Security Assistance; and Logistics - Federation of American Scientists

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guidance on stability operations that will evolve over time as joint operating concepts,mission sets, and lessons learned develop, and establishes DoD policy and assignsresponsibilities within the DoD for planning, training, and preparing to conduct andsupport stability operations.Inadequate Capacity in Iraqi Health Care SystemU.S. military medical treatment facilities located in Iraq provided emergency medical andsurgical care to Iraqi military, police, and civilians for emergency conditions where life,limb, or eyesight was at risk. This care often included inpatient hospitalization until theindividual could be transferred to an Iraqi civilian medical facility that could provideongoing care. However, because of the lack of medical treatment capacity within theIraqi health care system, many of these individuals remain in U.S. military medicaltreatment facilities and receive ongoing care for extended periods of time.Costs of Health Care Provided to Iraqi NationalsThe initial costs of inpatient care using standard U.S. military medical treatment facilitybilling charges for an overnight hospitalization were approximately $30 million to $36million annually. The initial costs for hospitalization did not include additional expensesincurred for outpatient care, surgical care, intensive care unit services, consumablemedical supplies, blood products, or pharmaceuticals.Management Controls for Wartime Theater Medical Care inStability, Security, Transition, and Reconstruction OperationsManagement controls for wartime theater medical care in DoD deployable medicalsystems have not been fully developed. Policies and guidelines have been developed inthe area of medical logistics, supplies, and equipment to enhance interoperability,increase efficiency, and maximize resources with a focus on joint operations, butguidance is limited on controls necessary in complex humanitarian assistance, stabilityoperations, or other contingency operations where medical care is provided to non-U.S.populations.Policies and guidelines are needed to collect sufficient managerial accounting data toachieve economies of scale; minimize wastage of personnel, supplies, and otherresources; and allow leaders and managers to properly plan and budget for SSTRoperations.Recommendations, Client Comments, and OurResponseDeleted Recommendation. Based on client comments, we have deleted draftRecommendation 23.a.(3) from the final report.166
23.a.(1) We recommend that the Commander, Multi-National Force-Iraq establish amedical expense record keeping system at U.S. military medical treatment facilities inIraq to document all direct and indirect inpatient and outpatient costs for health caretreatment provided to individual Iraqi military, police, and civilians.Client CommentsSee comments at Recommendation 23.b.23.a.(2) We recommend that the Commander, Multi-National Force-Iraq establishprocesses with the Ministry of Defense and the Ministry of Interior to reimburse the U.S.Government for all future costs obtained through the medical expense record keepingsystems for health care treatment provided to individual Iraqi military and police at U.S.military medical treatment facilities.Client CommentsSee comments at Recommendation 23.b.23.b. We recommend that the Commander, Multi-National Force-Iraq, coordinate withthe Chief, U.S. Mission-Iraq to establish processes with the Ministry of Health toreimburse the U.S. Government for all future costs for health care treatment provided toindividual Iraqi civilians at U.S. military medical treatment facilities.Client Comments to Recommendations 23.a.(1), 23.a.(2), and23.b.Commander, MNF-I non-concurred with these three recommendations and noted for eachrecommendation that the Defense Base Act calls for the military to provide reimbursablemedical care for DoD contractors. MNF-I reported that there were no implementinginstructions available and that medical units were not equipped or staffed to bill forservices rendered. The Commander stated that the MNF-I Surgeon was currentlyworking with MNF-I Admin Counsel for a way ahead. He said that the outcome of theirreview was unclear, but it was doubtful that reimbursable services applied to Coalition,ISF, or local national civilian care rendered. Finally, the Commander reported that MNF-I and U.S. medical care facilities in Iraq had been operating from a locally approvedexception to policy for non-Coalition Force medical care.Our ResponseCommander, MNF-I comments were not responsive to the intent of the recommendation.The Defense Base Act applies to DoD contractors, a population not addressed in thisrecommendation. DoD guidance cited above (DoD 6010.13-M and DoDI 6015.23)implements DoD policy on record keeping and reimbursement procedures and providesDoD intent on reimbursement services provided to individuals not eligible for DoDfundedmedical care. MNF-I has the ability to develop a locally approved exception topolicy that meets the intent of this recommendation while submitting a formal exceptionto policy request to the Assistant Secretary of Defense for Health Affairs (ASD(HA)).Simultaneously, MNF-I should recommend reasonable management controls and167
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INSPECTOR GENERALDEPARTMENT OF DEFE
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Report No. SPO-2009-002 (Project No
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Report No. SPO-2009-002 (Project No
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Table of ContentsExecutive SummaryR
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IntroductionBackgroundThe DoD Offic
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Appendix A discusses the scope and
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letter to clarify that DoD Instruct
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USCENTCOM guidance for its area of
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1. Describe the mission, roles, and
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Status of Implementation of Recomme
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Management Comments to Recommendati
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. Performing a 10 percent sample in
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94 personnel). The proposed JMD als
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MiTTs. Between February 15 and Marc
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Part II - Arms, Ammunition, and Exp
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Observation 1. Assistance to the Mi
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5, March 25, 2008, 12 addresses DoD
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MNSTC-I personnel made on-the-spot
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1.a. We recommend that the Commande
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Observation 2. Assistance to the Mi
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and procedures for receipt, process
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MNSTC-I and Iraqi military personne
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captured weapons, or if it permanen
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SAO manning has increased approxima
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End-Use Monitoring Compliance PlanT
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Observation 4. Accountability of Ni
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• Corrective actions implemented
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Observation 5. Multi-National Secur
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Observation 6. Multi-National Secur
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elationships with ISF personnel. In
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Originally, personnel filling the n
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FMS shipments to Iraq will sharply
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Client CommentsThe Assistant Secret
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Ministry of Defense and Iraqi Army
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uild 3 rd and 4 th Line maintenance
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Observation 8. Use of Iraq Security
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The Iraqi Government has progressiv
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Observation 9. Request for Forces f
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The IG team concurs with MNSTC-I’
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Taji Location CommandDuring our vis
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• Ministry of Defense Administrat
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Recommendations, Client Comments, a
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The MoD provided an increased alloc
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Recommendations, Client Comments, a
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and KMTB used diesel generators exc
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Observation 14. Location Commander
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The Life-Support Self-Reliance prog
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The Kurdish Minister of Interior (K
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Observation 16. Undistributed ISFF-
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Observation 17. Iraqi Army Maintena
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een occurring at the school. The te
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shortage of mechanics properly trai
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17.e. We recommend that Commander,
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Page 139 and 140: Observation 19. Iraqi Army Heath Ca
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Page 143 and 144: civilian patients. U.S. military me
Page 145 and 146: those deficiencies are many, but th
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Page 149 and 150: Our ResponseCommander, MNSTC-I comm
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Page 153 and 154: While some Iraqi Army mentoring and
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Page 157 and 158: Client CommentsCommander, MNF-I con
Page 159 and 160: numbers of billets on the MNF-I JMD
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Page 178 and 179: Client CommentsCommander, MNSTC-I c
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Final ReportReferenceRecommendation
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Commander, Multi-National Force-Ira
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Final ReportReferenceClick to add J
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Final ReportReferenceDraftRecommend
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Commander, Multi-National SecurityT
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Final ReportReferenceRenumbered toR
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Team MembersUnder the guidance of t
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