviewing the guidelines recommended by the task force I convened to review the issue of administrative skill qualifications for command of military treatment facilities. After I review the task force report and the comments regarding it, guidelines will be issued. I have tasked my staff to quickly perform their review.

Question. Do the guidelines establish standards "consistent to those commonly accepted in the civilian health community," as Secretary Atwood requested in his memo?

Answer. Yes. The preliminary information I have received, regarding the task force report, is that it considered civilian "standards" in developing its recommendations, and where applicable, recommended guidelines that are consistent with those commonly accepted in the civilian health care community.

Question. Secretary Atwood also directed you to establish a training program in hospital administration by mid-June. Will you meet that deadline?

Answer. Deputy Secretary Atwood's direction was to "arrange for programs in health services administration, including accredited degree-granting programs for members of the armed forces". The report, from the task force I convened to study the issue of administrative skill qualifications for command of military treatment facilities, is currently being reviewed by my Deputies. Every effort will be made to respond to Secretary Atwood on time.

Question. How much do you anticipate spending each year to provide doctors with the supplemental training they need to run hospitals? How would this training be structured, and where would it take place.

Answer. This question cannot be answered until after findings of the task force have been reviewed, and a course of action selected. I particularly need to know what the task force found regarding the training currently given to individuals being prepared for command, and what additional training is needed, especially in preparing commanding officers to implement the coordinated care program.

Question. Have you commissioned any studies to determine whether there is any difference in performance between hospitals run by doctors and those run by trained hospital administrators? Answer. No studies have been commissioned. However, Joint Commission on Accreditation of Healthcare Organization Surveys have found that the performance of the Military Health Care System is significantly better than that of civilian facilities. Also, the Civilian External Peer Review Program has shown that the quality of care provided by military treatment facilities is equal to, or better, than that provided by the civilian sector. These are two critical performance measures.

Question. Your coordinated care program will place extra administrative burdens on hospital commanders. How have you addressed that? Will future budgets allocate even more money for administrative training? Assuming administration responsibilities take away from time spent with patients, will you allocate extra money for patient care?

Answer. I understand the task force has addressed the special needs for administrative training for commanders who will work in

the CCP environment. We are in the process of identifying the cost of this additional training, and will include it in our POM. The dollars required for patient care are calculated on the basis of previous experience and any change in the demographics of our beneficiary population.

Question. For the record, please provide the Committee with data indicating how many trained hospital administrators (with a Master's Degree in business administration of health care management) each of the services currently has, how many are in command positions (both absolutely and as a percentage of available slots), and whether these figures indicate either significant differences between the services or recent trends in any direction.

Answer. A review of all senior Medical Department officers' personnel records is necessary to completely answer all parts of this question, because the requested information is not available in an automated data base. The following information was provided by each Service from data that was quickly available. Historical information was not available, therefore, we are unable to identify trends over time. The Navy and Air Force have officers from all Medical Department Corps assigned as commanding officers of medical facilities. Because of promotion policies, the Air Force presumes that all of their Medical Service Corps (MSC) officers have masters degrees. Navy MSC's are not required to have a masters in business administration or health care management for promotion. Many have other types of masters degrees.

a. Number of Medical Service Corps Personnel with a masters (or higher) degree in business or health care management. (The Navy data below and in (b) is a combination of information currently available or that obtained during a review of this issue performed in April and May of 1991.)

b. Other Corps Personnel with a masters (or higher) degree in business or health care management:

1 29 have masters degrees in either business administration or health services management, 155 have masters of public health.

c. Number of Medical Service Corps Personnel, with a masters degree, in command slots. These are O-5 and 0-6 positions. It is unlikely an Air Force Medical Service Corps officer will be promoted to these ranks unless she/he has a masters degree. therefore, the number of USAF MSC's assigned to command positions is as

sumed to equal the number of USAF MSC's with Masters degrees assigned to command positions.

d. Number of Other Corps Personnel (known or presumed to have a masters degree in business administration or health care management) in command slots:

1 All Medical Corps 2 have masters degrees in either business administration or health services management, 6 have masters of public health. 2 Unknown. Mostly medical corps, but also nurse corps and biomedical science corps (USAF). How many of these people have a masters in business administration or health care management is unknown

LEAD POISONING

Question. Last year, Congress directed the Department to begin dealing with the lead poisoning hazard to military dependent children, caused primarily by the ingestion of lead-based paint and dust. The Committee directed the Department to begin testing all children for lead poisoning, in keeping with the formal recommendations of the Centers for Disease Control, and to create a task force to examine the risk of lead hazards in military housing. Finally, we provided $1 million to support the federal interagency effort to develop safer methods to cleanup lead paint hazards. The Defense Authorization Act included a provision making blood lead tests eligible for reimbursement under the CHAMPUS program.

I have reviewed the Department's plan for both blood testing and abatement and I believe you have made a very good start. As I understand it, your plan calls for blood-lead testing at least 20 percent of military dependent children, with universal testing within five years. The Department's risk assessment and abatement plan calls for surveying housing, child care center, and schools, and dealing with lead hazards identified in the survey.

Cverall, I think this is a good start, but I have some questions: EPA, HUD, NIH, OSHA, and other federal agencies have a well organized "Federal Interagency Task Force" which meets on a regular basis. Has DOD appointed a representative to the task force? Answer. DOD has been represented on the Federal Interagency Task Force by the US Army's Corps of Engineers (COE) Research Laboratory. DOD has tasked the COE's Engineering Housing Support Center (EIISC) at Fort Belvoir to be the Executive Agent for utilizing the $1 million provided by Congress. In addition to the above representative, the Office of the Deputy Assistant Secretary