Lawmakers question management, progress at blast injury treatment centers

Three years after Congress required the Defense Department to create medical centers of excellence focused on treating blast injuries, only two of five planned centers are up and running, and those are failing to meet expectations, lawmakers said on Tuesday.

"The first appropriation for this purpose was made almost three years ago," said Rep. Susan Davis, D-Calif., chair of the House Armed Services Committee panel on personnel. Thus far, Defense has established centers for assessing treatment of traumatic brain injury and post-traumatic stress disorder, which have been combined into a single Defense Center of Excellence. Centers for treating vision, hearing and extremity injuries are still in the planning stages.

"We are concerned about the department's slow pace in developing such an important function. However, excessive delays are not our only issue," Davis said. "The Defense Center of Excellence, or DCoE, while having achieved some notable small-scale successes, has not inspired great confidence or enthusiasm thus far. The great hope that it would serve as an information clearinghouse has not yet materialized. The desire that the center become the preeminent catalogue of what research has been done, what is being done, and what needs to be done has not been realized," she said.

The centers were never intended to be physical entities, but rather virtual organizations that identify and proliferate best practices, prioritize medical research, and improve patient-centered care. For example, the DCoE, which is focused on TBI and PTSD, draws on expertise and resources from six existing organizations.

Army Surgeon General Lt. Gen. Eric Schoomaker agreed that progress has lagged behind expectations. "I foresee a day when these centers are acknowledged as the worldwide leaders in their respective disciplines; however, we are not there yet and we are moving slowly in some areas," he said.

The DCoE is most developed because the department received significant supplemental funding for psychological health and TBI in late 2007, which kick-started the effort, Schoomaker said. Likewise, significant progress has been made on the center for extremity injuries and amputation because of extensive work previously conducted jointly with the VA and academia, he said.

Bringing together multiple disciplines inherent in the centers' work has been a more complex undertaking than many predicted, said Dr. Charles Rice, acting assistant secretary of Defense for health affairs. He said he expects progress on the centers will improve as most of the planning and groundwork is near completion.