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Congress Seeks Fixes to Veteran Medical Care System

March 7, 2007 at 6:10 PM EDT

SEN. DANIEL INOUYE (D), Hawaii: I’d like to welcome all witnesses today, as we review the Department of Defense medical programs.

JUDY WOODRUFF: Today, it was the turn of the committees that control the Pentagon’s purse strings to look at the state of military medical care.

In his third appearance in as many days before a congressional panel, Army surgeon general, Lieutenant General Kevin Kiley, was joined at a Senate Appropriations Subcommittee hearing by his counterparts in the Air Force and Navy.

Apart from funding questions, Washington State Democrat Patty Murray sought guarantees that critics inside the military would not be punished.

SEN. PATTY MURRAY (D), Washington: I want your personal assurance, if you would please give that to me, that no soldier who blows the whistle on substandard care will be retaliated against.

LT. GEN. KEVIN KILEY, Army Surgeon General: Senator, you have my word. There’s a law that prevents that, also, the whistleblower law. And I share your concern that soldiers either feel that they can’t talk — certainly talk to their representatives.

Certainly, we want them to talk to us, but we’ve never put a prohibition or a threat of retaliation, for example, if they talk to the press.

JUDY WOODRUFF: The Navy’s surgeon general, Vice Admiral Donald Arthur, warned of the risks of cutting money for medical care.

VICE ADM. DONALD ARTHUR, Surgeon General, U.S. Navy: We are not going to be able to maintain services at the level that we have now with a one-sixth cut in our funding. So we’re facing a number of challenges that are coming together in a perfect storm.

It’s the funding; it’s the people; and it’s an increasing mission, not only for combat service support, but for those casualties who are coming back who need ever more services.

We have physicians who are doing their own administrative work, filling out workers’ compensation forms and other paperwork, because we don’t have the support staff, because they have been systematically cut over the last few years.

It’s degrading our efficiency; it’s degrading our morale; and it’s degrading our ability to take care of combat-wounded veterans.

JUDY WOODRUFF: Maryland Democrat Barbara Mikulski asked about long-term planning with the Veterans Administration.

SEN. BARBARA MIKULSKI (D), Maryland: The fact that here we are, in the fifth year of the war in Iraq, and we don’t have a plan for what happens when these men and women leave, truly acute care, that not only the 50-year plan, but we don’t have a three-year plan.

VICE ADM. DONALD ARTHUR: The Marines have a plan, the Marine for Life program and others that take care of Marines even after they’re discharged, active duty or reserves. The Marines have been very, very forthcoming and forward-leaning in taking care of their own Marine casualties.

JUDY WOODRUFF: After Mikulski was told that the Air Force has also worked with the Veterans Administration, she turned to Gen. Kiley of the Army.

SEN. BARBARA MIKULSKI: Have you met with them?

LT. GEN. KEVIN KILEY: I have not met with the secretary on this subject.

SEN. BARBARA MIKULSKI: I find this horrifying. After five years, I just find this — the lack of a continuum.

JUDY WOODRUFF: This afternoon, Gen. Kiley was joined by top Army brass for more questions from a House Appropriations Subcommittee.

The progression of the hearings

Sen. Patty Murray
I was glad that Gen. Kiley assured me that the men and women who have been told that they will be retaliated against if they speak out won't be. I will hold him to his word on that; that's absolutely critical.

JUDY WOODRUFF: For more on all of this, we turn to Democratic Sen. Patty Murray of Washington State. As we just saw, she serves on the Defense Subcommittee of the Senate Appropriations Committee.

And South Carolina Republican Lindsey Graham, he's on the Senate Armed Services Committee.

Senators, thank you both for being with us.

Sen. Murray, we saw you in that hearing today. What did you learn today about how the services -- the Army, the Navy and the others -- are dealing with these service members when they're making that transition out of active duty into and toward retirement and veteran status?

SEN. PATTY MURRAY: Well, I have to tell you, I am deeply concerned. We have a huge chasm, four years into this war, where we are failing the men and women who are serving us so honorably overseas that are wounded.

And they come home. They get good immediate care, when they need surgery and the immediate things they need to keep them alive. But if they stay in the system for long-term care, they sort of become the forgotten step-children, for the Army, in particular.

And we find out that they are -- Walter Reed in bad conditions, but that's only a symptom, I think, system-wide of what we're seeing. Then, as they try to get out of the service or try to get their medical board reviews, they wait for months, and months, and months, and then they finally get out at a disability rate that is too low, and then they come into a paperwork nightmare, as they try to move into the V.A. system.

This is just wrong. This is not planning for a long-term conflict and the impacts on men and women.

JUDY WOODRUFF: Were your questions answered today to your satisfaction?

SEN. PATTY MURRAY: No, they weren't. I mean, obviously, I was glad that Gen. Kiley assured me that the men and women who have been told that they will be retaliated against if they speak out won't be. I will hold him to his word on that; that's absolutely critical.

But as far as leadership, at the highest levels, from Gen. Kiley, I just don't feel satisfied that we have a plan even for the next few months to get through this.

We now have bipartisan commissions. We have people looking at it. We have oversight hearings. But the fact is, every single day that we wait for another study is a day that men and women and their families are struggling. And that's just wrong.

Members lost in the system

Sen. Lindsey Graham
I think it goes back to the fact that the war has lasted longer than people anticipated. The casualties have been greater. The system has been overflowing.

JUDY WOODRUFF: Sen. Graham, as we noted, you are on the Senate Armed Services Committee. You're also, we should point out, in the Air Force Reserves, so you have that perspective, as well.

Tell us, in your view, about yesterday's hearing. Were your questions answered? Did you come away reassured?

SEN. LINDSEY GRAHAM (R), South Carolina: Well, I was in the Armed Services Committee. The first question is, how did Building 18 become Building 18?

I think it goes back to the fact that the war has lasted longer than people anticipated. The casualties have been greater. The system has been overflowing. And as your lead-in piece indicated, the system is stressed. Everything about the military is stressed.

So Building 18 was brought into service to house patients; before, it had been housing people in transit. And $250,000 was spent in 2005 to renovate the building. My question is, as a military lawyer for 20-something years, who was the first sergeant in charge of Building 18? Who was the company commander whose job it is to inspect facilities?

And we want to hold commanders at the highest level accountable, but there is also a chain of command down below. Some rooms in Building 218 got to be deplorable because it was just not structurally sound. Somebody in the Army is responsible for maintaining that building. I want to know who they were and why they didn't do a better job.

Now, when it comes to people coming back from the war zone, whether you're a combat casualty or you've just been in an accident, the first thing that happens to you, Judy, is you go to a medical evaluation board. And they decide, can you be retained?

Are your injuries severe enough to question whether or not you can stay in service? If they are severe enough to question that, you go to another board. They determine whether or not you should be medically retired, what rate you get.

Then, as Patty said, you go to the V.A. Long-term health care is administered by the V.A., not DOD, and that's where people fall in the cracks.

SEN. PATTY MURRAY: Well, actually, I'll amend that a little bit. What's happened is, we have so many people coming into this medical hold decision, not enough people to process them, so instead of getting into that medical hold and getting out and getting into good V.A. care, they're left for months -- we're talking 18 months -- left in medical hold. And their families are just on hold through all this.


JUDY WOODRUFF: Why are they being held for so long, senator?

SEN. LINDSEY GRAHAM: Capacity -- I'm sorry.

SEN. PATTY MURRAY: Capacity. We do not have enough people to get them through the system, and that is a lack of long-term planning in this whole war.

JUDY WOODRUFF: Is it a funding question?

SEN. PATTY MURRAY: It is a funding question. It is enough personnel to process them. It is a system that's ready to take care of them.

And, again, that's called planning. Here we are, four years into the war, and we still haven't gotten from the military, from the White House, how much this is going to cost so that we can allocate the funds here based on the proper numbers to take care of these people. And I hold the people at the top of the military accountable for this.

Insufficient capacity for care

Sen. Patty Murray
We're hearing from a lot men and women who are given an extremely low disability rating. That affects their entire future. So we are asking, is the military low-balling this because of the cost?

JUDY WOODRUFF: But, Sen. Graham, why isn't it -- I mean, to someone looking at this -- and, granted, the bureaucracy is much more complicated than any of us can appreciate -- but the military, the Pentagon knows how many people they have in Iraq and Afghanistan. They know how many people are coming back with injuries. So where's the disconnect here?

SEN. LINDSEY GRAHAM: Well, it's a matter of the injuries pile up and the system hasn't accommodated. What was Abu Ghraib about? It was about not enough people to run the jail who were poorly trained.

And all I can tell you is that Patty is right in this regard. The system is a series of medical legal judgments that have to be made, because there's a process in place that does work, if you've got it adequately resourced.

We're playing catch-up, Judy. We're playing catch-up all over the military. We're redesigning our Humvees to absorb blasts that are saving lives. We're playing catch-up in equipment. We're playing catch-up in how to treat wounded people.

And Congress and the administration needs to sit down and listen to Bob Dole and Ms. Shalala and get their thoughts, but I've got a pretty good idea, as a military lawyer, where the problems are. We just don't have the capacity to deal with the claims.

SEN. PATTY MURRAY: Judy, I would say there is no excuse for this. This is an obligation we have; it's an obligation and a cost of war that we are responsible for.

And I'm embarrassed for all these men and women who served us so honorably, come home injured. Their families are struggling. And we can't figure out how to build the capacity in? We don't have an administration that's telling us we need them? We don't have a Pentagon that's telling us?

Where are the people on the ground with some kind of compassion in this? And I think that, you know, here in the Senate, we're not going to sit by idly and wait for more commissions. We are going to get to work and try to deal with this, but that takes honesty from this administration.

Traumatic brain injury, they still will not give us the numbers of soldiers who have been impacted so that we can adequately fund what we need to for the care for these families. And that's a tragedy.

JUDY WOODRUFF: One specific point, Sen. Graham, this disability rating that a service member has to have before he or she moves to veteran status, explain the importance of that, and why it is taking so long to get that in some of these cases.

SEN. LINDSEY GRAHAM: Well, in some of the cases, the injuries, we don't know how much they will resolve themselves, so you give a temporary rating. And every service member, almost to a person, wants to come back on active duty.

So one of the hardest news that you ever have to deliver as a lawyer to somebody in the military is that the board found you medically disqualified. Most people want to try to stay in, so they'll appeal their decision. They actually fight to stay in.

And sometimes the issue of whether you can stay or you have to leave medically takes a while to resolve itself because the injuries can over time get better.

We don't want a system that looks at someone and says, "You're out of the military," just blanket. The service members need to be rated fairly. And sometimes medically it takes a while. And the Congress, you know, the Congress has some role in this. We're not blameless.

SEN. PATTY MURRAY: There's two issues. It shouldn't take 18 months to have that happen.

But, secondly, we're hearing from a lot men and women who are given an extremely low disability rating. That affects their entire future. So we are asking, is the military low-balling this because of the cost? Are they trying to low-ball the cost on this? And, if so, that is a travesty for these families.

Reforming the V.A.

Sen. Lindsey Graham
At the end of the day, build in additional capacity, understand these are medical, legal decisions that affect people for a lifetime, that in 18 months your injuries may change so that you can stay in or they may get worse.

JUDY WOODRUFF: I want to ask you both about the Veterans Administration. I believe the secretary of the Veterans Administration, Jim Nicholson, has been put in charge of part of the oversight, the investigation the president has commissioned.

Is that the way this process should work? And what are your concerns about the Veterans Administration and the way it is interfacing with the Pentagon?

SEN. PATTY MURRAY: Well, it's a whole chasm between the paperwork that you get when you get out of the military and the paperwork that's required by the V.A. And when we asked at the committee today, it was very clear that the surgeon general of the Army, Gen. Kiley, had not even sat down with Secretary Nicholson to say, "Where do we have this bureaucratic problem?"

That's a beginning step, but there's a lot more to it. And, frankly, what we've seen from the V.A. is the same thing we've seen from the Pentagon, at this point, is that we haven't been given honest numbers and assessments of what this war is costing so that we can provide the resources that are needed.

JUDY WOODRUFF: Sen. Graham, once all these reviews are finished, the president's commission, that panel is still being put together, the Congress is doing its work. We've got other reviews underway by the Pentagon.

How confident are you that, when all that's done, that this complicated bureaucracy is going to have worked out these problems that you're not going to be right back where you are right now?

SEN. LINDSEY GRAHAM: I'm confident that we'll make the system better as we're trying to make things better on the ground. Half of the complaints I've received in my office are from military members who want to change the evaluation so they can stay in.

I don't know what's going on in Washington, but there are a lot of South Carolinians who have been injured who want to make sure they can stay in the Army, and they're asking me to intervene to downgrade. The other half are people who feel like they're not being handled quick enough.

At the end of the day, build in additional capacity, understand these are medical, legal decisions that affect people for a lifetime, that in 18 months your injuries may change so that you can stay in or they may get worse. And if we don't have enough capacity, we have not adjusted. The war has overwhelmed the system.

And this is just another example of the system being overwhelmed. And Congress, working with the administration, needs to provide the funding and the resources to get this right.

It's not about who loves the troops or who doesn't love the troops. It's about a system that's not working to the benefit of those who are serving. And I will sit here as a members of the Veterans Committee and Armed Services Committee and say that the Congress shares some of the blame, because the war is not unknown to us, either.

JUDY WOODRUFF: All right. We are going to have to leave it there. Sen. Lindsey Graham, Sen. Patty Murray, thank you both.