Defense Health Care

Since the Persian Gulf War, the Defense Department (DOD) has sought to improve the medical surveillance of military personnel returning from overseas missions. However, GAO found that many U.S. soldiers who had served in Bosnia either never received medical assessments or were tested for diseases like tuberculosis much later than required. Moreover, the database used to track deployed Air Force and Navy personnel is considered inaccurate by DOD personnel. GAO also reviewed servicemembers' medical records maintained by medical units in Germany and found that many were incomplete and inaccurate. In particular, nearly one fourth of the soldiers who received an investigational tick-borne encephalitis vaccine before deploying to Bosnia did not have this information noted in their files.

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

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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