House grills Defense health officials about centers of excellence

The Defense Department should operate one management infrastructure and network that will integrate its five medical centers of excellence, which Congress mandated three years ago to research treatments for battlefield wounds, top military health officials told a House panel on Tuesday.

Defense has made little progress in setting up the centers, which will research injuries that affect hearing and vision, and traumatic extremity wounds, said Rep. Susan Davis, D-Calif., at a hearing of the House Armed Services Subcommittee on Military Personnel. Congress called for the establishment of the centers to advance treatments for wounds troops suffer in the wars in Iraq and Afghanistan. Many of the injuries are caused by improvised mines.

One organization is in operation, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, which was founded in November 2007. Davis said the center has reported some small scale successes, but "has not inspired great confidence or enthusiasm thus far."

The center will spend $50 million this year on research into psychological health, which includes post-traumatic stress disorder and traumatic brain injury.

Davis faulted the center for serious management missteps, which she did not identify. She also said the start-up was difficult because the center needed to "create, or more accurately, recreate all of the administrative infrastructure and processes required to oversee medical research on such a monumental scale."

Dr. Charles Rice, president of Defense's Uniformed Services University of the Health Sciences, said one way to reduce management overhead and allow the medical centers of excellence to focus on their missions would be to rely on the Army's Medical Research and Materiel Command at Fort Detrick, Md., for administrative support. Rice also serves as assistant secretary of Defense for Health Affairs.

Lt. Gen. Eric Schoomaker, the Army's surgeon general, said the centers need a single support organization, such as the Medical Research and Materiel Command. Lt. Gen. Charles Bruce Green, the Air Force's surgeon general, said such an operation shared by the five centers would allow them to focus on their core missions.

Vice Adm. Adam Robinson, surgeon general for the Navy, endorsed the idea of using the command for support and added that duplication of efforts could be eliminated by setting up one network for all the centers.

In his prepared testimony, Rice said the Vision Center of Excellence, which will be run by the Navy, has developed the functional requirements for a Defense and Veterans Eye Injury and Vision Registry. The service is working with the Veterans Affairs Department to stand up the center.

He added that the Hearing Center of Excellence, managed by the Air Force, and the Joint Center of Excellence for Battlefield Health and Trauma Research, managed by the Army, are developing requirements for their registries. The centers will use a common database to manage treatment of wounded troops who have multiple injuries covered by the centers, such as hearing loss, vision problems and PTSD.

Schoomaker told the subcommittee that the joint center for battlefield health is under construction and expected to open this summer in San Antonio.

The Air Force, in collaboration with VA, plans to set up the Hearing Center of Excellence in San Antonio at the Wilford Hall Medical Center at Lackland Air Force Base, Green said.

Despite the delays in establishing the centers, Schoomaker said Defense has completed a lot of work on missions required by the charters. He cited development of the Joint Theater Trauma Registry as an unprecedented achievement in the management of battlefield casualties. The registry provides real-time information about soldiers' wounds, allowing medical teams to determine how quickly they should be evacuated.

The Army also uses information in the registry to develop ways to improve equipment such as helmet goggles, body armor and vehicles to prevent combat wounds.