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Hon. Harry E. Mitchell, Chairman, and a Representative in Congress from the State of Arizona

This hearing will come to order.

Thank you all for coming today.  I am pleased that so many folks could attend this oversight hearing on VA Polytrauma Rehabilitation Centers.  The VA polytrauma centers help mend and reintegrate into society service members who have suffered among the worst that war can inflict.  The most severely injured service members serving in Iraq and Afghanistan are medevac-ed out of theater through Germany to Walter Reed and Bethesda Naval Hospitals and, when they are ready, are sent to one of the four polytrauma centers, which are located in Richmond, Tampa, Minneapolis, and Palo Alto.  Most polytrauma patients have suffered traumatic brain injury in addition to a variety of other serious injuries, some which necessitate amputation.  The soldiers, sailors, airmen, and Marines who are treated at the polytrauma centers have paid a very high price for their service to their country, as have their families, both of whom face a long and difficult path to recovery and sometimes a lifetime of care.  The nation owes these service members and their families everything that a nation as rich as ours can provide.

The nation has many who need and deserve what we can give.  Survival rates for service members injured in combat are extremely high compared to previous conflicts, partly because of greatly improved protective equipment, but also because the military has moved surgical medical care practically to the front lines.  A soldier injured in an IED blast can be in surgery within 30 to 45 minutes or even less.  With these advances, however, comes the need to treat injuries that would have been fatal in the past.  Injuries like traumatic brain injury and post-traumatic stress disorder require medical treatment and long-term care of a new kind.   The VA polytrauma centers are an essential part of that care. 

Congress has provided significant resources, and is providing more, that have enabled the VA to establish and expand polytrauma care.  It must be said that the VA has stepped up to the plate to meet this need.  In addition to the four polytrauma centers, the VA has created a network of sub-acute polytrauma care centers in each of the Veterans Integrated Services Networks and outreach programs throughout the country.  This is not to say that everything is as it should be – we would not be having this hearing if that were the case.  Polytrauma care is not perfect.  There is also the sharing of electronic medical information and other issues that have been highlighted by Senator Dole and Secretary Shalala that the Subcommittee and the full committee will be addressing in the near future.  But there should be no misunderstanding – we are not here to criticize the VA’s care providers or to suggest that the quality of care that the nation’s most severely injured service members is anything less than exemplary.  The subcommittee has found some management issues that need to be addressed – that is why the title of this hearing is what it is.  The subcommittee’s oversight is intended to ensure that the superb care the VA provides is provided to those who deserve to receive it.

Data provided by the VA shows that the Palo Alto VA’s polytrauma center, from the beginning of this year through July, filled only 60 percent of its available beds, while the three other polytrauma centers combined have been running at 98 percent of capacity.  We have found no good reason why that should be.  The VA’s Palo Alto hospital has a beautiful facility, an even more beautiful Fisher House where family members can stay, and is practically married to the Stanford Medical School.  Palo Alto has all the resources it could need to provide care for all the polytrauma patients it can take.  The subcommittee has also found that the Palo Alto polytrauma center would not accept minimally responsive brain injured patients while the other polytrauma centers did so, until the VA created a treatment protocol for those patients in December 2006 and effectively forced Palo Alto to accept these patients.  This past spring, the VA’s Office of Medical Investigations found disarray, morale problems, insufficient programs for families, and lack of leadership.  All of this raises obvious issues not just about local management but also about VA’s central office.  Why, for example, did the fact that Palo Alto’s failure to fill its beds while the other polytrauma centers were at full capacity not raise a red flag at headquarters?

We begin today by hearing from the senior management of the Palo Alto health care system, headed by its Director, Lisa Freeman.   Subcommittee staff has spent much time with Ms. Freeman and her team and they are to be commended for their willingness to meet with and provide information to the subcommittee.  We hope, indeed expect, that their testimony will describe significant progress in addressing the concerns of the Office of Medical Investigations and this subcommittee.

The second panel is headed by William Feeley, Deputy Under Secretary for Health for Operations and Management,   The subcommittee extends its thanks to Mr. Feeley and the VA witnesses with him for their  efforts of to provide the best care possible to our injured service members and appreciates their cooperation with the subcommittee in meeting with and providing information to us.  We in no way doubt their good will and dedication.  But there are obvious management issues for the central office that are raised by the fact that there were empty beds in Palo Alto and these witnesses will be asked to address these issues.  Dr. Barbara Sigford and Dr. Shane McNamee, both of whom are personally involved in running polytrauma centers, are at the witness table as well.  We look forward to hearing from them about the good things they are doing for those who have made great sacrifices for their country.

On Sunday night, the Public Broadcasting System began a 15 hour presentation of Ken Burns’ documentary on World War Two.  America achieved great things in that war, but the documentary reminds us, or, perhaps, more realistically, teaches us of the terrible cost of war.  We as a nation owe a debt that can never be repaid to those who serve, and an obligation that must be met to meet the needs of those injured in that service.  We are here today to do our part in making sure that this happens.

No one can doubt the dedication of the men and women in the military and the VA who provide care for our service members.