Tuesday, June 14, 2011

Iraq Transition: One of the Biggest Risks? Contractor-Led and Run Medical Supply Chain

In March, during the telconference with prospective bidders for the medical support services in Iraq, prospective bidders and DOD/State representatives had a Q&A. The transcript of that telcon was posted at FedBiz as part of the solicitation package.  The excerpts I selected below includes what the Army considers one of the biggest risks during the transition (medical supply chain), right of refusal by the contractor (DOD-left equipment), credentialing and vetting of personnel, and the challenges of the blood supply chain from the transhipment site in Qatar to various sites in Iraq.

As to how many DOD medical providers/medical support staff is currently in theater, apparently, according to the govt reps in this telcon, "There is not a way to answer that."

INDUSTRY:  [...] In the Army’s mind, what are the biggest risks that the contractor will face during transition?
GOVERNMENT:  Lieutenant Colonel [...], CENTCOM.  I think one of the biggest risks are the transition to a contractor-led and run medical supply chain.  With that, I think they need to do a comprehensive study or analysis, if you will, of the transportation piece, and we will have to -- and issues, and things like that that are involved with that.

INDUSTRY:  Question number six.  How many medical providers -- physicians' assistance, nurse practitioners, medical doctors, medics, and corpsmen -- does the Department of Defense currently have at each site?
GOVERNMENT:  Yes.  Each of those sites, at this moment in time, serves a different purpose, and will not be analogous to our population at risk and the size of our missions. 
There is not a way to answer that.  There are some sites that have a troop medical clinic with one mid-level provider, and there are, of course, hospitals that, of course, have full staff.  So there is not really an answer that is suitable for this question.  It just can’t be compared to what we will have standing up.

INDUSTRY:  [...] Question 11, does the awarded contractor have the right of refusal on all items left behind by the Department of Defense?  For example, medical equipment.

GOVERNMENT:  [...] I think it would be the contractor’s call, whether to accept the equipment or not.  And if not, then the contractor would have to provide replacement equipment that we would have to agree to.  So
GOVERNMENT:  And this is [snip] in Baghdad.  I would agree.  There should be a compelling reason that the contractor would decline the use of equipment offered under this arrangement, and incur further expense to the U.S. Government.

INDUSTRY:  Question 16, will the transition period allow for proper credentialing, security vetting, redeployment training, and administrative processing?

GOVERNMENT:  Yes, I can.  The short answer is we are really uncertain at this point in time of the time frame that is going to be required for credentialing, security vetting, predeployment training, and the administrative processing.
The contractor, however, will not be penalized for delays due to the Department of State processes.

INDUSTRY:  Okay.  Question number 12.  What kind of support will DoD provide during the transition and full operating status of the following:  A, equipment, i.e. size, weight, and transportation issues; B, blood, critical resupply time, governing body for access, space to acquire blood supplies, transportation to Qatar; C, pharmaceuticals and vaccines, ministry of health regulations at each country; D, medical gases, hazmat issues, anesthesia and transportation?

GOVERNMENT:  This is [snip].  For A, USF-I will -- we will go ahead and set up each of the locations’ equipment -- medical supplies, minus pharmaceuticals.  And basically, we will set up each location ready for them to come in and go to work.  And that is portion A.

INDUSTRY:  Okay.  Major [....], on the blood?
GOVERNMENT:  All right, Major [...] on blood.  I know blood will be supplied through the Armed Services Blood Program System, and this will be done via coordination through the blood program officer forward, and the blood transshipment center at Qatar.

Inventory levels will be communicated via an Excel spreadsheet, and this is going to be submitted daily to the blood transshipment center, just with general inventory numbers for the blood products, so that the BTC can generate the orders required to fill the inventory levels.

There should be a centralized person from the civilian locations that will consolidate the Department of State blood inventory information from the multiple facilities, and then this will be submitted in the report.  This individual will work directly with the blood program officer forward, and the transshipment center office or staff, for ordering the inventory to include the critical resupply need.
The blood transshipment center keeps the red cell products and the frozen products on hand for re-order and any re-supply that is needed.
As far as critical resupply times, this is going to vary.  From experience, this is usually dependent on the transportation available.  And for those, it’s my understanding that there will not be military transportation, that this will have to be a civilian-provided transport.
From our experience, you know, we can usually get blood products out to theater within a day.  If there is transport delays or storms or anything, it could get up to 48 to 72 hours.
Let’s see.  Once the actual transportation method has been chosen and coordinated, I recommend working directly with the transshipment center officer and staff for any final coordination details. 
Pick-up, if it should occur directly from the BTC location, that civilian transportation will need to gain access to the base.  I have communicated with our transshipment center officer, and she has the initial contact information for the POC at Qatar who would arrange any base access, be it via flight or ground transport to get there.  It’s just recommended that documentation for access to the base has to be started as soon as possible, due to the time of processing.  Over.

Active links added above. Almost all the moving parts above will now be taken over by different contractors - medical support, air transport, site access, security, etc. And that's what worries me, frankly.

Read the MSSI transcript, edited 3-15-11.docx (35.38 Kb)

Also below is a diagram that represents how blood (red solid lines), pre-positioned frozen blood (red dotted lines), and reports (blue dotted lines) flow within the Armed Services system and demonstrates areas where efforts are coordinated (gray dashed lines).

Does the State Department or its contractors even have half a comparable system to this by end of 2011?

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