Unless the Defense Health Agency takes action to fix issues at military treatment facilities, problems could get worse and affect the overall condition, readiness, use and services provided to patients in the military community, according to a new report from the DoD Inspector General.
Delays in addressing the needs at those installations could worsen the overall condition of those MTFs, auditors stated. And some of the problems are imminent threats and should be fixed immediately, such as replacing an obsolete fire alarm system at the main hospital at Eglin Air Force Base, Florida; and moving an inaccessible emergency oxygen shutoff value at Fort Riley’s Irwin Army Community Hospital, according to the July 10 report.
The audit, at 24 MTFs at six selected installations, was conducted to identify issues that the Defense Health Agency will have to deal with as it completes the current reform effort that moves control of MTFs from the services to DHA. That includes the responsibility of keeping MTFs in good working order — sustainment, restoration and modernization.
But in the bigger picture, officials need to fix the overall $14.8 billion in unfunded projects for the more than 576 DoD hospitals and clinics and 87 dental facilities worldwide that were reported in September 2019, the July 10 report stated. The fiscal 2019 budget for sustainment, restoration and modernization of these MTFs totaled $1.1 billion.
The Military Health System serves about 8.5 million beneficiaries through care purchased from private providers, as well as directly through the system of DoD military treatment facilities.
Auditors selected six installations to examine the issues. There, facility management personnel for the MTFs reported 760 facility projects that hadn’t yet received funding, including seven problems that could cause death or major property damage if not addressed immediately at four installations, according to the IG report issued July 10. Those 760 unfunded projects had an estimated value of $552 million as of Sept. 17, 2019, at 60 MTFs at those six installations.
Auditors also identified 92 mission-related unfunded projects at three installations that facility management personnel said could cause moderate property damage and severe injury over time if not addressed.
A core problem is inaccurate and incomplete data about the needs of these facilities, which limits the ability of officials to prioritize the projects based on how critical the need is, and how severe the hazard is, auditors found.
“Unless facilities data quality is improved, the DHA may rely on less than accurate information related to future maintenance requirements when planning for short-term and long-term” needs, auditors stated. This could affect the $14.8 billion worth of unfunded needs at MTFs DoD-wide, they noted.
IG auditors found that the two primary information systems that DHA plans to rely on to manage facilities maintenance had missing and inaccurate data about how critical the needs were and how severe the hazards were, among other things. And while the auditors didn’t make a statement on the overall reliability of the data, they stated that DHA needs to verify that the data is accurate and complete.
The six installations the auditors selected to visit were Fort Riley, Kansas; Fort Campbell, Kentucky; Naval Air Station Pensacola, Florida; Marine Corps Base Camp Pendleton, California; Eglin Air Force Base, Florida; and Nellis Air Force Base, Nevada. The IG did not verify the accuracy of the codes the service MTF facility management personnel entered to indicate how critical the project was.
But in their review of 24 MTFs at the six installations, they found three needs coded with “imminent criticality,” meaning that the impact was likely to occur immediately and may cause either death or major property damage:
• Eglin AFB facility management personnel reported at the main hospital for the 96th Medical Group, the current fire alarm system components were obsolete and replacement components nearly non-existent. Estimated value is $4 million.
• Fort Riley: Personnel reported two safety requirements at Irwin Army Community Hospital: the need to move an emergency oxygen shutoff valve which is 15 feet above the floor and not readily accessible in an emergency; with an estimated cost of $20,000; and a need to create signage to help maintenance workers exiting a crawlspace, with an estimated value of $5,000.
During a hearing of the House Appropriations Defense Subcommittee, top military medical officers warned of Defense Health Agency growing pains.
Four imminently critical needs that could affect mission:
• Nellis AFB: Need to convert an administrative office space to a procedure room to ensure pain management providers can care for their population at the Mike O’Callaghan Military Medical Center, estimated valued of $150,000. Also need to renovate and expand clinical and administrative spaces to improve health care delivery to patients at that center, valued at $28 million. Also a realignment of clinical and administrative spaces to improve health care delivery to patients at the Medical Annex, valued at $8.5 million.
• Marine Corps Base Camp Pendleton: A new sign for the Naval Hospital Camp Pendleton, valued at $45,000.
Auditors recommended steps for Defense Health Agency officials to take to get a better handle on prioritizing the projects. They recommended that the Defense Health Agency implement guidance for standard procedures for prioritizing those projects; establish guidance for updating the data system to reflect the status of repair; and implement standard training for facility management personnel on using the data systems.
While the audit was going on, DHA issued several memorandums for interim guidance, requiring MTF facilities managers to review and update their requirement needs in the data base, and to establish DHA procedures for managing data, auditors stated.
DHA and the services have worked to define and create a new standard set of requirement codes to use across the services, and DHA is incorporating training to make sure facilities personnel have the skills needed for their positions, according to the report.
DHA’s comments addressed the IG recommendations satisfactorily, according to the report, and the recommendations will be closed when auditors confirm that the proposed actions are completed.
Congress mandated that the MTFs be transferred to the control of the Defense Health Agency. In October, 2019, the Deputy Secretary of Defense directed that authority, direction, and control over the MTFs and dental treatment facilities based in the continental United States, along with those in Alaska, Hawaii, and Puerto Rico, be transferred from the military departments to the DHA. They are in varying stages of transition.