Air Force flayed for fighting command shift
By Tom Philpott
The Air Force, the only service opposed to creation of a Unified Medical Command, saw its position get bombed during a Wednesday meeting of the Defense Business Board, a group of outside management experts that advises Defense Secretary Donald Rumsfeld.
The board unanimously recommended that Rumsfeld immediately appoint a task force to oversee establishment of a Unified Medical Command by Jan. 1, 2007, a year sooner than defense officials had planned.
The command would take charge of all direct-care health services of the Army, Navy and Air Force. It would streamline medical logistics, purchasing, information technology, research and development, facility operations, and the education, training and assignment of medical personnel.
The services would continue to control medical care in support of front-line units and field hospitals. But Level III operational medicine, which includes fixed military hospitals and clinics, would be run by the new command, which would report to the defense secretary.
The board, which endorsed the most sweeping reorganization of military medicine in 60 years, also recommended that:
The Defense Business Board is an advisory panel governed by sunshine laws, so the meeting on Wednesday was open. Held in a small Pentagon conference room, it offered a rare public look at a hotly contested issue between services.
Lt. Gen. James G. Roudebush, who became Air Force surgeon general last month, said his service opposes a unified command. It would take control only of the direct-care system, he noted, which has seen only modest cost growth in recent years. It is expansion of the Tricare benefit that "has driven costs upwards at a very alarming rate," Roudebush said.
Also, he argued, service missions and cultures are different, which justifies having separate medical staffs and resources.
Finally, he argued, the services are responsible under Title 10 of the U.S. Code to provide a fit and healthy force. A unified command "begins to move that away from the purview of the services," he said.
But Vice Adm. Donald C. Arthur, the Navy's top medical officer, challenged Air Force arguments. He said the services separately recruit, train and assign medical staff and operate three separate systems for logistics, for the purchasing of supplies and equipment, for budgeting and quality assurance. As a result, they waste up to $500 million annually, according to the Center for Naval Analyses, he said.
"We are not interoperable, interchangeable or even interdependent," Arthur added. The problems this creates aren't obvious when operating separate hospitals in peacetime. But they arise in war zones such as Iraq and Afghanistan, Arthur said.
Army Maj. Gen. Elder Granger stood to say he saw such difficulties firsthand while a senior medical commander and surgeon in Iraq. For lack of compatible gear, he said, Army medical staff could not communicate with Air Force colleagues regarding wounded arriving in medical evacuations. Also, he said, patient ventilators were not interoperable. Consequently, patients had to be taken off ventilators for brief periods during transport.
The wounded still got "world-class care," said Granger, now deputy director of Tricare. "But it's all, like, piecemealed together."
Retired Army Gen. William "Gus" Pagonis, chairman of the business board, said he would brief Rumsfeld on the board's recommendations as soon as possible. He predicted to Jones that if board recommendations are adopted, "you will see all kinds of savings."
