Congressional Hearing on Walter Reed Army Medical Center

House Committee on Oversight and Government Reform, Subcommittee on National Security and Foreign Affairs

CQ Transcripts Wire
Monday, March 5, 2007

SPEAKERS:

REP. JOHN F. TIERNEY, D-MASS. CHAIRMAN

REP. CAROLYN B. MALONEY, D-N.Y.

REP. STEPHEN F. LYNCH, D-MASS.

REP. BRIAN HIGGINS, D-N.Y.

REP. JOHN YARMUTH, D-KY.

REP. BRUCE BRALEY, D-IOWA

REP. BETTY MCCOLLUM, D-MINN.

REP. JIM COOPER, D-TENN.

REP. CHRIS VAN HOLLEN, D-MD.

REP. PAUL W. HODES, D-N.H.

REP. PETER WELCH, D-VT.

REP. TOM LANTOS, D-CALIF.

REP. HENRY A. WAXMAN, D-CALIF. EX OFFICIO

REP. CHRISTOPHER SHAYS, R-CONN. RANKING MEMBER

REP. DAN BURTON, R-IND.

REP. JOHN M. MCHUGH, R-N.Y.

REP. TODD R. PLATTS, R-PA.

REP. JOHN J. "JIMMY" DUNCAN JR., R-TENN.

REP. MICHAEL R. TURNER, R-OHIO

REP. KENNY MARCHANT, R-TEXAS

REP. LYNN WESTMORELAND, R-GA.

REP. PATRICK T. MCHENRY, R-N.C.

REP. VIRGINIA FOXX, R-N.C.

REP. THOMAS M. DAVIS III, R-VA. EX OFFICIO

REP. ELIJAH E. CUMMINGS, D-MD.

DEL. ELEANOR HOLMES NORTON, D-D.C.

WITNESSES:

DR. PETER GUERIN,

UNDERSECRETARY OF THE ARMY

STAFF SERGEANT JOHN DANIEL SHANNON (USA)

SPECIALIST JEREMY DUNCAN (USA)

ANNETTE MCLEOD,

WIFE OF SPECIALIST WENDELL "DELL" MCLEOD (USA)

LIEUTENANT GENERAL KEVIN C. KILEY, M.D. (USA),

U.S. ARMY SURGEON GENERAL

MAJOR GENERAL GEORGE W. WEIGHTMAN (USA),

FORMER COMMANDER,

WALTER REED ARMY MEDICAL CENTER

CYNTHIA A. BASCETTA,

DIRECTOR OF HEALTH CARE,

GOVERNMENT ACCOUNTABILITY OFFICE

GENERAL PETER SCHOOMAKER (USA),

ARMY CHIEF OF STAFF

GENERAL RICHARD CODY (USA),

ARMY VICE CHIEF OF STAFF

[*]

TIERNEY: A quorum being present, the Subcommittee on National Security and Foreign Affairs entitled: "Is This Any Way to Treat Our Troops: The Care and Condition of Wounded Soldiers at Walter Reed" will come to order.

I ask unanimous consent that the chairman and ranking minority member of the subcommittee, as well as the ranking minority member of the committee, be allowed to have five minutes to make opening statements.

Without objection, that is ordered.

And I would also like to first introduce the undersecretary, Peter Guerin, who would like to welcome people here in a brief statement.

Mr. Guerin?

GUERIN: Thank you, Mr. Chairman, members of the committee.

I'm the undersecretary of the Army now. Next Friday, I'll be the acting secretary of the Army. Last Friday night, the secretary asked me to take on the health care issue for the Army in the meantime, not wait until I become acting secretary next Friday.

On behalf of the Army, I want to welcome all of you to Walter Reed. As a former member of Congress, I want you to know I appreciate and value the role this Congress and this committee plays in the life of our Army. We treasure the partnership we have with Congress. We understand that the Constitution has forged the partnership from the beginning of this country for as long as this country lasts between Congress and our United States Army.

We have let some soldiers down. And working with the Congress and the leadership of the Army, all the way down to the lowest ranking civilian or uniformed military, we're going to fix that problem. In fact, we're in the process of fixing it.

Your involvement is going to help us do that. I'm glad so many of you are here today, showing this kind of interest in Walter Reed.

So many of you have been out here many, many times, been a part of the life at Walter Reed, worked with members and staff over the last several years in dealing with related problems. And we appreciate very much the role that the Congress plays.

There's a vow that's part of the soldier's creed: "I will never leave a fallen comrade."

GUERIN: That's the -- on the battlefield, in a hospital, as an outpatient.

(CROSSTALK)

GUERIN: That is the part of our soul of every soldier. And anytime that vow is broken, I can tell you it hurts the heart of the Army.

The men and women of Walter Reed are dedicated professionals. They make a considerable sacrifice, both financial and personal, to meet the needs of the patients here at Walter Reed, to meet the needs of the families. They provide excellent health care.

When it comes to wounded warriors, they set the standard for the world in health care. And they do this and turn down offers in private industry to make several times more money. They do it because they believe in the soldier's creed. They are dedicated to their fallen comrades, and it hurts them deeply when they see any members of this service (inaudible).

On behalf of the staff here, I also offer this welcome. They look forward to working with you. I want to thank them for their work. And again, Mr. Chairman, thank you, Chairman Waxman, Ranking Member (inaudible). I appreciate you being here.

TIERNEY: Thank you, Mr. Guerin.

A little bit of house cleaning here first.

I ask unanimous consent that the hearing record be kept open for five business days, so that all members of the subcommittee may be allowed to submit a written statement for the record.

Without objection, that's ordered.

I also ask that the following written statements be made part of the hearing record: the Iraq and Afghanistan veterans of America; Joe Wilson, social worker, Psychiatric Continuity Service; Sergeant David Yansey (ph), Mississippi National Guard; Sergeant Archie (ph) and Barbara Benware (ph); John Allen (ph), former sergeant first class, North Carolina National Guard; and Marine Sergeant Ryan Groves of Ohio.

Without objection, so ordered.

I also ask unanimous consent of the gentleman from Maryland, Representative Elijah Cummings, and the delegate from the District of Columbia, Representative Eleanor Holmes Norton, members of the full Committee on Oversight and Government Reform be permitted to participate in the hearing.

In accordance with our committee practices, they'll be recognized after all members of the subcommittee.

Without objection, so ordered.

TIERNEY: So, getting down to business, let me, first and foremost, welcome everybody here and thank the brave soldiers at Walter Reed for allowing us to have this hearing at this facility.

Thank you all for your service and your patriotism and your courage. Everybody here is mindful of what you've done and how you've answered the call of this country, without distinction for party or any other factor.

You're an inspiration to all of us. And from the bottom of our hearts, we appreciate all that you've done for your country and for each of us.

I also want to welcome the members of the National Security and Foreign Affairs Subcommittee.

It was vital that we convene a hearing at Walter Reed so that we'd be able to see and hear for ourselves whether or not what we've seen reported is actually accurate and true.

I intend that this subcommittee will conduct hearings and investigations into many areas of defense and homeland security and foreign policy. I can think of no more important topic for our very first hearing than the proper care of our nation's wounded soldiers.

I'd like to start by playing a short video clip from the WashingtonPost.com Web site that, I think, indicates for us the seriousness of this matter.

(BEGIN VIDEO CLIP)

(UNKNOWN): Marine Sergeant Ryan Groves told us he thought that the wounded at Walter Reed were treated more like front-line troops than outpatients. His mom came to be with him and he got hell for it. So he fought back and she stayed.

Staff Sergeant Dan Shannon loves the U.S. Army. But he couldn't understand why they didn't keep better track of soldiers, so he designed his own system for keeping track of them.

Sergeant Shannon has a wife and three kids, but he also has a bad case of PTSD, so the doctor gave him a separate room because his son's loud toys set him off.

Eventually, the Army made the entire family live in one small room. Shannon was motivated to help out when this corporal, Jeremy Harper, who was only 19 years old when he died of alcohol poisoning -- he was found in his room New Year's Day, 2005.

(UNKNOWN): Lots of soldiers told us they got the wrong medical records. Archie Benware, in the National Guard, got the gynecological report from a female soldier sent to him.

Building 18 was built in the mid-'30s. Now they're housing soldiers there. They talk about it as a depressing, isolating place.

Specialist Jeremy Duncan was rather surprised when mold started invading his room and he couldn't get anybody to fix it. Duncan almost died in Iraq. He's been in Walter Reed for more than a year. He's very grateful for the medical treatment he's received. He's about to get a new ear.

(END VIDEO CLIP)

TIERNEY: So Walter Reed has long been perceived as the model for taking care of our nation's soldiers when they return from battle.

The secretary is absolutely correct that people respect and honor the service of the medical personnel and other staff that are here at the hospital. But when we look at the unsanitary conditions and some of the other situations in the living quarters, we find it appalling.

But we also realize that not only is it flat wrong, that's the tip of the iceberg. For too many occasions, the soldiers at Walter Reed wait months, if not years, in sort of a limbo. And they must navigate through broken administrative processes and layers upon layers of bureaucracy to get their basic tasks accomplished.

Today, we're going to hear firsthand of the conditions and the lack of respect for our soldiers and their families.

I want to thank Staff Sergeant Dan Shannon; Corporal Dell McLeod and his wife, Annette; and Specialist Jeremy Duncan for your bravery, for your service, for your sacrifice, and for sharing your experiences with us here on this panel today.

I understand that you're frustrated. I think we all understand that. And we respect the fact and we understand why you are.

But let me be clear: This is absolutely the wrong way to treat our troops, and serious reforms need to happen immediately.

Over the past month, the perception of Walter Reed has gone from the flagship of our military health system to a glaring problem. This subcommittee wants some answers.

I want to thank Major General Weightman, former commander of Walter Reed; Lieutenant General Kiley, and the Army's current surgeon general, and also a former commander at Walter Reed. I want to thank General Cody, the vice chief of staff of the Army, and the Army's point person on this issue, for being with us today, as will be General Schoomaker.

I look forward to hearing from all of you why our wounded soldiers have been not getting the care and the living conditions that they deserve. I also want to hear what we're going to do about it in the future.

I want to stress that this is an investigative hearing and not an inquisition. Our purpose is to get to the bottom of things and to get honest answers. And it will take our cooperative efforts, all of us working together, to make sure that a broken system is fixed and fixed quickly.

That all being said, I do have serious concerns and many, many questions.

TIERNEY: First, is this just another horrific consequence of the terrible planning that went into our invasion of Iraq?

Did the fact that our top civilian leaders predicted a short war, where we would be greeted as liberators, lead to a lack of planning, in terms of adequate resources and facilities devoted to the care of our wounded soldiers?

Are we headed down the same path again with the president's surge, or are we prepared this time for the increase of injuries, patients and wounded veterans?

What concrete steps have been taken and are being taken, as a reaction to the surge, to make sure that every soldier gets cared for properly?

Did an ideological push for privatization put the care of our wounded heroes at risk?

A September 2006 memorandum that this committee has obtained describes how the Army's decision to privatize was causing an exodus of, and I quote, "highly skilled and experienced personnel from Walter Reed" and that there was a fear that patient care services are at risk of mission failure.

Did the fact that Walter Reed is scheduled to close in 2011 because of BRAC, Base Realignment and Closure, process, contribute to unacceptable conditions at Building 18 and elsewhere?

And with a Defense Department budget of $450 billion and more, this is not a case of there not being enough money to take care of our wounded soldiers. This is a case of a lack of proper prioritization and focus.

More and more evidence is appearing to indicate that senior officials were aware for several years of the types of problems that were recently expressed in the excellent reporting by The Washington Post reporters.

These are not new or sudden problems. Rats and cockroaches don't burrow and infest overnight. Mold and holes in ceilings don't occur in a week. And complaints of bureaucratic indifference have been reported for years.

Moreover, this committee, under former Chairman Davis and Chairman Shays, have been investigating, over the past several years, problems faced by our wounded soldiers, including those at Walter Reed. And I want to thank those members for their leadership so far.

TIERNEY: I also want to thank Congressman Peter Welsh of Vermont and others, who insisted that this committee have its first hearing out here at Walter Reed so we could see firsthand the conditions at question.

Where does the buck stop? There appears to be a pattern developing here that we've seen before: first deny, then try to cover up, then designate a fall guy. In this case, I have concerns that the Army is literally trying to whitewash over the problems.

I appreciate the first steps that have been taken to rectify the problems at Walter Reed and to hold those responsible accountable. We need a sustained focus here, and much more needs to be done.

I also, unfortunately, feel that these problems go well beyond the walls of Walter Reed, and that they are problems systemic throughout the military health care system. And as we send more and more troops into Iraq and Afghanistan, these problems are only going to get worse, not better. And we should be prepared to deal with them.

Let me conclude by thanking all the soldiers who were able to be with us here today for their sacrifice for their sacrifice on all of our behalf. We all agree that our soldiers deserve the best possible care, so let's give them that respect and gratitude that they rightly deserve. They have earned it with their dedication, with their patriotism, and with their sacrifice.

And with that I yield to Mr. Shays or Mr. Davis for his opening statement.

SHAYS: Thank you, Mr. Chairman.

Mr. Chairman, I'm going to defer my statement. I know we've got a short agenda, time, and we'll just have one on each side. So I welcome Mr. Davis making our statement.

DAVIS: Thank you, Mr. Shays.

And let me thank Chairman Waxman and Chairman Tierney for agreeing to convene this hearing at the Walter Reed Army Medical Center.

For too long, complaints about substandard and disjointed care for wounded soldiers who have been treated as distant abstractions. Here, no one should be distracted by numbing statistics, soul-less technical jargon, impersonal flow charts, or rosy, good-news action plans.

Here, we get an unfiltered look at a tortuous system that has proved so far stubbornly incapable of reaching the standard of care this nation is honor-bound to provide returning warriors.

We meet in the grounds of a world-class, world-renowned medical institution. Walter Reed has a venerable tradition of scientific advancement and clinical success. No one cared for here -- yesterday, today or tomorrow -- should doubt the skill and dedication of the doctors, nurses and administrative staff who labor every day to save lives and repair broken bodies and minds.

The problems that bring us here today are the product of institutional indifference, not a lack of individual commitment. Recent reports of decrepit facilities and dysfunctional outpatient procedures at Walter Reed amplified oversight work this committee started in 2004.

DAVIS: Pay and personnel systems that got it wrong far more than it got it right were inflicting financial friendly fire on those returning from war.

Some of those erroneous dunning notices found their way here. Men and women already struggling to regain their physical health were also being forced to fight their own government to protect their financial well-being. Members of the National Guard and Reserve units have a particularly difficult time navigating this Byzantine, stovepiped, paper-choked process that was never intended to deal with so many for so long.

The charts that we have lay out only parts of the MedHold system.

Apparently, some other pre-war planning errors that the Pentagon somehow failed to anticipate, deploying unprecedented numbers of reserve component troops into combat would produce an unprecedented flow of casualties.

As a result, the Defense Department has been scrambling ever since to lash together last-century procedures and systems to care for returning citizen soldiers. But institutional habits and biases have proven remarkably impervious to demands for change.

It took well over a year to stand up an ombudsman program to help guide soldiers and their families through a complex, confusing and frustrating medical and administrative labyrinth involving mountains of forms and multiple Army commands.

Last October, a systems analysis review team inspection of Walter Reed found no process to track submitted work orders, particularly for Building 18. They pronounced the facility "otherwise safe and secure." That must have been remarkably fast-growing mold that we found in The Washington Post in Building 18.

Two years ago, the Government Reform Committee heard testimony that concluded: "Army guidance for processing patients in medical hold units does not clearly define organizational responsibilities or performance standards.

"The Army has not educated soldiers about medical and personnel processing or adequately trained Army personnel responsible for helping soldiers.

"The Army lacks an integrated medical and personnel system to provide visibility over injured soldiers and as a result sometimes actually loses track of soldiers and where they are in the process."

And "The Army lacks compassionate customer friendly service."

The last one says it all and sadly appears to be as true today as in 2005.

These problems not unique to Walter Reed. Here uncertainty over the use of contractors or decisions by the Base Closure and Realignment Commission may have contributed to staff turnover and attrition.

But the crushing complexity and glacial pace of outpatient procedures in medical evaluation boards are Army-wide problems.

Building 18 is just one visible symptom of a far more insidious and pervasive malady. All the plaster and paint in the world won't cure a system that seems institutionally predisposed to treat wounded soldiers like inconveniences rather than heroes.

On the long road home from war, this is a place wounded soldiers and their families should be embraced, not abandoned. They should be healed and nurtured, not left to languish or fend for themselves against a faceless bureaucratic hydra.

DAVIS: What will transform this dysfunctional, uncaring arrangement into the compassionate, effective medical and military operation wounded soldiers deserve? All our witnesses today will help us find the answer to that question.

Those in our first panel speak from hard personal experience. They have every reason to be disillusioned, even bitter, about frustrations and indignities they endured or witnessed while captive to a broken process.

Their testimony is one more selfless act of bravery, and we are profoundly grateful for their willingness to speak out.

TIERNEY: Thank you, Mr. Davis.

The subcommittee will now receive some testimony from the witnesses before us today. I would like to start by introducing those witnesses on the first panel.

We have Staff Sergeant John Daniel "Dan" Shannon, I resident of Walter Reed since he was injured near Ramadi, Iraq, in November 2004. We have Mrs. Annette McLeod and her husband, Specialist Wendell "Dell" McLeod Jr. from Chesterfield, South Carolina. Actually, Mrs. McLeod will be testifying; Dell is with us here today. And Specialist Jeremy Duncan, currently an outpatient at Walter Reed residence who was housed in Building 18.

Welcome to all of you. Thank you for coming and sharing your experiences here today.

It's the policy of this subcommittee to swear you in before we testify, so I'm going to ask you to please stand and raise your right hand.

Do you solemnly swear to tell the truth, the whole truth and nothing but the truth?

Record will please reflect that all of the witnesses so swore.

And I'm going to ask that each of you now give a brief statement. We'll start from my left with Staff Sergeant Shannon, then Mrs. McLeod and Specialist Duncan. The statement are five minutes. If you can, please try to contain your remarks. Davis to my left is going to throw something in the air to get my attention when you get near that point in time and I'll just try to give you a signal. But we do want to allow you to fully express yourselves.

So, Staff Sergeant Shannon, if you'd please start.

SHANNON: Yes, sir. And I apologize, I do have a written statement so that I can stay within those time constraints. And of course more information with the written statement I submitted.

TIERNEY: All of the written statements have been entered in the record and will be there.

SHANNON: Mr. Chairman and members of the committee, thank you for inviting me to testify today on issues at Walter Reed Medical Center. My name is Staff Sergeant John Daniel Shannon. I do go by my middle name.

What has brought me to speak is my personal ethic as a professional soldier. I will not see young men and women who have had their lives shattered in service to their country receive anything less than dignity and respect.

I was wounded while serving in Iraq with the 1st Battalion, 503rd Infantry Regiment. We were conducting operations in out of Habbaniya, Iraq, and had moved to combat outpost, a small compound on the southeast side of Ramadi.

SHANNON: On November 13, 2004, I suffered a gunshot wound to the head from an AK-47 during a firefight with insurgent forces near Saddam's mosque. The result of that wound was primarily a traumatic brain injury and the loss of my left eye.

I arrived at the Walter Reed Army Medical Center's Ward 58 on or about the 16th of November, 2004. I was just discharged in outpatient status on approximately the 18th of November, 2004.

Upon my discharge, hospital staff gave me a photocopied map of the installation and told me to go to the Mologne House where I would live in while in outpatient. I was extremely disoriented and wandered around while looking for someone to direct me to the Mologne House. Eventually I found it.

I had been given a couple of weeks' appointments and some other paperwork upon leaving Ward 58, and I went to all my appointments during that time.

After these appointments, I sat in my room for another couple of weeks wondering when someone would contact me about my continuing medical care. Finally, I went through the paperwork I was given and started calling all the phone numbers until I reached my case manager, who promptly got me the appointments I needed.

I soon made contact with the medical holding company. At that time, I was in process and assigned to the 2nd Platoon MedHold company. I was informed that my medical evaluation board/physical evaluation board would not proceed until my face was put back together. This process is important to me because the result of the evaluation determines the percentage of my disability.

During the time my injuries were being fixed, post-traumatic stress disorder symptoms started surfacing. I was informed that the medical retirement process would not proceed until the PTSD was medicinally controlled.

Months later, I was informed that my medical board paperwork -- my medical board had to be restarted because my information had been lost. I began meeting with my new physical evaluation counselor, Mr. Geiss (ph), in late January and early February.

SHANNON: He informs that my MEB needed to be stopped again, until the plastic surgery and ocular prosthetic procedures were finished.

Therefore, two years after first being admitted to Walter Reed, I'm hearing the same thing about the process that I heard when I first began it two years ago.

I want to leave this place. I have seen so many soldiers get so frustrated with the process that they will sign anything presented to them just so they can get on with their lives.

We have almost no advocacy that is not working for the government, no one that we can talk to about this process who is knowledgeable and we can trust is going to give us fair treatment and informed guidance.

My physical evaluation counselor in the MEB/PEB process both worked for the government and have its interests, not our interests, in mind, in my opinion.

Danny Soto, who works in the Malogne House as an independent advocate for those of us going through the process, is priceless in the assistance he gives. But he is only one man.

The system can't be trusted. And soldiers get less than they deserve from a system seemingly designed and run to cut the costs associated with fighting this war.

The truly sad thing is that surviving veterans from every war we've ever fought can tell the same basic story: a story about neglect, lack of advocacy and frustration with the military bureaucracy.

Thank you again for allowing me the opportunity to share my experiences with this committee.

TIERNEY: Thank you, Staff Sergeant.

Mrs. McLeod?

MCLEOD: Mr. Chairman and members of the committee, thank you for holding this hearing today. My name is Annette McLeod and I am testifying today because my husband Wendell has been through the nightmares of the Army medical system.

I'm glad that you care about what happened to my husband after he was injured in the line of duty. Because for a long time, it seemed like I was the only one who cared.

Certainly, the Army didn't care. I didn't even find out that he was injured until he called me himself from a hospital in New Jersey.

When the Army realized it had made a mistake and sent him to Fort Dix instead of Walter Reed, they transferred him days later.

On September 23rd of 2004, Wendell was deployed on the Iraqi border in the 1178th Artillery out of (inaudible), South Carolina. He had been a soldier with the National Guard for 16 years when he was activated for this deployment.

About 10 months into his tour, he was hit in the head by a steel cargo door of an 18-wheeler while performing an inventory. The injuries were serious enough that he had to be evacuated to Germany under heavy medication. And after the hospital mix-up I just mentioned, he was sent to Summit Hills apartment complex leased at Walter Reed.

I took a leave from my job and went to see him in the capacity of a nonmedical attendant with Army approval. This was in August of 2005.

When I arrived to care for him, I found that he had no appointments scheduled with any Walter Reed staff. He had been assigned a social worker. Aside from the evaluation he received after his injury, the Army had just left him at Summit Hills, without any evaluation opportunities and therefore no treatment.

I complained and had him transferred to the Malogne House, where he clearly could get some help. He had back and shoulder injuries and mental problems.

After being admitted to the Malogne House, he was tested for brain functioning and comprehension. I remember how medicated he was when they gave him the test.

Later, the Army said the tests were inconclusive because he didn't try hard enough.

We waited for four months to get those results.

MCLEOD: He is a high school graduate. As I said before, he served in the National Guard for 16 and a half years. But the Army refuses to acknowledge that he suffered a brain injury.

He freely told the Army that he was a Title I math and English student in grade school, meaning that he needed extra help with reading and math. But the Army has taken this information and used it against him.

Over the months, we have listened in disbelief as the Army interpreted Title I math and English to mean that he has a learning disability. He was considered fit enough to serve in the National Guard for 16 years. He was fit enough for deployment. But now they're saying his mental problems he had before he went to Iraq.

In January of 2006, he was sent to a neurological care facility in Virginia for 10 weeks, at my urging. Before he transferred, he received steroid shots in his back for his back injury. I was assured by the Army that this was the first of many treatments. But for 10 weeks while he was in Virginia, he didn't receive any more shots.

Before leaving for Virginia, he was put on cholesterol medicine, which he had no trouble with before, that required blood work every month to monitor his body's response. The required blood work was never performed, and he developed an allergic reaction to the medication, which he sustained liver damage and gained 25 pounds during those 10 weeks.

Back at Walter Reed, a doctor ordered an MRI to check on the condition of his shoulder but the case manager refused to do the MRI. Her reason was that it would cost the Army too much money. And the only follow-up on his back injury was the decision of the Army that he suffers from degenerative disk disease, a preexisting condition that they claim is unrelated to injuries overseas.

On October 28, the Army and the National Guard retired him. He suffers from episodes of anxiety, forgetfulness and very bad mood swings. He walks with a cane and with a limp.

Mr. Chairman and members of the committee, American soldiers are injured every day in operations overseas. Every day, family members learn that their loved ones are coming home to them different than when they left.

I'm here for one of them, but I am also here because family members should not have to go through this with a loved one that we have already been through. I thank you again for the opportunity to tell my story.

TIERNEY: Thank you, Mrs. McLeod.

Specialist Jeremy Duncan has opted not to give a statement so much as to respond to questions.

And since we're moving on into the question-and-answer period now, and we'll be under the five-minute rule, alternating from one side to the other, I thought, Specialist Duncan, that I might start just by asking you, if you are willing to talk about it, could you tell us on this panel a little bit about what chain of events led you to become a patient at Walter Reed?

JEREMY DUNCAN: I, myself, was deployed in Iraq, in Samarra, with the 101st 3rd Brigade Reconnaissance (ph). We were doing patrol; came across an IED. I got blown up. And I came here and since then I've had no problems with medical care getting fixed from the problems I had.

TIERNEY: What were the nature of your injuries?

JEREMY DUNCAN: I had a -- fractured my neck, almost lost my left arm. I got (inaudible) lost left ear and lost the sight in the left eye.

TIERNEY: I think many of us first learned of your situation by reading The Washington Post and the description of the physical conditions of Building 18 and the area where you were staying.

Could you tell us on the record here today about those conditions in your room in Building 18?

JEREMY DUNCAN: The conditions in the room in my mind were just, it was unforgivable for anybody to live -- it wasn't fit for anybody to live in a room like that.

I know most soldiers have -- you've just come out of recovery, you have weaker immune systems. The black mold can do damage to people. Holes in the walls. I wouldn't live there, even if I had to. It wasn't fit for anybody.

TIERNEY: What did you do to try to get the room fixed?

JEREMY DUNCAN: I contacted the building manager and informed them there was an issue with my room.

JEREMY DUNCAN: They told me to put it in the system for a work order. I did that. A month went by, I asked them to do it again. He said, put it back in the system. That went on two or three times.

Finally, I had my chain of command from Fort Campbell, who came and visited me -- (inaudible) they made some phone calls, the person over here at Walter Reed -- I don't know where it went. And they still never got fixed. That's when I contacted the Washington Post.

TIERNEY: And after The Washington Post article was published?

JEREMY DUNCAN: I was immediately moved from that room, and the next day they were renovating the room.

TIERNEY: Do you have any personal thoughts about other ways that could be implemented to assist soldiers that are new to the facility here?

JEREMY DUNCAN: As in...

TIERNEY: In how to assist them in the services, the information, and how to get that process working better than it apparently did for you?

JEREMY DUNCAN: Keep following through and keep bugging them about it. Let them know. Just keep letting them know until finally somebody gets sick of it and it finally gets done.

TIERNEY: Mr McLeod, you had a situation of attempting at least to bring attention to Dell's condition and situation. Would you share that with us? Did you make known that you had some issues with his treatment and care? To whom did you go? And what were the results of that?

MCLEOD: I was very persistent. I went to his case manager. She even got tired of dealing with me. I would -- I went as far as the commanders. I went to the generals. Anybody that would listen to me, I would talk.

TIERNEY: Who was the commander here at that point in time? Was it General Farmer?

MCLEOD: General Farmer, yes, sir.

TIERNEY: Did you go to General Farmer and express to him the difficulties?

MCLEOD: Yes, sir, I did. I was on his -- I was at his office door for several days, and each time they turned me around.

TIERNEY: And how do you mean, turned you around?

MCLEOD: They told me he did not have time to talk to me.

MCLEOD: There was other situations present at the time also.

He knew of the situation. He knew of some of the conditions. And each time I went to him they told me that he did not have time, he knew the situation, there was nothing he could do to help me.

TIERNEY: At some point in time, did you have a chance to meet with General Weightman?

MCLEOD: I did. We were sitting in Burger King one day and we were enjoying the day. He had a day of leave. And so we were siting there and the General Weightman walked up.

In my recollection, he's a fine, honorable man. He had nothing to do with our situation. He was, in my perspective, being punished because he caught the tail end of it. Mr. Weightman, in my opinion, he was just shoved into a situation that was already there, and because somebody had to be the fall guy, he was there.

He's never done anything to me. He never knew about my situation. When I asked him questions, he was more than willing to give me answers that I needed.

TIERNEY: I have about a minute left here. We have a rather antiquated system on time watching over here because our lights aren't working.

But, Staff Sergeant, I wanted to ask you, I know that at some point you took matters into your own hands in trying to assist people that were just coming new to the facility. Would you tell us a little bit about what you did and what caused you to take that action?

SHANNON: Well, after the young servicemember died two doors down from me, New Year's of '05, I had been looking at the system as it stood. And we were having at that point up to 100 or over 200 personnel in one platoon, run by one E-7. Typically that type of level of authority is in charge of 30 to 40 personnel. And they had no E-6s -- my job -- underneath them to help them keep accountability of those personnel.

And at that point I started asking my platoon sergeant at the time to give me 25 percent of the people in the platoon and let me help track them. Because they worked long hours just trying to keep track of everyone.

The primary problem with the system, starting with the hospital, is it takes days for the paperwork to catch up with the medical holding company to let them know just that someone has gone outpatient to the Malogne House. I had already been going to my ward on a daily basis to see who was coming and going.

When I asked for a squad leader position, they moved me over to work with a Sergeant First Class Alexander in the OIF/OEF platoon at the time; an outstanding NCO, by the way.

SHANNON: And we implemented a program and eventually received 10 personnel to work underneath us that we check every ward in the hospital every day, receiving the patient report from the aeromedevac office here in the hospital to let us know incoming and outgoing personnel.

We would meet with incoming personnel, identify ourselves, give them business cards, let them know if they had any questions they can contact us. We implemented a program to provide escort from the hospital over to the Mologne House.

And the primary thing, some go to other hospitals. We identified those that were staying here and going outpatient to the Mologne House. When we identified them, then we were able to contact them in the Mologne House and give them, at that time, a proper in processing.

TIERNEY: Thank you very much.

SHANNON: You're welcome.

TIERNEY: Thank you.

Mr. Shays?

SHAYS: Thank you, Mr. Chairman, for holding these hearings and thank you, our witnesses, for coming and testifying under oath. You met with us before and you told us a number of stories that will be helpful to this committee.

I want you, Sergeant Shannon, to just describe one example of the kind of attitude you encountered more often than you should have when you came and asked for information five minutes before an office opened up. Do you remember that story?

SHANNON: Yes.

I have an anger problem. And I think this is common across the board with patients at the hospital. It's something these people are going to go through to some degree or another. And forgive, I've been told there's a time problem and I'm talking quickly.

TIERNEY: You needn't talk quickly. Take your time.

SHANNON: OK.

In the course of the work I did at the hospital, I became very familiar with how things worked at the hospital. I became a person that would take a new soldier around and show them where they needed to go and show them where they needed to go, who they needed to talk to.

SHANNON: Because if I didn't have the answers at that point, I could send them in the direction they needed to go.

SHAYS: And I'm just going to interrupt you. You described that that was quite common, that the soldiers helped other soldiers because...

SHANNON: Yes.

SHAYS: ... they weren't getting the help from a case worker or whomever?

SHANNON: There just wasn't the staff for it at the time. The staff has increased significantly since that time.

SHAYS: OK.

SHANNON: But still not enough staff.

But at that point I was showing a new soldier who was also a patient in ophthalmology down to the office. And it was five minutes before they opened and I just needed to ask the lady if a certain neuro-ophthalmologist worked there.

And she looked me up and down, in my opinion like a piece of dirt, and said, "Come see me when we open."

I won't repeat what I said to her. I cussed a blue streak and it took everything I had not to jump over the counter and smash the printer she was just using to copy something.

SHAYS: Do you feel that that was more typical, or an unusual kind of experience?

SHANNON: Human nature indicates that in the course of any given day in spite of your productivity, you'll have the easiest day you can have, OK?

What needs to not be forgotten here is there's a human issue involved with these guys. And the problem -- and I apologize; I talk a lot these days: It takes me a while to get to the point -- there's a hospital policy that regardless of hours -- this is a written policy at this hospital -- regardless of whether they're on the clock or not, they will always provide assistance to patients when they require it.

I found that out because my wife worked here.

SHAYS: That's the policy. You don't feel it happened?

SHANNON: No.

SHAYS: Let me ask you this: Almost all of you have said the help you received from the doctors when you received help was outstanding.

SHANNON: Yes.

SHAYS: Would you agree, Sergeant -- I mean, Specialist Duncan?

JEREMY DUNCAN: Yes, sir.

SHAYS: Mrs. McLeod, would you agree with that? Or would you?

MCLEOD: Fifty percent, yes.

SHAYS: OK.

Let me ask you this: You got the sense that you were being pushed out of the active Army, the military facilities, to the V.A. Describe to me your attitude about that and why -- what positions you took.

Let me start with you, Specialist Duncan. You don't chose to leave the military.

JEREMY DUNCAN: I'm not leaving the military at all, sir.

SHAYS: OK.

And this is something that's amazing to me. You told the military you had no intention of retiring. What was their reaction?

JEREMY DUNCAN: They were kind of shocked. At first, they were like, "Well, we don't think you can stay in," because of the conditions I had. But, like I said, some of the doctors here helped me find the actual regulations on my conditions, and I meet the requirements to stay in. So, therefore, I'm staying in.

SHAYS: So you don't have an issue of getting help with the V.A. So let me -- but, first, thank you for wanting to stay in; thank you for having to argue to stay in.

Thank you for your incredible service, all of you.

And, Mr. McLeod, thank you, sir.

But let me have both of you, Staff Sergeant and Mrs. McLeod, tell me whether you would prefer to have V.A. help or have the help (inaudible).

MCLEOD: In our situation, the V.A. has absolutely been wonderful to him. But he was only referred to the V.A. because they refused him treatment here.

My goal was to have him to receive his treatment, because I felt that he would receive better treatment when he was on active duty because they stand first priority.

SHAYS: OK. Thank you.

Because I only have 30 seconds left, Sergeant Shannon?

SHANNON: I will receive care anywhere I can get it.

SHAYS: But what are you waiting for right now? Describe to us what you are waiting for right now.

SHANNON: I'm waiting for the plastic surgery to be done, to make my face capable of receiving a prosthetic eye.

SHANNON: And then they will start the procedure to start a prosthetic eye.

They have given me the option to let the V.A. do it. I have a right to have it done before I'm retired. And, as a workaholic, I'm not taking 30 days off from a job to have surgeries done.

SHAYS: You told us your biggest concern. What's your biggest concern right now?

SHANNON: My biggest concern?

SHAYS: Yes, sir.

SHANNON: My biggest concern is having the young men and women that have had their lives shattered in service to their country get taken care of.

SHAYS: Thank you.

SHANNON: That's my biggest concern.

TIERNEY: Thank you, Mr. Shays.

Mr. Waxman?

WAXMAN: Staff Sergeant Shannon, that's your biggest concern, and it's got to be the biggest concern of all Americans. I think that people are shocked when they heard about The Washington Post story of the deplorable conditions here at Walter Reed.

And some of the reactions to those news reports have been, "We never knew things were out of hand."

Now, I can't understand that, when we get officials who say they just didn't know things were happening that were so shocking. Because I have --and I'm going to ask the chairman to make it part of the record -- I have a long list, a stack of reports and articles that sounded the alarm bells about what was going on here and around the country.

For example, in February 2005, Mark Benjamin wrote an article in Salon magazine describing appalling conditions and shocking patterns of neglect in Ward 54 at Walter Reed, the Inpatient Psychiatric Ward.

Another report from Salon, in 2006, warned that soldiers with traumatic brain injuries were not being screened, identified or treated; and others were being misdiagnosed, forced to wait for treatment, or called liars.

And then we have -- in June 2006, Military Times ran a story reporting on problems with the Physical Evaluation Board process. In 2005, Rand issued a very comprehensive report for the secretary of defense, finding that the military disability system is unduly complex and confuses veterans and policymakers alike.

And then the GAO, the Government Accountability Office, found inadequate collaboration between the Pentagon and the Veterans Administration to expedite vocational rehabilitation services for seriously injured servicemembers.

And GAO did some other reports as well. Because in February 2005, GAO reported on gaps in pay and benefits that create financial hardships for injured Army National Guard and Reserve soldiers.

WAXMAN: And in March 2006, GAO warned that a quarter of the active duty soldiers and more than half of Reservists and Guardsmen do not get their cases adjudicated according to Pentagon guidelines.

And in April 2006, GAO reported that military debts posed significant hardships to hundreds of sick and injured soldiers serving in Iraq and Afghanistan.

And in May 2006, GAO issued a report on problems with the transition of care between the Pentagon and the Veterans Administration. And in fact, two weeks ago, the Army inspector general revealed an ongoing investigation of problems with the Physical Evaluation Board system, an investigation which has already identified 87 problems with the medical evaluation system.

Even Congress acted on this issue. The 2007 defense appropriations bill called for Physical Evaluation Board members to document medical evidence justifying disability ratings, rather than simply allowing them to deny disabilities by writing pre-existing conditions -- the kind of problem that your husband had, Mrs. McLeod.

Despite all of these press reports, studies and investigations, it took The Washington Post finally to capture people's attention. They deserve an enormous amount of credit for what they've done.

But, despite all the work that went on before, top Pentagon officials reacted to the reports at Walter Reed two weeks ago by claiming surprise.

Let me just read what the Pentagon's highest civilian official in charge of the military medical program said in a press conference. Dr. William Winkenwerder Jr., the assistant secretary of defense for health affairs, said, "This news caught me, as it did many other people, completely by surprise."

Well, my question for the three of you, or for any of you who wants to respond: What's your reaction to these kinds of statements? What's your response to top military officials when they claim they had no idea that there were any of these kinds of problems?

Sergeant Shannon?

SHANNON: As you will read in my statement, I believe -- implicitly -- in an open-door policy. The biggest problem they have with me is I've been here long enough to see things constantly go up the chain.

To be told -- and I believe that is General Weightman's primary mistake. I don't think he should have been fired, but he said he didn't know. That is not true in my opinion.

WAXMAN: Let me ask Mrs. McLeod, because now I'm going to be running out of time: What's your reaction, when you've been trying to get people's attention to the situation with your husband, and now when we have it so clearly laid out in the press and there's attention being paid to it, the higher-ups say that they were just surprised to hear about all this?

MCLEOD: I have one question: Were they deaf? Because I worked the chain. I went anywhere they would listen. So if you don't want to hear it, you don't want to hear it.

WAXMAN: Specialist Duncan?

JEREMY DUNCAN: There's no way they couldn't have known. I mean, everybody had to have known somewhere. If they wanted to actually look at it or pay attention or believe it, it's up to them.

WAXMAN: There's another statement that I find even more offensive. On January 25, 2005, David Chu, the undersecretary of defense for personnel and readiness, was asked by the Wall Street Journal about the costs of military health insurance and pensions.

In response, he stated, quote: "The amounts have gotten to the point where they are hurtful. They are taking away from the nation's ability to defend itself," end quote.

WAXMAN: What's your view of this statement? Do you believe honoring our servicemembers by ensuring they are properly cared for lessens our nation's ability to defend itself?

MCLEOD: Absolutely not. The cost of care for veterans should not come out of monies that are designated to fight a war. The cost of care for veterans that are wounded in the course of that fighting war should come out of separate funds.

If a certain amount of designated -- I mean, I don't work at that level -- but if a certain amount of money is designated to fight a war, it needs to focus on the war and there needs to be separate funds set aside.

Because if they're going to indicate they don't have the funds to do it well, then, they need to break the issue down. You can't take away from what the soldiers need over there, you can't take away from the soldiers' need over here, and you can't combine the cost because it's too much.

WAXMAN: Undersecretary Guerin welcomed us this morning by saying that there's an Army, military tradition that you leave no wounded soldier behind.

(UNKNOWN): Hoo-ah!

WAXMAN: This sounds to me like this particular man was saying that it's more important to fight even if it means leaving some of our wounded brave men and women and patriots behind in their health care or their disability.

I'm very disturbed by what we're hearing, and I'm glad that Chairman Tierney has convened this hearing right here at Walter Reed.

And from what we're hearing, what's going on here in Walter Reed may be the tip of the iceberg of what's going on all around the country. People are flooding us with complaints that it's not just Walter Reed; check out what's going on all around the country.

And, right now in Los Angeles, the Veterans Administration wants to privatize the land rather than take care of the returnees and the veterans.

Thank you.

TIERNEY: Thank you, Mr. Waxman.

Mr. Davis?

DAVIS: Well, thank you.

And let me thank Mr. Waxman. As you know, a number of those GAO reports this committee requested, some of them coming from complaints from veterans that were stationed right here.

DAVIS: Ms. McLeod, let me start with you.

You went up the chain many times, didn't you?

MCLEOD: Yes, sir.

DAVIS: You finally called this committee you were so upset.

MCLEOD: Sir, I will talk to anybody that would listen. And it took the aid of another soldier who actually heard me cry, saw me cry one day and he says, "This is the number. Make a call." And that's when I called Ms. Washburn (ph). And then you know my story, because you've dealt with me.

Had I not had any other recourse, I wouldn't be here today. The thing of the matter is, Mr. Harvey made a statement made the other day that really bothers me. He said that he hoped The Washington Post was satisfied because they ruined careers.

First, let me come on record by saying I don't care about your career as far as anybody that is in danger. That doesn't bother me.

All I'm trying to do is have my life, the life that I had and that I know. My life was ripped apart that the day my husband was injured. And having to live through the mess that we lived through at Walter Reed has been worse than anything I've ever sacrificed in my life.

DAVIS: Thank you.

She's referring to Grace Washburn (ph) of our staff who's helped us and taking the lead in this when people weren't being paid right. Then they sic the bill collectors on them. People afraid of losing their houses when they come back languishing.

If they didn't have any warnings of this, they weren't paying attention, because as Mr. Waxman noted, we had a number of GAO reports that we authorized -- the GAO calls the balls and strikes for Congress -- showing this was a systematic problem.

Now, I understand that Walter Reed holds town hall meetings. Could each of you tell us about these, who runs these meetings, who attends them, how they're advertised, how often they take place, what types of issues are discussed, and do problems get resolved?

SHANNON: When I first got here, the wives at the Malogne House had started meeting on Thursdays to have a wives meeting to get issues addressed. That started doing some good.

I've been here a long time. The PTSD issues started kicking in. They started having me stay at home. I have never been to a town hall meeting.

I had an opportunity just before the Dana Priest story come out to go to a sensing session for NCOs, and any servicemembers, and I couldn't see the point in it. I've been here too long. It just hasn't done any good. So I didn't go.

DAVIS: Have any of you been to town meetings?

MCLEOD: I was the first wife that actually spoke up. I was the one that actually stated my piece, because they had denied him treatment. They sent him to Virginia for 10 weeks for the brain injury and I looked him -- I looked Colonel Hamilton (ph) in the face and I told him, I said, "You all must have thought you all cured him because you hadn't touched him since he's been back."

My thing is, he opened the floor and I blasted him with everything I had, because I was to the point I really didn't care, because it seemed like I had had enough.

MCLEOD: I was tired of fighting the system. I was tired of trying to help him get well.

At the same time they didn't seem to really care. They wanted him out of here. They wanted to turn him over to the V.A. His case manager at the time was Captain Virginia Long (ph). She got tired of dealing with me when he was in Virginia, because I started calling him three weeks -- calling her three weeks before he come back from Virginia, letting her know what he needed, what he didn't need, what he needed to follow up on.

And she got so aggravated with me because there was a span that I had gone home to try to get things together there that she actually sent him home to keep from having to deal with him. She told me, she said, "I cannot maintain him the way you want to maintain him," she said, "So I'm going to send him home until we can decide what to do with him. And we'll probably turn him over to the V.A."

I fought tooth and nail. That's an old saying for me. Because he should have been taken care of.

DAVIS: Thank you.

TIERNEY: Thank you very much.

Thank you, Mr. Davis.

DAVIS: I'll just ask -- Mr. Duncan wanted to respond to that.

TIERNEY: Sure.

JEREMY DUNCAN: I've never actually been in a town hall meeting myself, sir.

DAVIS: Thank you.

TIERNEY: Mr. Lynch from Massachusetts?

LYNCH: Thank you, Mr. Chairman.

I want to thank Chairman Tierney and Chairman Waxman, and also Ranking Members Shays and Davis, for holding this hearing.

I want to thank the panelists for your willingness to testify and to help this committee with its work. You really are speaking this morning not only for yourselves but everyone else in uniform.

A lot of members up here have been over to Iraq a number of times. I've been over five times and also Afghanistan. I know a lot of these members have gone with me.

And one of the things that always struck me whether we were at the Landstuhl medical facility in Ramstein, or whether we were in Balad visiting very severely wounded young men and women in uniform, they always talked about, "Well, it's going to be OK once I get to Walter Reed."

It was just this gold standard and this confidence and trust in our military personnel that when they got to Walter Reed it was going to be OK.

LYNCH: They were going to get put back together and they were going to have a maximum outcome, whatever their injuries were.

And I think these most recent revelations have been -- well, it's been a real blow to that reputation.

And so the task here for us and together with your help -- and I thank all members of the military who are here today. And I appreciate their service to our country.

Our job today is to make this right. It's not just about doing the right thing. It's about doing the thing right, and making sure that this process works.

One of the things that was stunning to me in going through all the testimony and previous hearings with the veterans groups is that for disability approval within the armed services -- I notice that the Marine Corps -- well, it's actually the Navy, but the Marine Corps approves about 30 percent -- 35 percent of its injured for temporary or permanent disability. The Air Force approves about 24 percent.

Now, the Army, that have the largest number of active duty soldiers and reservists, put less than 4 percent. It's a massive difference. And it can't be just random.

And I know each of you went through this process and also witnessed your fellow in arms together going through this process, and you saw how this was handled. I know the PTSD issue is out there and that we saw less willingness on the part of the military to approve disability based on PTSD.

What do you -- do you see a purposeful effort here to refuse the 30 percent disability that would bring, I think, dignity and the right benefits to those who are injured in uniform? I'd like to just get your sense of it, whether this is a purposeful attempt to deny those benefits to men and women in uniform.

MCLEOD: We were fortunate because I didn't give up.

MCLEOD: They had no intention of even compensating him for the cognitive dysfunction.

Only when we started the med board, they had already done all of his addendums and sent them in. They tested him for his brain injury. With the help of Mr. Davis and Ms. Grace Washburn (ph), they did a congressional investigation and they called me into the office and they -- all the colonels, all the case managers, nurse case manager, my husband's platoon sergeant, commander of the MedHold (inaudible), "What can we do to make this right?"

I said, "Exactly what you should have done to start with. You know, here's a man -- his life's messed up. But you not only messed his life up, you messed mine to. Give us what we need rightfully, and let me go home."

They tested him the very next day. Because when they first tested him, they said he didn't try hard enough. He went from being at Title I math and reading to, six months down the line, he was in special education, according to the Army.

He never was in special education. Before he was injured, he was as smart as most people are. Most children have trouble when they're coming up. I had trouble in math. But believe me, I'm far from being mentally retarded.

When the Army was through with him, they had him down to where he was mentally retarded. And that was on black and white.

So they retested him and they come up to me a week later and they told me, "Mrs. McLeod, we did find something. We found that he was slow. We found that his cognitive skills don't measure up. "

Well, you would have found them to start with if you'd have paid attention.

TIERNEY: Thank you, Mrs. McLeod.

Thank you, Mr. Lynch.

Mr. Platts?

PLATTS: Thank you, Mr. Chairman. I appreciate you and the ranking member holding this hearing. I believe that, as a nation, we certainly have no greater duty and responsibility than caring for those who defend our freedoms.

And it's a privilege to hear the testimony of Staff Sergeant Shannon and Specialist Duncan.

Mrs. McLeod, we appreciate your courage and service on the home front -- Staff Sergeant, Specialist and Mrs. McLeod, your courage and service on the home front and theirs on the war front.

I want to start, Staff Sergeant Shannon. You talk about your specific case. And to make sure I understand the circumstances of when you were first injured, two days later, here at Walter Reed, November 13th, then you arrived here -- three days; November 16th.

SHANNON: First of all, I don't remember the exact dates.

PLATTS: OK.

SHANNON: I was wounded November 13th, and I know I spent two or three days in Landstuhl, but I really don't remember.

PLATTS: Is it safe to say, within a week you'd been transferred here and then discharged to outpatient?

SHANNON: I'm pretty sure I was discharged on the 18th...

PLATTS: OK.

SHANNON: ... which is about three days -- or five days after I was shot, sir.

PLATTS: So five days after being wounded in Iraq, severe injuries, traumatic brain injury, you were discharged to outpatient and basically given a map of where to go and left to be on your own. Is that correct?

SHANNON: Yes, sir. And some of that's my fault. I'm a staff sergeant; I won't stay in bed. Somebody else can have it. Whether I need to be there or not is something I'm qualified to say. I just won't stay...

(LAUGHTER)

PLATTS: Well, we appreciate that can-do approach and wanting to look out for others, but it just is amazing that basically cut loose to that outpatient and without some guidance.

You talked about finally getting in touch with your case manager, and then your case manager did assist in setting up some appointments.

Once you made that contact, what was the give and take between you and your case manager? Did he regularly get in touch with you or it was always you having to pursue them?

SHANNON: The problem was directly related to the breakdown of the system.

Actually my case manager was a lady named Maggie Hardy (ph). She's a wonderful case manager. And after I had finally made contact with her, she, first of all, was wondering where I had been, and yet knowing I hadn't been AWOL because they were tracking my systems in the computer -- my appointment, I was making my appointments in the computer system.

But after I met her, and that became part of my counseling for incoming personnel: know who your case manager is and work with them because they'll keep things happening that need to be happening.

That answer the question?

PLATTS: So the contact, once you established it, then there was a good back and forth between you and her.

SHANNON: Yes, sir.

PLATTS: The gentleman you mentioned, Danny Soto, an independent, how did you come to be in touch with him and what's his official role at the Malogne House?

SHANNON: I've met Danny Soto a number of different times. I'm not sure who he works for. Actually, I think it might be Wounded Warrior...

MCLEOD: DAV.

SHANNON: I'm sorry?

MCLEOD: DAV.

SHANNON: DAV. OK.

But I know that many personnel at the hospital -- or at the Malogne House and the system can speak to the work that he does as an advocate for them in the MEB/PEB process for return to duty, medical discharge or medical retirement.

SHANNON: Like I said, he's just one man. There needs to be an entire staff of people that work outside of a government connection, that have knowledge of how the system is supposed to work and can give us guidance in that system.

Because a huge problem, regardless of what is done here, is to re-earn the trust of the patients here. And I spoke to some of the officers that are working on it. They can fix the problem. And I know, myself, I don't trust it. They have to figure out some way to get me to trust it again.

PLATTS: So Danny Soto would serve as a good example of the type of ombudsman that you think would be wise for those wounded and the families...

SHANNON: Absolutely, sir. He's priceless.

PLATTS: Question -- and Ms. McLeod, in the prior two terms, I chaired the Subcommittee on Financial Management and we saw significant difficulties with the Army on the financial side of dealing with Guard and Reservists.

And I understand your husband was a guardsman, and then activated, right?

MCLEOD: Yes, sir.

PLATTS: Did you feel that it was different treatment because of having been a guardsman family, as opposed to active duty, or do you think it was more across the board, regardless of active duty, Reserve, Guardsman?

MCLEOD: As far as the finance, we didn't have any trouble with the finance, as far as the issues. We did have a soldier that befriended my husband and stole his identity. That kind of finance I had trouble with.

But other than finance issues with the Army...

PLATTS: But the medical issues, such as you referenced a case manager denying the MRI even though the doctor ordered it.

MCLEOD: Right.

PLATTS: Those type of medical issues -- do you think -- did you see a difference -- and Staff Sergeant Shannon, maybe you can answer this, too -- as how active duty soldiers -- was there a difference in how they received care and follow-up, versus Guard and Reserve?

Did that create a problem because of the challenge of managing a very large deployment of Guard and Reservists?

SHANNON: Well, first of all -- I apologize. My...

PLATTS: That's all right. Take your time.

SHANNON: When I was a first here, the medical hold company was all services combined, OK? Now they have two companies, the medical holdover and medical hold. That was very necessary.

But watching them try to go through an additional paperwork process was -- there was no question in my mind that the indicators -- I say things like that because I'm a reconnaissance type -- but the indicators were such that they were having a lot more trouble figuring out the paper trail that is correct for the services they need and the connections they needed with their states in reference to those services.

PLATTS: My time's up.

I want to thank you for your service in taking the personal struggles that each of you've had and turning them into public good through public testimony here today. Thank you.

TIERNEY: Just for the benefit of the members, to let them know, the next speakers will be Mr. Yarmuth, Mr. Duncan, Mr. Braley and Mr. Turner and then on from there.

Mr. Yarmuth?

YARMUTH: Thank you, Mr. Chairman.

And thanks to all three of you for being here today.

And I would like to add my voice to what I'm sure are millions of American voices, who are not only very sorry for the ordeal you've gone through, but also are very angry about it.

I'm glad we had this hearing and I know that eventually we are going to correct the problems that resulted in your situations.

I would also like to say one thing as a former journalist: that it is precisely this type of situation for which the First Amendment was conceived. And I salute The Washington Post, Newsweek, Bob Woodruff and all those who brought this situation to light.

I'm also astounded that it took so long to come to light. These situations apparently are long-standing, and I'm curious as to know -- and this would be for Staff Sergeant Shannon and Specialist Duncan -- what the normal procedure would be for you to raise complaints about the treatment you were getting.

SHANNON: Open-door policy, sir.

Open-door policy works well, as long -- well, if people don't understand the policy, if you concern, a lower level soldier, he takes it to me. If I don't satisfy that concern for him, he has the right to take it above my head. And he continue up the chain until his concern is addressed.

And, first of all, The Washington Post didn't come to speak to me. They came to speak to my wife. She's a person that everyone knows, knows problems that go on here. In the course of that, they met me, and I decided to exercise what in my opinion was the necessary open-door policy for the problems here. It's called public opinion.

Because when a command uses, in my opinion, the open-door policy to keep problems in house -- which is the correct method -- but not to solve those problems -- which is an incorrect method -- then there's got to be a level it can go to that the problem can be fixed.

SHANNON: And my personal understanding of those problems going very high indicated that nobody was going to fix this.

And I'm a leader. My wife reminds me I'm a patient. Those kids -- no offense to the servicemembers -- are going to get taken care of, period.

(CROSSTALK)

JEREMY DUNCAN: I feel the same way. I mean, you address it as high as you can until you get fed up with it and just do what you have to do to get it done.

YARMUTH: I'm curious as to why, however, in this particular case, nobody along the chain of command reacted at all, apparently, to do anything about it, since you all had to go outside the system.

What is it about the mentality there? Did everyone feel complicit in that? Helpless? I'm curious as to why no one in the chain of command would have responded.

JEREMY DUNCAN: I guess they probably -- as they already said -- we didn't know this was happening like this; we didn't have any ideas.

Correct me if I'm wrong, Sergeant.

SHANNON: Sir, I feel the need to say this: They did respond.

And as I read my statement, of course, but the response was indicative of a broken system that's trying to survive. They fired a good man. They fired a few of them. Some of them may have deserved it.

But I've got to say, First Sergeant Walker (ph), the first sergeant of the medical holding company, is someone I've known for awhile and he's gone to bat for us on a daily basis.

I would just personally like to apologize to him. He's a good man and he didn't deserve it, I don't think.

Now, I'm not privy and I don't have a right to know the ins and outs of his case. But a system that fires people down the chain, once again, in my opinion is indicative of a system that is trying to protect itself, whether it fixes the problem or not, and, in my opinion, clearly not focused on fixing the problem.

YARMUTH: About a year ago, I had a situation in which I was on a plane talking to a man who had just come back from Washington, and had visited Walter Reed with a friend of his. And they were talking to a soldier who was from Lexington, Kentucky, had been a postal worker, was in the Guard, was wounded and so forth.

YARMUTH: It was near Christmas time. His life had been disrupted, financial stresses and all those things that we're well aware of now.

And this man to whom I was speaking asked him if there was anything he could for his family or for him for Christmas to make his life easier, and he said, that, yes -- he said, "I'd like some clean T-shirts because it's very cold where I am and they can't afford to give me clean T-shirts."

And I kind of forgot about it at the time, because you hear about Walter Reed and the extraordinary care that's provided here, and I thought it was an kind of an aberration.

I'm wondering how trivial and how many of these situations exist. We've heard of, in the Post series and others, some of the more heinous situations with patients being lost and, obviously, the deaths that have occurred and so forth, but at what level does this stop?

TIERNEY: The gentleman's time has expired.

YARMUTH: Sorry, Mr. Chairman.

TIERNEY: Perhaps one brief answer will suffice.

SHANNON: I can't speak to levels, but when I've got to, you know, get my Purple Heart in civilian clothing and show my Purple Heart to supply just so I can get my uniform, that's broken.

TIERNEY: Thank you.

Mr. Duncan?

JOHN DUNCAN: Thank you very much, Mr. Chairman, and I join the others in thanking you for calling this hearing.

And I want to also thank former Chairman Davis for the great work that he did in this regard, trying to at least start doing something about this.

Let me say first of all, though, that whenever any government agency seems to screw up in some big way, the two things they always say, they always say that their computers and technology wasn't good enough or wasn't up-to-date, which may have far better technology throughout the federal government than most major private businesses; but secondly -- and most often -- we hear the claim that they're underfunded.

I think we need to point out that both the Defense Department and the V.A., but particularly the Defense Department, have received massive increases in funding in the last five or 10 years, mega billions.

And so this is clearly not a shortage -- a problem of money. The Congress has given huge increases to the Defense Department in recent years, and we have tried to say many times that we want plenty of money going for this medical care, as I join all the others in saying this should be the highest priority.

JOHN DUNCAN: And I want to also join others in thanking each of you for coming forward.

But, Ms. McLeod, I noticed that you said you thought General Weightman might be a fall guy.

And then, Sergeant Shannon, you seemed to be less critical of him also. I believe he just came in August.

But in one of The Washington Post stories, it says Congressman Bill Young and his wife stopped visiting the wounded at Walter Reed -- which they were doing, I think, on a weekly basis -- out of frustration.

Young said he voiced concerns to commanders over troubling incidents he witnessed that was rebuffed and ignored. "When Bev and I would bring problems to the attention of authorities at Walter Reed, we were made to feel very uncomfortable."

Beverly Young said she complained to Kiley several times. She once visited a soldier who was lying in urine on his mattress pad in the hospital. When a nurse ignored her, Young said, "I went flying down to Kevin Kiley's office again and got nowhere. He has skirted this stuff for five years and blamed everyone else."

Did you find this to be true, that everybody was blaming somebody else with the problems that you had? I will ask each of you.

MCLEOD: I feel that everybody's passing the buck. You go to one, and they say, "Well, it's not my problem; you need to go to so and so."

I did everything but camp out, I mean, honestly. And if I could get away with that, I probably would have done that too.

You can't keep looking and not getting answers.

JOHN DUNCAN: Sergeant Shannon?

SHANNON: It's difficult for me to speak about people passing the buck. It's something that has surprised me by virtue of this story coming out in The Post, because I didn't want to see anybody fired, just wanted to see the problem get fixed.

I work at my level. I'm good at working at my level. I know that, on a constant basis, things were passed to higher.

JOHN DUNCAN: Well, let me ask you this: The subheadlines in the main Washington Post story said "bureaucratic bungling" and it said "frustration at every turn."

Do you think those are accurate descriptions of what you ran into?

SHANNON: Absolutely. The bottom line is, like the situation I know of, a young man missing his entire right arm, that the Army has seen fit to award 10 percent disability, because he's going to receive 80 percent of the use of his arm with his prosthetic.

SHANNON: That's the bottom line, sir.

JOHN DUNCAN: One of these stories says General Kiley lives right across the street from Building 18, which is apparently the worst example of what's going on here.

Did any of the three of you, did you see these top generals and the top brass here getting out and going around and observing what was going on? Or do you feel like they stayed isolated in their offices and just meeting with their staff people?

JEREMY DUNCAN: After the article came out, there was a lot of people visiting Building 18 and looking into it. That was after the article came out. Before then, it was occasionally a commander coming through to check on everybody, make sure everything's going right. It wasn't, like, overwhelmed as it is now. But before, just no -- a feel people going in and check on everybody, say, "Hey, how's everybody doing?"

JOHN DUNCAN: Well, that's what I was talking about was before the articles came out.

Let me just -- I know my time's about to run out, but let me say this: It's not just members of congress up here who are upset about this. I tell you, it's people all over the whole country. And they are very upset about this. And I think all of are going to demand that action be taken.

Thank you very much, Mr. Chairman.

TIERNEY: Thank you, Mr. Duncan.

Mr. Braley?

BRALEY: Staff Sergeant Shannon, Mrs. McLeod, and Specialist Duncan, thank you for your courage in coming here today and sharing your stories with us.

I'm here because my brother Brian works a kinesiotherapist at the V.A. hospital in Knoxville, Iowa, taking care of patients every day. And I know that every member who provides medical and psychiatric care to veterans is tainted by the stories we're talking about here today. Every person in a V.A. system should want these problems solved, so that we get back to having pride in the facilities that take care of our veterans.

One of the things that I'm not at all shocked about is the fact that case managers may be playing a role in denying access to veterans to the benefits that they're entitled to. Because I'm familiar with the AMA guides to permanent evaluation. I'm familiar with the DSM4 criteria that are used.

BRALEY: And I've represented veterans and their families in life and disability claims.

And one of the things that has been known for a long time is that case managers have two functions: one is to return a worker to workforce as quickly as possible; and, two, to minimize the cost to the employer of returning them to work. Those don't work at the same level of advocacy that patients need.

And what I'd like to know, is there anybody who serves the role as an ombudsman or as a patient advocate here at Walter Reed in assisting patients with these claims?

SHANNON: My first experience with that -- and I apologize; I talk too much. But my first experience with that was working with my initial PEBLO counselor, and he gave me all the information about, "Hey, you need to educate yourself about this process, because once this is done, it's done. And if you miss something you're entitled to, it's gone."

And so based on his knowledge of this system, I said, "OK, well, tell me what I need to do or tell me who to talk to." And he just had to smile at me and say, "I don't know who you should to talk to. They all retired and gone." At that point, I was no longer able to trust my PEBLO counselor in the process.

Danny Soto, once again, is a person outside of the system who is knowledgeable of the system. He is someone that we can trust because, based on what I consider an automatic conflict of interest: the PEBLO and the MEB/PEB process, both work for the same organization, the United States government.

BRALEY: Mrs. McLeod, one of the reasons I am concerned about what we are hearing today from you is that part of the response to the problems here at Walter Reed was to propose adding 39 additional case managers to assist with the processing of these disability claims.

And to me, what we're talking about is a solution to the problems that you and others have shared, is making sure there are people outside the case managers who are here to assist veterans and their families negotiate the difficult process of qualifying for and receiving an official determination of whether or not they are entitled to disability benefits.

Would you care to comment on that?

MCLEOD: My feeling is, if the doctor feels it's necessary to run a test, it's not the case manager's job to second-guess that. If it were, she would be in the doctor's place. I went to my husband's case manager, I begged her when -- on April 19th he was supposed to have set up the MRI to have it scheduled. He got that MRI June 23rd, when I took him myself.

MCLEOD: The case managers need to stop playing doctor and they need to be case managers. They're supposed to get them where they need to go, schedule the appointments and stop questioning it.

But instead, his case manager, Captain Virginia Long (ph), got so upset at me, she sent him home to keep from having to deal with him.

Now -- but she got quick enough. Whenever I put in the resources that I did, she gave him a physical in her office. Now, we're talking sanitary -- have you seen those offices? The last thing you want to be doing is examining in the office.

I won't tell you how mad I got, and I won't tell you the things that I said. But the treatment that she gave him before I had her fired as his case manager, a dog wouldn't have deserved.

BRALEY: Do the three of you know, does the JAG Corps provide any type of legal assistance to veterans who are processing disability claims?

SHANNON; I don't know about processing disability claims. But the JAG has been very helpful here, just in the course of my wife's vehicle being repossessed, the vehicle that I owned prior going to combat, and my not knowing -- I couldn't remember who to send payments to and stuff after I was wounded -- contacting those companies and getting the message across that we've been wounded and to give them time to catch up.

So I'm not sure about processing claims, but they're there and they have done good work for me.

MCLEOD: The only time I dealt with the JAG was during the episode where the guy tapped into all our accounts, when he stole my husband's identity. And they told me that it was not an issue for them; that I had to go through Finance.

TIERNEY: I thank the gentleman.

Mr. Turner?

TURNER: Thank you, Mr. Chairman.

Mr. Chairman, I want to thank you and, of course, Ranking Member Davis, for your efforts in trying to insure that we have quality medical care and the services that we need for our men and women who have served our country.

Staff Sergeant Shannon, Mrs. McLeod, Specialist Duncan, I want to personally thank you for your service and what you have done, not just in trying to ensure that there's appropriate care here but in making certain that the word is known as to what needs to be done.

You've got a great deal of courage, and you have certainly brought things to light that have saddened many people across the country.

I know that you're aware that the next panel, and then the third panel, that we have people that are going to come in and speak about this issue, who have various degrees of accountability or various degrees of answers.

We have General Kiley, General Weightman. We have General Schoomaker and General Cody.

What would you like to hear from them? And what type of questions would you like to hear them answer, with the issues that you've brought forward?

SHANNON: On their level, at this point, this is about accountability. Like I said, you know, I'm a firm believer in the Peter Principle: Don't ask me to work in a job I'm not qualified to do.

This has no reflection on whether they're qualified to do it, but it reflects directly on my ability to speak to what they should do.

I just want them to fix the problem.

In fact, I personally got a little angry when Harvey resigned. Now, I don't know how things work in Washington, D.C., but in combat, we don't get to resign when bullets are flying and people are dying.

SHANNON: Now, the way that reflects on this issue is that this is a political war, to some degree, on a daily basis. And when they're receiving political incoming rounds in the course of helping us or and in the course of dereliction of duty in that requirement, they continue to fight for us until they're fired. Pull themselves up by their bootstraps like any sergeant would do, admit to their mistakes and work to fix them until they're fired.

TURNER: Mrs. McLeod?

MCLEOD: On my level, as far as the family members are concerned, I'd like them to answer to the family, to say, "We can guarantee." That's what I want, I want a guarantee that not anybody would have to go through what I went through; that, "We're going to listen and we're going to take charge."

JEREMY DUNCAN: Me, I'd like to hear them actually say they're going to fix the problem, not just cover up what they're trying to do, make it, you know, sound like, "Hey, yes, we're fixing Building 18; all it is is paint and spackle." That doesn't fix. It just covers up. Just fix it, like they're trying to do now, you just need to fix it from the ground up, get it fixed so it's fit to live in.

TURNER: Thank you.

Thank you, Mr. Chairman.

TIERNEY: Well, thank you.

Ms. McCollum?

MCCOLLUM: Thank you, Mr. Chairman. Thank you for holding this meeting.

I'd like to thank the people who are testifying. I'd like to thank all of those who served our country. We need to show our thanks. We need to show it through respect and the way we welcome our veterans and their families home.

We're not doing a very good job, and that's why we're having this hearing.

I first became aware that the system at the V.A. level had challenges and was broken by being the daughter of a disabled veteran and watching benefits erode away; talking to veterans in my community about long waits, lack of equipment.

They knew when they saw the overworked staff, however, they were going to get the best of care. But it was having the ability to see the staff.

I'm very concerned about a lot of issues, but I want to follow up on one. And if you don't mind, Staff Sergeant, I'm going to quote from your full testimony.

Quote, "I've been lost in the system. I want to leave this place. I have seen so many soldiers get so frustrated with the process they will sign anything presented just so they can get on with their lives.

MCCOLLUM: "By signing documentation without fighting for the benefits they've earned, they are agreeing in writing to the Army's determination of their benefits."

And, as Mr. Lynch pointed out, the Army's only at 4 percent in determining benefits.

We almost have no advocacy -- that's not working for the government; no one that we can talk to about this process, no one who's knowledgeable and that we can trust who is going to give us fair treatment and informed guidance.

The physical evaluation counselors -- the MEP and the PEB -- both work for the government and have its interest at heart, not ours.

Mr. Lynch had been quoting from a document that he had. And I'd like to add a little more to what the staff sergeant just said in his own words, and then ask a question.

Each branch of the military provides for opportunities for injured servicemembers to challenge their ratings. Most of the injured simply pocket their severance checks and go home. Only 20 percent of the soldiers ask for formal hearings at which an attorney can present evidence and call witnesses. As the Army says, only half of those soldiers proceed with hearings.

Perhaps that indicates most injured soldiers are satisfied with their ratings. But veterans groups say more wounded servicemembers would challenge the ratings if it wasn't so complicated and time- consuming.

MCCOLLUM: Most of those hurt in the line of duty are young, weary of fighting and anxious to return home to their civilian lives.

And in other words -- and these are my own words -- the severance check can look really quick and a lot less painful at times, not realizing the benefits that they have been signing away.

I would ask you to tell us if you know of any pressures that you have either heard of or witnessed for people to sign away their benefits, and what we need to do in order to make sure that veterans know, either by providing an ombudsperson or whatever, that their rights will be protected, we do welcome them home and we do respect them.

MCLEOD: I'll take that one.

I know a soldier, fairly young, maybe early 20s, who was deployed. I took this soldier under my wing whenever we met, and he was a great guy. Very nice. He told his recruiter that he had had an episode in high school, and the Army took him anyway. They sent him to Iraq.

When he got back to Walter Reed, they diagnosed him with bipolar, but he was pre-existing. The Army gave him 0 percent. This guy has nothing. He's trying to find his way back into society and may never be what he was. So they gave him 0 percent.

This is how we treat our soldiers. We give them nothing, but they're good and tough to go and sacrifice their lives. And we give them nothing.

You need to fix the system; compensate where it's needed. This soldier needs care.

Yes, so they are treated, but the V.A. will treat them according to the ratings of the Army, because the first thing they ask, "What was your rating with the Army?" You get in a category. We were fortunate because my fight still continues. They know me first-name basis.

But what about the ones that don't have me? What about the ones that don't have a wife or a mother or a father that can stand up for them?

If you're good enough to go, you're good enough to be taken care of when you leave here. We need to take care of those that took care of us.

(UNKNOWN): Hoo-ah!

TIERNEY: Thank you, Mrs. McCollum.

Ms. Foxx?

FOXX: Thank you, Mr. Chairman, and I want to thank all of the folks who are here today, and all of our military people who are here for being willing to serve, to protect our rights to be here.

I am very interested in the issue of accountability, and I realize that, throughout our society, we have people who are unresponsive.

FOXX: We see it every day in the personnel in the Congress.

I will tell you that there are people who work throughout government agencies who don't always react the way they should react, particularly to other staff people.

What I'm interested in is: How do we fix the system? Casting blame doesn't do us any good if we aren't fixing the system.

Sergeant Shannon, Ms. McLeod, Specialist Duncan, do you have some specific recommendations to make? And you don't have to tell them to us today. But do you have some specific recommendations that you can make on how the system can be better, so that it's fixed?

And I'm particularly interested in: How do we assign responsibility in order to have accountability? It seems to me that the biggest complaint you all have made is this passing-the-buck complaint.

So, how can we establish a system that says: You've been to someone, you've asked a question, it is, in your mind, the responsibility of that person to take care of that problem, and they don't do it.

Unless we're willing to fire people who are either incompetent or unresponsive, then what alternatives do we have to trying to solve the problems that we are seeing?

SHANNON: I believe I can speak directly to that, based on the military system that I've grown to know so well myself.

Any noncommissioned officer can tell you that you don't just give people instructions to do things, you supervise them, OK?

SHANNON: A person can be getting close to a position where they need to be fired. However, with proper supervision, they can be brought back in line.

This directly relates to priorities, in my opinion, and the breaking of the story has changed priorities. And now things are getting done.

The priorities of the people above that need to be supervising what is done below them on a daily basis can be changed so that they are not supervising at the level they need to be supervising at.

If I were doing that at my level, I'd be in danger of getting fired in my job.

Like any system, whether it be a civilian or military, at a point you see someone that's having a problem doing their job correctly, you counsel them. And if they still can't do it, you counsel them again.

I believe it's three times, then they're fired.

But that requires proper supervision, ma'am. And if supervision's not happening, you know, how can you counsel someone if you're really not watching what they're doing?

FOXX: The others? If you...

MCLEOD: In my situation, for example, my husband went to a doctor. The doctor roughed him up pretty good. Finally, I wind up having to take him to the emergency room because he couldn't move for three days.

We filed a complaint.

When the patient rep call me, first she wouldn't talk to me. And then my husband said, "You need to talk to my wife; she can explain to you more."

I told her what happened. And she asks me -- she says, "Are you sure?"

I said, "Yes. I wouldn't have filed the complaint if I hadn't have been sure."

She says, "Well, I'm sorry on behalf of the hospital. Sometimes things like this happen."

No, it doesn't happen. When they tell you that's all they can do, that's all (inaudible).

We have doctors -- let me specify: he has doctors -- that were so eager to fight for the system, they made him able to move. They put him in the emergency room, but they made him able to move because they wanted to fight for the Army.

We need to turn around. We need to fight for the soldier. The soldier is the reason you have a job.

MCLEOD: When they go to the case manager, there shouldn't be second-guessing. They should say, "OK, we'll put you where you need to be. We'll get the doctor." When you go to the doctor and he says, "OK, we need to do this," you have to go back to the case manager, she has to set up everything. There shouldn't be, "Well, I'll talk to the doctor." No problem. This needs to be taken care of.

You need to start treating the soldiers like citizens, like the same representative anybody would want. You go to your doctor, you don't want him to second-guess you, you want him to find the problem, you want him to get a result. That's what you go to him for. That's exactly the same thing they need to do.

They need to start at the very bottom first and find out why they can't do their job to the capacity they need to do. You need to work your way up the system. When you find the broken link, you either put some glue on it and fix it or you get rid of it.

TIERNEY: Thank you very much.

Mr. Cooper?

COOPER: Thank you, Mr. Chairman.

And thanks to each one of the witnesses for your outstanding testimony.

If there are this many problems in Building 18, how about Buildings 1 through 17, or buildings with higher numbers? We need to make sure that we're getting to all the problems here at Walter Reed.

Are there any other facilities or personnel issues that we need to know about?

JEREMY DUNCAN: From my understanding, I just got currently moved over to Building 14 myself, as of Friday. Our complaint for people living in 18 didn't want to move, because over in Building 18 we had free cable and there were computers downstairs.

From my understanding, now they're moving TVs and computers over into Building 14. How long that's going to take, I'm not sure, but they're just trying to make it better now from the issues we've had before.

And everybody was comparing Building 14 with 18. There's no comparison. Building 18, honestly, I hate to say, it was like ghetto. It was tore up. It had nothing. But it had the stuff that we like to have.

Building 14 was luxury, but it didn't have the same things we had over in 18, which now they're fixing. So, in my opinion, they're starting to make it look better.

Everything's turning back toward the Malogne House. The Malogne House was like -- if you've been in the Malogne House and you moved out, you hated it. But you lived in the Malogne House, you were living the life. It was great. You had a kitchen downstairs, had food and everything, ready to go.

So, I mean, they're trying to make it better. I will give them that. But that's going to take a while for them to do that.

COOPER: The U.S. government, under the so-called BRAC round, has scheduled the closure of all of Walter Reed in a few years and to move everything over to the Bethesda campus.

COOPER: What opinion, if any, do you have about that shutdown of this entire facility and move over to the Bethesda campus?

JEREMY DUNCAN: Like I was telling the press, there's no reason -- you can't use that for an excuse: "We're closing down in so many years."

There are still soldiers coming in today and tomorrow and the next day; that the stuff needs to get fixed here now before those problems get worse for the new soldiers coming in.

Myself, I've got two months left here at Walter Reed and then I'm going back to my unit. I'm not sure how long Sergeant Shannon has. But I'm sure, when he leaves, the guy behind him is not going to live in the same conditions or deal with the same problems that we're having now.

Those need to get fixed before Walter Reed closes down. That's not an excuse.

COOPER: Thank you, Mr. Chairman.

TIERNEY: Thank you, Mr. Cooper.

Mr. Van Hollen?

VAN HOLLEN: Thank you, Mr. Chairman.

I want to thank all of the witnesses for testifying as well and add my voice to those who have thanked you and your families for your service to the country and the sacrifices you have made.

And, as Mrs. McLeod said, you know, you and your loved one's been fighting a war; you shouldn't have to come back here and fight a system. And I think that's absolutely correct.

And we need to make sure that the system provides you the respect you need. And what we've heard, unfortunately, is a system that has been providing more neglect than respect, at least with respect to outpatients that we're dealing with.

And as others have said, I think you've done a terrific service to the country. And if you look at the front page of today's Washington Post, you'll find that, because of the issues you've raised here at Walter Reed, others around the country who are facing similar circumstances will have their voices heard and will be empowered now.

So you have done a great service not just here at Walter Reed, but around the country as well.

We all hear from time to time about those insurance companies that tell people, you know, "We want to take care of you when you're in trouble," and advertise as such. But, when the time comes to pay claims, for certain insurance companies, they're not there. And they try and make their money -- make their savings by denying claims.

That's clearly not a model that we want the United States government and U.S. military to be following.

VAN HOLLEN: But from your testimony about your own personal circumstances, as well as other stories, as well as reports from the GAO and others, clearly when it comes to disability claims, it does appear that the system has been stacked against individuals like yourself and your loved ones.

Mr. Waxman quoted from a statement Mr. Chu made in 2005 suggesting that the health care we have to provide to our veterans is somehow a burden on the system that we somehow shouldn't be having to deal with.

Let me ask you with respect to the system itself: GAO essentially has said -- and I do want to mention their report -- in conclusion -- they issued a long report about the disability -- military disability evaluation system back in 2006. They concluded that, "DOD is not adequately monitoring disability evaluation outcomes in reserve and active duty disability cases," and said that there had been a lack of training, a lack of monitoring, and a lack of oversight.

And it's clearly an area I think this committee is going to be taking a look at, and other members of Congress, other committees in Congress.

Do you have any specific recommendations with respect to that disability system, which clearly seems to be designed more to, essentially, put an overwhelming burden on the individual seeking to show that their disabilities have been related to their service and not providing an ample opportunity for the individual? I don't know if you have specific recommendations with respect to that process.

MCLEOD: Well, that process, like I said, we were fortunate, and we took the compensation because he got the 50 percent.

The thing about it is, they never acknowledged that he has a brain injury. So they didn't compensate -- they compensated for the cognitive disorder.

My thing is, they're so busy trying to make everything acceptable -- several things on his med board was acceptable, but they still retired him. How can everything be acceptable if you're going to be retired?

MCLEOD: That's a little contradictory to me.

They gave him -- for the anxiety and for the cognitive disorder, they gave him the 30 percent with the attitude, in April of next year, when we have to come back, he's going to be better.

Well, if he's better -- which I really at this point don't see happening -- if he's better, he'll lose that rating and guess what? He'll get a severance package. And then he'll have nothing.

I don't think -- if the injury warrants it, I don't think there ought to be a TDRL. The brain injury is permanent. What they've told him is, compensatory measures. If he hadn't had a brain injury, why we they teaching him compensation measures to help him out? That's contradictory again.

My thing is, if you warrant a compensation, it ought to be permanent, not something you've got to bargain for 18 months down the road. And then we may not have insurance. Then we're going to have to get all his treatment at the V.A.

What about families? What are they supposed to do?

I'll have nothing. But all because we still have to bargain up to five years with the Army. He didn't bargain when he signed the line, he didn't bargain when he got injured. Why are you bargaining now?

VAN HOLLEN: Thank you, Mrs. McLeod.

Thank you.

TIERNEY: Mr. Hodes?

HODES: Thank you, Mr. Chairman. Thank you for holding these hearings.

And to the witnesses, thank you so much. You have been very brave. And your courage is being heard around the country now. And it's very important -- what you have done in shedding light on what's going on here is very important.

And I know that the feelings that we feel hearing what you're saying are only a very small, little piece of the feelings you've felt and what you've gone through. So thank you for being here.

Staff Sergeant Shannon, I want to ask you, you've talked about the help you got from Danny Soto. Do you think that there needs to be some independent office or agency that is committed to fighting for the soldiers in this system?

SHANNON: Yes, I do.

SHANNON: And, to clarify, I haven't received any help from Danny Soto yet. I have guided other people to him and I am sure he's helped many others. But I have not been able to start the MEB process -- sorry; to make it easier to understand: the medical retirement process -- because of the hold-ups I've gone through.

And when I get to that point, I'll be looking him up.

HODES: Thanks for that clarification.

Mrs. McLeod, do you think there needs to be some independent office or agency that fights for the soldier in this system, whose only duty is to the soldier and not to the system but to the soldier?

MCLEOD: I think you ought to stop giving it to the committees and give it to the families. That's who you need to be talking to. Give it to the ones that have to deal with day in and day out.

HODES: What do you think the best way for us to give that power, if you will, to the families would be, in your opinion?

MCLEOD: There needs to be a committee formed with a couple of spouses, a couple of people that have the power to get the things done. There needs to be a forum set up to say, "OK, we'll research the families and the situations. We know, because we've been there."

And we need to set action into force. This is what they said they need. Lay it against exactly where we are today and give them what they need instead of sitting there waiting on somebody else to do it.

HODES: Specialist Duncan?

JEREMY DUNCAN: I really have nothing to say on that matter. I mean, I'm not going through the same process as they are. So I mean...

HODES: Thanks.

Staff Sergeant Shannon, your picture appeared on the front page of The Washington Post.

SHANNON: Right.

HODES: Before your picture appeared, I understand that you were reporting to formation once to week. Is that correct?

SHANNON: That's correct.

HODES: After your picture appeared, my understanding is that you were ordered to report to formation daily.

HODES: Is that correct?

SHANNON: That is correct.

HODES: And who gave you that order, after your picture appeared, to report daily to formation?

SHANNON: Those instructions were passed on to me by my platoon sergeant. He said they came from the sergeant major.

HODES: And did you inquire about the reason for your being ordered to report to formation daily after your picture appeared in The Washington Post?

SHANNON: I just follow orders.

HODES: Did you consider that retribution against you for going public with your story?

SHANNON: I really couldn't say. I mean, they tell me to stay home because I tend to break things if I hang around too much, and I don't work well in complex environments.

So when they told me that, I'm like, "Fine." And the next time I decide to break somebody's arm or smash a piece of furniture or something, they'll just tell me to go back to my room again.

HODES: Specialist Duncan, have you experienced anything that you think might be retribution for your going public?

JEREMY DUNCAN: I can't say exactly maybe for sure it yes but, I mean, all of a sudden moving of rooms, moving from building to building, just all of a sudden quickly -- all I asked them to do was fix the walls, not move me a million times. (inaudible) some soldiers, I'm tired of moving rooms. I've acquired a lot of things being here for a year, and moving's not fun anymore. I'm just tired of moving here, moving there. I just want you to fix it so I can deal with it.

HODES: Mrs. McLeod, you had to end up coming to a member of Congress to get help for your situation.

MCLEOD: Yes, sir. After that, I think they were afraid to retaliate.

HODES: Thank you.

Thank you all very much.

TIERNEY: Thank you, Mr. Hodes.

Mr. Welch?

WELCH: Thank you, Mr. Chairman.

I just want to thank the witnesses. I'm at the end of the line here, and I want to tell you that it's been a very moving experience for me to hear each of you tell your stories.

My concern is that this is the tip of the iceberg. My concern is that there is a culture of disregard that has no place in how we treat wounded veterans. And my concern is that there is a lack of commitment to recognize the obvious, and that is that the cost of the war has to include the cost of caring for the warrior.

I'm going to yield the balance of my time because I appreciate that you have been answering lots of questions, and my questions have been asked and very eloquently answered. So I thank you for your service.

TIERNEY: Thank you, Mr. Welch.

Mr. Cummings?

CUMMINGS: Thank you very much, Mr. Chairman.

I, too, thank all of you for being here today. And as I listened to your testimony, I just said to myself: This should not be happening in America. It sounds as if we have a system which should be in intensive care and appears that we're putting Band-Aids on it.

And, as I listened to you, you know, I was just wondering, you know, in another hearing, in another committee -- I sit on Armed Services also, and we had, Sergeant Shannon -- and to all of you -- some testimony that there was a lack of psychiatrists and mental health people in the military, and that they were trying to find more.

CUMMINGS: The mental health piece of the treatment here, how have you found that?

JEREMY DUNCAN: I've had no problems with it, sir.

CUMMINGS: Have you, Sergeant Shannon?

SHANNON: Well, I have a big problem with their mental health thing, starting with their traumatic brain injury testing, OK?

First of all, they tell me I have no loss of cognitive function. Well, how can they do that if they give me a traumatic brain injury test that, in my opinion, my six-year-old son could pass, because it's designed for severely traumatically brain-injured people.

I know myself, and I know I have paid a price for the brain injury I received. And if they can't even take the time to bounce scores from tests I could take today that I've taken before and see what the difference is, I've got a big problem with that.

Now, the counseling and everything that they give, from the psychiatrist to the psychologist, PTSD counseling, I believe they're running a tremendous program. And we have access to a program called Polytrauma Recovery, and it's a tremendous program run out of the Washington, D.C., V.A.

However, the biggest problem they have is none of the servicemembers will receive benefit from that program until each individual soldier has reached a mental state where they're willing to go seek that treatment.

CUMMINGS: One of the questions that I've asked some members of the Joint Chiefs of Staff in this other hearing -- it went to the Bob Woodruff piece that ran on ABC News a few nights ago with regard to brain trauma and trauma to the head, and how people can get treatment here at Walter Reed, for example, but then when they go back to their rural areas or wherever they may go, to small towns or whatever, they were not able to get follow up, and so they found themselves going backwards.

Is that a concern of yours, Staff Sergeant?

SHANNON: Absolutely. It is very much a concern of mine, for me, starting with the beginning of the process of seeking the treatment, where I was told, "Well, you're not a bad enough brain injury to need the Polytrauma Recovery."

SHANNON: And I, you know, I got angry enough I had to get up and leave. Usually when I've gotten angry and -- well, I'm a sergeant -- bad language starts coming out of my mouth. And that's the point where I know a trigger's coming and I'm going to get violent.

But they tell me I don't have a bad enough brain injury to need treatment. I have found out, since then, I'm clearly a level two polytrauma recovery person -- the point being that proper supervision would be the word I would have to use in relation to that subject.

They have discovered that men suffer post-traumatic stress disorder symptoms from concussive force to their heads. We get mortared every day over there, depending on where we're working.

Just because a guy's not got a visible injury doesn't mean he hasn't got PTSD.

CUMMINGS: What about you, Ms. McLeod, with regards to your husband?

MCLEOD: When my husband was here, they gave him psychological evaluation treatment because they thought it was just a transition problem. I kept fighting and fighting. I knew there was something wrong. When they sent him to Virginia, he was treated there as well.

When he came back, he got so out of hand that a friend of ours, who her husband's a brain injury patient, she actually took him to her husband's psychiatrist. And that's how he got settled with a psychiatrist.

They never offered him any psychiatric treatment.

CUMMINGS: Well, let me say this, that -- I have about 30 seconds left -- what I'm hoping for is that we will not -- or not us, but even other congressmen in five years -- will not be sitting here going through these same things.

Hopefully, with Secretary Gates looking at this system and having this system revamped, we'll be able to resolve a lot of these problems.

And we thank you very, very much for you service. And we can do better as a country. We must do better.

MCLEOD: Thank you.

TIERNEY: Thank you, Mr. Cummings.

Ms. Norton?

NORTON: Thank you very much, Mr. Chairman. And I thank you, and Chairman Tierney, and Ranking Member Davis and Shays for your courtesy.

I'm a member of the full committee, not of this subcommittee. I'm very proud of this hospital all my life. Have been proud to have it in my district. I just want to say, for the record: All the indications are that it is still the crown jewel; it's still the state of the art hospital on the planet for treating soldiers like you.

To say thank you for your service sounds so shallow after what you've gone through, both in battle and here, that I want to just move first to Ms. McLeod. Because thank you for service -- it must include you, who have been apparently a volunteer caseworker with considerable family sacrifice, having to give up home and job to come here.

NORTON: I was very concerned you said, "What about those who don't have me?" Because that's what I've been thinking as a mother the whole time: What about those who don't have Mrs. McLeod?

May I ask, I mean, when you said you didn't even know -- you weren't even informed when your husband was wounded, were you ever officially informed that he was wounded?

MCLEOD: No.

NORTON: Unbelievable. So somehow...

MCLEOD: No one from the Army ever picked up the telephone and called and said, "There's been an accident." Nobody called me. He called me himself.

NORTON: This, I think, points to the systemic nature of the problem. It begins on the battlefield and carries through throughout the life of a soldier.

Let me ask you, all three of you, roughly -- you cannot know, you've not done a census, but you have been around this hospital. Roughly what percentage of soldiers are here without family, are here by themselves?

JEREMY DUNCAN: I would say about 25 percent or so, maybe less. I've seen a lot of people here just by themselves...

NORTON: Twenty-five percent are here with family?

JEREMY DUNCAN: Without.

NORTON: Without family.

JEREMY DUNCAN: It could be less.

NORTON: So 75 percent of the soldiers here have some family here. Is that your sense as well?

SHANNON: I'm not sure I would go that high, but definitely in the high range.

And one of the things that I believe is being discovered right now is that having a caring family member close during this time of recovery is incredibly beneficial to these soldiers as they go through this process.

These people understand them. Sometimes they are not coherent, based on medications and things, and it takes someone with intimate knowledge of that individual and how they were on a daily basis before to understand some of what they're trying to get across and some of what they're going through based on their knowledge of them before.

NORTON: Mrs. McLeod, I appreciate what you said about, well, you know, leave it to the families, because families obviously want to take care of their folks. But the fact is, there are very few women like you in the United States today who can give up everything and move here.

I won't have much time, so I want to move on to beyond accountability -- they fired some people, you know, they knew they had to do something -- I want to move to remedy.

NORTON: And given the systemic nature of the problem, that a soldier's life may be on dozens of computers which don't talk to one another, and the rest.

I'm not focused so much on long-term remedies. Because I think that, you know, the Army can plunge into long-term remedies and we have the same situation we have now.

We learn, for example, that a soldier could come here and not know -- not even given a piece of paper, at one point, at least, saying, "OK, this is what you do, A, B, C." These are the kind of short-term guidance you would expect for any wounded soldier. You might not expect that for Eleanor Holmes Norton; she's supposed to be able to know, if she comes, to find the doctor.

But let me ask you, given the systemic nature of the problem, whether or not a remedy might involve immediate assignment of people who have no -- given what you've said about conflict of interest and the rest -- no obligation to anybody but the soldier, and how many such -- not how many but, if that was to happen, should it be from veterans' organizations?

TIERNEY: Who would you like to direct that question to, Ms. Norton?

NORTON: I would like to direct that to anyone who could give me -- basically, it is, if you think the soldiers would be better treated if there were people outside of the system -- the first people that occur to me are people from veterans' organizations. Would those be people who would be most likely, in the short term, to be responsive to the needs you have discussed in your testimony?

TIERNEY: Would one of you like to respond to that?

SHANNON: No question in my mind. They've been through it. They need to be advocates for it.

And when it comes down to -- well, like my total -- being lost completely in the system when I went outpatient, when I complained about it, they informed me that I had spoken to someone within 24 hours of my arriving at the hospital.

Anybody want to laugh?

I was under a lot of medication. I have no knowledge of anybody speaking to me within that time frame. In other words, they need to assess the patients and give a time -- say, brief them when they go outpatient, instead of when they arrive on an aircraft from Germany.

TIERNEY: Thank you.

The gentlewoman's time has expired. And all time has expired for questioning.

I want to thank, on behalf of all the committee members and everyone else, your willingness to come here, your commitment, and the...

(APPLAUSE)

... sacrifice that you've made (inaudible).

(APPLAUSE)

We all wish you a speedy recovery, for those of you that are injured, and Dell, as well, Mrs. McLeod, and for you, your situation, fees (ph).

Your coming here is a continuation of your service. I think you've really benefited others that will come through here and others that are presently in the system somewhere. And hopefully we'll be able to take your testimony and work toward improving situations as well.

So with that, we thank you very, very much. We'll allow you to take your leave now, step down. And we appreciate all of your time and commitment. Thank you.

Now we'll invite our second panel, also, to take the seat as soon as they can.

TIERNEY: Thank you, and welcome all of you.

I'd like to begin by introducing our panel. On this panel, we have Lieutenant General Kevin Kiley, M.D., the surgeon general of the Army and the past commander at Walter Reed. We have Major General George Weightman, former commander of the Walter Reed Medical Center and North Atlantic Regional Medical Command. And we have Ms. Cynthia Bascetta, the director of the health care department at the United States Government Accountability Office.

Welcome to you all. Thank you for coming today.

As you've heard before, it's our policy at the subcommittee to swear you in and testify. I'd ask you if you'd rise and raise your right hand, please.

Do you swear to tell the truth, the whole truth, and nothing but the truth?

Thank you.

Reflect that all of the witnesses answered in the affirmative.

And with that, if we might, I would like to ask each of you to give a brief summary of your testimony. Your full testimony will be entered in the record. You have five minutes, so obviously we'll try to keep as close to that time as we can, and we'll try to give you some indication that you're nearing the end, if we can.

So we'll start with Lieutenant General Kiley, please.

KILEY: Mr. Chairman, Mr. Shays, Mr. Waxman, Mr. Davis and distinguished members of this committee, I'm here today to address your concerns about the quality of care, the quality of administrative process and the quality of life for our wounded warriors here at Walter Reed Army Medical Center and across all of our Army.

I'm Lieutenant General Kevin Kiley. I'm the surgeon general of the United States Army and our U.S. Army Medical Command. And as a commander, my first responsibility is for the health and welfare of my soldiers. As a physician, my first responsibility is the health and welfare of my patient.

As we've seen over the last several days, the housing condition here in one of the buildings at Walter Reed clearly has not met our standards. And for that, I am personally and professionally sorry, and I offer my apologies to the soldiers, the families, the civilian and military leadership of the Army and the Department of Defense and to the nation.

It's also clear that the complex and bureaucratic administration systems that support the medical evaluation board and physical evaluation board are complex and demand urgent simplification.

I'm dedicated to doing everything in my power and authority to bring a positive change to this process.

Simply put, I am in command. And as I share these failures, I also accept the responsibility and the challenge for rapid corrective action.

We're taking immediate actions to improve the living conditions and welfare of our soldier patients, to increase responsiveness of our leaders and the medical system, and to enhance support services for families of our wounded soldiers.

We're taking action to put in place long-term solutions for the complex bureaucratic medical evaluation process that's impacting on our soldiers.

Living conditions in Building 18 at Walter Reed are not acceptable. We're fixing them now. And as of this morning, we've moved out all but six soldiers to other, better accommodations on the campus.

Although Walter Reed base ops operations staff has corrected some of the things that you've seen in the paper, we are taking immediate action to begin more extensive renovations of the roof, the exterior. We're going to remodel the bathrooms, put new carpets, new air conditioning units into this facility, to bring it up to what we consider to be acceptable standards.

Lieutenant General Bob Wilson, the commander of the Installation Command, and I have sent a team out across 11 or so installations to look at similar bureaucratic, administrative and clinical conditions -- and infrastructure conditions -- to ensure that our other installations do not have issues associated with here at Walter Reed.

KILEY: So we know that we've had some brick-and-mortar problems, and we're fixing them. But we've got human problems here, too. And this is about soldiers and their families.

American soldiers go to war, and they're confident that, if they're injured, they'll be returned to a first-class medical facility.

It's said that a soldier won't charge an objective out of the sight of a medic. For us, it's the 68-W. And there's a connection between that 68-W on the battlefield, the transportation system, the air evac system, Landstuhl Regional Medical Center and Walter Reed and the rest of our facilities -- that it's unbroken.

And nothing can be allowed to shake the confidence in that system, to include the superb performance of Walter Reed in ensuring that our soldiers are cared for.

Secretary Gates has made it very clear that he expect decisive action. And he and our soldiers will get it.

The system that we use to decide if a soldier is medically fit for continued service -- or, if not, determining the appropriate disability system and transferring him to the V.A. -- is complex, confusing, and frustrating.

What we've realized, over these last four to five years, is the nature of the injuries these soldiers receive is also very complex. And I'll talk about that in just a minute.

The tactics, techniques and procedures we use in the asymmetric battlefield are required to be changed to adjust to our enemies. The procedures that we use in our medical system needs to be changed appropriately, as we see the circumstances surrounding our soldiers and the disabilities change.

And what we really need to do, in my opinion, is to make this whole process less confrontational, less adversarial.

To meet the human factor changes, we're making some adjustments here at Walter Reed. I think you've heard some of that already. We are bringing on more nurse case managers, more Physical Evaluation Board liaison officers, and more physicians to review medical cases.

This will lower the case ratio for case managers, improve communications, and speed the processing of paperwork.

We really need to reinvent this process. And we have a team, now, looking at iterative analysis of the MEB process, the PEB process, to see if we can better improve it.

The two most common complaints we hear from soldiers about the MEB/PEB process is that we take too long or we rush soldiers through.

KILEY: So we need to be very careful to simultaneously provide soldiers the very best medical care that modern science and medicine in America can offer, while at the same time ensuring that the rights of those soldiers -- to a full and equitable analysis -- is protected.

And we will be very careful to protect the quality of the care and the fair assessment of soldier's disability.

We want all of these soldiers to return to their units or to their homes as quickly as we can, but we want them to benefit from a full capability of modern medicine. We want to do it right.

Your Army medical professionals have earned a tremendous reputation during this war. The marvels of modern technology have allowed us to bring more soldiers off the battlefield, increase their survival rates.

The training of our combat medics and our front-line surgeons, the equipment we've placed, as I referenced earlier, our Air Force counterparts and their CCAT teams, moving soldiers, sailors, airmen and Marines are around the world is unprecedented. We can bring soldiers from the battlefield to this great facility in 36 hours or less.

TIERNEY: General, your comments are going to be put on the record. So if you can help us by just concluding.

KILEY: I will, sir.

TIERNEY: Thank you.

KILEY: In summary, I'd say that the staff here at Walter Reed, the technologies we have applied, and the unwavering support of Congress and the American people have made all this happen.

It's regrettable that it took The Washington Post to bring some of this to light but, in retrospect, it will help us accelerate the process of making change and improving things.

I'm committed -- personally -- to regaining the trust of the American people, of soldiers and their families everywhere that our Army Medical Department system can be trusted and that it is the best in the world.

I've served in the Army for 30 years as a physician and a soldier taking care of patients and serving our nation, and I remain honored to command and lead the great men and women of the Army Medical Department.

KILEY: Thank you, Mr. Chairman.

TIERNEY: Thank you, General.

General Weightman?

WEIGHTMAN: Mr. Chairman, Congressman Davis, Congressman Shays, distinguished members of the committee -- I appreciate the opportunity to appear to day to discuss the problems about which we're both concerned brought to light at Walter Reed Army Medical Center.

I am Major General George Weightman, and I commanded the North Atlantic Regional Medical Command and Walter Reed Army Medical Center from 25 August, 2006, until last week.

Secretary of Defense Gates, all of our Army leaders, and you have called this a failure of leadership.

I agree.

I was the Walter Reed commander and, from what we see, with some soldiers' living conditions and the administrative challenges that we faced, and the complex Medical Board/Physical Evaluation Board processes, it is clear mistakes were made and I was in charge.

We can't fail one of these soldiers or their families, not one. And we did.

There's another point on which I believe we should agree, because it's important that American people and our soldiers in harm's way believe that both inpatient and outpatient medical care delivered by the professional health care team at Walter Reed are superb.

They're not two separate medical systems of care at Walter Reed -- outpatients are seen by the same doctors and nurses as the inpatients. Outpatient medical care is not second class. It's on par with our inpatient care.

You have seen this on your visits, and our soldiers and families deserve it.

Having said that, I acknowledge that our problems and frustrations with the process of accessing and following up on that outpatient care, and we are aggressively seeking ways and implementing solutions to make that system more responsive, more efficient, more effective and more compassionate.

We did not see where some of these soldier-patients were living, and we should have. There are 371 rooms in Walter Reed, where we house our outpatients at Walter Reed. Twenty-six rooms in Building 18 were in need of repairs.

We should not have allowed that to happen, because our soldiers deserve better and it is important to their overall rehabilitation and well-being, which is entrusted to us.

Also, we did not fully recognize the frustrating bureaucratic and administrative processes some of these soldiers go through. We should have, and in this I failed.

WEIGHTMAN: Over the last two weeks, we have heard of problems from months and years ago, many of them individually fixed immediately. But we obviously missed the big picture, because not one of those soldiers deserves to be dissatisfied.

I'm disappointed that I will not be able to continue and lead the changes we must make to care for these soldiers and their families, but I respect the Army's decision. I retain, and I hope that you would share, the confidence in the abilities of the Army leaders' commitment and the Army medical department's wonderful health care professionals to care for soldiers and create the innovative and long overdue process changes we all agree are needed.

Thank you, Mr. Chairman, for holding this hearing. I hope my testimony today will allow us to address these problems and start to reaffirm America's confidence in Walter Reed Army Medical Center.

TIERNEY: Thank you, sir.

Ms. Bascetta?

BASCETTA: Mr. Chairman and members of the committee, thank you for inviting me here to discuss GAO's work on the challenges encountered by soldiers who sustain serious injuries in service to our nation.

Our work has shown the array of significant medical and administrative challenges these soldiers face throughout their recovery process as they navigate the DOD and V.A. health care and disability systems.

As you know, glass and fragments from IEDs, landmines and other explosive devices cause about 65 percent of their injuries, and many more of the wounded are surviving serious injuries that would have been fatal in prior wars. But the miracle of battlefield medicine is also the enduring hardship of the war borne by the soldiers and their families.

Following acute hospital care, their recovery often requires comprehensive inpatient rehabilitation to address complex cognitive, physical and psychological impairments. This exacts a huge toll on the patients and their families.

My testimony today is based on conditions we found during the time of our audit work regarding problems with the sharing of medical records, provision of vocational rehabilitation, screening for post- traumatic stress disorder and military pay.

BASCETTA: In 2006, we reported that DOD and V.A. had problems sharing medical records for servicemembers transferred from DOD to V.A. polytrauma centers. These V.A. facilities were mandated in statute to help treat seriously injured active duty service members returning from Iraq and Afghanistan.

Yet, two V.A. facilities lacked real-time access to electronic medical records at DOD facilities. V.A. physicians reported a time- consuming process involving multiple faxes and phone calls to get information they needed to treat their patients.

I emphasize that these are patients still on active duty, not veterans.

About three weeks ago, it was reported that DOD cut off V.A. physicians' access to DOD medical record because the two bureaucracies had not finalized data-use agreements.

It's hard to fathom such action and the potentially adverse effects that it could have had on patient care.

In 2005, we reported that seriously injured soldiers may not be able to benefit from early interventions services provided by V.A.

GAO put federal disability programs on its high-risk list in part because they lack focus on returning people with disabilities to work. The importance of early intervention for restoring injured persons to their full potential is well documented in the literature.

But DO expressed concerns that V.A.'s efforts to intervene early could have conflicted with the military's retention goals.

Meanwhile, soldiers treated as outpatients in military or V.A. hospitals were waiting months for DOD to assess whether they would be able to return to active duty.

We recommended that V.A. and DOD collaborate to reach an agreement for V.A. to have access to information that both agencies agree is needed to promote recovery and return to work, either in the military or in the civilian sector.

BASCETTA: Also in 2006, we reported that DOD screened service members for PTSD as part of its post-deployment health assessment, but could not reasonably assure that those who need referrals received them.

We found that only 22 percent of those who may have been at risk of developing PTSD had been referred for further mental health evaluation.

DOD had not identified the factors its clinical providers used in making referrals but concurred with our recommendation to do so.

As early as 2004, we also reported that officials at six out of seven V.A. facilities were concerned about meeting an increasing demand for PTSD services from new veterans returning from the war.

They estimated that giving priority to these veterans, as they had been directed to do, could delay appointments for veterans already receiving PTSD services by up to 90 days.

Compounding their health and rehabilitation struggles, we reported to this committee, in 2005 and 2006, that problems related to military pay had resulted in overpayments and debt for hundreds of sick and injured soldiers on active duty and in the National Guard and Reserves.

Hundreds of combat-injured soldiers were pursued for repayment of debt incurred through no fault of their own, including at least 74 who were reported to credit bureaus and collection agencies.

As a result of our audit, we understand that manual overrides are in place to help prevent this problem, but that the underlying payment systems have not been fixed.

We also found that administrative problems had caused some injured Reserve component soldiers to be dropped from active duty. And for some, this led to significant gaps in both pay and health insurance.

In summary, I would not want to overlook the dedication and compassion of the many providers we've met at DOD and V.A. facilities throughout the course of our work.

BASCETTA: But the cumulative message from our body of work is that too often our wounded soldiers have been poorly served or at risk of falling through the cracks of the two bureaucracies responsible for their health and well-being.

I'd be happy to answer any questions you might have.

TIERNEY: Thank you, Ms. Bascetta.

General Kiley, I understand that you might have some time constraints. We can either address questions to you and go through a round and then go back to the other two panelists or, if you can, can you stay and we'll deal with it as a panel?

KILEY: Sir, you know, I'm at your discretion.

TIERNEY: Thank you.

KILEY: However you'd like to do that.

TIERNEY: Thank you.

General Kiley, you were in charge of this facility at Walter Reed from 2000 to 2004.

KILEY: Correct.

TIERNEY: How many months were you here all together?

KILEY: I believe I assumed command in June. So it was just about 24 months. I hadn't stopped to...

TIERNEY: Just about a full two years?

KILEY: Yes, sir.

TIERNEY: And following you was -- was it General Farmer?

KILEY: Yes, sir.

TIERNEY: And he was here from 2004 through July of 2006?

KILEY: Yes, sir. Early August, I think.

TIERNEY: And then, General Weightman, you came in in July of '06 to March of 2007; a relatively short period of time compared to your predecessors?

WEIGHTMAN: Yes, Mr. Chairman.

TIERNEY: Now, General Weightman, when you came in, platoon sergeants, case managers, there was a significant gap in the ratio -- there was a lot of soldiers, 125, 130, to each platoon sergeant, was that correct?

WEIGHTMAN: No, sir, that's not correct.

TIERNEY: What is the number that was there?

WEIGHTMAN: The ratios that you cite were present when we peaked out of our MedHold -- the MedHold Over population in the summer of 2005.

TIERNEY: Before you even came?

WEIGHTMAN: Yes, sir.

TIERNEY: OK.

WEIGHTMAN: And at that point, I realized we only had one company to take care of all of those soldiers.

In January of 2006, just over a year ago, a second company was created. And that's when we split out the active duty wounded warriors into the medical hold company. And that's when the ratio dropped down from 1:125 to 1:50 to 55 for the active duty soldiers.

KILEY: And for the MedHold Over soldiers, the reserve component soldiers, that ratio is 1:25.

TIERNEY: Thank you, sir.

And you are quoted in one of the articles that appeared, saying that you had also ordered your staff to focus on a high risk priorities such as PTSD.

Was that not the case before you made the order, that the focus wasn't to the level that you wanted it to be?

KILEY: Sir, it became apparent to me that we need to focus on two different groups. We needed to focus on the groups that had been here the longest, to see why they had been here so long, and if it was bureaucratic or clinical hurdles that they were still facing. And there was another group that we found that had either a history of substance abuse, behavioral health issues, domestic violence or alcohol abuse that we wanted to keep a very close eye on to make sure that they got the care in an expeditious manner that they could.

TIERNEY: None of these things were new to your watch, though. These situations had been as predominant in General Farmer's watch and presumably before that as well. Correct?

KILEY: Yes, Mr. Chairman.

TIERNEY: At some point in time, General Weightman, the garrison commander, Peter Garibaldi, sent an internal Army memo to you, talking about the situation here, with competitive sourcing initiative, the president's initiative allowing the Office of Management and Budget under what they call the Circular 76 to -- the A-76 -- allow you to bid out to private contractors, let them submit a bid in competition with the federal employees and that process.

And I think, you know, some of us were looking at that memo, and we're a bit disturbed, because it seemed to call to your attention issues in reduction in force and the reduction of those employees that was a pretty substantial falloff.

And the commander's comments to you were basically that there was a great risk to the whole operation here as a result of that sharp decline.

He warned that the workload had grown exponentially since September 11th, obviously, because of the wars in Iraq and Afghanistan; that without favorable consideration of the request for increased staff, that the entire base operations and patient care services are at risk of mission failure.

Can you tell us what led up to his writing that memo to you; and then what action you took with respect to that memo; and what response, as you pushed that up the chain, occurred?

KILEY: Yes, Mr. Chairman, the A-76 process has been going on for, I think, about three or four years here, at Walter Reed. And it's been bounced back and forth, who wins that contract, whether the government does or the independent contractor.

As a result, I think that, not knowing what was going to be, in the future, has affected the work force, and particularly the one on garrison operations.

When Colonel Garibaldi floated that memo to me, it was outlined where -- in what areas that we were at greatest risk.

We passed that memo up to our headquarters and got support from them. However, I will add, at that point, that about that same time or within a month or two after passing that memo up, we got support for that but we were not able to hire the additional workers that we requested because the contract had been awarded to the contractor, government services. And previously the government had performed all those services itself.

So we had trouble attracting all the necessary people that we needed to those positions.

TIERNEY: It's reported, General Weightman, that, in September of 2004, the Army actually determined that the in-house federal workforce at Walter Reed could perform the support services at a lower cost than the bid that was received for the outside contractor, which was IAP Worldwide Services.

Despite that, there was an appeal taken. And we've seen no record of why this happened, but apparently, certification of the federal employees was withdrawn; unilaterally, the employee bid was raised about $7 million. And the determination was reversed in favor of the private company, IAP.

Can you tell us about that process and what happened there?

WEIGHTMAN: No, sir, I cannot. That happened before I came.

TIERNEY: As a result of that, a number of people -- at least according to this memo, it went from about 300 people down to about 60 on February 3 of 2007.

Had you see your personal decline to that degree?

WEIGHTMAN: Sir, not to that degree. They did decline. From a workforce, normally, of about 190, it declined to close to 100. It did not get down to 60, but it did get down to 100.

TIERNEY: Thank you.

Generally Kiley, did this process of the competitive sourcing initiative happen on your watch?

KILEY: Yes, sir. It began on my watch. And then the issues of awarding the contract, first to the MEO and then the appeals, was after I left Walter Reed and took command at MEDCOM.

TIERNEY: So you were not there when the reversal of determination came over from the federal employees to the private contractor?

KILEY: I think that was in the fall of '04, sir, and I was not the commander then.

TIERNEY: So where is General Farmer these days?

KILEY: Sir, I think he's retired.

TIERNEY: He's retired?

And would it have been on his watch, then, that that whole process would have played out and, at some point, the private contractor would have been given the award for $120 million over five years?

KILEY: Yes, sir. Under the direction of the Army, the contracting services that manage those -- and I don't know specifically the name of that. General Farmer would not specifically make the decision as to who to award the contract to. Those decisions are made, I believe, by Army, not by us, if I'm correct on that.

TIERNEY: Mr. Shays?

SHAYS: I'd like Mr. Davis to go, and then I'll just follow him...

TIERNEY: Mr. Davis?

DAVIS: I mean, I think these problems are far more systematic than going back to an A-76 or anything else, or even some of the things happening just right here on the post. What you have is a number of stovepipes. You have the Army not talking to the V.A., you have the National Guard and the Army not speaking to each other, and people are falling through the cracks.

Ms. Bascetta, would you agree with that?

BASCETTA: Yes, I would.

DAVIS: These are systemic problems that have been -- really, we've known about these for years, haven't we?

BASCETTA: That's correct.

DAVIS: And this recent manifestation really shouldn't surprise anybody. In fact, when I look back at a memorandum of the 12th of October, 2006, this is after Walter Reed officials were asked to attend our committee's quarterly briefing on medical holdovers, I requested a copy of the assistant secretary's analysis and review, their SAR report.

This review was conducted by individuals from all the medical commands involved in all of the processes, including installation management. It clearly indicates the review teams had concerns with Building 18 billeting, staffing, the soldier's handbook, training, outprocessing, separation transition, patient transportation, and the medical evaluation boards.

Attached to the review is a memo that was signed by Colonel Ronald Hamilton, the commander, that indicates that you, General Weightman, and General Kiley, received a copy of this review in October.

Do you remember receiving a copy or getting briefed on it?

WEIGHTMAN: Yes, sir, I do?

DAVIS: How about you, General...

KILEY: I believe I did, too, yes, sir.

DAVIS: So it really wasn't The Washington Post.

DAVIS: You knew these were problems. You may not have known specifically what it looked like, and you may not have been able to put faces and stories behind it, but this was an ongoing concern, wasn't it?

(CROSSTALK)

KILEY: Well, yes, sir. And it was not just at Walter Reed. We were concerned about medical holdover operations and medical hold operations at all of our installations.

DAVIS: So what did you do when you saw this report in October? We know what you're doing now, after the Post articles. What did you do in October to try to stay ahead of it?

KILEY: My staff informed me that the Walter Reed staff was working it, that they recognized that there were issues, and that they were taking action.

WEIGHTMAN: Sir, may I...

DAVIS: Yeah, please.

WEIGHTMAN: ... address some of the specifics on that?

We realized that to address some of the problems with how long it took our patients to get through the medical board process that we needed more physicians trained on the MEB process and to help move those records. So we added three different physicians part-time to work on those records. And we also designated an O-6 (ph), a colonel, to be in charge of that whole process.

We also recognized we didn't have enough of the PEBLO counselors available. And I think you've already heard from previous testimony their role in counseling, in being the patient's advocate in this whole process -- realized that they needed more training and that they were inadequate in number. So we've increased those, and that started after this report.

We also realized that we didn't have enough of the case managers, as well, to work with the patients within the medical hold and medical holdover companies. And we began active recruiting efforts for those as well.

DAVIS: General Kiley, you're no stranger to this committee. You cam before us in 2005. During your testimony, at that point, you assured us that improvements were being made to the medical holdover process. This was at the point that we had numerous soldiers come up and talk about how they'd fallen through the process, how they languished, their orders would be -- they'd leave from the Army and go back to the Guard, and they were in a kind of a limbo.

And you report at that point, you state under oath, "MHO soldiers can expect their treatment and recovery experience to meet or exceed that of the active component, because the Army's surgeon general has made their care the medical treatment facility's top priority." That was your position at that point.

KILEY: Yes, sir.

DAVIS: But it didn't happen, did it?

KILEY: Sir, you know. In my role as the MEDCOM commander, Walter Reed was not my only command. The southeastern and (inaudible) with Brooke and Tripler.

In my discussions routinely with my senior commanders, we discussed the issues of medical holdover processing, because we had often heard -- I had heard as the Walter Reed commander that our Reserve and National Guard soldiers felt like they were not getting the same priority as active duty.

KILEY: So I made it clear that, at a minimum, there would be no difference. And in many cases these soldiers -- because they were staying at our camps, post and stations instead of going home -- there was a sense of urgency to get them to the head of the line, to get the evaluations done.

And in my comments about a good-news story was the numbers of soldiers that we were able to heal and return to the force, on the order of magnitude of a 80 percent of those soldiers on MedHold Over.

So my take on this, and my comments to your committee were that, that while we have problems and we continue to have those problems, we were still caring for and healing and returning to the force a large number.

DAVIS: General, our problem -- I think -- is a systemic problem...

KILEY: Yes, sir.

DAVIS: ... that we have more people coming back than was anticipated. We have antiquated systems integrating the Reserves and the Guard and the Army back and forth. It's a paperwork nightmare. It's a labyrinth that you'd need a Ph.D. in law degree and you still couldn't navigate yourself through.

And the frustration of these poor, injured veterans coming back -- it is systemic. And I'm afraid this is just the tip of the iceberg; that, when we got out into the field, we may find more of this.

Ms. Bascetta, do you have any comment on that? If you'd look at it, is that a fair analysis, that this was...

BASCETTA: I think that, certainly from our work, it would warrant a top-to-bottom review of the situation across the country.

DAVIS: We keep putting a Band-Aid on something; it needs a complete overhaul, it seems to me.

BASCETTA: Correct.

TIERNEY: I thank the gentleman.

Mr. Waxman?

WAXMAN: Thank you, Mr. Chairman.

General Kiley, according to a Washington Post article on Saturday, former Army Secretary Francis Harvey described a telephone conversation that he had with you. And he said that after the Walter Reed story broke in The Washington Post, you called him and lambasted The Washington Post report of squalid conditions, and you said the Post story was "yellow journalism at its worst."

Did you tell the Army secretary you thought the Post story was "yellow journalism at its worst"?

KILEY: Sir, I had, as I remember, a couple of conversations -- from the start of the publication in The Post -- with the secretary. I believe one was in person.

I had a discussion with him over an article in the Army Times where he asked me to call him back and I called him back, told him I would go through that.

And then I had a discussion with him when he called me to inform...

WAXMAN: Whatever discussions you had with him, did you say to him that that report was "yellow journalism at its worst"?

KILEY: I don't believe my comment (inaudible) was directed at the larger report, but a follow-on article that took a series of facts that included me and began to say that, you know, what did I know and when I did I knew it. And I didn't think that was necessarily a fair article.

WAXMAN: You're talking about the Washington Post articles?

KILEY: All of them. Yes, sir.

WAXMAN: OK. Are you denying the accounts of the soldiers in the Post article or what happened to these soldiers?

KILEY: No, sir. No, sir.

WAXMAN: Then what were you outraged about?

KILEY: I was disappointed that the articles characterized the fact that I had been the commander from 2002 and that I was aware of some of the circumstances that The Post was revealing in its stories in 2005 and 2006, and that somehow I had known about them, and other parts of that article that I didn't think were accurate.

WAXMAN: So after you left -- when did you leave...

KILEY: I left in 2004.

WAXMAN: After you left, you didn't know what happened here?

KILEY: No, sir, that's not correct.

But I was the next higher commander. I had a two-star commander in command managing Walter Reed as well as the North Atlantic region. And as with General Weightman, we had routine video conferences to talk about issues, not just related to MedHold Over, but to the BRAC, to A-76.

WAXMAN: You had these conversations complaining about how you were treated in the articles. Did you say in any of your conversations, "We've got to do something; we've got to investigate this problem and straighten it out"?

KILEY: I'm sorry, to who, sir?

WAXMAN: To the head of the Army...

KILEY: Secretary Harvey?

WAXMAN: Yes.

KILEY: Oh, yes, sir.

We talked about getting engaged in finding out what was going on, getting an action plan together to fix those immediate problems that we could fix, and starting to look at the long-term issues, some of which we had already been taking on, to include my TBI task force, the mental health task force, and issues at looking specifically the MEB/PEB process.

WAXMAN: Now, the chairman asked about this contracting out. And this contracting out, according to the memo that was prepared -- which I presume you saw. Is that correct?

KILEY: Colonel Garibaldi's memo?

WAXMAN: Yes.

KILEY: Yes, sir.

WAXMAN: You saw it.

And, General Weightman, you saw that memo as well.

WEIGHTMAN: Yes, sir.

WAXMAN: That memo warned about the mission failure -- in other words, the failure to provide care that Walter Reed was supposed to provide because of the loss of personnel.

There were 350 government employees working here.

WAXMAN: The A-76 process decided to contract out that work to private organizations. But they didn't start for a whole year.

And during that year, the people who knew they were going to lose their job started leaving. They went to the private sector. They went to other places in the Department of Defense. They went wherever they could find new jobs.

So by the time the new contractor took his place, a year later, as I understand it, there were only 60 employees left of the 350.

Do you know whether that's an accurate statement, either of you?

WEIGHTMAN: Sir, I think I addressed that earlier. I believe the lower number was 100, not 60. And I think we had 180 people earlier in the year. So it didn't go from 300-plus down to 60...

WAXMAN: You didn't think it was 350? You think that's an inaccurate figure?

WEIGHTMAN: I believe so, sir.

WAXMAN: OK, so how do you think were here when the contract was let out?

WEIGHTMAN: When the actual -- it was about 100, sir.

WAXMAN: About 100?

WEIGHTMAN: Yes, sir.

WAXMAN: OK. And how many people were still here when the contractor, a year later, took over?

WEIGHTMAN: I'm sorry, sir. I misspoke. When the actual contractor took over on February 4 of 2007, that's when we had 100.

WAXMAN: The memo said that you're short of staff -- contractors were taking over; You're short of staff; the mission is threatened -- and asked for more staff to be hired.

Was more staff hired?

WEIGHTMAN: Yes, sir. I think I addressed that previously. We did get permission to hire more staff. Our ability to hire those additional 80 people was not successful, in that they knew that the contract was coming up, and if they got hired, it would only be for four months.

WEIGHTMAN: So out of those...

WAXMAN: So did the memo ask you to hire 80 more?

WEIGHTMAN: Yes, sir. I believe it did.

WAXMAN: How many did you actually hire?

WEIGHTMAN: Ten, sir.

WAXMAN: Ten.

WEIGHTMAN: Yes, sir.

WAXMAN: And when did they come on board?

WEIGHTMAN: Sir, I don't have that information, but it would be between October and December of 2006.

WAXMAN: Mr. Chairman, the only thing I would raise is, we've contracted out so much of this war. We have mercenaries instead of U.S. military, we have contractors instead of the work that could be done by checking very carefully what kind of job they're doing. And here at Walter Reed at Walter Reed, we had contracted out as well.

And the result of all this is we are, in Iraq, overpaying for the word of the contractors and here we're underserving our military. And something's got to be done about that.

TIERNEY: I thank the gentlemen.

I want to remind you that the comptroller general of the General Accountability Office has made that same point; that the contracting out has raised a problem. I suspect that we'll be exploring that in future hearings.

General Weightman, you said that there were 180 when it first, then it finally went down to 100...

(CROSSTALK)

WEIGHTMAN: Yes, sir.

TIERNEY: So I think those are the numbers, at least, as opposed to 350 and 360.

WEIGHTMAN: Yes, sir.

TIERNEY: Thank you.

Mr. Shays?

SHAYS: What I wrestle with is that there's not anyone involved in this that didn't know there were challenges. Mr. Waxman's gone through a whole host of reports, which he and I both can read and do read.

How can we know when a problem is being addressed? In other words, this committee has had hearings, and the word is back; it's getting taken care of.

Is it something where we need to have hearings every two months?

And is there a mindset that, to be a good soldiers you've got to basically, you know, stiff upper lip and just tell Congress, you know: We're taking care of it and so on when you know you don't have the resources necessary to take care of it?

SHAYS: I mean, that's what I'm wrestling with. I feel like in some way some people are going to take the hit on this. And are they taking the hit because they didn't tell us?

Because frankly -- I'll just make this last point -- these problems are huge. The only reason why this story got attention is there was something visual, there was mold on a wall. But the mold on the wall is, in fact, the tip of the iceberg.

And so help me out. Because you're going, and people are going to say it's going to be taken care of, and in two weeks from now or two months from now -- how do we know it is?

KILEY: Sir, I agree with you. The mold is brick-and-mortar issue. We've got it fixed in Building 18. We are examining all the rest of the brick and mortar in Medical Command to make sure we don't have those kinds of issues.

SHAYS: See, I think that's the easy part.

KILEY: Yes, sir.

The second piece is the thing I referenced, which is the heretofore not fully realized complexity of the injuries of these great young Americans.

I'm a co-chair of the Mental Health Task Force. Senators Boxer and Lieberman are coming to closure on our work this last year. The issues of mental health, PTSD, late-emerging PTSD, the issues of TBI, traumatic brain injury, how to diagnose it...

SHAYS: I don't know what you're saying to me right now...

KILEY: What I'm saying is these are very complex patients that are severely injured in multiple emotional, physical, and mental ways.

And then finally, sir, we're going to have a long-term challenge to continue to care for these soldiers and their families.

SHAYS: But, I mean, we know that.

KILEY: Yes, sir.

SHAYS: I guess what I'm trying to understand is: How does it get solved? How many case workers do we have? What is the workload of each case worker?

WEIGHTMAN: Sir, those average about 1:25 to 1:30.

SHAYS: OK. Under oath, you're saying that's what it is?

WEIGHTMAN: Yes, sir.

SHAYS: OK. So why would Sergeant Shannon basically have to find his own way and have to find his own caseworker without his caseworker finding him?

I feel like these men and women are almost in prison in the bureaucracy. I mean, they could be here -- it's kind of like the old song of the Kingston Trio, in the subway underneath...

(CROSSTALK)

SHAYS: That's the way it feels to me. So explain that to me.

WEIGHTMAN: Sir, it's absolutely right. We did not have a foolproof system to hand off our inpatients to the outpatient care. We had a system that probably was accurate about 80 percent of the time. About 20 percent of the time -- and I assume Sergeant Shannon fall into that group -- we did not do a good hand-off of those patients. So that he went from being an inpatient on one of our wards to his platoon sergeant and his case manager picking him up.

SHAYS: (OFF-MIKE) write these reports, they're available to Congress, they're available to the press -- even the press -- so this is nothing new. All of us, in a sense, are made aware of these problems.

How do you know when the problem's being addressed? And how do you get around and how do we deal with people telling us they're being addressed when they're not?

BASCETTA: Well, when we make recommendations, we always follow up on those recommendations to ensure that they have been implemented. But in this case, we have been very frustrated that we bring things to DOD's attention over and over and we see that they fix certain problems on an individual basis but the systemic fixes don't seem to happen.

And sometimes I think that part of the problem is that the rules and regulations are so monumental that we're focused more on that and not on the patients.

SHAYS: This is what I think. And I'll conclude with the few seconds I have left.

I believe that basically it's part of your mindset that says, if you're not going to get the resources, your job is to basically come to Congress and say, "We're getting the job done."

And, frankly, that's almost -- it's being dishonest. It's being dishonest to yourself and it's being dishonest to us. And I will look forward to the say when someone who's in a uniform comes to us and says, under oath, "I'm not given the resources I need to do my job."

KILEY: Mr. Chairman, may I respond to that?

TIERNEY: Briefly.

KILEY: I have said this, sir, in public. The Congress has given U.S. Army Medical Command under my command everything I have asked for in terms of resources.

The challenge is in some of the issues that we're addressing, which is how do we best apply those resources to best care for soldiers and then hand them off to the V.A.

I agree with you, there are issues, there are gaps in the systems, both electronic medical records, hand-offs. I have assigned Army personnel...

SHAYS: I understand. My time's up.

SHAYS: But what you're saying though, under oath, is that you have all the resources necessary to you. And I honestly don't believe that. I don't believe that.

TIERNEY: I think Mr. Duncan made the point of $450 billion in the defense budget and it maybe -- I think there's some truth to the matter that there's resources there. There's priorities, but I hear your point as well.

Mr. Lynch?

LYNCH: Thank you, Mr. Chairman.

First of all, I just want to say I've read this record pretty, pretty thoroughly.

And, General Weightman, I have to say that you having only been in this position for six months, you probably have a little more blame being laid at your doorstep than I think is probably appropriate -- I just want to get that on the record -- from my reading of this.

Ms. Bascetta, you're aware that GAO conducted a review of the Army's system for evaluating the fitness of wounded soldiers to stay in the service?

BASCETTA: Yes.

LYNCH: OK.

I'm just stuck on this number. I noticed that the Navy has an approval rate of about 35 percent for those who apply for retirement for disability. And the Air Force, their approval rate is around 24 percent. Then I notice the Army, which has a greater number of individuals applying, has an approval rate of about 4 percent.

Now, I'm just curious, if you looked at that. I know you just did the Army, but did you look as a comparison of what's going on? And could you help me with this? Could you explain why those numbers look the way they do?

BASCETTA: What I can tell you is that in our review of the disability system, we noticed, first of all, that the services don't always follow the same procedures. But more importantly, they don't have a quality assurance mechanism in place to assure that the decisions that are made are consistent across the services.

BASCETTA: And, without knowing that, it's difficult to explain whether the variations that you're seeing in those award rates are reasonable or not.

LYNCH: OK.

Let me ask you this. Recently, the secretary of defense appointed an independent panel to review all of this. Now, it's an independent review commission. It's headed by a former secretary, Togo West, and also former Secretary Jack Marsh -- both outstanding individuals.

But I just question whether it's independent. Both of these men, they're just top notch, but they are Army to the core.

And I'm just wondering, if we're looking for an independent review -- truly independent; someone that can be critical of this whole process -- I just question, in your own mind, in conducting a review like this -- again, I have enormous respect for Togo West and Jack Marsh, but I'm wondering if these are the best people for an independent and impartial review, since these two men, I know, absolutely love the United States Army.

And I am questioning whether or not they can be objective about the problems here.

BASCETTA: I can certainly understand your concern. I can tell you that there is a lot of work going on reviewing the disability systems, both in the V.A. and in the DOD.

There's a Veterans Benefits Commission that is looking at those issues now and the discrepancies between the ratings that are (inaudible), comparing them to those that are given in the V.A. for the same servicemembers.

LYNCH: OK.

And lastly, before I yield back -- General Kiley, I don't always trust the newspapers, but the (OFF-MIKE) quotes that you thought that the story was unfair. I know that Chairman Waxman mentioned it a little earlier and that you felt that this was not a failure or horrible situation at Walter Reed.

Your comments were in conflict with the secretary of the Army on the same issue. He said there was definitely a failure and that it was inexcusable -- "inexcusable" was the word he used.

Are your own thoughts the same as you sit here today, that you thought this was a one-sided report and that it didn't fairly represent the situation?

KILEY: Sir, just to make sure I'm clear on this, the original reports about the soldiers and the conditions, Building 18 -- again, I did not label that as yellow journalism. There was a follow-on article later that was focused on me that I had some concerns about and did say in a private conversation with the secretary that I thought it was yellow journalism.

What I did say -- and what you referenced, Mr. Lynch -- was that earlier on my concern that the issues in Building 18 -- which were clearly unacceptable, clearly unacceptable, and were a failure of leadership at the junior level in that building -- my concern for the American people and for the Army and for soldiers was that some of descriptors in the larger articles would be construed as if the entire Walter Reed system was a failure and that soldiers were being left to languish, were forgotten and lost and that Building 18 emblemized that. And I don't disagree that a visual image makes a big difference. But I know...

LYNCH: I don't have much time. Let me just ask you, these are the words, and you can tell me, sir, if this reflects your thinking.

TIERNEY: Mr. Lynch, your time has actually expired, but we'll let you ask one quick question.

LYNCH: OK. Yes.

Well, the quote is that, "I'm not sure it was an accurate representation. It was a one-sided representation. It's not the Ritz-Carlton at Pentagon City. I want to reset the thinking. While we have some issues here, this is not a horrific, catastrophic failure at Walter Reed."

I just want to know if that's -- I don't trust newspapers generally and I just want to find out if that's your thinking.

KILEY: I did say that, and I was not attempting to be at odds with Secretary Gates. I think we have some issues of leadership here, but we've got great facilities and a great medical system. And I just -- I was concerned that the whole thing would come down on the basis of some of these specific issues.

TIERNEY: Thank you, General.

Mr. Waxman, you had one follow-on...

WAXMAN: I'd like General Kiley and General Weightman just to answer yes or no.

In light of the memo by Mr. Garibaldi, and the experience we've seen, do you think it was a mistake to have contracted out the services as was done?

KILEY: Certainly with our ability to look at what's happened, I think it may -- we probably could have done it better. Maybe we shouldn't have done it at all, I think.

WAXMAN: General Weightman?

WEIGHTMAN: Sir, I don't think it was a mistake. I think we suffered from having a prolonged period between when we had the switchover. Since 4 February the contractor has done very well.

WAXMAN: I wasn't arguing the contractor didn't do well, but do you think it was a mistake to contract it out rather than leave things alone?

DAVIS: Can I just...

TIERNEY: Sure. Mr. Davis, you have a follow-on?

DAVIS: Just a quick. I mean, there was congressional interference in that as well, wasn't there?

WEIGHTMAN: Yes, sir.

DAVIS: And some doubt. And that stretched out the time period and added uncertainty. Is that correct?

WEIGHTMAN: Yes, sir.

TIERNEY: General Kiley, apparently those that are with you feel differently than you and I did about this. They have asked if we could get you somehow removed from this thing as quickly as possible.

TIERNEY: I was hoping the remaining members who have not asked questions yet, if you have questions you would like ask specifically of General Kiley, perhaps indicate that, and we will recognize the members.

And then we'll let General Kiley go and ask General Weightman and Ms. Bascetta to stay just a bit longer for the rest, if that's OK with them.

(OFF-MIKE)

(UNKNOWN): Thank you, Mr. Chairman.

General Kiley, in today's Washington Post, it says, quote -- it's referring to you -- "'His last concern was his concern for the patient,'" said retired Colonel Robert M. Tobachnekov (ph), chief of obstetrics and gynecology under Kiley at Landstuhl in the mid-1990s.

"Tobachnekov (ph) said Kiley wanted him to discharge new mothers within 24 hours of delivery to keep beds free and counted phone calls as office visits."

Quote, "'He was more concerned for meeting requirements and advancing his own career. At last, it's catching up with him. His leadership style is being exposed.'"

Do you have a comment?

KILEY: Well, needless to say, I don't think that's a fair characterization of what we were doing at Landstuhl Regional Medical Center at the time. And I'd be happy to address the specifics of the 24-hour discharge program, which mothers called for. They want to go home.

Workload and capturing what we do, instead of ignoring it -- and by the way, I differentiate a mother who wants to go home at 24 hours from one that has to go home at 24 hours. We never did that.

But I don't -- I'm not sure I need to comment on it any more on it than that, of the doctor who worked for me at Landstuhl, as I remember, back in the '90s.

(UNKNOWN): How about office visits becoming telephone calls?

KILEY: Well, the question there was my providers felt frustrated that the work they did, talking to patients wasn't counting as part of the workload that the hospital did that they got credit for so that we could get more money; that there was an issue of, you know, "If I spent 20 minutes on the phone with a patient, that ought to be an office call."

And we had no way to capture that data, as I remember, and get credit for it, which is not necessarily a game and it's not necessarily about workload.

I've spent my entire life taking care of patients, training doctors to take care of patients. And I'm committed to Army medicine and committed to taking care of soldiers and their families.

I take exception to his view of me as doing all of this as just for a career and not caring about patients.

KILEY: I don't think that's correct.

FOXX: Mr. Chairman, I have one quick question.

TIERNEY: Yes, Ms. Foxx.

FOXX: Thank you.

Thank you, General Kiley. I want to ask, you mentioned at the beginning that what needs to be done is simplification.

KILEY: Yes, ma'am.

FOXX: We're interested, again, in accountability. And I think simplification needs to be done, too.

Do you feel confident that you can institute simpler measures of accountability, simpler ways of getting the job done that will stick?

I think most people are concerned, as some of the previous witnesses said, that all we're doing (OFF-MIKE) what I am interested in, again, in is systemic change, and systemic change that's not just going here at Walter Reed, as you said, but that's going to work throughout the system and that perhaps could be a model for other government agencies.

So, tell us how we're going to know -- as some of the other questions have been asked, how are we going to know that this process is better? How can we monitor it? How can we make sure that it's going to go systemwide?

KILEY: I think that's a very good question.

I think we need to transform it first, because if we just apply more yardsticks and bells and whistles to the present process, we'll just get much better at measuring bells and whistles.

I think we need to relook the relationship between the MEB and PEB, which is, in fact, in many regards, despite the best efforts of both groups of people, adversarial.

I mean, the physician is attempting to capture all the data, make sure the soldier is as healed as he or she is going to be, and make sure you've got an accurate record with tests, et cetera, hand it to the physical evaluation board, which is driven, by law, by DOD regulations, and by regs, to apportion out disability in a system that doesn't recognize the whole person, like the V.A. system does.

KILEY: And all of that sets up an immediate -- an immediate -- adversarial role where, frankly, in some cases, nobody wins on this.

I think the Army is taking this on even as we speak. I know I'm taking it on to look at the process inside our organizations like Walter Reed with the MEB process and the kickback.

But I think we're going to have to reduce 22 different forms to fill out to go through this process.

It may be a simple as getting rid of a line of duty and commander statements. Let's start giving the benefit of the doubt to the soldier that, when they come back from Iraq missing a limb, that was in the line of duty; it was combat. And we don't need somebody to send us a piece of paper to validate it.

I think we've also got to understand it's going to take time for the soldiers to heal. Let's give them the benefit of the doubt, retire them, and then in three to five years, if they've fully recovered, we can bring them back and process them.

What we do now, because we want to give the soldiers the best chance, is we hold onto them. So our numbers grow at all our installations.

Some of them feel like they're being pushed out too quickly. We say we've got it, we've figured out what's going on with that.

And then the last piece again, I say, is we have still not come to grips with the PTSD/TBI process that most all of these soldiers, to one extent or another, have to deal with. And those are not particularly well recognized to date, particularly in the physical disabilities system.

I hope to bring some light to that with the mental health task force and the traumatic brain injury task force that I launched last fall to start looking at those.

TIERNEY: Thank you. Thank you.

General, once again, your plans have changed and you no longer have an appointment later today; that's been postponed.

(LAUGHTER)

So we're just going to...

(LAUGHTER)

We're just going to fire right through in our regular order and see if we can't bring this panel to a conclusion.

We appreciate the time that you've spent so far.

If members don't feel they have a question to present at this time, that it's already been asked, that's perfectly fine as well. But we'll try to go as quickly as we can. And maybe some members won't feel as compelled to do a complete five minutes as others.

So, Mr. Platts?

PLATTS: Thank you, Mr. Chairman.

General Kiley, General Weightman, Ms. Bascetta, appreciate all of your testimony and your service to our nation, and especially to both our generals, your many years of service in uniform.

PLATTS: In a previous question, Representative Shays talked about the bricks and mortar maybe being the easier things to see and fix, and the second challenge as greater. And I, kind of, put that in the human capital management of how we use people we have to provide this service.

And a common theme that seems to come across in the GAO finding, and that you've talked about, is that hand off. And it was well identified in the first panel, and I think we all agree with Staff Sergeant Shannon, Specialist Duncan, and Corporal and Mrs. McLeod: Their stories are just unacceptable and shouldn't happen.

And you look at Staff Sergeant Shannon five days after he's shot and seriously injured in Iraq, he is basically put into outpatient here, which speaks volumes about how quickly we got him here. But within five days of that trip (OFF-MIKE) that he's on his own and basically given a map. And that handover obviously didn't happen.

How confident are you today that handovers first from inpatient to outpatient is not the case any more, and that there is a smoother transition?

WEIGHTMAN: Sir, I am absolutely confident that we have a system now in place where we have a physical hand off from inpatient to outpatient.

PLATTS: But to a case manager? Or to a platoon sergeant?

WEIGHTMAN: To the platoon sergeant, sir.

But as you spoke to, there's multiple handoffs. Because, you know, once they become an outpatient, you have to hand off their care to the MEB process, and then you have to hand off their care to the PEB process, and then you may very well have to hand off their care to the V.A.

And those are the traditions that I think we feel that we need to put a lot more work into. That's where we've failed.

PLATTS: That was my follow-up: the first one being in- to outpatient, and then it seems like to these soldiers and their families -- that once they got there, there's no one place of, "Here's who I'm supposed to be dealing with to get the care and support I need." And that is very much on the radar now, I'm hearing you say, and we're seeking to address.

WEIGHTMAN: Yes, sir.

PLATTS: The -- specifically on the hand off V.A., if I understood your oral testimony, Mrs. Bascetta, that within a few weeks back, that there was a DOD decision to deny V.A. physicians access to DOD medical records as part of that hand off. And is that still the case?

BASCETTA: I can't tell you what the current situation is.

I can tell you that it was reported, I believe it was on February 16th, at their access -- and these are the V.A. physicians in the polytrauma centers that had their access cut off without warning.

PLATTS: General Kiley, are you aware, is that the situation today?

KILEY: As I understand it, as I sit here today, yes, sir, it is.

I think the access that was denied to the V.A. physicians comes out of the joint patient tracking system. And that's a database that picks up patients -- troops as they into the system coming out of the theater of operations, through Landstuhl, and back to CONUS-based facilities. And in that system, doctors that have access to JPTA and are authorized to be entering clinical data about patients and their clinical data.

As I understand it, just through a couple of e-mails, at some point someone recognized that all physicians in the V.A. had access to the joint patient tracking system. And that our lawyers -- and I don't mean my lawyers, I believe it was DOD Health Affairs lawyers -- I don't know that for that sure, but that's my suspicion -- said that that had the potential to be a HIPAA violation, because if a soldier coming back is not necessarily a designated patient for a V.A. physician, then that physician really doesn't have a need to know about that data.

PLATTS: Are we getting in to make sure that the V.A. physicians who do have a need to know retain the access?

PLATTS: Because it sounds like what we've done is shut off everybody.

KILEY: I think we have, sir. And I don't know where we are.

Frankly, I've been working this one...

PLATTS: OK. If we can have a follow-up to our...

KILEY: Yes, sir. I can take this. Yes, sir.

PLATTS: ... to our committee on that, that would be, I think, very helpful.

KILEY: Yes, sir.

PLATTS: And, if I may, a final quick question on the case manager issue.

In earlier testimony, Mrs. McLeod talked about a case manager denying an MRI that a doctor had ordered. Is that permissible? And does that occur? Because it seems contrary to everything we want where the medical professionals are making the decisions.

WEIGHTMAN: Sir, that is not permissible and it should not occur. It does. And how that probably manifests itself out is that case manager is responsible for scheduling that exam. So if that case manager does not schedule the exam, it is essentially denied.

But they do not have the ability to overrule that.

PLATTS: Is there disciplinary action if that comes to light, that they overrode the...

WEIGHTMAN: Absolutely, because the doctor's order takes precedence.

TIERNEY: I thank the gentleman.

PLATTS: Thank you, Mr. Chairman.

TIERNEY: Mr. Yarmuth?

YARMUTH: Thank you, Mr. Chairman.

In listening to both this panel and the panel that preceded it, it seems like we have two problems we're dealing with. One is finding out about problems and whether there is an adequate system in place to uncover these problems; and the second problem, of course, is how we find out what to do about it and who's responsible for that.

In today's Washington Post story, for instance, there was a mention that we are getting reports now from all over the country -- people calling and families calling journalists, even from my own state, Fort Knox and Fort Campbell, and reporting similar problems.

My question is: One could infer from listening to this that the Army relies on people telling the next level, the next rank about problems, rather than there being some kind of accountability, some kind of mandate on the commander to say: "This is part of our job to find out whether proper service is being rendered at every level."

Is there a deficiency there? Are we relying on a bottom-up type of reporting mechanism? Or do you see that as a problem or not?

WEIGHTMAN: Sir, I think there has been a failure.

We have three or four different mechanisms here at Walter Reed for patients and patient family members to tell us about issues that they have, whether it's I.G. complaints, whether it's commanders' open-door policy, whether it's surveys that come out that we do, periodic surveys; the town hall meetings, the newcomers' orientations you've heard about.

Based on those, I feel that, for whatever reason, we were not getting an adequate feedback from the patients and from the patient family members about all of the concerns that they had.

YARMUTH: But isn't -- but don't you think that proper management technique would be at the highest level of management -- and I'm not necessarily putting it on your desk; maybe it should be in the Pentagon -- has to create ways and actually has to make an affirmative effort to find out whether proper service is being given at every level? Is that not a responsibility at the highest command?

KILEY: Yes, sir.

My role as MEDCOM commander, I have accountability to the Army across all the installations similar to Walter Reed; holding my commanders, both the regional flag officers and the individual local hospital commanders accountable for the health care delivery in conjunction with, you know, General Wilson, who manages -- often manages the infrastructure solutions.

I send teams out. The assistant secretary of the Army sends teams out. I send my I.G. out. And we visit all the posts and camps over the year, getting assessments.

Additionally, you know, we talk to the commanders. We talk to the regional commanders, ask them how things are going and then they report data up to us about processes.

I will say that I don't get involved at my level, and I'm not sure the regional commanders would get involved in their level at an individual issue like a case manager who denies an MRI. But I would agree with General Weightman that we need to do a better job -- and we will do a better job -- of defining the roles and missions of the case managers and platoon sergeants, and we have evolved these processes so that we don't have cases like this coming up.

WEIGHTMAN: Sir, if I may add on to that, you know, under General Kiley's direction, over the last four months, there has been a survey conducted every couple weeks, looking at patient satisfaction with their case managers and with their providers. And they take different samples of all the different regions. And that's anonymous. You know, that just goes up.

You know, the most recent one that was done at the end of January showed patient satisfaction with their case manager and with their provider, their physician, be over 90 percent. But that's not what we've heard here.

So are we looking at the wrong population or are we making it too hard for them to tell us what their concerns are?

We had the Army Family Action Plan meeting here recently, which had very good representation from the MedHold and the MedHold Over patients, and almost none of these issues were raised there.

So that's obviously a failure in our sampling technique to get the feedback that we need.

YARMUTH: Thank you, sir.

TIERNEY: Your time's expired.

I think Mr. Duncan is out of the room, briefly. So, Mr. Turner?

TURNER: Thank you, Mr. Chairman.

General Kiley, General Weightman, obviously it's very difficult, in listening to the first panel and then listening to the statements that you are making, concerning the current status of things and what needs to be done.

There is a disconnect. You know, I hear the difficulty that the families and our service men and women are having. And then I hear that it's not happening now, or we'll fix it, or a case manager doesn't have that authority, but yet a case manager apparently has gone against a doctor's recommendation with respect to scheduling an MRI.

These things are very troubling. And my understanding, from both of you, is that both of you are saying, with respect to Building 18, that neither one of you were aware of the conditions of that building. Is that a correct characterization of what you said?

KILEY: Yes, sir.

WEIGHTMAN: Yes, sir.

TURNER: OK.

Well, I guess my question comes to: Well, how did you not know?

General Weightman, this is not that big of a facility. Did you really testify that there are 3,071 outpatient rooms?

WEIGHTMAN: Yes, sir.

TURNER: And, General Kiley, in looking at your testimony, you've got: "In spite of efforts to maintain Building 18, the building will require extensive repairs if it's going to remain in service."

This is not a question that people weren't satisfied with their accommodations. This is a situation where it doesn't meet our standards.

KILEY: I agree. Yes, sir.

TURNER: So what went wrong? How did you two not know that we had something where we had people being housed, not in just that they weren't satisfied, but that it doesn't mean our standards, and yet there were being housed there?

General Kiley?

KILEY: Sir, I can't explain that. It's been pointed out: I live across the street. But I don't do barracks inspections at Walter Reed in my role as MEDCOM commander.

You know, I have subordinate commanders across MEDCOM that do those things if they think there are problems and they're aware of them.

I would certainly inspect any barracks if asked to come look at it or if we had a problem we couldn't fix of one kind or another. You know...

TURNER: General Weightman?

WEIGHTMAN: During my initial orientation here, when I came, I walked through many barracks. I did not walk through Building 18.

TURNER: General Kiley, then this gets back to my question of systems. You said you do not do inspections.

I don't think anyone would think that the system that you have in place, as a manager of an organization, would be sufficient if your answer is that you don't do inspections but yet you still did not know.

I mean, there's something wrong with the organizational structure if we all have to hear from The Washington Post...

KILEY: Yes, sir.

TURNER: ... versus -- that there are facilities -- and, again, not just that don't meet the standards. It's just not like they thought that their accommodations were unacceptable. They don't meet our standards. But yet they were being housed there.

And you two gentlemen, who were given the responsibility in being in charge -- and again, as you said, General Kiley, you know, Congress can only appropriate funds, pass laws, and the government can pass rules and regulations, but there are people, individuals who have to implement this.

So you can see what people would be very disturbed.

KILEY: Yes, sir, I can.

TURNER: General Kiley, I have another question for you.

I believe that you said that you were not aware -- you were not prepared for the complexity of the injuries that these soldiers -- or the complexities of the injuries were not fully realized for these soldiers.

What was the plan, then? What was your expectation?

KILEY: As the commander at Walter Reed, we had done an assessment when I took over in 2002 of casualty-receiving processes that were coming from Operation Enduring Freedom in Afghanistan.

When operations started in Iraq, we very quickly had a much larger number of casualties coming in. We had all the resources we asked for to increase our contract nurses, physicians. We did some shifting of work at Walter Reed out into the community for retirees and elective health care.

And we watched inpatient and outpatient work very closely. A large number of the soldiers over time where healed and returned to the force or were medically boarded through the physical disability system and then moved onto the V.A. if appropriate.

I think what's happened is, over these last couple of years, there is a subset of patients that are complex, with more than just one human system engaged in recovery -- emotional, physical and mental organ systems, if I can use that term, as well as arms and legs, PTSD and TBI.

These get to be very complex patients, and it takes a long time for them to heal.

Some of the tools in the science of medicine for TBI and some of the tools in the science of medicine for PTSD were just starting to develop, to diagnose and to begin therapies for.

And this is in the face of a continuing stream of casualties. And when we -- we get busy at Walter Reed, we have an ability to move patients, for example, to Brooke or down to Eisenhower. Occasionally, we've ask Landstuhl Regional Medical Center to hold patients for a day or two.

So we've had a system that's reacted. But over time the number of soldiers that have arrived here have challenged the system, challenged it with caseworkers, challenged it through the MEB process and through the PEB process.

KILEY: And it's just a matter of reinventing that, simplifying it, and getting on with business.

TIERNEY: Thank you, General.

Thank you, Mr. Turner.

Mr. Braley, do you have questions?

BRALEY: I do.

Thank you, Mr. Chairman.

With all due respect, General Kiley, when you make the comment that some of the tools of the science of medicine for TBI and PTSD were just beginning to be established in this 2002-2003 timeframe, that's hogwash.

I've represented clients with TBI and PTSD disorders for 23 years. This science has been evolving throughout that entire period of time, but the basic medicine for recognizing, diagnosing and treating patients who suffer from this illnesses and disease processes has been out there a long time. And what we're really talking about here today is a failure of planning.

Isn't that true?

KILEY: I do -- but I may have been misinterpreted in my comments. What we're seeing is -- I agree with you that TBI and PTSD have been diagnosed and known. It's the level of these conditions. It's having two or three concussive events in combat, where you're actually not knocked out, you're not otherwise hurt. You have the fourth concussive event, and now you're starting to suffer from headaches.

That's the kind of TBI, the sensitivity of diagnosis that we have to reach. And we're beginning to understand that there's a crossover between potentially between PTSD and TBI.

And I've been up on the Hill in my role at Walter Reed to talk about research and support for TBI.

BRALEY: It is also part of a greater failure, which is to plan for the eventuality of casualties like we've been talking about here today, including amputations, which, you made a special point of noting in your written comments, deserve special note. As an example, some of the initiatives that are being taken here at Walter Reed.

Do you remember that?

KILEY: Yes, sir.

BRALEY: And, in fact, that's an area that's very, very near and dear to my heart because one of my constituents, Dennis Clark of Clark & Associates Orthotics and Prosthetics, was contacted in October of 2003 and asked to provide short-term assistance here at Walter Reed.

And over the next 18 months, he made weekly trips here at his own expense, staying in hotels at his own expense, shipping prosthetic devices at his own expense over a period of 18 months at great personal sacrifice to himself, his partners and his company.

And I guess the question I have is: How do I go back to Dennis and my neighbor, Don Burgen (ph), who made those trips, and say that your sacrifice was rewarded by the level of care and the planning that is being provided to veterans returning from Iraq and Afghanistan today?

KILEY: Sir, I was not aware that we had someone who was coming here and providing services like that outside of a contracted service because the amputee center at Walter Reed was fully funded. That was part of the global war on terrorism budget line that we were given that was fully funded. And I was just not aware of that.

But my comment about the amputee program and its success was the design of understanding that we were going to have amputees and that we were going to have to take care of them. And their numbers are large and it takes a long time for them to recover. And as we took care of them, we saw some new developments that have challenged us in terms of heterotopic bone formation, et cetera.

BRALEY: Ms. Bascetta, I have one follow-up question for you about PTSD.

One of the big concerns that I have is the impact of PTSD on returning veterans, like Joshua Omvig, who took his own life in his parents' driveway, in Grundy Center, Iowa. His mother was a client of mine.

Congressman Leonard Boswell has a Joshua Omvig Suicide Prevention Act that's currently pending in Congress to require a more detailed analysis of PTSD patients at risk for being suicidal.

And I was wondering if you think that would be a helpful screening process that would be a supplement to the current PTSD screening that is supposed to be taking place at our veterans' facilities?

BASCETTA: Yes, I think that would be very helpful.

One of the problems with PTSD is that it doesn't necessarily manifest as soon as the soldiers come home, that there could be a significant delays in their symptoms, and there could also be confusion or misdiagnosis of TBI and PTSD.

BASCETTA: And if there is misdiagnosis and the PTSD goes untreated, it certainly worsens to the point where this kind of tragedy could happen.

BRALEY: Thank you, Mr. Chairman. I would encourage all members of the committee to sign on as original co-sponsors of that bill.

TIERNEY: I thank the gentleman.

BASCETTA: May I also just add that...

TIERNEY: Yes.

BASCETTA: ... Congressman Braley is correct that there is a lot known about PTSD and TBI. In fact, V.A. has had a national center of excellence on PTSD for many years. They also have their four TBI centers of excellence.

And that, in fact, is why the polytrauma centers for active duty servicemembers were put there, because of the V.A.'s specialized expertise.

I would readily admit that the science is still evolving. There is a lot that we don't know yet. But this is one of the reasons that we think it is so crucial for V.A. and the DOD to work better together.

They have started working together on things like clinical guidelines. But much more needs to be done. In fact, at those polytrauma centers, in response to the comment that General Kiley made, DOD had actually installed DOD computers in those polytrauma centers so that V.A. physicians could use the DOD computers to access their data.

There were not accessed from V.A.'s own computers. So it's hard to understand how there could have been a system-wide access problem.

And we have been very frustrated about DOD raising the HIPAA issue repeatedly. The House V.A. Committee had many hearing on the failure to reach a data-sharing agreement. HIPAA was raised in virtually all those hearings.

And we believe that, when there's such a significant need for continuity of care with soldiers who are going back and forth between the V.A. and the DOD, that certainly there must be a way to overcome this HIPAA barrier -- if it is, indeed, a barrier.

TIERNEY: Thank you, Ms. Bascetta.

General Kiley, can we assume that you're going to get on that issue and find a way to get over that barrier?

KILEY: Yes, sir, I'll take that on. I'll certainly ask. I'm not in charge of it, but I'll take care of it.

That's a DOD decision, not my decision.

TIERNEY: OK.

SHAYS: Mr. Chairman, could I have a point of...

TIERNEY: Yes. Mr. Shays?

SHAYS: Mr. Chairman, I am going to the burial of Sergeant Richard Ford (ph) who lost his life in Iraq in Arlington at 2:00. So I ask to be excused.

TIERNEY: Yes, of course, sir.

SHAYS: Thank you.

TIERNEY: We still have about eight other members that have the right to ask questions here if they want. But again, I say if you have questions that have already been answered, you may want to pass. Otherwise, we'll be happy to have your comments.

Ms. McCollum?

MCCOLLUM: Thank you, Mr. Chairman.

I'm confused. Just to follow up on the HIPAA issue, it seems to me that that could be very easily cleared up by asking their patients if their information can be shared between the DOD and the V.A. And I asked that of the chiefs.

BASCETTA: That is one way. That's an individualized way to approach the problem. We think there might be broader ways to allow access.

MCCOLLUM: But for right now, just telling a patient, you know, in order to make sure you have seamless continuity of care, is it OK if the V.A. and the Department of Defense share your medical records? I think that could be a yes or no.

KILEY: I don't think there's a problem with that, ma'am. The issue that came up was every V.A. position having access to every soldier's medical records, whether they had a requirement to care for that soldier or not, I think that -- and, again, this was a DOD decision -- I think that's what concerned the DOD was that this was kind of a broad, sweeping access to medical records that, until the patients come to the V.A., the V.A. doctors really don't have a need to know. When there is coordination reported...

MCCOLLUM: Well, as a person in the private sector with good health insurance...

KILEY: Yes, ma'am.

MCCOLLUM: ... you sign broad agreements when you go in to have a radiology test done.

KILEY: Yes, ma'am.

MCCOLLUM: So I think there's a way you folks can figure that out.

KILEY: Yes, ma'am.

MCCOLLUM: Could I ask a question about Building 18? What has been the remediation for the mold in Building 18?

I saw it being painted over, so...

WEIGHTMAN: No. Ma'am, the remediation -- there was mold in seven rooms in Building 18.

Two rooms had mold on the walls and five rooms had mold in the shower/ bathtub area. For those that had mold in the showers and bathtubs, that was scrubbed off.

For those two rooms that had mold on the walls, underneath the wallpaper, the wall covering was stripped, mildewcide was applied, and it was painted over after that.

The bigger problem in Building 18 is a moisture problem. And that's why we keep getting mold, back and forth.

So the ultimate fix for Building 18, which has been started, is in the process of being started, is to put a new roof so that we don't have so much moisture coming into the building, as well as fixing some of the leaky plumbing that we have that also allows moisture to come in.

MCCOLLUM: So, in that room, you're confident that the mold has been eradicated in that room, just by stripping off the wallpaper, not replacing carpeting, not replacing ceiling?

WEIGHTMAN: No, ma'am. You know, what I said is we killed the mildew that was on the wall and repainted over it and put another wall covering. But I'm telling you that it will come back until we fix the moisture problem.

MCCOLLUM: So you had it tested, and you know it's just mildew? You tested the mold and you know it's just mildew?

WEIGHTMAN: Ma'am, I cannot address that.

MCCOLLUM: Could I ask a question about the testimony that was submitted by Annette McLeod and her husband?

They talk about his process of going through of having his brain injury addressed; quotes such as "he didn't try hard enough" because he was under medication when the test was administered to see what his cognitive disorder level might be; his paperwork even noting the fact that he had been in Title I, which is done primarily at the grade school level in this country, in reading and math, then being labeled as "special education classes", then being labeled as "retarded".

Who is doing this case management?

Do we have physicians and nurses during this case management?

Because if we do, to have charts that would radically change like this, with health care professionals, surprises me.

And what about those individuals who aren't looking at their charts, and then, as I said, at the end of the day, sign off as to what their disability is and how that can affect future benefits in the V.A.?

Could you tell me how this happens to an individual, that they go from admitting the fact that they had Title I, to being labeled as "retarded" by our governmental system?

WEIGHTMAN: Ma'am, I totally agree with you, that if this soldier was good enough to come in the Army, then he should be treated as such.

The case manager for this patient is a registered nurse and activated Reservist. And then he saw many health care professionals, from being social workers, psychologists and psychiatrists.

I do not have the particular details on who said what to whom, and I actually don't have their permission to talk about that case.

But I think it points out the problem that we raised earlier about the hand-off between the various -- between the Medical treatment to the Medical Evaluation Board to the Physical Evaluation Board, who does make that ultimate determination on what degree of disability that he has.

TIERNEY: Thank you very much.

Ms. Foxx, you asked questions earlier. Do you need another minute?

FOXX: A very quick question: The issue of HIPAA was mentioned. And it sounds to me like a lot of the problems that you all have run into -- for example, the sharing of information -- it sounds like it's above, again, your all's pay grade. And sometimes it sounds like it's coming directly back to Congress.

I've only been there one term, but it sounds to me that some of the things that have been created that have caused problems are coming from us.

And what I want to ask you and encourage you to do is to make sure that where the problems lie with the Congress, that those issues will be brought back to us so that, if we have an opportunity to solve some problems, we can help solve those problems.

Do we have your assurances on that?

KILEY: Yes, ma'am, thank you. The whole issue of the Department of Defense and Veterans Affairs computer systems, electronic medical records talking to each other is very important to both groups.

And I talk routinely with the V.A. and V.A. physicians. And both of us want our systems to talk together, but they don't. They're incompatible, to date, but they're moving closer together -- you know, the standard answer that it takes time and money.

It would make it a transparent electronic medical record for our soldiers. And we would like to see that. This specific JPTA and the HIPAA issue associated with that was a very narrow issue. And I have that...

TIERNEY: Mr. Davis?

(CROSSTALK)

DAVIS: I just want to ask one question. General Kiley and General Weightman, you heard the testimony of the previous panel. And we have, right -- the McLeods are right behind you.

Do you have anything you want to say to them, they who are caught up in this?

KILEY: I feel terrible for them. I know -- I've walked the halls of Walter Reed daily, for two years, and talked to soldiers and family members.

KILEY: And I know that this is very hard for them. And we have got to double our efforts, redouble our efforts to make these kind of cases disappear in the system. And we've got to simplify it.

And we have to give the benefit of the doubt to the soldier and his family, instead of working through a bureaucracy.

DAVIS: General Weightman, I guess you met him at Burger King before. Is that right?

WEIGHTMAN: I'd just like to apologize for not meeting their expectations, not only in the care provided, but also in having so many bureaucratic processes that just took your fortitude to be an advocate for your husband that you shouldn't have to do.

I promise we will do better.

TIERNEY: I just know, Mr. Weightman, apparently Ms. McLeod didn't have any difficulties with you, and I think you should know that.

And, General Kiley, I'm assuming that you didn't know that General Farmer was not allowing Ms. McLeod to make any statements...

KILEY: No, sir, I don't know anything about that. No, sir, I do not.

TIERNEY: Let me yield just briefly to Mr. Braley, who wanted to clarify one thing under HIPAA.

BRALEY: Yes. General Kiley, it's my understanding that HIPAA is designed to make sure that downstream providers of health care -- that is, those who are providing care later on in continuity-of-care systems -- have access to those records without the need for a new and separate release.

Is that your understanding of the HIPAA requirements?

KILEY: To be honest with you, I don't know about the downstream access. It would make sense to me, sir, but I can't give you an accurate answer on that, which is not...

BRALEY: Mr. Bascetta, is that what you were referring to earlier in that this is really an obstacle that is not an obstacle?

BASCETTA: Yes. That's my understanding of the situation. I'm not a lawyer, and HIPAA is very complicated, and there could be unintended consequences. But my understanding is that there is a way to overcome this problem within the confines of the current law.

BRALEY: Thank you.

KILEY: Sir, if I may, Mr. Chairman.

TIERNEY: Briefly, please.

KILEY: I agree that any physician who has got a requirement to care for a soldier in the V.A. has total access. That was not the issue that we ran into between...

TIERNEY: Thank you.

Mr. Cooper, you had questions earlier. Do you have...

COOPER: One quick question. This is a busy, sometimes overcrowded hospital. We're involved in the global war on terror, which has already lasted longer than most people anticipated. We've consistently underestimated the number of causalities.

Do we have any business shutting down this hospital?

KILEY: Sir, I made my recommendations concerning the future of Walter Reed during the deliberative process for the BRAC. I personally recommended against closing Walter Reed. The decisions were made by the secretary. The president approved it.

My tack was then twofold: to begin the process of merging Walter Reed with the National Naval Medical Center and to continue to articulate that the risk associated with that was of properly funding it. It's a very expensive decision to be able to take all the health care that is provided here and move it.

Subsequent to those decisions, and consistent with the discussions we've had all day today, I certainly think that we might want to reopen the national discussion on this, that maybe now is not the right time. But that is really not my call. It's in the law. And from my perspective, I'd be happy to provide information and observations about it. But I'm here to execute the law in that regard.

COOPER: But you recommended against closing Walter Reed.

KILEY: I did, sir. I mean, it was a deliberative process, looking at two major medical centers eight miles apart, and there was a committee that worked through the discussions and the pros and cons. And the committee's recommendation up the chain in the department was to close it and realign it over at Bethesda.

I didn't agree with that, but after the decisions were made it doesn't do any good to continue to subvert that process.

COOPER: Shouldn't we at least make sure the new facility is better before we close this one?

KILEY: Well, that's the challenge, because it is going to cost a lot of money to open the new -- to expand the Bethesda campus and build a new facility at Belvoir, which will capture all the work that's going on here at Walter, yes, sir. It will take a lot of money.

COOPER: Thank you, Chairman.

TIERNEY: Thank the gentleman.

Mr. Hodes?

HODES: Thank you, Mr. Chairman.

General Kiley, I understand that you ran Walter Reed from 2002 to 2004. You're now the surgeon general of the Army.

KILEY: Yes, sir.

HODES: And, Major General Weightman, you ran Walter Reed for six months, from August until recently, and you have been demoted, set somewhere else.

WEIGHTMAN: Sir, I've been relieved of command.

HODES: All right.

General Kiley, I want you to know that I think this is a massive failure of competence in management and command. And do you agree that the buck stops with you on these problems?

KILEY: Yes, sir.

HODES: Now, I want to know when the first time it was that you heard about the kinds of problems we've heard about today. When was the first time you heard about these kinds of problems, sir?

KILEY: These specific problems I heard about when I saw the articles in The Washington Post.

HODES: Now, sir, it's my understanding that former Congressman Bill Young and his wife approached you to talk about problems with soldiers lying in urine on mattresses.

Do you recall that?

KILEY: I recall that specific case and I recall my conversation with Mrs. Young.

HODES: And she said that you have skirted these problems for five years. Do you understand she said that?

KILEY: I understand she said that.

HODES: And, in December of this year, you met with a fellow named Mr. Robinson. Do you recall that?

KILEY: I wouldn't characterize it as meeting with him. Mr. Robinson briefed the DOD/congressionally mandated Mental Health Task Force along with three or four of his other officers in his organization.

HODES: And you heard graphic testimony during that briefing from him consistent with what we've heard today from Mrs. McLeod and the Staff Sergeant Shannon, isn't that correct?

KILEY: He briefed us about his concerns about the welfare of soldiers across the whole system -- and Marines -- as part of his role for his organization, some of which was focused at the Fort Carson installation.

But the issues that he talked about and the issues that Mrs. Young talked about have been issues that we have been challenged with and dealt and fixed on a case-by-case basis since I took command in 2002.

HODES: What did you do after the briefing on December 20th? Did you launch an investigation? Did you immediately go for yourself to make your own personal investigation of the conditions that Mr. Robinson was telling you about?

KILEY: I did visit Fort Carson. I talked to both the Installation Command, and I had not only listened to Mr. Robinson's brief, but I also talked to him after that conference about specific issues that I would talk to.

We then, as part of the task force mission out at Force Carson, talked to soldiers and had other discussions to analyze what was going on at Fort Carson.

HODES: Is it still your testimony that it wasn't until The Washington Post published accounts that you knew of the failures that had occurred at Walter Reed?

KILEY: By "failures at the Walter Reed," if you are talking about the individual soldier stories in Building 18 at Walter Reed in the time frame that was described in the article, I was unaware that those specific cases were going on.

HODES: And nothing you had heard up till that point led you to question whether or not you were overseeing a system that was completely dysfunctional and wasn't serving the soldiers?

KILEY: Well no, sir, I did not characterize my view of either Walter Reed, the North Atlantic or my other regions as being dysfunctional.

We've always had concerns that the large numbers of soldiers that we've had to manage across the installation create a challenge for the command; the deployment of soldiers, the redeployment of soldiers, the deployment of profess (ph) fillers creates challenges for the commanders in terms of their own assets, some of a very short nature.

KILEY: We've had issues with the MEB and PEB process, and we continue to work those solutions.

HODES: And so, that's why when you were asked about the Post reports, you essentially said that it's not a systemwide problem;our health care system is treating our soldiers well.

KILEY: Well, I think our health care system, in terms of the delivery of medicine across U.S. Army Medical Command and here at Walter Reed is outstanding. As I said earlier in my presentation, the bureaucracy, complexity and adversarial nature of the MEB-PEB process is something that we need to take on and fix.

HODES: Sir, if we find -- this Congressman finds that your failure to knowledge earlier the problems that have existed are a serious problems, how then can we take what you say about your proposed fixes and how do we know that that's going to happen?

KILEY: I guess I'm trying not to say that I'm not accountable, because I am accountable. I'm trying to say that we have known that these soldiers are injured, they are emotionally and physically vulnerable, that they need help and health care, that they need a system that cares for them continuously right into their either retirement or return to duty.

It happens all over America, and not just at Walter Reed. I command by commanding through my commanders and trusting them to execute the mission right down to the hospital commanders. And I give them the resources, and then we do inspect them and check them.

I did not personally inspect some of the issues at Walter Reed. I'll redouble my efforts on this. I'm not denying that we don't have challenges. We had challenges when I was the commander here.

We had stories were I walked up to a lieutenant and said, "Do you have any money?" He said, "I've got it in my wallet."

I said, "Where's your wallet?"

He said, "It's in my pants."

I said, "Where are your pants?"

He said, "I guess they're in Iraq."

I mean, we'd walk up to a young spouse with a baby in her arms, and her husband's lying there, and he's paralyzed from the waist down from an accident.

It tears your heart. And you look to the system and it doesn't necessarily give you a good sense that we're going to be able to take care of this family as well as we have come to expect in America and in our soldiers and their families.

And some of these things I can affect at my level as a hospital commander or as the MEDCOM commander. I can give resources for case managers and doctors and PEBLOs. Some of these other things, I've got to work with larger Army and DOD to get some of this bureaucracy out of the way.

HODES: Thank you, General.

TIERNEY: Mr. Welch?

WELCH: Thank you, Mr. Chairman.

There was a report recently in the Army Times that soldiers here had been intimidated, basically, and discouraged from speaking directly to the media about their conditions.

General Kiley, do you have any knowledge as to whether this is true?

KILEY: Sir, I spoke to the brigade commander after this article was released and asked, you know...

WELCH: That being whom?

KILEY: Colonel Hamilton -- and asked what had happened. And as the article had said, as I remember the article now, because I had a whole series of points I wanted to validate.

I asked whether, again, were all the soldiers going to have to get up at 6:00 o'clock to have a room inspection at 7?

He said, no, that's not going to happen.

He had asked the soldiers that if they had issues, they needed to know that the chain of command was open and ready to take those, to work those.

I can't remember all the other issues in the article right now, but it was my sense in talking to the commander that some of the fears or concerns or issues about the soldiers that were addressed at the formation by the commander that, you know, he was not in any way threatening them or saying other than, "Look, we're here to help you and get this thing fixed." But there were not...

WELCH: If I understood you correctly, you just said that the soldiers were told to take their complaints through the chain of command.

Is that what you just said?

KILEY: Well, I don't want to put words in Colonel Hamilton's mouth. And the conversation was very short. I was led to the impression that what Colonel Hamilton had told the soldiers in the formation was that they could come to him, that they could bring their complaints to them.

I don't want to give the impression that that meant that they had to or that that was their only option. We've got I.G.s, we've got chaplains. we've got a whole system for...

WELCH: Obviously, it's important for the soldiers to have confidence that they will be heard. I'm not certain you have clarity -- at least I'm not clear from your own answer as to whether you have confidence that if a soldier wants to speak out directly, perhaps to a reporter, about the circumstances of his care that that is acceptable as far as you're concerned or not.

KILEY: I think it's very acceptable. I wear this uniform in support of the Constitution and freedom of press. I've never told soldiers that they couldn't talk to the press.

WELCH: So, can you clarify that with -- I forget the name of the...

KILEY: Colonel Hamilton?

WELCH: With Colonel Hamilton?

KILEY: I am not -- sir, I don't want to give incorrect information here, but it's my impression that he did not put any kind of a proscription on soldiers.

KILEY: He did not threaten reprisal or retribution in any way with his discussion...

WELCH: Were you consulted about who would take command of this facility after General Weightman was relieved of command?

KILEY: No, sir. I was not -- you mean -- no, sir. First, I was not consulted because I was told to take the command until we could find someone, and then I was informed that General Schoomaker would replace General Weightman.

WELCH: Is it on the basis of your experience, both your two years of command here and your subsequent experience in other responsibilities, that the conditions that have been reported and described have been in existence for over six months?

KILEY: Well, I would say that there are two 15-6 investigations going on on Walter Reed right now; one, looking into chain of command issues, specifically health and safety, and who in the chain of command knew what and when they knew that; and there is another 15-6 looking at the clinical process of medical boards, MEB/PEB process.

I can't say right now whether this was a short term or long term problem. I think the number of soldiers that were here would lead you to think that General Weightman was working through these solutions.

WELCH: So if I understand your testimony, you were here for two years, then General Farmer, then General Weightman. The information you have to date is that General Weightman in fact was trying to work through these problems. He's been fired. Is that an inappropriate response to the situation that has been presented to us?

KILEY: Sir, that is a decision for the civilian leadership, the Department of the Army, for the Department of Defense.

WELCH: Right. I guess it's -- I'm sorry. The rank of...

(CROSSTALK)

KILEY: Major general, sir...

NORTON: OK. And the rank of Hamilton?

KILEY: Oh, colonel.

WELCH: Colonel Hamilton. And Colonel Hamilton is here, and perhaps -- he's not sworn in, Mr. Chairman, but he might be able to clarify this question about what was told to these soldiers about whether they could or couldn't speak, or whether there was any impression that the soldiers reasonably could have sustained that they were discouraged from speaking directly to the press.

(CROSSTALK)

TIERNEY: But otherwise maybe the next question can address that question.

NORTON: All right, thank you. I yield the balance of my time. Thank you.

TIERNEY: Thank you very much.

Ms. Norton?

NORTON: Thank you, Mr. Chairman.

I have question about the twin pressures here at Walter Reed, the crown jewel, as it is always called, where you send the most injured soldiers always, and certainly from Iraq and Afghanistan.

The BRAC pressure is clear. What it does is send the signal to everybody: Go look for another job because we think it's going to close down. If I may say so, I think congress would be insane to pump $2 billion or $3 billion into building a new hospital in the middle of a war.

And I don't expect that we will come up with those funds. But I do think that's a signal that's sent out on top of the BRAC pressure, who says, scatter, get a job if you can somewhere else. There was the privatization pressure. Where?

You, Mr. Kiley and Mr. Weightman, have privatized all of the base operations except, as I understand it, for medical care. Now, of course, those would be the very base operations that, General Kiley, would have to do with the upkeep.

NORTON: You have testified to about $400 million in renovations, $269,000 in renovations -- lots of money. But, of course, what difference does that make it there's not staff on board to keep the facility up?

These employees came to see me because I represent the hospital here. Many of them don't even live here. Your own publication, by the way, said that there were 350 employees. I don't know if all those positions were filled, but 350 employees -- that is exactly what the representatives of the employees told me.

These were workers who had competed for their own jobs and had won the competition and the Army overturned the competition. If I may say so, the notion that, therefore, Congress interfered and that must have elongated the process -- on the contrary. Some of them thought they might prevail because, in fact, we got an amendment through the House that would have restored the status quo ante; it just did not get through the Senate.

My question goes to the wisdom of privatizing everything except the clinical and medical matters in the middle of a war, especially since you, Mr. Kiley, and first here where privatization started and then when you were at MEDCOM and they asked you for more staff, denied more staff even as the staff was dwindling in that same memo from Colonel Spencer.

You are both put on notice: Due to the uncertainty associated -- well, first of all, they talked about critical issues that I'm here quoting: "Retaining skilled clinical personnel."

See, that scares me. "Skilled clinical personnel for the hospital and diverse professionals for the garrison." Those were the people who were to be privatized and just thinned out wherever they could find a job.

Then it said, "While confronted with increased difficulties in hiring" -- because who in the hell, excuse me, who in fact would want to be hired in the middle of that? "Due to the uncertainty associated with this issue, Walter Reed continues to lose other highly qualified personnel."

Could I ask you whether you believe that it would have been better not to privatize the entire garrison workforce when the facility was already undergoing pressures from BRAC and faced with those uncertainties -- when you surely would have known that it would scattered that workforce, that experienced workforce, and that your own workers had won the competition for, in fact, keeping this facility up, including Building 18.

Would it not have been better, in light of all the uncertainty, simply to go with the workforce you had? Why did you seek to privatize the workforce in light of the BRAC uncertainty and add to that with the uncertainty that always attends privatization?

KILEY: First, ma'am, I would like to say that the request -- Colonel Garibaldi through General Weightman -- I approved those at MEDCOM and we resourced those requirements from him.

He was unable to execute them, which was the issue. I gave him the money he needed, but you've already articulated the challenge.

KILEY: You've identified the issue: When you're not going to have a job much longer, why should you hire one?

NORTON: Therefore, why should you privatize it? It started on your watch, General Kiley.

KILEY: Actually, it started, as I understand it, in 2000, when it was identified as one of the privatization efforts under A-76. And once that installation was identified to the Army as a process...

NORTON: Just let me -- I'd trying to get an answer because I know they want to move on.

Would it have been the better side of wisdom not to privatize everything here except the clinical and medical workforce, and therefore add to the stability or the instability that inevitably comes with BRAC?

KILEY: It did increase the instability.

NORTON: Thank you, sir.

General Weightman?

WEIGHTMAN: Absolutely. Between BRAC and A-76 it was two huge impacts on our civilian workforce, which is two-thirds of our workforce here at Walter Reed.

NORTON: Thank you, Mr. Chairman.

TIERNEY: Thank you, Ms. Norton.

I want to thank all of you.

But before I let you go, General Kiley, in one of your written submissions, you indicated that you were having people look into these matters, both the physical condition of the buildings, but also the MEB-PEB situation and that you would report back to us.

We'd like to schedule a hearing for the purpose of this entire discussion, those matters in particular. Is 30 days' time or 45 days...

KILEY: Forty-five days, I can certainly give you more in 45 than in 30. But the team that I have sent out to those 11 facilities should be done within the next two weeks.

The process of looking at the MEB, a term we use, the Lean Six Sigma concept, and we've put personnel experienced in that onto the process here at Walter Reed, is going to take longer than 45 days, but I can give you an interim report at that time.

TIERNEY: Thank you.

I want to thank all of our witnesses for the testimony today and tell you we appreciate you being here and being willing to answer all of the questions. And we'll let you go at this time. Thank you.

(UNKNOWN): Mr. Chairman, a point of order?

TIERNEY: Yes, sir?

(UNKNOWN): While our third panel is being seated, can you clarify the point made in the committee memorandum about the request for information that was made on behalf of yourself and the ranking member of the subcommittee, for documents related to the inquiry today and whether we received any response to that?

TIERNEY: I can say that that was question number one coming up on the next panel. We have not yet received that documentation. We're going to ask the next witnesses on this panel to ensure us that they would be coming, as well as additional documents that are going to be requested.

(UNKNOWN): Thank you.

TIERNEY: Thank you.

Thank you, gentlemen.

By the way of a very brief introduction, I'll allow you gentlemen to introduce yourselves as you speak.

TIERNEY: General Schoomaker, you are a sort of late entry here, and we appreciate your being willing to come and testify today.

General Cody, we appreciate your appearance also.

Mr. Guerin is the undersecretary you've asked to sit on this panel, but I understand that there's no opening statement that you're providing, and I think our questions will probably be directed at the generals.

Do you have an opening statement, General?

SCHOOMAKER: Sir, only to say that I appreciate your agreeing to allow me to appear here today.

I am the senior uniformed officer in the Army. The buck stops with me when it comes to uniform. General Cody is the point man of the Army for what we're doing here, and I wanted to be here to make sure that we understood where the responsibility and accountability (inaudible).

Thank you.

TIERNEY: Is that your entire statement?

SCHOOMAKER: It is.

TIERNEY: General Cody?

CODY: Thank you, Chairman, Congressman Shays and distinguished members of this committee. Thanks for the opportunity to discuss the outpatient care of our nation's wounded warriors here at Walter Reed Medical Center, as well as throughout our Army.

Every leader in our force is committed to ensuring the Army health care for American soldiers is the best this nation can provide. From the battlefield through every soldier's return home, our priority is the lifelong expedient delivery of compassionate and comprehensive world class medical care.

I'm here today as the vice chief of staff of the Army, but I'm also here as a simple soldier who has spent over 34 years serving and leading our men and women in uniform through peace and in war, through health injury and the ultimate sacrifice that our soldiers are willing to make on behalf of this great nation.

Like many of our general officers and senior noncommissioned officers, I'm the father of two sons who are soldiers, each of whom have served multiple tours in combat. I'm the uncle of two nephews who have also served in harm's way.

And I can tell you, I have never been prouder than I am today to serve with our incredible soldiers who motivate me every day and who remain the focus of everything we do in our Army.

As Americans, we treasure the members of our all-volunteer force who have raised their right hand and said, "America, in your time of need, send me, I'll defend you." We all understand that in return for this service and sacrifice, especially in a time of war and demanding operational tempo, we owe these soldiers a quality of care that is at least equal to the quality of service that they have provided this nation.

I frequently visit Army medical facilities around the world. In the last year, I have met with soldiers, staff, and patients in Iraq, Afghanistan, at Landstuhl in Germany, at installations across the United Stats, and at every opportunity here at Walter Reed and Brooke Army Medical Center in Texas.

Without exception, the people I encounter inevitably remind me that the United States is truly a special nation blessed with incredible sons and daughters who are willing to serve and offer all of themselves in our defense.

In them, I have witnessed unparalleled strength, resilience, generosity, and I'm humbled by their bravery.

CODY: Even if all our facilities were the best in the world, and every process and every policy and every system were streamlined perfectly, our soldiers and families still deserve better. And without a doubt, they deserve better than what we have provided.

Today, we have 248,000 soldiers in more than 80 countries around the world for the Army. When injured or wounded, every one of these soldiers begins a journey through our medical treatment facilities with top-notch care delivered by Army medics, Army surgeons, nurses and civilians in forward operating facilities. There, our soldiers receive extraordinary acute care that has drastically lowered our died-of-wounds rate in this war and is regularly cited as being without peer.

But as after that incredible lifesaving work has been done and the recovery process begins that our wounded soldiers are subjected to a complex medical and disability evaluation process that can be difficult to negotiate and manage.

Due to a patchwork of regulations, policies and rules, many of which have not been updated in nearly 50 years, and have been stressed by five years of this war, soldiers and staff, alike, are faced with the confusing and frequently demoralizing task of sifting through too much information and too many interdependent decisions and bureaucracy.

Our counselors and case managers are overworked, and they do not receive enough training. We do not adequately communicate necessary information. Our administrative processes are needlessly cumbersome and, quite frankly, take too long.

Our medical holding units are not manned to the proper level, and we do not assign leaders who can ensure a proper accountability, proper discipline and well-being of our wounded soldiers and their health, welfare and morale, and our facilities are not maintained to the standards that we know is right.

Many of these issues, we're fixing now, and we can repair ourselves, and we're working aggressively to do so. Others will require your support and assistance to resolve.

In conjunction with the Office of the Secretary of Defense, we will work to identify and recommend to Congress changes in law or statutes that may be required to ensure our wounded warriors and their families...

(AUDIO GAP)

CODY: ... know that there is no compensation, no awards, no words that could measure their and their families' gift to this nation and to our army.

We will do what's right for our soldiers and their families. They can be assured that the army leadership is committed and dedicated to ensuring that their quality of life and the quality of their medical care is equal to the quality of their service and their great sacrifice.

With that, Chairman, I look forward to your questions.

TIERNEY: I thank you.

I thank all of you on the panel.

I forgot to swear you in originally, so if you would be so kind as to rise and raise your right hand.

Do you solemnly swear to tell the truth, the whole truth, and nothing but truth?

Thank you.

All the witness will be recorded as answering in the affirmative.

General, your statements well-taken. But I have to tell you, the first thing that pops into my mind is: Where've you been? Where has all the brass been?

All the things that heard, read about and heard earlier today, clearly, this can't all be pushed down at the lower level. Clearly this is not some junior officer's responsibility that nobody else has to claim anything for.

I think one of the earlier witnesses on the first panel said it well; that you need to have some supervision here. You people have to be responsible, and you don't just send them off to do that. And these issues, from what I can see, have gone back to General Kiley's stay, General Farmer's stay, and General Weightman.

And what is it that General Weightman did or didn't do that's so different than what General Farmer and General Kiley did?

Either one of you want to tell me why he got the axe and why the others walk on the earth today?

(LAUGHTER)

You know, why are they still in uniform and still going on?

I don't see any difference between the conditions -- 125:1 ratio -- between the difficulties people were having getting around to the different systems.

Can you tell me why it is that one, sort of, is being transferred out and the others not even recognize that the problem existed when we know it existed all this time?

SCHOOMAKER: General Weightman was relieved of his command by the secretary of the army. I supported that decision. The secretary of the army felt he'd lost trust and confidence in General Weightman. I've known...

TIERNEY: General, let me interrupt you. You lost trust and confidence because he's the one that reduced it from 125:1 to 25:1? You lost trust and confidence because he's the one to put more attention into the PTSD issue? I mean...

SCHOOMAKER: Sir, I think the issue was the Building 18 issue and the fact that a Building 18 existed when nobody knew that it existed. We are out here continuously. We are across the army continuously. We are with these soldiers and their families continuously. We get nothing but the most outstanding feedback from the way that they're treated and the medical care that they receive here.

TIERNEY: So we're to assume that Building 18's condition arose only in August of 2006 and didn't exist before?

SCHOOMAKER: No, it's very clear that it existed before. What I'm trying to say is the fact that, you know, nobody knew of a Building 18 until it arises this way. It certainly begs the question of why we didn't know it. And of course, you know, we -- I mean, I'll tell you, I was extraordinarily angry and embarrassed by the fact that we would have a Building 18.

TIERNEY: I would think that would be the case. You know, we go beyond the bricks-and-mortar issue, which I think is going to be resolved without as much difficulty as the other issue of what's been happening, in terms of their care, once they're here, and the hand- offs and the going through the process there.

TIERNEY: That's been all the way back to 2004, 2005.

SCHOOMAKER: The medical care here at Walter Reed is second to none.

TIERNEY: The medical care, sir, but the whole idea of the post- medical care, the outpatient care...

SCHOOMAKER: The outpatient care is a problem, a challenge that was anticipated. I would have told you, before these hearings, based upon the feedback that we have gotten, that the level that we are, that this would have been a bright spot in our history, in terms of how soldiers have been cared for.

Now, my father was a World War II, Korean War and Vietnam veteran. I was commissioned 38 years ago. I've got a brother who is now in command of Walter Reed, who's a major general.

I've got a daughter and a son-in-law that are on the way to combat. This is not something about people don't care. And I am not going to sit here and have anybody tell me that we don't care about...

TIERNEY: Let's not (inaudible) red herrings out there, General. Nobody said anything about people not caring, so we'll put that red herring aside and, if I can, calm you down and get you back to the issue here.

The issue is...

SCHOOMAKER: Listen, this isn't a red herring, and I'm not...

TIERNEY: Sir, nobody said anything about not caring. The question was, and continues to be: If these situations have been occurring since 2004, 2005, 2006, why weren't they resolved and why weren't they addressed?

SCHOOMAKER: That's a great question. And the issue is -- you asked me the question of why General Weightman was relieved by the secretary of the Army. It's because these issues hadn't been surfaced.

And General Weightman was in a position of accountability and responsibility. And the secretary of the Army didn't have trust and confidence in him, and relieved him. And I supported that decision.

TIERNEY: So is your testimony, sir, that in all of the reports that Mr. Waxman read earlier, the several GAO reports, the newspapers, going back to the Salon.com articles, the inspector general's reports going back several years now, that all speak to these issues which we've addressed today, none of them came to the attention of anybody higher than General Weightman?

SCHOOMAKER: I have -- that I cannot speak to. I can certainly say that they didn't come to my attention.

TIERNEY: General Cody?

CODY: I've been the vice chief since 2004. Prior to that, I was the operation officer of the Army. And so I can't speak before that because I was busy getting the Army ready for the war, back in 2002.

But when I became the vice chief, in charge, mostly, of the day- to-day operations for the chief of staff of the Army and the secretary of the Army and the undersecretary of the Army, occasionally we would get reports about medical hold. Occasionally, we would get reports about the process.

In each case, the secretary of the Army or the surgeon general of the Army had sent teams out to work through the process.

I'm not aware of the reports that I heard Chairman Waxman talk about. I have not read those reports. But we did know that the process for the MEB and the PEB are very, very complex.

I'm now very well aware of it. I've studied it, now, for the last two weeks. But before that, I've come to this hospital several, several times, since 2002, when this war began, and did not know of Building 18.

That's not an excuse. I just didn't know it was there because I spent most of my time on Ward 57 and Ward 58 and the neurosurgeon wards and stuff like that.

So, each time I heard about these problems, they were being addressed, and trying to care of it.

CODY: I think that the size and scope -- let me just say one thing. From 2002 until now, we were handling about 6,000 MEB and PEBs in the Army. About 2004 until now, it rose up to 11,000 a year, and that has been a problem and we have to address it. But I was not aware of the size and scope of this issue.

TIERNEY: Who in your chain of command would you expect that would have been aware of those reports that Mr. Waxman talked about?

CODY: Certainly the surgeon general and certainly the commander of our regions -- not just this region, but our other regions.

TIERNEY: Would it have been fair to suspect that they would have done something about it, at least looked at the systemic and complex issues and made recommendations to you?

CODY: Well, they would have made recommendations to the secretary of the Army on some of these. We did note -- in 2005 and 2006, I am aware that the Department of the Army inspector general was ordered by the secretary of the Army to go and look at the MEB and the PEB process. And the latest report was just briefed out to me today.

TIERNEY: So we have all of these reports and we have, apparently, nothing happening on the ground here that's really impacted the patients yet and their families on that, and I think that's what upsets people and what surprises them on that.

Here we've had a surge. Everybody knows that we apparently didn't expect -- or certainly our civilian leaders didn't expect -- that they were going to have this kind of casualties in the situation. That's increased, and at the same time, we have a decrease in personnel here. My time is pretty much up, so I'm going to pass it on.

I hope somebody else will get into that, the idea that as we're ramping up the number of people here for service we're having all kinds of difficulty with the personnel and also leave it to somebody else hopefully to ask what do we do in terms of we're planning for what may occur with 21,500 additional troops now going into combat.

With that, I'll refer to Mr. Davis.

DAVIS: Well, thank you very much.

I'm not sure where to start here but, General Schoomaker, if you think this is about Building 18, we've missed the point here. This is a far more systemic problem. This committee, as Mr. Waxman noted in a number of GAO reports, published reports, our hearings, Guardsmen not being paid in the field appropriately, computers that don't talk to each other. This is a systemic problem.

And Building 18 was the visual that was just kind of waiting to happen. It encapsulates all of the other problems, but the witnesses today, the testimony was less about Building 18. It was they couldn't get proper medical attention. They'd come back from the war, they're injured, and nobody is there to take care of them. They have to navigate a wave, a maze of regulations and procedures and paperwork that a lawyer couldn't navigate.

And, you know, so you're not going to be able to Scotch tape this over, which we've tried to do, and Band-Aid it. It takes a system problem. And we've had wave after wave of people come before our committee over the last four years saying they're going to fix it. I have here the last two Army medical holdover operations reports, and we always get, "Well, we're going to do better."

But we always seem to find a new manifestation of these systemic problems. We saw it in the pay, we saw it in the collection, we saw it in people falling through. What makes this round of promises any different? Why are you going to be more successful at integrating all of these different Army command responsibilities and processes so they are seamless and provide a better standard of care?

DAVIS: What makes this different from what we've heard before every time we get some embarrassing situation?

SCHOOMAKER: First of all, let me be very clear, my statement was not intended to say this is about Building 18. There's no question that this was bigger than that. It was about when this thing, you know, first came to our attention.

And clearly that's what it is and it's clearly become a metaphor for a much bigger problem.

But I believe that, as the vice chief has said, there is a Department of the Army inspector general report that he has read now, has taken the time to do. There's a very detailed action plan that is being put together under his purview that we fully intend to support.

I believe that there's a great deal of desire and emphasis to make this happen, because it has to happen. It's the right thing to do. And I told you. I couldn't be madder and I couldn't be more embarrassed and ashamed of the kinds of things that have turned up because, clearly, it's not what my impression would have been based upon the feedback that I've gotten as I've talked to soldiers and the family.

DAVIS: I mean, these are heroes, these people that are coming back here.

SCHOOMAKER: Absolutely.

DAVIS: You put their lives and their families at stake. Some of them will never be the same. And they're languishing. And they're not nuisances or things we have to check off, but they've been treated this way.

And I'll tell you, I was a Reserve officer, a retired first lieutenant -- never got any higher -- but I think it's time the generals at the very top be held accountable, because that's where the systems come from. You can't even have a commanding general here be able to patch together all of the different systems that are dysfunctional within the Department of Defense and the Veterans Administration.

And so I think we're maybe looking at the wrong scapegoats when we look. This is a far bigger problem that we failed to look at.

I just want to know: What are we doing, systematically, to make these computers all...

CODY: Let me take that on, Congressman.

First off, we are taking accountability across the board. Since this problem has highlighted, one of the issues I found very, very clearly when I went through and looked at it, it wasn't just Building 18; it dealt with how we treated and took care of the health, welfare and morale of these soldiers in a very vulnerable transitional peace, having served our country so well.

And so I clearly understood that we didn't have the right structure here at Walter Reed, so we've changed it immediately. We've taken the Medical Service Corps out taking care of our medical hold and medical holdover. I selected a colonel, a combat veteran, as well as a command sergeant major. These are combat arms soldiers. We've taken and put about 27 new E-7s that are coming in to fix that structure, because the rooms weren't being inspected.

That's not a big issue, but the appointments weren't being taken care of, there was no follow-up and to make sure they were on the right meds.

CODY: There was no follow-up on what type of training, no follow-up in terms of getting back to their units and checking with them. And so, that piece is being fixed immediately.

The systems you're talking about is the medical evaluation board (inaudible) that does not talk to the PD-CAPS (ph), which is the backside of the physical evaluation board.

We're trying to get that fixed now.

In between that is the liaison officers. These liaison officers are the ones who take the soldiers from the MEB process and hand them and work them through the physical evaluation board processes.

Clearly, we don't have enough. The training is not good enough. And there was no quality control to see if certain liaison officers were adequately trained and taking care of the soldiers all the way through the process.

We're now fixing that, as part of the action plan. And it's not just a production timeline, it is a quality control timeline. And we've raised the rank structure of these liaison officers.

That, right now, is our immediate work. But there is work to be done, making these two systems talk to each other.

On a larger scale, when you talk about Walter Reed in particular, this is not a spike that we're in. This is a global war. This war has gone on, now, for five years.

And when the decision was made, I believe, to look at Walter Reed for BRAC and to look at the A-76 process in a crown jewel that is going to support our wounded warriors all during this war, I think we need to take a look and re-address whether we sanctuary Walter Reed during this long war.

And we need to have to ask the hard questions because, clearly, when you take a look at a hospital that has been put on the BRAC list, and you're trying to get the best people to come here to work, and they know in three years that this place will close down, and they're not sure whether they will be afforded the opportunity to move to the new Walter Reed National Military Center eight miles away, that causes some issues.

The A-76 process that I heard discussed, we have to ask ourselves the question, is that the right thing to do at a hospital right now that is supporting this war.

And so, from a larger scale, these are the things that the two- star general and the three-star general were having to wrestle with.

And these are both (inaudible). I'm not complaining about them. But when those things were discussed, everybody thought this war was going to ramp down in '05 and '06. And the chief and I have said for a long time, "This is not a spike. This is a global war on terrorism, and we're going to be at this level for some time."

And so, I think we have to have a national discussion about that.

TIERNEY: Thank you.

Mr. Waxman?

WAXMAN: General Schoomaker, last Friday, the secretary of the Army, Francis Harvey, was fired.

And preceding him, General Weightman was fired.

Now, the secretary of the army looked to you as his chief of staff to try to understand what was going on, to try to give him the information to make sure that he knew what he had to know to make the system work.

WAXMAN: Now, the chairman asked you about some of these reports. There was in 2000 -- February of 2005 an article in Salon magazine describing appalling conditions and shocking patterns of neglect in Ward 54, Walter Reed's inpatient psychiatric ward.

Were you aware of that?

SCHOOMAKER: I was not.

WAXMAN: And...

SCHOOMAKER: I've been in that ward.

WAXMAN: Pardon?

SCHOOMAKER: And I have visited that ward.

WAXMAN: There was another report, in 2006, that warn that soldiers with traumatic brain injuries were not being screened, identified or treated, and others were being misdiagnosed, forced to wait for treatment or called liars.

Did you know about that report?

SCHOOMAKER: I did not know about the report, but I certainly know and we have been very concerned and working on traumatic brain injury and PTSD.

WAXMAN: In 2005, RAND issued a report finding that the military disability system is unduly complex and confuses veterans and policymakers alike.

Were you aware of this report?

SCHOOMAKER: I was not aware of the report, but I do agree with the synopsis or the conclusion that it states.

WAXMAN: And over the past two years, the Government Accountability Office has issued a number of reports.

In January 2005 they found inadequate collaboration between the Pentagon and V.A. to expedite vocational rehabilitation services for seriously injured service members.

And in February they reported on gaps in pay and benefits that create financial hardships for injured Army National Guard and Reserve soldiers.

Did you know about the GAO reports?

SCHOOMAKER: The GAO reports I probably was aware of, but have not read. But I have visited these V.A. centers. I was recently at one down in Florida, near Tampa, that is a polytrauma center. Have observed it. Have been watching the good work that's taken place to make the transition right in places like Tripler, where they're actually converting a wing to the V.A. to walk them across.

And so I think these things are known and have been being worked on.

WAXMAN: Well, you went to the passive use of the English language: were known and were being worked on.

SCHOOMAKER: Are known and are being worked on. I mean, I am talking about...

WAXMAN: There's a chain of command in the military.

SCHOOMAKER: That's correct.

WAXMAN: The secretary of the Army, Francis Harvey, would have looked to you to get him the information.

WAXMAN: Who do you look to to get you the information?

SCHOOMAKER: Well, in medical situations, I look to the surgeon general.

WAXMAN: And the surgeon general -- who is the surgeon general?

SCHOOMAKER: My purview is over the entire Army.

WAXMAN: Who is the surgeon general?

SCHOOMAKER: General Kiley's the surgeon general.

WAXMAN: So General Kiley just told us that, even though he was here in Walter Reed, no one told him about some of the things that were happening in Building 18. Who was supposed to report these things to him?

SCHOOMAKER: Well, the commander of Walter Reed, who is responsible for...

WAXMAN: And the commander? Who was the commander of Walter Reed?

SCHOOMAKER: General Weightman was the commander of Walter Reed.

WAXMAN: So General Weightman, but he was only commander for a short period of time.

SCHOOMAKER: He's been commander since the summer of 2006.

WAXMAN: Right.

SCHOOMAKER: General Farmer before him is retired. The commander before General Farmer was General Kiley.

WAXMAN: I guess I share the concerns that Congressman Davis expressed. We've got all these reports, we've got all these alarm bells going off in articles from popular magazines or information sources like Salon to GAO reports. And the information doesn't seem to get up the line of command.

General Cody, you gave us an excellent statement. But how much of those problems that you've outlined for us were you aware of before The Washington Post report; before all of this became such a focus of attention? You personally.

CODY: Sir, I was aware of -- because of my time as the G-3 of the Army and coming to this hospital and visiting soldiers, I was aware of the severely wounded warrior problem and I was concerned about it.

And we set up what you know now has the Army Wounded Warrior program back in 2004, early 2004, because we were concerned with the numbers of injuries, amputations and traumatic brain injuries.

We were concerned that, if we medically retired a severely wounded soldier, we wanted to make sure that the Army stayed with that soldier through that whole process.

WAXMAN: That was 2004; this is now 2007.

CODY: I'm getting...

WAXMAN: Today, The Washington Post says it's not just Walter Reed. They gave very heartbreaking stories about broken wheelchairs at a California V.A. hospital; rooms overflowing with trash and swarming with fruit flies in San Diego Naval Medical Center; mold, pealing paint and staff shortages in Knoxville, Kentucky.

I guess my question -- and my time is up -- is the same question that Congressman Davis asked you: If you didn't know and you didn't do, why are we going to believe that it's going to get done in the future? Why would we feel confident -- because a couple of heads have rolled -- that the job is going to get done not just at Walter Reed but in this whole system?

CODY: As I said, we started the Army Wounded Warrior program because we knew that part was going to be the piece that we were most concerned about. And that program has been run now for two and a half to three years and it's working very well.

The MEB and PEB process and the extent of what's happened here at Walter Reed, I did not have oversight or visibility of. I do now. I've been directed two weeks ago to shift my attention from my other duties, which is reset of the Army and the training of the Army and other things, to put me as the number two guy in the uniformed services; my full attentions to fixing these issues.

Thank you.

WAXMAN: And, General Schoomaker, what do you say? Why should we feel confident this is going to change?

SCHOOMAKER: Well, because we're going to change it.

(LAUGHTER)

WAXMAN: You should have changed it before, but it didn't happen.

SCHOOMAKER: Well, there's no question -- you know, there's no argument with you about what should have happened. It clearly didn't happen.

SCHOOMAKER: And I said earlier that if somebody had to ask me three weeks ago what was one of the bright spots, it would have been the way that we're now treating our wounded soldiers because of things like the Wounded Warrior Program, because of the kinds of wonderful things that are happening with the wonderful people that are medically caring for our wounded soldiers.

WAXMAN: You were very wrong about what was going wrong.

SCHOOMAKER: Absolutely.

TIERNEY: The gentleman's time has expired. Thank you.

Mr. Lynch? I'm sorry.

Mr. Platts?

GUERIN: Mr. Chairman, could I say one thing briefly in respond to Chairman Waxman's question? The only way we can prove it to you is show you, and I can assure you from the top of this Department of Defense down to the folks working on the ground here in this hospital, there is a commitment that is heartfelt.

The secretary of the Army appointed a committee that's looking at it, not only...

TIERNEY: The secretary of the Army that is gone or the one that's...

WAXMAN: Mr. Guerin, what is your job? Liaison to the Congress?

GUERIN: No, sir. It is not.

WAXMAN: It used to be?

GUERIN: No, sir, it has never been.

WAXMAN: It's not.

GUERIN: No, sir. I'm the undersecretary of the Army. I beg your pardon...

WAXMAN: Did you know about all these problems before?

GUERIN: No, sir, I did not. Friday night...

WAXMAN: But you just want to underscore that the commitment is there for the future...

GUERIN: Well, no, I'd like to point out...

WAXMAN: ... even though the commitment should have been there for the past.

GUERIN: Yes, sir. And we've got no excuse for the past.

TIERNEY: Thank you, Mr. Guerin.

Mr. Platts?

PLATTS: Thank you, Mr. Chairman. Appreciate the witnesses testimony and, again, all of your storied service to our nation in uniform, and also, Mr. Secretary, your service on the civilian side.

I think part of what this hearing has been about is to get to the bottom of what happened, why, and how we move forward positively, and the specific action, some that's breaking orders and that's human capital management and reallocation.

I think there's also a morale issue. We heard it certainly from our first panel, where two soldiers who have served courageously, a spouse of a soldier who, understandably, maybe how lost some faith in their government, their army, their nation, how we're treated them.

And to that point, I would hope that you would consider -- we heard the term open door policy. I heard Walter Reed. We hard town hall meetings.

As chief of staff, as acting secretary, the new commander of Walter Reed, perhaps a town hall that -- you're appearing before us as a congressional committee, but to go out and do that town hall meeting with all of the senior staff with the families, with the personnel here today to say, you know, "We are listening, this shouldn't have happened, and we're going to make sure it never happens again," I think for morale that certainly would be good.

PLATTS: And not just to the families and patients, but to the staff of Walter Reed -- that they hear from the senior people, that if you see wrongs like Building 18, you don't have to wait for a patient to complain about it. As a staff member, come forward.

You know, we want you to tell us what's going wrong. I mean, your staff is certainly going to be, you know, probably in the best position to know what isn't going right. And that they know that they have the full support of the senior staff in coming forth. So I hope you'll consider that.

I do want touch an issue that was touched on earlier -- the issue of the Guard and Reserve coming through versus active duty. And in my previous role in the last two terms as chairman of the subcommittee in financial management, we dealt a lot with the challenges of the Army dealing with this huge surge of Guard reservists from the pay issue, from travel reimbursement, and the challenges of the system just not being ready to deal with the volume that was going through it.

My worry is that if there's a little bit of that here at Walter Reed on the medical side -- and Staff Sergeant Shannon touched on it because of the soldiers having to deal with their home state and their status of active duty or on medical hold.

And are we comfortable and, again, confident that we are doing right by every soldier, regardless of Guard, Reserve, active duty, in their medical care, and then as we move forward to addressing the problems for all of them regardless of their status before being activated?

CODY: We have one Army. Whether you're Guard, Reserve or active duty, it is the duty of this Army to treat everyone the same. In the past, the Guard and Reserve were a strategic reserve. They're now part of the operating force of United States Army. We count on them every single day, and they cannot be treated differently when it comes to health care or anything else -- pay or benefits.

And that is a change. That's requiring culture change in some regards in the United States Army. But we're committed to that. And in health care, absolutely there should not be any distinction. Everyone deserves the highest quality care.

PLATTS: If we can prioritize as we go forward, and especially with the physical evaluations -- because of the complexity of our systems, these legacy systems you're dealing with (inaudible) let's say account for this volume, that we really give it special attention.

I have a Guard unit that just came back from Balad Airbase in Iraq -- that we are doing right by them, the same as all over troops over there.

I know I'm going to run out of time here quickly. The one issue that General Kiley did touch on, but seemed to be above his level, is the issue of the hand-off between the Army, the DOD, and the V.A., and the issue of access to information.

It sounded, from General Kiley, that it was at either the Army, you know, department level or DOD itself on physicians at the V.A. having access to medical records of those who are being transferred to those V.A. -- specifically the four centers that deal with the more traumatic cases -- do we have any knowledge from the three of you about where that stands? Is it an Army decision or is it DOD?

CODY: I don't know if it's a decision by Army, OSD, but I will say that in the last two weeks, as I pored through this, Congressmen, the teamwork between the V.A. and all the services is better than I've seen it in the past. And I think we owe it, as the Army, to make sure that we do that hand-off and we not wait.

I don't think we need any laws or antyhing else. I think we owe it to the soldiers to walk them through and hand off, and then -- that's why I talked about the wounded warrior program. Once that happens, we stay, our caseworkers stay with that wounded warrior when he hand him off to the V.A. for five years.

And we have caseworkers throughout the country now located on the Army payroll, located at each one of these places, so that we can continue to monitor our soliders, even though they're in the V.A. system.

And so I don't think it's anything more than better execution and better follow-up and probably some more caseworkers.

PLATTS: I think that human capital issue is what we come back to again.

CODY: That's right.

TIERNEY: Thank you.

PLATTS: Thank you, Mr. Chairman.

TIERNEY: Time has expired.

Mr. Lynch?

LYNCH: Thank you, Mr. Chairman.

I want to thank the panelists for helping us again with our work.

I do want to qualify some earlier remarks I made. While I generally do not trust everything I read in the newspaper, I think that the reporters in this case, Dana Priest and Anne Hull, did a remarkable job. And I think a lot of service families are going to benefit by the work that they've done.

We talked a little earlier with General Weightman about the survival rates. One of the good things that's happening right now is our survival rates are the highest they've ever been. That means the soldiers that would have (OFF-MIKE). You know, Mr. Platts and I actually follow troops who were (OFF-MIKE) taken to Balad, then to Landstuhl, and then back here to Walter Reed.

And my concerns is that because we are saving them now, perhaps that's why we're seeing PTSD as a more profound dimension of disability and recovery. And I'm wondering if we're not paying a great enough attention to it.

And my specific question is, to follow up on Chairman Tierney's question, we heard from General Weightman earlier that in light of the president's plan on a surge, this adding 21,500 troops into Baghdad, that the result of that plan could potentially result in much, much higher casualties.

What are we doing today here at Walter Reed, given the fact that we're, let's just say, we're maxed out or we're at the point of being overburdened here, what are we doing right now to prepare for that possibility?

SCHOOMAKER: Well, first, I'd like to address just one piece of this, and that is about the PTSD that you rightfully brought up.

I have been testifying and concerned for quite some time about the OPTEMPO on the Army. I've testified to my concerns about the readiness of the Army. I've testified to my concerns about the fact that we have compressed now down to a year and maybe less in some cases of reset time for soldiers.

PTSD is real, and it had another name in other days, but combat affects people.

SCHOOMAKER: And it will always affect people, as it always has. And it needs to be paid attention to.

And part of my concerns is that resetting the human dimension -- not just the hardware but the fact that people's recuperation time, their time to reintegrate, and to do those things -- is one of the very real concerns that I've got about the level at which we're asking our soldiers to operate.

In terms of what we're doing in anticipation of casualties and management of casualties, I believe what I've been told by the medical professionals that are looking at such issues as a different distribution across the country of those that we can distribute; overflight when it's not necessary to bring somebody to Walter Reed, that may be able to be dealt with some place else.

And there are probably lots of other techniques they've got in the medical regulation system, you know, how they regulate casualties. And they -- perhaps the vice has got some ideas on what else...

CODY: Yes, sir. We too are worried. We've been very, very fortunate, right now, that we haven't had a mass casualty. Every time a -- I'll just say that, every time a large aircraft flies, we're concerned, as well as any type of suicide bombers.

And what we're doing right now is we're hiring many more case workers. I put out that out as part of our action plan.

I talked about restructuring the MedHold brigade, the wounded warrior brigade.

I've got a colonel, a sergeant major and 126 leaders coming in, in the next two weeks, to get the ratio between platoon sergeant to the number of soldiers in the MedHold we have right now --we've directed that Building 18 be evacuated -- not evacuated, but everybody leave it.

And we're going to rebuild that facility and then have the permanent party soldiers live at Building 18, which gives us more on- campus capacity for our MedHold, so we don't have to put our soldiers off-post.

We're doing that. The Soldier Family Assistance Center -- we've increased the number of finance people there, increased the number of case workers there, so we can surge very quickly.

I will pick -- and check with the undersecretary by Friday -- a deputy commanding general, one-star, to be the deputy commanding general here at Walter Reed to help the new commander with his duties not just at Walter Reed, but he's got seven other hospitals in the northeast region.

CODY: And my assessment is that he needs to have a deputy commanding general. So we're going to do that.

This week, I will meet with all the hospital commanders. And we're going to talk about these things we're discussing right now -- this is throughout the country -- as well as what happens if we have a mass casualty event.

LYNCH: OK. Thank the gentleman.

TIERNEY: Thank you.

LYNCH: And I know my time is used up but, General Schoomaker, I just want to say that I am heartened by your remarks regarding PTSD, and I hope that that's a reflection of the entire armed services on that issue, because I think we need a lot of help on that.

Thank you. I yield back.

TIERNEY: Thank you, Mr. Lynch.

Mr. Turner?

TURNER: Thank you, Mr. Chairman.

General Cody, your last -- your ending statement about the concern for mass casualties leads into my question to both General Schoomaker and General Cody.

We've all heard very disturbing things in the testimony that we've had today. And it's just as disturbing of the conditions or the circumstances as it is the round of, "I didn't know," "I didn't know" that relate to a system failure. It's not a policy failure, it's not a funding failure, but a system failure when people say, "I don't know" that a situation was violating our policy or violating our standards.

And that goes to leadership, which is why it's being characterized as a leadership failure, because it's not an issue of what people were handed; it's what they did with it.

The most disturbing, I think, statement that I heard today was from General Kiley when he said we were not -- he said, "The complexity of the injuries of these soldiers was not fully realized."

General Schoomaker, you've been the chief of staff since August 1st, 2003, and, General Cody, you just described a scenario to us that would be catastrophic. And I guess I'm just at a loss as to what types of injuries could the system have been anticipating if it didn't anticipate these types of injuries.

Because I didn't hear of any injury in the testimony today that was not anticipatable.

And, General Schoomaker, certainly from the beginning of this conflict, these types of injuries would have been those that would have been easily projected.

And, General Cody, you just gave us a scenario that you think might occur in the future. We have, we were told, 371 outpatient rooms that are caring for individuals who were transferred from inpatient to outpatient. And, still, General Kiley's saying that the complexity of these injuries were not fully realized.

Can't we anticipate this?

SCHOOMAKER: Sir, I didn't hear General Kiley's statement, so I don't know what context it's in.

From what you're saying, it sounds to me like -- it's not that we don't anticipate or didn't anticipate the fact that we'd have traumatic injuries, it's that the people who have survived some of these injuries that in the past never would have survived them -- I mentioned that I've been down to the polytrauma center where people have got traumatic brain injury, they have amputations, they've lost their sight and hearing, burns, a variety of very complex things that, in previous wars, never would have survived.

TURNER: At what point, since August 1st, 2003, did that dawn on us?

SCHOOMAKER: Well, I think that the reason...

TURNER: Because it wasn't last week. It wasn't two weeks ago when The Washington Post...

SCHOOMAKER: And that's why -- and, again, I don't know what General Kiley has let off, but we are now preparing...

TURNER: We'll make certain you get those.

SCHOOMAKER: ... Sixty-eight Whisky medic, for instance, who we are training tens of thousands of at Fort Sam Houston that are the old squad medic are now doing medicine that we'd only see in special operations before.

SCHOOMAKER: The combat lifesaver, that we're now doing with all of the soldiers, the kind of first-aid kit they carry, the kind of training they have, the trauma medicine that we have forward, the regulation system that gets them to Landstuhl so quickly and to places like Walter Reed, I mean, the reason we have these things is because we are anticipating them; we are saving these lives.

And, like I told you, I've had nothing but compliments about the way we have been treating the people -- the medical treatment of the people inside of our medical treatment facilities.

TURNER: General Schoomaker, I'd invite you to look at that testimony, because just about everyone on this subcommittee hearing was very surprised by it. And many people asked follow-up questions because to have that be the testimony today of some of the reasons of the circumstances, is surprising, because it clearly -- it seems to me that it's an anticipatible situation.

But I appreciate you taking a look at it.

SCHOOMAKER: Certainly.

TURNER: And perhaps you could give us some additional follow-on to that post this hearing.

CODY: Could I say something about being anticipatory? I'm not a medical person, and so I can't speak for what Dr. Kiley said, but your Army looked at all the things on that battlefield as it emerged after the fall of Baghdad and when the IEDs first started showing up on the battlefield, and that's what changed our ensemble for our soldiers.

And we used the medical experts here to help us design other things than the SAPI plates, the arm protectors, the lower extremity protectors, as well as the helmet design, as well as the additional plates that we put on the side -- and I won't get into details on this, because, you know, we don't want to give away all the things that we've done for the soldier.

But the medical community helped us very quickly address those things, as well as the type of wounds that we saw with IEDs in Humvees versus other vehicles.

And so, we weren't as fast as we should have been, but we're certainly anticipatory. And that's why so many of our soldiers are surviving.

The other thing we did, back when we looked at the numbers of troops that were going to be needed for this fight, we put more Medivac (OFF-MIKE) normally would in-country (OFF-MIKE) teams than we would have normally, which is a good thing.

We put more combat support hospitals in.

And because of that, that magic hour and that magic two hours, that's why our soldiers are surviving.

Having that much push forward also puts a stress -- and I think Dr. Kiley or General Weightman mentioned it, puts stress back here, because we now have to have medical doctors so far forward.

And that's why the medical doctor ratio here at Walter Reed to civilians is a little bit different than we have forward.

So that we were anticipatory in a lot of these things. But, clearly, I'll go back and look at the testimony and see what he meant by the types of wounds. That's the first I've heard of it.

TIERNEY: Mr. Yarmuth?

YARMUTH: Thank you, Mr. Chairman.

One of the things that really disturbs me, listening to all of your testimony and the prior panel, is that while you minimize the question of funding, virtually every problem that we've talked about today and the media has talked about involves something that costs money, whether it's fixing up facilities that have deteriorated, whether it's providing more staff to handle the workload, whether it's having part of your operation reclassifying people so as to minimize the ongoing disability cost.

YARMUTH: Every aspect of this either would cost more money or involves an activity that is trying to save the government more money, and I wonder whether the entire problem area involves not necessarily a question or motivation or even a systemic failure, but the idea that we're trying to do it on the cheap as we've done so many other aspects of this war on terror.

I suspect I know what the answer is going to be, but I want to raise that question because in one of the Washington Post articles, a man is quoted named Joe Wilson -- not the ambassador, a clinical psychologist here who talked about the fact that -- he said they knew all about these problems but there was something about the culture of the Army that wouldn't allow them to address it.

And I'm wondering whether it's not the culture that "We can't afford to go in and ask anybody for more money because we've got to hold the line somewhere, and we're spending on bullets and we're spending it in other ways," but it seem astounding to me that there is -- you can come here and say "We don't need more money or resources to correct these problems" That just sounds inconsistent to me.

GUERIN: If I could speak to that, the issues that we've identified so far are not questions of money. We're going to study this and look at some of the long-term policy implications, and it's possible that we're going to have to come back and redirect additional funding in this area.

But our studies so far have indicated that failure of leadership from a very high level all the way down the enlisted folks that are working with these wounded warriors identified just questions of management of the facilities, and then the other issues that we talked about in great length, about how the various disability systems work together, the transition to the V.A.

At the end of the day, we may come back. We are going to work within the department. The president has announced a study. The secretary of the Army two weeks ago announced another study. We could come back to the Congress with a package to address this that would involve money. I'm confident we're going to come back to the Congress with a package to address some of the policy issues.

But, as Mr. Waxman pointed out, what's going on around the rest of this country? Are we making sure we're looking under every rock? We have a Tiger team going out -- started two weeks ago -- going to every single major medical facility, any place in the country, to make sure that the lessons that we've learned now are carried across the country so that we don't have something happen like this again.

The new leader that was brought into Walter Reed was brought in because of his leadership skills and specifically to address the issues here. You can be sure. He was appointed Friday afternoon. Saturday morning he was here on the ground working this issue, and he's worked it non-stop since then.

Will we ask for more money eventually? Who knows? We can't tell you right now. But we have the resources to meet this need in the short-term. In the long-term, it raises some additional issue and we'll be back to you with that.

YARMUTH: Well, let me follow up just a minute, because, as Congressman Waxman mentioned, today's Washington Post mentioned a problem in San Diego, in my own state, in Fort Dix, in North Carolina in Fort Bragg. It seems like there's a lot of these problems, and I'm wondering whether there's some kind of mentality -- maybe it's at the lower levels too -- that says, "Wait a minute, we know we're strapped, we know we can't have any more money, therefore, we're not even going to bother reporting these."

Is that potentially a problem or not?

SCHOOMAKER: Sir, I hope not.

YARMUTH: I hope not, too.

SCHOOMAKER: You know, anybody that's watched what we've been through over the last several years and has watched the Army fight for money and saw what we did last year pushing back on submitting a problem until we could rectify some things and get it through -- I believe I heard General Kiley say that he felt that, in his area, in MEDCOM, that he was fully funded under the global war on terrorism.

SCHOOMAKER: I mean, I don't think there's a mentality that we're shy to ask for the resources that we want. But I can tell you it's extraordinarily difficult, sometimes, to understand what it is that's needed, where it's needed, and to work through the process to get it.

And so, you know, I don't know. You know, perhaps there may be places out there that you can find people don't have confidence that, if they ask for things, that they can get it. But we, certainly, have been fighting tooth-and-nail to get the stuff that we believe we need to...

TIERNEY: The gentleman's time has expired.

GUERIN: Congress has been very responsive. If we need money for soldiers, you all have stepped up to the plate. We are not shy about asking and you all haven't been shy about delivering.

TIERNEY: Thank you, Mr. Secretary.

Mr. Braley?

BRALEY: Thank you, Mr. Chairman.

General Schoomaker, Secretary Guerin, General Cody -- General Kiley is an obstetrician. And one of the things I learned going through lamaze classes with my wife is that it's helpful to have a focal point to get you through periods of pain and discomfort and take your mind off what you're dealing with.

And I don't know if the three of you are familiar with this publication, Stripe (ph), but I would encourage you to pick up a copy of it and use this as your focal point in the months ahead.

This is published in the interests of the patients and staff at Walter Reed Army Medical Center. This is the March 2nd, 2007, issue -- the most recent issue.

And you'll see here in the upper left-hand corner a picture of Secretary Gates visiting Walter Reed to talk about some of the very issues we've been talking about today.

And up here in the upper right-hand corner, there's a story about Major General Weightman being relieved of his command.

And then, if you follow down here to, "What's happening," in a real touch of irony, I think, you'll see that today is Patient Safety Week. And, here in this publication, it is encouraging people to remember this year's theme: Patient safety: A road taken together, a collective effort for safer health care.

And it talks about the ongoing efforts here at Walter Reed to promote patient safety.

One of the concerns that this committee has is that we have heard these claims before. We have heard how post-traumatic stress disorder is not perceived the way it was in the movie "Patton."

We would like to think that, now, post-traumatic stress disorder is perceived the way it was portrayed in "Band of Brothers," when we saw Sergeant Buck Compton, a very real hero, deal with the stress of post-traumatic stress disorder.

What I need to know and what the other members of this committee need to receive assurances on is how the Army is going to put backbone behind the stories we see on the front page of Stripe (ph) and assure the brave men and women in uniform serving this country that their biggest challenge won't be facing the hardships they face overseas, but the hardships they face when they return to this country.

BRALEY: And one of the things that I'm concerned about is in this story that appeared in The Washington Post General Weightman was quoted as discussing that one of the responses that is going to take care of some of these problems is an increase in the numbers of case managers and patient advocates to help with the complex disability process which is one of the biggest sources of delay.

Can any of you tell us how many patient advocates currently serve the patients here at Walter Reed?

SCHOOMAKER: I think we have an exact number on the thing.

Do you have the...

CODY: I don't have it. I do know the caseworker load that we're trying to get to, Congressman, is 1-35. It has not been that. And I heard the other testimony, and, quite frankly, I don't have the numbers with me.

But we are increasing our caseworkers. But it's not just increasing caseworkers...

BRALEY: General Cody, I want to make sure we're talking...

CODY: ... it's the quality.

BRALEY: ... I want to make sure we're talking about the same thing. I'm not talking about case managers, which is a separate function. I'm talking about patient advocates. You understand there's a difference between the two.

So when you're talking about that ratio, are you talking about case managers to patients or patient advocates to patients?

CODY: Case managers to patients. The case managers deal with the process. And what we have to do is increase the number of advocates that we have for the patients when they go through this MEB/PEB process. But not just that, but also their stay here. And that's the piece that we have to work on.

BRALEY: So going back to my original question, can any of you tell me how many patient advocates, not case managers, are currently employed to serve the patients at Walter Reed.

SCHOOMAKER: I cannot tell you.

CODY: I cannot.

BRALEY: I think that's a crisis that needs to be dealt with, because everything we heard during the first panel shows -- and the news articles we're reading -- that that is one of the number one obstacles facing veterans returning with disability claims. And I will be working very hard with my staff to see that it gets addressed, and I would welcome your further input on that subject.

TIERNEY: Gentleman yield back?

BRALEY: Yes.

TIERNEY: Thank the gentleman.

Ms. Foxx?

FOXX: Thank you, Mr. Chairman.

And thank you, gentlemen, for being here.

Again, I've been listening very carefully to the kinds of things that are being talked about here.

FOXX: And it seems to me that, in my short time of being in office, that I hear very many of the same kinds of complaints from the civilian population, when it comes to dealing with disabilities, and how the Social Security system works.

So I do think that it's a widespread problem that we're talking about. I think that what has happened here has gotten the attention of the American people. And it should get the attention of the American people. It should get the attention of Congress.

Again, I want to ask you about your commitment to making this a system-wide effort, and say to you, perhaps you can show us, outside the military, how we can improve what happens with disability.

Because I know, in my office, we have people who are trying to get on disability. We've had people who have died waiting to get on disability through the Social Security system. Because I think that's a broken system, too. I'm not sure your system is as broken as the one that we have outside the military.

So I hope that you will look for ways to fix your system, make it better. And I think it's gotten your attention. And I, again, want to just hear you say -- you've said it before -- that you're going to work to make it such that the system you have will be a model, not just for the military but for the civilian system, too.

SCHOOMAKER: That has always been our objective, is to have military health care by a model for the world. And that's what's so disappointing about where we find ourselves on this.

FOXX: Thank you.

TIERNEY: So you yield back?

FOXX: Yes, sir.

TIERNEY: Ms. McCollum?

MCCOLLUM: Thank you, Mr. Chair.

Well, I asked the question earlier, of the first panel, about ombudspeople being available, ombudsmen. And my answer back was that there's zero. There's no one here that is seen as an impartial entity that people can go to, where they really feel that sides haven't been taken.

And in the V.A., they have veterans (inaudible) services officers, but they're being overwhelmed, right now, with being able to do what they need to do.

I appreciate what you gentlemen have said about working to be better prepared. We were not prepared with the conflict we found ourselves into, because of poor planning.

And I will say that that's my opinion, but I think it's beared out that this is not the war that many of those in Congress who voted for it thought it was going to be. I'm glad I didn't vote for it.

We saw injuries to eyes, burns, amputees, all, quite often, due to equipment and not having the right gear available for the soldiers, then, yes, the Army and the rest of the service has reacted and tried to address those issues.

MCCOLLUM: But when it comes to the traumatic brain injury and with the post traumatic stress syndrome, I'm feeling some alarms going off.

And I know that there was discussion about doing further studying.

One alarm is, with cognitive skills tests that are being given, as we have lowered the educational standards to meet recruitment needs, we are going to have soldiers coming in who are not going to be high school graduates in all cases.

And I don't know what kind of testing you're using, but I don't want to see someone who signs up who has a GED penalized later on by a test that's given to decide whether or not their cognitive ability has been up to speed.

With post traumatic stress syndrome, it wasn't that long ago that someone was going to sit at a desk and review documentation and take veterans off -- off the roles for having been originally clinically diagnosed with post traumatic stress syndrome.

So I'm a little concerned about how these unseen, untouchable injuries are going to be handled.

And so, as you're preparing -- and I heard what you're going to try to do here, and I pray that you're able to do it, I want to know what you're going to tell the V.A. that they need to do in order to be prepared. What kind of funding are they going to need? What kind of bedspace are they going to have to start reopening? What's their staffing levels going to have to be?

What's the hand-off here? Because, General Cody, I appreciate the fact -- and I think it's magnificent -- that there's a Wounded Warrior Program.

But years after these men and women come home, they're just called veterans by many. And they're still -- many of them from Korea and World War II are still waiting to get in the V.A. system today.

What are you telling the V.A. to be prepared to hand these warriors off to them for their care?

CODY: First, Congressman, I couldn't agree with you more.

We're going to fix this. We have a passion for it. These are our soldiers; these are our veterans.

The ombudsman I brought up, I guess a week ago, when we started talking about the handoff, and I said, "Well, who is the advocate during this process? And who does the soldier go to if he agrees or disagrees or has a problem?"

And I didn't get a satisfactory answer, so I've directed that we come up with an ombudsman-type program for the soldier going through this system.

The coordination that we have to do with the Veterans Administration is ongoing. I'll have to look into it. Quite frankly, I've been focused right here on Walter Reed, and I have not looked at what our service surgeon generals have done informing the Veterans Administration as to what type of more bed space or what type of more type of specialists they need as our soldiers transition into the Veterans Administration.

CODY: I do know, on the traumatic brain injury, that a lot of work has been done.

But PTSD and some of these other types of injuries, I'll have to go back and find out what our surgeon generals are telling the V.A.

MCCOLLUM: Thank you.

TIERNEY: Does the gentlelady yield back?

MCCOLLUM: I yield back.

TIERNEY: Thank you.

Mr. Hodes?

HODES: Thank you, Mr. Chairman.

Gentlemen, thank you for being here today. As you know, the administration has proposed an increase in troop strength in Iraq. And if that moves forward, it means folks who've been deployed and redeployment, maybe redeployed again, with increasingly shorter time frames between their deployments.

What steps are you taking in terms of medical system to ensure that people with PTSD and traumatic brain injuries are not being inappropriately redeployed to active service?

CODY: We have a follow-up. First off, we screen soldiers before they come out of theater. And then we screen them as part of the -- if they're active duty soldiers -- as part of their redeployment back at their home station. And if they're reserve component soldiers, we have a screening before we de-mobilize them.

And then we have another program, a 120-day follow-up program to re-evaluate any soldiers that have problems.

Now, I'll report to you today that that program is not going as well. I just got the inspector general's report today (inaudible) briefing this morning before this hearing. And we need to do better at training our leaders.

We can put all the medical specialists out there, but our leaders are the ones that are going to see that soldier first and say, "Specialist Jones -- he has a problem."

And so, because of the OPTEMPO, we have not trained some of our leaders as well as we should to be looking for these type of things. And that's something that I've directed that we re-address.

But we screen them when they come out. They have a reintegration program right after they come back from combat. And then, 120-day follow-up program.

I don't know if those measures are right. That's what our doctors have told me, and that's one of the things that I'm looking at right now.

HODES: Is the screening that you're talking about being done by physicians, psychiatrists?

CODY: Yes. We have a questionnaire, and they tell me that there's questions there that will indicate that there are problems. And I'm not deep enough into it, Congressman, to give you an accurate assessment.

HODES: What do you think is the time frame for your figuring out what the problems are with this process and for fixing it?

CODY: I think we know we have a problem because of the OPTEMPO. As the chief has said, you know, the OPTEMPO of the Army is just like you said, one year in, about 12 months out, and then you're going back in. And so that puts a stress to make sure that we get this post- deployment assessment done.

So I'm sure that it's not as good as it should be. I probably will find out here when I talk to all our hospital commanders this week, and that'll be part of our Army action plan to address soldiers that would not necessarily be eligible to deploy again.

HODES: I anticipate that there may be some tension between the need to redeploy people and determining whether or not they're suffering from a severity of PTSD or TBI that would in the ordinary course prevent or argue against their deployment.

What guidance is coming from the top, down the ranks, to give our soldiers the benefit of the doubt so that they're not getting sent out with PTSD and TBI that ought to disqualify them from having to go back into active service?

CODY: I don't know if we have any guidance out. You're talking about leadership 101 here, you're talking about 1st sergeants, platoon sergeants, company commanders, the first-line supervisors.

My experience in the last two years of being here at Walter Reed, in talking to soldiers that are still in units but have PTSD, is I've been heartened by the fact that our first-line supervisors recognize that a soldier has PTSD.

And in one case, when I was up talking to a soldier and asked him if he was afraid to come forward, he said, "No, my leadership took good care of me. My platoon sergeant's been here. My 1st sergeant's been here. And they know that I need to get well and they're supporting me." And that's just a small sample size. Clearly, we've got to go back and check this.

But I will tell you, we've got great leaders in charge, and we've got a very seasoned set of leaders that have been to combat several times. My son's a company commander, getting ready to go back to his fourth combat tour. And I'm sure that he's not going to deploy with any soldier that has these problems. And my hope is he and the other company commanders will see that and make sure the medical personnel are properly alerted.

But it's something we're going to have to go back and check.

TIERNEY: Thank you, Mr. Hodes. Your time has expired. I'm sorry.

HODES: Thank you, Mr. Chairman.

TIERNEY: Mr. Welch?

WELCH: Thank you, Mr. Chairman.

Generals, I'm sure you agree that the cost of the war has to include the cost of paying for treatment for the warrior. And there's a report from Peter Garibaldi, the garrison commander, about the privatization that occurred about services here at Walter Reed.

And what I understand is that prior to the decision to privatize support services, there were 300 federal employees doing facilities management and related work. And then IAP, which is a company run by someone who used to be with Halliburton, they eventually took over and the number of personnel dropped in the range of one report of 60 -- I think an earlier witness today said it was closer to 100.

Has the decision to move to privatization and, essentially, replace government employees who have got experience and had been doing a good job, as I understand it, with private contractors been detrimental to the delivery of services that our returning veterans need?

SCHOOMAKER: Sir, if I could take one swing at that -- and I'm no expert in privatization, but I can tell you that there's a lot of demand on the force and we've been trying to grow the operational force of the Army. And there's been a lot of effort to make sure that any place that we've got soldiers doing things, have soldiers doing things where somebody else can do them, we want soldiers doing things that only soldiers can do.

Now, I don't think that's the case here at Walter Reed. I think what we went through at Walter Reed was this A-76 thing, study, that basically competed the DPW against a private entity. And this thing went on, I think, since what, 2004, Dick? Or something like that?

CODY: Yes, it's the A-76 competition against the Department of Public Works, which was an entity of government D.A. civilians, and they initially won the competition and then it was protested. And then, in the protest, IAP won, and then it was protested again. So this thing started from 2004 and finally got where IAP, which won the contract -- I guess they took over about 7 February.

SCHOOMAKER: That's the point I was trying to make, because this is a very unusual kind of transaction that took place, and then you have BRAC on top of this, which, you know, people then are concerned about their future plan.

WELCH: No, that's my point. It seems very unusual. You had competent employees who won the bid. Then their bid was reversed for no explicit and clear reason, and then IAP, which gets $120 million contract, then downsizes furthermore, obviously boosting profits but apparently compromising service that presumably is a concern to you, correct?

SCHOOMAKER: Well, it's clearly a concern, but it's also something that we normally would not have any visibility into or anything -- we can't influence that process.

SCHOOMAKER: I mean, once that starts...

WELCH: All right, thank you. Let me ask you -- I understand that. That goes on outside of you.

You know, General Weightman served here for six months and he was the person in charge at the time that these reports came out from The Washington Post. But the information that we've received so far is that the conditions pre-existed his arrival, and that he was in fact taking some concrete steps to address them.

Obviously, once this story gets front-page news, it creates an enormous amount of anxiety and turmoil and demands a public response. But bottom line question is this: Has General Weightman been treated fairly, or is he being a scapegoat?

SCHOOMAKER: First of all, I wouldn't take part in something that was a charade.

WELCH: Sure.

SCHOOMAKER: I think it addresses one's integrity, OK?

And the secretary of the Army looked at this situation -- all of us were very upset with what we saw, and concerned about it -- and felt that the kinds of conditions that were here that we were not aware of should have been highlighted in a time frame that, regardless of when they started, with the commander that's here.

And when you take a look at who's accountable -- and the secretary said he had lost confidence in General Weightman. And he made the decision to do it. Nobody pressured anybody to do it, and nobody was lobbying to do it or looking for anything.

But, you know, it's clear that there were issues that were bigger than a couple of platoon sergeants and a company commander.

And so, listen, General Weightman has got a tremendous reputation. He's a fine doctor. I've known him for a long time. You know, my view is he's got a lot that he can do yet for us.

But the secretary of the Army felt that this was what was required, and he made that decision. I supported him.

WELCH: OK. Thank you, General.

I yield.

TIERNEY: Thank you.

Ms. Norton?

NORTON: Thank you, Mr. Chairman.

I don't know which of you I should speak to, but I think it's at your level. This GAO report literally just out, "Challenges encountered by injured servicemembers during the recovery process."

One of the things we've been trying to get to the bottom of is the frustration that we heard in testimony from veterans caught in what I can only call the indecision of the bureaucracy, where the soldier doesn't really know his fate and he feels caught in a bureaucratic tangle.

NORTON: Virtually all the testimony from the brass has essentially said this was a leadership problem, whereas the members have identified a systemic problem that they say is nationwide.

Whereas the testimony has seemed to say, you know: Change the people; that will change the system.

The GAO, it seems to me, points to, really, a quite pregnant example. It says -- and here, I'm quoting -- "V.A.'s efforts may conflict with the military's retention goals."

Interestingly, I don't know who put this chart here (inaudible) -- I'll try to find out who it was from -- a disability rating difference is an example, where they put an example from the V.A. and an example from the PEB or the health system, and where the same soldier with the same disabilities is rated 40 percent disabled by one and 70 percent disabled by another.

Now, that says to me that, not only do computers not talk to one another, but even freshly injured soldiers -- we're not talking about soldiers whose problems may have developed since release and, therefore, they've been in the system.

SCHOOMAKER: Ma'am, I think you'll see there's two different laws involved...

NORTON: Well, first of all, let me give you what they say...

SCHOOMAKER: ... one for the V.A. and one for the...

(CROSSTALK)

NORTON: ... in particular -- because I'm not suggesting that, somehow, they should be the same, so please don't misunderstand me; nor does GAO.

It says, in particular, DOD was concerned about the timing of V.A.'s outreach to servicemembers whose discharge from military service is not yet certain. DOD was concerned that V.A.'s efforts may conflict with the military's retention goals.

It seems, obviously, who pays for what between these two agencies comes into play here. And here we have a surge about to happen. In fact, some say that the surge may be over by May; that the soldiers may all be there.

Until now, our soldiers clearly were not -- there was an attempt to keep them out of the middle of what was, increasingly, a civil war. Now we send them right into the middle of it.

I am concerned we're going to get more people who come back and need to talk to both systems at the same time, and wonder what you can do to keep a soldier from experiencing two different ratings systems; and then to ask you, whose job is it to figure out what the soldier finally gets, fairly?

CODY: Madam Congresswoman, let me take that on because I'm as frustrated with it as you are. And it really gets to the heart of the issue.

First, let me be clear that it's not just a leadership problem. We understand that. When we talk about leadership failure, it dealt with just the one symptom of Building 18 and the MedHold unit.

CODY: We all recognize it is a much larger bureaucratic morass that our wounded soldiers have to face.

The chart you just held up is an interesting chart. You're talking about Title 38 for the V.A. and Title 10 for the military.

When we look at a disability rating for the military, it deals with being unfit for service in the military. So if a Sergeant Jones loses an eye, like we have on that chart, but he has vision in his other eye, we assess him as 40 percent disability.

He may have lost hearing. He may have lost some lower teeth. And he may have some scars. But those particular things would not make him unfit for military duty.

So that's why he gets assessed by 40 percent under the rules of Title 10 on how we look at disability.

I don't agree with it, but that's how it is.

The V.A., under Title 38, can assess all those things. And so, the soldier sits there and says, "Service will give me 40 percent; V.A. will give me 70 percent." And that's the first confusion.

The second confusion is, depending upon disability, if you're a lower enlisted soldier, you probably fare better under those circumstances than an E-7 or an officer, because it's based upon, for the military, based upon years of service and your base salary.

NORTON: Does the soldier get to choose? Who chooses?

CODY: Well, what we do is -- and this gets to the point that I talked about between the MEB process and the PEB process, the Physical Evaluation Board -- we have a liaison officer. And that's the clutching mechanism. And that's the piece we've got to fix.

And we've got to do a better job educating the soldier, because it is very, very confusing.

Let me give you one more that will just upset you.

NORTON: Excuse me, you haven't answered me, who gets to say which -- these numbers are different.

(CROSSTALK)

CODY: The soldier gets to pick. The soldier picks. And you're sitting there. And it's very complex. I had a two-hour session on it one night, and then had to come back and give it to me again, just on one thing.

NORTON: Well, who advises the soldier who has to pick?

CODY: The liaison officer. And then if he does not like the ruling of the Physical Evaluation Board, then he can appeal it. Then the lawyers -- because it's a process, a discharge -- the lawyers come and advise him as to what is best for him or her.

At the end of the day, it looks unfair. And, quite frankly, we're being a little stingy as a nation.

CODY: And we have to look at this whole thing.

SCHOOMAKER: And soldiers have said they feel disrespected because of what they're going through. They've said that.

CODY: Yes, because they have to demand it and fight for it, and they shouldn't have to.

NORTON: Thank you very much, Mr. Chairman.

And if I may say so, we talked about all kinds of computers not talking to one another. We talked about all parts of the system that we could understand not being fixed.

What concerns me about these soldiers is that they are fresh out of war, and whether or not you can fix this throughout the system -- and I focused on short-term versus long-term fixes -- the burden being on the soldiers and then appeal and the rest of it, these were not people who had mental difficulties.

And it seems to me that one of the first orders of business would have been to get your two departments of the government so that they agree on a way to deal with these soldiers that reduces -- considerably -- not only the confusion, but the time spent in two systems trying to figure out which one is best for you.

It's more than we ought to ask a soldier to do.

TIERNEY: Thank you, Ms. Norton.

Gentlemen, I understand all the confusion that's taken place since we started having these hearings scheduled, including our requests for documents that were sent out some time ago but we've, since then, had two commanders out here at the facility.

So can I have your assurance that our requests for documents will be provided to us in short order?

And we have an additional request that will be going out, just learning that this may be a little bit more systemic than what we thought -- at just Walter Reed. We'll be expanding that out. And I'd like to have your cooperation in getting the with respect to complaints that might have been made or efforts to resolve those complaints.

Do I have that?

GUERIN: Let me say about the documents -- I have not had an opportunity to review the document requests. And there may be some issues that we'll have to discuss with the committee, so I don't want to make a blanket commitment till we have an opportunity...

TIERNEY: That's too bad. I liked it better when General Schoomaker and General Cody nodded their heads.

(LAUGHTER)

I understand that you may have some...

(CROSSTALK)

TIERNEY: ... but I don't think you've got a (inaudible) problem. They're pretty straightforward and we would expect that they'd be met without much difficulty on that.

One last thing: In the privatization process, it's not a decision for General Weightman when he was here. It wasn't a decision for his superior, General Kiley. It wasn't a decision for General Cody. And it's not a decision for General Schoomaker.

So this whole thing is, what, a political decision kicked up to the suits? I mean, who decides whether something is going to get bid up or -- this is a medical facility within our armed services. I would think that each of you gentlemen and then the surgeon general and then the commander here would have the best idea of what kind of service our patients need.

SCHOOMAKER: Because it's a legal process, in this particular case it was challenged, the decision.

TIERNEY: But it was not your process.

SCHOOMAKER: It's not...

TIERNEY: It started over on the secretary's side.

(CROSSTALK)

SCHOOMAKER: ... and policy.

TIERNEY: The secretary is the one that operates that process on down?

GUERIN: I don't know how the decision is made to engage the A-76 project for a specific function of government. I'll get back to the committee on that.

TIERNEY: Could you get back to us on that? I think it's pretty amazing that the people most involved in the care don't.

NORTON: Mr. Chairman, could I ask that they get back to us on how much privatization of Army facilities is going on at this time? We had here the entire garrison base being privatized.

It does seem to me the committee needs to know how systemic that process is throughout the Army hospitals in the United States.

TIERNEY: General Schoomaker?

SCHOOMAKER: We'll have to respond for the record.

TIERNEY: Yes, if you would. Thank you.

FOXX: Mr. Chairman? Can I get one clarification, too, on this chart here?

FOXX: Is it such that, if a person has 40 percent disability from the left side, that they are able to remain in the military and draw their disability as opposed to becoming a veteran and drawing the other disability? Is that the distinction that is being made here?

CODY: No, ma'am. It's very complex. But 30 percent and above you get to be medically retired. If you're less than 30 percent, you don't get to be medically retired, and you could get more percentage from the V.A. than you could from the military, based upon the V.A. data tables.

And that is confusing.

But in this case here, because this soldier -- this is a sample -- this soldier lost an eye, he was 40 percent disabled. So he was medically retired.

However, based upon the other injuries, they did not render him unfit for military duty, so he wasn't scored. Against V.A. tables he was scored, and he would be better off going into the V.A. as a medical retired soldier.

SCHOOMAKER: Ma'am, you know there are amputees, for instance, that fight to stay on active duty -- they have 30 percent or greater, and they have to fight through the process to be able to do that and prove their abilities, their fitness to stay.

TIERNEY: Specialist Duncan, in fact, was one of those that was fighting through the process on that.

FOXX: And how many people do you have currently -- excuse me, Mr. Chairman?

CODY: I've got that number.

FOXX: You can give that to me later.

CODY: OK. I've got it.

TIERNEY: Let us thank you, Mr. Secretary and Generals, and all those that helped make this facility available to accommodate us here today.

We also want to thank all of the men and women who are patients here -- and their families -- for allowing us to use this as a forum to dig deeper into those matters.

We appreciate the fact that this is a complex problem, one that we have to work on together. It's not partisan and it's certainly not anything that's going to be done overnight.

But we will be coming back, as we said to General Kiley, within about 45 days or so looking for a follow-up on this and hoping that we'll have good news on that.

And the good thing that could come from all of this is that we focus and we get to work on it and, together, we come to a resolution for our men and women that have served us so well and to whom we owe so much.

So thank you all very much.

With that, the meeting is adjourned.

END

.ETX

Mar 05, 2007 17:18 ET .EOF

Source: CQ Transcriptions © 2007, Congressional Quarterly Inc., All Rights Reserved

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