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Witness Testimony of Honorable Brett Guthrie, U.S. House of Representatives 2nd District, Kentucky

Good morning and thank you, Chairman Benishek, Ranking Member Brownley, and distinguished colleagues of the House Committee on Veterans’ Affairs.

I come before you today as both a Member of Congress and a former Army Officer, to thank you for your past support of a priority issue for wounded warriors, and to ask that you continue to pursue needed work on the subject

As you may know, genitourinary trauma, or simply urotrauma, is a class of wounds that literally hit below the belt. Urotrauma accounts for wounds to the kidneys, reproductive organs, and urinary tract organs. These injuries are some of the most common and debilitating suffered by our veterans from IED detonations and have long-lasting physical and psychological impacts.  Urotrauma is one of the signature wounds of the IED and now accounts for one-eighth of all injuries suffered by our troops in Afghanistan.  Unfortunately, the most recent available data suggests that this figure is still rising, even after nearly doubling in incidence between 2009 and 2010.   

I know that we’re in the Veterans’ Committee today, but by way of background, let me paraphrase the Department of Defense’s report to Congress titled “Genitourinary Trauma in the Military,” and the Army Surgeon General’s report titled “Dismounted Complex Blast Injury”.

According to these papers, urotrauma on today’s battlefield exceeds incidence rates of all prior conflicts by at least 350 percent. And yet, the DoD Under Secretary for Personnel and Readiness concedes that “urotrauma injury is not part of the standards of pre-deployment training for U.S. military surgeons and nurses,” and that the existing infrastructure for tracking these casualties “is not sufficient to assess the long-term prognosis of GU trauma injuries.”  This lack of adequate infrastructure is exacerbated by the inherent complications of transitional care from DoD to VA, where most victims will receive treatment for the remainder of their lives.

Now let me say that it is not my view that the VA and DoD are ignoring urotrauma. To the contrary, I believe that many skilled professionals are hard at work on the issue; but as is often the case in government, their efforts are divided, un-integrated, and because of this, less effective.

By my tally, there are six government agencies currently working on urotrauma. And while I’m heartened that this research is occurring, I’m discouraged that there seems to be little dialogue or centralization of information. Put simply, we aren’t learning from experience and if we are, we’re learning too slowly.

And that’s why I introduced H.R. 984, a bill that I have authored with the help of practicing urologists who have cared for wounded warriors in Iraq and Afghanistan.  This bill would unite public and private resources to address the growing problem that is urotrauma.

I’d like to highlight two specific opportunities for improved care that are within this committee’s jurisdiction.

First, the existing infrastructure to track urotrauma patients is not sufficient. We need the research infrastructure to facilitate urotrauma outcomes research and corresponding follow-up within DoD and, most critically, after transition to the VA. Unfortunately, one thing I have heard time and time again is that the Joint Theater Trauma Registry (JTTR), which tracks approximately 16,000 trauma victims, lacks the specificity of detail needed to accomplish this end. VA, DoD, and health care providers need a better platform to coordinate care across a lifetime for our wounded warriors.

Related to this is the second issue I’d like to focus on – transition of care. Rather than mincing words, I will quote the American Urologists Association’s Urotrauma Task Force directly:

“It is clear to those urologists in DoD who care for soldiers with complex urotrauma that the transition to the VA is currently fraught with barriers. These barriers include deficits of communication of the detailed medical and surgical history of injured service members from DoD physicians to VA physicians. Another problem continues to be GU-injured soldiers within the VA system being cared for in locations where access to expertise in GU trauma is lacking.”

One solution to this problem would be to designate care coordinators to urotrauma victims.  These coordinators would need access to DoD and VA health information and guide our wounded warriors towards existing centers of excellence in polytrauma care.

However, as a Member of Congress, I am not wedded to a single solution to this or any other improvement to urotrauma care. That is why H.R. 984 allows for a “big tent” solution. As DoD has said in writing, we need “inter-Service and inter-agency relationships to facilitate aggressive, innovative, and relevant translational and outcomes-based clinical research,” and that’s what H.R. 984 does: bring together VA, DoD, HHS, the Surgeon Generals of each of our Armed Services, and civilian expertise to create a plan to care for these wounded warriors from the point of injury to their final resting place, decades from now.
       
This is a bipartisan bill with many cosponsors who represent communities like Ft. Knox, in my district, where their constituents are frequently deployed to the front lines.  These communities understand the frequency and severity of these wounds at a human level and a professional one.  We have all met families who show true courage as they care for their gravely wounded loved ones; and we have met the men who march into harm’s way knowing that the next IED could have their name on it.  

Let me say in closing that the miracles of modern medicine, combined with the devotion of our military medical corps, have allowed many of these wounded warriors to live long lives rather than dying in the line of duty.  However, giving these service men and women the ability to survive is not enough.  We have a responsibility to do what we can to ensure that they are allowed to live as full a life as possible.  That’s the debt we owe to those who defend freedom.

I urge this committee to continue the work it has already done to further our care for these wounded warriors suffering the effects of urotrauma and yield back my time.