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Highlights

The 2005 Base Realignment and Closure (BRAC) provision required the Department of Defense (DOD) to close the Armed Forces Institute of Pathology (AFIP). GAO was asked to address the status and potential impact of implementing this BRAC provision. This report discusses (1) key services AFIP provides to the military and civilian communities; (2) DOD's plans to terminate, relocate, or outsource services currently provided by AFIP; and (3) the potential impacts of disestablishing AFIP on military and civilian communities. New legislation requires DOD to consider this GAO report as it develops its plan for the reorganization of AFIP. GAO reviewed DOD's plans, analysis, and other relevant information, and interviewed officials from the public and private sectors.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense 1. As part of DOD's initiative to develop a plan for disestablishing AFIP, the Secretary of Defense should include in the December 2007 plan to Congress implementation strategies for how DOD will use existing in-house pathology expertise available within military treatment facilities, identify and obtain needed consultation services from subspecialty pathologists with appropriate expertise through the Program Management Office in a timely manner, and solidify the source and organization of funds to be used for outsourced consultation services.
Closed - Implemented
In its comments on this report, DOD concurred with this recommendation. The Nat'l Defense Authorization Act of 2008 directed DOD to establish a federal Joint Pathology Center (JPC) in DOD which would provide diagnostic pathology consultations to DOD and other federal agencies. DOD's Initial Operating Capability for the JPC was October 1, 2010. Formal full operating capability for the JPC is expected to be September 15, 2011. The JPC's Diagnostic Consultative Service, which will include the Program Management Office, has been fully operational since April 1, 2011, and AFIP's Diagnostic Consultative Service ended on April 15, 2011.
Department of Defense 2. As part of DOD's initiative to develop a plan for disestablishing AFIP, the Secretary of Defense should, within 6 months of completion of DOD's study regarding the usefulness of the pathology material in the repository that is to be finished in October 2008, require Uniformed Services University of Health Sciences (USUHS) to provide Congress with information on the status of the repository's assets and their potential for research use.
Closed - Implemented
In its comments on this report, DOD concurred with this recommendation. On August 2008, DOD reported that the Uniformed Services University of Health Sciences (USUHS) had commissioned a study to evaluate the assets of the Armed Forces Institute of Pathology (AFIP) Tissue Repository and that the contract period was through Sept. 31, 2008. On February 2009, DOD reported that it had received the contractor's final report on December 31, 2008, USUHS was reviewing the results of the study, and planned to submit a report to Congress by the summer of 2009 that would provide an evaluation of the status of the Tissue Repository's clinical data and pathology specimens. In a memo dated February 26, 2010, to the Acting Chief Financial Officer, the Acting Deputy Assistant Secretary of Defense for Clinical and Program Policy stated that this recommendation is complete. The DAMIS record shows it as being completed on April 20, 2010.
Department of Defense 3. As part of DOD's initiative to develop a plan for disestablishing AFIP, prior to USUHS assuming responsibility for the repository, the Secretary of Defense should provide a report to Congress on its implementation strategies for how it will populate, manage, and use the repository in the future. The implementation strategies should include information on how USUHS intends to use pathology expertise to manage the material, obtain pathology material from a wide variety of individuals, maximize availability of the repository for research through cooperative ventures with other academic institutions, and assist interested groups--if any--in supporting the continuation of educational services, such as the Radiologic-Pathologic Correlation course.
Closed - Implemented
In its comments on the GAO report, DOD concurred with this recommendation. On August 2008, DOD noted that the strategic plan for the Joint Pathology Center (JPC) had been developed, and in accordance with statutory guidance, would provide for the maintenance and modernization of the Tissue repository. Although the DOD DAMIS records dated April 20, 2010, June 20, 2011, and July 2012, all showed the status of this recommendation as closed, GAO did not close it because DOD did not show how the JPC would populate, manage, and use the unique assets of the repository. DOD asked Institute of Medicine (IOM) for a report on the appropriate use of AFIP's tissue repository following transfer to the JPC. In September 2012, the IOM issued a report from the Committee on its review of the appropriate use of AFIP's Tissue Repository following its transfer to the JPC. The report titled "Future Uses of the Department of Defense Joint Pathology Center Biorepository" provides detail on how the assets can be populated, managed, and used in the future. GAO followed up with DOD's IG to obtain information about whether it endorsed these strategies.

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