Kit Bond

Mr. BOND

Mr. BOND. Mr. President, I now see my distinguished colleague from Nevada is in the Chamber. I yield the floor to him for such comments as he wishes to make.

Mr. BOND. Mr. President, I send an amendment to the desk on behalf of Senator Hollings and Senator Graham of South Carolina. This is an amendment permitting the Secretary of VA to enter into an enhanced-use lease for the Medical University Hospital Authority in Charleston.

Mr. BOND. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. BOND. Mr. President, I move to reconsider the vote.

Mr. BOND. On behalf of the leadership, I object.

Mr. BOND. Mr. President, I believe we can accept this amendment. This is an increase, obviously. Our budget has been short in every area. We share the concern of the author of this amendment in ensuring EPA enforcement is strong enough. There is no objection on this side.

Mr. BOND. Mr. President, Senator Ensign has a statement he wishes to make, but in the meantime we have a number of amendments that have been cleared on both sides. Amendment No. 2172 to Amendment No. 2150

Mr. BOND. Mr. President, a request has been made by the distinguished ranking member of the Appropriations Committee that we have a voice vote and not just accept these amendments without objection. It would be in order to ask for a voice vote.

Mr. BOND. On behalf of the leadership, I object.

Mr. BOND. I ask unanimous consent the reading of the amendment be dispensed with.

Mr. BOND. Mr. President, we are on the amendment, the emergency designation by my friend and colleague from Maryland. She seeks to add $3 billion to the vitally important State revolving funds that are so important to cleaning up our environment. I could not agree with her from my heart more strongly because this is an area of need. We have fought very hard to get our funding up to where it is. That is not enough. We have not been able to fund the National Science Foundation as we should. We had a major effort by the leadership of the full committee to get us the money that we need to get an additional $1.3 billion for veterans health care. Having said that, this, unfortunately, is far beyond the budget allocated to the committee. It is in conflict with the stated position of the OMB with respect to emergency designations. Therefore, it is with regret that out of necessity I note that section 502, House Concurrent Resolution 95, the fiscal year 2004 concurrent resolution on the budget, created a point of order against an emergency designation on nondefense spending. The amendment contains nondefense spending with an emergency designation; therefore, pursuant to section 502 of H. Con. Res. 95, the fiscal year 2004 concurrent resolution on the budget, I make a point of order against the emergency designation contained in the amendment.

Mr. BOND. On behalf of the Senators from Illinois, Mr. Durbin and Mr. Fitzgerald, I send an amendment to the desk dealing with the North Chicago VA Medical Center, making it available to the maximum extent feasible. I ask for its immediate consideration.

Mr. BOND. I yield for any statement by the Senator from Illinois.

Mr. BOND

Mr. BOND. Madam President, I am going to send a very brief amendment to the desk that removes the emergency designation. The committee has reallocated funds to us so that our bill now comes within the allocation offered by our committee. Madam President, the amendment was with us in the cloakroom. I apologize to my colleague in the chair. Here it is. This is it. Madam President, I send this amendment to the desk and ask for its immediate consideration.

Mr. BOND. Madam President, I ask for its adoption.

Mr. BOND. Madam President, I ask unanimous consent to add, as cosponsors, Senators McConnell, Talent, and Chambliss.

Mr. BOND. Next, Madam President, I call up the Craig amendment on pesticides.

Mr. BOND. This is the Bond amendment on small engines.

Mr. BOND. Madam President, I think we have had a full debate on that amendment. I know of no other debate.

Mr. BOND. Madam President, there are about 45 seconds worth of things that we need to clear up, pending amendments. Then I intend to turn to the distinguished minority whip for the offering of an amendment, on which we will have a very short time limit. I see my colleague, Senator Mikulski, is in the Chamber. Amendment No. 2156 Madam President, I believe we have had a full debate on the Bond amendment. I call up the Bond amendment and ask for its adoption.

Mr. BOND. Madam President, I thank my colleagues. Madam President, I also ask unanimous consent to add Senator Miller of Georgia as a cosponsor to amendment No. 2156.

Mr. BOND. Madam President, is the pending business now the VA-HUD appropriations bill?

Mr. BOND

Mr. BOND. Mr. President, I thank my colleague from Texas and the others who have spoken. It is a great honor and privilege to be on the Senate floor on this Veterans Day to acknowledge the sacrifices of America's veterans and the priceless service our veterans have rendered to a grateful Nation. Earlier this morning Senator Thomas, Senator Inhofe, and I visited the Washington VA hospital to say thank you. Previously, I had been to Walter Reed and Bethesda National Naval Medical Center, as I know many Members have, to say thanks also to those returning from the current war. In all of these visits and in everything we do, we should express our thankful appreciation to America's veterans, particularly while we find ourselves embroiled in a war against those seeking to destroy all America stands for, what we hold most dear, our freedom. It is the soldier, sailor, airman, and the marine to whom we have turned for protection from terrorists and the failed nation states that support them. Our troops are performing in an exemplary manner, taking the fight to those who would harm us on enemy territory and on our terms. The events of September 11 and the military operations that have ensued since then have brought a renewed understanding and respect for our Nation's military and our veterans. In response to the horrendous acts carried out on 9/11, our men and women in uniform have taken action, as our veterans have done countless times throughout history. We are fighting the war on terrorism on many fronts, using all the tools at our disposal. We will win this conflict through the patient accumulation of successes, by meeting a series of challenges with determination, with will and with purpose. This campaign is a marathon, not a sprint. We must be mindful to think not only in the near term but to look ahead 5, 10, 15 years and to take this opportunity to shape our future world. We must find a way to help contribute to the peace and stability of what is clearly still a dangerous and unpredictable world. After 9/11, President Bush said: In the months ahead, our patience will be one of our strengths . . . patience and understanding that it will take time to achieve our goals; patience in all the sacrifices that may come. Today, sacrifices are being made by our troops who defend us far from home, and by their proud yet worried families. The sacrifices they make are the same sacrifices made by those who served before them. We ask an awful lot of those who wear the uniform. We ask them to leave their loved ones, to travel great distances, to risk injury, even risk death. They are dedicated, they are honorable, and they represent the very best of our country. We are indeed grateful for these countless sacrifices. We can never repay our debt to those who serve our Nation, but we can ensure they know they will never be forgotten. Today, we have some very real reminders of the cost of freedom. It is an absolute that we would not enjoy the freedoms we have today were it not for the willingness of our men and women to serve each of us and our country by committing to fight on our behalf in the armed services. We are fighting every day on the many fronts around the world and those of us in this body work to provide not only the resources we need to ensure that our men and women in the field are the best trained, best equipped, best prepared, and the best protected, but we also work to ensure we meet the commitments made to our veterans who have served in the past. As former Secretary of Defense William Cohen once said, we are ``unwilling to live in a world in which evil triumphs. And as a result, the flag of freedom flies not only over America, but over those countries whose people had to yield to the terror of tyranny and under the heel of boots of dictators.'' Our veterans have kept the flame of freedom alive, and they are a true reflection of the American spirit. There are many accolades for veterans, but the one I like best is from Father Dennis Edward O'Brien's ``What Is A Vet?'' He is an ordinary yet extraordinary human being, a person who offered some of his life's most vital years in the service of his country and who sacrificed his ambitions so others would not have to sacrifice theirs . . . He is a soldier and savior and a sword against the darkness, and his is nothing more than the finest, greatest testimony on behalf of the finest, greatest nation ever known. So remember, each time you see someone who served our country, just lean over and say thank you. That is all most people need, and in most cases will mean more than any medals they could have been awarded or were awarded. President Bush said it best when he described the will of our Nation by saying: We will not waiver; we will not tire; we will not falter; and we will not fail. Peace and freedom will prevail. That peace and freedom will prevail because of the commitment of those who serve in uniform. America's veterans are the rock on which we have defended America's shores and are the reason our President can make such promises. May God bless our veterans for their service, and may He continue to bless America.

Mr. BOND

Mr. BOND. Mr. President, I thank our leader for bringing this matter to the floor. I join with the very distinguished chairman of the Armed Services Committee because that is what we really ought to be about. We ought to be focused on winning the war against terrorism, not allowing one of our primary, sensitive committees, the Intelligence Committee, to be focused on winning the White House. I can't say it any better than the Senator from Virginia. We have heroic young men and woman in harm's way fighting to bring order to a region of the world where we have had many threats to our security. The least these brave men and women could expect would be that our country and our Congress would be behind them. Frankly, one of the reasons I sought membership on the Senate Intelligence Committee as a new member was I realized that in this critical battle against terrorism worldwide, we cannot win unless we have the best possible intelligence. As I understand it, the job of the Intelligence Committee is not only one of oversight but of taking a look and seeing what has happened in the intelligence-gathering analysis and sharing in the past, how we can do a better job. Our staffs have been deeply engaged in this exercise for many months. We have followed it. We have had numerous hearings. We have read some, but not all, of the tens of thousands, perhaps hundreds of thousands, of pages that have come before us. We need, on a bipartisan basis, to be able to find out how we can improve that intelligence. One of the reasons the Intelligence Committee is so special is the tradition it has. The intelligence community members, whose lives are at risk because of what they are doing--often undercover work, dealing with classified, sensitive subjects--have been able to come before the committee in the past, knowing they could count on confidentiality, professionalism, and on a body that was not going to be using their words or their actions for partisan political gain. Unfortunately, when we first saw this memo, it looked as if there was somebody, or ``somebodies,'' in the Intelligence Committee who wanted to use it to win the White House. That is just unacceptable. Some people on the other side have said this is just an options memo tossed up for review. I have been around here for a few years, and a staff person on his or her own doesn't write a memo saying: We have carefully reviewed our options under the rules and we believe we have identified the best approach. Our plan is as follows. I say that the occupant of the chair, and probably everybody else here, would be totally stupefied if they got a memo from the staff that was supposed to be an option memo and said: This is our plan. This is not an accident. Days have passed and there have been no consequences. If somebody was really off base, there would have been something that would have happened. Some steps would have been taken. As the distinguished majority leader has pointed out, nothing has happened. Unfortunately, too many of the actions we have seen seem to fit right in with this plan. Not only are they not disavowing it, they appear to be preparing to implement it, or are in the process of implementing it. What is this plan? Is it to find out how the intelligence gathering could be better? Not likely. In addition to the President's State of the Union speech, they say, they want to look at the activities of the Office of the Secretary of Defense, as well as Secretary Bolton's office at the State Department. They want to go after political figures. Somebody in my office said, ``This looks like a political witch hunt.'' I said maybe that is not a bad way to characterize it. They are going after political scalps, not trying to find out whether the intelligence that we received, the White House received, the Department of Defense received, and the State Department received was good, but how they can use the process of the Intelligence Committee to win political points. By the way, when they talk about ``when we can pull the trigger''-- pull the trigger on an investigation--they say the best time to do so will probably be next year. If I remember correctly, that happens to be a general election year. That would seem to square with some of the statements made by the many Democratic Presidential candidates who want to raise questions, who want to attack the President, using the process of the Intelligence Committee. One of the things that is really bothersome is that they are not just speaking to an audience in the Senate. When they launch these attacks, these attacks get carried across the Nation and across the world. They get back to the people we are trying to fight. Do you know something? There is nothing a terrorist likes better than seeing discord, disharmony, and political infighting among the people they are trying to terrorize. That is one of the victories of terrorists. If they can tie up the intelligence-gathering operation, which is so critical for the protection, first and foremost, of our soldiers on the front line, but ultimately our allies and ourselves--if they can see that tied up in a political Gordian knot, then they know they are winning. I strongly support what the majority leader has said. I strongly believe that our fine chairman has not only gone the extra mile, he has gone the extra mile and a half. Some on the other side said we have not been able to get the information we want. When we have found we could not get information, the chairman has demanded it and we are going to get it. When they want to ask questions, they can do so. When they want to call witnesses, they can call witnesses. There has been a suggestion that there was pressure on intelligence community members. The chairman has gone out and asked publicly of the intelligence community, if anybody has any information or concerns that they have been pressured, to come forward and talk to staff. We have set up elaborate procedures so they can come forward. We are still waiting. If we find any of that, we will certainly let it out. In the meantime, it is time for us to get back to the job of the Intelligence Committee--how we can support, rather than tear apart, our intelligence-gathering system. It is with great regret we note that we have gone down this path and there doesn't seem to be any remorse or disavowal from the other side. I thank the Chair and yield the floor.

Mr. BOND

Mr. BOND. Madam President, I don't have time to go over the entire report, but I think many colleagues will find it of interest to know what we experienced. First, let me say that the Army was very open and responsive to our staff when they came to review the situation. They were most anxious to have us get a complete look at the situation and to offer to help in any way they could. So they recognized there was a problem. Basically, there are not enough medical personnel--doctors, clinicians, support staff, specialists--available during ``peak'' mobilization and demobilization phases at a number of mobilization sites. Consequently, injured and ill soldiers have a difficult time scheduling appointments with medical care providers and seeing the specialists required to get the best possible care. Some of them had been waiting literally months to get the kind of care they deserve. Compounding the problem, large numbers of soldiers either mobilizing or demobilizing created shortages of available housing at mobilization sites, which resulted in some of the returning guards and reservists being placed in housing totally inadequate for their medical condition. Some of these Guard and Reserve members who had been activated and were coming back were put in temporary barracks, with outside latrines, where they normally would house Guard or Reserve members called up for summer maneuvers. We could neither confirm nor deny that there was any difference in medical treatment between the returning formerly Active and Guard and Reserve soldiers coming back, but one of the things that was different when the Active came back to the bases from which they had been mobilized was that they already had their housing, so they could go back to the housing from which they started. The Guard and Reserve coming back from service had to be put in some form of temporary housing, which, in some instances, was clearly inadequate for people with injuries or illnesses. So what is being done? Senator Leahy and I issued the report to highlight the problems to senior leaders at the Army, National Guard, and the Army Reserve. I was very encouraged by the response the military gave us. The Acting Secretary of the Army, Les Brownlee, visited Fort Stewart on Saturday, the weekend after we sent our teams there. He met with me last week to lay out his plans for dealing with the situation. He recounted what he discovered at Fort Stewart and promised swift support and changes, where necessary. Specific issues addressed by Secretary Brownlee included the adequacy of facilities and where they would get treatment. He said, if appropriate, soldiers will be moved to facilities where they can provide more timely care. We suggested that if they don't have the medical personnel available there, why not send them someplace else. He said he would encourage the commands to contract out for special services, such as MRIs, for example. If they don't have the equipment, they can contract out. I also asked the Secretary to allow soldiers in a medical hold status to be moved to facilities closer to their home, using military, veterans health administration, or civilian providers, as necessary. Secretary Brownlee told me some of the soldiers at Fort Stewart had already been moved to nearby Fort Gordon, where the medical staff was not so badly overworked. Also, at his direction, the Army Medical Command is transferring medical care clinicians to mobilization sites that need them. The Secretary has also established minimum standards for housing in medical hold status. He said, No. 1, facilities will be climate controlled, meaning air-conditioned and heated. Some of the facilities didn't have that. Second, facilities must have showers and restrooms indoors, and not a path in the back, and facilities must be clean and in good repair. The Secretary also indicated he is considering erecting prefab facilities to alleviate the housing shortages during mobilization and demobilization surges that could be used to house medical hold soldiers. Secretary Brownlee has issued policy guidance that allows the Army to deactivate Guard and Reserve personnel who do not meet the physical requirements for deployment due to a preexisting condition. One of the problems at Fort Stewart was the fact that some 10 percent of the Guard and Reserve called up had not had adequate pre-callup medical care, a situation we are addressing with the TRICARE measures, and they could not be deployed. They were then the responsibility of the Army at Fort Stewart, and at the time we were there, a third of the 650 soldiers on medical hold had never even been deployed because they did not meet the standards for deployment. Those people will be sent home rather than kept on medical hold. Also, after meeting with Secretary Brownlee, I followed up with LTG Steven Blum, Chief of the National Guard Bureau and LTG James Helmly, Chief of the Army Reserve, asking them to work with the Army in resolving these issues. Specifically, we asked their cooperation: No. 1, by doing a better job medically prescreening Guard and Reserve soldiers so they do not activate soldiers who cannot serve. No. 2, to coordinate the callup and retention of medical personnel-- clinicians, support staff, specialists--to ensure the Army mobilization sites have sufficient medical personnel onsite. I saw in the news today where the Department of Defense is looking to call up certain support personnel from other Reserve units, other than the Army, to provide perhaps naval medical personnel to assist with caring for the sick and injured soldiers. No. 3, we asked them to check on Guard and Reserve soldiers who are on medical hold, making sure somebody was looking after them, to let them know they have not been forgotten, or to find out if they have other needs. Further, Senator Leahy and I have asked the GAO to conduct a survey into the Army's medical hold process to ascertain the breadth of the problems that we saw at Fort Stewart and Fort Knox, and to determine if there is any disparity in medical treatment of returning guardsmen and reservists who come back in demobilization and have health care problems. It is our understanding that the Senate Armed Services Committee, as well as its House counterpart, is going to conduct hearings into the conditions uncovered by Mark Benjamin and confirmed by Senator Leahy's and my investigation, but I regret very much, as all of us do, that this situation has occurred. It is unacceptable to all of us to think that injured, ill soldiers returning from the theater of battle would not get the medical care they need, would not be placed in appropriate housing. Once it came to our attention and we brought it to the Army's attention, we are very encouraged by the way everybody is handling this, from the garrison commanders and medical directors to mobilization staff to the Acting Secretary of the Army. This is a matter of taking care of our soldiers regardless of whether they are traditional active-duty soldiers or National Guard and Army Reserve soldiers. Senator Leahy and I are going to continue to monitor the progress of the Army in addressing these issues. We plan on sending staff to additional mobilization sites in the next few weeks and months to make sure there are no problems. We know that in the next few months the National Guard and Reserve will be mobilizing thousands of additional troops. We want to make sure the Army gets it right and keeps it right. The next mobilization schedule is to begin in the January-April timeframe, which means when they go, we want to make sure soldiers get timely care and housing, suitable to getting well, no exceptions. We know the Army knows of the problems and is aggressively tackling them. We expect garrison commanders at mobilization sites to continue to do their best, and we will continue to support them, as well as every soldier in the war on terrorism. We owe a great debt of gratitude to our fighting men and women. They have and deserve our highest regard and respect. We will do all we can to ensure they get the kind of care we would expect for them. I thank the Chair, and I yield the floor. Exhibit 1 U.S. Senate National Guard Caucus Report Senators Kit Bond and Patrick Leahy, co-chairs of the U.S. Senate National Guard Caucus, dispatched their aides to Ft. Stewart to investigate reports that activated Guard and Reserve members were being poorly housed, with inadequate medical attention, while on ``medical hold.'' Summary Approximately 650 members of the National Guard and the Army Reserve who have answered the call-to-duty and in many cases were wounded, injured or became ill while serving in Iraq, are currently on medical hold at Ft. Stewart, GA. Army base. As a result of an investigation by a reporter and expeditious follow-up by a veteran service organization representative it has come to our attention that these National Guard and Army Reserve soldiers have been receiving inadequate medical attention and counsel while being housed in living accommodations totally inappropriate to their condition. Of the roughly 650 injured soldiers currently awaiting medical care and follow-up evaluations, approximately one-third of these soldiers were found not physically qualified for deployment and therefore never deployed overseas. The remaining two-thirds deployed overseas and were returned to Ft. Stewart as a result of wounds or injuries sustained while serving or as the result of illness encountered either before or after deployment. Regardless of the nature of the medical malady, these soldiers have been enduring unacceptable conditions for as many as 10 months. The return of the 3rd Infantry Division from the Middle East (18,000-strong which is permanently stationed at the base), has forced commanders to lease barracks from the Georgia National Guard that were designed as temporary quarters for National Guard soldiers undergoing annual training. They are not designed to accommodate wounded, injured or ill soldiers awaiting medical care and evaluation. The Army has designed a Disability Evaluation System that is purposely slow to ensure that National Guard and Army Reserve citizen-soldiers who are found not physically qualified for duty receive a fair and impartial review when undergoing a medical evaluation board. The process, similar in many respects to the workmen's compensation process, requires that these soldiers be given every opportunity to recover. If full recovery is not possible, the system works to establish a baseline condition before the soldier is evaluated by a medical evaluation board. The situation at Ft. Stewart unfortunately was, and remains, hampered by an insufficient number of medical clinicians and specialists, which has caused excessive delays in the delivery of care. Exacerbating the situation, was the Army's placement of wounded and injured soldiers in housing totally unsuitable for their medical condition. Additionally, these soldiers were placed under the leadership of soldiers who were also injured, resulting in a situation where the sick and injured were leading the sick and injured. Furthermore, the perception among these soldiers is that the traditional active duty soldier is receiving better care, compounding an already deteriorating situation that had a devastating and negative impact on morale. Most of the soldiers in the medical hold battalion, which was established administratively to provide a military structure for the soldiers, have families living within hundreds of miles; yet they have been unable to join their families while awaiting the final deliberation of their cases. In the short term, we must alleviate the unacceptable conditions at Ft. Stewart and determine if the problem is isolated to Ft. Stewart alone or part of a larger system wide problem. Alleviating the problem at Ft. Stewart will require the immediate assignment of additional medical clinicians, specialists and medical support personnel and/or the transfer, where appropriate, of our National Guard and Army Reserve soldiers to faculties close to their families so they can continue to receive quality care and await further medical reviews if necessary in an environment conducive to healing. We must also ensure that the conditions at Ft. Stewart are not replicated elsewhere, while ensuring the fixes we install at Ft. Stewart are applied throughout the Army if necessary. In the long term, the Congress must address the physical readiness of the National Guard and the Reserve by passage of a pending bill, TRICARE for Guard and Reservists, to ensure that every member of the Guard and Reserves has adequate health insurance coverage and is medically ready to deploy. Fundamental Problem More than 650 members of the National Guard and Army Reserve, who have been activated and put on active duty (some of whom have already served in Iraq or Afghanistan) are currently on medical hold at Ft. Stewart, GA. These numbers change almost daily as some soldiers are returned to duty, others receive medical evaluations for medical conditions that prohibit their continued service on active duty, while more soldiers are brought into the system (the result of sustaining injuries, wounds or falling ill overseas; or failing to qualify for deployment after being mobilized because of injuries or preexisting conditions.) About one-third of the citizen-soldiers currently in the disability evaluation system at Ft. Stewart could not originally deploy with their units because they were not medically fit, while approximately two-thirds were injured, wounded or fell ill while on deployment overseas and were returned stateside to receive special medical attention. When the 3rd Infantry Division, which is based at Ft. Stewart, returned from its deployment in Iraq, available housing was in short supply which resulted in those on medical hold being moved from one barracks to another in a form of musical housing. The U.S. Army resorted to leasing open-bay barracks with detached restroom facilities and no air-conditioning in most cases, which are normally used to house Georgia National Guard troops during their two weeks of annual training. These National Guard and Army Reserve soldiers have been kept in place at Ft. Stewart according to standard Army policy while they await medical care and work-ups, which senior officials say is designed to protect their careers and ensure they receive the best medical care. The goal is to put these medically held Reserve soldiers in a holding pattern until they are healthy enough to return to duty and go back to their units or to prevent soldiers from being permanently discharged from service until the nature of their conditions have been fully assessed and optimal treatment regime prescribed. When soldiers cannot return to duty, a final determination about their status is made by a Medical Evaluation Board (MEB). The MEB process can take anywhere from an average of 42 days to 76 days after the soldier's treatment has been ``optimized.'' That is when a sufficient diagnosis and treatment regime has been put in place to establish enough confidence to make a decision. Some troops have been on medical hold for more than 10 months. The primary task of the Army Medical Department is to return these soldiers to duty. While undergoing medical care and reviews they can be assigned light duty around the post. Adequate convalescence requires a great deal of rest in most cases and cannot be properly pursued if there are unnecessary life stressors, such as placement in housing that is designed to house ``healthy'' National Guard forces on annual training--not injured, wounded or ill soldiers. The barracks for these medically held National Guard and Army Reservists are totally inappropriate for soldiers injured, wounded or ill who are in need of quality care and are garrisoned in a stateside Army installation. The worst accommodations to which these medically challenged soldiers were subjected are 1950s-style, concrete-foundation barracks with no air-conditioning or insulation and detached toilets and shower facilities, though they do have heat. On a relatively cooler day in the area (October 22nd), the temperature in one of these huts was noticeably warm if not stifling. Bunks sit in open bays, no more three feet apart. In some cases, there are no footlockers for the troops to store their gear. In a few of the better barracks, for soldiers with more severe medical conditions, there is air conditioning, indoor-plumbing, and storage space. The fundamental problem, as summarized colorfully by one of the base commanders, is that soldiers are going through a ``go slow medical review system while living in `get them the hell out of here barracks.''' Many of the medically held reservists--mostly from Southern states like Georgia, Alabama, and Florida--expressed frustration and anger over the duration of their medical hold and the quality of their housing while in this seemingly interminable holding pattern. complicating factors Feeding these justifiable frustrations are several real and perceived considerations regarding their medical care and treatment on the base. There has been a shortage of clinicians and specialists to see the medically held Reservists and to accelerate the review and treatment process. At various points over the past several months there may have been only a handful of doctors to care for these hundreds of troops, as well as to assist with regular forces and their families. Most reserve doctors called to active duty were deployed forward, and those remaining in the states can stay on duty for only 90 days before returning to their civilian practices. One soldier on medical hold said it took him almost three weeks to get a follow-on appointment necessary to optimize his care. Further feeding the anger and frustration is inadequate leadership. Typically, a soldier will receive advice, counsel, and assistance in accessing the military's health system from the soldiers's unit or from upper echelon chain- of-command. The units of the medically held reservists, however, have deployed abroad in most cases, and their commanders are focused on their operational mission overseas. The Reservists at Ft. Stewart have been grouped together in a ``medical hold'' battalion for administrative purposes but the effectiveness of the unit chain of command is suspect. Additionally, many of the battalion leaders--at the officer and NCO level--are sick themselves, raising the question of whether these leaders are capable to care for themselves, let alone hundreds of their comrades. Without a familiar advisor and leader, deployed away from home and their parent National Guard or Army Reserve commands, and lacking experience dealing with a huge bureaucracy like the Army, these Reservists were left without the leadership to which they were accustomed. Moreover, many of the medically held Reservists perceive bias against them on the post. Whenever they go the hospital, PX, or dining hall, they are asked whether they are a Reservist or a traditional active duty service member. This question is made for accounting purposes, but it makes the Reservists--many of whom are likely disappointed about being on sick call in the first place--feel like they are being singled out. Similarly, many of the medically held Reservists, lacking sufficient knowledge of the military's medical bureaucracy, chalk up delays in treatment to preferential treatment for active forces. an avoidable situation This situation could have been avoided. In early June, medical and garrison staff realized that there would be a surge in housing needs when the 3rd Infantry Division returned from Iraq. The division was manned at over 115 percent authorized strength, which would force commanders to use triple bunks to accommodate 6500 troops in their barracks that usually hold about 4300. These commanders recognized then that these permanently assigned troops would have to take priority over the troops temporarily at the post on medical hold. Six weeks ago, medical staff submitted a request up the chain-of-command for 18 additional care providers who could help manage and accelerate the reviews of the medical holds. No action was taken on the request. At about the same time, the garrison commander submitted a request to 1st Army Headquarters at Ft. MacPherson, Georgia, for additional funds to renovate the barracks that are leased from the Georgia National Guard. The command provided $4 million, divided into two parts, but the prospective contractors could not begin work until this week. That project, which would have taken 90 days at the very least, was postponed pending the outcome of the investigations the Army has currently undertaken after media reports about the medical hold situation surfaced. Additionally, it is reported that the Army had the opportunity in the initial stages of the mobilization process to provide for rear-detachment elements staffed by National Guard personnel. These elements are designed to provide stateside oversight and support to National Guard personnel and units deployed overseas. Had they been present it is possible the conditions described herein might have been identified and rectified before they reached a crisis point. medical readiness of the guard and reserves It is clear that part of the situation was created by the fact that some of the mobilized reservists were not as healthy as possible. Almost ten percent of Guard/Reserve personnel mobilized for duty at Ft. Steward could not deploy because of a medical condition and were put on medical hold status for some period of time. In the barracks visits, there were also troubling indications that a handful of Reservists were knowingly activated and sent to mobilize with medical conditions that would preclude them from actually deploying. Such an unjustified deployment might have been designed to take advantage of the fact that once soldiers are activated (put on active duty orders) they become the full-scale responsibility of the U.S. Army. The service is then charged with their care and feeding to include medical care and medical evaluations. The hundreds of Reservists who could not deploy because they were medically unready raises a number of larger questions, which the caucus has already begun to address through its effort to ensure every member of the Guard and Reserves has adequate health insurance. The caucus will continue to address the issue in detail during its ongoing investigation of the medical readiness and mobilizations, examining questions like whether the resources and process for screening at the unit level within the National Guard and Army Reserve ranks are sufficient, and how to explain the recall of soldiers to active duty who are not fit for duty. recommendations There are a number of actions that the Army must take to address this situation at Ft. Stewart and the larger issue of ``medical holds,'' which will continue to arise as the country pursues the war against terrorism and sustains operations in Iraq, Afghanistan and other areas where military forces are operating. In the short term, the Army National Guard and the Army Reserve must jointly provide for the leadership, guidance and medical care our Reservists require to operate at maximum proficiency. These dedicated and loyal soldiers need to know what to expect in the medical review process. They need to understand thoroughly the Army's health care system, warts and all. This strong, steady leadership must have the goal of reaffirming the Army's seamless support for the ``Army of One'' and the country's gratitude for their service and sacrifice, reassuring them that they are not forgotten despite the fact they are separated from their units. To move the Reservists along to a Medical Evaluation Board if required, many more doctors need to be assigned to Ft. Stewart and, specifically, to these cases. The biggest delay in getting the Reservists off medical hold is the wait to optimize care. Many soldiers are seeing a different doctor every time they enter the hospital, each of whom may prescribe a different remedy. Additional doctors and specialists, who could help coordinate care, would provide greater continuity-of-care, one of the central reasons to keep them at their mobilization station in the first place. It is unacceptable to have these citizen-soldiers--every one of whom answered the call-to-duty--living in such inadequate housing. However, more adequate barracks cannot be completed quickly because it will take almost three months to complete any upgrades. Other 3rd Infantry Division barracks are unlikely to become available soon. It would be far better to send these troops back home. They could be assigned to another Military Treatment Facility (MTF), a State Area Command (STARC) or possibly a VHA medical facility closer to their families. Liaisons from the TRICARE management authority could ensure that they are receiving adequate care and that they would be available to return to Ft. Stewart if they get better and can return to duty. The benefit to morale among the medically held Reservists would far outweigh any of the unlikely risks that might go along with moving troops away from their mobilization station. Current Army Regulation 40-501 directs medically held soldiers to remain near their mobilization post, but there is no statutory restriction against assigning them to another facility close to home. In the longer-term, the Army, working together with the leadership of the National Guard and the Army Reserve, must ensure that our citizen-soldiers who are identified for activation are medically ready to deploy. Enactment of the cost-share TRICARE proposal for Reservists, currently attached to the Senate version of the Fiscal Year 2004 Supplemental Spending Bill for Iraq and Afghanistan, would ensure that every member of the Reserves has access to health insurance and would increase the likelihood that citizen- soldiers are medically and physically ready for duty. Currently, reservists are required to complete a physical once every five years. The high percentage of reservists found to be physically unable to deploy raises the questions of whether this five-year interval is too long. Another question the Caucus may want to raise, is the Army's mobilization and demobilization policy sufficient in providing a housing standard for soldiers on medical hold? Furthermore, is the working relationship between the Army's medical department and the Veterans Health Administration (VHA) structured to allow for the transfer of soldiers on medical hold from Army military facilities to VHA facilities? Also, new medical case management software included in the second version of the military's Composite Health Care System (CHCS II) will permit continuity-of-care wherever a soldier accesses care. Guard and Reserve units across the country could assign liaisons to help manage a Reservist's care and maintain contact with their mobilization base at any point. Lastly, it has been reported that architectural hardware and software exist that will allow the Army to equip its hospitals, dining halls, and commissaries with scanners that could read an ID that can show whether a member of the service is from the active component or the Reserves. Perhaps the Caucus should look at such systems as a means of addressing the perceived bias that exists when reservists are queried about their service status.