Military's Top Doctors Discuss Centers of Excellence

By Lisa Daniel
American Forces Press Service

April 14, 2010 - The military's top doctors were on Capitol Hill yesterday to give their assessment of the Defense Department's Medical Centers of Excellence, four hospital centers they say are on their way to becoming the best in the world for research and treatment. Dr. Charles L. Rice, assistant secretary of defense for health affairs, and the Army, Navy and Air Force surgeons general also told members of the House Armed Services Committee's military personnel subcommittee that they are working to open the remaining two medical centers more quickly and run all four more efficiently.

"Like the Congress, we remain concerned about duplication of services" and other coordination and administrative problems, Rice said, but he expressed confidence that the department is moving in the right direction.

The three surgeons general soon will offer a plan "to help us get our infrastructure in place so we can execute more efficiently," he said.

Rice, who assumed his position six weeks ago, said department officials have struggled to bring together the diverse specialties – including fields such as psychology, pharmacology and engineering – inherent in the Centers of Excellence.

"Bringing this group of disparate professionals together is a complex undertaking," he said. "That said, we all feel the sense of urgency."

The variety of specialties is necessary, Rice said, noting that no "gold standard" diagnostic test exists for the common diagnosis of traumatic brain injury and post-traumatic stress disorder.

He also acknowledged a rough start in the effort. "I think we've had some growing pains," he said, "but we are beginning to get our arms around it. As time has gone by, there's been the realization that keeping the organizational responsibility in what was intended to be a policy development office was not the best choice."

The centers, mandated by Congress, include the National Intrepid Center of Excellence for psychological health and traumatic brain injury in Bethesda, Md., and the Center for the Intrepid for physical rehabilitation in San Antonio. Two more centers – one focused on vision and hearing, the other on neuroscience regeneration -- are being developed, defense officials said.

"Ultimately, these centers will achieve their original vision," Lt. Gen. (Dr.) Eric B. Schoomaker, the Army surgeon general, said. The centers are a single point of contact for vetting new ideas, bringing the best practices and research from the services and the Veterans Affairs Department, he said.

"I foresee the day when the centers are recognized worldwide as the best" in innovative care, he added.

Rice and the military surgeons general said the congressional mandate has value.

"What you did was galvanize the department's attention around a set of injuries that we did not [focus on] in the past," Rice said, "in part because this is a different kind of war with different kinds of injuries, and because our success in the field is greater now" than in past wars, Rice said. He suggested, however, and members of the subcommittee agreed, that the Centers of Excellence should be re-evaluated in five to seven years.

"Each person thinks they have the answer," Air Force Surgeon General Lt. Gen. (Dr.) Bruce Green said. "This effort is about trying to find out what it is we need, and how to prove it's going to do what we say it's going to do."

Navy Surgeon General Vice Adm. (Dr.) Adam Robinson said those running the centers are working toward efficiencies by trying to ensure they don't duplicate efforts in areas such as information technology, engineering and public affairs.

"Part of the slowness in getting the centers up is in trying to figure out how we execute this," Robinson said. "It's been slow, but it's been fruitful."

The centers have made fast improvements in battlefield and post-combat care, Schoomaker said. "We've essentially managed what community hospitals do, but across three continents ... and thousands of miles," he said.

"The respect that our line commanders have for this, all the way up to the senior leaders of the Army, is very profound," he added.