Defense Health Care:

Medical Surveillance Improved Since Gulf War, but Mixed Results in Bosnia

NSIAD-97-136: Published: May 13, 1997. Publicly Released: May 13, 1997.

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Pursuant to a legislative requirement, GAO determined what action, if any, the Department of Defense (DOD) has taken to improve medical surveillance before, during, and after deployments, focusing on Operation Joint Endeavor.

GAO noted that: (1) DOD has initiated actions to improve its medical surveillance for deployments since the Gulf War; (2) a joint medical surveillance policy, currently under development since late 1994, calls for a comprehensive DOD-wide medical surveillance capability to monitor and assess the effects of deployments on servicemembers' health; (3) provisions of the draft policy address the medical surveillance problems experienced during the Gulf War; however, its success in resolving the problems cannot be assessed until the directive and implementing instruction are finalized and applied to a deployment; (4) DOD officials expect the policy to be finalized by September 1997; (5) after the policy is issued, the services and responsible offices are to develop detailed implementing instructions; (6) DOD has also implemented two comprehensive medical surveillance plans--one for Operation Joint Endeavor in Bosnia-Herzegovina, Croatia, and Hungary, and the other for the current deployment in southwest Asia; (7) these plans address the medical surveillance problems experienced during the Gulf War and specifically call for identifying servicemember deployment information, monitoring environmental health and disease threats, doing personnel medical assessments, maintaining a centralized collection of medical assessment data, and employing certain medical record-keeping requirements; (8) recognizing that this is DOD's first attempt, its success in implementing the medical surveillance plan for Operation Joint Endeavor has been mixed; and (9) although the plan provided for enhanced medical surveillance compared to the Gulf War, GAO's review disclosed the following problems, all of which offer DOD and the services lessons to be learned as they continue to develop their medical surveillance capabilities: (a) the personnel database used for tracking which Air Force and Navy personnel were deployed is considered inaccurate by DOD personnel; (b) many Army personnel who should have received postdeployment medical assessments did not receive them; (c) when postdeployment medical assessments are done, they are frequently done late; (d) the centralized database for collecting both in-theater and home unit postdeployment medical assessments is incomplete for many Army personnel; and (e) many servicemembers' medical records GAO reviewed, maintained by medical units in Germany, were incomplete regarding in-theater postdeployment medical assessments done, medical servicemembers' visits during deployment, and documentation of personnel receiving the tick-borne encephalitis vaccine.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: A DOD Instruction, "Implementation and Application of Joint Medical Surveillance for Deployments," was approved by the Deputy Secretary of Defense on August 7, 1997, and a DOD Directive, "Joint Preventive Medicine Support of Military Operations," was approved on August 30, 1997. The DOD instruction and directive still need to be published, disseminated, and implemented.

    Recommendation: In light of the problems discussed in this report, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs, along with the military services, the Joint Chiefs of Staff, and the Unified Commands, as appropriate, to complete expeditiously and implement a DOD-wide policy on medical surveillance for all major deployments of U.S. forces, using lessons learned during Operation Joint Endeavor and the Gulf War.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: Responsibilities for ensuring implementation of the medical surveillance policies and procedures were established through the publication and dissemination of the DOD Instruction, "Implementation and Application of Joint Medical Surveillance for Deployments" and the DOD Directive, "Joint Preventive Medicine Support of Military Operations."

    Recommendation: In light of the problems discussed in this report, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs, along with the military services, the Joint Chiefs of Staff, and the Unified Commands, as appropriate, to develop procedures to ensure that medical surveillance policies are implemented to include emphasizing the need for: (1) unit commanders to ensure that all servicemembers receive the required medical assessments in a timely manner; and (2) medical personnel to maintain complete and accurate medical records.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: The procedures for providing accurate and complete medical assessment information to the centralized database will be established through the publication and dissemination of the DOD Instruction, "Implementation and Application of Joint Medical Surveillance for Deployments" and the DOD Directive, "Joint Preventive Medicine Support of Military Operations."

    Recommendation: In light of the problems discussed in this report, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs, along with the military services, the Joint Chiefs of Staff, and the Unified Commands, as appropriate, to develop procedures for providing accurate and complete medical assessment information to the centralized database.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: According to the Deputy Undersecretary of Defense for Requirements and Resources, the office knows the deficiencies in the Defense Manpower Data Center's database. It is anticipated that the deficiencies will be corrected From implementation of DOD instruction, "Implementation and Application of Joint Medical Surveillance for Deployments", Issued August 7, 1997 and DOD Directive, "Joint Prevent Medicine Support of Military Operations", issued August 30, 1997.

    Recommendation: The Secretary of Defense should direct the Deputy Undersecretary of Defense for Requirements and Resources to investigate the completeness of information in the Defense Manpower Data Center's personnel deployment database and take corrective actions to ensure that the deployment information is accurate for servicemembers who deploy to a theater.

    Agency Affected: Department of Defense

 

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