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NOT FOR PUBLICATION UNTIL

RELEASED BY THE HOUSE

ARMED SERVICES COMMITTEE

 

 

 

 

 

Mr. Chairman, members of the subcommittee, I appreciate the opportunity to appear today to address the management of medical supplies within the Marine Corps' Chemical Biological Incident Response Force (CBIRF).

I command CBIRF, having assumed that responsibility in August 1999. During my 25 years' of Marine Corps service I have had the privilege of leading Marines in several operational commands. From that perspective, I can assure you that the Marines and Sailors assigned to CBIRF are both professional and mission ready. And, as an officer with training and assignments in law enforcement, force protection, physical security, and combating terrorism, I fully appreciate the nature of the threat that now confronts us.

With me today is Commander (Captain select) Warren R. Dalton, a U.S. Navy Medical Officer and board certified emergency medical physician who serves as the Senior Medical Officer for CBIRF.

Prior to commenting on the matter before us today, I would like to offer some background for members of the subcommittee who may not be familiar with CBIRF. The command was activated in April 1996 in response to Presidential Decision Directive 39. Since that time, the unit has evolved from a concept to an operational response entity. Comprised of an average of 340 Marines and Sailors, CBIRF includes over 43 different military occupational specialties. These individuals have supported numerous national security level events, including Presidential inaugurals, State of the Union addresses, the Atlanta Olympic Games, Summit of Eight meeting, the Papal visit to St. Louis, and the NATO 50^th anniversary celebration. Additionally, the unit has deployed personnel in support of our combatant commanders for nine theater level exercises or operations.

The Government Accounting Office (GAO) visit to CBIRF prompted me to take a close look at procedures used to manage our medical supply account. While our supply and medical personnel are well versed in the requirements mandated by existing military directives, I fully recognize the inherent benefit of being reviewed by an external set of eyes.

As you are aware, in July 1999, representatives of the GAO visited CBIRF at Camp Lejeune, North Carolina. As a result of this visit, the GAO noted some concerns regarding our medical supply account operations. Appropriate action has been undertaken to address management areas highlighted by the GAO's visit. These actions, either completed or planned, are addressed in subsequent portions of this statement. I think to understand the approach we have taken, it is important to provide the background surrounding the GAO's visit to CBIRF.

GAO's visit to CBIRF was in conjunction with their effort to assess the readiness of our Nation's "stockpile" of medical supplies held for the treatment of chemical and biological civilian casualties. My staff and I understood that the intent of the GAO effort was to focus on the readiness of those entities operating under the parameters of the National Pharmaceutical Stockpile program, a program in which the Marine Corps is not a participant. As originally conceived the GAO study was not projected to look at any Department of Defense agencies. Specifically, the GAO undertook to "review the accuracy and currency of the inventory tracking systems for federal medical stockpiles that would be used to treat the civilian population following a chemical or biological terrorist attack".

As the GAO team conducted its evaluation of CBIRF's medical supply account, it became apparent to CBIRF medical personnel that a difference in perception existed regarding the nature of the medical supplies held by CBIRF. GAO personnel regarded all of the medical items held by the unit as a "stockpile," thus making the entire unit medical supply account subject to the standards applied to those participants formally operating under the parameters of the National Pharmaceutical Stockpile program. Navy medical personnel made attempts to explain that the medical items held by CBIRF did not constitute a "stockpile" as these items were held for organic unit use. As such, these items are more appropriately viewed as working stock used primarily for the general medical care of personnel assigned to the unit and to ensure the ability of the unit to execute its response mission.

In my view, the very concept of a "stockpile" implies that items within that category are held for the purpose of further distribution. While portions of CBIRF's medical supplies could be used in emergency response situations to provide lifesaving care for chemical or biological casualties, the bulk of items held are used in general medical care treatment programs.

The unit holds only three items that can be categorized as specifically for the treatment of persons exposed to chemical or biological agents. These three medications - 2 Pam Chloride, atropine, and diazepam - are held primarily for the purpose of protecting unit personnel who, in their response role, face the potential of exposure. Nonetheless, such items could also be used to treat civilian casualties at the scene of a chemical or biological incident. CBIRF medical personnel deploy with a sufficient quantity of such items to provide emergency lifesaving care in the event local medical authorities lack ready access to such medications. However, it has never been envisioned that these items, nor any other routine care medical items, would be released from military control or turned over to local medical personnel. Referring to CBIRF's medical supplies as a "stockpile" for simplification does not alter the fact that we truly do not possess a stockpile, but simply a "working stock" used to provide care for assigned personnel as well as to respond to any emergency situation.

One of the concerns raised by GAO was that there were some 2,300 "missing" items within CBIRF's medical supply account, of which 1,500 were listed as missing antidotes. This finding resulted from two factors, a duplicative database entry and the classification of consumed medical supplies as missing. One container of atropine (1,500 doses) was mistakenly entered into the computer database twice. While this duplicative entry highlights the need for greater attention to detail on the part of personnel making clerical entries, it was simply a database entry error. This error, which would have been noted during the next scheduled inventory, was identified and documented during the GAO visit and corrective action was immediately taken. This clerical entry accounted for 1,500 of the 2,300 "missing" items. These items were not "missing", as they never existed. With regard to the remaining 800 "missing" items, the GAO did not provide a breakdown of the items. However, Navy medical personnel present during the audit reported the items were mainly in the category of consumables (bandaids, alcohol pads, tongue depressors, etc.), none of which could be specifically classified as items unique to the care of chemical or biological casualties. These 800 items, out of over 38,000 counted, constitute a 2% error and we have undertaken various steps to tighten our procedures. I believe that a 2% deviation in routine consumables does not adversely affect the ability of CBIRF to perform its incident response mission.

It should be noted that of the 38,000 medical supply items inventoried at CBIRF by the GAO, only approximately 7,000 items, which includes both initial response and follow-on medical supplies, are specifically related to the treatment of chemical or biological casualties. The remainders are standard medical supplies typically maintained by any military medical unit and are routinely consumed to support day-to-day operations. In addition to being prepared to provide emergency medical care as part of the unit's chemical and biological response mission, assigned medical personnel provide care for Marines and Sailors assigned to CBIRF. Accordingly, consumable items are expended in the course of routine medical care and replenished as needed. The consumption of expendable items for routine medical care does not adversely impact upon the ability of CBIRF to execute its incident response mission.

The GAO further noted that CBIRF did not have an approved list of medical supplies which it was authorized to maintain. As this new and unique unit transitioned from a concept to a viable response force, one of its inherent responsibilities was to develop standardized techniques, procedures, and equipment. To this end, CBIRF was confronted with the need to develop standardized medical equipment and supply lists. As the unit has matured and exercised its response concepts, adjustments have been continuously made and we have gained a better understanding of exactly what types and quantities of medical equipment and supplies are needed for the unit to remain mission ready.

Existing military units know what medical equipment and supplies they must maintain as those items are set forth in a standardized Navy Authorized Medical Allowance List (AMAL). As a relatively new unit with responsibility for an emerging threat mission, no AMAL currently exists for chemical and biological response forces such as CBIRF. Accepting responsibility to standardize this area, CBIRF has submitted a proposed chemical-biological AMAL to the Marine Corps Systems Command at Quantico, Virginia, that will eventually serve as an approved list for our medical equipment and supply holdings.

Since its inception, the unit has sought to stay abreast of technology while at the same time eliminating non-essential property. During the past six months, many medical items found to be excess have been returned to the supply system. The 5,700 excess items cited by the GAO were part of this effort, an undertaking that was already underway when the GAO visited in July 1999. Our total medical inventory has been reduced by approximately 25% over the past six months.

Further, the GAO noted that Marine Corps officials have not required reports on our "stockpile". This is an accurate statement since no one within the Marine Corps has ever regarded our medical supply holdings as a stockpile, rather as a working stock. The scope of medical items held by CBIRF is similar in terms of items and quantities to that found in the medical supply account of any deploying military unit conducting battalion level aid station operations. With the exception of the three medications held specifically for treatment of chemical or biological casualties, CBIRF holds medical supplies that could be found in most any operational military organization. No requirement exists to report medical supply account status for any of these units, to include CBIRF.

The management of CBIRF's medical supply account is conducted per Marine Corps Order P4400.150E (Consumer-Level Supply Policy Manual) which requires that medical supplies be handled in the same manner as organic property. The GAO noted that CBIRF was not following management control guidelines set forth in Office of Management and Budget Circular A-123. However, this does not obviate the fact that as a Marine Corps organization we have conducted our supply operations in accordance with existing military regulations. Our medical supply account was subject to a review by the Field Supply Maintenance Analysis Office (FSMAO) just prior to the GAO's visit and no significant problems regarding medical supply operations were noted.

While I do not think that CBIRF should be held to higher supply management standards than those required of any other military unit, I recognize that the unique nature of our unit and mission make consideration of GAO's observations prudent. To this end, my staff and I have carefully reviewed the recommendation of the GAO to institute additional management and control procedures. The GAO specifically recommended that CBIRF:

a. conduct risk assessments and organize program activities to identify and mitigate risks;

b. arrange for periodic, independent inventories;

c. implement a tracking system that retains complete documentation for all supplies that have been ordered, received, and destroyed; and

d. rotate supplies properly.

In response to these recommendations, the following actions have either been completed or are programmed for completion in the immediate future.

a. The Commanding Officer completed a written risk assessment on 16 December 1999. This risk assessment considered the physical security of medical supplies as well as control and accountability factors. Additionally, a formal evaluation was completed on 20 January 2000 by a trained physical security specialist to identify any improvements that could be made to enhance the security and control of the warehouse area housing our medical supplies. Specific actions that will result from this evaluation include enhancing access control procedures for the medical supply storage area; implementing key and lock control procedures; and the conduct of annual crime and loss prevention training for personnel performing supply related duties. It is envisioned that physical security of our supply warehouse will be enhanced as a result of CBIRF's relocation to Naval Surface Warfare Center, Indian Head, Maryland, during the fall of this year as the warehouse facility will be located within a designated "restricted area".

b. During the first quarter of this calendar year, the Supply Officer reviewed the operating procedures for our medical supply account. As a result of the review, which was completed on 28 February 2000, modifications are planned for the existing database used to account for our medical supplies. These modifications will enhance tracking and control for the 7,000 unique chemical and biological medical supply items by documenting consumption, rotation, and disposal actions. The medical supply account holdings are subject to periodic spot checks by the unit Supply Officer and the database will be reconciled quarterly. These actions will validate the effectiveness of operating procedures, check accountability, and identify any areas requiring corrective action. Further, the Supply Officer will ensure that medical supply procedures and accountability are reviewed as a part of all supply account inspections or audits and will further take action to provide specific focus on medical supply procedures during regularly scheduled FSMAO evaluations.

c. The Senior Medical Officer submitted a request to our higher headquarters on 17 December 1999 soliciting an independent inventory by an external agency having knowledge of Navy medical logistics procedures. On 11 February 2000, the Commanding Officer, Medical Logistics Company, Second Force Service Support Group was tasked to conduct this assessment. The assessment is presently ongoing and I expect written results to be provided within the next month. Once received, we will implement appropriate action to ensure that our medical supply account operations are in full compliance with all applicable Naval Bureau of Medicine, Naval Medical Logistics Command, and Marine Corps Supply System directives.

d. The Supply Officer has been tasked with three additional initiatives that will be considered upon completion of the independent review of our procedures by Medical Logistics Company. First, to ensure that Navy medical personnel performing supply actions for the unit's medical supply account are properly trained. Second, to develop, in concert with the Senior Medical Officer, an authorized medical supply allowance list. This list will be approved by the Commanding Officer and serve as the baseline for account holdings until such time as a chemical-biological AMAL is fielded. Finally, the Supply Officer will develop written policy for approval by the Commanding Officer that specifically addresses medical supply procedures to include rotation and disposal of medical supplies.

In conclusion, while I do not believe that the medical supplies held by CBIRF truly constitute a stockpile, and as such do not specifically fall under the parameters of the GAO's review of national stockpile readiness, my staff and I nonetheless recognize the value added by GAO's observations. The external review has provided a different perspective beyond the bounds of a purely military viewpoint and served as a catalyst for the unit to reevaluate its operating procedures. This review not only afforded us the opportunity to ensure compliance with existing military directives, but also a means by which to implement measures within our capabilities to enhance our existing procedures.