The Congress Should Mandate Formation of a Military-VA-Civilian Contingency Hospital System

HRD-80-76: Published: Jun 26, 1980. Publicly Released: Jun 26, 1980.

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In response to a request, GAO reviewed the Department of Defense's (DOD) plans to use nonmilitary hospitals to treat battlefield casualties in the event of war or conflict, and discussed the need for developing a contingency hospital system consisting of DOD, the Veterans Administration (VA), and civilian medical resources. The primary emphasis is that the VA role should be greater than currently planned by DOD. The extent of support VA will provide DOD in treating returning battlefield casualties is the most important issue in developing a civilian-military contingency hospital system for medical treatment of wartime casualties. DOD has looked primarily to civilian medical resources to meet anticipated shortfalls should the United States become involved in war. Only recently has specific consideration been given to VA medical capability. DOD officials said that civilian resources would still be needed to treat battlefield casualties even if DOD and VA resources were fully used for that purpose.

DOD recently revised several aspects of its original system. Major changes are: (1) elimination of a new, possibly duplicative administrative structure as originally proposed; and (2) reliance on the military services for patient administration responsibilities. GAO agreed with these revisions. DOD-revised plans are still unclear about how civilian beds and staff would be made available. Available beds and staff should be identified assuming patients are discharged early whenever possible and nonemergency admissions are restricted during the war surge period. Failure to resolve issues regarding civilian physician and hospital reimbursement and liability could limit implementation of the planned system. VA should be much more involved in planning and caring for battlefield casualties than it would be in caring only for those who will not return to duty. Just how much VA can participate is questionable. DOD has not told VA what its needs are, nor has VA told DOD what its capabilities are. GAO believes that the nation should prepare for a possible conflict by planning to appropriately use federal medical resources before calling on civilian resources. A strong peacetime medical resources sharing program could provide a more effective relationship between VA and DOD that could prove invaluable in war.

Matter for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: When we determine what steps the Congress has taken, we will provide updated information.

    Matter: Congress should enact legislation which provides that both DOD and VA fully participate in federal medical planning for and care of returning wartime casualties. Such legislation should: (1) give VA the mission of providing direct medical support to DOD for treating battlefield casualties; (2) place battlefield casualties above veterans with non-service-connected, nonemergency conditions in priority for care; and (3) remove numerous obstacles to interagency sharing, as GAO previously recommended, so that VA and DOD may establish a strong peacetime medical resources sharing program to serve as an effective foundation for a military-VA-civilian contingency hospital system.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense and the Administrator of Veterans Affairs should develop and establish the framework for a military-VA-civilian contingency hospital system. As part of this development, a mechanism should be established for obtaining civilian medical care capability that: (1) recognizes the responsibilities of the Federal Emergency Management Administration, the Department of Health and Human Services, and other federal agencies during war or conflict; and (2) adequately considers other unresolved issues, such as physician reimbursement and liability, and ground transportation availability.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense and the Administrator of Veterans Affairs should develop and establish the framework for a military-VA-civilian contingency hospital system. As part of this development, a mechanism should be established for obtaining civilian medical care capability that: (1) recognizes the responsibilities of the Federal Emergency Management Administration, the Department of Health and Human Services, and other federal agencies during war or conflict; and (2) adequately considers other unresolved issues, such as physician reimbursement and liability, and ground transportation availability.

    Agency Affected: Department of Defense

  3. Status: Closed - Not Implemented

    Comments: VA considered this recommendation and decided that, to keep the wartime nonmilitary hospital system simple, affiliated hospitals should enroll in the civilian-military contingency hospital system directly rather than through VA.

    Recommendation: The Administrator of Veterans Affairs should ascertain the extent to which VA-affiliated hospitals would be able to assist VA in treating battlefield casualties.

    Agency Affected: Veterans Administration

  4. Status: Closed - Not Implemented

    Comments: DOD initially stated that the Military Airlift Command (MAC) was to incorporate action to implement this recommendation in a MAC study of patient movements. The MAC study did not address this recommendation. DOD stated, however, that NDMS were designated to address the concerns that gave rise to this recommendation.

    Recommendation: The Secretary of Defense should determine the optimal number and placement of U.S. aeromedical staging facilities with emphasis on locations near concentrations of military and VA medical resources.

    Agency Affected: Veterans Administration

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense and the Administrator of Veterans Affairs should identify federal and civilian capability that could be provided assuming that: (1) patients are discharged early whenever possible; and (2) nonemergency admissions are restricted during the war surge period.

    Agency Affected: Department of Defense

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense and the Administrator of Veterans Affairs should identify federal and civilian capability that could be provided assuming that: (1) patients are discharged early whenever possible; and (2) nonemergency admissions are restricted during the war surge period.

    Agency Affected: Department of Defense

  7. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense and the Administrator of Veterans Affairs should analyze DOD and VA medical care resources to determine the federal patient treatment capability on a time-phased basis. This analysis should be made first near existing DOD aeromedical staging facilities, but should also include other locations where there are large concentrations of DOD and VA medical resources.

    Agency Affected: Veterans Administration

  8. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense and the Administrator of Veterans Affairs should analyze DOD and VA medical care resources to determine the federal patient treatment capability on a time-phased basis. This analysis should be made first near existing DOD aeromedical staging facilities, but should also include other locations where there are large concentrations of DOD and VA medical resources.

    Agency Affected: Department of Defense

  9. Status: Closed - Implemented

    Comments: DOD stated that Memos of Understanding signed by each NDMS provider identifies the minimum and maximum number of beds they will provide and agrees to provide all necessary treatment and hospitalization required.

    Recommendation: The Secretary of Defense should compare the medical care requirements calculated under various wartime scenarios with available federal medical resources to determine how much and what type of civilian medical care capability would be needed to augment federal capability.

    Agency Affected: Veterans Administration

  10. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense, in concert with other agencies having contingency planning responsibilities, should assume overall coordinating responsibility for plans jointly developed by DOD and VA using federal medical resources and necessary civilian medical capability under the military-VA-civilian contingency hospital system.

    Agency Affected: Veterans Administration

  11. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs should provide estimates to DOD concerning its potential capabilities, in terms of both facilities and staffing, to treat returning battlefield casualties regardless of whether those casualties would be expected to return to duty. Such estimates should be based on the assumptions that patients would be discharged early whenever possible and nonemergency admissions would be restricted during the war surge period. These estimates should be developed through the joint DOD-VA planning effort to establish a military-VA-civilian contingency hospital system.

    Agency Affected: Department of Defense

 

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