I have a feeling, knowing you, you have a statement you want to make.

Mrs. MALONEY. I'm looking forward to the testimony. I'll put my statement in the record in the interest of time.

Mr. SHAYS. Thank you very much.

[The prepared statement of Hon. Carolyn B. Maloney follows:]

Statement of Congresswoman Carolyn B. Maloney
House Government Reform Committee

Subcommittee on National Security, Emerging Threats, and International Relations

Protecting the Health of Deployed Forces: Lessons Learned from the Persian Gulf War March 25, 2003

I thank the Chairman and Ranking Member for their leadership on this issue.

I also would like to thank Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs, for his willingness to provide the Subcommittee a more comprehensive detailing of the sites at which our troops may have been exposed to chemical and other toxic agents. Additionally, I greatly appreciate his commitment to include in his report to the Subcommittee an analysis of the locations listed in Saddam's Bombmaker, by Khidhir Hamza.

The witnesses provided to the Subcommittee a welcomed update on the extensive neurodegenerative research being conducted by both the Departments of Defense and Veteran Affairs. These agencies are investigating the causes, mechanisms and treatments of neurodegenerative diseases. With this research, the hope for our troops is that we may be able to better prevent, detect and treat environmental toxicity that may result from exposure to military threat agents and operational hazards. As a co-chair of the Congressional Parkinson's Disease Working Group, I know that this research has the great promise of leading to accelerated development of better treatments or even cures for devastating illnesses like Parkinson's, Huntington's, Alzheimer's and other neurodegenerative diseases. I applaud the Departments of Defense and Veteran Affairs work on this vital research.

I must add that I am still deeply troubled that information about the 1991 Gulf War continues to be hard to unearth. It has long been unclear to what degree our fighting men and women were exposed to toxins in the Gulf War.

Today's testimony did add some level of clarity. According to the senior Defense Department officials testifying today, in addition to the facility at Khamisiyah, based on testimony today, we were told that there were two other locations where chemical exposure could have taken place - Muhammadiyat and Al Muthanna. Full disclosure is so important for our troops and veterans.

Yet, there continues to be confusion about exposures.

For the sake of our troops and our veterans, I call on the Defense Department to stop focusing on the unknowable (about exposures) and notify ALL troops that were on the ground, either during or after the Gulf facilities were bombed, so that our servicemen and women can be screened for health effects.

Most importantly, I implore the Pentagon to do an extraordinarily better job on behalf of troops in the field today.

Mr. SHAYS. I would like to first take care of some business and ask unanimous consent that all members of the subcommittee be permitted to place an opening statement in the record and that the record remain open for 3 days for that purpose. And without objection, so ordered.

I ask further unanimous consent that all witnesses be permitted to include their written statements in the record. And without objection, so ordered.

We have two panels. Our first panel is Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs, Department of Defense; accompanied by Dr. Michael Kilpatrick, Deputy Director of the Deployment Health Support Directorate, Department of Defense; accompanied by Dr. Robert H. Roswell, Under Secretary for Health, Department of Veterans Affairs. Excuse me. I'm sorry. Dr. Robert H. Roswell will be making a statement, accompanied by Dr. K. Craig Hyams, Chief Consultant, Occupational and Environmental Health, Department of Veterans Affairs. And Dr. Roswell is Department of Veterans Affairs as well for Under Secretary for Health.

At this time, gentlemen, I will swear you in. Now, if there is anyone who might be behind you that might need to respond to questions, I'd like them to respond as well so we can swear them in, if you have anyone you want to direct to stand. So if you'd rise, I'll swear you in. Raise your right hands.

[Witnesses sworn.]

Mr. SHAYS. Note for the record that our witnesses have responded in the affirmative.

Am I pronouncing your name Roswell-is that-I'm sorry. I'm a tennis fan. I think we'll start with you, Dr. Winkenwerder.

STATEMENTS OF WILLIAM WINKENWERDER, JR., M.D., M.B.A., ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE, ACCOMPANIED BY MICHAEL E. KILPATRICK, DEPUTY DIRECTOR FOR THE DEPLOYMENT HEALTH SUPPORT DIRECTORATE, DEPARTMENT OF DEFENSE; ROBERT H. ROSWELL, M.D., UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY K. CRAIG HYAMS, CHIEF CONSULTANT, OCCUPATIONAL AND ENVIRONMENTAL HEALTH, DEPARTMENT OF VETERANS AFFAIRS

Dr. WINKENWERDER. Thank you, Mr. Chairman. Mr. Chairman, members of the subcommittee, thank you for the opportunity to appear here today. With your permission, I will summarize my written statement. And also with me today to answer questions, if that is acceptable to you

Mr. SHAYS. That is fine.

Dr. WINKENWERDER [continuing]. Is Dr. Michael Kilpatrick, whom you've already introduced.

I want to begin

Mr. SHAYS. Let me just ask, can you all hear in the back of the room? No. I need you to speak up a little louder. Thank you very much. It is the silver mic that projects your voice.

Dr. WINKENWERDER. All right. Thank you.

I want to begin by adding my condolences to those of President Bush and the Secretary of Defense for the families' of the U.S. casualties since operations began last week. Each of you is in our prayers. Our country's ultimate weapon against any enemy is the valor of the men and women in our armed services who serve the cause of freedom. They comprise the most powerful force on Earth, and, in this particular case today, a force for peace and liberation of the Iraqi people.

On behalf of all the men and women in medical service to our Armed Forces, I want to recognize the cause for which many have now given their lives and the efforts to ensure the safety of everyone engaged in this conflict. The courage, skill and discipline of our military medical personnel is matched only by the high-quality, swift and effective medical care that they provide.

You have already seen reports by embedded media of heroic acts by U.S. Armed Forces medics to save lives; for example, the MediVac crews and surgical teams that have gone into very dangerous situations. We can be assured that today such acts will continue, and they will continue until our final mission is accomplished. In Operation Iraqi Freedom we have more than sufficient capability to move casualties from their point of wound to any level of care their injuries might require. We have more than sufficient medical supplies, including blood supplies, for all of our troops operating in the field, and all of this is regulated by an integrated logistics system in the theatre.

Our medical medics and soldiers are trained, equipped and prepared to operate in the contaminated environment, if necessary, with equipment decontamination and antidotes. We are prepared for what Saddam Hussein might attempt to deliver to U.S. forces. As the Assistant Secretary of Defense for Health Affairs, safeguarding the health and safety of our military members is my highest priority. Our force health protection program has made great strides based on the lessons learned from the Gulf war and subsequent deployments. I believe our efforts are in line with your own objectives, as these have been expressed in public law.

The Department is committed to providing an ongoing continuum of medical service to service members from entrance into the military through their separation and as many transition to the Department of Veterans Affairs after their service.

The vigorous requirements of entrants' physical exams, periodic physical examinations, periodic HIV screening, annual dental examinations, routine physical training and periodic testing and then regular medical record reviews are all part of this continuum.

We've established a comprehensive program to sustain and document our service members' health and fitness for duty. All deploying personnel are required to complete individual predeployment health assessments. These health assessments are coupled with a review of medical and immunization records. We look at whether there is a DNA sample on record, and if a blood serum sample has been drawn within the prior 12 months. This information is considered, along with the availability of personal protective and medical equipment. Predeployment briefings on deployment-specific health threats and countermeasures are also provided. All personnel complete postdeployment health assessments when they return.

Any indication of health concerns results in an individual health review and, if appropriate, referral for further medical evaluation or testing. These health assessments are to be maintained in the individual's medical records and centrally in electronic format in the defense medical surveillance system.

Additionally, all immunizations are tracked by service-specific systems, and the data are fed into a central data base. We're currently transitioning from paper-based medical records to automated medical records for patient encounters and reporting of nonbattle and disease events.

Health care focused on postdeployment health concerns is available through both military and VA providers who are using jointly the postdeployment health clinical practice guidelines. These guidelines were designed to ensure that the medical providers render effective and appropriate responses to the medical concerns of our deployed service members and their families upon return.

We've established three deployment health centers. One focuses on deployment-related health care, one on related health surveillance, and the third on health research. All are working toward prevention, treatment and understanding of deployment-related health issues.

Desert Shield, Desert Storm taught us knowledge of the environment is vital if we're to protect the health of our service members. Today the Army's Center for Health Promotion and Preventive Medicine conducts environmental health assessments that enable intelligence preparation of the battlefield before and during deployments. This unit employs equipment to monitor the combat environment, and it samples soil, air and water. They also perform extensive environmental assessments of staging areas and base sites. This information is used to make determinations of where we can safely put our military people. We also archive that information so that we can go back amend, look at it later to evaluate for correlation between an area of known or suspected exposure and illness that may appear in the future.

In the past few months, we've been working to develop and have implemented a joint medical workstation. This is an important development. We're using a Web-based force health protection portal to our classified system, and DOD now has the electronic capability to capture and disseminate real-time and near real-time information to commanders about in-theatre medical data, patient status, environmental hazards, detected exposures and critical logistics information like blood, beds and equipment availability.

The transition from paper-based processes to automated systems offers us a much greater opportunity for collecting and analyzing medical information that is useful in real time. We proceed with that work with an awareness of operational security and personal security for our service members who expect their medical records to remain confidential.

When we deploy, we bring a formidable medical capability. This includes far-forward surgical care, and we've seen this on the battlefield just in the past few days; medical evacuation assets, with the ability to provide intensive care, ICU care, inside an airplane; and ship-based medical capabilities.