contract allows for certain psychiatric cases is just not adequate. Before that is renewed, I hope you will give some of us a chance to talk to you a little bit about it.

Admiral ZIMBLE. Yes, we would be happy to.

Mr. RAY. Second, General Becker, it is good to be with you here today. I have been told that some of the program PRIMUS nearly fell under the budget ax in the last budget drill within the Pentagon. I am not sure that is correct, but since one has just been granted for Fort Benning, GA, it has been overwhelmingly accepted, and I have been kind of classified as the hero for getting it there with the help of this committee, and I hope that that program is secure. What would you think?

General BECKER. The one at Fort Benning is alive and well, I guess, unless some very immediate disaster strikes, but as I sit here, that one is planned to be carried through.

I think we have got a problem that you need to be aware of, and that is, will we be able to carry through the funding in the outyears? That is what is worrying me. But right now that one is on track.

Mr. RAY. I will address that with another comment in just a few minutes, but let me talk a minute about the catchment area demonstration projects that you have going. As you know, this subcommittee recently held a field hearing at Fort Benning, GA, and, based on what we saw and heard there, it was my impression that that facility presently has the management capability to do an excellent job on the catchment area management demonstration project.

I don't mean to be totally parochial on my questions here, but I noticed that when we were interested in it, it did not make the cut, and the Army demonstration projects are going to be conducted at Fort Bragg and Fort Sill, and I think it is important that these demonstration projects be done in locations where the commander and the staff understand and enthusiastically support the concept. I hope that you will not only watch over these other two very carefully and others but give Fort Benning every consideration for the future. I would be pleased to have any comments you might want to make on that.

General BECKER. There is a little bit of weakness in that project at the moment. That is, Fort Bragg may not be the prime place. So we will reconsider, and I can tell you that Fort Benning is high on the list, and it doesn't have anything to do with you and I being here together today, it is just that that is a good place.

Mr. RAY. OK. I want to put a couple of support comments into the record. I think that legislation ought to be introduced which would lift the ceilings for medical personnel and not, at the same time, at the expense of the other military branches.

Madam Chairman, I would be certainly interested in talking to committee staff and yourself and being helpful in that area at some future point.

Mrs. BYRON. General Chesney has a question.

General CHESNEY. Yes, Ma'am. May I address that?

The language in the congressional bill this year was very unclear. It said exempt physicians and maybe nurses, but it did not say take it out of our-I have got 15,000 officers, I have got 4,000

doctors, and 5,000 nurses. Can I exempt those? Then I have to take double out of the other. If I exempt it that way, does the service have to take for me for what I lost? That is very unclear, and we are right now fighting that.

Mrs. BYRON. We very specifically said you will not take medical personnel cutbacks.

General CHESNEY. OK. I think that we would appreciate clarification of that.

Mrs. BYRON. If I am not mistaken, the language was not just for this year, the language was in there, and the question that we are going to have to address from this side is whether what we were trying to achieve has been achieved and should we repeal that language next year, or shall we leave it in.

General CHESNEY. Yes. I think we need clarification. Thank you.
Mrs. BYRON. OK. I will get the staff with you all on that.
General CHESNEY. All right. Thank you.

Mrs. BYRON. Yes, General.

General BECKER. A suggestion that might help some-because there is a lot of consternation about this officer cut-is that the medical officers be removed from the denominator of-in other words, that the services would suffer a cut of certain percentages, but when we put our numbers into the denominator it really makes it tough for the rest of the service.

Mrs. BYRON. OK.

Mr. RAY. Madam Chairman, I would be an advocate in trying to support that.

Finally, if we are going to give, in my opinion, bonuses and incentives to the glamour branches of the service, so to speak, such as to pilots, $12,000 a year to keep pilots retained, including leather flight jackets, then I really do believe that we ought to look at very strong incentives to the medical service for the future.

Admiral ZIMBLE. Mr. Ray, I would just like to comment that I have taken an initiative, working very closely with our chief of naval personnel, Admiral Bud Edney, to contract to the Center for Naval Analysis, plus putting together working groups, looking at both recruiting and retention, to come together with some things. that we think are vital, not just compensation but beyond compensation, and looking not just to the medical corps but to all the various elements of our medical department. I hope to have to this committee some preliminary results of that working group. I think you will find it will be helpful to you.

Mr. RAY. Finally, just a bit of legislation and I am through. There are two proposals currently being considered to increase the transfer authority of the Secretary of Defense from $1.5 billion to $4 billion. The first is a supplemental that DOD will be submitting. It will increase transfer authority from $1.5 billion to $4 billion, allow transfers between fiscal years, allow expired appropriations to go into the foreign currency fluctuation account for expenditures instead of expiring.

The second is the Hansen bill, H.R. 3955, which I introduced and cosponsored in Mr. Hansen's absence that day. It would increase the transfer authority, but it would not allow for the use of expired prior year balances, and it would not allow DOD to extend the time

during which funds can be obligated. It would allow transfers between fiscal years.

The primary concern with both approaches is that they would allow the outlay ceilings to be breached, which we cannot allow to happen.

But I want you to know that we are going to do everything we can to be sure that this $4 billion in transfer authority is given to the Secretary with the idea that he puts an emphasis on the medical services.

Thank you, Madam Chairman.

Mrs. BYRON. Let me now touch on some of the issues that had come up at some of our field hearings. I will get down now to specifics. We have talked about all of the overalls.

At Okinawa and Clark, we heard many complaints about the shortfall in physician staffing. I think that was a surprising experience to us, because we were under the impression from previous hearings that our overseas locations got priority medical staffing, followed by isolated or remote areas of the United States. We have also found by field hearings that that isn't true either.

We heard many of the complaints about staffing at the naval hospital in Okinawa. The Navy wasn't the only problem, Admiral, that we encountered on our travels. The Air Force only has one ophthalmologist in the Pacific-one for the entire area.

If these locations are getting staffing priorities-and it certainly wasn't apparent to us or the beneficiaries-how do you ensure that the active duty families stationed abroad have access to adequate medical care?

Admiral ZIMBLE. First let me say that we are staffing our overseas-and I just came back from 3 weeks in the Pacific region-we are staffing our overseas better than we have ever staffed it.

Mrs. BYRON. Then it must have really been horrible.
Admiral ZIMBLE. That is exactly right; it was.

We are staffing it now at the expense of some of our hospitals in the continental United States, to the point where we are eroding that seed corn, that vital element, the graduate medical education program. As I think I have told you before, we have reduced the surgical billets at Portsmouth from four to two; we have had to reduce urology from two to one; the anesthesia program is on probation-all at Portsmouth, all because we can't give them the case mix they need to meet the residency review committee.

But I digress. Let me go back to Okinawa. When I was there and talked with the staff-and not only did I talk with the staff but I talked with the commanding general of the Third MAF, General Norm Smith, and several of the other CG's. They all told me that they felt that Okinawa was giving far better support than they had seen in the past and they were satisfied.

The problem is that not only do we take care of those dependents that are sponsored, that accompany their husbands, but we take care of unsponsored dependents who decide on their own to show up. To me, it is a great concern because we are not staffed to take care of them, we will never turn them away from our doors when they need medical care, and I have great concerns about their wellbeing. I have discussed this with both the CNO and with the commandant of the Marine Corps, and we are looking at ways of ad

dressing this problem. But the problem does become more acute with the nonsponsored dependent. Furthermore, we don't do an overseas screening for the nonsponsored dependent.

Mrs. BYRON. One of the things-and I wasn't going to really address this to you because I have got a lot of other questions to address to you, but in the Far East field hearings we heard a great deal of concern about the impact of the noncommand-sponsored dependents, and the other category that we heard time and time again mentioned was the extended family which has access to the facilities, particularly the medical facilities overseas. I think the magnitude of the extended family issue is one that I find very difficult to address.

Would you kind of briefly give us an outline on the eligibility of both of those groups for medical care? They count on determining the size of the facility and the staffing requirements when we are looking at those.

Admiral ZIMBLE. First of all, they are hard to count. It is hard to know how many we are talking about, and they are eligible by law; they have statutory eligibility for care.

Mrs. BYRON. The extended family, how far down-General Chesney, feel free to get into this dialog also-how far down does the extended family extend?

General CHESNEY. It is really a personnel question.

Mrs. BYRON. Well, I asked it of the personnel people last week, and it really impacts on your medical facilities.

General CHESNEY. If I remember, it is a mother or father or a child less than 21 years of age that lives with or gets a large majority of their welfare, their income, from that person-a dependent mother or father, for instance.

Mrs. BYRON. We are dealing with a lot of mothers-in-law, fathersin-laws, et cetera.

General CHESNEY. That is true. A dependent parent-in-law is eligible for care

Mrs. BYRON. Is that true in the States?

General CHESNEY. Yes-and can come in and get an ID card.

Admiral ZIMBLE. They are not eligible for CHAMPUS care, but they are eligible for care in our facilities. Overseas, in the Pacific Region especially, we are the only game in town, so that's where they come.

Mrs. BYRON. I know; I know.

Mr. Ravenel.

Mr. RAVENEL. Thank you, Madam Chairman.

I would just make the observation now that those folks, if they are not eligible for CHAMPUS care but they are eligible for care in the facilities, they are preferred beneficiaries. Wouldn't you say so? Admiral ZIMBLE. That is certainly one way of looking at it. Overseas in the Pacific Region, CHAMPUS is very seldom the issue. In Japan there are good state-of-the-art facilities, but the differences in the culture and the differences in the language almost proscribe a great deal of CHAMPUS utilization.

In Okinawa, we really are the only game in town. In Guam, there is one civilian hospital with most of the patients preferring to come to the naval hospital there, so most of them come there. In

the Philippines, it is Clark or Subic, and Subic, sir, is Naples in a quonset hut-not very much.

Mr. RAVENEL. Admiral, your demonstration project down there, where you are going to conduct a survey and you are going to sign everybody up-either they sign up for care in your facilities or by CHAMPUS that would not irrevocably commit them to

Admiral ZIMBLE. NO.

Mr. RAVENEL. They could transfer; is that right? What you are trying to do is really trying to find out how many people want to use the facilities so that when you go to the contracting out you will be able to contract for what you need. Is that it?

Admiral ZIMBLE. I have not seen the full proposal yet. There are several items in that proposal that are absolutely critical. The first one is that Naval Hospital, Charleston, has the right of first refusal on the care of a patient. No matter what way we enroll them, first of all, we think we can provide good care to the limit that we have it available. We need to have that patient population as much as they need us.

We are trying to provide for graduate medical education in Charleston. We have a fine family practice program, and in order to maintain that program we need a cross-section of patients from pediatrics through geriatrics. We want to make sure that we keep our facility as well occupied as possible either with our own providers, with contract physicians and CHAMPUS providers that come into our facility, as we described, and then when we get to that element we will have a health care finder, someone who can, on a case management basis, help these patients find the appropriate care, effective quality care, at the most reasonable and efficient cost. We can be far more supportive of our beneficiaries in that way. That is what we are looking for.

Mr. RAVENEL. Madam Chairman, I would just like to say for the record that it is not the quality of Navy care in my particular area that has ever been at fault, because we get many, many letters and calls, going around and seeing people just commenting on the quality of the care, which is excellent. The problem has always been the availability of care.

Thank you, Madam Chairman.

Mrs. BYRON. Let me follow up on what my colleague has said. The nonavailability statement update that we had, as you know, in one hearing last year at Camp LeJeune, and it now appears that the situation there is worse, not better, than when we were there 8 months ago, in July. Looking at the nonavailability statement data, 942 nonavailability statements were issued for the first quarter of 1988 compared with 650, 749, 616, and 678, respectively, for the four quarters of 1987. It is a 26 percent increase above the worst quarter's performance last year.

What is happening? What has happened to the additional medical staff that we were told were going to be assigned to LeJeune because of its remote nature? We looked at the numbers at Pendleton, the numbers of population, the problems in those two areas, and the numbers of physicians. I think you were in the office when Secretary Webb and I talked at great length about the matrix of where the Navy physicians and health care people were, looking at