of Defense for Environment (ODASD(E)) will attend meetings of the Federal Interagency Task Force on as needed basis.

Question. What progress has DOD made with HUD and EPA in coordinating the used of the $1 million we provided to support the interagency effort on new cleanup methods?

Answer. EPA and HUD reviewed DOD's draft policy on the assessment and abatement of lead-based paint (LBP) and the screening of children for lead poisoning. As mentioned above, the EHSC will become more involved with the EPA and HUD. DOD will be establishing a working group to serve as a coordinating body and a sounding board to oversee the expenditure of the $1 million. EPA and HUD will be asked to provide representatives to this working group. DOD, EPA and HUD will work together to produce a product that can be used not only by DOD, but by all of the Federal Agencies.

Question. I understand the actual portion of eligible children to be tested the first year may be higher than 20 percent. How does that work? Will you focus your efforts on children identified as high-risk?

Answer. The 20 percent figure refers to the percentage of children who come in for the twelve month well-baby visit who must have the blood lead testing done as part of a routine visit. One manner in which this can be accomplished is for them to test every fifth child who comes in for the visit.

In addition to this population, children identified as high-risk will also be tested. This population is identified by a questionnaire that is given to all children coming in for treatment. Any question answered in the affirmative puts a child in the high-risk category and leads to testing.

Question. Have you determined what the blood testing program will cost in each of the five years, beginning with fiscal year 1991? How are those costs broken down? How much will each test cost, and how do those costs compare to the civilian sector, where some state labs have projected test costs as low as $10? As testing volume goes up, do you expect the unit cost to go down?

Answer. An exact cost is difficult to measure, since both the number to be tested and the cost for the tests is fluid. Based on stated assumptions, however, the following cost figures are presented:

Based on a dependent population 0-1 years of age of 160,000 and with 20 percent of the well-babies being tested the first year and increasing by 20 percent each year thereafter, and $20 as the cost for a test, the cost would be: 1st year 32,000 well babies at $.6 million, 2nd year 64,000 at $1.28 million, 3rd year 96,000 at $1.92 million, 4th year 128,000 at $2.56 million, and 5th year 160,000 at $3.2 million. In the remainder of the population, assuming that one in six children is at risk, 154,667 children 0-6 years of age would be at risk and that testing would cost an additional $3 million.

There is much variance in the cost of testing. Naval Hospital Bethesda has a contract with the Providence Laboratory in Washington, D.C. with a test list price of $20.05. The Annapolis Medical Clinic uses the Maryland State Department of Health and Hygiene laboratory at $18.03. The WRAMC laboratory indicated it could

run the tests in the first year for $11 and the following year for $7.70. This does not include the cost for shipping and handling.

Question. I have been told all blood samples originally will be sent to Walter Reed Army Medical Center for analysis. Why?

Answer. While for costing purposes, we have explored WRAMC capabilities, it will be up to the individual Services and local commanders to obtain testing at the best price available. The Tri-Service members that were a part of the working group that developed the DoD plans and who will be an integral part of the plans implementation in each Service are well aware of all the testing alternatives.

Question. Have you determined what additional investments will be needed to implement universal screening? For example, do you need additional equipment for blood analysis? Do you need to train more medical technicians?

Answer. The $11 testing figure from the WRAMC laboratory is based on the fact that to do 9000 tests a year requires two machines for a total cost of $30,000, a technician for $30,000, and reagents for $40,000. The machine costs are start-up only, but the technician and reagent costs are recurring and account for the $7.70 testing costs. These additional investments will depend on decisions made by the Services.

Question. When do you intend to notify military families that their dependents are eligible for blood lead testing? When will you issue the notice that CHAMPUS program will pay for blood lead testing?

Answer. Notification of military families will take place as the services implement the program. As part of the notification process, we are planning to produce a public affairs video that will be broadcast on the overseas network. A news release was prepared and released March 27, 1992. The news release is widely distributed to, for example, military organizations including retiree organizations, public affairs offices at each military installation, each editor of base and post newspapers, recruiting commands, all Naval ships, Health Benefits Advisors of each of the Services, etc. Our claims processors have also been notified to process claims for blood level screenings for infants up to the age of two. The effective date of this additional benefit is December 5, 1991, the date this legislation was signed authorizing their benefit.

Question. I understand there is a possibility that DOD could end blood lead testing in certain areas. Why? On what grounds would you decide to forego testing in some areas?

Answer. Such a decision is in accordance with the Centers for Disease control guidelines which state that all children should be screened, unless it can be shown that the community in which these children live does not have a childhood lead poisoning problem. Deciding that no problem exists requires that a large percentage of children be tested. If over a reasonable period of time, communities are seen not to have a problem, it would be appropriate to discontinue the screening.

Question. When will the abatement plan be sent to the base commanders? Will the notice be sent through the services or from the office of Health Affairs? Will your guidance to field commanders be coordinated with the interagency task force.

Answer. The DoD draft policy for the assessment and abatement of LBP and the screening of children for lead poisoning is presently being coordinated with the Military Departments Comments are due to the ODASD (Environment) not later than April 15, 1992. Shortly thereafter, the final policy documents will be forwarded to the Military Departments for implementation by a joint memorandum from the ASD (Health Affairs) and ASD (Production & Logistics).

Question. I notice the abatement plan indicates that two different kinds of x-ray fluorometer (XRF) are recommended for measuring lead in paint on walls. Does DoD currently possess these machines, or does it have plans to acquire them?

Answer. Several of the military installations (bases/post) have procured the XRF's; however, there has not been any mass buy of XRFS. Once the DOD policy is forwarded for implementation, the Military Departments will have to go through the planning, program and budget system (PPBS) for the purchase of the XRFs. Nevertheless, the Army's Environmental Hygiene Agency (AEHA), the Air Force's Armstrong Laboratories and the Naval Environmental Health Center (NEHC) use XRFS as part of their industrial hygiene capabilities. In addition, the Navy will begin a LBP/Asbestor inventory of Naval housing, which will lead to the procurement of several additional XRFs.

Question. As I understand it, the mere presence of LBP does not constitute a health hazard-a more critical variable is actual exposure to lead dust. Will your surveys concentrate on XRF tests to detect lead paint, or on assessments of risk based upon lead wipe tests?

Answer. DoD's policy for the assessment and abatement of LBP and the screening of children for lead poisoning is based on the potential for exposure to lead. DoD's policy uses HUD guidelines for determining the potential for exposure, and, if the potential exists, all methods for evaluating the presence of lead will be used. Ingestion, not inhalation, poses the greatest potential risk to children for lead poisoning. In-place management techniques will also be addressed to prevent painting, peeling and dusting.

Question. Who within the Department will ensure that these building surveys are done?

Answer. DoD's policy for the assessment and abatement of LBP and the screening of children for lead poisoning will be implemented by the Military Departments which will provide instruction to their respective commands with additional guidance. This program is the responsibility of each base commander. At the installation level, the commanders, through their engineering/housing, medical, safety, etc., will actually do the work of identifying, evaluating and controlling the potential exposure to LBP.

Question. Are the services currently equipped for lead hazard abatement? I understand that only two states, Maryland and Massachusetts, have programs to test and certify lead abatement specialists. Is that factored into the equation?

Answer. The Military Departments are aware of the lead hazard abatement in DoD. The AEHA, Armstrong Laboratories and NEHC are equipped to respond to emergency situations and operate certi

fied laboratories for providing analysis of many substances (lead being one).

Question. Is there any extra money in the budget for lead abatement?

Answer. There are no extra monies in the budget for lead abatement. The commander will have to put this program on his list of priorities, and then address future resources through the PPBS.

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

NATIONAL MUSEUM OF HEALTH AND MEDICINE

Question. The Committee is aware that legislation will soon be introduced to return the public portion of the National Museum of Health and Medicine (AFIP) to the Washington Mall. The proposed new facility will be designated as the National Center for Health and Education. Operating funds for the new Center will come from the Department of Defense, the Department of Health and Human Services, and public sources. The Center will devote permanent public exhibit space to military medical history and current activities. Does the Department support Congressional efforts to return the public portion of the Museum back to the Mall?

Answer. The Department of Defense supports efforts to return the public portion of the National Museum of Health and Medicine (AFIP), to the Mall. The Department also supports the museum's decision to follow current museum practice at the Smithsonian Institution and elsewhere and to separate its public programs and exhibition space from its collections and research facilities. As it has done since 1949, the Armed Forces Institute of Pathology will continue to provide the support for acquisition and maintenance of collections at its current location at Walter Reed. AFIP will lend items from the collections for display in the public facility on the Mall.

Question. The Armed Forces Institute of Pathology and Walter Reed Army Medical Center currently allocate $2.5 million annually in direct and indirect costs for Museum operations. Within this allocation $1.5 million is dedicated to the public portion of the Museum. The Committee understands that the Department has informally approved allocating this $1.5 million to the operations of the new National Center for Health Education pending the passage of necessary authorizing legislation. Will the Department formally approve this allocation of funds for the new Center?

Answer. Since AFIP is designated as the nation's medical repository, the museum repository is constantly acquiring new collections which must be accessioned, catalogued and cared for in order to make them available to scholars, medical and legal professionals, and to the public as general exhibits from the repository collection. The $2.5 million and $1.5 million cited as an AFIP expenditure for the total museum and the public portion of the museum respectively are in error. The portion of the AFIP budget that is identified for museum operations approximates $800,000 annually. The majority of this amount goes to the maintenance of the museum repository, while only a small portion of this $800,000 amount goes to the operation of the public facility. The Department endorses the

creation of a new public facility that will provide an opportunity for the public display of a portion of the repository collection. The Department has indicated that its contribution to the museum concept will be its continued support and maintenance of the museum repository collection in addition to contributing the salary for the museum director and any additional monies currently expended by AFIP in support of the public portion of the museum.

PSYCHOLOGISTS PRESCRIBING DRUGS

Question. The American Psychiatric Association's most recent concern over the DOD psychologist prescribing project is that DOD is allowing several psychologists involved in the project to "audit" their required courses. In auditing the courses, the concern is that the psychologists will be excused from taking all course examinations. In fact, there is further concern that this alarming change in the pilot program has come about because some of the psychologists in the pilot have done so poorly on their exams to date that they are "failing". Please respond to these concerns and provide the Committee with an update on how the DOD Psychologists Prescribing Project is progressing?

Answer. An issue was raised recently regarding the exemption of the trainees from taking exams. This policy was initiated during the second trimester and has been reversed. The fellows took examinations for the first trimester and have resumed with the current (third) trimester. While it would not be appropriate to divulge the individual test scores of any student, whether in the demonstration or not, their performance on these tests will be the subject of scrutiny by the evaluator, the American College of Neuropsychopharmacology (ACNP). The ACNP will be looking beyond the raw test scores to determine how well the trainees performed in those areas relevant to their knowledge base for prescribing psychotropic medications.

Question. Please describe in detail the responsibilities and functions of the Navy's Bureau of Medicine and Surgery, located at 23rd and E Street, N.W., Washington, D.C.? Do any State Department employees park at the Bureau of Medicine and Surgery on a regular basis? If so, approximately how many? What is the assessed commercial value of this property.

[CLERK'S NOTE.-The Department was unable to provide a response in time to be printed in this hearing volume.]

DOD MEDICAL INVENTORY

Question. In December 1991, the GAO issued a report which compared DOD's medical logistics operations with similar practices of private industry and the VA.

The GAO's concluded that DOD's health care system can save millions of dollars by increased use of inventory management practices pioneered by leading civilian hospitals. The GAO recommended DOD conduct pilot programs to demonstrate the applicability of commercial practices to military medical facilities and integrate those proven successful.

When do you plan to give pilot demonstrations on each recommendation?