We reviewed this draft policy and found that it addresses the types of medical surveillance problems experienced during the Gulf War—the lack of personnel deployment information and medical assessments, the failure to monitor environmental and disease health threats, and the failure to meet record-keeping requirements. The draft directive and implementing instruction are currently under review by various offices within DOD. DOD officials expect the directive and instruction to be issued by September 1997. DOD’s Implementation of a Medical Surveillance Plan in Operation Joint Endeavor

While DOD was still developing its joint medical surveillance policy for deployments, the Assistant Secretary of Defense for Health Affairs issued, in January 1996, a medical surveillance plan for U.S. forces deploying to Bosnia-Herzegovina, Croatia, and Hungary under Operation Joint Endeavor. Our review indicated that DOD continues to experience problems with its capability to track the population at risk during deployments. During the Gulf War, servicemembers frequently did not remain with their units. This is being done during Operation Joint Endeavor. Our review of the Deployment Surveillance Team’s database for the 6,624 Army personnel in our universe requiring medical assessments indicated that 43 percent of the personnel had not received the required in-theater postdeployment medical assessment, 82 percent had not received the home unit postdeployment medical assessment, and 41 percent did not have a postdeployment blood sample drawn. The medical surveillance plan includes provisions for the centralized collection and maintenance of a database for the in-theater and home unit postdeployment medical assessments done for servicemembers deployed under Operation Joint Endeavor. They are also important for epidemiological analyses following military deployments. Our review disclosed that many of the medical records were incomplete regarding documentation reflecting that (1) in-theater medical assessments were conducted, (2) servicemembers had received the tick-borne encephalitis vaccine, and (3) visits had been made by servicemembers to battalion aid stations. We did not test, however, the services’ implementation of the Southwest Asia medical surveillance requirements. Conclusions and Recommendations

Overall, DOD has taken initiatives to overcome the medical surveillance problems experienced during the Gulf War. In light of the problems discussed in this report, we recommend that the Secretary of Defense direct the Assistant Secretary of Defense for Health Affairs, along with the military services, the Joint Chiefs of Staff, and the Unified Commands, as appropriate, to complete expeditiously and implement a DOD-wide policy on medical surveillance for all major deployments of U.S. forces, using lessons learned during Operation Joint Endeavor and the Gulf War; develop procedures to ensure that medical surveillance policies are implemented to include emphasizing (a) the need for unit commanders to ensure that all servicemembers receive the required medical assessments in a timely manner and (b) the need for medical personnel to maintain complete and accurate medical records; and develop procedures for providing accurate and complete medical assessment information to the centralized database.
Why GAO Did This Study

Pursuant to a legislative requirement, GAO determined what action, if any, the Department of Defense (DOD) has taken to improve medical surveillance before, during, and after deployments, focusing on Operation Joint Endeavor.

What GAO Found

GAO noted that: (1) DOD has initiated actions to improve its medical surveillance for deployments since the Gulf War; (2) a joint medical surveillance policy, currently under development since late 1994, calls for a comprehensive DOD-wide medical surveillance capability to monitor and assess the effects of deployments on servicemembers' health; (3) provisions of the draft policy address the medical surveillance problems experienced during the Gulf War; however, its success in resolving the problems cannot be assessed until the directive and implementing instruction are finalized and applied to a deployment; (4) DOD officials expect the policy to be finalized by September 1997; (5) after the policy is issued, the services and responsible offices are to develop detailed implementing instructions; (6) DOD has also implemented two comprehensive medical surveillance plans--one for Operation Joint Endeavor in Bosnia-Herzegovina, Croatia, and Hungary, and the other for the current deployment in southwest Asia; (7) these plans address the medical surveillance problems experienced during the Gulf War and specifically call for identifying servicemember deployment information, monitoring environmental health and disease threats, doing personnel medical assessments, maintaining a centralized collection of medical assessment data, and employing certain medical record-keeping requirements; (8) recognizing that this is DOD's first attempt, its success in implementing the medical surveillance plan for Operation Joint Endeavor has been mixed; and (9) although the plan provided for enhanced medical surveillance compared to the Gulf War, GAO's review disclosed the following problems, all of which offer DOD and the services lessons to be learned as they continue to develop their medical surveillance capabilities: (a) the personnel database used for tracking which Air Force and Navy personnel were deployed is considered inaccurate by DOD personnel; (b) many Army personnel who should have received postdeployment medical assessments did not receive them; (c) when postdeployment medical assessments are done, they are frequently done late; (d) the centralized database for collecting both in-theater and home unit postdeployment medical assessments is incomplete for many Army personnel; and (e) many servicemembers' medical records GAO reviewed, maintained by medical units in Germany, were incomplete regarding in-theater postdeployment medical assessments done, medical servicemembers' visits during deployment, and documentation of personnel receiving the tick-borne encephalitis vaccine.